Fear Detection in Multimodal Affective Computing: Physiological Signals versus Catecholamine Concentration.

Affective computing through physiological signals monitoring is currently a hot topic in the scientific literature, but also in the industry. Many wearable devices are being developed for health or wellness tracking during daily life or sports activity. Likewise, other applications are being proposed for the early detection of risk situations involving sexual or violent aggressions, with the identification of panic or fear emotions. The use of other sources of information, such as video or audio signals will make multimodal affective computing a more powerful tool for emotion classification, improving the detection capability. There are other biological elements that have not been explored yet and that could provide additional information to better disentangle negative emotions, such as fear or panic. Catecholamines are hormones produced by the adrenal glands, two small glands located above the kidneys. These hormones are released in the body in response to physical or emotional stress. The main catecholamines, namely adrenaline, noradrenaline and dopamine have been analysed, as well as four physiological variables: skin temperature, electrodermal activity, blood volume pulse (to calculate heart rate activity. i.e., beats per minute) and respiration rate. This work presents a comparison of the results provided by the analysis of physiological signals in reference to catecholamine, from an experimental task with 21 female volunteers receiving audiovisual stimuli through an immersive environment in virtual reality. Artificial intelligence algorithms for fear classification with physiological variables and plasma catecholamine concentration levels have been proposed and tested. The best results have been obtained with the features extracted from the physiological variables. Adding catecholamine's maximum variation during the five minutes after the video clip visualization, as well as adding the five measurements (1-min interval) of these levels, are not providing better performance in the classifiers.

Validación psicométrica del cuestionario COPE-Index (Carers of Older People in Europe) / Psychometric validation of the COPE-Index questionnaire (Carers of Older People in Europe)

OBJETIVO: describir el proceso de validación psicométrica del instrumento COPE-Index en población española. MÉTODO: estudio de validación del cuestionario COPE-Index, que cuenta con 15 ítems divididos en tres subescalas: valoración del impacto negativo, valoración del impacto positivo y calidad del apoyo. Los sujetos de estudio fueron 165 figuras cuidadoras de personas mayores, pertenecientes a la Asociación de Familiares de Alzheimer de la Comunidad de Madrid. Mediciones principales: factibilidad del instrumento COPE, consistencia interna, efecto techo y suelo, análisis factorial exploratorio, validez convergente y divergente (para ello se usaron los cuestionarios PACS, Duke-Unc y SF-12). RESULTADOS: la muestra de estudio estuvo formaba por 150 sujetos (tasa de respuesta del 90,9%). El 65,33% (n= 98) era mujer; la edad media (DE) fue de 64 (12,23). Los resultados se mostraron fiables en cuanto a su homogeneidad interna en relación con la subescala negativa y la subescala de calidad (alfas de Cronbach > 0,7) y menor en la subescala positiva (alfa de Cronbach: 0,61). No se apreció efecto techo ni suelo. La validez de constructo confirmó tres dimensiones del cuestionario COPE, que explicaban el 52% de la varianza total. En las pruebas de validez convergente/divergente se correlacionaron las puntuaciones de la subescala positiva del cuestionario COPE con los ítems del cuestionario PACS, la subescala negativa del cuestionario COPE se relacionó con las preguntas del cuestionario Duke-Unc y, finalmente, la subescala de calidad del cuestionario COPE se correlacionó con los ítems del instrumento SF-12 versión dos. CONCLUSIÓN: la versión española del cuestionario COPE-Index fue válida y confiable para identificar los aspectos positivos, negativos y de calidad del cuidado en cuidadoras de personas mayores

