Stress and suicide risk among adolescents: the role of problematic internet use, gaming disorder and emotional regulation.

BACKGROUND: Previous studies have associated videogame playing and social media use with suicidal behaviors together with lower stress coping or poor emotion regulation strategies. Due to the inconclusive evidence regarding the factors associated with suicidal behavior, the present study aimed to overcome the limitations of previous research and explored the relationship between adolescent stress, problematic internet use (PIU), gaming disorder (GD), and emotional regulation (ER) in a cross-section design. It was hypothesized that stress would have a direct effect on suicide risk (SR) as well as being mediated by PIU, GD, and ER. METHODS: The participants comprised 430 adolescents (58.4% male) aged between 16 and 19 years. They completed an online survey including the Mobile-Related Experiences Questionnaire, Internet Gaming Disorder Scale-Short Form, Meta-Mood Trait Repair Scale, and Spanish version of the Suicidal Behaviors Questionnaire. RESULTS: A total of 34.2% of the adolescents (N = 147) were at risk for SR. Results also indicated that 30,7% had experienced suicidal ideation at some point in their life, 12.1% had at least one plan to die by suicide, and 5.1% had attempted suicide. Results of path analysis confirmed that stress appeared to be a risk factor for suicide, but that its effects were not mediated by PIU. However, ER and GD mediated the effect of stress on SR. The results suggest that stress is a main risk factor for suicide, especially among adolescents with poor emotional regulation or problematic gaming. CONCLUSIONS: Considering the prevalence of suicide among adolescents, the results of the present study suggest that suicide prevention programs should include emotional regulation strategies, stress coping, and videogaming management skills in the early stages of high school. Providing these protective resources to adolescents will help them face the stressful and changing situations typical of adolescence and will help them to attain greater well-being and satisfaction with life.

Pharmaceutical pictograms to improve textual comprehension: A systematic review.

INTRODUCTION: Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS: A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS: Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION: The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.

Impacto de la adición de pictogramas farmacéuticos como ayuda visual sobre la comprensión de prospectos en estudiantes de educación secundaria / Impact of the addition of pharmaceutical pictograms as visual aids on the comprehension of package inserts in students completing secondary education

Introducción: La Atención Farmacéutica requiere que los pacientes comprendan la información brindada. La inclusión de ayudas visuales podría mejorar la comprensión de textos complejos como son los prospectos de los medicamentos. Nuestro objetivo fue evaluar los efectos de la inclusión de pictogramas farmacéuticos sobre la comprensión de instrucciones elementales para el uso de medicamentos por estudiantes que finalizan la enseñanza básica. Método: De un total de 309 alumnos participantes, se aleatorizaron 160 para leer tres prospectos de medicamentos de uso frecuente (ibuprofeno, amoxicilina/ácido clavulánico y omeprazol), mientras que 149 recibieron pictogramas junto a los prospectos. La aleatorización fue alterna según la posición de los alumnos en el aula. La comprensión fue estimada mediante cuestiones básicas del uso de medicamentos. Resultados: En el grupo control solo el 38.75% de los alumnos contestaron correctamente cuándo tomar el ibuprofeno en relación a las comidas el 32.25% acertaron cual es la dosis habitual del antibiótico y el 61.88% identificó la indicación del omeprazol. En los tres casos, se encontraron diferencias significativas en favor de la comprensión en el grupo experimental (OR = 1.93; 95% IC, 1.23 – 3.05; p = 0.0041, OR = 3.87; 95% IC, 2.43 – 6.25; p = 10-7 y OR = 3.55; 95% IC, 2.07 – 6.29; p = 3.67x10-5 respectivamente). Conclusiones: La inclusión de pictogramas farmacéuticos en los prospectos es una estrategia sencilla que podría potencialmente favorecer el uso racional del medicamento. (AU)

