Effects of tai chi, ba duan jin, and walking on the mental health status of urban older people living alone: the mediating role of social participation and the moderating role of the exercise environment.

With the global trend of aging, lacking of interpersonal communication and spiritual support and companionship have had a great impact on the mental health of older people living alone. This study examines the multifaceted impacts of engaging in tai chi, ba duan jin, and walking on the mental wellbeing of older people residing alone in urban areas. Additionally, this research aims to explore the association between tai chi, ba duan jin, and walking, and the mental health status of urban older people living alone, by considering the mediating influence of social participation and the moderating influence of the exercise environment. To do so, 1,027 older people living alone in six Chinese cities were investigated using the Physical Activity Rating Scale (PARS-3), the Geriatric Health Questionnaire (GHQ-12), the Social Participation Indicator System Scale, and the Exercise Environment Scale. SPSS 25.0 was utilized for conducting mathematical statistical analysis, specifically for doing linear regression analysis. Additionally, AMOS was employed to develop the study model. We found that a significant negative correlation between tai chi, ba duan jin, and walking and mental health status; among these, tai chi had the greatest impact on the mental health status of urban older people living alone. Social participation mediated the relationship between tai chi, ba duan jin, walking, and mental health status, and the exercise environment had a moderating effect on this relationship. The findings of this study indicate that tai chi, ba duan jin, and walking have a positive impact on the mental health of urban older people living alone, which can be influenced by the mediating efficacy of social participation and the moderating effect of the exercise environment.

Understanding the home environment of older adults living with dementia: A scoping review of assessment tools.

Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care.

Home environment and nutritional status mitigate the wealth gap in child development: a longitudinal study in Vietnam.

BACKGROUND: Inequity in child development is found at early age, but limited evidence exists on whether these gaps change over time and what are the mediators. OBJECTIVE: We aim to (1) quantify wealth related gaps in cognitive and socio-emotional development in early and middle childhood; (2) examine how these gaps were mitigated by maternal, child factors and home environment. METHODS: We assessed the offspring of women who participated in a randomized controlled trial of preconception micronutrient supplementation in Vietnam (n = 1599). Child development was measured by the Bayley Scales of Infant Development-III (at 1-2y) and the Wechsler Intelligence Scale for Children®-IV (at 6-7y). We used multivariable regression to estimate the changes in wealth gaps for child development over time, adjusting for potential factors that potentially influence cognitive development. RESULTS: We found significant wealth gaps in cognitive development during early childhood (gaps between top and bottom quintiles: 0.5 SD); these gaps increased substantially in middle childhood (0.9 SD). Wealth disparity in social emotion did not change over time (0.26-0.28 SD). Maternal factors, quality of home environment, and child nutritional status mitigated the wealth gap in cognitive development (7-42%) in early childhood. The contribution of these mitigating factors was smaller in middle childhood (2- 15%). Wealth gap in social emotion reduced by 13% and 43% among children with better nutritional status at 2y and higher quality of home environment at 6-7y, respectively. CONCLUSION: Interventions focusing on improving quality of home environment, maternal education, wellbeing, and child nutrition status may help reduce developmental deficits associated with poverty.

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Dietary Nutrient Intake and Blood Micronutrient Status of Children with Crohn's Disease Compared with Their Shared-Home Environment, Healthy Siblings.

(1) The nutritional status of children with Crohn's disease (CD) is rarely described. This study aimed to assess the dietary intake and blood micronutrient status of children with CD compared with their healthy, shared-environment siblings. (2) Methods: This observational study included children with CD (cases) and their shared-environment siblings (controls). The dietary nutrient intake was assessed with a four-day food/beverage diary and was compared with the recommended daily intakes (RDI). Blood micronutrient concentrations were measured using laboratory methods. The nutritional analyses were completed through a multivariate analysis of variance between groups. Between-group comparisons of single-nutrients were assessed using a Mann−Whitney U-test. Chi-squared analyses compared the proportion of children who did not meet the RDI for each nutrient. The results were significant at 0.05. (3) Results: The dietary intake was similar for most nutrients, except the controls had a lower intake of vitamins A and E, copper, zinc, iron, and selenium (p < 0.05). Children using partial enteral nutrition had significantly higher intakes of many micronutrients. It was common for both groups to not meet the RDI's­more than 50% of cases for 9 nutrients and more than 50% of controls for 13 nutrients. (4) Conclusion: New Zealand children with CD and their shared-environment siblings did not meet the RDI for several micronutrients. Dietary education and/or micronutrient supplementation may be required.

