Due to the exponential growth in offshore renewable energies and structures such as floating offshore wind turbines and wave power converters, the research and engineering in this field is experiencing exceptional development. This emergence of offshore renewable energy requires power cables which are usually made up of copper to transport this energy ashore. These power cables are critical structures that must withstand harsh environmental conditions, handling, and shipping, at high seas which can cause copper wires to deform well above the limit of proportionality and consequently break. Copper, being an excellent electric conductor, has, however, very weak mechanical properties. If plasticity propagates inside copper not only will the mechanical properties be affected, but the electrical properties are also disrupted. Constantly monitoring such large-scale structures can be carried out by providing continuous strain using fiber-optic sensors (FOSs). The embedding of optical fibers within the cables (not within the phase) is practiced. Nevertheless, these optical fibers are first introduced into a cylinder of larger diameter than the optical fiber before this same fiber is embedded within the insulator surrounding the phases. Therefore, this type of embedding can in no way give a precise idea of the true deformation of the copper wires inside the phase. In this article, a set of numerical simulations are carried-out on a single phase (we are not yet working on the whole cable) with the aim of conceptualizing the placement of FOSs that will monitor strain and temperature within the conductor. It is well known that copper wire must never exceed temperatures above 90 °C, as this will result in shutdown of the whole system and therefore result in heavy maintenance, which would be a real catastrophe, economically speaking. This research explores the option of embedding sensors in several areas of the phase and how this can enable obtaining strain values that are representative of what really is happening in the conductor. It is, therefore, the primary objective of the current preliminary model to try to prove that the principle of embedding sensors in between copper wires can be envisaged, in particular to obtain an accurate idea about strain tensor of helical ones (multi-parameter strain sensing). The challenge is to ensure that they are not plastically deformed and hence able to transport electricity without exceeding or even becoming closer to 90 °C (fear of shutdown). The research solely focuses on mechanical aspects of the sensors. There are certainly some others, pertaining to sensors physics, instrumentation, and engineering, that are of prime importance, too. The upstream strategy of this research is to come up with a general concept that can be refined later by including, step by step, all the aspects listed above. Extensive research work has been devoted to offshore wind generation in recent years in aspects of both large-dimension wind blades and high-voltage electrical transport cables ,4,5,6,7.The technique of embedding FOS can help monitor the cable  11]. Th. Th11]. The core of the power phase is made up of copper, which is a weak metal. If plasticity propagates inside copper wires, both their individual mechanical properties and their individual electrical properties are disrupted. Plasticity is the consequence of massive defects proliferation into crystal lattices of the metal that lower electrical and thermal conduction . LookingPresently, XLPE is widely used in submarine cables due to its good electrical and thermomechanical behaviors and relatively low cost . The maxEmbedding of optical sensors within XPLE is quite easy to handle technically, whereas embedding between copper wires is technologically challenging. Indeed, either embedding along the central copper wire and/or helically-wound the same way as other copper wires can lead to extensive sliding/friction and eventually fiber-optic sensor failure. To avoid this, FOSs can be covered by friction-resistant fiber-optic coatings, whereas embedding within XPLE can underestimate the magnitude of thermal parameters inside the phases. The question raised in this article is whether the underestimate is constant or not, after the embedding location is shifted from copper to XPLE . The objective of the current article is to check these points numerically, which will help further engineers to target the right cost-effective solutions. Until today, optical fibers are not embedded within the phase, but in the cables and, more precisely, in the insulator that surrounds the phases. Moreover, such optical fibers are not embedded to monitor wire plasticity (fine damage) as we wish to do. Indeed, these optical fibers are embedded into a cylindrical tube, with a diameter much greater than that of the optical fiber, and this difference in diameter in no way makes it possible to follow the true deformation of the copper wires. What we bring back as innovation consists of (i) the embedding of the optical fiber in the phase (and not in the cable), (ii) the embedding of the optical fibers between copper wires to monitor true wire strains, along the central wire in order to measure its deformation, (iii) around the helical wires in order to measure their 3D deformation as well, and (iv) in the insulator at different distances from the center of the phase, to check for the magnitude of the strain offset vs. strain measured at the central wire location. It is worthwhile to note that the article is concentrating on mechanical aspects pertaining to sensors embedding. The aspects linked to the type of sensors physics and associated engineering are too premature to address at this stage.We will be working on a single phase of the 35kV Nexans submarine power XLPE cable, 2XS2YRAA 18/30(36) kV. The conductor screen is insulated by a thick layer of XLPE (cross-linked polyethylene). The XLPE insulation is mostly recommended for usage in submarine cables as they perform well in both high and low temperatures . At high(i)Static weight of the cable between the ship and sea floor.(ii)Residual bottom tension, which translates to an extra tension force at the laying wheel.(iii)Dynamic forces when the laying wheel is moving up and down.Submarine cables are designed in such a way that they can withstand all mechanical stress during manufacturing, transport, handling, installation, and operation. These stresses imposed on submarine cables are completely different from the factors which are affecting the underground cables. In case of inappropriate design and layouts, the cable is more prone to damages and results in high repair cost. Thus, such inappropriate designs are usually abandoned and replaced rather than being rectified. From the previous studies, the tensile and torsional loading cases were considered on a cable armor by using the energy method to create a balance equation . The cabTensile loading on one face of the phase was considered, as shown in There are two common methods for calculating temperature and the ampacity of submarine cables. One is the equivalent thermal resistance method that is based on International Standard IEC 60287. This method has high efficiency and accuracy in calculating the temperature and the ampacity of the direct buried cables. It can satisfy the calculation of the load in the simple scenario. For instance, the IEC calculation cannot address the physical problems coupling with air convection, radiation, and heat transfer, and it will cause large errors in calculation of the multi-loop and complex environment. Another method is the numerical method, including the boundary element method , differe of time . The traIn previous articles ,2,3,4, sMore recent works ,2,3,4 haIn the following, the same reasoning conducted in the above for the case of a single high-voltage transmission phase is used. In the above, the monitoring has been optimized in order to ensure the maximum coverage of the area of the composite structure under surveillance, while in the case of the phase, the problem of helical copper wires is more complex, due to the multiplicity of constraints to which they are subjected and the fear of plasticity which threatens them.A set of test cases were considered, trying to determine the best optimal location for embedding FOSs inside the core and/or as close as possible to the core. This is necessary because the closer the FOSs are to the core, the more accurate the monitoring results will be. Thus, FOSs were embedded close to the core but without compromising their safety. It is worthwhile to note that, here, the article is discussing the conceptualization of FOS embedding inside a single electric phase only, and it is still a little far from engineering applications, which would impose extensive experimental validation. Thus, the current article has to be considered mainly as a proof of concept.(i)Test case A—Placement of linear FOS in parallel arrangement with varying length from the core.(ii)Test case B—Placement of FOS helically wound around the complete core.The longitudinal length of the linearly-placed FOS is considered in all simulations as 40 mm, which corresponds to the helical step. From The FOS being in direct contact with copper wire is expected to record an averaged value of copper deformation. The red curve represent strain values of the central wire of the copper core. The strain values in the FOS which is placed parallel and in contact with the core (in blue) provides almost the same value of all directional strain as that of the copper wire (in red). Statistically, this seems to be the most convenient case which could be adopted, but arrangement of FOS parallel to the central wire of the core is risky and accounts for a high probability of failure, unless proper coating is used. All simulations were conducted using fiber-optic made of silica glass  and acrylate coating .From From the above results, a better perspective about the placement of FOS for accurate SHM can be observed. Placement of an FOS inside the copper core provides exactly the same results as that of copper, but technically implementing this case is somewhat risky and must be considered along with appropriate fiber-optics coating technologies. The same risk is still to be considered when FOS is helically wound the same way as copper wires, although this would bring the most valuable outputs, i.e., multi-parameter strains. Thus, this case can be considered if full assurance is given that FOS will not suffer failure following helical winding coupled to sliding/friction with copper wires. The second case with placement of FOS 1 mm inside the XLPE provides almost the same lateral strain  for offshore farms was numerically introduced as a preliminary study to directly monitor true strain of copper wires. The idea is to be informed well before extensive plasticity develops within the wires, thus avoiding electric shutdown. The strain values of FOSs were compared with the strain values of copper cores. The test case where FOS was placed parallel to the central wire produces very good results, although integrity of FOS must be carefully checked by using appropriate coating technologies. The other test cases were favorable, of which the case of embedding the FOS 1 mm inside the XLPE insulator was promising, too. This could be further implemented and tested to perform the most reliable SHM for smart energy transport phases. The other test case, where the FOS is helically wound around and is directly in contact with copper core, provides the most information with the lateral, shear, and longitudinal strain all known at the same time, although it raises a strong technical challenge, which could be dealt with in the future upcoming developments. Finally, through this article, the option of embedding optical fiber within the phase for finer monitoring of plastic deformation of copper wires and their individual failure seems interesting, although extensive work pertaining to refining sensors placements, physics of sensors, and engineering still needs to be performed, to better emphasize the concept which is suggested. Current results, although not totally enough to validate the concept at the engineering step, do however light the way towards obtaining real, accurate, and in situ 3D strain of copper wires inside electric transport cables for offshore farms.


