A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.

Hospital admission and vaccination as predictive factors of long COVID-19 symptoms.

Background: Since the beginning of the COVID-19 pandemic, a great variability of symptoms that affect all organs and systems of the body has been identified in patients with SARS-CoV-2 infection; this symptomatology can sometimes persist over time, giving rise to the so-called long COVID or post-COVID. The aim of this study is to delve into the clinical characterization of these patients, as well as to take into account the influence of factors such as hospitalization, admission to ICU, history of pneumonia, or vaccination status on the persistence of symptoms. Material and methods: An observational, descriptive, multicenter, and retrospective study was designed with a series of cases of people who presented long COVID, which includes univariate, bivariate, and multivariate analyses. Data were obtained from an online ad hoc questionnaire, and statistical analysis was performed using SPSS Software Version 25 (IBM-Inc., Chicago, IL, USA). Results: Hospitalization, ICU admission, history of pneumonia, and vaccination were predictive factors (positive or negative) for the following long-COVID symptoms: headache, menstrual disorders, joint pain, cough, chills, nasal congestion, back pain, abdominal pain, weight loss, eye discomfort, facial erythema, itching, tremors, dizziness, seizures, sleeping difficulty, dry eyes, palpitations, fatigue, paresthesia, dyspnea, aphonia, chest pain, high blood pressure, vomiting, memory loss, brain fog, hypothermia, low blood pressure, sputum or phlegm, lack of concentration, hair loss, and erectile dysfunction. Conclusion: This study provides evidence on the clinical characterization of patients suffering from long COVID in order to offer them the most appropriate treatments.

Long COVID Symptomatology and Associated Factors in Primary Care Patients: The EPICOVID-AP21 Study.

Persistent COVID-19 condition includes a wide variety of symptoms and health problems of indeterminate duration. The present study examined the sociodemographic and clinical characteristics of the population with Long COVID seen in Primary Care using a questionnaire based on the existing scientific literature. It was an observational and descriptive study of the characteristics of the Spanish population with Long COVID over 14 years of age. The responses were analysed by means of a descriptive analysis of the variables recorded, in addition to a bivariate analysis to determine the existence of a relationship between persistent COVID-19 and variables such as gender, age, vaccination status or concomitant pathology. The results obtained clearly describe the sociodemographic characteristics of the population, highlighting the predominance of female gender and the prevalence of tiredness and fatigue. Furthermore, relevant information was obtained on the differences in symptomatology according to gender, age, previous pathologies and alterations derived from infection and/or vaccination. These data are important for better detection, diagnosis and treatment of Long COVID and the improvement of the quality of life of this population.

Hospital admission and vaccination as predictive factors of long COVID-19 symptoms

Background Since the beginning of the COVID-19 pandemic, a great variability of symptoms that affect all organs and systems of the body has been identified in patients with SARS-CoV-2 infection;this symptomatology can sometimes persist over time, giving rise to the so-called long COVID or post-COVID. The aim of this study is to delve into the clinical characterization of these patients, as well as to take into account the influence of factors such as hospitalization, admission to ICU, history of pneumonia, or vaccination status on the persistence of symptoms. Material and methods An observational, descriptive, multicenter, and retrospective study was designed with a series of cases of people who presented long COVID, which includes univariate, bivariate, and multivariate analyses. Data were obtained from an online ad hoc questionnaire, and statistical analysis was performed using SPSS Software Version 25 (IBM-Inc., Chicago, IL, USA). Results Hospitalization, ICU admission, history of pneumonia, and vaccination were predictive factors (positive or negative) for the following long-COVID symptoms: headache, menstrual disorders, joint pain, cough, chills, nasal congestion, back pain, abdominal pain, weight loss, eye discomfort, facial erythema, itching, tremors, dizziness, seizures, sleeping difficulty, dry eyes, palpitations, fatigue, paresthesia, dyspnea, aphonia, chest pain, high blood pressure, vomiting, memory loss, brain fog, hypothermia, low blood pressure, sputum or phlegm, lack of concentration, hair loss, and erectile dysfunction. Conclusion This study provides evidence on the clinical characterization of patients suffering from long COVID in order to offer them the most appropriate treatments.

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial.

BACKGROUND: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb's functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. METHODS: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. RESULTS: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η2 ≤ 0.080). In the rest of the variables, no significant differences were found. CONCLUSIONS: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial.

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η2 = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η2 = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η2 = 0.071-F (2.79) = 2.874; p = 0.049; η2 = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial.

BACKGROUND: Approximately 40-70% of people with Parkinson's disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. OBJECTIVE: To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. METHODS: Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. RESULTS: This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. CONCLUSION: In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694443.

Clinical Presentation of the SARS-CoV-2 Virus Infection and Predictive Validity of the PCR Test in Primary Health Care Worker Patients of the Spanish National Health System.

BACKGROUND: Despite the impact that the SARS-CoV-2 virus infection has presented in Spain, data on the diagnostic capacity of the symptoms associated with this infection are limited, especially among patients with mild symptoms and who are detected in the primary care field (PC). The objective of the present study was to know the associated symptoms and their predictive criterial validity in SARS-CoV-2 infection among professionals working in PC. METHODS: A cross-sectional, multicenter study was carried out in the Spanish National Health System, through an epidemiological survey directed to patients who underwent the PCR test for SARS-CoV-2 in the PC setting. RESULTS: A total of 1612 patients participated, of which 86.6% were PC healthcare professionals, and of these, 67.4% family doctors. Hyposmia, with a sensitivity of 42.69% (95% CI: 37.30-48.08) and a specificity of 95.91% (95% CI: 94.78-97.03), and ageusia with a sensitivity of 39.47% (34.15-44.80) and a specificity of 95.20% (93.98-96.41) were the symptoms with the highest criteria validity indexes. CONCLUSIONS: This study identifies the specific symptoms of loss of smell or taste as the most frequently associated with SARS-CoV-2 infection, essential in the detection of COVID-19 given its high frequency and predictive capacity.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain.

