In 2019, WHO prioritized updating recommendations relating to three labour induction topics: labour induction at or beyond term, mechanical methods for labour induction, and outpatient labour induction. As part of this process, we aimed to review the evidence addressing factors beyond clinical effectiveness  to inform WHO Guideline Development Group decision-making using the WHO-INTEGRATE evidence-to-decision framework, and to reflect on how methods for identifying, synthesizing and integrating this evidence could be improved.We adapted the framework to consider the key criteria and sub-criteria relevant to our intervention. We searched for qualitative and other evidence across a variety of sources and mapped the eligible evidence to country income setting and perspective. Eligibility assessment and quality appraisal of qualitative evidence syntheses was undertaken using a two-step process informed by the ENTREQ statement. We adopted an iterative approach to interpret the evidence and provided both summary and detailed findings to the decision-makers. We also undertook a review to reflect on opportunities to improve the process of applying the framework and identifying the evidence.Using the WHO-INTEGRATE framework allowed us to explore health rights and equity in a systematic and transparent way. We identified a lack of qualitative and other evidence from low- and middle-income settings and in populations that are most impacted by structural inequities or traditionally excluded from research. Our process review highlighted opportunities for future improvement, including adopting more systematic evidence mapping methods and working with social science researchers to strengthen theoretical understanding, methods and interpretation of the evidence.Using the WHO-INTEGRATE evidence-to-decision framework to inform decision-making in a global guideline for induction of labour, we identified both challenges and opportunities relating to the lack of evidence in populations and settings of need and interest; the theoretical approach informing the development and application of WHO-INTEGRATE; and interpretation of the evidence. We hope these insights will be useful for primary researchers as well as the evidence synthesis and health decision-making communities, and ultimately contribute to a reduction in health inequities.The online version contains supplementary material available at 10.1186/s12961-022-00901-7. Induction of labour at or beyond term (developed 2011 and updated 2018 ),Mechanical methods for induction of labour (developed 2011), andOutpatient induction of labour (developed 2011).Induction of labour is an intervention undertaken in a healthcare setting that aims to “induce cervical ripening and/or to induce uterine contractions” , p. 6. PThe updates of these recommendations were published in October 2022, together with the evidence-to-decision frameworks –12.As part of the United Nations Development Programme (UNDP)/UN Population Fund (UNFPA)/UN Children’s Fund (UNICEF)/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction guideline development process , evidencFor this update, we decided to use the WHO-INTEGRATE (INTEGRATe Evidence) framework for our work, as it enabled both a pragmatic approach given time and resource constraints, while ensuring the application of rigorous and comprehensive methods grounded in theory, and WHO norms and values. WHO-INTEGRATE also has a strong emphasis on and guidance around assessing equity and human  rights, which is critical for global recommendations with a primary intended audience of health decision-makers and clinicians in low- and middle-income settings . WHO-INTIn this paper, we describe the methods used to apply WHO-INTEGRATE and present summary results of the evidence review for each of the EtD criteria for the three induction of labour topics. Detailed results of the evidence review are reported in section 1 of Additional file Cochrane’s Pregnancy and Childbirth Group reviewed the effectiveness evidence for the WHO GDG and prepared GRADE-based summary of findings tables and narrative summaries based on recent Cochrane review updates for each of the topics , 17, 18.We prepared a protocol for search, selection and assessment of evidence relevant to WHO-INTEGRATE criteria. Depending on the nature of the intervention under review, WHO-INTEGRATE authors suggest that criteria, sub-criteria and framing questions may be excluded from the assessment framework. The consideration of societal implications is of particular importance and relevance to complex interventions with several active components targeting a range of levels at a population or system level, multiple health and non-health outcomes, and long, complex causal pathways . InductiWe were aware that the GDG were not familiar with WHO-INTEGRATE as an EtD framework. To enable consistency of presentation and ease of understanding, we presented the results of the WHO-INTEGRATE assessment within the GRADE EtD heading structure. We provided a summary-level EtD document and a full report of the detailed findings for each EtD criteria ahead of the GDG meetings. We presented summarized versions of our findings for each criteria in slides during the GDG meeting for discussion. Mapping of the WHO-INTEGRATE and GRADE framework criteria and questions is documented in section 7 of Additional file We searched PubMed on 12 July 2021 and Epistemonikos on 13 July 2021 for systematic reviews and qualitative evidence syntheses (QES) of induction of labour published since 2018  of the included studies. Primary studies that were not included in the selected QES, but included in other high-quality QES, were then screened for additional relevant findings and to address gaps in the evidence in relation to country income setting or participant perspective .Eligible primary cost-effectiveness studies were identified from a WHO living scoping review of cost-effectiveness evidence for maternal and perinatal health interventions . Review,Model-based studies were not included in our analysis due to challenges in determining their risk of bias and transferability . DetaileTo identify additional evidence and framing information for the criteria of equity, sociocultural acceptability (human rights) and feasibility, we screened the reference lists of the 2011 WHO recommendations for induction of labour  and the The process of preparing the EtD sections was undertaken in a series of stages: data extraction, thematic coding and analysis. At each stage, the work was initially undertaken by a single researcher, discussed with and reviewed by a second researcher, and additional input gathered from a third researcher as needed. See section 6 of Additional file As part of standard project close-out processes at Cochrane Australia, we reflected on the methods, processes and outputs domains of our work. We considered three open questions for each of these three domains: What worked well? What would we do differently next time? What have we learned for future work? These reflections were discussed within the team, and a summary of the key findings are presented in Table Melissa Murano has a social sciences and public health background, and has contributed to research to increase the uptake and implementation of evidence-informed policy and practice in low-income settings. Tari Turner is a mixed-methods researcher who has worked in high-, middle- and low-income settings, with a focus on systematic reviews of effectiveness evidence, and uptake and implementation of evidence-informed policy and practice. Both Melissa and Tari are white Australians living and working in a high-income setting. Throughout the evidence review, we reflected on our own social identities, views, values and beliefs and how these could influence our selection and interpretation of findings to minimize the possibility of bias. We are still learning how to do this well, and are aware that in many areas we may be blind to our privilege and biases.The results of the evidence review were presented to and discussed with the WHO GDG, which has global/regional representation and includes people with a wide range of backgrounds, expertise views, and perspectives.Table Overall, our review was unable to identify qualitative evidence from geographical settings and populations most impacted by structural inequities and most often excluded from research. The included qualitative research from high-income settings did not explore the intersection of social categories and their impact on values and acceptability, rights and equity. The qualitative evidence relating to the period of care (intrapartum) supports the findings from other research in relation women’s experiences and human rights . We did A 2019 QES of women’s experiences of induction of labour (Coates 2019)  was seleTable Using WHO-INTEGRATE and providing both high-level and detailed evidence review findings to the GDG centred women’s voices and allowed us to explore health rights and inequity in a detailed, systematic and transparent way within the constraints of time and resources. This facilitated more meaningful consideration of the interplay of women’s experiences, values and preferences, and socio-structural impacts on feasibility, rights and equity.WHO-INTEGRATE assists in the detailed consideration of these issues by clearly identifying the important criteria and sub-criteria to evaluate sociocultural acceptability, rights and equity, and providing framing questions to guide the selection and assessment of a variety of evidence sources. This detailed approach is particularly valuable in helping researchers who do not have social sciences expertise to identify and reflect more deeply on the upstream structural issues that are the root causes of social and economic determinants of health . RetainiAdequately assessing rights and equity is challenging. Equity and rights are often poorly dealt with in EtDs for guidelines, resulting in a narrow or limited approach that does not consider these critical issues through the entire EtD process , 64. ThiThere may be opportunity for the WHO-INTEGRATE developers to incorporate a more matrix-like, intersectional approach to assist EtD developers in considering multiple forms of power, privilege, inequality and identity simultaneously, rather than adopting a single-issue, additive or sequential approach . This woOther users of WHO-INTEGRATE have also noted the overlapping and intersecting nature of the criteria, whereby values, acceptability, rights, equity, resources and feasibility must be considered in an iterative manner . AdditioThe use of additional frameworks developed specifically for the healthcare period  or procOur review identified a lack of qualitative and other evidence from low- and middle-income settings and in populations that are most impacted by structural inequities and/or traditionally excluded from research. The qualitative research undertaken in high-income settings either explicitly excluded women from diverse populations on the basis of language who may have different experiences, values and expectations of accessing maternal healthcare, or did not identify, report or explore the intersection of social categories and their impact on values and acceptability, rights and equity.The lack of primary qualitative research undertaken in settings and populations of highest need is a common challenge faced by those synthesizing evidence for healthcare decision-making . The quaOur experience highlighted an important role for evidence gap maps –71 in maIn the absence of qualitative evidence from low- and middle-income settings, it is even more important to maximize the usefulness of the quantitative evidence for evaluation of impacts on equity. This can be done by undertaking subgroup analyses considering relative and absolute effects based on key indicators, such as those proposed by PROGRESS-Plus, if the primary studies present disaggregated data . At a miIn summary, we identified significant gaps in the qualitative and other evidence for assessing values, acceptability, rights, equity, resource requirements and feasibility in populations and settings of need and interest. In spite of this lack of direct evidence, WHO-INTEGRATE enabled us to consider questions of acceptability, rights and equity in a systematic and transparent way. However, we also found that the linear application of discrete criteria limited our ability to consider the interaction of key EtD domains and the resulting impact on rights and equity.There are a few limitations on this work, largely arising from limited time and resources. For example, searches for QES were only undertaken in two databases; we did not systematically search for additional relevant primary qualitative studies published after the selected QES search date; and duplicate review was not used for some elements of the process. Having a team member with health economics expertise would also have strengthened our ability to integrate this evidence. However, we believe that the methods used are robust, reflecting the practical nature of the undertaking and potentially increasing generalizability to similar real-world activities. A number of issues were identified that require addressing, or would have strengthened our work: the generation of primary qualitative evidence in settings and populations that are of high need and/or overlooked; incorporating an integrative intersectional approach into the theoretical underpinnings and application of WHO-INTEGRATE; the benefit of interdisciplinary collaboration with social scientists to adequately address rights and equity; and a need to continue addressing barriers to participation so that researchers from low- and middle-income countries can lead this important work. In addressing these needs, evaluation of non-effectiveness evidence for health policy decision-making can advocate for change by highlighting structures that uphold both privilege and discrimination, and draw attention to forms of evidence and experiences from individuals, communities and populations who are often excluded from the decision-making process.Using the WHO-INTEGRATE EtD framework, we undertook an evidence review of key criteria to inform health policy decision-making in a global guideline for induction of labour. During a reflective process, we identified both challenges and opportunities relating to the lack of evidence in populations and settings of need and interest, the theoretical approach informing the development and application of WHO-INTEGRATE, and interpretation of the evidence. We hope these insights will be useful for individual researchers as well as the evidence generation and health policy decision-making communities, and ultimately contribute to a reduction in health inequities.Additional file 1. Supplementary methods and data for “Using the WHO-INTEGRATE evidence-to-decision framework in the development of induction of labour recommendations”. Detailed evidence review findings, 2. Search strategies, 3. Qualitative evidence eligibility and quality assessment, 4. Qualitative evidence selection, 5. Cost and cost-effectiveness evidence, 6. EtD framework mapping, 7. Characteristics of included qualitative studies, 8. Participant characteristics in included qualitative studies, 9. References.Additional file 2. Economic data extraction “Using the WHO-INTEGRATE evidence-to-decision framework in the development of induction of labour recommendations”. 1. Economic study design and characteristics, 2. Treatment and cost data.