When seeking to explain the eventual outcomes of a higher education experience, do the personal attributes and background factors students bring to college matter more than what the college is able to contribute to the development of the student through education or other institutional factors? Most education studies tend to simply ignore cognitive aptitudes and other student characteristics—in particular the long history of research on this topic—since the focus is on trying to assess the impact of education. Thus, the role of student characteristics has in many ways been underappreciated in even highly sophisticated quantitative education research. Conversely, educational and institutional factors are not as prominent in studies focused on cognitive aptitudes, as these fields focus first on reasoning capacity, and secondarily on other factors. We examine the variance in student outcomes due to student  versus institutional characteristics . At the level of universities, two contemporary U.S. datasets are used to examine the proportion of variance accounted for in various university rankings and long-run salary by student cognitive characteristics and institutional factors. We find that depending upon the ways the variables are entered into regression models, the findings are somewhat different. We suggest some fruitful paths forward which might integrate the methods and findings showing that teachers and schools matter, along with the broader developmental bounds within which these effects take place. When seeking to explain the eventual outcomes of a higher education experience, do the personal attributes and background factors students bring to college matter more than what the college is able to contribute to the development of the students through education or other institutional factors? A long line of work within the fields that study cognitive reasoning and aptitudes would suggest that student background characteristics, especially cognitive aptitude, is important to outcomes not only within college but well beyond it e.g., , whereasUltimately, it is very hard to disentangle student and background factors from what a college adds, and, in part, all studies on education depend on the factors and methodological approach a researcher wishes to emphasize e.g., . Most edIn this paper, we study student characteristics and institutional factors at the level of institutions to assess whether the findings align with the past studies on cognitive aptitudes and student characteristics, but also to examine the role of institutional or other factors. The aim of our paper is not to clearly adjudicate between the two different perspectives but to consider how our approach provides a way of thinking about this problem in different ways. We first provide a historical overview focused on the role of cognitive aptitudes, as this contribution adds to that line of work, and it also illustrates that this ongoing discussion surrounding what factors matter for education has a thread that can be traced back decades. We emphasize that our view on cognitive abilities and aptitudes is that they are developed and that education is both a product of cognitive aptitudes and can enhance cognitive aptitudes .The importance of cognitive aptitudes for life outcomes has been widely replicated across the decades in numerous longitudinal samples globally e.g., . DevelopIn a landmark U.S. educational report , data weOver the following half century, reviews of the findings of what has come to be known as the Coleman report have largely confirmed them e.g., . Jencks Other than large sample randomized controlled trials (RCTs), studies of twins are able to account for endogenous factors such as genetics in the estimation of how much of the variance in student achievement is due to students versus teachers or schools in education research . In a reAn unusual opportunity for a natural experiment arose in World War II, due to the city of Warsaw, in Poland, being destroyed. The government assigned residents randomly in the newly reconstructed city. Studies using K-12 student-level administrative data in the U.S. on a sample of about 23 million students in the states of Florida and North Carolina across the decade studied  were ablThis tendency of education research to neglect the contribution of students to student achievement is probably due, in large part, to the focus of the education research community on what variables they think they can change in the educational environment of the student e.g., . We shouThus, the approach taken in this paper focused on reverse causal questions, providing some of the fuzzy boundaries around expectations of what teachers or schools might be able to contribute to the eventual achievement of students, but it does not necessarily take away from the utility of teachers and schools in improving student achievement and outcomes within reasonable bounds. The largest threat in most approaches from the economics of education is selection bias, which is even stated by education economists and policy researchers as cognitive abilities e.g., . For exaUp to this point we have focused on reviewing studies looking at the variance in student achievement accounted for by schools or teachers, but So far, we have reviewed findings in K-12 education. But what about higher education? At the individual level, Value-added in higher education. As more attention has been drawn to accountability and transparency in higher education in the past decade, many researchers turn to using the value-added methodology to determine the aspects that higher education may add to economic opportunities . We use two datasets for this study at different time points and measurement of different outcomes to attempt to see if the findings replicate. The first dataset was compiled in 2014 from the U.S. News website using a premium account for full access as well as public data from PayScale. The second dataset was drawn from the College Scorecard database from 2017–2018. This dataset is free and available to access and download via Student characteristics. We used average SAT and ACT scores at the institutional level as a proxy for students’ average general cognitive aptitude level , and diversity . Researchers have also studied the relationship between classroom diversity as well as diversity courses and students’ cognitive outcomes . Roksa eIn the College Scorecard data, we had more than 6000 observations. However, there are also significant missing observations in this dataset. For example, among more than 6000 institutions, only 1300 of them reported average SAT scores at the institutional level. Some patterns we observed in this dataset are: (1) the average SAT score is 1060, (2) there is a wide range of admission rates, total enrollment, faculty salary, and cost to attend, for example; (3) the majority of institutions are private-for-profit. For the U.S. News dataset, we faced a less significant issue of missing data. We see that the majority of institutions in this dataset are private-not-for-profit institutions. More details can be found in We used ordinary least squared (OLS) techniques to analyze the relationship between student aptitude, institutional factors, and student outcomes. First, we ran a model with only SAT scores on student outcomes to uncover the variance explained by student characteristics or cognitive aptitude alone  to determine the importance of independent variables  and 64% of the long-term salary (ten years out). In the 2014 U.S. News data, institutional factors accounted for 38% of the variance in the average early-career salary and 53% of the variance in the average mid-career salary at the institutional level. In terms of rankings, institutional factors could account for between 75% (in the College Scorecard data) and 75% (in the U.S. News data) of variance in the THE U.S. ranking, and between 59% (in the College Scorecard data) and 52% (in the U.S. News data) of the variance in the Lumosity ranking. In When including both average SAT scores and institutional factors in the model, we observed increases in the explained variance of our outcome measures. We also examined the proportion of variance explained by calculating R-squared ratios. We compared two ratios: Finally, we report findings using the College Scorecard dataset in Looking at rankings, specifically the THE U.S. ranking and Lumosity ranking, we found that the top three predictors of THE U.S. ranking using the College Scorecard data were completion rate, retention rate, and faculty salary see  Panel C.Overall, our findings aligned historically with much of the research on cognitive aptitudes and variance explained in outcomes, even after accounting for various institutional factors. However, this was from the perspective of cognitive aptitudes being the core variable of importance to consider as a starting point. On the flipside, when entering the multitude of institutional factors first into the regression model, these numerous variables collectively accounted for the majority of the variance in outcomes , suggesting that institutional factors very likely do matter, in addition to student characteristics and cognitive aspects. Of course, test scores such as the SAT are just one short measure that students take prior to high school, so the fact that much of the variance in outcomes is captured by this singular measure should not be underemphasized. At the same time, this analysis illustrates that other institutional factors can matter collectively, and/or the contribution of student characteristics might be obscured or highlighted depending upon which variables one prioritizes in the research design and analysis. Depending upon the ways variables are prioritized and entered into regression models, findings can be quite different. In the remaining part of this discussion, though we fully acknowledge that institutional factors play an important role in addition to student characteristics, we discuss our findings that link to the historical focus of the academic field focused on cognitive aptitudes, and consider our findings in that broader context, and through the lens of cognitive aptitudes’ usefulness.A core limitation of this study is that our research design is in the form to address a reverse causal question where we cannot isolate causes. Thus, we likely have omitted variable biases. However, because one purpose of the study was to determine whether the proportions of variance in student achievement due to students or to institutional factors aligned with the large historical literature going back to developed cognitive aptitudes at the point of testing and institutional or other factors and their contributions to long-run outcomes.Despite these important limitations, our findings illustrate contemporary replications across two U.S. datasets at different time points at the level of colleges and universities, with the many studies reviewed in K-12 education, and also historically. Overall, the proportion of variance accounted for by student characteristics as indicated by average SAT/ACT scores or general cognitive aptitude—even after accounting for various institutional factors—was quite consistent across not only typical college rankings but also a critical thinking ranking and a Lumosity brain games ranking see  may in fThe proportion of variance accounted for by SAT/ACT scores or general cognitive aptitude on long-run salary was replicated across the U.S. News and College Scorecard datasets which used two different measurements of salary. Overall, College Scorecard data showed that approximately 47% of the variance in salary a decade after graduation was accounted for by such test scores and U.S. News, and PayScale data showed that approximately 41% of the variance in salary at mid-career was accounted for by test scores. Findings for salary, even after accounting for institutional factors, were consistently replicated across different career time points and datasets, ranging from 72% up through 74%.In a classic paper, Teachers and other institutional factors do matter . However, at least from the broad empirical historical perspective of cognitive aptitudes research, how and the extent to which institutional and educational factors can matter is bounded in some ways by this broader pattern of student characteristics, accounting for a large portion of the variance in long-run student outcomes. For example, Taken from the lens of cognitive aptitudes as being important, this paper replicated and extended findings in two contemporary U.S. datasets at the level of universities extending decades of research at many levels of education, suggesting that a large portion of the variance in student outcomes may be due to student characteristics—in particular developed cognitive aptitude. When coupled with the large literature showing that general reasoning is related to numerous outcomes across the lifespan , these fSome fruitful avenues to explore taking individual differences in aptitude into account for more optimal talent or human capital development might be to more carefully examine what aspects of education could improve intelligence , which e


