Public health emergencies are extraordinary events of disease spread, with health, economic, and social consequences, which require coordinated actions by governments and society. This work aims to analyze scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management, using the components of the Health Emergency and Disaster Risk Management Framework (H-EDRM) and the Preparedness, Prevention, Response and Recovery Model (PPRR Model), providing guidelines for the development of new models. A systematic literature review was carried out using the Web of Science, Scopus, and Pubmed knowledge databases on studies published between 2016 and 2023, and thirty-six articles were selected. The outcomes show a concentration of frameworks on short-term emergency response operations, with a limited emphasis on the political and strategic components that drive actors and responsibilities. Management prioritizes monitoring, evaluation, and information management frameworks. However, the models need to overcome the challenges of multisectoral and interdisciplinary action, different levels of decisions and actors, data sharing, and development of common platforms of evidence for decisions fitted to the various emergencies. In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency (PHE) of International Concern affecting the lives of millions of people on a global scale until May 2023, when the slowing of transmission of the coronavirus (SARS-CoV-2) was achieved, but with attention to its consequences. Health emergencies, especially pandemics, epidemics, and disasters, are extraordinary events of disease spread, with health, social, economic, and political consequences, which require coordinated actions by states and affect, especially, the most vulnerable populations [In emergency situations, the manager makes decisions under dynamic and chaotic conditions, when interpreting the context under pressure from ethical and political constraints , seekingConsidering this complexity, the WHO increased its perspective on response, prevention, recovery, prediction, and preparedness mechanisms to achieve an intelligence hub, with multidisciplinary collaboration, multisectoral decision making, global data sharing architectures, and expanded health context analysis capabilities to support health manager decision making .In public health emergencies, such as the COVID-19 pandemic, each country has the challenge of making decisions tailored to the limitations of its health systems and related subsystems, guided by global guidelines such as the WHO standards, the Sustainable Development Goals (SDGs), the Sendai Framework for Disaster Risk Reduction 2015–2030, and the International Health Regulations ,7.In this sense, frameworks serve as the interface between the decision maker and the problem to be solved, in various formats such as conceptual models, application of multicriteria methods, and systematic literature review. However, governments can adopt their frameworks without regard for system interoperability and information sharing . In furtThe bounded rationality of decision makers and the behavior of their heuristics and biases in contexts with variables of uncertainty pose a challenge to framework models , requiriCountry planning for an emergency is comprehensive and must begin before the health event, with the challenges of information analysis, expert decision-making approaches and priority setting, choices of methods and models, budget programming, the establishment of a data infrastructure, and evidence production, which condition alert, preparedness, assessment, and crisis control actions, posing a challenge to managers and government structures ; therefoThe examined works present the challenges of decision frameworks in emergencies, focusing on a gap between model type, actor expectation, and context constraints, which this article seeks to mitigate by describing the characteristics and requirement constraints to support country governments in developing frameworks for emergencies using a more adaptive approach incorporating the system dynamics of  and the In this sense, this work aims to analyze the scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management using components of the Health Emergency and Disaster Risk Management Framework (H-EDRM)  and the In recent decades, the global population has been confronted with recurrent health issues that undermine the ability of governments to respond , establiThe WHO guidelines for a public health information center emphasize a predictive perspective to produce better data, better analyses, and better decisions as part of an adaptive, comprehensive, and contextualized approach. Interpreting the context depends on prioritizing risk dynamics rather than managing isolated events, proactive action rather than reactive action, considering the dangers, uncertainties, and vulnerabilities and capacities of each context, as well as involving society and sharing responsibilities. The challenge is directly related to the capacity for resilience in the face of the entropy of the entire health system in an EPS, generated by a scarcity of resources, disputes over political narratives, and indeterminacies between science and common sense ,5.As an illustration, the Brazilian government issued an ESPIN in January 2023 due to a lack of assistance to the Yanomami indigenous population, which is characterized by a crisis that requires the mobilization of national strategies in the health, environmental, management, and regulatory dimensions of the territory, in response to the dangers posed by the presence of illegal mining in the Amazon Region . At the The International Health Regulations, the central instrument for actions to protect countries against the international spread of disease, define public health risk as “the probability that an event will adversely affect the health of human populations, with an emphasis on those that can spread internationally or pose a grave and direct threat” . More thA PHE is a surprising event generating uncertainty, dealing with turbulent problems, and challenging states’ forecasting and protection strategies. There are resilience challenges to restore the previous equilibrium of a situation, which is not always possible or even enough. These are complex decision-making contexts for managers, requiring collaborative relationships and the strengthening of partnerships at all levels, adoption of innovative solutions, and effective communication about risks to achieve a new reality .Decision making in PHEs requires a complexity calculation as close to reality as possible, considering the information available in the time interval of the decision, considering the scientific, technological, political, and managerial data, when the use of frameworks can mitigate the bounded rationality of the decision makers . This huA framework, based on Design Science Research (DSR), is an “artefact” in the form of constructs with conceptual aspects, models that attempt to describe reality, its variables, and their interactions. In the DSR approach, the method relates steps for the execution of actions and analysis and may adopt heuristics and algorithms; instantiation verifies the application of one or more artifacts in the environment, to know the technical feasibility and effectiveness, according to the characteristics of the context . This coOne of WHO’s mechanisms for preparing countries for a PHE is the Health Emergency and Disaster Risk Management Framework (H-EDRM), an expert-developed management framework that reinforces the paradigm of an integrated approach to deal with health emergencies and disaster risks , guidingThe prevention measures reduce the impact of hazards and risk events on health, especially in the more vulnerable population. Recovery is a slow process that promotes actions to restore community life, such as physical, social, or psychological rehabilitation. The response measures include urgent life-saving support, such as the deployment of workforce, infrastructure, logistics, and communication systems. Preparedness increases PHE readiness by strengthening the capacity of governments, institutions, and society through proper legislation, resource planning, and community empowerment ,22.The H-EDRM Policies, Strategies, and Legislation (H-EDRM-PSL) outline organizational structures, roles, and duties. Planning and Coordination (H-EDRM-P&C) emphasize the integration of health planning at all levels. The Monitoring and Evaluation (H-EDRM-M&E) component tracks risks and the implementation of strategies, programs, and activities. The Information and Knowledge Management (H-EDRM-I&KM) integrates health surveillance, early warning, and evidence-based technical guidance. Health Infrastructure and Logistics (H-EDRM-HI&L) address safe and sustainable health facilities. Human Resources (H-EDRM-HR) build capacity and establish human competencies to address PHEs. The Health and Related Services (H-EDRM-H&RS) component guides actions such as prevention, basic care, rehabilitation, and immunization programs. The Risk Communication (H-EDRM-RC) component reports communication strategies to society, and the Community Health Capacities (H-EDRM-CHC) component assesses community risk prevention, population engagement, and territory planning. Finally, the Financial Resources (H-EDRM-FR) mobilize program budgets, contingency funds, and financial arrangements .As shown in Effective decision making in public health emergencies integrates institutions, public policy, science, and society; integrates multidisciplinary and multisectoral collaboration platforms; bridges knowledge generation and action; overcomes fragmentation; and strengthens the sharing of comprehensive and contextualized data, thereby empowering decision makers to understand and manage health risks. Reliable decisions adopt analytical methods and tools, access collective knowledge, and include cognitive characteristics of the decision maker . The comA PHE is a complex process guided by the interdependence of political, social, economic, and health issues, which involves local, regional, and global components . In thisThis systematic literature review is a qualitative approach, which allows the identification of key issues in the field . Our stuhttps://osf.io/u6xfb (accessed on 15 June 2023). The strategy resulting from this validation process is described in the following sections.This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which aims to “help systematic reviewers transparently report why the review was done, what the authors did, and what they found” . This reStudies on decision making in PHEs are recent, and a bibliometric analysis indicates an increase since 2014, associated with the intensification of health events, with 73.27% of the publications identified in the last 5 years, with an indication of growth in the coming years. The results indicate that there is little coordination between countries, institutions, and authors about decision making in PHEs, which raises the possibility of interdisciplinary analysis from a multicultural perspective which is more interpretative of the context of