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Purpose: The purpose of this paper was to explore the health of trafficking survivors in Spain, which is relatively unstudied (Sweileh, 2018). Therefore, the objectives of this study are to describe the health conditions, access to health-care facilities, COVID-19 protection and health challenges in relation to the COVID-19 pandemic reported by women survivors of human trafficking in Spain. Design/methodology/approach: Due to the pandemic situation, limited research and the complexity of the issue, the authors took a qualitative approach. A cross-sectional study was carried out through interviews with women survivors of human trafficking for sexual exploitation in Spain. Prior to the interviews, the researchers conducted written interviews with social workers to understand the most important challenges that the women survivors were experiencing during confinement. As a result of these written interviews, the interview script for the survivors was modified. Findings: To sum up, the COVID-19 situation poses several challenges, including social difficulties (food insecurity; violence; terrible housing conditions; working pressure; poor sleeping habits; and cultural, linguistic and religious challenges), medical insecurity (due to lockdowns, negative experiences in care, lack of official documents, collapse of hospitals, telephone monitoring and fear of contagion), great emotional distress reported by women (anxiety, fear, sadness, post-traumatic stress disorder, stigma and substance use) and physical health problems (serious weight loss, muscle pains, dental problems and sexual and reproductive health-care limitations). Research limitations/implications: As is usual in qualitative research, rather than obtain generalizable results, the main objective was to delve deeper into under-researched or complex issues (Polit and Beck, 2010). While this report provides a timely overview marked by COVID-19 of an important population, there are some limitations. The major limitation of this research was the sample representativity, because the sample was conducted with only one non-governmental organization and only individuals who voluntarily agreed to make the interview; as such, other victim profiles may not be represented. Practical implications: The findings can provide information for detecting victims of human trafficking for sexual exploitation and contribute to understanding the pandemic's impact. Furthermore, the paper emphasizes the need to adopt measures for the recovery of victims, such as medical and psychological assistance, in accordance with the Palermo Protocol. As people transition out of the pandemic, it is crucial for Spain, along with other European countries, to guarantee that all residents, particularly the victims of human trafficking, have access to social and health-care protections during times of crisis. Social implications: As already mentioned, further investigation should be done to fill the gaps on health of human trafficking (Sweileh, 2018) and improve the recovery of victims of trafficking (García-Vázquez and Meneses-Falcón, 2023 0; Sweileh, 2018). The paper acknowledges the existing research gap in the field and emphasizes the importance of future studies to delve deeper into the challenges faced by victims, calling for a more nuanced understanding of health. Originality/value: The Coronavirus pandemic has increased and reinforced the vulnerability of sex-trafficked victims, especially creating different mental health problems. One of the biggest concerns for this group has been the difficulty of access to basic goods such as food. Furthermore, psychological distress impacted the well-being of trafficking victims, and many suffered from eating disorders. Less than half of the women who were forced to continue in prostitution did not have the means to protect themselves against COVID-19 and did not have easy situations to overcome illness. [ABSTRACT FROM AUTHOR]

Introduction: Spain is one of the leading countries in the application of proactive and personalised telecare to help support frail and vulnerable service users to live independently in their own homes for longer*. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased by 1.3 years. Aims, Objectives, Theory and Methods: The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n=202.1k to 247.9k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services by Televida Servicios Sociosanitarios over the period 2014-18. The population was subject to change over time as new service users became eligible to register for the service, and others ceased the service. Each of these factors were also studied to assess potential confounding or covariate factors in the population also influencing the mobilisation of ambulances. Key Findings: For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced over the period despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. Overall mobilisations reduced by 27.9% (0.665 to 0.479 pp/pa) over the period whilst for ambulances there was a reduction of 33.3% (0.461 to 0.307 pp/pa). There were also smaller reductions in the number for family and state security mobilisations. The study identified the positive correlation coefficient between ambulance mobilisations and service user's dependency levels, and marginal negative correlation in older age bands. We are aware of no other studies which have investigated the impact on ambulance mobilisations of advanced proactive telecare and the increasing age of the services users supported to continue living independently. We believe this paper, therefore, contributes new insight which extends the existing research literature. Conclusions: The increasing age at cessation has not correlated with an increased proportion of higher dependency service users. The share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service contributing to increased time living independently may also have helped service users remain in lower risk bands. Limitations: There is a risk that use of mean annual measures may obscure important variations within the data. Changes in levels of proactivity, personalisation and increased use of sophisticated monitoring sensors of the telecare services are not the subject of this paper, but addressed in part in allied research. [ABSTRACT FROM AUTHOR]

Background: E-learning has shown to be an effective intervention in helping informal caregivers of people living with dementia. It has the potential to reach people living in remote areas, increasing service coverage. As a response to the demographic context in Spain associated with a higher percentage of ageing, depopulation, and the complexities of health service delivery in rural areas, this paper describes the cultural adaptation and co-design of the iSupport online training and support programme for Castilla y León, Spain, as a potential e-health intervention to mitigate these constraints. Methods: The translation and cultural adaptation were performed following the WHO guidelines, with some adaptation due to the cultural context of Spain. Three focus groups were conducted with informal caregivers, health professionals, and a group of experts on cognitive impairment and dementia. The co-design process was performed as a Patient and Public Involvement activity with three groups consisting of people living with dementia, informal caregivers, rural population and experts on technology and dementia. Results: A total of 435 suggestions were proposed for adaptation associated with erroneous terminology, rewording text/writing, grammatical or punctuation marks errors, and repeated information or need for additional content. Several recommendations were exposed during the co-design process: preference for interactive material such as videos or images, a forum to receive feedback from health care professionals and to leave satisfaction comments, availability in multiple platforms (e.g., tablet, laptop, mobile), slide format for information presentation, and availability to edit letter size and background colours. Conclusions: A culturally adapted version of the iSupport was developed for Castilla y León, Spain. The need for modification of words and expressions, information links to local resources websites, adjustments of characters' names and caregivers' scenarios, and additional content to some sections were recommended. Suggestions for the design should be taken into account for further adapted versions and platform developments. [ABSTRACT FROM AUTHOR]

