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Okay.

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Okay, good evening everyone. Nice to see you for the session on fertility and the family. My name is Linda Gibson.

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I'm a professor of global public health from Nottingham Trent University. So I'm going to start by reading the acknowledgement of country.

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On behalf of everyone gathered, I pay respect to the spirit of country here in Narm where we are meeting.

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I acknowledge the past and present cooling nation were under I will rungo as this sovereign people here, the cultural knowledge holders who maintain and promote the NAME Aboriginal law.

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Where's that gone? Okay.

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Not quite sure what to do with that.

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Okay. Okay, so I'm I've lost the statement I don't know it off by heart my apologies but I think we all we all have read the acknowledgement before so I think we'll take that management as if everybody's happy with that in the room.

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Okay thank you very much. Yes, they're very pleased to to welcome you to this session. We have 5 speakers.

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The first speaker is online and is doing The first 2 presentations. And then we have 3 speakers in the room.

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So, 15 min per speaker. I'm going to be very strict on time. And I will have Q&A at the end, okay?

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So we'll have all the presentations and then Q&A if everybody's happy with that.

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Okay. Right, so let me just Click. To here.

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Well, shouldn't I share this? Hi. Shouldn't I share the screen?

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Just hose on remote. Just high level. Yes, I think you should. Let me just go back.

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Because okay

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I try to share now. Should I?

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Yes, please. Yeah, I think I have to stop sharing first. There we are. Got you.

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Okay, that's

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Okay, now I'll try.

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Okay, so, Limo Gonin, very nice to meet you. And we look forward to your presentation.

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Honey.

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Yes.

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At 15 min. OK, so I'll hand over to you to introduce yourself. And to start the presentation.

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OK, thank you.

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Okay, thank you. Hi. My name is Limo Dynam from the Department of Economics and Business Administration.

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At a real university in Israel. And I'm honored to present my paper valuing the invaluable.

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The emotional experience during fertility treatments affect the willingness to pay for them.

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Over the years, there has been significant research in health psychology exploring the relationship between biological, psychological, behavioral and social factors and their impact on health outcomes.

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Ground breaking studies have shed light on the complex interplay between biological processes psychological factors, behavioral patterns, and social determinants.

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These studies have provided valuable insights into various areas of health psychology. With the ultimate goal of developing intervention and strategies to promote better health and well-being.

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This increased focused on interdisciplinary research and collaboration has contributed to a deeper understanding of the connections between biology, psychology, economics and society in relation to health.

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The experience of infertility is often described as emotionally intense. In fertility refers to the inability to conceive a child.

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After a year or more, or, and protective intercourse. It can have a significant impact on individuals and couples who desire to have children.

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The emotional experience of infertility can vie wisely among individuals and couples, but many commonly reported motions include Grief and last, frustration.

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And disappointment, anxious and stress, depression and sadness, socialized solution and stigma.

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Assisted with productive technology, is a general term referring to methods used to achieve pregnancy by artificial or party artificial or party artificial or party artificial means rather than sexual or party artificial means rather than sexual intercourse.

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ALTHY includes in visual fertilization, IVF, a process whereby an open is fertilized by sperm outside the body.

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Ovum and embryo donation and surgacy. Our study focuses on IVF.

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Most studies recognize that IVF is a complex procedure which involves physical suffering and emotional disorders. IVF of course is a wide a wide range of feelings such as frustration, depression, tension, anger and others.

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Over the last 30 years, Israel has had a significant impact on promoting and using IVF research.

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His National Health Insurance Program covers nearly all fertility treatments includes all IVF costs. For the first and second child for all Israeli women.

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IVF treatments for the third child and even private IVF treatments are partially covered by public funds.

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The aim of this study is to, characterize the emotional responses of individuals undergoing the IVF procedure.

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To discover whether psychological variables are correlated to reference factors, demographic, socioeconomic and healthcare characteristics.

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To find whether psychological variables have an influence on the willingness to pay for IVF treatment. To investigate.

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And the moderating effect of satisfaction from IVF treatment on the relationship between the psychological variables and the willingness to pay for IVF treatments.

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In various fields such as psychology, statistics and social sciences the term moderating effect refers to the phenomenon where the relationship between 2 variables is influenced or modified by the presence of the third viable.

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These third viable is referred to as the moderator.

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We investigate the moderating effect of 5 years treatment satisfaction which includes several dimensions on the relationship between the psychological viables and the willingness to pay for IVS treatment.

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We investigate whether a different level of satisfaction the psychological factors have a different influence on the willingness to pay for IVF treatment.

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Meaning whether at a higher level of satisfaction, the psychological factor will have a different influence on the willingness to pay then at a lower level of satisfaction.

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The psychological state of the respondents was assessed using the positive effect negative effect scale. The items cover cover diverse aspects of experiences expressed by IVF patients.

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For the purpose of assessing patient satisfaction with IVF treatment, 3 major dimensions were tested. The humans factor professionalism on off the fertility clinic staff attitudes and sensitivity of the fertility clinic staff and their relationship with patients.

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Information factor, information on the chances of success, information on prognosis and the different treatment options.

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And physical conditions factors. Sector, graphical accessibility, physical conditions in the operating room, medical equipment and physical conditions in the recovery room.

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With in cost benefit analysis, the benefits and the cost of an intervention are evaluated in monitoring units. For my research, the most appropriate method is the contingent valuation technique.

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The contingent valuation technique is based on the willingness to pay. The willingness to pay is the maximum monetary amount that the person willing to pay to acquire a service or a product.

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The IVF patient population in this study was patients who have been determined with absolute certainty to require fertility treatments.

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Those who have failed to conceive for at least one year and up and were approved by a committee of experts for IVF treatment.

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IVF patients treated at IVF units in public hospitals in Israel. Infertile couples who in the past had received or were presently receiving IVF treatment.

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The Israeli medical regulation recommended IVF treatment for unexplained infertility and maternalosis, male infertility and mechanical infertility.

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The survey was constructed and carried out in feed that stages of data gathering. For the initial stage in-depth interviews with fertility experts were conducted.

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The pilot study was consisted of IVF patients. Based on the pilot study, the research questionnaire was modified and adjusted.

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Facture analysis was conducted on the patient's psychological responses and on the patient satisfaction responses. To discover the statistical relationship between Deep Psychological factors that had been generated by factor analysis and the background factors we conducted multivariate regression analysis.

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Oh, no, ordinary lists where regression were conducted. The dependent variables were the 3 factors that had been generated by factor analysis, pessimism, activists, and shame.

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The For each regression, the following independent variables. Were excited as continuous. Personal income, age number of children not from IVF perceive chances to conceive and give birth to a healthy baby in the presence treatment, medical face and satisfaction from physical conditions.

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So satisfaction from information provision. Satisfaction from medical care and number of 5 year treatments. The following variables were treated as categorical, education, degree of religious observance and diagnosed infertility.

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In order to find out whether psychological variables have an influence on the willingness to pay for aviate treatment, 2 models were constructed, a linear model and a moderation model.

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Background factors were found to have a significant impact on IVF patients emotional outcomes. Evidence was found for gender based variance in psychological reaction related to infertility.

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Willingness to pay remains robust and was not influenced by psychological viables.

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The results show that satisfaction from treatment can be regarded as moderating viable between the psychological viable between the psychological variables and the willingness to pay for IVS treatment.

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Fertility problems affect the quality of life of women more adversely than of men. And women suffer more negative emotions as a result of infertility.

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A unique emotional response that seems to be an important outcome in the experience of infertility and that was demonstrated in our study is shame.

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The socio-cultural

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The social-cultural environment affects emotional responses regarding willingness to pay while IVF patients satisfaction with medical treatment may moderate the emotional effect of psychological factors on the willingness to pay for IVF treatment.

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Did the limitations of the study. So self-reported question is a defensive attitude taken by women when filling out self-reported questionnaires may have been at work.

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Medication, hardware and medication may have had an impact on female emotional responses. Funding of fertility treatments, the state funding of fertility treatments may encourage the religious So social imperative regarding fertility to the point of over overeating emotions which would normally have a negative effect on the willingness to pay for fertility

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treatments.

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Thank you.

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Thank you very much.

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Okay, thank you. Thank you Limour. Okay, so that was very well timed. So I think we move on to your next session.

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Let me just.

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Okay, I'll share. I'll share the screen.

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Okay, yes, that'd be great.

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Okay.

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Just a moment.

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Just now one moment.

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Is it okay now?

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Yes, if you could put it onto full screen

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So that's what I did. I see it on full screen, don't you?

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No, we've got slideshare at the minute.

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Maybe I should I stop sharing and try again? Just a moment.

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Okay.

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Just a moment.

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Just one moment.

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And now is it okay now?

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We're still on the slide share but I think everyone can see your your slides quite well. So I think if you want, we can see all the sides at the side as well.

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But if you want to If you want to carry on, that's fine as it is. And everyone can.

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Okay. I don't know how to do it differently.

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Everyone can see the slides, I think that's okay. Okay. Okay, thanks.

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Okay, okay, thank you. So, again, hi, I'm Nimo from the Department of Academy and Business Administration at a real university in Israel.

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I'm honored to present my second paper. Satisfaction with individual fertilization treatments, patients experiences and professionals perceptions.

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The evaluation of patients experiences and need in health care is crucial aspect of quality improvements. It involves gathering feedback from patients to assess the satisfaction, identified areas for improvement and ensure that health care services meet their needs effectively.

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By evaluating patients experiences and needs in healthcare, organizations can make informed decisions, implement targeted improvements and ensure that the care they provide aligns with patients expectations.

