Skills in DC electrical circuits by doctors in training

This study describes the understanding of concepts and problem-solving skills associated with direct current electrical circuits of doctors in training at a private university in Bogotá (Colombia) in times of the COVID-19 pandemic. The study of direct current electrical circuits is conducted through a didactic sequence supported by active learning and internet resources. In the research, the Inventory of Basic Conceptions - DC Circuits (IBCDC) instrument is used. The implementation of the study was carried out in four phases: a Pre-test, a pedagogical strategy in which the theoretical approach is carried out while the real application of this thematic nucleus in the human body is mentioned, the integration of a simulation as a technological tool that allows giving continuity to the practical and theoretical character of physics and a post-test. The results invite researchers to conduct an implementation exercise in the face-to-face modality, to generate a comparative study.

[Situation and activity of the liaison geriatrics units with nursing homes in the Community of Madrid]. / Situación y actividad de las unidades de geriatría de enlace con residencias de mayores en la Comunidad de Madrid.

INTRODUCTION: In June 2020, after the first wave of the COVID-19 pandemic, Hospital-Based Liaison Geriatrics units and Primary Care nursing care units were created in the Community of Madrid to improve health care for residents in a coordinated manner. OBJECTIVE: To analyze the situation and the activity of the Hospital-Based Liaison Geriatrics units. MATERIAL AND METHODS: A cross-sectional study was conducted using an electronic survey prepared and sent to the liaison geriatricians in March 2022, including the following sections: available resources, areas of health care, reasons for consultation, care interventions, research and teaching activity, profiles of residents attended and coordination with other health professionals at that time. A descriptive analysis of the data was performed. RESULTS: 100% of the existing Liaison Geriatrics units responded, describing essential differences in human resources, hours of care and volume of patients attended. Regarding the care activity of these units, they highlighted the telematic consultation, and the face-to-face assessment during hospitalization and in the emergency department. The main reasons for assessment were decision-making, acute pathology and geriatric syndromes; and the in-hospital drug management or orthoprosthetic aids among the interventions. CONCLUSIONS: Despite the heterogeneity in the resources of the different Liaison Geriatric units, there is a similarity in their care activity and the use of telemedicine. It is common to request an assessment for decision-making, acute pathology or geriatric syndromes and interventions for managing in-hospital drugs and tests, orthoprosthetic aids and coordination with other specialists. Liaison Geriatrics units must continue leading quality health care coordinated with nursing homes, as well as continuity of care for residents.

Situación y actividad de las unidades de geriatría de enlace con residencias de mayores en la Comunidad de Madrid Situation and activity of the liaison geriatrics units with nursing homes in the Community of Madrid

Introducción En junio de 2020, tras la primera ola de la pandemia de COVID-19, se crearon unidades de geriatría de enlace hospitalaria y unidades de atención a residencia de atención primaria en la Comunidad de Madrid, para mejorar la atención sanitaria a los residentes de forma coordinada. Objetivo Analizar la situación y la actividad realizada por las unidades de geriatría de enlace hospitalaria. Material y métodos Estudio transversal realizado mediante una encuesta electrónica que se envió a los geriatras de enlace en marzo de 2022, incluyendo los siguientes apartados: recursos disponibles, áreas de atención sanitaria, motivos de consulta, intervenciones asistenciales, actividad investigadora y/o docente, perfiles de residentes atendidos y coordinación con otros profesionales hospitalarios en dicho momento. Se realizó un análisis descriptivo de los datos. Resultados Respondieron 100% de las unidades de geriatría de enlace existentes, describiendo importantes diferencias en cuanto a los recursos humanos, el horario de atención y el volumen de pacientes atendidos. Respecto a la actividad asistencial de estas unidades, destacaron la consulta telemática, la valoración presencial durante la hospitalización y en el servicio de urgencias. Los principales motivos de valoración fueron la toma de decisiones, patología aguda y síndromes geriátricos y, entre las intervenciones, la gestión de fármacos de uso hospitalario y de material ortoprotésico. Conclusiones A pesar de la heterogeneidad en los recursos de las distintas unidades de geriatría de enlace, existe similitud en su actividad asistencial y en el uso de la telemedicina. Es común la solicitud de valoración para la toma de decisiones, de patología aguda o síndromes geriátricos e intervenciones para la gestión de fármacos y pruebas hospitalarias, material ortoprotésico y la coordinación con otros especialistas. Las unidades de geriatría de enlace deben seguir liderando la atención sanitaria de calidad y coordinada con las residencias, así como la continuidad asistencial de los residentes.

