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This journal issue includes s of papers presented at the conference. Topics discussed are: sleeping characteristics among primary school children in Gampaha District, Sri Lanka;cosmetic effects of post thyroidectomy scar and evaluation of patient satisfaction;post-vaccination symptoms of COVID-19 vaccines among adults in Galle;multiple chest trauma in a victim of road traffic collision;anatomical variations of renal vein in a group of Sri Lankan cadavers;hospital acquired infections among patients in Intensive Care Units in Teaching Hospital, Karapitiya;serum Vitamin D level among 1 to 5-year-old children in Galle Municipality and Bope Poddala MOH area.
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We present results from a single case study based on semi-structured interviews with a student (a boy in school year 3) diagnosed with autism spectrum disorder and his school staff after participating in a short and small-scale intervention carried out in a socio-economically disadvantaged Swedish elementary school in 2019. The student participated in a seven week long intervention with a total of 12 philosophical dialogues (ranging from 45 to 60 minutes). Two facilitators, both with years of facilitation experience and teacher degree and at least BA in philosophy, facilitated the majority of the dialogues and mainly followed a "routine" procedure. The student was interviewed in direct connection to the end of the intervention about his experiences from the dialogues and his perceptions about whether and how the dialogues had influenced him. The student's two teachers, who had participated in the dialogues as participants, were interviewed as a pair, also in direct connection to the end of the intervention, while the school principal was interviewed two years after the study. These staff interviews concerned the staff's experiences of the influence of the dialogues on the students within the intervention as well as transfer effects to other contexts in school. The data from the study include detailed elaborations from a student perspective of different effects on the student's communicative and cognitive development, which are in several respects supported also by staff reports. The results show that the student was able, interested, and willing to participate in philosophical dialogues, and our data point to several positive outcomes for the student in the communicative and cognitive domains.
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This study explores what types of digital life scenarios children practiced while facing the challenges of epidemic isolation, in which distance learning and limited social contact depended largely on new digital platforms. The study of children's mediatised activities within epidemic isolation can be approached from the perspective of radical contextualism, which has been widely used since the ethnographic turn in audience research that began in the late 1980s. Following this conceptual framework, the aim of the study is to identify the predominant experiences of isolated everyday life in a case study of schoolchildren and uncover typical collective groupings among young people. Based on a follow the child perspective, an online survey was conducted at a selected primary school, targeting children from 6th to 9th grade, to capture children's perceptions of online education and distance learning, prevalent digital use and their personal digital positioning. In an analytical sense, the collected sample of 110 schoolchildren was categorised using a cluster analysis to identify the typical scenarios of digital culture and show the diversity of online practices that children experienced during the COVID-19 isolation, even in a relatively homogeneous group of schoolchildren. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Myopia is a prevalent yet confusingocular disorder. Myopia,formerlyconsidered abenignrefractivecondition, is nowassociatedwithanincreasedriskofdevelopingseveraloculardisorders,evenatmodestlevels.Myopiaisaglobalproblemthatexpe rts have documented. Despite the fact that the specific cause of myopia remains a mystery, it appears to be a combinationof genetic and environmental factors, making the prevention and treatment of the condition difficult and highly personalised.Myopia can have a positive impact on both the quality of life and the health of the eyes if it is prevented. Progressive additionlenses (PAL), topical atropine, ortho-k (orthokeratology) lenses and multifocal contact lenses are some of the most commoncontrol options currently available. Myopia has gained prominence in optometry studies as a result of its high prevalence. It ismore common for children to suffer from problems, such as extreme myopia and myopic macular degeneration, if they begindevelopingmyopiaatanearlyage.Thepurposeofthisstudywillbetoconductaninquiryintotheepidemiologyandriskfactorsfor myopiainschool-agedchildren(aged 6-19years)aroundtheworld.Copyright © 2022, Anka Publishers. All rights reserved.
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The results of a study of retrospective attitudes towards distance learning during the COVID-19 pandemic among secondary school students are presented (N=439, grades 5-8th). Motivational predictors of this relationship were analyzed, explaining the individual differences among schoolchildren in their preference for distance learning. With the help of structural equation modeling, it is shown that a negative attitude towards distance learning that took place in the recent past, compared to traditional learning, is associated with greater satisfaction of their basic needs for autonomy, competence and relatedness with teachers and classmates, and this relationship is mediated by intrinsic learning motivation, which, in turn, predicts attitudes towards forced distance learning, school satisfaction, and academic performance. It is shown that intrinsically motivated schoolchildren who are interested in the educational process, in general, have a negative attitude towards the forced distance learning that took place during COVID-19 pandemic and would not want it to return. © 2022 Moscow State University of Psychology and Education. All rights reserved.