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Psychological Effects of Home Confinement and Social Distancing Derived from COVID-19 in the General Population-A Systematic Review.

(1) Background: Home confinement and social distancing are two of the main public health measures to curb the spread of SARS-Cov-2, which can have harmful consequences on people's mental health. This systematic review aims to identify the best available scientific evidence on the impact that home confinement and social distancing, derived from the SARS-CoV-2 pandemic, have had on the mental health of the general population in terms of depression, stress and anxiety. (2) Methods: A systematic search was conducted on PubMed, Scopus, Web of Science and ScienceDirect between 2 January 2021 and 7 January 2021, in accordance with the recommendations of the PRISMA Declaration. The selection of studies and the evaluation of their methodological quality were performed in pairs, independently and blindly, based on predetermined eligibility criteria. (3) Results: The 26 investigations reviewed were developed in different regions and countries. Factors that are associated with poor mental health were female gender, young ages, having no income and suffering from a previous psychiatric illness. Inadequate management of the pandemic by authorities and a lack or excess of information also contributed to worse mental health. (4) Conclusions: There are groups of people more likely to suffer higher levels of anxiety, depression and stress during the restrictive measures derived from COVID-19.

Exploring the Occupational Balance of Young Adults during Social Distancing Measures in the COVID-19 Pandemic.

(1) Background: A balanced life is related to good health in young people, one of the groups most affected by confinement and social distancing measures during the COVID-19 pandemic. This study aims to explore the occupational balance of young adults during home confinement and its association with different sociodemographic factors. (2) Methods: A cross-sectional study was designed, and an online survey was disseminated to collect sociodemographic and occupational balance data, using the Occupational Balance Questionnaire (OBQ). The statistical analysis was performed using the SPSS statistical software package version 24.0. (3) Results: 965 young adults between 18 and 30 years old participated in the study. A predictive model showed that the main predictors of a lower occupational balance were a negative self-perception (ß= 0.377; p = <0.0001), student status (ß = 0.521; p = 0.001), not receiving enough information (ß = 0.951; p = 0.001) and long periods of quarantine (ß = 0.036; p = 0.007). (4) Conclusions: Considering people's occupational health and related factors could lessen many of the psychosocial consequences of isolation and contribute to the well-being of young people.

Life Satisfaction during Forced Social Distancing and Home Confinement Derived from the COVID-19 Pandemic in Spain.

Life satisfaction is one of the main dimensions of well-being related to psychological factors, being essential for a person to adjust to difficult circumstances. The restrictive measures adopted to minimize the diffusion of the coronavirus disease (COVID-19) could alter the subjective dimension of well-being, so the objective of this study was to determine the factors related to life satisfaction of the Spanish population during forced home confinement derived from the COVID-19 pandemic. A cross-sectional study was designed, based on an online survey, and disseminated through the main social networks, which included the Satisfaction with Life Scale (SWLS) and sociodemographic and COVID-19-related variables. The possible relationships between the different variables were studied using univariate and multivariable regression analyses. A total of 3261 subjects participated in the study. Factors associated with greater personal life satisfaction were fewer days of home confinement (ß = (-0.088); p ≤ 0.001), the perception of having received enough information (ß = 0.076; p ≤ 0.001), having private access to the outside (ß = 0.066; p ≤ 0.001), being employed (ß = 0.063; p ≤ 0.001), being male (ß = 0.057; p = 0.001) and not having been isolated (ß = 0.043; p = 0.013). The results of this study provide novel information about the profiles of people related to greater well-being and life satisfaction during forced social distancing and home confinement, but more studies are needed to help to understand and complement these findings.

Relationship of Forced Social Distancing and Home Confinement Derived from the COVID-19 Pandemic with the Occupational Balance of the Spanish Population.

Abrupt interruption in the performance of everyday occupations as a consequence of forced social distancing and home confinement, coupled with a lack of regulatory capacities and skills, can trigger harmful effects on people's health and well-being. This study aimed to determine the factors related to the occupational balance in the Spanish population during home confinement as a consequence of the coronavirus disease 19 (COVID-19) pandemic. A total of 3261 subjects completed an online survey, which was disseminated through the mainstream social media platforms in Spain and included the Occupational Balance Questionnaire (OBQ), sociodemographic variables, and factors related to COVID-19 infection. The mean age of the participants (81.69% women) was 40.53 years (SD ± 14.05). Sociodemographic variables were related to a greater occupational balance, and the multivariate analysis showed that age (ß = 0.071; p = 0.001), the perception of having received enough information (ß = 0.071; p ≤ 0.001), not telecommuting (ß = -0.047; p = 0.022), and not being infected by COVID-19 (ß = 0.055; p = 0.007) contributed to a better occupational balance. There were profiles of people less likely to suffer disturbances in occupational balance during home confinement, but more studies are needed to help understand and analyze the effects of the COVID-19 pandemic on people's occupational and mental health.