[Functional status and quality of life of geriatric patients with wounds in acute hospitals : A comparison between patients with acute and chronic wounds: a cross-sectional study]. / Funktioneller Status und Lebensqualität von geriatrischen Patienten mit Wunden im Akutkrankenhaus : Ein Vergleich zwischen Patienten mit akuten und chronischen Wunden: eine Querschnittsstudie.

BACKGROUND: Geriatric patients are more predisposed to the occurrence of wounds due to age and disease, affecting functional status and quality of life. This aspect has rarely been researched in this population. OBJECTIVE: The aim of this study was to investigate the influence of chronic (cW) and acute wounds (aW) on the objective functional status and wound-related subjective quality of life in hospitalized geriatric patients. METHODS: In this exploratory cross-sectional analysis, data from 41 patients with wounds were examined. Patients were participating and recruited in the TIGER study (n = 244). Depending on the type of wound, patients were assigned to the aW (n = 19) or cW (n = 22) group. The two groups were compared in terms of physical function, hand strength, activities of daily living, depression, cognition, nutrition, quality of life (Wound-QoL) and sociodemographic data. RESULTS: There was a significant difference between the aW and cW groups in terms of gender (p = 0.045) and living conditions (p = 0.047). The type of wound was associated with the Barthel index (p = 0.010) and the Wound-QoL (p = 0.022). CONCLUSION: Compared to aW patients, cW patients were more limited in the physical and social dimensions and reported a lower quality of live. Living alone seems to play a relevant role. Among the patients of the TIGER study, men living alone were particularly more affected by cW. The care for these specific patients population should follow a holistic approach.

Efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) on loneliness and perceived stress of rural older adults living alone in China: a randomized controlled trial.

OBJECTIVES: This study aimed to explore the efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) to mediate the loneliness and perceived stress of older adults living alone in rural China. The results can provide a scientific foundation for improving psychological health. METHOD: A randomized controlled trial of 64 (aged 65.70 ± 3.69 years) Chinese rural older adults living alone was conducted. They were randomly divided into either an eight-month intervention group or a control group. The perceived stress scale (PSS) and the UCLA loneliness scale (UCLA-LS) evaluated the perceived stress and loneliness of the two groups at three different times. A repeated-measures analysis of variance model was used to compare each outcome measure of the two groups. RESULTS: The CTFA-GRT yielded a benefit for the perceived stress and loneliness of rural older adults living alone in the intervention group. Combined with a simple effects test, the PSS and UCLA-LS of those in the intervention groups significantly decreased at eight months after the baseline (F PSS = 23.540, F UCLA-LS = 40.159; all P < 0.01). In addition, the sustainable effect of this program lasted three months after the intervention (F PSS = 65.756, F UCLA-LS = 60.983; all P < 0.01). CONCLUSION: The CTFA-GRT significantly decreased the perceived stress and loneliness of rural older adults living alone in China.

Contemporary Issues and Practicalities in Completing Advance Care Planning for Patients With Severe COPD Living Alone: A Qualitative Study.

Health care professionals working with older people living alone with chronic obstructive pulmonary disease (COPD) to complete advance care planning (ACP) often encounter the double burden of social isolation and acute exacerbations in this planning. The study explored clinicians' perceptions regarding factors influencing the completion of ACP for older people with COPD living alone. Individual interviews were conducted with 18 health care professionals using the video meeting platform in 2020. A semi-structured interview guide included: (a) behavior and lifestyle related to decision-making, (b) desired place to die, and (c) facilitators and barriers to autonomy in patients with severe COPD who live alone. Five main themes were identified: information sharing among team members, patient readiness, desired place of death, economic constraints, and care at the time of and after death. Partly due to the heterogeneity and complexity of clinical courses and treatment responses of COPD, a wide range of social issues of a person's life were related to practicality in the completion of ACP for older people with COPD living alone. Social work knowledge and skills such as in-depth interviewing, outreach finance and welfare support, and holistic perspective play an essential role in completing ACP for COPD patients living alone.

