The older the age of patients, the more severe tics, and anxiety disorder significantly correlated with CTPh. CTPh may be considered as a part of tic spectrum with a substantial impact of anxiety disorder. CTPh are a late and age-related symptom of GTS.Coprolalia and echophenomena repeated in the patients’ mind (CTPh—cognitive tic-like phenomena) have been rarely recognized as part of Gilles de la Tourette syndrome (GTS) symptomatology and their assignment to tics, OCD or other psychopathologies has not been settled. The aim of the paper was to assess the incidence and clinical associations of CTPh in GTS, and to establish if CTPh belong to the tic spectrum. We performed a prospective, one-registration study on a cohort of 227 consecutive patients with GTS. CTPh were diagnosed during the interview and defined as brief, sudden, involuntary thoughts that had corresponding complex vocal tics. CTPh occurred at some point in the lives of 34 (15.0%) patients. The median age at onset of CTPh was 14.5 years (IQR: 10.5–17.5). CTPh were found more frequently in adults, with the most frequent onset in adolescence (44.1%). Four mental phenomena resembling tics were recognized: echolalia ( Diagnostic and Statistical Manual of Mental Disorders  in order to diagnose GTS [Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder that most commonly affects children and adolescents, but in some cases persists into adulthood. According to the nose GTS , numerounose GTS . Individnose GTS . Neverthnose GTS , this kiOn the basis of current understanding, tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations . Even thIt is crucial to differentiate CTPh with the spectrum of obsessive-compulsive phenomena. OCD can be diagnosed when a patient reports obsessions/compulsions or both, the presence of which is time consuming or debilitating in terms of daily functioning and cannot be attributed to physiological effects of a substance or another medical condition. Obsessions are defined as recurrent, persistent thoughts, urges or impulses that are perceived by the patient as intrusive and unwanted; therefore, they are usually associated with anxiety and distress. In contrast to obsessions, CTPh are experienced as pleasant or neutral, do not lead to negative repercussions and are sequences in themselves (one type of CTPh does not connect to another phenomenon), while obsessions are often a coherent line of thoughts ,12. The Psychopathology related to GTS may be different in children and adults. Hirschritt reported that adults and adolescents were most likely to have OCD as well as mood, anxiety, eating and substance use disorders, whereas children were more likely to have ADHD . This laTo the best of our knowledge, there have been no studies that investigate CTPh in a clinical sample. The aims of this study were (i) to assess the prevalence and age at onset of CTPh in individuals with GTS; (ii) to assign this phenomenon to tics, OCD or another psychopathology; (iii) to distinguish between the clinical correlates of CTPh for children and adults. Based on available findings as well as our clinical experience, we hypothesized that (i) the prevalence of CTPh may vary depending on the age of the patients, (ii) CTPh are part of tic phenomenology and are neither part of OCD nor another psychopathology and (iii) clinical correlates of CTPh in children differ from those in adults.The cohort of individuals with GTS comprised 241 consecutive patients, who were evaluated from 2013 to 2019. In 14 patients, data on the presence of CTPh were not available, as these were young children unable to comprehend questions during the interview, resulting in a total sample size of 227 patients. In this group, the age of the patients ranged from 5 to 50 years . In total, 140 children  and 87 adults  were enrolled. The median age of tic onset was 6 years . The median duration of GTS was 4 years  in children and 18 years  in adults. Overall, 189 (83.3%) patients had at least one psychiatric comorbidity. Psychiatric comorbidities of GTS patients are presented in In total, 103 patients already received therapy at the time of examination, including behavioral therapy, tic-reducing drugs and OCD symptom-relieving medications.All the patients were recruited from one single outpatient clinic and were personally reviewed and evaluated by the same clinician, who was well experienced in tic disorders (PJ). Patients were referred to the clinic by general neurologists and psychiatrists, due to problematic diagnosis or tics refractory to treatment, or sought medical advice on their own because of troublesome tics. The study was designed as a one-time registration study, as patients were registered in the database only once, and no additional clinical data obtained in follow-up visits were included in the analysis.The patients were evaluated for the clinical diagnosis of GTS according to the Diagnostic and Statistical Manual of Mental Disorders criteria that were valid at the time of evaluation . All patients were systematically interviewed with the aid of a semi-structured interview that comprised demographic and clinical data that was gathered for all the patients. This schedule is based on the Tourette syndrome international database consortium (TIC) data entry form, developed by Freeman et al. , in whicThe prevalence of the most common comorbid disorders encountered in GTS was evaluated on the basis of the same, mentioned above, semi-structured clinical interview. Disorders that were listed in this semi-structured interview were as follows: ADHD, OCD, depression, anxiety disorder , oppositional defiant disorder, conduct disorder. The list of obsessions and compulsions included in the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) was used to establish clinical spectrum of OCD. Each patient was carefully questioned about all the symptoms included in the DSM as the diagnostic criteria of the above-mentioned comorbid disorders. The diagnoses of mental disorders that was made in psychiatric clinics before our evaluation were accepted and included into the analyses. One-third of children and adolescents, with more complex psychopathology, were assessed with the M.I.N.I. International Neuropsychiatric Interview for Children and Adolescents. Patients with severe psychiatric comorbidities were referred to psychiatrist to confirm the diagnosis. In this case, the psychiatric diagnosis was considered to be definite, and as such taken into consideration in the study analyses.Tic severity was measured using the Yale Global Tic Severity Scale (YGTSS) on the day of each patient’s evaluation . CTPh weCTPh were identified during the dialogue-based interview through an active inquiry. Due to lack of instruments validated for the assessment of CTPh, we used the clinical definition established by previous investigators , which wCTPh were defined as brief, sudden, recurring, neutral or pleasant mental acts, which had the equivalent among typically recognized complex vocal tics such as coprolalia, echolalia, palilalia and repeating of words or phrases. Complex and long-lasting thoughts, e.g., mentally jumping over telegraph poles along the roadside, drawing three-dimensional constructions in the mind or having the same tune in the mind for hours, were not classified as CTPh, as they do not have an analogous vocal tic. This type of diagnostic attitude precluded confusing CTPh with delusional disorder, ruminations in depression and obsessions, hyperquantivalent ideas or other psychiatric disorders. Importantly, none of the patients included in the study group were diagnosed with a psychotic disorder or bipolar disorder .CTPh were differentiated with obsessions and mental compulsions according to the differential diagnosis described in the introduction. For this purpose, interviews with patients covered questions about their emotional attitude towards appearing thoughts, the consequences of the thoughts, the natural form of the thoughts’ sequence, the possible aim of the thoughts, the resistance the patient made against these thoughts and if they were acceptable or not for the subject. Patients received questions on whether they had ever experienced short-lasting thoughts that appeared spontaneously in the mind. We asked the patients if they had repeated their own words or phrases in the mind two or more times in a row , if they had imitated several times in their mind words or phrases spoken by other people  or if they had repeated curse words voicelessly . We also asked the patients when those thoughts started, if they were present at evaluation and if the patients had ever experienced typical vocal coprolalia and echophenomena, to assess the relationship between CTPh and their vocal equivalent. If the patient reported the presence of at least one CTPh during the lifetime, he/she was included into CTPh+ group. The CTPh- group consisted of patients who had never experienced thoughts of this kind.We assumed that the factors that influence the lifetime prevalence of CTPh in GTS may differ from those that are related to CTPh at the time of examination. For example, a lifetime diagnosis of OCD does not necessarily contribute to the occurrence of CTPh as both symptoms could have occurred at different moments in the lifetime. In order to assign CTPh to tics or OCD phenomenology, lifetime and current comparative analyses were conducted. The lifetime comparative analysis included the group of the patients without any history of CTPh (CTPh-) and the group of the patients with a history of CTPh in the past or at the time of evaluation (CTPh+). When categorizing patients as having CTPh at evaluation, we took into account the two preceding weeks. In the current comparative analysis, we divided all the patients in two groups: CTPh current+  and CTPh current- (GTS patients without CTPh within last two weeks). As a result, CTPh current- included both patients without any history of CTPh and those with CTPh in the past but not at the time of evaluation. Moreover, in this analysis, we took into account only CTPh and OCD symptoms that were present at the time of the examination. The exact relationship could be determined only when both symptoms were present at the same time.Our plan of analysis included a comparison of the CTPh+ and CTPh- groups when considering the demographics and distribution of psychiatric comorbidities as well as premonitory urge and tic severity. Apart from analysis in the whole group, we also conducted the same comparison in adults and children. The statistical analyses were performed using STATISTICA version 13.1 , SPSS version 25 software  and R programming language. The Shapiro–Wilk test was used to assess the normality of distribution. In the case of the parametric variables, data were presented as arithmetic means and standard deviations (mean ± SD). For the non-parametric variables, we chose the median and quartiles (25:75) to present data. The categorical variables were presented as frequencies (percentages). Parametric data was compared using an independent t-test. For the nonparametric data, we used the Mann–Whitney U-test. The Chi-square test was performed for comparison of categorical data. For comparison of subgroups of patients with different CTPh, we used a test for small groups, the Fisher’s exact test.p-value had to reach <0.05 for the comparisons between the groups to be considered significantly different. In the course of the primary analyses, we isolated variables that emerged as significant and entered them into a logistic regression analysis in which the dependent variable was the presence of CTPh. Additionally, sex and age served as control variables in the multivariate model. Logistic regression analysis was also used to check whether CTPh were associated with their vocal equivalent.In both analyses, the n = 17), cognitive coprolalia (n = 16), cognitive palilalia (n = 13) and repeating words or phrases in the mind (n = 7). The presence of one CTPh occurred in 22 patients, of 2 CTPh in 5 patients and of 3 CTPh in 7 patients. The group of patients with only mental