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The evaluation of fertility patients experiences and needing health care is an important aspect of understanding and improving the quality of care provided to individuals taking fertility treatments.

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The valuation of fertility patients experiences and needs in healthcare plays a crucial role in enhancing the quality of care and ensuring that patients receive the support they require through their fertility treatment journey.

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Since infertility and the attended medical intervention impose physical and emotional burden on fertility patients and since one third of the infertile couples ultimately do not deliver a child.

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Yeah.

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Assessing patients experiences and needs with regard to fertility services and facilities can provide insight through the patient's eyes and help healthcare staff better understand their patients needs preferences and wishes.

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Limo, can I just interrupt? Sorry, Limo. Your slides aren't moving on.

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They could Yes.

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So we only stuck on the introduction slide at the moment.

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So I will try to share it again. Sorry.

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Yeah, yeah

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Let's see what can I do. Just a moment.

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It's not fine now. It's a Okay.

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That looks better. That looks better. Yeah. So if you could click through to the, I think you're on the second or third slide, won't you?

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Okay. Okay. Okay, thank you.

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I was here assessing patient experiences and needs. Okay. Thank you. Assessing patients, experiences any with regard to fertility services and facilities can provide insight through the patient's eyes and help healthcare staff better understand their patients needs preferences and wishes.

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They could shed light on the weaknesses and strength of the care as currently delivered and highlight patients needs as well.

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Making this perspective known to healthcare professionals may lead to improvements in the quality of care.

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IS a general term. Referring to methods used to achieve pregnancy by artificial or party artificial means.

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Rather than sexual intercourse. Assisted reproductive technology has provided a rare hope for individuals or couples experienced infertility or other reproductive challenges.

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However, it is essential to know that AERT procedures can be emotionally physically and financially demanding.

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Invited to Fatalization IVF is the most well known and commonly used LT procedure, a process whereby an oven is fertilized by sperm outside the body.

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Over the last 30 years, Israel has had a significant impact on promoting and using IVF research.

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It's National Head Insurance Program for all Israeli citizens, cover nearly all fertility treatments.

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So especially this coverage includes all IVF costs for the first and second child for all Israeli women. IVF treatments for the third child and even private IVF treatments are also partially covered by public funds.

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The aims of this study is to identify different aspect of satisfaction with fertility care relevant to patients to identify gender differences in evaluation of patient satisfaction with fertility services and facilities in the fertility clinics.

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To identify predictors of satisfaction and to determine with what accuracy fertility specialists can assess the patient's experiences as way to measure patient suspension and quality of care.

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Patience experiences and satisfaction is typically evaluated through interviews and questionnaires. This can be important if professionals perception of the patient's experience experiences with care do not accurately reflect the actual state of affairs because this may impede their ability to make changes that are truly beneficial to their patients.

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2 service were conducted. The patients in this sampling were infertile couples. The IVF patient's population includes individuals who will need fertility treatments with absolute certainty, individuals who have failed to conceive for a year or more and receive the approval of committee of experts for the IVR treatment.

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According to the Israeli regulation, IVF is indicated for unexplained infertility and the metreosis we can't and the metreosis, mechanical infertility and male infertility.

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The sample of healthcare professionals consisted of fertility doctors and fertility nurses in public IVF units in public hospitals in Israel.

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All the question is were printed out and delivered manually for both IVF patients and healthcare professionals.

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The survey, were constructed and carried out in 3 stages of that are gathering for the initial stage in depth in depth interviews were conducted with in-depth interviews were conducted with fertility experts in depth in in-depth interviews were conducted with fertility experts and IVF patients.

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The pilot study was consisted of IVF patients. Based on the pilot study, the research questionnaires were modified and adjusted.

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Final versions were, were created for each of the 2 population groups.

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In order to evaluate patient satisfaction with IVF treatment and the perception of 8 by professionals, the following 3 major dimensions were tested.

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Coordination and integration of care. Professionalism of the fertility clinic staff attitude and sensitivity of the fertility client staff.

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And their relationship with patients, provision of consulting services and follow up support. Information on the chances of success information on prognosis, different treatment options and possible side effects.

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Geographical accessibility, physical conditions in the operating room, medical equipment, physical conditions in the recovery room and stand by times on the waiting list.

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For the economic aviation of IVF treatment, the willingness to pay method was used. Respondents are asked questions directly in a survey about their maximum willingness to pay, the maximum amount which they would be willing to pay for service or products.

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Willingness to place based on the assumption that the maximum amount of money an individual is willing to pay for a commodity is an indicator of the value to him of this commodity.

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Each of the 2 service was analyzed. Stream methods were used for processing the data. Principal component analysis, indices, construction, regression and and regression analysis.

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The study found that overall infertile patients are satisfied with the care they receive. Several demographic viables, age, education, income, number of fertility treatments and psychological factors, pessimism and activeness were found to boost to be significant correlated with patient satisfaction with IVF.

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The results yielded a negative correlation between the willingness to pay for IVF treatment and the satisfaction with access to care and physical conditions.

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A second important finding was that psychological factors were significantly correlated with patient satisfaction. Improving patient satisfaction with IVF services treatments and facilities may have a positive influence on the psycho psychological and mental state of patients and in turn affect the outcome of fertility treatments and treatments drop up, drop, dropout.

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Drop out rates.

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The current study shows a correspondence between healthcare professionals perception of the patient's experiences. And the patient's actual experiences as regard as regards to information, satisfaction and satisfaction with physical conditions.

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Patient satisfaction is an important component in the evaluation of infertility treatment as well as other medical intervention.

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In the site into the quality of care as seen from the patient's perspective may help healthcare staff better meet Patience needs wishes and.

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And priorities.

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And the sampling of a fish was not random. Since there is a limited number of physicians and nurses working in IV clinics, the sample of participants in this study might not be fully represented of the total group of fertility professionals in Israel.

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D the selection bias caused by the under representation of patients from IV from private clinics. Granted, free treatments may answer questions differently than patients who pay for treatments.

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Thank you very much.

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Thank you.

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Thank you very much Limore. OK, thank you for keeping to time. So well. Okay.

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Right, so if I could ask the next presenter to come up, Steph, yes. I'll Sabrina, sorry Sabrina, let's get your presentation up.

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Constructing insemination fraud as a social problem.

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So good afternoon everyone. So my name is mentioned is Sabrina Zukish. I'm a post-doctoral fellow at the University of Quebec in Tau.

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And work at the disprovision of Isa Belkoti who is right here and who's also part of the project that I will be talking to you about today.

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So my presentation as mentioned is entitled, Constructing insemination for as a Social Problem.

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So I guess I just have to click.

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Sure. Okay. So I will get into what is meant by insemination of art in a second, but before that I just wanted to let you know that what I will be presenting today is just based on preliminary results from an ongoing project.

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So basically what that means is that you will see like a very descriptive undertone to the presentation today and that's just because we're still working on the data to bring more another cool and theoretical outlook to our analysis.

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So what is insemination fraud? So insemination fraud is a specific type of fertility fraud where the health care provider which can include also the doctor and in the people like in our sample most of the cases were involved that actually all of them included a doctor so the doctor here with mess represents the source of the reproductive material IE.

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The sperm sample using the source of the reproductive material, IE. The sperm sample, the source of the reproductive material, ie the sperm sample, use in insemination.

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So what does that mean more precisely is that a woman goes to see a fertility doctor to conceive a child either alone or with a partner.

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And the healthcare provider intentionally inseminates her with a different sperm sample than the one she chose alone or with her partner.

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So basically the chosen sperm can be that of her partner or of a specific donor, but actually what she's inseminated with is this sperm of another man.

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It can be another donor or another further to be or it can even be the sperm of the doctor in seminary the patient.

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So insemination fraud has not been very much documented in in the literature, but what we know is that most of the known cases date back to the seventys and eightys, but we have more recent cases which date back to the first decade of the 2,000.

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So far more than 50 doctors have been found to intentionally misrepresent the source of their productive material and we can estimate that this number will go higher as DNA tests become more and more available.

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So what we wanted to do is to examine this phenomenon by carrying out a study on people who work conceived in a context of insemination fraud and what we wanted what we want to discuss today is what those people so donor can see people do in response to discovering the insemination fraud.

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Ultimately, when we really analyze the data in depth, we want to examine the process through which insemination fraud is constructed as a social problem.

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That requires a regulatory response.

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So we carried out semi-structured interview with donor-conceived people, victims of insemination fraud in the fall, 2,021 and winter, 2,022.

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So in total we met with 17 people, 13 women, 3 men and one person who identified as non-binary.

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Our sample covered different types of insemination fraud. So most of them as you see involved the sperm of the Chosen donor or the sperm of the father swapped for the sperm of the doctor.

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But we had also one case where this form of the father was swapped for the sperm of a donor.

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And we had 2 cases where the sperm of the chosen donor will swapped with this firm of another donor.

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So the preliminary results show 3 interrelated planes of claim-making activities by those donor-conceived people that we met.

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So one is going public, 2 is pressing charges, 3 is pushing for legislative changes and he and I will address each category separately.

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And each time I will let you know what people did in that regard, why they did what they did, what kind of achievement they they attained and what obstacles they were faced with.

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But before that I just want to specify that the third category, which is pushing for legislative changes, this one is really specific to the US context.

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Because as far as we are aware of, it's the only country that has seen an advocacy movement pushing for legislation making this practice illegal.

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So the first category which is going public, so most people that we met decided to go fully public, which means they decide they they agree to show their face, to give out their name, to speak on TV and very few decided to tell their story but anonymously.

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So what they did, so going public spans all the way from writing blogs to using social media to contacting or responding to journalists.

