Medical service policy plays a prominent role in the development of a “Healthy China.” This paper constructs a three-dimensional framework for text mining of medical service policy using the elements of policy instruments, policy strength, and types of medical service activity. Taking Sichuan Province as an example, 221 medical service policy documents, issued by the government and related departments, are selected as the research sample; the policy instruments, policy strength, and medical service activity types are analyzed using ROST and Nvivo 11.0 software. It is concluded that the government needs to optimize the structure of policy instruments, to appropriately reduce the use of environmental policy instruments in particular, while increasing the use of demand-based policy instruments. It is necessary to strengthen the interaction between the various sub-policy instruments, and to increase the use of financial services, fiscal taxes, overseas communications, and strategic measures. An increase in the implementation of government policy assists the acceleration of the policy landing, the further improvement of the supervision system, and the safeguard mechanism of the three medicine policy linkage, which can improve the sustainability of the medical service policy, and further resolve the difficulty and expense of seeing a doctor. Health is the foundation of a better life for everyone, and, increasingly, attention has been paid to factors affecting health, ranging from global environmental problems , 2, climAdvice on progressing the reform of the medical and health system in 2019, which was issued by the General Office of the State Council, clearly identified the need to study and formulate relevant policy documents; guidance, management, assessment methods; and regulations on medical and health care within 1 year, in order to implement the Healthy China strategy and further reform the medical and health system. Therefore, in-depth analysis of the content of the medical service policy document is of great practical significance to the improvement of the medical service and the promotion of the “health of all people.” At present, there are many problems to be solved in China's medical service . The assPolicy instruments , which aRothwell and Zegveld's policy instrument classification gave relatively little importance to plays down their mandatory characteristics and strengthens the role of government as environmental architect in the process of promoting policy projects, rather than only as an interventionist and controller , which iThe strength of a policy depends on the administrative level of the relevant government agencies: the higher the administrative level of a government agency, the greater its authority. This phenomenon reflects the government's priority on medical development. The weaker policy was promulgated by the lower-level government agencies, which also reflected the importance attached by the lower-level government to the development of medical care. At present, research on policy strength mainly focuses on quantitative research. Cheng and Qian  cited PeMost existing policy content analysis frameworks select two or more of the dimensions of policy instruments, policy subjects, policy strength, and so on. However, medical service policy is characterized by multi-type activities, therefore this feature is introduced here into the policy analysis framework. The types of activity related to medical service can generally be divided into three categories: medicine-related activities, medical activities, and medical insurance activities . In thisThis paper constructs a three-dimensional framework for analyzing medical policy based on the elements of policy instruments, policy strength, and medical service activities, as shown in The research method adopted is content analysis, which enables systematic and objective analysis of the policy text, both quantitatively and qualitatively . This haRoumell and Salajan  conducteThe sample policy documents used in this article were obtained from the official website of the People's Government of Sichuan Province, the Health Committee of Sichuan Province, the Sichuan Provincial Healthcare Security Administration, the Sichuan Drug Administration, and the Sichuan Traditional Chinese Medicine Administration. These government documents were selected according to the following principles: (1) the issuing unit is the Sichuan Provincial Government and its relevant departments; (2) the selected policy document is directly related to the medical policy; and (3) the policy document is issued in the comprehensive medical reform stage. Based on the feasibility of the policy document acquisition, a total of 221 valid samples of policy issued during the period 2010–2018 were collected; some of these are shown in The word network association diagram obtained using ROST software reflects the overall situation of medical service policy in Sichuan Province from 2010 to 2018; however, it is impossible to analyze the text content in detail. Therefore, this paper continues to use Nvivo 11 software to further mine and explore the policy text to ensure the integrity of the research results. The main method used is line-by-line coding of the research samples, to determine the research dimensions and keywords according to the relevant data and industry characteristics; this selects “supply-side policy instruments,” “environmental policy instruments,” “demand-side policy instruments,” “policy strength,” and “medical service activities” as tree nodes, constructing sub-nodes under each of these. Nvivo 11 software is used to code the reference points of each node according to the selection of nodes and reference points. If the total amount of text is consistent, the more reference points there are, the more adequate the disclosure of information. The reference points are the reflection of the absolute number of nodes in the policy text.The classification results for policy instruments are obtained from the coding analysis of medical service policy texts. As shown in The frequent use of environmental policy instruments reflects the importance attached in Sichuan Province to medical service policy and aims to create a favorable environment for their development through macro policy. Specifically, among the sub-policy environmental policy instruments, regulation and supervision is the most widely used, accounting for 36.96% of reference points. The malpractice in medical service systems and mechanisms in Sichuan Province has not yet been completely removed. In the 13th Five-Year Plan for the Development of Health and Family Planning in Sichuan Province, it is clearly pointed out that the existing costs of medical services is unreasonable, that the reform of a medical insurance payment system is overdue, and the price of drugs and consumables is high. Therefore, the long-term application of a regulatory and supervisory instrument is the highest priority. The second priority is goal programming, accounting for 25.82% of reference points, improving comprehensive medical reform of all aspects of medical security, services, and the drug supply and regulatory system, the implementation of which needs to be carried out in stages, making it necessary to formulate corresponding specific target plans in each stage of reform. The application of strategic and preventive measures and guaranteed work is a high priority, accounting for 11.14, 11.14, and 11.68% of reference points, respectively. The Sichuan Provincial Government has the lowest use of regulation and supervision, and financial services, accounting for 2.17 and 1.09%, respectively. As the fundamental guarantee of the development of medical services, this has not received adequate attention from the government, which needs to encourage the medical development agencies and enterprises to make available innovative financing and investment mechanisms. Furthermore, relevant medical institutions and enterprises should be given assistance in the form of financial subsidies and tax allowances.Supply-side policy instruments are also used frequently in Sichuan Province. In the sub-policy instruments, the proportion of infrastructure, human resources, and scientific and technological support on the supply-side is 24.61, 24.92, and 20.50% of reference points, respectively. Infrastructure is a basic prerequisite for ensuring the rapid development of the medical service; human resources cannot directly promote the development of the medical industry alone, however, they contribute to improving the utilization and allocation efficiency of other input factors. Scientific and technological support directly promotes the improvement in quality of medical services, and under the remit of the “talent plan” and the current situation, the government should establish a long-term and comprehensive human resource development plan, with specific implementation measures to achieve the strategic objective of developing the provincial medical service. This will accelerate scientific and technological innovation to construct the medical science and technology innovation platform, promote medical scientific research, and to transform and promote medical scientific and technological achievements. Information services account for 15.46% of the total reference points, and in order to effectively promote the development of the three medical institutions, the Sichuan Provincial Government needs to establish a medical service information platform for the province, city, and county, that consists of information services; a management information system of all medical and health institutions; and make full use of available online knowledge and big data to promote the development of medical information. Financial support is 14.51% of reference points; this sub-policy tool has the lowest utilization rate of supply-side policy instruments, and the government should provide more financial support to strengthen the capacity of medical services such as medical institutions , this paper shows the amount of policy publications related to these different activities in Sichuan Province. Some medical policy documents involve more than one medical service activity. The results of the coding analysis show that there are 84 policy texts related to medicine-related activities, 166 related to medical activities, and 27 to medical insurance activities. The volume of publications for different types of policies shows that medical service activities accounts for the largest proportion of medical activities in Sichuan Province. Medical care has always been an important guarantee of the health of all people in a region. Also, the province attaches great importance to the development of the pharmaceutical industry or production and supply of medicines. In addition to the drug procurement mechanism and innovative drug research and development, the highlight in the field of medicine in Sichuan Province is the development of traditional Chinese medicine. The Province plans to include the traditional Chinese medicine health service industry in the important strategic arrangements for its “5+1” trillion-level modern industrial system.In this paper, the difference between the policy instruments used in different medical service activities is analyzed by using the matrix query method of Nvivo 11. Firstly, the situation of the first-level policy instruments is analyzed, and the statistical results of the reference point account ratios are shown in In order to understand more clearly the strengths and weaknesses of policy instruments used by each medical service activity and the differences in their use, this paper provides in-depth analysis of the specific use of the sub-policy instruments in the policy documents of the three types of medical service activities; the statistical results of the proportions of reference points are shown in Table 5Two-dimensional analysis of reference points between medical service activities and secondary policy instruments.A total of 188 secondary policy instruments were used in the policy paper on medicine activities. The frequency of regulation and supervision in environmental policy instruments is the highest, accounting for 26.06% of reference points; the use of secondary policy instruments has a frequency of <5% for financial support and information services in the supply-side policy instruments, preventive measures, financial services, and fiscal levy in the environmental policy instruments; and for all demand-side policy instruments, the government purchase of policy instruments has been at zero. A total of 540 secondary policy instruments were used in the policy paper on medical activities, with the highest frequency of regulation and supervision use in environmental policy instruments, accounting for 14.63% of reference points, and the use of secondary policy instruments with a frequency of <5% being financial services, strategic measures, and fiscal levy in environmental policy instruments, as well as all demand-side policy instruments; a total of 22 secondary policy instruments for policy documents on medical insurance activities, with the highest frequency for regulation and supervision in environmental policy instruments, accounting for 27.27%. The use of secondary policy instruments with a frequency of <5% has human resources, science and technology support in the supply-side policy instruments, preventive measures, financial services, strategic measures, and fiscal levy in environmental policy instruments, as well as all demand-side policy instruments; of these, only