The prevalence of feigning and concealment of Covid-19 infections in an international sample.

We asked 463 participants from 21 countries whether they had feigned and/or concealed having a coronavirus infection during the pandemic period. 384 respondents (83%) reported having experienced a coronavirus infection. They were, on average, younger and reported more chronic health issues than participants who said they had never been infected. 65 (14%) admitted to having feigned the infection. Prevalence doubled (28%) when asked if they knew anyone who had feigned a coronavirus infection. Main motives for feigning were to stay at home and to obtain sick leave. As to having concealed a coronavirus infection, 56 (12%) responded affirmatively, but when asked about others, the prevalence reached 51% (n = 210). The most common reasons for concealment were to avoid letting others know and to not miss an event. Thus, both feigning and concealing infections can occur on a nontrivial scale, directly affecting prevalence rates in studies that rely on self-reported data collected from social platforms.

Classification accuracy and resistance to coaching of the Spanish version of the Inventory of Problems-29 and the Inventory of Problems-Memory: A simulation study with mTBI patients.

Objective: The present study aims to evaluate the classification accuracy and resistance to coaching of the Inventory of Problems-29 (IOP-29) and the IOP-Memory (IOP-M) with a Spanish sample of patients diagnosed with mild traumatic brain injury (mTBI) and healthy participants instructed to feign. Method: Using a simulation design, 37 outpatients with mTBI (clinical control group) and 213 non-clinical instructed feigners under several coaching conditions completed the Spanish versions of the IOP-29, IOP-M, Structured Inventory of Malingered Symptomatology, and Rivermead Post Concussion Symptoms Questionnaire. Results: The IOP-29 discriminated well between clinical patients and instructed feigners, with an excellent classification accuracy for the recommended cutoff score (FDS ≥ .50; sensitivity = 87.10% for coached group and 89.09% for uncoached; specificity = 95.12%). The IOP-M also showed an excellent classification accuracy (cutoff ≤ 29; sensitivity = 87.27% for coached group and 93.55% for uncoached; specificity = 97.56%). Both instruments proved to be resistant to symptom information coaching and performance warnings. Conclusions: The results confirm that both of the IOP measures offer a similarly valid but different perspective compared to SIMS when assessing the credibility of symptoms of mTBI. The encouraging findings indicate that both tests are a valuable addition to the symptom validity practices of forensic professionals. Additional research in multiple contexts and with diverse conditions is warranted.

User violence prevention and intervention measures to minimize and prevent aggression towards health care workers: A systematic review.

Workplace violence in the health care setting is a social problem of great interest both at the health care level and in research in recent decades. The most common type of violence is the one coming from the user towards the professional. Although the bibliography includes multiple preventive actions focused on working with professionals, there are hardly any studies that explore and collect actions aimed at the user. The aim of this study is to analyze the results of the literature to provide an overview of the current evidence. Specifically, it aims to describe the various user-directed strategies or interventions aimed at reducing workplace violence experienced by professionals within the healthcare sector. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), methodology of publications published up to December 2022 in the main databases. Studies that met the previously established eligibility criteria were identified. A peer review of the risk of bias was performed and the data were extracted from a previously elaborated template. The search yielded 5231 articles of which 11 were finally included in the review. Of these, 3 had a quantitative design, 7 had a qualitative design and one had a combined design. Of these, 38 measures or actions aimed at the user were compiled, grouped into four blocks according to the attitudinal objective pursued: Improvement of communication and creation of links, involvement of the user in joint decisions with the staff, informing and training the user, and other independent proposals. This study makes it possible to explore actions aimed at users with the objective of reducing violence towards health professionals. It collects and makes available to the scientific community a set of measures aimed at making a change of attitude in the perpetrator themselves, with the involvement of the perpetrator in the health system. This set of collected measures provides researchers with a basis to be taken into account for the implementation of future prevention plans according to the new multicomponent prevention models and with the involvement of the perpetrator themselves.

Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis.

OBJECTIVE: The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of these variations, as well as the corresponding prevalence of clinically significant pathologies and complications associated with them. METHODS: The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS, and GOOGLE SCHOLAR, using as search terms; "Maxillary bone," "Maxillary sinus," "Paranasal sinus," "Anatomical variations," "Sinusitis" and "Clinical anatomy." RESULTS: A total of 26 articles and 12969 samples were included, from which 12,594 subjects had their sex recorded giving a total of 5802 males and 6792 females. The variants reported by the included were Haller cells, Concha Bullosa, Number of septa, Hypoplastic sinus, Agger Nasi, Thickening of the MS mucosa, Deviation of the nasal septum, Accessory ostium, and Onodi cells. Among the mentioned, the ones that presented the greatest number of studies (between 8 and 10 studies included) were: the Haller Cells, the Concha Bullosa, and the Number of septa, where prevalence was 0.30, 0.36, 0.39 respectively. These variations can lead to sinusitis, cause some types of tumors, or affect neighboring structures that could be compromised by this variation. CONCLUSION: As a result, it is certainly complex to distinguish the presence of anatomical variations from pathological abnormalities. Therefore, knowledge of the different variations and their clinical relationships could be a useful asset for clinicians dedicated to this region.

Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease.

INTRODUCTION: Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. OBJECTIVE: To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. METHOD: Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. RESULTS: In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine. CONCLUSION: Early detection and vaccination have prevented the occurrence of serious complications.

Multidimensional analysis of immune cells from COVID-19 patients identified cell subsets associated with the severity at hospital admission.

BACKGROUND: SARS-CoV-2 emerged as a new coronavirus causing COVID-19, and it has been responsible for more than 760 million cases and 6.8 million deaths worldwide until March 2023. Although infected individuals could be asymptomatic, other patients presented heterogeneity and a wide range of symptoms. Therefore, identifying those infected individuals and being able to classify them according to their expected severity could help target health efforts more effectively. METHODOLOGY/PRINCIPAL FINDINGS: Therefore, we wanted to develop a machine learning model to predict those who will develop severe disease at the moment of hospital admission. We recruited 75 individuals and analysed innate and adaptive immune system subsets by flow cytometry. Also, we collected clinical and biochemical information. The objective of the study was to leverage machine learning techniques to identify clinical features associated with disease severity progression. Additionally, the study sought to elucidate the specific cellular subsets involved in the disease following the onset of symptoms. Among the several machine learning models tested, we found that the Elastic Net model was the better to predict the severity score according to a modified WHO classification. This model was able to predict the severity score of 72 out of 75 individuals. Besides, all the machine learning models revealed that CD38+ Treg and CD16+ CD56neg HLA-DR+ NK cells were highly correlated with the severity. CONCLUSIONS/SIGNIFICANCE: The Elastic Net model could stratify the uninfected individuals and the COVID-19 patients from asymptomatic to severe COVID-19 patients. On the other hand, these cellular subsets presented here could help to understand better the induction and progression of the symptoms in COVID-19 individuals.

ORIENTATE: automated machine learning classifiers for oral health prediction and research.

