Ajuste y adaptación psicosocial de adultos jóvenes supervivientes de un cáncer en etapa pediátrica: Revisión sistemática / Psychosocial adjustment and adaptation in young adults surviving pediatric cancer: A systematic review

Introducción: Los efectos a largo plazo de tumores en la infancia pueden alterar la trayectoria de adaptación y ajuste psicosocial de los supervivientes en etapas de vida posteriores. Objetivo: Esta revisión sistemática se centra en analizar las experiencias de crecimiento postraumático, estrés postraumático, malestar emocional y dificultades psicosociales sufridas por jóvenes adultos supervivientes a un cáncer en etapa pediátrica. Resultados: Los resultados sugieren una trayectoria mayoritaria que podría definirse como adaptativa, en la que se observa tanto crecimiento postraumático (prevalencia superior al 60%), como síntomas de estrés postraumático (prevalencia inferior al 30%). No obstante, en comparación con población control no oncológica, estos supervivientes tienen mayor riesgo de padecer síntomas de ansiedad y depresión, de alcanzar menores logros educativos y profesionales, y de permanecer solteros o vivir solos, lo que se hipotetiza que podría estar relacionado con las secuelas de cada tipo de tumor y tratamiento, y no únicamente con la vivencia de la enfermedad. Conclusiones: La atención a jóvenes adultos supervivientes a un cáncer pediátrico debería centrarse en proporcionar mayor apoyo médico y psicosocial a largo plazo, a través del abordaje interdisciplinar y la atención centrada en la persona, como aproximación que favorezca una trayectoria de ajuste adaptativa.(AU)

Introduction: Long-term effects of childhood tumors can alter the trajectory of adjustment and psychosocial adjustment of survivors later in life. Purpose: This systematic review focuses on analyzing the experiences of posttraumatic growth, posttraumatic stress, emotional distress, and psychosocial difficulties experienced by young adult survivors of pediatric cancer. Results: The results suggest a more prevalent trajectory that could be conceptualize as adaptive, in which both post-traumatic growth (prevalence greater than 50%) and post-traumatic stress symptoms (prevalence less than 30%) are observed. However, compared to the non-oncology control population, these survivors are at higher risk for anxiety and depressive symptoms, lower educational and occupational attainment, and remaining single or living alone, which is hypothesized to be related to the sequelae of each tumor type and treatment, and not just the disease experience. Conclusions: Care for young adult survivors of pediatric cancer should focus on providing enhanced long-term medical and psychosocial support through an interdisciplinary approach and person-centered care as an approach that supports a trajectory of adaptive adjustment.(AU)

Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App.

BACKGROUND: Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. OBJECTIVE: This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability-based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. METHODS: In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). RESULTS: All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=-1524; P<.001) on daily steps. CONCLUSIONS: The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs.

Co-designing implementation strategies to promote remote physical activity programs in frail older community-dwellers.

Background: The "AGIL Barcelona (AGILBcn)" community-based integrated care program is a multicomponent healthy aging intervention for frail older adults. In this context, the present study aimed to identify implementation strategies to optimize the accessibility, acceptability, and adaptability of mobile health (mhealth) interventions to enhance physical activity in frail older adults, and to prioritize action points according to their importance and feasibility, through a co-design process. Material and methods: A mixed methods approach was used. In the qualitative phase, a method adapted from the World Café was applied in 6 virtual groups to identify strategies to facilitate the virtual physical activity program. In the quantitative phase, prioritization and feasibility of the strategies was analyzed through surveys. Strategies were ranked based on priority vs. feasibility, revealing if strategies should either be: implemented first; if possible; taken into account for future consideration; or directly disregarded. The convenience sample included older adults (n = 7), community professionals (n = 9) and health professionals (n = 13). Qualitative data were analyzed by summative content analysis and quantitative data by nonparametric descriptive analyses. Results: A total of 27 strategies were identified and grouped into four categories: general strategies for reducing barriers; specific strategies for facilitating the use of a digital application; specific strategies for facilitating participation in virtual exercise groups; and specific strategies for facilitating external support. According to the ranking of strategies, the first ones to be implemented included: digital literacy, digital capability assessment, family technology support, weekly telephone follow-up by professionals, personalizing exercises, and virtual exercises in small groups. Conclusion: The active participation of all stakeholders enabled us to identify potential strategies for implementing person-oriented technology in physical activity programs and for engaging older adults.

