Archive for the ‘Social Networking’ Category

The Internet Origin Story You Know Is Wrong – WIRED

But weve been telling the same story about Arpanet and the web for 25 years, and it isnt satisfying anymore. It doesnt help us understand the social internet we have now: It doesnt explain the emergence of commercial social media, it cant solve the problems of platformization, and it wont help us to imagine what comes after.

Todays social media ecosystem functions more like the modem world of the late 1980s and early 1990s than like the open social web of the early 21st century. It is an archipelago of proprietary platforms, imperfectly connected at their borders. Any gateways that do exist are subject to change at a moments notice. Worse, users have little recourse, the platforms shirk accountability, and states are hesitant to intervene.

Before the widespread adoption of internet email, people complained about having to print up business cards with half a dozen different addresses: inscrutable sequences of letters, numbers, and symbols representing them on CompuServe, GEnie, AOL, Delphi, MCI Mail, and so on. Today, we find ourselves in the same situation. From nail salons to cereal boxes, the visual environment is littered with the logos of incompatible social media brands. Facebook, Google, Twitter, and Instagram are the new walled gardens, throwbacks to the late 1980s.

In recent years, it has become commonplace to blame social media for all our problems. There are good reasons for this. After decades of techno-optimism, a reckoning came due. But I am troubled by how often peoplenot platformsare the object of this criticism. Were told that social media is making us vapid, stupid, intolerant, and depressed, that we should be ashamed to take pleasure from social media, that we are hardwired to act against our own best interest. Our basic desire to connect is pathologized, as if we should take the blame for our own subjugation. I call shenanigans.

People arent the problem. The problem is the platforms. By looking at the history of the modem world, we can begin to extricate the technologies of sociality from what weve come to call social media. Underlying many of the problems we associate with social media are failures of creativity and care. Ironically, for an industry that prides itself on innovation, platform providers have failed to develop business models and operational structures that can sustain healthy human communities.

Silicon Valley did not invent social media. Everyday people made the internet social. Time and again, users adapted networked computers for communication between people. In the 1970s, the Arpanet enabled remote access to expensive computers, but users made email its killer app. In the 1980s, the Source and CompuServe offered troves of news and financial data, but users spent all their time talking to one another on forums and in chat rooms. And in the 1990s, the web was designed for publishing documents, but users created conversational guest books and message boards. The desire to connect with one another is fundamental. We should not apologize for the pleasures of being online together.

Commercial social media platforms are of a more recent origin. Major services like Facebook formed around 2005, more than a quarter-century after the first BBSs came online. Their business was the enclosure of the social web, the extraction of personal data, and the promise of personalized advertising. Through clever interface design and the strategic application of venture capital, platform providers succeeded in expanding access to the online world. Today, more people can get online and find one another than was ever possible in the days of AOL or FidoNet.

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The Internet Origin Story You Know Is Wrong - WIRED

#InstagramDown: Users vent with memes, wonder if they should uninstall – The Indian Express

Instagram again went down for a number of users on Monday, with many rushing over to Twitter to complain and ask what was wrong with the photo-sharing app this time. It has suffered a number of outages recently. Many also wondered if it is time to log off permanently from the app.

Late on Monday, many users on the app were confused when their explore tab suddenly started showing posts that are not usually seen on their feed; most of them were nature-related posts. Others complained they could not send messages on the app and Instagram Stories wouldnt load.

So, this is pretty but can I have my Instagram feed back to normal. I love nature and aesthetics, but give me my memes back, wrote an user sharing photo of her feed, complaining on Twitter. Who called it Instagram glitch and not Mark Zuckerbug, another tweeted, taking a jibe at the companys CEO.

According to Down Detector, the site recorded nearly 1,200 reports in India with users unable to load Reels or failing to upload anything on Stories. The graph showed the outage peaking around 11 pm and things resolving in an hour. Many also wondered if it was time to say goodbye to the app.

However, that didnt stop netizens from having fun and sharing hilarious memes to react to the outage almost every now and then.

Lots of social media apps like Instagram, Facebook, and Twitter have been reporting outage in the recent past quite frequently, leaving netizens unhappy. Moving beyond social networking apps, food delivery services apps like Zomato and Swiggy too faced outage issues last month.