BACKGROUND: The application of data-driven methods is expected to play an increasingly important role in healthcare. However, a lack of personnel with the necessary skills to develop these models and interpret its output is preventing a wider adoption of these methods. To address this gap, we introduce and describe ORIENTATE, a software for automated application of machine learning classification algorithms by clinical practitioners lacking specific technical skills. ORIENTATE allows the selection of features and the target variable, then automatically generates a number of classification models and cross-validates them, finding the best model and evaluating it. It also implements a custom feature selection algorithm for systematic searches of the best combination of predictors for a given target variable. Finally, it outputs a comprehensive report with graphs that facilitates the explanation of the classification model results, using global interpretation methods, and an interface for the prediction of new input samples. Feature relevance and interaction plots provided by ORIENTATE allow to use it for statistical inference, which can replace and/or complement classical statistical studies. RESULTS: Its application to a dataset with healthy and special health care needs (SHCN) children, treated under deep sedation, was discussed as case study. On the example dataset, despite its small size, the feature selection algorithm found a set of features able to predict the need for a second sedation with a f1 score of 0.83 and a ROC (AUC) of 0.92. Eight predictive factors for both populations were found and ordered by the relevance assigned to them by the model. A discussion of how to derive inferences from the relevance and interaction plots and a comparison with a classical study is also provided. CONCLUSIONS: ORIENTATE automatically finds suitable features and generates accurate classifiers which can be used in preventive tasks. In addition, researchers without specific skills on data methods can use it for the application of machine learning classification and as a complement to classical studies for inferential analysis of features. In the case study, a high prediction accuracy for a second sedation in SHCN children was achieved. The analysis of the relevance of the features showed that the number of teeth with pulpar treatments at the first sedation is a predictive factor for a second sedation.

[Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease.] / Comparación entre la primera y la sexta ola de la pandemia por el coronavirus SARS-COV-2 en pacientes con enfermedad inmunomediada.

Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination.Objective To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves.Method Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts.Results In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine.Conclusion Early detection and vaccination have prevented the occurrence of serious complications.

Systematic Review and Meta-Analysis: Recurrent Laryngeal Nerve Variants and Their Implication in Surgery and Neck Pathologies, Using the Anatomical Quality Assurance (AQUA) Checklist.

INTRODUCTION: The recurrent laryngeal nerve (RLN) is the structure responsible for sensory and motor innervation of the larynx, and it has been shown that its lesion due to a lack of surgical rigor led to alterations such as respiratory obstruction due to vocal cords paralysis and permanent phonation impairment. The objectives of this review were to know the variants of the RLN and its clinical relevance in the neck region. METHODS: This review considered specific scientific articles that were written in Spanish or English and published between 1960 and 2022. A systematic search was carried out in the electronic databases MEDLINE, WOS, CINAHL, SCOPUS, SCIELO, and Latin American and Caribbean Center for Information on Health Sciences to compile the available literature on the subject to be treated and was enrolled in PROSPERO. The included articles were studies that had a sample of RLN dissections or imaging, intervention group to look for RLN variants, or the comparison of the non-recurrent laryngeal nerve (NRLN) variants, and finally, its clinical correlations. Review articles and letters to the editor were excluded. All included articles were evaluated through quality assessment and risk of bias analysis using the methodological quality assurance tool for anatomical studies (AQUA). The extracted data in the meta-analysis were interpreted to calculate the prevalence of the RLN variants and their comparison and the relationship between the RLN and NRLN. The heterogeneity degree between included studies was assessed. RESULTS: The included studies that showed variants of the RLN included in this review were 41, a total of 29,218. For the statistical analysis of the prevalence of the RLN variant, a forest plot was performed with 15 studies that met the condition of having a prevalence of less than 100%. As a result, the prevalence was shown to be 12% (95% CI, SD 0.11 to 0.14). Limitations that were present in this review were the publication bias of the included studies, the probability of not having carried out the most sensitive and specific search, and finally, the authors' personal inclinations in selecting the articles. DISCUSSION: This meta-analysis can be considered based on an update of the prevalence of RLN variants, in addition to considering that the results show some clinical correlations such as intra-surgical complications and with some pathologies and aspects function of the vocal cords, which could be a guideline in management prior to surgery or of interest for the diagnostic.

Euthanasia Attitudes Questionnaire in Medical Personnel (AHE-PM) / Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

Abstract The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient's emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient's subjective emotional suffering.

