DiabeText, a mobile health intervention to support medication taking and healthy lifestyle in adults with type 2 diabetes: Study protocol for a randomized controlled trial.

AIM: To evaluate the effectiveness of DiabeText, a low-intensity, multifaceted, mobile health (mHealth) intervention to support medication taking and lifestyle change targeted to people with type 2 diabetes (T2D). DESIGN: Phase III, 12-months, two-arm (1:1 allocation ratio), randomized parallel-group trial. METHODS: We will recruit 740 adults with glycated hemoglobin (A1c) >8% (>64 mmol/mol) and with at least one prescription of a non-insulin antidiabetic drug. They will be allocated to a control (usual care) group or an intervention (DiabeText messaging intervention) group. The primary outcome measure will be A1c at 12 months follow-up. Secondary outcomes will include medication possession ratio and behavioral and psychological outcomes. DISCUSSION: Recent trials suggest that digital health interventions can effectively support diabetes self-management improving T2D control and reducing important T2D complications. In Spain this type of interventions is understudied. IMPACT: This trial will strengthen the evidence base of the impact of mHealth interventions to support diabetes self-management. If effective, DiabeText may offer a low-cost and highly scalable strategy to improve health at the population level in a sustainable way. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05006872; Official Title: Supporting People with Type 2 Diabetes in Effective Use of their Medicine Through a System Comprising Mobile Health Technology Integrated with Clinical Care.

Development and Evaluation of a Digital Health Intervention to Prevent Type 2 Diabetes in Primary Care: The PREDIABETEXT Study Protocol for a Randomised Clinical Trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease associated with an increased risk of comorbidities, premature death, and health costs. Prediabetes is a stage of glucose alteration previous to T2DM, that can be reversed. The aim of the study is to develop and evaluate a low-intensity, multifaceted, digital intervention to prevent T2DM. The intervention comprises: (1) the use of mobile health technology to send tailored text messages promoting lifestyle changes to people at risk of T2DM and (2) the provision of online education to primary healthcare physicians and nurses about management of prediabetes. METHODS: In stages 1-4 we will design, develop and pilot-test the intervention. In Stage 5 we will conduct a phase II, six-month, three-arm, cluster randomized, clinical trial with 42 primary care professionals and 420 patients at risk of T2DM. Patients will be allocated to a control group (usual care), intervention A (patient messaging intervention), or intervention B (patient messaging intervention plus online education to their primary healthcare professionals). The primary outcome will be glycated haemoglobin. All the procedures obtained ethical approval in June 2021 (CEI-IB Ref No: IB4495/21PI). DISCUSSION: Digital health interventions can effectively prevent T2DM and reduce important T2DM risk factors such as overweight or hypertension. In Spain, this type of intervention is understudied. Moreover, there is controversy regarding the type of digital health interventions that are more effective. Findings from this study may contribute to address T2DM prevention, through a low-cost and easily implementable intervention.

Perspectives and Views of Primary Care Professionals Regarding DiabeText, a New mHealth Intervention to Support Adherence to Antidiabetic Medication in Spain: A Qualitative Study.

BACKGROUND: Antidiabetic medication is effective in preventing diabetes-related complications. However, 40% of type 2 diabetic patients do not adhere to their medication regimes adequately. Brief text messages represent a promising approach to support medication adherence. The aim of this study was to explore the perspectives of primary care professionals (PCPs) concerning the DiabeText intervention, a new text messaging intervention to be developed to support medication adherence in people with type 2 diabetes (T2D) in Mallorca, Spain. METHODS: We conducted four focus groups (n = 28) and eight semi-structured interviews with doctors and nurses. Data collection and analysis were carried out by researchers independently following Braun and Clark's methodology. RESULTS: Three main themes were identified: (1) text messaging interventions have the potential to effectively support diabetes self-management; (2) involving PCPs in the intervention would facilitate its design and implementation; (3) obtaining evidence supporting the cost-effectiveness is a key prerequisite for large-scale implementation of the intervention. PCPs identified barriers and enablers of the design and implementation of the intervention and made suggestions about the content and format of the text messages. CONCLUSION: The DiabeText intervention is perceived as useful and acceptable by PCPs provided its cost-effectiveness.

