A multi-centre, randomized, 3-month study to evaluate the efficacy of a smartphone app to increase caregiver's positive mental health

Background: To assess the effectiveness of a smartphone app-based intervention compared to a regular intervention of caregivers in primary health care institutions. The intervention is aimed at increasing positive mental health and decreasing caregiver's burden. Methods/design: Randomized and controlled trial with an experimental group and a control group. Subjects: 108 caregivers over 18, with a minimum of 4 months of experience as caregivers. Description of the intervention: an intervention with a smartphone app (n = 54) or a regular intervention for caregivers (n = 54). Each caregiver installs a smartphone app and uses it for 28 days. This app offers them a daily activity (Monday-Friday). These activities are related to the Decalogue of Positive Mental Health, which was designed ad hoc by a group of experts. The outcomes will be the score of caregiver burden, the positive mental health and participant satisfaction. These results will be assessed after the first, third and sixth month. Discussion: The results of this study will offer evidence of the effectiveness of an intervention using a free smartphone app. If its effectiveness is proven and the results are acceptable, this could lead to a rethinking of the intervention offered to caregivers in primary care

Microscopía virtual en la enseñanza de la Anatomía Patológica en Medicina

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Introducción y objetivos: La microscopía virtual (MV) se ha introducido en la educación post-graduada en las Facultades de Medicina. No obstante, la experiencia acumulada con esta tecnología es aún limitada y existen muy escasas evidencias sobre su impacto sobre los estudiantes. Los objetivos del estudio fueron: 1) determinar si el posible impacto sobre las notas en los exámenes prácticos de la asignatura del paso de las preparaciones de cristal y el microscopio convencional (MC) a las preparaciones virtuales y el MV, y 2) evaluar la impresión subjetiva de los estudiantes en relación con el impacto de la MV en su aprendizaje. Métodos: Se evaluaron dos grupos que realizaron la asignatura de Anatomía Patológica en el curso 2013-2014, uno usando MC y el otro MV. Las mismas preparaciones utilizadas en el grupo de MC fueron digitalizadas en un escáner Ventana iScan HT a 20x y presentadas a los estudiantes con el visor Virtuoso (Roche diagnostics). Se evaluó el nivel de conocimientos alcanzado por los estudiantes mediante un examen online. Se realizó una encuesta a los estudiantes del grupo MV para evaluar sus impresiones sobre el recurso docente. Resultados: No existieron diferencias entre los dos grupos en cuanto a las notas obtenidas en el examen online: 9,87 ± 0,34 para el grupo de MC, vs 9,86 ± 0,53 para el grupo de MV; p=0,880). La característica más valorada de la MV fue la posibilidad de acceder a las imágenes en cualquier lugar y a cualquier hora (93.3%). El 86.6% de los estudiantes encontraron que el software era fáci

Unraveling the forcings controlling the vegetation and climate of the best orbital analogues for the present interglacial in SW Europe

The suitability of MIS 11c and MIS 19c as analogues of our present interglacial and its natural evolution is still debated. Here we examine the regional expression of the Holocene and its orbital analogues over SW Iberia using a model-data comparison approach. Regional tree fraction and climate based on snapshot and transient experiments using the LOVECLIM model are evaluated against the terrestrial-marine profiles from Site U1385 documenting the regional vegetation and climatic changes. The pollen-based reconstructions show a larger forest optimum during the Holocene compared to MIS 11c and MIS 19c, putting into question their analogy in SW Europe. Pollen-based and model results indicate reduced MIS 11c forest cover compared to the Holocene primarily driven by lower winter precipitation, which is critical for Mediterranean forest development. Decreased precipitation was possibly induced by the amplified MIS 11c latitudinal insolation and temperature gradient that shifted the westerlies northwards. In contrast, the reconstructed lower forest optimum at MIS 19c is not reproduced by the simulations probably due to the lack of Eurasian ice sheets and its related feedbacks in the model. Transient experiments with time-varying insolation and CO2 reveal that the SW Iberian forest dynamics over the interglacials are mostly coupled to changes in winter precipitation mainly controlled by precession, CO2 playing a negligible role. Model simulations reproduce the observed persistent vegetation changes at millennial time scales in SW Iberia and the strong forest reductions marking the end of the interglacial "optimum".SFRH/BD/9079/2012, SFRH/BPD/108712/2015, SFRH/BPD/108600/2015info:eu-repo/semantics/publishedVersio

Comparison between Concentrated Solar Power and Gas-Based Generation in Terms of Economic and Flexibility-Related Aspects in Chile

