"Healthy immigrant effect" among individuals experiencing homelessness in Spain?: Foreign-born individuals had higher average age at death in 15-year retrospective cohort study.

BACKGROUND: Individuals experiencing homelessness (IEHs) suffer from severe health inequities. Place of origin is linked to health and mortality of IEHs. In the general population the "healthy immigrant effect" provides a health advantage to foreign-born people. This phenomenon has not been sufficiently studied among the IEH population. The objectives are to study morbidity, mortality, and age at death among IEHs in Spain, paying special attention to their origin (Spanish-born or foreign-born) and to examine correlates and predictors of age at death. METHODS: Retrospective cohort study (observational study) of a 15-year period (2006-2020). We included 391 IEHs who had been attended at one of the city's public mental health, substance use disorder, primary health, or specialized social services. Subsequently, we noted which subjects died during the study period and analyzed the variables related to their age at death. We compared the results based on origin (Spanish-born vs. foreign-born) and fitted a multiple linear regression model to the data to establish predictors of an earlier age at death. RESULTS: The mean age at death was 52.38 years. Spanish-born IEHs died on average almost nine years younger. The leading causes of death overall were suicide and drug-related disorders (cirrhosis, overdose, and chronic obstructive pulmonary disease [COPD]). The results of the linear regression showed that earlier death was linked to COPD (b = - 0.348), being Spanish-born (b = 0.324), substance use disorder [cocaine (b =-0.169), opiates (b =.-243), and alcohol (b =-0.199)], cardiovascular diseases (b = - 0.223), tuberculosis (b = - 0.163), high blood pressure (b =-0.203), criminal record (b =-0.167), and hepatitis C (b =-0.129). When we separated the causes of death for Spanish-born and foreign-born subjects, we found that the main predictors of death among Spanish-born IEHs were opiate use disorder (b =-0.675), COPD (b =-0.479), cocaine use disorder (b =-0.208), high blood pressure (b =-0.358), multiple drug use disorder (b =-0.365), cardiovascular disease (b =-0.306), dual pathology (b =-0.286), female gender (b =-0.181), personality disorder (b =-0.201), obesity (b =-0.123), tuberculosis (b =-0.120) and having a criminal record (b =-0.153). In contrast, the predictors of death among foreign-born IEHs were psychotic disorder (b =-0.134), tuberculosis (b =-0.132), and opiate (b =-0.119) or alcohol use disorder (b =-0.098). CONCLUSIONS: IEHs die younger than the general population, often due to suicide and drug use. The healthy immigrant effect seems to hold in IEHs as well as in the general population.

Evaluation of the efficacy of WhatsApp through a harm reduction intervention group for injecting drug users. / Evaluación de la eficacia de WhatsApp en un programa grupal de reducción de daños asociados al consumo inyectado de drogas.

This study aims to analyse the use of an instant messaging app (WhatsApp®) as a means of communication for reaching people who inject drugs. An eight-week prospective longitudinal and observational study with three observations was designed for five addiction centres in Catalonia. The participants were 105 people who inject drugs, distributed in five intervention groups. The results of the Risk Assessment Battery (RAB) were compared in the three levels of analysis pre-test, post intervention and one month after the intervention. The main results indicate a significative reduction in RAB scores after the intervention. The main conclusion was that the WhatsApp® intervention has great potential for developing harm reduction interventions and to reduce the HIV contagion risk.

El presente estudio analiza el uso de una aplicación de mensajería instantánea (WhatsApp®) como canal de acceso a personas que se inyectan drogas. Se diseñó un estudio observacional longitudinal prospectivo de ocho semanas y tres observaciones en cinco centros de adicciones en Cataluña. Participaron 105 personas que consumían drogas por vía parenteral, distribuidas en cinco grupos de intervención grupal. Se compararon los resultados de la escala Risk Assessment Battery (RAB) (después de ser traducida al español y analizada su consistencia interna) en las tres fases de análisis pre test, post intervención y un mes después de la intervención. Los resultados indican una disminución significativa de las puntuaciones RAB tras la intervención a través de WhatsApp®. Se concluye que la intervención grupal a través de WhatsApp presenta grandes potencialidades para realizar intervenciones en reducción de daños y reducir el riesgo de contagio del VIH.

