The coronavirus disease 2019 (COVID-19) pandemic suspended face-to-face assistance offered by community spaces, such as day centers (DCs). People with dementia (PwD) and their families were faced with the risks posed by social detachment and suspension of treatments.This study aimed to present a virtual day center (VDC) program offered as a preventive strategy to reduce the damage caused by social isolation and interruption of treatment imposed by the pandemic.The experience report, describing the feasibility of a VDC program, offered to 26 PwD and their caregivers, during the first year of the pandemic. The VDC held individual and group meetings with PwD and their families and psychoeducational support groups for caregivers.The attendance rate in group activities was 80%, and that in the caregiver group was 68%, showing a good virtual interaction. Throughout the year, three PwD interrupted the service due to difficulties of the caregivers to reconcile the schedules of the activities with their professional commitments and the absence of a support network, three others died, and two were institutionalized. PwD remained physically, socially, and cognitively active through daily virtual activities. Guidance and support for caregivers contributed to the organization of routines and adaptation to the isolation and maintenance of the bond. Family meetings made it possible to mediate conflicts and expand the support network.VDC is a promising modality to assist the needs and demands of PwD and their caregivers. VDC can contribute to the expansion of this intervention to individuals and families who do not have access to face-to-face treatment. The emergency preventive action was social distancing, with circulation authorized only for basic needs. To reduce its traumatic impact on individuals, families, and communities, it requires agility of the social responsibility in the organization of prevention and intervention strategies.The coronavirus disease 2019 (COVID-19) pandemic has burdened health systems. has been correlated with increased morbidity in COVID-19, and people with dementia (PwD) have an increased risk of COVID-19. In addition, PwD would have a higher risk of contamination due to cognitive impairment, which would limit their ability to understand the pandemic and the need for biosafety procedures, such as washing hands, wearing masks, and maintaining social distance. COVID-19 can worsen cognitive impairment and increase the incidence of psychological and behavioral changes, temporarily during the infectious process, or permanently if the duration of the infectious condition is very long.The vulnerability of the elderly, such as hypertension, diabetes aggravating the situation of socioemotional isolation frequently reported by PwD caregivers. Livingston et al. suggested that social isolation is a risk factor for dementia, presenting a relative risk higher than the risk associated with alcohol abuse, physical inactivity, diabetes, and air pollution.Social detachment can increase the feeling of loneliness, emotional isolation, and disconnection from existing relationships, This context imposed the reorganization and flexibility of families, health services, and community support networks. For these reasons, the team of the DC for PwD of the Center for Alzheimer’s Disease and Other Mental Disorders in Old Age (CDA) of the Psychiatry Institute (IPUB) of the Federal University of Rio de Janeiro (UFRJ) restructured the intervention to a model totally virtual. This experience report presents a VDC for PwD and caregivers, from March 2020 to February 2021, during the COVID-19 pandemic.The pandemic suspended outpatient care and the closure of community and psychosocial care spaces, such as the day centers (DCs). Consequently, the PwD and their families began to experience a critical situation, given the risk and impact of discontinuing treatment.We designed a qualitative study to report a virtual day center (VDC) experience offered for 26 PwD and their caregivers. This study is part of the research project approved by the Ethics Committee of IPUB/UFRJ (CAAE: 80423217.4. 0000.5263). All PwD and their caregivers signed the informed consent form. Demographic and clinical data, frequency of activities, and information on PwD and caregivers were collected from medical records. The availability of Internet resources, computers, and tablets was informed through the telephonic interviews. Mini-Mental State Examination (MMSE), duration of the disease, treatment duration, and caregivers . The descriptive data analysis was performed using SPSS® software, version 26.0 .Descriptive statistics were used to present the sociodemographic and clinical data of PwD, which were assessed through in the medical records by the attending physician at the last face-to-face consultation, gender, education, marital status, diagnosis, age, Clinical Dementia Rating (CDR), 34.6% were in the mild stage with a mean MMSE score of 24.4, 38.5% were in the moderate stage with a mean MMSE score of 19.1, and 26.9% were in the severe stage with a mean MMSE score of 8.5. The mean attendance time was 61.6 months, with a range of 14–189 months. The sociodemographic and clinical data are shown in Most of the PwD (80.76%) are at the age of 70–89 years and have a diagnosis of Alzheimer’s disease . According to the CDR,The PwD showed satisfaction during the virtual meetings. The majority of PwD and their caregivers (69%) participated in the activities and groups of caregivers during the 12 months of the program. Three PwD discontinued after 3 (8%) and 6 months (4%), respectively. Two were institutionalized (8%) after 7 and 9 months of care, respectively, and three died after 2 (4%) and 9 (8%) months of participation, respectively.The majority of PwD (76.9%) cohabited with their caregivers, being cared for their children (65.4%) or spouses (30.8%). Most of the caregivers (96.2%) were females, and 23.1% did not have a family support network. All of them had access to a smartphone with Internet access, and approximately 30% had a computer or tablet. The sociodemographic data of the caregivers are shown in It was observed in the caregiver’s organization of routines, adoption of creative mediation strategies in the care relationship, and new stress-mediating practices, such as meditation and aromatherapy. Caregivers shared their experiences with peers in groups of caregivers with a frequency rate of 68%. Most of the families (54%) who participated in family meetings, which contributed to the engagement of new members of the family network in care, expanded the support network of caregivers. The DC is theoretically guided by the Reuven Feuerstein’s theory of Mediated Learning Experience, whose paradigms are the structural cognitive stimulation, the centrality of the caregiver role, and the modification of the environment. In addition, the Conceptual Model of Alzheimer’s Caregivers Stress proposed by Pearlin et al., which considers the impact of primary and secondary stressors on caregiver burden.The DC offers an intervention program that assists PwD referred by the clinical staff of the CDA outpatient clinic after diagnosis. Before the pandemic, users attended the service accompanied by a caregiver, twice a week, staying 4–6 hours a day. The team includes psychologists, occupational therapists, music therapists, and students from the Specialization Course in Psychogeriatrics. The therapeutic program includes cognitive, motor, and psychosocial stimulation activities, which is preferably carried out in groups, i.e., psychoeducation groups, and support for caregivers, food, and recreational tours.The implantation of the VDC was performed in the following three steps.In the second half of March 2020, the DC staff established an emergency intervention plan with the objective of minimizing the risks and mitigating the suffering of its users. The first virtual strategy was to establish contact by video call, twice a week, with the caregivers and PwD who attended the DC. The 26 PwD were divided into three groups, considering the level of cognitive and functional impairment. Each group was accompanied by a team member, two psychologists, and an occupational therapist, respectively. The initial objectives were to maintain the link with PwD and their family; know how families were organizing, their understanding of the pandemic and biosafety measures; identify risk and protection factors and reinforce coping strategies; identify patterns of dysfunctional responses and mediate the adoption of new behaviors; and advise on low-risk alternatives for the purchase of food and medicines and what procedures should be adopted in case of contamination of the PwD or caregiver.Four videos were recorded and sent via WhatsApp, addressing topics such as the pandemic, its risks, psychological impact, and coping and biosafety strategies; the organization of routines; and virtual strategies for socio-affective interaction and recreational activities. The Physical Activity and Psychoeducation Program for Autonomous Life with Quality (PROAPTIVA), a CDA extension project, recorded four videos with movement guidelines to encourage mobility and avoid a sedentary lifestyle.Development of nine handouts with cognitive stimulation activities, with different levels of complexity to meet the PwD in their different commitment profiles. The handouts were sent via email or post.To facilitate the development of a repertoire of more functional and less impulsive behavioral strategies, the team implemented two actions as follows: At this stage, 100% of caregivers adhered, and the use of technology did not represent an obstacle. In some cases, we observed difficulties in understanding the need for biosafety rules and restricting visits, family conflicts, breaking contracts with formal caregivers, and overlapping tasks for caregivers. Some caregivers showed risk behaviors and anxious responses, such as agitation, unnecessary exits, difficulty sleeping, obsessive cleaning, irritability, and need for exacerbated control in the management, infantilization, and demands incompatible with the cognitive and functional limitations of PwD. In these cases, the caregivers reported and the professionals observed during the video calls that some PwD had disorientation, agitation, apathy, depression, and daytime sleepiness. The active listening offered in video calls helped the caregivers to express feelings and reflect on the patterns of behavior adopted, in addition to assisting in the adoption of more adaptive behaviors. In contrast, some caregivers showed greater resilience and adaptive coping strategies that favored family life.For the development of the work, the team