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To make their story known to the public. Why they did what they, I mean, why they chose to go publics.

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So for several reason, one is to make fertility fraud known to the public because it has gone under the radar for a very long time and these doctors have enjoyed complete impunity for a very long time.

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So they chose to go public to expose those doctors and by doing that they also strive to put an end to secrecy because there is a lot of secrecy because there is a lot of secrecy around donor conception and even more of secrecy around donor conception and even more so in a context of

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fraud. Donor conception and even more so in a context of fraud. They also hope to prevent in a context of fraud.

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They also hope to prevent insemination fraud from happening again because by going public now doctors will know that insemination fraud from happening again because by going public now doctors will know that by acting in such a way, from happening again because by going public now doctors will know that by acting in such a way their name will be known to the public and

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exposed.

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They also hope to educate people on what it feels like to be a victim of insemination fraud.

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There is a tendency to minimise their experience. So they want to raise awareness on the profound ramification of insemination for it, be it in terms of identity but also psychological well-being and also in terms of the repercussion that it can have on family ties.

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It's also a form of social justice for those who could not neither press charges no nor go on the legislative realm.

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For them it was the only way to regain a form of agency. And finally, some told us that going public held the cause because it is easier to gain a deerst from the general public by having a face that embodies their story.

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So what they have achieved, there has been a lot of media coverage these past few years on insemination fraud on mainstream platforms.

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So the people that we met, some of them took part in talk shows like very famous ones like Dr.

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Filler, Good Morning America, others. Talk to journalists on national broadcast channels like BBC or CBC.

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Others were interviewed by journalists working in very known newspapers like the New York Times, The Washington Post and others took part in podcasts and in documentary films and the most recent most famous one is the Netflix documentary film Our Father.

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So what were the obstacles? Some told us that their relatives were uneasy with the media exposure.

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So then they felt torn between their desire to go public but they're also their desire to respect the family's privacy.

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Others said that the negative feedback they got after going public made them think twice about expressing themselves again publicly.

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And some were advised not to go public by their attorneys because they were told that it would interfere with the legal proceedings against the doctors.

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If you were concerned that their anonymity would not be protected when they didn't want to go fully public and others did not want to give in to voyeurism and become a weird story told in a sensationalist manner.

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So the second category of claim making activities is pressing charges. So here I just need to say that not all the people that we met decided to go that route and those who did told us it was not their first option.

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They basically tried most of the people we talked to, their first option was to actually reach out to the doctor, ask them questions and ask them the reasons why they did what they did and most of them were faced with a no response basically they were shut down and after that then they decided they resorted to taking legal measures against the doctors.

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So what they did is they either filed not all of them but those who did either filed a lawsuit or joined the class action if many of them were victims of the same doctor.

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And some of those who like the pioneers I would say in a way well they who discovered the fraud early on they wanted to help others by putting up online resources to guide them on how to get legal help, how to find an attorney, guide them on the steps involved in this in the legal proceedings.

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Why they did it for obvious reasons to hold those doctors accountable for their actions. But also as I said to get answers because as I said earlier their first option was to reach out to the doctors and because they couldn't get answers that way, they resort to the legal route.

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Also to obtain compensation for the harm incurred and here I want to stress that they all the people that we talk to sought moral compensation more than financial compensation.

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They wanted that these doctors to be found guilty before the law, but the legal system could only offer them a civil settlement, most of them.

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What they achieved. Here the situation is different according to whether or not there is a law prohibiting fertility fraud.

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So in most countries except as I said the US is a different case. It's important to know that there is a legal vote that prevents victims from holding those doctors legally accountable.

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So what I'm going to say here ties in with the obstacle section that you see in the other column.

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So there is no law in most countries. That specifically targets the issue of misrepresenting the source of the reproductive material.

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Even in rare cases where a breach of consent can be proved. The statute of limitations prevents victims from pressing charges because too many years have passed since the act itself.

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In some cases the doctors record have been destroyed so we cannot prove intentionality. And the offspring cannot file a lawsuit because they're not considered a party to the contract.

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They were not born at the moment of the wrongdoing.

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So the only option left to most of them is a settlement with a financial compensation and usually it includes a non-disclosure agreement which goes against their desire to expose those doctors.

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So what victims can achieve is very dependent on whether or not there is a law. So without a fertility fraud law, there most cases as I said get settled before they even make it to court and many of them get rebuilt from the get-go.

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But with a fertility fraud bill, like the ones that we see in the US, then doctors can be found guilty of a felony.

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They can be sentenced to civil and criminal penalties, even jail time. And we see with the media coverage and the momentum with the fertility fraud bills being passed in the US more lawyers and law firms specializing in fertility fraud.

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So the obstacles, of course, finding a lawsuit is not easy. It can be very intimidating, scary.

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It can also be very costly. It can also lead to disagreement between victims of insimation fraud.

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Not all of them agree that it's the appropriate route to go about. Some of them still hope to build a relationship with the doctor if they're conceived with hisperm.

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Finally, the last category of claim making activities is pushing for legislative changes. So in the US we're witnessing the rise of an advocacy movement to act on legislation.

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So basically what they do is they ask legislators to support fertility fraud bills. And the leading figures of those movements, basically they offer help or support to other citizens who want to join the cause.

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They also inform legislators on what it means to be a victim of insemination for and why it's important to pass such bills.

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And they can take a more active role by joining bipartisan roundtables to advocate for fertility fraud bills.

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Why they do it as I mentioned earlier, there is a legal vote. So the way to bypass that is to act on the legislation.

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So it's a way to rectify the judicial and legal void and allow that allowed for fertility fraud, fraud, sorry, to remain unpunished for so long.

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But it's also a way to press for a better regulation for the fertility in industry more broadly.

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What they have achieved. So this is the area where the outcomes are the most visible and the most promising in a span of 4 years of fertility fraud bill was passed in 10 US states and is being discussed in 6 others and there is even a fertility a federal fertility fraud bill that is being proposed in the US.

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They correct these legislation characterized insemination for it as a felony as I said leading to criminal and civil penalties.

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The obstacles were just like pressing charges calling on a legislator can be intimidating. Passing a bill is time consuming.

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It taken it can take up to several months even if not years and it's also conditional on finding a senator or a representative who's willing to support the bill.

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So just a few concluding remarks. We believe it's important to focus on what donor conceived people do and not only on what they endure because it allows us to see them as actors of social change and not only as victims and to see that their claim-making activities are a source of empowerment and healing.

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And this exploratory study allowed us to see that donor conceived people were able to construct insemination for it as a social problem that is being discussed publicly and acted upon from a legal and legislative point of view.

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It allowed us to see that this process involved a combination of bottom up and top-down activities where different actors interacted, claim makers, allies.

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And finally, this process is marked both by favorable conditions, so we see a momentum. Of health patient advocacy and also structural constraints as I said like legal financial obstacles as well as power imbalance.

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So that concludes my.

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Yeah. That's a fascinating piece of work, really interesting. Okay.

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Okay, and now I invite Just loading that in by Alessandra. To come. That's the right one, isn't it?

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Good afternoon. This presentation is mine. I'm a Alessandra Dicato and of my colleague Konnerouso, both from University of Milano Bkoka.

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I will discuss discuss on preterm patienthood and parenthood. B is a multi problematic event with 3 main constituencies.

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First of all, a medical risk to the newborn, with 3 main constituencies. First of all, a medical risk to the newborn, the economical and medical cost of caring for these babies and the third consequences is related to the fact that the premature birth of a child and an admission to a Natalie

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intensive care unit and I see you is a very distressing experiences for the 4 parents of the baby.

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Every year, 50 million babies are born prematurely. 60% of them comes from a subsidiary in Africa and suede East Asia.

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5% of them are born before 28 weeks. And 10% of them are born between 28 and 31 weeks.

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Every year worldwide approximately 1 million babies dies from prematurely related issue. In Italy in 2,020 when we were planning this research.

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2,000 403,000 babies were born and 6.3% of them were born and 6.3% of them were premature but during 2,003% of them were premature but during 2,020 the premature rate but during 2,020 the premature rate is lower than in 2,020 the premature rate is lower than in previous and consequent years

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because of women in previous and consequent years because of women, the premature rate is lower than in previous and consequent years because of women in previous and consequent years because of women pregnant women were in force at the rest because of lockdown.

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Primeta, parents over preterm babies often describe premature birth and sex subsequent hospitalization in an NICU as an emotional roller coaster for them and a disruptive life event because an expected birth can trigger feelings such as guilty for not completing pregnancies, helplessness and the fear of not being able to

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protect one's child. Moreover, parent infant separation due to factors such as medical equipment that the baby need parents and employment or caring for other children or needing to leave and I see you if there is no provision for parents to stay during the day or during the night represent a runway the source of stress for parents but also for their

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children. Factors such as parental well-being and family creation make a significant contribution to the developing development developmental outcomes of the child.

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The 4 it is important to assess the veteran parents level of stress and negative feelings, a level of stress and negative feelings during the hospitalisation of their baby, a level of stress and negative feelings during the hospitalisation of their baby, but also of stress and negative feelings during the hospitalisation of their baby, but also after it is discharged the hospitalisation of their baby but also after it is discharged when the family is at

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home. Our, research, boys in return parents and multi-disciplinary study to set Nanatal practices and announce the family's well-being powerly is an interdisciplinary and action research project which investigates the relation between return birth and parental stress, self-perceived efficacy and environmental setting of

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the 2 neanatal intensive and sub-intentional units in Milan in Italy. We use the both both standardized tools such as questioners and the narrative in depth interviews.

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And we made use also of SAT to support strategies to parents by health care staff. We have opted adopted analystic perspectives on families families well-being using mixed matters also add your visual methods but and a mixed methods, also add your visual methods but and a participatory approach.