problems that affect the management dimension, especially in countries with populations in situations of economic, social, and environmental vulnerability that intensify in a PHE . In anotThis article reports on the general aspects of frameworks. It considers complexity through the interface of individuals and organizations, dependent on the connectivity of systems and the ambiguities and uncertainties of contexts . The intIn this sense, our article covers the last 7 years in a systematic literature review on aspects and configurations of decision support frameworks in PHEs, which interprets the interface of management problems through the components of the H-EDRM  and the Planning defines the scientific knowledge bases that will be investigated in the research  as folloIn defining the scope, guiding questions were formulated to be addressed to achieve the objective of this study. The text is organized by the H-EDRM and the PPRR model, which address specific topics. The questions guide the analysis of the frameworks studied. These are the following: Q1: How are management decision support frameworks characterized in PHE contexts? Q2: What type of intervention are the frameworks geared towards in a PHE? Q3: What are the challenges and gaps to be overcome by frameworks for strengthening decision making in PHE contexts?Considering the importance of an integrated view and the boundaries between PPRR measures and the H-EDRM components in PHEs, the identification of the theme should be in more than one H-EDRM, which could accommodate an interdisciplinary approach. However, we tried to locate the article studied in the H-EDRM with the greatest intensity, without prejudice to bringing them closer together in the composition of the texts and analyses.In the literature search step, following the questions presented in the scoping, a string is used to query the databases . In theshttps://decs.bvsalud.org/sobre-o-decs/ accessed on 16 June 2023) to find words and synonyms, resulting in the following string composition:  OR  OR  AND (“humanitarian”) OR (emergenc*) OR (“emergency management”) OR (“disaster”) OR (“outbreak”) AND  OR (“assessment”) OR  AND (framework*) OR (“structure”) OR (“method”) OR (“model”) OR (“tool”) OR (“mechanism”) OR (“technique”) AND (“decision-making”) OR (“Decision Support Techniques”) NOT . The search eliminates medical research that has no relation to the areas of management and administration.The definition of the search string in the knowledge bases analyzed bibliographies linked to the topic and accessed the Health Sciences Descriptors (DeCS) base , with 1.0 being the global average . Notablyhttps://bit.ly/3QZ6DUA (accessed on 15 June 2023). The results are organized by the H-EDRM and answer the presented questions. Q1 addresses the characterization of the frameworks: contexts, identification of the H-EDRM and the PPRR model, scope, and method or model of analyses. Q2 identifies the type of intervention by H-EDRM components and PPRR model measures and the interface between them. Q3 analyzes the gaps and challenges in an interdisciplinary approach. The dynamics observed in our framework study are those located between the causes of a health emergency with its ambiguities and uncertainties and the limits of health systems, whose contexts present challenges for management, based on which we seek to identify their dynamics and sense of intervention, scopes, and relationship of variables and tendencies.This section presents the analysis of the selected frameworks, according to the appendix available at The frameworks are presented in several formats, adopting conceptual structures ,16,17,20The dimensions of information and monitoring and evaluation of the results of managers’ responses deal with the evolution of risk dynamics that need to be managed in emergencies ,52,55,59The provision of structures and resources focuses on hospitals that are under immediate pressure in PHE situations. The focus is on the agility of adapting physical infrastructure  and leveA PHE requires the attention of different areas according to the ambiguities and uncertainties of a context, considering a multidisciplinary approach that includes economic, social, psychological, and health impacts , which cIdentifying frameworks using H-EDRM and PPRR Models implies observing permeable borders on their components to look at management dynamics in the context of a PHE. In this sense, Due to the magnitude that the COVID-19 pandemic has reached since 2020, response efforts predominate, followed by preparedness, prevention, and a recovery measure, suggesting a focus on the system’s reaction; however, the strengthening of preparedness activities affects the evolution of all health systems during a crisis, resulting in a more effective response and capacity for resilience to recovery of the health system.Future research must investigate the conditionality relationship between these actions to determine the extent to which having more preparedness actions can produce more assertive responses and require less time to recover structures and the relationship between measure types and management components, as depicted in Framework development incorporates decision support concepts, theories, and multicriteria methods, which address the “multidimensional representation of problems with identification of critical information, comparisons of alternatives, and preference structures” . AlthougThe H-EDRM-PSL component presents The Analytical Framework of China’s Governance Responses to COVID-19 (response), with centralized governance for effective coordination of implemented measures, in a framework that integrates institutional, administrative, coordination, and governance configurations, with rational behavior of the actors, which generate a dynamic to reduce positive entropy in management that compromised government responses during the pandemic . DecisioHowever, as the frameworks established by nations reflect the opinions and circumstances of their authors, the exchange of models between different country realities is not automatic, and it is vital to expand PHE research into the operational and ethical dimensions of models that address the dynamic complexity of management in a context . It is aWhat must be investigated is the suitability of frameworks in diverse PHE situations, with models that include characteristics of the nations’ governance style in accordance with the degree of centralization of activities. The absence of command and the perception of a PHE as a political game compromises the responses of governments, as in the United States during the COVID-19 pandemic; however, the Chinese experience of more effective control of the pandemic is not easily adopted by other nations because their decision-making contexts differ .H-EDRM-P&C addresses mechanisms for planning intervention in an epidemic. The definition of action plans is presented in a framework to support the integration of priority setting in the preparedness, alert, control, and evaluation stages of a disease pandemic, using documentary analysis and incorporating the experiences of health professionals, in an outbreak of the Ebola virus in Uganda . In thisThe countermeasure strategies present a multicriteria decision support system for choosing strategies to mitigate (prevention) the effects of COVID-19 using Bayesian networks to addresses uncertainty in dynamic environments, in the transition from short term to long term. Despite the improvement in multicriteria decision support methods for health emergencies, the scoring adjustment of the attributes of analysis may be harmed in contexts of uncertainty, for dealing with strategies not previously tested and for more uncertain attributes that receive less weight in the analyses, compromising a broad view of the problem .(recovery) to a state of normality [In terms of resilience, managing COVID-19 presented a hybrid approach that identifies causal factors, security barriers, and key lessons using bowtie modelling. Modelling societal resilience in health emergencies integrating causation, barriers, and lessons learned relies on hypothetical scenarios rather than probabilities and immediate problem-solving that is not always possible. Few studies have focused on frameworks for dynamically addressing the context of uncertainty, able to integrate accumulated management experiences from previous health crises to understand how contexts returned ormality . The resormality .Ethics, as a component of the planning and coordination measures in a PHE, also depends on developing ethically robust policies for community protection. The framework of ethical values for planning, policy enactment, and action on disasters, based on a decision guide, includes benefit and harm, effectiveness, precautionary principles, harm from intervention, respect, equity, and trust. The framework is a decision tree that provides guidance on the potential of the crisis, the establishment of recommendations, communications for intervention, and the verification of results, but the achievement of an adequate level of protection (prevention) for the population in public health emergencies, based on evidence, still lacks models that integrate the scientific, ethical, and management dimensions, with social, infrastructure, and logistical factors, for interventions that are appropriate to the context, especially for the least favored populations .In problem analysis, planning for a PHE is a complicated system with interdependent variables . Thus, MH-EDRM-HR components are strategic resources to face pandemics because they reinforce guidelines for personnel planning, occupational health, personnel safety, and capacity building in technical, epidemiological, diagnostic, service, and communication areas, in all cycles of the PPRR model and even for the H-EDRM components, at all levels . Despiteresponse to a PHE to straighten the decision-making process in complex emergency contexts, guided by the domains of decision theory, ethical principles, and the individual and group emotions of decision makers. The tool was based on the OODA loop , which incorporates intuition and deliberative process in choosing alternatives. Chaos and unpredictability condition decision making in emergencies, establishing a gap between the intuitions, heuristics, and biases of the decision maker. What is missing is a structured analysis of the variables of the context of uncertainty to achieve a more rational and deliberative process. It is a challenge to be studied to guide the training processes of health authorities in this context. Human resources can also be understood in the face of a PHE by the integration of agents participating in the decision-making process [The framework for training public health practitioners in crisis decision making was also identified as a necessity for the  process .The alignment of different agents in PHE decision making requires overcoming collective risk framing positioning, nonlinear preferences, dependence on source conditions, and estimation of gains and losses of each actor or group of actors. Additionally, cognitive and complex linguistic