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#InstagramDown: Users vent with memes, wonder if they should uninstall - The Indian Express

Examination of influence of social media education through mobile phones on the change in physical activity and sedentary behavior in pregnant women:…

Design and sampling

This randomized controlled trial study with parallel groups was conducted on pregnant women referred to Urmia health centers in 20182019. The study was last 12months for execution, from April 2018 to May 2019. This trial was registered in Iranian registry of clinical trials (IRCT) in 05/06/2020 with IRCT20151004024340N15 identifying number. Also this study was verified by the Urmia ethics committee with IR.UMSU.REC.1397.162 code.

The sample size was calculated according to the Michele Bisson [29] study, because of the similarity in the targeted primary and secondary outcomes, where the moderate and vigorous physical activity (MVPA) index was 11.79.5min/day in their control group and 25.420.4min/day in their treatment group after the intervention. With the 90% of study power (Z1=1.28), and the two-sided alpha level at 0.05 (Z1/2=1.96), and a 10% chance of dropout, the sample size was determined 45 subjects for each group. Therefore, ninety subjects were included in the study. The flow diagram of participants has shown in Fig.1.

Flow diagram of entering the study and completing of trial by participants

Inclusion criteria in the study were: the tendency to participate in the study, having an ability for reading and writing, be under 20weeks of gestational age, lack of chronic diseases (i.e., diabetes, hypertension, kidney disease), lack of any medical limitation for improving physical activity by mother, no mental illness and no history of hospitalization (based on the participant's self-report), lack of cerclage and prenatal care, having a smartphone, access to the internet, and residence in Urmia. The exclusion criteria were: having any problems or special diseases in the current pregnancy such as preeclampsia, diabetes, anemia, high-risk pregnancy and cerclage surgery, frequent bleeding during the intervention, premature contractions, reduction of fetal movements, amniotic fluid leakage, diet for a specific disease, and migration from Urmia.

We used stratified sampling method for including subjects from different socioeconomic strata of Urmia. There were three levels of health centers; 1, 2, and 3 according to their social and economic status. Then, two centers from each category were chosen randomly by lottery (drawing). Also participants for each group were randomly assigned with one to one allocation ratio with the block randomization method. First, the blocks were created with the combination of AAABBB by computer and all the possible statuses were identified and an exclusive code was assigned for each. Next, considering the sample size (N=90) and block sizes (S=6), 15 blocks were chosen by a simple randomization method by the researcher. Selected subjects were allocated to control or intervention group consecutively by the study manager. All these stages were done under the provision of a consultant epidemiologist and using Random Allocation Software version 1.0.0.

In this study, demographic, Pregnancy Physical Activity Questionnaire (PPAQ) questionnaires was used and completed. Height measured with a Stadiometer and weight by a Seca scale. Demographic information questionnaire had questions such as age, weight, height, education level, employment status, economic status, BMI, pregnancy age, number of fetuses, number of pregnancies, history of the underlying disease, history of infertility, cerclage, ectopic pregnancy, and specific disease in the current pregnancy.

Standard PPAQ, which is related to physical activity in pregnancy, includes two parts: Part I consisted of information about individual characteristics and Part II includes 32 questions on physical activities. The questionnaire of pregnancy physical activity consists of 4 groups of questions related to activities: at home (16 questions), community (3 questions), and activity in the workplace (5 questions), and sports and entertainment (8 questions). Within the manual of PPAQ the categorization and classification of daily physical activities based on the intensity and duration of them has been explained well. Based on that manual sum of the values of multiplied intensity and duration for some activities within the questionnaire can predict the amount of MET/Min for each category of activities as sedentary, light, moderate and sever that has pointed in detail in the data analysis section.

After selection of subjects in the first meeting, the researcher introduced herself to mothers and explained the study purpose. Informed written consent was then obtained. Later the questionnaires related to personal information and physical activity were filled in. Body mass index (BMI) was calculated and assessed. The mothers weight was checked with minimum clothing and without shoes, using a digital scale with a precision of 100g. Peoples height was measured using a wall gauge with an accuracy of 1cm while standing barefoot by the wall, as the shoulders were in a normal position. BMI was calculated by dividing weight by height squared.