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The project themes are to monitor a parental discomfort which has been observed to be an important long-term risk factor for the child and to improve collaboration between parents and healthcare staff.

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By empowering the voice and experiences of pro-term parents. How our main research questions are from fourth?

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How does the environmental setting of an NICU can influence the relationship between a and birth and parental stress and negative feelings.

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What is the parents perception of social support received by health care staff, family and friends. What is the parental perception of the preparedness for their infants discharge?

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And what is the difference between mothers and fathers, and's a to return birth. Because a lot of literature study the condition of the mother and of the baby as excluding the father point of view.

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104 parents accepted to participate in our project. The participants were selected according to 5 main criteria.

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They are selected according to 5 main criteria. They are selected according to 5 main criterion. They were able to understand Italian or English.

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The Platinum babies were in medical stable conditions. The Platerin babies were in medical stable condition at the moment of our English.

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The Platerin babies were in medical stable condition at the moment of our interviews. Therefore, and babies were in medical stable condition at the moment of our interviews were in medical stable condition at the moment of our interviews.

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Therefore, a medical stable condition at the moment of our interviews that 4 are ready to be discharged from the hospital and the infant was hospitalised for at least 10 days actually from 10 days to 5 months.

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And they say in any formal content form. We, enroll 60 newborns that is 43 fathers and 61 mothers one from an 45 from an hospital and a 55 from another hospital.

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The parents participated through a survey at the moment of this discharge. After we were monitored for a year after the discharge of their baby by a specific web app and 16 of them participated also to an in-depth interview.

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In our presentation we talk about, I talk about the result of in-depth interviews. Parents are a strange animal in an ICU because they are not patients science.

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They are not the object of a clinical intervention. But they need specific clinical support from a health professional. While doctor and nurses care for their infants health the families are being shaped by complicated interplays of problem problemas and delaying problems and delay associated with the experience of an ICU.

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Sometimes healthcare staff perceive parents as obstacles in when I see you because they need to act sharply when the baby has some problems.

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And the 4 parents of a term born children embody a specific hybridity which shapes their nature of parenthood and patience inside the N ICU.

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The interviews in depth, the interviews were conducted from October, 2,022 to April, 2,023, fully recorded and transcribed and subsequently they analyzed the by and vbo program.

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Among the 16 parents who participated in death interviews, 10 were birth mothers and 6 were fathers. Fathers who were generally more difficult to involve after we see how, why they are so difficult to involve fathers.

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In addition to representing a betrayal of parents expectations in terms of what a new board should look like.

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Pretend baby and the subsequent it's subsequent hospitalization challenges the parental role in the way parents to be to be tended to feature it during the pregnancies.

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And Elena, for example, told Dise, I felt very guilty. I cried because the baby was too fed and I couldn't breastfeed her and then I had not breast milk and I felt guilty but then I spoke to the hospital psychologist who made me understand, which helped me to accept it.

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Father, in Italy, especially during the Covid-nineteen pandemic, many hospitals applied a restriction on the frequency and timers of access by power answer to N ICU and in particular in some cases further access was denied.

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During all hospitalization of the baby. In our research in one of the 2 hospitals involved, parents had a complete access to the NICU.

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And in the other one, just matters where are allowed to access it every day. Meanwhile, fathers could access it only weekly for an hour.

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How about for apps for for example, said, I certainly cried. I was a worried mother, but I think my husband suffered more than me because he could only see the baby in photos.

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Sitting aside the contingencies caused by the Covid-nineteen pandemic, fathers often declare that during their child's NICU hospitalization they felt less involved than mothers both in caring for the newborn.

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Such as doing a scheme to skin therapy or also kangaroo care and more generally in communicating with hospital staff.

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Maurits you're told to ask. When I went to the N ICU, not excuse me.

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I prefer a Robert declaration at one to point and to 1 point the head of the department took my wife aside and told her frankly that he didn't know if our daughter could make it.

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Hi wasn't there at that time and I thought that she was alone in these 2. To take hold of the burden on.

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Okay, in the representing the role they role and their tendency in the N ICU. Mothers recalled and almost everyday attendance and the general sense of even established the communication with hospital staff.

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On the other hand, father narrated themselves well narrated by their wives as a busy with work.

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Juggling to attend the Ni see you a few hours a week or when described only as a really supportive for their partner.

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To interpret as a result, we how to consider that the otherance to stereotypical gender role responsibilities where women are supposed to carry out the formal care labor and the men are supposed to undertake the role of a primary breadwinner is still common in Italy.

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Nerik for example said with my work scheduled despite trying to be there as much as I could. Some communication from the neural networks reached the only my wife.

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So there was also an imbalance in the only my wife. So there was also an imbalance in my wife.

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So there was also an imbalance in the loss we carried on those days.

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Sam conclusive remark. Very different separation once admitted to an ICU represents a major source of stress for both parents.

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But it appears to be harder on mothers, in particular the ones that cannot press feed. Indeed the scholars found that not giving the chance of breastfeeding it challenges a woman's sense of marrying does increasing maternal psychological distress.

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The fact that the hospital staff spends more time with the baby than the parents can do often produce feelings of incompetency and insecurity that affected the bond between parents and their child.

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The fathers in particular being the parent of win the less and I see you attendance felt less involved in the communication with the hospital staff often built the relationship with their child only after when the baby was at Thorma.

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Overall, coherently to the literature we found it is crucial to consider the TREED mother father infant or mother partner in not binary or not in other kind of relationship in front of characteristics and the points of view because both parents mental health and mental health is at risk after predator and birth.

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Scholars argue also that parent well being and infant development outcome are closely and mutually related. Hi, Finish the you.

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If you are interested of for further information, you can write to you or visit our project website. Thank you.

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Okay. Thank you very much, Alessandra. That was really interesting.

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Okay, so now can I invite Eric over? Hand over to you to introduce yourself. Okay, thank you.

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Hi there. So this is the presentation that we're still not sure how it ended up in this session.

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So please, my apologies. It's supposed to be in the alcohol session and I kind of got here. I didn't know.

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We tried to ask some questions, we never figured it out. But there is a little bit of a gender component and a lot of you consider yourself medical sociologist so maybe you care about health this is a health study but here we go so gender so social lives and older adult alcohol abuse with older adult alcohol abuse with a focus on the United States and Ireland.

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I'm from Cal State, and older adult alcohol abuse with a focus on the United States and Ireland.

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I'm from Cal State, a focus on the United States and Ireland. I'm from Cal State San Bernardino. I'm from Cal State San Bernardino.

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For the Irish component. I'm from Cal State, San Bernardino. For the Irish component, my collaborator is Katrina Murphy.

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She's a Dublin City. For the Irish component, my, collaborator is Katrina Murphy.

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She's at Dub

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Okay. Could I hope it didn't get cut off too much, I guess there. Okay.

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So anyway. This slide, this seems to have taken from the Guardian, I guess, a couple years ago.

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It just says it's kind of cut off at the top with with this part but there's a binge drinking boom among older people and what does it mean for the nation's mental health.

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This, so we're starting to see some concern about a focus on older adults in drinking where in the past maybe we didn't so much but but it's not just about mental health.

323
01:01:46.000 --> 01:01:59.000
Whether alcohol use is increasing or even staying the same, there are reasons to be concerned about this. So some of the reasons, right, why might alcohol use an abuse be more of an issue for older adults?

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01:01:59.000 --> 01:02:06.000
Well, one issue and I kind of hint at this. I think maybe worth talking about later is There are some things.

325
01:02:06.000 --> 01:02:12.000
Anyway, interactions with medications, right? We know that who takes a lot of medication, older adults.

326
01:02:12.000 --> 01:02:23.000
Sleep disorders we're finally recognizing that older adults have major sleep disorders that both are related to other morbidities or could even lead to more morbidities and alcohol use does not contribute to good sleep despite what some people think.

327
01:02:23.000 --> 01:02:39.000
Ties to loneliness and depression. Of course, this is a major issue of older adults. Also, and this is kind of one of my, it's not the point of the paper.

328
01:02:39.000 --> 01:02:47.000
Older adults, generally have a lower tolerance for drinking, yet the drinking standards don't seem to change when we talk to older adults.

329
01:02:47.000 --> 01:02:58.000
I've not reached older adult age yet. But I can tell you my tolerance is not what it used to be in my early twentys so I would think it's probably gonna be even worse in my early, for example,'s.

330
01:02:58.000 --> 01:03:07.000
Okay, so there's 3 things I look at here and 2 countries. So there's almost like a million hypotheses, but I just briefly touch upon everything.

331
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So alcohol use and abuse and the social, the social part were sociologists. This one of the studies I'm citing just that there were.

332
01:03:18.000 --> 01:03:22.000
Theoretical indications and some empirical that alcohol use and abuse is likely shared by your social relationships.

333
01:03:22.000 --> 01:03:40.000
For this paper, of course, social relationships is very broad. I'm focusing on really the family and social participation and my social participation, I mean friends in the community, kind of non-family others near you.

334
01:03:40.000 --> 01:03:48.000
Okay, so one of the hypotheses is how does maybe your family relationships tie to alcohol abuse in later life?

335
01:03:48.000 --> 01:03:55.000
So, maybe it stands the reason that you're, like a better word, your family culture, right?

336
01:03:55.000 --> 01:04:05.000
Do people always drink at family events? Some, yeah, some families you do. Is there a history of drinking in your family?

337
01:04:05.000 --> 01:04:20.000
For example, This was about smoking, but I found this one paper I really liked that if you had, for example, a chain smoker, a very heavy smoker in your family, you tend to have a kind of a smoker, a very heavy smoker in your family.

