Transcranial Magnetic Stimulation for the Treatment of Cocaine Addiction: A Systematic Review

Cocaine use disorder; Craving; Non-invasive brain stimulationTrastorn per consum de cocaïna; Ànsia; Estimulació cerebral no invasivaTrastorno por consumo de cocaína; Ansia; Estimulación cerebral no invasivaLong-term cocaine use is associated with cognitive deficits and neuro-psychiatric pathologies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging therapeutic strategy relating to changes in brain activity. It stimulates the prefrontal cortex and is involved in inhibitory cognitive control, decision making and care. This systematic review aims to evaluate and synthesize the evidence on the safety, effectiveness, and cost-effectiveness of rTMS for the treatment of cocaine addiction. A systematic review of the literature was carried out. The following electronic databases were consulted from inception to October 2020: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Web of Science. Randomised controlled trials, non-randomised controlled trials and case-series and full economic evaluations were included. Twelve studies were included. No identified study reported data on cost-effectiveness. Significant results of the efficacy of TMS have been observed in terms of the reduction of craving to consume and the number of doses consumed. No serious adverse effects have been observed. Despite the low quality of the studies, the first results were observed in terms of reduction of cocaine use and craving. In any case, this effect is considered moderate. Studies with larger sample sizes and longer follow-ups are required

Gender differences in the decision-making process for undergoing total knee replacement

Acord transformatiu CRUE-CSICThis project was supported by Instituto de Salud Carlos III, Ministry of Health, Spain (grant number PI15/01264).Objective: To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). Methods: A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. Results: Women showed less knowledge (MD = −7.68, 95% CI: −13.9, −1.46, p = 0.016), reported less satisfaction (MD = −6.95, 95% CI: −11.7, −2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). Conclusion: The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. Practice implications: A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases

Needs of patients with multi-morbidity and heart failure for the development of a mHealth to improve their self-management: A qualitative analysis

Objective: To provide practical information regarding needs, preferences of content and format of an app to assist the self-management in patients with multi-morbidity and heart failure (HF). Methods: The three-phase study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. Data collection continued until data saturation was reached. All data were transcribed verbatim and analysed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. Results: Integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes that captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain (a) components that increase the patient's understanding of HF, (b) self-care, (c) self-efficacy and participation of the family/informal caregiver, (4) psychosocial well-being and (5) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), nutritional information (70%), type of exercises in order to improve their physical condition (75%) and information about food and drug interaction (60%). The importance of motivation messages (60%) was highlighted by transversal way. Conclusions: The three-phase process integrating theoretical basis, evidence from integrative reviews and research findings from target users has been considered a guide for future app development17 página

Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain

In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain. Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information

La influencia del escenario educativo familiar en el uso de internet en los niños de primaria y secundaria

Con el fin de estudiar el impacto de internet en el hogar se analiza la influencia del componente físico (dónde, con quién) y actitudinal (quién decide su uso y qué motivación se tiene para su uso) del escenario educativo familiar en la frecuencia y diversidad de uso de internet por parte de los hijos, reportados por los padres. Los participantes fueron 711 padres y madres con hijos que cursaban educación primaria y secundaria en la isla de Tenerife. Los resultados indican que cursar la educación secundaria, usar internet en zonas privadas del hogar, sin compañía para compartir la actividad, estando los contenidos de internet bajo control del niño y con motivaciones parentales Con el fin de estudiar el impacto de internet en el hogar se analiza la influencia del componente físico (dónde, con quién) y actitudinal (quién decide su uso y qué motivación se tiene para su uso) del escenario educativo familiar en la frecuencia y diversidad de uso de internet por parte de los hijos, reportados por los padres. Los participantes fueron 711 padres y madres con hijos que cursaban educación primaria y secundaria en la isla de Tenerife. Los resultados indican que cursar la educación secundaria, usar internet en zonas privadas del hogar, sin compañía para compartir la actividad, estando los contenidos de internet bajo control del niño y con motivaciones parentalesWith the aim of studying the impact of the internet in the home, this paper analyses how the physical component (where and with whom) and attitudinal component (who decides what the child is to see on the internet and motivations for internet use) of the family educational scenario influence the frequency of internet use and diversity of uses, as reported by parents. The participants included 711 parents of children in primary and secondary school. Results showed that being in secondary school, using the internet in privacy at home, without company, internet content under the child�s control, and parental motivations based on the internet being used as a means for the child to relax, predicted higher frequency of internet use. Some of these factors, as well as the presence of peers and new parental attitudes related to the use of the internet for social and learning purposes, predicted a greater variety of uses, suggesting a more appropriate family scenario. The practical implications for parental education on this matter are described

Infancia y aprendizaje

Título, resumen y palabras clave también en inglésResumen basado en el de la publicaciónSe estudia el impacto de internet en el hogar desde la influencia del componente físico (dónde, con quién) y actitudinal (quién decide su uso y qué motivación se tiene para su uso) del escenario educativo familiar en la frecuencia y diversidad de uso de internet por parte de los hijos, reportados por los padres. Participan 711 padres y madres con hijos que cursan Educación Primaria y Secundaria en la isla de Tenerife. Los resultados indican que cursar la Educación Secundaria, usar internet en zonas privadas del hogar, sin compañía para compartir la actividad, estando los contenidos de internet bajo control del niño y con motivaciones parentales basadas en que internet sirve para relajarse, predicen una mayor frecuencia de uso de internet por parte de los hijos.Biblioteca del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review

Background: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. Methods: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. Results: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. Conclusions: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.This work was financed by the Spanish Ministry of Health, in the framework of activities developed by the Spanish Network of Agencies for Health Technology Assessment for the National Health Service.S

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

Abstract Background Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening. Methods We performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients’ goals/concerns and intention. Results In center A, there were significant differences favoring the DA in decisional conflict (p < 0.001) and knowledge (p < 0.001). The absolute differences favoring DA group in intention to undergo fecal occult blood test (10.5%) and colonoscopy (13.7%) were significant only before correction for attenuation. In center B the differences were significant only for knowledge (p < 0.001). Patients’ goals and concerns regarding the screening did not significantly predict their intention, and therefore we could not calculate a measure of concordance between the two constructs. Conclusions A DA improved the decisional process of participants who had never been invited to participate in the Spanish public CRC screening program, replicating previous results in this field. Future research is needed to identify subgroups that could benefit more from these interventions. Trial registration International Standard Registered Clinical/social Study Number: ISRCTN98108615 (Retrospectively registered on 27 December 2018)

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

BACKGROUND: Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening. METHODS: We performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients' goals/concerns and intention. RESULTS: In center A, there were significant differences favoring the DA in decisional conflict (p < 0.001) and knowledge (p < 0.001). The absolute differences favoring DA group in intention to undergo fecal occult blood test (10.5%) and colonoscopy (13.7%) were significant only before correction for attenuation. In center B the differences were significant only for knowledge (p < 0.001). Patients' goals and concerns regarding the screening did not significantly predict their intention, and therefore we could not calculate a measure of concordance between the two constructs. CONCLUSIONS: A DA improved the decisional process of participants who had never been invited to participate in the Spanish public CRC screening program, replicating previous results in this field. Future research is needed to identify subgroups that could benefit more from these interventions