Drawing on the conceptual frameworks of Bourdieu and postfeminism, this article analyses extant tensions between young women's gendered habitus and the health-related learning spaces of Physical Education (PE) and Instagram. We draw on data from a two-phase qualitative research project with thirty-seven young women (aged 15–17) from three secondary schools in Spain who self-defined as physically active and engaging with exercise content on Instagram. Data obtained through focus groups and semi-structured interviews reveal how these young women's subjectivities are formed through negotiating the gender 'rules of the game' within these key pedagogical fields. Notably, most participants were critical of their learning in PE, which mainly remains a traditional masculine field. By contrast, they valued Instagram as an engaging space in which to learn about fitness to transform their bodies toward the feminine ideal. This involved a constant process of self-optimization, including the development of the 'right' mental dispositions, fitting strongly with their gendered habitus. Within this paper, we have developed the concept of 'postfeminist habitus' to explain the participants' engagements with health-related content on Instagram, which through language of choice and empowerment, disciplined the young women to achieve the normative body as a marker of success. We argue that while there are notably different patterns of engagement with PE and Instagram, in both spaces there is evidence of symbolic violence that reproduces the gender order. We conclude by suggesting changes that might make PE a more meaningful and hybrid learning space for young women. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal. Design/methodology/approach This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency. Findings Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation. Originality/value Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services. [ABSTRACT FROM AUTHOR]

Introduction: Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years. Methods: Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. Main measures: referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation. Results: The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations. Conclusions: Teledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies. Registry: ClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 (https://clinicaltrials.gov/ct2/show/ NCT05625295). [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to report results of the impact of the information and communication technology (ICT) platform and telecare services developed by the MonAMI consortium on the quality of life (QOL) of older people in three European communities. Design/methodology/approach – In a three-month trial, the MonAMI technology was installed in the homes of older people with various needs, in the cities of Stockholm, Sweden; Zaragoza, Spain; and Kosice, Slovakia. Evaluation criteria and instrumentation were developed to assess the effects of the services on users' perceived QOL in the domains of independence, physical health, psychological wellbeing, social networking, and physical environment. Findings – A total of 62 users, with a mean age of 79 years, participated in the trial. Results demonstrate that the MonAMI services had some positive, significant effects on users' QOL. For instance, users with a higher number of disabilities at baseline reported greater confidence in keeping intruders from entering their home compared to users with fewer disabilities (OR=2.51, 0.01 p<0.05). However, overall findings show that healthier, more independent users perceived more benefits from the services compared to users who report more health problems and are less independent. Research limitations/implications – The complexities of conducting the MonAMI trial led to a small, heterogeneous sample of users over a short time span. This in turn created difficulties in observing the potential effects of the services and achieving significance on some indicators of QOL. Originality/value – This paper provides quantitative analyses around the impact of telecare services; suggests important directions for further research; and highlights the methodological challenges of evaluating ICT-based care services in a community setting. [ABSTRACT FROM AUTHOR]

We searched the MEDLINE database for publications about telemedicine from 1966 to 2003. Only publications with a first institutional address in Spain and from journals listed in the JCR Science Edition 2002 were included in the study. A total of 118 publications were found. The first publication appeared in 1988 and publication output showed a sudden increase starting in 1995, reaching a maximum in 2002 with 21 publications. The number of authors per publication in non-multicentre studies ranged from 1 to 14 (median 6.5). Most authors (79%) contributed to only a single publication; 10% of authors participated in three or more publications. Most publications were full papers (88%). The most active Autonomous Community in the number of publications relative to inhabitants was Galicia (0.91 publications per 100,000 inhabitants). The Community that produced the highest absolute number of publications was Madrid (29% of the total). The mean impact factor of the journals in which the publications appeared was 0.961. Production of telemedicine publications in Spain has followed the same temporal course as has been observed worldwide. There is an unequal geographical and institutional distribution of publications. The highest production is concentrated in a few institutions and only a small number of authors show steady research activity. [ABSTRACT FROM AUTHOR]

Background: Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process. Aim: To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations. Design & setting: Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain. Method: Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation. Results: Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care. Conclusion: Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care. [ABSTRACT FROM AUTHOR]

Background: Process evaluation studies are recommended to improve our understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results and on their potential transferability to practice. This paper aims to document the translation of a type-2 diabetes (T2D) prevention program into the routine context of several primary care centers, assessing process indicators related to clinician adoption, patient recruitment, exposure to the intervention components and baseline characteristics.Methods: An observational descriptive process evaluation study was conducted of the 2.5-year implementation of the Prevention of Diabetes in Euskadi cluster randomized trial in 14 primary care centers of the Basque Health Service (Osakidetza). The clinical intervention consisted of three components: (1) risk screening, (2) an educational intervention promoting healthy lifestyles, and (3) remote support (follow-up). A passive dissemination strategy of providing training and materials was used to translate the intervention into practice. All non-diabetic patients aged 45 to 70 years who were identified as being at high risk of developing T2D were eligible for study inclusion. The RE-AIM framework guided the process evaluation.Results: Overall, 31.4 % of family physicians and 57.6 % of nurses participated in the study, while 4170 out of 67,293 (6.2 %) targeted patients who attended the centers during the implementation period were reached through the screening. Around half of the screened patients were identified as being at high risk of developing T2D (FINDRISC score ≥14). The rate of refusal to participate and the proportion of women were higher in the intervention group. Finally, 634 and 454 non-diabetic 45- to 70-year-old patients who were at high risk of T2D were included in the control and intervention group centers (intervention reach = 48 %). Significant variability in most process indicators was observed at center level.Conclusion: The passive dissemination strategy has produced modest process indicators related to the adoption, reach and implementation of the intervention program, and reduced the possibility of its standardized application in heterogeneous contexts. The resulting different procedures and strategies used by the centers were associated with process outcomes. Context-specific variability and possible confounding will require rigorous procedures for analysis of the intervention effects.Trial Registration: The trial was registered in ClinicalTrials.gov (identifier: NCT01365013 ). Registered on June 2011. [ABSTRACT FROM AUTHOR]

End-user development is a new trend to provide tailored services to dynamic environments such as hospitals. These services not only facilitate daily work for pharmacy personnel but also improve self-care in elder people that are still related to hospital, such as discharged patients. This paper presents an ambient intelligence (AmI) environment for End-user service provisioning in the pharmacy department of Gregorio Marañón Hospital in Madrid, composed of a drug traceability infrastructure (DP-TraIN) and a ubiquitous application for enabling the pharmacy staff to create and execute their own services for facilitating drug management and dispensing. The authors carried out a case study with various experiments where different roles from the pharmacy department of Gregorio Marañón Hospital were involved in activities such as drug identification, dispensing and medication administering. The authors analyzed the effort required to create services by pharmacy staff, the discharged patients' perception of the AmI environment and the quantifiable benefits in reducing patient waiting time for drug dispensing. [ABSTRACT FROM AUTHOR]

