To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil.Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study.An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: The profile of routine prescrption in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization.It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety. Turner proposes the classification of off-label medication use when the medication is used in the dose, age, route of administration, and/or indication other than registration, while its unlicensed use is defined by the use of extemporaneous formulations.The pediatric age group is known to be a therapeutic orphan, due to the low availability of formulations adapted to this population. As a result, there is a high prevalence of off-label and/or unlicensed use of medications.Newborns or neonates (0–28 days after birth) use off-label drugs 90% of the time and can reach 100% in neonatal intensive care units. Due to the lack of information on the safety, efficacy, and quality of these drugs, a high frequency of adverse drug events (ADE) is observed in this population, especially among hospitalized patients. have shown that extemporaneous formulations are widely used, due to the lack of liquid dosage forms for oral use suitable for neonatology, especially for medicines of the cardiovascular pharmacological group. This is due to the patient’s physiological and anatomical immaturity. In this context, formulations for oral use are the ones with the best cost-effectiveness and lower risk, allowing better adherence, compatibility with medicine dispensers, and greater ease of administration (which can be done by tubes); however, some disadvantages have been reported, such as the difficulty in guaranteeing stability, the palatability of the formulation, the possibility of interaction with the tube and with formulas that replace milk and with other medications. Such factors must be evaluated, standardized, and validated during the preparation of formulations in the hospital setting, including the addition of excipients to maintain the homogeneity and stability of the pharmaceutical formulation.Several studiesIt is worth considering that drugs registered in the oral liquid dosage form can be good alternatives for use in the practice scenario, after evaluating their specificities and their suitability for the neonatal population, even with regard to the toxicity of the excipients and the dose.Pediatric pharmaceutical services in Brazil: recommendations and strategies to expanding coverage, access and rational use of medicines in children, the present review aimed to map the cardiovascular medicines used in neonatology in Brazil, considering those that have unlicensed use, related to the transformation of the original dosage form, described in the literature, but which are not registered in the Brazilian Health Regulatory Agency . With this mapping, the authors proposed that safe alternatives be sought for the use of these drugs, guiding both the facilitated registration based on formulations already registered in other countries and the validation, standardization, and provision of information on methods for compounding extemporaneous formulations in neonatology.In this scenario, in line with the document intensive care, neonatal, off-label use, and pharmaceutical preparations. The consulted databases were the Virtual Health Library (VHL), PubMed, and the Scientific Electronic Library Online (SciELO). The search was individually carried out by two researchers in June and July 2020 and considered publications from the last 20 years. After reading the abstracts, according to relevance and consistency, the following inclusion criteria were applied: original articles written in Portuguese, Spanish, and English languages; open access articles; and focused on Brazil. Exclusion criteria were: opinion articles; reflection articles; congress proceedings; editorials; articles that do not directly address the topic or that did not include neonatal patients in the scope of the study.An integrative review of the literature was carried out, through the established guiding question: what are the cardiovascular compounded medications needed in neonatology inpatient units in Brazil? To answer this question, searches were performed using the descriptors  to assess information on the registration of the oral liquid dosage form in the United Kingdom, as well as to verify if the medicines were part of the List of Essential Medicines for Children of the World Health Organization, if the medications had a registration of the oral liquid dosage form at ANVISA, through the System of Consultation to Registered Products (Sistema de Consulta a Produtos Registrados), and if there was information on the use of these medicines in the National Therapeutic Form  for neonatal patients.The results were compared with documents of the British National Formulary for Children (BNFC)A total of 16 articles were chosen, which addressed cardiovascular medications prescribed in neonatology. Seven duplicate articles were excluded and one from an alternative source was added. The 10 final articles were included for evaluation and discussion. The flowchart of the process for selecting articles for analysis is shown in The 10 studies were named by the editors as originals. As for the types of study, there were five descriptive studies; two cross-sectional studies; two cohort studies; and one prospective study, covering the years of publication between 2009 and 2020. All studies enabled to evaluate the prescription profile within the routine of the unit. All studies described the use of cardiovascular medications compounded for neonatology in a Neonatal Intensive Care Unit (NICU), according to the inclusion criteria.The 10 articles used in the analysis of the present study are described in  Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine.For better data analysis, the cardiovascular drugs indicated in the studies are presented in  and verified the existence of registration of the oral liquid dosage form in Brazil and in the United Kingdom, as described in The present study also compared the presence of the cardiovascular drugs mentioned in this review with the List of Essential Medicines for Children, of the World Health Organization, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. Considering that the articles have representative data of the routine of that clinical unit, the most cited drugs are more likely to be part of the list of medicines standardized for a given establishment. Therefore, these drugs are important medicines in neonatology.The studies used in this review state that the most indicated cardiovascular medications in pediatrics and neonatology are: Spironolactone, evaluated the demand for compounding oral liquid pharmaceutical formulations containing cardiovascular drugs, through interviews with pediatricians. In the interview, physicians identified the main drugs whose pharmaceutical formulation represented a problem in pediatrics, such as Captopril (5mg/mL), Spironolactone , Hydrochlorothiazide (50mg/5mL), and Propranolol (4 and 8mg/mL).Costa et al. described the cardiovascular medications prescribed to different groups of neonates through a cross-sectional study carried out in the Pediatric Intensive Care Unit (ICU) of a hospital in the city of Belo Horizonte , and found prescriptions containing the drugs Captopril, Furosemide, and Hydrochlorothiazide for neonatal use. Pereira et al. studied the use of magistral oral solutions and suspensions in newborns and children at a university hospital, by analyzing compounding request forms for patients admitted to the neonatal, obstetrics, and pediatrics ICU. This study mentioned pediatric oral liquid preparations of Captopril, Furosemide, Spironolactone, Hydrochlorothiazide, Hydralazine, Amiodarone, Propranolol, and Enalapril, which were produced in the compounding pharmacy, under the responsibility and guidance of the pharmacist.Ferreira et al. studied prescriptions for newborn patients with a mean age of 15 days and analyzed the prescriptions of compounded medication for newborn patients and their pharmacotechnical feasibility. The authors observed that drugs were obtained in the form of solutions based on the drug Captopril; as suspensions, for delivering the drugs Spironolactone and Furosemide; and as syrup, for delivering the drug Propranolol.Passos et al.. They are obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations such as solution, suspension, or syrup. This process occurs in 75.63% of medications in the pediatric ICU, due to patients’ difficulty or inability to swallow and the need for lower doses.Such drugs are not marketed in Brazil in liquid form, but are used in hospitals to make treatments viable. Therefore, they are invariably prepared extemporaneously. found that the cardiovascular drugs most prescribed in underdoses were Spironolactone, Captopril, and Furosemide, while Captopril and Digoxin were among the most prescribed drugs in overdoses, with the majority of overdoses occurring among lactating women.A relevant aspect in relation to obtaining pediatric medicines is the dose adjustment, which must be performed through complex calculations, which in turn are necessary to adapt the formulation indicated for adult use to another formulation aimed at pediatric use, usually with very small doses, as those used for neonates. Thus, Ferreira et al. which are essential to adapt the shelf life, packaging, storage, control procedures of quality, and traceability of these drugs. In this context, the use of such medications has become less safe and with less predictable results.Within this scenario, it is necessary to understand that the production of extemporaneous formulations, from the transformation of solid oral dosage forms into liquid oral dosage forms, represents a risk due to the presence of different excipients in the composition of these pharmaceutical products, which can cause adverse events in patients. In addition, there is the lack of information on bioavailability and physical, chemical, and microbiological stability of the resulting formulations that are not readily available, Thus, the compounding of medicines has a fundamental role in obtaining the feasibility of the drug therapy in neonatology.Moreover, the non-complete use of the compounded medication by the pediatric patient can occur and generate financial losses. Nevertheless, given the total absence of a suitable dosage form for this group of patients, compounding can still represent one of the alternatives to make the prescribed treatment feasible. it was verified that, with the exception of Captopril and the liquid oral form of Propranolol, the main drugs, such as Spironolactone, Furosemide, and Hydrochlorothiazide, are referenced for the treatment of priority diseases. Furosemide is included in the core list of the document, which deals with the minimum drugs necessary for an effective, safe, and cost-effective treatment for priority diseases in the health system. Conversely, Spironolactone and Hydrochlorothiazide, despite being part of the document, are included in the complementary list, concerning medicines to treat priority diseases that require specific diagnosis and therapy with a specialized professional, and must be evaluated as for safety and cost-effectiveness.Regarding the presence of the cardiovascular drugs mentioned in this review that are part of the List of Essential Medicines for Children of the World Health Organization,Captopril, although not listed in the document of the World Health Organization, has a well-established use for the treatment of various conditions in neonatology, such as: hypertension, heart failure, proteinuria in nephritis, and diabetic nephropathy in type 1 diabetes mellitus. The protocols for use, indication, forms of administration, and monitoring care are described for term and preterm neonates in the BNFC.Digoxin, despite being part of the core list of essential medicines for children of the World Health Organization and having its use established by the BNFC, was not observed in the NICU in