In the era of the digital economy, farmers’ digital literacy has a profound impact on household green cooking energy consumption. Based on data from the China Family Panel Studies (CFPS) in 2018, this paper constructs a digital literacy index using an entropy method and employs the Probit model regression and mediation effect model test to study the impact effect and theoretical mechanism of individual digital literacy on household green cooking energy consumption. The research results show that the improvement of digital literacy can effectively promote the consumption of green cooking energy in households. After using the IV-Probit model and CMP model to solve the endogeneity, this conclusion remains valid; The heterogeneity analysis shows that the impact of digital literacy on green cooking energy consumption of households in different regions and different income stages is different. This performance is specific to the eastern and western regions and low-income households. The improvement in digital literacy can significantly promote green cooking energy consumption in rural households; however, in the central region and high-income households the improvements were insignificant. Mechanism analysis shows that digital literacy has a significant positive impact on household green cooking energy consumption through non-agricultural employment and information acquisition. Based on this, it is suggested that the construction of a digital countryside should not only consider the construction of digital infrastructure, but also reasonably guide the cultivation of the internal digital literacy of the construction subject. Moreover, the cultivation of digital literacy should not only focus on regional differences, but also focus on key subjects and implement precise cultivation. We should give full play to the synergistic effect of digital literacy, and pay attention to the non-agricultural employment of farmers and information elements. The International Energy Agency pointed out in “Energy Balances of OECD Countries” that household energy consumption has been increasing in recent years and has become the main source of global energy demand and carbon emission growth . MeanwhiThe influencing factors of farmers’ green energy consumption mainly focus on education, gender, age, income, etc. In terms of farmers’ education level, Sun et al.  pointed At the same time, the Opinions of the CPC Central Committee and the State Council on Promoting the Key Work of Rural Revitalization in an All-Round Way in 2022 pointed out for the first time that efforts should be made to promote the construction of digital villages and to strengthen the training of farmers’ digital literacy and skills. The Action Plan for Digital Village Development 2022–2025) also proposes to strengthen the combination of digital construction and green village building. Therefore, under the background of digital construction rising to the national top-level design, the rapid development of digital information technology will have a far-reaching impact on the decision-making of individual farmers. Digital literacy, as the basic literacy for farmers to effectively use digital tools, access digital resources, and promote information sharing . It is d also proAlthough some studies have discussed the impact of the application of digital technology on farmers’ green energy consumption , furtherBased on the above analysis, this paper uses data from the China Family Panel Studies (CFPS) in 2018 as a sample. Through the construction of farmers’ digital literacy indicators, this work analyzes whether digital literacy affects farmers’ household green cooking energy consumption from a multi-dimensional perspective, explores its internal mechanism to observe whether the further development of digital literacy can change China’s rural energy consumption structure and provide a new opportunity for the construction of a beautiful countryside, improvement of the rural living environment and the realization of rural revitalization. The structure of this paper is as follows: With the rapid development of the digital internet, the digital literacy of individual farmers is an important factor that affects family decision-making. In theory, digital literacy, as human capital in the digital era, is mainly embodied in the use, processing, and creation of new value of digital technology, which in turn can influence individual decision-making by changing the relative income and cost of farmers’ participation in various economic activities . As “tecFirst, digital literacy improves farmers’ awareness and use of digital technology, which can influence farmers’ household green cooking energy consumption by promoting non-agricultural employment. Previous studies have shown that non-agricultural employment can promote the transformation of household energy into green sustainable energy . SpecifiFurthermore, digital literacy, as a kind of digital ability, can improve an individual’s ability to obtain information and reduce information asymmetry, thus affecting the household’s green cooking energy consumption. The enhancement of digital literacy can effectively improve farmers’ environmental behavior attitude and health risk awareness. This may be achieved through the use of digital tools such as mobile phones and computers that can enable farmers to more intuitively recognize damage to the ecological environment caused by the use of traditional energy such as straw burning. Digital methods such as browsing pictures, watching videos, and exposure to related publicity concerning the impact of traditional energy use on the agricultural ecological environment system , strengtTo sum up, this paper puts forward the following three hypotheses:Hypothesis 1.The improvement of farmers’ digital literacy will promote household green cooking energy consumption.Hypothesis 2.Farmers’ digital literacy promotes household green cooking energy consumption by promoting non-agricultural employment.Hypothesis 3.Farmers’ digital literacy promotes household green cooking energy consumption by broadening access to information.The research data used in this paper are from China Family Panel Studies (CFPS) in 2018. CFPS is implemented by the China Social Sciences Research Center (ISS) of Peking University. It aims to track and collect data on individual, family, and community levels to reflect the changes in China’s society, economy, population, education, and health. The sample includes 25 provinces  in China excluding Hong Kong, Macao, and Taiwan Province, as well as Xinjiang Uygur Autonomous Region, Tibet Autonomous Region, Qinghai Province, Inner Mongolia Autonomous Region, Ningxia Hui Autonomous Region, and Hainan Province. It is comprehensive and representative. To effectively reveal the impact of digital literacy on the green cooking energy of farmers’ households, 4100 data files were finally obtained after merging and filtering the individual, family, and community data. The specific screening process is as follows: firstly, as the research group is the group that can have certain decision-making power over the household cooking energy consumption, the head of the household sample is used when selecting the sample, and the age is controlled to be between 16 and 65 years old; secondly, after removing the urban residents, the missing values and abnormal values in the core variable cooking fuel are removed. Finally, the values of the remaining control variables are further cleaned.The explained variable is green cooking energy. Drawing on the research of He et al.  and Liu The explanatory variable is digital literacy. Based on the above analysis, this paper adopts the definition of digital literacy given by Eshet-Alkalai  and the First, to eliminate the differences caused by different dimensions of the original data, the range standardization method is used to process the original data, and since all indicators are positive indicators, the following algorithm is selected for data standardization:Second, the weights of each indicator are calculated as follows, by standardizing the value Third, the entropy value Then, calculate the information entropy redundancy Further, the weight Finally, the comprehensive digital literacy score To better demonstrate the relationship between digital literacy and farmer household green cooking energy consumption, we draw on previous relevant research and start from individual characteristics, family characteristics, and village characteristics to prevent the regression bias of digital literacy on household green cooking energy consumption caused by missing variables. The level of individual characteristics includes factors such as the age of the household head, the square of age, gender, education level, and health status. The level of family characteristics includes per capita household income, family size, total family assets, and family favor expenditures. The village level selects Village terrain. The definitions, assignments, and descriptive statistics of specific variables are shown in t-test. The specific results are shown in Assessing the average difference between green cooking energy and non-green cooking energy is helpful to further analyze the impact of farmers’ digital literacy on farmers’ household green cooking energy. In this paper, the mean values of green cooking energy and non-green cooking energy are analyzed via In this study, “green cooking energy” belongs to a binary variable. According to the structural characteristics of this data, this paper uses the binary Probit model to study the impact of digital literacy on the consumption of green cooking energy in rural households. The specific model is as follows:In the formula, In Among the control variables, the age of the head of household bears a significant positive impact on the green cooking energy consumption of the households. However, the age square is significantly negative at the level of 10%, indicating that the impact of age on the green cooking energy consumption of the households is inverted “U” type, i.e., with the increase in age, the households gradually change preference from green cooking energy to non-green cooking energy, which is consistent with the research conclusion of Twumasi et al.  in the cAlthough the stepwise regression method is adopted in the benchmark regression, endogenous problems still remain a possibility due to other missing variables and reverse causality, which may lead to erroneous regression results. On the one hand, the adoption of green cooking energy by households may be affected by other factors, such as consumer preferences, cultural practices, government policies, and other unobservable variables; on the other hand, whether the households use green cooking energy has a potential impact on the individual digital literacy of the households, e.g., the household members who use green energy have higher education level and income conditions, and these households have complete conditions to support the improvement of individual digital literacy. To avoid the endogeneity problem as much as possible, this paper employs the existing research methods ,45 for rIn the benchmark regression, the measurement of farmers’ digital literacy is measured by the unified entropy method. However, this measurement method does not take into account the development of digital infrastructure between different provinces and the status of individual human capital. Thus, it is likely to produce measurement errors of digital literacy, which will lead to errors in the regression results. Therefore, this paper uses the replacement variable method and the replacement regression model to test the robustness. This paper adopts the research method of Asfaw et al.  for refeThe above article verified the promotion of digital literacy on green cooking