Wastewater-Based Epidemiology Mitigates COVID-19 Outbreaks at a Food Processing Facility near the Mexico-U.S. Border-November 2020-March 2022.

Background: Wastewater-based epidemiology (WBE) has the potential to inform activities to contain infectious disease outbreaks in both the public and private sectors. Although WBE for SARS-CoV-2 has shown promise over short time intervals, no other groups have evaluated how a public-private partnership could influence disease spread through public health action over time. The aim of this study was to characterize and assess the application of WBE to inform public health response and contain COVID-19 infections in a food processing facility. Methods: Over the period November 2020-March 2022, wastewater in an Arizona food processing facility was monitored for the presence of SARS-CoV-2 using Real-Time Quantitative PCR. Upon positive detection, partners discussed public health intervention strategies, including infection control reinforcement, antigen testing, and vaccination. Results: SARS-CoV-2 RNA was detected on 18 of 205 days in which wastewater was sampled and analyzed (8.8%): seven during Wild-type predominance and 11 during Omicron-variant predominance. All detections triggered the reinforcement of infection control guidelines. In five of the 18 events, active antigen testing identified asymptomatic workers. Conclusions: These steps heightened awareness to refine infection control protocols and averted possible transmission events during periods where detection occurred. This public-private partnership has potentially decreased human illness and economic loss during the COVID-19 pandemic.

Population level SARS-CoV-2 fecal shedding rates determined via wastewater-based epidemiology.

Wastewater-based epidemiology (WBE) has been utilized as an early warning tool to anticipate disease outbreaks, especially during the COVID-19 pandemic. However, COVID-19 disease models built from wastewater-collected data have been limited by the complexities involved in estimating SARS-CoV-2 fecal shedding rates. In this study, wastewater from six municipalities in Arizona and Florida with distinct demographics were monitored for SARS-CoV-2 RNA between September 2020 and December 2021. Virus concentrations with corresponding clinical case counts were utilized to estimate community-wide fecal shedding rates that encompassed all infected individuals. Analyses suggest that average SARS-CoV-2 RNA fecal shedding rates typically occurred within a consistent range (7.53-9.29 log10 gc/g-feces); and yet, were unique to each community and influenced by population demographics. Age, ethnicity, and socio-economic factors may have influenced shedding rates. Interestingly, populations with median age between 30 and 39 had the greatest fecal shedding rates. Additionally, rates remained relatively constant throughout the pandemic provided conditions related to vaccination and variants were unchanged. Rates significantly increased in some communities when the Delta variant became predominant. Findings in this study suggest that community-specific shedding rates may be appropriate in model development relating wastewater virus concentrations to clinical case counts.

The Impact of COVID-19 Outbreak on Camping Tourism in Spain: A Spatial Approach to Tourist Destinations.

The COVID-19 health crisis has wreaked devastation on the world economy, especially on the tourism sector. The camping sector has been little studied despite its high economic impact and participation rate. Moreover, the observable effects of phenomena such as the COVID-19 pandemic have received little research attention. Consequently, the objective of this paper is therefore to analyse the effects of the pandemic on camping tourism by characterising the factors that determine it. The study is carried out by providing a geographical perspective of the sector by tourist areas, whereby two types of tourist destinations are considered: campsites located in coastal areas, and campsites located in natural areas. This is the main contribution of the work, as the proposed geographical analysis studies smaller territorial units than those usually used in tourism research. For the study, Multivariate Analysis techniques are applied, specifically Factor Analysis and Cluster Analysis. The results show that there is a balance between supply and demand in the sector, with a significant economic impact, especially on employment and the performance of the sector. The impact of the COVID-19 pandemic has led to nature tourism gaining greater popularity, and shows an evolution in travellers' preferences for tourist destinations in favour of campsites located in natural areas over those located in coastal destinations. The geographical location of the tourist destination, therefore, plays a key role in the characterisation of Spanish campsites. This has practical implications for both camping companies and institutions, as the fact that some areas are more attractive than others is a decisive factor in deciding on the location of new campsites.