Patients' Views on the Design of DiabeText, a New mHealth Intervention to Improve Adherence to Oral Antidiabetes Medication in Spain: A Qualitative Study.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) is a long-term condition affecting around 10% of people worldwide. This study aimed to explore T2DM patients' views on DiabeText, a new text messaging intervention to be developed to support adherence to diabetes medication. METHODS: A total of four focus groups were conducted with a purposive sample of people with T2DM (n = 34). The data were analysed by multiple researchers independently, and coded using thematic analysis. RESULTS: There were two main themes that emerged: (1) "patients' perspectives on unmet needs for diabetes self-management", and (2) "acceptability and perceived utility of DiabeText". The patients identified a number of barriers for diabetes self-management, including lack of appropriate information and support with diet and physical activity. Support for medication-taking was not perceived as urgently needed, although several barriers were identified (eating outside, traveling, polymedication, dispensation at the pharmacy). The participants anticipated that the proposed intervention would present high levels of patient acceptability and perceived utility as long as its content addresses the barriers that were identified, and includes specific features (short and clear messages, and personalized information). CONCLUSION: The proposed intervention has the potential to be well accepted and perceived as useful by T2DM patients who require support not only in terms of medication-taking, but more prominently of lifestyle behaviour.

Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes / Spanish adaptation of the Gambling Advertising Impact Scale for adolescents

La presión mediática de publicidad de apuestas ha alcanzado niveles preocupantes. Constituye un riesgo para la salud mental de los jóvenes y adolescentes al promover una actitud favorable hacia las apuestas, una mayor frecuencia de juego y una percepción de mayor accesibilidad. En la actualidad no se dispone de un instrumento capaz de evaluar el impacto de la publicidad de apuestas.ObjetivoAdaptar y validar la Escala de Impacto de Publicidad de Apuestas (IGAS, Impact of Gambling Advertising Scale).DiseñoInvestigación instrumental. La escala IGAS fue traducida del inglés garantizando su equivalencia lingüística, conceptual y métrica. A continuación, se comprobaron las propiedades psicométricas.EmplazamientoComunidad Valenciana (España).Participantes1.724 adolescentes con una media de 16,52 años (DT = 0,759).Intervención Se administró un cuestionario autoaplicado en formato de papel en una única medida.Principales medidasImpacto de la publicidad, severidad e intención de apostar, y accesibilidad.ResultadosLa consistencia interna y la fiabilidad dos mitades fueron buenas, α de Cronbach = 0,782 y 0,70, respectivamente. El análisis factorial confirmatorio concluyó que la versión española reproduce la original de tres dimensiones. Los análisis de la validez convergente mostraron relaciones directas y significativas con diferentes aspectos de la conducta de juego, y otros factores predictores.ConclusiónLa versión adaptada de la IGAS es una medida fiable y válida para la evaluación del impacto de la publicidad en adolescentes. La escala es un instrumento útil para el diagnóstico del nivel de riesgo y la evaluación de intervenciones preventivas.

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising.ObjectiveThe present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS).DesignThe IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested.SiteComunidad Valenciana (España).Participants1724 adolescents with a mean age of 16.52 years (SD=.759).InterventionSelf-administered, paper-based questionnaire in a single measure.Main measurementsAdvertising impact, and gambling intention, severity and availability.ResultsInternal consistency and two-half reliability were good, Cronbach's α=.782 and α=.70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors.ConclusionThe adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.

[Spanish adaptation of the Gambling Advertising Impact Scale for adolescents]. / Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes.

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising. OBJECTIVE: The present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS). DESIGN: The IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested. SITE: Comunidad Valenciana (España). PARTICIPANTS: 1724 adolescents with a mean age of 16.52 years (SD=.759). INTERVENTION: Self-administered, paper-based questionnaire in a single measure. MAIN MEASUREMENTS: Advertising impact, and gambling intention, severity and availability. RESULTS: Internal consistency and two-half reliability were good, Cronbach's α=.782 and α=.70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors. CONCLUSION: The adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.

Urgencias tras consumo de cocaína: factores relacionados con el ingreso hospitalario / Emergencies following cocaine use: factors related to hospital admission

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Medication overdoses: changes over time. / Evolución temporal de las intoxicaciones medicamentosas.

OBJECTIVES: To review changes occurring over time in cases of medication overdose attended by an emergency department. MATERIAL AND METHODS: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. RESULTS: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). CONCLUSION: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing.

OBJETIVO: Análisis de la evolución temporal de las intoxicaciones medicamentosas (IM) atendidas en urgencias hospitalarias. METODO: Estudio retrospectivo, con análisis multivariante de variables epidemiológicas y asistenciales de IM, comparando la casuística de los años 2007 con 2017, en un hospital universitario. RESULTADOS: Se incluyeron 750 casos, 58,4% del 2007. En 2017, disminuyeron la causa suicida (p < 0,001), el empleo de descontaminación digestiva (p < 0,001) y antídotos (p = 0,007), y los ingresos (p = 0,004), altas voluntaria o fugas (p = 0,03). Se incrementó por el contrario la intoxicación múltiple (p = 0,001), especialmente en varones y en contexto recreativo. Las benzodiacepinas fueron los fármacos más implicados en las IM (65,1%). CONCLUSIONES: Existe una tendencia al descenso de las IM atendidas, con incremento en varones, menos intencionalidad suicida, menos uso de terapéuticas específicas y menos admisiones hospitalarias.