energy consumption of farmers’ households, and then the heterogeneity analysis was carried out according to the regional development level and income level. The selection of regional development level as the dividing standard is due to: the unbalanced development between regions since the reform and opening up, advanced development in the eastern region and backward development in the western region , large dThis paper draws on existing research  to dividTo verify whether digital literacy can increase the consumption of green cooking energy by affecting farmers’ non-farm employment, this paper will consider the impact of digital literacy on non-farm employment and non-farm employment stability. The stability of non-agricultural employment refers to the practice of the existing research work  and takeIn CFPS2018, there are some questions about the importance of TV, Internet, newspapers, periodicals, and radio as information acquisition channels for the interviewed farmers . This paper draws on the research practice of Zhang , and aftThis paper uses theoretical and empirical analyses to verify the positive impact of digital literacy on the green cooking energy of farmers’ households. The findings presented herein are similar to those of He et al.  and LangThis paper uses a sample of farmers from the CFPS2018 database to systematically explore the impact of digital literacy on the green cooking energy consumption of farmers’ households through the Probit model, and uses the mediating effect model to identify the impact mechanism of non-agricultural employment and information acquisition. The main research conclusions are as follows: (1) Improvements in digital literacy can effectively promote the consumption of green cooking energy in households. This conclusion remains valid after using the IV-Probit model and CMP model to solve the endogeneity; (2) The robustness test is conducted from three aspects: replacing the core explanatory variables, and changing the regression model and the explained variables. The results still show that digital literacy can significantly promote the household consumption of green cooking energy; (3) Heterogeneity analysis shows that the impact of digital literacy on the green cooking energy consumption of households varies among different regions and income levels, specifically in the eastern and western regions and low-income households. Improvements in digital literacy can significantly promote the green cooking energy consumption of households; however, among central region residents and high-income households the results were insignificant; (4) Mechanism analysis shows that digital literacy indirectly affects household green cooking energy consumption through its impact on non-agricultural employment and information access, revealing that the income effect and reductions in information asymmetry are conducive to promoting the transformation and upgrading of household cooking energy source.(1)The construction of a digital countryside should not only consider the construction of digital infrastructure but also reasonably guide the cultivation of the internal digital literacy of the construction subject. First, it is necessary to support the construction of rural digital literacy education systems, enrich the supply of high-quality digital resources, explore the lifelong path of digital learning, strengthen farmers’ use of digital tools and digital software, consistently improve farmers’ digital literacy level, narrow the digital divide between urban and rural areas, and enhance farmers’ ability to occupy digital welfare; Second, it is necessary to improve farmers’ digital living standards, satisfy farmers’ sense of self-efficacy in digital technology, give full play to farmers’ initiative, actively participate in digital life, enhance their willingness to use digital tools, and jointly create a harmonious digital living atmosphere; Lastly, we should promote the further development of farmers’ digital skills, build a modern agricultural service system and a diversified training system, improve farmers’ ability to use digital “new farm tools”, and introduce social capital and non-profit organizations to participate in the improvement of farmers’ digital skills, so as to promote the extension of digital services and training to rural areas.(2)The cultivation of digital literacy should focus on both regional differences and key subjects, and implement accurate cultivation. Firstly, regional differences lead to heterogeneity in the improvement of individual digital literacy. Compared with the eastern and western regions, the central region should focus on giving play to the tangible hand of government policy regulation. In the construction of the “East-to-West Computing” project, it should actively undertake the transfer of relevant digital industries and part of the “computing power” role, cultivate the digital ecology in the central region from the top-level design and market, strengthen the cultivation of individual digital literacy, and at the same time play the spillover effect of digital agriculture to reverse promote improvements in individual digital literacy of farmers. Secondly, it is necessary to reasonably guide the digital training of different income groups. Compared with high-income groups, improvements in digital literacy can achieve a higher marginal effect. On the one hand, it is necessary to pay more attention to the digital cultivation of low-income groups, on the other hand, it is also necessary to strengthen the “digital–ecological” cultivation of high-income groups, and to guide and construct sustainable consumption concepts.(3)Give full play to the synergistic effect of digital literacy, and pay attention to farmers’ non-agricultural employment and information elements. Firstly, it is necessary to strengthen the orientation training of digital skills, meet the needs of the market, increase the opportunities for farmers to obtain non-agricultural employment, and prevent the decoupling of “demand and supply”. At the same time, it is necessary to increase support for new digital occupations, improve relevant policies and regulations, and provide policy support for farmers to develop diversified occupations. Secondly, it is necessary to broaden the information elements and build a diversified information circulation and access mechanism. Moreover, it is necessary to strengthen the construction of information security to reduce the additional losses of individual farmers caused by false information and to provide a security mechanism for farmers to enjoy digital welfare.Based on the above conclusions, digital literacy can effectively promote the transformation and upgrading of household cooking energy consumption. This presents an important consideration of digital rural construction and the main dilemma of building a beautiful countryside to realize rural revitalization. To better play the positive role of digital literacy in promoting the ecological priority of low-carbon life’s development path, this paper proposes the following policy implications:


With Facebook’s name changing to Meta, the metaverse concept has become popular again. There are many indications that the current fashionableness of the metaverse is not driven by technical factors, rather related to the public hype. To clarify the reasons for the increasing popularity of the concept, this study develops a model based on embodied social presence theory. We surveyed 292 metaverse users, and analyzed the obtained data using partial least squares structural equation modeling (PLS-SEM). The results show that the main technical factors influencing the metaverse popularity do not significantly predict users’ embodied presence and embodied co-presence, while users’ imagination positively predicts their embodied presence in the metaverse and positively influences users’ willingness to continuously participate through the multiple mediating effects of embodied presence and co-presence. The results of this study confirm, to some extent, that user imagination triggered by public opinion drives the popularity of the metaverse. With the rapid development of virtual reality (VR) and augmented reality (AR) technologies in the past decade, people’s desire to live, learn and work in virtual worlds has grown . When FaThe metaverse is not a new concept, as it appeared in Neal Stephenson’s science fiction novel <<snow crash> > in 1992. The metaverse allows people to live and work in an immersive three-dimensional virtual world through virtual characters . Users cThe metaverse provides an immersive experience based on mixed reality (MR) technology, generates a mirror image of the real world based on digital twin technology . and buiResearch on the metaverse started before 2006, but the subsequent development was not satisfactory. In particular, attempts to integrate business into the metaverse failed . One of Therefore, is the current repopularization of the metaverse driven by current technological breakthroughs? The rapid development of deep learning technologies has significantly improved the accuracy of visual and speech recognition, providing a more immersive environment. The use of new end-to-end solutions reduces system processing time and complexity . With thRQ1: How do technological factors influence users’ continuous participation and dominate this repopularization of the metaverse?Since the current impact of technological advances on user participation in the metaverse is controversial, do social factors then exist that influence the repopularization of the metaverse? Recent studies have investigated social factors that influence the repopularization of the metaverse. There are signs that the involvement of major technology companies, especially Facebook’s proposed metaverse transformation, has driven the public opinion  and led In summary, the dominant factors of the current metaverse repopularization are not sufficiently clear. First, there are studies with opposing views on the impact of current technology on user engagement . Second,RQ2: Is the popularity of the metaverse driven by technological or psychological factors?Embodied presence comprises technical preparation, content variables, and user variables . TechnicWhen a user who generates a sense of embodied presence feels his or her presence in the virtual world by receiving messages  from other avatars, the user enters a state of embodied co-presence. After generating a sense of embodied presence and co-presence, he or she feel a social presence in the virtual world through interaction and co-participation, thus generating a sense of themselves and others. In addition, under the influence of embodied presence, users develop physiological and psychological effects such as collaborative participation, establishing quasi-social relationships, and enjoying virtual social life .The ESP theory provides a framework within which user interactions in virtual worlds can be studied. This theory analyzes behavior in virtual worlds from a human psychological perspective, clarifying the different stages of social presence in virtual worlds. Consequently, it has been widely applied in the study of virtual worlds , 2018. AIn other words, the technological capabilities of the metaverse determines the quality of interaction between a person and his avatar, which leads to the mental or behavioral aspects of the avatar in the metaverse, such as trust, sharing, and understanding. The psychological state and behavior of avatars will, in turn, facilitate communication and interaction, continuously improving the virtual environment of the metaverse and eventually producing various results. The framework suggests that metaverse technologies must have the ability to communicate, render, interact, and provide teamwork tools that can influence the representation of people and their incarnations in the metaverse, such as presence and immersion . This inThe Interaction is often associated with the design of computer-based products and systems. It is an issue that describes the usability of a computer product and is actively related to the way people interact with the system. The quality of interaction determines when and how users connect with a computer , and is Interaction and co-presence are also related. Co-presence can be measured by user engagement with the environment . When inIn a metaverse environment, the better the quality of interaction provided by the metaverse technology, the more realistic the user will be able to interact with the avatars instantly and with the metaverse environment; and the higher the quality of interaction, the more the user will be able to interact with other people’s avatars in multiple ways. Therefore, this study proposes the following hypotheses:H1a: The quality of interaction provided by the metaverse technology has a positive impact on the user’s embodied presence.H1b: The quality of the interaction provided by the metaverse technology has a positive impact on the user’s’ sense of embodied co-presence.The rendering technology involves creating lifelike images on a screen; thus, it requires personalization and vividness . PersonaH2a: The rendering quality of metaverse technologies has a positive impact on the user’s embodied presence.H2b: The rendering quality of metaverse technologies has a positive impact on the user’s sense of embodied co-presence.Communication is the basis for interaction and collaboration, and its quality can be enhanced by improving openness, efficiency, and effectiveness . Davis eH3a: The quality of communication of metaverse technologies has a positive impact on the users’ embodied presence.H3b: The quality of communication of metaverse technologies has a positive impact on the users’ sense of embodied co-presence.Mass media are adept at compensating for the lack of reality by channeling users’ fantasies . In partH4a: In the metaverse, the user’s imagination has a positive effect on his or her embodied presence.H4b: In the metaverse, the user’s imagination has a positive effect on his or her sense of embodied presence.The ESP theory states that users experience the metaverse using avatars to participate in shared activities and gain a sense of embodied presence . In otheH5: In the metaverse, the user’s embodied presence has a positive effect on his or her embodied co-presence.H6a: In the metaverse, the user’s embodied presence has a positive impact on his or her continuous engagement intention.H6b: In the metaverse, the embodied co-presence of the user has a positive impact on his or her continuous engagement intention.We designed a questionnaire suitable for this study based on the scales proposed by existing studies. The questionnaire used a 5-point Likert scale. Experts in the field revised it. The final version of the questionnaire is shown in Data from the Baidu Indexp < 0.05) and multivariate kurtosis , indicating multivariate non-normality  and variance-based structural equation models (VB-SEM). In this study, we used variance-based partial least squares structural equation modeling (PLS-SEM) with the corresponding software package SmartPls 3.0 for data analysis. The main reasons for this were as follows: (1) PLS-SEM is more suitable for measuring complex models than CB-SEM, especially those with more than six variables , and thiormality ; (3) PLSormality . In concThe questionnaire was sent to the participants through Amazon Simple Notification Service (SNS), and 456 answers were collected. After removing invalid answers from respondents who did not know the metaverse, did not use metaverse applications, and those who repeated their answers, 292 valid answers were obtained (64%). Among them, 156 (53.4%) were male and 136 (46.6%) were female; 137 (46.9%) aged between 20 and 29 years, 78 (26.7%) aged between 30 and 39 years; and 98 (33.6%) had a specialist degree, 94 (32.2%) had a bachelor’s degree. The majority of respondents earned RMB 0–1999, with 88 (30.1%) having an income ranging between RMB 4,000 and 5,999, followed by 76 (26.1%). In terms of metaverse applications, 122 people used “Creator City” (41.8%), 61 people used “Zepeto” (20.9%), 52 people used “Roblox “(17.8%), and 57 people used other applications (19.5%).To avoid nonresponse bias, we performed a paired t-test on the demographic data of the first and last 20 people who answered the questionnaire. The results showed no significant difference; therefore, nonresponse was not a serious problem in this study.In this study, two methods were used to measure common method bias. (1) Harman’s single-factor analysis , was conFirst, we assessed the reliability validity of the model. As shown in p < 0.001), thus confirming H4a. However, we found no significant positive effect of imagination on embodied co-presence, thus refuting H4b. Embodied presence had a significant positive effect on embodied copresence , thus confirming H5. Embodied presence had no significant positive effect on continuous engagement intention, thus refuting H6a. Embodied co-presence had a significant positive effect on continuous engagement intention ; thus confirming H6b  of the model, although according to the properties of PLS-SEM, PLS-SEM itself does not need and does not have a reliable way to accurately measure the fit of the model. However, earlier studies noted that a global criterion of goodness-of-fit (GoF) can be proposed as the geometric mean of the average communality and average REM model . A goodnEM model . The GOFEM model , with thEM model . The SRMEM model . Combinip < 0.001). There was a significant mediating effect of embodied co-presence on the relationship between embodied presence and continuous engagement intention . We also found a multiple mediator in the model, that is, imagination had a significant effect on continuous engagement intention after the mediation of embodied presence in embodied co-presence.Based on the measurement results of the structural model, to determine how the user variables in this study affect sustained engagement, we analyzed the mediating role in the model using SmartPls. The mediating effects are shown in The primary purpose of this study is to clarify whether the current repopularization of the metaverse is driven by technical or user psychological factors. The findings confirm that technical factors  do not significantly predict the users’ embodied presence and co-presence in the metaverse, nor do they predict the users’ continuous engagement intentions through the mediating effect of embodied presence and co-presence, that means that the current re-popularization of the metaverse is not dominated by technology factors. This may be due to the fact that the metaverse is still in the stage of technological development and perfection, and the current technical factors of the various metaverse apps do not predict the continuous engagement of users with the metaverse. The current technology in the metaverse is not yet able to maximize user satisfaction, such as the low quality of metaverse images and interaction makes it difficult for users to gain a sense of presence in the metaverse .The results of this study confirm that the users’ imagination can significantly and positively influence their embodied presence in the metaverse, but not their embodied co-presence. In addition, the users’ imagination can positively influence their intention of continuous engagement through the serial mediation effects of embodied presence and co-presence. This suggests that imagination is currently an important factor that drive the use of the metaverse applications, and that imagination of a better future for the metaverse increases the users’ sense of embodied presence. Further, under the effect of embodied presence, the users establish a sense of embodied co-presence with others and eventually continue to engage in the metaverse, thus validating the ESP theory .The results of this study have some theoretical contributions. First, this study provides the first empirical analysis to test the embodied presence theory in the context of metaverse applications. This study verifies that user psychological variables have a positive effect on Embodied Social Presence Theory but do not directly affect embodied co-presence. Additionally, this study confirms that imagination can be a psychological variable within the Embodied Social Presence Theory framework, which enriches the ESP theory.Second, this study verifies that embodied co-presence can trigger the users’ intention to engage in the metaverse. Moreover, it finds that embodied co-presence cannot trigger the users’ intention to engage, which broadens the Embodied Social Presence Theory and enriches the metaverse research literature.Thirdly, this study verifies that embodied presence can be used as a mediating variable for user psychology and continuous use intention, providing a favorable theoretical basis for explaining users’ usage behavior in virtual reality.Finally, this study shows empirically that technical factors in embodied presence theory do not affect users’ intention to continuously participate in the metaverse, questioning the current development of the metaverse from the perspective of technical factors and enriching the research related to the metaverse field.The results of this study have some practical implications. First, artificial intelligence techniques in metaverse applications should be improved. Artificial intelligence can improve the interaction ability of non-player characters (NPCs) in the metaverse. For example, NPCs in the metaverse can become autonomous through machine learning, thus enhancing the social authenticity of interactions in the metaverse and allowing users to gain a sense of embodied presence and co-existence by being more immersed in the metaverse.Second, the quality of 3D modeling of the rendering technology can be improved. To make the metaverse a realistic immersive platform, the virtual environment needs to be constructed as consistent as possible with the real world. Companies that want to participate in metaverse development can build metaverse environments using 3D modeling tools, such as infrared depth scanning devices, to transpose real-world objects with fidelity into the metaverse. In addition, the development of metaverse environments needs to rely on the user generated content (UGC). Therefore, we should encourage the majority of users to participate in the 3D modeling of the metaverse. For example, individual users can use an iPhone LiDAR sensor to transfer elements from the real world into the metaverse in real time to enhance their sense of authenticity.Third, the quality of the communication technologies can be improved. For the ubiquitous accessibility required by the metaverse, the users need highly synchronous and low-latency wireless communication technologies, which can allow users to have a perfect and smooth experience in real time and achieve a seamless link between the real and virtual worlds. It is recommended to enhance the rollout of 5G base stations and improve global 5G network coverage, thus promoting metaverse operational capability.Finally, the development of any new industry to a certain stage may produce a certain bubble, such as the “economic bubble,” “real estate bubble,” and “the Internet bubble.” In social development, these bubbles can have drastic impacts due to unrealistic expectations; thus, we should help people understand the metaverse objectively, to prevent the adverse effects of excessive speculations.This study has the following limitations. First, the generalizability of the results is limited because this study was conducted with Chinese users and the sample size is not large enough to be representative. There are significant differences between Western and Chinese cultural contexts, etc., and such differences can affect users’ psychological and behavioral responses. Therefore, by testing our model in different cultural contexts using samples from other environments, other interesting findings may be observed.Second, many applications claiming to be metaverse are more similar to “sandbox” games; thus, the results of this study need further validation. In particular, a full involvement with metaverse technologies by the users is not verified in this study. Therefore, further research is necessary with the gradual development of metaverse technologies.