Introduction: Pharmaceutical Care requires that patients understand the information provided. The inclusion of visual aids could improve the comprehension of complex texts such as drug package inserts. Our objective was to evaluate the effects of the inclusion of pharmaceutical pictograms on the comprehension of elementary instructions for the use of drugs by students completing basic education. Methods: Among a total of 309 participating students, 160 were randomized to read three frequently used drug package inserts (ibuprofen, amoxicillin/clavulanic acid and omeprazole), while 149 received pictographs together with the package inserts. Randomization was alternated according to the position of the students in the classroom. Comprehension was estimated by means of basic questions on the use of drugs. Results: In the control group only 38.75% of the students answered correctly when to take ibuprofen in relation to meals, 32.25% were right about the usual dose of the antibiotic and 61.88% identified the indication for omeprazole. In all three cases, significant differences in favor of understanding were found in the experimental group (OR = 1.93; 95% CI, 1.23 - 3.05; p = 0.0041, OR = 3.87; 95% CI, 2.43 - 6.25; p = 10-7 and OR = 3.55; 95% CI, 2.07 - 6.29; p = 3.67x10-5 respectively). Conclusions: The inclusion of pharmaceutical pictograms in package inserts is a simple strategy that could favor potentially the rational use of drugs. (AU)

The relationship between suicidal behavior and perceived stress: The role of cognitive emotional regulation and problematic alcohol use in Spanish adolescents.

Suicidal behavior has become an important public health problem, correlating with stress and emotional deficits in recent research. This study examined the relationship between perceived stress and suicidal behavior risk, testing the mediating roles of cognitive emotion regulation and impulsivity, and the moderating role of problematic alcohol use in stress-suicidal behavior association in a sample of 121 Spanish adolescents surveyed online. Results showed positive and significant associations between perceived stress and suicidal behavior risk, as well a mediation role of adaptive cognitive emotion regulation strategies and a moderation role of problematic alcohol use between perceived stress and suicidal behavior risk, supporting stress as an influential factor in suicidal behavior. Our findings emphasize adaptive emotional regulation strategies in stressful situations, as well as the importance of promoting responsible alcohol consumption to decrease suicide risk in adolescents. Additionally, they contribute to effective educational suicide prevention programs for young people.

Evaluating the Energy Requirements of Assistive Technologies for Older Adults.

The successful adoption of assistive technologies for older adults requires considering and evaluating many different factors and dimensions such as effectiveness, usability, cost and equity of access, to name some of the most relevant. In line with this, the energy requirements to power such assistive technologies remains a hidden factor that might to some extent influence the success in their adoption and the user experience in a wider sense. Very often energy availability is taken for granted and its associated costs and operational requirements are mostly neglected. In this paper, the energy-related requirements of assistive technologies are analysed from a general perspective. This analysis is subsequently particularised for a use case within the SHAPES project, in the context of active and healthy ageing. This use case includes a wide variety of assistive technologies, namely: wearable devices, home sensors and a smart mirror, which provides connectivity and a set of software services. The energy requirements of all these technologies are evaluated and analysed to investigate their impact and relevance on the overall cost and user experience, following the proposed protocol.

Uso de Anticonceptivos Orales y Percepción del Papel del Farmacéutico Comunitario entre Adolescentes: un estudio observacional / Oral Contraceptive Use and Perception of the Role of the Community Pharmacist among Adolescents: an observational study