held weekly supervision meetings, in which the cases were discussed and the activities planned. These meetings also served to welcome team members into their own fears and difficulties in dealing with the pandemic.From the first week of April, the focus was to help PwD and caregivers to establish a routine that would organize the experience of seclusion at home, encouraging self-care practices and socio-interactive activities. The PwD and their caregivers participated in a video call per week, lasting 60 minutes, comprised of 2 dyads. The pairs of PwD were formed considering their cognitive profiles. We started our first experience of a virtual group activity with 100% of user adhesion. In the meetings, we encouraged the exchange of experiences between PwD and caregivers. We talked about biosafety care and carried out the activities of cognitive stimulation , by keeping the meeting as playful as possible. We maintained a second individual weekly contact for each dyad, in which we reviewed the exercises of the handouts carried out throughout the week and received individualized demands. Thus, virtual activities, homework, and physical activity guided by the PROAPTIVA videos enabled a more active routine for PwD. The group activity represented a stimulus to sociability, being expected by everyone. For dyads with severe PwD, two individual weekly video calls were added, since virtual interaction was more difficult and required more individualized management. All meetings lasted, on average, for 60-minute sessions.Regarding technology, cell phone, or computer, some older caregivers were initially reticent. These caregivers as well as mild PwD received training to handle the cell phone . The mild PwD achieved greater autonomy in relation to caregivers. In turn, PwD with moderate and severe difficulties needed to be accompanied by caregivers in activities, due to the limitations imposed by sensory difficulties — auditory or visual — and/or cognitive.After a month of the pandemic, there was no forecast of returning to normal, which required a reconfiguration of the program.The team, PwD, and caregivers were already adapted to virtual activities. Thus, we proposed to start cognitive stimulation groups with four dyads. The groups had 60-minute sessions, twice a week, coordinated by two professionals from the DC team. In response to caregivers’ requests, psychoeducation and support groups for caregivers were initiated weekly. The PROAPTIVA team started to offer virtual groups of physical activity. The training consisted of a supervised program of 45 minutes of multimodal physical exercises  twice a week. The daily virtual activities helped caregivers to implement routines for waking hours, food, hygiene, and sleep. For PwD with severe disabilities, in addition to psychoeducation and cognitive stimulation, individual video calls were added for the practice of physical activity given by a physical educator. Some PwD and caregivers regularly participate in the virtual choir. PwD who were most anxious started in person or group psychotherapy.Throughout the year, demands for family meetings for various purposes emerged: guidance on biosafety behaviors and on the risks of family visits; activation of family support networks as a socio-affective or operational resource for purchases; and mediation of past conflicts or those that arose during quarantine. Surprisingly, more family members attended the virtual meetings than those that used to happen in person before the pandemic when it was more difficult to reconcile schedules.The VDC therapeutic program, with regular activities four times a week, will continue until the face-to-face service is authorized. In these 12 months, we included some virtual parties that brought together all users and the team, such as Easter, Christmas, and birthdays. In addition, some resources to stimulate self-care and stress mediation were presented, such as meditation exercises at the beginning of the groups of caregivers, lectures on nutrition, and a minicourse on the use of aromatherapy in daily life.In the third month of the pandemic, 1 PwD and 1 spouse were diagnosed with COVID-19 and died. At this moment, the activities were permeated by sadness and mourning shared by all participants. In groups, the caregivers reported the fear of death of PwD and themselves. Three PwD interrupted the intervention due to caregivers’ difficulty in reconciling the activities of the VDC with their professional commitments and the absence of a support network. In November, two PwD died but were not due to COVID-19. Two PwD with greater impairment were institutionalized due to their caregiver’s illness. In both cases, institutionalization proved to be the best alternative for other family members. The team analyzed, with these families, the costs and benefits and strategies for adapting PwD to their new environments, given the restriction of visits imposed by the pandemic. In May 2020 and February 2021, we paid two virtual tributes to our deceased friends because the pandemic made the farewell rites fundamental to facilitate the mourning.During this period, the team’s cohesion was fundamental. The weekly supervision meetings become enriching learning spaces with the revision of the guiding theories in light of new challenges. The adequacy of the intervention methodology took into account the difficulties imposed by technology and the Internet, as well as the specificities of each PwD and their caregiver in their cognitive and socio-affective processes.The social distance imposed a sudden change in everyone’s routine, mobilized intense affections, with a high risk of becoming a traumatic experience. In this context, the support, through video calls, for PwD and their families, to minimize the impact of interruption of treatment presented itself as a viable alternative. The VDC program was built based on the demands, limitations, and possibilities of its users. The adhesion of PwD and caregivers and their adaptation to the use of technology were the main indicators of the feasibility of the VDC. At the beginning of the pandemic, an Inter-Agency Standing Committee (IASC) highlighted the importance of interventions that favor the organization of routines and the adoption of creative mediation strategies, i.e., self-care practices and stress mediators, as strategies to reduce the traumatic impact of the pandemic.Social isolation is a risk factor for dementia8 and represents a risk of increased morbidity and mortality for the elderly in general and for the PwD and their caregivers. The lack of stimuli and the cognitive and physical inactivity resulting from social isolation can contribute to the appearance of neuropsychiatric symptoms, aggravate the clinical condition of PwD, and can increase the burden on caregivers8. In contrast, the literature reveals that the offer of physical, cognitive, and social stimuli positively impacts the well-being, functionality, and cognitive readiness of individuals. and, as an aggravating factor, the limitations such as sensorial, cognitive impairment, and the need for adherence of caregivers in the face of functional dependence. Surprisingly, given the adherence and adaptation to the observed virtual modality, the use of the Internet proved to be a resource for social interaction.In this scenario, the possibility of a regular virtual intervention for PwD seemed impossible, considering that many healthy elderly people have resistance and difficulties in assimilation and adaptation to new languages and technologiesTherefore, it was necessary to adapt activities and methodologies to the virtual modality to a diversified program that met the needs. In general, even in face-to-face activities, flexibility and adaptation of activities and methodologies are necessary according to the characteristics, motivations, resources, and limitations of group members. an objective made impossible by the pandemic. Given the complexity of the situation experienced by caregivers, the support in the pandemic had a triple function: psychoeducational to stimulate the adoption of adapted behavioral and biosafety strategies, minimizing isolation and its potential damage to the health of the dyad and the continuity of treatment. Therefore, the development of the VDC was made progressively in compliance with the guiding recommendations of psychosocial intervention during the pandemic and the demands presented by the caregivers. Most caregivers and PwD voluntarily adhered to the program and maintained their regular attendance for 12 months. Only three caregivers were unable to reconcile VDC activities with professional and family demands. The observed adherence suggests that the VDC played a role in the organization of its routines.Another aspect considered was the risk that virtual activities would represent an additional burden for caregivers. It is known that DC has as one of its objectives to offer a break for caregivers and reduce their burden and exposure to primary stressors, emphasized the role of the social support offered by the caregiver’s relationship network, including the family and the assistance offered by the community-based health technologies, such as DCs, in managing stress, in linking the caregiver to a larger community, minimizing the isolation and alienation that many caregivers experience. Thus, the VDC seemed to favor the engagement of new members of the family network in care and the maintenance of the caregiver’s bond with their peers and with the team, minimizing their socioemotional isolation.Regarding sustaining social engagement as fundamental to the mental health of PwD and their caregivers, Pearlin et al.Old equipment and the instability of the Internet caused possible interruptions in the calls. The qualitative design included a small sample, an aspect that would not permit generalization. Also, we did not apply measures of cognition and neuropsychiatric symptoms, which would allow the effectiveness of the intervention.The integrated care program, in the form of VDC, for PwD and their caregivers represented a challenge in which it was necessary to reinvent and make more flexible techniques, activities, and management, exercising creativity without losing the theoretical and ethical north of the work that the DC proposes, which is based on the sensitive encounter between science and compassion.The knowledge produced in this experience and the results achieved can contribute to the expansion of this assistance to individuals and families who do not have access to face-to-face treatment. Thus, both in the present and in the future, remote assistance can be an excellent alternative to overcome barriers to access health devices.