Despite the opportunities the health sector will offer as a result of the design and development of a technology infrastructure, the fact is that hospitals have been slow to adopt telemedicine technologies, largely because very few organisations are prepared to face this challenge. A possible explanation for the efficiency and effectiveness gaps of services provided by Hospital-in-the-Home Units (HHUs) may relate to the advantages and disadvantages of the knowledge processes that these units exhibit as a result of their different structural properties. This paper investigates the approaches that HHUs have used to update the knowledge of physicians and their members' knowledge of technology, and relates them to an unlearning context (UC) and improvement in the quality of health services. These relationships are examined through an empirical investigation of 55 doctors and 62 nurses belonging to 44 HHUs. The research findings suggest that the key benefits of a UC in HHUs are clear. It enables them to identify and replace poor practices and also avoids the reinvention of the wheel; it enables cost reduction by minimising unnecessary work caused by the use of poor methods and it enables improvements adopting new telemedicine technologies. [ABSTRACT FROM AUTHOR]

Objectives: Telehealth for mental healthcare expanded rapidly with the COVID‐19 pandemic's onset; however, global access disparities emerged. Telehealth challenges and opportunities for Latino cancer patients from different geographical regions must be explored. Methods: A cross‐sectional online survey (March‐July 2021) of mental health providers, serving Latino cancer patients in Latin America, United States, and Spain, contained close‐ended questions related to the use of telehealth during the pandemic and open‐ended questions on recommending/not recommending telehealth. Results: In a sample of 148 providers from 21 countries, 60.5% reported that at least some of their patients had difficulties with Internet speed and connectivity and lacked knowledge about using electronic devices (43.2%) or the Internet (45.4%). Lacking privacy at home (66.0%) and childcare (26.0%) were reported patient challenges. Internet connectivity or speed were issues for providers (43.2%) themselves. Improving patient reach was a reported telehealth benefit (64.2%). Geographical access (43.2%) and physical limitations (35.8%) were considerations in offering telehealth. Considerations for not recommending telehealth were patient age (24.3%) and lacking technological knowledge (29.1%). Conclusions: Telehealth for mental healthcare may improve patient access issues caused by geographical and transportation conditions and patient functionality. Findings provide insight into telehealth benefits and challenges in Latino patient populations. Future studies should examine patient access and use by region. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to assess the effect of the FreeStyle Libre device implantation in adult type 1 diabetics in a Health Area of Castilla La Mancha (Spain) during the COVID‐19 pandemic. Background: FreeStyle Libre is a so‐called mHealth device that supports health care. During COVID‐1 confinement, diabetic patients could have improved their glycaemic monitoring thanks to these devices, although health care in these patients may have been limited due to confinement. Methods: A 12‐month longitudinal study in which a total of 206 type I diabetics participated, belonging to a single health area. Sociodemographic and analytical data and the Self Care Inventory Revised questionnaire (SCI‐R) were collected. STROBE checklist was followed. Results: The analysis showed differences related to the use of the sensor. After the study period, patients obtained better levels of basal glucose, glycosylated haemoglobin, creatinine, cholesterol, triglycerides and LDL. In addition, a significant increase in the total score of the SCI‐R questionnaire was observed after the use of the monitor (MD −7.77; 95% CI −10.43, −8.29). The same occurred with different SCI‐R items such as diet (MD ‐2.995; 95% CI −3.24, −2.57), glucose determination (MD −3.21; 95% CI −3.52, −2.91), medication administration (MD −2.58; 95% CI −2.53, −1.96) and hypoglycaemic episodes (MD −1.07; 95% CI −1.21, −0.93). In the analysis by groups, worse values of glycosylated haemoglobin and adherence to treatment (p <.05) were observed in overweight/obese subjects versus those with normal weight after one year of study. Conclusion: The use of flash monitoring is related to better adherence to most of the recommended habits in diabetes. Nevertheless, there seems to be no relationship with an improvement in physical exercise and preventive aspects of diabetes. A good nursing intervention to support physical exercise and the use of mHealth devices could improve the control of diabetic patients. Relevance to clinical practice: The use of this mHealth device has shown positive results and reduced complications. Despite less contact with healthcare facilities due to the pandemic, type 1 diabetic patients have improved their blood results and adherence after using the device for one year. Nursing staff should focus on promoting physical activity and routine disease care in type 1 diabetics. [ABSTRACT FROM AUTHOR]