Obsessive-compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic.

BACKGROUND: Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive-compulsive disorder (OCD). This study aims to investigate whether the pandemic is associated with increased referral of young people with OCD, any changes in their symptom severity and treatment offered. METHODS: Service data were used to investigate 58 young people (8-17 years) referred and assessed in the Central and Northwest London NHS Foundation Trust Child and Adolescent Mental Health Service (CAMHS), before and during the COVID-19 pandemic (months March-October 2018-2020). Changes in symptom severity were measured using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). Patient records were reviewed to assess if COVID-19 had exacerbated symptoms. Type of treatment offered was compared. RESULTS: 26 (5.62%) assessments to CAMHS related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < 0.001). There was no significant difference in any HoNOSCA dimensions on initial assessment. However, 69.2% of patients in 2020 showed symptom worsening over the COVID-period, versus 46.7% of cases first assessed pre-pandemic. Significantly more patients were discharged without being offered treatment pre-pandemic (X2 (2, N = 58) = 12.7, p = 0.002). In 2020, there was an 8.5% increase in the frequency of medication offered. DISCUSSION: The proportion of OCD cases in CAMHS increased in 2020 despite the overall number of CAMHS referrals falling. Furthermore, many cases reportedly worsened during the pandemic, and services will need to address the increased burden of more severe cases. Further larger investigation of this subject is warranted.

SARS-CoV-2 pharmaceutical drugs: a critical review on the environmental impacts, chemical characteristics, and behavior of advanced oxidation processes in water.

This review summarizes research data on the pharmaceutical drugs used to treat the novel SARS-CoV-2 virus, their characteristics, environmental impacts, and the advanced oxidation processes (AOP) applied to remove them. A literature survey was conducted using the electronic databases Science Direct, Scopus, Taylor & Francis, Google Scholar, PubMed, and Springer. This complete research includes and discusses relevant studies that involve the introduction, pharmaceutical drugs used in the SARS-CoV-2 pandemic: chemical characteristics and environmental impact, advanced oxidation process (AOP), future trends and discussion, and conclusions. The results show a full approach in the versatility of AOPs as a promising solution to minimize the environmental impact associated with these compounds by the fact that they offer different ways for hydroxyl radical production. Moreover, this article focuses on introducing the fundamentals of each AOP, the main parameters involved, and the concomitance with other sources and modifications over the years. Photocatalysis, sonochemical technologies, electro-oxidation, photolysis, Fenton reaction, ozone, and sulfate radical AOP have been used to mineralize SARS-CoV-2 pharmaceutical compounds, and the efficiencies are greater than 65%. According to the results, photocatalysis is the main technology currently applied to remove these pharmaceuticals. This process has garnered attention because solar energy can be directly utilized; however, low photocatalytic efficiencies and high costs in large-scale practical applications limit its use. Furthermore, pharmaceuticals in the environment are diverse and complex. Finally, the review also provides ideas for further research needs and major concerns.