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Purpose: Childhood obesity has become a social problem due to the social distancing necessitated by the coronavirus disease 2019 pandemic. This study aimed to identify the dietary problems of obese children through various dietary assessment methods and to confirm the usefulness of each method. Methods: The subjects were 88 students in the 4th to 6th grade of elementary school who participated in the nutrition camp organised by the Busan Metropolitan Office of Education, 2020. To evaluate dietary problems and assess diet quality, 24-hour meal records, monthly food intake frequency, and Dietary Screening Test (DST) data were analyzed. Results: Of the subjects, 15.7%, 30.3%, and 53.9% were normal weight, overweight, and obese, respectively. The average age was 11.77 +or- 0.77 years and the average body mass index was 23.96 +or- 3.01 kg/m2. It was observed from the 24-hour meal record method that the overweight and obese subject groups consumed fewer green vegetables (p < 0.001) and white vegetables (p < 0.01) than the normal weight group. In the monthly food intake frequency method, the consumption of ramen (p < 0.01), snacks (p < 0.05), and sausages (p < 0.05) were high in the obese group, and that of anchovies, broccoli, and sweet pumpkin was high in the normal group (p < 0.05). The comparative data from the DST revealed that the overweight and obese groups had less vegetable intake than the normal weight group (p < 0.01) and had higher intakes of dairy products, fast food, and sweet snacks (p < 0.05). Conclusion: The usefulness of each method in the dietary evaluation of obese children was confirmed. To address the problem of obesity, it is necessary to evaluate the dietary problem and approach it with a customized solution tailor-made for the individual subject.
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Objective: To understand the epidemiological and etiological characteristics of influenza in Mianyang City from 2019 to 2021, so as to provide a basis for the prevention and control of influenza. Methods: Influenza surveillance data in Mianyang City from 2019 to 2021 were collected and analyzed statistically. Results: A total of 55 970 cases of influenza were reported in Mianyang City from 2019 to 2021, with an average annual incidence of 388.08/100 000. A total of 103 723 cases of influenza-like illness cases (ILI) were reported, with an average annual ILI% of 3.58%. The incidence, ILI%, and positive detection rates of influenza were all far higher than those in the corresponding period in 2019. The classification of the population is mainly composed of students under the age of 15. The top three reported cases were Fucheng District (20 118, 35.94%), Youxian District (6 394, 11.42%) and Jiangyou District (5 800, 10.36%). 10 126 samples of ILI were received and detected, with a positive rate of 19.53%, the positive rate of ILI samples was mainly students under 15 years old. The dominant strains of influenza viruses showed an alternating trend over the years, and A (H3) was the predominant type in 2019. Except for 2 A (H9) strains detected in 2021, the rest were all BV strains. Due to the impact of COVID-19 in 2020, the positive detection rate was low throughout the year. 43 outbreaks of ILI were reported, which were mainly occurred in winter, and most of them were in primary schools. Conclusion: From 2019 to 2021, the characteristics of cases, ILI, pathogen surveillance and outbreak events of influenza in Mianyang City are basically the same, with students under 15 years of age and schools remaining the key population and sites of concern. the importance of non-pharmaceutical interventions for influenza prevention and control is further evidenced by the low incidence of influenza during the COVID-19 pandemic.
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Introduction: Intensive introduction of digital technologies and educational tools poses risks of visual impairment in children and adolescents as the most active users of the digital space. Objective: To assess risks of visual impairment in children and adolescents in the context of active dissemination of digital technologies in education and everyday life based on a literature review in order to choose directions for pediatric prevention of eye diseases. Materials and methods: We did a review of Russian and English language scientific literature published in 2007-2021, found on eLIBRARY.ru, PubMed, Web of Science, and Scopus information portals and platforms. We selected 48 articles containing an evidence-based assessment of risks of eye diseases related to e-learning and long screen time in children and adolescents, especially during the COVID-19 pandemic and associated lockdown. Results: We observed combined risks of visual impairment and musculoskeletal disorders due to violation of hygienic requirements for illumination, working posture, distance to the screen, and screen time when using various gadgets. Concom-itant risk factors for eye diseases related to vitamin D deficiency were evaluated. Conclusions: We identified groups at risk of visual impairment based on health indicators and the intensity of using the digital environment. We also specified basic methodological and regulatory documents, the compliance with which could reduce the risks of visual impairment in children, adolescents, and students, and proposed up-to-date directions of research on the topic of the review for maintenance of eye health. © 2022, Federal Center for Hygiene and Epidemiology. All rights reserved.