Based on weight status (i.e., normal, overweight, and obese) and through the permuted block randomization, all the pregnant women were randomly assigned to the control and treatment group by Random Allocation Software version 1.0.0. Both groups received individual diets according to BMI, by a nutritionist, who also provided the necessary explanations. All educational content in the format of text, audio, and video files was delivered and provided through of what's app as social media platform. All intervention and control subjects received their specific educational contents according to the prepared study protocol for each group.

The control group subjects were quiet match and nearly similar in properties with the intervention one. They received a routine pregnancy care that was provided by health care centers and were followed alongside with the intervention group in the same time period. Subjects joined a virtual group in a social network (What's app) that was accessible through both mobile, laptop or PC devices for all subjects from each centers in control group. They received prepared individually diets and materials about that how to track its effect on their weight gain during pregnancy. In parallel, the treatment group also joined a virtual training group in a social network (What's app), that was similarly accessible through mobile, laptop or PC devices for all subjects from each centers in intervention group. Just the difference that was for this group, they received special and prepared educational content as written, audio or video materials to improve their physical activity along with an individually designed diet during 16 sessions in 8weeks. The content delivered to the virtual group twice a week and in a specified time period. Each session was about 90min that all educational programs were delivered by an educated and specialized midwife. During different session subjects regarding the advantages of executing appropriate exercises and physical activities during pregnancy, introducing suitable exercises for pregnant women and the manner of their execution was educated. Also in some sessions topics about the necessary precautions and probably health risks with some activities was discussed. Reminder massages was sent twice a week regarding the importance of doing proposed exercises and activities truly, the importance of good adhering to the diet, and announcement about the time of next session and its content. All womens questions were answered both within the group and in private chat based on the type of question. The respondent rate for both groups was %87.8 in average. Mothers weights were recorded after a face-to-face meeting in the fourth week. All delivered massages deposited in virtual group by the end of intervention. Our primary outcome was measuring the amount of changes in the mean daily total physical activity level, while secondary outcomes were measuring the level of changes in other subgroups of daily physical activity alongside with the level of weight gain during pregnancy.

At the end of the intervention, pregnant mothers in both groups filled the PPAQ questionnaires for the second time. The data acquired in this phase were compared with the first one.

Quantitative data were reported as meanstandard deviation and qualitative data were expressed in the form of frequencies and percentages. Activity intensity was measured based on the amount of Metabolic Equivalent of Task (MET). To calculate the total MET/Min of activities, the MET level regarding the intensity of activities was multiplied by the amount of time spent per day. The level of daily activity determined based on the amount of MET/Min obtained for activities and their average per day. The categorization for the level of physical activity was done according to the PPAQ specific manual. An activity with MET/Min less than 1.5 was considered as inactivity or sedentary, with MET/Min 1.53 as light activity, with MET/Min 36 as moderate activity, and with MET/Min more than 6 as a sever activity. An independent t-test was used to compare the data about the groups for comparing them at start and at the end of intervention. A paired t-test was used for comparing changes within groups and comparing before and after data. Also, the chi-square test was used to compare data regard the qualitative variables between the two groups at start of the study. To control the possible influence of confounding factors and better determination of treatment effect, multivariate analysis was done. The significance level for all statistical tests was considered less than 0.05. We used per protocol analysis for comparing the extracted results between study groups. All analyses were performed using SPSS-21 software.

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Examination of influence of social media education through mobile phones on the change in physical activity and sedentary behavior in pregnant women:...

LinkedIn was the top targeted social media network for phishing attacks in Q1 – The Star Online

A new study has shown a growing trend in which hackers are impersonating popular social networking sites in order to obtain users personal information or payment credentials via phishing attacks.

Check Point Research, the threat intelligence arm of Check Point Software Technologies and a cybersecurity solutions provider, highlighted the brands that were most frequently imitated by cybercriminals in its Brand Phishing Report for the first quarter of this year.

LinkedIn shot to the top for the first time, accounting for 52% of all phishing attempts globally in January, February and March.

This is a significant 44% jump from the previous quarter, when LinkedIn was ranked sixth and was associated with only 8% of phishing attempts.

The other most-imitated companies are DHL (14%), which ranked top in the last quarter, Google (7%), Microsoft and FedEx (both at 6% each), and WhatsApp (4%).WhatsApp remains in the top 10, the research says, and that the messaging application is responsible for nearly one in every twenty phishing-related attacks worldwide.