338
01:04:20.000 --> 01:04:27.000
You tend to have a kind of a bifurcated reaction to that which is that you also become a chain smoker or you hate smoking and never want to try it ever, right?

339
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And so maybe a similar thing could be seen with drinking. When it comes to older adults, I found that prior studies We're tying.

340
01:04:37.000 --> 01:04:48.000
The maybe characteristics of the marriage itself and how that could lead to drinking instead of mortal status but but there is some maybe some tie between marriage.

341
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And marital relationship and drinking.

342
01:04:53.000 --> 01:05:03.000
So here is some theoretical you know notes about social participation in older ages and why it might be tied to alcohol abuse and by social.

343
01:05:03.000 --> 01:05:20.000
So one thing I want to say is that this is more for the RC 11 next door which is the aging group but but they hear a lot about that we want older people if you're no longer working and no longer or if you're not with your kids or grandkids that we want them to be productively engaged and

344
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and that being socially active in your community. Might have a number of health benefits. And we might think that some social activities are linked to avoiding alcohol.

345
01:05:31.000 --> 01:05:44.000
Just one that might come to mind is maybe religion, right? Maybe you're if you're very religious and you're in the community, maybe your religion ascribes with either limited drinking or no drinking.

346
01:05:44.000 --> 01:05:52.000
But could it also be that some social activities are associated with drinking more alcohol? That's one thing that we explore in our study.

347
01:05:52.000 --> 01:06:07.000
This kind of dark side of linked lives, which in gerontology I find that we don't talk about this that much that so maybe like dark-sided link lives maybe you're a teenager you hang out with other troublemakers then it's good to have friends but maybe not those friends kind of thing.

348
01:06:07.000 --> 01:06:15.000
We don't seem to talk about this when older adults and I but I think that Ray could be tied to maybe some.

349
01:06:15.000 --> 01:06:19.000
Behaviors like drinking. What about gender differences in alcohol abuse? Again, I'm focusing on late life.

350
01:06:19.000 --> 01:06:33.000
Clearly, particularly in the past and we're talking about somebody who's 70 now, right, when they were a teenager was, you know, 50, 60 years ago.

351
01:06:33.000 --> 01:06:47.000
So, lot of countries has and even now of course have gender drinking norms. What I have found is that men tend to abuse alcohol more, although this gap is narrowing particularly in countries, although this gap is narrowing particularly in countries such as Australia and the United States.

352
01:06:47.000 --> 01:06:57.000
In, what I found with women again with my limited study is that there's, again, this is an gender difference that women are more likely to mimic their spousal drinking behavior, whether it's heavy drinking or not drinking at all, right?

353
01:06:57.000 --> 01:07:10.000
And maybe men just do them and then, for example, and then women kind of follow. In those cases.

354
01:07:10.000 --> 01:07:15.000
And right, I cared about social participation, so oh, we know a special builder adult social participation networks differ by gender.

355
01:07:15.000 --> 01:07:27.000
So might those different kind of networks shape the drinking by gender? Okay. I changed the color for Ireland, right?

356
01:07:27.000 --> 01:07:39.000
I wanted to give some tribute to Ireland. So I don't do a formal comparison partly because of the different type of data but just thinking about how might this differ there's kind of like 2 different papers actually 2 different studies for at least for now and then I kind of do a light comparison.

357
01:07:39.000 --> 01:07:54.000
Why is Ireland interesting? You know, there's kind of this stereotype in the world level about Ireland and drinking and being involved in the community and we see this in that export of pub culture, right?

358
01:07:54.000 --> 01:08:02.000
You go to every country and there's an Irish pub for some reason, right? But yes, could this could this tie to older adult drinking?

359
01:08:02.000 --> 01:08:10.000
We also think of Irish as Ireland as a very religious country, Irish Catholicism that could that change drinking norms.

360
01:08:10.000 --> 01:08:20.000
And this is one that I'm still working with Katrina with, but could there be also gendered drinking norms that differed between the US and Ireland.

361
01:08:20.000 --> 01:08:28.000
So just very quickly about the data, I used this study called the Wisconsin Lunitudinal Study that we can talk about if you have some questions.

362
01:08:28.000 --> 01:08:42.000
But basically, 10,000 men and women that graduated high school in 1,957 and then so a couple of reasons i use this study but one of them is that starting in age 53 they asked actually quite detailed alcohol questions and detailed social participation questions.

363
01:08:42.000 --> 01:08:53.000
So that helped me. They surveyed them about every, what is this, 1015 years so we have for this study 3 ways of data when they were in their early fiftys, early sixtys and early seventys.

364
01:08:53.000 --> 01:09:00.000
And for Ireland it's a little different but there's this anybody knows this this tilde of the Irish longitudinal study on aging.

365
01:09:00.000 --> 01:09:07.000
It doesn't fall. Well, anyway, right, so everybody in the Wisconsin study are the same age during the years.

366
01:09:07.000 --> 01:09:13.000
That's not the case in the Irish data. It's just 50 plus 7,000 and followed them also 3 times.

367
01:09:13.000 --> 01:09:20.000
That's what's publicly available. They were about 65 years old on average in all 3 of those waves.

368
01:09:20.000 --> 01:09:31.000
So I think this is just very just some very interesting descriptive that right so I think the descriptive data here is actually kind of interesting and or maybe at least I think it's so.

369
01:09:31.000 --> 01:09:38.000
This is bisects which we're using as a proxy for gender. So that I don't, you'll see later.

370
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I don't like to throw a lot of numbers usually up but. So for females, we see, now remember, this is the Wisconsin longitudinal study.

371
01:09:50.000 --> 01:09:54.000
So they are all the same age. So this actually shows you that for female as they're getting older they're drinking slightly more days per week.

372
01:09:54.000 --> 01:10:04.000
Slightly more distantly and also for fermented right maybe one more day as they get older.

373
01:10:04.000 --> 01:10:09.000
Average 7 are they a regular at-risk as they get older? Average 7. They get older. Average 7.

374
01:10:09.000 --> 01:10:13.000
Are they a regular at-risk. They get older. Average 7. Are they a regular at-risk drinker.

375
01:10:13.000 --> 01:10:16.000
Right, that decreases at rates amend more than women, but decreasing as they get older. We can talk about that later.

376
01:10:16.000 --> 01:10:21.000
Is that that they're getting healthier or did they have your drinker is die off right that could be part of it too.

377
01:10:21.000 --> 01:10:36.000
I mean so this is a self-reported that did you have these kind of alcohol abuse or alcoholic symptoms and you can see there again slightly more than women write the decreases as they get older.

378
01:10:36.000 --> 01:10:52.000
For Irish descriptive. Oh, okay, and because this show also changes between waves. So when I'm only for a lot of that I'm just trying to highlight the interesting thing not give you everything in Ireland the descriptive statistics did not change much between waves at all.

379
01:10:52.000 --> 01:10:55.000
So this is just the overall what I found. And again, they measured alcohol a little differently, but did you drink any alcohol at all over the past 6 months?

380
01:10:55.000 --> 01:11:19.000
75, 80%. Were you a weekly drinker hovering around 50%? Were you a weekly drinker hovering around 50% slightly more with men?

381
01:11:19.000 --> 01:11:30.000
All right, so I think this is, right. So I think we're just getting to the results now and I just have a little bit so.

382
01:11:30.000 --> 01:11:35.000
I just wanna make sure. Okay, so I measured a few different types of drink. Okay, this is where I said.

383
01:11:35.000 --> 01:11:42.000
One interesting thing about alcohol is that it's measured, so like what is alcohol misuse? What is alcohol abuse? What is binge drinking?

384
01:11:42.000 --> 01:11:47.000
Kind of differs by country. Sometimes it differs by gender or what they say to the norms and it's changing all the time.

385
01:11:47.000 --> 01:11:52.000
So we do measure a couple of different things. So this is just, did you drink at all? How many days do you drink a month?

386
01:11:52.000 --> 01:12:06.000
And so one thing we found here is that meeting your friends regularly, which we usually think good, but it leads to, sorry, it leads to, but meeting your friends more tend to drink more days per month.

387
01:12:06.000 --> 01:12:22.000
Anything by the way above one kind of means increased odds anything lower than one decreased odds. Those that exercised in a group fashion tended to drink more regularly more days per month than those that did not exercise in a group.

388
01:12:22.000 --> 01:12:31.000
So that there we go with a regular at risk. So this is more at risk drinking, right? This is those that consume quite a number of drinks in one sitting regularly.

389
01:12:31.000 --> 01:12:42.000
Again, meeting your friends regularly more likely to have this type of drinking behavior. This is in the US, more likely to have this type of drinking behavior. This is in the US.

390
01:12:42.000 --> 01:12:47.000
If you have frequent religious participation. This is in the US. If you have frequent religious participation less likely to do that and if you're involved in arts, if you have frequent religious participation, less likely to do that.

391
01:12:47.000 --> 01:12:51.000
And if you're involved in arts and cultural events, less likely to do that. And if you're involved in arts and cultural events, and if you're involved in arts and cultural events, less likely to perhaps be an at-risk drinker.

392
01:12:51.000 --> 01:12:57.000
So these are again, this is the alcohol dependence. Do you report the symptoms perhaps being alcoholic or alcohol dependence?

393
01:12:57.000 --> 01:13:07.000
The 2 most interesting things I found were, did you live with an alcoholic as an adult? Or as a child, they both had the same right.

394
01:13:07.000 --> 01:13:16.000
You could be compounded if you had his adult and a child, it would increase it even more. I'd increase your odds by 4 times of of reporting.

395
01:13:16.000 --> 01:13:20.000
Alcohol dependence. Now this doesn't mean you actually do drink currently, right, but that you kind of classify yourself as being a problematic drinker.

396
01:13:20.000 --> 01:13:31.000
And interestingly enough, in this religious participation, the more religious you are, you were more likely to claim alcohol dependence.

397
01:13:31.000 --> 01:13:35.000
Again, it doesn't mean that you were actually drinking more.

398
01:13:35.000 --> 01:13:40.000
I did not know notice much in the way of gender differences actually in the United States. There's just a couple I'm going to highlight here.

399
01:13:40.000 --> 01:13:50.000
So men were more likely to engage at at-risk drinking when they were divorced or with when they met their friends.

400
01:13:50.000 --> 01:14:00.000
That kind of friendship drinking seemed to be a lot more with men. And also right, we're being divorced and increase your risk of drinking for men not for women.

401
01:14:00.000 --> 01:14:09.000
But talking about alcohol dependence or signs of it was more likely with women. Again, so almost this, well, anyway, talk about this later.

402
01:14:09.000 --> 01:14:16.000
So last we will talk about Ireland. Do I want to highlight some things here? So this is just, do you drink alcohol at all?

403
01:14:16.000 --> 01:14:26.000
Not surprisingly, men more likely to do it, but for women here it was the social component for women but not for men were you a member of these social organizations more likely to drink alcohol at all.

404
01:14:26.000 --> 01:14:27.000
Man, it didn't matter. Did you have a lot of close friends? For women it was higher but not for men.

405
01:14:27.000 --> 01:14:34.000
So almost you're seeing this anyway a little different than the US. Were you a weekly drinker?

406
01:14:34.000 --> 01:14:46.000
Again, this says the same thing. It's really what I want to focus here on the women or you a member of the social club do you have a lot of close friends then you're more likely for an Irish older woman to drink alcohol compared to those that were not like that.

407
01:14:46.000 --> 01:14:55.000
But the alcohol abuse and you had a lot of friends was more for men. So a brief discussion last couple I think in the last 2 slides.

408
01:14:55.000 --> 01:15:10.000
For for in the United States. Being married was a, I didn't really show this, but being married was associated as an older adult again associated with more daily drinking but less at risk drinking.

409
01:15:10.000 --> 01:15:22.000
And as I said, more for men, but this idea of that, and we don't want people socially isolated but they're hanging out with their friends and maybe because of that they're more likely to drink. And maybe because of that they're more likely to drink. You know, why is that?

410
01:15:22.000 --> 01:15:26.000
It could be this kind of birds of a feather, why is that? It could be this kind of birds of a feather, right?

411
01:15:26.000 --> 01:15:30.000
If you like to drink, you're going to seek out people that drink maybe. If you just something that people do, if there may be men watching the football game in the United States or something like that.

412
01:15:30.000 --> 01:15:48.000
There's somebody that told me and there might be some I'm not a psychology expert but there someone said there's something to do with extroverted individuals and they more likely to want to hang out with friends or also extroverted individuals might be more likely to actually like to drink too.

413
01:15:48.000 --> 01:15:56.000
So I thought that was kind of interesting. I don't talk about the results here, but for gender, gender scholars here, there's a much more complicated relationship between alcohol and either your spouse or relationship status or man who was a little more simple.

414
01:15:56.000 --> 01:16:15.000
And then for Ireland, my last what 3 points here, that religious participation in Ireland was protective against all 3 types of alcohol use that was more complicated in the United States.

415
01:16:15.000 --> 01:16:23.000
For women right at, yeah, closer friends and social groups and I didn't show it here but Ed education was associated with greater drinking in Ireland, it was a little more complicated in the United States.

416
01:16:23.000 --> 01:16:33.000
That's it. Thank you.

417
01:16:33.000 --> 01:16:37.000
Thank you.

418
01:16:37.000 --> 01:16:49.000
To be fantastic. Let's just get the limo on the screen as well. Oh.

419
01:16:49.000 --> 01:16:57.000
Highly mock. Can you see us or? Yeah, we can all see you. That's fantastic.

420
01:16:57.000 --> 01:17:09.000
Right. So I'll just ask you if you like to ask a question if you don't mind coming to the micron if you don't mind coming to the mic just so that Limore can't mind coming to the mic just so that Limore can hear as well.

421
01:17:09.000 --> 01:17:29.000
So, and can I invite some Q&A, some questions? Yes, okay. Would you like to introduce yourself as well when you ask the question.

422
01:17:29.000 --> 01:17:33.000
Seeing text to stroke.

423
01:17:33.000 --> 01:17:38.000
So I have another question as well as agree with this.

424
01:17:38.000 --> 01:17:44.000
So.

425
01:17:44.000 --> 01:17:50.000
A friend of the attack was

426
01:17:50.000 --> 01:18:00.000
Okay.

427
01:18:00.000 --> 01:18:07.000
I can't hear. Sorry.

428
01:18:07.000 --> 01:18:11.000
Hi.

429
01:18:11.000 --> 01:18:12.000
I didn't hear.

430
01:18:12.000 --> 01:18:28.000
This is like, Thank you. Okay, great. And hi, thank you for your wonderful presentations and shouting from the Chinese University of Hong Kong and I first have a question for Sabrina because you your research cover men and women and married and single and I don't know maybe heterosexual and

431
01:18:28.000 --> 01:18:38.000
non-heterosexual so I wonder if there is any differences in their narratives and their rows, degrees or ways of action.

432
01:18:38.000 --> 01:18:50.000
And also I have some questions for them more. I wonder why is it important to study the willingness to pay in the first place?

433
01:18:50.000 --> 01:19:07.000
And then, like, do you think there is any? Exogenous factor of this variable like since the the Israeli state is very generous in covering IVF costs and it has been selectively pro-natalist.

434
01:19:07.000 --> 01:19:20.000
Do you think that the belief that the state should be is responsible for covering IVF would affect how people evaluate their willingness to pay their willingness to pay and then a probable related fraction is to pay.

435
01:19:20.000 --> 01:19:30.000
And then a probable related fraction is to pay and then a probable related fraction is is there any differences in terms of ethnicity and religious background if it is covered in your research. Is there any differences in terms of ethnicity and religious backgrounds if it is covered in your research?

436
01:19:30.000 --> 01:19:37.000
And then lastly, do you think what are some other perspectives to understand? Commodities of IVF.

437
01:19:37.000 --> 01:19:47.000
Besides the weakness to pay. Thank you. And what's the?

438
01:19:47.000 --> 01:19:59.000
Okay. So, As for the willingness to pay, As I said, the willingness to pay is based on the assumption that the maximum amount.

439
01:19:59.000 --> 01:20:09.000
Of money and individual is willing to pay or for a commodity is an indicator of the value to him off date.

440
01:20:09.000 --> 01:20:21.000
And it's it's not important if the state funds the IVF treatments or not because it's kind of.

441
01:20:21.000 --> 01:20:40.000
And, it's kind of, I think, in the cater about the utility a person have from, the IVF treatment and it's not important even if he is a patient or not.

442
01:20:40.000 --> 01:20:51.000
In other studies, I, I, did, I ask also the general public about their willingness to pay for IF treatments.

443
01:20:51.000 --> 01:20:57.000
And, and even, even though the general public don't have fertility problems.

444
01:20:57.000 --> 01:21:05.000
And so the willingness to pay question is very a good question because it's actually predicts the utility.

445
01:21:05.000 --> 01:21:20.000
From a commodity or service. Well, there are other, ways to, evaluate utility, but I did not use them in my research.

446
01:21:20.000 --> 01:21:39.000
Very like to use the willingness to pay methods. I think it's very easy. And it's very and communicated a communicative to use people understand the willingness to pay questions and and answer them well.

447
01:21:39.000 --> 01:21:46.000
So I use the willingness to pay and I think it's very appropriate for a for my and research.

448
01:21:46.000 --> 01:21:54.000
A call regarding the Israeli Israeli, yeah. Well, Israel is very prominent at least.

449
01:21:54.000 --> 01:22:08.000
Nice country. And because of the Israelis history, the Holocaust, Israel's wars, etc.

450
01:22:08.000 --> 01:22:17.000
So, that's why Israel a, funds and they fertility treatments.

451
01:22:17.000 --> 01:22:41.000
And, if it's right or not, it's not for me to say. I can only, try to find out whether, the public or the patients are willing, willing to pay for IVF treatments and according to most of my research the public and patients are willing to pay for I don't

452
01:22:41.000 --> 01:22:53.000
know if there was another question that I didn't answer. So we have to answer.

453
01:22:53.000 --> 01:22:54.000
I can't hear.

454
01:22:54.000 --> 01:22:55.000
Yeah, OK, that's OK. Thank you very much. So that's a very good question.

455
01:22:55.000 --> 01:23:18.000
And I'm thinking about it as giving you the answer I think so In our sample, all the participants that we talked to were all involved in a heterosexual relationship so in that way I can't really say what would have happened if they were not.

456
01:23:18.000 --> 01:23:38.000
Parents, I think we had one or 2 who came from same-sex. Parental from same-sex parents but that didn't seem to make a difference in the way they got involved or the type of claim-making activities that they made.

457
01:23:38.000 --> 01:24:02.000
I would say if there was any difference at least in the way they experienced the discovery of the fraud is what type of insemination fraud they were victims of victims of so for example I know the people who discovered that they were conceived with this sperm of the doctor while they had a a harder time dealing with the fact that they were

458
01:24:02.000 --> 01:24:16.000
byologically related to the author of the fraud. So some of them were worried that maybe that that doctor who didn't have like a very, very great ethics, well, what does it mean about me?

459
01:24:16.000 --> 01:24:25.000
You know, being related to and it also like I think the differences is how they discovered it. So were they young when they discovered it?

460
01:24:25.000 --> 01:24:31.000
Were they old? What kind of relationship they had with their father, what kind of relationship they had with their father.

461
01:24:31.000 --> 01:24:40.000
So all those things tie in more than I think. The sexual orientation or the gender of the person.

462
01:24:40.000 --> 01:24:48.000
Next question. That's right.

463
01:24:48.000 --> 01:25:00.000
We'll sort of come up with the Sometimes. Hi, my name is Lenin and I am from the Chinese University of Hong Kong and my background is social work.

464
01:25:00.000 --> 01:25:22.000
So I'm a doctor of social work candidate at Hong Kong Polytechnic University and my question actually the first one is to Limer because like I know IVF is like the, the, the motivation why people are doing, like in China they are trying to after the release of the

465
01:25:22.000 --> 01:25:43.000
one child policy and many people like the middle aged people they need to go IVF for infertilization and I don't know like according to your study do you have some like why people doing IVF is because of which kind of reason the motivation.

466
01:25:43.000 --> 01:25:52.000
And Is that clear?

467
01:25:52.000 --> 01:25:53.000
It's based.

468
01:25:53.000 --> 01:26:00.000
Should I answer? Yes, okay. So in Israel, only individuals with fail to conceive for a year or more.

469
01:26:00.000 --> 01:26:13.000
And and receive the approval of a committee of expert for the IVF treatment. Are, are unable to, have a IVF treatments.

470
01:26:13.000 --> 01:26:25.000
According to the Israeli regulation, IVF is indicated only for unexplained fertility and endometriosis, mechanical infertility and male infertility.

471
01:26:25.000 --> 01:26:43.000
That's the reasons for, individuals to have, IVS treatments. And the country, as I said before, and funds the, IVF treatments.

472
01:26:43.000 --> 01:26:47.000
I am comfortable about that. This year and the like in Geneva.

473
01:26:47.000 --> 01:26:52.000
I don't understand if I don't I don't hear so

474
01:26:52.000 --> 01:26:59.000
Just try.

475
01:26:59.000 --> 01:27:11.000
Why?

476
01:27:11.000 --> 01:27:12.000
In in Israel.

477
01:27:12.000 --> 01:27:16.000
Why are you waiting? Okay, is there any difference that first your generation of IVF first generation second generation and third generation so I, yeah, for ART.

478
01:27:16.000 --> 01:27:29.000
Of course there is Israel and has had a significant impact over the 30 years about, er, in IVF research and then.

479
01:27:29.000 --> 01:27:53.000
Promoting IBF using IVF, of course. It's very important for, the Israeli, there's really people to have children and IVF is one way and to do it when we you have If fertility problems and there are of course, they, they're the generation of

480
01:27:53.000 --> 01:27:59.000
IVF children in Israel, of course. But I did not. Research.

481
01:27:59.000 --> 01:28:12.000
Or I did not ask children or parents for children about their children and And it's not my questions in my, in my research.

482
01:28:12.000 --> 01:28:29.000
The questions I ask is about the utility the willingness to pay and whether the country should fund yeah, fertility treatments according to the, economic theory.

483
01:28:29.000 --> 01:28:37.000
Maybe I did not understand what you asked, but II couldn't, I couldn't hear you well.

484
01:28:37.000 --> 01:28:43.000
I think that's fine. Thank you very much Nimal. Next week up, yes, at the back.

485
01:28:43.000 --> 01:28:46.000
Sure.

486
01:28:46.000 --> 01:28:52.000
Yeah.

487
01:28:52.000 --> 01:28:58.000
Is hopefully it's working. Is it working? Oh, so it's a bit fair. Just move around.

488
01:28:58.000 --> 01:29:07.000
It might work. Talk to the

489
01:29:07.000 --> 01:29:30.000
So, Yeah. You just seem to have to shake it and it works. And just about the pandemic and I wasn't not sure if you

490
01:29:30.000 --> 01:29:44.000
That before or happening that means. So yeah, we'll say something about that.

491
01:29:44.000 --> 01:29:56.000
Yes, both in both, great question. And actually in the alcohol session 2 days ago some there was one feel country they were looking at now.

492
01:29:56.000 --> 01:30:12.000
I guess it was Australia, but they were looking at that. They were wondering if, oh, it's early in the get right it's early work but there were Yes, we've heard about these stories about that people will drink more, but I don't think we know as much details, especially like you said.

493
01:30:12.000 --> 01:30:34.000
age. Both of my studies were done the more recent about 2,010 was the most recent way of 2,012 so I guess they were 10 years old so it had nothing to do with the pandemic but you Make a good point and the only anecdotal evidence I had near my university they have this kind of I

494
01:30:34.000 --> 01:30:54.000
like continuing education or classes that a lot of older people take and one interesting thing is that after the pandemic was not as bad or whatever, some met and they did say yes that older adults did not really still want to go out as much even though they kind of got used to their sedentary lifestyle and there was some that did talk

495
01:30:54.000 --> 01:31:05.000
about drinking more actually but again I don't know if that means more frequently. Right? I kind of think it was a little more more frequently or were they actually binge drinking more or etc.

496
01:31:05.000 --> 01:31:11.000
I'm not sure about that but Yes, thank you for your question. It's definitely something.

497
01:31:11.000 --> 01:31:16.000
Yeah.

498
01:31:16.000 --> 01:31:24.000
Thank you very much for all of the questions from our study. I really looked at slightly because you have a standardized.

499
01:31:24.000 --> 01:31:28.000
I mean, they' a speech in Manning.

500
01:31:28.000 --> 01:31:33.000
I question is, do the new cousin is in class?

501
01:31:33.000 --> 01:31:40.000
FRANCIS, DATA research, Apart from London, and also from Johnson and I'm understanding that.

502
01:31:40.000 --> 01:31:48.000
Leaving line's a social anticipation is more said than to give him going to be in practice at big hunting down.

503
01:31:48.000 --> 01:31:58.000
Even as it's integrating the social anything about this. You mentioned about the social gathering also of a Google more chance.

504
01:31:58.000 --> 01:32:18.000
2, Instead of choosing with us because a source of participation can support people to to to bring back Lennis and I have big impressions because you if you see in your slide Rein, you say that.

505
01:32:18.000 --> 01:32:22.000
People bring the

506
01:32:22.000 --> 01:32:31.000
After that, I've been engaged in social transportation is also kind of big enough that it thinks about Bringing habits.

507
01:32:31.000 --> 01:32:40.000
So. Fine It's also magnification is a example of the

508
01:32:40.000 --> 01:32:54.000
Oh, is it more of a, yeah, yeah, thank you. So yeah, so the one question was about class and so one question was about class and so one mistake I made for both of my presentations as I try to streamline my slides.

509
01:32:54.000 --> 01:33:04.000
Yeah, so the one question was about class and so one mistake I made for both of my presentations as I is, I try to streamline my slides by not just throwing a lot of my presentations as I is, I try to streamline my slides by not just throwing a lot of numbers, but then I didn't have the other

510
01:33:04.000 --> 01:33:13.000
numbers. As I is, I try to streamline my slides by not just throwing a lot of numbers, but then I didn't have the other numbers that I ran, right?

511
01:33:13.000 --> 01:33:20.000
So I did look at, and I mentioned only one here about the, about the relationship with education and alcohol, but I definitely looked at income, of course with older adults income maybe is not as it's harder to tell sometimes, right?

512
01:33:20.000 --> 01:33:31.000
Because maybe someone's rich, but they don't Yeah, your question though about social participation and overall is it more facilitated or

513
01:33:31.000 --> 01:33:45.000
Yes, and then it comes what I said like the what came first right that maybe people that were gonna use alcohol out anyway seek out people that help that I don't say enablers right but if that's one of the hobbies they like, right?

514
01:33:45.000 --> 01:33:54.000
They're going to seek out people to do that hobby anyway. You know, it's almost like drinking it's, well no, that's not.

515
01:33:54.000 --> 01:33:58.000
In general, I think of course social participation is good. We want we don't want social isolation.

516
01:33:58.000 --> 01:34:05.000
We don't want people that are older adults because we do know that leads to all sorts of mental and physical and early death actually.

517
01:34:05.000 --> 01:34:15.000
So I think on the whole social participation is, is good. I just think, yeah, for people that are already problem problematic drinkers.

518
01:34:15.000 --> 01:34:23.000
But it's almost like alcohol use, right? We heard all, I didn't mention this, but we, 15 years ago we said a glass of wine is good for you, right?

519
01:34:23.000 --> 01:34:33.000
It's good for your heart. They still kind of think that one glass of red wine is okay for your heart but it's upset by higher risks of like 20 different types of cancer.

520
01:34:33.000 --> 01:34:41.000
So now there are saying the World Health Organization is now saying we can't support any type of drinking at all.

521
01:34:41.000 --> 01:34:49.000
Australia because you know when you like them was also gathering people saying that yes, glass and white's okay.

522
01:34:49.000 --> 01:35:00.000
I have the lots of music. So I don't really die of understand how people have sat high on the slogan about, yeah, I'm paying for your difference. Yeah.

523
01:35:00.000 --> 01:35:11.000
And how is the effect of we go about the high cost. Wow. And I think that's when you get out of it.

524
01:35:11.000 --> 01:35:17.000
It's funny, well yes, and we know that people that drink when they're younger of course are more likely to drink when they're older of course are more likely to drink when they're older.

