A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study

The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18–55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP–patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction (‘e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems.Spanish Ministry of Health, the Institute of Health Carlos IIIThe European Regional Development Fund Una manera de hacer Europa (grant references: PI15/00401PI15/01035, and PI15/01021), the Andalusian Council of Health (grant reference: AP-0095-2016);Prevention and Health Promotion Research Network redIAPP (RD16/0007/0010RD16/0007/0005, RD16/0007/0003, and RD16/0007/0001), Ministry of Health of Andalusia (PS-0330- 2016)The Chronicity, Primary Care, and Prevention and Health Promotion Research Network RICAPPS (RD21/0016/0012RD21/0016/0005, RD21/0016/0010, and RD21/0016/0001)The Ministry of Science and Innovation, the Institute of Health Carlos III (SCIII)The European Funds of the Recovery, Transformation and Resilience Plan, and by the EU funds Next-Generatio

Arquitectura morfo-funcional de la válvula íleo-cecal : sistemas integradores en el feto y en el recién nacido

Fac. de MedicinaTRUEProQuestpu

La isla secreta del Dr. Jack Mercer

Este TFM se realiza como continuación de la investigación a la que dio lugar la anterior realización del TFG. Ambos proyectos estudian, desde un punto de vista eminentemente práctico, la representación tradicional y actual de animales y criaturas, tanto reales como imaginarias y fantásticas. Este TFM se centra en la posibilidad de diseñar y crear animales ficticios siguiendo las normas y estándares del mundo natural, al mismo tiempo que se investigan los límites del conocimiento, la verosimilitud y la fantasía. El resultado de este proyecto es una serie de ilustraciones en un formato similar a la ilustración científica de animales, que surgen como conclusión de un estudio taxonómico, evolutivo, biológico y anatómico de seres vivos reales (especies actuales y extintas), además de ilustraciones de apoyo contextual (personajes y lugares relevantes) y cartas que aportan un hilo narrativo. El objetivo ha sido crear o representar animales surgidos de la imaginación, partiendo de una base documental sólida, para que, finalmente, la existencia de estas criaturas pudiera ser posible. Para contextualizar este trabajo, el resultado final se ha incluido en la misma historia de ficción en la que se desarrolló el TFG: el viaje de un explorador del siglo XIX en busca de conocimiento. Del mismo modo que hicieran Darwin o Livingstone, El protagonista de este relato, el Doctor Jack Mercer, realiza una travesía en la que descubre criaturas y lugares nunca vistos. Junto con el diseño de criaturas, para este proyecto también se ha creado un lugar ficticio, la isla del Pacífico Sur en la que se localizan los descubrimientos que atañen a este TFM en particular.Abstract: This Master’s Final Project is made as a continuation of the research which started in the former execution of the Undergraduate Final Project. Both projects study, from an entirely practical point of view, the traditional and current representation of animals and creatures, real, imaginary and fantastic. This Master’s Final Project focuses on the possibility of designing and creating fictional animals by following the rules and standards of the natural world, at the same time as the limits of knowledge, verisimilitude and fantasy are researched. The result of this project is a series of illustrations in a similar format as any animal scientific illustration, which spring forth as a conclusion of a taxonomic, evolutive, biological and anatomic study of real living beings (current and extinct species), apart from contextual support illustrations (relevant characters and places) and letters which contribute to the narrative. The objective was to create or represent animals issued from imagination, originated from a solid basis of documentation, so that, eventually, the existence of these creatures could be possible. In order to contextualize this work, the final result has been included in the same fictional story in which the Undergraduate Project was developed: the journey of a 19th century explorer seeking for knowledge. Equally as Darwin or Livingstone did, the main character in this account, Doctor Jack Mercer, embarks upon a voyage in which he discovers creatures and places never seen before. Together with the creature design, a fictional place has been created too. An island in the South Pacific where the discoveries concerning this project in particular are located.Universidad de Granada. Máster Oficial Universitario en Dibujo: Creación, Producción y Difusión. Curso 2017-201

Arquitectura morfo-funcional de la válvula íleo-cecal : sistemas integradores en el feto y en el recién nacido

Fac. de MedicinaTRUEProQuestpu

Patients’ opinions about knowing their risk for depression and what to do about it: The PredictD-Qualitative study

Background: The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. Methods: A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socioeconomic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. Results: The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a ‘‘patient-centred’’ approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. Conclusions: Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.Junta de Andalucía 2008/0195Gobierno Vasco 2008/111021Spanish Network of Primary Care Research (redIAPP) RD06/0018Salud Mental, Servicios y Atención Primaria (SAMSERAP

Effectiveness of online interventions in preventing depression: a protocol for systematic review and meta-analysis of randomised controlled trials

IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials. gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collaboration Tool). Baseline depression will be required to have been discarded through standardised interviews or validated self-reports with standard cut-off points. The outcomes will be the incidence of new cases of depression and/or the reduction of depressive symptoms as measured by validated instruments. Pooled standardised mean differences will be calculated using random-effect models. Heterogeneity and publication bias will be estimated. Predefined sensitivity and subgroup analyses will be performed. If heterogeneity is relevant, random-effect meta-regression will be performed

New action plan proposals for the study of the oppidum of Iliturgi based on the archaeology of the territory