El Rezago Educativo Y El Abandono Escolar: Las Experiencias De Docentes

Con el propósito de abordar la temática del rezago educativo y el abandono escolar, se presenta una investigación ubicada en el paradigma interpretativo, con enfoque cualitativo y metodología fenomenológica, cuyo objetivo es analizar las experiencias que tiene el profesorado ante esta problemática, y los factores que inciden en ella. Como técnica se empleó la entrevista a profundidad a cinco docentes que ejercen su profesión en diferentes niveles educativos en estado de Chihuahua, México. De lo expresado por ellos, se destaca el hecho de que todos han vivido esta problemática, y consideran que esta se ha agravado debido a las secuelas provocadas por la Covid-19. Identifican factores que inciden en este fenómeno acorde a la literatura revisada y plantean estrategias centradas en la atención individualizada del estudiantado, tales como las tutorías, gestión de apoyos económicos y capacitaciones para las problemáticas más frecuentes en la comunidad.Alternate : With the purpose of exploring the topic of educational lag and school dropout, a research positioned in the Interpretative framework is presented;it uses the qualitative approach and phenomenological method, with the objective of analyzing the experiences that teachers have regarding this issue, as well as identifying the factors that they consider come into play. The technique used was the in-depth interview, with five teachers, workers in the state of Chihuahua, Mexico. The fact of all teachers have experienced the problem of educational lag and school dropout is highlighted, and also their considerations about this phenomenon, which is worse because of Covid-19 consequences. They identify factors that come into play in this phenomenon according to the literature review and pose strategies centered on individualized attention for students, such as tutoring, obtain economic support for them and training for the most frequent problems in their communities.

Nucleocapsid as a next-generation COVID-19 vaccine candidate.

Multiple new variants of the SARS-CoV-2 virus have emerged globally, due to viral mutation. The majority of COVID-19 vaccines contain SARS-CoV-2 spike protein, which is susceptible to mutation. It is known that protection against COVID-19 after two doses of mRNA vaccine continuously wanes over time. If viral variants contain mutated spike protein, current vaccines may not provide robust protection. This perspective suggests the inclusion of SARS-CoV-2 nucleocapsid protein in future COVID-19 vaccines and boosters, as nucleocapsid is much less vulnerable to mutation and may provide stronger immunity to novel viral variants.

High Incidence Rate of SARS-CoV-2 Infection in Health Care Workers at a Dedicated COVID-19 Hospital: Experiences of the Pandemic from a Large Mexican Hospital.

Health care workers (HCW) are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The incidence of SARS-CoV-2 infection in HCW has been examined in cross-sectional studies by quantitative polymerase chain reaction (qPCR) tests, which may lead to underestimating exact incidence rates. We thus investigated the incidence of SARS-CoV-2 infection in a group of HCW at a dedicated coronavirus disease 2019 (COVID-19) hospital in a six-month follow-up period. We conducted a prospective cohort study on 109 participants of both sexes working in areas of high, moderate, and low SARS-CoV-2 exposure. qPCR tests in nasopharyngeal swabs and anti-SARS-CoV-2 IgG serum antibodies were assessed at the beginning and six months later. Demographic, clinical, and laboratory parameters were analyzed according to IgG seropositivity by paired Student's T-test or the chi-square test. The incidence rate of SARS-CoV-2 infection was considerably high in our cohort of HCW (58%), among whom 67% were asymptomatic carriers. No baseline risk factors contributed to the infection rate, including the workplace. It is still necessary to increase hospital safety procedures to prevent virus transmissibility from HCW to relatives and non-COVID-19 patients during the upcoming waves of contagion.

The Impacts of COVID-19 on Technological and Polytechnic University Teachers

University teachers have adapted to different situations during the development of distance learning due to the pandemic caused by the COVID-19 virus. This study was conducted by assigning a data collection instrument to 993 teachers who are part of 15 technological universities (TUs) and 7 polytechnic universities (PUs) to determine how they were affected by COVID-19. The questions asked were related to the social, economic, academic, emotional, and health effects experienced. The results show that 63% of the teachers working online complained that online teaching invaded their family privacy;56% pointed out that working from home and the virtual classes affected their performance as teachers;90% of the teachers thought that they dedicated too much extra to preparing for their classes;15% were stressed;4% felt negative under the new teaching scheme of virtual classes;finally, 38% of the teachers stated that repeated interaction with electronic devices had a lot of negative impacts on their emotional wellbeing. By means of a G-test, it was determined that gender was independent from the studied effects. Through a multiple correspondence analysis (MCA), it was determined that, of the total number of teachers who responded to the questionnaire, half were comfortable with the online teaching model and the other half were not. The most impacted effects were the economic, training and connectivity independently from the gender.