information capture presents a challenge. The gaps point to the development of consensus models which integrate psychological factors, information quality, and decision speed. Thus, decision-maker hesitation and perception demand weights and ranking of alternatives in structured analysis to mitigate their bounded rationality ,13 and aIn H-EDRM-M&E, the analysis of risk dynamics in contexts of uncertainty requires the development of decision support frameworks with the application of advanced hybrid dynamic methodologies to overcome the shortcomings of conventional probabilistic static models. The framework evaluates risk dynamics in time-dependent contexts and the dynamic variation of process variables, using a dynamic risk analysis (DRA) for mapping, managing, and identifying risk dynamics , with thGovernments strategies are subject to evaluating factors to respond to the COVID-19 pandemic, taking care to apply the guidance factors established by the WHO for countries. The framework uses Decision-Making Trial and Evaluation Laboratory (dematel) and Fuzzy Rule-Based Techniques and identifies causal relationships between factors and critical elements impacting Covid-19 virus infection, like social media sharing, mass crowding control, people movement control, international travel restrictions, distance learning, and economic stimulus measures. However, the study calls attention to the challenge of linking multicriteria decision support methods to the Dematel method to analyze complementary components (factors) influencing the spread of COVID-19, including different statistical techniques with larger sample sizes . The evaThe adjusting government strategies to contain SARS-CoV-2 transmission by analyzing the interactions and behaviors of agents integrates geographical factors, climatic factors, displacements, and contacts between agents in public spaces, called residents in quarantine or confirmed cases, the transportation agents, or even the government agent which establishes policies to address the emergency. The model relates the agents, their attributes, and interactions, based on data for simulation in the time and space of the analysis, in multi-agent modeling, which uses the tool Repast Simphony 2.8.1 , developed in the Eclipse Platform and using the Java language. It analyzes the spatial dynamics and produces, from scientific evidence, dynamic feedback about the interactions in time, allowing the government to analyze scenarios and adjust prevention and control actions, adopting effective intervention measures according to the context. The restrictive measures for the population are incorporated according to the behavior of the agents and the dynamics of the contexts, without the prevalence of a one-size-fits-all approach. However, this creates a challenge for governments in knowing the impacts of different measures in space and time, given by the economic and social development of a region .Particularly regarding the humanitarian response in PHE contexts, the identification and assessment of factors facilitating agility capacity in the aid network, the framework includes the timeliness of delivery of products and services, health risk management, long-term needs, health information and donor organization, and government and non-governmental organization policies to face the challenge of overcoming the gaps in verifying the effectiveness of action plans (response). It is an application of a hybrid evaluation approach that combines fuzzy decision trial evaluation laboratory (DEMATEL) and the analytic network process (ANP) to deal with ambiguities, uncertainties, and inaccuracies inherent in the evaluation process. The methods assess interactions between elements and establish reliability ratings .Monitoring and evaluating disaster actions within the scope of the health department (responses) is a framework that generates records for learning and preparing future responses to address emergencies. It is a conceptual framework developed based on a literature review on quality improvement, and it can be applied to enhance the disaster monitoring and evaluation cycle, including stages of documentation, evaluation, dissemination, and implementation of measures, looking at context settings and response mechanisms, focusing on the studies that explain ways of intervention and operation in different contexts .Monitoring and evaluating risk dynamics ,52, goveIt is known that the performance of health systems in a PHE allows for an adaptive response for epidemics, which addresses the analysis of context, intervention, process, performance, and impact, and a route to performance analysis and optimization of interventions, but the studies show models focused on specific contexts, with low capacity to reformulate the intervention, frameworks with limited structures for reapplication in different contexts and an iterative approach, missing settings of evaluation of the full cycle of an intervention .www.gradeworkinggroup.org—accessed on 15 June 2023), that checks and makes recommendations on the quality of evidence to support decision making, applied in the context of public health emergencies [The H-EDRM-I&KM brings together frameworks to support better evidence for decision making, first on an application by the Emergency Operational Committee (EOC) of the Saskatchewan Health Authority, Canada, to identify COVID-19 policy priorities, providing rapid reviews and evidence reporting, in a web-based data dashboard. The COVID-19 evidence support team produce and sustain the best available evidence on COVID-19 to facilitate the decision making of policymakers, researchers, and clinical practitioners and foster the context-based learning cycle in health, which depends on information sharing; however, an aspect still to be overcome is the performance of experts in isolated silos of their own characteristics, which compromises the integration of knowledge from multiple actors and the generation of quality evidence in the emergency . AnotherA disaster impacts the environment and public health, and it is understood that it requires going through different phases of risk mitigation . However, risk assessment frameworks need to advance the identification of evidence in the early stages of the emergency (response) with the involvement of experts and specialized and multidisciplinary technical contributions. In this way, a methodology was developed to strengthen decision making, communication, planning, and action management to assess risks, an on-line tool that integrates the European Union Civil Protection Mechanism . In anotThe decision-making process to response and prevention plans to the COVID-19 pandemic, according to the studies, requires the application of multicriteria methods for decision support, integrating the expression of uncertainty by decision makers, setting criteria weights for choosing an optimal solution , and ranThe decision-making process asks for a system of emergency intelligence with the capability to deal with a context full of uncertainty and complexity. In this way, studies have been carried out about interagency decision support systems for sharing critical information in cross-border situations, which addresses the emergency management life cycle, integrating preparedness measures with stages of planning, simulations, and training; response measures using a decision support system and real-time monitoring; and recovery measures for vulnerable groups, highlighting the interoperability of existing systems and end-user-oriented solutions . In anotH-EDRM-HI&L presents framework studies on safety risk factors in the hospital environment during COVID-19 in India, using a Fuzzy Delphi Method (FDM). The weights of categories and their respective factors are calculated and ranked based on their criticality using the Fuzzy Analytic Hierarchy Process (FAHP), and the ranking of Indian hospitals is conducted by the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (FTOPSIS). The preparation of health services for the response to a pandemic integrates guidelines from reference bodies such as the WHO and can adopt multicriteria decision support methods to analyze risk factors. However, the exact definition of the criteria and the attribution of values for analysis of services is a challenge to be overcome due to the dynamics of contexts, ambiguities of expert opinions, and scarcity of resources that affect hospitals mainly during the PHE .A literature review on health care agility to classify hospitals in Tehran, Iran, in the context of disaster and the application of the Flowsort method with IT2FSs  build a framework to classify hospitals by level of agility, based on management capacity to deal with disasters in contexts of uncertainty. It verifies the relationships between agility factors and the actions to prepare, mitigate, rebuild, and respond to a disaster situation, including organizational structure, hospital chain management, clinical governance, technological upgrading, market awareness, and trained staff. Hospital agility is a structuring component of health service responses in situations of natural or man-made disasters in terms of how effectively facilities respond to the emergency, with competence, flexibility, and speed . A pandeCOVID-19 exposed the weaknesses of supply chain systems by the sudden increase in global demand for health supplies, which challenged the limits of production and logistics and increased the need for studies on frameworks for assessing optimal stock levels in preparedness measures for health emergency contexts. In this way, a decision model about stock levels of health systems in emergency scenarios was developed, using multicriteria spherical fuzzy regret. It represents the level of hesitation or adherence of decision makers to listed alternatives, considering the availability of local production and proximity to production centers, necessary quantity of product or equipment, supply costs, the criticality of use, inventory, and stock maintenance .The spread and speed of cases of a severe acute respiratory syndrome may increase the need for equipment and inputs such as mechanical ventilators and oxygen. A conceptual framework for determining the need for and allocation of ventilators during a PHE was developed (response), capable of planning actions and adequate logistics of equipment, supplies, and qualified personnel in intensive care, analyzing patient demand and the need for adequacy and increase in resources in hospitals, strengthening provisions at federal, state, and local levels. Despite the definition of strategies for technology allocation, frameworks for the situation analysis of the health system need to contemplate the capacity of structures, qualified personnel, and especially ethical principles to serve different population groups .H-EDRM-H&RS listed only one study in decision support methods for managers on improvements for the reduction in overcrowding in emergency rooms in Paraná, Brazil, which addresses feedback relationships, interdependence, and influences among criteria, with emphasis on resource utilization, layout efficiency, productivity and