Introducción: Los embarazos no deseados en adolescentes tienen graves consecuencias tanto para las propias adolescentes y sus bebés como para el uso de los recursos del sistema sanitario. Una de las razones es el escaso uso de píldoras anticonceptivas orales (ACO) entre esta población, debido principalmente a la falta de información o a la no adherencia a los medicamentos. El objetivo de este estudio fue describir la información que reciben las adolescentes sobre los ACO y su uso, así como su percepción del papel del farmacéutico comunitario en este campo. Método: Se realizó un estudio observacional transversal mediante encuesta, aplicada a mujeres entre 12-19 años residentes en España, independientemente de si habían utilizado o no ACO, durante abril de 2021. Para la difusión de esta encuesta se utilizaron diferentes redes sociales. Asimismo, se contactó con diferentes asociaciones españolas dedicadas a la orientación de la planificación familiar y la salud sexual en adolescentes. Resultados: El 81,7% (n=76) de los encuestados no había tomado ACO, aunque el 35,5% (n=33) sí había mantenido relaciones sexuales. El 6% (n=1) que tomaba o había tomado ACO informó que eran adherentes. El 88% (n=82) pensaba que el farmacéutico tiene conocimientos sobre medicamentos; sin embargo, sólo el 19,4% (n=18) les consultaría para resolver dudas sobre ACO. Conclusiones: Para resolver los problemas de falta de información sobre ACO y de adherencia en mujeres adolescentes, el farmacéutico comunitario es un profesional accesible que puede contribuir a ello adoptando una actitud activa y utilizando diferentes formas de material educativo. (AU)

Introduction: Unintended pregnancies in adolescents have serious consequences both for the adolescents themselves and their babies and for the use of health system resources. One of the reasons is the low use of oral contraceptive pills (OCPs) among this population, mainly due to lack of information or non-adherence to the medication. The aim of this study was to describe the information adolescents receive about OCPs and their use, as well as their perception of the role of the community pharmacist in this field. Method: A cross-sectional observational study was carried out by means of a survey applied to women aged 12-19 years living in Spain, regardless of whether or not they had used OCPs, during April 2021. Different social networks were used to disseminate the survey. Different Spanish associations dedicated to family planning and adolescent sexual health counselling were also contacted. Results: 81.7% (n=76) of respondents had not taken OCPs, although 35.5% (n=33) had had sex. The 6% (n=1) who were taking or had taken OCPs reported adherence. 88% (n=82) thought that the pharmacist is knowledgeable about medicines; however, only 19.4% (n=18) would consult them for OCP questions. Conclusions: To solve the problems of lack of information about OCPs and adherence in adolescent women, the community pharmacist is an accessible professional who can contribute to this by taking an active role and using different forms of educational materials. (AU)

Protocolo de autocuidado para pacientes con psoriasis desde la farmacia comunitaria / Self-care protocol for patients with psoriasis from community pharmacy

Introducción: Debido a la baja calidad de vida y ad-herencia al tratamiento de los pacientes con psoria-sis se plantea desarrollar un protocolo de empode-ramiento que conduzca a un mayor conocimiento del autocuidado en pacientes con esta patología, acorde a sus necesidades, siendo importante el papel del farmacéutico para la mejora de ambos. Método: Se administró el test Morisky Green-4 items y el cuestionario Dermatology Life Quality Index a 40 pacientes con psoriasis que acudían a una farmacia comunitaria. Con estos datos, la información de las guías clínicas y la colaboración con un dermatólogo, se diseñó un protocolo de autocuidado.Resultados: Se observó falta de adherencia en el 100% de los pacientes y una calidad de vida leve/moderada (5,3±4,2), en las preguntas relacionadas con: los síntomas cutáneos afectan mucho/muy al 50% de los pacientes y la sensación de vergüenza y dificultad con su tratamiento entre poco y mucho en el 60%. Con estos resultados se diseñaron dos dípticos. A los 3 meses la calidad de vida mejoró a 3,98±2,05, p=0,048, y se observó falta de adheren-cia en el 70% de los pacientes.Conclusiones: Los protocolos de autocuidado son necesarios para mejorar la calidad de vida de los pacientes crónicos. El papel del farmacéutico es importante a través de un protocolo de autocuida-do en pacientes con psoriasis, ayudando a mejorar la adherencia al tratamiento y la calidad de vida. (AU)

