Patricia Otero

Background/Objective: Video games offer an innovative tool for delivering active aging interventions. The objective of this study was to analyze the efficacy of an enhanced version of a cognitive–behavioral intervention to promote active aging, administered through a video game, on perceived health and healthy lifestyle habits. Methods: A total of 556 participants aged 45 or older (74.3% women, mean age of 60.8 [SD = 8.0]) were randomly assigned to a cognitive–behavioral intervention to promote active aging administered via an interactive, multimedia, online, and serious video game with a complementary smartphone app (CBI-V; n = 279) or to a control group receiving non-specific online information (CG; n = 277). Perceived health (General Health, Body Pain, Physical Functioning, Physical Role, Vitality, Social Functioning, Emotional Role, Mental Health, Physical and Mental Summary Indices); healthy habits, including sleep hygiene behaviors, physical activity, and eating habits; dropouts; adherence to the intervention (completed modules; total playtime; time devoted to cognitive training; number of cognitive task attempts and tasks completed between modules); and satisfaction with the intervention were assessed by independent, blind evaluators via an online platform before and after the intervention. Results: At the post-intervention, the CBI-V group obtained significantly better scores in General Health (p < 0.001), Mental Health (p = 0.015), sleep hygiene (p < 0.001), physical activity (p = 0.024), and eating habits (p = 0.001) than the CG. The effect sizes were small (d = −0.188 to 0.334). Clinically significant changes were higher in the CBI-V group than in the CG in General Health (p = 0.029), Physical Function (p = 0.028), Social Function (p = 0.011), Emotional Role (p = 0.008), Mental Health (p = 0.026), Physical Summary Index (p = 0.010), sleep hygiene (p = 0.020), and eating habits (p = 0.019). Participants reported a high level of satisfaction with the intervention, with a mean score of 25.4 (SD = 4.0) out of a maximum of 32 on the intervention satisfaction measure. Conclusions: These findings support the efficacy of a cognitive–behavioral video game intervention in enhancing perceived health and promoting healthy lifestyle habits among people aged 45 and above.

Background: Physician burnout is a growing issue that affects both the quality of healthcare and the mental well-being of medical professionals. However, research on this phenomenon in Ecuador is limited and methodologically deficient. The objective of this study was to examine the national prevalence of burnout among Ecuadorian physicians, its associated factors, and its impact on mental health. Methods: A cross-sectional study was conducted on 1976 physicians from all provincial capitals of Ecuador (51.8% women; mean age: 37.1 years). Results: It was found that 25.3% of physicians had high levels of emotional exhaustion and 23.8% had high levels of depersonalization. Factors associated with the higher levels of emotional exhaustion among physicians included part-time jobs, long working hours, work–family conflicts, psychological inflexibility, and perceived loneliness. Higher levels of depersonalization were associated with working shifts, having work–family conflicts, exhibiting psychological inflexibility, and perceived loneliness, while lower levels of depersonalization were associated with being female. Experiencing higher levels of depersonalization were associated with suffering from higher levels of depression, while having higher levels of emotional exhaustion were associated with suffering from higher levels of stress. Conclusions: A considerable proportion of Ecuadorian physicians suffer from burnout. Preventive programs and psychological interventions tailored to their specific needs should be developed.

Background/Objectives: Although burnout among physicians is a serious and growing problem in healthcare, research on this issue in Ecuador is scarce and suffers from methodological limita-tions. This study examined the prevalence of burnout among Ecuadorian medical professionals at the national level, as well as its correlates and consequences on their mental health. Methods: A cross-sectional study was conducted with a sample of 1,976 physicians (51.8% women, mean age 37.1 years) from all provincial capitals of Ecuador. The presence of burnout was assessed, as well as sociodemographic, organizational, and psychological variables (including psychological in-flexibility, perceived loneliness, and symptoms of depression, anxiety, and stress). Results: Notably, 9.0% of physicians exhibited burnout syndrome. Working in shifts for more than eight hours a day, having work-family conflict, psychological inflexibility, and perceived loneliness were associated with an increased risk of suffering burnout. Meanwhile, being a woman was associated with a decrease in risk. The presence of burnout significantly increased the risk of experiencing depressive and stress symptoms. Conclusions: Clearly, a significant number of medical professionals suffer from burnout. As such, stakeholders should promote the develop-ment of prevention programs that incorporate the insights from this and other studies to design effective psychological interventions for burnout adapted to the specific needs of this population.

Background: Due to the accessibility barriers of in-person programs for active aging, the development of programs that use innovative technologies is needed. Video games can be an engaging tool for disseminating active aging interventions. Objective: The objective of this pilot study was to analyze the feasibility of a cognitive–behavioral intervention to promote active aging administered through a video game. Methods: Fifty-five participants (63.6% women, mean age = 53.0 years) were randomly assigned to a cognitive–behavioral intervention to promote active aging administered through an interactive multimedia online video game with a complementary app (CBI-V; n = 29) or to a control group that received nonspecific online information (CG; n = 26). Results: Only 3.6% of the participants dropped out of the study (6.9% in CBI-V and 0.0% in CG; without significant differences between groups). The mean number of modules completed was 7.6 (SD = 0.9) out of 8 in the CBI-V and 7.9 (SD = 0.5) in the control group (CG), without significant between-group differences. In the CBI-V, the mean total time dedicated to the game was 516.8 min (SD = 94.3), including 143.2 min (SD = 31.6) of cognitive training tasks, and the mean of completed tasks was 206.2 (SD = 33.7) out of 259. Participants were highly engaged (M = 39.9, SD = 8.6) and satisfied (M = 25.8, SD = 4.5) with the intervention. After the intervention, the CBI-V group significantly improved on SF-36 dimensions of General Health (p = .0386), Vitality (p = .0283), Social Functioning (p = .0130), and Physical Summary Index (p = .0370) compared to the CG, with medium effect sizes (d = 0.56–0.75). Conclusions: The results demonstrate the feasibility of the video game intervention to promote active aging and encourage conducting a large-scale randomized controlled trial.