The current study aimed to assess trends, associated factors and the changes in these factors for exclusive breast-feeding (EBF) over the past two decades in Lao People’s Democratic Republic (Lao PDR).The current study used a quasi-longitudinal design. Descriptive analyses were done with correction for complex survey design. Inferential analyses were done for survey years separately using multiple logistic regression. Finally, pooled logistic regression analysis was done using interaction terms to quantify the difference in association per year.The current study used data from all provinces of Lao PDR collected in the years 2000, 2006, 2011/2012 and 2017.Children aged six months or younger from Lao PDR.EBF practice was estimated at 19·03 %, 26·87 %, 40·67 % and 44·89 % in the four survey years, respectively. Factors significantly associated with EBF included: region of residence, ethnicity, wealth index and age of child. Region and ethnicity saw significant changes in association, and the South developing positively over time as well as in the Lao-Thai ethnic group. Having had any antenatal visits was not associated with EBF practice, nor did this change over time.Our study shows how EBF trends, and factors associated with EBF, changed over time. We applied an easily replicable methodology to assess similar public health phenomena. We argue that such analysis is particularly relevant for transitioning countries. In such rapidly evolving settings, it is crucial to take into account changing underlying factors when assessing and developing public health policy. Examples of these large-scale collections are the Demographic Health Survey and equivalents such as the Multiple Indicator Cluster Survey (MICS), aimed at measuring the results of efforts made on public health issues with respect to the Millennium Development Goals and Sustainable Development Goals. One such issue is exclusive breast-feeding (EBF), one of the most important practices for infant development and survival, as breastmilk contains all the necessary nutrients for the first years of the infant’s life. Most infant deaths occur in these six months, especially in lower-income countries; this is the most neglected period for adequate quality of care–5. The worldwide rate of EBF was estimated at 40·06 % in 2014, with the highest rates found mostly in countries on the African continent–9. Although the global rate of EBF has been rising, the increase has stagnated in recent years and is still falling short of the global goal of 50 % coverage by 2025,7,10–12. If EBF rates were to be scaled up to near-universal levels, an estimated 823 000 deaths of children under five (CU5) could be prevented annually,13. Lack of EBF is associated with lower infant intelligence in later life, and with estimated annual global economic losses of $302 billion, or 0·49 % of the worldwide Gross National Income,13. Considering the benefits of EBF, it should be one of the most intelligent and cost-effective stimuli for economic growth and human capital. Considering the evident benefits, many efforts have been made to increase EBF rates, such as the Baby-Friendly Hospital Initiative and WHO Code of Marketing of Breast Milk Substitutes (The Code),15.The WHO recommends that all children receive EBF for the first six months of their life,13. The framework stipulates that the practice of EBF is not a one-woman job, but requires an enabling environment, support from the father and adequate government policy, among other factors,13. Many of these factors, such as maternal employment, antenatal care (ANC) and ethnicity, have been identified through research in different study settings which has provided input for the formulation of health policy–22.The factors that determine whether a mother practices EBF have been the subject of extensive research. The conceptual framework adopted by UNICEF, which indicates that EBF is a multi-dimensional concern, is a result of such research,23–25. For example, Santos et al. showed that the inequalities in breast-feeding between poorer and wealthier mothers from Pelotas, Brazil, changed over time and that EBF adaptation was picked up more rapidly among the wealthier mothers.While most of the associations are described in relation to locations and contexts, how they change over time is often unknown, as they are often based on cross-sectional study results. Given the adaptive and thus fluctuating nature of human behaviour, the assumption that the associations remain static over time is highly unlikely and therefore naive. Additionally, to determine whether policy is successful in improving EBF, trends and temporal associations should be assessed. This is especially important for transitioning countries that experience significant developments from both an economic and a human capital point of view. A few studies have already shown that associations can appear, disappear or change over time,25. In addition, such rates can be statistically tested using trend tests, but they lack the benefit of measuring effect sizes and thus direction and magnitude. While there are studies that statistically quantify changes between years with respect to the magnitude and direction of associations, they remain scarce, as does research investigating which statistical methodologies are most applicable,23.The few studies that assessed these changes over time did so with a range of different methodologies. For example, more qualitative interpretations of the study results were used, when comparing the prevalence of EBF over several years and/or among the factors studied,27. EBF has important implications for Lao PDR, as the country still faces a large burden of stunting among CU5 as a result of chronic malnutrition. In order to support maintaining the momentum in EBF improvement, the current study aims to investigate the trends, associated factors and the changes in these factors for EBF over the past two decades in Lao PDR, in an effort to contribute to the development of robust and appropriately designed policies and programmes. We have applied an easily replicable statistical methodology which quantifies change over time, using the rich data available from the MICS and Lao Social Indicator Survey (LSIS) data banks in Lao PDR.One transitioning country lacking temporal analysis of EBF trends and associated factors is Lao People’s Democratic Republic (Lao PDR). Similar to the global trend of EBF, Lao PDR has seen improvements in the past two decades, but these improvements have stagnated in the more recent yearsThe current study used a quasi-longitudinal study design, allowing for a time-efficient and simple comparison of multiple large-scale survey data in a temporal fashion. Data were derived from four large-scale representative survey samples of the Lao population: the MICS of 2000 and 2006 and the LSIS of 2011/2012 and 2017.. A two-stage sampling strategy was used, the first of which consisted of selecting villages as primary sampling units/clusters. These primary sampling units were selected proportional to the distribution of urban, rural and rural without road proportions present in each of the three regions based on the most recent census frame available. The combination of the urban rural distribution and the regions were used as the sampling strata in the MICS 2000 survey, resulting in six strata. In the following year, a similar division was used with the addition of rural with/without road, resulting in nine strata. With the introduction of the LSIS, a more elaborate method was used by using urban, rural with/without road in combination with the seventeen provinces in 2011/2012 and eighteen provinces in 2017, resulting in fifty-one and fifty-four strata, respectively. The second stage entailed the sampling of households within each village, by means of standard systematic sampling. Finally, sampling weights in the samples were based on the PSU and are the inverse probabilities of individuals selected in the survey.The national surveys selected their original samples with a probability proportional estimation size. These estimations were based on a list of area units with the latest estimates of the household sizes from the latest agricultural censusPrimary criteria were data recorded on the outcome variable and age between 0 and five months. The age gaps included children that ranged from 0 to six months (excluding the latter), indicating that the true range was from the moment of birth to five months and 28, 29, 30 or 31 d depending on the month and year. Any children for whom data on their mother/caretaker were not available were also excluded from the analyses. Finally, twins were also excluded from the analyses. Selected predictor variables, their value labels and availability across the data sets can be found in the supplementary file.Across all data sets, different codes were used for similar variables. Data were merged on the basis of these unique identifiers: cluster number, household number and caretaker line number. The merge strategy used was a one-to-many merge, as caretaker variables could apply to multiple children (some caretakers/mothers had more than one CU5).The outcome variable for EBF was a dichotomous variable constructed using the following conditions: whether the woman was breast-feeding at the time of the survey and whether she had given the infant any food (besides vitamin supplements and/or ORS) besides her breastmilk within the 24 h preceding the survey. Thus, the variable was coded to be 0 = the mother/caretaker gives anything else besides breast-feeding, or 1 = the mother/caretaker exclusively feeds her infant breastmilk (may include vitamin supplements and/or ORS). The variables used for the study can be found in Table . Descriptive and inferential statistics were further carried out using STATA se version 16.Analysis of the data was carried out using descriptive and inferential statistics. Recoding and aggregation of data was done using IBM SPSS statistics version 25SE. By indicating the various components in the module, such as the sampling weights, primary sampling units and sampling strata, further estimates could be done per survey. Within the survey design corrections, sampling weights were used. For the descriptive statistics, variance estimation was done employing the commonly used Taylor-linearisation method, which is computationally efficient. Variance estimation was done using the entire population of each individual survey sample. Every analysis that was done using the complex survey design correction was carried out on the pre-specified subpopulation, based on the discussed in/exclusion criteria. Design efficiency was assessed with the design effect, which is the ratio between the actual estimated variance based on the design and the variance of the same sample regarded as a simple random sample (SRS). Any singleton units (clusters having only one observation) were marked as certainty units in the design correction, indicating that they did not contribute to variance estimation. Weighted frequencies were rounded up or down to integer values, as well as adjusted subpopulation sizes, which deviated across variables due to missing values. Missing values per variable and survey year can be found in the supplementary file.For the descriptive analysis of the study, correction for the complex survey designs was done in order to provide valid estimates of population parameters such as the proportion of EBF per survey year. These corrections were done using the ‘svyset’ function in STATA First, logistic regression analyses for each survey year were done to assess the associations between the selected indicators and the outcome variable for each year separately. Finally, pooled logistic regression analyses, including data of all survey years, were carried out. Both the separate and pooled regression analyses were adjusted for urbanisation and region of residence to account for sample design elements instead of using the ‘svyset’ command that was used in the descriptive analyses. Design correction could not be done while analysing all survey data together, as each survey can only be accounted for by its own design.