Family Factors Related to Suicidal Behavior in Adolescents.

Objective: This research aims to investigate what type of family patterns (specifically attachment, bonding and family functioning) and stressful life events can trigger or protect adolescents from developing suicidal behavior. Methods: For these purposes, a case-control study (adolescents with suicidal behavior vs. paired adolescents with no suicidal behavior) was conducted with one hundred 12 to 17-year-old adolescents (50 controls, 50 cases, 74% females), assessed between 2018 and 2020. Results: Negligent (p < 0.001) or affection-less control bonding (p < 0.001), insecure attachment (p = 0.001) and stressful life events (p < 0.001) revealed to be significant risk factors for suicidal behavior. On the contrary, parents' care (p < 0.001) and security (p < 0.001) were revealed as protective factors for suicidal behavior. Conclusions: Considering these results, family interventions and improving coping skills seem to be two essential targets for any suicide prevention intervention in adolescents.

Non-Pharmacological Interventions for the Management of Chronic Health Conditions and Non-Communicable Diseases.

A chronic health condition has been defined by the World Health Organization (WHO) as a disease being of long duration, generally slow in progression and not passed from person to person; that is to say, a non-communicable disease (NCD) [...].

Predictors of Suicide Re-Attempt in a Spanish Adolescent Population after 12 Months' Follow-Up.

Background: This study aims to identify the main predictive factors that allow for the recognition of adolescents with a higher risk of re-attempting suicide. Method: A longitudinal 12-month follow-up design was carried out in a sample of 533 Spanish adolescents between 12 and 17 years old. The data collection period comprised September 2013 to November 2016, including a one-year follow-up after hospital discharge. Results: A statistically significant regression model was obtained to predict suicide re-attempt at 12-months' follow-up (χ2 = 34.843; p < 0.001; Nagelkerke R2 = 0.105), including personal history of self-injury (OR = 2.721, p < 0.001, 95% CI [1.706, 4.340]) and age (OR = 0.541, p = 0.009, 95% CI [0.340, 0.860]), correctly classifying 82.6% of the sample. Our results show that having a personal history of self-injury and being younger than 14 years old were predictors of suicide re-attempt during the first year after an adolescent's first admission to emergency services. Conclusions: Considering these factors could contribute to the design of more tailored and effective interventions to prevent suicidal behavior in adolescents at high risk of re-attempting suicide.

Correlates to psychological distress in frail older community-dwellers undergoing lockdown during the COVID-19 pandemic.

BACKGROUND: This study identifies correlates of the lockdown's psychological distress in frail older community-dwellers (Catalonia, Spain). METHODS: Participants from a community frailty intervention program, with a comprehensive geriatric assessment within the 12-months pre-lockdown and COVID-19 free during the first pandemic wave (March-May 2020), underwent a phone assessment past the lockdown to assess COVID-19-related emotional distress (DME) as well as other sociodemograhic, clinical and psychosocial factors. RESULTS: Of the 94 frail older adults (age = 82,34 ± 6,12 years; 68,1% women; 38,3% living alone), 84,9% were at risk of experiencing moderate-to-high psychological distress, according to the backward stepwise logistic regression model obtained (χ2 = 47,007, p < 0,001, Nagelkerke R2 = 0,528), based on the following factors: absence of depressive symptoms before lockdown (OR = 0,12, p = 0,014, 95%CI[0,023-0,647]), not carrying out leisure activities during lockdown (OR = 0,257, p = 0,023, 95%CI[0,079-0,832]) and currently experiencing high malaise due to COVID-19 situation (OR = 1,504, p < 0,001, 95%CI[1,241-1,822]). DISCUSSION: These findings suggest that it is necessary to favour a prior overall health status and to empower frail older community-dwellers in the use of a broad repertoire of coping strategies in the face of adversity to foster mental health and keep at bay the potential emotional impact of the situation generated by the COVID pandemic.