Resumen La eutanasia voluntaria activa se define como la petición de un paciente que quiere morir y la acción que es llevada a cabo por otra persona para provocar dicha muerte. El derecho a morir es un dilema sobre el que se debate a nivel internacional. Algunos países y estados ya cuentan con leyes que regulan una de las aplicaciones más comunes de este derecho. Los datos aportados por estos países ponen de manifiesto la importancia de un marco bioético que permita limitar algunas de sus aplicaciones. En este sentido, la evaluación de las actitudes hacia la eutanasia en personal médico permitirá conocer las actitudes de estos profesionales y cómo estos pueden enfrentarse a dichas solicitudes, o no, sea de muerte asistida por parte de los pacientes o su entorno. Además, se ha reportado en la bibliografía diferentes actitudes según la experiencia o el sexo de los trabajadores, por lo que es de relevancia su exploración diferencial. Por ello, el objetivo del presente trabajo un instrumento de evaluación de actitudes hacia la eutanasia diseñado y validado por y para profesionales médicos en ejercicio. En esta línea, los objetivos de este estudio son obtener una escala corta con propiedades psicométricas adecuadas, que proporcione información relevante sobre las actitudes hacia la eutanasia, así como la posible evaluación de algunas prácticas médicas relacionadas con ésta que pueden ser bioéticamente dudosas. La muestra estaba compuesta por 419 profesionales de la medicina procedentes de tres provincias del sur de España. Se siguió una doble estrategia en el diseño. Por un lado, un diseño psicométrico con un análisis factorial exploratorio y confirmatorio. Se dividió la muestra en dos submuestras aleatorias para realizar de forma paralela ambos análisis. Se utilizaron los estadísticos KMO, Bartlett, RMSEA, RMRS, CFI, NNFI, GFI y AGFI para explorar el ajuste de modelos. Po otro lado, se utilizó un diseño asociativo descriptivo para la comparación de grupos mediante la t de Student, ANOVA, Tukey y la prueba d de Cohen. Se extrae una escala de seis ítems (AE-PM) y dos factores. El primero de ellos está centrado en las actitudes hacia la eutanasia para aliviar el sufrimiento por cuestiones médicas y el segundo para aliviar el sufrimiento emocional del paciente. Respecto al estudio de las diferencias, no se observaron diferencias significativas según el sexo del profesional ni la antigüedad en la profesión. La escala (AHE-PM) es útil para la exploración rápida de las actitudes hacia la eutanasia en médicos, un grupo profesional con limitado tiempo libre que, además, puede encontrarse con relativa frecuencia ante solicitudes de eutanasia voluntaria activa. Los dos factores obtenidos permiten evaluar, por un lado, las actitudes desde una perspectiva bioética. Es de especial relevancia en estas situaciones el conocimiento de las actitudes del personal médico hacia la eutanasia, exponiéndolo a un dilema bioético y personal. La autoconciencia de estos profesionales sobre sus propias actitudes hacia la eutanasia y su adaptación a los códigos éticos vigentes podría minimizar el impacto generado por estas situaciones y, por tanto, mejorar la relación terapéutica y la calidad asistencial. Por otro lado, el instrumento aporta información sobre la posible recomendación de estas prácticas bajo aparente justificación médica y/o en situaciones basadas en el sufrimiento emocional subjetivo del paciente. Estudios previos indican que los profesionales se ven afectados emocionalmente cuando se enfrentan a los conceptos de muerte y eutanasia en pacientes terminales. En este sentido, la escala también podría servir de evaluación de actitudes y el trabajo en planes de prevención de salud laboral en los centros sanitarios.

Solid State Processing of BCZT Piezoceramics Using Ultra Low Synthesis and Sintering Temperatures.

