Impact of COVID-19 pandemic on cultural ecosystem services from urban green spaces: a case from English Bazar Urban Agglomeration, Eastern India.

Urban green space (UGS) provides multiple cultural ecosystem services (CES) and enhances people's physical and mental well-being. The importance of UGS was more critical during crisis periods such as the COVID-19 pandemic. Recently, UGS has been under severe threats due to rapid urban expansion and climate change. Particularly, the cities in developing countries have experienced a dramatic loss of green spaces due to land use and land cover (LULC) change. This study aims to assess the impact of the COVID-19 pandemic on CES perception obtained from two public UGS, i.e., Subhankar Sishu Uddyan (SSU) and Bandh Road (BR) in English Bazar Urban Agglomeration (EBUA), Eastern India. A survey was performed to assess the valuation of CES, CES obtained from UGS, and the use of CES difference during partial (unlock phases) and after lockdown periods. The non-parametric tests were carried out to understand the significant differences between CES and UGS perceived by the respondents. Explanatory factor analysis was also performed to find the association among CES for each UGS. The results reported substantial variations of UGS use during partial and after lockdown periods. During the after-lockdown period, the UGS mainly were used for social relations (51%), spending time with relatives and friends (25%), spending time with children (11%) in SSU and walking (25%), spending time with relatives and friends (21%), and physical activities (17%) in BR. During the partial lockdown period, a significant difference between SSU and BR was recorded from social relations and health value among all CES. After the full lockdown period, a significant difference was observed in recreation, social relations, health, and aesthetic value. The frequency and duration of UGS use during partial lockdown periods substantially increased. About 12% of the total visitor visited UGS daily after the lockdown, whereas it was 4% during the partial lockdown. The study's findings will assist urban planners and policymakers in understanding the need for UGS to promote the well-being of the citizens.

Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre study

Background: Minimally invasive lumbar interbody fusion (MI-LIF) procedures are an effective treatment for patients with degenerative lumbar disease (DLD). However, consensus does not exist among surgeons for selecting 1 approach over another. The objectives were to collect patientreported, surgical and fusion outcome data at 1 year after surgery for patients receiving either anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF), oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or midline lumbar interbody fusion (MIDLF) for DLD. Methods: A total of 340 patients with DLD were consecutively enrolled in a prospective, global, multicentre cohort study (MASTERS-D2;NCT02617563). Patients were treated according to the surgeon's choice with 1 of 6 MI-LIF procedures. Outcome data for disability (Oswestry Disability Index), back and leg pain (Visual Analogue Scale), quality of life (EQ-5D) were collected at baseline, 4 weeks, 3 months and 12 months. Demographic, surgical and safety data were also recorded. Fusion status was assessed by using computed tomography or x-rays at 1 year (plus or minus 6 mo) after surgery. Paired sample t tests were used to test for improvement from baseline. Results: One year after surgery, patients attained clinically significant improvements on all patient-reported outcome measures regardless of approach used. Patients who were selected to receive an ALIF comprised the highest proportion of smokers, were the youngest and had the longest operating time, but low fluoroscopy exposure. Anterolateral (ALIF, DLIF, OLIF) compared with posterior (MIDLF, PLIF, TLIF) approaches had the least amount of blood loss, despite similar or longer surgical times. Within 1 year of follow-up, 7 device-related and 7 surgery-related serious adverse events (SAEs) had been recorded. Assessment of fusion was hindered by the effects of COVID-19. In total, 196 out of 340 (57.6%) patients were assessed. The aggregate fusion rate for anterolateral approaches was 88.1% and for posterior approaches 85.1% at 12 months of follow-up. Conclusion: All 6 approaches for MI-LIF surgery demonstrate favourable patient-reported and surgical outcomes for patients with DLD. Continuing data collection up to 5 years after surgery will yield information on long-term effectiveness, safety, health economics and revision surgery and on the long-term impact of surgeons' choice of approach.