Experiência em cuidar de idosos com demência no ambiente domiciliar: uma síntese qualitativa de evidências / Experience in caring for the older people with dementia in the home environment: a qualitative synthesis of evidence / Experiencia en el cuidado de mayores con demencia en el ambiente doméstico: una síntesis cualitativa de evidencia

Objetivo: compreender a experiência de cuidadores familiares no cuidado de idosos com demência em ambiente domiciliar. Métodos: foi realizada uma busca sistemática por estudos qualitativos e análise temática para sintetizar os resultados. Resultados: foram incluídos nove estudos. Emergiram quatro temas analíticos: Reconhecendo a demência e desvendando o cuidar; "Você está sozinha"; Limitações e desconhecimentos no cuidar com demência; "É um último recurso (colocação em instituição de longa permanência) ". A perda de autonomia dos idosos gerou sentimentos de luto e solidão. O conhecimento limitado sobre demência suscitou em um cuidado inábil. Os cuidados temporários eram percebidos como uma solução frente à necessidade de ajuda, porém, a institucionalização foi abordada como uma última alternativa. Conclusão: os resultados obtidos são importantes para fornecer subsídio para a criação de políticas públicas mais humanizadas que considerem a integralidade no cuidado, auxiliar profissionais de saúde na prestação de cuidados aos idosos com demência e sua família.

Objective: to understand the experience of family caregivers in caring for older people with dementia in the home environment. Methods: a systematic search for qualitative studies and a thematic analysis was carried out to synthesize the results. Results: nine studies were included. Four analytical themes emerged. Recognizing dementia and unraveling care; "You are alone"; Limitations and lack of knowledge in caring for dementia; "It's a last resort [full institutionalization nursing home]." The older people's loss of autonomy generated feelings of grief and loneliness. Limited knowledge about dementia has given rise to awkward care. Temporary care was perceived as a solution to the need for help. However, institutionalization was approached as a last alternative. Conclusion: the results obtained are important to provide support for the creation of more humanized public policies that consider comprehensive care, assist health professionals in providing care to older people with dementia and their families.

Objetivo: comprender la experiencia de los cuidadores familiares en el cuidado de personas mayores con demencia en la residencia. Metodos: se realizó una búsqueda sistemática de estudios cualitativos y un análisis temático. Resultados: se incluyeron nueve artículos. Surgieron cuatro temas analíticos: Reconocer la demencia y deshacerla atención; "Estás sola"; Limitaciones y ignorancia en el cuidado de la demencia; "Es un último recurso [institución de larga permanencia]". La pérdida de autonomía de los ancianos generó sentimientos de dolor y soledad. El conocimiento limitado sobre la demencia ha dado lugar a cuidados incómodos. El cuidado temporal fue una solución a la necesidad de ayuda, sin embargo, la institucionalización se abordó como última alternativa. Conclusión: los resultados obtenidos son importantes para apoyar la creación de políticas públicas más humanizadas que consideren la atención integral, ayudar profesionales de la salud en la atención a las personas mayores con demencia y sus familias.

Sarcopenia risk and associated factors among Chinese community-dwelling older adults living alone.

Sarcopenia, defined as a progressive loss of muscle mass and reduced muscle strength and functional capacity, is common among older adults. This study aimed to assess the proportion of people at risk of sarcopenia and probable sarcopenia among Chinese community-dwelling older adults living alone and to identify the associated factors. A total of 390 older adults were included in this study. Sarcopenia and probable sarcopenia were defined according to the criteria of the Asian Working Group for Sarcopenia 2019. Data on socio-demographic characteristics, health status, health behaviours and lifestyle characteristics, nutritional status, physical activity level, and depressive symptoms were collected. The association between these characteristics and sarcopenia risk was analysed using a multivariate ordinal logistic regression. The proportion of subjects at risk of sarcopenia and probable sarcopenia was found to be 57.7% and 30%, respectively. Older age, being malnourished and being at risk of malnutrition were significantly associated with sarcopenia risk. Being educated to secondary level or above, being overweight or obese and higher physical activity level were associated with decreased sarcopenia risk. Our results showed that older adults living alone were at high risk of developing sarcopenia and probable sarcopenia. These results emphasise the urgent need to initiate aggressive screening and holistic lifestyle therapeutic intervention strategies for this high-risk population.