technology, in a composition of Decision-Making Trial and Evaluation Laboratory—DEMATEL—and Preference Ranking Organization—PROMETHEE II. The management of the health emergency room to avoid overcrowding deals with problems that are difficult to identify and with patient management factors that cannot be changed quickly; however, according to the complexity of the context, there is a need for the association of multicriteria decision support methods to prioritize alternatives, such as assigning weights, establishing causal relationships between criteria, identifying improvement, and ordering the choices in time .To the best of our knowledge, the studies did not present a specific financial resources framework (H-EDRM-FR); however, it is a strategic resource to provide financing expeditiously and maintain all the programs and measures in different stages of a PHE. The lack of studies also applies to risk communication (H-EDRM-RC), which plays a special role in positioning society in complex contexts of contradictory information that compromises risk mitigation strategies and the protection of citizens, especially vulnerable populations. Communication is closely related to the level of response according to a society’s community capacities (H-EDRM-CHC), which includes health professionals and civil society in shared crisis planning with the community , but no Governments and societies face challenges for assertive decision making in contexts of health emergencies, where the complexity of management lies between the health event’s behavior and the health system’s limit, implying a multidisciplinary and interdisciplinary, multisectoral, and contextualized approach. In this sense, the framework is at the interface between the decision maker and the problem, which in a context of uncertainty takes on nonlinear and counterintuitive proportions.The analysis of the frameworks using H-EDRM recorded the prevalence of components in the areas of information and knowledge, monitoring and evaluation, planning and coordination, and infrastructure and logistics; however, policies, strategies and legislation, human resources and services, risk communication, and the community capacity were of a lower priority. In the analysis, response measures predominate, followed by preparedness, prevention, and recovery. This conclusion presents a question for future research, which is the conditionality relationship between measure types and management priorities in a PHE, to verify to what extent strengthening the preparedness action can generate more assertive responses and a shorter recovery time of health structures.This article does not exhaust the analysis of the gaps in multicriteria methods, as synergistic relationships must be strengthened between multicriteria analysis, cognitive psychology, decision-maker behavior, and decision support systems  for a moAdapt the development of frameworks to the country’s governance model, according to its organizational forms, vulnerabilities, and capacities, to mitigate the introduction of models that are disconnected from reality.Prioritize ethical aspects in the planning of PHEs in all actions , with special attention to the most vulnerable populations, incorporating historical data to know the behavior of society in previous events and strengthen the resilience capacity for future emergencies.Strengthen policies, strategies, and legislation to prepare the states, prioritizing planning and scenario projection as a conditioning step for response time, improving the effectiveness of interventions and the recovery of health systems.Integrate the expectations and hesitations of decision makers at all levels, individual and collective, with frameworks that best interface heuristics and bias and the rationale of context in the face of variables of uncertainty.Develop within the framework functions that incorporate community capacity into PHE decision making to produce appropriate responses at all levels and increase the social resilience through collective action to strengthen the capacity of the society to deal with the effects of positive entropy in complex and dynamic PHE contexts.Apply methods capable of incorporating the linguistic expressions of the agents, feedback relations, and interdependence among criteria in framework development, making hypotheses and behaviors explicit in the context analysis, due to the uncertainties that compromise the accuracy of predictions.Improve evidence sharing and analysis frameworks, with quality analysis and guidance on levels of certainty, to define local strategies aligned to global challenges in PHEs. In this regard, the interoperability of information systems needs to be strengthened.Forecast complexity scenarios in all phases of a PHE, continuously confronting the behavior of the health event and the limits of the health services and the supply chain, production, and logistics to develop strategies for allocating strategic inputs to health, including human, cognitive, financial, and technological resources.Expand the capacity of the communication frameworks with society, as a strategic action to avoid misinformation and to strengthen sensemaking in society about the interventions.In conclusion and based on the analysis of aspects regarding context constraints, the historical perspective of emergency behavior and future impacts, the limits of provision of technologies and infrastructure, governance styles, and decision maker cognition factors, this article presents the following guidelines for the development of decision support frameworks in PHEs:The studies have shown that the main challenge for the development of frameworks is supporting an adaptive outlook by the manager regarding the complexity of PHE contexts, with tools and mechanisms suited to different circumstances, models of government, and society, since the intervention takes place in a part of a larger reality.


Aging is an inevitable process that leads to changes in various dimensions of older adult life, including physical, psychological, and social aspects. Unfortunately, older adults are more susceptible to health problems caused by adverse experiences such as the Corona outbreak.The current study examines the lived experience of older adults in facing the conditions of the Corona epidemic to see how green spaces at various scales can influence the physical and mental health of this group.Relevant articles published, from 2019 to February 17, 2023, were searched using in the Scopus and Web of Science databases. Eligible studies published in English and all studies passed a quality evaluation.In the final search, 40 articles were selected and analyzed. The majority of studies conducted during the pandemic categorized the impact of green spaces on the health of older adults into three main categories: Place-based attribute, Process, and Function.The findings of this study demonstrated that people were using private green spaces , small local green public spaces, sitting and gathering spaces in the neighborhood, nearby open spaces, and urban green-blue spaces throughout the epidemic era. They visited green spaces outside the city and urban areas, including urban gardens, agricultural areas, forestlands, and pastures. In this research, we investigated the characteristics of these spaces and classified them into four physical categories: urban landscape, land use, activity, movement, and accessibility. The results showed that exposure to nature or green space improved physical and mental health and increased attention and decision-making quality in older people. We have proposed design implications recommendations for crises to improve safety, security, and social capital by increasing the safe access of older adults to diverse and high-quality green spaces on different scales, which will ultimately enhance the physical and mental health of people in different age groups. The health issues caused by the COVID-19 pandemic have had severe repercussions for urban areas, including detrimental impacts on urban health, society, and the economy ]. As a rAccess to urban green spaces improves people's quality of life in cities as it allows for the creation of jobs and food, the promotion of biodiversity, urban heat mitigation, and the creation of health advantages . IncreasThe COVID-19 crisis has highlighted the vulnerability of the older adult population, particularly in terms of their physical  and mentPrior to COVID-19, research consistently shows nature exposure improves mental health and wellbeing. Urban green spaces, water bodies, private gardens, and visual experiences are linked to these benefits. Nature connections also reduce the risk of psychiatric disorders , and thThe sense of isolation among older adults can also be attributed to individual factors. Research has shown that age greatly impacts access to services and amenities, as well as participation in cultural and leisure activities. Additionally, factors such as retirement and marital status may contribute to feelings of loneliness and isolation . DespiteIn the various reviews, some policies need to be established to create friendly communities for older adults. In this context, places far from the community should be examined, people far from social activities should be studied, and policies at the neighborhood scale to increase social participation should be considered ; Table 1Table 1 sNumerous studies have demonstrated that exposure to natural environments offers extensive physical and psychological benefits . These eDuring lockdown, it is possible to enhance the mental and behavioral health of older adults by considering their personality traits, such as higher intelligence, emotional stability, and extroversion, while also promoting public communication . AccessIn a study by Bartalucci et al. , the comThe emphasis on green space in previous reviews has been consistent. However, other forms of nature, such as blue space , green In 40 selected articles, the focus was on factors such as the density of commercial facilities, the density of schools, access to public transportation, the density of roads, and access to green spaces, along with the environmental characteristics of built space, such as urban density and mixed language use, the health impacts of urban residents' land use, and long-term active travel behaviors.Older adults, as a vulnerable group of people to epidemic diseases, rarely use green space due to the dread of infection . They arThis narrative review study shows that some socio- demographic factors  , and actDuring the COVID-19 pandemic, the requirements to observe social distancing highlight to what extent the quality of life (QOL) is related to social and physical activity in middle and old age. They also show the necessity for more mobility in the living space. During lockdown, the amount of activity and mobility of middle-aged people at home or in private outdoor spaces decreased . A studyUrban green spaces are mainly used for various activities, such as running, walking, and outdoor sports, which depend on many interconnected variables and the type of city texture, including the construction and population