Development and Application of an SPR Nanobiosensor Based on AuNPs for the Detection of SARS-CoV-2 on Food Surfaces.

A new transmission route of SARS-CoV-2 through food was recently considered by the World Health Organization (WHO), and, given the pandemic scenario, the search for fast, sensitive, and low-cost methods is necessary. Biosensors have become a viable alternative for large-scale testing because they overcome the limitations of standard techniques. Herein, we investigated the ability of gold spherical nanoparticles (AuNPs) functionalized with oligonucleotides to detect SARS-CoV-2 and demonstrated their potential to be used as plasmonic nanobiosensors. The loop-mediated isothermal amplification (LAMP) technique was used to amplify the viral genetic material from the raw virus-containing solution without any preparation. The detection of virus presence or absence was performed by ultraviolet-visible (UV-Vis) absorption spectroscopy, by monitoring the absorption band of the surface plasmonic resonance (SPR) of the AuNPs. The displacement of the peak by 525 nm from the functionalized AuNPs indicated the absence of the virus (particular region of gold). On the other hand, the region ~300 nm indicated the presence of the virus when RNA bound to the functionalized AuNPs. The nanobiosensor system was designed to detect a region of the N gene in a dynamic concentration range from 0.1 to 50 × 103 ng·mL-1 with a limit of detection (LOD) of 1 ng·mL-1 (2.7 × 103 copy per µL), indicating excellent sensitivity. The nanobiosensor was applied to detect the SARS-CoV-2 virus on the surfaces of vegetables and showed 100% accuracy compared to the standard quantitative reverse transcription polymerase chain reaction (RT-qPCR) technique. Therefore, the nanobiosensor is sensitive, selective, and simple, providing a viable alternative for the rapid detection of SARS-CoV-2 in ready-to-eat vegetables.

Achieving the Sustainable Development Goals in the post-pandemic era.

The COVID-19 pandemic continues to pose substantial challenges to achieving the Sustainable Development Goals (SDGs). Exploring systematic SDG strategies is urgently needed to aid recovery from the pandemic and reinvigorate global SDG actions. Based on available data and comprehensive analysis of the literature, this paper highlights ongoing challenges facing the SDGs, identifies the effects of COVID-19 on SDG progress, and proposes a systematic framework for promoting the achievement of SDGs in the post-pandemic era. Progress towards attaining the SDGs was already lagging behind even before the onset of the COVID-19 pandemic. Inequitable distribution of food-energy-water resources and environmental crises clearly threaten SDG implementation. Evidently, there are gaps between the vision for SDG realization and actual capacity that constrain national efforts. The turbulent geopolitical environment, spatial inequities, and trade-offs limit the effectiveness of SDG implementation. The global public health crisis and socio-economic downturn under COVID-19 have further impeded progress toward attaining the SDGs. Not only has the pandemic delayed SDG advancement in general, but it has also amplified spatial imbalances in achieving progress, undermined connectivity, and accentuated anti-globalization sentiment under lockdowns and geopolitical conflicts. Nevertheless, positive developments in technology and improvement in environmental conditions have also occurred. In reflecting on the overall situation globally, it is recommended that post-pandemic SDG actions adopt a "Classification-Coordination-Collaboration" framework. Classification facilitates both identification of the current development status and the urgency of SDG achievement aligned with national conditions. Coordination promotes domestic/international and inter-departmental synergy for short-term recovery as well as long-term development. Cooperation is key to strengthening economic exchanges, promoting technological innovation, and building a global culture of sustainable development that is essential if the endeavor of achieving the SDGs is to be successful. Systematic actions are urgently needed to get the SDG process back on track.

Spotlights on the latest opinions on identification, prevention, and management of newer CoV-2 variants: A roundup appraisal on innovative ideas and designer vaccines for Omicron.

