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1.
Psychol Rep ; : 332941241253601, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38727086

RESUMO

Measuring people's self-efficacy in navigating the digital world has become essential in an age where the Internet permeates every aspect of life. This paper describes the creation and validation of the VISES (Virthulab Internet Self-Efficacy Scale), an instrument designed for the modern Internet environment. The way we work, communicate, and access information is changing as a result of the digital revolution, and VISES encapsulates the abilities and self-assurance needed to succeed in this Web 4.0 era. The study investigated the connections between VISES scores, Internet usage habits, net frustration, self-disparagement, and Internet addiction using a rigorous methodology. The study included a sample of 773 participants who could speak Italian (66.5% women). Participants were 31.38 years old on average (standard deviation = 11.19). The 3-factor structure of VISES, which demonstrated strong reliability for each subscale, was discovered by confirmatory factor analysis (CFA). According to the study, there is a substantial positive link between the VISES Internet self-efficacy ratings and both the frequency and duration of online use. Additionally, VISES scores exhibited positive associations with expected outcomes of Internet use, including social outcomes, personal entertainment, and personal information. The negative link between VISES scores and net frustration and self-disparagement emphasized the importance of self-efficacy in reducing negative emotional and cognitive states while using the Internet. Surprisingly, the association between VISES scores and Internet addiction was found for just one of the dimensions of VISES.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38082676

RESUMO

Raising awareness of environmental challenges represents an important issue for researchers and scientists. As public opinion remains ambiguous, implicit attitudes toward climate change must be investigated. A custom Single-Category Implicit Association Test, a version of the Implicit Association Test, was developed to assess climate change beliefs. It was administered to 20 subjects while eye movements were tracked using a smart glasses system. Eye gaze patterns were analysed to understand whether they could reflect implicit attitudes toward nature. Recurrence Quantification Analysis was performed to extract 13 features from the eye-tracking data, which were used to perform statistical analyses. Significant differences were found between target stimuli (words related to climate change) and bad attributes in reaction time, and between target stimuli and good attributes in diagonal length entropy, suggesting that eye-tracking may provide an alternative source of information to electroencephalography in modeling and predicting implicit attitudes.


Assuntos
Atitude , Tecnologia de Rastreamento Ocular , Humanos , Movimentos Oculares , Fixação Ocular , Tempo de Reação
3.
Psychol Rep ; : 332941231219921, 2023 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-38041685

RESUMO

Nowadays it is important for companies to keep their profits and productivity high. This can be achieved by creating a good environment in which employees can perform at their best. Unfortunately, counterproductive work behavior (CWB) is widespread in the workplace and poses a serious threat to both organizational performance and employee well-being. Among the many potential risk factors for CWB, the Dark Triad (DT) personality traits (Machiavellianism, narcissism, and psychopathy) have received increasing attention in recent years. To assess the robustness and magnitude of the association between DT and CWB, we conducted a systematic review of the available literature on DT and CWB using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines after a thorough search of several databases, 21 papers were included. The results showed that DT and CWB are positively associated. Psychopathy exhibited the strongest positive association with CWB, followed immediately by Machiavellianism and narcissism. Moreover, Machiavellianism and psychopathy showed positive correlations with both forms of CWB (organisational and interpersonal), whereas narcissism was positively correlated only with interpersonal CWB. Our findings highlight that even though organisations could benefit from people with DT at the performance level, there could be serious implications for well-being and an appropriate work environment due to CWB.

4.
Eur J Investig Health Psychol Educ ; 13(11): 2642-2680, 2023 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-37998074

RESUMO

This literature review aims to analyze studies published by researchers on the topic of the relationship between the psychological constructs of the Dark Triad and Cognitive Empathy. This study hypothesizes how having good cognitive empathic skills could benefit people who demonstrate Dark Triad traits, as this could facilitate the implementation of manipulative strategies. Through the process of identifying studies via databases and registers, 23 studies were included in this literature review, and the results and theories brought forward by the researchers find more agreement regarding the individual components of the Dark Triad than the whole construct: narcissism seems to have, for the most part, relatively small and typical positive correlations (more than 50% of correlations), Machiavellianism has relatively small and typical negative relationships (about 80% of correlations), and psychopathy has relatively large negative relationships (about 90% of correlations). This study conveys that Machiavellians and psychopaths, having reduced empathic abilities, use manipulation techniques that do not have to do with empathy (for example seduction, intimidation etc.), while narcissists would be, among these three dimensions, those most likely to understand others' states of mind and thus be able to use this knowledge to their advantage-although there are doubts about the veracity of the statements and answers given by narcissists in the tests administered to them. This literature review could be a valid aid to professionals dealing with people who exhibit Dark Triad traits; understanding how those exhibiting Dark Triad traits manage their empathic abilities, the areas in which the various dimensions show deficits or not, and how they act to implement their manipulative and controlling tactics could aid in the development of more effective helping strategies to be utilized in therapy settings.