density of the neighborhood, the amount of green space available, and the safety and security of traffic and crime . With reThe study by Noszczyk et al. , in whicSeveral studies have indicated that the physical and spatial characteristics of a neighborhood can influence the attendance of older adult individuals during the COVID-19 pandemic. Factors such as the physical attributes of housing, urban landscapes, land use, and activity levels have been found to impact the quality of attendance for this population . NotablyThe characteristics of the local environment in the neighborhood level play a vital role in promoting adaptive behaviors and enhancing the health and wellbeing of older adults. For instance, a study conducted in New York demonstrated that individuals living in disadvantaged neighborhoods, who faced challenges in leaving their homes due to physical disabilities, encountered similar difficulties . Those wHowever, the presence of greenspace alone does not guarantee access. Barriers such as inadequate transportation, connectivity infrastructure, provisions for disability, and socio-cultural issues, including harassment and violence against women, continue to persist . In summNeglecting the quality of design in green spaces, both in terms of their qualitative and quantitative aspects, can have detrimental effects on social interactions, civic participation, community involvement, and the health of older adults . The WoTo highlight the benefits of green spaces in older adults' lives in this narrative review, worth noting is that, during the pandemic, living in greener neighborhoods with more public green spaces can increase older people's willingness to engage in physical activities such as walking and cycling  as well Having more benefits of green space during the pandemic depends on reducing transmission by design based on three crucial factors: the density of development and construction, the level of connectivity and design of green infrastructure, and the availability of urban green-blue spaces . To miniFurthermore, Poh et al.  have fouResearchers have extensively confirmed the impact of “place-oriented” factors on health outcomes . The plNumerous social and economic factors, including age, gender, education, income, race, female-to-male population ratio, employment status, and occupation type, can influence the risk of COVID-19 . IndividFurthermore, there is a significant relationship between education level, engagement in sports, and recreational activities in urban green spaces during the epidemic. Individuals with higher education tend to recognize the importance of utilizing green spaces and improving their mental wellbeing while staying at home . OccupatNotably, Van Tilburg et al.  found thBesides, some research indicates that older individuals in disadvantaged neighborhoods face higher social exclusion levels than in other neighborhoods. This discrepancy arises from neighborhood deprivation in areas such as access to services and amenities, social relations and civic participation, and cultural and recreational activities, as well as green spaces . The COVMoreover, the rate of COVID-19 infections is directly related to the percentage of the black population, non-native immigrants, households without access to a vehicle, and the population over 65 years old . The panThe studies related to older adult activity show that throughout the pandemic, individuals attended parks for various activities, including sightseeing, strolling, exercising, and jogging. The purpose of such activity was to enhance their mental wellbeing, and the presence of greenery was a crucial component in attracting older adults. The landscape of parks, particularly the plants, played a significant role in this regard, as evidenced by the popularity of cherry blossoms in Olympic Forest Park, lotus flowers, and red leaves in Xishan National Forest Park . IncorpoThe desirability of a neighborhood for older adults is influenced by the distribution, quality, and accessibility of green spaces . The proYe and Qiu  discoverA study proposed the “Urban Meteoropathy” planning tool for high-density cities like Macau Peninsula, suggesting the implementation of multiple layers of greening on the ground, walls, and rooftops of buildings to address the lack of green spaces . To enhFinally, urban planners and designers can enhance the green space experience, especially during the pandemic, by creating green walls, small parks, and gardens  66), an, an66), Our goal was to investigate the impact of green spaces on older adults' wellbeing during the COVID19 pandemic. In the next studies, these benefits and effects can be examined in different socio-economic and cultural conditions. It is also possible to check how the policies of different countries have responded to the needs of older people during the pandemic.This study draws upon available studies to identify the individual characteristics of older adults and their living environment to see the effects of the pandemic on the health of the older adult. Moreover, this study examines the qualities of green spaces, the benefits of using green spaces, the types of spaces used by older adults, and the desirable activities of the older adult in the green space during the COVID pandemic. This narrative review study highlights the substantial and enduring impact of the coronavirus on the physical and mental wellbeing of older adults. It also reveals that there is a strong relationship between the surrounding green environment and the incidence of physical problems, anxiety, and depression symptoms among the older population. In addition, in the lived experience of older adults, there was a positive encounter with the condition of the disease, which included sub-themes such as facing the crisis of acceptance and inflexibility in difficult conditions, which made the older adult adapt to the conditions related to the spread of Corona.According to the findings, there are several stakeholders and experts, including urban planners, health professionals, local communities, and lawmakers, who may collaborate to develop successful strategies to improve people's quality of life. Officials, designers, and urban planners should consider the following measures to help reduce crises:Enabling access to and promoting the use of green and open spaces in various dimensions to alleviate overcrowding,Enhancing the quality of green spaces by improving biodiversity and tree diversity in urban areas,Strengthening pedestrian and bicycle paths to enhance mobility, reduce inequality, promote physical activity, and facilitate access to urban and green areas,Developing public and semi-public spaces to foster social interactions and cohesion within neighborhoods,Establishing private or shared green spaces, such as terraces and patios, to encourage activity and communication and improve the physical and mental health of the older adult,Enhancing neighborhood safety and security while simultaneously strengthening social capital,Utilizing mass media to disseminate relevant information,Prioritizing health measures and providing access to medical consultations, andFocusing on public transportation networks and their ability to minimize risks and injuries, especially for the older adult.As the global population continues to age, there is an urgent need for further research in the field of the physical and mental health of older adults. This is particularly crucial in the context of urban environments, where the majority of the population resides, and where environmental factors can significantly impact health outcomes. To effectively address the challenges facing the older adult population, it is critical to understand the influence of various environmental variables on their physical and mental health.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


In the published article, there was an error in the author list, and author [Yasser Abdelazim Abdelmawgoud Samak] was erroneously [excluded]. The corrected authors list and affiliations are appears below.1*, Huda Aseem1, Amira Alzain1 and Yasser Abdelazim Abdelmawgoud Samak2Mogeda El Sayed El Keshky1Department of Psychology, Faculty of Arts and Humanities, King Abdulaziz University, Jeddah, Saudi Arabia2Department of Geography and GIS, Faculty of Arts, Assiut University, Assiut, Egypt.In the published article, there was an error in the Author contributions. The statement was incorrectly written as “MK contributed to the definition of research objectives, model and hypotheses, data analysis plan, writing – original draft, funding acquisition, and reviewing and approval of the final manuscript. HA and AA contributed to the provision of materials , participated in data collection. All authors contributed to the article and approved the submitted version.”The corrected statement is:ME contributed to the definition of research objectives, model and hypotheses and funding acquisition. ME and YS participated in data analysis plan, writing—original draft, and approval of the final manuscript. ME, HA, AA, and YS contributed to the provision of materials , participated in data collection, review and editing. All authors have read and approved the final version of the manuscript.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


To identify the scientific evidence on the impacts caused by the use of screens during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public.This is an integrative literature review, conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (PubMed), Scopus, Web of Science, and Embase, published from March 2020 to January 2022, in Portuguese, English and Spanish.The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in the maintenance of 62 studies. Of these, 31 were excluded from the reading of the full text, since they did not clearly present the phenomenon investigated. Thirty-one were eligible, resulting in five categories: eye consequences; increased sedentary behavior and weight; change in eating habits; implications for sleep quality and impacts on mental health.The excessive use of screens during the pandemic led to numerous consequences for children and adolescents, with a higher incidence of visual damage, sedentary lifestyle, inadequate eating habit and increased weight gain, in addition to impaired sleep quality and mental health. This study provides subsidy for health professionals to carry out continuing education focused on this theme, and elaborate effective interventions for this public in this transition to the post-pandemic period. In childhood, heavy use of these devices may increase the risk of cardiovascular diseases and psychological disorders, in addition to favoring exposure to inadequate content. Some authors associate prolonged screen exposure to delays in linguistic domains and fine motor skills. In adolescence, it significantly influences social and family interactions and mood, with a greater risk of developing depression, self-extermination attempts, low self-esteem, as well as other behavioral problems.Technologies evolve rapidly, and are inserted in the daily lives of children and adolescents through pocket, mobile and