coprolalia (n = 8) was compared with the group with only mental echophenomena . These groups did not differ with regard to age, gender, YGTSS, premonitory urges, possibility of control over tics, relief after tic execution and psychiatric comorbidities. In 7 patients, mental coprolalia co-occurred with at least one echophenomena.All the patients who experienced CTPh recognized them as neutral, neither pleasant nor distressful in any way and reported them only when they had been asked for, and never spontaneously. Some individuals did not even realize they had these mental thoughts. CTPh occurred at some point in the lives of 34 (15.0%) patients. Four types of mental phenomena were evaluated: cognitive echolalia . In contrast, the presence of mental coprolalia did not increase the risk of mental echolalia  or mental palilalia .CTPh were reported in both patients who experienced their vocal equivalent as well as in those who did not present analogous vocalization. We checked whether CTPh were associated with their vocal equivalent but failed to demonstrate such relationship. Moreover, we assessed whether mental echophenomena had the tendency to occur together and demonstrated that mental palilalia and echolalia were associated with each other  were associated with CTPh. The YBOCS score that was available for 35 of 47 patients did not differentiate the CTPh+ and CTPh- groups . The age at onset of CTPh was known in 26 of all cases with the median value of 14.5 years (IQR 10.5–17.5). In 7 of the cases, CTPh started during childhood (before 11 years of age), in 15 of the cases it started during adolescence (12–18 years of age) and in 4 of the cases it started in adulthood.The prevalence of CTPh differed between adults and children/adolescents: 23.0% (20/87) and 10.0% (14/140), respectively  and coprolalia were similarly presented either in a form of vocalization or mental act. These observations indicate only a certain degree of relationship between the mental and vocal forms of the tic.We also looked for potential differences between various types of CTPh. However, we did not find any significant demographic and clinical differences between mental coprolalia and mental echophenomena, although very low numbers of comorbid psychiatric disorders and other variables taken into the comparative analysis do not allow for any final conclusions to be drawn. On the other hand, in a few cases mental coprolalia and mental echophenomena appeared in the same patients, which would be rather expected if these CTPh were to have a similar background. These statements should be verified in future studies.As we mentioned, the emotional attitude of the patients toward the experienced mental acts was neutral and not troublesome in any way, and they reported these thoughts only when they had been actively inquired, never spontaneously. That same was true for mental (silent) coprolalia. It was somehow surprising because, e.g., vocal coprolalia nearly always causes distress. Based on clinical experience, the possible explanation is that ‘loud’ coprolalia is distressful because it draws attention of other people and is socially unacceptable. If vulgar words/sentences are distorted or uttered in a low voice they are less bothersome and cause less distress for a patient. That is why we consider CTPh egosyntonic symptoms.CTPh correlated significantly with tic severity, premonitory urges and anxiety disorder. We formulated a hypothesis that particular mental phenomena reported by certain GTS patients may be a form of tic manifestation and we juxtaposed it with the theory that these symptoms are a representation of another psychopathology. Inferring from the positive correlation between CTPh and YGTSS , we consMoreover, we hypothesized that patients’ age could be a variable associated with the rate of CTPh, especially in patients below the age of 18. Age of the CTPh onset falls during adolescence in most patients, although it may occur at any time during the course of the disease. There is an evident association between the prevalence of this mental phenomenon and the age of the patients . The facWe found significant differences in correlates of CTPh in children/adolescents and adults. The older the child/adolescent patient was, the greater risk of CTPh they had. This correlation was not observed in adult group . MoreoveAnother possible consideration of CTPh character arises from the careful understanding of its definition: CTPh are pleasant or neutral, stimulating in their nature rather than regulating negative emotional states. Current research emphasizes two main basic human needs that should be taken into general consideration in describing and understanding psychiatric phenomena: the regulation of negative emotional states and reward seeking (stimulation) ,22. ImpoThe value of the performed study arises from both extending of scientific knowledge in the topic of mental phenomena in patients with GTS and the prospective clinical application of acquired data. In opposition to OCD, CTPh do not require treatment as they are perceived by patients as neutral and egosyntonic. It also seems important to pay attention to the presence of mental phenomena resembling tics, which do not fulfill the current diagnostic criteria of this hyperkinetic movements and, although unobservable, may belong to the spectrum of tic phenomenology. Our results suggest that GTS-affected patients who also have CTPh at the time of examination should be carefully evaluated for existing anxiety disorders and more severe tics. This could certainly influence the choice of appropriate treatment.There are several limitations to our study which include the following: lack of a control group; lack of any validated instrument in CTPh assessment; no confirmation of CTPh diagnosis from the another researcher who would evaluate the patient’s report independently; the established CTPh definition was limited to tic phenomenology with exclusion of overlapping, long-lasting mental phenomena from the OCD spectrum; recall bias could potentially influence the reported prevalence rate and age at onset of CTPh; the one-time registration study design could influence the rate of CTPh and psychiatric comorbidities; no validated rating scales for all adults and some patients under the age of 18 were used for the assessment of comorbidities; no rating scale was used to assess premonitory urges quantitatively; there could have been referral bias as the patients were evaluated by a neurologist and the cases with more severe psychopathology were referred to psychiatric clinics, which explains the low numbers of OCD and depression in the children group.We conclude that some complex tics may appear in two forms, vocal and mental. CTPh should presumably be considered as a part of the tic phenomenology with a crucial impact of comorbid anxiety disorder. CTPh are rather rare and late symptoms of GTS, tend to appear over the course of the disease and, hence, are an age-dependent symptom.


One Health in Canada-based research aligns with traditional Indigenous notions of health and wellness.This paper examines whether the usage of the concept of One Health and Indigenous Health were selected and analyzed through Nvivo12 to generate common themes across the studies.A comprehensive search of the literature was conducted using primary databases, including Scholars Portal, ProQuest Social Science, Sociological Abstracts (ProQuest), OVID Healthstar, Embase, Medline, Pubmed and Google Scholar. Papers discussing One Health as it relates to climate change, zoonosis, and social relationships between humans and animals. Climate change was seen to have affected the environmental health of Northern latitude areas where many Indigenous communities reside. Infectious diseases within Indigenous communities were a frequent topic of study and indicated that infections transmitted by dogs are likely to be addressed with One Health interventions. One Health interventions are likely to equally address the health of humans, animals, and the environment.The analysis identified three major themes that focused on One Health and Indigenous knowledges was established in the analyzed articles. Articles discussed One Health as it pertains to epidemiological surveillance and research. The implications of utilizing One Health towards Indigenous Peoples and culture were not explicitly addressed.No significant connection between  Across modern-day Canada, Indigenous Peoples have lived in harmony with the land since time immemorial. However, with the arrival of colonial settlers and the forceful removal of autonomous, prospering nations from their traditional territories, Indigenous ways of living, being, and knowing were forever altered . ColonisWestern conceptualizations primarily define physical health through a deficit-based approach, as the absence of illness and disease . AlternaOne Health. As articulated by the WHO in 2017, One Health is defined as the use of multidisciplinary approaches in the implementation of policy design and public health interventions. It recognizes that the health of humans is intricately tied to the health of animals and the environment  partners with Inuit representational organizations to implement engagement processes that respect the role of Inuit in decision-making when it comes to research involving our people, wildlife, and environment.” [One Health approach that happens alongside with Indigenous Peoples and organizations.One Health and the scholars that use it have the distinct opportunity to take a concept already being used within Indigenous communities and to blend it with Indigenous perspectives, knowledges, and ways of knowing and being to create something truly unique. In the past decade we have seen Two-eyed seeing, or l alike”  (p. 21).l alike” . Similaronment.”  (p. 4). 4.2One Health approach while incorporating Indigenous perspectives of health and wellbeing [One Health’, and therefore were not included in this review. Therefore, it is even more important that we develop a comprehensive understanding that ties together Indigenous knowledges and concepts of health and wellbeing with a One Health approach. In doing this, we will be better positioned to understand and respond to the unique needs of Indigenous Peoples and communities.It is important to note, that there are existing studies which consider and use a ellbeing ,30. Howe5One Health and Indigenous health. Of the eleven analyzed articles, three major themes were identified, focusing on the One Health implications of climate change, zoonosis, and the social relationships between humans and animals. Climate change was seen to have affected the environmental health of Northern latitude areas where many Indigenous communities reside. Warming climates impact the ability of communities to live and hunt, thereby affecting their health outcomes. Infectious diseases within Indigenous communities were analyzed by many of the articles, and the studies indicate that dog borne infections are likely to be addressed with One Health interventions. Some Indigenous communities consider animals to be an equal part of society and would benefit from seeing the health of those animals improved. One Health interventions are likely to equally address the health of humans, animals, and the environment. Although Indigenous communities could benefit from interventions that would avoid harmful practices such as the mass culling of dogs, no clear and specific connection was demonstrated between One Health and Indigenous ways of knowing. No significant discussion was identified regarding the implications of utilizing the One Health on Indigenous Peoples.This review analyzed 20 articles that covered diverse topics within the field of For this type of study formal consent is not required.10.13039/501100000024Canadian Institutes of Health Research (CIHR), Funding Reference No. NGR–167542, with additional research funding from 10.13039/501100000024CIHR Funding Reference No: 43980.This study was supported by a grant from the The authors declare that they have no conflict of interest.