the utilization of a fiscal levy was not zero and the use of other secondary policy instruments with a utilization rate of <5% was zero.The above data show that in the use of secondary policy instruments, the structure of policy instruments for each medical activity is different; the difference is most obvious between medical insurance activities and the others. No demand-side policy instruments are used in the policy text of medical insurance activities, and the use of secondary policy instruments in environmental policy instruments and supply-side policy instruments is also very different. The particularity of medical insurance activities does not involve developmental policy instruments such as human resources, scientific and technological support, financial services and strategic measures, and policy instruments such as information services, goal programming, and guarantee work are preferred. However, the most frequently used secondary policy instruments in the policy documents of medicine activities, medical activities, and medical insurance activities are regulation and supervision, indicating their importance in the development of medical services.Through the application of content analysis and text mining and using Sichuan Province as an example, medical service policy documents published since the implementation of the new medical reforms are selected and frequency analysis of various policy instruments, policy strength, and medical service activities are applied to draw the following conclusions: The overall composition of policy instruments is uneven, with a high proportion of environmental and supply-side policy instruments, and a serious shortage of demand-side policy instruments. This demonstrates the government's attempts to optimize the environment of medical services, to vigorously improve the supply of related elements of medical development, and to promote the long-term development of medical services: however, the level of attention received by the medical service market is low. The distribution of secondary policy instruments is also uneven. Among the various environmental policy instruments, the Sichuan Provincial Government is more likely to ensure the stable and controllable development of medical services through strong regulation and supervision by the government; this emphasizes the importance of the development of medical services in accordance with the rules and regulations, which is conducive to the improvement of medical service capacity and the protection of the people's basic rights and interests relating to health. However, the proportion of financial services and fiscal levy is very low, which, to some extent, will affect the implementation of target planning in policy documents. In the supply-side policy instruments, there is no significant disparity in the use of secondary policy instruments (human resources and infrastructure). In the demand-side policy instruments, foreign exchange, and service outsourcing policy instruments are low, with the shortage of government purchases warranting the most concern. As can be seen in the structural distribution of policy instruments, the government has focused on regulation, supervision, and goal programming; however, the supporting factors of financial services, in terms of fiscal levies, government purchases, and overseas communication are weak, which limits the pace of development of the medical service market.In terms of policy strength, 42% of the policy documents are relevant circulars and announcements issued by the Sichuan Provincial People's Government and its committees, bureaus, and offices, while 38% of the policy documents are temporary regulations, implementation plans, decisions, opinions, methods, and standards. The government's policy efforts mainly focus on the goals, operational principles, and clear tasks related to medical services. Secondly, the medical industry mainly abides by the relevant laws and regulations formulated by the state, and the local laws and regulations formulated by the government are secondary. From 2009 to 2018, the overall policy strength of Sichuan Province has changed substantially, but it has been stable in 2016–2018 the past 3 years, and the number of policy issues has also shown an increasing trend, indicating that the government attaches growing importance to the development of the medical industry.In terms of the types of medical service activities, there are great differences in the number of policy issues between medicine, medical, and medical insurance activities: 60% of the medical service policies are related to medical activities; in contrast, the number of policy documents issued in relation to medical insurance activities is the lowest, at 10%. The policy texts of the three kinds of medical service activities prefer the use of environmental policy instruments, and the frequency in the use of demand-side policy instruments is the lowest, which indicates that the government attaches great importance to the environment of these three medical service activities and constantly optimizes the environmental factors in order to provide a better service environment. The utilization rate of secondary policy instruments in each medical service activity is very different, especially when comparing medical insurance activities with the former two. No demand-side policy instrument is used in medical insurance activities, and the use of secondary policy instruments in environmental and supply-side policy instruments is also very different. There is a serious lack of policy instruments, such as human resources, scientific and technological support, preventive measures, financial services, and strategic measures.The improvement of the national level of health is essential for the improvement of national productivity, sustainable economic development, and social harmony. The government undertakes the role of the basic demand guarantor, the system supplier, and the market regulator in the medical service through the formulation and implementation of medical service policy in order to safeguard national health. Using the analysis of medical service policy in Sichuan Province as an example, this paper offers policy suggestions on the development of medical service from the following three angles.From the point of view of policy instruments, the government needs to optimize the their overall structure and the structure of internal secondary policy instruments in order to appropriately reduce the use of environmental policy instruments, increase the application of demand-side policy instruments, and enhance the interaction between secondary policy instruments. In particular, this increases the frequency of use of supportive policy instruments such as government purchases, financial services and fiscal levies, as well as market shaping, overseas communication, and strategic measures, and encourages medical development institutions and enterprises to carry out innovative financing through investment and other measures, while providing support to relevant medical institutions and enterprises in terms of financial subsidies and tax incentives. The government needs to consider the coordinated use of various policy instruments, enhance continuity and stickiness among secondary policy instruments, and focus on strengthening policy synergies in order to enhance the policy effect and improve the sustainability of health care policies.From the point of view of policy strength, the government must continue to strengthen the policy and accelerate the establishment of basic medical service systems for urban and rural residents. To improve the attitudes toward implementation and make these more conducive to the development of medical services, government policy should be implemented as soon as possible to enable universal access to essential medical services.From the point of view of medical service activities, the linked development of three kinds of medical service activities should be accelerated. Medicine activities need to focus on improving drug supervision mechanisms, drug supply shortage guarantee mechanisms, and drug purchase mechanisms. Medical activities must aim to strengthen overseas communication and meet the requirements of financial services and fiscal levies, directly provide more support to the service capacity of medical service subjects such as medical institutions in relation to funding, promote the formation of new medical service models such as intelligent medical services, and improve their overall standard. There are still some problems in medical insurance activities, such as weak supervision of medical insurance funds and misappropriation of insurance. It is necessary to strengthen supervision and preventative measures, continue to implement reform of the system, improve the payment mechanism for medical insurance, solve the problems of accessing medical care in various locations, and mitigate commercial risks as soon as possible in order to improve the level of basic medical insurance.All datasets generated for this study are included in the article/supplementary material.HZ: project administration, supervision, and writing—review & editing. LZ: data curation, methodology, software, and writing—original draft. CZ: data curation and methodology. XC: methodology, supervision and writing—review & editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Dear EditorOne of the current worldwide challenges is struggling with the emerging disease of COVID-19. Following the announcement of the outbreak of the disease by the World Health Organization (WHO), numerous measures have been taken in the field of education, treatment and research at the national, regional and international levels by governmental and non-governmental organizations (NGOs).1Immediate and necessary decisions and measures such as closing schools and universities were taken and implemented by this headquarter. The initial instructions about the COVID-19 were published by official websites, including the Ministry of Health and Medical Education (MoHME) and the Universities of Medical Sciences included information on disease symptoms, methods of the prevention, diagnosis, and treatment of COVID-19. Iran, like other countries in the world, has taken extensive measures in this regard. On Feb. 25, 2020, the National Headquarter for Combating Corona (NHCC) was formed. 2Another concern about public health was mental and psychological health. Unknown and unpredictable future in the COVID-19 pandemic, along with misinformation and myths, has led to misunderstandings of health messages in the community. Restrictions on travel and quarantine at domestic and international airports in the spring, when most flights take place, have also raised concerns. 4Therefore, following the activities of the NHCC and MoHME, booklets on stress management and coping with anxiety were published. In this regard, a phone line for psychological counseling has been opened in the Ministry of Health and universities of medical sciences. Meanwhile, children are exposed to a lot of news about the disease epidemic. Therefore, publishing some booklets for children was another measure taken by MoHME to reduce their stress and anxiety.On the other hand, as previous studies have shown, fear of infectious diseases with high prevalence and mortality rate is associated with other psychological challenges such as stigma, discrimination, loss, feelings of fear of getting sick or dying, and helplessness. Another activity that took place in the first weeks of the illness and after the closure of schools and universities in Iran was teaching the students by distant education using virtual content and software. This kind of education ensured the students and their family and made them calm because they did not need to attend schools, universities or dormitories. In addition to government agencies, NGOs and charity organizations have taken steps to address the physical, economic, social and psychological harms of the disease. For example, some of these groups provided the equipment and supplies needed for patients and even members of the medical team, such as masks, gloves, and gown. These charity groups have also provided financial support to people suffering from financial problems during the closure of their businesses.5Despite all the measures taken in various areas at the national and provincial levels by government and non-government agencies, there are still some shortages. Because Iran is under numerous sanctions, especially in the field of health, and due to the lack of resources and equipment for healthcare services, an increase in the morbidity and mortality rate might happen in the long time. Although some efforts were made regarding the stress and anxiety of the public health, especially children and youth, there are some other measures which could be applied. Through online counseling, psychologists can provide training on how to deal with health issues caused by domestic conflicts, tensions between children and parents, and anxiety about illness. It is important to note that financial worries, sanctions, pressures, and deficiencies resulting from them could be associated with physical and mental disorders for people in Iranian society, especially for vulnerable, high risk groups such as low-income individuals and their families. Therefore, the support of international community and WHO, at least in lifesaving medical supplies, is essential. These kinds of lifting sanctions could decrease the tragedy and contribute to preventing the second wave of spreading the disease.