Lead-free (Ba0.92Ca0.08) (Ti0.95 Zr0.05) O3 (BCZT) ceramics were prepared by a solid-state route (SSR) using ultra-low synthesis (700 °C/30 min and 700 °C/2 h) and sintering temperatures (from 1150 °C to 1280 °C), due to prior activation and homogenization by attrition milling of the starting high purity raw materials for 6 h before the synthesis and of the calcined powders for 3 h before the sintering. The comparison of the thermal analysis of the mixture of the starting raw materials and the same mixture after 6 h attrition milling allowed to evidence the mechanisms of activation, resulting in a significant decrease of the perovskite formation temperature (from 854 °C down to 582 °C). The secondary phases that limit the functional properties of the ceramic and their evolution with the sintering conditions were analyzed by X-ray diffraction (XRD) and scanning electron microscopy (SEM), which allowed the design of a two-step sintering method to eliminate them. A pure tetragonal BCZT perovskite phase (P4mm, c/a = 1.004) and homogeneous ceramic microstructure was obtained for synthesis at 700 °C for 2 h and sintering with the use of a two-step sintering treatment (900 °C for 3 h and 1280 °C for 6 h). The best electromechanical properties achieved were d33 = 455 pC/N, kp = 35%, Qm = 155.

Long-term follow-up on the effects of sodium oxybate on daytime sleepiness and sleep architecture in patients with narcolepsy type 1. / Efecto a largo plazo del oxibato de sodio en la somnolencia diurna y en la estructura del sueño en pacientes con narcolepsia de tipo 1.

INTRODUCTION: Sodium oxybate (SXB) was administered for the first time in 1979 in 16 patients with narcolepsy with cataplexy (NT1) that improved up to 20 months. AIMS: To evaluate the effect of SXB on daytime sleepiness and sleep architecture by video-polysomnography in a sample of 23 NT1 adult patients (13 men, 10 females) treated up to three years. Additional goal was to study the presence of sleep comorbidities. PATIENTS AND METHODS: NT1 patients were diagnosed according to International Classification of Sleep Disorders, third edition. We conducted a longitudinal observational study and a video-polysomnography comparing the sleep parameters of patients treated with an initial nocturnal dose of 4.5 g of SXB after six months (FU-1), one year (FU-2) and three years (FU-3) of uninterrupted treatment. Video-polysomnography parameters were analyzed including apnea-hypopnea and periodic leg movements indexes. RESULTS: Patients were HLA-DQB1*06:02 positive except a familial case. Thirteen patients (56%) discontinued SXB treatment over the three-year of the study. The two-nightly doses has been one of the reason for discontinuing treatment as well as insufficient compliance, mild or severe side effects, comorbidities and pregnancy. We found significant differences at FU-2 in sleep structure with an increased in stage N2 (p < 0.03) and a higher periodic leg movements index (p < 0.01). At FU-3 we found significant differences in sleep structure with an increase in stage N1 (p = 0.03) and in comorbidities (periodic leg movements and apnea-hypopnea indexes). There was not significant change on daytime sleepiness during the study. CONCLUSIONS: SXB was administered in low-medium doses. Two-nightly doses and sleep fragmentation linked to sleep comorbidities at long-term lead to drug withdrawal.

TITLE: Efecto a largo plazo del oxibato de sodio en la somnolencia diurna y en la estructura del sueño en pacientes con narcolepsia de tipo 1.Introducción. El oxibato de sodio (SXB) se utilizó en 1979 en 16 enfermos con narcolepsia-cataplejía (NT1) que mejoraron tras 20 meses de tratamiento. Objetivos. Evaluar el efecto del SXB en la somnolencia diurna y en la estructura del sueño mediante videopolisomnografía en una muestra de 23 enfermos de NT1 (13 hombres y 10 mujeres) tratados durante tres años. Investigamos adicionalmente la presencia de comorbilidad. Pacientes y métodos. Diagnosticamos a los enfermos de acuerdo con la Clasificación Internacional de Trastornos del Sueño, tercera edición. Realizamos un estudio longitudinal, observacional y de videopolisomnografía, comparando los parámetros de sueño y los índices de apnea-hipopnea y de movimientos periódicos de las piernas de los enfermos, tratados con una dosis nocturna inicial de 4,5 g de SXB al cabo de seis meses (C-1), un año (C-2) y tres años (C-3) de tratamiento ininterrumpido. Resultados. Todos los enfermos eran HLA-DQB1*06:02 positivos, excepto un caso familiar. Trece enfermos (56%) interrumpieron el tratamiento debido a las dos tomas nocturnas, así como a la presencia de efectos secundarios, comorbilidad y embarazo. Encontramos diferencias significativas en C-2 en la estructura del sueño con aumento del estadio N2 (p < 0,03) y del índice de movimientos periódicos de las piernas (p < 0,01). En el control C-3 encontramos diferencias significativas en la estructura del sueño con aumento del estadio N1 (p = 0,03), y de los índices de movimientos periódicos de las piernas y de apnea-hipopnea. Conclusiones. El SXB se administró en dos dosis nocturnas, lo que, unido a la fragmentación del sueño y a la aparición de comorbilidades, condujo a la interrupción del tratamiento a largo plazo.