Due to increased human activity, the amount of copper in air, soil and water has increased. Copper, at minimum concentrations, is essential for the normal functioning of the organism . At higher concentrations, copper is deposited in the liver, brain tissue, and bone marrow.To investigate the protective role of the supplement, glutathione (GSH), the S-donor ligand, in conditions of chronic copper intoxication via the parameters of oxidative stress, ie. Alkaline and acidic DNase values in brain tissue in albino rats of Wistar strain.The model system for testing the effects of copper exposure and the protective effect of GSH was a study on female albino rats of Wistar strain, stored in the vivarium of the Scientific Research Center for Biomedicine, Faculty of Medicine, Niš, Serbia. Endonucleases, alkaline and acidic DNase activities were determined spectrophotometrically from homogenates of brain tissue.Copper is believed to be a likely cause of oxidative damage to the DNA molecule, as manifested by increased alkaline and acidic DNase activity. The results of this study show that GSH is a potent chelator that binds copper and enables its elimination from the body.In this experiment, the beneficial role of GSH supplements, which has an antioxidant character, in the prevention and reduction of the adverse effects of chronic copper intoxication was demonstrated. In this way, GSH acts as a powerful protector and antioxidant.No significant relationships.


An analysis of the national traffic collision trends in Japan for the January 2018 to June 2022 period using existing statistical data indicates that the number of traffic incidents, injuries, and fatalities decreased over time. After the outbreak of COVID-19 in December 2019, traffic volume decreased. In this study, to explore how the COVID-19 pandemic correlates with traffic collisions, we used the Spearman rank correlation of non-parametric statistical test to compare the number of COVID-19 infections with the number of traffic collisions. The number of COVID-19 infections showed a significant inverse correlation with the number of traffic collisions nationwide, in some regions, and in some prefectures. When the number of COVID-19 infections increased, a State of Emergency or Semi-Emergency Spread Prevention Measures were repeatedly declared. We submit that these measures along with the restrictions on the population’s autonomy and movement to prevent the spread of infection, reduces the number of traffic incidents, injuries, and fatalities owing to a decrease in traffic volume. Therefore, these lessons learned from the COVID-19 pandemic advocate that regulation of vehicle traffic volume is an effective means of reducing the occurrence of traffic collisions. These results can be applied to future policy development to support road safety improvements during unique events. The number of new infections of the coronavirus disease of 2019 (COVID-19) has been increasing worldwide since the Chinese government notified the World Health Organization (WHO) on December 31, 2019 of a case of pneumonia of unknown cause that was detected in Wuhan, Hubei Province. In March 2020, the WHO classified the COVID-19 crisis as a pandemic [COVID-19 can be transmitted through droplet or contact infection. One individual may infect another when droplets containing the virus are scattered by an infected individual when they cough or sneeze and these droplets are inhaled through the nose or mouth of an uninfected individual. Contact infection occurs when an individual touches an object with infected droplets on it and then touches the mucous membranes of their eyes, nose, or mouth with their droplet-covered hand. It is therefore necessary to pay special attention to public areas where more than one individual touches specific items, such as doorknobs, light switches, and suspension rails, and to try to avoid touching one’s mucous membranes without first washing hands. To prevent the spread of COVID-19, it is recommended that the three “Cs” be avoided. These are: closed or poorly ventilated spaces, crowded places, and close-contact settings where individuals speak to one another in close proximity. Remote working and staggered working hours have also been advised in an effort to curb the spread of the virus .At the end of January 2020, the Japanese government established a COVID-19 task force headed by the prime minister. This task force promoted various measures to limit the spread of the virus and implement programs to deal with the effects of the pandemic. These programs and policies included the designation of COVID-19 as a designated infectious disease and quarantine infectious disease based on the Infectious Diseases Control Law and the Quarantine Act; regulations for immigrants based on the Immigration Control Law; the improvement of medical care provision systems, including returnee and contact counseling centers at public healthcare centers as well as support for businesses and employment sectors . During The number of traffic collisions in Japan increased along with the increase in the number of motor vehicles owned, reaching a peak of approximately 718,080 collisions in 1970. Immediately after that, the number of collisions decreased slightly as a result of the oil shock and other factors, but later it began to rise again, reaching a high of 952,720 collisions in 2004. Since then, the number of traffic collisions has decreased steadily, and in 2017, an estimated figure of 472,165 collisions took place. This is approximately half the number of collisions that took place in 2004 [We hope that statistical analysis of these interrelationships will lead to a method of regulating traffic collisions. We also expect that the knowledge gained from the results of this study will contribute to the development of policies to support the improvement of traffic safety during future unique events.In the previous study by Shimada , the numThe number of traffic incidents, injuries, and fatalities that occurred in each month for the January 2018 to June 2022 period were extracted from “Table 4–1 Road traffic incidents, fatalities and injuries by prefecture (monthly)” in the “Monthly” portion of statistics relating to the “Traffic Accident Situation” component in the “Statistics about Road Traffic” section published on the E-Stat Portal Site of Official Statistics of Japan .The number of traffic collisions that occur in December of each year is the value for “Table 6–2 Road traffic incidents, fatalities and injuries by prefecture” in the “Yearly” component of the “Traffic accidents situation (December)” part in the “Statistics about Road Traffic” portion , minus tThe term “traffic collision” refers to a collision that takes place on a road that is caused by a vehicle, streetcar, or train as is prescribed in Article 2, Paragraph 1, Item 1 of the Road Traffic Act. The term “fatality” refers to the death of an individual that results from a traffic collision and occurs within 24 hours of the collision taking place. The term “injury” refers to both a “serious injury,” which is defined as an injury resulting from a traffic collision requiring medical treatment for 30 days or longer, and a “slight injury,” which requires medical treatment for less than 30 days .The number of new COVID-19 infections for the January 27, 2020 to June 30, 2022 period was extracted from Ministry of Health, Labour and Welfare’s website, especially the page “Visualizing the data: Trend in the number of newly confirmed cases (daily) of information on COVID-19 infections” .The number of traffic collisions, including the number of traffic incidents, injuries, and fatalities that occurred, was extracted for the entire nation, regions, and prefectures for the January 2018 to June 2022 period. In addition, the number of new COVID-19 infections per month for the whole country, regions, and prefectures for the January 2020 to June 2022 period was compared with the number of traffic incidents, injuries, and fatalities that occurred during the same period. The Tokyo prefecture was excluded from the Kanto region and dealt with separately.The population of the prefectures was extracted from “Table 2–2 Population by Sex, Age (single years) and All nationality or Japanese, and Average age and Median age by Sex and All nationality or Japanese—Japan, Prefectures (DIDs)” of the 2020 population census, published by E-Stat Portal Site of Official Statistics of Japan in October 2020 .The area of the prefectures was based on the “2021 National Survey of area by prefecture, city, town and village (as of October 1)” that was published by the Geospatial Information Authority of Japan, Ministry of Land, Infrastructure, Transport and Tourism on December 21, 2021 .The information in respect of the number of vehicles owned was extracted from the “Table of number of vehicles owned by prefecture and vehicle model (including mini vehicles)” published by the Automobile Inspection & Registration Information Association at the end of September 2021 .The area of the roads in each prefecture was extracted from “Table 4 current status of roads by prefectures ” of road statistics annual report 2020 compiled by the Ministry of Land, Infrastructure, Transport