The energy sector in Chile demands a significant increase in renewable energy sources in the near future, and concentrated solar power (CSP) technologies are becoming increasingly competitive as compared to natural gas plants. Motivated by this, this paper presents a comparison between solar technologies such as hybrid plants and natural gas-based thermal technologies, as both technologies share several characteristics that are comparable and beneficial for the power grid. This comparison is made from an economic point of view using the Levelized Cost of Energy (LCOE) metric and in terms of the systemic benefits related to flexibility, which is very much required due to the current decarbonization scenario of Chile’s energy matrix. The results show that the LCOE of the four hybrid plant models studied is lower than the LCOE of the gas plant. A solar hybrid plant configuration composed of a photovoltaic and solar tower plant (STP) with 13 h of storage and without generation restrictions has an LCOE 53 USD/MWh, while the natural gas technology evaluated with an 85% plant factor and a variable fuel cost of 2.0 USD/MMBtu has an LCOE of 86 USD/MWh. Thus, solar hybrid plants under a particular set of conditions are shown to be more cost-effective than their closest competitor for the Chilean grid while still providing significant dispatchability and flexibility

A method to calculate the personal impact of online exercises to improve the positive mental health of family caregivers of chronically ill patients

Background: taking care of chronic or long-term patients at home is an arduous task. Non-professional caregivers suffer the consequences of doing so, especially in terms of their mental health. Performing some simple activities through a mobile phone app may improve their mindset and consequently increase their positivity. However, each caregiver may need support in different aspects of positive mental health. In this paper, a method is defined to calculate the utility of a set of activities for a particular caregiver in order to personalize the intervention plan proposed in the app. Methods: based on the caregivers' answers to a questionnaire, a modular averaging method is used to calculate the personal level of competence in each positive mental health factor. A reward-penalty scoring procedure then assigns an overall impact value to each activity. Finally, the app ranks the activities using this impact value. Results: the results of this new personalization method are provided based on a pilot test conducted on 111 caregivers. The results indicate that a conjunctive average is appropriate at the first stage and that reward should be greater than penalty in the second stage. Conclusions: the method presented is able to personalize the intervention plan by determining the best order of carrying out the activities for each caregiver, with the aim of avoiding a high level of deterioration in any factor

A mobile app-based intervention program for caregivers to promote positive mental health: A randomized controlled trial

Background: While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs. Objective: The aim of this study was to evaluate the effectiveness of a smartphone app-based intervention program to increase positive mental health for nonprofessional caregivers. Methods: This study was a randomized controlled trial of 3 months' duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months' experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users' satisfaction was also measured. Results: In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1-Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5-Problem solving and self-actualization (5.69; P<.001; d=0.71), F2-Prosocial attitude (2.47; P<.001; d=1.18), and F3-Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program's duration would be beneficial. Conclusions: The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app-based intervention programs may be useful tools for increasing nonprofessional caregivers' well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies

Microscopía virtual en la enseñanza de la Anatomía Patológica en Medicina

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Introducción y objetivos: La microscopía virtual (MV) se ha introducido en la educación post-graduada en las Facultades de Medicina. No obstante, la experiencia acumulada con esta tecnología es aún limitada y existen muy escasas evidencias sobre su impacto sobre los estudiantes. Los objetivos del estudio fueron: 1) determinar si el posible impacto sobre las notas en los exámenes prácticos de la asignatura del paso de las preparaciones de cristal y el microscopio convencional (MC) a las preparaciones virtuales y el MV, y 2) evaluar la impresión subjetiva de los estudiantes en relación con el impacto de la MV en su aprendizaje. Métodos: Se evaluaron dos grupos que realizaron la asignatura de Anatomía Patológica en el curso 2013-2014, uno usando MC y el otro MV. Las mismas preparaciones utilizadas en el grupo de MC fueron digitalizadas en un escáner Ventana iScan HT a 20x y presentadas a los estudiantes con el visor Virtuoso (Roche diagnostics). Se evaluó el nivel de conocimientos alcanzado por los estudiantes mediante un examen online. Se realizó una encuesta a los estudiantes del grupo MV para evaluar sus impresiones sobre el recurso docente. Resultados: No existieron diferencias entre los dos grupos en cuanto a las notas obtenidas en el examen online: 9,87 ± 0,34 para el grupo de MC, vs 9,86 ± 0,53 para el grupo de MV; p=0,880). La característica más valorada de la MV fue la posibilidad de acceder a las imágenes en cualquier lugar y a cualquier hora (93.3%). El 86.6% de los estudiantes encontraron que el software era fáci

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival