Vickybot, a Chatbot for Anxiety-Depressive Symptoms and Work-Related Burnout in Primary Care and Health Care Professionals: Development, Feasibility, and Potential Effectiveness Studies

Background: Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. Objective: We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Methods: Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Results: Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76{\%} female; mean age 36.5, SD 9.7 years) received 98.8{\%} of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76{\%} [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100{\%} (34/34) presenting anxiety symptoms, 94{\%} (32/34) depressive symptoms, and 65{\%} (22/34) work-related burnout. In addition, 27{\%} (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=−2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9{\%} (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. Conclusions: The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required.We are grateful to all participants. GA is supported by a Rio Hortega 2021 grant (CM21/00017) from the Spanish Ministry of Health financed by the Instituto de Salud Carlos III (ISCIII) and cofinanced by Fondo Social Europe Plus. MS was supported by a grant from the Baszucki Brain Research Fund. AM is supported by the Agència de Gestió d’Ajudes Universitàries I de Investigació—PANDÈMIES 2020 grant (PI047003) from the Generalitat de Catalunya. IG thanks the support of the Spanish Ministry of Science and Innovation (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondos Europeos de la Unión Europea (FEDER, Fondo Social Europe, Next Generation European Union or Plan de Recuperación Transformación y Resiliencia_PRTR); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme or Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022). AHY’s independent research was funded by the National Institute for Health Research Biomedical Research Centre in South London and Maudsley National Health Service Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health and Care Research, or Department of Health. JR is supported by a Miguel Servet II contract (CPII19/00009), funded by ISCIII and cofunded by the European Social Fund “Investing in your future.” CT has been supported through a “Miguel Servet” postdoctoral contract (CPI14/00175) and a Miguel Servet II contract (CPII19/00018) and thanks the support of the Spanish Ministry of Innovation and Science (PI17/01066 and PI20/00344), funded by the Instituto de Salud Carlos III and cofinanced by the European Union (FEDER) “Una manera de hacer Europa.” AMA thanks the support of the Spanish Ministry of Science and Innovation (PI18/00789, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the ISCIII; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365); the CERCA Programme; and the Departament de Salut de la Generalitat de Catalunya for the Pla estratègic de recerca I innovació en salut (PERIS) grant SLT006/17/00177. AM thanks the support of the Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación and the FEDER. GF is supported by a fellowship from “La Caixa” Foundation (ID 100010434)—fellowship code—LCF/BQ/DR21/11880019. SA has been supported by a Sara Borrell contract (CD20/00177), funded by ISCIII and founded by the European Social Fund “Investing in your future.” EV thanks the support of the Spanish Ministry of Science, Innovation and Universities (PI15/00283, PI18/00805, PI19/00394, PI21/00787, and CPII19/00009) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación and the FEDER; the ISCIII; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), and the CERCA Programme or Generalitat de Catalunya. We would like to thank the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. DHM´s research was supported by Juan Rodés JR18/00021 granted by the ISCIII. The PRESTO project has been funded by Fundació Clínic per a la Recerca Biomèdica through the Pons Bartran 2020 grant (PI046549). The development of a version of the digital solution adapted to health workers is funded by the Spanish Foundation for Psychiatry and Mental Health, Spanish Psychiatric Society, and Spanish Society of Biological Psychiatry (PI046813). The enhancement of the digital solution with Natural Language Processing techniques in a chatbot user-interface in collaboration with the text mining technologies in the health domain of the Barcelona Supercomputing Center is funded by the Agència de Gestió d’Ajudes Universitàries I de Investigació—PANDÈMIES 2020 grant (PI047003), from La Generalitat de Catalunya.Peer Reviewed"Article signat per 50 autors/es: Gerard Anmella; Miriam Sanabra; Mireia Primé-Tous; Xavier Segú; Myriam Cavero; Ivette Morilla; Iria Grande; Victoria Ruiz; Ariadna Mas; Inés Martín-Villalba; Alejandro Caballo; Julia-Parisad Esteva; Arturo Rodríguez-Rey; Flavia Piazza; Francisco José Valdesoiro; Claudia Rodriguez-Torrella; Marta Espinosa; Giulia Virgili; Carlota Sorroche; Alicia Ruiz; Aleix Solanes; Joaquim Radua; María Antonieta Also; Elisenda Sant; Sandra Murgui; Mireia Sans-Corrales; Allan H Young; Victor Vicens; Jordi Blanch; Elsa Caballeria; Hugo López-Pelayo; Clara López; Victoria Olivé; Laura Pujol ; Sebastiana Quesada; Brisa Solé; Carla Torrent; Anabel Martínez-Aran; Joana Guarch; Ricard Navinés; Andrea Murru; Giovanna Fico; Michele de Prisco; Vicenzo Oliva; Silvia Amoretti ; Casimiro Pio-Carrino; María Fernández-Canseco; Marta Villegas; Eduard Vieta; Diego Hidalgo-Mazzei"Postprint (published version

Parents'diet quality and physical activity are associated with lifestyle in spanish children and adolescents: the PASOS study

Background: Non-communicable chronic diseases are associated with a low-quality diet, low physical activity, and sedentary behavior. Objective: To assess how parents’ diet and physical activity habits were associated with their offsprings’ lifestyles. Study design: A cross-sectional analysis of 8–16-year-old children and adolescents (n = 2539; 51.9% girls) was carried out within the frame of the first edition of the Physical Activity, Sedentarism, Lifestyles, and Obesity in Spanish Youth study (PASOS-2019). Data on adherence to the Mediterranean Diet (MedDiet), daily moderate–vigorous physical activity (MVPA), and screen time per day (television, computer, video games, and mobile phone) were collected from children and adolescents, and data on parents’ diet quality and physical activity were compiled. Logistic regression models were used to assess the association between parents’ lifestyles and those of children and adolescents. Results: High diet quality of parents was associated with higher adherence to the MedDiet of children and adolescents, as well as high consumption of fruit, vegetables, fish, nuts, and legumes. The high physical activity level of parents was associated with the low consumption of fast foods, sweets, and candies in children and adolescents. Children with high levels of physical activity were those whose parents showed better diet quality and physical activity levels. Conclusions: Parents’ high diet quality and physical activity were associated with healthy lifestyles, higher adherence to the MedDiet, and physical activity of their offspring, mainly in adolescents.The PASOS study was funded by Fundación PROBITAS and the Gasol Foundation. Additional funds were received from the FC Barcelona Foundation, Banco Santander, IFA, Vienna, and the Fundación Deporte Joven (no references are applicable). M.M.M., M.R.M., M.G.G., J.A.T. and C.B. were funded by CIBEROBN (CB12/03/30038), and M.M. and I.L. (CB22/03/00058) by the Institute of Health Carlos III (ISCIII), and co-funded by the European Regional Development Fund

Independent and joined association between socioeconomic indicators and pediatric obesity in Spain: the PASOS study

Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16–0.48), severe obesity (OR = 0.20; 95% CI: 0.05–0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23–0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.The PASOS study was funded by Fundación PROBITAS (2019) and the Gasol Foundation (2019-2020). Additional funds were received from the Barça Foundation (2019-2020), Banco Santander (2019), IFA (2019-2020), Vienna (2019), and the Fundación Deporte Joven (2019) (no references are applicable). J.A.T., M.G.-G. and C.B. are funding by Instituto de Salud Carlos III through the CIBEROBN CB12/03/30038, which are co-funded by the European Regional Development Fund

Determinants of adherence to the mediterranean diet in Spanish children and adolescents: the PASOS Study