OBJECTIVE: to describe the psychometric validation process of the COPE-Index instrument for the Spanish population. METHOD: a validation study of the COPE-Index questionnaire, which consists of 15 items classified into three sub-scales: assessment of negative impact, assessment of positive impact, and quality of support. The study subjects were 165 carers for older people, from the Madrid Association of Relatives of Alzheimer's Patients. The main measurements were: the feasibility of the COPE instrument, internal consistency, ceiling and floor effect, exploratory factor analysis, convergent and divergent validity (the PACS, Duke-Unc and SF-12 questionnaires were used for this). RESULTS: the study sample was formed by 150 subjects (90.9% response rate). Of these, 65.33% (n= 98) were female, and their mean age (SD) was 64 (12.23). Results appeared reliable in terms of internal homogeneity regarding the negative sub-scale and the quality sub-scale (Cronbach's alphas > 0.7), and lower in the positive sub-scale (Cronbach's alpha: 0,61). Neither ceiling nor floor effect were observed. The construct validity confirmed three dimensions of the COPE questionnaire, which explained 52% of the total variance. In the convergent / divergent validity tests, the scores from the positive sub-scale of the COPE questionnaire were correlated with the PACS questionnaire items, the negative sub-scale of the COPE questionnaire was associated with the questions from the Duke-Unc questionnaire, and finally, the quality sub-scale of the COPE questionnaire was correlated with the items from the second version of the SF-12 instrument. CONCLUSION: the Spanish version of the COPE-Index questionnaire was valid and reliable to identify the positive, negative and quality aspects of care in caregivers for elderly persons

Opinions of nurses regarding conscientious objection.

BACKGROUND: In the last decades, there have been important developments in the scientific and technological areas of healthcare. On certain occasions this provokes conflict between the patients' rights and the values of healthcare professionals which brings about, within this clinical relationship, the problem of conscientious objection. AIMS: To learn the opinions that the Nurses of the Madrid Autonomous Community have regarding conscientious objection. RESEARCH DESIGN: Cross-cutting descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: The nurses of 9 hospitals and 12 Health Centers in the Madrid Autonomous Community. The study was done by means of an auto completed anonymous questionnaire. The variables studied were social-demographical and their opinions about conscientious objections. ETHICAL CONSIDERATIONS: The study was approved by the Ethical Community of Clinical Research of the University Hospital Príncipe de Asturias. Participants were assured of maximum confidentiality and anonymity. FINDINGS: A total of 421 nurses answered the questionnaire. In total, 55.6% of the nurses confirmed they were religious believers, and 64.3% declared having poor knowledge regarding conscientious objection. The matters that caused the greatest objections were voluntary abortions, genetic embryo selection, refusal of blood transfusions, and therapy refusal. DISCUSSION: Different authors state that the most significant cases of conscientious objections for health professionals are those regarding carrying out or assisting in abortions, euthanasia, the practice of assisted reproduction and, finally, the prescription and dispensing of the morning-after pill. In our study, the most significant cases in which the nurses would declare conscientious objections would be the refusal to accept treatment, the selection of embryos after genetic diagnosis preimplantation, the patient's refusal to receive blood transfusions due to religious reasons and pregnant women's request for voluntary abortions within the first 14 weeks. CONCLUSION: Nurses' religious beliefs influence their opinions regarding conscientious objection. The nurses who declare themselves as religious believers object in a higher percentage than those without religious beliefs.

Influence of acupuncture on the third stage of labor: a randomized controlled trial.

INTRODUCTION: A prolonged third stage of labor is considered to be a risk factor for postpartum hemorrhage. The objective of this study was to determine the ability of acupuncture to reduce the length of the third stage of labor. METHODS: Seventy-six puerperal women who had a normal spontaneous birth at the Hospital Universitario Principe de Asturias, Alcalá de Henares, Spain, were included in a single-blind randomized trial and evaluated by a third party. Women were randomly assigned to receive true acupuncture or placebo acupuncture (also known as sham acupuncture). In the first group, a sterilized steel needle was inserted at the Ren Mai 6 point, which is located on the anterior midline between the umbilicus and the upper part of the pubic symphysis. In the second group, the insertion site was located at the same horizontal level as the Ren Mai 6 point but shifted slightly to the left of the anterior midline. The management of the third stage of labor was the same in both groups. RESULTS: Statistically significant differences were found, with an average time to placental expulsion of 15.2 minutes in the placebo group and 5.2 minutes in the acupuncture group. No major complications occurred in either group. DISCUSSION: These results confirm that acupuncture at the Ren Mai 6 point can decrease the time to placental expulsion. This treatment represents a simple, safe, and inexpensive way of decreasing the duration of the third stage of labor.

Conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas / Knowledge and attitudes about advance directives on physicians and nurses

Objetivos: Describir y comparar los conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas. Diseño: Estudio piloto descriptivo transversal. Emplazamiento Área Asistencial Este de la Comunidad de Madrid. Participantes: Médicos y enfermeras de atención primaria y especializada. Mediciones principales: Cuestionario autocumplimentado acerca de conocimientos y actitudes sobre las instrucciones previas, compuesto por variables dicotómicas y de escala tipo Likert (0-10). Resultados: Respondieron al cuestionario un total de 192 médicos y enfermeras (tasa de respuesta = 83,4%); 72,4% eran mujeres y 27,6% hombres. La media de edad fue de 39,6 años (DE = 10,9). Para el conocimiento general sobre las instrucciones previas la mediana fue de 5 (rango intercuartílico: 3-7). El 60,1% conocía la regulación por ley, pero solo el 22,8% había leído el documento. Conclusiones: El conocimiento de médicos y enfermeras sobre las instrucciones previas es bajo, por lo que es necesario mejorar este conocimiento. Los médicos y enfermeras de ambos niveles muestran actitudes favorables hacia el uso, la utilidad y el respeto del contenido del documento de instrucciones previas. El diseño metodológico propuesto es eficaz para aplicar en un estudio más amplio, aunque se debe mejorar el sistema de distribución y recogida de cuestionarios (AU)

Objectives: To describe and compare the knowledge and attitudes of the physicians and nurses towards the advance directives. Design: A descriptive, cross-sectional pilot study. Setting: East healthcare area of the Community of Madrid (Spain)Participants: Primary care and specialized care physicians and nurses. Main measurements: Questionnaire about knowledge, use and attitudes from the healthcare professionals over the advance directives given, with dichotomous and Likert scale (0-10) variables. Results: Replies were received from a total of 192 physicians and nurses (response rate = 83,4%),72,4% were women and 27,6% were men. The mean age was 39,6 years (SD = 10,86). For general knowledge on advance directives the median was 5 (RI = 3-7). 60,1% were aware of the regulation by law, but only 22,8% had read the document. Conclusions: The knowledge of physicians and nurses on advance directives is low, so it is necessary to improve this knowledge. Physicians and nurses from both levels show positive attitude towards the use and usefulness and respect the contents of advance directive. The methodology proposed is efficient to implement in a larger study, but should improve the distribution and collection of questionnaires (AU)

[Knowledge and attitudes about advance directives on physicians and nurses]. / Conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas.

OBJECTIVES: To describe and compare the knowledge and attitudes of the physicians and nurses towards the advance directives. DESIGN: A descriptive, cross-sectional pilot study. SETTING: East healthcare area of the Community of Madrid (Spain) PARTICIPANTS: Primary care and specialized care physicians and nurses. MAIN MEASUREMENTS: Questionnaire about knowledge, use and attitudes from the healthcare professionals over the advance directives given, with dichotomous and Likert scale (0-10) variables. RESULTS: Replies were received from a total of 192 physicians and nurses (response rate=83,4%), 72,4% were women and 27,6% were men. The mean age was 39,6 years (SD=10,86). For general knowledge on advance directives the median was 5 (RI=3-7). 60,1% were aware of the regulation by law, but only 22,8% had read the document. CONCLUSIONS: The knowledge of physicians and nurses on advance directives is low, so it is necessary to improve this knowledge. Physicians and nurses from both levels show positive attitude towards the use and usefulness and respect the contents of advance directive. The methodology proposed is efficient to implement in a larger study, but should improve the distribution and collection of questionnaires.

Los derechos de la persona al final de la vida. A la luz de la nueva legislación / The rights of the person at the end of life. In light of the new legislation

En los dos últimos años se ha producido un importante desarrollo legislativo sobre los derechos de la persona en el proceso final de la vida. El objetivo de este trabajo es analizar el contenido de estas nuevas leyes para conocer cómo quedan regulados los derechos de las personas durante el proceso de muerte, los deberes del personal sanitario que atiende a estos pacientes, y las garantías que las administraciones públicas e instituciones sanitarias están obligadas a proporcionar para asegurar el correcto ejercicio de estos derechos(AU)

In the last two years there has been a major legislative developments on the individual rights at the end of life process. The aim of this paper is to analyze the content of these new laws in order to know how are regulated the individual rights during the process of death, the duties of health workers who treat these patients and guarantees that public authorities and health institutions are required to provide to ensure the proper exercise of these rights(AU)

[The rights of the person at the end of life, in light of the new legislation]. / Los derechos de la persona al final de la vida a la luz de la nueva legislación.

In the last two years there has been a major legislative developments on the individual rights at the end of life process. The aim of this paper is to analyze the content of these new laws in order to know how are regulated the individual rights during the process of death, the duties of health workers who treat these patients and guarantees that public authorities and health institutions are required to provide to ensure the proper exercise of these rights.