Background: The growth of diabetes prevalence is causing an increasing demand in health care services which affects the clinicians' workload as medical resources do not grow at the same rate as the diabetic population. Decision support tools can help clinicians with the inspection of monitoring data, providing a preliminary analysis to ease their interpretation and reduce the evaluation time per patient. This paper presents Sinedie, a clinical decision support system designed to manage the treatment of patients with gestational diabetes. Sinedie aims to improve access to specialized healthcare assistance, to prevent patients from unnecessary displacements, to reduce the evaluation time per patient and to avoid gestational diabetes adverse outcomes.Methods: A web-based telemedicine platform was designed to remotely evaluate patients allowing them to upload their glycaemia data at home directly from their glucose meter, as well as report other monitoring variables like ketonuria and compliance to dietary treatment. Glycaemia values, not tagged by patients, are automatically labelled with their associated meal by a classifier based on the Expectation Maximization clustering algorithm and a C4.5 decision tree learning algorithm. Two finite automata are combined to determine the patient's metabolic condition, which is analysed by a rule-based knowledge base to generate therapy adjustment recommendations. Diet recommendations are automatically prescribed and notified to the patients, whereas recommendations about insulin requirements are notified also to the physicians, who will decide if insulin needs to be prescribed. The system provides clinicians with a view where patients are prioritized according to their metabolic condition. A randomized controlled clinical trial was designed to evaluate the effectiveness and safety of Sinedie interventions versus standard care and its impact in the professionals' workload in terms of the clinician's time required per patient; number of face-to-face visits; frequency and duration of telematics reviews; patients' compliance to self-monitoring; and patients' satisfaction.Results: Sinedie was clinically evaluated at "Parc Tauli University Hospital" in Spain during 17 months with the participation of 90 patients with gestational diabetes. Sinedie detected all situations that required a therapy adjustment and all the generated recommendations were safe. The time devoted by clinicians to patients' evaluation was reduced by 27.389% and face-to-face visits per patient were reduced by 88.556%. Patients reported to be highly satisfied with the system, considering it useful and trusting in being well controlled. There was no monitoring loss and, in average, patients measured their glycaemia 3.890 times per day and sent their monitoring data every 3.477days.Conclusions: Sinedie generates safe advice about therapy adjustments, reduces the clinicians' workload and helps physicians to identify which patients need a more urgent or more exhaustive examination and those who present good metabolic control. Additionally, Sinedie saves patients unnecessary displacements which contributes to medical centres' waiting list reduction. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic has challenged healthcare systems worldwide. The aim of this study was to assess the results of a Respiratory Telerehabilitation Program implemented to patients post-COVID-19 in postacute phase of mild to critical course of COVID-19 who had persistent respiratory symptoms and had not received any vaccination. The intervention was performed during confinement. Methods: A quasi-experimental nonrandomized study was conducted in Spain during confinement. Respiratory Telerehabilitation Program was guided by a specialized physical therapist through a web platform (Zoom by Zoom Video Communications, San Jose, CA, USA). Participants were recruited through social webs. Outcome measures included respiratory rate, heart rate, percutaneous oxygen saturation, Mahler's Dyspnea Index, anxiety status, and quality of life [EuroQol 5 Dimension 5 (EQ-5D)]. Results: A total number of 148 participants were recruited, with a final number of 100 participants completing the protocol (50 experimental group (EG)/50 control group (CG)). A total of 500 telerehabilitation sessions were performed for this study. In the EG, pre–post intervention comparative analysis showed significative changes in Mahler's functional dyspnea (p < 0.001), the State-Trait Anxiety Inventory (p < 0.001), oxygen saturation (p < 0.001), heart rate (p < 0.001), quality-of-life questionnaire (p < 0.001), and respiratory rate (p < 0.001). Participants in the CG showed an improvement in all the variables, but the differences were not statistically significant except in Mahler's functional dyspnea (p = 0.001) and in the quality-of-life questionnaire (p = 0.043). Percentage changes in pre–post intervention were calculated and compared between EG and CG. There were statistically significative differences in all the outcomes in favor of the EG. Conclusion: The implementation of a pulmonary telerehabilitation program for COVID-19 not vaccinated survivors in postacute phase with mild to critical course of COVID-19 with respiratory sequelae has proven its benefits in cardiorespiratory variables and dyspnea-related anxiety. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a multicomponent, eHealth‐based self‐efficacy intervention to promote subjective well‐being and self‐efficacy in patients with cardiovascular disease, exploring sex differences. Design: A pilot study of a two‐arm non‐randomized controlled trial. Methods: Forty‐two cardiovascular patients (31% women) participated in the study. The experimental group received a personalized psychoeducational session and a 14‐days eHealth intervention. Subjective well‐being (positive and negative affect) and self‐efficacy (chronic and cardiac) were assessed at baseline, post‐psychoeducational session, post‐eHealth intervention and at two follow‐ups. Results: The levels of the experimental group in positive affect, at post‐eHealth and follow‐up 1, and self‐efficacy, at post‐eHealth, and both follow‐ups, were statistically significantly higher compared to the control group (all ps <.05). When considering sex, the intervention was effective only for men. The results highlight the potential of eHealth interventions for cardiac patients and underline the importance of considering a gender perspective in their treatment. [ABSTRACT FROM AUTHOR]

Aim: This study explores the profile of pregnant women interested in the online assessment of their emotional status according to their sociodemographic and obstetric characteristics, history of psychopathology, and healthcare setting used (private vs. public). Design: This is a comparative and descriptive cross‐sectional study. Method: Participants were 281 Spanish pregnant women assessed with the MamáFeliz (HappyMom) website. Results: Participants were probably to be unemployed, in a relationship, and generally had a high educational level and an intermediate economic status. Most of them were primiparous, had non‐complicated natural pregnancies and presented healthy habits and good physical and emotional health, despite 31.3% of them had a history of psychological treatment. Our results reveal the profile of women interested in the online assessment of their emotional status, which can contribute to improving future initiatives to facilitate rapid screenings of perinatal mental health by nurses in both public and private settings. [ABSTRACT FROM AUTHOR]

Background Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. Methods The sample ( n = 74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users’ inclusion. Results The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users’ perceptions of satisfaction and usefulness were highly positive. Conclusions Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. Implications Further adjustments are needed to address a comprehensive response to the needs of the global population of reference. [ABSTRACT FROM AUTHOR]

The aim of this qualitative research is to examine the difficulties perceived by caregivers for taking part in an offered intervention, exploring whether there are differences depending on caregiver's degree of kinship. Forty‐two family caregivers from Salamanca (Spain) were interviewed after declining an invitation to take part in an intervention programme. All the telephone conversations were transcribed verbatim. The transcriptions were subject to a thematic content analysis using QDA MINER software. The barriers identified were (1) difficulties adapting to the intervention's schedule due to a lack of time, or incompatibility with its dates or timetables, (2) belief among the caregivers that they do not need or are not interested in the support the intervention provides, (3) impossibility to separate from the family member to attend due to the absence of relief or a feeling of guilt, (4) caregiver's health issues, (5) difficulties with accessibility, and (6) belief that the therapies serve no useful purpose. Certain differences were identified depending on the caregiver's kinship. Understanding the difficulties caregivers face for taking part in the interventions will enable steps to be taken to remove and/or reduce such barriers, whereby more caregivers will benefit from interventions. [ABSTRACT FROM AUTHOR]

This paper offers an ethnographic interpretation of how in a changing context of family care different Spanish home telecare services provide older people with social links to prevent their isolation, granting them "connected autonomy": the promotion of their autonomy and independent living through connectedness. To do so, services need to craft a network of "contacts". Different versions of the term figuration are employed to describe the practical materializations of the forms of relatedness put in place by such services: what roles become available and explicitly supported; what other figurations of relatedness (e.g., kinship, friendship, neighbourliness) they come across; what happens when these different figurations of relatedness meet. In doing this, our aim is to allow space to reflect ethically on the practical relational promises and challenges of these forms of technologized care of older people. [ABSTRACT FROM AUTHOR]

eHealth has grown significantly over the last decade. The aim of this study was to determine the level of use of information and communication technologies for health care in Spain and identify the main barriers to development. We used a qualitative study based on data obtained from 8 Spanish autonomous communities through semi-structured, in-depth interviews with key informants in eHealth management and planning. Programs present varying degrees of implementation. Services such as electronic prescriptions, digital medical records, and appointment requests via the Internet are advanced and widespread; others, such as digital imaging, are advanced but not fully deployed; and some, such as telecare programs, are experimental. The study also revealed diverse levels of interoperability and barriers to the expansion of these technologies, which can be classified into 4 fields: technological, organizational, human, and economic. eHealth might evolve more slowly in the coming years. Unless the payoff is clearly seen, major budget cuts in the current economic climate will prevent the implementation of new projects. Programs that help reduce health spending are more likely to be implemented, to the detriment of projects involving simple techniques or even clear health care improvements. [ABSTRACT FROM AUTHOR]