5.
Behav Sci (Basel) ; 13(11)2023 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-37998696

RESUMO

The present research aimed at understanding individuals' vaccination intentions and protective behaviours against COVID-19 through two different studies. In Study 1 (N = 213, 73% women; mean age = 24.03) the Protection Motivation Theory model was tested considering the fear of COVID-19 as a possible mediator between threat appraisal (in terms of both health and social life) and intentions to get vaccinated when the vaccination was not yet available. Study 2 (N = 1111, 68.9% women; mean age = 38.33) was conducted when the vaccine became available for the entire population. Through this study, by adopting the 5C model of vaccine hesitancy as a theoretical framework, we aimed to understand how people who got vaccinated and the ones who did not differed, considering fear of vaccination, personality and vaccination hesitancy. In Study 1, social limitations, perceived severity and COVID-19 perceived vulnerability were significantly and positively related to fear of COVID-19. Contrary to what we expected, fear of COVID-19 was not a significant predictor of vaccination intention, which was predicted by both response efficacy and self-efficacy. In Study 2, in line with previous studies, vaccine hesitancy was negatively related to vaccination. More specifically, the social-oriented dimension of collective responsibility was the strongest predictor of effective behaviour. Our findings provide insights into the complexity of vaccine acceptance and emphasise the need for targeted interventions to promote vaccination and mitigate the spread of infectious diseases.

6.
J Transl Med ; 21(1): 755, 2023 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-37885010

RESUMO

BACKGROUND: Med-Index is a one-health front-of-pack (FOP) label, based on Mediterranean diet (MedDiet) principles, developed to summarize information about the nutritional properties and related-health benefits of any food as well as its sustainable production processes, and the associated food company's social responsibility parameters in a new "Planeterranean" perspective. Thus, Med-Index can be adopted in and by any European region and authority as well as worldwide; this is achieved by consumption and cooking of locally available and sourced foods that respect MedDiet principles, both in terms of healthy nutrition and sustainable production. The huge body of scientific evidence about the health benefits of the MedDiet model and principles requires a comprehensive framework to encompass the scientific reliability and robustness of this tool. A systematic review was carried out to examine the association between human health and adherence to MedDiet patterns upon which the "Med-Index" tool was subsequently developed. METHODS: MEDLINE and PubMed databases were searched for eligible publications from 1990 to April 2023. Systematic literature reviews, with or without meta-analysis, of clinical trials and observational studies were screened by two independent investigators for eligibility, data extraction, and quality assessment. English language and the time interval 1990-2023 were applied. A registry code CRD42023464807 was generated on PROSPERO and approved for this search protocol. The corrected covered area (CCA), calculated to quantify the degree of overlap between reviews, gave a slight overlap (CCA = 4%). RESULTS: A total of 84 systematic reviews out of 6681 screened records were selected. Eligible reviews included studies with predominantly observational designs (61/84, 72.6%%), of which 26/61 referenced studies of mixed observational and RCT designs, while 23/84 (27.4%) were RCT-only systematic reviews. Seventy-nine different entries were identified for health outcomes, clustered into 10 macro-categories, each reporting a statistically significant association with exposure to the MedDiet. Adherence to MedDiet was found to strongly benefit age-related chronic diseases (21.5%), neurological disorders (19%), and obesity-related metabolic features (12.65), followed by CVDs (11.4%), cancer (10.1%), diabetes (7.5%), liver health (6.3%), inflammation (5%), mortality (5%), and renal health (1.2%). The quality of the studies was moderate to high. CONCLUSION: In the context of a "Planeterranean" framework and perspective that can be adopted in any European region and worldwide, MedDiet represents a healthy and sustainable lifestyle model, able to prevent several diseases and reduce premature mortality. In addition, the availability of a FOP, such as Med-Index, might foster more conscious food choices among consumers, paying attention both to human and planetary health.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Dieta Mediterrânea , Saúde Única , Humanos , Reprodutibilidade dos Testes
7.
Nurs Rep ; 13(3): 1203-1215, 2023 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-37755346