β1 represents the ‘base’ effect of the indicator. Specifically, this represents the effect of the studied indicator for the first survey year (2000). The β4 coefficient represents the interaction term between the survey year and the studied indicator. The interaction term quantifies the added change to the base effect in effect from a given year compared to the first year (2000). When the regression coefficient from one of the interaction terms is added to the base effect, the effect size of the particular year of interest can be calculated . P-values of 0·05 or less were considered as statistically significant for all of the associations, and 95 % confidence intervals were reported for all estimates. Post-hoc margin plots were used to provide graphical depictions of the changes of associations.To assess the change over time of the studied associations, a multiple regression with interaction terms was used. The general equation of the models can be seen above, where the Data was derived from the Lao PDR MICS and LSIS surveys from UNICEF. Consent was asked for each interview and recorded in the datasets. For those who refused consent, no values were recorded on any of the questionnaire questions and they were excluded from any analyses. Datasets were accessed through correspondence with and consent of UNICEF, with the condition that datasets were used only for the intended and reported purposes and were not distributed. Finally, any reports made from the data were forwarded to UNICEF and discussed with the Lao government and stakeholders before dissemination or publication.N 554, 439, 1135, 1114  in the years 2000, 2006, 2011 and 2017, respectively, as seen in Table After the application of the inclusion and exclusion criteria the analytical cohorts consisted of Adjusted rates of EBF were estimated at 19·03, 26·87, 40·67 and 44·89 % in the years 2000, 2006, 2011/2012 and 2017, respectively . Across the samples, there was an increase observed in receivers of ANC, growing from 30·64 % in 2000 to 84·14 % in 2017. Additionally, the number of caretakers/mothers that received more than the WHO recommended number of ANC visits (four) increased from 27·23 % to 48·77 % between 2011/2012 and 2017. The proportion of children with mothers having secondary education rose from 14·17 % to 42·38 %, whereas the proportion of women having no education decreased from 42·64 % to 18·41 %. The proportion of mothers engaging in early initiation (time put to breast: immediately) of breast-feeding increased from 31·71 % to 48·10 %. Finally, the proportion of children with a vaccination card also increased from 30·77 % to 77·40 % over the years.In the multivariate analyses per survey year Table , variousA higher age of the child was negatively associated with exclusive breast-feeding; the odds for the child being exclusively breastfed decreased for each subsequent month of age , whereas the central region had not improved at all, compared with the North. The changes in both associations can be seen by the predicted margin proportions in Fig. .Using the rich data from the MICS and LSIS, we showed that the rates of EBF rose from 19·03 to 26·87 to 40·67 and finally to 44·89 % in the respective years: 2000, 2006, 2011/2012 and 2017. The increase in EBF rate between the succeeding years was statistically significant, but with the development between 2011 and 2017 showing a stagnation of this increase. This development in EBF rates follows a similar trend reported by other countries, both in and outside of South-East Asia, hinting at global trends of EBFOur analysis of temporality of associated factors revealed that the region of residence was strongly associated with EBF and also changed over time. Over the years, it can be observed that the mountainous northern region of Lao PDR had the highest EBF rates, but the Southern region of the country made efforts to close the gap between there and the North, surpassing the Central region. Furthermore, when we compare our prevalence maps in Fig. ,36. Additionally, different gender roles and post-partum practices can be found between ethnic groups, possibly explaining differences in adherence to breast-feeding practices between groups. Implications can be drawn from the fact that the arena of policy making and scientific research is primarily dominated by the educated Lao-Thai. Policy changes may be most favourable to the Lao-Thai, since they are formulated primarily by people from this group. This is similar to the results found by Santos et al., in which EBF compliance increased most among wealthier mothers. These findings align with the inverse equity hypothesis, which states that new health policy is generally picked up by wealthier populations first. In the case of Lao PDR, this is most likely the result of disparities between ethnic groups in terms of wealth, education and cultural practices, and therefore of opportunities to implement EBF, and serves as a reminder that one size may not fit all when formulating policy.Additionally, ethnicity of respondents played an important role in the rate of EBF. Of the changes found in association of ethnic group with EBF, the Lao-Thai in particular was observed to be closing the gap and showing an increased compliance with EBF. Ethnicity in Lao PDR explains various disparities between individuals. For example, individuals from the Lao-Thai ethnic group are generally well educated and wealthier when compared with the poorer and lesser educated Hmong-Mien, who often live in the more mountainous areas of LaosAlthough there is much overlap between ethnicity and region of residence, the analysis for ethnicity – which was corrected for region of residence – still explained disparities between EBF rates. This shows that region and ethnicity do not simply explain the same differences in EBF, even though the two factors are related.,41. This also becomes evident from the meagre 1·9 % of hospitals in Lao PDR that were Baby-Friendly Hospital Initiative certified in 2014. The impact of the apparent lack of adequate ANC is also evident from other studies carried out in Lao PDR, showing that mothers often lack the knowledge on the specifics and benefits of EBF,44. This has important implications as there has been some evidence that although deeply rooted traditional practices such as food taboos are in place, women from the Khmu ethnic group who were in strong engagement with health care showed some behaviour changes.In the setting of rapid development, change can also fail to take place, even where it would be expected. An example from the current study is the association with ANC visits, with which no association was established nor did this develop in the later years, despite the rapid upscaling of ANC to near-universal coverage (approaching 90 %). This finding coincided with the inverse association between the ownership of a vaccination card and EBF. Vaccination cards are often acquired from ANC visits and therefore may be a proxy for access of care, but not necessarily quality of care. Available research on the quality of  care in Lao-PDR shows that it is often very poor, as health providers, among other issues, often lack adequate communication skills and provide insufficient health educationThe current study had several strengths and limitations worth noting. To our knowledge, no study of this kind has been carried out within the context of Lao-PDR, in which (recent) research on EBF is already scarce. Additionally, while there is a considerable amount of research on the trends and associated factors of EBF, very few studies have quantified and tested statistically how associations change over time. The present study succeeded in all three of these components, with the use of highly representative survey data from four years over a period of two decades in Lao PDR.Given the standardised nature of health survey questionnaires, such as the MICS/LSIS, aggregation of data was relatively simple and valid. Another strength is that, due to the use of the MICS and LSIS survey data, fairly large sample sizes were achieved to arrive at high statistical power for the inferences made. By far and large variables were measured similarly across survey years, which supported aggregation and comparison. However, some variables were added or omitted over time. For example, practicing food taboos was part of the survey in 2000 and 2006, but omitted in the following years, while on the contrary, number of ANC visits was only added from 2011 onward. Also, categories of some variables changed over time. For example, in 2006, a variable consisted of categories ‘rural’ or ‘urban’, which was expanded in subsequent years to ‘urban’, ‘rural with road’ and ‘rural without road’. While variables can be collapsed into fewer categories, and thus allow for comparison, it inevitably leads to loss of information.As with most studies using standardised survey data, there are limitations with respect to the use of 24 h recall questions, which is also the case for EBF. The nature of this measurement means that we know the rate of mothers practicing EBF at the time of the survey, but not the rate of mothers completing the full recommended six months of EBF. Thus, the estimated rate of EBF in these studies will be an overestimation of the women who complete the six months. This is also illustrated by the decline of EBF rates with increased age of infants..Furthermore, complex sampling design corrections can only be accounted for one-at-a-time, therefore limiting the inferential analysis to using the shared sampling variables instead of the design correction, inevitably leading to a loss of statistical power. In this process, the estimation of numerous parameters also leads to another limitation of the current study: multiple testing. Considering the numbers of estimates and joint hypothesis tests conducted and due to the very nature of hypothesis testing, it is important to realise that multiple tests might lead to alpha-inflation. While it is not common practice to adjust for multiple comparisons in regression settings, it may be important to acknowledge and considerBecause of the strong data set, detailed analysis and minor limitations, the current study provides considerable evidence for changes in EBF practice. Based on representative data of Lao PDR, and the efforts made in the sampling designs, careful inferences can be made. Furthermore, the body of evidence surrounding EBF in Lao PDR has been mostly limited to cross-sectional studies, whereas the current study takes into account the missing temporal aspect of associations.We believe that the evidence gained from studies utilising (quasi) longitudinal study designs is important in the steering of policy making. This methodology allows us to track changes in associations over time, rather than isolated in separate years. The apparent benefit of this becomes clear through our study: we showed that increases in EBF rates were especially significant for the Lao-Thai, closing the gap with other ethnic groups, even though they practiced EBF the least overall. The latter would have likely been the conclusion of a cross-sectional study. This information enables policy makers to act on trends, rather than a snapshot.With the wide availability of rich, routinely collected survey data, we recommend that such studies are carried out in addition to cross-sectional studies. Also, to ensure the validity and reproducibility of these studies, we would like to encourage investigation into which types of analyses are most applicable in these cases. For instance, the current study initially aimed to utilise a mixed-model analysis approach, but this idea was abandoned due to the small cluster sample sizes. Such analyses may be more parsimonious with respect to parameter estimation, and therefore provide analyses with higher statistical power. Whether such analyses provide more valid and robust results should be the subject to future research.,48. Finally, it also leaves us with the question of what the true rate of mothers is who complete the full six months of EBF. The need for such ways of measurement can potentially be satisfied with qualitative studies. Such studies can also provide explanations with respect to the established associations of the present and other studies, as well as providing new hypotheses for future studies.Besides the statistical considerations, the limitation with regard to the standardised measurement of EBF calls for alternative ways of measuring EBF. The recommendation is that mothers practice EBF for a six-month period, but the current methodology of measurement does not help us to assess this. Thus, inferences made from studies using the current methodology of measurement may not be entirely compatible with the goal we are trying to achieve. This is especially true since most evidence points towards the added benefit of practicing EBF for six months, particularly in low-income settingsThe findings of the current study further emphasise the importance of and need for improved quality of care. The concerted efforts in the early 2000s have shown their successes, but have to be pushed forward so that the momentum is kept in improving EBF. Due to the discrepancies between ethnic groups and regions, special attention should be given to diversifying these initiatives so that they align with the goals and needs of the diverse population of Lao PDR, especially within the setting of ANC.The transitioning countries, among which Lao PDR is one, are in a stage of rapid development in all facets of society. These developments, both spatial and temporal, inevitably lead to changes in human behaviour, and in turn, to changes in phenomena such as EBF. When considering the formulation of policy and law, such developments need to be taken into account. The current study applied an easily replicable methodology that allows for the scrutiny of the kind. Finally, in the context of Lao PDR, the current study showed temporal discrepancies between regions and ethnicities, emphasising the need for appropriately designed interventions to improve EBF. These interventions are of special importance in the setting of ANC, as it is often the first and most important moment for EBF education for the mother and is currently lacking in Lao PDR.