A progressive shift away from traditional healthy dietary patterns, such as the Mediterranean diet (MedDiet), has been observed in recent decades. The aim of this study was to assess determinants of optimal adherence to the MedDiet in Spanish children and adolescents. A cross-sectional analysis was included in the PASOS nationwide representative study in Spain. Participants were 3607 children and adolescents; 8–16 years old. Primary and secondary outcome measures of weight and height were measured. Adherence to the MedDiet, physical activity, and sedentary behavior in children and adolescents, as well as parental physical activity and dietary habits, were assessed. Optimal adherence to the MedDiet was observed in 45.5% of primary school students and 34.8% of secondary school students (OR: 0.65; 95%CI: 0.56–0.75). Optimal adherence to the MedDiet was higher in children/adolescents meeting daily recommended moderate and vigorous physical activity (OR: 2.39, 95%CI: 1.97–2.89) and in those meeting daily recommended screen time on week-days (OR: 2.05, 95%CI: 1.77–2.38) and weekends (OR: 1.76, 95%CI: 1.48–2.10). Participants with optimal adherence to the MedDiet were more likely to have mothers with a high-level education and high-tercile of SDQS, mothers who never smoked or were former smokers, and mothers who met the recommended physical activity and screen time. It can be concluded that a low prevalence of optimal adherence to the MedDiet was found among current Spanish children and adolescents. Optimal adherence to the MedDiet was associated with reaching the recommendations on physical activity and screen time, with the highest maternal educational level, and healthier maternal life-styles.The PASOS study was funded by Fundación PROBITAS and the Gasol Foundation. Additional funds were received from the Barça Foundation, Banco Santander, IFA, Vienna and the Fundación Deporte Joven (no references are applicable). J.A.T., C.B., M.M.G., and M.M.B. were funded by CIBEROBN (CB12/03/30038) of the Institute of Health Carlos III (ISCIII), and co-funded by the European Regional Development Fund

Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades.

Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8–16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998–2000, n = 1001) and PASOS (2019–2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019–2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019–2020 (mean ± SE: 6.9 ± 0.04) and the 1998–2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental onePartial funding for open access charge: Universidad de Málag

iMAGING: a novel automated system for malaria diagnosis by using artificial intelligence tools and a universal low-cost robotized microscope

IntroductionMalaria is one of the most prevalent infectious diseases in sub-Saharan Africa, with 247 million cases reported worldwide in 2021 according to the World Health Organization. Optical microscopy remains the gold standard technique for malaria diagnosis, however, it requires expertise, is time-consuming and difficult to reproduce. Therefore, new diagnostic techniques based on digital image analysis using artificial intelligence tools can improve diagnosis and help automate it.MethodsIn this study, a dataset of 2571 labeled thick blood smear images were created. YOLOv5x, Faster R-CNN, SSD, and RetinaNet object detection neural networks were trained on the same dataset to evaluate their performance in Plasmodium parasite detection. Attention modules were applied and compared with YOLOv5x results. To automate the entire diagnostic process, a prototype of 3D-printed pieces was designed for the robotization of conventional optical microscopy, capable of auto-focusing the sample and tracking the entire slide.ResultsComparative analysis yielded a performance for YOLOv5x on a test set of 92.10% precision, 93.50% recall, 92.79% F-score, and 94.40% mAP0.5 for leukocyte, early and mature Plasmodium trophozoites overall detection. F-score values of each category were 99.0% for leukocytes, 88.6% for early trophozoites and 87.3% for mature trophozoites detection. Attention modules performance show non-significant statistical differences when compared to YOLOv5x original trained model. The predictive models were integrated into a smartphone-computer application for the purpose of image-based diagnostics in the laboratory. The system can perform a fully automated diagnosis by the auto-focus and X-Y movements of the robotized microscope, the CNN models trained for digital image analysis, and the smartphone device. The new prototype would determine whether a Giemsa-stained thick blood smear sample is positive/negative for Plasmodium infection and its parasite levels. The whole system was integrated into the iMAGING smartphone application.ConclusionThe coalescence of the fully-automated system via auto-focus and slide movements and the autonomous detection of Plasmodium parasites in digital images with a smartphone software and AI algorithms confers the prototype the optimal features to join the global effort against malaria, neglected tropical diseases and other infectious diseases

Imaginaries and Discourses. Research, Art and Creation 2019

Catálogo de Exposición del Máster en Investigación en Arte y Creación de la UCM. Muestra celebrada del 23 de septiembre al 14 de octubre de 2019 en la Sala de Exposiciones de la Facultad de Bellas Artes. C / Pintor el Greco 2, Ciudad Universitaria. 28040 Madrid. Comisariado de Javier Mañero Rodicio.Exhibition catalog of the Master in Art and Creation Research of the UCM. September 23 to October 14, 2019 in the Exhibition Hall of the Faculty of Fine Arts. C / Pintor El Greco 2, University City. 28040 Madrid. Curated by Javier Mañero Rodicio.Fac. de Bellas ArtesFALSEFacultad de Bellas Artes. Universidad Complutense de Madrid.pu