Evolución histórica de la lactancia materna. Derechos y conciliación familiar / Historical evolution of breastfeeding. Rights and family conciliation

La leche humana ha sido y es un importante medio de supervivencia para el ser humano. La historia de la lactancia materna ha estado unida a la situación social y cultural de la mujer y ha pasado por distintas vicisitudes. Durante un largo periodo fue considerada como una práctica antiestética, indigna y propia de clases bajas; las mujeres que disponían de recursos utilizaban nodrizas. En el siglo xix aparece la lactancia artificial que se desarrollará de forma importante a partir de mediados del siglo siguiente, relegando, de nuevo, a un segundo plano a la lactancia natural. Con el inicio del siglo xx aparecen los primeros derechos de los trabajadores y entre ellos se regula por primera vez el derecho al permiso para lactancia. Con el avance del siglo diversas normas amplían su contenido. Así se llega al momento actual en el que el derecho goza de un amplio reconocimiento legal dentro de las normas que regulan la conciliación familiar(AU)

Human milk has been and it is an important means of survival for the human being. The history of the breastfeeding has been linked to the woman's social and cultural situation and it has gone by different vicissitudes. During a long period the breastfeeding was considered as an unsightly, unworthy practice and characteristic of low classes, women that had resources nurses used. In the xix century artificial nursing appears that will be developed significantly starting from half-filled of the following century, relegating, again, to a second plane to the natural nursing. With the beginning of the xx century the first rights of the workers appear and among them it is regulated the right for the first time to the permission for nursing. With the advance of the century diverse norms enlarge their content. Arriving to the current moment in which the right enjoys a wide legal recognition inside the norms that regulate the family reconciliation(AU)

[Historical evolution of breastfeeding. Rights and family conciliation]. / Evolucion histórica de la lactancia materna. Derechos y conciliación familiar.

Human milk has been and it is an important means of survival for the human being. The history of the breastfeeding has been linked to the woman's social and cultural situation and it has gone by different vicissitudes. During a long period the breastfeeding was considered as an unsightly unworthy practice and characteristic of low classes, women that had resources nurses used. In the XIX century artificial nursing appears that will be developed significantly starting from half-filled of the following century relegating, again, to a second plane to the natural nursing. With the beginning of the XX century the first rights of the workers appear and among them it is regulated the right for the first time to the permission for nursing. With the advance of the century diverse norms enlarge their content. Arriving to the current moment in which the right enjoys a wide legal recognition inside the norms that regulate the family reconciliation.

¿Existe el derecho a morir con dignidad? / Does the right to die with dignity exist?

La muerte es una de las pocas certezas del ser humano. Ante esta realidad se genera la inquietud de cómo se producirá, sobre todo en torno a la soledad y al sufrimiento que puede generar la agonía. En este trabajo se analiza primero la existencia del derecho a morir con dignidad, como derecho humano que alcanza la naturaleza de derecho subjetivo. En segundo término se expone la problemática existente en su aplicación en relación con el llamado mecanismo de doble efecto y la eutanasia. Para concluir se proponen las instrucciones previas o voluntades anticipadas como instrumentos idóneos para hacer valer el derecho a una muerte con dignidad(AU)

Death is one of the few certainties in human beings. This reality generates uneasiness regarding how death will occur, especially in circumstances of loneliness or suffering which can become agony. In this report, the author first analyzes the existence of the right to die with dignity as a human right which takes on the nature of being a subjective right. In continuation, the author describes the existing problematic in the application of this right to die in relationship to the so-called double effect mechanism and euthanasia. The author concludes this article by proposing previous instructions or anticipated desires as ideal measures to make the right to die with dignity valid(AU)

[Does the right to die with dignity exist?]. / Existe el derecho a morir con dignidad?

Death is one of the few certainties in human beings. This reality generates uneasiness regarding how death will occur especially in circumstances of loneliness or suffering which can become agony. In this report, the author first analyzes the existence of the right to die with dignity as a human right which takes on the nature of being a subjective right. In continuation, the author describes the existing problematic in the application of this right to die in relationship to the so-called double effect mechanism and euthanasia. The author concludes this article by proposing previous instructions or anticipated desires as ideal measures to make the right to die with dignity valid.