The outbreak of COVID-19 in late 2019 has had a huge impact on people’s daily life. Many restaurant businesses have been greatly affected by it. Consumers’ preferences for catering industry in China have changed, such as environmental hygiene, variety of dishes, and service methods. Therefore, the analysis of consumer preference differences and changes before and after the epidemic can not only provide emergency strategies for the catering industry but further improve the catering industry’s ability to deal with public health emergencies. This paper takes five cities in China as representatives to explore the impact of COVID-19 on China’s catering industry. Based on catering review data from August 2019 to April 2020, this paper first carries out Latent Dirichlet Allocation (LDA) topic analysis and SNOWNLP (A Python library for processing Chinese text) sentiment analysis. Then this paper compares the results of topic classification and sentiment analysis before and after the epidemic. Furthermore, differences and changes of consumer preferences are obtained and preferences of consumers under COVID-19 are analyzed and forecasted. The results of LDA thematic analysis before the outbreak of COVID-19 show that consumers tend to punch in cyber celebrity restaurants and pay more attention to the taste of dishes, whereas after it consumers pay more attention to the changes of dishes, dining environment as well as epidemic prevention. The number of packages and takeout was also increasing. However, the waiting time is constantly considered by consumers before and after COVID-19. Firstly, to our surprise, final outcome of emotional analysis showed that consumers’ emotional state was more positive after the epidemic than before. COVID-19 has changed the lifestyle of consumers, consumption concepts, and consumption habits. Therefore, businesses also need to take positive and flexible measures to actively get feedback from consumers to adjust dishes and business methods. Secondly, the psychological attitude of catering consumers is relatively positive during the epidemic period, which indicates that consumers have great confidence in the recovery and development of the catering industry. Businesses can comply with consumers’ psychology and combine consumption vouchers with restaurant discounts to promote consumers’ consumption. Finally, the environment and service play more and more important effect on consumers’ emotional scores at present, which indicates that dining state and comfortable mealtime environment are becoming increasingly valuable. Therefore, businesses need to improve service standards. Small and medium-sized enterprises have encountered greater difficulties than ever before under the outbreak of COVID-19 at the end of 2019 . Among tAccording to statistics, the catering industry ranked second among the top ten industries that most affected by the epidemic . The dinThe work resumptions of all walks of life have been widely concerned by the society. Since the outbreak of COVID-19, tertiary industry has been carried out investigation and research on the survival and development under the epidemic. Typical literatures are as follows: Yang and Han  found thAccording to this situation, this paper crawls review data in China from August 2019 to April 2020, and divides the data into “before the outbreak” and “after the outbreak” by taking January 2020 as the dividing point. Subsequently, through analyzing these comments by LDA topic analysis method, this paper compares the theme results and comes to the differences of consumer preferences before and after the outbreak. According to the score through the analysis of consumers’ emotion after the epidemic, this paper gets the consumers’ preference for catering after the epidemic, analyzing as well as predicting the consumers’ preference under public health emergencies, so as to provide emergency strategies for the catering industry and further improve the catering industry’s ability to deal with public health emergencies.In this paper, the authors use method of text mining to study the collected review data, apply LDA model (Latent Dirichlet Allocation) to construct the topic, and utilize SNOWNLP library to supplement the emotional analysis.LDA ,17 is a Each word of LDA topic model is obtained through the process of selecting topics with a certain probability and selecting words from each topic with a certain probability. The core formula is as follows:SNOWNLP is a Chinese natural language processing Python sentiment analysis library, with Chinese sentiment training set. It reads each line of text in the file through code, analyzes its sentiment and outputs the final result. It uses naive Bayesian principle ,19 to coStep 1:The authors crawl the restaurant comment data in China from August 2019 to April 2020 through python.Step 2:In order to get intuitive and effective analysis results, the authors first cleaned the review data and filtered the stop-words.Step 3:The authors visualized the review data through word frequency statistics and word cloud graph.Step 4:Determining the subject words by LDA topic analysis, mined the effective information from the review text.Step 5:SNOWNLP was used for emotion analysis.The flow chart of the proposed method is shown in https://www.dianping.com, accessed on 21 January 2021) from August 2019 to April 2020. In addition, 20 January 2020 was taken as the cut-off point. Then the data are divided into “pre-epidemic” and “post-epidemic” parts. A total of 11,705 pre-epidemic comments and 2749 post-epidemic comments were obtained (the number of post-epidemic comments affected by COVID-19 was lower than that before COVID-19). The results are shown in At first, all the cities are split into three groups: high risk area , medium risk area  and low risk area (The cumulative number of patients is less than 1000) according to the severity of the epidemic. By using stratified random sampling, Hangzhou and Guangzhou were selected as low-risk areas, Beijing and Shanghai were selected as medium-risk areas, and Wuhan was selected as high-risk area. Python programming was used to crawl the catering review data of Dianping platform , and then take into account the specific situation of the comment data to remove characters such as emoji expressions and low quality review evaluation, etc. Then the text is filtered, and the short sentences below five characters are deleted. Finally, the text is filtered, and the stop-words are deleted by using the stop-words to optimize the text quality and make the analysis results more reliable. Repeat the second data cleaning after the first data cleaning is completed.After sentence segmentation processing, the text needs to be filtered. There are a large number of colloquial words which cannot reflect the theme but appear frequently in the comment data. It will affect the experimental results to a certain extent. Therefore, stop-word filtering is needed. In this paper, Jieba ,21, a thAt first, the data of low, medium, and high risk areas was analyzed, and this paper got the occurrence of high frequency words, respectively. The specific words are as shown in We can see from After text preprocessing, we get the cleaned text data. Then, the word frequency statistics of these processed comments data is carried out. Due to the complexity of Chinese parts of speech, a word may have different parts of speech in different contexts. Therefore, it is necessary to distinguish between word parts of speech in order to ensure their correctness in context. In this paper, POS-Tag is adopted for part of speech tagging of words after word segmentation, and the top ten words with the largest word frequency are selected for easy observation, as shown in Based on Python, this paper uses comment word segmentation ,23 to coThe word cloud map makes it more clear that the most common words in these comments, such as “taste”, “service”, “price”, and “feature”, are consumers’ preferences for the restaurant industry before the epidemic; “protection”, “take-out”, and “disinfection” are measures taken by consumers and businesses to reduce the possibility of further spread of the disease during the epidemic. The paper can use word cloud to understand the consumer psychology and consumer behavior in food and beverage during the epidemic period, which is helpful for us to study the psychological behavior of consumers in public health emergencies.According to the degree of confusion corresponding to the subject words run by the Python program , the folIn this paper, LDA thematic model is used to mine the potential topics of pre-epidemic and post-epidemic commentary texts, respectively. Four themes were selected before and after the epidemic, and six keywords were selected for each theme to get the following As shown in As shown in By comparing the four themes before and after the outbreak, the authors found difference and relationships in consumers’ psychological behavior before and after the outbreak: first, compared with before, after the outbreak of consumers were more focused on the dining environment, paying attention to the epidemic prevention and health conditions of dining place, at the same time also noticing whether the shop, when arranging customers to line up and eat, required them to keep a certain distance. Secondly, the way that the consumers’ diet before, and after, the epidemic has greatly changed. Before the epidemic, they tended to go to online celebrity stores to punch in, but after the epidemic, they tended to pack home or buy takeaway food. Thirdly, before the outbreak, consumers considered whether the store had tasty food, and if the store was a recommend web celebrity restaurant. Moreover, after the outbreak, consumers paid more attention to food safety degree. For