Pharmacovigilance in China has experienced rapid development in the past 30 years. The implementation of Good Pharmacovigilance Practice in China since the end of 2021 heralds a new era of pharmacovigilance affairs, which puts forward higher requirements for the quantity and quality of pharmacovigilance personnel. This study aimed to preliminarily explore the current career situations of pharmacovigilance professionals working in China for pharmaceutical companies.A questionnaire was adapted from research in the USA and Europe with the help of several pharmacovigilance experts. Snowball sampling was used to conduct an exploratory survey to obtain the frequency of basic demographic information, work status, and career expectations of pharmacovigilance professionals working for pharmaceutical companies.The personnel engaged in pharmacovigilance work for pharmaceutical companies were mainly medical or pharmaceutical undergraduates within 3 years of graduation. Their work intensity and pressure were relatively high. The training provided by their universities and enterprises could not well meet their needs to improve their job competence. Although they were optimistic about pharmacovigilance and will not change their career, most of them were planning to change their employers.There was a gap between the demand and supply of pharmacovigilance personnel. Relevant regulatory authorities and industry associations should guide higher education institutions to collaborate with pharmacovigilance specialists to strengthen pharmacovigilance education for medical or pharmaceutical students, on the basis of which pharmacovigilance certification courses and continuing education courses can be developed. Meanwhile, pharmaceutical enterprises should consider reasonably adjusting work intensity and income to avoid a high turnover rate.The online version contains supplementary material available at 10.1186/s12913-023-09089-0. World Health Organization (WHO) defined pharmacovigilance as “the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other medicine/vaccine related problems” . So far However, more than 80% of the ADR reports of 2021 were still submitted by healthcare professionals in hospitals , which wThe aim of this survey was to preliminarily explore the basic demographic features, working conditions, competency-based training, mental pressure, and views on the pharmacovigilance career of pharmacovigilance professionals working in China for pharmaceutical companies, the outcomes of which will be beneficial to pharmacovigilance human resources development and management.We designed an online survey to get information from pharmacovigilance professionals. The initial version of the questionnaire was adapted from research in the USA and Europe in 2017. Then it was sent to three pharmacovigilance experts for revision suggestions to ensure its applicability in China. After two rounds of revision, the final version of the questionnaire consists of 5 parts , mild pressure (11–15), and heavy pressure (≥ 16).Data collected from April 2020 to May 2020 was exported from the questionnaire platform named questionnaire star and imported to Excel 2019 to be analysed. Incomplete questionnaires were excluded. Frequency analysis was conducted to describe the respondents’ demographic information, working conditions, training experience, and career prospects. The relation between pressure scores and annual income were illustrated by the percentages of three pressure types in different income groups.A total of 139 questionnaires were collected, of which 127 are valid and 12 are filled incomplete. The effective recovery rate of questionnaires was 91.37%. Table The Working conditions of the sample are displayed in Table As shown in Table Table The respondents’ opinions on the existing state and prospects of pharmacovigilance career are in Table Among the respondents, the ratio of the number of people working for foreign-owned pharmaceutical companies to that of people working for domestic ones is approximately 1:2, which is much higher than the ratio of these two kinds of pharmaceutical companies in China . One reaThe majority of respondents were young. Most of them had bachelor's degrees in medicine or pharmacy and had worked in pharmacovigilance for less than 3 years. Some of the respondents received barely any knowledge of adverse drug reactions or pharmacovigilance in their university education. Despite widespread in-house training by pharmaceutical companies, respondents still felt the need to upgrade their knowledge and skills in all aspects of pharmacovigilance. Therefore, it can be inferred that there exists a huge demand for education and training in pharmacovigilance.In fact, there were flourishing pharmacovigilance training courses, conferences, and seminars in China in recent years. The International Society of Pharmacovigilance (ISoP) and The Uppsala Monitoring Center of WHO (WHO-UMC) held pharmacovigilance joint courses with Shenyang Pharmaceutical University, Shenzhen Hospital of Hong Kong University, and NMPA in January 2018, November 2019, and October 2021, respectively [Chinese colleges and universities haven’t extensively taken part in pharmacovigilance course development. To our knowledge, Shenzhen University and Shenzhen Pharmacovigilance Institute jointly offer an individual Pharmacovigilance and Risk Management course . BesidesPriority should be given to integrating professional seminars and university courses into the internal pharmacovigilance training of pharmaceutical companies. It’s feasible for the relevant regulatory authorities and industry associations to encourage colleges and universities to vigorously develop pharmacovigilance education. In addition to distinguished pharmacovigilance monographs, what can be used for reference includes the WHO-UMC online courses , the EurIt can be seen from the sleep time, business trip, and annual leave of the respondents that pharmacovigilance professionals had somewhat great work intensity and pressure increases with income. Most of the respondents were willing to leave their company, even though they were satisfied with the working environment and optimistic about the prospect of the pharmacovigilance career thus less willing to change their career. One of the reasons for the high work intensity and pressure is the lack of pharmacovigilance personnel at present. The large number of job vacancies for pharmacovigilance in enterprises prompts the on-the-job personnel to bear more work. In addition to the work intensity and pressure, the strong turnover intention may be caused by the fact that the annual salary of most respondents working in highly developed cities is lower than the local average salary. It’s in turn possible to obtain more income by changing employers in the same industry because of the high job vacancies.A reasonable mobility of pharmacovigilance personnel is helpful to the development of the industry, but frequent job-hopping requires a long adaptation period, resulting in the waste of human resources. Therefore, the education and training of new pharmacovigilance personnel to fill job vacancies, hence reducing labor intensity and pressure has fundamental help. Under the background of the declining employment rate of medical students in China , it is sThe sampling was conducted before the implementation of Good Pharmacovigilance Practice which will undoubtedly have quite an impact on pharmacovigilance practice. However, the survey results can be a reflection of current and even near-future conditions because adaptation by the pharmaceutical industry is difficult to be completed in a short period. Snowball sampling may affect the representativeness to a certain extent. Still, it is acceptable for acceleration access to the sample. Besides, this study is an exploratory study aiming to reveal the overall situation of pharmacovigilance professionals. It merely provides some basis for further in-depth research, including but not limited to the investigation of pharmacovigilance training needs and the factors of pharmacovigilance staff work stress.This survey shows that pharmacovigilance professionals working for pharmaceutical enterprises in Chinese are mostly medical or pharmaceutical bachelors who have recently graduated, and their work intensity and pressure are relatively high. The implementation of Chinese Good Pharmacovigilance Practice will increase the shortage of qualified pharmacovigilance personnel. In this circumstance, colleges and universities should speed up the construction of pharmacovigilance training courses, including undergraduate, vocational certification, and continuing education courses, together with experienced experts in pharmacovigilance practice. Domestic pharmaceutical enterprises, especially innovative drug companies, should pay attention to the construction of their own pharmacovigilance system. At the same time, enterprises should take into consideration reasonable adjustments of labor intensity and income to avoid the influence of a high turnover rate on the continuity of pharmacovigilance work.Additional file 1. Questionnaire.