portable devices, having consequences for healthy development. The trajectory of screen use was analyzed at 24, 36 and 60 months of age in Canadian children, and heavy use showed poorer child development and sub-optimal learning outcomes. In addition, intense use of screens contributes to weight gain that can trigger obesity, sedentarism, and accelerate or accentuate possible physical and mental disorders.Children's early access to technologies and the inappropriate use of these tools can compromise their social, cognitive, and affective development. In these media, they are exposed to advertisements that rely on persuasive and appealing techniques to reach mainly children, exercising intense control over their behavior.Use of screens, including television sets, video games, and computers, is a practice that works as a source of leisure and entertainment for adolescents, replacing outdoor activities. The impact of this habit results in consumption of unhealthy foods and physical inactivity, increasing the prevalence of overweight and obesity in this age group. In addition, excessive use of these technologies can have negative consequences on vision development, as well as on sleep quality and psychological health. that required necessary global preventive measures, such as social distancing to break the disease's transmission chain. Currently, the impacts of these restrictions on the population's health, communication, interpersonal, family, social and economic relationships can be observed.Such a reality and its problems have been intensified with the advent of COVID-19. In March 2020, the World Health Organization declared the Coronavirus Disease 2019 (COVID-19) pandemic — an acute, potentially serious respiratory infection with high transmissibility There was an absence of school space and decreased outdoor leisure activities, increasing the use of screens and affecting quality of life. This new reality presents short, medium and long-term effects directly linked to the development of comorbidities, in addition to physical, psychological and behavioral complications that may arise.Initially, with the interruption of school activities, children and adolescents witnessed abrupt changes in their daily routines, were physically more distant from friends, remained in home confinement, and were more exposed to alarming information about the pandemic, increasing feelings of anxiety, stress and sadness. With the advancement of vaccination and its benefits, there was a decrease in restrictive measures, including the return to school. However, studies show that even after going back to school children have low levels of physical activity and increased screen time and sedentary activities.In January 2021 the vaccination campaign against COVID-19 began in Brazil, in a gradual progress, and in 2022 the vaccine was made available to children.This study is justified by the need to investigate the impacts caused by screen use during the pandemic in children and adolescents, grouping information essential for the performance of health professionals given the repercussions of the COVID-19 pandemic. Thus, it aimed to identify scientific evidence of the impacts of screen use during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public.This is a study that used the integrative review, broad method, which combines experimental and non-experimental research to achieve a more didactic understanding of a phenomenon of interest, presenting the state of science and applicability in health practice.For the elaboration of this integrative review, the following steps were performed: identification of the problem (clear definition of the review purpose), search of the literature , evaluation and data analysis.To guide the integrative review, the following question was formulated: What are the impacts caused by the use of screens during the COVID-19 pandemic on children and adolescents?The following electronic databases were used: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine and National Institutes of Health (PubMed), Scopus, Web of Science, and Embase. The search was conducted by the authors independently in order to ensure the legitimacy of the study, recovering scientific articles published from March 2020, after the beginning of the pandemic and the consequent establishment of prevention measures. Articles that did not include the guiding question, review, abstracts and conference proceedings, editorials, experience reports, theoretical essays, single case study and duplicate studies were excluded from the selection.The inclusion criteria of the articles were: original, complete studies, published in English, Portuguese and Spanish, with full texts, available online in the selected databases, addressing the impacts of the use of screens on children and adolescents during the COVID-19 pandemic in the period from March 2020 to January 2022. This is the period between the recognition by the World Health Organization of COVID-19 as a pandemic and the date of the search for articles in the databases.The search was conducted during the month of January 2022, using combinations between the keywords, which are descriptors in Descriptors in Health Sciences (DeCS), Medical Subject Headings (MeSH) and Embase subject headings (Emtree): Screen Time/Tempo de Tela/Tiempo de Pantalla and Child/Criança/Niño and Adolescent/Adolescente/Adolescente, combined with the term COVID-19 in all three languages.The studies retrieved by searching the databases were exported to the Rayyan QCRI Program. Subsequently, duplicate studies were removed, and titles and abstracts were read by three reviewers  using the double-blind method in order to identify potentially eligible studies. Those studies that presented doubts and/or divergences between the reviewers regarding the inclusion or exclusion were solved by a fourth author with expertise in child and adolescent health (ECRG).For the compilation of results, a table was built with the main characteristics of the studies, such as: title, authors and year of publication, journal, language, country of origin, objective, methodological approach, population, main results, conclusions, and bibliographic references.There was no need for approval by the Research Ethics Committee because this is a bibliographic study. Ethical aspects and copyright were respected, and the studies referenced.The articles included in this study were selected, evaluated, and classified hierarchically according to their level of evidence. This practice contributes to the decision-making of health professionals. In this study, the proposal of Melnyk and Fineout-Overholt was adopted, which is shown in The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in 62 studies being included. Of these, 31 were excluded from reading of the full text, since they did not clearly present the phenomenon investigated, and 31 were included in the review, as shown in the flowchart .Of the 31 papers analyzed, all were quantitative articles, except one. As for year of publication, the highest incidence was 2021 (27 articles), 2020 (2 articles) and 2022 (2 articles). Seven were developed in China, four in Canada, two in Italy, India, France and Turkey, and one in the Netherlands, Spain, Japan, Brazil, Saudi Arabia, Iran, the United States of America (USA), Hungary, Jordan, Indonesia, Poland and Egypt. All studies were published in English. The table shows the studies’ main characteristics .2,5,6,1All the papers examined addressed the theme of the impacts of screen use during the COVID-19 pandemic on children and adolescents. Five categories emerged from these findings: eye consequences; increased sedentary behavior and weight; altered eating habits; implications for sleep quality and impacts on mental health.The studies analyzed revealed the association between high use of screens and higher risks of myopia, as well as other eye problems in children and adolescents during the COVID-19 pandemic. The researchers also claim, that the use of computers and smartphones has a higher probability of facilitating the progression of myopia compared to the use of television for remote education.Chinese researchers carried out a large-scale survey, finding that the use of screens in this period increased due to school closures, as well as myopia was more prevalent among respondents who were in high school and fundamentally, screen time was associated with greater risks of symptomatic myopia progression and the study population used more computers and smartphones. An association was also found between excessive exposure to electronics eyestrain, blurred vision or dry eyes.Similar results were found in other studies regarding the progression and incidence of myopia associated with restrictive measures to contain the spread of Covid-19, in addition to axial stretching. Furthermore, there was an increase in children's weight and body mass index (BMI) due to longer time watching television and using computers.The studies revealed greater use of screens during the period of restrictive measures to control COVID-19, providing increased sedentary activities, decreased physical exercise and less time outdoors, compared to the year before the pandemic. Electronic devices, whether televisions, computers, laptops or tablets, when located in bedrooms, present a greater risk of being used for long periods.With the restrictions imposed, the increased use of screens was inevitable, since they became educational tools and a form of leisure, especially for those with restricted access to external areas. Therefore, ending the COVID-19 restriction measures alone will not by itself promote new habits in children and adolescents.The alarming fact is that, even after relaxation of the restriction measures, children still reported performing fewer physical activities than in the previous year, showing that the reopening of schools did not fully restore these activities. This indicates that there may be a lasting impact related to screen use time in that such behavior has been normalized. This is related to higher fat intake and consumption of advertised products, such as sugary cereals, sweets, drinks and snacks. Such behavior was more observed as of the start of distance education during the pandemic, compared to the previous year. The use of screens can indirectly increase food consumption and the intake of unhealthy foods, reduce physical activity and energy expenditure, increasing the risk of obesity.Another issue analyzed in the studies was the diet associated with the use of electronics, where a common habit of eating while watching TV was found. Scientific evidence suggests that the change in diet and lifestyle caused by the pandemic has led to excessive body weight gain in children and adolescents, and this can have serious health consequences.Investigating the relationship between screen time and changes in the diet of children and adolescents showed that increased use of mobile phones, television, laptop and video games was associated with increased appetite, increased consumption of sweets and unhealthy foods, snacks and frequent snacks between meals, as well as with children