this review. This result can be attributed to the fact that there are drugs with a higher therapeutic index, such as Propranolol and Amiodarone, to treat supraventricular arrhythmias, which is the main indication for the use of Digoxin in neonatology.The therapeutic class of diuretics includes the main prescribed drugs, as they are medicines of first choice in the treatment of pulmonary edema in neonates, which can be caused by conditions such as pulmonary stress or bronchopulmonary dysplasia, as well as in the clinical management of neonates with congenital heart disease. Overall, diuretics can be prescribed together, as long as they belong to different classes and act synergistically: Spironolactone as a potassium-sparing diuretic; Hydrochlorothiazideas a thiazide diuretic; and Furosemide as a loop diuretic. This can be attributed to the fact that there are regulatory incentives to gather information for important medicines in pediatrics, such as, for example, the pediatric investigation plan, in the registration of a particular drug or class of drugs, in addition to financial incentives and patent extension for companies that produce drugs with information on efficacy and safety for pediatric use.In addition, it was verified that, among the main cardiovascular medicines compounded for neonatology in Brazil, none has a registration of the oral liquid dosage form at ANVISA. Conversely, in the United Kingdom, four are registered, one of them being Chlorothiazide (ATC code: C03AA04), a thiazide diuretic that replaces Hydrochlorothiazide. Chlorothiazide is registered as a liquid oral dosage form and its use is licensed for neonatology. In comparison with the BNFC, it can be noted that there is no official reference of information for the safe and effective use of important drugs in neonatology (and pediatrics as a whole) in Brazil. The BNFC has pieces of information ranging from protocols for the administration and maintenance of therapy, standardized strategies for compounding extemporaneous forms, and data on efficacy and safety, including management of adverse events, doses, and medications registered and available on the market, and charged costs.None of the cardiovascular medicines compounded for neonatology had information on their use in the latest edition of the National Therapeutic Form. and the authors highlighted the need to also evaluate data on toxicity of excipients to ensure that the formulation is suitable for this age group.All cardiovascular drugs described in this review, regarding the demand for pharmaceutical compounding, can be classified as compounded medications necessary in neonatology, due to the lack of registration of the oral liquid dosage form in Brazil. This approach takes into account the adaptability of oral liquid dosage forms with regard to their cost-effectiveness and the suitability of this form concerning the anatomical and physiological immaturity of the neonate. This approach has already been used by Castro et al.,Assistência farmacêutica em pediatria no Brasil , which compiles recommendations and strategies that address these aforementioned points, seeking, in the long term, to correct the gap in access to safe and effective medications and to ensure the rational use of medicines for the pediatric population.Furthermore, there are few governmental, regulatory, or financial incentives for the manufacture and/or registration of dosage forms intended for pediatrics in the country, or for gathering safety and efficacy information, or even an official reference for unified information, for cases in which the need for compounding and the use of the unlicensed form are justified by the principle of beneficence. However, in 2018, a document was published within the scope of the National Medicines Policy entitled  Carvalho et al. correlated the non-standardized and unlicensed use of drugs in the NICU with severity scores and showed that the greater the severity of the clinical involvement, the greater the chance of the patient receiving a drug of this classification.Finally, it is worth highlighting that the use of off-label and unlicensed drugs in neonatal and pediatric patients may be associated with the emergence of adverse events.The main limitation of this study concerns the search for Brazilian articles, which should be considered regarding the generalization of data, despite the comparison with the BNFC.In this study, through the literature review, it was possible to map the cardiovascular drugs needed in neonatology in Brazil, such as Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. Despite their well-reported use in the literature, these medications are not registered as an oral liquid dosage form in the country, in contrast to the United Kingdom. Moreover, none of these drugs has an official reference for safe and effective use in neonatal patients in Brazil.The lack of appropriate formulations for pediatric use has repercussions on medical practice in Brazil and is exacerbated by the lack of adequate conditions for the compounding of medications by pharmacists in Brazilian hospitals. Such factors highlight the need for investment in the production and registration of medicines suitable for the pediatric population with the creation of regulatory and financial incentives for the pharmaceutical industry, as well as validation, standardization, and provision of information on methods for compounding extemporaneous formulations in the neonatology to increase the safety of these drugs, which are essential to improve the access of this group, therapeutic orphan, to safe, effective, and quality treatment and to reduce health inequities.


During the Coronavirus disease 19 (COVID-19) pandemic, isolation and prevention measures to reduce COVID-19 contagions are essential for the care of all people; these measures should comply with the principles of inclusion and accessibility for people with disabilities (PWD), with all kinds of deficiencies and levels of dependency. Thereby, the aim of this article is to present the measures adopted for PWD or people with rehabilitation needs, for containment, mitigation, or suppression of the SARS-CoV-2 virus in different countries of all continents and of all income levels.A narrative approach was used in this article. First, a broad search was carried out in the 193 member states of the UN, and then 98 countries that issued any document, report, or information related to disability and COVID-19 were selected. Finally, 32 countries were included in this article because they presented official information. We considered official sources, the information available in the government, or on the health ministry page of the country. In this way, the countries that presented information which did not correspond to an official source were excluded. The search was conducted in August 2020 and updated in March 2021.First, the non-pharmacological general interventions for PWD included informative measures and general recommendations during the stay at home, isolation, and biosecurity measures, contagion prevention, detection of positive cases, mobilization measures, and measures implemented in institutions or residences of PWD. Second, we identified the economic and social benefits provided to PWD during the pandemic. Finally, we identified the measures taken by countries according to the type of impairment  during the COVID-19 pandemic.In response to the COVID-19 pandemic, only 50% of countries from the five world regions created and implemented specific measures for PWD to containment, mitigation, or suppression of the SARS-CoV-2 virus. There is very little specific information available about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD, and for the prevention and response to violence, especially for women with disabilities. The Coronavirus disease 2019 (COVID-19) pandemic began in the city of Wuhan (China) at the end of 2019 and it was declared, according to the WHO  represent a vulnerable population; in this way Centers for Disease Control and Prevention (CDC) and WHO stated that some PWD may be more likely to become infected with the SARS- CoV-2 virus, or may develop a serious illness due to the underlying medical conditions, congregational living environments, systemic social inequities, and some barriers they might face in accessing healthcare during the pandemic –8. ThereIt is expected that COVID-19 affects this vulnerable population. Too often, PWD is left behind in emergencies, and this is a risk in the ongoing COVID-19 pandemic . PandemiIn some countries where health services have been accessible and affordable, governments find it increasingly difficult to respond to the growing health needs of populations and the rising costs of health services . During In this way, rehabilitation services must keep continuing during the pandemic; it is an essential component of high-value care to optimize physical and cognitive functioning to reduce disability. In this way, the interruption of these services may affect the well-being and quality of life of PWD and impose more burdens on a population that is already vulnerable , 16. SomOne study described the timely innovative proposals of scientific associations and rehabilitation professionals of different countries, focusing on delivering rehabilitation services, protection and prevention measures, physical distancing, isolation, hand washing, and disinfection measures in the context of the COVID- 19 pandemic. In this way, measures to prevent and protect against transmission of COVID-19 are necessary for all patients in rehabilitation care around the world .Bettger  publisheThis information allows for knowing some of the adaptations and reorganization of the rehabilitation services carried out in different countries to the health emergency by COVID-19, which had an impact on PWD or with rehabilitation needs , 18. UntThe main aim of this study was to describe the measures adopted by different countries around the world and of all income levels to guarantee universal coverage, access to information, and actions for prevention and mitigation of direct and indirect consequences of the COVID-19 pandemic, on PWD and with rehabilitation needs.We used a narrative approach  to identWhich were the responses and measures adopted by different countries for PWD and with rehabilitation needs, for containment, mitigation, or suppression of the SARS-CoV-2 pandemic?A narrative approach was used to identify the measures adopted by different countries for PWD or with rehabilitation needs during the COVID-19 pandemic. First, a broad search was carried out in the 193 member states that belong to the UN . Then 98In this way, the countries that presented information that did not correspond to an official source were excluded. We considered the official sources, the information available in the governments, or the health ministry pages of the country. Thus, we excluded 66 countries that presented information that did not correspond to an official source. We considered the following official sources: (1) The information is available on the government page of the country. (2) The information is available on the ministry page of the country. We excluded other sources of information, such as NGOs, foundations, private organizations, or independent organizations because this was not the focus of this review. The search was conducted in August 2020 and updated in March 2021.Eight researchers  conducted the data extraction using a predefined form to record the following information: (1) date of the declaration of emergency; (2) specific measures for PWD related to social distancing, biosecurity measures, travel restrictions, detection and tracking of cases, isolation of cases of PWD, economic benefits, and others related to the guarantee of rights; and, (3) specific measures according to the type of disability: hearing disability, visual disability, physical disability, cardiopulmonary limitation, intellectual disability, autism, and dementia.Finally, four researchers with expertise in rehabilitation screened the search results and selected 32 countries from five world regions: Africa (5 countries), America (10 countries), Asia (6 countries), Europe (9 countries), and Oceania (2 countries). Hence, 32 countries were included in this article because they presented official information issued by the government or the health ministry's official pages refer to .We categorized the information in non-pharmacological interventions for general PWD and interventions according to specific types of disabilities. First, we included the following interventions: informative measures and general recommendations during the lockdown, protection measures and prevention of COVID-19 contagion, detection of positive cases, management, and isolation of PWD; mobility, transport, and isolation; and measures taken within care institutions. Then, we categorized the interventions according to the following types of disability: visual impairments, hearing impairments, physical disability, cardiopulmonary limitation, and mental function that included autism, dementia, and intellectual disability.The findings reflect that some governments have made an effort for reducing the transmission of the disease in this vulnerable population because they have recognized the importance of providing access to health services and the need to adopt special and different measures for the prevention of contagion in PWD  refer t.Some countries made a declaration that PWD could have a greater vulnerability in this pandemic because they are constantly faced with physical barriers in the application of hygiene measures or social distancing. Besides, they require support from other people to carry out their daily activities .6).In this synthesis, we considered the following impairment conditions: visual, hearing, physical impairments, cardiopulmonary limitations, and alterations in mental function –6.People with visual impairments may have a higher risk of contagion by SARS-CoV-2 because daily they need to be in contact with objects, surfaces, or assistive devices to recognize the environment and to move in the space. For this reason, the countries around the world focused on recommendations based on frequent handwashing, cleaning of assistive devices, such as sticks, guide dogs, and other recommendations mentioned in Around all continents, the need to implement sign language to obtain better and clearer access to all information about COVID-19 has been recognized. This action would improve the rights of people with hearing impairment. The government states that not only translation is important, but it needs actions to prevent and mitigate the spread of COVID-19 in this population, such as the following measures shown in Most of the countries have a general concern regarding the people with physical disabilities, that is the cleaning of assistive devices and surface contact areas because this population usually needs help from another person and close contact with people or their own devices refer to .Countries focus their attention on preventing contagion by COVID-19 in people with any impaired cardiopulmonary function because they have a higher risk to develop secondary complications due to Coronavirus. In this way, most measures seek to prioritize the special care that this population group should have when they have a virus infection refer to .Some countries issued information focused on recommendations to orient people with autism, intellectual disabilities, or dementia. Governments issued information in easy-to-read material with information focused on prevention measures to avoid the spread of the virus. Furthermore, countries issued recommendations and advice about the care of mental health in this population during the pandemic refer to .Some American countries, such as Colombia, created programs to identify the PWD who had support needs to ensure their levels of quality of life and food security during the COVID-19 state of emergency . Chile mBrazil invested in the Social Assistance System with the aim of maintaining programs, projects, and services in the vulnerable areas of the country, mainly for the care of PWD and the elderly . The UniThe European countries, such as France made exceptional provisions to avoid any violation of the rights of the holders of the allowance for PWD, to deal with the social and economic consequences of the COVID-19 epidemic . Italy pIn Asian countries, such as Japan, there were guidelines for financial support for children with disabilities, due to the temporary closure of special support schools . The govIn some countries of Oceania, such as Australia, there was a payment to PWD to help them keep their jobs . New ZeaIn Africa, the country of Zambia carried out an inclusive, multi-partner socio-economic impact study on the effects of the COVID-19 outbreak to ensure that no one was left behind by targeting the most vulnerable group, such as PWD and the marginalized groups .In this narrative review, we described the non-pharmacological interventions for PWD that included informative measures and general recommendations during the quarantine period, isolation, and biosecurity measures, contagion prevention, detection of positive cases, mobilization measures, measures implemented in institutions or residences of PWD, the main economic and social benefits provided to PWD, and the measures taken by countries according to the type of impairment  during the COVID-19 pandemic.The WHO called for an action to strengthen the rehabilitation planning and implementation, including sanitary emergency preparedness and response to the current COVID-19 pandemic , 169. Invia telemedicine and through community-based networks, ensuring equitable healthcare access; guidelines prohibiting blanket decisions on medical rationing, solely on the grounds of disability, employment, and financial protection delivered through disability-related welfare provision; the development of support frameworks for people who need to shield from COVID-19 but who are outside of the social welfare or social care context ; education interventions and reasonable accommodations through online special education classes, accessible education activities, and distribution of educational materials; social care services, including psychosocial support, personal assistance, and support for independent living; prevention from and response to violence, in the forms of accessible hotlines for gender-based violence, especially for disabled women, and emergency services and shelters prepared to meet the needs of the disabled people; measures addressing the intersectional disadvantage the disabled people face, including the early release of disabled prisoners, and the provision of accessible health services for homeless people; and the inclusion of disabled people in the recovery phase, ensuring that structural changes are implemented, making the societies more inclusive (The disability considerations of WHO during the COVID-19 outbreak included the following: the provision of accessible information; provision of health services nclusive .Therefore, it is evident that there has been a real concern for the protection of the rights of PWD by supranational organizations which called on governments to guarantee the protection and promotion of the rights of PWD, as evidenced in our recent synthesis about the rights of PWD during the COVID-19 pandemic .Although there have been explicit statements about the prevention and mitigation measures from several countries, others did not do it, as many countries from Africa, Asia, and America especially, central America. Fewer were the declarations to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD. These kinds of responses were timely and more creative on the part of a professional's associations . Only 35Most of the countries involved in this synthesis had an inclusive response to the pandemic with the creation of measures for PWD but not all countries developed specific measures for each type of impairment. We also note that some countries developed guidelines about the recommendations to be taken for a specific type of disability, while other countries only issued a little information about it; also, some other countries only adapted the recommendations that other countries issued.The North American countries had a broad focus on the population living in the residential centers or home cares. Some other countries in Europe, such as the United Kingdom and Spain, had a real concern for people with impaired cardiopulmonary function. Most of the recommendations issued by the countries for people with a physical impairment only focused on the cleaning of assistive devices or surface contact areas; however, the recommendations in this population could be covered in a broader way.However, our findings are consistent with the WHO report that states that PWD may have a greater risk of acquiring COVID-19 because they daily deal with barriers to implementing basic hygiene measures, difficulty in carrying out the social distancing, the need to touch contact surfaces, assistive devices, or some objects to obtain information from the environment, or for the physical support. Besides, some others are institutionalized and others face barriers to the access of the public health information .As Bettger  describeOur results are consistent and support Armitage's approach that COVID-19 mitigation strategies must include PWD to ensure that they maintain respect for “Dignity, human rights, and fundamental freedoms, and avoid widening existing disparities” . This reMoreover, we share the approach of Ceravolo et al.  which stPandemics, such as COVID-19, place everyone at risk, but certain risks are differentially more severe for groups already vulnerable by the preexisting forms of social injustice and discrimination . For thiEven though an exhaustive search was made in the national pages of each country, relevant information, issued by different countries, such as reports, guides could have been disregarded due to the language of the information, or perhaps there was no easy way to access this information. The consensus process of recommendations is heterogeneous and, in some cases, not clear. Lack of evidence is inherent because no studies on long-term outcomes were available. Data about the care of PWD in low- and middle-income countries is lacking. There is little information about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD. Besides, the information is scarce about the consequences of COVID-19 in PWD, and we do not know the effectiveness of the implementation of these prevention measures in disabled people or with rehabilitation needs.We suggest that appropriate actions and prevention strategies for PWD should be implemented to reduce the contagion of COVID-19, such as vaccination prioritization, access in public places to wash hands when they are away from home, and provision of accessible information for this population through all media.It is necessary to strengthen and provide health services through telemedicine, telerehabilitation, and home-based rehabilitation, ensuring equitable access to medical care. Besides, we suggest that PWD who need educational interventions and reasonable accommodations for learning can use other methods for their learning, such as online special education classes or accessible educational activities. Also, we consider it important to strengthen social care services for PWD in times of confinement and social distancing.In those countries where specific guidance for the provision of rehabilitation for PWD was not prioritized, we recommend that national rehabilitation associations and providers make statements to ensure access to rehabilitation services.Therefore, we call for action from all authorities and other stakeholders to continue and strengthen the creation of measures that manage to address the needs of PWD and to reduce the barriers they experience in the current pandemic. In this contingency, it has not been enough to maintain the health care conditions for PWD. The need to work on strengthening communication and innovation in health care, the integration of countries and human groups to build the way of living in a new world, called