Background: The metaverse as a digital environment for Industrial Revolution 4.0 is one major form of use of the internet. There are 202.6 million internet users in Indonesia in 2021, or 73.7% of the total population. A total of 138.1 million Indonesians aged 18–64 years have used the internet to make purchases through e-commerce and 74.4% make food purchases through online food delivery applications. Most of the foods sold in online applications are foods that are high in carbohydrate and fat, but with fewer vegetables and fruits. So, it can be concluded that the food sold is energy dense, nutrition poor. Because of that, people run the risk of degenerative diseases such as hypertension, diabetes mellitus, stroke, and others. By using the health belief model approach, this study aims to analyze the association between the habits of consuming food and beverages purchased online through the Grab Food or Go Food applications with the nutritional status of the people in Surabaya and Pasuruan, East Java, Indonesia. Methods: This research is quantitative research using a cross-sectional approach. Data collection was carried out offline using paper questionnaires and analysis with SPSS. Result: There was significant association between the characteristics of the respondents  and health beliefs. However, there was no association between health beliefs and the frequency of online orders. Finally, no significant association was found between perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, self-efficacy and nutritional status. Thus, it is still important for the government to increase socialization and education in the importance of balanced nutrition and nutritional status so that people can protect themselves and prevent the onset of degenerative diseases. The metaverse as a digital environment for Industrial Revolution 4.0 is one major form of use of the internet. There are 202.6 million internet users in Indonesia in 2021, or 73.7% of the total population [A total of 138.1 million Indonesians aged 18–64 years have used the internet to make purchases through e-commerce and 74.4% have made food purchases through online food delivery applications in East Java, to date. In a study conducted by Nielsen, the food and beverage category was ranked second (42%) as the category of goods most frequently purchased online by Indonesians .The online food and beverage shopping application offers the convenience of selecting, ordering, paying and delivery in one application. Most of the foods sold in online applications are foods that are high in carbohydrates, high in fat, and low in fruit and vegetables, so it can be concluded that the food sold is energy dense, nutrition poor . Based oBased on the results of basic health research by the Ministry of the Republic of Indonesia, there was an increase in the prevalence of obesity by 7% from 2013 to 2018 to 21.8% . In addiPreliminary studies that have been conducted on students in the city of Surabaya showed that one of the obstacles in controlling salt and sugar consumption through online applications was the absence of information on salt and sugar content on the online ordering applications. Direct observations on the food delivery applications were also in line with the results of a preliminary study, namely that the information on food and beverages sold on online food delivery applications only gave brief food descriptions.The health belief model is a model that focuses on efforts to improve public health by understanding why people fail to adopt preventative health measures. This model can be used to explain and predict various positive health-related behaviors . In thisBased on these problems, this study aims to determine the relationship between the habit of buying food and beverages online from the perspective of health beliefs or the health belief model with the nutritional status of the population in East Java. The role of empowerment and the education system play an important role in encouraging healthy lifestyles, one of which is diet for young people who are prone to overconsumption and obesity . We hopeThis research is a quantitative research study. The quantitative method uses a cross sectional design to determine the association between consumption habits and health beliefs related to the habit of consuming food and drinks purchased online with the nutritional status of the population in East Java. This research was conducted in two big cities in East Java, namely Surabaya and Pasuruan.Data collection was carried out offline using paper questionnaires from respondents who met the inclusion criteria. The inclusion criteria in this study were adolescents and adults who ordered online food more than once, aged 18–50 years, lived in Surabaya and Pasuruan, Indonesian citizens, and who provided filled-out questionnaires. The exclusion criteria were respondents who never ordered food online or did not provide data. Samples were taken by random sampling until 100 samples were obtained.p-value < 0.05. This questionnaire passed the reliability test with a Cronbach alpha p-value > 0.70. The test was carried out using chi square with the help of the IBM SPSS version 20 application.This research passed the ethics test through the ethics committee of Universitas Airlangga Surabaya with the ethical number 438/HRECC.FODM/VII/2022. The research questionnaire contained questions about respondents’ characteristics ; the frequency of buying food online; the popular brands of food and beverages they bought most often and questions about Health Belief Model (HBM). Measurements of height and weight were carried out directly by researchers using a digital weight meter and stadiometer. The popular food and beverage brands were analyzed by researchers through the Grab Food or Go Food applications on the most popular food menus in Surabaya and Pasuruan with a minimum rating of 4.5+. Questions regarding HBM were presented with a choice of 1–5 on Linkert scales and were analyzed using statistical methods. The score of each HBM variable was calculated based on the maximum and minimum values and intervals. The research questionnaire also passed the validity and reliability tests conducted in Indonesia with a significance value or This study was conducted on 100 respondents. The majority of the respondents were aged 18–25 years, amounting to 74 people. The majority in this study were female, 85 people, and the males amounted to 15 people. Their educational backgrounds were very diverse with the mean number graduating from high school being 39 people. There were 78 people not married; 65 people were still students. The workers had an income of IDR 2,000,000 or IDR 2,000,000–<4,000,000 per month amounting to 12 people. Meanwhile for students, 17 people had an allowance of IDR 400,000–<600,000 per month. Forty-nine people lived in their parents’ house. Based on body mass index (BMI), the majority of respondents, 64 people, had a normal nutritional status. Characteristics of the respondents are described in the The results of the data analysis related to the frequency of buying food and beverages online in one month, for 100 respondents in Surabaya and Pasuruan are described in the The results of the study showed that the frequency of ordering food and drinks online was varied. The majority of respondents rarely or never ordered food and drinks online in the morning or breakfast, while for lunch, the majority of respondents thought that they had never ordered food or drinks online. However, the answers to rarely and often consuming food and drinks online were not much different. Respondents rarely bought food and drinks online for lunch and some respondents often consumed food and drinks online for lunch. For snacks during the day, the majority of respondents never ordered food and drinks online through the Grab Food and Go Food application. As with lunch, the frequency of food and drinks ordered for dinner also only had small differences. The numbers of respondents who never bought food and drinks online for dinner were similar to those who bought rarely or often. At mealtimes or snacks after dinner, the majority of respondents never ordered food or drinks online through Grab Food and Go Food applications.The frequency of buying food and drinks online measured how much food and drink was purchased using the Grab Food or Go Food applications in the past month. The types of food and drinks selected by the researchers were the 12 popular foods and drinks consumed by users of the application. From the table, the information was obtained that the frequency of consuming food and drinks purchased on Grab Food or Go Food was very diverse. For the types of drinks, the majority of respondents consumed boba drinks 1–5 times a month. As for soft drinks, the majority of respondents had never bought them through online applications. Similar to boba drinks, most respondents bought drinks containing coffee 1–5 times a month. However, the others never ordered them online. As for the type of food, the majority of respondents often consumed various types of processed chicken, noodles, and meatballs 1–5 times a month. As for various fried foods, vegetables and fruit, the majority of respondents did not buy them online.Perceived susceptibility is an individual’s belief about his or her susceptibility to disease risk in encouraging people to adopt healthier behaviors. The question asked was about the respondent’s perception of their perceived vulnerability when consuming food and beverages purchased from Grab Food or Go Food. The following are the results of the distribution of answers from 100 respondents.Based on Perceived severity is the feelings about the seriousness of degenerative disease including the evaluation of clinical and medical consequences  and the possible social consequences . Many experts combine the two components above as a perceived threat.Based on Perceived benefit is the acceptance of a person’s susceptibility to a condition that is believed to cause serious risk (perceived threat) which encourages them to produce a force that supports changes in nutritional behavior. This depends on a person’s belief in the effectiveness of the various available means in reducing the threat of degenerative disease, or the perceived benefits of making these health changes. When a person shows a belief in susceptibility and seriousness, he or she is often not expected to accept any recommended health measures unless they are felt to be appropriate and effective.Based on A perceived barrier is the potential negative aspect of a prevention and treatment effort in dealing with degenerative disease (such as uncertainty and side effects), or perceived barriers , which may serve as barriers to recommending a behavior.Based on Perceived cues to action are signs that exist in an individual’s life that can support and encourage them to perform health behaviors. Based on the results of a survey of 100 respondents, information was obtained which is described in the table below.Based on Self-efficacy is a belief in a person’s ability to take an action related to balanced nutrition consumption and physical activity in order to achieve a goal in preventing and dealing with degenerative diseases.Based on There was an association between age, last education level, marriage status, profession, income per month (for workers), allowance per month (for students), and health beliefs. However, there was no association between gender, domicile status, weight, or height, and health beliefs.p value < 0.05. The significance association also occurred with other characteristics such as last education level, marriage status, profession, income per month (for workers), allowance per month (for students), and health beliefs. However, there was no significant association between gender and health beliefs. The insignificant association is shown by the p value > 0.05. The insignificance association also occurred with other characteristics, such as domicile status and BMI, and health beliefs.Based on There was no association between health beliefs and frequency of online order based on mealtime, such as