Although mass vaccination combined with some other preventative strategies and lockdown was associated with some early signs that COVID-19 infection might be fading away, the over 35 sites mutated new South African variant, "Omicron", emerged almost globally. Certain predisposed hosts may develop severe inflammatory thrombotic or mild long-Covid conditions due to this variant, which depletes T-cells, neutralizes antibodies circulating in the body, and coincidentally induces hypercoagulability. The surge of Omicron combined with Delta variants may confer unresponsiveness to the currently available vaccines even when the second dose is given up to 90 days. A drop in the antibody levels by 30 % has been identified in omicron-infected individuals, and one in five people is resistant to antibody treatment. This poses major concerns in the transmissibility rate of this new variant, even in a heavy mass vaccinated environment. This heavily mutated Omicron with other spike sites facilitates viral entry into the cells through conformational changes, irrespective of circulating neutralising antibody. Based on this consideration, we believe that speeding up mixed-matched vaccines with higher T-cell stimulation ability may improve the current situation. Moreover, large orders for antiviral drugs and monoclonal antibodies that could tackle Omicron combined with other variants may be valuable. The use of free polyclonal antibody donations and, hopefully, T-cell immunotherapy, may represent further breakthrough therapeutic interventions. However, Omicron infection is relatively milder than the ongoing Delta variant but is extremely contagious, and therefore the development of novel interventions is highly demanding.

Electrochemical immunosensors using electrodeposited gold nanostructures for detecting the S proteins from SARS-CoV and SARS-CoV-2.

This paper reports the development of a low-cost (< US$ 0.03 per device) immunosensor based on gold-modified screen-printed carbon electrodes (SPCEs). As a proof of concept, the immunosensor was tested for a fast and sensitive determination of S proteins from both SARS-CoV and SARS-CoV-2, by a single disposable device. Gold nanoparticles were electrochemically deposited via direct reduction of gold ions on the electrode using amperometry. Capture antibodies from spike (S) protein were covalently immobilized on carboxylic groups of self-assembled monolayers (SAM) of mercaptoacetic acid (MAA) attached to the gold nanoparticles. Label-free detection of S proteins from both SARS-CoV and SARS-CoV-2 was performed with electrochemical impedance spectroscopy (EIS). The immunosensor fabricated with 9 s gold deposition had a high performance in terms of selectivity, sensitivity, and low limit of detection (LOD) (3.16 pmol L-1), thus permitting the direct determination of the target proteins in spiked saliva samples. The complete analysis can be carried out within 35 min using a simple one-step assay protocol with small sample volumes (10 µL). With such features, the immunoplatform presented here can be deployed for mass testing in point-of-care settings.

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Updating the use of nano-biosensors as promising devices for the diagnosis of coronavirus family members: A systematic review.

Coronavidae viruses, such as SARS-CoV, SARS-CoV-2, and MERS-CoV, cause severe lower respiratory tract infection, acute respiratory distress syndrome and extrapulmonary manifestations, such as diarrhea and fever, eventually leading to death. Fast, accurate, reproductible, and cost-effective SARS-CoV-2 identification can be achieved employing nano-biosensors, reinforcing conventional methodologies to avoid the spread of COVID-19 within and across communities. Nano-biosensors built using gold, silver, graphene, In2O3 nanowire and iron oxide nanoparticles, Quantum Dots and carbon nanofibers have been successfully employed to detect specific virus antigens - nucleic acid sequences and/or proteins -or host antibodies produced in response to viral infection. Biorecognition counterpart molecules have been immobilized on the surface of these nanomaterials, leading to selective virus detection by optical or electrochemical transducer systems. This systematic review assessed studies on described and tested immunonsensors and genosensors designed from distinct nanomaterials available at the Pubmed, Scopus, and Science Direct databases. Twenty-three nano biosensors were found suitable for unequivocal coronavirus detection in clinical samples. Nano-biosensors coupled to RT-LAMP/RT-PCR assays can optimize RNA extraction, reduce analysis times and/or eliminate sophisticated instrumentation. Although promising for the diagnosis of Coronavidae family members, further trials in large populations must be adequately and rigorously conducted to address nano-biosensor applicability in the clinical practice for early coronavirus infection detection.