who were indifferent to eating fruits and vegetables. This can be explained due to changes in the biological clock, which plays an important role in the good performance of restorative sleep. Night exposure to intense light can stimulate the wakefulness system, making individuals more alert and causing them to sleep later.The excessive use of electronics, according to the studies analyzed, has consequences on hygiene and sleep quality, especially when these devices are used at night. bringing physical and psychological consequences to children and adolescentes.Poor sleep quality may be related to the exacerbated use of screens, changes in routines and schedules, little exposure to light during the day and a lot of exposure to light at night, changes that may be related to the restriction measures imposed during the pandemic, This new reality implies less time for performing outdoor activities and lack of socialization with peers, consequently fostering the use of electronic devices both for education and as a form of leisure.The changes caused by social isolation had a great impact on the mental health of the pediatric and adolescent population. In contrast, although education implies spending several hours in front of a screen, learning can act as a form of protection, since it allows the reduction of stressors caused by confinement.Children who use screens for long periods have higher levels of depressive and anxiety symptoms. Therefore, it is necessary to adopt measures aimed at minimizing damage, using other devices in a moderate way and with limited time.The use of smartphones at younger ages may be a risk factor for mental health in the context of the COVID-19 pandemic. In addition, longer screen time is associated with more conflicts with parents, since this habit can lead to a negative mood in adolescents.Studies show that more time on TV or digital media causes high levels of inattention and hyperactivity, and the excessive use of video games provoke irritability, inattention and hyperactivity. Although in developed countries access to electronic devices is easier compared to developing countries, among the studies analyzed, the largest amount of research was conducted in emerging countries (n=17), showing that the impacts of screen use have been a global concern, also confirmed by the diversity of countries developing research on the subject.With globalization, the use of technologies has become commonplace, and this reality has both positive and negative aspects; in the pandemic period experienced in recent years, this scenario has become more evident. In 2019, Brazilians were ranked third in relation to daily hours online, Brazilian teenagers in particular ranked second in internet connection time outside of school hours. However, only one of the studies analyzed here was developed in Brazil, showing the need to develop more research on the subject, especially after the pandemic.The more frequent access of children and adolescents to the web is not a recent concern, but has intensified in several countries including Brazil, since the problematic use of these devices can cause mental, visual and auditory disorders.As addressed in category one, although myopia is considered a benign alteration, its prevalence has become increasingly common. This pathology can lead to severe visual complications, including macular degeneration, posterior staphyloma, cataract, glaucoma, and retinal detachment, becoming a public health concern. This should be taken into account and given due importance, since school activities through virtual tools during the pandemic significantly increased screen time, which contributed to symptomatic myopia incidence.Myopia is related to individual characteristics, but it is also caused by environmental factors and lifestyle, thus prolonged screen use is an important factor in its development. These effects are more frequently observed in children and adolescents, since optical development is not fully completed.The size of the screen, as pointed out by the studies, can also influence the progression of myopia, devices that have larger screens provide viewing at a more acceptable distance, minimizing the use of close vision, which reduces stimulation of hypermetropic blur, while with smaller screens the distance is shorter, which can lead to increased eye impairment.Based on these findings, it is necessary to disseminate information, especially to parents and guardians, to warn them of the recommendations regarding the necessary distance when looking at a screen, so they can prioritize those that appear to be less harmful and limit use time, since the risks of developing myopia increase every hour that a child is exposed to a digital device.The change in the lifestyle of the investigated population during the pandemic, with the consequent exacerbated use and the consequent sedentary lifestyle are associated with several health risks, including hypertension, metabolic syndrome and obesity, which presented worrying indicators even before the pandemic.According to data from the Brazilian Society of Bariatric and Metabolic Surgery, the COVID-19 pandemic has had a major impact on the childhood obesity picture in several countries, including Brazil, due to changing lifestyle habits and increased screen time. The Brazilian Institute of Geography and Statistics (IBGE) points out that, in a group of three children from five to nine years old, one is overweight in the country. The context of obesity in Brazil was already worrisome and worsened during the pandemic. Such reality implies morbidities that can cause various damage to health. On the other hand, the pandemic showed regional disparities in Brazil, as there were groups of children and adolescents with malnutrition caused by the worsening of the economic crisis, compromising the growth and development of children and youth.This corroborates the Brazilian study developed in 2022, which sought to investigate the consequences of social isolation in relation to weight gain in children, analyzing the nutritional diagnosis of children in the five Brazilian regions, between the years 2019 and 2021, through reports of the Food and Nutrition Surveillance System (SISVAN) of the Ministry of Health, which observed an increase in weight in children during the pandemic in all Brazilian regions, reflecting changes in lifestyle during this period.Understanding that these long-term habits can have numerous consequences for this population, it is necessary to develop strategies to reduce screen time and stimulate physical activity by retrieving games that stimulate physical abilities and encouraging sports.In addition to the increase in sedentary lifestyle, another concern related to the use of screens is poor diet. As well as the implications found in studies for the consumption of foods with low nutritional content and excess calories associated with technologies, other complications arise, which can be justified by the economic crisis faced during this period, the worsening in family income, the increase in food prices, providing food insecurity and malnutrition. Such reality is faced by Brazilian children and adolescents who suffer from neuropsychomotor impairments, that have a greater likelihood of developing chronic diseases such as diabetes, hypertension, and overweight.The Brazilian Society of Pediatrics points out that during the pandemic families started to overeat foods with high sugar content that provide a sense of pleasure. Despite this, family meals can be a nutritional protection mechanism, by favoring the consumption of complete meals, with appropriate intervals, which can ensure an adequate intake of macronutrients, minerals, antioxidants, and vitamins, thus ensuring adequate nutrition.Guidelines on food in the school environment or offered by the family members are necessary so that this public is encouraged to create healthier habits in the current transition to the post-pandemic period, an important factor for a good nutritional status, favoring the adequate development of children and adolescents. During childhood and adolescence, it gains even more importance by acting in the physiological processes of growth, maturation and health, in addition to having an important role in strengthening the immune system.Sleep is essential for the proper functioning of the human body, since it contributes to physical and mental homeostasis. In addition, short sleep and early awakening can lead to depressive or stress symptoms. Thus, it is essential to guide this public about creating routines, having regular and appropriate schedules for sleep, adapting exposure to light, and limiting the use of screens at night.As shown by the investigated studies, the exposure to light-emitting diodes (LED) with a short wavelength (blue range) at night also blocks the secretion of hormones that are important for sleep regulation, such as melatonin, thus morning awakening is later. There is a need to identify the threats to the mental health of this population and to carry out prevention and intervention strategies to minimize the damage caused by confinement as a result of the COVID-19 pandemic.Thus the importance of stimulating outdoor activities to reduce risks to mental health. Although the quality of mental health is related to numerous factors, controlling exposure to screens is essential.Among the study's limitations is the fact that analysis of the impacts of screen use during the COVID-19 pandemic was restricted to the month of January 2022, not allowing these impacts to be evaluated up to the present moment. Another limiting factor is the publication of studies in different countries, with only one Brazilian study being retrieved, which shows regional disparities in publications on the subject and makes it impossible to generalize the data. Regarding the levels of evidence, a prevalence of cohort studies, case-control and systematic reviews of qualitative studies was noted. It is believed that the randomized clinical studies not found could clarify the most severe consequences of the use of screens in children and adolescents.The findings reveal that excessive use of screens during the pandemic has led to numerous consequences for children and adolescents, with a higher incidence of visual impairments, sedentary lifestyle, inadequate eating habits, in addition to weight gain, impaired sleep quality and losses in mental health. The changes in habits due to the restrictive measures presented a contrast between the increase in the consumption of foods with low nutritional content and the excess of calories associated with technology, which points to the problem of overweight and malnutrition that compromises the development of children and adolescents, something that is no longer restricted to developed countries. Thus, this study provides subsidy for health professionals to carry out continuing education focused on this theme, warning parents and guardians of the implications of the use of screens, as well as developing interventions that are effective for children in the prevention and promotion of health in the transition to the post-pandemic period.