breakfast, lunch, snacks in the afternoon, dinner, and snacks in the evening.p value > 0.05. The insignificance association also occurred for other mealtimes such as lunch, snacks in the afternoon, dinner, and snacks in the evening. However, health beliefs are 4535 times more likely to affect online orders for food and drinks at breakfast-time. Furthermore, health beliefs are 0.776 times more likely to affect online orders for food and drinks at lunchtime. Health beliefs are also 3446 more likely to affect the frequency of online orders for snacks in the afternoon. Health beliefs are 5330 times more likely to affect online orders for food and drinks for dinner. Finally, health beliefs are also 5157 times more likely to affect the frequency of online orders for snacks in the evening.Based on Most of the respondents in this study had average scores in perceived benefit, cues to action, and self-efficacy, but scored high in perceived susceptibility, perceived severity, and perceived barriers. There was no association between perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, or self-efficacy, and nutritional status.p value > 0.05. The insignificance association also occurred with other independent variables, such as perceived severity, perceived benefit, perceived barrier, cues to action, self-efficacy, and nutritional status. However, perceived susceptibility showed that those who had high perceived susceptibility were 4256 times more likely to see an effect on nutritional status. Another variable, perceived severity, showed that those who had high perceived severity were 9803 times more likely to see an effect on nutritional status. Perceived benefit respondents were also 2358 more likely to see an effect on nutritional status. Perceived barrier showed that those who had a high perceived barrier were 2993 times more likely to affect nutritional status. Cues to action respondents are also 5814 more likely to see an effect on nutritional status. The last independent variable, self-efficacy, showed that those respondents were also 3644 times more likely to see an effect on nutritional status.Based on Health is a condition that is not only free from disease, but also covers all aspects of human life which include the physical, emotional, social and spiritual. According to the WHO (1974), health can be defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. In the broadest sense, health is a dynamic state in which individuals adapt to changes in the internal  and external  environments in order to maintain their health .Factors that affect human health have been described in various theories and research. Among these, is the health belief model. The health belief model is a model that focuses on efforts to improve public health by understanding why people fail to adopt preventative health measures. This model can be used to explain and predict various positive health-related behaviors . HBM theThe studies conducted by Hochbaum, in 1952, related to a prevention program against tuberculosis, were fundamental for the development of the HBM . These sAs previous studies explained, there are many roles for the HBM in various aspects. Some of them are used to analyze individual health perspectives through six HBM variables, or use them as models for an educational approach to change individual habits and behavior. This explains that health belief is often an independent variable in various studies. In addition to analyzing the relationship between health beliefs related to food and beverage consumption habits when purchasing online through Grab Food and Go Food, this study tried to analyze the relationship between demographic factors and health beliefs. As a result, several variables were interrelated. The variables are age, education level, marriage status, profession, income, and monthly allowanceAge can affect a person’s health belief. The older a person gets, the greater their confidence in their health will be. Several studies explain the same thing. Research conducted using online surveys on apps  on residents of Ontario, Canada explained that middle-aged and older adults reported greater concern about the personal risks of hospitalization and death, the economic and social impact of COVID-19 than young adults . StructuEducation level. Education is a means that allows a person to acquire a variety of useful knowledge about aspects of life, one of which is health. In this study, there was a significant relationship between education level and health beliefs related to the habit of consuming food and beverages purchased online using the Grab Food and Go Food applications. The higher the level of education, the higher the health belief. This is in line with research conducted by Tiziano that the level of education can affect a person’s knowledge and prevent someone from believing there is a virus related to health problems, such as COVID-19 .Marriage status. This study explains that marriage can affect a person’s health, especially in terms of the habit of consuming food and drinks ordered through the Grab Food and Go Food applications, as well as a healthy lifestyle. Most of the respondents often cook themselves at home with the aim of reducing costs due to buying food and drinks through online applications. This is in line with Backer’s statement, In his influential work through specialization and economies of scale, marriage causes an increase in the resources of a married couple, thereby increasing their economic wealth . There hProfession. A person’s profession or type of work can affect their beliefs and their healthy behavior, especially in terms of the habit of consuming food and beverages purchased through online Grab Food and Go Food applications. Researchers assume that working hours and workload can affect the habit of buying food and drinks online. Someone will choose a practical way by ordering online . This asIncome and allowance. Income and allowances can affect beliefs and perspectives on health, especially related to the habit of consuming food and beverages purchased online through the grab food and go food applications. Researchers assume that the availability of money can be an enabling factor that makes someone consider buying food and drinks online. The availability of more money to meet the need for practical food and drinks makes a person more vulnerable to consuming food and drinks purchased online. This assumption is in line with the explanation of C. Bywalec and L. Rudnicki that one of the factors that influences food-buying behavior is the economic factors, among which are: the resources, and the availability of food, household income and the percentage of income spent on food, the level and the relationship of price of consumer goods, the supply of consumer goods; there is also the impact of environment, size and following the standard model .p value 0.000 [In addition to testing the characteristics of the respondents’ demographic factors on health beliefs, the researchers examined the relationship between health belief and order frequency. However, there is no significant relationship between the two variables. Several previous studies have explained that the frequency of eating can affect health problems that have already occurred. Research conducted in Indonesia on students at SMA Kartini Batam, in 2018, showed 22 respondents with a percentage (42.3%) whose frequency of eating junk food was rare and 28 respondents with a percentage (53.8%) had normal nutritional status. Based on the correlation test, it was found that there was a significant relationship between the frequency of eating junk food and nutritional status in students with ue 0.000 .The more often a person eat junk food, the more it will affect their nutritional status and they may experience overweight or obesity. Previous research explained that when we refer to food, overconsumption means overeating, and it is the situation in which an individual consumes food above the body’s energy requirements in relation to energy expenditure, leading to excess fat in the body. When practiced constantly for long periods of time, and coupled with lack of physical activity, overeating is the principal cause of overweight and obesity in both adults and children .Finally, this research found no significant relationship between health belief and nutrition status. The question posed about perceived susceptibility concerned the relationship between behavior and habits of consuming food and beverages purchased online in Grab Food and Go Food, as well as behaviors relating to a healthy lifestyle. In this study, most of the respondents were in the score of as much as 65% of perceived vulnerability. As many as 65% of respondents with high susceptibility beliefs had normal nutritional status. This was to be expected because belief makes a person more certain of a healthy lifestyle. One of the behaviors is food consumption with exercise.Perceived severity or perceived seriousness concerns perceptions or beliefs that are felt about the serious impact of the problem due to an unhealthy lifestyle and consumption patterns of foods and beverages that contain a lot of calories and a person with insufficient physical activity . This inPerceived benefit is the acceptance of a person’s vulnerability to a condition that is believed to cause serious risk (perceived threat) which encourages them to produce a force that supports changes in nutritional behavior . The effPerceived barriers are potential negative aspects or perceived barriers of the effort leading to healthy behavior and a healthy lifestyle . In thisCues to action are anything that can encourage and support behavior. In this study, emphasis was placed on matters relating to activities, actions and facilities that could encourage a person to carry out healthy behavior and a healthy lifestyle, including how they ensured their nutritional status was good and normal. From the results, it was found that the majority of respondents had signs for moderate cues to action (47%) with the majority of them having normal nutritional status. This indicates that more efforts are needed to present those things related to behavioral drivers, with the hope of creating optimal healthy behavior.Self-efficacy is the belief in one’s ability to take an action to achieve a goal in carrying out a healthy lifestyle and behavior. In this study, most of the respondents had a moderate score. This means that respondents had moderate confidence in carrying out healthy behavior, including when ordering and choosing types of food and drinks from Grab Food and Go Food. Based on the results of the analysis using SPSS, information was obtained that there was no relationship between each HBM variable and the high nutritional status of the community in Surabaya and Pasuruan. This could be caused by external factors including the local social environment.External factors that can affect a person’s nutritional status include the variety of food consumed and the environment in which they live. The total energy consumption, fat consumption, snack frequency, fast food consumption frequency, snacking habits while watching TV, between physical activity, watching TV, sleeping, parental education level, mother’s work status, knowledge of maternal nutrition, all have a significant relationship to the nutritional status of the child . CommuniMost of the respondents in this study scored average in perceived benefit, cues to action, and self-efficacy. However, they scored high in perceived susceptibility, perceived severity, and perceived barriers. There is a significant association between the characteristics of the respondents  and their health beliefs. There is no association between health beliefs and frequency of online order. Finally, no significant association was found between perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, or self-efficacy and nutritional status. Thus, it is still important for the government to increase socialization and education in the importance of balanced nutrition and nutritional status so that the people can protect themselves and prevent the onset of degenerative diseases.