Recover the food-energy-water nexus from COVID-19 under Sustainable Development Goals acceleration actions.

The interwoven relationship between food, energy, and water (FEW) is described as the FEW nexus. The COVID-19 pandemic has interrupted the FEW nexus and impeded the progress of FEW-related Sustainable Development Goals (SDGs) (SDG 2: Zero Hunger; 6: Clean Water and Sanitation; 7: Affordable and Clean Energy). We aim to find solutions to recover the FEW nexus from COVID-19. First, we discussed the challenges faced by FEW amid COVID-19. Second, we observed responses of the FEW nexus under COVID-19's interference. Finally, we proposed the solutions that guide the FEW nexus in recovery from the pandemic by mining 164 FEW-related SDG Acceleration Actions. The key solutions include 1) building or upgrading FEW facilities and infrastructure, 2) improving nature's contribution to the FEW nexus, 3) developing digital technologies, 4) innovating the source and production of FEW, and 5) promoting community production and transforming the lifestyle. Our work highlights the importance of feasible and accelerated actions that recover the FEW nexus in the post-pandemic era.

Meteorological factors' effects on COVID-19 show seasonality and spatiality in Brazil.

The meteorological conditions may affect COVID-19 transmission. However, the roles of seasonality and macro-climate are still contentious due to the limited time series for early-stage studies. We studied meteorological factors' effects on COVID-19 transmission in Brazil from February 25 to November 15, 2020. We aimed to explore whether this impact showed seasonal characteristics and spatial variations related to the macro-climate. We applied two-way fixed-effect models to identify the effects of meteorological factors on COVID-19 transmission and used spatial analysis to explore their spatial-temporal characteristics with a relatively long-time span. The results showed that cold, dry and windless conditions aggravated COVID-19 transmission. The daily average temperature, humidity, and wind speed negatively affected the daily new cases. Humidity and temperature played a dominant role in this process. For the time series, the influences of meteorological conditions on COVID-19 had a periodic fluctuation of 3-4 months (in line with the seasons in Brazil). The turning points of this fluctuation occurred at the turn of seasons. Spatially, the negative effects of temperature and humidity on COVID-19 transmission clustered in the northeastern and central parts of Brazil. This is consistent with the range of arid climate types. Overall, the seasonality and similar climate types should be considered to estimate the spatial-temporal COVID-19 patterns. Winter is a critical time to be alert for COVID-19, especially in the northern part of Brazil.

Global COVID-19 pandemic trends and their relationship with meteorological variables, air pollutants and socioeconomic aspects.

Meteorological variables, air pollutants, and socioeconomic factors are associated with COVID-19 transmission. However, it is unclear what impact their interactions have on COVID-19 transmission, whether their impact on COVID-19 transmission is linear or non-linear, and where the inflexion points are. This study examined 1) the spatial and temporal trends in COVID-19 monthly infection rate of new confirmed cases per 100,000 people (Rn) in 188 countries/regions worldwide from March to November 2020; 2) the linear correlation between meteorological variables (temperature (T), rainfall (R), wind speed (WS), relative humidity (RH), air pressure (AP)), air pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3)) and socioeconomic aspects (population density (PD), gross domestic product per capita (GDP), domestic general government health expenditure per capita (GHE)) and Rn, and 3) the interaction and non-linear effects of the different variables on Rn, based on GeoDetector and Boosted regression tree. The results showed that the global Rn had was spatially clustered, and the average Rn increased From March to November 2020. Global Rn was negatively correlated with meteorological variables (T, R, WS, AP) and positively correlated with air pollutants (NO2, SO2, O3) and socioeconomic aspects (GDP, GHE). The interaction of SO2 and O3, SO2 and RH, and O3 and T strongly affected Rn. The variables effect on COVID-19 transmission was non-linear, with one or more inflexion points. The findings of this work can provide a basis for developing a global response to COVID-19 for global sustainable development.