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.GZ and JC: conceptualization. GZ: methodology and writing—original draft preparation. JC: software and project administration. GZ and JQ: formal analysis. GZ, DL, and JC: writing—review and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In this study, we conducted a qualitative and quantitative analysis of anthocyanins, proanthocyanidins, flavonols and triterpenoids in samples of introduced and bred large cranberry fruits from the collection of the National Botanic Garden of Latvia. The highest total anthocyanin levels (8638–9316 µg/g) were detected in the fruit samples of the cranberry cultivars ‘Black Veil’, ‘Franclin’ and ‘Early Black’. The highest total proanthocyanidin levels (2775–3389 µg/g) were found in cranberries of cultivars ‘Kalnciema Agrā’, ‘Kalnciema Tumšā’, ‘Searles’, ‘Howes’, and ‘Kalnciema Ražīgā’. The highest levels of flavonol compounds (1373–1402 µg/g) were detected in cranberries of cultivars ‘Howes’, ‘Black Veil’ and ‘Salaspils Melnās’. The highest levels of triterpenoids (5292–5792 µg/g) were determined in cranberries of cultivars ‘Kalnciema Agrā’, ‘Septembra’, ‘Džbrūklene’ and ‘Early Black’. The results of our study allow for the estimation of differences in the content of secondary metabolites in the fruit samples of the studied cranberry cultivars and for the selection of promising cultivars for further introduction and cultivation in the climatic conditions of the Baltic countries. These results are also important for the selection of the most promising cranberry cultivars for the preparation of cranberry raw material, and the high-quality composition of plant material ensures the effectiveness of cranberry supplements and other cranberry preparations. Vaccinium macrocarpon Aiton) is a perennial evergreen plant that grows naturally in North America [Large cranberry  is the predominant species in the natural cenopopulations of raised bogs and intermediate bogs [Under the climatic conditions of the Baltic region, the small cranberry , ‘Kalnciema Tumšā’ (1998), ‘Kalnciema Ražīgā’ (1998) and ‘Septembra’ (1998), as well as cranberry–lingonberry hybrid cultivars ‘Tīna’ (2006), ‘Dižbrūklene’ (1997), ‘Salaspils Agrās’ (1996) and ‘Salaspils Melnās’ (1996). He has also prepared recommendations for their cultivation in the climatic conditions in Latvia.In Latvia, important breeding and introduction studies on cranberries have been carried out at the National Botanic Garden of Latvia in Salaspils. The first The production of cranberry fruit preparations in Latvia has been increasing over the last 20 years ,8. IndusThe content of bioactive compounds in cranberries is determined by climatic factors  and the genetic characteristics of the plant . StudiesCranberries and their processed products are used in the confectionery industry  and in the production of wine and juice ,15. CranThe purpose of this study was to estimate the qualitative and quantitative compositions of triterpenoids, proanthocyanidins, flavonols and anthocyanins in fruit samples of large cranberry cultivars grown in the collection of the National Botanic Garden of Latvia. The conducted study can provide new information on the variability in the phytochemical composition of cranberries and is significant for the identification of the most promising cranberry cultivars for growing in the climatic conditions of Latvia and other countries of the Baltic region. The climatic conditions in these countries are similar, and therefore, the results of our research are relevant for scientists in these countries conducting research on breeding and introducing cranberry cultivars .In cranberry breeding and introduction, the bright red color of cranberry fruit is one of the important criteria for cultivar selection ,11. The We analyzed the compositions of anthocyanins and anthocyanidins in cranberries of the cultivars ‘Beckwith’, ‘Ben Lear’, ‘Black Veil’, ‘Crowley’, ‘Franclin’, ‘Kalnciema Agrā’, ‘Kalnciema Tumšā’, ‘Pilgrim’, ‘Salaspils Agrās’, ‘Salaspils Melnās’, ‘Searles’, ‘Septembra’, ‘Tīna’, ‘Dižbrūklene’, ‘Early Black’, ‘Howes’, ‘Kalnciema Ražīgā’ and ‘Washington’ . Four prViskelis et al. conducted a study on the cranberry cultivars “Stevens”, “Pilgrim”, “Ben Lear” and “Black Veil” grown under Lithuanian climatic conditions and found that four major anthocyanins were predominant, and their quantitative compositions are consistent with the results of our study . ČesonieThe total amounts of anthocyanins and anthocyanidins in the analyzed cranberries varied from 3788.33 ± 78 µg/g to 9316.32 ± 154 µg/g. The highest total anthocyanin content (9316.32 ± 154 µg/g) was determined in the cranberry cultivar ‘Franclin’ . The lowBrown et al. carried out a quantitative analysis of anthocyanin content in fruit samples of cultivars ‘Stevens’, ‘Pilgrims’, ‘GH 1’, ‘Bergman’ and ‘Ben Lear’. The total anthocyanin content varied from 2810 µg/g to 7980 µg/g . GardanaGardana et al. established that the levels of anthocyanins in the fruit samples of the ‘Howes’ cultivar were 5070 µg/g, which was higher than the amount (4683 µg/g) found in the fruit samples of this cultivar in our study. Gardana et al. found a cumulative variation in anthocyanin content from 2650 µg/g to 4140 µg/g in cranberries of the ‘Ben Lear’ cultivar. The total anthocyanidin content found by the researchers was lower than our finding of 4766 µg/g in the fruit samples of this cultivar .Urbstaite et al. investigated samples of cranberry cultivars grown under Lithuanian climatic conditions and established that the total anthocyanin and anthocyanidin levels varied from 1950 µg/g to 8130 µg/g in the samples of the studied cultivars . SamplesThe comparative analysis of the anthocyanins content in the fruit of large cranberry cultivars introduced and bred in the collection of the National Botanic Garden of Latvia was carried out by applying hierarchical cluster analysis. The cluster analysis of the fruit samples of the cultivars was carried out by analyzing the results of the qualitative and quantitative analysis of anthocyanins and anthocyanidins. Based on the quantitative composition of anthocyanins in cranberry fruit samples, the samples were divided into three clusters .The cranberries of the cultivars ‘Beckwith’, ‘Howes’, ‘Kalnciema Agrā’, ‘Ben Lear’, ‘Kalnciema Ražīgā’, ‘Kalnciema Tumšā’, ‘Pilgrim’, ‘Salaspils Agrās’, ‘Salaspils Melnās’, ‘Searles’, ‘Tīna’ and ‘Washington’ were attributed to cluster I because their total anthocyanin content was lower than the average total anthocyanin content of the tested cultivars, ranging from 3788 µg/g to 6284 µg/g. The cultivars ‘Tīna’, ‘Salaspils Melnās’, ‘Salaspils Agrās’ and ‘Kalnciema Tumšā’, developed by Latvian scientists, were attributed to the subgroup of cluster I, as they had a similar anthocyanin composition. The cranberry cultivars ‘Tīna’, ‘Salaspils Melnās’ and ‘Salaspils Agrās’ are hybrids of lingonberry and cranberry. The predominant anthocyanins found in lingonberry fruit samples were cyanidin-3-galactoside (58%), cyanidin3-arabinoside (35%) and cyanidin-3-glucoside (7%) . HoweverCluster II consisted of the large cranberry cultivars ‘Black Veil’, ‘Franclin’ and ‘Early Black’, with anthocyanin levels ranging from 8638 µg/g to 9316 µg/g . The totCluster III included fruit samples of the cultivars ‘Septembra’, ‘Dižbrūklene’ and ‘Crowley’, where the total anthocyanin content was found to be 1.2 times higher than the average anthocyanin content of all the tested cultivars, ranging from 6465 µg/g to 7719 µg/g. Tikuma et al. found that ‘Septembra’, a cultivar developed in Latvia, has large, intensely red berries, and that the anthocyanin content of the fruit samples of this cultivar is higher than the anthocyanin content of the fruit samples of the cultivars ‘Stevens’, ‘Bergman’ and ‘Pilgrim’, and lower than the anthocyanin content of the fruit samples of the ‘Early Black’ cultivar . UrbstaiThe highest levels of anthocyanins were found in cranberry cultivars assigned to clusters II and III. The cultivation of ‘Black Veil’, ‘Franclin’, ‘Early Black’, ‘Septembra’, ‘Dižbrūklene’ and ‘Crowley’ cultivars, which were assigned to these clusters, is promising, as the plants accumulate higher amounts of anthocyanins in their fruit. The cultivation of these cranberry cultivars is relevant for the preparation of plant material with a high anthocyanin content. Anthocyanins determine the red color of the fruit, and the fruit of these cultivars may therefore have applications in the confectionery and bakery industry as a natural coloring agent . AnthocyProanthocyanidins are an important group of biologically active compounds with antibacterial  and antiUsing spectrophotometry, we determined that the total proanthocyanidin content in cranberries of cultivars grown in the collection of the National Botanic Garden of Latvia ranged from 1727.40 ± 45 µg EE/g to 3386.94 ± 41 µg EE/g . The meaThe quantitative comparative analysis of the proanthocyanidin compositions of the fruit samples of cranberry cultivars grown in the National Botanic Garden of Latvia was carried out using hierarchical cluster analysis. The studied cranberry samples were divided into three groups .The proanthocyanidin content of the fruit samples of cluster I cranberry cultivars ‘Washington’, ‘Septembra’, ‘Salaspils Agrās’, ‘Salaspils Melnās’, ‘Pilgrim’, ‘Early Black’, ‘Black Veil’ and ‘Beckwith’ was close to the average of the total proanthocyanidin content of all the tested cultivars. Cluster II consisted of the cranberry cultivars ‘Tīna’, ‘Franclin’, ‘Beech’, ‘Crowley’ and ‘Ben Lear’, in which the total proanthocyanidin content in the fruit samples was lower than the average total proanthocyanidin content of the samples of the tested cultivars.The total proanthocyanidin content of the samples of the cranberry cultivars ‘Kalnciema Agrā’, ‘Kalnciema Tumšā’, ‘Searles’, ‘Howes’ and ‘Kalnciema Ražīgā’ assigned to cluster III was higher than the average proanthocyanidin content of the tested cultivars. The cranberry cultivars ‘Kalnciema Agrā’, ‘Kalnciema Tumšā’ and ‘Kalnciema Ražīgā’ developed in Latvia in 1998 were included in the cluster due to their high total proanthocyanidin content, which was not statistically significantly different from the average proanthocyanidin content of the tested cultivars. The high proanthocyanidin content found in the fruit samples of these cranberry cultivars bred in Latvia could be due to genetic factors. Vorsa et al. pointed out that the total proanthocyanidin content of cranberry fruit samples is influenced by environmental and genetic factors . GeneticCarpenter et al. carried out proanthocyanidin assays on fruit samples of the US-grown cranberry cultivars ‘Ben Lear’, ‘Bugle’, ‘Early Black’, ‘Howes’ and ‘Mullica Queen’. The authors indicated that the proanthocyanidin content of the fruit samples of these cultivars follows a decreasing trend, as follows: ‘Howes’ > ‘Mullica Queen’ and ‘Early Black’ > ‘Bugle’ > ‘Ben Lear’ . The proVaccinium macrocarpon cultivars grown in New Zealand and found that fruit samples of the cranberry