Background: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action.Methods: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023.Discussion: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals.Trial Registration: C linicalTrials.gov NCT04620707. Registered on November 3, 2020. [ABSTRACT FROM AUTHOR]

Background: Interventions with patients with Serious Mental Illness (SMI) had to adapt rapidly to the COVID-19 safety restrictive measures, leading to the widespread use of teletherapy as an alternative. Objectives: The aims of this study were to compare the use of different intervention modalities with patients with SMI during the first wave of the pandemic and examine their association with emergency hospital visits and hospitalization rates six months later. Methods: Records of 270 service users of fifteen outpatient mental health services across Spain, were retrospectively assessed. We retrieved clinical data and data on the modality of intervention received (in-person, over the phone, videoconferencing) in three time points (before, during and after the first COVID-19 wave). Also, data were retrieved regarding the frequency of their emergency hospital visits and hospitalization rates, two, four and six months later. Results: During the first wave of the pandemic, teletherapy (over the phone and videoconferencing) was the modality most widely used, whilst in-person therapy sessions were significantly reduced, though they seemed to return to pre-COVID levels after the first wave had passed. Importantly, patients receiving teletherapy during the first wave seemed to have significantly fewer emergency visits and hospitalization rates four and six months later (χ2 = 13.064; p <.001). Multilevel analyses revealed that patients receiving videoconferencing interventions had fewer hospitalizations six months after the first wave (OR = 0.25; p =.012). Conclusions: Under challenging circumstances as those created by the COVID pandemic, teletherapy is a useful tool for protection against hospitalizations and can be used as an alternative to in-person therapy, to ensure continuity of care for patients with SMI. [ABSTRACT FROM AUTHOR]

We have developed a parametric model to quantify the Key Quality Indicators which affect video-based Tele-operated Driving (ToD) over a mobile network, as well as their relationship with the network Key Performance Indicators. This model can be easily used to specify Quality of Service policies (e.g. through network slicing) that guarantee the required conditions for remote driving on specific areas. We have used our model to validate the feasibility of deploying remote-assisted driving in different real networks, both from current 4G deployments and from pre-commercial and commercial 5G pilots. Our results show that some ToD services (supervision and, up to some point, parking) may be feasible with high-end existing 5G networks. However, full remote driving requires some improvements in the system, particularly to reduce end-to-end latency, increase uplink performance, and minimize service losses. Both the model and its results will be used in the framework of European Union H2020 project 5G-MOBIX to deploy a ToD proof-of-concept in the cross-border corridor between Spain and Portugal. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this paper is to report and discuss a successful experience in the setting up of a telemedicine solution for remote video-electroencephalography consultation (tele-EEG) in La Rioja, Spain. The setup has been implemented between a primary hospital situated in Calahorra (Calahorra Hospital Foundation, FHC) and a secondary hospital in Logroño (San Pedro Hospital, HSP), the capital city of the region of La Rioja. Methods: During the twelve first months of the setting-up a detailed evaluation study was performed. During this period we evaluated the technical aspects of the setup and also demonstrated the clinical viability of the system. The impact on hospital organization and the impact on patients regarding the improvement in their quality of life, as well as their financial savings, were also evaluated. Results: During these twelve months a total of 259 consultations were conducted through the telemedicine system. The clinical viability study was completely successful, and technical problems were detected only during the first months of setting-up. Regarding patients’ preferences (177 completed an opinion questionnaire), 99% expressed a high degree of satisfaction with the telemedicine service. They also remarked that they preferred the telemedicine service to previous methods for the EEG test, on the grounds that it provided a significant improvement in access to specialized medical care and important financial savings in terms of travel (around 30€ per visit) and of time (approximately 2h) invested in consultations. Conclusions: After one year of evaluation, we concluded that the tele-EEG system had been successfully introduced into the clinical routine. As a matter of fact, the success of the telemedicine system has led to its widespread use and it has now replaced the conventional EEG service for FHC patients almost completely. [Copyright &y& Elsevier]

Aims and Objectives: We aimed to determine the impact of COVID‐19 related home confinement on the paediatric population by focusing on anxiety, behavioural disturbances and somatic symptoms. Background: To limit the spread of the COVID‐19 outbreak, governments have imposed nationwide lockdowns to prevent direct contact; this has affected everyday lives and activities such as attending school classes. Such isolation may have impacted children's anxiety levels. Design and Methods: We conducted a cross‐sectional observational study using a web‐based anonymous questionnaire from 22–26 April, 2020, among children (N = 2,292) in Spain. For children below 7 years of age, parents reported the children's behavioural, emotional and somatic symptoms and family environment data on a questionnaire designed by the researchers. Children over 7 years answered the Revised Children's Manifest Anxiety Scale either independently or with their parents' assistance. Results: Children over 7 years, boys in particular, scored high on the anxiety spectrum. Moreover, participants who knew someone who had suffered from COVID‐19 at home or whose parent was directly involved in the pandemic, obtained higher Total Anxiety scores. Significantly high values were found in all aspects of anxiety among those who feared infection or whose parents been unemployed. Of the children below 7 years, 56.3% had four or more anxiety‐related symptoms, the most frequent of which were tantrums, emotional changes, restlessness and fear of being alone. The number of symptoms reported was significant when someone in the family home had been infected with COVID‐19. Conclusions: The COVID‐19 home confinement had a significant impact on children, causing anxiety, behavioural problems and somatic manifestations. Relevance to clinical practice: Nurses play a key role in screening children who have experience confinement owing to the COVID‐19 pandemic in order to detect early anxiety symptoms using tele‐health. Suitable direct interventions can then be implemented or interdisciplinary manage could be started. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence of AMD among optometric telemedicine users in Spain and to identify risk factors. Methods: Retrospective analysis of a nationwide database conducted on subjects attending to optometry centers, between January 2013 and December 2019. Fundus photographs were performed by optometrists, using non-mydriatic cameras, and evaluated by a group of 12 retina specialists. Results: Among the 119,877 subjects included, the overall prevalence of AMD was 7.6%. The prevalence of early, intermediate, and advanced AMD was 2.9%, 2.7%, and 2.0%, respectively. Of the 9129 AMD subjects, 1161 (12.7%) had geographic atrophy, and 1089 (11.9%) had neovascular AMD, either scar (4.5%) or exudative (7.4%). There was a significant association between AMD and age (per year older, adjusted odds ratio, OR 1.116; 95% CI 1.114 to 1.119, p<0.0001). Women had higher prevalence (adjusted OR 1.17; 95% CI 1.12 to 1.23, p<0.0001). Every diopter (spherical equivalent) of progress toward hyperopia was associated with a significant increase in early AMD prevalence (adjusted OR 1.02, 95 CI 1.01 to 1.04, p=0.0074). Presence of diabetes was associated with a lower AMD prevalence (p<0.0001). Conclusions: The prevalence of AMD (any eye and any severity) was 7.6%, with a prevalence of advanced AMD of 2.0%. Older age and women were significantly associated with a higher prevalence of AMD, whereas myopia and presence of diabetes were associated with significantly lower odds of any AMD. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness‐based approaches on the mental health of healthcare workers at the frontline against COVID‐19 in Spain. Design: We will carry out a two‐week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention. Methods: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID‐19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS‐21 questionnaire—primary endpoint), insomnia (ISI), burnout (MBI‐HSS), post‐traumatic stress disorder (DTS), and self‐efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. Discussion: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context. Impact: Despite the lack of solid evidence about their effectiveness, mobile‐based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. Clinical trial registration: NCT04393818 (ClinicalTrials.gov identifier). Approved funding: May 2020. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has brought great disruption to health systems worldwide. This affected ongoing clinical research, particularly among those most vulnerable to the pandemic, like dementia patients. Fundació ACE is a research center and memory clinic based in Barcelona, Spain, one of the hardest-hit countries.Objective: To describe the ad-hoc strategic plan developed to cope with this crisis and to share its outcomes.Methods: We describe participants' clinical and demographic features. Additionally, we explain our strategic plan aimed at minimizing the impact on clinical trial research activities, which included SARS-CoV-2 RT-PCR and IgG serological tests to all participants and personnel. The outcomes of the plan are described in terms of observed safety events and drop-outs during the study period.Results: A total of 130 patients were participating in 16 active clinical trials in Fundació ACE when the lockdown was established. During the confinement, we performed 1018 calls to the participants, which led to identify adverse events in 26 and COVID-19 symptoms in 6. A total of 83 patients (64%) could restart on-site visits as early as May 11, 2020. All SARS-CoV-2 RT-PCR diagnostic tests performed before on-site visits were negative and only three IgG serological tests were positive. Throughout the study period, we only observed one drop-out, due to an adverse event unrelated to COVID-19.Discussion: The plan implemented by Fundació ACE was able to preserve safety and integrity of ongoing clinical trials. We must use the lessons learned from the pandemic and design crisis-proof protocols for clinical trials. [ABSTRACT FROM AUTHOR]