Introduction: Due to the low quality of life and adherence to treatment of patients with psoriasis, it is proposed to develop an empowerment protocol that leads to greater knowledge of self-care in pa-tients with this pathology, according to their needs, with the role of the pharmacist being important for the improvement of both.Method: The Morisky Green-4 items test and the Dermatology Life Quality Index questionnaire were administered to 40 patients with psoriasis who attended a community pharmacy. With these data, information from clinical guidelines and collabora-tion with a dermatologist, a self-care protocol was designed.Results: Lack of adherence was observed in 100% of the patients and a mild/moderate quality of life (5.3±4.2), in questions related to: skin symptoms af-fect a lot/very much 50% of the patients and feeling of embarrassment and difficulty with their treat-ment between a little and a lot in 60%. With these results, two diptychs were designed. Three months later, the quality of life improved to 3.98±2.05, p=0.048, and non-adherence was observed in 70% of the patients.Conclusions: Self-care protocols are necessary to improve quality of life of chronic patients. The role of the pharmacist is important through a self-care protocol in patients with psoriasis, helping to im-prove adherence to treatment and quality of life. (AU)

Potential uses of cytisine for smoking cessation in menopausal women - literature summary.

Introduction: Menopause is a vital stage in which the risk of the appearance of metabolic syndrome and cardiovascular diseases is increased. Cardiovascular risk in menopausal women must be monitored because it is one of the most common causes of mortality in these women. Smoking is an important risk factor for the development of many diseases, including cardiovascular diseases, so promoting smoking cessation in these women is important for the maintenance of cardiovascular health. Material and methods: Current smoking cessation programs mainly include nicotine and varenicline as therapeutic agents, due to their history of success, safety, and efficacy in aiding in cessation, but they do not include "new" agents such as cytisine as coadjuvant in the elimination of the habit of smoking. Results: Cytisine is a therapeutic agent traditionally used in Eastern Europe, which has demonstrated efficacy and safety in smoking cessation, also showing other new pharmacological actions. It has been widely used since World War II as a nicotine substitute. Conclusions: These pharmacological actions, together with their efficacy in smoking cessation, should be explored to evaluate the convenience of the use of cytisine in premenopausal and postmenopausal women, so that cytisine can be identified as a useful therapeutic tool in smoking cessation programs and in particular in menopausal women.

[Analysis of the legal framework on food supplements for menopause in Spanish community pharmacies]. / Análisis del marco legal sobre complementos alimenticios para la menopausia en farmacias comunitarias españolas.

OBJECTIVE: To analyze the legal framework for the marketing of specific food supplements prescribed and indicated for menopause symptoms, so that it is verified if according to the effects on health that they produce, should be considered in the category of food supplements, or in others included in our legal system. METHOD: An exhaustive review of the legal frameworks applicable to food supplements used both in Spain and in Europe, collecting those aspects that are related to legal concepts such as the definition of medicine for human use, medicine based on medicinal plants, or the so-called "frontier products". RESULTS: There is a large number of products that can be called "frontier products", they can fit into different product categories, they can fit into different product categories, since some of the plants in their formulation are also authorized for use as industrial medicines or medicines based on traditional medicinal plants. CONCLUSIONS: There are currently specific food supplements for menopause that raise reasonable doubts about their inclusion in other legal categories, both as medicines for human use, or as herbal medicines, so the legislator would need to enable more agile mechanisms and more frequent reviews of the new certainties that science finds, and that can change the status of these products.

Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties.

BACKGROUND: Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM: This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN: Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS: Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS: 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS: The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.