Computers and Education, American Journal of Pharmaceutical Education, and Theory into Practice. The author with most articles is Reddy, from Rutgers University. The most productive institution is the University of Virginia. The United States is the country with most academic publications, citations and with most international collaborations in its works. Worldwide research has followed an increasing trend, with optimum publication levels in latest years.The university learning classroom, in addition to a space for activities and architectural object, has a direct impact on the academic motivation, well-being and social relationships of the students. Thus, the link between the university classroom and the management of the socio-educational well-being of the student, in accordance with the principles of well-being theory, is a challenge that the current university must manage. The progress of worldwide research on this topic has been studied during the period 2004–2018. For this aim, a bibliometric study of 1982 articles has been applied. The results provide data of the scientific productivity of the journals, authors, institutions and countries that contribute to this research. The evidence reveals growing interest, especially in the last six years. The main category is Social Sciences. The most productive journals are  In recent decades, the progress reached in educational theories and paradigms, in addition to the development of information and communication technologies (ICT), have led to the need to transform the organization of learning spaces in higher education institutions (HEIs) ,2. This Nowadays, the classroom remains the physical framework that symbolizes educational pedagogy. It is the main element on which school buildings are projected ,5. ThereIn this context, learning spaces are not understood as a simple volumetric container of activities, but their concept goes beyond a mere architectural object. Appropriate for students and teachers, it manages to influence academic motivation, well-being and social relationships ,11. SincIn this same order, the link of the university classroom with the management of the socio-educational well-being of the student must be established according to the principles of the well-being theory, as one of the challenges to be met by the current university. The interest in the well-being and quality of life of students focuses on fully developing their capabilities and potentials. Indicators such as happiness, health and sociability allow you to focus on a healthy and sustainable university ,16.The revised literature has found the terminology around the main concept of research. In this sense, the concept of the classroom refers to the basic cell that is part of learning, where individuals are related according to certain physical, human, cultural and social circumstances and situations. In the classroom, diverse and meaningful learning modes are generated. The classroom therefore does not exist without the network of relationships between students, teachers, objects and facts ,18. At tLikewise, the term socio-educational well-being refers both to the psychological experience of happiness of the university student, due to the control and perception of their physical and mental conditions in relation to the act of teaching and learning ,20. As fThe purpose of this study is to analyze the research trends on the impact of the university educational space on the well-being, motivation and social interaction of the student, considering the physical-environmental, socio-perceptual and motivational attributes.In relation to the review of the literature carried out, and the work found that addresses this topic, the research problem concerns whether the design of the university educational learning and teaching space influences the socio-educational well-being of the student.As regards the main limitation found in this research is to discern whether, among other variables, the number of publications relates to a certain regulatory regulation, is due to the requirements of interest groups, or, on the contrary, to the needs demanded by the education system itself.Therefore, the principal objective of this research is to evaluate research trends on the impact of university classroom design on the socio-educational well-being of students globally during the period 2004–2018, considering the physical-environmental, socio-perceptual and motivational attributes.To get responses to research issues, a sample of 1982 articles from a selection of scientific journals from the Scopus database has been evaluated. This review applies the bibliometric method to synthesize the knowledge base on the impact of the university classroom on managing the socio-educational well-being of the student. The results revealed contributions in this field of research, so that it has made it possible to identify the main drivers, their potential trends, and reveal gaps in critical knowledge. Thus, it can be assumed that, at present, university learning spaces require a transformation that positively links the socio-educational well-being of the university student with the classroom where the teaching act is practiced and learning.Finally, it should be noted that among the lines of research currently being established in relation to the topic of the study, these relate, inter alia, to comparing the effect of the intrinsic characteristics of the university classroom on stress both in public and private universities, and in different countries; in addition to different studies that analyze the outcome in terms of inclusion and diversity.The study of the impact of the university classroom on managing of the socio-educational well-being of the student is supported by the analysis of the main theory that together with the basic concepts define the framework of reference in this issue of research. In this way, explanatory theory defines how a set of phenomena behave, in order to generalize and perform a separate generalization of cases.The literature review has allowed the detection and analysis of empirical, theoretical, critical, analytical or methodological scientific documents on the subject of research. The objective of this review was to obtain the research problem and the purpose of the study, in addition to generating a framework. Therefore, the literature analysis has offered publications that respond to the empirical study in the university classroom worldwide and has determined the impact factors of the classroom on the motivation and socio-educational well-being of the university student. The main publications in relation to the purpose of this study have made it possible to define in a concise and balanced way the definitions, concepts and theory on the impact of the university classroom in the management of the socio-educational well-being of the students.Otherwise, the revised literature provides definitions for the basic concepts of this research topic. Hence, it includes some reflections on the terms and concepts used in the context of this research.The link of the university classroom with the management of the socio-educational well-being of the student must be established according to the axioms of the well-being theory or the PERMA model  of Seligman, in 2011 . It is aThe well-being theory, in line with positive psychology, relates to the state of flow, referring to an intense concentration, the flexibility to react to new problems, the maximum performance of the capacity of the individual, and the feeling of pleasure and happiness, derived from the activity performed ,32.In order to define the concept of socio-educational well-being in the context of research, the term of well-being, as an abstract concept, refers both to the psychological experience of pleasure and happiness, as well as to the state of satisfaction and tranquility that individual submits because of their good physical and mental conditions ,34,35.Likewise, well-being focuses on capacity development and personal growth, as indicators of positive functioning. In other words, well-being encompasses a series of sensations that allow an individual to judge her/his life globally ,37. OtheThis concept transferred to the educational context has a special relevance. Thus, well-being in the environment is related to improving the teaching and learning process, increasing the capacity for attention and concentration, and promoting creative and holistic thinking ,39. In pNotwithstanding the above, social welfare includes the factors that participate in the quality of life of the individual, so that they allow their tranquility and satisfaction. It is an unobservable condition directly, which is understood and can be compared between different spaces from reflections. Thereby, the term socio-educational adds the goal of education to the concept. In this way, the concept of socio-educational well-being of student is a key factor in achieving better levels of care, success and motivation. While, historically, academic classrooms have not considered the parameters of comfort and well-being, it is now an analyzed factor, which links the learning space with student behavior ,41.The concept of personal space, studied by Hall in 1966, refers to the interpersonal distance that helps and allows the individual to interact with peacefulness and this is influenced by culture . In 1975Personal space is understood as a mechanism that regulates the boundaries between people and as a resource of alert to the invasion of space by another individual. Hence, it fulfills two fundamental roles, of self-protection and as a regulator of privacy ,38,47.Thereby, the concept of the university classroom refers to the educational space where the discents live, coexist, knowledge is transferred and, therefore, they are formed as citizens, with critical capacity, values and as protagonists of society. Nowadays, learning spaces are not understood as a simple volumetric container of activities, but their concept goes beyond a mere architectural object. This, being appropriated by students and teachers, manages to influence academic motivation, behavior and social relationships ,38,43,48The revised literature recognizes certain design factors involved in the classroom and their level of impact, both on the motivation ,43,49,50In 1995, Göttler expressed the influence of the physical and environmental characteristics of the educational environment on the social interactions and other psychosocial aspects of the student. Since then, numerous authors have continued with the approach to the issue from a psychological and physical approach ,40,48,51In recent decades, this research topic has become particularly relevant with the publication of a large number of papers worldwide ,28,36,40The design, quality and adequacy of learning spaces encourage students to maintain positive emotions, feel integrated and, thereby, to experience more favorable academic results ,49,52,53The literature shows evidence of the link between student satisfaction with the environment and the academic results obtained. Consequently, if the student experiences personal well-being and attachment to where she/he spends much of her/his daily life, this results in a positive impact on the attention, motivation, learning and sociability ,54.On the other hand, the impact of design on learning spaces, considering that the space intervenes in the social connection of students, thus encouraging collaboration, reflection, exchange and interaction. Conversely, if the design is insufficient, it can promote the development of childhood disorders, such as tacit muteness and lack of social interaction ,50.The influence of learning environments on children’s cognitive development and early literacy is undeniable. In such away, the primary cognitive development of human beings occurs through the relationships we maintain with our environment and the sociocultural stimuli perceived as external information. Hence, the study of the relationship between physical space and its impact on human behavioral processes is not novel . LearninLiterature indicates that the physical attributes of the environment and the configuration of the learning space act on the perception of students. In this dialogue where the level of well-being and the functional possibilities offered by space are related, the impact