Background: Health messages become most pertinent during elections, when citizens are more receptive to political messages. Political communication tools work to create a 'climate of opinion' to influence public sentiment and reporters' perceptions of health political ideologies and priorities. In considering how parties communicate with voters about health, this study aimed to examine the health-related discourse during presidential elections. Method: A content analysis was undertaken, including the political manifestos and the first address to the parliament of the elected candidate in the latest presidential elections of France, Spain, and the US. Results: A total of 266 content units were identified and analyzed. Findings revealed the dominance of the health-related political debate around the following themes: 'costs' (n = 89), 'health systems' (n = 59), 'healthcare' (n = 59), 'welfare' (n = 42), 'preventive care' (n = 22), and 'telehealth' (n = 21). The French campaign highlighted some current public health challenges, such as 'prevention' and 'health inequalities'. Conclusions: In the three analyzed countries, a narrow dimensional view of health was found in political communication materials, mainly focusing on health costs and healthcare services. The theoretical and practical implications of the findings are further discussed. [ABSTRACT FROM AUTHOR]

Introduction: We present the first registry of patients with congenital bleeding disorders and COVID‐19. The study has been carried out in the Community of Madrid, which has the highest number of cases in Spain. The objective is to understand the incidence of COVID‐19, the course of the disease if it occurs and the psychosocial and occupational impact on this population. Methods: We included 345 patients (246 of haemophilia, 69 of von Willebrand Disease, two rare bleeding disorders and 28 carriers of haemophilia). A telephone survey was used to collect the data. Results: Forty‐two patients presented symptoms suggestive of infection by COVID‐19, and in six cases, the disease was confirmed by RT‐PCR. The cumulative incidence of our series was 1.73%. It is worth noting the complexity of the management of COVID‐19 in two patients on prophylaxis with non‐factor replacement therapy. Adherence to the prescribed treatment was maintained by 95.5% of patients. Although 94% were independent for daily living activities, 42.4% had a recognized disability and 58% required assistance, provided by the Madrid Haemophilia Association (Ashemadrid) in 75% of cases. Only 4.4% of consultations were held in person. Conclusions: Patients with congenital bleeding disorders infected with SARS‐CoV‐2 presented a mild course of the disease that did not require admission. Their identification and treatment by a specialist team from a Haemophilia Treatment Center are essential to make a correct assessment of the risk of haemorrhage/thrombosis. COVID‐19 had a major impact on the psychosocial aspects of these patients which must be remedied with recovery plans. [ABSTRACT FROM AUTHOR]

Objective: The current multicentre randomized controlled trial assessed the clinical efficacy of a combined mHealth intervention for eating disorders (EDs) based on cognitive behavioral therapy (CBT). Method: A total of 106 ED patients from eight different public and private mental health services in Spain were randomly assigned to two parallel groups. Patients of the experimental group (N = 53) received standard face‐to‐face CBT plus a mobile intervention through an application called "TCApp," which provides self‐monitoring and an online chat with the therapist. The control group (N = 53) received standard face‐to‐face CBT only. Patients completed self‐report questionnaires on ED symptomatology, anxiety, depression, and quality of life, before and after treatment. Results: Significant reductions in primary and secondary outcomes were observed for participants of both groups, with no differences between groups. Results also suggested that the frequency with which patients attended their referral mental health institution after the intervention was lower for patients in the experimental group than for those in the control group. Discussion The current study showed that CBT can help to reduce symptoms relating to ED, regardless of whether its delivery includes online components in addition to traditional face‐to‐face treatment. Besides, the additional component offered by the TCApp does not appear to be promising from a purely therapeutic perspective but perhaps as a cost‐effective tool, reducing thus the costs and time burden associated with weekly visits to health professionals. [ABSTRACT FROM AUTHOR]