When people who inject drugs speak: Qualitative thematic analysis of the perception of a mobile app for needle exchange programs. / Cuando las personas que consumen drogas inyectadas tienen la palabra: Análisis cualitativo de contenido temático sobre la percepción de uso de una aplicación móvil para los programas de intercambio de jeringas.

Spain is the Western European country with the highest prevalence of Human Immunodeficiency Virus among people who inject drugs. The Hepatitis-C Virus affects over fifty per cent of this population. At the same time, the World Health Organization considers that the average coverage of injection material for drug user per year is low. Harm reduction programs and services have been deployed for over thirty years, and these could now incorporate the advantages of eHealth and mHealth to improve harm reduction. The aim of this qualitative and descriptive study is to analyze how people who inject drugs perceive an application for mobile devices. Fifty-one such drug users participated actively in five focus groups. The main results of the thematic content analysis indicated that the application was welcomed as easy and useful. Participants reported that the application contributed to improving access to injection material, reducing the stigma of drug-dependence and optimizing the organization of the ritual of injection. Excessive preventive information and problems downloading the web app were identified as aspects for improvement. In conclusion, the application was seen as a useful eHealth tool that complements the normal intervention of needle exchange programs.

España es el país de Europa Occidental con más prevalencia del Virus de la Inmunodeficiencia Humana entre personas que se inyectan drogas. La presencia de Virus de la Hepatitis-C supera el cincuenta por ciento en esta población. Al mismo tiempo, la Organización Mundial de la Salud considera que la cobertura media de material de inyección por usuario y año es baja. Con más de treinta años de experiencia en el despliegue de los servicios y programas de reducción de daños, las ventajas que posibilita la eSalud y la mSalud como la accesibilidad y asequibilidad, pueden incorporarse también a la reducción de daños. El objetivo de este estudio fue analizar la percepción que las personas que consumen drogas inyectadas tienen sobre una aplicación móvil para mejorar el acceso a material de inyección. Partiendo de un enfoque cualitativo se recogió información a través de cinco grupos focales en los que participaron 51 personas consumidoras de drogas inyectadas en activo. Se llevó a cabo un análisis de contenido temático cuyos principales resultados indicaron que la aplicación tuvo una buena aceptación y se consideró sencilla y útil. Los participantes refirieron que la aplicación contribuía a mejorar el acceso a material de inyección, a reducir el estigma de los drogodependientes, y a optimizar la planificación del usuario para adquirir la jeringa en el proceso ritual del consumo. Como puntos a mejorar, destacaron reducir el exceso de información preventiva y simplificar la ruta de descarga de la webapp. En conclusión, la aplicación se posiciona como una herramienta útil para complementar la intervención ordinaria de los programas de intercambio de jeringas.

Internet Addiction Test research through a cross-cultural perspective: Spain, USA and Colombia. / La investigación del Internet Addiction Test desde una perspectiva intercultural: España, Estados Unidos y Colombia.

Internet users worldwide often experience problems related to their Internet use, and although culture has an important influence over how people communicate, what they value, and therefore how they use the Internet, little cross-cultural research on the subject of problematic Internet use has been carried out. The Internet Addiction Test (IAT), the most common measurement tool for this purpose, has been used in various countries. In this study we compared and analyzed the cross-cultural results found in the most recent research on the IAT factor analysis. We found that in countries with two or more studies, results are often replicated, suggesting that cultural context influences Internet behaviors. We conducted our own IAT factor analysis studies in three countries - Spain, USA, and Colombia - with a total of 1,273 participants. We compared our results with those from previous studies in the same countries and found similar results. The most notable finding was that all the IAT factor analyses, both ours and the previous ones in the same regions, contained a factor related to loss of control/time management problems and another factor related to emotional/psychological problems, thereby suggesting that impulse control problems and unfulfilled emotional needs are the most important components in the development of problematic Internet use in various countries around the world. Future research on problematic Internet use should focus on these aspects.