example, when some frozen fish tested positive during the COVID-19 outbreak, consumers reduced their demand for such ingredients, so changes to food types also needed to be made accordingly. The relationship between consumer behavior before and after the epidemic was mainly focused on the waiting time for meals (including waiting time and serving speed). All consumers paid attention to the service standard and attitude of the staff in the restaurant. In the highly competitive catering industry, a good service attitude can make a restaurant have more repeat customers and praise rate. Especially during the epidemic, when many stores are closed, good service not only warms customers, but also extends the life of stores.Comments represent the feelings of consumers and can reflect the psychology of their behavior. During the epidemic period, people reduced their consumption outside. Online comments have become an important reference for consumers to choose products, and the emotional tendency of comments is the main factor affecting consumers’ choice. Therefore, after getting the keywords from LDA topic model, this paper uses SNOWNLP ,26 to juBefore COVID-19, the positive comments accounted for about 43%, while the negative comments accounted for about 57%. After COVID-19, positive comments accounted for about 54%, while negative comments accounted for about 46%. Compared with before the outbreak of COVID-19, the proportion of positive comments on food and beverage after the outbreak of COVID-19 did not decrease but increased, which is more optimistic, indicating that during the epidemic period, people’s consumption tolerance increased. Their requirements for some basic conditions of food and beverage that they care about before the outbreak decreased. Moreover, they generally had the psychological behavior of expecting the epidemic to end soon and businesses to resume normal business.This paper converts the three kinds of scores of taste, environment, and service obtained by Python into one point system. It compares consumers’ emotional tendency with three kinds of scores to explore which aspect of influence is more similar. It takes the mean value of every 50 data to eliminate the influence of extreme values, and then draws a double line chart to compare with the emotional tendency shown in Compared with emotional scores, taste, environment, and service scores are generally higher. The broken line of taste score and emotion score has the lowest fitting degree. Furthermore, it is the most stable among all the scoring lines, indicating that the food taste of restaurants did not change significantly before the epidemic, and consumers’ score of taste fluctuated less. The broken lines of environment and service scores fit well with the broken lines of emotion scores. The peaks and valleys are roughly consistent, indicating that environment and service scores have a greater impact on the overall emotional scores of consumer reviews. Before the outbreak of epidemic, many restaurants did good business. Especially in the dinner rush hour, it is easy to have environmental health problems such as noisy dining environment, overdue cleaning of debris, and foreign bodies in dishes. In addition, there would be long queues, slow delivery of food, and insufficient service personnel leading to lower service standards. Consumer emotion and the emotional score are obviously affected by the environment and service, and therefore arise an obvious peak period.As can be seen from For example, some measurement including providing hot drinks and seat and so on can be used. Due to the outbreak of COVID-19, the transportation of food materials has been limited to some extent, especially the imported frozen meat products such as salmon and aquatic products, which have been greatly affected. The waiter should inform the consumers of the adjustment of the dishes in the store in time, so as to avoid the change of food materials that may lead to the dissatisfying taste of the dishes, which may affect the consumption experience. In addition, epidemic prevention measures are extremely crucial as well ,28. Wait(1)Improve the level of epidemic prevention services and the transparency of food information to gain consumers’ trust.This paper uses data mining technology to study consumer preferences before and after the epidemic. First of all, through cleaning and sorting of the collected data, the authors get relatively clean comment data. Based on this, the paper carries out word frequency statistics and word cloud mapping and analyzes both psychological behavior and psychological changes of consumers under public health emergencies. After that, this paper conducts a thematic study on comment data  and compUnder public health emergencies, consumers pay increasingly attention to the epidemic prevention of restaurants. The catering industry should strengthen the epidemic prevention measures, disinfect on time every day, prepare disinfectant and masks, as well concentrate on cleaning and disinfecting of tableware. At the same time, reasonable arrangements for consumers queuing and dining distance need attention, either. Catering service personnel need regular training to ensure that they can also have professional service standards and warm service attitude in the face of public health emergencies. For example, when consumers are dissatisfied, they can take appropriate measures to appease and compensate, so as to minimize the loss.From the semi-finished products made from the purchased raw materials to the final products, information such as the name of the ingredients, the place of origin, the place of passage, and the results of various food safety tests are presented on the QR (Quick Response) code. By setting the QR code on the dining table and the network platform, consumers can directly scan the code to understand the changes of the ingredients and the safety of the ingredients. In addition, it can also reduce the time for the waiter to explain the dishes to consumers. Thus, they are available to focus on the service to improve service efficiency while give consumers a sense of security in the event of public security emergencies.(2)The combination of online and offline double line discount and consumption coupon to win the “heart” of consumer.The competition in the catering industry is fierce, and all kinds of preferential activities emerge in endlessly. How to stand out in the competition is worth thinking about. Each store can adopt different online and offline discount methods. It can adopt the system of issuing food consumption coupons and exchanging a certain amount of accumulated consumption for dishes online, so that consumers can not only enjoy the discount but continue to consume in the store. At the same time, online sales are more suitable to launch “small dishes” package discount and encourage consumers to buy dishes in the form of package, which can not only save food and beverage stores. The types and costs of food materials procurement can also save consumers’ choice time. Offline preferential activities are more diversified than online ones. Consumers can not only “buy back” by presenting e-coupons to shop customers, but also present their own special dishes or new dishes or store related small gifts to consumers in the form of lucky draw, so that consumers will have a good time; meanwhile, their heart will dance with happiness.(3)Actively obtain feedback to awaken consumer demand and seize the “stomach” of consumers.During the epidemic, consumers’ choice and demand for dishes changed. The service personnel should take the initiative to ask consumers about their taste and feelings of the dishes and record the problems so as to rectify the dishes and meet the needs of consumers. Let consumers in the restaurant to obtain “stomach” satisfaction, at the same time to obtain emotional and social satisfaction. Moreover the restaurant can flexibly adjust dishes according to market supply and demand, to give consumers satisfaction.(4)Reasonable use of community group purchase to provide consumers with “convenience”.In the context of the epidemic, people generally do not want to wait in line, but want to be able to eat quickly. The community group purchase with the community as the unit arises at the historic moment. The restaurant can accordingly change its business form and flexibly adjust the products it sells according to the market demand. Catering stores can launch meals in the form of group purchase, such as semi-finished products and group purchase packages, in order to meet the living needs of surrounding residents and give consumers convenience.(5)Develop environmentally friendly takeout mode, leaving consumers with “beauty”.In the event of public health and security, the increase in the number of people ordering takeaway food has led to the problem of excessive use of disposable cutlery. Catering stores can encourage consumers to reduce the use of disposable tableware by offering certain preferential measures to those who bring their own tableware. Catering stores should replace plastic packaging boxes with degradable paper boxes as much as possible, so as to reduce the harm to the environment and achieve long-term sustainable development.(6)Data help the recovery of the catering industry.Local governments can set up data centers and local online epidemic prevention workstations based on “counties’ street” to provide corresponding policy information support for local catering enterprises. At the same time, commercial banks can cooperate with catering enterprises to provide consumption discounts to consumers who handle business in the bank, so as to increase the cash flow of the catering industry and promote the recovery of catering enterprises during the epidemic period.