The Inventory of Problems-29 (IOP-29): A systematic review and bivariate diagnostic test accuracy meta-analysis.

The Inventory of Problems-29 (IOP-29) is a 29-item self-administered symptom validity test (SVT) that assesses the credibility of clinical presentations related to posttraumatic stress disorder, depression/anxiety, psychosis, cognitive impairment and combination thereof. To date, no publications have summarized the classification accuracy of the IOP-29 using a bivariate meta-analytical approach that preserves the two-dimensional nature of the estimators. Our objective was to conduct a systematic review and bivariate diagnostic test accuracy meta-analysis of the IOP-29 according to the relevant guidelines. Twenty-one independent samples were included, with a total sample size of 4,163 participants. The results indicated that the IOP-29 is able to discriminate adequately between instructed simulators and healthy controls/clinical patients. Using the recommended cutoff (False Disorder Probability Score [FDS], ≥ .50), a sensitivity of 82% was achieved, maintaining specificity at 93% (false positive rate of 7%). The language of the test and the type of comparison group have been identified as possible sources of heterogeneity. Specificity decreases for the non-English version of the IOP-29, for the FDS ≥ .30, and also decreases for studies using clinical controls, for all three cutoff scores. In general, our findings support the usefulness of the IOP-29 as an SVT; however, most of the included studies use a simulation design and have been coauthored by the test authors. Likewise, about half of the studies did not include bona fide patient controls but only nonclinical controls. The results obtained are highly promising, but further research, especially that using the criterion group paradigm, is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence Estimates of Symptom Feigning and Malingering in Spain.

Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little research in Spain that evaluates its prevalence. The aim of this study was to investigate this issue using the perception of the general population, students, and professionals of medicine and forensic psychology. Three adapted questionnaires were applied to a total of 1003 participants (61.5% women) from 5 different groups. Approximately two-thirds of participants reported knowing someone who feigned symptoms, and one-third disclosed feigning symptoms themselves in the past. Headache/migraine, neck pain, and anxious-depressive symptoms were the most commonly chosen. Experts in psychology and forensic medicine estimated a prevalence of 20 to 40% of non-credible symptom presentations in their work settings and reported not having sufficient means to assess the distorted presentation of symptoms with certainty. Professionals and laypersons alike acknowledge that non-credible symptom presentations (like feigning or malingering) are relevant in Spain and occur at a non-trivial rate, which compares with estimates in other parts of the world.

Towards Outdoor Electromagnetic Field Exposure Mapping Generation Using Conditional GANs.

With the ongoing fifth-generation cellular network (5G) deployment, electromagnetic field exposure has become a critical concern. However, measurements are scarce, and accurate electromagnetic field reconstruction in a geographic region remains challenging. This work proposes a conditional generative adversarial network to address this issue. The main objective is to reconstruct the electromagnetic field exposure map accurately according to the environment's topology from a few sensors located in an outdoor urban environment. The model is trained to learn and estimate the propagation characteristics of the electromagnetic field according to the topology of a given environment. In addition, the conditional generative adversarial network-based electromagnetic field mapping is compared with simple kriging. Results show that the proposed method produces accurate estimates and is a promising solution for exposure map reconstruction.

