Data-Driven Personalized Care in Lung Cancer: Scoping Review and Clinical Recommendations on Performance Status and Activity Level of Patients With Lung Cancer Using Wearable Devices.

PURPOSE: Performance status (PS) is a crucial assessment for research and clinical practice in lung cancer (LC), including its usage for the assessment of the suitability and toxicity of treatment or eligibility for clinical trials of patients with LC. These PS assessments are subjective and lead to substantial discrepancies between observers. To improve the objectivity of PS assessments, Electronic Activity Monitoring devices (EAMs) are increasingly used in oncology, but how these devices are used for PS assessments in LC is an issue that remains unclear. The goal of this study is to address the challenges and opportunities of the use of digital tools to support PS assessments in patients with LC. METHODS: The literature review followed PRISMA-ScR methodology. Searches were performed in the ScienceDirect, PsycInfo, ACM, IEEE Xplore, and PubMed databases. Furthermore, a panel discussion was performed to address the clinical use cases. RESULTS: Thirty-two publications were found. Most of the studies used wrist accelerometry-based wearables (59%) and monitored sleep activity (SA; 28%) or physical activity (PA; 72%). Critical findings include positive usefulness of the use of wearables to categorize moderate-to-vigorous/light PA, which was associated with better sleep and health. In addition, steps and time awake immobile were found to be associated with risk of hospitalization and survival. Use cases identified included the health assessment of patients and clinical research. CONCLUSION: There are positive experiences in the use of EAM to complement PS assessment in LC. However, there is a need for adapting thresholds to the particularities of patients with LC, for example, differentiating moderate-to-vigorous and light. Moreover, developing methodologies combining PS assessments and the use of EAM adapted to clinical and research practice is needed.

The whole-body motor skills of children with autism spectrum disorder taking goal-directed actions in virtual reality.

Many symptoms of the autism spectrum disorder (ASD) are evident in early infancy, but ASD is usually diagnosed much later by procedures lacking objective measurements. It is necessary to anticipate the identification of ASD by improving the objectivity of the procedure and the use of ecological settings. In this context, atypical motor skills are reaching consensus as a promising ASD biomarker, regardless of the level of symptom severity. This study aimed to assess differences in the whole-body motor skills between 20 children with ASD and 20 children with typical development during the execution of three tasks resembling regular activities presented in virtual reality. The virtual tasks asked to perform precise and goal-directed actions with different limbs vary in their degree of freedom of movement. Parametric and non-parametric statistical methods were applied to analyze differences in children's motor skills. The findings endorsed the hypothesis that when particular goal-directed movements are required, the type of action could modulate the presence of motor abnormalities in ASD. In particular, the ASD motor abnormalities emerged in the task requiring to take with the upper limbs goal-directed actions with low degree of freedom. The motor abnormalities covered (1) the body part mainly involved in the action, and (2) further body parts not directly involved in the movement. Findings were discussed against the background of atypical prospective control of movements and visuomotor discoordination in ASD. These findings contribute to advance the understanding of motor skills in ASD while deepening ecological and objective assessment procedures based on VR.

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial.

BACKGROUND: Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. OBJECTIVES: The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. METHOD: A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). CONCLUSIONS: It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04659746.

Digital health for emotional and self-management support of caregivers of children receiving growth hormone treatment: a feasibility study protocol.