on the learning process of those who inhabit it can be positive if the conditions are ,38,40,55Learning is a multi-causal process that requires the integration of physical and environmental conditions to generate an enabling climate, allowing students’ behaviors to be more assertive and school environments to be healthy and rewarding ,50. The Thus, there is a relationship between the environmental variables of the built space and its effect on teaching and learning processes, such as lighting, temperature, thermal comfort, color, materials, noise level, indoor air quality ,52,53,56In this way, spatial variables defined by the physical characteristics of the classroom act as a scenario. It underpins the social and motivational actions that the student requires, maintaining a reciprocal and complementary relationship ,45,57. DIn this sense, the morphology of the building, the size, the enclosures, the floors and ceilings and internal divisions of the classrooms must offer a visual continuity, supported by methodologies that favor participatory, active, collective and collaborative. Thus, students better perceive group cohesion, commitment to tasks and cooperation when the organization of seats is in small groups and allows the visibility of the rest ,47. ThisThe socio-perceptual dimension considers the subject as an active protagonist that inhabits the school space, and the impact on her/his behavior. The analysis focuses on human action and interaction in spaces, an aspect that addresses Environmental Psychology ,38,45. AIn this sense, the location within the classroom is decisive in the perception of the student, while the preference of the company with friends generates positive differences in motivation and social relationships ,58. On tIn 1978, Canter, a precursor to the psychological perception of the classroom and the degree of satisfaction provided by a school space in the subject, noted that “by inhabiting the classroom, the individual is involved in the physical experimentation of his architectural space, all of this, taking into account the responses to certain variables” ,56. In tFrom this perspective, the classroom is not only a space where the students live, but it is also the place that represents the family, the activities, customs and culture to which the person belongs ,44, and Finally, the motivational dimension emerges from other variables misused in research, such as academic performance. This dimension serves cognitive and attitudinal factors that influence student efficiency ,37,55. IMotivation influences learning, so the design of the university classroom must improve motivation in learning environments. For example, Keller’s ARCS model  explains its relationship to learning processes ,62, in rDigital technologies applied to training and education also enhance motivation in teaching and learning processes and offer new opportunities for learning . The resIn order to achieve the objective proposed in this study, bibliographic data has been analyzed using two methods. A systematic  and a bibliomeric (quantitative) analysis of the data has been carried out.Scientometric is recognized as the scientific study of science and its results and is based primarily on the works of Solla Price and Garfield. In practice, there is a significant connection between scientometric and other scientific disciplines: bibliometric, information system, information science and scientific policy .Likewise, bibliometric is a component of the scientometric that utilizes mathematical and statistical processes to the scientific production and the authors that generate it, with the purpose of researching scientific activity. The instruments applied to measure aspects of scientific activity are bibliometric indicators; these are measures that offer evidence on the results of scientific activity ,66. It wThe purpose of this study is to recognize, organize and analyze research trends in the impact of the university classroom on managing of the socio-educational well-being of students, considering the physical-environmental, socio-perceptual and motivational attributes. To accomplish the proposed purpose, a quantitative analysis has been implemented, using bibliometric. In latest decades, it has provided to the review of scientific knowledge, and has been used productively in various scientific disciplines: health, engineering, economics, administration, education or ecology ,68,69.The methodology has been developed to analyze the scientific communities associated with this theme. The relationships between authors, institutions and countries, interpreted through the co-authorship of each document, have been analyzed, as well as analyzing the relationships between the keywords of all articles based on co-occurrence .The co-citation analysis allows the observation of documents with citations and references cited, which can show the intellectual basis and trends in a particular field of research. Thus, the authors, institutions and countries are determined based on the co-citations of the rest, which represent relevance in this discipline, so that these generators of scientific production can be substitutes for the ideas they represent.In this line, the co-occurrence analysis is used in order to provide a graphic visualization of the interconnection of the key terms within the documents analyzed. Generally, co-occurrence networks are used in order to facilitate a graphic visualization of potential relationships between authors, institutions, countries or terms in a text. Thus, the proximity relationship of two or more terms in a text unit can be observed, so that, if the terms co-occur in a sentence, there is a probability of their semantic relationship .In short, the co-occurrence criteria allow revealing and grouping strongly related concepts within the set of documents or records. This procedure examines documents in order to look for two or more concepts that tend to be presented together.The indicators of the collaboration structure, which measure the links between the authors, institutions and countries, have been analyzed through the processing tools and network maps due to their reliability and suitability in the bibliometric analysis .Through this methodology, the interest in the subject matter of our study has evolved, by modifying the most relevant authors, countries, journals and keywords in recent years. Several databases of scientific papers related to the subject that have been studied have been consulted.The two large scientific databases, Web of Science and Scopus, raise the main problem of the comparison and consistency of statistics derived from different data sources. It has been shown that Scopus has more indexed journals than Web of Science, in addition to minimizing the risk of losing documents during the search. Among its advantages, it stands out that it is easily accessible and offers some tools for viewing and analyzing data, as well as the option to download content in different formats, and that it provides a variety of data for each selected publication, its analysis and the comparison between them .The Google Scholar database has not been taken into account, as it has some limitations. In this sense, it includes a greater amount of non-relevant variables, so that the cleaning of the data is more laborious, the processing and classification of the results require more effort, and includes a large number of articles not reviewed by peers, that is, it contemplates publications with a low quality level.For these reasons, the information received from the Scopus database of Elsevier has been selected, as it is the largest repository of scientific articles and with a greater number of journals and authors, with peer review, compared to the rest of the databases . In addiThe method used was to carry out a complete search on the Scopus database, applying a search string, applying Boolean operators to the terms that combine this research: “higher education”, “university”, “classroom”, “well-being”, “integration”, “socioeducational” and “management”.A descending search has been carried out in order to study the topic of research. With this type of search, first a sample of data from a broad general topic is selected and, sequentially, more restricted searches of the initial sample are performed, in order to define the data of a specific topic. Moreover, data abstraction consists in reducing a particular set of data to a simplified representation, that is, it refers to the process of removing characteristics from a research field to reduce it to a set of particular characteristics.Accordingly, in a first search, the key concepts extracted from the review of the literature were included, including the entire time horizon, that is, from the publication of the first document on thematic study until the last full year, that is, from 1944 to 2018. In addition, all types of sources were included, according to the Scopus database . This search yielded a total of 4379 documents. Subsequently, the time horizon was limited to the last fifteen years (2004–2018), a period where the study presents relevance, including all types of sources. This second search yielded a total of 2389 documents. Finally, in the third search, only the articles were selected. The decision is based on the fact that the articles are the only documents submitted to a peer review process, which guarantees the scientific quality of the works. This last search yielded 1982 documents.In such manner, the purpose was to analyze the subfields of the title, abstract and keywords over a period of 15 years (2004 to 2018), as reflected in other bibliometric works ,76. The VOSviewer  is a software tool for keyword processing and grouping analysis used for map visualization, which allows grouping by co-authorship and co-occurrence. Additionally, using the VOSviewer tool, the collaborative structure indicators, which measure the links between authors and countries, have been studied through network mapping and processing instruments due to their reliability and suitability in the bibliometric analysis, as well as for the identification of research trends based on the use of keywords ,78,79. TIn the same way as with the articles, the total number of authors has also increased for the period analyzed. In the last triennium, 2016–2018, 37.30% of the total authors of the 15-year period are concentrated. It is noted that the number of authors who published in this topic of research between 2004 and 2006 was 289, amounting to 1986 authors in the triennium 2016–2018. This is a larger increase than experienced in the number of articles published, because the average number of authors by article has also increased. Thus, in 2004–2008 the average number of authors by article stood at 2.1 authors by article, while in the last period (2016–2018) it increased to 2.8 authors by article, with a maximum of 3.1 in the fourth period (2013–2015).On the other hand, the number of countries involved in the publication of articles on this topic of research has increased from 43 in the 2001–2003 triennium to 179 of the last period analyzed. Throughout the period analyzed, the total number of countries that have contributed to the publication of articles on the impact of the university classroom on managing of the socio-educational well-being of students amounts to 134.In addition, the number of citations increased from the first period (2004–2006) with 3,011 to the third triennium analyzed (2010–2012) with 4972. Since this trienium, the total number of citations of the total articles has been decreasing, with 3705 in the following period (2013–2015), and with 1257 in the last period (2016–2018). This circumstance is due to the fact that the published articles, that is, those corresponding to the last 6 years, will receive a greater number of citations in the coming years, for their recent publication and impact, in addition to their distribution in open-access , and thiThe number of journals that published articles on the subject of study increased from 127 in the first period, 2004–2006, to 535, in the last triennium analyzed, 2016−2018. Likewise, the number of institutions increased from 215 in the 2004–2006 period, to 1296 in 2016–2018.Finally, the number of references increased from the first period (2004–2006) with 3547 to the last three-year period