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Introduction: A high level of competition for the quality and quantity of acquired knowledge is observed in modern society. It entails an increase in time children spent studying in school and doing their homework, the latter being an integral and critical component of the educational process. Objective: To summarize and systematize the results of research on physiological, hygienic and pedagogical challenges of doing homework as well as on rationalization and optimization of this type of schoolchildren's activity in the digital educational environment aimed at preventing fatigue and school-related diseases, including in the historical perspective. Materials and methods: Appropriate publications in Russian and English languages were search for in the Russian Science Cita-tion Index, PubMed, and Scopus databases, print editions of scientific journals, and other sources. Forty-two full-text papers published in 1989–2021 were eligible for inclusion in the review. Results and discussion: The data analysis shows that contemporary schoolchildren spend significantly more time doing homework than is recommended, which disrupts their daily routine by reducing the duration of walks and night sleep and deteri-orates health. Distance learning during the COVID-19 pandemic only exacerbated the situation. A whole number of publications in pedagogy are devoted to didactic issues of homework while little attention is paid to health-related improvement of conditions and organization of this important type of educational activity. Conclusion: Global digitalization and the associated transformation of the education system necessitates hygienic optimization of all the components of the learning process, including homework, the content of which has undergone significant changes. © 2022, Federal Center for Hygiene and Epidemiology. All rights reserved.
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Resumen Antecedentes: la pandemia y el confinamiento por COVID-19 modificaron las condiciones de vida de los escolares y sus familias. Objetivo: describir la ejecución de una intervención educativa alimentaria en escolares de la Institución Educativa Monseñor Gerardo Valencia Cano, Medellín, Colombia, antes y durante el confinamiento por COVID-19. Materiales y métodos: investigación cualitativa con apoyo de variables cuantitativas. La recolección y análisis de datos se hicieron con base en la teoría fundamentada. La población estuvo conformada por escolares y padres de familia de la Institución Educativa Monseñor Gerardo Valencia Cano. Antes de la COVID-19 se realizaron cuatro grupos focales y una encuesta semiestructurada a 416 estudiantes y sus padres de familia, y con 42 docentes se realizaron cuatro grupos focales más; estos se realizaron hasta alcanzar la saturación. Durante el confinamiento se aplicaron 237 encuestas a familias (escolares y padres). Se evaluó el estado nutricional. Resultados: el 37 % de los escolares entre tercero y séptimo grado tenía exceso de peso. Se logró identificar de manera participativa los factores de riesgo y protectores frente al exceso de peso, para definir una intervención educativa alimentaria desde y con los sujetos. Los nodos conceptuales de la intervención fueron alimentación saludable, métodos de cocción, preparación de alimentos saludables y alimentación para la prevención del exceso de peso y cáncer de colon. Conclusiones: el reconocimiento de las condiciones alimentarias antes y después del confinamiento de los escolares y sus familias, o del cambio de estas a lo largo de la intervención educativa, contribuyó a lograr coherencia entre las necesidades, objetivos educativos y metodologías implementadas. El hecho de tener reunidos en un mismo espacio (hogar) a los escolares y sus padres durante el confinamiento propició un microentorno favorecedor de conductas que motivaron una mejora de los hábitos alimentarios familiares.