cultivars ‘Crowley’ and ‘Howes’ have the highest levels of proanthocyanidins, suggesting that they are potential food resources for health use [Lu et al. performed a quantitative analysis of proanthocyanidins in 21 fruit samples of alth use . In our alth use .Cranberry fruit plant material is used in juice as well as in tablet and capsule formulations for the treatment and prevention of urinary tract infections, with proanthocyanidins mediating this effect . StudiesStudies on the biological effects of flavonols detected in cranberry fruit samples have shown their anticancer ,42, antiWe performed an analysis of the composition of flavonol compounds in cranberry fruit samples . We idenWang et al. investigated the qualitative composition of flavonols in the fruit of the cranberry cultivars ‘Crimson Queen’, ‘Stevens’, ‘Ben Lear’, ‘Howes’, ‘Early Black’, ‘Demoranville’ and ‘Mullica Queen’ and found that myricetin-3-galactoside comprises 19–32%, quercetin-3-galactoside comprises 31–46%, quercetin-3-rhamnopyranoside comprises 7–14% and quercetin-3-arabinofuranoside comprises 7–17% of the total flavonol content . These rWe found that the flavonol content in cranberries varied from 705.15 ± 14.5 µg/g to 1401.79 ± 27 µg/g. The average total flavonol content of cranberry fruit samples was 1100.94 ± 26 µg/g. The highest total flavonol content (1401.79 ± 27 µg/g) was determined in cranberries of the ‘Black Veil’ cultivar, which was not statistically different from that found in the fruit samples of the cranberry cultivars ‘Howes’, ‘Kalnciema Tumšā’ and ‘Salaspils Melnās’ . The lowGudžinskaitė et al. investigated the fruit samples of cranberry cultivars grown in a Lithuanian climate and established that the total flavonol content varied from 149.59 mg/g to 370.38 mg/g . OszmiańThe comparative analysis of the flavonol content of different large cranberry cultivars was conducted by applying hierarchical cluster analysis. The cluster analysis of the cultivar samples was carried out by investigating the results of studies on the qualitative and quantitative composition of flavonols in the fruit samples of different cultivars. Based on the quantitative compositions of flavonols in the cranberry fruit samples, the samples were divided into three clusters .Cluster I consisted of fruit samples of the ‘Early Black’, ‘Franclin’, ‘Kalnciema Agrā’, ‘Kalnciema Ražīgā’, ‘Kalnciema Tumšā’, ‘Pilgrim’, ‘Salaspils Melnās’, ‘Septembra’ and ‘Washington’ cultivars, in which quercetin-3-galactoside was found to account for 32.18% ± 3.38% of the total flavonol content, and myricetin-3-galactoside was found to account for 22.72% ± 2.22% of the total flavonol content. The average total flavonol content of cluster I cranberry fruit samples was 1149 ± 26 µg/g.Cluster II included the cranberry cultivars ‘Searles’, ‘Howes’, ‘Black Veil’ and ‘Beckwith’. Cluster II cranberry fruit samples were found to contain 1.5 times higher amounts of myricetin-3-galactoside than the average total myricetin-3-galactoside content of the tested cultivars, whereas the total flavonol content was higher by 1.2 times. In the samples of the cultivars belonging to the cluster, the quercetin-3-galactoside content was found to account for 31.50% ± 2.23% of the total amount of flavonols, and the myricetin-3-galactoside content was found to account for 27.67% ± 3.06% of the total amount of flavonols. Urbstaite et al. and Gudžinskaitė et al. performed comparative studies on the flavonol content of different cultivars and found that cranberries of the ‘Searles’ cultivar have the highest total flavonol content ,46.Cluster III included the cultivars ‘Ben Lear’, ‘Crowley’, ‘Salaspils Agrās’, ‘Tīna’ and ‘Dižbrūklene’, in which the total flavonol levels were 1.3 times lower than the average total flavonol levels of the tested cultivars. In the fruit samples of cluster III cultivars, quercetin-3-galactoside accounted for 29.87% ± 1.50% of the total flavonol content, and myricetin-3-galactoside accounted for 20.19% ± 2.60% of the total flavonol content.Differences in the qualitative and quantitative compositions of phenolic compounds in the fruit samples of different cranberry cultivars may be influenced by genetic factors due to differences in the synthesis of secondary metabolites . MyricetTriterpenoids are a group of biologically active compounds. Triterpene compounds have been demonstrated to have antioxidant , anti-inOur study showed that ursolic acid accounted for 70.79% to 79.20% of the total triterpenoid content in the fruit samples of the tested cranberry cultivars. Klavins et al. and Oszmiański et al. confirmed that ursolic acid is the predominant triterpene compound in cranberries ,57.The other compounds of the terpenoid group accounted for 20.80% to 29.21% of the total triterpenoid content. Of these, oleanolic acid accounted for 16.46% to 20.84%, corosolic acid accounted for 1.40% to 6.67%, maslinic acid accounted for 0.36% to 1.93%, α-amyrin accounted for 1.01% to 3.00%, and β-amyrin accounted for up to 1.93%. Šedbarė et al. studied samples of cranberry cultivars grown under Latvian climate and established that ursolic acid accounts for 68.31 ± 0.95%, oleanolic acid accounts for 15.75 ± 0.95%, corosolic acid accounts for 1.21 ± 0.37%, maslinic acid accounts for 0.17 ± 0.13%, and α-amyrin accounts for 0.52 ± 0.30% of the total triterpenoid content . The resThe study of the triterpenoid composition showed that the total triterpenoid content of the cranberry fruits varied from 4468.77 ± 50 µg/g to 5791.49 ± 192 µg/g . The aveSedbare et al. found that the total triterpenoid content of cranberry fruit samples varies from 4215.78 ± 45 to 6232.74 ± 123 µg/g . The triThe comparative analysis of the quantitative composition of triterpenoids in cranberry cultivars was carried out by applying hierarchical cluster analysis, based on the quantitative composition of triterpenoids found in the fruit samples of different cultivars. The cranberry fruit samples were divided into three clusters based on their triterpenoid compositions .Cluster I included the fruit samples of the cranberry cultivars ‘Searles’, ‘Howes’, ‘Franclin’, ‘Crowley’, ‘Black Veil’ and ‘Beckwith’, which were found to have lower levels of triterpenoids than the average total amount of triterpenoids in fruit samples of the tested cultivars. Cluster I included samples with low levels of maslinic acid and β-amyrin .Cluster II included the fruit samples of the cranberry cultivars ‘Ben Lear’, ‘Tīna’, ‘Salaspils Agrās’, ‘Salaspils Melnās’, ‘Pilgrim’, ‘Kalnciema Tumšā’, ‘Kalnciema Ražīgā’ and ‘Washington’, in which the total triterpenoid content was found to correspond to the total average triterpenoid content in the fruit samples of the tested cultivars.Cluster III included the fruit samples of the cranberry cultivars ‘Kalnciema Agrā’, ‘Septembra’, ‘Dižbrūklene’ and ‘Early Black’, in which the total triterpenoid content was higher than the average total triterpenoid content in the fruit samples of the tested cultivars. The chemical compositions of the triterpenoids in the fruit samples of cluster III cranberry cultivars ‘Septembra’ and ‘Early Black’ were characterized by the highest levels of maslinic acid and corosolic acid .Qualitative and quantitative analysis of the triterpenoid compositions of cranberry fruit samples showed that ursolic acid, together with oleanolic acid, comprised 94% of the total triterpenoid content. Ursolic and oleanolic acids detected in cranberries have antioxidant , anti-inv/v) was purchased from AB Stumbras , formic acid was bought from Merck , and Trolox  was purchased from Scharlau . Reference standards for myricetin-3-galactoside, cyanidin chloride, peonidin chloride, malvidin-3-galactoside, malvidin-3-arabinoside, malvidin chloride, peonidin-3-arabinoside, cyaniding-3-galactoside, delphinidin-3-galactoside, peonidin-3-glucoside, peonidin-3-galactoside, cyaniding-3-glucoside and cyaniding-3-arabinoside were purchased from Extrasynthese . Standards for quercetin and quercetin-3-galactoside were purchased from Carl Roth . The standard for quercetin-3-O-glucoside was bought from Biochemistry . Purified deionized water was provided using a water purification system .All solvents, reagents, and standards were of analytical reagent grade. Acetone, methanol, acetonitrile, hydrochloric acid, 4-(Dimethylamino) cinnamaldehyde and reference standarts for β-Amyrin, maslinic acid, oleanolic acid, corosolic acid, ursolic acid, α-Amyrin, quercetin-3-rhamnoside, myricetin, quercetin-3-α-L-arabinopyranoside and quercetin-3-α-L-arabinofuranoside were purchased from Sigma-Aldrich . Ethanol 96% (Vaccinium macrocarpon Aiton) grown in the climatic conditions of Latvia, in the collection of the National Botanic Garden  (56°51′55.4″ N 24°21′36.9″ E). The climate in Latvia is temperate and transitional from maritime to continental [The object of the research was samples of different cultivars of large cranberries  ethanol containing 1% hydrochloric acid in an ultrasonic bath  for 15 min at 80 kHz and 565 W at room temperature. Each lyophilized cranberry sample was extracted three times. The extracts were filtered into a 20 mL volumetric flask.Extraction procedures of anthocyanins, proanthocyanidins and flavonols from cranberry fruit samples were performed using the methodologies described by Urbstaite et al. . During (v/v) acetone in an ultrasonic bath  for 60 min from 22 ± 1 °C to 60 ± 1 °C at 1130 W and 80 kHz. Each lyophilized cranberry sample was extracted three times. The extracts were filtered into a 10 mL volumetric flask.Extraction procedures of triterpenoids from cranberry fruit samples were performed using the methodologies described by Sedbare et al. . During The produced extracts were stored in dark glass containers at −20 °C. Extracts of cranberry samples were filtered through membrane filters  prior to chromatographic analysis.v/v) solvents were used for an autosampler needle-washing step.The qualitative and quantitative compositions of anthocyanins, phenolic compounds and triterpenoids in cranberry fruit were determined using an Ultra-High-Performance Liquid Chromatography system  with a photodiode array detector . Compounds were separated using an ACE C18 reverse phase  column . During analysis, 20% acetonitrile (2) of all the identified compounds used in the chromatography methods is described in the The amounts of identified compounds were estimated from the calibration curves and expressed as µg/g dry weight. Information about the parameters  (solvent A) and aqueous 10% formic acid solution (v/v) (solvent B), as follows: 0.0–2.0 min, 5% B; 2.0–7.0 min, 9% B; 7.0–9.0 min, 12% B; 9.0–10.0 min, 25% B; 10.0–10.5 min, 80% B; 10.5–11.0 min, 80% B; and 11.0–12.0 min, 5% B. The column temperature was maintained at 30 °C. All the identified anthocyanins and anthocyanidins were quantified at a wavelength of 520 nm. Chromatograms of cranberry fruit samples and the standards mixture are provided in the The content of anthocyanins and anthocyanidins in cranberry fruit samples was determined according to the methodology validated by Vilkickyte et al. . The volv/v) (solvent A) and aqueous 0.1% formic acid solution (v/v) (solvent B), as follows: 0 min, 5% B; 1 min, 12% B; 3 min, 12% B; 4 min, 13% B; 9 min, 25% B; 10.5 min, 30% B; 12 min, 30% B; 12.5 min, 90% B; 13 min, 90% B; 13.5 min, 5% B; and 14.5 min, 5% B, delaying the next injection by 2 min. The column temperature was maintained at 30 °C. All the identified flavonols were quantified at a wavelength of 360 nm. Chromatograms of cranberry fruit samples and the standards mixture are provided in the The content of flavonols in cranberry fruit samples was determined according to the methodology developed and validated by Urbstaite et al. . The volv/v) (solvent A) and 100% methanol (v/v) (solvent B), as follows: 0 min, 