and Tourism .p ≤ 0.05 [For statistical analysis, the Spearman rank correlation of non-parametric statistical test was used to compare the correlations between the number of COVID-19 infected persons, the number of traffic collisions  that occur, population density, and vehicle density. Statistical analysis was performed using version 16 of the JMP Pro software released by JMP Statistical Discovery LLC in 2021. The differences were considered significant at p ≤ 0.05 .From January 2018 to June 2022, the number of national and regional traffic incidents and injuries decreased year by year and the number of fatalities as a result of national traffic collisions also declined , S2 FigsDuring the peak months of COVID-19 infections for the January 2020 to June 2022 period, the numbers of traffic incidents and injuries were found to have decreased to a minimum; further, the number of traffic fatalities showed a downward trend nationwide, as well as in many regions and prefectures, although the number of traffic fatalities varied over the period Figs . The invSpecifically, the first peak of COVID-19 infections occurred nationwide as well as in most regions and prefectures in April 2020. However, the first peak of infections took place in the Tokushima prefecture in March 2020 and the number of COVID-19 infection in the Iwate prefecture was zero from January to June 2020. In the first peak month of COVID-19 infections, the number of traffic incidents, injuries, and fatalities nationwide as well as in the regions, and most prefectures had decreased to a minimum, however, the number of traffic fatalities in the Yamagata, Okayama, Tokushima, and Kochi prefectures increased Figs .The second peak of COVID-19 infections occurred nationwide as well as in most regions and prefectures in August 2020. However, the second peak occurred in July 2020 in the Aomori, Yamagata, Wakayama, and Kagoshima prefectures, and in July and September 2020 in the Miyagi, Tochigi, and Tottori prefectures. In the second peak month of COVID-19 infections, the number of traffic incidents and injuries were minimized and the number of traffic fatalities decreased nationwide as well as in most regions and prefectures, However, there were increases in some areas: the number of traffic injuries nationwide; the number of traffic incidents and injuries in the Kanto region; the number of traffic incidents in the Kinki region; the number of traffic incidents and fatalities in Hokkaido region; the number of traffic incidents, injuries, and fatalities in Chiba prefecture; the number of traffic incidents and injuries in Kanagawa prefecture; the number of traffic injuries and fatalities in Tottori prefecture; the number of traffic incidents in Gunma, Saitama, and Yamaguchi prefectures; and the number of traffic fatalities in Aichi, Shimane, and Kochi prefectures Figs .The third peak of COVID-19 infections occurred in January 2021 nationwide, as well as in most regions and prefectures. However, the third peak occurred in November 2020 for the Hokkaido and Tohoku regions, and in December 2020 for the Chugoku region and the prefectures of Iwate, Yamagata, Shimane, Hiroshima, and Kochi. During month of the third peak of COVID-19 infections, the number of traffic incidents, injuries, and fatalities decreased nationwide, as well as in most regions and prefectures Figs .The fourth peak of COVID-19 infections occurred in May 2021 nationwide as well as in most regions and prefectures. However, the fourth peak occurred in April 2021 in the regions of Kinki and Shikoku and in the prefectures of Yamagata, Nagano, Fukui, Osaka, Hyogo, Nara, Wakayama, Tottori, Tokushima, and Ehime, and in March 2021 in the Miyagi prefecture. In the month of the fourth peak of COVID-19 infections, the number of traffic incidents and injuries decreased and the number of traffic fatalities declined nationwide as well as in most regions and prefectures, except for certain prefectures. The number of traffic injuries in Iwate and Fukui, and the number of traffic fatalities in Aichi increased Figs .The fifth peak of COVID-19 infections occurred in August 2021 nationwide and for all regions and prefectures. In the month of the fifth peak of COVID-19 infections, the number of traffic incidents and injuries decreased, and the number of traffic fatalities declined nationwide as well as for most regions and prefectures; however, the number of traffic incidents and injuries in Nagano, Shimane, and Kyoto; the number of traffic injuries and fatalities in Okinawa; and the number of traffic fatalities in Yamagata and Tokushima prefectures did not decline Figs .The sixth peak of COVID-19 infection occurred in February 2022 nationwide and in most regions and prefectures. However, the sixth peak occurred in January and March 2022 in the Shimane, Hiroshima, and Okinawa prefectures. During the sixth peak of COVID-19 infections, the number of traffic incidents and injuries decreased and the number of traffic fatalities declined nationwide, in all regions, and in most prefectures; however, the number of traffic fatalities in the Tottori and Shimane prefectures increased Figs .th in population density, was the 28th prefecture in vehicle density. The Shiga prefecture, which ranked 16th in population density, was the 14th prefecture in vehicle density. The bottom 15 prefectures (from 47th to 33rd) in terms of population density were Shimane, Iwate, Akita, Kochi, Hokkaido, Yamagata, Nagano, Fukushima, Yamanashi, Tokushima, Tottori, Aomori, Miyazaki, Kagoshima, and Wakayama. The prefectures in the bottom 15 in terms of vehicle density were almost the same as those in the bottom 15 in terms of population density, although there were differences in the order. The Yamanashi prefecture, which was ranked 39th in population density, was ranked 18th in vehicle density and the Wakayama prefecture, which was ranked 33rd in population density, was ranked 20th in vehicle density. The Oita prefecture, which was ranked 30th in population density, was ranked 38th in vehicle density and the Fukui prefecture, which was ranked 31st in population density, was ranked 34th in vehicle density  compared to numbers in 2018 and 2019. However, the number of traffic fatalities varied –S5 Figs.The number of COVID-19 infections showed a significant inverse correlation with the number of traffic incidents, injuries, and fatalities nationwide; in the Tohoku, Chubu, and Kyushu regions, as well as in the Akita, Niigata, and Shizuoka prefectures. In other regions and prefectures, where significant inverse correlations were found, the number of COVID-19 infections showed a significant inverse correlation with either the number of traffic incidents, and/or injuries and/or fatalities. The peak month of COVID-19 infections was different in some regions and prefectures than in others, and the number of traffic collisions increased inversely during the peak month of COVID-19 infections. However, significant inverse correlations were also obtained. The number of COVID-19 infections within misaligned regions or prefectures showed a significant inverse correlation with the number of traffic injuries and fatalities in the Kanto region; the number of traffic incidents in the Kinki region; the number of traffic injuries in the Shikoku region; the number of traffic incidents and injuries in the Fukushima, Ehime, and Yamaguchi prefectures; the number of traffic incidents in the Iwate and Hiroshima prefectures; and the number of traffic injuries in the Kochi prefecture.At the time of the first peak of COVID-19 infections in April 2020, the Act on Special Measures against New Influenza (“the Act”) was amended to attempt to prevent the spread of COVID-19 and the basic policy response to COVID-19 was determined on the basis of the Act. Based on the amendments made to the Act, the first State of Emergency was declared on April 7, 2020. The initial State of Emergency covered the following seven prefectures: Tokyo, Saitama, Chiba, Kanagawa, Osaka, Hyogo, and Fukuoka. This was later extended to all prefectures on April 16, 2020. During the first State of Emergency, human contact was required to be reduced by at least 70%, with a goal of an 80% reduction, and the nation was requested to refrain from venturing outdoors, using public facilities, holding events, and conducting business . In ApriThe first State of Emergency was lifted in 39 prefectures on May 14, 2020 and in the following prefectures on May 21, 2020: Kyoto, Osaka, and Hyogo. The first State of Emergency was eventually lifted in the Tokyo, Saitama, Chiba, and Kanagawa prefectures of the capital area and in the Hokkaido region on May 25, 2020 after approximately one and a half months . The secIn December 2020, the number of new COVID-19 infections in the capital area reached a high level and on January 8, 2021, the Japanese government declared a second State of Emergency for the capital city area, including the Tokyo, Saitama, Chiba, and Kanagawa prefectures, that was terminated on March 21, 2021. Subsequently, a second State of Emergency was declared in the Tochigi, Aichi, Gifu, Kyoto, Osaka, and Hyogo prefectures on January 14, 2021, and this was terminated on February 28, 2021 in all