the ‘New Normal’ is evident.In summary, our findings suggest that most countries around the world have adopted appropriate actions, creating and designing measures and strategies for PWD in response to the health emergency due to COVID-19. The response of different countries to the pandemic showed the need to implement actions for the prevention of contagion of PWD, their families, caregivers, and health professionals who provide rehabilitation services.However, there is very little specific information available about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD, and for the prevention and response to violence, especially for women with disabilities. Finally, it is important to highlight that PWD is still a vulnerable population because they are constantly facing barriers that hinder the implementation of prevention and protection measures in the COVID-19 pandemic.LL: definition of the research question and the objectives of the study, elaboration of the methodology for the research, selection of studies, data extraction, synthesis, elaboration of results, and writing the final article. MS: information selection, information research in different organizations, data extraction, information analysis, elaboration of the results, and writing the final article. JV: design and organization of templates for data extraction, content data extraction, and data organization and grouping. MG: analysis and preparation of results and annexes and writing the final article. AP: definition of the research question and the objectives of the study, elaboration of the methodology for the search, selection of studies, and data extraction. VO: synthesis, elaboration of results, selection, extraction, analysis of data from different associations, and writing the final article. LM: selection of studies, data extraction, and synthesis of results. KC: selection of information, information search in different organizations, data extraction, and information analysis. RD: selection, extraction, analysis of data from different associations, and writing the final article. CG: synthesis and elaboration of results and writing and reviewing the final article. DP: data extraction, synthesis and preparation of results, and writing the final article. 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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Taking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses the questionnaire survey method to analyze the effect of artificial intelligence (AI) on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. The questionnaire design has a total of 34 question classified into 6 role cognition items, with a 5-level score; a total of 1012 questionnaires were distributed, and 978 were recovered with a recovery rate of 96.64%, in which 957 were valid questionnaires with an effective rate of 97.85%. The study results show that the learning of AI-assisted courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activity methods. Therefore, the effect of AI on role cognition in the education system needs to be systematically analyzed from the aspects of function realization form, resource presentation method, supporting hardware form, teacher-student interaction method, and representation method of works. As connecters, teacher's role cognition is limited by the degree of understanding learners, the amount of resources, and data processing capabilities, but the advantage is that they can flexibly monitor and adjust. AI technology is flexible and diverse, it functions in learning and teaching activities in a variety of ways, and there is no agreement on the terminology to describe its role in role recognition. The results of this paper provide a reference for further researches on the effect of AI on role cognition in the education system. Artificial intelligence (AI) capable of autonomous perception, understanding, prediction, and action is an unprecedented powerful learning technology, which enhances the flexibility and adaptability of computers as interactive subjects in the process of teaching and learning. In the context of promoting the research and practice of AI education on a large scale, it is very necessary to systematically sort out the microscopic mode of action and role cognition of AI in supporting learning and teaching . In thisThe arrival of the era of AI has had a huge impact on role cognition in the traditional education system, requiring teachers to establish a new concept of talents, teachers and students, and teaching concepts, and reunderstand the role of teachers. Although each scholar has different views on role cognition, they all share a common view that role cognition is the early stage of the role development process . For teaTaking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses the questionnaire survey method to analyze the effect of AI on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. Taking secondary education as an example, the sample selection first randomly selects a class of five grade students in each school and then selects students with odd student numbers in each class as the survey object. For the convenience of the survey and to ensure the randomness of the sample, the parents or relatives of the selected student sample are taken as the family sample. The teacher sample was identified as qualified and full-time teachers, excluding principals, deans, and other administrators and service personnel. The detailed chapter arrangement is as follows: Using the method of questionnaire survey, this study takes the entire education system of Taiyuan City, Shanxi Province in Central China as an example to explore the effect of AI on role cognition in the education system. The education system targeted by the questionnaire involves school education system, computer network education system, enterprise education system, and social education system; the school education system also includes preschool education, primary education, secondary education, higher education, and adult education. The objects of the questionnaire design include teachers, students, administrators, and family members of various education categories. The questionnaire sorted out a total of 64 descriptions of the role cognition of various objects in various educational systems and then further sorted out the descriptions into 34 questions. Finally, according to literature materials, these 34 questions were classified as 6 role recognition items. The questionnaire uses a 5-level score, and the subjects are asked to make a choice of “extremely important,” “very important,” “relatively important,” “not very important,” and “not important” for each question listed in the above order and make a 5-point rating of 5-1 .The questionnaire of this study includes three parts: basic information, investigation themes, supplementary questions, and open-ended questions. The investigation subject part consists of 34 questions and is classified into 6 role cognition items: morality and discipline, knowledge and professionalism, activities and communication, guidance and consultation, research and practice, and goals and feedback. The thematic parts of the questionnaires used in this study for teachers, students, administrators, and families are consistent with each other and aim to understand the perceptions and attitudes of various object roles in various education systems with the possibility of side-by-side comparisons. At the end of each questionnaire, supplementary items of self-made questions are designed, such as “please write the questions that you think are important but not listed in the question, and give the corresponding score.” An open-ended question was also designed at the end of each questionnaire: “What other suggestions do you have,” aiming to further obtain more materials to have a more comprehensive understanding of the effect of AI in the effect of AI in the education system.The selection of the questionnaire survey sample adopts the combination of purposeful sampling and random sampling. A total of 5 units in each of the preschool education, primary education, secondary education, high education, adult education, network education, enterprise education, and social education in Taiyuan City, Shanxi Province, were selected, including 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners. The detailed sampling distribution of each system is shown in Teacher questionnaires were distributed and recovered with the assistance of the educational affairs department of the surveyed units; a total of 368 questionnaires were distributed, and 348 were recovered with a recovery rate of 94.57%, in which 343 were valid questionnaires with an effective rate of 98.56%. The student questionnaires were distributed and recovered by a combination of online and offline methods; a total of 402 questionnaires were distributed, and 399 questionnaires were recovered with a recovery rate of 99.25%, in which 393 were valid questionnaires with an effective rate of 98.50%. The school manager was distributed and recovered with the assistance of management department of the surveyed unit; a total of 118 questionnaires were distributed, and 118 were recovered with a recovery rate of 100%, in which 117 were valid questionnaires with an effective rate of 99.15%. The family questionnaires were distributed and recovered by means of online links; a total of 124 questionnaires were distributed, and 113 were recovered with a recovery rate of 91.13%, in which 104 were valid questionnaires with an effective rate of 92.04% .t-test and one-way analysis of variance were used to analyze the effect of AI on role cognition in the education system.Statistical analysis was carried out on 34 questions in the main part of the survey, text analysis was used for self-made questions and open-ended questions, and they were classified as qualitative analysis. SPSS 19.0 statistical software was used for statistical processing, the input data were analyzed, and the measurement data were expressed as mean ± standard deviation. The From a psychological point of view, role cognition is the foundation, and role behavior is the foothold. Therefore, this study discusses in the order of role cognition, role emotion, and role behavior and regards role identification as a structure that integrates knowledge, emotion, and behavior. The learning of AI courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activities. The form of function realization, the way of resource presentation, the form of supporting hardware, the way of interaction between teachers and students, and the way of representation of works are systematically analyzed. The design and practice of the cognition of the learning roles in the course support are highly consistent with the educational concept and value cognition of the AI course. Most of the supporting role cognition used in the current AI course teaching is based on code programming or graphical programming, and some schools have participated in the development of some learning role cognition . Most ofWith the support of AI technology, respecting the individual characteristics of learners and providing personalized guidance for learners is about to become a reality. Based on the learner's personal information, cognitive characteristics, learning records, location information, media social information, and other databases, the AI program can self-learn and build a learner model and continuously adjust and optimize the model parameters based on the expanded and updated data set, thereby realizing the push of personalized resources, learning paths, and learning services. The clearer the individual's cognition of the theoretical positioning of the role, the more successful the role plays; otherwise, it may lead to the failure of the role. Role cognition is also the premise and foundation of role behavior. There is still a big difference between face-to-face communication and face-to-face interaction between people. For the learning of students in school, it is necessary to respect the knowledge structure of the course, take into account the students' learning interests, and