This paper describes the design and function of an application that enables vulnerable people to provide medical information for use in disasters, and presents the results of an initial test of its usability in Nankoku, Japan. The application consists of two parts: K-DiPS Solo, a smartphone app, and K-DiPS Online, a web application for disaster management by local governments. We asked vulnerable people or their family caregivers to enter medical information into the app on their smartphones and connected this information to a local government application as a demonstration of a disaster response solution that manages information. We targeted a group of 14 healthy older people. The user information that they entered into the app was stored in the cloud via the communication system of the mobile phone. A ledger of vulnerable people for use in the event of a disaster was automatically created on the web application using the information supplied by the individuals. Local government staff corrected the location information, if necessary, by dragging points plotted on a map. This disaster response solution was shown to connect individuals to government offices, and to enable a consistent flow of information from patient details to stocking of supplies, and for simulation, training, and response during disasters. Large-scale disasters occur relatively frequently in Japan. The 2016 Kumamoto Earthquake killed 55 people and required more than 180,000 people to be evacuated . In receMedically vulnerable populations generally prepare their medication in case of a disaster, but are unlikely to have a home preparation kit or an emergency evacuation plan to mitigate any issues caused by their health problems . In partIn recent years, societies around the world have faced growing healthcare challenges linked to aging populations. Fortunately, ICT solutions in healthcare are developing rapidly. There is also an increased use of technology in the medical treatment applied following emergencies and disasters . In JapaWe have researched and helped to develop a smartphone application that allows these groups to enter their medical information, allowing them to receive assistance from medical personnel in the event of a disaster. This is known as K-DiPS Solo (KDS). We are also developing web applications that connect KDS to the Internet and store information in local government-run clouds. These applications will contribute to disaster preparedness and staff training, and support the confirmation of safety, ongoing treatment, and transportation in the event of a disaster. This app is known as K-DiPS Online (KDO). This paper describes the design and function of KDS and KDO, and presents the results from an initial test of its usability at Nankoku in Kochi, Japan.In recent years, several smartphone applications have been developed to help people affected by disasters ,20,21. F“My Disaster Training” allows people to obtain disaster training information in the event of floods. The aim of this application is for Malaysians to find accurate and up-to-date disaster training information while increasing their knowledge and skills about disaster preparedness before a real disaster occurs . “EdugamJapan has several smartphone applications for sending real-time alerts about weather information, and for helping people to prepare emergency kits in case of a disaster. The Japan Broadcasting Corporation’s “NHK News Disaster Prevention” provides the latest news and weather information on a map, and sends alerts and information about disasters in a live feed . Each muKanazawa and Kochi Disaster Preparedness System (K-DiPS) is a smartphone application for people who need regular medical care or equipment at home (referred to as vulnerable people). It consists of the KDS smartphone app and KDO web application for disaster management by local governments. Vulnerable people enter their information into the KDS app and send it to the local government’s KDO server, enabling local governments to ensure reliable disaster preparedness based on detailed information about individual patients’ needs . KDS infThe study target area was Nankoku city in Kochi, Japan. This is located on the Pacific side of the island and has a population of approximately 46,000. When an earthquake occurs in the Nankai Trough, it may cause a tsunami of 10 m or more in the area on the Pacific coast from Shikoku to Kyushu ,43. FiguWe planned to conduct a demonstration experiment with medically vulnerable people from Nankoku. However, the spread of COVID-19 changed this plan, because medically vulnerable people were at high risk from the disease. Instead, we targeted 14 healthy older members of the Voluntary Disaster Preparedness Organization (VDPO) in Nankoku. Japan’s VDPO was promoted by the Government of Japan to build a more sustainable and resilient community against disasters . The VDPWe held a briefing session on how to use KDS for the participants and asked them to undertake a training session. During the demonstration experiment, local government officials and mobile phone company staff built a system to support the use of KDS. We also made it possible for users to contact the principal investigator at any time by mobile phone or email.To maintain the confidentiality of user information and produce a suitable communication environment for the demonstration experiment, we used the closed NTT DoCoMo network. This closed network was not directly connected to the Internet, and only terminals registered in advance could be connected . We alsoWe distributed these dedicated smartphones (iOS 7 or Android 7) to the participants and asked them to enter their information into KDS. The participants were then asked to tap the sync button on the KDS app. If their information changed during the demonstration experiment, such as if they started taking a new medication, we asked them to correct the information on KDS and tap the sync button each time. The workflow of the system is shown in The users’ information was retrieved in the crisis management department via the cloud. The staff of the crisis management department were asked to check the information and ensure that the participants’ addresses were correctly plotted on the map. If the location on the map was not plotted correctly, we asked the staff to correct it using the correction function. During the demonstration experiment period, we asked the staff to confirm the synchronization of user information from KDS to KDO whenever necessary.After the demonstration experiment was completed, the KDO information was output in CSV format and aggregated. The demonstration experiment lasted from 27 July to 29 October 2020.The user information entered into KDS was passed to the cloud using the communication system of the mobile phone. An administrator password was issued to staff in the crisis management department to enable them to access the protected KDO. The ledger of vulnerable people in the event of a disaster was automatically created on the KDO web application using the information from KDS. This ledger displayed users’ names, dates of birth, genders, and addresses. By clicking on the information list, staff could access user photos, emergency contacts, supporter details, information about support needed with activities of daily living (ADL), medical information, and notes. The users’ addresses were geocoded and plotted on the KDO map. The location information was corrected, if necessary, by dragging the points plotted on the map.Overall, 14 people participated in the demonstration experiment. The average age (standard deviation) was 71.1 years (10.8). Six people were male (42.9%), three were female (21.4%), and five did not specify a gender (35.7%). The users’ primary contact was their wife (four people), father, mother, eldest daughter, child, and niece (one person each); four participants did not specify a primary contact. Six people lived with their primary contact. A main disease was given by 10 people. One participant had no main illness and was not on medication. Nine people regularly went to the hospital to receive dosing treatment. Four had hypertension and two had hyperlipidemia. Gout, mild dementia, chronic renal failure, interstitial pneumonia, pulmonary suppuration, diabetes, and atrioventricular block were each reported by one person. (Note that multiple answers were possible.)The study participants were all able to enter information into KDS on their smartphones. This process would enable them to quickly inform the disaster medical assistance team (DMAT) of their medical condition in the event of a disaster. Nara Prefecture in Japan recommends that children in need of medical care prepare and carry a written list of necessary supplies so that they can pass this to their supporters in the event of a disaster . HoweverThe link between KDS and KDO may be useful for disaster preparedness, prompt treatment, and the provision of nursing and transportation in an emergency. The stock of supplies for disasters in Japan is calculated by each local government using information from previous disasters, knowledge of the population, and damage estimation. Kochi Prefecture, which includes the target area of this study, uses this calculation method . BecauseAnalyzing the data added to KDS in this demonstration experiment, there were some items that were unused. The target of the demonstration experiment was older people, and a dedicated terminal was used. It is possible that particular items were not input because people were unfamiliar with that type of smartphone. If home-based patients start using KDS on their smartphones, they may need some support. Above all, assistance is needed to enter medical information. This may require someone who is familiar with KDS, such as a visiting nurse. Such support would ensure that nothing was missed, because visiting nurses would be familiar with the medical and home needs of vulnerable people. Lack of incentives for information sharing between individuals and organizations may be a barrier to information sharing for disaster preparedness . It is tThis study had several limitations. The number of people targeted for the demonstration experiment was small (14), making the experiment insufficient for verifying the applicability or usability of the app. Therefore, our results cannot be generalized. Second, the target group was limited to healthy older people living in the community, none of whom needed medical care. Hence, it was only possible to verify certain items of medical information in KDS. Third, this experiment used a dedicated smartphone for the experiment and a closed network line, which is different from the communication environment that would be used in reality. In the future, we will carry out demonstration experiments using standard communication networks. Finally, the spread of COVID-19 meant that group interviews on user experience and usability were canceled. To establish a strong reputation for this app, a further demonstration experiment with a significant increase in the number of participants is required. However, despite these restrictions, this study has shown that the app may help vulnerable people prepare for disasters. It may also help municipalities to identify home-based patients in the area and ensure that they remain safe and well in the event of a disaster.Municipalities could encourage the use of KDS among home-based patients and other vulnerable people as a means of managing the supplies and support required by these groups in the event of a disaster. Increasing the number of home-based patients who enter their medical information in KDS and send it to KDO will improve the disaster prevention capability of the area by improving the evidence base for planning and disaster preparedness.