BACKGROUND: Caregivers of children undergoing growth hormone treatment often face stress and stigma. In this regard, family-centered approaches are increasingly considered, wherein caregivers' mental wellbeing is taken into account to optimize children's health-related outcomes and behaviors (e.g., treatment adherence). Here, mindfulness and parenting-based programs have been developed to support the mental wellbeing of caregivers and, in turn, promote richer interactions with the children. Nevertheless, this type of program can face drawbacks, such as the scheduling and availability of family members. Recent digital health (DH) solutions (e.g., mobile apps) are showing promising advantages as self-management support tools for improving wellbeing and behaviors related to the treatments. Although, further evidence is necessary in the field of Growth Hormone Treatment (GHt). Accordingly, this study aims to examine the usability of a mobile DH solution and the feasibility of a DH intervention designed to promote emotional and mental wellbeing of caregivers of children undergoing GHt. METHODS: This is a prospective mixed-methods (qualitative-quantitative) exploratory study composed of two sub-studies, including caregivers of children undergoing GHt. Sub-study one (SS1; n = 10) focuses on the usability of the DH solution (detecting potential barriers and facilitators) and an ad hoc semi-structured interview will be administered to the caregivers after using the DH solution for one month. Sub-study two (SS2; n = 55) aims to evaluate the feasibility of the DH intervention on caregivers' perceived distress, positive affectivity, mental wellbeing, self-efficacy, together with the children's quality of life and treatment adherence. All these parameters will be assessed via quantitative methods before and after 3-months of the DH intervention. Usability and engagement will also be assessed during and at the end of the study. RESULTS: It is expected that significant amounts of data will be captured with regards of the feasibility of the DH solution. DISCUSSION: The manuscript provides a complete protocol for a study that will include qualitative and quantitative information about, on one hand, the user-friendliness of the DH solution, and on the other, the effects on caregivers' emotional, as well as, behavioral parameters in terms of the usability and engagement to the DH solution. The findings will contribute to the evidence planning process for the future adoption of digital health solutions for caregiver support and better health-related outcomes. Trial registration ClinicalTrials.gov, ID: NCT04812665.

Influence of Resilience and Optimism on Distress and Intention to Self-Isolate: Contrasting Lower and Higher COVID-19 Illness Risk Samples From an Extended Health Belief Model.

The study investigated the influence of resilience and dispositional optimism on, first, emotional distress and, second, the intention to self-isolate, experienced by people with a lower and higher illness risk, during the lockdown imposed in Spain during the first COVID-19 wave. These effects were investigated against the background of the Health Belief Model (HBM). A convenience sample of N = 325 participants completed an online survey including an ad-hoc questionnaire measuring the HBM core factors: Perceived health threat (susceptibility and severity of getting infected), and perceived quarantine benefits and costs. Self-efficacy and perceived social pressure were also measured. Based on reviews regarding pandemic outbreaks, quarantine benefits were conceptualized as the perceived effectiveness and solidary contribution of self-isolating in line with the quarantine protocols. Quarantine "psychosocial" costs were conceptualized as a composite of perceived boredom, loneliness, and economic concerns. Findings revealed an asymmetrical pattern of results so that (i) people at higher risk were more distressed by the perceived severity of getting infected whereas people at lower risk were more distressed by the psychosocial costs. Moreover, (ii) resilience and optimism were more "protective" against distress within the lower and higher risk groups, respectively. In addition, (iii) quarantine benefits and self-efficacy promoted the intention to self-isolate within both groups. However, (iv) optimism hindered such intention. This finding is discussed in the light of links between dispositional optimism and optimistic bias; the underestimation of experiencing negative events, which can relax the perceived health risk. Based on these findings, communication campaigns should prioritize information about the effectiveness of the implemented preventive behaviors rather than the costs of not implementing them, and be cautionary in encouraging excessive optimism.

Protective role of mindfulness, self-compassion and psychological flexibility on the burnout subtypes among psychology and nursing undergraduate students.

AIMS: To explore the relationship between mindfulness, self-compassion and psychological flexibility, and the burnout subtypes in university students of the Psychology and Nursing degrees, and to analyse possible risk factors for developing burnout among socio-demographic and studies-related characteristics. DESIGN: Cross-sectional study conducted on a sample of 644 undergraduate students of Nursing and Psychology from two Spanish universities. METHODS: The study was conducted between December 2015 and May 2016. Bivariate Pearson's correlations were computed to analyse the association between mindfulness facets, self-compassion and psychological flexibility, and levels of burnout. Multivariate linear regression models and bivariate and multivariate binary logistic regressions were also computed. RESULTS: The three subtypes of burnout presented significant correlations with psychological flexibility, self-compassion and some mindfulness facets. Psychological flexibility, self-compassion and the mindfulness facets of observing and acting with awareness were significantly associated to burnout. Among the risk factors, 'year of study' was the only variable to show significantly higher risk for every burnout subtype. CONCLUSION: The significant associations found between mindfulness, self-compassion, psychological flexibility and burnout levels underline the need of including these variables as therapeutic targets when addressing the burnout syndrome in university students. IMPACT: Undergraduate students, especially those of health sciences, often experience burnout. This study delves into the protective role of some psychological variables: mindfulness, self-compassion and psychological flexibility. These should be considered as potentially protective skills for developing burnout, and therefore, undergraduate students could be trained on these abilities to face their studies and their future profession to prevent experiencing burnout syndrome.