analyzed with 24,899. This assumes that the average has been increasing from 25.61 in the first triennium (2004–2006) to 35.67 in the last period (2016–2018).In this regard, During the time horizon analyzed, 2004−2018, there are several categories where work related to the impact of the university classroom on managing of the socio-educational well-being of students has been found. Thus, according to the Scopus classification, there are a total of 27 thematic areas in which the 1982 articles analyzed are classified. It is necessary to clarify that the same article can be classified in more than one category, depending on the interest of the author and the publisher.The association of publications in this field of study, mainly, to the Social Sciences category makes sense, since the sustainability factors of higher education relate to learning opportunities in the classroom university , or the By country, among the 20 most important journals are those of European origin: United Kingdom (7), Germany (1) and Ireland (1), which are also the journals that have a better position in the SJR 2018 ranking, and those of American origin, United States (6) and Canada (1).The journals that have published most articles on this field of research have been Computers and Education (31), Teachers College Record (27) and Asia Pacific Education Researcher (22), so these journals represent 4.04% of the total articles published since 2004–2018. Computers and Education stands out because it concentrates a great interest in the scientific community, as evidenced by the high number of citations that concentrate its work, 976, and for the average number of citations by published articles, with 31.48 citations by article. Additionally, it is also the journal that presents the largest H index for published articles on this topic of research, 19, although it is quite far from the overall H index of the journal, for all subjects, which stands at 149. It is also the journal with the highest SJR impact factor: 2.323 (Q1), followed by Journal of School Psychology, with 1.751 (Q1), and Teaching and Teacher Education, with 1.512 (Q1).The importance attached to the relationship of the university classroom with socio-educational well-being for the most productive thematic areas. Thus, Social Sciences includes journals such as Teachers College Record, Asia Pacific Education Researcher, Theory into Practice or Australian Journal of Teacher Education; while the area of Computer Science, contains Computers and Education, International Journal of Emerging Technologies in Learning, Australasian Journal of Educational Technology or International Journal of Engineering Education. These findings are linked to the factors or variables described in the literature review. The journals contained in the thematic area of Computer Science assess the physical variables of the classroom ,60; whilThe author who has published the most articles on the subject of research is the American, Reddy, from Rutgers University, with five documents, followed by a group of authors with four documents each: the Americans Bradshaw, Dudek, Vazou and Webster, Chai (Hong Kong), and Hudson . However, the author with the highest number of citations on the research study is the American Bradshaw, with a total of 125. Furthermore, he is the author with the highest average number of citations by article, with 31.25, followed by Chai (Hong Kong), with 76 citations and an average of 19 citations by article. Of the 10 most prolific authors in this field of research, six—Reddy, Bradshaw, Chai, Dudek, Vazou and Webster—have the highest H index, with 4.It is noteworthy that the 10 most prolific authors in the publication of articles on this subject of research have American origin (6), followed by Hong Kong, Australia, Spain and Greece, with one each one. In addition, four authors published a final paper in 2018, the last year analyzed in this study, and three authors in 2017, indicating the importance and interest of the research topic.These results are in line with cooperative learning in university classes, as well as communication of teaching experiences and expectations in educational policies and classroom practices ,98.The impact and influence of the United States on the subject of study is well defined by both its scientific production and the cooperation in its publications. The United States, despite having the most powerful and influential HEIs at the international level, is a country that records a very high gap between the results obtained by those who did not finish secondary school and who have at least two years of university courses . In addiThe terms “Human”, in 437 documents, and “Teaching”, in 346, occupy the first two positions throughout the period analyzed. They are followed by the term “Education”, in 332 publications, and “Students”, in 2031. On the other hand, the composition “Organization and Management”, is in fifth position, with 213 articles. For its part, the terms “University”, with 211 articles, and “Higher Education”, with 154, occupy the sixth and eighth positions, respectively. Also noteworthy are the terms “Well-being”, “Classroom” and “Integration”, among the 20 keywords in the period analyzed (2016–2018).These lines of research bring together all the concepts related to the topic of research, since it includes aspects related to the sustainability of institutions education in a globalized and connected world , and witAs an additional advantage, it is noted that research on this topic continues to advance at the global level, with other concepts and strategies, such as “Knowledge Management”, “Education for Sustainability” or “Managing Behaviour” ,106,107.Organizations are also making an effort in line with education for sustainable development, since it is understood that, as UNESCO points out, education, in all its forms and all its levels, is one of the most effective tools for inducing necessary changes in order to achieve sustainable development and optimal management of socio-educational well-being ,110,111.The evolution of the keywords and their association in clusters is related to the dimensions or factors of the study theme indicated in Other relevant terms have also been grouped around the line of educational management  students”, “management of innovation and change”, “management development”, “management and regulation of education”). On the other hand, the research is linked to the different thematic areas of Scopus, generating a map highlighting the terms “Education”, “University”, “Students”, “Higher Education” and “Organization and Management”.The aim of this study was to study research trends on the impact of the university classroom on managing the socio-educational well-being worldwide over the previous 15 years, considering the physical-environmental, socio-perceptual and motivational attributes.A bibliometric study of 1982 articles achieved from the Scopus database has been developed. Thematic areas, journals, authors, institutions and most productive countries have been recognized in publications on this field of research.The number of scientific papers by year during the period 2004–2018 has increased, mainly in the last six years, where 1207 articles have been published, representing 60.90% of contributions on this research topic.The Social Sciences thematic area is the most relevant, grouping 45% of the articles, and it is followed by Computer Science and Medicine, with 8% and 7%, respectively.The most prolific journals have been Computers and Education, American Journal of Pharmaceutical Education, and Theory into Practice, with 4.04% of all articles published each one (34) in the analysis period. It should be noted that 40% of the journals that contribute to this topic are positioned in Scopus’ first quartile. Journal of School Psychology is the journal with the highest number of citations (420), which presents the highest H index for published articles on this subject area (8) and presents the best average number of citations by article, with 46.67.The authors who have published the most about the field of research are the American Reddy from Rutgers University, with five articles, followed by a group of American authors , Chai (Hong Kong), and Hudson , with four publications each one. Bradshaw, from the University of Virginia, is the author with the highest number of citations (125) and the highest average of citation by article (31.25).The most prolific institutions in this area of research are the American ones Iowa State University, University of Texas at Austin and University of Virginia, and The University of Hong Kong (Hong Kong), and the University of Queensland , with 12 publications each one. The University of Virginia (United States) has the highest number of citations (466) and the highest average citations by article (38.83). In the group of the top 10 institutions with the most contributions to the subject of study, by country, the United States stands out with 7.The main countries that have made an effort is this field of research, in order of importance are the United States, the United Kingdom, Australia, Spain and Turkey. Thus, the United States presents the largest number of published articles (787) and citations (9496). In relation to the countries that have made the greatest international collaboration in their articles, the United States, the United Kingdom and Australia stand out.Nevertheless, this research has some limitations, which could be the basis for future research. Mainly, these come from the intrinsic characteristics of the quantitative analysis of the bibliometric method. One of these restrictions is that some authors publish few articles with high influence in a certain field of research. Furthermore, this method could be extended with other databases or quantitative or qualitative instruments, which would simplify a distinct perspective of the research. Alternatively, other types of documents, additionally to scientific articles, could also be incorporated in the study.In the context of the limitations of this research, these refer to the breadth of the focus of the purpose of the study for university students, since their location, grade, course, gender, race or other defining characteristics have not been specified. In addition, another limitation refers to the use of a sample with quantitative data and not having considered the advantages of qualitative data. It is also noteworthy that the study addresses the possible metabias, particularly as parameters for study samples demographics were not delineated.Future lines of research on this topic will focus on how neuroarchitecture analyses the impact that educational space has on learning activities, through holistic measurements and interpretations. Alternatively, other contributions should also study the impact of the interrelationship of the different natures of which the learning space is composed , in order to observe how their level of relationship may benefit or impede the notion of identity and the sense of belonging of the students. In addition, it should be explored how the transition between the intermediate level and higher education requires students to adapt to different processes and situations that require the implementation of various personal resources and assume participation in the new roles. This involves describing academic stress from the cognitive and affective processes that the student perceives of the impact of academic stressors.In this regard, it is necessary that future research be directed, not so much to the description of the factors that impact the well-being of the student, since they are very developed, and to investigate in a practical way how specific modifications, for example physical space, have impacts on the motivation and well-being of university students. In line with the findings of this study, they can be referred to practical applications, such as visual thinking, flipped classroom and active cooperative learning methodologies that influence students’ communication and interpersonal relationships.Finally, it should be noted that it has been noted that trends in research on the impact of the university classroom on managing of the socio-educational well-being of students worldwide have followed an upward trend and stabilized in optimal publication rates in recent years.


