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

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

The Effectiveness of Advanced Practice Nurses with Respect to Complex Chronic Wounds in the Management of Venous Ulcers

This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role

El Ecosistema canario de I+D+i

The growing importance that Research, Technological Development and Innovation (R+D+I) is acquiring for the Canary Islands justifies the interest of this study that analyses the Canary Islands R+D+I ecosystem, making a distinction between provinces of the Archipelago in the description of the different agents that make up such an ecosystem. More specifically, this work analyses various Canary Islands technology-based companies generated within the framework of this ecosystem.La creciente importancia que está adquiriendo para Canarias la Investigación, el Desarrollo tecnológico y la Innovación (I+D+i) justifica el interés de este estudio que analiza el ecosistema de I+D+i Canario, realizando una distinción entre provincias del Archipiélago en la descripción de los diferentes agentes que integran tal ecosistema. De forma más particular, el presente trabajo realiza un análisis de diversas empresas canarias de base tecnológica generadas en el marco de dicho ecosistema

Aportación desde los procesos territoriales a las lecturas iconográficas de los santuarios del Alto Guadalquivir

En el siglo IV a.n.e. se desarrolla una nueva experiencia de expansión territorial promovida por Cástulo, en la que los santuarios de Collado de los Jardines (Santa Elena) y Los Altos del Sotillo (Castellar) tuvieron un papel fundamental como fronteras físicas y simbólicas. Los exvotos de bronce ibéricos de estos santuarios se convierten en su principal expresión iconográfica. La romanización de estos santuarios conllevará sustanciales transformaciones, evidentes a partir del siglo II a.n.e. Una consecuencia es la introducción de modelos iconográficos importados que supusieron una ruptura del anterior sistema de ritos, desestimándose el bronce como base de representación en pro de la incorporación de un soporte nuevo: la terracota.A new stage of territorial expansion was fostered by Castulo in the 4th century b.C. The sanctuaries of Collado de los Jardines (Santa Elena) and Los Altos del Sotillo (Castellar) were crucial in that expansion as physical and symbolic borderlines. The Iberian bronze votive offerings of these sanctuaries became their major iconographic expressions. The romanization of these sanctuaries brought about major changes which became apparent from the 2nd century b.C. onwards. As a result, iconographic models were imported which meant a break with the former ritual system: bronze was replaced by terracota as the representation material