Stimulant medication and psychotic symptoms in offspring of parents with mental illness

BACKGROUND: Stimulants, such as methylphenidate, are among the most commonly used medications in children and adolescents. Psychotic symptoms have been reported as rare adverse reactions to stimulants but have not been systematically inquired about in most previous studies. Family history of mental illness may increase the vulnerability to drug-induced psychotic symptoms. We examined the association between stimulant use and psychotic symptoms in sons and daughters of parents with major mood and psychotic disorders. METHODS: We assessed psychotic symptoms, psychotic-like experiences, and basic symptoms in 141 children and youth (mean ± SD age: 11.8 ± 4.0 years; range: 6–21 years), who had 1 or both parents with major depressive disorder, bipolar disorder, or schizophrenia, and of whom 24 (17.0%) had taken stimulant medication. RESULTS: Psychotic symptoms were present in 62.5% of youth who had taken stimulants compared with 27.4% of participants who had never taken stimulants. The association between stimulant use and psychotic experiences remained significant after adjustment for potential confounders (odds ratio: 4.41; 95% confidence interval: 1.82–10.69; P = .001) and was driven by hallucinations occurring during the use of stimulant medication. A temporal relationship between use of stimulants and psychotic symptoms was supported by an association between current stimulant use and current psychotic symptoms and co-occurrence in cases that were assessed on and off stimulants. CONCLUSIONS: Psychotic symptoms should be monitored during the use of stimulants in children and adolescents. Family history of mood and psychotic disorders may need to be taken into account when considering the prescription of stimulants.

Use of pneumococcal vaccine in people with chronic disease in United States

Objective. The risk of complications and deaths related to pneumococcal infections is high among high risk population (i.e. those with chronic diseases such as diabetes or asthma), despite current immunization recommendations. The aim of this study is to evaluate the use of pneumonia vaccine in adults with and without diabetes or asthma by year of age and whether immunization practices conform to policy recommendations. ^ Methods. Data were drawn from 2005 Behavioral Risk Factor Surveillance Study. Age specific estimated counts and proportions of pneumonia vaccination status were computed. The association of socio-demographic factors with vaccination status was estimated from multiple logistic regression and results were presented for adults (18-64yrs) and elderly (65 or older). ^ Results. Overall 12.3% of the adults and 61.5% of elderly reported ever received pneumonia vaccine. 66.8% of diabetics and 72.6% of asthmatics received the vaccine among elderly. 33.4% of diabetics and 21.6% of asthmatics received the vaccine among adults. These numbers are far away from Healthy people 2010 objective coverage rates of 90% for elderly and 60% for high risk adults. Though diabetes was one of the recommendations for the pneumonia vaccine still the status was less than 70% even at older ages. Although asthma was not an indication for pneumonia vaccine, asthmatics still achieved 50% level by an early age of 60 and reached up to 80% at as early as 75 years. In those having both asthma and diabetes, although the curve reaches to 50% level at a very early age of 40yrs, it is not stable until the age of 55 and percentages reached to as high as 90% in older ages. Odds of receiving pneumonia vaccine were high in individuals with diabetes or asthma in both the age groups. But the odds were stronger for diabetics in adults compared to those in the elderly [2.24 CI (2.08-2.42) and 1.32 CI (1.18-1.47)]. The odds were slightly higher in adults than in elderly for asthmatics [1.92 CI (1.80-2.04) and 1.73 CI (1.50-2.00)].The likelihood of vaccination also differed by gender, ethnicity, marital status, income category, having a health insurance, current employment, physician visit in last year, reporting of good to excellent health and flu vaccine status. ^ Conclusion. There is a very high proportion of high risk adults and elderly that remain unvaccinated. Given the proven efficacy and safety of vaccine there is a need for interventions targeting the barriers for under-vaccination with more emphasis on physician knowledge and practice as well as the recipient attitudes.^

Is sexual intimacy among older adults positively associated with mental well-being?

Background. The elderly population aged 60 and above is increasing rapidly throughout the world. The aging process affects physical health of individuals, which in turn affects sexuality and sexual activity. However, many elderly adults continue to engage in one or more forms of sexual activities well into their 70s, 80s, and even in 90s. Despite the widespread stereotypes, misconceptions, and negative attitudes surrounding sexuality in elderly adults, it has been found to be an important aspect of the health of the elderly. However, association between the frequency of sexual activity and mental well being among older adults has not been documented in the literature. ^ Methods. To test the hypotheses that mental well being indicators such as depression, anxiety, and stress were inversely associated with greater frequency of sexual intimacy, a secondary data analysis was conducted using the National Social Life Health and Aging Project (NSHAP) using multivariate logistic regression. The NSHAP was a population-based study that was conducted on a national scale including 1455 men and 1550 women aged 57-85.^ Results. Approximately 1430 (54.1%) of the total population reported being sexually intimate in the past 12 months whereas 1481 (45.9%) participants reported that they did not perform any sexual activity in the past 12 months. In addition, approximately 895(31.1%) participants reported engaging in sexual activity ≥ 2-3 times per month with 665 (78.9%) of these participants reported performing vaginal intercourse only, 14(2.0%) oral sex only, and 89(10.5%) reported performing both vaginal intercourse and oral sex. Controlling for socio-demographic characteristics, frequently (≥2-3 times per month) sexually active participants showed lower odds ratio of depression (OR= 0.60; 95%CI = 0.46, 0.78), anxiety (OR= 0.67; 95% CI= 0.53, 0.86), and stress (OR=0.73; 95% CI = 0.6, 0.88) compared to those who had less frequent sexual activity or who had no sexual activity in the past 12 months.^ Conclusion. Lower levels of depression, anxiety, and stress appear to be associated with greater frequency of sexual activity. Public health interventions should focus on educating elderly adults about their sexual health and how to seek medical help for their sexual problems. Public health professionals should also be educated on how to best assess sexual needs of the elderly adults.^

End -of -life planning and decision -making: Implications for adults with mental retardation

This research focused on the topic of end-of-life planning and decision-making for adults affected by mental retardation. Adults with mental retardation have unique challenges in this regard, including difficulty communicating their wishes without assistance and diminished decision-making skills. The primary research objective was to identify factors that can affect opportunities for adults with mental retardation in community-based services settings (and their advocates) to be involved in planning and deciding about their own end-of-life experience. ^ A descriptive qualitative inquiry was designed to explore issues related to death and dying, and the notion of end-of-life planning, from the perspective of adults with mental retardation who receive publicly-funded community services ("clients") and family members of individuals who receive such services. Study participants were recruited from a single mental retardation service provider in a large urban setting (the "Agency"). Sixteen clients and 14 families of Agency clients took part. Client data collection was accomplished through face-to-face interviews, focus group meetings, and record reviews; family members were involved in a face-to-face interview only. ^ An initial coding scheme was developed based upon literature and policy reviews, and themes related to the research questions. Analysis involved extracting data from transcripts and records and placing it into appropriate thematic categories, building support for each theme with the accumulated data. Coding themes were modified to accommodate new data when it challenged existing themes. ^ Findings suggest that adults with mental retardation do have the requisite knowledge, interest, and ability to participate in decisions about their end-of-life experience and handling of affairs. Siblings are overwhelmingly the chosen future surrogates and they (or their children) will likely be the end-of-life advocates for their brothers and sisters affected by mental retardation. Findings further point to a need for increased awareness, accurate information, and improved communication about end-of-life issues, both in general and particular to adults affected by mental retardation. Also suggested by the findings is a need to focus on creating accommodations and adaptations that can best uncover a person's authentic views on life and death and related end-of-life preferences. Practical implications and suggestions for further research are also discussed. ^

Herramienta de control de dispositivo móvil mediante un ordenador

Este trabajo fin de máster se integra con el sistema Localiza, un sistema previamente desarrollado para la localización bajo demanda de personas que requieran un cierto grado de supervisión. El proyecto amplia las funciones del sistema Localiza, añadiendo una nueva funcionalidad que permita a un usuario con movilidad reducida controlar su dispositivo móvil a través de su ordenador personal. Este proyecto se integra con el proyecto Localiza bajo el título: “Desarrollo de una herramienta software para el manejo de un teléfono móvil adaptada a personas con discapacidad física severa”. El proyecto citado se centra en el desarrollo de una aplicación móvil, que se comunicara con el ordenador personal del usuario. El desarrollo del sistema residente en el ordenador personal, es el ámbito central que ocupa a este trabajo fin de Master. El usuario final al que está destinada la aplicación desarrollada en este proyecto, es un usuario con grado de discapacidad motórica, de forma que con ligeros movimientos de cabeza sea capaz de controlar remotamente el terminal móvil a través de un ordenador personal. El objetivo principal del proyecto es el control remoto de un terminal móvil desde un ordenador personal. La comunicación entre el terminal móvil y el ordenador personal se ha realizado bajo el protocolo Bluetooth. Para desarrollar la aplicación residente en el ordenador personal, se ha utilizado la plataforma Java. SUMMARY. This Master Tesis develops an application, which is intended to provide an added value to the already existing project Localiza, on-demand position system for people with severe disabilities. This project extends the functions of the Localiza system, adding a new feature that allows a user with limited mobility to control their mobile device. This project is integrated with the project under the title: “Desarrollo de una herramienta software para el manejo de un teléfono móvil adaptada a personas con discapacidad física severa”. The above project it is focused on the development of mobile application and the development of the application that resides in the personal computer is the main work of this project. Both projects are closely related and together they complement. The end-user of the application that is developed in this project is a person with motor disabilities. This person may control the computer mouse with slight head movements. The aim of this project is to facilitate the access to the personal computer and to the mobile telephony environment for disabled people. The Communication between the mobile and personal computer has been conducted under the Bluetooth protocol. To develop the application resident on the personal computer have been used the Java platform.