Cannabis has been widely used as a medicinal plant for millennia; however, studies related to its main components were first conducted in 1960. Subsequently, laboratories have produced new components and structures related to its active biological properties. Countries that have approved the medicinal use of cannabis impose regulations that govern its clinical and scientific use. One means of administering medicinal cannabis is via a magistral preparation that must have a medical prescription and be prepared in an establishment that meets quality standards to ensure the quantities of its main components, such as tetrahydrocannabinol (THC) and cannabidiol (CBD). Furthermore, suppliers must have a clear indication of its use in the patient before prescription. This review shows the published evidence regarding the clinical use of medicinal cannabis magistral preparations in the management of post-chemotherapy nausea and vomiting, neuropathic pain in multiple sclerosis, and anorexia and cachexia in patients with HIV. The history of cannabis dates back to the year 4000 BC, with its first remains found in China. The first records of the use of cannabis are also found in a Chinese treaty, according to which, marijuana tea was used for the treatment of gout, rheumatism, malaria, and memory loss. However, the treaty warns of the main adverse effects, such as hallucinations and a feeling of “light body” . SubsequThis situation changed with the stigmatization of use at the end of the 19th century, when the epidemic of opioid abuse arose and legislation was introduced that regulated chemical substances related to psychoactive components, mainly as a control measure to address addiction. Therefore, in 1937, the Marijuana Tax Law was approved in the US, which made the non-medicinal use of cannabis illegal. In 1939, the Colombian government prohibited the cultivation of the plant and ordered the destruction of existing plantations .Documents and evidence related to the use of medicinal cannabis in a clinical context are scarce. According to a review of the research, the National Academy of Sciences, Engineering, and Medicine concludes that there is conclusive or substantial evidence of the effect of cannabis on chronic pain, chemotherapy-induced nausea and vomiting, multiple sclerosis-associated spasticities, and refractory epilepsy. Moderate or low evidence indicates an effect on sleep disturbances  ,4,5, HunOne means of administering medical cannabis is via compounding formulas. According to the technical definitions of the US Pharmacopoeia, chapter 795 , and theIn the context of medicinal cannabis in Colombia, under the regulations of Decree 613 of 2017 , these mDispensing of these magistral preparations must include : common The regulations in Colombia regarding the magistral formulation relate to the following: (i) The norms for the control, monitoring, and surveillance of the import, export, processing, synthesis, manufacture, distribution, dispensing, purchase, sale, destruction, and use of substances subjected to control, medicines, or any other product other than cannabis, its resin, extracts, and tinctures on the yellow list of narcotic drugs, and THC on the green list of psychotropic substances . (ii) ReTo understand the importance of the key characteristics of medical cannabis, its pharmacokinetics and pharmacodynamics are described in ®), synthetic THC (Dronabinol), and pure CBD extract (Epidolex). The above ligands can act on CB1 or CB2 receptors and are designed to create cannabis-like properties and reduce undesirable side effects [Concerning the pharmacodynamics of medicinal cannabis, the endocannabinoid system is responsible for maintaining body homeostasis by regulating temperature, sugar, pH, and the elimination of metabolites. Its activation can be conducted by endocannabinoids (anandamide and 2-arachidonylglycerol (2-AG)), by phytocannabinoids  and synthetic cannabinoids , THC/CBD extracts  management of nausea and vomiting post-chemotherapy, (ii) neuropathic pain in multiple sclerosis, and (iii) anorexia and cachexia in HIV. We also aim to show the main regulations related to these master products in Colombia.To increase consistency between the results, the three reviewers reviewed the 735 articles selected for the indication of anorexia and cachexia in HIV, 742 articles for the indication of post-chemotherapy nausea and vomiting, and 763 articles for the indication of neuropathic pain in multiple sclerosis. A free web application, Rayyan, was used as an aid in conducting systematic reviews, in which the analysis of the searches and elimination of duplicates was carried out according to each indication. Disagreements in the selection of the studies, and the extraction of the data by consensus and discussion with the other reviewers, if necessary, was documented in PRISMA format for panoramic reviews ,34,35.Data were extracted based on the characteristics of the article . The studies were grouped and summarized for each of the proposed clinical indications and the type of population and study design, in addition to key measures of interest to our search. After selecting the included articles for each indication, the studies described in The results obtained from the search of the literature, in general, draw attention to the small number of studies that met the inclusion criteria and the scant evidence of the use of these magistral preparations based on medicinal cannabis. Regarding the selected indications and the use of magistral preparations: anorexia and cachexia in HIV have one published article; post-chemotherapy nausea and vomiting have three articles; and for neuropathic pain in multiple sclerosis, no related article was found.In the studies that met the selection and inclusion criteria for the indication of post-chemotherapy nausea and vomiting, it is observed that the evidence corresponds to publications over 30 years. This indicates that there is no new evidence related to the use of these magistral preparations. Furthermore, according to the chronological order of the studies in the case of the indication of post-chemotherapy nausea and vomiting, it is observed that in the first study, by Frytak et al. in 1979, the doses of the magistral preparations based on THC were high compared to those in other studies. No maximum dose of THC was applied, and the study therefore showed a greater number of adverse events and treatment discontinuations .The articles identified during the panoramic review of the characteristics of the cannabis-based magistral preparations for the two indications of anorexia and cachexia in HIV and post-chemotherapy nausea and vomiting agree with the finding in the literature that the main component of these formulas must be THC. However, it has been shown that the use of formulas rich in THC can predispose patients to an increase in psychoactive adverse events, which could be reduced with doses of CBD, given its properties of control over THC-induced psychoactive effects .Regarding the excipient, only one of the magistral preparations contains sesame oil, which influences the pharmacokinetics of medicinal cannabis because it allows optimization of its absorption and bioavailability. Most of the magistral preparations based on cannabis have poor bioavailability . The litHowever, one of the limitations described in the studies is that these medicinal cannabis-based drugs are not front-line for the treatment of established indications, but must be considered in indications that are refractory to conventional treatment, and additionally, they are not exempt from the presentation of adverse events.Regarding the risk management of cannabis-based magistral preparations, adverse events have been recorded in relation to the use of formulas rich in THC, such as psychoactive symptoms, sedation, and alterations in mood. These are observed in greater quantity with high doses of THC compared with few adverse events associated with the comparators used (prochlorperazine and placebo), consistent with the effect being mediated by dose-dependent THC . CurrentIn the case of drug interactions, in the indication of post-chemotherapy nausea and vomiting, Orr et al. in 1981 observed that cannabis may be more effective in controlling vomiting associated with some types of chemotherapy, such as cyclophosphamide, 5-fluorouracil, and doxorubicin, and less effective for nitrogen mustards and nitrosurea . InteracThe panoramic review had a number of limitations. Some of the obtained studies did not describe the specific characteristics of the magistral preparations used, which precludes a more in-depth analysis of these magistral preparations and their clinical use in relation to the outcomes or adverse events. In addition, since the initial study found in the literature, a lack of previous studies or reports of the use of these medicinal cannabis magistral preparations has been documented, which may result in little knowledge of these magistral preparations.The following aspects are recommended for the evaluation and management of patients who could benefit from the use of cannabis-based magistral preparations ,42. The The study protocol was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement, in addition to the panoramic review recommendations of Levac et al. and The Johanna Briggs Institute, which have been reviewed in detail ,35,43,44To be included in the review, the articles had to be original articles, literature reviews, narrative reviews, systematic reviews, or meta-analyzes that examined the use of magistral preparations of medicinal cannabis for the management of post-chemotherapy nausea and vomiting, neuropathic pain in multiple sclerosis, and anorexia and cachexia in patients with HIV, in a population of men and women over 18 years of age. No restrictions on publication time or language were applied. Each indication was searched for separately. The articles were excluded if they did not fit with the conceptual framework of the study or focus on the use of the magistral preparations in the three previously established indications. Letters to the editor and editorial comments were also excluded.Published articles (published until April 2020) that reported the use of magistral preparations were identified using computerized literature searches in Pubmed, Medline, EMBASE, Google Scholar, Cochrane, LILACS, and OpenGrey . The seaMagistral preparations based on medical cannabis are specific preparations for a patient who is undergoing optimal treatment, or in the case of refractory conditions, because there is not enough evidence to indicate the efficacy of these preparations as a front-line treatment. These preparations require a prescription from a doctor who determines the potential benefit of their use. Although it is known that cannabis-based drugs have a favorable safety profile compared to other drugs, there is not enough conclusive evidence in this regard. This research provides key tools to understand the importance of individualizing prescriptions for these types of formulas, monitoring them in the context of efficacy and safety, and monitoring the therapeutic levels for their use in the examined indications.