RESUMO

INTRODUCTION: The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances. MATERIALS AND METHODS: A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI). RESULTS: a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score. DISCUSSION AND CONCLUSION: Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

9.
BMC Public Health ; 23(1): 1501, 2023 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-37553624

RESUMO

BACKGROUND: A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines. METHODS: To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts. RESULTS: Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed. CONCLUSION: The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.


Assuntos
Letramento em Saúde , Vacinas , Humanos , Letramento em Saúde/métodos , Saúde Pública , Vacinação , Meio Social
10.
Eur J Investig Health Psychol Educ ; 13(5): 861-869, 2023 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-37232703

RESUMO

Orthorexia nervosa (ON) is characterized by an intense avoidance of foods considered unhealthy, obsession with healthy eating behaviors, and pathological fixation on healthy foods. Although there are still debates in the literature about the psychological factors and symptoms of ON, it should be noted that many of the symptoms share common features with obsessive compulsive disorder (OCD). The aim of the present study was to investigate the relationship between ON and OCD with its subtypes. In this framework, the cross-sectional study was conducted with an opportunistic sample of 587 participants (86% women and 14% men), with an average age of 29.32 (s.d. = 11.29; age range = 15-74). Our work showed that almost all OCD subtypes were largely correlated with ON. The lowest correlation was for "Checking" and the highest for "Obsession". Overall, the OCD subtypes (i.e., Indecisiveness, Just Right, Obsession, and Hoarding) were more strongly associated with ON measures, while subtypes Checking and Contamination, although positively associated, had lower correlation coefficients.

11.
Behav Ther ; 54(3): 595-604, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37088513

RESUMO

Callous-Unemotional (CU) traits are strongly related to early-onset and severe levels of conduct problems. However, much less research has focused on their association with potential problems in adolescents' social relationships. Further, it is important to determine if CU traits explain variance in important social variables, independent of conduct problems or general personality dimensions related to sociability, like agreeableness. In the current study, we examined the association of CU traits with a range of social variables in a community sample of Italian adolescents (N = 563; 460 girls; mean age = 15.80, SD = 1.50). Measures for the social variables included assessment of peer rejection, adolescents' prosocial behaviors, satisfaction in peer relationships, and feelings of connection with school and classmates. We also obtained self-report ratings of CU traits, conduct problems (CP) and agreeableness. Analyses showed that CU traits were significantly associated with all the social variables. After controlling for CP and agreeableness, CU traits were still positively associated with ratings of peer rejection and negatively associated with prosocial behavior and satisfaction in relationships with peers. However, the negative associations with feelings of connection to school and peers were no longer significant. These findings provide further support for the clinical usefulness of CU traits and further evidence for potential targets of intervention, particularly focused on the adolescent's relational skills.


Assuntos
Transtorno da Conduta , Comportamento Problema , Adolescente , Feminino , Humanos , Transtorno da Conduta/psicologia , Emoções , Empatia , Comportamento Problema/psicologia , Estudantes
12.
Behav Sci (Basel) ; 12(12)2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36546972

RESUMO

The use of new technologies and information communication technology services (ICTs) has greatly increased, especially after the COVID-19 pandemic, resulting in an irrevocable change in people's work-life balance (WLB). Despite the thriving literature on the dysfunctional use of new technologies, a functional use of ICTs also seems to be possible. Inspired by the theory of psychology of harmony and referring to behavioral addiction models and substance use models, we defined the construct of digital life balance to indicate a harmonic balance between digital life and real life. In this context, the imbalance between online and offline life may reflect a dysfunctional use of ICTs and can be seen as a process of disharmonization. With this perspective in mind, the aim of this study was to develop a dedicated measuring instrument that could capture both people's balanced and unbalanced use of ICTs. Through two cross-sectional studies (Study 1= 1473 participants; Study 2 = 953 participants), we validated the scale internally and externally. In line with the literature, Digital Life Balance scores appeared to be negatively associated with addiction measures and positively associated with well-being measures. In conclusion, the Digital Life Balance (DLB) Scale appears to be a reliable (ω = 0.89) and valid instrument to investigate people's harmonic and disharmonic use of ICTs.