(Mis)Information, Fears and Preventative Health Behaviours Related to COVID-19.

Social and mass media platforms (SMM) are essential tools for keeping people informed about health-promoting practices. However, the potential to spread misinformation or false rumors exists. These might influence preventive health behaviours and incite anxiety and/or fear among the population. A sample of 300 adults participated in a survey to understand information needs, fears and preventive health behaviours related to COVID-19 while analyzing differences in COVID-19 acceptance rates. Descriptive-correlational, between-group comparisons and regression analyses were applied. Most of the sample revealed a willingness to accept COVID-19 vaccines (65.4% vs. 34.5%) and was prone to use and trust different SMM without experiencing significant obstacles in managing COVID-19-related information except for the need to ration it from time to time (χ2(2, N = 298) = 6.654, p = 0.036). Preventive behaviours/measures carried out were similar among the people resistant, hesitant or willing to get vaccinated for COVID-19. However, higher self-efficacy was observed in resistant vaccine individuals (F(2) = 3.163, p = 0.044). Psychological impact (need for psychological support due to COVID-19 situation) in accepting (F(5, 189) = 17.539, p < 0.001, R2 = 0.317) and hesitant individuals (F(5, 77) = 17.080, p < 0.001, R2 = 0.526) was explained by female gender, younger age, threat susceptibility and differential characteristics in terms of psychological symptoms experienced and SMM trust. No explanatory model was obtained for the resistant individuals. SMM could be effective tools to promote COVID-19 health preventive behaviours. However, psychographic characteristics might modulate information-seeking and management as well as self-perceived threat susceptibility and severity. All these factors must be accurately considered when designing different health preventive campaigns for the general public.

Psychological impact in the time of COVID-19: A cross-sectional population survey study during confinement.

The transformation that COVID-19 has brought upon the world is unparalleled. The impact on mental health is equally unprecedented and yet unexplored in depth. An online-based survey was administered to 413 community-based adults during COVID-19 confinement to explore psychological impact and identify high risk profiles. Young females concerned about the future, expressing high COVID-related distress, already following psychological therapy and suffering from pre-existing chronic conditions, were those at highest risk of psychological impact due to the COVID-19 situation. Findings could be employed to design tailored psychological interventions in the early stages of the outbreak to avoid the onset/exacerbation of psychopathology.

Unveiling Associations of COVID-19 Vaccine Acceptance, Hesitancy, and Resistance: A Cross-Sectional Community-Based Adult Survey.

COVID-19 vaccines are essential to limit and eliminate the infectious disease. This research aims to identify strong vaccination resistance profiles and/or hesitation considering health, psychosocial, and COVID-related variables. A cross-sectional online survey (N = 300) was conducted in the context of strict COVID-related gathering and mobility restrictions (January-March 2021). Data collected were vaccine acceptance, hesitancy and resistance rates, general psychosocial status, and preventive practices and beliefs regarding COVID-19 and its vaccination, among other factors. Logistic regression was applied to a real-world data set and a significant model (χ2 (7, N = 278) = 124.548, p < 0.001) explaining 51.3% (R2 Nagelkerke) of attitudes towards vaccination was obtained, including the following predictors for acceptance: to have greater confidence in the COVID vaccine security (OR = 0.599) and effectiveness (OR = 0.683), older age (OR = 0.952), to be a healthcare professional (OR = 0.363), to have vulnerable individuals in charge (OR = 0.330), and sustain the belief that the vaccine will end the pandemic situation (OR = 0.346) or not being sure but give some credence to that belief (OR = 0.414). Findings could help understand the rate and determinants of COVID-19 vaccine resistance/hesitancy among a Spanish population sample and facilitate multifaceted interventions to enhance vaccine acceptance.

The Gaze Fixation Assessed by Microperimetry: A Useful Tool for the Monitoring of the Cognitive Function in Patients with Type 2 Diabetes.