Análisis del marco legal sobre complementos alimenticios para la menopausia en farmacias comunitarias españolas / Analysis of the legal framework on food supplements for menopause in Spanish community pharmacies

Objetivo: Realizar un análisis sobre el marco legal de los complementos alimenticios prescritos e indicados para la sintomatología de la menopausia, verificando si de acuerdo con los efectos sobre la salud que producen deben ser considerados como complementos alimenticios o bien en otras categorías recogidas en el ordenamiento jurídico español. Método: Se realiza una revisión de los marcos jurídicos aplicables a los complementos alimenticios utilizados en España y Europa, recogiendo aquellos aspectos que resulten aplicables o relevantes para los utilizados durante la menopausia, y la relación que guarden con conceptos jurídicos como la definición de medicamento de uso humano, medicamento a base de plantas medicinales o los denominados «productos frontera». Resultados: Existe una gran cantidad de productos que pueden ser considerados «productos frontera» y pueden encajar en categorías de productos diferentes, ya que algunas de las plantas en su formulación también se encuentran autorizadas para su uso como medicamentos industriales o medicamentos de plantas medicinales tradicionales. Conclusiones: Existen complementos alimenticios para la menopausia que suscitan dudas razonables sobre su inclusión en otras categorías legales, tanto como medicamentos de uso humano o como medicamentos a base de plantas, por lo que el legislador necesitaría habilitar mecanismos más agiles y revisiones más frecuentes de las nuevas certezas que la ciencia encuentre, y que pueda cambiar la consideración de estos productos. (AU)

Objective: To analyze the legal framework for the marketing of specific food supplements prescribed and indicated for menopause symptoms, so that it is verified if according to the effects on health that they produce, should be considered in the category of food supplements, or in others included in our legal system. Method: An exhaustive review of the legal frameworks applicable to food supplements used both in Spain and in Europe, collecting those aspects that are related to legal concepts such as the definition of medicine for human use, medicine based on medicinal plants, or the so-called “frontier products”. Results: There is a large number of products that can be called “frontier products”, they can fit into different product categories, they can fit into different product categories, since some of the plants in their formulation are also authorized for use as industrial medicines or medicines based on traditional medicinal plants. Conclusions: There are currently specific food supplements for menopause that raise reasonable doubts about their inclusion in other legal categories, both as medicines for human use, or as herbal medicines, so the legislator would need to enable more agile mechanisms and more frequent reviews of the new certainties that science finds, and that can change the status of these products. (AU)

Fatores associados à qualidade de vida de crianças com epilepsia em um hospital nacional de Honduras / Factors associated to the quality of life in children with epilepsy in a national hospital in Honduras

A epilepsia representa um problema de grande escala que afeta a esfera social dos pacientes que dela sofrem. O presente estudo tem como objetivo avaliar a qualidade de vida de pacientes pediátricos com epilepsia e identificar os fatores associados à sua menor qualidade de vida. Foi realizado um estudo transversal, descritivo e analítico em pacientes com diagnóstico clínico e eletroencefalográfico de epilepsia, atendidos no ambulatório do serviço de neuropediatria do Hospital Universitário. Foi aplicado um questionário subdividido em dados da criança, dados dos pais ou cuidador, tipo de epilepsia, tratamento e Escala de Qualidade de Vida para Crianças com Epilepsia (CAVE). As variáveis foram analisadas por meio de estatística descritiva e modelo de regressão múltipla para encontrar preditores de qualidade de vida. Dos 187 pacientes, 68 (36,4%) apresentaram boa qualidade de vida. Não foram observadas diferenças significativas por sexo em nenhum dos itens estudados, nem na pontuação geral do questionário. Ter menos necessidades básicas insatisfeitas (P=<0,0001) e não ter epilepsia refratária foram preditores de melhor qualidade de vida (P=<0,0001). A qualidade de vida relatada pelos pais foi em sua maioria boa ou razoável, ter um maior número de necessidades básicas insatisfeitas e ser classificado como tendo epilepsia de difícil manejo foram preditores de piora na qualidade de vida medida pelo questionário CAVE.