Regeneración Urbana, Calidad de Vida y Salud”  or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile.The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The “RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data  is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population.RUCAS’ design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors –including COVID-19 pandemic and associated lockdowns– and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS’ outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.The online version contains supplementary material available at 10.1186/s12889-021-10739-3. There is strong evidence that housing conditions and the built and social environments of neighborhoods affect health –8. TheseHealth relevant features of built and social environments include the availability of green space and healthy foods , 10, socWithin the framework of urban health, researchers posit that unequal access and exposure to the benefits and risks of urban life are fundamental social determinants of health inequalities. In large Latin American cities, the spatial distribution of populations follows a clear pattern of inequality as a product of exclusion and gentrification at both the level of cities and neighborhoods , 23, cauWhile one solution to this problem is the mobility of low-income neighborhood dwellers, another, arguably more sustainable solution is the renovation and improvement of these neighborhoods. Several studies have evaluated whether improvements in housing and neighborhood conditions yield health benefits. Capitalizing on urban regeneration initiatives as natural experiments, these studies have shown increases in satisfaction with housing, improvements in perceived quality of life, reduction of violence, and mental health benefits, among others –33. HoweRegeneración Urbana, Calidad de Vida y Salud, or Urban Regeneration, Quality of Life and Health in English) aims to contribute to the evidence of how housing and built environment interventions may impact health and wellbeing.By means of the evaluation of an urban regeneration program in Chile, the RUCAS Project  faced aamentos” . In the amentos”  in “vill deficit . The con deficit .These housing blocks are built in brick masonry and equipped with basic utilities . Eventually, this public housing solution proved incapable of meeting minimum living standards due to poor construction and rapid deterioration . AccordiPrograma Segunda Oportunidad), without consideration of best practices for urban planning and design. Today, however, following guidelines developed by United Nations as described in their New Urban Agenda [Following the acknowledgement of the poor quality of these housing blocks, housing policies shifted their attention towards the “qualitative” deficit of buildings and their surrounding neighborhoods, initially through massive demolition of buildings and relocation of neighbors , initiated in 2013, aims to “regenerate social housing complexes whose urban and residential configuration has insufficient or deteriorated access, roads, green space, and facilities, weakened community organizations and deficiencies in the size and habitability of housing” [MINVU’s housing” . Overallhousing” . The stuHousing: The expansion and remodeling of dwellingsThe intervention is comprehensive, with a master plan developed for each villa detailing the content of the planned works which may vary according to the needs of each neighborhood. The intervention can be disaggregated into three components:2 in BDM, and from 42 to 84 m2 in MB, on average. In all dwellings, equipment will be replaced, and new insulation throughout the building walls will be provided. While in MB the extension works are carried out with the families out of the apartments (they must leave for approximately 1 year and are temporarily placed in other apartments that may be inside or outside the villa), in BDM the works are carried out along the perimeter of the buildings, with the families living inside while construction is done, which may last from 6-8 months.2.Built environment: Construction and improvement of parks, urban equipment, and roads, among others. Dwelling’s demolition.The intervention aims to meet current standards for the construction of social housing, which are now improved as compared to those of the 1990s . As can 3.Community: Revitalization and strengthening of community organizations and neighborhood participation.This component includes the renovation and construction of new public spaces, green areas with sports facilities and playgrounds, replacement of street surfaces and sidewalks, and public lighting improvement. Also, to reduce residential density and provide space for new green areas, a small proportion of housing blocks were demolished previous housing intervention and baseline measurements. In BDM two new community centers and one new park were already in use when the study was initiated. In MB, park renovation will take place after data collection for this study has been initiated.Secretaría Regional Ministerial V Región (SEREMI) in BDM and Equipo de Regeneración Urbana (ERU) in MB.This component includes the implementation of participatory social diagnoses and reactivating neighborhood councils. The activities of this component, while fulfilling their own specific objectives, make the work of the other two components viable, thus accomplishing the mandate of the program to have a participatory design. These activities are implemented directly by MINVU professionals in each villa: In BDM, works associated with the intervention began in 2017 (before baseline), while in MB, the first works were carried out in 2019, after baseline data collection was completed. The differences in the number of households involved and the intervention strategies used in each villa mean that the intervention times are different, with work possibly extending until 2023 in BDM and 2028 in MB. In both cases, the interventions will be implemented within sections of the neighborhood in succession, adding new households to the group of those that have been “intervened” at each measurement wave  over 4 years as the intervention unfolds, collecting primary data with repeated measures using five different data collection instruments. RUCAS is an ancillary study to the Salud Urbana en America Latina (SALURBAL) project .The main research objectives addressed by the project include assessing the effect of dwelling improvements on general, mental, and respiratory health, and health-related outcomes; to estimate the impact of the improvement in recreational public spaces in the utilization of these areas and potential impact on general and mental health and perceptions regarding the neighborhood; and assess the impact of the intervention on dwellers perceptions and experiences.Based on the literature, we developed a conceptual model identifying the direct or proximal effects of each component of the intervention and the health outcomes most likely to be affected by these, considering seasonal variability in these effects. We focused on health effects that could be observed within the time frame of the project (i.e. short term effects) , 47, 48.Figure While the analytic framework separates the variables related to characteristics of dwellings, the built environment, and the community, may be challenging to distinguish how changes in health outcomes could be attributed separately to these three components . On the other hand, it should be noted that the framework is a general approximation to the design of the instruments and analyses. Nevertheless, for each analysis, it will be necessary to evaluate the specific causal mechanisms that may be producing any observed outcomes.Capitalizing on the urban regeneration program as a natural experiment, RUCAS is a longitudinal study where dwellers exposed and unexposed to the intervention will be compared over time within the study villas, following a stepped wedge design. At baseline, most dwellings had not yet been exposed, and by the final wave winter 2021), nearly 30% in MB and 62% in BDM will have received the intervention. The progress of the intervention across dwellings and waves is shown in Fig. 021, neardueña de casa), who is most likely to be at home at the time of the interview and to be better informed about the dwelling and the health and health-related conditions of family members. Three waves of the survey are programmed to be applied in summer (January–March) and three in winter (August–September), 6 waves in total in each villa : Face-to-face interviews administered by trained interviewers to one household key informant in their homes. Household key informants are over 18 years old and provide information concerning the household, dwelling and neighborhood, as well as health and health related data for themselves and each household member. The key informant is aged 18 years or older and, preferably, the female head of each household (Intra-domiciliary observation tool (RUCAS IDO tool): Structured guideline applied by the interviewers, accordingly trained, to assess dwellings’ features such as the number of rooms, maintenance, and presence of mold, among others. It is administered jointly with the questionnaire in each dwelling in all waves.hygrochrons): In a sub-sample of dwellings, temperature and humidity data-loggers will be installed in winter and summer at the beginning and the end of the study for 2-4 weeks before the RUCAS survey. The first winter and summer measurements have been performed in each villa between the winter of 2018 and summer of 2020 in sub-samples of 34 and 30 dwellings in BDM and MB, respectively. The iButton Hygrochron [Intra-domiciliary hygrothermal conditions   and PhysFive instrument sets were designed or adapted for this study. Each of these instruments will be applied at least twice , according to the measurement timeline. A detailed representation of the proposed measurement timeline is presented in Additional file Most variables are collected periodically through one or more instruments. Key health outcomes are assessed with the RUCAS survey in various manners, some allowing for greater sensitivity, others greater specificity. For example, we measure respiratory health broadly, ranging from symptoms  to hospitalizations (granting higher specificity but less sensitivity and lower incidence). We also characterized dwelling-related exposures  using both self-reports and objective measurements. In Table In BDM, data gathering began after the dwelling intervention had begun and families not eligible for the intervention had already left, so we used a census strategy to recruit participants , visiting each dwelling in the villa. In MB we initiated data collection before the dwelling intervention began, so the sampling frame was provided by ERU in the form of a list of households eligible for intervention. In both villas, households representing security concerns, dwellings used for non-residential purposes, and dwellings without inhabitants were excluded (28 in BDM and 22 in MB). This resulted in a sampling frame of 260 dwellings in BDM and 807 in MB.At each survey wave we contacted all households that we had contact (or attempted to contact) in the prior wave, except for refusals. Those who left the villa are contacted by telephone and surveyed one last time, and then dropped from the sample. Dwelling and neighborhood level data, as well as information on individual household members reported by the key informant yields a sample of individuals clustered within households. In successive waves, new members of households were included in the survey. When strictly necessary the original key informant has been replaced by another member of the household, due to physical or mental impairment that made him/her unable to answer the survey, death or prolonged absence.Considering that lost to follow-up represents one of the greatest challenges in a longitudinal study, substantial efforts have been devoted to the follow-up of the participants of both cohorts. A team member who keeps regular contact with the villa’s community leaders, is fully dedicated to these activities. Based on recommendations identified in the literature , the teaBoth the study design as well as a selection of preliminary results have been systematically shared with community leaders and with SEREMI-ERU, not only for retention, but also for the validation of findings, and to provide valuable information for the interventions’ masterplans and recommendations for households. Regular meetings with SEREMI-ERU are held to maintain awareness among the research team of the evolution of the master plans for the two neighborhoods and to monitor the progress of the interventions in each villa. Preliminary results have also been presented to Ministry of Housing authorities on several occasions, emphasizing the need to evaluate housing policies and urban regeneration from a health perspective in the medium and long term.The design of RUCAS allows for a broad range of cross-sectional and longitudinal hypotheses to be tested, drawing on repeated measures on exposed and unexposed groups. The impact of dwelling improvements on health will be assessed via multilevel models. Considering the stepped wedge design for this study , repeateThe impact of the improvement of recreational public spaces on use of these spaces will be estimated using survey data for courts and park visits and by comparing changes in PARA and SOPARC results between the intervened (MB) and the control neighborhood, using a difference-in-difference analysis . We willBy July 2020, three waves of the RUCAS survey and IDO tool have been applied in each villa , but higher in both villas compared to the country (6.5% ). SatisfReports of regular or poor general health, medically diagnosed hypertension and diabetes among those aged over 15 years reaches levels similar to the self-report obtained at the national level  . While tWave 3 collected information for 792 households, representing 82.8% of the baseline sample. At the household level, causes of lost to follow-up were change of place of residence out of the villa , study withdrawal , not reachable  and death of the informant who was the only household member . This resulted in data collection at wave 3 for 2528 individuals previously included in the baseline, whose basic sociodemographic characteristics and prevalence of chronic health conditions (diabetes and hypertension) do not significantly differ from the baseline sample  that took place in Chile starting in October 2019, as well as the ongoing COVID-19 pandemic and associated lockdowns. Hence, the proportion of intervened dwellings in each villa for each wave has been lower than initially expected.The complexity of such interventions offers some important research challenges for health evaluation studies . So far,. In BDM, the second set of three survey waves were delayed in order to incorporate a larger number of intervened dwellings by the end of the study, given delays in the intervention. On the other hand, the incidence of the COVID-19 virus in both cities (Santiago and Viña del Mar) has been particularly high, as well as the duration of the lockdowns. Therefore, survey wave 4 has been applied via telephone, and waves 4 and 5 -conducted during winter of 2020 and summer of 2021- included questions about the health and social effects of COVID19, which is of great interest in themselves and as factors that may affect the trajectory of the study’s key health outcomes.Given the stepped wedge design, and that the study capitalizes on within household changes over time, RUCAS has the flexibility to adapt to these external circumstanceshygrochrons to further validate the data about thermal comfort, given the potential role of thermal conditions in reducing respiratory health problems, as well as their centrality to the intervention in its aim to reduce fuel poverty by improving energy efficiency in the renovated buildings, favoring healthier and more sustainable social housing.Another challenge of the RUCAS design lies in the collection of health and other data via a key informant. To this end, we use different approaches to measure the key health outcomes of this study, provide regular training to interviewers, and examine our results for longitudinal consistency, among others. For example, there exists comparable national estimates for some of our indicators (described above), which have proven to be similar or consistent with our sample characteristics; seasonal variations of the data are consistent with expectations; results across waves and villas are consistent in time. Similarly, for example, general health has been stratified across age and sex groups, as well as number of non-communicable diseases, with results behaving as expected in all cases  and interpretation of observed effects of the built environment and community interventions (which are for the neighborhood as a whole), as distinct from the specific effects of the dwelling intervention (which varies from dwelling to dwelling), represents another challenge. This has made been evident by our interviews and interaction with community leaderships, who have described how the intervention components intersect with each other. For example, mothers and caregivers have pointed out that they prefer their children to spend their leisure time inside because they fear insecurity and violence in the neighborhood. Thus, improvements in the neighborhood’s security could mitigate some of the effects of dwelling overcrowding, regardless of whether dwellings have been renovated or not. The selected design allows to separate these effects by comparing within household changes over time across residents of intervened and non-intervened dwellings while also accounting for time varying characteristics of the neighborhood as a whole. Interactions between dwelling and neighborhood factors can also be explored. However, the correct interpretation of the study findings will be a result of the integration of information from the study’s various sources of data.Furthermore, qualitative data may contribute to the generation of new study hypothesis concerning, for example, potential negative effects of the intervention process when the works are disturbing to the household members, due to temporary relocation of families, or if the intervention is being largely delayed. Also, it may prove helpful in understanding whether a spillover beneficial effect may be in place in those that have not yet received the intervention but are expectant that the interventions are taking place. These insights, again, highlight the relevance of the complementarity of methods used in RUCAS, where qualitative data provides an input for the interpretation of results obtained with quantitative data, as well as for the generation of new hypotheses to be tested.As in all longitudinal studies, lost to follow-up represents a major challenge. In the context of RUCAS, three major potential causes of lost to follow-up are: migration away from the villas, the burden of repeated surveys, and refusals to participate given the residents’ potential discomfort with the intervention, especially regarding delays in its implementation . Although migration away from the villas has not been frequently reported, we will conduct a short survey to explore the causes of migration and the extent to which it may be an undesired consequence of the intervention due to, for example, gentrification. To reduce whitdrawals because of the burden of participation, we will apply the full questionnaire only at baseline and at the end of the study, and short versions in the other 4 survey waves, while allowing to keep regular contact with participants and thus contributing to retention rates . Finallymean something different. These changes, to the extent that they are also perceived as beneficial by actors outside the villas, could encourage the arrival of new inhabitants from different socioeconomic backgrounds or even an improvement in the supply of urban services, thus reducing residential segregation. The villas will be perceived as a different place in the future only if what characterizes them  changes today. While it is likely that some health outcomes will not be significantly improved during the time frame of the RUCAS project, some proximal effects that can improve health are likely to be, such as satisfaction with the dwelling and the neighborhood, improved social relations within the villa, or the use of better-equipped recreational areas. RUCAS is an exhaustive evaluation of a comprehensive intervention, looking for the material (infrastructure) and immaterial  effects of urban regeneration, understanding that it is in the combination of both types of effects that the improvements of the wellbeing and health of their inhabitants will be made possible.As noted, the project is based on the concepts of urban health, following a relational approach of the link between health and place. The villas being studied are examples of the residential segregation that characterizes Latin American metropolitan cities operating within the context of neoliberalism. Sample description shows that the study populations have worse social indicators (higher unemployment , lower eThe RUCAS project will allow the estimation of the short-term health and wellbeing effects of a comprehensive urban regeneration program implemented in two social housing villas in the periphery of two metropolitan Chilean cities. This will be accomplished through several different but complementary measurement instruments applied longitudinally between 2018 and 2021. This will allow us to capitalize on the intervention as a natural experiment. In doing so, RUCAS will contribute to the scarce evidence on the effects of formal housing and neighborhood improvement interventions on health and health determinants in Latin American cities. This research will inform the urban policy agenda of the region in the future, given that the qualitative housing deficit that characterizes Chilean social housing is a problem shared by other countries . At the Additional file 1. Measurement timeframe by instrument.Additional file 2. Characteristics of the RUCAS sample at baseline and remaining sample at wave 3.


Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. However, frequent in-house referrals were found to increase the number of incoming patients resulting in unsustainable situations due to an insufficient workforce. In 2011, the Center for Perioperative Medicine was established at our hospital to function as a management gateway for patients scheduled to undergo surgery under general anesthesia. The “oral triage” system, wherein a dental hygienist conducts an oral screening to select patients who need preoperative oral hygiene and functional management, was established in 2012. A total of 37,557 patients who underwent surgery at our hospital from April 2010 to March 2019 (two years before and seven years after introducing the system) were evaluated in this study. The sustainability and effectiveness of introducing the system were examined in 7715 cancer surgery patients. An oral management intervention rate of 20% and a significant decrease in the incidence of postoperative pneumonia (aOR = 0.50,  The development of minimally invasive surgical techniques has improved the chances of selecting an appropriate surgical treatment method, even in elderly patients with comorbidities. Therefore, the need for multidisciplinary care to conduct the procedures safely is gaining recognition. Since the establishment of a management gateway called the Center for Perioperative Medicine in April 2011, multidisciplinary approaches have been used to provide risk-free and reliable surgery to patients in our hospital. The perioperative oral management  section, which plays a significant role in these approaches, was implemented in April 2012.Simultaneously, the “perioperative oral management fee” was listed in the fee schedule for insured medical treatments  in April 2012. Since then, various hospitals affiliated with medical schools and municipal hospitals initiated the perioperative management of oral hygiene and function at the time of surgery, under general anesthesia, through collaborations between the medical and dental teams.In general, it is common for the surgeon in charge to refer patients to a dental or oral surgery clinic at the hospital . However, this referral is made solely by a surgeon; therefore, in some instances, patients with poor oral hygiene may not visit a dental clinic or receive oral treatment before the surgery due to a last-minute referral. Moreover, as the in-house referral to dental professionals has become a commonly known approach, it is predicted that the referral will be conducted without evaluating the oral conditions. Consequently, the number of incoming patients would increase every year, resulting in unsustainable situations due to an insufficient workforce in dental and oral surgery clinics. If all surgical patients are automatically sent for oral management, the visits of those who do not require treatment will increase the burden on both patients and government finances. Lastly, oral management for all surgical patients may force medical providers to sacrifice the time for thoughtful explanation to patients, which might compromise the quality of care under the limited amount of preoperative time and human resources in the dental and oral surgery clinics. Thus, a reasonable solution that can affect sustainability is required.We established the “oral triage” system in our hospital, wherein dental hygienists conduct an oral screening to select patients who need preoperative oral hygiene management based on the guidelines established by oral surgeons. For instance, they instruct patients with the risk of dislodging loose teeth during endotracheal intubation and extubation to visit a dentist or an oral surgeon, within the limitations of the dental hygiene instructions in the Dental Hygienists Act.Among the several postoperative complications, such as wound infection and hemorrhage, the present study focused on postoperative pneumonia because it is known to be affected by poor oral hygiene . The aimIn April 2011, the Center for Perioperative Medicine was developed in the central surgery section to predict various perioperative complications under general anesthesia. The surgeon in charge is obligated to strictly comply with the rule to send patients to the Center for Perioperative Medicine at least two weeks before the surgery, except in case of an emergency.The Center is comprised of anesthesiologists, surgical nurses, pharmacists, dental hygienists, clinical engineers, a Medical Affairs section, and a Properties Management section. Medical personnel, such as surgeons, nurses in outpatient clinics, and oral surgeons or dentists, collaborate with the members in the Center to constitute team care.The patient flow at the Center for Perioperative Medicine is presented in In the oral management section, a dentist develops a treatment plan at an oral surgery outpatient clinic after oral screening at the Center for Perioperative Medicine. Professional oral care such as scaling, removal of the tongue coating, provision of oral hygiene instructions, extraction of teeth that can act as reservoirs of infection, and delivery of protective devices for the teeth  is provided in the oral management section.The curved arrow in Subsequent patient education protocols should include instructions for self-care during professional oral care close to the day of surgery, as well as for instructions for cleaning dentures, rinsing with povidone-iodine mouthwash, and practicing oral self-care even on the morning of surgery when no food is eaten.In this system, a dental hygienist evaluates the oral hygiene, the intraoral reservoirs of infection, and the risk of dislodging or damaging the teeth under the management of an anesthesiologist . Oral scAll dental hygienists are trained to perform a standard level of professional oral care at least one or two times a week. The oral treatments were carried out one to three times before the operation. The aim was to achieve a plaque-free oral cavity immediately before surgery.Oral care and instructions for oral hygiene management are provided once the patients are stabilized after the surgical procedure conducted under general anesthesia. Furthermore, a referral letter is sent to a family dentist requesting continuous management before discharging the patient from the hospital .The subjects in this study comprised patients who underwent surgery under general anesthesia at our hospital between April 2010 and March 2019. The sustainability and effectiveness of the system for cancer surgery patients were evaluated within this population. The items used for the analyses were the annual trends of the oral management execution rate, the trends of the incidence of postoperative pneumonia, and factor analyses of the onset of pneumonia by multivariate analyses.The analyses were limited to cancer surgery because of the initial introduction of the patients into the Japanese social healthcare system and the lack of perioperative oral management for cancer patients prior to the addition to the fee schedule, which simplified the statistical analyses.Oral management has been routinely advocated for patients who underwent cardiovascular surgical procedures and organ transplantations to prevent surgical site infection. However, prior to implementing this system, the concept of oral management before cancer surgery was non-existent .This retrospective study used data from the Diagnosis Procedure Combination (DPC) database system in Japan, the details of which have been described in the literature previously . The DPCApproval for the study was obtained from the ethics committee of the Toho University Oomori Medical Center (M16057).The variables retrieved from the DPC database were as follows: sex, age, date of hospitalization, three categories of the names of the diseases , and DPC codes.A total of 37,557 patients who underwent oral screening and surgery from April 2010 to March 2019 at our hospital were observed in this study. Subsequently, 7715 cancer surgery patients, excluding surgical patients with the onset of pneumonia at the time of the acceptance, were selected from this population to form the target group .The annual trend in the rate of oral management execution was defined as the oral management execution rate per executed oral screening. The rate was at 0% for two years before the implementation of the Center for Preoperative Medicine. The data were collected for nine years from 2012 to 2018 after implementing the Center for Preoperative Medicine.The first year between April 2012 and March 2013 was defined as the trial period, and the incidence rates of postoperative pneumonia two years prior to the introduction  and the following eight years after the introduction (post-introduction) were compared. The following six years of post-introduction were divided into an early period (April 2013 to March 2015), middle period (April 2015 to March 2017), and late period (April 2017 to March 2019). With regard to the factor analyses of cancer type comparisons and the incidence of postoperative pneumonia, 1186 patients within the two years of pre-introduction and 2131 patients with the two years in the late period of post-introduction were compared .The diseases at hospitalization in DPC were classified into “primary diseases for hospitalization”, “comorbidities at hospitalization”, and “diseases after hospitalization”. For example, when a patient with hypertension was hospitalized for the treatment of gastric cancer, the primary disease for hospitalization and the comorbidity at hospitalization were recorded as gastric cancer and hypertension, respectively, at the time of admission. If the patient experienced pneumonia after admission, the disease was additionally recorded under the section “diseases after hospitalization”.Therefore, in the present report, patients with a record of any type of pneumonia in the “diseases after hospitalization” section who had no record of pneumonia in the “primary diseases for hospitalization” or “comorbidities at hospitalization” sections are considered as those with postoperative pneumonia. In other words, the disease is recorded only in the “diseases after hospitalization” section in patients who develop postoperative pneumonia, whereas patients without postoperative pneumonia would have no record of pneumonia in any of the three sections. Patients who had a record of any type of pneumonia in the “primary diseases for hospitalization” or “comorbidities at hospitalization” sections were considered as “excluded cases”.The DPC database includes a 14-digit code called the DPC code. This code is specific to each patient and describes the cause of hospitalization, whether surgery or treatment was performed, the presence of side effects, and other details. The first six digits of the DPC code indicate the name of the disease. The DPC codes were used to classify the disease distribution of the sample population into 19 disease groups, and the target group was classified into 28 types of cancers. In the target group, the patients were classified based on the status of surgery; all cancer patients who underwent surgery were extracted from the database .Statistical analyses were performed using EZR ver1.40  [t-test, and sex and the incidence of postoperative pneumonia were compared using a Chi-square test. In the target group, the incidence of postoperative pneumonia by age and cancer type were calculated, and the incidence of pre-introduction was compared to that of post-introduction using the Chi-square test.For a general understanding of the factors contributing to the development of pneumonia, age, sex, the incidence of postoperative pneumonia, and category of disease (cancer) were compared before (hereinafter referred to as pre-introduction) and after (hereinafter referred to as post-introduction) the introduction of the “oral triage” system in the sample population and the target group. Age was compared using a p-value of <0.05 was considered statistically significant.Based on the result, a multivariable logistic regression analysis was performed. The objective variable for the analysis was the onset of postoperative pneumonia, and the explanatory variables were pre-introduction and post-introduction of ‘oral triage’ system, sex, age, and cancer type. Age was classified into five variables , and cancer type was classified into five variables . A two-tailed The characteristics of the sample population and target group (pre-introduction and late period of post-introduction) are summarized in The trend in the oral management execution rate after the introduction of the oral triage system from 2012 to 2018 is presented in The trend in the incidence rate of postoperative pneumonia in the target group was observed before and after implementing the “oral triage” system . The nump = 0.04).A significant difference in the incidence of postoperative pneumonia was observed between 2010 (pre-introduction) and 2018 .When comparing the risk of postoperative pneumonia before and after the introduction of the “oral triage” system with corrections for sex, age, and type of malignant tumor, the odds ratio was significantly lower in the post-introduction group (late period) compared to that in the pre-introduction group . The odds ratio increased with an increase in age, demonstrating that patients ≥80 years  were at a significantly higher risk of postoperative pneumonia relative to those <50 years of age.The risk in males was about 4.5 times as high as that in females (p < 0.01), followed by those with malignant esophageal tumors . The odds ratios in patients with malignant stomach and lung tumors were 2.21 and 2.03, respectively, but there was no statistically significant difference  [015–2017 In general, it is most common for a surgeon in charge to recommend patients to visit a dental or oral surgery clinic in the hospital. When a referral is made solely by a surgeon, patients with poor oral hygiene may not visit the dental clinic, and in some instances, the oral management might not be started before the surgery due to a last-minute referral. Moreover, as the in-house referral to a dental professional gains popularity, the number of incoming patients will increase every year, resulting in an unsustainable condition due to an insufficient workforce in the dental and oral surgery clinics. Oral management at the perioperative phase is becoming a standard procedure; yet, few hospitals have a sustainable system in place.The patients are required to visit the Center for Perioperative Medicine two weeks prior to the surgery; consequently, the oral complications can be systematically resolved before the procedure. The rate of visits to our oral surgery clinics was around 20%. Considering the advantages with regard to the minimal human resources of doctors and dental hygienists performing oral management and treatments, our approach was considered sustainable.Additional studies are required to investigate regional differences in the triage rates.Several studies have reported the effectiveness of perioperative oral management in recent years. Nisio et al. conducted a retrospective study examining oral care intervention and the onset of postoperative complications in 27 intervention and 25 non-intervention cases among lung cancer patients who underwent thoracoscopic lobectomy . The numLikewise, in the present study, the incidence rate of postoperative pneumonia in approximately 37,000 subjects was 2.07% before the introduction of the system and 0.97% six years after its introduction. The annual trends showed a gradual decrease in the incidence rates. A significant decrease was observed in 2018 (post-introduction). The possible reason for the gradual decrease might be an increase in the number of surgeons who referred patients to the Center for Perioperative Medicine strictly on a two-week deadline. Thus, if all surgeons adhere to this promise, the incidence of postoperative pneumonia is expected to decrease further.In addition, among the patients who were triaged due to the need for oral management, some may have received multiple surgical treatments with repetitive explanations regarding the importance of oral management, which might have led to considerable improvements in preoperative oral hygiene, resulting in a decrease in the incidence of postoperative pneumonia over time.The incidence of postoperative pneumonia was decreased in patients with malignant tumors of the stomach, esophagus, lung, colon, and brain after the introduction of the “oral triage” system in the present study. The fact that only patients with gastric cancer demonstrated a significant difference in the incidence of pneumonia revealed that the system might be effective for postoperative pneumonia after cancer surgery of the digestive system. Previously, Nishino et al.  comparedIn the current study, subgroup analyses in each malignancy were not performed due to the possibility of obtaining inaccurate results owing to sample size reduction caused by group splitting. In the future, we aim to investigate the difference in the rate of oral management intervention due to the “oral triage” system in each malignant tumor.p = 0.03) times that before the introduction, thus indicating that the introduction of this system significantly reduced the incidence of postoperative pneumonia.According to the results of the multivariable logistic regression analysis for the risk factors of postoperative pneumonia, the odds ratio after the introduction of the “oral triage” system was 0.50 (p = 0.02) than that in patients <80 years of age.The odds ratio was higher in patients who were ≥50 years of age; hence, age was considered to be a relative factor. Teramoto et al. reported that 70% of all pneumonia patients who were ≥70 years presented with aspiration pneumonia . Therefop < 0.01). The mortality rate of males due to pneumonia is higher than that of females in elderly people in Japan [The risk of pneumonia among males was about four times as high as that in females (in Japan .p < 0.01) than in those with esophageal cancer . Furthermore, it was suggested that impaired consciousness and dysphagia commonly occurred as sequelae of craniotomy for brain tumors. In addition, esophageal cancer patients who underwent surgery were presumed to have postoperative pneumonia due to gastroesophageal reflux; it was concluded that patients with esophageal cancer have the second-highest incidence of postoperative pneumonia after brain tumors.The risk of pneumonia was higher in patients with brain tumors  analysis ,17 Tabl. The NDBIn an observational study using the database, the intervention group is not randomly allocated when the effects of the oral intervention group are compared to that of the non-intervention group. Thus, the backgrounds of the patients vary, and patient selection bias may affect the estimated results. Therefore, a method using the propensity scores (PS) has been used, wherein background items, including comorbidities affecting the intervention effects, are included in the model as covariates to adjust the effects of the intervention group.High-risk cases of postoperative pneumonia were present among the non-intervention subjects in the 2018 study by Ishimaru et al.  due to pIshimaru et al. reported that the oral intervention rates in all patients and the incidence rate of pneumonia in patients with oral intervention were 16% and 3.28%, respectively [Although postoperative aspiration pneumonia was the main focus of this study, additional studies are required to investigate whether the “oral triage” strategy can be used to prevent conditions such as wound infection caused by poor oral hygiene from the perspective of periodontal medicine .Using the “oral triage” system, we were able to successfully remove the reservoirs of oral infection within a sufficient treatment time frame of two weeks. In addition, the incidence rate of pneumonia was lowered by employing limited human resources to render oral management relative to the conventional method, thereby emphasizing the superiority of this system. The system proved to be a sustainable and developmental perioperative oral management strategy.