525
01:35:17.000 --> 01:35:20.000
I found the most interesting thing actually is when they're older. I found the most interesting thing actually is that as people got older, I found the most interesting thing actually is that as people got older they were drinking more frequently, maybe not drinking more.

526
01:35:20.000 --> 01:35:25.000
But it's funny you said that and I don't want to talk too much but I lived in Australia a couple years because you said you're talking about Australia social gatherings at work.

527
01:35:25.000 --> 01:35:36.000
It's very popular in Australia more than the US, right? US people love to work, but then they totally go home and they, so if they have drink it's with their other friends, right?

528
01:35:36.000 --> 01:35:37.000
We're all straight. But I was thinking about that because when I was going to social gatherings, I did feel more included.

529
01:35:37.000 --> 01:35:53.000
Kind of this dirt high meal or something and I felt like I'm part of this group and I have all my friends and their lifelong friends, but then I thought, gee, some of the things we're doing here might not be good for us right so it is that I don't know which is more powerful but

530
01:35:53.000 --> 01:36:04.000
thank you. Thank you so much. Yeah.

531
01:36:04.000 --> 01:36:20.000
You'd be discuss that?

532
01:36:20.000 --> 01:36:36.000
And then we have been trying it out. Yeah, that's a lot. It's never cluttered in the West End place.

533
01:36:36.000 --> 01:36:43.000
I thought, yeah, yeah, yeah.

534
01:36:43.000 --> 01:36:55.000
Follow up the discussion about the you know the source openness and also in a participation I think depending on what sort of activity you are, what sort of club you are joining.

535
01:36:55.000 --> 01:37:19.000
So either you are naveling or you know, encouraging people smoking in answers drinking. So that was in your motto you can sell you know if you are religious people right you participate in church meetings or not so you tend to be less slowly to drink but if you are choi you know social club hanging around with your friend and then

536
01:37:19.000 --> 01:37:25.000
you've got a fear that while you drink more you smoke more. So I think it's more, you smoke more.

537
01:37:25.000 --> 01:37:30.000
So I think it's also connects me either, And I've got it all good for the mental health.

538
01:37:30.000 --> 01:37:36.000
Because it's it's it can do with the, depression, you know, lotliness.

539
01:37:36.000 --> 01:37:42.000
But depending on what sort of a club you are joining. So, not to be,

540
01:37:42.000 --> 01:37:58.000
We should now, you know, negative for state. Right. And the question for Limoi, you talking about, the treatment of, infinity, you know, having a stronger effect on women than men.

541
01:37:58.000 --> 01:38:10.000
So, I could think the depending on you know the problem of infinity from which partner, either a female partner or male partner.

542
01:38:10.000 --> 01:38:23.000
The problem from your main partner, you know, Marathon, hopefully, I don't think you have a very strong worry concern about you know because this is also normal to a woman.

543
01:38:23.000 --> 01:38:45.000
If you don't have IV and then you know people look at you with the strain eyes so you concern and you worry and that's why you know the effect on your you know on woman is stronger than on men so I wonder whether in your symbolsai or representative of a couple having infinity.

544
01:38:45.000 --> 01:38:50.000
By my gender, you know, how many percent my men and Muhammad was in my woman.

545
01:38:50.000 --> 01:38:53.000
Thank you.

546
01:38:53.000 --> 01:39:12.000
Well, my, research, I'm looking for the data. Was about I think that for my memory it was about 142 women and 62 men.

547
01:39:12.000 --> 01:39:29.000
That participated in the research. In the survey and as they answered the same questions. There were, the both were, people with fertility problems.

548
01:39:29.000 --> 01:39:43.000
And they were not couples, they actually. There were women and men separately that have infertility problems and participated in the server.

549
01:39:43.000 --> 01:39:50.000
It's about as I said, 142 or a woman and 60, 62 men.

550
01:39:50.000 --> 01:40:04.000
That was the sampling. In my research. And regarding your question about the women and And man, well,

551
01:40:04.000 --> 01:40:15.000
We, try to find out statistically if there was a difference between them. And yes, there was a significant difference between men and women.

552
01:40:15.000 --> 01:40:33.000
Regarding their satisfaction regarding their psychologically psychological emotions. And women and and women influenced more and and than men.

553
01:40:33.000 --> 01:40:43.000
That's what this was my, yeah. That's where my results from my studies.

554
01:40:43.000 --> 01:40:55.000
Can you answer this question? Okay, yeah. About the, and I forget if you said this about the, and I forget if you said this about the, so when you talked about that maybe some of the physicians were confronted.

555
01:40:55.000 --> 01:41:04.000
So when you talked about that maybe some of the physicians were confronted, of course most of them said nothing, so when you talked about that maybe some of the physicians were confronted, of course most of them said nothing, some of the physicians were confronted, of course most of them said nothing, which I couldn't write part of that is

556
01:41:04.000 --> 01:41:06.000
probably a legal issue right. Part of that is probably a legal issue right there probably maybe they talked to the lawyer.

557
01:41:06.000 --> 01:41:21.000
Are there I think I might have read one of the same motivation but but have there been instances later of the physicians then talking about what they did and either remorse or reasons why and I think I might have read about one but I'd be interested to hear about it.

558
01:41:21.000 --> 01:41:22.000
So.

559
01:41:22.000 --> 01:41:27.000
I don't and don't I I'm not sure I understood what your question is can you repeat it please?

560
01:41:27.000 --> 01:41:36.000
Oh, that was for me about the insemination of fraud. So the question was what were the motives of the doctors?

561
01:41:36.000 --> 01:41:40.000
Did they explain why they did what they did?

562
01:41:40.000 --> 01:41:41.000
Okay.

563
01:41:41.000 --> 01:41:48.000
Yeah. And so, so the physicians when they were contacted directly by the patient, the patient that donor conceived people, none of them wanted to give an answer.

564
01:41:48.000 --> 01:42:02.000
The patient that donor conceived people, none of them wanted to give an answer as to why. A lot of them wanted to give an answer as to why. A lot of them kept quiet like they didn't.

565
01:42:02.000 --> 01:42:12.000
Some of them said It was they were trying to calibrate whatever the tools that they were using and they used their osprend to calibrate and then there was some contamination.

566
01:42:12.000 --> 01:42:21.000
Others said, well, the day your parents came, there were no donors. So your parents wanted a child.

567
01:42:21.000 --> 01:42:26.000
I was there. I provided this firm. I figured they wanted to be inseminated. So what was the big deal?

568
01:42:26.000 --> 01:42:36.000
You have to realize also the seventys and eightys they didn't realize that they would be exposed like this.

569
01:42:36.000 --> 01:42:45.000
But then others like the one, I don't know if you've seen the Netflix documentary, but basically, no, you haven't.

570
01:42:45.000 --> 01:42:58.000
Okay, so, so in in his case, It was really intentional because one of the person I talked to he said his parents went to him for the first time.

571
01:42:58.000 --> 01:43:06.000
And he they were supposed to use the father's purr. So in that first attempt he used his program.

572
01:43:06.000 --> 01:43:16.000
And and about a hundred like almost a hundred 94 people were conceived with his own sperm so it's not an error, it's not because a daughter didn't show up.

573
01:43:16.000 --> 01:43:26.000
It was So, but then it's left to our, yeah, he, he, he didn't really explain why.

574
01:43:26.000 --> 01:43:36.000
To be I think the key is that why, you know.

575
01:43:36.000 --> 01:43:50.000
Like a key reason why you don't know, you know, find it's only reason I'm so litter the reasons the reason why doctors do that?

576
01:43:50.000 --> 01:44:08.000
Again, like it So In some cases it's almost ideological. In other cases you could we could speculate that maybe they wanted to increase the success rate.

577
01:44:08.000 --> 01:44:22.000
So sometimes in some cases the doctors tried with the chosen sperm sample and after failed like a series of failed attempts He swapped and sometimes he used his own.

578
01:44:22.000 --> 01:44:32.000
But these are speculations because he didn't really, they don't really exactly say because of course legally than they would be.

579
01:44:32.000 --> 01:44:46.000
If they say that it was intentional, then legally they are accountable. So most of the time they just keep quiet and don't really explain why they did what they did.

580
01:44:46.000 --> 01:44:59.000
And some of them were I mean, the situation was exposed where they were already dead. So that again, like we can't really know their motivation but But it is disturbing.

581
01:44:59.000 --> 01:45:09.000
Very disturbing. Spending on a wall by in Guantanamo and Lazi Maya.

582
01:45:09.000 --> 01:45:20.000
On some of them yes but as I said again like some of them didn't even try with the chosen sperm.

583
01:45:20.000 --> 01:45:28.000
Right away use their own. So is that a way to disseminate their genes, like having more children?

584
01:45:28.000 --> 01:45:32.000
So, but again, it's just a speculation. I can't really tell. But again, it's just a speculation.

585
01:45:32.000 --> 01:45:40.000
I can't really tell what was going on in their mind. OK, so I'm going to bring this session to a close because it's getting 720 now.

586
01:45:40.000 --> 01:45:51.000
So I'd like to thank the presenters for some really interesting presentations. It raises real problems and real issues, doesn't it?

587
01:45:51.000 --> 01:46:00.000
In the contemporary era around, you know, medical technology. And some raises real ethical issues as well.

588
01:46:00.000 --> 01:46:09.000
And yeah, and Eric, thank you very much for yours as well. That was very interesting. Interesting discussion.

589
01:46:09.000 --> 01:46:18.000
So thank you very much everyone. And I'm sure if you want to carry on talking to our presenters afterwards you you can do but thank you very much for your excellent presentations.

590
01:46:18.000 --> 01:46:25.000
Thank you