"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.

Hepatitis C in homeless people: reaching a hard-to-reach population.

OBJECTIVE: the aim of this study was to analyze the process of detection and treatment of hepatitis C in individuals experiencing homelessness (IEH). METHODS: an analytical cross-sectional study was performed in a Primary Care center. The center screened and registered patients with a positive hepatitis C antibody test and referred them to the Digestive Service. RESULTS: finally, 8.3 % presented with a positive HCV antibody test, of which six were patients who had already received treatment. Of those who had not received treatment, one patient was successfully treated; 30.8 % of the total could not be located or did not wish to participate. CONCLUSION: community coordination and the use of rapid tests would improve detection.

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.

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.

Differences in Drug Use among Persons Experiencing Homelessness According to Gender and Nationality.

The main aims of this article are to update the data related to drug and alcohol use in persons experiencing homelessness (PEH) who use shelters, and to see if there are significant differences in their drug use depending on their gender and nationality. The article presents an analysis of the interconnections between the results of drug dependence detection tools (Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10), Severity of Dependence Scale (SDS)) according to gender and nationality with the intention of identifying specific needs that lead to new lines of research into better approaches to homelessness. A cross-sectional, observational and analytical method was used to analyse the experiences of persons experiencing homelessness who use various shelters in the cities of Madrid, Girona, and Guadalajara (Spain). The results show that there are no gender differences in the risks of using drugs and drug addiction, but there are differences in terms of nationality for drug addiction, with Spanish nationals showing a greater tendency to develop drug addiction. These findings have significant implications, as they highlight socio-cultural and socio-educational influence as risk factors in drug addiction behaviours.

Cigarette, e-cigarette and waterpipe cognitions and use among university students in Guangzhou, China.

INTRODUCTION: There is currently little research on polytobacco use in China. The present study examined cognitions that predicted the use of cigarettes, e-cigarettes and waterpipes in a Chinese sample of students. METHODS: A convenience sample of 281 university students, obtained using snowball sampling, completed an online survey during the 2019-2020 academic year in Guangzhou, China. RESULTS: Men more strongly agreed, than women, with the possible advantages of using alternative nicotine and tobacco products, including: young people who smoke have more friends, smoking makes young people look cool, smoking makes young people feel more comfortable, smoking helps relieve stress, and it would be easy to quit. Factors significantly associated with regular cigarette use were the cognitions: 'I would smoke if my best friend offered', 'Young people who use these products have more friends', and 'It would be easy to quit these products' (global good classifications= 80.1%). In the case of waterpipes, agreement with the cognition: 'The product helps people relieve stress' was significantly associated with its use (global good classifications=80.1%). In the case of e-cigarettes, agreement with the cognitions: 'I would smoke if my best friend offered' and 'It would be easy to quit using these products' were significantly associated with the use of e-cigarettes (global good classifications=74.7%). CONCLUSIONS: The results highlight the need to develop prevention programs that prepare young Chinese people to resist social pressure from friends to use tobacco products. There is also evidence of the need to facilitate and disseminate rigorous scientific information among young people about the possible negative health effects of alternative tobacco products. There were also gender differences in the use of these products and in the cognitions towards their use, so it is important to take the gender perspective into account in the analysis of the results and when writing future questionnaire items.

Mating Performance and Singlehood Across 14 Nations.

Adult individuals frequently face difficulties in attracting and keeping mates, which is an important driver of singlehood. In the current research, we investigated the mating performance (i.e., how well people do in attracting and retaining intimate partners) and singlehood status in 14 different countries, namely Austria, Brazil, China, Greece, Hungary, Italy, Japan, Peru, Poland, Russia, Spain, Turkey, the UK, and Ukraine (N = 7,181). We found that poor mating performance was in high occurrence, with about one in four participants scoring low in this dimension, and more than 57% facing difficulties in starting and/or keeping a relationship. Men and women did not differ in their mating performance scores, but there was a small yet significant effect of age, with older participants indicating higher mating performance. Moreover, nearly 13% of the participants indicated that they were involuntarily single, which accounted for about one-third of the singles in the sample. In addition, more than 15% of the participants indicated that they were voluntarily single, and 10% were between-relationships single. We also found that poor mating performance was associated with an increased likelihood of voluntary, involuntary, and between-relationships singlehood. All types of singlehood were in higher occurrence in younger participants. Although there was some cross-cultural variation, the results were generally consistent across samples.