Evolución temporal de las intoxicaciones medicamentosas / Medication overdoses: changes over time

Objetivo: Análisis de la evolución temporal de las intoxicaciones medicamentosas (IM) atendidas en urgencias hospitalarias. Método: Estudio retrospectivo, con análisis multivariante de variables epidemiológicas y asistenciales de IM, comparando la casuística de los años 2007 con 2017, en un hospital universitario. Resultados: Se incluyeron 750 casos, 58,4% del 2007. En 2017, disminuyeron la causa suicida (p < 0,001), el empleo de descontaminación digestiva (p < 0,001) y antídotos (p = 0,007), y los ingresos (p = 0,004), altas voluntaria o fugas (p = 0,03). Se incrementó por el contrario la intoxicación múltiple (p = 0,001), especialmente en varones y en contexto recreativo. Las benzodiacepinas fueron los fármacos más implicados en las IM (65,1%). Conclusiones: Existe una tendencia al descenso de las IM atendidas, con incremento en varones, menos intencionalidad suicida, menos uso de terapéuticas específicas y menos admisiones hospitalarias

Objective: To review changes occurring over time in cases of medication overdose attended by an emergency department. Methods: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. Results: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). Conclusions: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing

Data mining classification techniques: an application to tobacco consumption in teenagers / Técnicas de clasificación de data mining: una aplicación al consumo de tabaco en adolescentes

El presente trabajo tiene el propósito de analizar el poder predictivo de diversas variables psicosociales y de personalidad sobre el con-sumo o no consumo de nicotina en la población adolescente mediante el uso de diversas técnicas de clasificación procedentes de la metodología Data Mining. Más concretamente, se analizan las RNA -Perceptrón Multicapa (MLP), Funciones de Base Radial (RBF) y Redes Probabilísticas (PNN)--, los árboles de decisión, el modelo de regresión logística y el análisis discriminante. Para ello, se ha trabajado con una muestra de 2666 adolescentes, de los cuales 1378 no consumen nicotina mientras que 1288 son consumidores de nicotina. Los modelos analizados han sido capaces de discriminar correctamente entre ambos tipos de sujeto en un rango comprendido entre el 77.39% y el 78.20%, alcanzando una sensibilidad del 91.29% y una especificidad del 74.32%. Con este estudio, se pone a disposición del especialista en conductas adictivas, un conjunto de técnicas estadísticas avanzadas capaces de manejar simultáneamente una gran cantidad de variables y sujetos, así como aprender de forma automática patrones y relaciones complejas, siendo muy adecuadas para la predicción y prevención del comporta-miento adictivo

This study is aimed at analysing the predictive power of different psychosocial and personality variables on the consumption or non-consumption of nicotine in a teenage population using different classification techniques from the field of Data Mining. More specifically, we analyse ANNs - Multilayer Perceptron (MLP), Radial Basis Functions (RBF) and Probabilistic Neural Networks (PNNs) -decision trees, the logistic regression model and discriminant analysis. To this end, we worked with a sample of 2666 teenagers, 1378 of whom do not consume nicotine while 1288 are nicotine consumers. The models analysed were able to discriminate correctly between both types of subjects within a range of 77.39% to 78.20%, achieving 91.29% sensitivity and 74.32% specificity. With this study, we place at the disposal of specialists in addictive behaviours a set of advanced statistical techniques that are capable of simultaneously processing a large quantity of variables and subjects, as well as learning complex patterns and relationships automatically, in such a way that they are very appropriate for predicting and preventing addictive behaviour

Estudio de los factores asociados al uso de sustancias en la adolescencia mediante Reglas de Asociación / Study of the factors associated with substance use in adolescence using Association Rules