Vocational education helps students develop or enhance their knowledge, skills and abilities for a particular occupation. As a result, vocational education plays an important role in the economic and social development of countries (and regions) around the world. It has also made an important contribution to educational equity. The development of quality and sustainable vocational education has become an issue of concern for governments, educational institutions, educators and researchers. In the past, many experts have been thinking about how to develop policies to help promote vocational education. However, in addition to national goals, industry needs and expert opinions, the education policy system also needs to take into account the views and opinions of the stakeholders in order to implement the policy effectively.The psychology of vocational education is broad in scope, because it encompasses stages of vocational probation, vocational preparation and continuing vocational education, from K-12 education to higher education and to lifelong education. Consequently, the issue of how to improve the quality and learning outcomes of vocational education has become an important topic in education. From the theoretical perspective of educational psychology, psychological and cognitive factors can be used to facilitate students' learning performance or to enhance teachers' teaching effectiveness. It can also help teachers in vocational schools better understand and develop students' vocational literacy in a more in-depth way, so that they can better respond to the challenges of their work.The psychology of vocational education can be based on a cross-disciplinary theoretical approach to facilitate educational policy implementation, educational management, curriculum development, instructional design, apprenticeship, workplace learning, career counselling, skills training, career preparation, workplace learning, and so forth. The importance of the psychology of vocational education is therefore self-evident.Liu Y.-B. et al.; Peng et al.), career adaptation , career exploration , creativity , critical thinking , discrimination perception , education climate , employability , entrepreneurship education , learning engagement , learning methods , learning motivation , learning readiness , online learning , postgraduate education , professional literacy , prosocial behavior , self-efficacy , skills training , social support , and teaching methods . As can be seen from the above, there is a wide range of research issues in the psychology of vocational education.The study of the psychology of vocational education contributes to the development of vocational and technical personnel and the understanding of individual differences. It is more helpful to identify the effects or problems from the perspectives of the persons involved and to understand the reality of the situation. There is a wide range of specific Research Topics in the psychology of vocational education. Examples include: academic achievement (e.g., In addition, the dramatic impact of the COVID-19 pandemic on education systems around the world has given us insights into the impact of context in educational research. From the perspective of the psychology of vocational education, we have also gained a better understanding of the learning difficulties encountered by vocational education students and the teaching constraints of teachers when learning online. While it is important to understand successful stories, the reasons why they fail or succeed also need to be explored in order for us to understand the reasons. The results of these analyses can also help us understand how to effectively improve the design of online teaching and learning. In the post-epidemic era, vocational education is entering a new phase. Researchers, teachers and government agencies will be considering how to compensate for the impact of the COVID-19 epidemic on vocational education. This highlights the need for more research on teaching and learning to inform us of how up-to-date vocational education is.Furthermore, because of the COVID-19 epidemic, positive psychology has gained more attention in vocational education. Therefore, future research could be conducted on the role of helping people understand positive and negative emotions, career choices and career adaptation in the process of career development and construction, within the framework of occupational emotion theory. We can also use more positive psychology-related theories and variables to help us understand the psychology of vocational education.It is clear from the above that, given the specificity and importance of the psychology of vocational education, interdisciplinary research methods, theoretical foundations and statistical models are needed to help us understand it more comprehensively. As time changes, new variables and localized variables need to be proposed to explain more current situations. In addition, the development of research on the psychology of vocational education needs to take into account the characteristics of the localization, global trends and educational policy directions, as well as to extend the scope of the psychology of vocational education to different cultures, groups and contexts. It is also possible to expand the psychology of vocational education in different cultural groups and contextual contexts. The need for education encompasses many dimensions, from the Macrocosm, to the mesocosm, to the microcosm—all need to be considered.Of course, the research themes in the psychology of vocational education are not limited to those mentioned above. We are also looking forward to a wider range of Research Topics to help us understand the situation of vocational education. Although the formal system of vocational education is only a few hundred years old, the concept of skill training has been around since the creation of civilization. The development of vocational talent has also been around for thousands of years. Therefore, it needs to be paid with more attention and importance.J-HY and M-YC: concept, design, and drafting of the manuscript. J-HY and Y-WH: critical revision of the manuscript. All authors contributed to the article and approved the submitted version.


Our aim was to analyze the strength of the family’s influence on the internalization of the ideal of an athletic figure and, consequently, on the multifactorial image of the body, from the perspective of intercultural differencesA total of 488 healthy women aged 19–26; of Polish (154), Ukrainian (228), and Italian (106) took part in the study. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-4) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ 69) were used to measure athletic ideal internalization and family pressure. The body image of Ukrainian, Polish, and Italian women depends both on the degree of internalization the ideal of an athletic figure and influence of the familyThe research also suggests significant differences between the three populations, which may suggest cultural differences between young women living in Eastern, Central, and South European countries. The search for scientific evidence confirming the existence of sociocultural and family predictors explaining the specificity of the pursuit of the perfect body appearance and its musculature is a subject that increasingly inspires contemporary psychological research in nonclinical and clinical populations . The athThe image of an ideal female body, strongly promoted in the media in Europe  and the Research on the subject of the standards of an ideal fit and muscular body was more often conducted on male populations in various European countries –17 or thFewer studies have been conducted on women, who are traditionally tested for the pursuit of thinness rather than athleticism. Although there are few studies, their results seem to be consistent. On the one hand, internalizing the ideal of an athletic body can be as harmful as internalizing the ideal of a lean body and may be associated with effects such as eating disorders , 23, excThe literature review suggests the inconsistency of models describing the influence of sociocultural factors on the internalization of the athletic figure ideal. While peer pressure and family and media pressure are often seen as key variables in internalizing the slim ideal, causing body dissatisfaction and, consequently, eating disorders —from Poland, Ukraine, and Italy. The intention of the sample selection was, among others, to examine the differences but also similarities in terms of the specificity of family influences on body image in young women brought up in families living in the Eastern (Ukraine), Central (Poland), and Western  European countries. On the one hand, striving to achieve the ideal of an athletic body and its internalization may be an expression of the implementation of pro-health behaviors of physical activity, but also, when applied excessively and restrictively, it may lead to the consolidation of bigorectic tendencies (behaviors).The study undertaken by the authors of this article aims to analyze the strength of the family’s influence on the internalization of the ideal of an athletic figure and, consequently, on the multifactorial image of the body. The study of the family role seems to be particularly important in the analysis of the cultural specificity of the studied populations. The selection of women brought up in families and living in Ukraine, Poland and Italy reflects the potential degree of intensity of the influence of Western culture: Italy, the Western European country that has undergone “westernization” for the longest time ; UkraineEven though these countries are at different stages of political and social transformation, all three seem to be influenced by Western culture today. However, what is particularly important, in all three countries, is that the family plays a large role in shaping the identity of young people, their system of values, and the transmission of attitudes and beliefs  tha tha46)] An important factor that could influence the obtained results is the period of data collection. The study was conducted during the COVID-19 pandemic, which could have influenced many of the factors considered in the study. Some studies suggest that during a pandemic, women may experience increasing difficulties in eating regulation, preoccupation with food, and deteriorating body image . TherefoDespite these limitations, however, the project appears to be a valuable contribution to the study of the body image of young women. The study is all the more valuable, as it indicates significant intercultural differences in the level of intensity of phenomena traditionally associated with nutritional psychopathology. This, in turn, suggests that research on risk factors and predictors of recovery disorders is insufficiently versatile and that there is a need to conduct research on these issues while considering sociocultural background.The research may be of application significance because the results may be used in the creation of educational programs. Evidence-based prevention programs may be more positively accepted by parents. Due to the comparisons of three cultural perspectives and family factors: Italy, Poland, and Ukraine in relation to the ideal of an athletic female figure and different ways of perceiving one’s own body image, the results may be useful in building European programs for use in health prevention and working with young people on their image. Body and stimulating proper health behavior toward the body in the trend of “body positivity.”The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Board for Research Projects at the Institute of Psychology, University of Gdansk, Poland (decision no. 33/2020). The patients/participants provided their written informed consent to participate in this study.BI, BB-K, and ML: conceptualization. SL and ML: methodology. BI and SL: formal analysis. BI, TY, NB, RO, ML, US-R, and BMR: investigation. BI, BB-K, and SL: data curation. BI, KG, BB-K, TY, NB, RO, SL, KS-W, US-R, BMR, and ML: writing—original draft preparation. BI, BB-K, TY, NB, SL, KS-W, US-R, BMR, and ML: writing—review and editing. BI, BB-K, KS-W, and ML: supervision. BI and ML: project administration and funding acquisition. 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.


In the published article, there was an error regarding the affiliations for Gianfranco Parati and Martino F. Pengo. They both have the following affiliations:Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy and Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Access to and choices of food are doubtless beyond the realms of biological and nutritional needs. This does not mean that limitations to individuals’ access to the social, cultural, economic, and psychological aspects should also be overlooked. Access to safe, nutritious, pleasant, sustainable, and healthy food for all individuals should be the focus of food producers, industries, services and policymakers ,2,3,4. IConsidering these premises and the continuous demand for, interest in, and topicality of the subject, as demonstrated in the Special Issue first edition , we promHealthy and sustainable food systems are essential in the efforts to meet increasing food security, nutrition and health demands . DespiteThere is great concern about animal products consumption and the impact of the practice on health and the environment. In this sense, the food industry and consumers are searching for alternatives to reduce animal product consumption globally. However, the use of plant-based foods as substitutes for animal products is challenging from technological, sensory, nutritional, consumer acceptance and sustainable points of view ,11. Furt