13.
Artigo em Inglês | MEDLINE | ID: mdl-36361430

RESUMO

Starting in early 2020, the COVID-19 pandemic has been responsible, worldwide, for millions of deaths and patients with long-COVID syndrome. In an attempt to stop the spread of the virus, the blanket administration of COVID-19 vaccines proved to be the most effective measure, yet the existence and availability of functional vaccines did not and, still, do not ensure the willingness and intent of people to be vaccinated. This study assessed the similarities and differences in vaccine fears and vaccine hesitancy through between clusters of subjects: people that were not infected with COVID-19, people that had COVID but did not develop long-lasting symptoms, and people that were infected with COVID and developed long-COVID syndrome. From the sample of 1111 Italian people, it was found that individuals who experienced mild symptoms showed higher vaccine hesitancy (confidence, complacency, and collective responsibility) than those who did not contract COVID-19. People affected by long-COVID showed a lower overall hesitancy than individuals who had COVID-19 without incurring long-lasting symptoms and, thus, essentially resembled people who had no experience of COVID-19 infection in terms of the vaccine hesitancy scores. Vaccine fear remained unchanged across all three of the examined clusters.


Assuntos
COVID-19 , Vacinas , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Hesitação Vacinal , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Vacinação , Medo , Síndrome , Síndrome de COVID-19 Pós-Aguda
14.
Eur J Investig Health Psychol Educ ; 12(8): 1108-1120, 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-36005227

RESUMO

Social media (SM) are the new standard for social interaction and people with OCD use such platforms like everyone else. However, the research on these individuals provides limited, sporadic, and difficult-to-generalize data outside of social-media evidence for one specific context concerning how SM is experienced by people with OCD. Our cross-sectional study involved 660 participants (71.4% females, 28.6% males) with 22% of the sample surpassing the 90° percentile threshold to be identified as high-level OCD-symptomatic individuals. Our work highlighted that roughly all OCD types are affected by social media in terms of mood and that these individuals appeared to give SM more importance than non-OCD individuals. The evidence presented, although very narrow, can be conceived as the first building blocks to encourage future research considering how individuals with OCD experience social media, since they appear to be affected more by them compared to non-OCD individuals.

15.
Behav Sci (Basel) ; 12(7)2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35877298

RESUMO

The COVID-19 pandemic has brought important changes to how we engage in relationships of any kind. To combat the spread of the virus, schools resorted to remote-learning, and teenagers had to rely on various technologies to meet many of the needs that they used to satisfy offline (e.g., social, informational, and recreational/leisure purposes). This article was written to investigate the changes that the students at an Italian high school went through in terms of use of technologies, loneliness, and sense of community, through a survey focusing on their retrospective perceptions. The study was carried out on 917 students. In general, we have found that the COVID-19 pandemic has greatly increased the perception of loneliness in teenagers (especially in female respondents), as well as their use of technologies for social, informational, and leisure purposes. However, maybe thanks to the opportunities provided by ICTs and remote learning, the sense of community in Italian teenagers was only marginally impacted.

17.
Spinal Cord ; 60(9): 826-830, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35414698

RESUMO

STUDY DESIGN: Multicentric psychometric study. OBJECTIVES: The aim of this study is to introduce the development of the Sitting Balance Assessment for Spinal Cord Injury (SitBASCI) and assess its inter-rater reliability and internal consistency. SETTING: The study was developed among the three Spinal Units of San Bortolo Hospital in Vicenza, Niguarda Hospital in Milan and AOU Careggi in Florence. METHODS: SitBASCI is a 13-item scale developed to evaluate trunk control in individuals with SCI. Subjects were filmed while performing the 13 items of the scale. The videotapes were submitted to 25 examiners who evaluated patients' performances with the scale. The power of the study was estimated. The interclass correlational coefficient (ICC) was used to assess the inter-rater reliability of the examiner's evaluations regarding each item and the total. Cronbach's alpha was used to assess internal consistency of the scale and internal consistency of the scale on the eliminated item. RESULTS: The study showed to have a significant power. The inter-rater reliability for the total score was ptot = 0.997 (item's values were p = 0.876-0.998). The internal consistency of the scale was alpha = 0.925, while the internal consistency of the scale on the eliminated item was alpha = 0.912-0.930. CONCLUSION: SitBASCI had a high inter-rater reliability and internal consistency. Items had also good inter-rater reliability and item-total correlation. Therefore, SitBASCI could be proposed as a good and reliable instrument for Italian clinicians to evaluate sitting balance and trunk control in patient with SCI despite of aetiology and level of injury.