Maternal depression is the predominant persistent risk for child cognitive and social-emotional problems from early childhood to pre-adolescence: A longitudinal cohort study.

RATIONALE: Brain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes. METHODS: We assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001-2004: at 3.5 years in 2006 and 9-12 years in 2012-2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9-12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9-12 y), for example, the residual of 3.5 y MDS predicting 9-12 y MDS (rMDS). RESULTS: Three early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: -0.07 [-0.12, -0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: -0.13 [-0.23, -0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome. CONCLUSIONS: Our findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development.

Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review.

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.

Psicologia ambiental e recursos em sustentabilidade: revisão integrativa / Environmental psychology and sustainability resources: integrative review / Psicología ambiental y recursos de sostenibilidad: revisión integradora

O objetivo deste estudo foi examinar, por meio de revisão integrativa de artigos empíricos, a produção científica relacionando a Psicologia Ambiental (variáveis de comportamento/cognição) e sustentabilidade, considerando diferentes recursos. Para efeitos deste estudo, foram analisados os artigos que abordam um recurso único. A busca foi realizada nos periódicos Environment and Behavior, Journal of Environmental Psychology e Psyecology, reconhecidos pela relevância internacional em produção científica no campo da Psicologia Ambiental. Foram selecionados 24 artigos, publicados entre os anos de 2012 e 2016, a partir dos critérios de inclusão pré-estabelecidos. Os anos com maior número de publicação foram 2014 (n = 8) e 2015 (n = 8). A maioria dos artigos se refere a estudos realizados na Europa, apenas um trata de pesquisa no Brasil. Os recursos abordados nos estudos abrangeram transporte, produtos, água, energia elétrica, sacola plástica e pastagem natural. Os resultados revisados demonstram que há uma diversidade de conceitos na mediação entre comportamentos/cognições e diferentes recursos, indicando a relevância destas abordagens para a promoção de sustentabilidade. Sugere-se caminhos para pesquisa e intervenção nas relações sustentáveis entre pessoas e recursos disponíveis em seus meios.(AU)

The objective of this study was to examine, through an integrative review of empirical articles, the scientific production on the relation between Environmental Psychology (behavior/cognition variables) and sustainability considering different resources. For that purpose, this analysis considered articles approaching a unique resource. Search was conducted in three journals with international relevance in the scientific production of Environmental Psychology: Environment and Behavior, Journal of Environmental Psychology and Psyecology. Following pre-established inclusion criteria, results included 24 articles published from 2012 and 2016. Years with higher number of publications were 2014 (n = 8) and 2015 (n = 8). The articles found refer mostly to studies conducted in Europe; only one article is a research from Brazil. Resources included transportation, products, water, energy, plastic bag, and natural grassland. Results indicate that there is a diversity of concepts mediating behaviors/cognitions and different resources, which reveals the relevance of these approaches to the promotion of sustainability. Research and intervention paths are suggested to sustainable relations between people and resources available in their surroundings.(AU)

El objetivo de este estudio fue examinar, por medio de una revisión integradora de artículos empíricos, la producción científica que relaciona la Psicología Ambiental (variables de comportamiento/cognición) y la sostenibilidad, considerando diferentes recursos. Para los propósitos de este estudio, se analizaron artículos que abordan un solo recurso. La búsqueda fue realizada en los periódicos Environment and Behavior, Journal of Environmental Psychology y Psyecology, reconocidos por la relevancia internacional en producción científica en el campo de la Psicología Ambiental. Se seleccionaron 24 artículos, publicados entre los años 2012 y 2016, basados en criterios de inclusión preestablecidos. Los años con el mayor número de publicaciones fueron 2014 (n = 8) y 2015 (n = 8). La mayoría de los artículos se refiere a estudios realizados en Europa, sólo uno trata de investigación en Brasil. Los recursos abordados en los estudios incluyeron transporte, productos, agua, energía eléctrica, bolsas de plástico y pastoreo natural. Los resultados revisados demuestran que hay una diversidad de conceptos en la mediación entre comportamientos/cogniciones y diferentes recursos, indicando la relevancia de estos enfoques para la promoción de la sostenibilidad. Se sugieren caminos para la investigación e intervención en las relaciones sostenibles entre personas y recursos disponibles en sus medios.(AU)