Performance assessment of an architecture with adaptative interfaces for people with special needs

People in industrial societies carry more and more portable electronic devices (e.g., smartphone or console) with some kind of wireles connectivity support. Interaction with auto-discovered target devices present in the environment (e.g., the air conditioning of a hotel) is not so easy since devices may provide inaccessible user interfaces (e.g., in a foreign language that the user cannot understand). Scalability for multiple concurrent users and response times are still problems in this domain. In this paper, we assess an interoperable architecture, which enables interaction between people with some kind of special need and their environment. The assessment, based on performance patterns and antipatterns, tries to detect performance issues and also tries to enhance the architecture design for improving system performance. As a result of the assessment, the initial design changed substantially. We refactorized the design according to the Fast Path pattern and The Ramp antipattern. Moreover, resources were correctly allocated. Finally, the required response time was fulfilled in all system scenarios. For a specific scenario, response time was reduced from 60 seconds to less than 6 seconds.

Using cloud technologies for engaging people with cultural heritage

Cultural heritage is an important asset of Europe which is largely underexplored. One of the main reasons is that the general public do not really incorporate cultural activities in their life style. Currently, curators and professionals in the heritage sector face the toughest challenges on how to attract, engage and retain visitors of heritage institutions (libraries, museums, archives and historical societies). TAG CLOUD FP7 European project seeks to overcome this situation and promote lifelong engagement with culture by personalising the visitors? cultural experiences through cloud technologies.

Análisis sistemático de pautas para la accesibilidad TIC para personas con discapacidad cognitiva

Este trabajo de investigación presenta los resultados de una revisión sistemática realizada a partir de la recopilación, lectura y análisis de distintas fuentes bibliográficas dentro de un conjunto heterogéneo consistente de 175 estudios que forman la base bibliográfica actual del documento “Cognitive Accessibility User Research” (W3C, 2015a) del W3C. Esta base bibliográfica está compuesta por publicaciones científicas basadas en libros, artículos, conferencias y sitios Web especializados, en los cuales se potencia como objeto particular de análisis, la indagación en la búsqueda de pautas de accesibilidad en las tecnologías Web que apoyen la integración a personas con discapacidad cognitiva. Como parte de este proceso de investigación se ha recopilado y descrito la situación actual, particularmente, de los retos en la utilización de las tecnologías de la información y la comunicación (TIC) en relación a personas con dificultades de aprendizaje o discapacidades cognitivas, tales como la Dislexia, Afasia, Trastorno de Aprendizaje No verbal, Envejecimiento-Demencia, Trastornos por Déficit de Atención con o sin Hiperactividad, Autismo, Síndrome de Down y Discalculia. Como aporte primordial de este Trabajo Fin de Master (TFM), se intenta trazar una línea de criterios que permitan la evaluación objetiva de este tópico, con miras a ofrecer un enfoque práctico y reciente sobre ésta temática, mostrando de forma esquematizada las pautas existentes y sirviendo de síntesis orientativa para el diseño accesible de las TIC con la finalidad de promover un soporte real a personas con los tipo de discapacidad cognitiva en los que se ha enfocado esta investigación. Logrando obtener como resultado principal de este estudio, 36 pautas generales que agrupan las coincidencias del grupo de discapacidades estudiadas y que han sido distribuidas en categorías: texto, navegación y generales, para su mejor interpretación y manejo de la Accesibilidad en las TIC´S para Personas con Discapacidad Cognitiva.---ABSTRACT---This research presents the results of a systematic review from collecting, reading and analysis of different bibliographic sources within a heterogeneous group consisting of 175 studies that form the basis of current literature document "Accessibility User Cognitive Research" (W3C , 2015th) of the W3C. This bibliographic database is composed of scientific publications based on books, articles, lectures and specialized Web sites, in which is enhanced as a particular object of analysis, the inquiry into the search for accessibility guidelines for Web technologies to support integration of people with cognitive disabilities. As part of this research process, the current situation has been collected and described, particularly the challenges in the use of information and communications technology (ICT) in relation to people with learning disabilities or cognitive disabilities, such as Dyslexia, aphasia, nonverbal learning disorder, aging-Dementia, Attention Deficit Disorders with or without hyperactivity, autism, Down syndrome and dyscalculia. As primary contribution of this Master's Thesis (TFM), it tries to draw a line of criteria to allow an objective assessment of this topic, in order to provide a practical and recent focus on this theme, showing schematically existing guidelines and serving as guidance for accessible design of ICT in order to promote a real support to people with cognitive disabilities where this research has focused on. Managing to obtain the main result of this study, 36 general guidelines that group the set of disabilities studied and have been distributed in categories: text, navigation and general, for better interpretation and management of ICTs for Accessibility people with cognitive disabilities.