discover hidden laws based on data such as learning content, teacher suggestions, students' interests, and learning behaviors, so as to build an effective learning support model .The analysis of the effect of AI in the education system is characterized by active intervention in the learning process of students according to the cognitive characteristics of different students on the basis of data analysis, so as to optimize the learning process and scientifically evaluate learning effectiveness. The adaptive learning system based on cognitive level ability can apply the model to guide, intervene, optimize the learning process, and make scientific evaluation, which can be regarded as a system with real intelligent and adaptive functions. The application of AI technology in the establishment of students' personalized learning space, optimization of personal learning process, and improvement of learning efficiency can be expected, and its value is relatively easy to judge. The effect of AI is far lower than the role that students can play in the process of propositional knowledge learning. But in fact, on the one hand, the data processed by the perception layer is quite scarce, which greatly restricts the possibility of perceiving students' knowledge level and learning status through AI; therefore, it is still difficult to produce a truly intelligent and adaptive system.In role identity theory, scholars believe that role identity includes multiple dimensions, such as role cognition, role emotion, and role behavior. The feelings expressed by the individual's evaluation of the role cognition and the role affection are affected by the individual's experience of the role played and the environment in which the role is located. The combination of AI technology and education and teaching system has greatly improved the interaction between teachers and students in classroom teaching and the uniqueness of the education model . The popAccording to the different forms of existence, roles can be divided into three levels: expected roles, comprehension roles, and practical roles. An expected role is a set of ideal behavioral norms and action patterns set by a society or an organization for a specific social role; so, it is sometimes called an ideal role. The comprehension role is the behavioral norm and action mode that the individual understands, recognizes, and internalizes to the level of concept and consciousness. Practical roles are the practical behaviors and results that individuals show in the process of playing roles and performing normative duties according to their understanding of roles . When anArtificial intelligence has a positive and significant impact on both the cognitive and noncognitive levels of roles in the education system, and the effect at the cognitive level is higher than that at the noncognitive level. At the same time, AI has a positive effect on students' creative thinking ability, problem-solving ability, and academic performance. It further shows that AI has great potential in cultivating students' multiple abilities. Making full use of the advantages of AI's teaching aids to design courses will bring about the improvement of students' cognitive ability in different dimensions. AI has positive effects in different school stages, and the effect is the best in primary schools. The analysis results show that AI has positive and significant effects in elementary school, junior high school, high school, and university, and the effect is the best in elementary school, achieving a highly significant effect . Under tArtificial intelligence is sometimes unable to achieve detailed and emotional education; so, teachers should be confident in their status and role as educators. The effect of AI in the education system can be analyzed through the three core driving forces of big data, cloud computing, and deep learning to track and record the learning process of learners, pay more attention to the behavior and emotional changes of students, and analyze them according to AI. The data of intelligent statistics further analyzes the law of students' emotional changes and the incentives that cause emotional changes. The role cognition in the education system can take targeted and effective positive intervention methods to guide students to adjust and control their emotions, which is conducive to the sense of belonging, security, and identity of the role, thus producing a positive emotional experience. As shown in Teachers should have the courage to face reality, constantly enrich their literacy, and do a good job in information-based teaching and handle the cooperation and distribution relationship between teachers and AI. Facing the ever-developing AI technology environment, teachers should do a good job in coping with implementation, accurately positioning their own work, rationally distributing workload, and realizing human-machine symbiosis. Teachers should pass on moral emotions and logical innovative thinking to students, so that knowledge is always passed on in emotions, which is a human characteristic that cannot be replaced by AI. The natural learning environment includes teaching objects and public facilities in the real teaching environment. Teachers should reflect the subjectivity of students in environmental design . All envAI technology may already play the role of teachers in the education system and perform their knowledge imparting responsibilities, which will also lead to the gradual weakening of teachers' identity and status as knowledge imparters. The knowledge level of students is no longer the only criterion for measuring the quality of school education. The so-called good school is a school where teachers can give full play to their own advantages and values and can cultivate students' information literacy, coordination, and cooperation with AI: a school for innovative thinking and creativity to better adapt to the future society. According to this, some scholars have asserted that the work form of teachers in the future will not focus on teaching, and their responsibility will no longer be knowledge instillation . The effRole cognition is the premise and prerequisite of role transformation; role cognition is the key factor affecting role identity. The social role theory holds that individual role-playing is mainly affected by two factors: internal and external factors. The external factor is people's social expectations for the role, and the internal factor is the individual's role cognition. This kind of personalization will increasingly show the characteristics of objectivity and quantification. In a certain social situation, the social function of the role is displayed through the behavior of the subject, which is a collection of its behavior. Teachers can only meet expectations in behavior if they know what role they should assume in their ideological understanding. Teaching role cognition is a general metaphor for the role or way in which a computer system supported by AI technology plays a role in promoting learners' learning process . In the In the era of AI, in the process of promoting intelligent education, teachers and students are prone to risks in the transformation of teaching roles. For teachers, role change is a change in knowledge structure, teaching methods, and thinking concepts. In addition, through the accumulation of learners' learning data on a regular basis, targeted learning process analysis is carried out, and the weak links of students' learning are more clearly and intuitively understood through big data. However, in the face of the advanced AI technology in the future, some teachers may worry that they will be replaced, or they may not be confident that they can master intelligent technology well. There are also some teachers who may overtrust AI, which leads to the decline of their own abilities and gradually loses their own unique reflection on teaching . For stuSince the knowledge organization and reasoning process in the expert system is a simulation of the way of thinking of human experts, the organization of the knowledge base and the systematic reasoning process can better reflect the thinking process of role cognition in the education system. In the process of building a knowledge base, role cognition needs to conceptualize, formalize, and organize the fragmented and unformed knowledge. As shown in Traditional school teaching pays more attention to scores and results and mostly adopts the summative evaluation method of standardized tests. Although the formative evaluation advocated now is also widely promoted by schools, most of them focus on form, and the concept of focusing on scores is still deeply rooted. Although the emergence of AI cannot fundamentally subvert this method of teaching evaluation, it is necessary to use various forms of tests to understand students' mastery of learning content. Teachers not only assume the role of knowledge imparting but also need to have good intellectual literacy and cultivate students' core literacy and moral sentiment. They need to learn to use AI; otherwise, they will be easily eliminated, and they need to reflect on their relationship with AI to enhance their self-worth. In addition, text recognition, speech recognition, image recognition, and biometric recognition can monitor and evaluate the learners' psychological state and attention state in real time according to the learners' words, voices, demeanor, movements, expressions, etc. The visual form presents role cognition in the education system and provides timely feedback for teaching. The AI system can work in a wider range, but the information grasped by each object is relatively shallow, and most of the learners are in a specific cognitive state, lacking personality, emotion and behavior management, family background, learning history, etc.The advent of the era of AI has had a huge impact on the traditional perception of teachers' roles, requiring teachers to establish a new outlook on talents, teachers and students, and teaching, and reunderstand the role of teachers. First of all, teachers should establish a new concept of talents that everyone can become a talent, correctly view the differences and individuality of each student, and pay attention to the individualization of students' learning needs . Every sTaking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses questionnaire survey method to analyze the effect of AI on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. The education system can make use of this characteristic or expand on the original basis to meet the needs of students' own learning needs. After all, it cannot replace human learning and innovation. This is the subjective condition for students to form a correct learning attitude and motivation to further enhance their independent learning ability and creativity. From the perspective of technology acceptance, the information literacy of teachers and students is directly related to the perceived ease of use and perceived usefulness of intelligent technology, and such technology perception will largely determine teachers and students' willingness to use intelligent technology and their perceived usefulness. The research results show that the learning of AI courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activity methods. Therefore, AI plays a role in role cognition in the education system. The role of the project needs to be systematically analyzed from the aspects of function realization form, resource presentation method, supporting hardware form, teacher-student interaction method, and representation method of works. As a connecter, teachers are limited by the degree of understanding learners, the amount of resources, and data processing capabilities, but the advantage is that they can flexibly monitor and adjust. AI technology is flexible and diverse, it functions in learning and teaching activities in a variety of ways, and there is no agreement on the terminology to describe its role. The results of this paper provide a reference for further researches on the effect of AI on role cognition in the education system.