Los usuarios de Internet frecuentemente experimentan problemas relacionados con su uso de Internet y, aunque la cultura tiene una influencia importante en la forma en que las personas se comunican, en lo que valoran y, por lo tanto, en cómo utilizan Internet, hay escasas publicaciones sobre investigación intercultural del uso problemático de Internet. La herramienta más común para medir dicho uso, el Internet Addiction Test (IAT) se ha utilizado en varios países. En este estudio comparamos los resultados interculturales de las investigaciones más recientes sobre el análisis factorial del IAT. Encontramos que los resultados a menudo se replican en países con dos o más estudios, lo que sugiere que el contexto cultural influye en los comportamientos en Internet. Llevamos a cabo nuestros propios estudios de análisis factorial del IAT en tres países (España, EE. UU. y Colombia) con 1.273 participantes. Al comparar nuestros resultados con los de estudios anteriores, encontramos que nuestros resultados fueron similares a los de estudios anteriores. El hallazgo más notable fue que todos los análisis factoriales de IAT, tanto los nuestros como los anteriores en las mismas regiones, contenían un factor relacionado con la pérdida de control/problemas de gestión del tiempo y otro factor relacionado con problemas emocionales/psicológicos, lo que sugiere que el control de impulsos y las necesidades emocionales no satisfechas son componentes importantes en el desarrollo del uso problemático de Internet en todo el mundo. La investigación futura sobre el uso problemático de Internet debería centrarse en estos aspectos.

Is Facebook use healthy for individuals experiencing homelessness? A scoping review on social networking and living in the streets.

Background: Although they are faced with a situation of extreme social exclusion, individuals experiencing homelessness (IEH) have gradually begun to incorporate the use of social networking sites (SNS) into their everyday lives. Aims: To review the publications that have examined the use of SNS among IEH and to analyze the impact that this online activity has on the health of these individuals. Methods: This study employed a scoping review method, analyzing scientific literature published up to the end of 2016. Results: An analysis was performed on nineteen peer-reviewed articles and three grey literature publications. IEH, especially those who are younger, use SNS in a similar proportion to the overall population. When these individuals used the networks due to their own initiative, it was found to have a positive health effect in that it mitigated the consequences of living on the street. Interventions aimed at improving the participants' health achieved positive results, both in terms of preventing problems associated with drug abuse and high-risk sexual behavior and of promoting mental health. Conclusions: The use of SNS presents some health benefits for IEH. Virtual communication and information alternatives provide opportunities to improve the mental and general health of people in social exclusion situations.

[Early drop-outs and retentions in substance abuse outpatient clinics: a cross-sectional comparative study of factors that increase or decrease adherence]. / Abandono precoz y retención en servicios ambulatorios de drogodependencias: análisis transversal comparativo de factores que aumentan o disminuyen la adherencia.

AIM: The aim of this study is to define the risk factors associated with early discharge in out-patients clinics. DESIGN: Cross-sectional and observational study. SETTING: Substance abuse clinics in Girona (Catalonia, Spain). PARTICIPANTS: A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n=92). PROCEDURE: Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence. MAIN MEASUREMENTS: The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable. RESULTS: The results indicated that attending the appointments unaccompanied (OR=3.13), being female (OR=2.44), having cocaine related issues (OR=1.14), and being younger (OR=0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR=0.28). CONCLUSIONS: It is concluded that special attention must be devoted to the patients' families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users.

Diagnostic Distribution of eating disorders: Comparison between DSMIV- TR and DSM-5.

INTRODUCTION: The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a significant revision of Eating Disorders (ED). The objective of this study is to compare the distribution of diagnosis of ED in adolescents according to DSM-VI-TR and DSM-5 criteria. A second objective is to study the psychopathological differences between patients with ED (based on DSM-IV-TR) and those whose diagnosis changed by applying DSM-5 criteria. METHODOLOGY: One hundred and one adolescents diagnosed with ED (mean: 14.68 years; SD: 1.46) were evaluated with clinical interviews and scales for eating psychopathology, perfectionism, anxiety, and depression. RESULTS: Applying the DSM-5 criteria led to a significant decrease in the diagnosed cases of Eating Disorders Not Otherwise Specified (EDNOS) (from 34.7% to 23.8%; p<0.001) and to a significant increase in those of anorexia nervosa (AN) (from 58.4% to 66.3%; p<0.001) and of bulimia nervosa (BN) (from 6.9% to 8.9%; p<0.001). No significant psychopathological differences were found between patients diagnosed with AN and BN based on DSM-IV-TR criteria and those newly diagnosed with AN and BN based on DSM-5 criteria. DISCUSSION: Using DSM-5 criteria for adolescents with ED leads to a significant decrease in the frequency of an EDNOS diagnosis. As similar psychopathological characteristics were observed between ED patients diagnosed based on DSM-IV-TR and those who were switched from EDNOS to AN or BN based on DSM-5, we conclude that the new criteria for ED in DSM-5 are valid for an adolescent population.