Forecasting of a complex phenomenon using stochastic data-based techniques under non-conventional schemes: The SARS-CoV-2 virus spread case.

Epidemics are complex dynamical processes that are difficult to model. As revealed by the SARS-CoV-2 pandemic, the social behavior and policy decisions contribute to the rapidly changing behavior of the virus' spread during outbreaks and recessions. In practice, reliable forecasting estimations are needed, especially during early contagion stages when knowledge and data are insipient. When stochastic models are used to address the problem, it is necessary to consider new modeling strategies. Such strategies should aim to predict the different contagious phases and fast changes between recessions and outbreaks. At the same time, it is desirable to take advantage of existing modeling frameworks, knowledge and tools. In that line, we take Autoregressive models with exogenous variables (ARX) and Vector autoregressive (VAR) techniques as a basis. We then consider analogies with epidemic's differential equations to define the structure of the models. To predict recessions and outbreaks, the possibility of updating the model's parameters and stochastic structures is considered, providing non-stationarity properties and flexibility for accommodating the incoming data to the models. The Generalized-Random-Walk (GRW) and the State-Dependent-Parameter (SDP) techniques shape the parameters' variability. The stochastic structures are identified following the Akaike (AIC) criterion. The models use the daily rates of infected, death, and healed individuals, which are the most common and accurate data retrieved in the early stages. Additionally, different experiments aim to explore the individual and complementary role of these variables. The results show that although both the ARX-based and VAR-based techniques have good statistical accuracy for seven-day ahead predictions, some ARX models can anticipate outbreaks and recessions. We argue that short-time predictions for complex problems could be attained through stochastic models that mimic the fundamentals of dynamic equations, updating their parameters and structures according to incoming data.

The Influence of the COVID-19 Pandemic on the Clinical Application of Evidence-Based Practice in Health Science Professionals

(1) Background: Evidence-based practice (EBP) informs daily clinical interventions with the purpose of seeking changes to traditional practice through scientific evidence that justifies the reasons for our actions. The objectives were to describe the barriers, beliefs, and attitudes in the application of EBP among university health professionals (not doctors) and to evaluate the influence of the COVID-19 pandemic among them. (2) Methods: This prospective study is both descriptive and observational. The individuals under study were university health professionals (not doctors) from various autonomous regions within Spain, in both public and private spheres. Sociodemographic and labor-related variables linked to the research and its completion were studied. Likewise, the survey instrument Health Sciences Evidence-Based Practice questionnaire (HS-EBP) was administered to evaluate the barriers to, beliefs in, and attitudes towards evidence-based practice. (3) Results: A total of 716 responses were gathered, of which 387 were collected during the period of confinement, and 343 in the COVID-19 post-confinement period. Possible associations that might help respond to the objectives were explored through a correlational study between the sociodemographic variables and each sub-scale of the HS-EBP 30 questionnaire (n = 716). (4) Conclusions: Barriers to, beliefs in, and attitudes towards evidence-based practice are described. There is a leadership gap where line management provides insufficient motivation to follow work routines. The COVID-19 pandemic has caused immense stress among health professionals. The post-confinement group showed a significant change in the variables 'beliefs and attitudes';, and likewise in the 'evaluation';block, justified by the need to update knowledge and to apply evidence.