Polydrug Definition and Assessment: The State of the Art.

Polydrug use is a very common phenomenon and represents an important public health problem. The definition of the term has varied since its inception, and consequently so have forms of self-report evaluation. The aim of this review is to offer an overview of how the concept has evolved and its forms of evaluation through self-reporting. A search of the term polydrug was conducted on the PubMed portal up to August 2022, with a total of 2076 publications detected containing the word polydrug in their title, abstract or keywords. This includes publications that represent an advance in the definition and assessment of this construct through self-reports, which may be useful for researchers carrying out future studies in the field. The importance of distinguishing between concurrent and simultaneous polydrug use and the need to employ comparable measures in parameters for the frequency, magnitude and combination of psychoactive substances involved in polydrug use are two of the main recommendations emerging from this review.

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.

The TriClip system for edge-to-edge transcatheter tricuspid valve repair. A Spanish multicenter study.

INTRODUCTION AND OBJECTIVES: In patients with tricuspid regurgitation (TR), edge-to-edge transcatheter tricuspid valve repair (TTVR) is the strategy with the highest penetration worldwide. A dedicated edge-to-edge TTVR system has recently become available in Europe. The present study describes the initial experience with the system in Spain. METHODS: This multicenter study collected individual data from the centers accepted for the use of the novel system within an initial limited release. Between June 2020 and March 2021, all patients undergoing an edge-to-edge TTVR using the TriClip system in Spain were included in the study. The primary endpoint was the achievement of a TR reduction of at least 1 grade at discharge. RESULTS: We included 34 patients. Most of them reported a previous history of atrial fibrillation (91%) and only 1 had a pacemaker lead. The primary endpoint (TR reduction of at least 1 grade at discharge) was met in all patients. Most of the patients required 1 (47%) or 2 clips (44%) with a clear predominance of XT (87%) over NT (13%). The location of the first clip was anteroseptal in >90% of the patients. Only 1 patient had a partial detachment, which was stabilized with additional clips in the same procedure. At discharge, TR severity was≤2 in 91% of patients. At 3 months, mortality was nil. Overall, 88% of patients were in New York Heart Association functional class≤2 and 80% had residual TR≤2. CONCLUSIONS: Edge-to-edge TTVR seemed to be effective and safe with a sustained TR reduction at 3 months. Further studies will be needed to confirm our findings.

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.

Facebook Intrusion as a Mediator Between Positive Capital and General Distress: A Cross-Cultural Study.

Background: Social networking sites (SNSs) play an important role in many aspects of life nowadays, and it seems to be crucial to explore their impact on human well-being and functioning. The main aim of the study was to examine the mediating role of Facebook intrusion between positive capital and general distress. Positive capital was considered as comprising self-esteem, ego-resiliency, and self-control, while general distress was seen as having three dimensions: depression, anxiety, and stress. Methods: The sample consisted of N = 4,495 participants (M = 22.96 years, SD = 5.46) from 14 countries: Australia, Cyprus, Greece, Hong Kong, Lithuania, New Zealand, Peru, Poland, Russia, Spain, Turkey, Ukraine, United Kingdom, and United States. We used the following methods: the Facebook Intrusion Questionnaire (FIQ), the Self-Esteem Scale (SES), the Brief Self-Control Scale (SCS), The Ego Resiliency Revised Scale and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results: We found that Facebook intrusion was a mediator between self-esteem and general distress and between self-control and general distress. Limitations: The present study was based on a cross-sectional study, and the measures used were self-report measures. The majority of the participants were recruited using convenience sampling. Conclusions: The present findings contribute to a better understanding on how the social media have impact on individual mental health. Implications for future studies are discussed.