El objetivo del presente trabajo es el de exponer las propuestas de actuación que se van a desarrollar entorno al oppidum de Iliturgi gracias al Proyecto de Investigación de “Iliturgi: conflicto, culto y territorio s. III a.C.- I d.C." (PI12-HUM-2619), en base a un nuevo enfoque metodológico, desde la arqueología del territorio, que podrá aportar ciertas claves que permitan reconocer la evolución política y social desde época ibérica hasta su definitiva transformación en municipio romano. La propuesta de análisis que planteamos se sustenta en un plan integral de prospecciones arqueológicas fortalecidas mediante un Sistema de Información Geográfica (SIG) centrando nuestra investigación en tres modelos fundamentales para entender la evolución histórica de Iliturgi y su territorio; 1. El modelo metodológico de investigación de la Segunda Guerra Púnica y su ensayo en el territorio de Iliturgi. 2. El modelo de evolución de las prácticas cultuales y rituales y su plasmación en los sistemas de articulación de los territorios antiguos. 3. El modelo de estructuración del territorio de un oppidum del Alto Guadalquivir entre los siglos VII a.C. – I d.C. puesto que el sistema de organización del asentamiento en el territorio puede informar sobre la dinámica propia del oppidum.The aim of this paper is to present action proposals for the study of the oppidum of Iliturgi part of the Research Project “Iliturgi: conflicto, culto y territorio s. III a.C.- I d.C." (PI12-HUM-2619), based on a new methodological approach , from archaeology of the territory , which may provide some clues to its political and social evolution from the Iberian period to its eventaual transformation into a Roman town. The proposed analysis is based on a global plan of archaeological surveys reinforced by a Geographic Information System (GIS) with our investigation focused on three basic models for understanding the historical evolution of Iliturgi and its territory; 1. The Second Punic War methodological research model and its experimentation in the territory of Iliturgi. 2. The evolutionary model of the cult practices and rituals; and their manifestation in the structural systems of the ancient territories; 3. The model of structuring the territory of an oppidum in the Upper Guadalquivir Valley between the 7th century BC and the 1st century AD as the system of organizing the settlement in the territory can inform us of the dynamic of the oppidum itself

Culto y rito en cuevas: modelos territoriales de vivencia y experimentación de lo sagrado, más allá de la materialidad (ss. V-II a.n.e.)

In the Alto Guadalquivir between the 5th and the 2nd centuries BCE we find different kinds of worship places in caves. They have an intrinsic relationship with the territorial model in which they are inserted. By analysing them, we aim to point out the heterogeneity of their features and the variability of their evolution in different local historical processes. They range from the territorial shrines of Collado de los Jardines (Santa Elena) and Cueva de la Lobera (Castellar), in the territory of Cástulo, to the recently excavated suburban sanctuary of La Piedra del Águila (Orcera) and the urban model of the oppidum of Puente Tablas (Jaén). In all these cases we discuss the different factors related to the worship process, including mobility, the scale of participation and the motivation involved in it.The heterogeneity of the functions and mythical stories recreated in the caves is discussed through the cases of hierophany detected at the sanctuaries in question. We emphasise the role of the cave as a place of emotional mediation built and anthropised for such a purpose. It was where astronomical events, such as the equinoxes, played a decisive role in measuring the periods of communication with the divinity and the carrying out of rites that ratified the measurement of the seasons and agrarian cycles, as well as formalising the scenario for the mythical narrations themselves.En el Alto Guadalquivir, entre los siglos V y II a.n.e., encontramos distintos espacios de culto en cueva, los cuales guardan una relación intrínseca con el modelo territorial en el que se insertan. A través de su análisis pretendemos señalar la heterogeneidad de sus rasgos y la variabilidad de su evolución en distintos procesos históricos locales, desde los santuarios territoriales de Collado de los Jardines (Santa Elena) y la Cueva de la Lobera (Castellar), pertenecientes al territorio de Cástulo, pasando por el recientemente excavado santuario extraurbano de la Piedra del Águila (Orcera), al modelo urbano del oppidum de Puente Tablas (Jaén). En todos los casos se discute sobre los distintos factores relacionados con el proceso cultual, desde la movilidad, la escala de participación y la motivación que interviene en el mismo.La heterogeneidad en las funciones y los relatos míticos recreados en las cuevas, viene discutida a través de los casos de hierofanías detectados en los santuarios expuestos, insistiendo en el papel de la cueva como espacio de mediación y conculcación emocional construido y antropizado a tal efecto, donde eventos astronómicos, como los equinoccios, juegan un papel determinante para medir los periodos de comunicación con la divinidad y realización de ritos que sancionan la medición de las estaciones y ciclos agrarios, además de formalizar el escenario de las narraciones míticas propias

Nuevos datos sobre la zona arqueológica de Marroquíes Bajos: el Quinto Foso

The present paper presents the results that were obtained in the excavation carried out in the plot DOC-1 (SUNP-1) in the Archaeological Area of Marroquíes Bajos. The main contribution of this excavation in the context of all the research done in this archaeological area has to do with its Chalcolithic phase, in particular with the delimitation and documentation of the fifth ditch in an extension that was hitherto unknown. Along with this ditch, a fortified structure was also documented, which consisted of two walls and a semicircular hollow tower which was very likely to protect an entrance. Finally, the research has yielded the first data on the food and health of the people in this settlement by analysing a set of bone remains located on the bottom of the ditch.Este trabajo presenta los resultados obtenidos en la excavación realizada en la parcela DOC-1 (SUNP-1) de la Zona Arqueológica de Marroquíes Bajos. La principal aportación de la excavación al ámbito de las investigaciones desarrolladas en esta zona arqueológica se centra en su fase calcolítica, concretamente en la delimitación y documentación del quinto foso en una extensión no conocida hasta el momento. Asociado este foso se documentó igualmente una estructura fortificada compuesta por dos muros y una torre semicircular hueca que muy posiblemente protegía un acceso. Finalmente la investigación desarrollada a permitido obtener los primeros datos sobre alimentación y salud de la población del asentamiento mediante el análisis de un conjunto de restos óseos localizados en el fondo del foso