but the Tochigi prefecture . Unlike with the first State of Emergency, the government did not prevent such a wide range of socio-economic activities in the second State of Emergency, but rather requested restaurants to shorten their trading hours, focusing on situations with a high risk of infection, specifically those involving eating and drinking [By March 2021, the second State of Emergency had been lifted nationwide and the number of COVID-19 infections had stopped decreasing in each prefecture and especially in urban areas, such as Osaka, which exhibited a tendency to rebound. On April 5, 2021 the first Semi-Emergency Spread Prevention Measures were applied to the Miyagi, Osaka, and Hyogo prefectures, but these were gradually extended nationwide as follows: on April 12, 2021 to the Tokyo, Kyoto, and Okinawa prefectures; on April 20, 2021 to the Saitama, Chiba, Kanagawa, and Aichi prefectures; on April 25, 2021 to the Ehime prefecture; on May 9, 2021 to the Hokkaido region and the Gifu and Mie prefectures; and on May 16, 2021 to the Ishikawa, Gunma, and Kumamoto prefectures. As the situation worsened due to the spread of mutated strains of COVID-19 and the healthcare system experienced increased pressure, the government declared a third State of Emergency in the Tokyo, Kyoto, Osaka, and Hyogo prefectures from April 25 to June 20, 2021, and subsequently in the Aichi and Fukuoka prefectures from May 12 to June 20, 2021. The third State of Emergency was declared in the Hokkaido region and the Okayama and Hiroshima prefectures from May 16 to June 20, 2021 as well as in the Okinawa prefecture on May 23, 2021 [The third State of Emergency was lifted nationwide on June 20, 2021, except in the Okinawa prefecture, but the Semi-Emergency Spread Prevention Measures were maintained from June 21 to July 11, 2021 in the Hokkaido region as well as the Tokyo, Aichi, Kyoto, Hyogo, and Fukuoka prefectures and were maintained until August 1, 2021 in the Osaka prefecture. Semi-Emergency Spread Prevention Measures remained in place from April 20 to August 1, 2021 in the Saitama, Chiba, and Kanagawa prefectures without the declaration of a third State of Emergency [As the number of COVID-19 infections increased in Japan, a State of Emergency was declared again. The third State of Emergency in the Okinawa prefecture was only terminated on September 30, 2021, while the fourth State of Emergency was declared in the Tokyo prefecture from July 12 to September 30, 2021 and in the Saitama, Chiba, Kanagawa, and Osaka prefectures from August 2 to September 30, 2021. Semi-Emergency Spread Prevention Measures were implemented in areas where the COVID-19 infections had not yet reached severe levels: in the Hyogo, Kyoto, Fukuoka, and Ishikawa prefectures and in the Hokkaido region from August 2, 2021; in the Gunma, Ibaraki, Tochigi, Shizuoka, Aichi, Shiga, Fukushima, and Kumamoto prefectures from August 8, 2021; in the Miyagi, Mie, Gifu, Hiroshima, Okayama, Toyama, Yamanashi, Ehime, Kagoshima and Kagawa prefectures from August 20, 2021; and in the Kochi, Saga, Nagasaki and Miyazaki prefectures from August 27, 2021. When the number of COVID-19 infections became significant, the fourth State of Emergency was declared: from August 20 to September 30, 2021 in the Kyoto, Fukuoka, Gunma, Ibaraki, Tochigi, Shizuoka and Hyogo prefectures; from August 27 to September 12, 2021 in the Okayama and Miyagi prefectures; from August 27 to September 30, 2021 in the Mie, Gifu, Shiga, Hiroshima and Aichi prefectures and the Hokkaido region. On September 30, 2021, both of the fourth State of Emergency and the Semi-Emergency Spread Prevention Measures were terminated nationwide [The sixth peak of COVID-19 infections occurred around February 2022 and the number of COVID-19 infections rose to an unprecedented level. Therefore, Semi-Emergency Spread Prevention Measures were implemented by the government again in the most heavily infected prefectures, beginning on January 9, 2022 and extending to almost all areas nationwide. The government terminated these Semi-Emergency Spread Prevention Measures on March 21, 2022 [In the regions and prefectures where there was no inverse correlation between the number of COVID-19 infections and the number of traffic collisions, the number of traffic collisions increased during the peak months of COVID-19 infections. Considering the number of traffic collisions that occurred in 2018 and 2019 before the COVID-19 pandemic, we submit that the number of traffic collisions would not be reduced to nil even if the number of traffic collisions that occurred decreased in the peak months of COVID-19 infections as many prefectures showed a tendency towards an increase in collisions in the months with highest numbers of infections –S5 Figs.In addition, during the peak months of COVID-19 infections, the number of traffic collisions did not decrease to a minimal amount in many prefectures: the Tokyo, Kanagawa, Saitama, and Chiba prefectures in Kanto region, Osaka prefecture in Kinki regions, Kyoto and Okinawa prefectures, which were among the top 15 prefectures in terms of population density and vehicle density ; the AomSince January 2020, the Japanese government has declared multiple States of Emergency and implemented various Semi-Emergency Spread Prevention Measures in order to prevent the transmission of COVID-19. Citizens were urged not to leave their homes unnecessarily and the nation became more aware of the importance of preventing the spread of the virus and reducing activities involving human contact. This resulted in a decrease in the traffic volume compared to previous years , 8 and lThe number of traffic collisions was examined in this study, but not the age structure of casualties; the distinction between drivers, passengers, and pedestrians among casualties; the type of vehicle involved in the collision; or the road on which the collision occurred. A more detailed analysis of these data would result in more targeted countermeasures to traffic collisions. Furthermore, analyzing traffic collisions during the pandemic could aid other countries in developing traffic safety strategies.This study used existing statistical data, performed statistical analyses, and compared the results of the analyses to understand the changes in the number of traffic collisions during the various waves of COVID-19 infection in Japan. It was found that from January 2018 to June 2022, the number of traffic collisions that occurred each year exhibited a continuous downward trend. During the peak months of COVID-19 infections, the number of traffic collisions decreased further and reached a minimum. The number of COVID-19 infections showed a significant inverse correlation with the number of traffic incidents, injuries, and fatalities nationwide as well as in some regions and prefectures. Whenever the number of COVID-19 infections increased, a State of Emergency was declared and Semi-Emergency Spread Prevention Measures were issued repeatedly. These measures affected the autonomy of the population and resulted in a decrease in the number of traffic collisions owing to a decrease in traffic volume. Our analysis indicates that controlling the traffic volume is related to a reduction in traffic collisions. Therefore, we submit that the regulation of vehicle traffic volume is an effective measure that can be used to control the occurrence of traffic collisions and subsequent injuries. These lessons learned from the COVID-19 pandemic can be applied to future policy development related to road safety improvements during unique events.S1 Fig(TIF)Click here for additional data file.S2 Fig(TIF)Click here for additional data file.S3 Fig(TIF)Click here for additional data file.S4 Fig(TIF)Click here for additional data file.S5 Fig(TIF)Click here for additional data file.S1 TableInfection: Number of people infected with COVID-19. Incident: Number of traffic collision incidents. Injury: Number of injuries due to traffic collisions. Fatality: number of fatalities in traffic collisions. No: The number is zero in the month. The data in the table represents the peak months for the number of COVID-19 infections and the months of the least number of traffic collision, for example “4” means April, “8” means August, etc., “,” means “or”. The name of the region or prefecture appears in the left column of the table.(XLSX)Click here for additional data file.


Global aging has proceeded at an unprecedented and accelerating rate. The aging of the population creates both opportunities and challenges for older adults, their families, and society in general. Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics. Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of older adults. This symposium assembles editors at five leading gerontology journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. Editors include: Edward Alan Miller, PhD, FGSA, Journal of Aging & Social Policy; Jeffrey Burr, PhD, FGSA, Research on Aging; Julie Robison, PhD, FGSA,, Journal of Applied Gerontology; Sandra Torres, PhD, FGSA, Ageing & Society; and Julie Hicks Patrick, PhD, FGSA, International Journal of Aging & Human Development. Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship.