The problematic use of Information and Communication Technologies (ICT) in adolescents by the cross sectional JOITIC study.

BACKGROUND: The emerging field of Information and Communications Technology (ICT) has brought about new interaction styles. Its excessive use may lead to addictive behaviours. The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine associated factors. METHODS: Cross sectional, multi-centric descriptive study. POPULATION: 5538 students enrolled in years one to four of ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain). DATA COLLECTION: self-administered socio-demographic and ICT access questionnaire, and validated questionnaires on experiences related to the use of the Internet, mobile phones and video games (CERI, CERM, CERV). RESULTS: Questionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals; problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %. Problematic Internet use was associated with female students, tobacco consumption, a background of binge drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an intensive use of the computer. Factors associated with the problematic use of mobile phones were the consumption of other drugs and an intensive use of these devices. Frequent problems with video game use have been associated with male students, the consumption of other drugs, poor academic performance, poor family relationships and an intensive use of these games. CONCLUSIONS: This study offers information on the prevalence of addictive behaviours of the Internet, mobile phones and video game use. The problematic use of these ICT devices has been related to the consumption of drugs, poor academic performance and poor family relationships. This intensive use may constitute a risk marker for ICT addiction.

[The model of the big five personality factors and problematic Internet use in Colombian youth]. / El modelo de los cinco grandes factores de personalidad y el uso problemático de Internet en jóvenes colombianos.

The aim of the study was to relate the basic dimensions of personality formulated by the model of the big five factors with problematic Internet use in a sample of 411 Colombian youngsters, 18-28 years of age, attending three private universities. Online survey questionnaires were administered for: socio-demographics and Internet usage habits, the Big Five Inventory (John, Donahue and Kentle, 1991), to assess personality, and the Internet Addiction Test (Young, 1998), to determine the degree of use of the Internet (controlled, problematic or addictive). The results revealed that 9.7% of the sample has a problematic Internet use. Among them, the majority were male (x2= 12.93, p= 0.01) and performing communication and leisure activities. The problematic use correlates positively with neuroticism and negatively with friendliness and responsibility. On the other hand, is not related to extraversion and openness to experience. Being female and the responsibility dimension are protective factors from problematic use, while neuroticism predicts it. In conclusion, the study data provides empirical evidence of the relationship between personality and problematic Internet use.

[The Questionnaire of Experiences Associated with Video games (CERV): an instrument to detect the problematic use of video games in Spanish adolescents]. / El Cuestionario de Experiencias Relacionadas con los Videojuegos (CERV): un instrumento para detectar el uso problemático de videojuegos en adolescentes españoles.

The aim of this study is to validate the Video Game-Related Experiences Questionnaire (CERV in Spanish). The questionnaire consists of 17 items, developed from the CERI (Internet-Related Experiences Questionnaire - Beranuy and cols.), and assesses the problematic use of non-massive video games. It was validated for adolescents in Compulsory Secondary Education. To validate the questionnaire, a confirmatory factor analysis (CFA) and an internal consistency analysis were carried out. The factor structure shows two factors: (a) Psychological dependence and use for evasion; and (b) Negative consequences of using video games. Two cut-off points were established for people with no problems in their use of video games (NP), with potential problems in their use of video games (PP), and with serious problems in their use of video games (SP). Results show that there is higher prevalence among males and that problematic use decreases with age. The CERV seems to be a good instrument for the screening of adolescents with difficulties deriving from video game use. Further research should relate problematic video game use with difficulties in other life domains, such as the academic field.

The evolution of risk factors for respiratory syncytial virus-related hospitalisation in infants born at 32-35 weeks' gestational age: time-based analysis using data from the FLIP-2 study.