Mapping the Impact of COVID-19 Lockdown on Urban Surface Ecological Status (USES): A Case Study of Kolkata Metropolitan Area (KMA), India

An urban ecosystem’s ecological structure and functions can be assessed through Urban Surface Ecological Status (USES). USES are affected by human activities and environmental processes. The mapping of USESs are crucial for urban environmental sustainability, particularly in developing countries such as India. The COVID-19 pandemic caused unprecedented negative impacts on socio-economic domains;however, there was a reduction in human pressures on the environment. This study aims to assess the effects of lockdown on the USES in the Kolkata Metropolitan Area (KMA), India, during different lockdown phases (phases I, II and III). The land surface temperature (LST), normalized difference vegetation index (NDVI), and wetness and normalized difference soil index (NDSI) were assessed. The USES was developed by combining all of the biophysical parameters using Principal Component Analysis (PCA). The results showed that there was a substantial USES spatial variability in KMA. During lockdown phase III, the USES in fair and poor sustainability areas decreased from 29% (2019) to 24% (2020), and from 33% (2019) to 25% (2020), respectively. Overall, the areas under poor USES decreased from 30% to 25% during lockdown periods. Our results also showed that the USES mean value was 0.49 in 2019but reached 0.34 during the lockdown period (a decrease of more than 30%). The poor USES area was mainly concentrated in built-up areas (with high LST and NDSI), compared to the rural fringe areas of KMA (high NDVI and wetness). The mapping of USES are crucial in different biophysical environmental conditions, and they can be very helpful for the assessment of urban sustainability.

Coach Training Within the Covid-19 Pandemic: Challenges and Potential Pathways.

In this article we aim to provide insights about the challenges stakeholders in Portugal and across the globe may face throughout the Coronavirus Disease 2019 pandemic to reorganize coach training programs and suggest strategies to help coaches learn. Such reflection may help stakeholders across socio-cultural contexts consider the consequences of the changes made to coach training programs, the rationale for these decisions and the need to acknowledge existent challenges such as lower course completion rates, pressures to deliver the curriculum and dilemmatic decisions about course format. Furthermore, we also suggest pathways for stakeholders to develop strategies that consider contextual variables and contribute to meaningful learning. Based on the Portuguese context, several issues are discussed.

Integrate ecosystem services in socio-economic development to enhance achievement of sustainable development goals in the post-pandemic era

The COVID-19 pandemic has stalled and rolled back progress on Sustainable Development Goals (SDGs). Ecosystem services (ESs), defined as the contributions of ecosystems to human well-being, underpin the achievement of SDGs. To promote SDG achievement in post-pandemic era, we teased out the links between ESs and SDGs while examining the impact of COVID-19. We found that ESs benefited all SDGs, yet man-made pressures led to degradation of ecosystems and their services. There is broad consensus that the virus lurks in degraded ecosystems and generates spillover due to human interference. The pandemic and global lockdown/restriction disrupted the flow of ESs and altered human ESs demand, threatening the efforts for the SDGs. We suggested: 1) to study the association and traceability of ESs-SDGs under the pandemic;2) to prioritize pressing issues such as health care, livelihood, and resource security and in the long run, we should promote human-nature harmony to achieve the SDGs;and 3) to enhance ESs and to promote the SDGs through local community efforts, ESs accounting, and ecosystem restoration. This paper provides insights into the importance of ESs to the SDGs and helps to promote the SDG achievement by leveraging ESs’ contribution after the pandemic.

Spatial distribution characteristics of the COVID-19 pandemic in Beijing and its relationship with environmental factors.