El objetivo del presente estudio es analizar los factores relacionados con el uso de sustancias adictivas en la adolescencia mediante reglas de asociación, herramientas descriptivas incluidas en Data Mining. Para ello se cuenta con una base de datos referidos al consumo de sustancias adictivas en la adolescencia y se utiliza el paquete arules, integrado en el programa de libre distribución R (versión 2.10.1). La muestra está formada por 9.300 estudiantes de edades comprendidas entre los 14 y los 18 años (47,1% chicos y 52,9% chicas) con una edad media de 15,6 años (SE=1,2). Los adolescentes contestaron un cuestionario anónimo que incluía preguntas sobre factores de riesgo personales, familiares y ambientales para el consumo desustancias. Las mejores reglas obtenidas en relación al consumo de sustancias relacionan el consumo de alcohol con la educación paterna percibida y el consumo de los amigos (confianza= 0.8528), el consumo de tabaco, cannabis y cocaína con la actuación paterna percibida y la realización de conductas ilegales (confianzas de 0.8032, 0.8718 y 1.0000, respectivamente)y el uso de éxtasis con el consumo de los iguales (confianza = 1.0000).En general, las reglas de asociación muestran de forma sencilla la relación existente entre ciertas pautas de actuación paterna percibida, la emisión de conductas desviadas de las normas de comportamiento social, el consumo por parte del grupo de iguales y el abuso de drogas, legales e ilegales, en la adolescencia. Se describen las implicaciones de los resultados obtenidos así como la utilidad de esta nueva metodología de análisis (AU)

The aim of this study is to analyse the factors related to the use of addictive substances in adolescence using association rules, descriptive tools included in Data Mining. Thus, we have a database referring to the consumption of addictive substances in adolescence, and use the free distribution program in the R arules package (version 2.10.0). The sample was made up of 9,300 students between the ages of 14 and 18 (47.1% boys and 52.9% girls) with an average age of 15.6 (SE=1.2). The adolescents answered an anonymous questionnaire on personal, family and environmental risk factors related to substance use. The best rules obtained with regard to substance use relate the consumption of alcohol to perceived parenting style and peer consumption (confidence = 0.8528), the use of tobacco (smoking), cannabis and cocaine to perceived parental action and illegal behaviour (confidence= 0.8032, 0.8718 and 1.0000, respectively), and the use of ecstasy to peer consumption (confidence = 1.0000). In general, the association rules show in a simple manner the relationship between certain patterns of perceived parental action, behaviours that deviate from social behavioural norms, peer consumption and the use of different legal and illegal drugs of abuse in adolescence. The implications of the results obtained are described, together with the usefulness of this new methodology of analysis (AU)

The methodology of Data Mining. An application to alcohol consumption in teenagers.

This paper is aimed mainly at making researchers in the field of drug addictions aware of a methodology of data analysis aimed at knowledge discovery in databases (KDD). KDD is a process consisting of a series of phases, the most characteristic of which is called data mining (DM), whereby different modelling techniques are applied in order to detect patterns and relationships among the data. Common and differentiating factors between the most widely used DM techniques are analysed, mainly from a methodological viewpoint, and their use is exemplified using data related to alcohol consumption in teenagers and its possible relationship with personality variables (N=7030). Although the overall accuracy obtained (% correct predictions) is very similar in the three models analyzed, the Artificial Neural Network (ANN) technique generates the most accurate model (64.1%), followed by Decision Trees (DT) (62.3%) and Naïve Bayes (NB) (59.9%).

La metodología del Data Mining. Una aplicación al consumo de alcohol en adolescentes / The methodology of Data Mining. An application to alcohol consumption in teenagers

El presente trabajo pretende principalmente acercar a los investigadores del campo de las drogodependencias una metodología de análisis de datos orientada al descubrimiento de conocimiento en bases de datos (KDD). El KDD es un proceso que consta de una serie de fases, la más característica de las cuales se denomina Data Mining (DM), en la que se aplican diferentes técnicas de modelado para detectar patrones y relaciones en los datos. Se analizan los factores comunes y diferenciadores de las técnicas DM más ampliamente utilizadas, desde una visión principalmente metodológica, y ejemplificando su uso con datos provenientes del consumo de alcohol en adolescentes y su posible relación con variables de personalidad (N=7030). Aunque la precisión global obtenida (% de predicciones correctas) es muy similar en los tres modelos analizados, las redes neuronales generan el modelo más preciso (64.1%), seguidas de los árboles de decisión (62.3%) y Naive Bayes (59.9%) (AU)

This paper is aimed mainly at making researchers in the field of drug addictions aware of a methodology of data analysis aimed at knowledge discovery in databases (KDD). KDD is a process consisting of a series of phases, the most characteristic of which is called data mining (DM), where by different model ling techniques are applied in order to detect patterns and relationships among the data. Common and differentiating factors between the most widely used DM techniques are analysed, mainly from a methodological viewpoint, and their use is exemplified using data related to alcohol consumption in teenagers and its possible relationship with personality variables (N=7030). Although the overall accuracy obtained (% correct predictions) is very similar in the three models analyzed, the Artificial Neural Network (ANN) technique generates the most accurate model (64.1%), followed by Decision Trees (DT) (62.3%) and Naïve Bayes (NB) (59.9%) (AU)