Current guidelines recommend annual screening for cognitive impairment in patients > 65 years with type 2 diabetes (T2D). The most used tool is the mini-mental state evaluation (MMSE). Retinal microperimetry is useful for detecting cognitive impairment in these patients, but there is no information regarding its usefulness as a monitoring tool. We aimed to explore the role of retinal microperimetry in the annual follow-up of the cognitive function of patients with T2D older than 65 years. MATERIALS AND METHODS: Prospective observational study, comprising patients > 65 years with T2D, attended at our center between March-October 2019. A complete neuropsychological evaluation assessed the baseline cognitive status (mild cognitive impairment, MCI, or normal, NC). Retinal microperimetry (sensitivity, gaze fixation) and MMSE were performed at baseline and after 12 months. RESULTS: Fifty-nine patients with MCI and 22 NC were identified. A significant decline in the MMSE score was observed after 12 months in the MCI group (25.74 ± 0.9 vs. 24.71 ± 1.4; p = 0.001). While no significant changes in retinal sensitivity were seen, all gaze-fixation parameters worsened at 12 months and significantly correlated with a decrease in the MMSE scores. CONCLUSION: Retinal microperimetry is useful for the monitoring of cognitive decline in patients > 65 years with T2D. Gaze fixation seems a more sensitive parameter for follow-up after 12 months than retinal sensitivity.

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature.

BACKGROUND: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. OBJECTIVE: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. METHODS: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions' effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. RESULTS: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. CONCLUSIONS: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults' sensory deficits is necessary.

Depressive Symptoms, Fatigue and Social Relationships Influenced Physical Activity in Frail Older Community-Dwellers during the Spanish Lockdown due to the COVID-19 Pandemic.

Due to the dramatic impact of the COVID-19 pandemic, Spain underwent a strict lockdown (March-May 2020). How the lockdown modified older adults' physical activity (PA) has been poorly described. This research assesses the effect of the lockdown on PA levels and identifies predictors of sufficient/insufficient PA in frail older community-dwellers. Community-dwelling participants from the +ÀGIL Barcelona frailty intervention program, suspended during the pandemic, underwent a phone-assessment during the lockdown. PA was measured before and after the lockdown using the Brief Physical Activity Assessment Tool (BPAAT). We included 98 frail older adults free of COVID-19 (mean age = 82.7 years, 66.3% women, mean Short Physical Performance Battery = 8.1 points). About one third of participants (32.2%) were not meeting sufficient PA levels at the end of the lockdown. Depressive symptoms (OR = 0.12, CI95% = 0.02-0.55) and fatigue (OR = 0.11, CI95% = 0.03-0.44) decreased the odds of maintaining sufficient PA, whereas maintaining social networks (OR = 5.07, CI95% = 1.60-16.08) and reading (OR = 6.29, CI95% = 1.66-23.90) increased it. Living alone was associated with the reduction of PA levels (b = -1.30, CI95% = -2.14--0.46). In our sample, pre-lockdown mental health, frailty-related symptoms and social relationships were consistently associated with both PA levels during-lockdown and pre-post change. These data suggest considering specific plans to maintain PA levels in frail older community-dwellers.

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors.

BACKGROUND: Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. METHODS: We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. DISCUSSION: Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03434938 , registered on January 2018.

Assessing the user experience and usability of the PRECIOUS system: a randomized controlled trial in obese patients.