Evaluación del tiempo de reacción en velocistas con y sin discapacidad auditiva: aplicaciones para la inclusión

Este trabajo de investigación trata de aportar luz al estudio del tiempo de reacción (TR) en velocistas con y sin discapacidad auditiva desde las Ciencias del Deporte. El planteamiento del presente estudio surgió al cuestionarnos la existencia de las diferencias en cuanto al TR visual y auditivo aplicado a velocistas con y sin discapacidad auditiva, pensando en el desarrollo futuro de competiciones inclusivas entre ambos colectivos. Por ello, este estudio trata de resolver las dificultades que los velocistas con discapacidad se encuentran habitualmente en las competiciones. A priori, los atletas con discapacidad auditiva compiten en inferioridad de condiciones como consecuencia de una salida que no parece la más adecuada para ellos (desde los tacos, han de mirar hacia la pistola del juez o el movimiento de un rival). El documento se divide en tres partes. En la primera parte se realiza la pertinente revisión del marco teórico y justificación del estudio. La segunda parte se centra en los objetivos de la investigación, el material y el método, donde se muestran los resultados, discusión y conclusiones del estudio realizado, así como las limitaciones del presente trabajo y sus futuras líneas de investigación. La tercera parte corresponde a la bibliografía y la cuarta parte a los anexos. En la primera parte, presentamos el marco teórico compuesto por cinco capítulos organizan la fundamentación que hemos realizado como revisión sobre los aspectos más destacados del TR, determinado por las características de la tarea y otros factores que influyen en el TR como objeto de nuestro estudio. Después exponemos los principales aspectos estructurales y funcionales del sistema nervioso (SN) relacionados con el TR visual y auditivo. Tras ello se expone la realidad del deporte para personas con discapacidad auditiva, indagando en sus peculiaridades y criterios de elegibilidad que tiene ese colectivo dentro del ámbito deportivo. A continuación abordamos el estudio de la salida de velocidad en el atletismo, como aspecto clave que va a guiar nuestra investigación, especialmente los parámetros determinantes en la colocación de los tacos de salida para atletas con y sin discapacidad auditiva, la posición de salida y la propia colocación de los estímulos en dicha situación. Es la segunda parte se desarrolla el trabajo de investigación que tiene como objetivos estudiar los valores de TR visual simple manual, TR en salida de tacos y los tiempos de desplazamiento a los 10m y 20m de velocistas con y sin discapacidad auditiva, así como analizar las posibles diferencias en TR según posición y tipo de estímulo luminoso, respecto a ambos grupos de atletas. Como tercer objetivo de estudio se evalúa cualitativamente, por parte de los propios atletas, el dispositivo luminoso utilizado. La toma de datos de este estudio se llevó a cabo entre los meses de febrero y mayo del 2014, en el módulo de atletismo del Centro de Alto Rendimiento Joaquín Blume (Madrid), con dos grupos de estudio, uno de 9 velocistas con discapacidad auditiva (VDA), conformando éstos el 60% de toda la población en España, según el número de las licencias de la FEDS en la modalidad de atletismo (velocistas, pruebas de 100 y 200 m.l.), en el momento del estudio, y otro de 13 velocistas sin discapacidad (VsDA) que se presentaron de manera voluntaria con unos mismos criterios de inclusión para ambos grupos. Para la medición y el registro de los datos se utilizaron materiales como hoja de registro, Medidor de Tiempo de Reacción (MTR), tacos de salida, ReacTime®, dispositivo luminoso conectado a los tacos de salida, células fotoeléctricas, ordenador y software del ReacTime, y cámara de video. La metodología utilizada en este estudio fue de tipo correlacional, analizando los resultados del TR simple manual según vía sensitiva (visual y auditiva) entre los dos grupos de VDA y VsDA. También se estudiaron los TR desde la salida de tacos en función de la colocación del dispositivo luminoso (en el suelo y a 5 metros, vía visual) y pistola de salida atlética (vía auditiva) así como el tiempo de desplazamiento a los 10m (t10m) y 20m (t20m) de ambos grupos de velocistas. Finalmente, se desarrolló y llevó a cabo un cuestionario de evaluación por parte de los atletas VDA con el objetivo de conocer el grado de satisfacción después de haber realizado la serie de experimentos con el dispositivo luminoso y adaptado para sistemas de salida en la velocidad atlética. Con el objetivo de comprobar la viabilidad de la metodología descrita y probar en el contexto de análisis real el protocolo experimental, se realizó un estudio piloto con el fin de conocer las posibles diferencias del TR visual desde los tacos de salida en velocistas con discapacidad auditiva, usando para dicha salida un estímulo visual mediante un dispositivo luminoso coordinado con la señal sonora de salida (Soto-Rey, Pérez-Tejero, Rojo-González y Álvarez-Ortiz, 2015). En cuanto a los procedimientos estadísticos utilizados, con el fin de analizar la distribución de los datos y su normalidad, se aplicó la prueba de Kolmogorov-Smirnof, dicha prueba arrojó resultados de normalidad para todas las variables analizadas de