Epilepsy represents a large-scale problem that affects the social sphere of the patients who suffer from it. The following study aims to assess the quality of life of pediatric patients with epilepsy and to identify the factors associated with a lower quality of life. A cross-sectional, descriptive and analytical study was carried out in patients with clinical and electroencephalographic diagnosis of epilepsy, who attended the outpatient clinic of the neuropediatric service of the Teaching Hospital. A survey was administered, subdivided into data on the child, data on the parents or caregiver, type of epilepsy, treatment and the Quality of Life Scale for Children with Epilepsy (CAVE). The variables were analyzed using descriptive statistics and a multiple regression model to find predictors of quality of life. Of the 187 patients, 68 (36.4%) had a good quality of life. No significant gender differences were observed, nor in the overall score of the survey. Having fewer unmet basic needs (P=<0.0001) and not having refractory epilepsy were predictors of better quality of life (P=<0.0001). Parent-reported quality of life was mostly good or fair, having a higher number of unmet basic needs and being classified as having difficult-to-manage epilepsy were predictors of worsening quality of life as measured by the CAVE scale.

Demystifying Bretton Woods Institutions' Rhetoric on Public Services.

This article reviews Bretton Woods Institutions' approach to public services, including during the recent COVID-19 crisis. Drawing on the specific case of IMF and World Bank's response to the multiple crisis triggered by the pandemic, it shows that there is a discourse-practice disjuncture in the institutions approach to public services as they continue to favour austerity and market-oriented solutions for the delivery of public services. The article therefore seeks to demystify the Bretton Woods institutions rhetoric and demand the adoption of a different way of understanding public services, and social policy more broadly.

Pictogramas farmacéuticos: ¿una oportunidad para la Alfabetización en Salud? / Pharmaceutical Pictograms: an opportunity for Health Literacy?

Introducción: El material educativo para el uso del medicamento frecuentemente es poco legible para el paciente, especialmente si es poco Alfabetizado en Salud. Ello pone en relieve la necesidad de alternativas al prospecto tradicional. El objetivo de este trabajo fue revisar la evidencia disponible sobre los pictogramas como herramienta conducente al uso racional del medicamento. Método: Se realizó una búsqueda de los artículos que consistieran en estudios de la eficacia comunicativa de los pictogramas farmacéuticos en Scopus, Web of Science y Medline a través de PubMed. Resultados: Se identificaron 24 estudios con los criterios de inclusión aplicados. 10 de los 12 estudios controlados aleatorizados obtuvieron resultados favorables a la inclusión de pictogramas. Los estudios transversales exploraron la importancia del contexto cultural o educativo. Todos los estudios longitudinales obtuvieron resultados positivos tras el seguimiento, que podrían explicarse gracias a una explicación previa. Conclusiones: Los pictogramas son una herramienta simple, económica y con un elevado potencial para mejorar el uso del medicamento. (AU)

Introduction: Instructional material for the use of medicines is often unreadable by the patient, especially if he or she is poorly literate in Health. This alleviates the need for alternatives to the traditional leaflets. The aim of this work was to review the available evidence on the pictograms as a tool leading to the rational use of medicines. Method: A search was carried out for articles that considered studies of the communicative efficacy of pharmaceutical pictograms from Scopus, Web of Science and Medline through PubMed. Results: 24 studies were identified with the inclusion criteria applied. 10 of the 12 randomized controlled studies obtained results favorable to the inclusion of pictograms. Cross-sectional studies explored the importance of cultural or educational context. All longitudinal studies obtained positive results after follow-up, which could be explained by prior knowledge. Conclusions: Pictograms are a simple, economical tool with a high potential to improve the use of medication. (AU)

Bedtime Monitoring for Fall Detection and Prevention in Older Adults.