(Un)Broken: Lateral violence among hospital nurses, user violence, burnout, and general health: A structural equation modeling analysis.

Introduction: Workplace violence is a social problem yet to be solved. Although it is present in virtually all work environments, its prevalence in healthcare settings stands out, being perceived as something inherent to the job. Most studies in this context have focused on user violence against professionals. However, it has been observed that violence among colleagues in these types of jobs is a risk factor for the health of workers and has rarely been studied as a whole. Among the main consequences of exposure to violence reported in the literature, burnout syndrome, depression, anxiety, or somatic problems have been among the most studied. On the one hand, some authors claim that being exposed to workplace violence can increase the associated physical and psychological pathology and lead to a picture congruent with burnout. On the other hand, it has been hypothesized that violence is associated with burnout, which can trigger physical and psychological symptoms. Taking into account this background, the aim of this study is to explore workplace violence in health personnel, symptomatology, and burnout syndrome through mediation models that allow us to know the interrelationships between the variables. Methods: A cross-sectional design with a double descriptive-associative strategy was used. The sample was composed of 950 nursing professionals from public hospitals. The scales of physical and non-physical violence from users to professionals HABS-U, personal, social, and occupational violence among co-workers using the Health Aggressive Behavior Scale - Co-workers and Superiors (HABS-CS) scale, the burnout scale Maslach Burnout Inventory - General Survey (MBI-GS) which evaluates professional exhaustion, efficacy and cynicism, and the factors referring to depression, anxiety, somatization, and dysfunction of the GHQ-28 scale were applied. In order to calculate the models, workplace violence was used as a predictor of symptomatology, using the burnout variables as mediators. Regression coefficients with and without mediation model, direct and standardized estimates were obtained. For statistical power, Bootstrap analysis was used to calculate direct mediation effects. Results: After controlling the mediation effects of burnout and cynicism, physical and non-physical user violence toward healthcare personnel were significant predictors of the GHQ-28 scores. These same results were obtained when assessing the relationship between social, occupational, and personal violence among co-workers and GHQ-28 scores. Conclusion: Our results contribute to increase the evidence about the effects of violence on the health of professionals and to advance in the characterization of the possible consequent psychological damage. Regardless of the type of violence experienced, exposure to violence can lead to anxious, depressive or somatization symptoms, among others. Violence is also a predictor of burnout syndrome, which in turn accentuates the rest of the consequences studied. Despite the limitations of the proposed model, these results serve to highlight the complexity of the situation experienced by healthcare professionals. Moreover, it serves as a basis for proposing intervention/prevention programs to raise awareness and protect professionals from these risks. To this end, self-care tools should be proposed with which professionals take care of their own health through the management of violent situations and/or the improvement of occupational health.

The Impact of Different Forms of Coaching on the Structured Inventory of Malingered Symtomatology (SIMS).

BACKGROUND: Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS). METHODS: A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs. RESULTS: The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs. CONCLUSIONS: SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.

Evaluation of blood glucose level control in type 1 diabetic patients using deep reinforcement learning.

Diabetes mellitus is a disease associated with abnormally high levels of blood glucose due to a lack of insulin. Combining an insulin pump and continuous glucose monitor with a control algorithm to deliver insulin is an alternative to patient self-management of insulin doses to control blood glucose levels in diabetes mellitus patients. In this work, we propose a closed-loop control for blood glucose levels based on deep reinforcement learning. We describe the initial evaluation of several alternatives conducted on a realistic simulator of the glucoregulatory system and propose a particular implementation strategy based on reducing the frequency of the observations and rewards passed to the agent, and using a simple reward function. We train agents with that strategy for three groups of patient classes, evaluate and compare it with alternative control baselines. Our results show that our method is able to outperform baselines as well as similar recent proposals, by achieving longer periods of safe glycemic state and low risk.