Global Strategy for Women’s, Children’s and Adolescents’ Health in Latin America and the Caribbean (LAC), including adaptation to region specific needs, to end preventable deaths, ensure health and well-being and expand enabling environments for the health and well-being of women, children and adolescents. To advance the equitable achievement of these objectives, EWEC-LAC’s three working groups collectively support LAC countries in measuring and monitoring social inequalities in health, advocating for their reduction, and designing and implementing equity-oriented strategies, policies and interventions. This support for data-driven advocacy, capacity building, and policy and program solutions toward closing current gaps ensures that no one is left behind. Members of EWEC-LAC include PAHO, UNAIDS, UNFPA, UNICEF, UN WOMEN, the World Bank, the Inter-American Development Bank, USAID, LAC Regional Neonatal Alliance, and the LAC Regional Task Force for the Reduction of Maternal Mortality. To date, EWEC-LAC has developed and collected innovative tools and resources and begun to engage with countries to utilize them to reduce equity gaps. These resources include a framework for the measurement of social inequalities in health, data use and advocacy tools including a data dashboard to visualize trends in social inequalities in health in LAC countries, a methodology for setting targets for the reduction of inequalities, and a compendium of tools, instruments and methods to identify and address social inequalities in health. EWEC-LAC has also engaged regionally to emphasize the importance of recognizing these inequalities at social and political levels, and advocated for the reduction of these gaps. Attention to closing health equity gaps is ever more critical in the face of the COVID-19 pandemic which has exploited existing vulnerabilities. More equitable health systems will be better prepared to confront future health shocks.The Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) initiative was established in 2017 as a regional inter-agency mechanism. EWEC-LAC coordinates the regional implementation of the  Global Strategy for Women’s, Children’s and Adolescents’ Health [Global Strategy) was launched in 2016 to “[provide] guidance to accelerate momentum for women’s, children’s and adolescents’ health” and its Operational Framework was approved in the 69th World Health Assembly. The interagency mechanism Every Woman Every Child (EWEC) was created in 2010 by former UN Secretary-General H.E. Ban Ki-moon to catalyze a political movement to advance the health and well-being of women, children and adolescents everywhere and as a framework to support the implementation of the Global Strategy on a global level. In 2017, APR-LAC became the regional inter-agency mechanism Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) with a mandate to adapt and implement the Global Strategy in the LAC context. Given widespread health inequalities for women, children and adolescents in the LAC region [Plan of Action for Women's, Children's, and Adolescents' Health [Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas [In 2013, the Millennium Development Goals (MDGs) were approaching their target year. Despite progress in health in Latin America and the Caribbean (LAC) countries during the MDGs era, differences in health coverage and outcomes among social groups, which we refer to here as social inequalities in health, remained widespread both between and within LAC countries. In this context, the A Promise Renewed for the Americas (APR-LAC) initiative was established to promote cooperation with an equity lens to countries in the Americas and to assist in measuring and monitoring inequalities in reproductive, maternal, children and adolescent health. In 2015, the 2030 Global Agenda for Sustainable Development was launched and the MDGs were superseded by the Sustainable Development Goals (SDGs). Subsequently, the Americas . This arEWEC-LAC is formed by 8 organizations, namely: the Inter-American Development Bank (IDB), the Pan American Health Organization (PAHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS), the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF), the United Nations Entity for Gender Equality and the Empowerment of Women (UN WOMEN), the United States Agency for International Development (USAID), and the World Bank (WB). Among some of its collaborative partners are the Regional Task Force for the Reduction of Maternal Mortality  and the LAC Regional Neonatal Alliance. EWEC-LAC has three key areas of work: (i) supporting and promoting the measurement and monitoring of social inequalities in health affecting women, children, and adolescents; (ii) addressing social inequalities in health through evidence-based policy-making, and (iii) advocating for public and political agendas that strive for social equity in the health of women, children, and adolescents. EWEC-LAC is therefore structured in three working groups: (i) the Metrics and Monitoring Working Group (MMWG), (ii) the equity-based Policies, Strategies, and Interventions Working Group (PSIWG), and (iii) the Communications and Advocacy Working Group (CAWG), which work together to advance the initiative’s priorities as detailed below.“Health inequities are the unjust differences in health between persons of different social groups, and can be linked to forms of disadvantage such as poverty, discrimination and lack of access to services or goods” . As a noGlobal Strategy was used as a guide, and emphasis was placed on adapting it to reflect the needs and priorities of the LAC region. The resulting list contains indicators from the SDGs and the Global Strategy. Furthermore, it is structured according to the Global Strategy Framework that includes Survive, Thrive, and Transform objectives as key pillars encompassing preventable deaths, health and well-being, and enabling environments.To measure social inequalities in the health of women, children, and adolescents in the LAC region, EWEC-LAC has defined a Regional Monitoring Framework that includes 32 priority indicators and 6 equity stratifiers [To summarize social inequalities in the health of women, children, and adolescents, EWEC-LAC uses specific methodologies and simple and complex standard inequality measures , 7, 8. TGiven that the emphasis of EWEC-LAC’s data work are equity analyses, data for priority indicators predominantly comes from nationally representative survey programs at the household level, such as the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS) programs, which are a good source for data disaggregated into various socioeconomic characteristics. For some indicators, data may also come from administrative data sources , 10. TheGlobal Strategy targets set for 2030, the monitoring of health inequalities is useful to track and accelerate their progress, and to create accountability on the promise to leave no one behind.EWEC-LAC’s data dashboard also presents visualizations based on historical data to track trends. For example, Fig. Another key aspect that promotes reducing social inequalities in health is establishing clear and specific targets for the reduction of current gaps. In this area of work, EWEC-LAC has proposed a methodology to establish SDG 3  targets and reduce their inequalities . It consGlobal Strategy. This work is multi-pronged and involves improving the capabilities of technical country teams to apply equity-based tools and methods; analyzing, documenting and disseminating good practices and lessons learned regarding equity-based approaches; and promoting equity-based policy-dialogue on the health of women, children and adolescents in LAC countries. Collectively, and in combination with efforts to collect and analyze disaggregated data with an equity focus as well as implementation research activities, these actions contribute to improving LAC country capabilities to implement and scale-up evidence-based interventions to reduce national and local inequities in the health of women, children and adolescents.EWEC-LAC works with countries in the LAC region to promote the implementation of evidence-based multi-sectoral policies, strategies, and interventions that reduce inequalities in the health of women, children and adolescents and are in line with country priorities within the context of the SDGs and the To support countries in their equity-oriented health actions, EWEC-LAC completed a systematic review of equity-based approaches to address maternal mortality and adolescent pregnancy. Despite progress in some countries, there is a persistent need across the region for strengthening of multisectoral interventions targeting the most vulnerable populations and addressing structural social determinants in health affecting maternal mortality and adolescent pregnancy.To complement the above resource, EWEC-LAC also developed a compendium of tools, instruments and methods to identify and address social inequities affecting the health and well-being of women, children and adolescents in LAC. The compendium was developed through a systematic search using specific criteria defined by inclusion and exclusion criteria. The search for these tools, instruments and methods was restricted to those published after 2000 in English, Spanish or Portuguese; focused on women, children and adolescents or the general population; and addressing social inequalities in health. Subsequently, the studies that conformed to the criteria were screened and selected independently by two reviewers based on their credibility, dependability, confirmability and transferability; with disagreements resolved by joint review. The compendium is targeted to a wide range of stakeholders, including policy-makers, non-governmental organizations, and academia. It includes key information for each tool, instrument, and method, such as their author, year of design, goals, objectives, design specification, intended users, requirements for implementation, countries and sites where they have been previously implemented, experiences and lessons learned from the implementation, references to access them, and case studies. EWEC-LAC aims to update the compendium periodically, so that it includes state-of-the-art tools, instruments and methods. By providing an overview of these, the compendium may be used to strengthen systematic identification, analysis and responding to social inequities in the health of women, children, and adolescents in LAC.Another example of key activities conducted by EWEC-LAC was a regional competition to identify good practices applying equity-based approaches in reproductive, maternal, adolescent and child health. To participate, these practices had to respond to a specific health challenge disproportionately affecting women, children or adolescents living in vulnerable situations; incorporate or address intermediary or structural determinants of health and health inequities affecting women, children or adolescents living in vulnerable situations; receive government support to ensure long-term sustainability; be replicable in other contexts and on a larger scale; and have a monitoring and evaluation mechanism to track quantitative or qualitative indicators demonstrating impact or results in relation to practice objectives or goals. The competition resulted in the selection of ten country experiences. The good practices and lessons learned are being documented in a report as well as in video format for sharing in the region for potential utilization in other contexts.The LAC region represents a disproportionate number of COVID-19 cases and some of the highest mortality rates in the world . In the Global Strategy in the LAC region. Through these activities, EWEC-LAC identifies key goals, strategies and timelines for the recognition of social inequalities in the health of women, children and adolescents in the LAC region at social and political levels. EWEC-LAC coordinates its communications through social media, newsletters, websites, and public media targeted to specific audiences and tailored to their needs. Furthermore, relevant spokespersons are identified and key messages, taglines and slogans are developed. EWEC-LAC’s communication activities to advocate for health equity also include the creation and dissemination of technical products, which are used in training workshops, and advocacy materials.The implementation of EWEC-LAC’s communication and advocacy activities positions the initiative as a central catalyst for the implementation of the In the context of the COVID-19 pandemic, it is essential to prioritize the health of women, children and adolescents in the LAC region. EWEC-LAC developed an infographic providing five methodological recommendations to improve institutional capabilities to monitor inequalities in the health of pregnant women during and after the COVID-19 pandemic . These rGlobal Strategy in a targeted manner that considers contextual realities and addresses the specific challenges faced in the LAC region. The three working groups of EWEC-LAC work together to support LAC countries in measuring and monitoring their social inequalities in health, implementing equity-based public health strategies, policies and interventions, and advocating for the reduction of social inequalities of health in the region.EWEC-LAC promotes the implementation of evidence-based strategies to reduce social inequalities in the health of women, children and adolescents across the LAC region. Building on preliminary work of the APR-LAC movement, since 2017, EWEC-LAC has played a key role in the implementation of the EWEC-LAC acknowledges current challenges to achieving health equity in the LAC region. Importantly, the COVID-19 pandemic has disrupted the normal functioning of the health system, affected the coverage and quality of health services, and required governments to direct their funding of public health towards policies and actions mitigating the spread of COVID-19. As such, it poses a threat to equity in the health of women, children and adolescents and is exacerbating existing widespread within-country and between-country social inequalities and derailing progress towards the SDGs.Although the COVID-19 pandemic has affected the availability of recent data, complementing survey data with data from administrative sources allows to continue to monitor health inequalities among LAC countries during the pandemic. Nonetheless, it is essential to further improve the collection, reporting, and monitoring of these data, which would allow for greater room for evidence-based policy-making and advocacy for the reduction of social inequalities in health. Particularly, it is important that relevant stakeholders, such as ministries of health, ministries of finance, national statistical institutes, and public and private academic institutions and research centers, collaborate to strengthen national information systems to ensure the collection and reporting for health indicators for women, children, and adolescents disaggregated by equity stratifiers, with data disaggregated at a minimum by age and other relevant characteristics, such as place of residence , race, ethnicity, occupation, education, or socioeconomic status, as well as subnational geographic regions. This would allow countries to monitor social inequalities in health, and especially the inequalities between subgroups to identify those that are left behind, as in , as wellThe work with technical teams from LAC countries has achieved important results to date, such as improving capabilities in applying methodologies for measuring and monitoring inequalities in health. For instance, central technical teams within South American countries were formed and trained in measuring and monitoring health inequalities. Notably, the central team in Chile subsequently trained teams at the subnational regional level, and each of these subnational teams developed profiles of inequalities within each region of the country . NonetheGlobal Strategy and SDGs, approaches, EWEC-LAC remains committed to overcoming these challenges. Now, more than ever, inequity issues could not be left aside. Consequently, for the near term future, EWEC-LAC seeks to promote the reimagining and rebuilding of health systems in the region in the post-COVID-19 era with a focus on equity, and continue supporting countries in strengthening their efforts to promote equity-based policies.Finally, it should be noted that there are multidimensional factors affecting the health and well-being of women, children and adolescents which underscores the importance of a multisectoral approach in which governmental and non-governmental sectors, academia and civil society work jointly to leverage competitive advantages, increase accountability, and ensure an inclusive approach. As 2030, the target year for the


Food traceability is very important for the quality and safety of agricultural products, which is related to the people’s livelihood and national economy and has drawn great attention from governments and scientists around the world. The existing studies have not yet overcome the crisis characteristics comprehensively and systematically. A traceability system of red jujube is constructed by a hybrid mode of blockchain and the Internet of Things (IoTs). The system integrates the blockchain and the IoT technologies with characteristics of tamper-proof, decentralization, and distributed storage and solves the problem of date quality traceability by designing the technical process and architecture of date quality traceability and the big data of red jujube, jujube plantation, processing enterprise, commercial enterprises, and market administration. The whole process from planting to processing and sales of red jujube are recorded in the block to ensure the realization of quality traceability of red dates in the process. Through the whole process of big data processing, the key information collected in each process is stored in the database to ensure the realization of quality traceability of red dates in the framework. The system can help to minimize the production and distribution of unsafe or poor-quality products, thereby minimizing the potential for bad publicity, liability, and recalls. The quality and safety of agricultural products are related to the people’s livelihood and national economy. The frequent occurrence of agricultural product quality and safety crises has drawn great attention from countries around the world. Quality control in agricultural production and throughout the supply chain is one of the most challenging issues in the world today, especially when it comes to typical food products. The quality and safety of agricultural products are an important study direction at present, which is a multidisciplinary study field. Its purpose is to explore the technology, measure and supervision guarantee system to ensure the hygiene and food safety of agricultural products, reduce the potential disease, and prevent the risk of food poisoning in the process of agricultural products processing, storage, and sales. In recent years, many agricultural quality control systems have been presented and various companies are trying to experiment with joint use of radiofrequency identification (RFID), Internet of Things (IoTs), and blockchain technologies to solve problems in scenarios where numerous untrusted actors get involved .Good traceability systems help to minimize the production and distribution of unsafe or poor quality products and minimize the potential for bad publicity, liability, and recalls. The current food labeling system cannot guarantee that the food is authentic, good quality, and safe. Blockchain technology is a new digital technological approach underpinned by the Industry 4.0. It is used to ensure data integrity and prevent tampering and single point of failure through offering fault tolerance, immutability, trust, transparency, and full traceability of the stored transaction records to all the agri-food value chain partners. Agricultural products traceability management integrated system can produce the data uploaded to the agricultural products of the whole process of cultivation of traceability management integrated system, the digital information, so supervision department can do random inspection of agricultural products, through the data to verify reliability, record results, give consumers a greater sense of trust, enhance consumer confidence. The problems of traceability agricultural products system are summarized as: (1) Enterprises developing traceability agricultural products system are not the same, so traceability information cannot be shared, many system software are not compatible, and the purpose of query cannot be achieved in different systems. Some query terminals can only be queried in supermarkets, which make it inconvenient to use; (2) At present, the traceability system is not unified in many aspects, such as identification code, storage information, and network query system, and it also faces different kinds of food; and (3) The accuracy of traceability is not high, some of them can only be traced back to the enterprise, and the specific process of planting, processing, or transportation cannot be traced.Xinzheng red jujube (XRJ) is a specialty of Xinzheng city, Zhengzhou City, Henan Province, China. It is a good fruit nourishing blood and spleen beauty, has high medicinal value, and its leaves, flowers, fruits, skins, roots, and thorns can be used as medicine. However, the development of XRJ industry is also facing many problems, such as the quality and safety system is not perfect, especially the pesticide and fertilizer residues are too high, which greatly restrict the development pace of XRJ industry. The quality and safety of XRJ is not only a major livelihood issue related to people’s health, but also a major obstacle to the international XRJ trade. To guarantee safety in food, an efficient tracking and tracing system is required. RFID devices allow recording all the useful information for traceability directly on the commodity. By analyzing the problems existing in the quality and safety of XRJ and discussing the quality and safety problems of XRJ based on the IoT, this article tries to construct a quality control system of XRJ based on the IoT, improve the quality and safety control level of XRJ, and then realize the intelligent and scientific management of XRJ production, which have important practical significance for promoting the development of modern XRJ. This proposed system aims to reduce the chemical pesticides, fertilizers and antibiotics usage, stimulating sustainable food consumption, and promoting affordable healthy food for all. Consumers are encouraged to choose healthy and sustainable diets and reduce food waste. Farmers and producers are encouraged to provide more details about food origin, nutritional value, and environmental footprint. The contributions of this article are as follows.(1)A hybrid mode of blockchain and the IoT is used to construct a quality control system of XRJ.(2)Data processing of XRJ traceability system is introduced in detail.(3)The XRJ traceability system is verified in the Henan Xinzheng Xinxing Jujube Industry Corporation Ltd.The rest of the article is organized as follows. In Section 2, the related work is introduced. Section 3 focuses on XRJ quality traceability system in detail. The experiments and analysis are conducted in Section 4. Section 5 concludes the study work and point out the future work.The Internet of Things (IoTs) is an extended network based on the internet through a variety of sensors, RFID technology, global positioning system (GPS), infrared sensors, laser scanner, and other equipment and technology, no need to monitor real-time acquisition, connected, interactive object or process, collect the sound, light, heat, electricity, mechanics, chemistry, biology, location, and other needed information, through all the kinds of possible internet access, to realize the ubiquitous connection between objects and objects, objects and people, and realize the intelligent perception, recognition, and management of objects and processes. The Internet of Things is an information carrier based on the internet, traditional telecommunications networks, etc. It enables all the ordinary physical objects that can be independently addressed to form an interconnected network .At present, XRJ production mainly depends on manual experience management and lack of scientific and systematic guidance. Information acquisition is one of the most important key technologies to realize the high level of facility production of XRJ and to optimize the facility biological environment control. The agricultural IoT plays a crucial role in revolutionizing agricultural production. From the practical experience of developed countries, the IoT has many applications in the field of agriculture and is developing in the direction of reliability, energy saving, environmental adaptability, low cost, information, and intelligence. If it is a jujube production base of thousands of acres, if the IoT technology is applied, manual control only needs to click the mouse tiny action, only a few seconds before and after, can completely replace the tedious manual operation such as watering and fertilization. From the point of view of different stages of XRJ production, whether from the cultivation stage of planting and harvest stage, the IoT technology can be used to improve its work efficiency and fine management.