las situaciones experimentales EA, EVsuelo y EV5m. Es por ello que en el presente trabajo de investigación se utilizó estadística paramétrica. Como medidas descriptivas, se calcularon el máximo, mínimo, media y la desviación estándar. En relación a las situaciones experimentales, para estudiar las posibles diferencias en las variables estudiadas dentro de cada grupo de velocistas (intragrupo) en la situación experimental 1 (MTR), se empleó una prueba T de Student para muestras independientes. En las situaciones experimentales 2, 3 y 4, para conocer las diferencias entre ambos grupos de velocistas en cada situación, se utilizó igualmente la prueba T para muestras independientes, mientras que un ANOVA simple (con post hoc Bonferroni) se utilizó para analizar las diferencias para cada grupo (VDA y VsDA) por situación experimental. Así mismo, se utilizó un ANOVA de medidas repetidas, donde el tipo de estímulo (situación experimental) fue la variable intra-grupo y el grupo de velocistas participantes (VDA y VsDA) la entre-grupo, realizándose esta prueba para evaluar en cada situación el TR, t1m0 y t20m y las interacciones entre las variables. Para el tratamiento estadístico fue utilizado el paquete estadístico SPSS 18.0 (Chicago, IL, EEUU). Los niveles de significación fueron establecidos para un ≤0.05, indicando el valor de p en cada caso. Uno de los aspectos más relevantes de este trabajo es la medición en diferentes situaciones, con instrumentación distinta y con situaciones experimentales distintas, del TR en velocistas con y sin discapacidad auditiva. Ello supuso el desarrollo de un diseño de investigación que respondió a las necesidades planteadas por los objetivos del estudio, así como el desarrollo de instrumentación específica (Rojo-Lacal, Soto-Rey, Pérez-Tejero y Rojo-González, 2014; Soto-Rey et al., 2015) y distintas situaciones experimentales que reprodujeran las condiciones de práctica y competición real de VsDA y VDA en las pruebas atléticas de velocidad, y más concretamente, en las salidas. El análisis estadístico mostró diferencias significativas entre los estímulos visuales y sonoros medidos con el MTR, siendo menor el TR ante el estímulo visual que ante el sonoro, tanto para los atletas con discapacidad auditiva como para los que no la presentaron (TR visual, 0.195 s ± 0.018 vs 0.197 s ± 0.022, p≤0.05; TR sonoro 0.230 s ± 0.016 vs 0.237 s ± 0.045, p≤0.05). Teniendo en cuenta los resultados según población objeto de estudio y situación experimental, se registraron diferencias significativas entre ambas poblaciones, VDA y VsDA, siendo más rápidos los VDA que VsDA en la situación experimental con el estímulo visual en el suelo (EVsuelo, 0.191 ±0.025 vs 0.210 ±0.025, p≤0.05, respectivamente) y los VsDA en la situación experimental con el estímulo auditivo (EA, 0.396 ±0.045 vs 0.174 ±0.021, p≤0.05), aunque sin diferencias entre ambos grupos en la situación experimental con el estímulo visual a 5m de los tacos de salida. Es de destacar que en el TR no hubo diferencias significativas entre EA para VsDA y EVsuelo para VDA. El ANOVA simple registró diferencias significativas en todas las situaciones experimentales dentro de cada grupo y para todas las variables, por lo que estadísticamente, las situaciones experimentales fueron diferentes entre sí. En relación al de ANOVA medidas repetidas, la prueba de esfericidad se mostró adecuada, existiendo diferencias significativas en las varianzas de los pares de medias: el valor de F indicó que existieron diferencias entre las diferentes situaciones experimentales en cuanto a TR, incluso cuando éstas se relacionaban con el factor discapacidad (factor interacción, p≤0,05). Por ello, queda patente que las situaciones son distintas entre sí, también teniendo en cuenta la discapacidad. El η2 (eta al cuadrado, tamaño del efecto, para la interacción) indica que el 91.7% de la variación se deben a las condiciones del estudio, y no al error (indicador de la generalización de los resultados del estudio). Por otro lado, la evaluación del dispositivo luminoso fue positiva en relación a la iluminación, comodidad de uso, ubicación, color, tamaño, adecuación del dispositivo y del equipamiento necesario para adaptar al sistema de salida. La totalidad de los atletas afirman rotundamente que el dispositivo luminoso favorecería la adaptación al sistema de salida atlética para permitir una competición inclusiva. Asimismo concluyen que el dispositivo luminoso favorecería el rendimiento o mejora de marca en la competición. La discusión de este estudio presenta justificación de las diferencias demostradas que el tipo de estímulo y su colocación son clave en el TR de esta prueba, por lo que podríamos argumentar la necesidad de contar con dispositivos luminosos para VDA a la hora de competir con VsDA en una misma prueba, inclusiva. El presente trabajo de investigación ha demostrado, aplicando el método científico, que el uso de estos dispositivos, en las condiciones técnicas y experimentales indicadas, permite el uso por parte del VDA, usando su mejor TR visual posible, que se muestra similar (ns) al TR auditivo de VsDA, lo que indica que, para competiciones inclusivas, la salida usando el semáforo (para VDA) y la salida habitual (estímulo sonoro) para VsDA, puede ser una solución