Development of an online service for coping with spousal loss by means of human-centered and stakeholder-inclusive design: the case of LEAVES.

To support older mourners after the loss of their partner, LEAVES, an online self-help service that delivers the LIVIA spousal bereavement intervention, was developed. It integrates an embodied conversational agent and an initial risk assessment. Based on an iterative, human-centered, and stakeholder inclusive approach, interviews with older mourners and focus groups with stakeholders were conducted to understand their perspective on grief and on using LEAVES. Subsequently, the resulting technology and service model were evaluated by means of interviews, focus groups, and an online survey. While digital literacy remains a challenge, LEAVES shows promise of being supportive to the targeted end-users.

Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps.

Objective: Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners. Method: The module consists of two components: a user profile that collects relevant information about the user from the application, enabling the second component, a fuzzy cognitive map (FCM) decision-making algorithm that detects risk situations and to recommend the user to seek offline support, whenever advisable. In this article, we show how we configured the FCM with the help of eight clinical psychologists and we investigate the utility of the resulting decision tool using four fictitious scenarios. Results: The current FCM algorithm succeeds in detecting unambiguous risk situations, as well as unambiguously safe situations, but it has more difficulty classifying borderline cases correctly. Based on recommendations from the participants and an analysis of the algorithm's erroneous classifications, we propose how the current FCM algorithm can be further improved. Conclusion: The configuration of FCMs does not necessarily demand large amounts of privacy-sensitive data and their decisions are scrutable. Thus, they hold great potential for automatic decision-making algorithms in mental eHealth. Nevertheless, we conclude that there is a need for clear guidelines and best practices for developing FCMs, specifically for eMental health.

A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries.

BACKGROUND: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. OBJECTIVE: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. METHODS: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention's clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). RESULTS: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. CONCLUSIONS: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons. TRIAL REGISTRATION: Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37827.

Pre-vaccination immune response to COVID-19 in a population in Northeast Portugal.

PURPOSE: To study the immunization status and IgM and IgG antibody behavior against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an unvaccinated population of Northeast Portugal (including RT-PCR diagnosed and undiagnosed individuals). METHODS: Application of a clinical-epidemiological survey, and analysis of IgM and IgG SARS-COV-2 antibodies (against N core protein) in 362 participants that voluntarily sought the laboratory for testing. RESULTS: At the time of the analysis, 31.7% (n = 114) of the study population had a previous SARS-CoV-2 diagnosis, 48.3% of which were asymptomatic, and 71.9% IgG seropositive. Of these, 83.3% and 60% were, respectively, IgM and IgG seropositive within 2 weeks after the initial diagnosis. Both antibodies peaked in the 3rd week post diagnosis, with titers decreasing over the following weeks, until a state of seronegativity was achieved after the 6th week for IgM, and the 21st for IgG. Symptomatic patients showed higher IgM and IgG values, when compared to asymptomatic ones. Fever, the most reported symptom, was found to be positively associated with IgM values. Ages of ≤ 18-year-old and ≥ 65-year-old exhibited the highest median values for both IgM and IgG, with the former being statistically significant. In the undiagnosed group, 13.9% and 11.1% were seropositive for IgM and IgG, respectively. CONCLUSION: IgM and IgG displayed a similar initial increase (within 1/2 weeks), with IgG having a significant decrease after the 21st week post-diagnosis, translating a loss of immunity at this point. The youngest and oldest symptomatic age groups were found to be the highest responders. Antibody assays enabled the identification of previously undiagnosed participants.

Linguistic and cultural adaptation of the EARP Questionnaire to European Portuguese.

OBJECTIVE: This study aims at the linguistic and cultural adaptation of the Early ARthritis for Psoriatic Patients (EARP) questionnaire into European Portuguese, for psoriatic patients attending dermatology medical examination. METHODS: Firstly, we performed a process of translation and back-translation of the English version of the EARP Questionnaire to European Portuguese, with interim and final harmonization. The resulting Portuguese version was approved by the EARP original author. Secondly, individual interviews were conducted to complete the linguistic and cultural adaptation of the initial translated Portuguese version, with the think-aloud and probe methods. At this stage, we conducted eight interviews, four with rheumatology and dermatology doctors (experts), and four with patients with psoriasis and psoriatic arthritis. Finally, the version resulting from the adaptation process was back-translated from Portuguese to English. RESULTS: Our results showed that EARP Questionnaire's items are easy to understand and do not raise comprehension concerns in experts or patients. Our findings suggested that items demanding health literacy from patients and that do not include a precise cue to signal the inflammatory nature of the joint pain may lead to confusion while answering, potentially leading to the patient's need for assistance. CONCLUSION: The Portuguese version of the EARP Questionnaire demonstrated adequate comprehension properties. Our findings support the use of this measure in clinical practice and future research, however, a validation study with Portuguese patients is needed.

How Your Power Affects My Impression of You.

In the present article, we investigate how a person's power affects the way we infer traits from their behavior. In Experiment 1, our results suggest that, when faced with behavioral descriptions about others, participants infer both positive and negative traits about powerless actors, whereas for powerful and control (power irrelevant) actors, only positive but no negative traits are inferred, an effect we call the benevolence bias. In the second experiment, (a) we replicate this effect, (b) we show that it does not depend on the specific traits used in Experiment 1, and (c) we show that it is also detected when an implicit measure of inferences is used. Experiment 3 further shows that this effect generalizes to a more generic power manipulation. Theoretical explanations for these findings are discussed.

A conceptual model for generating and validating in-session clinical judgments.

OBJECTIVE: Little attention has been paid to the nuanced and complex decisions made in the clinical session context and how these decisions influence therapy effectiveness. Despite decades of research on the dual-processing systems, it remains unclear when and how intuitive and analytical reasoning influence the direction of the clinical session. METHOD: This paper puts forth a testable conceptual model, guided by an interdisciplinary integration of the literature, that posits that the clinical session context moderates the use of intuitive versus analytical reasoning. RESULTS: A synthesis of studies examining professional best practices in clinical decision-making, empirical evidence from clinical judgment research, and the application of decision science theories indicate that intuitive and analytical reasoning may have profoundly different impacts on clinical practice and outcomes. CONCLUSIONS: The proposed model is discussed with respect to its implications for clinical practice and future research.