Abstract: Background: The pandemic and COVID-19 confinement changed the living conditions of schoolchildren and their families. Objective: To describe the implementation of an educational food intervention in schoolchildren at the Monseñor Gerardo Valencia Cano Educational Institution, Medellín, Colombia, before and during the COVID-19confinement. Materials and Methods: Qualitative research supported by quantitative variables. Data collection and analysis were based on grounded theory. The population consisted of schoolchildren and parents of the Monseñor Gerardo Valencia Cano Educational Institution. Before COVID-19, four focus groups and a semi-structured survey were conducted with 416 students and their parents, and four more focus groups were conducted with 42 teachers; these were carried out until saturation was reached. During the confinement, 237 surveys were administered to families (students and parents). Nutritional status was evaluated. Results: 37% of the students between third and seventh grade were overweight. It was possible to identify in a participatory way the risk and protective factors against excess weight, in order to define an educational food intervention from and with the subjects. The conceptual nodes of the intervention were healthy eating, cooking methods, preparation of healthy food, and food for the prevention of excess weight and colon cancer. Conclusions: The recognition of the nutritional conditions before and after the confinement of the schoolchildren and their families, or the change of these throughout the educational intervention, helped to achieve coherence between the needs, educational objectives, and methodologies implemented. The fact of having schoolchildren and their parents gathered in the same space (home) during confinement generated a microenvironment that favored behaviors that triggered an improvement in family eating habits.
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School-aged children, as a developmental stage, are a group at high risk for mental health issues, particularly during this pandemic of COVID-19. Children may be perpetrators, witnesses, or victims of violence or irregularities perpetrated directly or through social media. This community service activity is designed to improve the mental health of children during the COVID-19 pandemic through early detection, prevention and early treatment of mental health issues through parental and teacher empowerment programs. When children learn online and do more activities at home with their families, there are many factors that affect children's mental health. For instance, cyberbullying, addiction to gadgets and the Internet, withdrawing from family interactions, anxiety, dishonesty and discipline in the performance of duties and children as witnesses and victims of abuse by those closest to them. This is not widely known by the school, teachers, counsellors and parents clearly, which results in the state of the child getting worse. Through an empowerment program that was conducted with socialization and training on early detection, preventive efforts and early treatment of mental health problems among school-aged children, they can discover early deviations that occur and take preventive measures with early treatment efforts. Henceforth, through this empowerment program, teachers and parents work together to carry out counselling activities and reflection sessions to understand the issues faced by students so that they can intervene immediately. Teachers and parents can work as a team to help children improve physical and mental health through online learning during the COVID-19 pandemic.
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Background: Since the start of the global pandemic of coronavirus disease 2019 (COVID-19), not only adults but also many children have suffered from it. However, the clinical characteristics of long COVID in children remain unclear. Methods: In this retrospective observational study conducted in a single facility, we reviewed the medical records of all long COVID patients who visited Okayama University Hospital from February 2021 to October 2022, and we compared the clinical characteristics of long COVID in teenagers (11 to 18 years of age) with those in adults. Results: Data for 452 long COVID patients including 54 teenagers (11.9%) were analyzed. Fatigue was the most frequent symptom in teenagers (55.6% of the patients) and also in adults. On the other hand, the percentage of teenagers who complained of headache, which was the second most frequent complaint, was significantly higher than the percentage of adults (35.2% vs. 21.9%, p < 0.05). A comparison of the frequencies of symptoms depending on the viral variant showed that fatigue and headache were predominant symptoms in the Omicron variant phase. Of the 50 teenagers who were enrolled in schools, 28 (56.0%) could not attend school due to long COVID symptoms. The most common symptoms as reasons for absence from school were fatigue (85.7% of the patients), headache (42.9%), and insomnia (32.1%). Conclusions: Attention should be paid to the symptoms of fatigue and headache in teenagers with long COVID.
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COVID-19 , Post-Acute COVID-19 Syndrome , Adult , Child , Adolescent , Humans , East Asian People , SARS-CoV-2 , Fatigue , Headache , Observational Studies as TopicABSTRACT
The objective of this study was to evaluate whether exposure to information about physical activity and its barriers can increase the level of physical activity and reduce the time exposed to sedentary behaviors in high school students involved in integrated professional and technological education during the coronavirus disease 2019 pandemic. This quasi experimental study was conducted with integrated education high school students, divided into two groups: Intervention Group (IG; n = 59) and Control Group (CG; n = 54). Physical activity and sedentary behavior were identified and measured using the International Physical Activity Questionnaire pre-and post-intervention for both groups. IG students received educational material thrice a week for four weeks. The focus of the material was the importance of physical activity and need to reduce the time exposed to sedentary behavior. The results revealed that IG students showed an average daily reduction of 47.14 min in time exposed to sedentary behaviors, while the CG students showed an increase of 31.37 min. Despite this, the intervention was not effective in improving physical activity levels in the IG and the mean reduction in the time exposed to sedentary behavior was not significant (p = 0.556). The intervention was ineffective in increasing the practice of physical activity and reducing the time exposed to sedentary behavior.