Due to the limited availability of in-person interventions for caregivers, the development of effective programs that use new technologies to prevent depression is needed. The goal of this research was to assess the efficacy of a cognitive behavioral intervention for the prevention of depression, administered to nonprofessional caregivers through a smartphone application (app). One hundred and seventy-five caregivers were randomly assigned to either an app-based cognitive behavioral intervention (CBIA), the CBIA intervention plus a telephone conference call (CBIA + CC), or an attention control group (ACG). At post-intervention, the incidence of depression was lower in the CBIA and CBIA + CC compared to the ACG (1.7% and 0.0% vs. 7.9%, respectively). The absolute risk, relative risk, and number needed to treat compared to the ACG were 6.2%, 21.6%, and 16 for the CBIA, whilst they were 8%, 0.0%, and 13 for the CBIA + CC. Depressive symptomatology was significantly lower in the CBIA and CBIA + CC compared to the ACG (d = 0.84, Cliff’s δ = 0.49; d = 1.56, Cliff’s δ = 0.72), as well as in the CBIA + CC compared to the CBIA (d = 0.72, Cliff’s δ = 0.44). The prevention of depression was more likely in participants who received the CBIA, and adding the conference call in the CBIA + CC group improved the likelihood of this.

Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese older adults with cognitive impairment. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a sample of Portuguese older adults with mild-to-moderate cognitive impairment. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild-to-moderate cognitive decline (76.9% female, M_age = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with the Beck Depression Inventory-II (GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in the identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking older adults with cognitive impairment.

Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese cognitively impaired persons. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a Portuguese mild-to-moderate cognitively impaired sample. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild to moderate cognitive decline (76.9% female, Mage = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with Beck Depression Inventory-II GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking cognitively impaired persons.

Although sleep issues are among the symptoms commonly experienced by the non-professional caregiver population, and the Pittsburgh Sleep Quality Index (PSQI) is the most widely used instrument for the assessment of sleep quality, this has not been validated specifically for this population. The objective of this study was to analyze the factorial structure and psychometric properties of the Spanish version of the PSQI in a sample of Spanish non-professional caregivers. Trained clinical psychologists assessed sleep quality using the PSQI, as well as caregiver burden and psychological distress in 201 non-professional caregivers (87.1% female, M_age = 56.2 years). The internal consistency of the PSQI was 0.75. The two-factor model (Sleep quality and Disturbances) had an acceptable fit to the data, was found to be superior to the one-factor model, and more parsimonious than the three-factor model. There was a significant correlation between the PSQI and caregiver burden, as well as between the PSQI and psychological distress (p < 0.001 in all cases). A total score ≥ 9 allowed the identification of caregivers with possible anxiety and depression disorders (sensitivity 70.5%, specificity 71.9%). The results show that the PSQI is a reliable and valid instrument for the assessment of sleep quality in caregivers.

This case-control study analyzed the sleep disturbance, psychological distress and perceived burden in female family caregivers of dependent people with dementia (n = 74) compared with female family caregivers of dependent people without dementia (n = 74) and with age-matched non-caregiver control females (n = 74). Participants completed the Pittsburgh Sleep Quality Index (PSQI), the 12-item General Health Questionnaire (GHQ-12), the Caregiver Burden Inventory (CBI) and an ad hoc questionnaire to collect sociodemographic data. There were significant differences between the groups in PSQI total (F = 24.93; p < 0.001), psychological distress (F = 26.71; p < 0.001) and in all sleep domains assessed: subjective sleep quality (F = 16.19; p < 0.001), sleep latency (F = 9.5; p< 0.001), sleep duration (F = 18.57; p < 0.001), habitual sleep efficiency (F = 19.77; p < 0.001), sleep disturbances (F = 9.22; p < 0.001), use of sleep medications (F = 4.24; p< 0.01) and daytime dysfunction (F = 5.57; p < 0.01). In all measures, the female family caregivers of dependent people with dementia showed the significantly higher mean scores. Regarding the two groups of female caregivers, statistically significant differences were found in daily hours of care (t = −2.45; p < 0.05) and perceived burden (t = −3.65; p < 0.001), as well as in the following dimensions of caregiver burden: time-dependence burden (t = −5.09; p < 0.001), developmental burden (t = −2.42; p < 0.05) and physical burden (t = −2.89; p < 0.01). These findings suggest that female family caregivers of dependent patients with dementia should be subject to psychopathological screening and preventive cognitive-behavioral interventions in clinical practice in primary health care.