equitativa en base a la evidencia demostrada en este estudio. De esta manera, y como referencia, indicar que la media de los TR de los velocistas en la final de los 100 m.l. en los Juegos Olímpicos de Londres 2012 fue de 0.162 ±0.015. De esta manera, creemos que estos parámetros sirven de referencia a técnicos deportivos, atletas y futuros trabajos de investigación. Las aplicaciones de este trabajo permitirán modificaciones y reflexiones en forma de apoyo al entrenamiento y la competición para el entrenador, o juez de salida en la competición que, creemos, es necesaria para proporcionar a este colectivo una atención adecuada en las salidas, especialmente en situaciones inclusivas de práctica. ABSTRACT This research aims to study of reaction time (RT) in sprinters with and without hearing impairment from the Sports Science perspective. The approach of this study came asking whether there were differences in the visual and auditory RT applied to sprinters with and without hearing impairment, thinking about the future development of inclusive competition between the two groups. Therefore, this study attempts to resolve the difficulties commonly founded by sprinters with hearing impairments during competitions. A priori, sprinters with hearing impairment would compete in a disadvantage situation as a result of the use of a staring signal not suitable for them (from the blocks, they have to look to the judge´s pistol or the movement of an opponent). The document is divided into three parts. In the first part of the review of relevant theoretical framework and justification of the study is presented. The second part focuses on the research objectives, material and method, where results, discussion and conclusions of the study, as well as the limitations of this study and future research are presented. The third part contains references and the fourth, annexes. In the first part, we present the theoretical framework consisting of five chapters, organizing the state of the art of RT, determined by the characteristics of the task and other factors that influence the RT as object of our study. Then we present the main structural and functional aspects of the nervous system associated with visual and auditory RT. After that, sport for people with hearing disabilities is presented, investigating its peculiarities and eligibility criteria is that group within the deaf sport. Finally, we discuss the theoretical foundation of the study of start speed in athletics as a key aspect that will guide our research, especially the determining parameters in placing the starting blocks for athletes with and without hearing impairment, the starting position and the actual placement of stimuli in such a situation. The second part of the research aims to study the values of simple manual visual RT, RT start from blocks and travel times up to 10m and 20m of sprinters with and without hearing impairment, and to analyze possible differences in RT as position and type of light stimulus with respect to both groups of athletes. The third objective of the study is to assess the pertinence of the lighting device developed and used in the study, in a qualitatively way by athletes themselves. Data collection for this study was carried out between February and May 2014, in the Athletics module at the High Performance Centre Joaquin Blume (Madrid) with the two study groups: 9 sprinters with hearing impairments(VDA, reaching 60% of the population in Spain, according to the number of licenses for athletics at FEDS: sprint, 100 and 200 m.l., at the time of the study), and another 13 sprinters without disability (VsDA) who voluntarily presented themselves, with same inclusion criteria for both groups. For measuring and data collection materials such as recording sheet, gauge reaction time (MTR), starting blocks, ReacTime®, luminous device connected to the starting blocks, photocells, computer and software ReacTime, and video camera were used. The methodology used in this study was correlational, analyzing the results of simple manual RT according sensory pathway (visual and auditory) between the two groups (VsDA and VDA). Also auditory and visual RT was studied depending the placement of the start light signal (on the ground and 5 meters, visual pathway) and athletic start gun signal (auditory pathway, conventional situation) and travel time up to 10m (t10m) and 20m (t20m) for both groups of sprinters. Finally, we developed and carried out an evaluation questionnaire for VDA athletes in order to determine the degree of satisfaction after completing the series of experiments with lighting device and adapted to start systems in athletic speed. In order to test the feasibility of the methodology described and tested in the context of real analysis of the experimental protocol, a pilot study in order to know the possible differences visual RT from the starting blocks in sprinters with hearing impairments was performed, to said output using a visual stimulus coordinated by a lighting device with sound output signal (Soto-Rey Perez-Tejero, Rojo-González y Álvarez-Ortiz, 2015). For the statistical procedures, in order to analyze the distribution of the data and their normality, Kolmogorov-Smirnov test was applied, this test yielded normal results for all