92% B; 8 min, 97% B; 9 min, 98% B; 29.5 min, 98% B; and 30 min, 92% B, delaying the subsequent injection by 10 min. The column temperature was maintained at 25 °C. All the identified triterpenoids were quantified at a wavelength of 205 nm. Chromatograms of cranberry fruit samples and the standards mixture are provided in the The content of triterpenoids in the cranberry fruit samples was determined according to the methodology developed and validated by Sedbare et al. . The volm/v) in ethanol-hydrochloric acid: 9:1 (v/v)), and the absorbance of this solution was measured at 640 nm after 5 min on a spectrophotometer . The DMCA solution in acidified ethanol served as the reference solution. The total proanthocyanidin content was estimated from the (–)-epicatechin (0.0625–1 mg/mL) calibration curve  and expressed as µg/g (–)-epicatechin equivalent (EE) dry weight.The total proanthocyanidin content was estimated using the DMCA (4-(Dimethylamino)cinnamaldehyde) method . An amoup < 0.05.Data analysis was performed using the computer software programs Microsoft Excel 2016  and SPSS Statistics 21 . During the study, each cranberry extract was evaluated using one-time chromatographic and spectrophotometric tests. The averages and standard deviations (SD) of the independent evaluations of three technical replicates were calculated. The Kruskal–Wallis A-way ANOVA test for multiple comparisons was used to evaluate differences in the amounts of identified compounds between fruit samples of cranberry cultivars. Hierarchical cluster analysis, applying the complete-linkage clustering method with Euclidean distances, was performed to determine the groupings of cranberries. The level of significance was chosen as A comparative analysis of the qualitative and quantitative compositions of anthocyanins, proanthocyanidins, flavonols and triterpenoids in the fruit samples of cranberry cultivars showed that the phytochemical compositions of the fruit samples of the studied cultivars varied and that different cultivars were able to accumulate different amounts of biologically active compounds in their fruit. This study did not evaluate the influence of environmental factors and fruit development on the amount of biologically active compounds in cranberry fruit samples. However, a detailed investigation of the phytochemical composition of introduced and bred large cranberry fruits from the collection of the National Botanic Garden of Latvia was carried out for the first time. The results of our research show that the chemical compositions of cranberries of the cultivars bred in Latvia correspond to the phytochemical compositions of cranberries of the cultivars bred in the United States. Thus, the results of the chemical compositions of the cranberries indicate that the cultivars bred in Latvia are quite promising for introduction and cultivation in the Baltic countries.The analysis of the quantitative composition of proanthocyanidins showed that the highest levels of these compounds were present in fruits of the cranberry cultivars ‘Kalnciema Agrā’, ‘Kalnciema Tumšā’ and ‘Kalnciema Ražīgā’ bred in Latvia, and in the fruits of the cranberry cultivars ‘Searles’ and ‘Howes’ bred in the United States. The highest levels of flavonols were found in the cranberries of cultivars ‘Kalnciema Tumšā’, ‘Salaspils Melnās’, ‘Howes’ and ‘Black Veil’. The highest levels of anthocyanins were found in cranberries of the ‘Franclin’ cultivar. The analysis of the quantitative compositions of triterpene compounds showed that the cranberries of the ‘Early Black’ cultivar contained the highest levels of triterpene compounds. The cranberry fruit is a natural plant source of anthocyanins, proanthocyanidins, flavonols and triterpenoids, which are groups of biologically active compounds, and it is therefore promising to carry out the breeding, introduction and cultivation of cranberry cultivars in order to produce new high-quality cranberry fruit preparations with antioxidant and other health benefit effects.


There has been a recent increase in body-oriented interventions implemented in educational contexts. Body-oriented interventions are grounded on the body–mind relationship, involving body and movement awareness and expression. In this systematic review of the literature on body-oriented interventions implemented in preschool contexts, we review the scope and quality of the quantitative evidence of each type of body-oriented intervention regarding social-emotional competence. Seven databases were searched for randomized controlled trials (RCTs) and quasi-RCTs. Seven core body-oriented intervention programs were found . Play programs were the most studied and appear to be the most effective to improve social-emotional competence. Nevertheless, the level of scientific evidence was compromised by the lack of studies with high methodological quality. Social-emotional competence is crucial for children’s health and well-being. It includes the capacity to understand other’s emotions and feelings, properly regulate and express emotions in different contexts, and positively adapt behavior to form close and secure interpersonal relationships ,2. RecenBody-oriented interventions focus on the premise that movement and emotional functioning are associated, and include a broad scope of approaches, such as psychomotricity, relaxation, play and dance ,12. BodyResults from a prior systematic review  revealedFor example, play-based intervention programs use play as the central mediator. Some programs integrate activities based on specific types of play . Other programs involve free play, where children have the opportunity to play with different materials and freely engage in different types of play , either alone or in a group.In dance-based intervention programs, different kinds of dance offer the opportunity to integrate a diversity of movement possibilities. While most interventions focus on children’s spontaneous movements and expression , others focus on specific dance styles .Relaxation intervention programs aim to obtain the relaxation response, either through attention regulation  and/or through muscle tone regulation  . RelaxatPsychomotricity focuses on the interactions between movement and body experiences and the mind, integrating the individual cognitive, emotional, social, and physical dimensions. The main mediators are the body in movement, physical activity, and body awareness .Exercise-based intervention programs use different types of physical exercise . These programs provide numerous movement opportunities and experiences, allowing children to move their bodies in a structured way, discovering their own body and the environment that surrounds them.Despite the common conceptual body–mind framework, different mediators can play a distinct role in preschoolers’ social-emotional competence. For example, while relaxation is expected to improve emotion awareness and regulation , play-baContrary to a previous systematic review which followed a general approach of body-oriented interventions , the preThe current systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guidelines  and was The inclusion criteria for the studies were: (1) randomized controlled trials (RCTs) or quasi-RCTs written in English, French and Portuguese, published between 1 January 2000 and 10 October 2020; (2) children’s age ranged between 3 and 7 years old; (3) typical developing children; (4) children enrolled in preschool education; (5) a minimum of one experimental group received body-oriented interventions in the school setting that was carried out by people (as opposed to computers) and; (6) main focus on children’s social-emotional outcomes.The following databases were searched on October 10, 2020: CINAHL, ERIC, Portal Regional da BVS, PsycInfo, Pubmed, Scopus, and Web of Science. Additional potentially relevant articles were identified through the manual search of the bibliography of the selected studies’ references. In line with the theoretical framework underlaying body-oriented interventions ,13,14 anIn a first phase, two reviewers (A.D.R. and G.V.) independently read all abstracts of the extracted articles and classified them as potentially included or rejected. If there was a disagreement, a third reviewer (J.M.) was consulted. Studies references lists of selected studies were verified as well. In case the search team found some unclear information on those studies, a contact was made with the paper’s corresponding author.The extraction of the data was executed by two researchers (A.D.R and G.V.), including authors and study publication year, study characteristics, participants, intervention program implemented, outcomes and measurement instruments, and results. If there were disagreements between the two reviewers, the third reviewer (J.M.) was consulted to come to a conclusion.Two reviewers (A.D.R. and A.C.-F) independently assessed the methodological quality of the studies using the Physiotherapy Evidence Database (PEDro) scale , with thOutcomes were grouped considering their definition and measurement , followTo measure the studies’ level of scientific evidence, two researchers (A.D.R. and A.C.-F.) used the Best Evidence Synthesis—BES , which iThe full details related to the study selection and methodological quality of the selected studies are outlined in Dias Rodrigues and colleagues’  systematAcross all the included studies, participating children were aged between 3 and 7 years old attending preschool education. The participants of nine of the studies were Europeans ,33,34,35The number of participants in each study ranged from 19  to 372 . Only seWe systematized all the body-oriented interventions in seven core programs, namely, play, dance, relaxation, psychomotricity, exercise, and two combined programs. In this context, 10 studies were found focused on play programs ,40,41,42The duration of play intervention programs ranged from 4 to 60 weeks. Sessions’ frequency ranged from 1 to 5 per week, with sessions’ duration ranging from 30 min to 5 h.Intervention programs were implemented in the classroom ,40,42 orRegarding the types of play observed and/or encouraged through the implementation of play programs, role play ,40,41,42The dance intervention program was consisted of two 35 min sessions per week for 8 weeks . The proRelaxation-based interventions’ duration ranged from 1 to 12 weeks. The frequency of sessions ranged from 2 to 3 times per week, with sessions ranging from 11 to 30 min. One of the programs was based on mindfulness activities , incorpoThe psychomotor intervention program was comprised of two 40 min sessions per week for 8 weeks . The proExercise-based intervention programs had a duration of 5 to 14 weeks. The frequency of sessions ranged from 2 to 3 times per week, with sessions’ duration ranging from 30 to 60 min. One of the programs was based on gymnastics educational experiences , which wThe combined (play and dance) intervention program consisted of four 40 min week-sessions for 8 weeks. The program involved folk dance  from BasThe combined (play and relaxation) intervention program consisted of daily 70 min sessions for 1 week . The proIn social-emotional outcomes, improvements were found in social-emotional competence ,39, specIn children’s play, improvements were found in play, especially in interaction with communication regarding child-directed play, number of groups and interaction with communication regarding teacher-directed play . No diffIn children’s behaviors, improvements were reported in general internalizing behaviors ,35,40, gImprovements were reported in all the studied outcomes. More specifically, regarding social-emotional outcomes, improvements were found in social competence. In children’s behaviors, the dance intervention program  proved tIn social-emotional outcomes, improvements