Parkinson's disease is a chronic neurodegenerative disease, which can be alleviated in drug treatment, but with evident side effects. At the same time, increasing evidence shows that exercise can significantly improve the symptoms of patients with Parkinson's disease, with an effect that cannot be achieved by drug treatment. The related research on exercise on Parkinson's disease increases rapidly with the passage of time. However, the research analysis on Parkinson's disease by means of bibliometrics is rare. The purpose of this study is to perform a bibliometric analysis of the research hotspots and development trends of the global movement on Parkinson's disease from 2012 to 2021.The literature was derived from the Web of Science core collection database, and the social science citation index was set as SCI-EXPANDED. The language was set to English, and the literature category was set as article and review and published from 2012 to 2021. CiteSpace and other software were used to analyze the relationship among published documents, countries, institutions, journals, authors, references, disciplines, and keywords.Movement Disorders journals are the main institutions and journals. The cited keywords show that trial, cognition, and interference are the research hotspots and development trends in recent years.A total of 2,222 articles were included in the analysis. The analysis showed that the publication volume increased with the increase in years, with a total of 76 countries and 546 academic journals published; the largest number was that of the United States. The journals are mainly concentrated in the fields of neurology, sports, and ophthalmology. Rush University and The number of published articles on Parkinson's disease by exercise has increased rapidly in the past 10 years, and the bibliometric analysis can provide useful information for future research teams and researchers. Parkinson's disease (PD) is one of the most common neurodegenerative diseases  is a quantitative statistical method for the study of published literature , references, disciplines and keywords, and development trends are extracted using CiteSpace and Microsoft Excel software. The extracted literature data are counted and analyzed in the analysis software, and visual maps and intuitive charts are developed. This study explains the impact of exercise on PD through the following parts: (1) the distribution and development trend is analyzed according to year, country, discipline, institution, and author; (2) the cooperation among countries, institutions, and authors is analyzed; (3) through cluster analysis, citation analysis, and H-index analysis in this field, the citation frequency is the sum of the cited times of all items in a set, which can generally reflect the quality of publications. H-index is the number of papers whose citations are larger than H. This new method is used to evaluate academic achievements. H-index can accurately reflect the academic achievements of researchers and can be used as an index to measure the output of scientific research achievements of researchers Hirsch, . (4) TheA total of 2,222 articles have been included, as shown in As shown in As shown in Disciplines were involved in all 2,222 papers on exercise intervention on PD, and we analyzed the top 10 published disciplines . The neuNew England Journal of Medicine (impact Factor 91.253 in 2020). Patients with Parkinson's are randomly assigned to Taijiquan for resistance training and stretching exercises according to the degree of disease, after 24 weeks of intervention twice a week. Compared with resistance training and stretching exercise, Taijiquan can significantly improve balance, posture control, and other functions of patients with PD and effectively reduce the incidence of falls in patients with PD , citation , citation per article (61.61), and H index (25). Open access has 33; it plays a leading role in the field of PD, and its main research direction is neurosciences neurology, rehabilitation, and sport sciences. Rush University, McGill University, University of Toronto, Columbia University, Oregon Health, and Science University cooperate closely with other institutions.Among the 2,222 articles searched, 10,046 authors participated in the publication of 546 journals and produced a network graph of related authors . The cooParkinsonism-related Disorders journals is the largest (107). The number of citations in the journal Movement Disorders  and the number of citations per article (66.43) are the highest, and the journal has the highest impact factor (10.338 in 2020) and the highest H index (33). The number of PLoS ONE journals Open access (71) is the highest. A total of 546 academic journals on exercise on PD have been published, As shown in New England Journal of Medicine, Lancet Neurology, Angewandte Cheme International Edition, Brain, and Movement Disorders according to the ranking of impact factors.The production table of the top 10 papers cited in sports on PD research is shown in The analysis of references is an important part of bibliometrics research. The citation degree of keywords reflects the degree of concern of the discipline and can reflect the trend of the development of the discipline. PD is the second-largest neurodegenerative disease; it is second only to Alzheimer's disease , accounting for 61% of the total, indicating that exercise has received more attention in the field of PD in recent years. The years 2012 to 2013 had the highest citation volume , the highest citation volume per article (43.84), and the highest H index (62). However, the growth in the number of papers in this form does not indicate an improvement in the quality of the literature. This condition is because the retrieval process of literature data extraction only obtains the number of papers in this field, and the quality cannot be judged by the quantity. The high volume of papers and citations can only reflect the attention of the scientific research team in this field. The rapid increase in the publication of papers in the past 5 years may be related to the Guide to American Physical Activity published in 2018, which points out that physical exercise can effectively reduce the risk of many chronic diseases, and that the elderly should engage in various forms of physical exercise, such as balance, aerobics, and resistance exercise  and the number of citations per article (66.43) are the highest, with the highest impact factor (10.338 in 2020) and the highest H index (33). It is the most influential journal in this field in the United States.The volume of articles is mainly concentrated in the United States, China, and Germany. Through the analysis of authors and journals, Bloem BR and Nieuwboer A are the main authors in this field; they maintain a high volume of articles and centrality. Among the articles on exercise on PD, Bloem BR, and Nieuwboer A have a randomized controlled trial published in the journal The dual-map overlay , timelinBased on WOS data, this study makes a bibliometric analysis of the current situation and trend of exercise research in the field of PD in the past 10 years with CiteSpace and other analysis software. A total of 2,222 articles were retrieved from 546 academic journals in 76 countries. In addition to the analysis of the volume of publications, citations, and the cooperative relationship among countries, institutions, and authors, the classification of disciplines, types of documents, references, and keywords are analyzed.This research also has certain limitations. The retrieval strategy is limited to the WOS core database. The social science citation retrieval is set to SCI-Expanded, the language is English, and the papers are limited to articles and reviews. These factors may lead to errors in the results, that is, some high-quality and high-impact articles may not have high citations or be late in publication and are ignored, whereas some high-cited articles may not result in hotspots.This study analyzes the papers on PD published in the past 10 years and provides a new perspective for research in this field. Although some limitations exist, it fully expounds on the research hotspots and future development trends of exercise in the field of PD research. The analysis results may enable exercise therapy to carry out more research in the field of PD. Sports will receive increasing attention in the field of PD in the future, In conclusion, this study may help researchers to quickly understand the knowledge structure and current hotspots in the field.The original contributions presented in the study are included in the article/J-WC wrote the paper. S-HD performed the data analyses. T-CC and KZ contributed to the conception of the study and helped further revise the paper. 