variables analyzed during EA, EVsuelo and EV5m experimental situations. Parametric statistics were used in this research. As descriptive measures, the maximum, minimum, mean and standard deviation were calculated. In relation to experimental situations, to study possible differences in the variables studied in each group sprinters (intragroup) in the experimental situation 1 (MTR), a Student t test was used for independent samples. Under the experimental situations 2, 3 and 4, to know the differences between the two groups of sprinters in every situation, the T test for independent samples was used, while a simple ANOVA (with post hoc Bonferroni) was used to analyze differences for each group (VDA and VsDA) by experimental situation. Likewise, a repeated measures ANOVA, where the type of stimulus (experimental situation) was variable intra-group and participants sprinters group (VDA and VsDA) the variable between-group, was performed to assess each situation for RT, t10m and t20m, and also interactions between variables. For the statistical treatment SPSS 18.0 (Chicago, IL, USA) was used. Significance levels were set for  ≤0.05, indicating the value of p in each case. One of the most important aspects of this work is the measurement of RT in sprinters with and without hearing impairment in different situations, with different instrumentation and different experimental situations. This involved the development of a research design that responded to the needs raised by the study aims and the development of specific instrumentation (Rojo-Lacal, Soto-Rey Perez-Tejero and Rojo-Gonzalez, 2014; Soto-Rey et al., 2015) and different experimental situations to reproduce the conditions of practical and real competition VsDA and VDA in athletic sprints, and more specifically, at the start. Statistical analysis showed significant differences between the visual and sound stimuli measured by the MTR, with lower RT to the visual stimulus that for sound, both for athletes with hearing disabilities and for those without (visual RT, 0.195 s ± 0.018 s vs 0.197 ± 0.022, p≤0.05; sound RT 0.230 s ± 0.016 vs 0.237 s ± 0.045, p≤0.05). Considering the results according to study population and experimental situation, significant differences between the two populations, VDA and VsDA were found, being faster the VDA than VsDA in the experimental situation with the visual stimulus on the floor (EVsuelo, recorded 0.191 s ± 0.025 vs 0.210 s ± 0.025, p≤0.05, respectively) and VsDA in the experimental situation with the auditory stimulus (EA, 0.396 s ± 0.045 vs 0.174 s ± 0.021, p≤0.05), but no difference between groups in the experimental situation with the 5m visual stimulus to the starting blocks. It is noteworthy that no significant differences in EA and EVsuelo between VsDA to VDA, respectively, for RT. Simple ANOVA showed significant differences in all experimental situations within each group and for all variables, so statistically, the experimental situations were different. Regarding the repeated measures ANOVA, the sphericity test showed adequate, and there were significant differences in the variances of the pairs of means: the value of F indicated that there were differences between the different experimental situations regarding RT, even when they were related to the disability factor (factor interaction, p≤0.05). Therefore, it is clear that the situations were different from each other, also taking into account impairment. The η2 (eta squared, effect size, for interaction) indicates that 91.7% of the variation is due to the conditions of the study, not by error (as indicator of the generalization potential of the study results). On the other hand, evaluation of the light signal was positively related to lighting, ease of use, location, color, size, alignment device and equipment necessary to adapt the start system. All the athletes claim strongly in favor of the lighting device adaptation system to enable athletic competition inclusive. Also they concluded that light device would enhance performance or would decrease their RT during the competition. The discussion of this study justify the type of stimulus and the start light positioning as key to the RT performance, so that we could argue the need for lighting devices for VDA when competing against VsDA the same competition, inclusive. This research has demonstrated, applying the scientific method, that the use of these devices, techniques and given experimental conditions, allows the use of the VDA, using his best visual RT, shown similar (ns) auditory RT of VsDA, indicating that for inclusive competitions, the start signal using the light (for VDA) and the usual start (sound stimulus) to VsDA can be an equitable solution based on the evidence shown in this study. Thus, and as a reference, indicate that the average of the RT sprinters in the 100 m. final at the 2012 Summer Olympic Games was 0.162 s ± 0.015. Thus, we believe that these parameters become a reference to sports coaches, athletes and future research. Applications of this work will allow modifications and reflections in the form of support for training and competition for the coach, or judge, as we believe is necessary to provide adequate attention to VDA in speed starts, especially in inclusive practice situations.