Investigating the spatial distribution characteristics of the coronavirus disease 2019 (COVID-19) and exploring the influence of environmental factors that drive it is the basis for formulating rational and efficient prevention and control countermeasures. Therefore, this study aims to analyze the spatial distribution characteristics of COVID-19 pandemic in Beijing and its relationship with the environmental factors. Based on the incidences of new local COVID-19 cases in Beijing from June 11 to July 5, the spatial clustering characteristics of the COVID-19 pandemic in Beijing was investigated using spatial autocorrelation analysis. The relation between COVID-19 cases and environmental factors was assessed using the Spearman correlation analysis. Finally, geographically weighted regression (GWR) was applied to explore the influence of environmental factors on the spatial distribution of COVID-19 cases. The results showed that the development of COVID-19 pandemic in Beijing from June 11 to July 5 could be divided into two stages. The first stage was the outward expansion from June 11 to June 21, and the second stage (from June 22 to July 5) was the growth of the transmission in areas with existing previous cases. In addition, there was a ring of low value clusters around the Xinfadi market. This area was the key area for prevention and control. Population density and distance to Xinfadi market were the most critical factors that explained the pandemic development. The findings of this study can provide useful information for the global fighting against COVID-19.

Immunity and inflammatory biomarkers in COVID-19: A systematic review.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Patients can be asymptomatic or present respiratory and gastrointestinal symptoms, and even multiple-organ failure which can lead to death. The balance between an effective antiviral response and dysregulated immune response is the key factor determining the severity of COVID-19 progression. A systematic review was performed using the NCBI-PubMed database to find the articles related to COVID-19 immunity and inflammatory response published from 1 December 2019 to 15 April 2020. Haematological, immunological and biochemical parameters were extracted and correlated with disease severity, age and presence of comorbidities. Twelve articles were analysed comprising a total of 1042 hospitalized patients infected with SARS-CoV-2 and 95 different parameters. Total lymphocyte count and levels of CD3+ and CD4+ T cells were decreased in severe and critical cases. Neutrophilia was found in patients who progressed to acute respiratory distress syndrome (ARDS). Interleukin-six (IL-6) was high in mild and severe patients regardless of comorbidities. Erythrocyte sedimentation rate (ESR) and count and C-reactive protein (CRP) levels were increased regardless of disease severity or presence of comorbidities. High levels of D-dimer and lactate dehydrogenase were present in diabetic patients and patients who developed ARDS. Procalcitonin levels were elevated to varying degrees in severe and critical patients. We conclude that the total lymphocyte count, CD3+ and CD4+ T cells are low, especially in severe and critical COVID-19 patients; ESR, CRP and IL-6 were elevated, independent of the severity of disease. Understanding the inflammatory response of COVID-19 patients is essential for the development of better therapeutic and management strategies.

COVID 19-Depression and Neurosurgeons.

OBJECTIVE: The goal of this survey was to determine factors associated with anxiety/depression among neurosurgeons during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: An online survey was performed of neurosurgeons worldwide, conducted over 3 weeks. Depression in neurosurgeons was assessed by Self-Reporting Questionnaire-20. RESULTS: A total of 375 responses were received from 52 countries. Among all neurosurgeons, 34% felt tense, 32.5% were unhappy, 25% experienced insomnia, almost 20% had headaches, and 5% had suicidal ideation during the pandemic. Of participants, 14% had a score on Self-Reporting Questionnaire-20 consistent with depression. The likelihood of depression was significantly higher among those who did not receive guidance about self-protection from their institutions (odds ratio [OR], 2.47), those who did not feel safe with provided personal protective equipments (OR, 3.13), and those whose families considered their workplace unsafe (OR, 2.29). Depression was less likely in neurosurgeons who had minor concerns, compared with those with significant health concerns for their families (OR, 0.36). In multivariate analysis after controlling for effects of other covariates, odds of depression were significantly higher among neurosurgeons who did not feel safe with the provided personal protective equipment (OR, 2.43) and who were exposed to a COVID-19-positive colleague (OR, 2.54). Participants who had moderate concerns for their families had lesser odds of anxiety/depression than did those with significant concerns (OR, 0.28). CONCLUSIONS: Based on the modifiable risk factors of depression in this study, it is recommended that the safety of neurosurgeons be ensured by providing appropriate safety measures for them to regain their confidence and hence reduce the incidence of depression.