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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Giovanni Paolo Martelli passed away on 8 January 2020 , nine daLongidoridae. Upon his return to the Institute of Plant Pathology at Bari in 1963, Giovanni established the Plant Virology Laboratory to study viruses and virus diseases of economically important vegetable plants, as well as grapevines and fruit trees such as citrus, stone fruit, olive and fig. The Plant Virology Laboratory quickly became nationally and internationally eminent under Giovanni’s leadership.At the beginning of his scientific career, Giovanni had acquired highly significant knowledge of Plant Pathology. In the 1950s, he investigated the biology and control of plant pathogenic fungi that infect olive trees, grapevine, fruit and vegetable crops, and described new micromycetes and diseases . At a yoMost of Giovanni’s teaching career was spent at the University of Bari. From 1965 to 1969, he taught Microbiology; he then spent a two-year term (1971–1973) teaching Plant Pathology at the University of Palermo and directing the Institute of the same name. Back at the University of Bari, he was appointed Full Professor and served as Chair of Plant Virology for 30 years, from 1980 to 2010, when he retired [At the University of Bari, Giovanni directed the Institute of Plant Pathology (later to become a Department) from 1980 to 1986 and the Department of Plant Protection and Applied Microbiology from 2000 to 2006. His primary aim was always the advancement of knowledge, and he transmitted his passion to colleagues and collaborators. Among the faculty members involved in plant virology research when Giovanni was Chair of Plant Virology were Maria Antonietta Castellano, Donato Gallitelli, Pasquale Piazzolla, Antonio Quacquarelli, Marcello Russo, Vito Savino and Makis Vovlas. All held important academic and research positions during their careers.As a member of the Board of Professors for the Ph.D. program in Plant Pathology from 1984 to 1991, and for the Ph.D. program in Plant Protection starting in 1992, Giovanni was an outstanding example of scientific integrity and rigor.Giovanni Martelli in Rome in June 2012 relaxing with old friends.His competence was widely acknowledged. Starting in 1972, Giovanni was a member of the Scientific Council of the Institute of Applied Phyto-Virology of the CNR in Turin. He was also a member of the Scientific Council of the Plant Biosynthesis Institute of the CNR, Milan.In 1982, he established the CNR Study Center on Viruses and Virus-like Diseases of Mediterranean Crops, based in Bari, and became its director until his retirement in 2010. Among the scientists who were hired early by CNR and contributed to its scientific success were Donato Boscia, Angelantonio Minafra and Luisa Rubino. The Center no longer exists as such; it later merged with the Institute for Sustainable Plant Protection (CNR-IPSP), with Donato Boscia as its research director. From 1989 until its disbandment, Giovanni chaired the Scientific Council of the Research Group of the CNR on Viruses and Virus Diseases of Plants.In 1985, Giovanni was among the supporters of the International Course on Production and Protection of Mediterranean Fruit Crops (now Integrated Pest Management of Mediterranean Fruit Crops) at the Mediterranean Agronomic Institute of Valenzano (Bari), an Italian subsidiary of Center International de Hautes Etudes Agronomiques Mediterraneennes, of which he was the coordinator of the related “Master of Science” program in Plant Virology until 2008.Giovanni investigated viruses and virus diseases of crops grown in the Mediterranean basin, including fruit trees, grapevine , vegetabIn the mid-1980s, Giovanni established a molecular biology/immunology research unit for the use of recombinant DNA technology and monoclonal/polyclonal antibodies in different research projects . Some reGiovanni was an international recognized authority on viruses and virus diseases of grapevine, and he is considered the founder of modern grapevine virology ,27,28,29Vitis and Prunus spp. [Giovanni never ignored or forgot the application of applied plant virology to grapevine and other plant species. In 1963, he established a thermotherapy unit for producing virus-free grapevine and fruit trees . In the nus spp. .Giovanni carried out study missions on behalf of the Food and Agricultural Organization (FAO) of the United Nations, United Nations Development Program (UNDP), CNR, and the Italian Ministry of Foreign Affairs. He was a member of the Steering Committee of the FAO-UNDP Regional Project on Control of Virus and Virus-like Diseases of Fruit Crops, the Comitè d’Evaluation of the Institut National de la Recherche Agronomique (INRA) and the Comitè Scientifique du Laboratorie d’Ingenierie Agronomique de l’ENSAT-INPT. Giovanni was also invited to participate in study missions by officials from five countries in North Africa , eight countries in the Middle East , most Eastern European countries, one country in Central Asia (Afghanistan), two countries in the Far East (China and Japan), Australia and New Zealand. These missions established international scientific collaborations with scientists in various institutions in these countries.Giovanni Martelli in June 2012 on top of Vittorio Emanuele II Monument (Il Vittoriano) in Rome City Center. Behind Giovanni, the Winged Victory Statue on Chariot.Closteroviridae [Flexiviridae [Tombusviridae [Tymoviridae [Fimoviridae, which includes the genus Emaravirus [groups and viruses were not recognized taxa and did not correspond to any taxon in the “parallel” classification. Group members did not represent species and had only vernacular English names [Giovanni had an excellent background in Latin. In 1978, he became an active member of the International Committee on Taxonomy of Viruses (ICTV) of the International Union of Microbiological Societies. He chaired the study group on the family oviridae ,34. He wiviridae ,36, Tombsviridae , Tymoviroviridae  and Fimoaravirus . For sevsh names ,41. The sh names .Foveavirus, Aureusvirus, Tepovirus [Martellivirales [Bromoviridae, Closteroviridae, Endornaviridae, Kitaviridae, Mayoviridae, Togaviridae and Virgaviridae.Giovanni described novel plant virus genera, e.g., epovirus ,44,45,46epovirus . In 2021ivirales , includiPhytopathology, European Journal of Plant Pathology and Vitis. He also served as senior editor and, from 2002, as Editor-in-Chief of the Journal of Plant Pathology . He was extremely convinced of the importance of editorial roles in the advancement of knowledge, and his reviews were always very helpful to the authors, allowing them to improve their research work and presentation of results.Giovanni served as an associate editor of Giovanni was Chairman of the International Working Group on Vegetable Viruses of the International Society of Horticultural Sciences from 1979 to 1981, and President of the Italian Phytopathological Association from 1980 to 1986. He also represented the Italian Phytopathological Association in the International Society for Plant Pathology. Moreover, he was a member of the Executive Boards of the Italian Society of Virology and of the Italian Society of Plant Pathology, of which he was President (2002–2004). Giovanni was a member of many scientific societies and committees, including the Italian Academy of Vine and Wine (of which he was a member of the Academic Council), a member of the National Winemaking Committee of the Ministry for Agricultural and Forestry Policies, the Georgofili Academy, the National Academy of Oil and Olive, the National Academy of Agriculture and Apulian Academy of Sciences, and he was a corresponding member of the National Academy of the Lincei and of the Agricultural Academy of Turin. He was a member of the American Phytopathological Society, the Association of Applied Biologists, the British Society of Plant Pathologists, the Mediterranean Phytopathological Union, the Society of Plant Molecular Biology, the Italian Plant Protection Society the Italian Society of Plant Pathology and the Italian Society of Virology. Giovanni also chaired numerous scientific meeting sessions at national and international conferences.Giovanni is the co-author of a textbook on Plant Virology and one book on viruses of vegetable crops. He is also the co-author of two books ,29 and tIn recognition of his scientific achievements, Giovanni was awarded the Gold Medal Diploma from the Académie d’Agriculture de France for a book he co-authored on grapevine viruses in 1982; and in 1997, he was elected Fellow of the American Phytopathological Society [Xylella fastidiosa subsp. pauca as the causal agent of the olive trees decline in southern Italy, completely sequenced the bacterial DNA genome and determined its size as a 2,514,616 base pair, and established that the bacterial country of origin is Costa Rica in Central America [Philaenus spumarius was experimentally proven to be the vector of the olive-infecting bacterial strain [During the last decade, Giovanni vigorously defended the integrity of science and scientists when plant pathologists at the CNR in Bari were viciously and falsely attacked by individuals or groups of individuals deprived of phytopathological scientific knowledge while Bari scientists correctly identified the bacterium  America ,49. The l strain .Beyond his scientific achievements, Giovanni’s legacy lives on in the hundreds of people across the world that he trained, mentored, encouraged and supported in various ways. He advised many graduate students and postdoctoral fellows, who have gone on to careers in academia, industry and beyond. Giovanni was generous in accepting seminar invitations and delivering keynote addresses at national and international meetings. As such, thousands of junior and established scientists had the opportunity to interact with him throughout his career. His interactions were characterized by warmth and generosity. Overall, Giovanni will be remembered as a brilliant plant virologist, the founder of modern grapevine virology and a very kind and wonderful human being who had a great impact on the people around him.Giovanni is survived by his wife Nicoletta, their daughter Maria Carla and their son Giuseppe, and he was a proud grandfather to his five lovely grandchildren, whom he adored.