Altering emotions near the hand: Approach-avoidance swipe interactions modulate the perceived valence of emotional pictures.

Approaching positive objects and avoiding negative ones are general action tendencies in human behavior. Interestingly, hand or arm positions connoting approach (arm flexion) or avoidance (arm extension) have also been shown to influence how the valence of a stimulus is evaluated. However, this causal effect on valence evaluation has been typically examined within experimental paradigms that do not require acting upon objects such as when touching or moving them. Accordingly, the current study attempts to integrate approach-avoidance paradigms with findings suggesting that manipulating visual stimuli directly by hand modulates their cognitive processing. Sixty participants evaluated the valence of 40 emotional pictures from the International Affective Picture System (IAPS) twice, first after watching them on a monitor (i.e., baseline evaluations) and second after swiping them on a touchscreen, either toward or away from their body (i.e., interactions regulating distance). Our findings confirmed that, in contrast to just watching the pictures, (a) swiping positive pictures closer and negative pictures away led to positively change their valence evaluation (i.e., reinforcing the perceived valence of positive pictures and attenuating the perceived valence of negative pictures). However, (b) swiping negative pictures closer and positive pictures away barely changed their initial valence evaluation. Against this background, we argue that swiping emotional pictures closer or away directly by hand, may intensify the attentional prioritization to interactions leading to more desirable consequences, namely, approaching positive and avoiding negative stimuli. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Designing Visual-Arts Education Programs for Transfer Effects: Development and Experimental Evaluation of (Digital) Drawing Courses in the Art Museum Designed to Promote Adolescents' Socio-Emotional Skills.

An active engagement with arts in general and visual arts in particular has been hypothesized to yield beneficial effects beyond arts itself. So-called cognitive and socio-emotional "transfer" effects into other domains have been claimed. However, the empirical basis of these hopes is limited. This is partly due to a lack of experimental comparisons, theory-based designs, and objective measurements in the literature on transfer effects of arts education. Therefore, the aim of the present study was to design and experimentally investigate a theory-based visual-arts education program for adolescents aged between 12 and 19 years (M age = 15.02, SD age = 1.75). The program was delivered in a museum context in three sessions and was expected to yield specific and objectively measurable transfer effects. To conduct a randomized field trial, three strictly parallelized and standardized art courses were developed, all of which addressed the topic of portrait drawing. The courses mainly differed regarding their instructional focus, which was either on periods of art history, on the facial expression of emotions, or on the self-perception of a person in the context of different social roles. In the first and more "traditional" course portrait drawing was used to better understand how portraits looked like in former centuries. The two other courses were designed in a way that the artistic engagement in portrait drawing was interwoven with practicing socio-emotional skills, namely empathy and emotion recognition in one course and understanding complex self-concept structures in the other. We expected positive socio-emotional transfer effects in the two "psychological" courses. We used an animated morph task to measure emotion recognition performance and a self-concept task to measure the self-complexity of participants before and after all three courses. Results indicate that an instructional focus on drawing the facial expressions of emotions yields specific improvements in emotion recognition, whereas drawing persons in different social roles yields a higher level of self-complexity in the self-concept task. In contrast, no significant effects on socio-emotional skills were found in the course focussing on art history. Therefore, our study provides causal evidence that visual-arts programs situated in an art-museum context can advance socio-emotional skills, when designed properly.

Coding valence in touchscreen interactions: hand dominance and lateral movement influence valence appraisals of emotional pictures.