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In 2020, a state of emergency (SOE) was enforced by the Japanese government, which included temporary school closures with the aim of overcoming COVID-19 spread, which prevented access to school lunches. We evaluated the relationship between meal quality and guardians' literacy of meal preparation for a nationally representative sample of 1107 Japanese schoolchildren (aged 10-14 years) before, during, and after the SOE on the basis of 7 questions scored using a 5-point Likert scale. The guardians' literacy of meal preparation for children was divided into quartiles, with Q1 and Q4 including participants with the lowest and highest scores on food literacy, respectively. School lunch menu was handed out monthly to each household by their classroom teacher. The consumption of (i) meat, fish, or eggs and (ii) vegetables at least twice a day indicated "well-balanced dietary intake", which was less frequent in all four quartiles, especially for Q1 and Q2, during compared to before the SOE. The relative risk increases (95% CI) were Q1: -40.6% (-41.4% to -39.8%; p < 0.001), Q2: -34.0% (-34.7% to -33.3%; p < 0.001), Q3: -13.1% (-13.8% to -12.4%; p < 0.001), and Q4: -15.3% (-16.0% to -14.7%; p < 0.001), adjusted for sex, age, BMI, equivalent income adjusted for the number of household members, and educational level of parents. The interaction p was <0.001 for Q1-3 vs. Q4. Guardians with low total scores were significantly more likely to have less time, mental capacity, and financial ability to prepare meals after the SOE. Therefore, schoolchildren's meal quality deteriorated during the SOE, particularly among those with guardians with low food literacy even after adjustment for household income level and guardians' educational level.
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Because of COVID-19, the indoor environmental quality (IEQ) in sports facilities has been a concern to environmental health practitioners. To develop an overall understanding of the available guidelines and standards and studies performed on IEQ in sports facilities, an extensive literature study was conducted, with the aim of identifying: (1) indicators that are being used to assess IEQ in different sports facilities;(2) indicators that are potentially interesting to be used to assess indoor air, in particular;(3) gaps in knowledge to determine whether sports facilities are safe, healthy and comfortable for people to stay and perform their activities. The outcome indicates that most current standards and previous investigations on IEQ in sports facilities mainly focused on dose-related indicators (such as ventilation rate), while building-related indicators (such as ventilation regime) and occupant-related indicators (such as IEQ preferences) were rarely considered. Little attention is given to the fact that ventilation systems may play an important role in the air quality of the location, and few investigations have been performed on the transmission of SARS-CoV-2. This study recommends more research into both occupant and building-related indicators as well as cross-modal effects between various IEQ factors for developing future standards on sports facilities.
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For schools and academic studies to continue, children as well must adhere to the measures taken to prevent the spread of Covid-19. The aim of this study was to develop a scale to assess schoolchildren's attitudes toward Covid-19 measures. The sample of this study, which was designed in a methodological type, consisted of 205 children. This study was conducted at primary schools in Zonguldak, Turkey. The validity of content and construct was examined to evaluate the validity of the Schoolchildren's Attitudes toward Covid-19 Measures Scale. This scale is a valid and reliable measure for assessing the attitudes of schoolchildren toward Covid-19 measures. The results of the factor analysis indicated a scale with 28 items and six factors. Cronbach's alpha value for the overall scale is 0.928. According to the results of the analysis, the developed scale was found to have excellent content and construct validity and reliability for schoolchildren.