Learning Difficulties relates to significant and unusual difficulties in the acquisition and use of one or more of the following areas: listening, speaking, reading, writing and mathematical skills. In the last twenty years, following the research conducted by cognitive psychology, from neuropsychology, from pedagogy and from the confrontation between educators and psychologists, the attention was focused on the cognitive modalities of the subjects engaged in learning tasks.Thanks to the study of cognitive styles and Learning Styles thelearning subject was placed at the center of the educational project, stimulating from on the one hand there is also reflection on teaching styles and the most appropriate ones methodologies, teaching methods and methods of approaching the individual disciplines and, on the other hand, prompting clinicians to research around the intellectual peculiarities of each subject and a outline a descriptive criterion of his / her cognitive functioning profile.The intellectual scale (WISC IV) of 32 children (aged between 7 and 15 years) with specific learning disabilities was analyzed, in order to highlight the underlying intellectual functioning and any cognitive styles.According to the international scientific literature, the results show a greater fall in the area of working memory, followed by the cognitive domain concerning processing speed.In detail, by analyzing the individual subtests, greater difficulties are noted, at all ages, in the processes of abstraction and conceptualization, in short-term auditory memory, in the speed of processing and visual-praxic motor coordination.


The health information system is a component of the healthcare system. The health information system in health services in Indonesia has experienced many problems in getting support for policy making, the implementation of the industrial revolution 4.0, and national health insurance (JKN). To answer the above problems, it is necessary to make a concept of health information systems in health services that based on environment and one health perspectives. This research was part of the thematic research of the 2019 JKN National Health Facilities Survey (Rifaskes) in Indonesia. The systems approach and cross-sectional research were carried out by collecting quantitative data. A structural equation model with Lisrel 88 software was used to model the health information system. The health information system produced a concept that included the following structured input components: governance, human resources, infrastructure, types of information system (IS) , and financing; process components: funding, technical guidance, and verification and validation; and output components: open access, standards and quality, utilization, bridging, and security. The concept for strengthening the health information system prioritizes improving the output components  in the process components  while the input components . Indonesia implements sustainable development in the health sector based on the principle of non-discrimination. Sustainable development begins with strengthening the system, which in this case is the health information system. The health information sys-tem can only be the basis for decision-making if the data is accurate, open, and interoperable, which was called one data in 2018 . The heaIn this case, the Ministry of Health is like a health organization, where this organization has service efforts in the form of hospitals, health centers, and clinics. The Ministry of Health also has administrative management at each level, from the central administration all the way to the smallest sub-district. Health service efforts with these administrations aim to make health services more accessible for communities in order to promote a healthy society , 15. To In this article we propose an environment and one health framework for developing a high-level prospective concept of the implementation of health information systems in healthcare organizations. Based on the existing framework, we identified several critical dimensions that exist in the health information system, namely, management, financing, human resources, infrastructure, and the types of existing information systems  as an effort to achieve national health goals at the sub-district, district, provincial and national levels. This captures two important characteristics in the healthcare delivery process: the level of mediation and the level of internal and external collaboration.This paper was developed based on the results of research on health information systems with Ethics Permit LB.02.01/2/KE.186/2019 .The study was conducted in 2019 (July–December) in 7 provinces  in 103 districts with 420 healthcare units   and external (Border Remote Areas and Islands (DTPK) fiscal capacity) topics. Processes covered funding, technical guidance, and verification. And outputs consisted of quality standards, data utilization, bridging/interoperability, open access, and security. The researchers used a generic health facility research data collection team that had been retrained for the purposes of this thematic data collection. Researchers supervised the collections twice to maintain the quality of the research.The analysis required structural equation modeling using the Lisrell method . The firThe research revealed several very useful findings, which were largely missing in existing literature. Several variables formed the input component: leadership/governance, human resources, infrastructure, funding, management information systems, program information systems and JKN information systems, types of health services, health service facilities according to DTPK status, fiscal capacity status. Thus, the variables of monitoring and evaluation, technical guidance, and verification and evaluation form the components of the process. Furthermore, the standard and quality variables, data utilization, bridging and interoperability, open access and security, formed the output components .Information system modeling is essentially input modeling with several steps, namely, making an initial estimate and making a final estimate. The final estimation results of indicators that met the requirements of good validity were governance, human resources, infrastructure, funds, IS management, IS Program, and IS JKN [absolute value of Standardized Factor Loading (SFL) > 0.50]. However, several indicators had an SFL <0.50  and were thus be excluded from the measurement model .The process modeling shows the initial estimation and final estimation of the indicators that comprised the process components that met the requirements for entering the measurement model. The three indicators that comprised the process component can be seen in the .Output modeling produces initial estimates of 5 constituent variables.The Path Diagram shows that the SFL of Standard, Utilization, Bridging, Open Access, Security ≥ 0.50. The five indicators are valid indicators for the output variable. The next modeling forms a full model using the inputs, processes, and outputs and considers SFL, composite reliability, and validity. The  and Fig below shThe  below ilFrom the The results showed that the indicators of leadership/governance, HR, infrastructure, financing, IS management, IS Program, and IS JKN comprise the input components of the health information system in this modeling. Regulations that relate to the results of this study are the 2012 National Health System  article 2 paragraph 1, which states that health information is part of health management. Furthermore, Article 3 states that in the management subsystem includes health information and regulation. In the implementation of the JKN health information system at the public health center, the health information system was constrained by the lack of internet and human resources . To contIn implementing the health information system at the health office, there were problems with human resources, supporting facilities, and commitment from the activity leaders who had not been trained to understand good data and information management , 24. As Further modeling finds that several indicators that make up the process components are technical guidance, monitoring, and evaluation as well as verification and validation. In some cases of recording and reporting systems, if there is no monitoring by village supervisors and program holders, it will usually be late. Because it is late, the head of the puskesmas often does not have time to check and dispose of it. Thus, it is signed and reported to the health office , 25. TheThe results of modeling the output components revealed the vital indicators of standards, utilization, bridging, open access, and security. The final modelers with the highest influence are HR, governance, program, infrastructure, funds, IS JKN, and management. In the process component, it is necessary to successively improve the health information system in monitoring and evaluation, technical guidance, verification and evaluation. Meanwhile, the output components are open access, standards, PE, the use of bridging, and security. Several studies have found that health information systems need bridging or interoperability. Too many health centers using health information systems require users to enter the same health data repeatedly, especially about the patient's social identity and clinical data, which makes the work inefficient . There nThe health information system is a means to support health services provided to the community. An effective health information system provides information support for the decision-making process at all levels, even at puskesmas or small hospitals. Not only data, but also complete, precise, accurate, and fast information can be presented with a well-organized and well-implemented health information system , 31. TheThe health services concept in the JKN era for strengthening the health information system that based on environment and one health approach is formulated by each components including standardized and utilized input, process, and output. These can include factors such as bridging, open access, and security. In process, the recommend strengthening components, especially funding, verification, technical guidance. It is also important to strengthen input components: funding, human resources, governance, information system programs, infrastructure, JKN information systems, and information system management.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study was approved by the Institutional Ethics Committee of Indonesian Ministry of Health (LB.02.01/2/KE.186/2019). Written informed consent was obtained from the participants.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This research was funded by the National Institute for Health Research and Development, Indonesian Ministry of Health. The publication was also funded by the Hibah PUTI UI 2022 (NKB-455/UN2.RST/HKP.05.00/2022). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.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. The reviewer ID declared a shared affiliation with the author(s) AA to the handling editor at the time of review.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.