The Body-Specificity Hypothesis postulates that the space surrounding the dominant hand is perceived as positive due to the motor fluency of this hand, whereas the space surrounding the non-dominant hand is perceived as negative. Experimental studies based on this theoretical framework also revealed associations between affective valence and hand dominance (i.e., dominant hand-positive; non-dominant hand-negative), or lateral movements of the hands (i.e., right hand toward the right space-positive; left hand toward the left space-positive). Interestingly, these associations have not been examined with regard to how lateral actions of the hands may influence affective experiences as, for example, in valence appraisals of affective objects that have been manipulated. The study presented here has considered this question in light of the emerging interest of embodied cognition approaches to interactive technologies, particularly in affective experiences with touchscreen interfaces. Accordingly, right-handed participants evaluated the valence of positive and negative emotional pictures after interacting with them either with the dominant right or with the non-dominant left hand. Specifically, they moved the pictures either from left to right or from right to left sides of a touchscreen monitor. The results indicated that a valence matching between the hand used for the interactions, the picture's valence category, and the movement's starting side reinforced the valence appraisals of the pictures (i.e., positive/negative pictures were more positively/negatively evaluated). The findings are discussed against the background of the Theory of Event Coding, which accounts for both the affective properties of the stimuli and the affective connotation of the related action.

Moved by Emotions: Affective Concepts Representing Personal Life Events Induce Freely Performed Steps in Line With Combined Sagittal and Lateral Space-Valence Associations.

Embodiment approaches to cognition and emotion have put forth the idea that the way we think and talk about affective events often recruits spatial information that stems, to some extent, from our bodily experiences. For example, metaphorical expressions such as "being someone's right hand" or "leaving something bad behind" convey affectivity associated with the lateral and sagittal dimensions of space. Action tendencies associated with affect such as the directional fluency of hand movements (dominant right hand-side - positive; non-dominant left hand-side - negative) and approach-avoidance behaviors (forward - positive; backwards - negative) might be mechanisms supporting such associations. Against this background, experimental research has investigated whether positive and negative words are freely allocated into space (e.g., close or far from one's body) or resonate with congruent (vs. incongruent) predefined manual actions usually performed by joysticks or button presses (e.g., positive - right; negative - left, or vice versa). However, to date, it is unclear how the processing of affective concepts resonate with directional actions of the whole body, the more if such actions are performed freely within a context enabling both, lateral and sagittal movements. Accordingly, 67 right-handed participants were to freely step on an 8-response pad (front, back, right, left, front-right, front-left, back-right, or back-left) after being presented in front of them valence-laden personal life-events submitted before the task (e.g., words or sentences such as "graduation" or "birth of a child"). The most revealing finding of this study indicates that approach-avoidance behaviors and space-valence associations across laterality are interwoven during whole body step actions: Positive events induced steps highly biased to front-right whereas negative events induced steps highly biased to back-left.

Valence-space associations in touchscreen interactions: Valence match between emotional pictures and their vertical touch location leads to pictures' positive evaluation.

Embodied cognition research suggests that bodily experiences might ground mental representations of emotional valence in the vertical dimension of space (i.e., positive is up and negative is down). Accordingly, recent studies show that upward and downward arm movements may also influence the evaluation of valence-laden stimuli, suggesting that upward (downwards) movements lead to more positive (negative) evaluations. Interestingly, these studies typically did not investigate paradigms that require a direct hand interaction with the stimuli. With the advent of touchscreen devices and their use for experimental environments, however, a direct and more natural hand interaction with the stimuli has come to the fore. In this regard, the goal of the present study is to examine how direct hand interaction with valence-laden stimuli on a touchscreen monitor affects their perceived valence. To do so, participants evaluated emotional pictures after touching and moving them either upwards or downwards across a vertically mounted touchscreen. In contrast to previous findings, the results suggest that positive pictures were evaluated as more positive after downward movements while negative pictures were evaluated as less negative following upward movements. This finding may indicate that a matching between the pictures' valence and the valence associated with their vertical touch location leads to more positive evaluations. Thus, the present study extends earlier results by an important point: Touching the emotional pictures during movement may influence their valence processing.