If there was any doubt that social media would become one of the most heavily targeted sectors by criminal groups, the first quarter has laid those doubts to rest, Check Point Research said, as social media has surpassed transportation companies and technology behemoths such as Google, Microsoft, and Apple as the most targeted category.

The firm stated that its findings are based on data obtained from Check Point ThreatCloud and its Cyber Threat Map, which analyses cyberattacks in real-time around the world.

These phishing attempts are attacks of opportunity, plain and simple.

Criminal groups orchestrate these phishing attempts on a grand scale, with a view to getting as many people to part with their personal data as possible, said Omer Dembinsky, data research group manager at Check Point Software.

Typically, a hacker would attempt to steal user data by sending malicious emails using the brands name as the sender address, taking care to include elements such as the brands logo or colour scheme to make them appear authentic.

The report highlights an example where LinkedIn users were contacted via an official-looking email in an attempt to lure them to click on a malicious link.

Once there, users would be prompted to log in via a fake portal where their credentials would be harvested, the company said, adding that criminals will attempt to imitate the official website by using a similar domain and design.

In another example, a hacker used Maersks branding and a spoofed email address to make it appear as if it was sent from Maersk Notification.

The user was asked to download an Excel document that contained the Trojan known as Agent Tesla, a type of malware that is capable of granting access to a victims computer through a backdoor.

Some attacks will attempt to gain leverage over individuals or steal their information, such as those were seeing with LinkedIn.

Others will be attempts to deploy malware on company networks, such as the fake emails containing spoof carrier documents that were seeing with the likes of Maersk, Dembinsky said.

The brands of shipping companies like DHL and Maersk, he said, are being abused by threat actors to target both companies and consumers due to the rising popularity of ecommerce, and its critical that staff be taught to be more alert when it comes to recognising phishing schemes.

Employees in particular should be trained to spot suspicious anomalies such as misspelt domains, typos, incorrect dates and other details that can expose a malicious email or text message, he said, urging LinkedIn users to be extra vigilant over the course of the next few months.

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LinkedIn was the top targeted social media network for phishing attacks in Q1 - The Star Online

Public health perinatal promotion during COVID-19 pandemic: a social media analysis – BMC Public Health – BMC Public Health

Our Internet/social media analysis of perinatal health promotion by a multijurisdictional sample of Canadian governmental/NGO agencies reflected the emergence of COVID-19, impacts on health services and acknowledgement of considerable stress and uncertainty. Although it is well established that infectious respiratory diseases such as SARS, MERS and influenza are associated with increased disease severity and pregnancy complications including preterm birth and spontaneous abortion, [16] Canadian governmental agencies generally missed opportunities to disseminate COVID-19-associated perinatal health information via websites and social media platform-Facebook. Social media posts were regionally-relevant, included local COVID-19 restrictions, reports of outbreaks and evolving hospital/clinic access policies. Breastfeeding, infant care, labor/delivery, parenting support and healthy pregnancy were among the major perinatal themes promoted by governmental Facebook posts. NGO Facebook posts reflected the values and perspectives of host organizations, with Dad Central emphasizing fatherhood and Native Womens Association of Canada describing cultural and traditional practices associated with pregnancy.

Perinatal health promotion may be addressed in secondary school sexual education, prenatal classes, targeted interventions for communities marginalized by poverty, racism, xenophobia and other structural inequities, and generalized public health messaging. Generalized public health messaging is a cost-effective strategy that can work in concert with individualized counseling, targeted interventions and community-based programs to mitigate modifiable pregnancy risk factors. Such health communication campaigns typically increase uptake of desired health behavior by about 5% [21]. In the context of perinatal health promotion, online public health messaging may reinforce mass media campaigns and social norms about health-risk behaviors such as smoking, drug and alcohol use, and obesity/sedentary behavior, [21, 22] however only two municipal and one provincial government hosted-Facebook posts addressed lifestyle risk factors for perinatal health. As lifestyle risk behaviors are often concordant within couples/families, [23] generalized health promotion targeted to all household members would mitigate pregnancy risks, and increase likelihood of behavior modification.

Major Facebook perinatal-themed posts were positive in tone- emphasizing pregnancy/birth, breastfeeding and parenting. Although all organizations included in our sample promoted perinatal health, their use of Facebook was varied in terms of breadth of topics posted. Breastfeeding was promoted by municipal/regional health both actively (e.g. description of benefits, subject of classes/presentations) and passively (e.g. job titles for profiled staff members, resources). Several organizations used World Breastfeeding Week as a basis to promote breastfeeding, services and staff profiles, previously described as an example of social breastfeeding campaigns [24]. Such promotion campaigns translate to about 18% increase in breastfeeding, proving to be quite effective [21].