Obsessive compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic

Aims Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive compulsive disorder (OCD), who are thought to be particularly vulnerable. This study aims to investigate whether the COVID-19 pandemic is associated with increased referral of young people with OCD in one area of London and determine if COVID-19 has been associated with change in symptom severity and treatment offered in recent years. Method A retrospective study was conducted using clinical service data investigating 58 young people (8–17 years) referred and assessed in CNWL NHS Foundation Trust CAMHS, before and during the COVID-19 pandemic in 2020 (months March–October 2018–2020). Changes in symptom severity were measured using the health of the nation outcome scale for children and adolescents (HoNOSCA). Total HoNOSCA and three HoNOSCA items were used;emotional symptoms, family relationships and school attendance. Patient clinical records were reviewed to assess if COVID-19 had exacerbated OCD symptoms. The type of treatment offered (cognitive behavioural therapy -CBT- only vs combined CBT and medication) was also compared. Analysis was carried out using Chi-square, Kruskal–Wallis and Mann–Whitney U tests. Result 26 (5.62%) initial assessments to CAMHS were related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < .001). There was no significant difference in total HoNOSCA, emotional, family relationships, or school attendance scores on initial assessment. However, 69.2% of clinical records in 2020 showed symptom worsening over the COVID-period, compared to 30.8% of cases assessed pre-pandemic.There was a significant difference between the type of treatment offered before and during COVID-19 (X2 (2, N = 58) = 12.7, p = .002), with a higher proportion of patients who were referred to CAMHS for OCD but discharged without treatment before the pandemic (37.5% vs 0%). While CBT only remains the most frequent treatment offered, combined treatment was more frequent during the pandemic, although this difference was not significant. Conclusion The proportion of OCD-related initial assessments in CAMHS increased during the pandemic despite the overall number of referrals falling. Furthermore, fewer cases were discharged without treatment in CAMHS during this period. Given this, and that many were reported to have deteriorated during the pandemic, services will likely need to address the increased burden of more severe cases. Further research is warranted to assess the generalisability of our findings.

COVID-19 associated with disseminated histoplasmosis in a kidney transplant patient.

We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.

COVID-19 asociado a histoplasmosis diseminada en un paciente trasplantado renal COVID-19 associated with disseminated histoplasmosis in a kidney transplant patient

Se presenta un caso de histoplasmosis diseminada e infección por COVID-19 en un paciente trasplantado renal en Argentina. El paciente presentó un cuadro clínico respiratorio y la tomografía computarizada (TC) de tórax mostró múltiples opacidades centrolobulillares bilaterales con patrón de árbol en brote. El paciente fue tratado inicialmente con antibióticos para agentes causantes de neumonía bacteriana adquirida en la comunidad y luego como tuberculosis. Un mes después se le diagnosticó una histoplasmosis diseminada y el hongo fue aislado de esputo, piel y mucosa oral. El hongo fue tipificado molecularmente como Histoplasma capsulatum clado LAmB. El paciente fue hospitalizado y se inició tratamiento con anfotericina B liposomal vía intravenosa. Durante el transcurso de la terapia antifúngica los síntomas respiratorios del paciente empeoraron, una nueva TC de tórax mostró una lesión unilateral con apariencia de vidrio esmerilado y se detectó SARS-CoV-2 en el hisopado nasofaríngeo. El paciente fue tratado con plasmoterapia y se modificó el régimen de inmunosupresión (se interrumpió everolimus, se redujo micofenolato de mofetilo y se incrementó la meprednisona). La evolución del paciente fue favorable y fue dada de alta con tratamiento oral con itraconazol.

Smart Homes as Enablers for Depression Pre-Diagnosis Using PHQ-9 on HMI through Fuzzy Logic Decision System.

Depression is a common mental illness characterized by sadness, lack of interest, or pleasure. According to the DSM-5, there are nine symptoms, from which an individual must present 4 or 5 in the last two weeks to fulfill the diagnosis criteria of depression. Nevertheless, the common methods that health care professionals use to assess and monitor depression symptoms are face-to-face questionnaires leading to time-consuming or expensive methods. On the other hand, smart homes can monitor householders' health through smart devices such as smartphones, wearables, cameras, or voice assistants connected to the home. Although the depression disorders at smart homes are commonly oriented to the senior sector, depression affects all of us. Therefore, even though an expert needs to diagnose the depression disorder, questionnaires as the PHQ-9 help spot any depressive symptomatology as a pre-diagnosis. Thus, this paper proposes a three-step framework; the first step assesses the nine questions to the end-user through ALEXA or a gamified HMI. Then, a fuzzy logic decision system considers three actions based on the nine responses. Finally, the last step considers these three actions: continue monitoring through Alexa and the HMI, suggest specialist referral, and mandatory specialist referral.