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The COVID-19 pandemic is having an unprecedented impact on schools and schoolchildren across the globe. There is still a dearth of studies that investigate this recent phenomenon in a developing country context, and this is true of Pakistan. Much of the population in Pakistan resides in rural settings and a lack of technology and of online provision of teaching for more than one year must have had huge negative impacts on students' learning. The school dropout rate was already high in rural settings (Geven & Hasan, 2020) and, with school closures, this will likely have increased further, and cause some schoolchildren to lose interest in going back to school. However, no current data appear to exist to corroborate this. Due to the lack of available current quantitative and qualitative data, this study seeks to explore the impact of COVID-19 on schoolchildren's education in Pakistan by examining recently published related studies. This study employs a literature review technique that gathers data to ascertain the potential overall impact on schoolchildren during the pandemic. The findings reveal that there remains a lack of detailed studies on this important topic and that urgent attention is needed from researchers to assess the scale of the impact. In addition, the review found that many children from rural communities had little to no school engagement due to technology poverty and their families being unable to support home-schooling, either due to family and/or work constraints or a lack of prior education and/or skills. Themes that emerged were that families, especially mothers, struggled to balance both caring and home-schooling duties, pupils from private schools had a better experience than those from public school backgrounds, and many of these reported that online provisions helped students develop new skills. This study may help to improve the understanding of the impact on the lost learning of schoolchildren during the pandemic by guiding practitioners as well as policymakers. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Children and youth of school age form a special population group highly sensitive to various stressors and negative effects in everyday life. The COVID-19 pandemic crisis characterized by uncertainty, vulnerability, changes in quality of life together with urgent transition to distant/online learning affected significantly psychological well-being of children and youth. The aim of this study was to assess the cross-cultural differences in actual stress in Russian and Kyrgyz schoolchildren with high and low levels of anxiety and depression during the initial stage of the COVID-19 pandemic and after a year life during the pandemic. The descriptive cross-sectional study was conducted via an online survey completed by total 1834 schoolchildren aged from 13 to 18 from Russia and Kyrgyzstan, the periods of survey: 10th May-10th June, 2020;18th May-15th June, 2021. The Perceived Stress Scale and Hospital Anxiety and Depression Scale were used to assess stress, anxiety and depression scores. The findings suggest that there are cross-cultural differences in perceived stress amongst schoolchildren with high level of depression and anxiety: Russian respondents in 2021 demonstrated less pronounced index of the perceived stress than Kyrgyz schoolchildren. The stress level of Kyrgyz schoolchildren increased significantly in 2021 in comparison to the period of outbreak of the pandemic. In 2021 in both countries we found the same pattern: girls had significantly more pronounced stress than boys. The results disclose important aspects of the impact of COVID-19 on schoolchildren and demonstrate the emerging need of psychological aid and for supporting schoolchildren mental health. © 2022 by the authors.
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Lockdown due to the COVID-19 pandemic has negatively impacted the social, psychological, and physical well-being of the world population. In the case of people with intellectual disabilities, the impact of lockdown on their physical condition and functionality is not completely clear. This study aimed to determine the effects of COVID-19 lockdown on the anthropometric indicators of cardiometabolic risk, muscle strength, and functionality on schoolchildren with intellectual disabilities. The sample was composed of 132 students of both sexes (n = 74 pre-lockdown; n = 58 lockdown) belonging to two special education centers from the Metropolitan Region of Santiago, Chile. Our results showed significant reductions (p ≤ 0.05) in absolute and relative handgrip strength, as well as in functionality, when comparing pre-lockdown and lockdown measurements, with a greater loss in girls than boys. The design and implementation of physical exercise programs centered on strength training are necessary for the physical and functional reconditioning of this population. These programs need to be implemented in special education centers considering the general well-being, quality of life and work needs of people with intellectual disabilities.
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Lost learning during a pandemic causes students' learning outcomes to drop. An alternative solution to the child's learning problem is learning with modules. Learning modules suitable for elementary school students need to be developed. Therefore, the study aimed to: (1) Discover the condition of elementary school students learning during the pandemic period;(2) Investigate the importance of independent learning;(3) Examine the use of modules as a supporting tool;(4) Delivering module illustration that can be developed for students. Furthermore, this study used a qualitative method with a phenomenology approach, and elementary school students, parents, and teachers serve as informants. The data were collected by interview and document, using the citation technique known as snowball citation, while the data was analyzed using data triangulation. The following conclusions were drawn: (1) Students felt uncomfortable learning during the pandemic;(2) Independent learning was important for elementary school students;(3) All parents agreed that the module could facilitate independent learning during the pandemic period;(4) The module illustration developed for elementary school students was completed by examples or real-life application. In cooperation with relevant individuals, the learner can make the decisions necessary to meet their learning needs and comprises internal and external components. Reflective skills are a combination of the learner's cognitive, metacognitive, and affective abilities, which we will refer to as their "internal components." The learner's "external environment" refers to the learning facility, time available, and peer and facilitator interaction. It contained learning material, objectives, question model, and evaluation and was understandable, attractive, and pleasing to learn. Also, this was completed by video link, adapted to the learning needs, and contained character development.