AIM: The aim of this study was to examine whether the risk for respiratory syncytial virus (RSV)-related hospitalisation changes through the first year of life in infants of 32-35 weeks' gestational age (wGA). METHODS: Risk factors from the FLIP-2 study (190 cases/4566 age-matched controls) were included in a Cox regression analysis wherein time slices were taken at 1-month intervals from birth. RESULTS: Half of all RSV hospitalisations occurred in the first 68 days after birth, with 56% occurring within 90 days. The time taken for 50% of hospitalisations to occur was 148 days for those born outside the RSV season and 58 days for those born within the season. By 90 days old, 84% of infants born in the season and 20% of those born outside the season were hospitalised. In both groups, hospitalisations occurred ≥5 months after birth. Male sex, smoking whilst pregnant, month of birth, duration of breastfeeding, number of siblings at school, and number of smokers in household all contributed to the risk of RSV hospitalisation beyond the age of 90 days. CONCLUSIONS: The risk of RSV hospitalisation appears to persist to at least 5-6 months old in 32-35 wGA infants, which has implications for the optimal management of disease prevention.

The Prevalence and Nature of Violence Against Women Experiencing Homelessness: A Quantitative Study.

Individuals experiencing homelessness-an extreme form of social exclusion-have considerably higher risk of being victims of violence than the general population. We analyze the episodes of violence suffered by 504 individuals experiencing homelessness in Spain, as well as the differences between men and women. The results indicate high levels of violence and suggest that gender (specifically, being a woman) is the primary factor driving exposure to violence among this group. Highlighting the reality of women experiencing homelessness can help social, mental health, and addiction services adjust responses to better address the needs of this group and offer comprehensive care.

Absence of Objective Differences between Self-Identified Addicted and Healthy Smartphone Users?

Smartphones are used by billions of people worldwide. However, some psychologists have argued that use of this technology is addictive, even though little research utilises objective smartphone usage records to verify this claim. We conducted an exploratory study to identify whether behavioural differences exist between those who self-identify as addicted smartphone users and those who do not. We gathered retrospective smartphone usage data from 131 Android users and asked them about their past use to compare their perception of their usage against their actual usage. We could not identify any reliable differences between the smartphone activity of those self-identified as addicted smartphone users and other users. Furthermore, smartphone scales are generally good at identifying who believes themselves to be addicted, although they do not reflect objective smartphone use. This study questions the use of self-report measures to diagnosis behavioural addictions without relevant psychopathological constructs and emphasises the need for more rigorous study to conceptualise smartphone addiction.

[Homelessness and mental health diagnose during the Great Recession (2008-2017): the effect of immigration.] / Sinhogarismo y salud mental durante la Gran Recesión (2008-2017): el efecto de la inmigración.

OBJECTIVE: Homelessness, which is a severe social problem across Europe and on the rise over the past decade, is closely linked to organic and mental health problems. In front of the lack of diagnostic analysis studies in the Spanish territory, this research aimed to determine the sociodemographic characteristics of a sample of individuals experiencing homelessness (IEH), to determine the prevalence of diagnoses of substance use disorders, dual pathology and other mental disorders and to analyze the existence of diagnostic differences between IEH born in the country and immigrant IEH. METHODS: A transversal and observational study was carried out, based on the analysis of mental health diagnostics of the medical histories of a sample of 1,072 IEH (453 locals and 619 immigrants) assisted between 2008 and 2017 in mental health services in Girona, northeastern Spain. For the statistical analysis, Student's t test was used to compare means and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression analysis was carried out to establish the predictor variables for the diagnosis of drug addiction and dual pathology. RESULTS: IEH showed high rates of mental disorders, especially psychoactive substances (82.6% of diagnosed people). 43.9% of IEH showed alcohol dependence as the reason for their diagnosis, followed by cocaine addiction and opiates. Foreign born IEH had more diagnoses for alcohol dependence and less for opiates or dual pathology than spanish born IEH. IEH born in Spain showed a higher vulnerability and received more mental health diagnoses than immigrant IEH. CONCLUSIONS: Even though immigrant PESS show more diagnoses for alcohol dependence, PESS born in Spain show a higher vulnerability and receive more mental health diagnoses than immigrant PESS. The process of migrating seems to establish a difference in the kind of mental disorders and addictions the PESS collective is prone to.