Objective To assess users' usability, satisfaction, acceptance and effectiveness of the PRECIOUS system to promote behavior change toward healthier lifestyles. Design: Thirty-one adult patients with BMI>30 (M = 44.23, SD = 5.91) were recruited and randomized into three conditions for a longitudinal study (3 months length): 1) Control group (TAU + biofeedback + follow-ups); 2) PRECIOUS only (app + biofeedback + follow-ups); 3) PRECIOUS + MI (app + biofeedback + motivational interviewing follow-ups). Main Outcome Measures: Usability, satisfaction, acceptance and effectiveness of PRECIOUS, and stages of change (S-Weight questionnaire). Results: The system was described as easy to use, flexible, fairly satisfying and good as a preventive health system. Participants rated biofeedback and the Physical Activity module as the most satisfying features. However, participants were unsatisfied with the Diet module. All additional features received acceptable scores in terms of satisfaction. Despite this, the PRECIOUS only group reported that they would probably recommend the system to others because it meets its purposes quite well. Conclusion: PRECIOUS was found a usable and acceptable solution, although improving several features in the Diet module in successive versions of the app would promote sustained use and satisfaction among users, possibly increasing its effectiveness in promoting healthier lifestyles. Abbreviations: ADA American Diabetes Association; BG2: BodyGuard2; BMI: Body Mass Index; CBT: Cognitive-behavioral therapy; EMA: Ecological Momentary Assessment; eHealth: Electronic health; mHealth: Mobile health; MI: Motivational interviewing; NCD: Non-communicable diseases; PA: Physical activity; PRECIOUS: PREventive Care Infrastructure based On Ubiquitous Sensing.

Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification: Development and Feasibility Testing of the Precious App.

BACKGROUND: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. OBJECTIVE: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. METHODS: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants' interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. RESULTS: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. CONCLUSIONS: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials.

Realidad virtual para el diagnóstico y tratamiento de Trastornos de Conducta Alimentaria: una revisión sistemática / Virtual Reality for the Diagnosis and Treatment of Eating Disorders: A Systematic Review

INTRODUCCIÓN: Los trastornos de la conducta alimentaria (TCA) se caracterizan por un miedo intenso a ganar peso y conductas de control del mismo. Las personas con TCA manifiestan peor calidad de vida que la población general y el abordaje de sus complicaciones supone elevados costes socio-sanitarios. MATERIALES Y MÉTODOS: Para comprobar la eficacia de la Realidad Virtual (RV) como herramienta de diagnóstico y/o soporte al tratamiento de TCA, se realizó una revisión sistemática de artículos publicados entre 2012 y 2018 en PubMed (MEDLINE). RESULTADOS: Se seleccionaron 7 artículos que emplearon la RV como tratamiento, 5 como soporte diagnóstico y 3 como ambas (N = 15). CONCLUSIONES: La RV demuestra ser efectiva para mitigar la ansiedad ante la exposición a alimentos, reducir conductas exageradas de control de peso, y facilitar el abordaje terapéutico del autoconcepto e imagen corporal. También demostró mayor eficacia frente al tratamiento convencional o como tratamiento de segundo nivel

INTRODUCTION: Eating and weight disorders (EWD) are characterized by intense fear of gaining weight and control behaviors. People affected by a EWD present worse quality of life than the general population, and the management of their complications implies high socio-sanitary costs. MATERIALS AND METHODS: In order to verify the effectiveness of Virtual Reality (VR) as a diagnostic and/or supportive tool for the treatment of EWD, a systematic review of articles published between 2012 and 2018 in PubMed (MEDLINE) was carried out. RESULTS: 7 articles that used RV as treatment, 5 as diagnostic support and 3 as both were selected (N = 15). CONCLUSIONS: VR demonstrates effectiveness in mitigating anxiety when exposed to food, reducing exaggerated weight control behaviors, and facilitating the therapeutic approach to self-concept and body image. It has also demonstrated greater efficacy in comparison to treatment as usual or as a second level treatment

Functional Near-Infrared Spectroscopy to Study Cerebral Hemodynamics in Older Adults During Cognitive and Motor Tasks: A Review.