Life expectancy has increased, so the number of people in need of intensive care and attention is also growing. Falls are a major problem for older adult health, mainly because of the consequences they entail. Falls are indeed the second leading cause of unintentional death in the world. The impact on privacy, the cost, low performance, or the need to wear uncomfortable devices are the main causes for the lack of widespread solutions for fall detection and prevention. This work present a solution focused on bedtime that addresses all these causes. Bed exit is one of the most critical moments, especially when the person suffers from a cognitive impairment or has mobility problems. For this reason, this work proposes a system that monitors the position in bed in order to identify risk situations as soon as possible. This system is also combined with an automatic fall detection system. Both systems work together, in real time, offering a comprehensive solution to automatic fall detection and prevention, which is low cost and guarantees user privacy. The proposed system was experimentally validated with young adults. Results show that falls can be detected, in real time, with an accuracy of 93.51%, sensitivity of 92.04% and specificity of 95.45%. Furthermore, risk situations, such as transiting from lying on the bed to sitting on the bed side, are recognized with a 96.60% accuracy, and those where the user exits the bed are recognized with a 100% accuracy.

Phyx.io: Expert-Based Decision Making for the Selection of At-Home Rehabilitation Solutions for Active and Healthy Aging.

While the importance of physical activity in older adults is beyond doubt, there are significant barriers limiting the access of older adults to physical exercise. Existing technologies to support physical activity in older adults show that, despite their positive impacts on health and well-being, there is in general a lack of engagement due to the existing reluctance to the use of technology. Usefulness and usability are two major factors for user acceptance along with others, such as cost, privacy, equipment and maintenance requirements, support, etc. Nevertheless, the extent to which each factor impacts user acceptance remains unclear. Furthermore, other stakeholders, besides the end users, should be considered in the decision-making process to develop such technologies, including caregivers, therapists and technology providers. In this paper, and in the context of physical rehabilitation and exercise at home, four different alternatives with incremental characteristics have been defined and considered: a software-based platform for physical rehabilitation and exercise (Alternative 1), the same software platform with a conventional RGB camera and no exercise supervision (Alternative 2), the same software platform with a convention RGB camera and exercise supervision (Alternative 3) and finally, the same software platform with a depth camera and exercise supervision (Alternative 4). A multiple attribute decision-making methodology, based on the ordinal priority approach (OPA) method, is then applied using a group of experts, including end users, therapists and developers to rank the best alternative. The attributes considered in this method have been usefulness, cost, ease of use, ease of technical development, ease of maintenance and privacy, concluding that Alternative 3 has been ranked as the most appropriate.

Psychological impact of COVID-19 pandemic: Effects of optimism and uncertainty on distress during the lockdown in Spain / Impacto psicológico de la pandemia de COVID-19: efectos del optimismo y la incertidumbre sobre el malestar emocional durante elconfinamiento en España

The objective of this study is to make a quick assessment of the psychological resources and emotional distress of the general population locked down during the COVID-19 pandemic (in Catalonia, Spain), and to observe their evolution over the course of two waves during lockdown: at two weeks and at one month (April 1th to 3th and April 17th to 19th). The longitudinal study collected data from 29,231 participants aged 18 or older through an online platform who answered questions which evaluated: optimism, uncertainty, perceived competence, self-efficacy, emotional distress, current job situation, sadness and anger in conjunction with sociodemographic variables. The main results indicated that general beliefs about the future, uncertainty, and optimism, together with beliefs about one’s own conduct, such as perceived competence when facing the situation or self-efficacy to maintain routines, could predict the emotional distress experienced by an individual. A clear gender pattern was found. Between the two waves, optimism, perceived competence to manage the situation and self-efficacy to maintain routines decrease, uncertainty grows, and emotional distress remains. Taking these results into account we can prevent possible emotional scars and offer coping strategies to overcome the pandemic and the future situations of confinement in a more efficient way.