Background: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution.Objective: To share our experience in adapting our model of care to the new situation to ensure continuity of care.Methods: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed.Results: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began.Discussion: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients' health-related quality of life (HRQoL), and physicians' satisfaction in patients with type 1 diabetes.Research Design and Methods: PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians' satisfaction.Results: At month 6, the mean change in HbA1c levels was -0.04 ± 0.5% (-0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05).Conclusions: The use of telemedicine in patients with type 1 diabetes with HbA1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the key factors of adopting self‐care behaviours in the treatment of diabetes mellitus II, hypertension and hypercholesterolaemia when the three conditions appear simultaneously. Background: Diabetes, hypertension and hypercholesterolaemia are chronic health problems which often appear together. The correct monitoring of these pathologies when they concur simultaneously requires specific health management behaviours, to which a significant part of the population is unable of adhering, despite recommendations from professional healthcare workers. Design: A qualitative study using focus groups techniques was carried out. The elements related to the content were drafted following the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ checklist). Methods: Patients with simultaneous diabetes, hypertension and hypercholesterolaemia, as well as nursing professionals and family doctors who have treated patients at primary care centres, were the key sources of information. The methodology used to analyse the information was content analysis. Results: There were factors which can positively or negatively determine the adoption of the self‐management recommendations that healthcare professionals make to patients who simultaneously have diabetes, hypertension and hypercholesterolaemia. These factors were not only associated with the patient, but also with the health carers themselves and the healthcare system and policies in force. Conclusions: When health professionals provide recommendations for self‐care to people diagnosed with diabetes, hypertension and hypercholesterolaemia simultaneously, they should bear in mind not only the determinants of behaviour associated with the patient, but also those that are related to the health professionals themselves and with the healthcare system. The PRECEDE model could be a good tool to identify and design health education programs. Relevance to clinical practice: The knowledge of the determinants of health behaviour of patients with chronic diseases could improve adherence patients to health recommendations, avoid associated complications and increase their quality of life. [ABSTRACT FROM AUTHOR]

Home‐based tele‐rehabilitation programs are under development and may be a future option for some patients. The objectives of this non‐randomized clinical trial are to design a home‐based multidisciplinary tele‐rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home‐based usual outpatient rehabilitation protocol. Seventy patients treated for an acute hip fracture, aged 65 years or older, with a high pre‐fracture functional level (Functional Independence Measure score >90), without severe cognitive impairment, absence of terminal disease, discharged to their own home or a relativés home postoperatively, allowed weight‐bearing, and with signed informed consent, will be allocated into a tele‐rehabilitation group (n = 35) or a control group (n = 35). The inclusion criterion for the intervention group will be to have a caregiver with the ability to access the Internet who is willing to perform exercises and activities with the patient at home. The intervention includes a program of physical exercise and occupational therapy (five weekly sessions during 12 weeks), and recommendations for patients and their caregivers, all delivered through a website. The patient's functional level (Functional Independence Measure), quality of life (Euro‐Qol), physical performance (Timed Up and Go), caregiver burden (Zarit Interview), and other descriptive data will be assessed at hospital discharge, 4 weeks, and 12 weeks. This project will add to the knowledge concerning the feasibility of tele‐rehabilitation as an option to promote recovery of the pre‐fracture functional level for some patients with a hip fracture. ClinicalTrials.gov Identifier: NCT02968589NCT. [ABSTRACT FROM AUTHOR]

If Electronic Health Records contain a large amount of information about the patient’s condition and response to treatment, which can potentially revolutionize the clinical practice, such information is seldom considered due to the complexity of its extraction and analysis. We here report on a first integration of an NLP framework for the analysis of clinical records of lung cancer patients making use of a telephone assistance service of a major Spanish hospital. We specifically show how some relevant data, about patient demographics and health condition, can be extracted; and how some relevant analyses can be performed, aimed at improving the usefulness of the service. We thus demonstrate that the use of EHR texts, and their integration inside a data analysis framework, is technically feasible and worth of further study. [ABSTRACT FROM AUTHOR]

Objective: An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment. Method: A two-arm digital intervention with 269 men and 395 women (Mage = 41.2, SDage = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform. Results: Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes. Conclusion: FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan. [ABSTRACT FROM AUTHOR]

We present the results of the use of a cognitive behavioral therapeutic intervention tool to improve the mental, physical, and social health of a group of long-term unemployed women in Spain. Method: We sent automated text messages (SMS) to the mobile phones of long-term unemployed women selected at random from public social services. During a 28-day intervention period, women received four daily automated text messages on her mobile phone on a predetermined hourly schedule. We measured depression symptoms at the start and end of the intervention and we analyzed qualitative data to determine the acceptability of a remote SMS program. Results: Depression symptoms using the Personal Health Questionnaire-9 (PHQ-9), went from an average of 13.8 at baseline to 4.9 at the end of 28 days (p = 0.89). One hundred percent of the women reported that they liked receiving the text messages and most found them helpful. [ABSTRACT FROM PUBLISHER]

Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects' mean age was 83.3 ( SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 ( SD 1.1), and the mean number of prescribed medications per day was 5.6 ( SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years. [ABSTRACT FROM AUTHOR]

Background: Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk.Methods: A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life.Results: No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme.Conclusions: The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life.Trial Registration: Retrospectively registered NCT02796404 (May 23, 2016). [ABSTRACT FROM AUTHOR]

Introduction: Help4Mood is an interactive system with an embodied virtual agent (avatar) to assist in self-monitoring of patients receiving treatment for depression. Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy. We aimed to evaluate system use and acceptability, to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future randomised controlled trial (RCT).Methods: We conducted a pilot RCT of Help4Mood in three centres, in Romania, Spain and Scotland, UK. Patients with diagnosed depression (major depressive disorder) and current mild/moderate depressive symptoms were randomised to use the system for four weeks in addition to treatment as usual (TAU) or to TAU alone.Results: Twenty-seven individuals were randomised and follow-up data were obtained from 21 participants (12/13 Help4Mood, 9/14 TAU). Half of participants randomised to Help4Mood used it regularly (more than 10 times); none used it every day. Acceptability varied between users. Some valued the emotional responsiveness of the system, while others found it too repetitive. Intention to treat analysis showed a small difference in change of Beck Depression Inventory II (BDI-2) scores (Help4Mood -5.7 points, TAU -4.2). Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of -8 points.Conclusion: Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels. [ABSTRACT FROM AUTHOR]

This article presents the technological solution of a tele-assistance process for stroke patients in acute phase in the Seville metropolitan area. The main objective of this process is to reduce time from symptom onset to treatment of acute phase stroke patients by means of telemedicine, regarding mobility between an intensive care unit ambulance and an expert center and activating the pre-hospital care phase. The technological platform covering the process has been defined following an interoperability model based on standards and with a focus on service-oriented architecture focus. Messaging definition has been designed according to the reference model of the CEN/ISO 13606, messages content follows the structure of archetypes. An XDS-b (Cross-Enterprise Document Sharing-b) transaction messaging has been designed according to Integrating the Healthcare Enterprise profile for archetype notifications and update enquiries.This research has been performed by a multidisciplinary group. The Virgen del Rocío University Hospital acts as Reference Hospital and the Public Company for Healthcare as mobility surroundings. [ABSTRACT FROM AUTHOR]