Social isolation is currently identified as the best way to prevent theinfection by the new coronavirus. However, for some social groups, such aschildren and adolescents, this measure carries a contradiction: the home,which should be the safest place for them, is also a frequent environment ofa sad aggravation: domestic violence. This study aims to evaluate thenotifications of interpersonal/self-inflicted violence available in theInformation System for Notifiable Diseases in the State of Santa Catarina(southern Brazil), for the juvenile age group, before and during the newcoronavirus pandemics. Cross-sectional, descriptive study of violence against children andadolescents (from 0 to 19 years) notified by health professionals bycompleting and entering the occurrence in the Information System forNotifiable Diseases of the State of Santa Catarina in 11 weeks in which thesocial isolation measure was instituted as mandatory, comparing with thesame period before this measure. During the study period, 136 municipalities in Santa Catarina made 1,851notifications. There was a decrease of 55.3% of them in the isolationperiod, and the difficulties encountered in seeking protection andassistance institutions were listed. The society needs to be aware of possible cases of violence in the childrenand adolescent population. It is important to provide accessible, effective,and safe ways for complaints and notifications, as well as a quick responseto the cases, aiming at protecting victims and minimizing damages to preventthe perpetuation of the violence. On March 11, 2020, the World Health Organization (WHO) recognized that COVID-19disease, caused by the new coronavirus (SARS-CoV-2), has taken pandemicproportions.Since the first cases identified in Brazil, the population has turned its attentionto the devastating numbers of contaminated people and deaths, the adequacy with theways to avoid contagion and the sanitary obligation of social isolation. As aresult, daily activities of children and adolescents outside their home wereprohibited, such as attending classes, circulating in public environments, and evenhanging out with friends, restricting the social space of individuals to the homeenvironment.Despite laws and advances in the development of assistance and care strategies, thenumbers on violence in pre-pandemic Brazil were already worrying.Data from the Informatics Department of the Unified Health System (DATASUS) revealthat in 2017 there were 126,230 cases of violence against children and adolescentsup to the age of 19 .The record of 21,559 deaths from external causes, accidents, and violence up to theage of 19 shows that many did not resist the abuse. Of these cases, a quarter diedbefore the age of 10, and more than 10%  were up to 4 yearsold.In 2019, the Dial Human Rights , a telephone tool provided by the Braziliangovernment to receive, analyze, and forward complaints of human rights violations,including cases of violence, revealed 159,063 complaints of maltreatment - anincrease of 15% compared to 2018. Of these complaints, 86,837 were violence againstchildren and adolescents (55%), distributed as follows: 38% linked to negligence,23% to psychological violence, 21% to physical violence, 11% to sexual violence, 3%to exploitation/child labor, and 3% associated with other violent injuries. The mostfrequent place of occurrences was the victim's home.In the state of Santa Catarina, from 2015 to 2019, 65,672 notifications wereregistered in the Information System for Notifiable Diseases (SINAN). Of these,38.4% occurred in the age group of children and adolescents.Intrafamily violence is difficult to unravel, as it occurs in the private sphere, inthe domestic environment, within homes and is protected by the law of silence, bythe fear, and impunity of its agents - people who should support and protectchildren and adolescents. This violence covers five types: physical, sexual,psychological, neglect, and specific forms, which are expressed in the forms ofMünchhausen syndrome, chemical violence, and filicide.This study aimed to present data on compulsory notifications on cases of violenceagainst children and adolescents in the state of Santa Catarina, in the months afterthe emergence of the new coronavirus, and how the establishment of sanitary measuresof social isolation influenced the increase in domestic violence against childrenand adolescents when comparing this information to that of the pre-pandemic, toalert health professionals, public institutions, and society to the need toreinforce actions to prevent injuries, protection, and adequate care forvictims.This is a cross-sectional, descriptive, and analytical study of violence againstchildren and adolescents (aged 0 to 19 years old) notified by health professionals,by filling out and inserting into the SINAN the Notification Forms for IndividualInvestigation of Interpersonal/Self-inflicted Violence,2.According to the Brazilian Institute of Geography and Statistics (IBGE), in 2012,the Brazilian state was the 11th in size of the population, with 6,248,436inhabitants. The estimated population in 2019 was 7,164,788 inhabitants, with971,034 being the population of children and adolescents. Santa Catarina has 295 municipalities, distributed over 95,730,921kmThe study analyzed the data using descriptive statistics.From January 1 to May 31, 2020, 136 of the 295 municipalities in Santa Catarina made1,851 notifications in SINAN of suspected or confirmed cases of interpersonal orself-inflicted violence in the 0 to 19 age group. These events were characterizedas: neglect or abandonment, physical, psychological, sexual, and other violence, andchild labor .10At the time of data collection for this study, only 46% of the municipalities hadincluded cases of violence in SINAN. The data request was sent to all municipalhealth departments in the state of Santa Catarina. The response of less than half ofthem may be due to the need for restructuring health facilities and adapting theirfacilities to the service demands of the pandemic.For 30 years, the Child and Adolescent Statute (ECA), under Law No. 8,069/90, madechildren and adolescents “subjects of law” in Brazil. It delegates to society theduties to protect and care for these developing Brazilian citizens and emphasizesthe obligation to ensure full compliance with the rights necessary to promote theirfull potential, removing any form of oppression or discrimination. In its Article13, ECA determines the obligation to report all cases of suspected or confirmedphysical punishment, cruel or degrading treatment, and maltreatment of children tothe local child protection councils, without damage to other legal measures.In 2001, the notification of suspected or confirmed cases of abuse against childrenbecame mandatory and directed to municipal epidemiological surveillance and thechild protection council.Data from social organizations and non-governmental institutions published in themedia report an increase in violence against children and adolescents in thepandemic, such as the 7.4% increase in the Federal District,The state of Santa Catarina has provided data on the number of cases of domesticviolence against children and adolescents since the emergence of the COVID-19pandemic.Based on SINAN notifications from 136 municipalities in Santa Catarina that releaseddata  for 2020, there was a progressive decrease in the totalnumber of notifications since the beginning of social isolation, the absolutenumbers in January, February, March, April, and May are, respectively, 469, 506,434, 273, and 169 .10 WheDoes this data mean that violence has decreased? We believe it has not. Severalfactors can justify the significant reduction in notifications. The need forrestructuring and adapting health services to the pandemic reality, directingemployees and health units for the exclusive care of cases of acute respiratorysyndromes, and overload of the teams of health workers due to the increased demandfor care may have made it difficult for users to access services usually availableto the population. Added to this, we have the interruption of public transportservices, which imposed difficulties in traveling and accessing health services. Thefear of contamination, the social isolation imposed, the limitations for leavinghome, added to the financial difficulties resulting from the pandemic, may haveconstituted barriers to reporting violence and seeking assistance and the consequentdecrease in notifications.For many women, the health measures adopted to cope with the new coronavirus demandedmore domestic work, greater care for children, away from daycare centers andschools, besides greater assistance to the elderly and sick family members. It isinferred that movement restrictions, financial limitations, and generalizedinsecurity encourage abusers, giving them a greater sense of power and control.Confinement also brings different changes in the routine of family members, leadingto stress, which, if not well conducted, can lead to consequences for the entirefamily dynamics. These consequences can affect the physical and mental health ofchildren and adolescents, especially young children, who do not have the necessarytools to adjust to stress or to overcome it, which can make it especiallyharmful.Family stress is closely associated with uncertainty/insecurity in the near future,the possibility of falling ill and experiencing the illness of a family member/lovedone, fear of not getting adequate access to health, not promising news in the media,economic problems related to job loss and/or reduction of monthly family income.Added to these facts is the increased time spent with children and adolescents, nowalmost 24 hours, both due to the need for social isolation and the closing ofschools, parks, and leisure areas in the condominiums.Stress is also associated with the absence of other components of the family supportnetwork, such as the interaction with grandparents, uncles, neighbors, domesticworkers, and even institutions such as churches and social projects. This tensionexperienced and expressed by parents is reflected in children and adolescents, whostart to adopt the same behavior: tension, demotivation, and aggression, which canbe intensified by the excessive time on screen.This whole range of factors favors a violent domestic environment, which, associatedwith the distance from the protection agencies, the fear of losing the only providerof the family, of not being able to leave the house, for example, to stay at theirparents' house (grandparents of the children), even because of the fear of rupturingthe relationship, thus enabling the maintenance of the pact of