Assuntos
Traumatismos da Medula Espinal , Humanos , Equilíbrio Postural , Psicometria , Reprodutibilidade dos Testes , Postura Sentada , Traumatismos da Medula Espinal/diagnóstico
18.
Artigo em Inglês | MEDLINE | ID: mdl-35162544

RESUMO

AIM: Few studies in the literature specifically address the hardiness of nurses during the COVID-19 pandemic. Thus, the primary aim of this study was to assess the impact of COVID-19 on the hardiness levels in an Italian cohort of nurses. The secondary aims were to assess the level of hardiness in nurses directly caring for patients with COVID-19 and to verify the presence of related risk and promoting factors. METHODS: A descriptive and explorative study was performed through an online survey from March to July 2020. The survey was composed of a multiple answer questionnaire with open, closed, and semi-closed-ended questions. Hardiness and anxiety were assessed using two psychometric instruments: the Dispositional Resilience Scale (DRS-15) and State-Trait Anxiety Inventory (STAI-Y). RESULTS: A total of 1250 nurses completed the questionnaire entirely (92.3% of respondents). The average length of service was 17.8 ± 11.5 years. A decrease in the hardiness was recorded after the first wave of COVID-19 if compared to the baseline (mean Δ DRS-15 total = 1.3 ± 5.0), whereas in the subsample of nurses caring for COVID-19 patients, the total hardiness level decreased more consistently (mean Δ DRS Total = 1.9 + 5.3). Multivariate analysis showed that high levels of anxiety were risk factors for reducing hardiness. In contrast, anxiety, when associated with a greater length of service, was a promoting factor for the increase in hardiness. CONCLUSIONS: The correlation between anxiety and years of length of service appears to be pivotal. Future research should focus on the role of anxiety to establish its actual role as a predictor of hardiness.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Ansiedade/epidemiologia , Humanos , Pandemias , Fatores de Risco , SARS-CoV-2
19.
Artigo em Inglês | MEDLINE | ID: mdl-35162658

RESUMO

More than a year has passed since "patient 0" was found and COVID-19 is now an established reality that a lot of people have had to accept and coexist with. In Italy, the pandemic hit in "waves", but the studies assessing the longitudinal impact of the pandemic in the general population are not many. In this paper, we compared data collected during the first wave with data gathered during the second one, so that we can provide insights about the Italian population's psychological adaptation to the pandemic also by comparing them with pre-pandemic normative scores. From our results, it seemed that people were seeking a compromise: indeed, despite the still-relevant risk perception, people apparently "learned" how to deal with the pandemic as indicated by an increase in self-efficacy and a more internal locus of control.


Assuntos
COVID-19 , Pandemias , Humanos , Itália/epidemiologia , SARS-CoV-2
20.
J Community Appl Soc Psychol ; 32(3): 358-373, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34518754

RESUMO

Following an ecological perspective, reactions to a disaster-such as the COVID-19 pandemic-should be analysed in the interdependence between individual and community dimensions. The present study aims to analyse individual emotional dimensions (anxiety, joy, fear or depressive feelings) and their community dimensions (connectedness, emotional sharing and solidarity) with a longitudinal approach among university students from Italian universities. Participants were 746 university students at t1 (during the lockdown) and 361 at t2 (after the lockdown) recruited in six Italian universities from different areas of Italy. Comparing emotional dimensions in the two times, t2 is characterized by a generalized ambiguity: both happiness or joy because of the end of limitations and a kind of 'post-lockdown anxiety' because of a sense of individual inadequacy in facing the return to normality, conducting daily activities and attending community spaces. Data confirms that after the so-called 'honeymoon phase' in community dimensions (first phase of t1 time), a sort of 'depressive reaction' arises at t2: Italian university students seem more aware of the need for individual and social responsibility and that many events are not under their personal control. The reconstruction phase and exit from the emergency are perceived as necessary but also as a difficult and risky period. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

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