OBJETIVO: El sinhogarismo, grave problema social en toda Europa y en aumento durante la última década, está estrechamente vinculado a problemas orgánicos y de salud mental. Frente a la ausencia de estudios de análisis diagnóstico en territorio español, esta investigación pretendió conocer las características sociodemográficas de una muestra de personas en situación de sinhogarismo (PESS), determinar la prevalencia de diagnósticos de trastorno por uso de sustancias psicoactivas, patología dual y otros trastornos mentales y analizar la existencia de diferencias diagnósticas entre PESS nacidas en el país y PESS inmigrantes. METODOS: Se realizó un estudio transversal, observacional y analítico a partir del análisis de los diagnósticos de salud mental de las historias clínicas de una muestra de 1.072 PESS (453 autóctonas y 619 inmigrantes), atendidas durante 2008 y 2017 en los Servicios de Salud Mental de Girona (noreste de España). Para el análisis estadístico se utilizó t de Student para la comparación de medias y el ji-cuadrado para el análisis de variables categóricas. Se efectuó un análisis de regresión logística binaria para establecer las variables predictoras del diagnóstico de drogodependencias y patología dual. RESULTADOS: El 44% de la muestra estaba historiado en la Red de Salud Mental y Adicciones. Las PESS mostraron elevados índices de trastornos mentales, especialmente trastornos por uso de sustancias psicoactivas (82,6% de las personas diagnosticadas). El 43,9% de las PESS diagnosticadas lo fueron por dependencia al alcohol, seguidos de la dependencia a cocaína y a opiáceos. Las PESS inmigrantes tuvieron más diagnósticos por dependencia al alcohol y menos por dependencia a los opiáceos o patología dual que las PESS autóctonas. CONCLUSIONES: Aunque las PESS inmigrantes presentan más diagnósticos en dependencia al alcohol, las PESS nacidas en España muestran una mayor vulnerabilidad y reciben más diagnósticos de salud mental que las PESS inmigrantes. El proceso migratorio establece pues diferencias en el tipo de trastornos mentales y por uso de sustancias en la población de PESS.

Mortality Risk Factors for Individuals Experiencing Homelessness in Catalonia (Spain): A 10-Year Retrospective Cohort Study.

(1) Background: Current evidence suggests that mortality is considerably higher in individuals experiencing homelessness. The aim of this study was to analyze the mortality rate and the mortality risk factors in a sample of individuals experiencing homelessness in the city of Girona over a ten-year period. (2) Methods: We retrospectively examined the outcomes of 475 people experiencing homelessness with the available clinical and social data. Our sample was comprised of 84.4% men and 51.8% foreign-born people. Cox's proportional hazard models were used to identify mortality risk factors between origin groups. (3) Results: 60 people died during the ten-year period. The average age of death was 49.1 years. After adjusting for demographic characteristics and the duration of homelessness, the risk factors for mortality were origin (people born in Spain) (HR = 4.34; 95% CI = 1.89-10.0), type 2 diabetes (HR = 2.9; 95% CI = 1.62-5.30), alcohol use disorder (HR = 1.9; 95% CI = 1.12-3.29), and infectious diseases (HR = 1.6; 95% CI = 1.09-2.39). Our results show a high prevalence of infectious and chronic diseases. Type 2 diabetes emerges as an important risk factor in homelessness. The average age of death of individuals experiencing homelessness was significantly lower than the average age of death in the general population (which is greater than 80 years). (4) Conclusions: Foreign-born homeless people were generally younger and healthier than Spanish-born homeless people. Chronic diseases were controlled better in Spanish-born people, but this group showed an increased risk of mortality.

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study.

BACKGROUND AND AIMS: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. METHODS: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. RESULTS: For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. CONCLUSIONS: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Ethical dimensions of periviability.

The birth of neonates at the limits of viability, or periviability, poses numerous challenges to health care providers and to systems of care, and the care of these pregnancies and neonates is fraught with ethical controversies. This statement summarizes the ethical principles involved in the care of periviable pregnancies and neonates, and provides expert clinical opinion about the numerous challenges posed by this problem around the world. Topics addressed include a summary of the published experience, an ethical framework, translating neonatal outcome data to the obstetric arena, management as a trial of intervention, referral to tertiary centers, neonatal resuscitation, cesarean delivery for fetal indication, and limits on life-sustaining neonatal treatment.

Distinguishing male offenders through juvenile personality traits, coping strategies, feelings of guilt and level of anger.