El objetivo de este estudio es realizar una valoración rápida de los recursos psicológicos y y el malestar emocional de la población general durante el encierro por la pandemia de COVID-19 (en Cataluña, España), y observar su evolución a lo largo de dos oleadas durante el confinamiento: a las dos semanas y al mes (del 1 al 3 de abril y del 17 al 19 de abril). El estudio longitudinal recopiló datos de 29.231 participantes de 18 años o más a través de una plataforma en línea que respondieron preguntas que evaluaban: optimismo, incertidumbre, competencia percibida, autoeficacia, malestar emoción, situación laboral actual, tristeza e ira y variables sociodemográficas. Los principales resultados indicaron que las creencias generales sobre el futuro, la incertidumbre y el optimismo, junto con las creencias sobre la propia conducta, como la competencia percibida ante la situación o la autoeficacia para mantener las rutinas, pueden predecir el malestar emocional que experimenta un individuo. Se encontró un patrón de género claro. Entre las dos olas, el optimismo, la competencia percibida para manejar la situación y la autoeficacia para mantener las rutinas disminuyen, creciendo la incertidumbre y persistiendo el malestar emocional. Teniendo en cuenta estos resultados podemos prevenir posibles secuelas emocionales y ofrecer estrategias de afrontamiento para superar la pandemia y las futuras situaciones de confinamiento de una forma más eficiente.

Caregiver emotional distress: external open-behaviour signs.

OBJECTIVES: To determine whether specific external signs of emotional distress (ESED) can be an indirect measure of emotional distress in caregivers. METHODS: A cross-sectional multicentre design was used. 148 primary caregivers of advanced cancer patients attended in four Spanish palliative care units participated in this study. The emotional distress of caregivers was measured using both the Emotional Distress of Caregivers Scale and a psychological interview. Health professionals collected data using a standard clinical interview process after a brief training period. RESULTS: More than half the caregivers (60%) presented with emotional distress. A positive correlation (r=0.566) was found between the intensity of ESED and emotional distress per se. Caregivers who presented emotional distress showed more ESED than those that did not (p<0.01). The study found significant differences for the categories 'visible signs of sadness, fear, crying, feeling overwhelmed' (p<0.001), 'difficulty in separating from the patient: family refuses to let the patient make decisions and insists on care' (p<0.001) and 'visible signs of anger, irritability or frequent disagreement with therapeutic measures' (p<0.001). No significant differences were found with respect to gender. The set of items to measure these external signs presented an adequate reliability assessed using Cronbach's alpha (α=0.773). CONCLUSIONS: The assessment of ESED in caregivers could serve as a useful method to assess their emotional distress. Incorporating the systematic assessment of these external signs as part of the assessment of the emotional distress of primary caregivers could improve the overall assessment and treatment provided to these caregivers.

Circulating levels of calprotectin, a signature of neutrophil activation in prediction of severe respiratory failure in COVID-19 patients: a multicenter, prospective study (CalCov study).

OBJECTIVE: Severe COVID-19 is characterized by a dysregulated immune response in which neutrophils play a critical role. Calprotectin reflects neutrophil activation and is involved in the self-amplifying thrombo-inflammatory storm in severe COVID-19. We aimed to evaluate the role of calprotectin in early prediction of severity in COVID-19 patients. METHODS: This was a multicenter prospective observational study enrolling consecutive adult COVID-19 patients. On arrival to emergency department, blood samples were collected for laboratory tests, including serum calprotectin. The primary outcome was severe respiratory failure requiring invasive mechanical ventilation and the secondary outcome was need for Intensive Care Unit (ICU) admission. RESULTS: Study population included 395 patients, 57 (14.4%) required invasive mechanical ventilation and 100 (25.3%) were admitted to ICU. Median serum calprotectin levels were significantly higher in intubated (3.73 mg/L vs. 2.63 mg/L; p < 0.001) and ICU patients (3.48 mg/L vs. 2.60 mg/L; p = 0.001). Calprotectin showed a significant accuracy to predict the need for invasive mechanical ventilation (ROC AUC 0.723) and ICU admission (ROC AUC 0.650). In multivariate analysis, serum calprotectin was an independent predictor of invasive mechanical ventilation (OR 1.161) and ICU admission (OR 1.068). CONCLUSION: Serum calprotectin can be used as an early predictor of severity in COVID-19 patients.