•At the plant preparation stage, a bunch of sensors can be arranged in the greenhouse to analyze real-time soil information and choose the right date varieties.•At the planting and cultivation stage of jujube, the IoT technology can be used to collect temperature and humidity information for efficient management, so as to cope with environmental changes and to ensure plant seedlings grow in the best environment.•At the growth stage of jujube, the IoT can be used to monitor the environmental information, nutrient information, and crop diseases and insect pests in real time. Using relevant sensors are accurate and real-time access to soil moisture, environmental temperature and humidity, illumination, through real-time data monitoring and special varieties of expert experience, combining with control system regulating crop growth environment, improve crop nutrition state, crop pest and disease outbreaks in time period, to maintain the best crop growth conditions. It plays a very important role in the growth and management of jujube.•At the harvest stage of jujube, the IoT technology is used to transfer information such as appearance, fruit diameter, and nutritional composition of jujube to the data center. According to the data of planting environment, weather condition, and fruit tree status, the planting scheme is optimized for next year through big data technology analysis.Through the IoT technology, the production and operation of XRJ can be rapidly transformed from extensive and empirical management to fine and scientific management, so as to improve the yield and quality of XRJ, reduce the production cost of XRJ, and protect the agricultural environment. Data acquisition in Blockchain is a chain of blocks, each containing a certain amount of information, connected in the chronological order of their creation . The chaBlockchains allow people to have a distributed peer-to-peer network where non-trusting members can interact with each other without a trusted intermediary in a verifiable manner. Combining blockchain with the IoT, namely, blockchain-IoT is powerful and can cause significant transformations across several industries, paving the way for new business models and novel, distributed applications . It faciFrom the actual needs of the whole quality and safety management of XRJ, based on the quality and safety standards of XRJ, technical standards of XRJ, safety law, and other regulations and standards, the whole process risk management and traceability system framework of pollution-free XRJ quality and safety are designed. The wireless network remote environment monitoring technology is used to collect and analyze the data of XRJ in the whole circulation links such as XRJ, processing, storage, transportation, and sales, and generate reports with the results, so that managers can understand the situation in each link and solve related problems in time. All the monitoring report and pictures are numbered, using the information classification and coding standards, designing the pollution-free XRJ quality security coding, generating the QR code identification of XRJ, so that the consumers by smartphone scanning, back to the whole process of XRJ circulation. The whole process of pollution-free XRJ quality and safety can be monitored and traced.The XRJ quality traceability system based on hybrid mode is mainly divided into hardware and software system. The hardware module mainly realizes the real-time data collection of crops from planting to processing, circulation and sales of XRJ, and writes the data into the database. The software system is divided into Web Service and Android client. Since the Android client cannot interact directly with the database, this document uses Web Service as a bridge. The Web Service retrieves data from the database and the Android client retrieves data from the Web Service through Simple Object Access Protocol (SOAP).(1) Hardware environment design: The hardware part of the system mainly includes power supply module, sensor module, ZigBee module, and gateway module. The power supply module supplies power to other modules. The sensor module collects environmental data in real time and then transmits the data to the gateway module through ZigBee module. Finally, the gateway module uploads the data to the database through a specific serial port communication program.(2) Software design: The gateway module of the hardware part writes the real-time data collected by the sensor into the database through serial communication. The Web Service obtains data from the database and the Android client obtains data from the Web Service through SOAP protocol. The Android client interacts with the database through Web Service, so as to realize the data query function.The architecture and flowchart of traceability system of XRJ based on hybrid mode of blockchain and the IoT are shown in Choose the high-quality characteristics in XRJ varieties to quality and safety traceability system demonstration experiment, on the basis of sufficient study, analysis of demand, study and development to establish traceability anticounterfeiting XRJ whole-industry chain management system, unified data standard system construction, software and hardware, and the reliable technology are constructed to obtain integrity, practicality, advanced, and scalability. Anticollision method of RFID tag in large dynamic change and fast moving environment is carried out synchronously and is used in traceability anticounterfeiting management system to improve batch tag identification efficiency in complex environment. The advantages and characteristics of the XRJ whole-industry chain traceability anticounterfeiting management system based on radiofrequency identification technology will be gradually promoted to red jujube, planting, and sales enterprises in the province, benefiting the majority of villages and growers.According to the distribution of relevant personnel in the enterprise, the application scheme is determined: (1) personnel in the headquarters. Due to data center server deployment in enterprise headquarters, system administrator in the enterprise headquarters, production management personnel, and technical personnel can switch to the traditional C/S architecture system client data reporting and can carry out data analysis and statistics, the traditional C/S architecture system data reporting and management of the purpose is to improve the response speed data, reduce the influence of Windows Communication Foundation (WCF) frame on system performance; (2) Personnel other than the headquarters. The staff in the base, processing plant, or outside can choose different system clients for data reporting and management according to whether the network is smooth. When the network is not smooth, people can choose the traditional C/S frame system client to input the local data into the local server and carry out the local data analysis and statistics. When the network is normal, people can use the WCF client to synchronize data from the local server to the data center at the headquarters. After the synchronization, the WCF client can directly report data to the data center at the headquarters in real time and analyze and collect statistics over the internet.The Henan Xinzheng Xinxing Jujube Industry Corporation Ltd. is chosen to validate the system. The network infrastructure of the enterprise is better. The enterprise has a provincial planting base of red dates: Nankou red jujube production center and 9 large-scale planting bases. Some bases have poor network infrastructure and the network cannot be guaranteed to be smooth all the time. According to the network infrastructure of the enterprise, it is very suitable to use the agricultural production traceability management system based on hybrid architecture. At present, the client of the whole system has been deployed in three planting bases and the server has been installed in the corporate headquarters. The production management department is in urgent need of obtaining the real planting area, number of trees planted, amount of pesticides and fertilizer applied and their types, yield, and other data of each base. However, such data can only be collected after the production cycle is completed for a period of time. After adopting this system, the above data can be obtained on the same day. In addition, the following functions are also realized: (1) query the planting and production situation of different batches, different people, different bases, and different time periods; (2) Trace codes are formed according to relevant rules; (3) Query the quality management of the whole production process according to the traceability code; and (4) Upload enterprise traceability data to the ministerial traceability data center through the upload component. https://hyperledger-fabric.readthedocs.io/en/release-1.2/network/network.html stable” and Sudo apt-getinstall docker-ce docker-ce-cli container. IO installs the Docker container.After setting up the Fabric operating environment, the next step is to build the Fabric blockchain, consisting of the following major steps: generating certificates and keys, generating genesis blocks, creating channels, starting the Fabric network, nodes joining channels, and installing and instantiating smart contracts.The blockchain-based agricultural product traceability system consists of six modules: source and origin, product, agricultural operation, quality inspection, warehousing and storage, and transportation. The data of agricultural operation, quality inspection, warehousing and storage, and transportation shall be stored in the blockchain after verification. We collectively refer to the data of these four modules as source information. The specific implementation of each functional module of the traceability system is demonstrated through sequence diagram analysis. The system development environment configuration is shown in In the development stage of the system, white-box test is applied to simulate all the kinds of possibilities inside the program to improve the robustness of the processing method. In the test stage, black-box test is used to test each functional module by simulating user behavior. The test results of each module of the system are shown in With the rapid development of economic level, some agricultural product enterprises reduce production costs to maximize the profits of some agricultural enterprises and result in a lot of agricultural product safety incidents in recent years. Therefore, people have to pay more attention to food safety in daily life. This article constructs a set of XRJ quality traceability system and carries on the system analysis and application verification. The hybrid model in the system makes use of its unique time stamp, consensus mechanism, and other technical means to realize the data of jujube planting, jujube purchasing, jujube processing, jujube sales, and other data that cannot be tampered and traceable. At the same time, the market supervision bureau and consumers are included in the date quality traceability supervision system, which breaks the information island of traditional traceability, provides information support, realizes the full transparency of production and sales process to a certain extent, provides technical support for good market operation order, and provides quality guarantee for consumers’ life and health. With in-depth study and development of blockchain technology, coupled with the requirements of high-quality development of the date industry, blockchain technology will provide new solutions to date traceability, pesticide residues, and brand counterfeiting. While establishing XRJ safety supervision and supervision mechanism, relevant departments need to establish traceability XRJ system, implement relevant responsibility to individuals, and strengthen food production supervision at the source.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Written informed consent was obtained from the individual(s) for the publication of any identifiable images or data included in this article.RJ contributed to the model construction and manuscript writing. PL contributed to the data acquisition and experimental verification.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.