silence inside thehouse, making everyone vulnerable to suffering violence.Family violence has a strong historical-cultural connotation: parents who wereeducated in a violent manner reproduce this form of education, resorting to physicaland psychological violence, manifested by beatings, hair pulling, spanking,shouting, and the most diverse threats as a way to impose discipline to theirchildren.The protective role of the school is recognized as paramount, identifying in theteacher often the confidant, the professional with a watchful eye on the studentsunder their care, the one who can be the trigger for the protection and care networkand guarantee the rights of children and adolescents. However, according to theUnited Nations Educational, Scientific and Cultural Organization (Unesco), about 1.5billion children and adolescents worldwide are out of school because of the closureof educational institutions as an initiative to contain cases of COVID-19.Still, much of the state's child protection structure, such as child protectioncouncils and police stations, is providing virtual assistance only. Additionally,public transport is absent in many regions and greater consumption of alcohol andother drugs, as well as psychoactive medications.A recent publication was assertive when it was titled “The pandemic paradox”, as thispandemic creates a paradox concerning security at home: a place where we should beprotected and safe is where violence occurs for the most vulnerable groups. Theauthors emphasize that we must all pay attention to this issue: “Governments aroundthe world have asked all of us to participate in the fight against COVID-19 bystaying at home, but it is also important to pay critical attention to what thismeans for many women and children”.Given this, specific and regional regulations were developed, initiatives to bethought and reproduced by states and municipalities, such as the National Councilfor the Rights of Children and Adolescents, dictating recommendations for the fullprotection of children and adolescents during the COVID-19 pandemic,On June 10, the National Council of Justice and the Association of BrazilianMagistrates launched the Red Flag Against Domestic Violence campaign. The initiativefocuses on helping women in situations of violence to ask for help in pharmacies inthe country, offering a silent channel of communication and assistance: with a red Xin the palm of the hand, which can be done with a pen or even lipstick, the victimindicates she is in a situation of violence. With the woman's name and address inhand, pharmacies and drugstore attendants who join the campaign should immediatelycall 190 and report the situation. At the time of its launch, the project had apartnership with 10,000 pharmacies and drugstores across the country.In the same direction, the Military Police of Santa Catarina and the National Councilof General Commanders of the Military Police and the Military Fire Brigade joinedforces, dispatched and disseminated, through the internal network, normativeinstruction with the addition of standard operating procedures for the specifichandling of incidents involving domestic violence against women.In the same state, Technical Note 012/2020, from the State Department of Health,dated May 19, 2020, deals with measures to combat domestic violence in the contextof the COVID-19 pandemic. It warns of the importance of notifying suspected orconfirmed cases and referring them as soon as possible to protection agencies andmultiprofessional care as recommended in the care protocols. The note also listssuggestions for protective actions for victims and informs contact phones ofentities in the protection network.Law no. 14.022 was recently published in the Federal Official Gazette of Brazil, which ensures the full functioning, during theCOVID-19 pandemic, of entities assisting women, children, adolescents, the elderly,and citizens with disabilities who are victims of domestic or family violence.According to the law, assistance to victims is considered an essential service andcannot be interrupted while the state of public calamity caused by the newcoronavirus lasts.We chose to study data on domestic violence in children and adolescents underCOVID-19, considering the current concern of society for the risk of itsintensification during home confinement imposed by the pandemic. The small number ofmunicipalities that provided the notification data and the short period analyzed canbe mentioned as limitations of this study. Nonetheless, we understand that theselimitations are minimized by the relevance and urgency of the topic.It is possible to conclude that the reduction in the number of complaints of violenceagainst children and adolescents does not encourage, nor does it seem to reflect adecrease in the incidence of this condition. On the contrary, it can demonstratedifficulties that people may be facing in making the complaints and using existingsocial resources to care for the victims. Initiatives, although specific, areunderstood as beneficial, which warn of the need for attention to the problem. Inthis pandemic moment, with the confinement of children in potentially violent homesand spaces, it is essential that their surroundings and the whole society be alertto the suspicion and evidence of cases of violence and that accessible, effective,and safe ways are provided so that complaints, notification, and prompt response tocases occur, aiming at protecting victims, minimizing damage and, thus, preventingthe perpetuation of violence.


Currently, in the field of dentistry literature, one of most active research topics is clearly related to implants, bone materials, and regenerative strategies for the reconstruction of different oral tissues. Biomaterials and related technologies used with these purposes could only be derived from the integration of the knowledge of different disciplines, which together are skilled in generating innovation and research development, with extensive support of basic sciences and intense international cooperation. The combination of these resources, associated with the greater need for increasingly comprehensive and predictable therapeutic protocols, brings a substantial change in the treatment of oral rehabilitations. The development of biotechnologies and related new biomaterials is a major field of research and clinical innovation in all modern dentistry divisions, but especially so in oral surgery. In the current era of tissue engineering with the evolution of the properties, safety and efficiency of tissue regeneration and implantable materials, biomaterial research has contributed largely to the improvement in treatments strategy and to the suggestion of new therapeutic approaches in oral rehabilitation ,2,3.However, currently the most important research topic is clearly related to dental implants, bone materials, and regenerative medicine strategies for the reconstruction of oral tissues  These biThe interdisciplinary field of implant-supported oral rehabilitation alone is generating considerable literature, probably the largest literature from all dental-related topics today ,7. This This interdisciplinary collaboration also extends far outside the limited dental field to most medical disciplines as biomaterials often have multiple potential applications in the human body. Dental implants, bone substitutes, surgical adjuvants, and other instruments and the way to combine them all into a successful therapeutic strategy, particularly represent a new frontier in regenerative medicine with numerous applications in orthopedic, plastic surgery, and other related medical disciplines ,13.Today, the field of dental implants and related biomaterials is also the heart of translational research in dentistry. All of the new biomaterials are thoroughly designed and tested by material scientists, before they are finally tested in vitro, in vivo, in animal models, and finally in clinical settings. The translational research movement is always in both directions: basic to clinical sciences and vice versa ,15,16,17The international cooperation is an important step to develop and spread new ideas and projects, promote debate, contradiction, and sometimes consensus, and finally grow a shared literature with less misunderstandings, confusion, and bias .One final aspect of this field is related to the social sciences and appeared quite recently with the considerable development of this scientific field: the internationalization of higher education and research in this domain, its importance, and its consequences. With the growth of the scientific field and its industrial development, implant dentistry step by step became a major discipline worldwide in oral and maxillofacial sciences, leading to the constitution of various national leaderships and centers of research and education ,14,15.In this special issue on new materials in oral surgery and implant dentistry, we continued our task to gather a meaningful corpus of relevant articles. More than before, a better control of the specialized literature is due. We particularly describe the strengths, weaknesses, opportunities, and threats of these disciplines and how research in implantable materials, especially dental implants (new implant design and surfaces), bone materials, or surgical adjuvants, is affected by not only scientific bias and misunderstandings, but also industrial and financial interferences, creating many inaccuracies in the literature. Despite the incredible potential and revolution that these disciplines are supporting for patients and the clinical approach to oral rehabilitation, there is also a major threat to the credibility of this field ,20.We selected a series of articles with new data on a wide range of topics in biomaterials and regenerative research in periodontology, oral surgery, and aesthetic and implant dentistry, and we highlight how these interconnected fields of research are both transversal (multidisciplinary) and translational . In the following articles, most of the major current aspects of biomaterials in oral surgery are introduced.Several articles have focused on the molecular, cellular, and pharmaceutical aspects of the biomaterials used for bone grafting. More specific aspects have been investigated by other authors such as the biological mechanisms of dental implants, insisting in particular on the impact of implant surface topography on peri-implant tissues.Therefore, the articles gathered for this Special Issue highlight only a selection of key aspects of the current dental biomaterial sciences, which are both founding knowledge and innovative perspectives for the future of the field.