were found in social-emotional competence, emotion regulation, social competence, sharing, and prosocial behavior . No diffNo differences were found in the outcome studied—more specifically, in peer acceptance .Regarding social-emotional outcomes, exercise programs were found to effectively improve emotion regulation , social Improvements were found in the outcome studied—more specifically, in social competence .The combined play and relaxation program  showed iDetailed information regarding the level of scientific evidence of play, dance, relaxation, exercise, and combined programs is presented in strong evidence for the absence of positive effects in altruism, in comparison with 2 active [Findings regarding social-emotional outcomes indicated the 2 active  and 1 in2 active  groups.moderate evidence for the improvements in social-emotional competence and empathy compared with inactive groups [We found e groups ,39; and e groups , and 1 ie groups , respectLimited evidence was observed for improved emotion recognition and dysfunctional emotion regulation strategies compared with inactive group [ve group , and socve group ,35; and ve group , emotionve group .no evidence for improved self-awareness [There was wareness , social wareness , social wareness , and peewareness , all comwareness . The conwareness  and 1 inwareness ; emotionwareness  and 1 inwareness ; self-rewareness ,30,36,39wareness ; social wareness ,36,39 anwareness ; and prowareness  and inacwareness ,40.no evidence was observed in any of the studied outcomes. More specifically, for the improvements in play, interaction with communication on child-directed play, number of groups, and interaction with communication on teacher-directed play, comparing with an inactive group [In children’s play, ve group ; and forve group .strong evidence was observed for the absence of positive effects in anger/aggression compared with active [In children’s behaviors, h active  and inach active .Limited evidence was observed for decreasing general internalizing behaviors in comparison with inactive groups [e groups ,35,40, ge groups ,35, behae groups ,40; and e groups .limited evidence was found for increasing social competence, and in children’s behaviors, for decreasing general internalizing behaviors and externalizing behaviors, compared with one inactive group [Concerning social-emotional outcomes, ve group .Moderate evidence, regarding social-emotional outcomes, for the nonexistence of effects in delaying gratification, and inhibitory control compared with inactive groups [e groups ,43.No evidence was observed for improved social-emotional competence, emotion regulation, social competence, sharing, and prosocial behavior, and for the absence of positive effects in cognitive flexibility, compared with an inactive group [ve group .limited evidence for the absence of positive effects in peer acceptance compared with an inactive group [There is ve group .Limited evidence was observed for the absence of positive effects in gratification delay compared with an inactive group [ve group .No evidence was observed for improvements in: emotion regulation and friendship skills compared with an inactive group [ve group ; social ve group .no evidence for positive effects in social competence compared with an inactive group [There is ve group .limited evidence for the absence of positive effects in emotion expression [There is pression , and forpression .The present study aimed to determine the strength of scientific evidence of play, dance, relaxation, psychomotricity, exercise, and combined programs on the social-emotional competence of preschool age children. While play is the most focused program, with 10 related studies, only 3 RCTs were found regarding exercise, 2 for the relaxation program, and 1 for dance, psychomotricity, and combined programs. The scarce number of studies on dance, relaxation, psychomotricity, exercise, and combined programs did not allow us to find a similarity or standard in the characteristics or methodological quality of each study. As such, in this discussion, we focused only on play programs.It is important to note that the studies that focused on play are more recent, revealing a recent growth of publications in the last seven years. Play has been long recognized as an essential component of early childhood education by remarkable theorists, such as Vygotsky , Piaget Play is an instinctive language during childhood, and it also promotes social-emotional development ,55. DuriThe different play programs analyzed in this systematic review have distinct features . As addressed in a previous review , it is dAnother reason that may explain the difference in play programs results is the fact that in some studies, assessment was based on teacher’s or parent’s reports. Report-based instruments may be biased, since teachers’ and parents’ perspectives may be different according to the contexts in which children were observed ,61.Considering the recent publication of studies focused on play, a higher methodological quality was expected. However, the majority of the studies were of low quality. For example, none of the studies satisfied the criterion of concealed allocation , by omission of this information. Again, considering that most play programs studies are recent, this criterion was expected to be satisfied. Another important finding was that in none of the studies, the subject was blind, and only in one study the therapist was blind. The fact that these criteria were not met contributed to the studies’ lower quality.In fact, strong evidence was only found for play programs, since this type of programs encompasses a greater number of studies (10 studies) with higher methodological quality (4 studies). In the remaining programs, moderate and limited evidence was expected due to the small number of studies that investigated each outcome, even if some of them had higher methodological quality. No evidence was expected in exercise and combined (play and dance) programs considering that each outcome was investigated only by one study of low quality. No evidence due to contradictory findings requires that the outcome is measured by at least two studies. This condition was only verified for play, relaxation, and exercise programs studies. However, contradictory findings were only found for play programs, probably due to the differences between studies characteristics  that investigate the same outcome.strong evidence that play programs do not improve altruism [In play programs, altruism ,41, and altruism ,42. Thisaltruism , the lacaltruism ,42, thisaltruism .moderate evidence that play programs have positive effects on social-emotional competence [There was mpetence ,39, empampetence ,39, and mpetence ,41. AlthLimited evidence was observed regarding improvements of play programs on emotion recognition [ognition , dysfuncognition , and socognition ,35. Thesognition ,63,64. Tognition , emotionognition , and funognition . These rognition , emotionognition . Concernognition ,35, suchognition , and hypognition ,40. It iIn addition, limited evidence was found for the improvements of play programs in general internalizing behaviors ,35,40, ano evidence was found for emotion attribution and regulation, self-regulation, inhibitory control, social competence, and prosocial behavior. Differences in the programs’ duration and comparison groups [When contradictory results are found for some outcomes, we conclude that there is a lack of scientific evidence regarding the effects of body-oriented interventions. In this way, n groups ,41, sessn groups ,30,36,39n groups ,40,41,42n groups ,36,39 milimited evidence was found for improvements in social competence; and regarding children’s behaviors, in general internalizing behaviors and externalizing behaviors [In the dance program, ehaviors . During moderate evidence that they do not improve gratification delaying and inhibitory control [Regarding relaxation programs, there was  control ,43. Thes control . Possibl control ,67. InteThe psychomotricity program showed limited evidence for absence of positive effects in peer acceptance , which climited evidence for the nonexistence of effects in delay of gratification [Concerning exercise programs, there was fication . These rno evidence for the positive effects in social competence [Regarding the combined play and dance program, there was mpetence  since thlimited evidence exists that this type of intervention program does not improve emotion expression [In the combined play and relaxation program, pression . This repression ,70. Simipression ,71.limited evidence was observed for the positive effects of combined play and relaxation program in happiness after play, and play disruption, disconnection, interaction, extent, intensity, and skill [In child’s play, nd skill .The limitations of the present review are the following: we excluded all studies that were not RCTs or quasi-RCTs; the validity and reliability of the instruments used in the studies or the adequation of the statistical analysis were not determined; the absence of information about intervention programs characteristics presented in some of the studies; given some interventions were delivered by the classroom teachers and outcome assessments were also completed by them, blinding of assessors or therapists was impossible for some studies, which could lead to a risk of outcome bias; the PEDro scale can lead to a bias of the results, since for one of the items to be satisfied, the study must report that a certain criterion was met; the final limitation is the use of BES, since contradictory results within one type of program of 1 low-quality study led to no evidence of the effects of this type of program in the outcome studied.Future research should describe in more detail some aspects of the intervention program, such as the materials used, whether the approach is child directed or teacher directed, whether the intervention participants were divided into groups and how many children were included in each group, or if the implementation of the intervention program was in classroom or outdoors. These details might allow us to understand which specificities of the programs bring the most benefits to children.This review showed that the majority of the body-oriented intervention programs were play based, although most of them presented a low methodological quality compromising the strength of effects’ evidence of play-based programs on preschoolers’ social-emotional competence. We found strong evidence that play programs do not positively affect preschoolers’ altruism and anger/aggression, and moderate evidence that social-emotional competence, empathy, and social interaction can be promoted with this type of intervention program. These findings suggest that play-based interventions should not be used to manage preschoolers’ anger/aggression nor to promote altruism. However, play-based interventions seem to be beneficial to improve preschooler’s emotional competence, particularly empathy, and social interaction.In the remaining body-oriented programs, there was only limited and no evidence for the outcomes studied, since the methodological quality of some of the studies was low. Therefore, future studies should consider the following aspects: (1) calculate and report both between-group and within-group effect sizes to compare effect sizes across studies; (2) provide detailed descriptions of the intervention programs to increase the methodological quality, but also to allow researchers and other professionals to replicate them; (3) consider the impact of the intervention dosage, and compare different durations and frequencies of interventions. The need for more studies focused on the effects of dance, relaxation, psychomotricity, exercise, and combined programs is evident.