On the basis of a comparative, descriptive, cross-sectional study, our aim was to determine differential traits of adolescent offenders with respect to personality traits, feelings of guilt, level of anger, and coping strategies. 128 adolescent residents of Barcelona (86 high school students and 42 young inmates aged between 16 and 18 years) replied to a variety of questionnaires (SC-35, EPQ-R, STAXI, ACS). Significant differences between the two groups were found. Young offenders present higher levels of guilt feelings, neuroticism, psychoticism, and trait anger. They also tend to repress their anger or, on the contrary, express it verbally and physically and use passive or avoidance coping strategies. Education and psychological therapy focussed on guilt may contribute to reduce recidivism.

Developing and Testing the Populi Needle Exchange Point Finder: An App to Reduce Harm Associated With Intravenous Drug Consumption Among Homeless and Non-homeless Drug Users.

The spread of viral infections remains a serious public health problem. People who inject drugs represent one of the highest-risk groups. eHealth and mHealth have been shown to be effective in improving individuals' management of their own health and their access to health care and to contribute to reducing the costs associated with certain medical interventions. People who inject drugs, including homeless people, tend to have access to technology. Young homeless people in particular are likely to use smartphones and social networking sites in ways that are similar to the general population. Despite this widespread use of technology, there are no apps designed specifically to reduce harm in people who inject drugs. The objective of this study is to analyze the development and usability testing process for an application for mobile devices, designed to complement the Needle Exchange Program. This app-the first of its kind-was developed by a public health agency, specialized professionals and people who inject drugs. We analyzed the differences in how health providers and drug users experienced the usability of the app. The participants were 61 members of multidisciplinary professional group and 16 people who inject drugs. We used a cross-sectional quantitative, observational design. First, we created and administered a questionnaire to collect the sociodemographic characteristics that could mediate the use of technology. Next participants tried the app and filled out a second questionnaire in which they rated their experience on a Likert scale from 1 to 7 in the following dimensions: overall attractiveness of the app, ease/difficulty of use, the extent to which they believed the app could improve access to injection materials, the extent to which they thought it would improve PWID's participation in the needle exchange program, overall utility, the degree to which they thought PWID would use the app, and the need for the app. To analyze the answers, we used contingency tables and compared means using a Student's t test. Finally, we conducted six audio-recorded focus groups about how the participants experienced the usability of the app. The objective of this part of the study was to classify and quantify the contributions of individuals and the group according to three predefined categories: potential benefits and positive aspects, potential obstacles or difficulties in carrying out the project, and concrete suggestions for improving the interface. There were not significant differences between the sociodemographic variables and the variables related to use of the app between professionals and PWID. Both professionals and PWID rated the app as intuitive and useful, especially the geolocation function for NEPs. Both groups also thought that the interface contained too much information and that this excess could be confusing for users. Both groups also had similar opinions about the app and its uses. An important difference between the two groups is that PWID reported that they would use the app, while professionals reported that they didn't think PWID would use it. All participants proposed improvements on the prototype, suggestions that will be applied in the creation of the definitive interface. Including professionals and patients in this sort of usability test enables researchers and developers to detect the needs of potential app users.

Individuals experiencing chronic homelessness: A 10-year follow-up of a cohort in Spain.

With the start of the great economic recession in 2007, homelessness increased fivefold in some regions of southern Europe. Larger numbers of people experiencing homelessness, compounded by a lowered capacity for social and health services to respond to their needs, precipitated an increase in so-called 'chronic homelessness'. The aim of this study was to establish the presence of chronic homelessness in a defined geographical area of Spain, and to determine the prevalence of diagnosed mental disorders within both the chronic and non-chronic homeless population. A prospective and descriptive study was designed to monitor a cohort of 826 individuals experiencing homelessness who constituted the entire identified homeless population in the relevant territory in 2006. This sample was followed until 2016 and sociodemographic as well as clinical information was collected, including the time spent homeless. The results obtained indicated that one in 10 participants met the criteria for chronic homelessness, a rate that is lower than in the US, where the definition of chronicity that was applied originates from. Alcohol use disorder was the most common mental health disorder that contributed to the chronicity associated with homelessness. Being born in the country (Spain) where the study was conducted and being older were the main other variables associated with chronicity. People defined as chronically homeless in Spain were on average younger than in the US, but women were present in the chronic subgroup at a similar rate. We also reflect on the limitations of the study and in particular the appropriateness of the concept of chronicity as applied to homelessness.