Number sense is the ability to estimate the number of items, and it is common to many species. Despite the numerous studies dedicated to unveiling how numerosity is processed in the human brain, to date, it is not clear whether the representation of numerosity is supported by a single general mechanism or by multiple mechanisms. Since it is known that deafness entails a selective impairment in the processing of temporal information, we assessed the approximate numerical abilities of deaf individuals to disentangle these two hypotheses. We used a numerosity discrimination task (2AFC) and an estimation task, in both cases using sequential  or simultaneous  stimuli. The results showed a selective impairment of the deaf participants compared with the controls (hearing) in the temporal numerosity discrimination task, while no difference was found to discriminate spatial numerosity. Interestingly, the deaf and hearing participants did not differ in spatial or temporal numerosity estimation. Overall, our results suggest that the deficit in temporal processing induced by deafness also impacts perception in other domains such as numerosity, where sensory information is conveyed in a temporal format, which further suggests the existence of separate mechanisms subserving the processing of temporal and spatial numerosity. We defined GROUP (deaf and hearing participants) and STIMULI  as fixed effects, while the participant was added as a random effect [car” package in R). Further statistical analyses were performed via a series of post hoc pairwise tests (“emmeans” version 1.5.3 package in R) to obtain an estimate of the marginal means for factor combinations in the model. This analysis allowed us to compute and contrast the predicted probability distributions relative to each response level. We considered pairwise comparisons with p < 0.05 to be significant only after applying a family-wise error rate correction (FWER) according to the Holms correction for multiple comparisons. In addition, since the age between participants in the deaf group and hearing controls differed, we tested the correlation between the participants’ ages and the dependent variables of the discrimination task (PSE and JND) to assess whether the difference found between the two groups could be due to age difference. None of these correlations were significant. The results are shown in We used the same statistical analysis for both tasks, running a linear mixed model analysis  and a significant interaction between the stimuli and group . Post hoc analysis showed a significant difference only for the deaf group between the two stimuli conditions  and between the hearing and deaf group in the temporal stimuli condition .The bar graph at the bottom of 2 = 4.31, p < 0.05) and a significant interaction between the stimuli and group . Post hoc tests showed a significant difference only for the deaf group between the two stimuli conditions  and between the hearing and deaf group in the temporal stimuli condition .Precision in the numerosity discrimination task was instead assessed in terms of WFs  nor the interaction between the group and stimuli  were statistically significant, while we found a significant difference between the temporal and spatial estimation conditions .In a second experiment, the participants were required to estimate the numerosity of either an array of dots or sequences of flashes (tested in separated sessions). 2 = 14.39, p < 0.01) but not for the group  and no interaction between the group and stimuli .The results for the average participant’s precision in the estimation task are shown in the right panel of In the present study, we compared the ability of deaf and hearing participants to perceive numerosity in two different types of tasks (discrimination and estimation) and two different presentation formats . The main goal of the study was to assess whether early deprivation of auditory experience might induce impairment in the processing of numerosity. Such a hypothesis arises from previous studies showing that the precision of temporal processing is affected by early deafness ,40,41,42We achieved two main results. First, when comparing the performance of the deaf and hearing individuals in the discrimination task, we found that both the precision and accuracy of the deaf group were worse compared with the control group but only when the stimuli were presented over time . On the contrary, when the stimuli were presented simultaneously , the performance was similar in the two groups. This result suggests that the numerosity ability of deaf people is strictly dependent on the presentation format of the stimuli used. The second result concerns the different patterns of results obtained in the discrimination and the estimation tasks. We found that the impaired performance in judging sequentially presented stimuli was specifically for the discrimination task, suggesting that the difference in numerosity perception between the groups was task-specific. Therefore, we might speculate that the impairment caused by early hearing deprivation is limited to specific aspects of numerosity perception more closely related to temporal processing, and this, in turn, supports the idea that numerosity perception is not supported by a single mechanism but more likely by different, potentially independent mechanisms dedicated to “spatial” and “temporal” numerosity.How can we explain this pattern of results? A possibility is that the difference found in the discrimination task between hearing and deaf people, which was selective for the temporal numerosity, may be due merely to the working memory load. More specifically, in the condition with sequential stimuli, the cognitive load could be greater than in the simultaneous condition. Indeed, in the temporal numerosity format, the duration of the stimuli presented was longer, and this might have led to a greater cognitive effort and worse performance compared with the spatial numerosity format. However, we calculated the proportion of correct responses, and previous studies have shown that deaf participants have equal if not superior working memory performance compared with hearing groups ,49,50. FFirst, it has to be noted that most of the deaf participants tested in this study had previously been tested in an experiment from our group aimed to assess their ability to process temporal information. In the study by Amadeo et al. , the parSuch impairment in temporal processing by deaf individuals could be accounted for in terms of the cross-sensory calibration theory. According to this theory, different sensory modalities calibrate the others during development based on their sensitivity in a specific domain. For instance, vision’s superior spatial resolution contributes to developing spatial processing in audition . The absIn light of this, we propose that the processing of numerosity information might be divided into two steps: first a low-level processing stage with independent subsystems for spatial and temporal numerosity ,20,21 anThese findings are also in line also with recent results showing that brain responses tuned to numerosity could be observed across multiple areas along the dorsal visual stream, from the early visual areas (V1–V3) to higher-order associative areas in the parietal cortex ,56,57,58By focusing exclusively on the ability of deaf individuals to process numerical information, several studies have shown that their numerical (abstract and symbolic) processing abilities are equal to those of hearing people ,61,62,63To the best of our knowledge, only one previous article assessed the dissociation between temporal and spatial numerosity in deaf children, but only relative to the subitizing domain. The authors found no differences in performance between the deaf and hearing children in either the spatial or temporal number task . Thus, oOverall, our results suggest that the numerosity processing mechanism was neither entirely composed by multiple systems nor completely generalized but likely organized in a hierarchical fashion of increasing complexity. The absence of early auditory experience, as in deaf individuals, may affect the processing of temporally defined numerosity at the lower step of this hierarchy. However, downstream to sensory processing, the system is likely to compensate for such an impairment when participants are engaged in tasks entailing a more abstract mapping of numerosity information. This can be linked to the ATOM theory , for whiFinally, we need to acknowledge two possible limitations of the present study: the potential confound of non-numerical dimensions in the numerosity tasks employed and the co-varying cognitive contributors to numerical processing.For the first point, when it comes to simultaneously presented arrays of dots, other stimulus dimensions like density or the total area covered by the dots could indeed contribute to participants’ judgments, especially in a discrimination task. Although this topic is currently debated in the numerosity perception literature , there Regarding the second limitation, it has been shown that in deaf adolescents, the processing of numerical magnitude is associated with arithmetic, even when controlling for general cognitive abilities . HoweverTo conclude, our results show the impact of deafness on approximate temporal numerical abilities. Indeed, the absence of cross-sensory calibration from audition to vision impairs the processing of sequential and temporal numerosity, especially when the task requires a relative judgment relying more on perceptual processing. These results highlight the flexibility of the numerosity processing system and its hierarchical organization, showing that high-level processing could overcome a low-level deficit, referring to an abstract representation of magnitude.