BackgroundThis study proposes a system for teaching and surgical support with the benefits of online Information and Communications Technology (ITC) -based telementoring for laparoscopic bariatric surgery (LBS).Material and methodsA system of telementoring was established between a university center and two community hospitals. Telementoring was performed via internet protocol using a direct point-to-point connection, ASDL 1.2 Mbps, time delay 150 ms, 256-bit advanced encryption standard (AES). In the period of time selected, all interventions for LBS in both hospitals were included. When patients agree with telementoring, data outcomes (operating time, hospital stay, conversion to open surgery and complications) were collected. The rest of these interventions were recorded.ResultsThirty-six patients underwent elective LBS, 20 of whom were referred and accepted for telementoring. Patients selected without telementoring took longer: 200 (46) min vs 139 (33) min,p < 0.01. There were two conversions in non-mentored groups. The hospital stay was 4.6 (0.5) days for telementored interventions and 6.7 (0.5) days without mentoring (p < 0.01). Four patients (12,5%) in non-mentored groups suffered minor complications.ConclusionsThis program supports the safety and feasibility of telementoring in LBS. Telementoring is an alternative in community hospitals because it can improve the quality of advanced procedures of laparoscopic surgery. [ABSTRACT FROM PUBLISHER]

Existing studies on the online asynchronous consultation mode afforded by 'Ask-the-Expert' health websites (e.g. Thomson et al. 2012) are concerned with the possible loss in the quality of interaction between patients and clinicians in this type of consultation. The potential loss is worrying, given the central role of patient-centred communication (PCC), particularly empathy, in medical consultation practice and patients' increasing use of and reliance on online consultations. This study addresses the following three related questions: (1) To what extent is PCC represented in 'Ask-the-Expert' healthcare websites? (2) Are there noticeable differences in PCC between sites operating in different linguistic and cultural settings (the UK, Spain and Italy)? (3) What are the implications of the above? Seventy exchanges from the leading independent health websites NetDoctor (UK), Netdoctor (Spain) and Medicitalia (Italy) were analysed, adapting a framework developed for the linguistic analysis of clinical empathy (combining discourse analytical and pragmatic categories - Pounds 2011) and drawing on existing definitions of PCC and classifications of advice-giving structures. The analysis shows that PCC is used on these sites to varying degrees, conforming to the site's affordances. The significance of the findings and potential further applications of the analytical framework are discussed in the final part. [ABSTRACT FROM AUTHOR]

Measures taken to reduce the rate of contagion during the first months of the COVID-19 pandemic in Spain led to the interruption of nursing interventions for many patients with serious mental illness (SMI), while others stayed in touch with their nurses telematically. However, published research into the impact of mental telehealth and the outcome of the changes that took place in the pandemic is very limited. Aim: The aim of this study was to analyze the changes in nursing interventions received by severe mental illness (SMI) patients and to test whether telemental health (TH) has been effective in reducing relapses during the COVID-19 pandemic. Materials and methods: Information was gathered retrospectively from about 270 patients under treatment at 15 mental health day hospitals (MHDHs) in Spain during the year 2020. Results: Face-to-face nursing interventions were found to have decreased and TH interventions were found to have increased in the first few months of the pandemic. In the following months, TH interventions—especially those conducted by video call—helped reduce the number of relapses. Conclusions: TH helps provide news forms of effective telematic nursing interventions that reduce the number of relapses and admissions in patients with serious mental health disorders. [ABSTRACT FROM AUTHOR]

Learning and using new technologies by the older people is seen as a demand for their integration in society and as a factor related to active aging. The goal of this article is to understand the attitudes of the elderly towards information and communication technologies in the context of a training course about the utilization of a digital platform. It is the result of an empirical study with a sample of 240 older people registered in the course Tele-Services for the Elderly, that took place in the Centers for the Elderly in the province of Cuenca, Spain. Through a self-administered questionnaire, aspects related to social activity, knowledge and use of the computer and Internet, expectations on learning and use of computer technology, personal competence, and self-concept were evaluated. The results obtained showed relationships between implication in the activities, experience with computers, and belief in the usefulness of learning new technologies. The participants' involvement in the activities was related to greater contact with information and communication technologies (ICT), which, in turn, generated more positive attitudes toward its learning and utility as well as more self-confidence. The elderly said that they enrolled in different activities to learn and to keep their minds active, and they thought of training as a means of social participation and lifelong learning. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment and mild dementia progressively compromise the ability of people to live independently and can have a negative impact on their quality of life. Within the current European Active and Assisted Living programme (AAL), project TV-AssistDem has been developed to deliver a TV-based platform service to support patients with mild cognitive impairment or mild dementia and provide relief to their caregivers. The application is intended to be used daily at home, mainly by the participants themselves, with the help of their informal caregivers. The aim of this study is to evaluate the effectiveness of TV-AssistDem to improve quality of life in people with mild cognitive impairment or mild dementia.Methods: This is a 12-month European multicentre randomized controlled trial which will be performed in two countries: Spain and Romania. Two hundred and forty older adults will be recruited using identical inclusion/exclusion criteria. The primary outcome will be the change from baseline of TV-AssistDem on patient quality of life at 12 months. The secondary outcomes will be the changes from baseline of: 1) informal caregiver quality of life, 2) informal caregiver burden, 3) patient treatment adherence, 4) patient treatment compliance, 5) patient functional status, and 6) healthcare cost-effectiveness at 12 months. Patients in the intervention group will have access to an interactive platform which offers remote assistive services through a device connected to the television. The core services of the platform are: 1) Calendar and reminders, 2) Health monitoring and data transmission to a health server and 3) Videoconference; service-oriented applications are: 4) Cognitive stimulation; 5) Reminiscences; and 6) Patient and caregiver healthcare education. The analysis will be made following an intention-to-treat procedure. Linear and Generalized Mixed Model analysis will be performed.Discussion: We hypothesize that the regular use of TV-AssistDem will result in an improvement in patient quality of life. The uniqueness of this home TV-based intervention lies on its widespread accessibility and its integrative approach to quality of life in people with mild cognitive impairment or mild dementia and their informal caregivers. However, several anticipated challenges will need to be faced: poor engagement and connectivity problems.Trial Registration: ClinicalTrials.gov Identifier NCT03653234 , Date of registration: 31 August 2018. [ABSTRACT FROM AUTHOR]