Social media is fairly ubiquitous among commercial organizations, with government agencies slower to capitalize on the benefits of established and emerging media platforms for health promotion[11, 25]. As perinatal health promotion is encompassed within a broader public health mandate by Canadian governments included in our sample, we were unable to assess the general use of social media by these organizations. It was evident that perinatal-themed post frequency varied considerably across jurisdictions, perhaps reflecting only limited use by some agencies. Conceptually, social media health promotion falls within the evolving promise of e-government to best use information technologies to enhance activities [26]. The universal reach of Internet- and social media communications in industrialized countries serves to democratize government messaging by widespread accessibility [25, 26]. Governmental public health agencies use of social media is primarily unidirectional, used to ensure transparency and accountability through dissemination of organizational updates, health promotion and health policy news [25]. Although we can confirm that Canadian government Facebook posts provided promotion and updates related to perinatal health, we did not assess public response to these posts. Similar to mass media campaigns, [22] Facebook followers (Table 2) receive updated posts with further study required to evaluate awareness, uptake and resulting behavior changes from these perinatal-themed posts.

Social medias public reach and timeliness make these platforms ideal for emergency communications [27]. Prior to the emergence of COVID-19, government agencies have used social media for emergency communications related to H1N1, [28] Ebola,[29] Zika virus [30] and a broad spectrum of localized natural disasters and emergencies [27]. As with the Zika outbreak, COVID-19 has serious implications for pregnancy, necessitating perinatal-specific public health guidance [30, 31]. Pregnancy emerged gradually as a risk factor for severe COVID-19 illness [32]. COVID-19 vaccine roll-out across much of the Western world began in late 2020, including Canada, however this was complicated by the initial recommendation by the National Advisory Committee on Immunization (NACI) and other agencies, to withhold COVID-19 vaccination from pregnant people pending further evidence [33]. As our social media analysis was restricted to 2020, we did not capture public health government-Facebook promotion of COVID-19 vaccines, however our review of Canadian government health website content into early 2021 did yield updated NACI-messaging regarding vaccine safety during pregnancy and breastfeeding [34]. Whereas a limited number of government websites addressed COVID-19 risks of pregnancy complications/disease severity, Facebook posts predominantly focussed on disruptions to health services and related visitor restrictions/need for infection control masks, physical distancing at healthcare centers.

Government agencies can respond to trending myths or barriers to health behaviors through amplification of evidence-based directives that specifically address rumors and misinformation [27]. Although adverse pregnancy outcomes are now well-established sequelae of COVID-19 [35, 36], throughout 2020, often contradictory public health guidance and misinformation regarding COVID-19 and risks to pregnancy appeared on social media [31]. COVID-19-themed perinatal Facebook posts peaked in the second quarter (AprilJune) of 2020, with only municipal/regional health authorities exhibiting a modest rebound of activity in the final quarter, indicating missed opportunities by public health agencies to reinforce messaging. Pre-emptive risk communication about COVID-19 vaccines and pregnancy by these public health agencies was warranted, as rumors and misinformation related to infertility, menstrual cycle irregularities and miscarriages accompanied COVID-19 vaccination programs and the eventual prioritization of pregnant people in 2021 [35,36,37]. Social media provides the opportunity for public health agencies to monitor real-time responses to emergency management and related intervention, but also to curtail the spread of misinformation.