The integrity of the frontal areas of the brain, specifically the prefrontal cortex, are critical to preserve cognition and mobility in late life. Prefrontal cortex regions are involved in executive functions and gait control and have been related to the performance of dual-tasks. Dual-task performance assessment may help identify older adults at risk of negative health outcomes. As an alternative to neuroimaging techniques that do not allow assessment during actual motion, functional Near-Infrared Spectroscopy (fNIRS) is a non-invasive technique that can assess neural activation through the measurement of cortical oxygenated and deoxygenated hemoglobin levels, while the person is performing a motor task in a natural environment as well as during cognitive tasks. The aim of this review was to describe the use of fNIRS to study frontal lobe hemodynamics during cognitive, motor and dual-tasks in older adults. From the 46 included publications, 20 studies used only cognitive tasks, three studies used motor tasks and 23 used dual-tasks. Our findings suggest that fNIRS detects changes in frontal activation in older adults (cognitively healthy and mild cognitive impairment), especially while performing cognitive and dual-tasks. In both the comparison between older and younger adults, and in people with different neurological conditions, compared to healthier controls, the prefrontal cortex seems to experience a higher activation, which could be interpreted in the context of proposed neural inefficiency and limited capacity models. Further research is needed to establish standardized fNIRS protocols, study the cerebral hemodynamic in different neurological and systemic conditions that might influence cortical activation and explore its role in predicting incident health outcomes such as dementia.

Aspectos psicosociales de la calidad de vida en supervivientes pediátricos de tumores en el sistema nervioso central / Psychosocial aspects of the quality of life in pediatric survivors of tumors in the central nervous system

Introducción: Los supervivientes de tumores del sistema nervioso central (TSNC) presentan peor calidad de vida en relación a la salud (CVRS) que los supervivientes de otras neoplasias y la población normativa. El tipo y gravedad de las secuelas no parecen tener un impacto claro en la CVRS, pero la afectación del cociente intelectual (CI) sí podría modular la CVRS. Además, las estrategias de afrontamiento del paciente y de los progenitores y el malestar emocional parental podrían también actuar sobre la CVRS. Objetivo: Determinar si las estrategias de afrontamiento del adolescente y su CI, y las estrategias de afrontamiento, el estrés general y el malestar emocional parental, modulan las dimensiones psicosociales de la CVRS del superviviente. Método: Estudio transversal descriptivo-correlacional. Se reclutaron 37 adolescentes (12-19 años) que llevaban ≥1 año fuera de tratamiento oncológico y 44 progenitores. Resultados: En la CVRS valorada por los adolescentes, las dimensiones Relación con los Padres y Vida Familiar, Amigos y Apoyo Social, y Entorno Escolar dependen de la estrategia de afrontamiento de resolución del problema usada por el adolescente. La dimensión Aceptación Social depende del estilo de afrontamiento improductivo del adolescente y del estilo de búsqueda de ayuda social de los padres. La CVRS valorada por los padres depende de las secuelas, el CI del adolescente y, el tipo de tratamiento oncológico recibido. Discusión y conclusiones: Las estrategias de afrontamiento centradas en la resolución del problema, deben ser consideradas para valorar e intervenir en la mejora de la CVRS de los supervivientes TSNC

Introduction: Central Nervous System Tumor (CNST) survivors tend to show worse HRQoL than survivors of other types of cancer and general population. There are still many doubts about what variables and to what extend these are related to their HRQoL. Type and severity of late effects have not a clear impact on HRQoL. However, Intelligence Quotient (IQ) changes as a specific late effect of this sample population, could modulate their HRQL. Furthermore, coping from both patients and parents, as well as parental distress could play a significant role modulating HRQoL in these survivors. Aim: To study whether survivors' coping strategies and IQ, as well as coping, general stress and cancer-related distress of parents could modulate some psychosocial dimensions of their children HRQoL. Methodology: Correlational descriptive cross-sectional study. Thirty-seven teenagers (12-19 years old, both included) ≥1 year free of disease and 44 parents were recruited for the study. Results: When HRQoL is assessed by adolescents, the dimensions Parent Relations and Home Life, Social Support and Peer, and School Environment are related with the use of coping with problem style by adolescents. Social Acceptance/Bullying dimension is related with nonproductive coping by the adolescent and helpseeking coping style by parents. HRQoL assessed by parents is related with late effects, adolescents' IQ, and type of oncological treatment received. Discussion/Conclusion: Coping strategies, and specifically problem-solving strategies must be taken into account to assess and to intervene in the improvement of HRQoL of this sample population