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.

Using Facebook for Improving the Psychological Well-Being of Individuals Experiencing Homelessness: Experimental and Longitudinal Study.

BACKGROUND: Web-based social networks are a powerful communicative element and their use is increasingly widespread. Persons living in extreme social exclusion such as individuals experiencing homelessness can benefit from the positive elements of communication and relationship associated with social networking sites. OBJECTIVE: This study aimed to suggest the comparison of a Facebook training course and an office software course and their effect on psychological well-being in a group of individuals experiencing homelessness. METHODS: An experimental and longitudinal study was designed. Individuals experiencing homelessness were randomly assigned to either the Facebook group or the office software group, and their social skills, self-esteem, self-efficacy, and satisfaction with life were measured on 4 occasions: pretest, at the end of the training course, 1 month later, and 3 months later. A mixed analysis of variance of repeated measures (2×4) was performed. RESULTS: A total of 92 individuals experiencing homelessness participated in the study. The number of cases in which the 4 measurements were completed was 71 (35 in the intervention group and 36 in the control group). The mixed analysis of variance of repeated measures and the multiple regression analysis indicated a significant increase of the 4 analyzed parameters, with greater significance in the areas of social skills and self-esteem. The critical levels associated to the interaction Time×Program were significant in all variables and levels. Therefore, the scores in the 4 analyzed constructs were not equal according to the program carried out throughout the work. The effect size associated to the interaction Time×Program in the social skills scores was large (η2=0.32); in the self-esteem and self-efficacy scores, it was medium, (η2=0.13); and in the satisfaction with life scores, it was small (η2=0.09). The results of the adjustment of the different models of multiple linear regression indicate that the number of hours devoted weekly to the use of Facebook was a predictor of the increase in the scores of social skills (B=3.43, r2=.405) and self-esteem (B=.382). Age (B=.175) and self-efficacy (B=.09) were also variables, which with independence and in equal conditions, predicted self-esteem (r2=.29). Finally, self-esteem (B=.69) was also a predictor variable of the increase of satisfaction with life (r2=.195). CONCLUSIONS: These findings suggest that Facebook could be a key element in homeless psychological well-being and socialization.

May the passion be with you: The addictive potential of collectible card games, miniatures, and dice of the Star Wars universe.

BACKGROUND AND AIMS: In recent years, we have witnessed a growing research interest in behavioral addictions and in pleasurable behaviors that generate a certain discomfort in the people who engage in them. The objective of this study was to assess if users of collectible card games, miniatures, and dice from the Star Wars Universe Games (SWUG) may also present criteria of addiction and if the presence of these criteria is related to demographic variables, game-playing habits, and other variables. METHODS: SWUG players were contacted through specialized gaming chats, and 218 of them completed the Internet Gaming Disorder Scale - Short Form (IGDS-SF9), a scale that assesses motivation to engage in the game (Massively Multiplayer Online Motivations Scale), the Rosenberg Self-Esteem Questionnaire, the Diener Satisfaction with Life Scale, and a question for the self-assessment of addiction. RESULTS: Significant predictors of addictive symptoms were the motivation to seek dissociation and (negatively) self-esteem. Users more significantly dedicate indirect hours to the game (thinking about the game, preparing material, etc.) than to actually playing. No participant could be considered pathologically addicted, as no one scored above the tentative cut-off point of the IGDS-SF9. DISCUSSION AND CONCLUSIONS: Despite the fact that many players considered themselves "addicted" and some presented various economic and family problems related to their activity, it was found that playing these games could not be equated to true addictive behavior, since no player had scores above the cut-off point. This finding contributes to current discussions about the tendency to overestimate excessive pleasurable behaviors.