Risk perception is decreased by privilege and social status [38]- such that racialized women- most likely to experience severe COVID-19-related pregnancy outcomes [31]- are also likely to perceive COVID-19 as a high health hazard. In response to the heterogeneous public framing of any health risk issue, influenced by gender, race/ethnicity, emotions and experience, risk communication is most effective if the agency/spokesperson inspires trust [39]. Trust in government agencies may be gained by transparency, credibility, and acknowledgement of scientific uncertainty in the face of evolving information, [27, 39] however countering this trust is social medias contributions to the increasingly political polarization of science and the recognition of societys structural racism which contributes to inequities [40]. Performance indicators identified for Canadian public health emergency preparedness included credible, culturally-competent emergency leaders with bilateral crisis communication skills, community engagement, and redundant in emergency communication channels including social media [41]. Ottawa Public Healths creation of a distinct Parenting in Ottawa Facebook page with 100 perinatal-themed posts in 2020 suggests this agency has fully embraced social media and opportunities of community engagement. Ottawa Public Health consistently attributed authorship of perinatal health Facebook posts to named healthcare professionals with credentials (e.g. registered nurses, lactation consultants, nutritionists)- thereby imbuing their posts with expertise, credibility and authority. Beyond perinatal health, Ottawa Public Health emerged as the most followed local public health unit in North America on Twitter, entertaining and informing over 130,000 followers in 2021 with empathy, honesty, nuance, humor and celebrity endorsements to promote COVID-19 and other public health messaging. Although most public health social media applications emphasize community engagement, social media may also provide platforms for health professionals to network, collaborate and exchange emerging science and practices [42].

We included NGO websites and Facebook pages in our analysis, recognizing the diverse landscape of online perinatal health information. NGO content reflected the mission, values and philosophies of each organization, and unlike the governmental organizations in the sample, NGO topic areas were exclusively women, fatherhood and perinatal health. NGO websites more consistently provided COVID-19-themed perinatal health promotion, including content related to disease severity, vertical transmission, breastfeeding and pregnancy outcomes. Similarly, NGO Facebook posts more frequently mentioned infection control, breastfeeding and emotional health, in the context of COVID-19. Two NGOs profile important aspects of perinatal health that are often overlooked- fatherhood and the realities facing Indigenous pregnant people in Canada. Cohabitating fathers and non-biological partners, contribute to both the physical and psychosocial environments of pregnant people. The impact of the non-pregnant partner on pregnancy outcomes has been largely studied heteronormatively, using marriage status among the determinants of concordant health behaviors [43]. Bringing attention to fathers, and non-biological partners recognizes their contributions to modifiable risks to pregnancy such as smoking, exposure to second-hand smoke, physical activity [23] and intimate partner violence and social support [44]. Perhaps due to social support and relationship integrity, fathers involvement in pregnancy is associated with better pregnancy outcomes and improved maternal health behaviors [45]. Influenza vaccination exhibits spousal concordance, with female partners generally influenced by positive health behaviors exhibited by male partners, [46] suggesting similar dynamics may occur with COVID-19 protective behaviors, although this remains to be studied.

Indigenous peoples face environmental, economic and health disparities due to colonialism and Canadas legacy of cultural genocide [47]. Pregnancy outcomes are similarly affected, challenged by limited prenatal and birthing care in rural and remote communities [48]. Recognized as priority communities for public health engagement during emergencies, [41, 49] Indigenous peoples were identified as key populations to receive early COVID-19 vaccinations [50]. Indigenous traditions and stories along with stark depictions of medical abuse/racism comprised the Native Womens Association of Canada (NWAC)s perinatal-themed Facebook posts. The tone of NWACs Facebook posts reveals a devastating portrayal of the experience of pregnancy and motherhood in the context of Missing and Murdered Indigenous Women and Girls, and the lasting trauma of forced removal of Indigenous children from their families, first by nationally-run residential schools and now through the child welfare system. Social media and the Internet are useful tools for pregnancy and parenting support, particularly as these modalities enable anonymous information seeking and sharing, thereby reducing discriminatory and stereotyping treatment, and addressing rural and remote barriers to healthcare [51]. Culturally-safe perinatal care, both in-person and through public health Internet and social media messaging, developed collaboratively with Indigenous stakeholders, improves pregnancy and neonatal outcomes [52].

We acknowledge that both government and NGO groups included in our sample provide services and resources addressing a breadth of topics, in addition to the perinatal-themed social media and online content evaluated here. As data collection was completed in early 2021, we also recognize that these organizations may have deleted or modified relevant posts, and may have since updated perinatal promotion messaging with possibly increased or different emphasis. We did not ascertain the public reach of online/social media messaging, nor did we measure Facebook interactions such as post comments, likes or shares. Facebook followers for each page appear in Table 2, which provides a crude estimate of the number of people who viewed each post on their respective Facebook newsfeeds.

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Public health perinatal promotion during COVID-19 pandemic: a social media analysis - BMC Public Health - BMC Public Health