Sistema de orientación en espacios interiores mediante balizas digitales

El planteamiento inicial de este proyecto surge debido a que hay personas con discapacidad cognitiva que se desorientan con mucha facilidad en espacios interiores. Para guiar a esas personas no se pueden usar los sistemas basados en GPS que se utilizan hoy en día en vehículos, ya que estos sistemas no funcionan en lugares cerrados porque no reciben la señal de los satélites. Por consiguiente se ha propuesto una solución basada en otra tecnología para que estas personas, a través de su dispositivo móvil, puedan guiarse en un sitio cerrado. Este Trabajo de Fin de Grado parte inicialmente de un Practicum realizado en el semestre anterior, donde se investigó sobre posibles soluciones de balizas digitales (iBeacons) y se estudió la tecnología iBeacon para conocer la posición del móvil en un espacio cerrado. El principal problema que se encontró fue la falta de precisión a la hora de estimar la distancia (en metros) que hay entre baliza y dispositivo móvil. El objetivo para este trabajo de fin de grado ha sido primeramente resolver el problema comentado anteriormente y una vez resuelto, implementar un prototipo móvil para el sistema operativo Android de un sistema de orientación en espacios interiores para personas con discapacidad cognitiva. Este prototipo ha sido implementado ayudándose de balizas digitales (iBeacons) y utilizando el método de trilateración para conocer la posición del usuario en un sitio cerrado. Además se han aprovechado los sensores (acelerómetro y sensor magnético terrestre) del dispositivo móvil como refuerzo de posicionamiento y para seguir de forma más precisa el movimiento del usuario. En el prototipo actual no se han dedicado recursos a diseñar una interacción fácil para personas con discapacidad cognitiva, debido a que su principal objetivo ha sido evaluar el funcionamiento de las balizas y las posibilidades del sistema de orientación. El resultado final de este TFG es incorporar una serie de luces asociadas a cada una de las balizas que ayuden al usuario a orientarse con mayor facilidad.---ABSTRACT---The initial approach of this project arises because there are people with cognitive disabilities who become disoriented in closed sites. To guide these people it cannot be used GPS, because this system does not work in closed sites because it does not receive the satellite signals. Therefore, it has proposed a solution based on another technology so that these people, through their smartphone, can be guided in a closed site. This final degree project comes from a Practicum made in the previous semester, where possible solutions about iBeacons were investigated and the iBeacon technology was studied too. All this, to know the mobile position in a closed site. The main problem encountered was the lack of precision to calculate the distance between a mobile phone and a beacon. The first objective has been to solve distance problem mentioned above, once resolved it has implemented a prototype, which consists in a guidance system in closed sites for a people with cognitive disabilities. This prototype has been implemented with beacons and trilateration to know user position in a closed site. In addition, mobile phone sensors have been used to follow user movement. In the current prototype, the main objective has been evaluate iBeacons performance and the guidance system. The result of this TFG is to incorporate a series of lights associated with each of the beacons to make easier the orientation.

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation : a systematic review and economic evaluation

Peer reviewed

Potential Benefit of Singing for People with Parkinson’s Disease : A Systematic Review

Acknowledgements including sources of support This study was not supported by any particular grant or funding source. The senior author MSB, an epidemiologist with research experience in PD, wishes to thank clinician authors JB, RAA and SMB for their invaluable contributions. JB is a retired health professional with long-standing experience in community health. RAA and SMB are qualified and practising speech and language therapists and RAA specialises in adult neurological disorders. Additionally, we thank Dr Katherine Deane of the University of East Anglia for expert input regarding the Threats to Validity quality tool, on which she was the lead developer.