Gamification, defined as the introduction of game elements in nongame contexts, has shown potential for addressing disease prevention and health promotion through new technologies. The aim of this study was to identify and describe gamified eHealth interventions for health promotion and disease prevention in children and adolescents, the theoretical frameworks that support or endorse these interventions and the key attributes of games with evidence of their effectiveness. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The search was carried out in the PubMed, Scopus, and Science Direct databases. Related data were extracted on the basis of the research questions, and a qualitative content analysis was conducted. We retrieved 930 records, 26 of which met the eligibility criteria, and 15 studies were ultimately analysed. Most of the gamified interventions were based on the implementation of mobile health applications or video games. A high percentage of studies (80%) demonstrated the effectiveness of gamification, which improved the health-related knowledge, motivation, and attitude outcomes of the participants in the intervention group. The theoretical models underpinning the studies were reported in only 40% of the studies. The attributes of game evaluation, conflict/challenge, and rules/goals were included in all the studies analysed and were related mainly to extrinsic motivation. Despite promising results on the use of gamification in the paediatric population, more research is still needed to validate the theoretical models and consolidate the evidence. Gamification should be based on a motivational theoretical model in which the intrinsic motivation of participants is accounted for.

Introduction: Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences.Materials and methods: This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU.Results: Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function.Conclusions: The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.

The aim of this study was to determine the role of global postural reeducation for people with ankylosing spondylitis. We compared the effects of treatments on pain, dysfunction (using the Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index), range of motion, and chest expansion in a specific population aged over 18 years old with ankylosing spondylitis. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. The search was conducted using the PubMed, Physiotherapy Database (PEDro), Scientific Electronic Library Online (SciELO), and Web of Science (WoS) databases. Clinical trials and systematic reviews/meta-analysis were reviewed. Results: 154 studies were found. Finally, four were included. Conclusions: global postural reeducation is beneficial for ankylosing spondylitis, but no more so than other conventional treatments, except for spinal mobility, where Global Postural Reeducation demonstrated an advantage.

Objective: To provide practical information regarding needs, preferences of content and format of an app to assist the self-management in patients with multi-morbidity and heart failure (HF). Methods: The three-phase study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. Data collection continued until data saturation was reached. All data were transcribed verbatim and analysed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. Results: Integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes that captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain (a) components that increase the patient's understanding of HF, (b) self-care, (c) self-efficacy and participation of the family/informal caregiver, (4) psychosocial well-being and (5) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), nutritional information (70%), type of exercises in order to improve their physical condition (75%) and information about food and drug interaction (60%). The importance of motivation messages (60%) was highlighted by transversal way. Conclusions: The three-phase process integrating theoretical basis, evidence from integrative reviews and research findings from target users has been considered a guide for future app development.

To compare and contrast the Classification of Causes of Historical Mortality (CCHM) with the International Classification of Diseases 4^th Revision (ICD-4) as methodological elements that can be implemented in historical mortality studies. We conducted a longitudinal descriptive study of the causes of death in two different localities in Spain, namely, Cadiz and Vejer de la Frontera (1900–1950), to compare the International Classification of Diseases 4^th Revision (ICD-4) and the Classification of Causes of Historical Mortality (CCHM). This study proposes the CCHM and its use in statistical analyses of mortality, especially from the mid-19^th century to the second half of 20^th century. It is a methodological instrument based on the theoretical precepts of Thomas McKeown, expanded through knowledge gained in studies of historical mortality and contrasted with editions of the ICD. The results showed several differences between the ICD-4 and the CCHM. The ten main causes of death (CoDs) in the CCHM account for 74.3% in Cadiz, compared to 56.6% accounted for by the ICD-4. According to the ICD-4, the number of infectious CoDs exceed the number of noninfectious ones in Cadiz every year. On the other hand, based on the CCHM, we observed that while infectious CoD causes of death predominated over noninfectious ones, there was a change in trend, with noninfectious CoDs predominating the following year. During the interval from 1915 to 1937 in Vejer de la Frontera, there were 12 deaths due to ill-specified causes (ICD-4: 18.200) and 0 due to ill-defined causes (CCHM: 3.0.0.0). The CCHM accurately determines the differences between infectious and noninfectious causes of death and explains sociodemographic and health-related aspects in the population and its use in employment, illegitimacy or place-of-death studies. Moreover, it has more advantages, such as the incorporation of new diagnostic expressions, and it can be constantly updated, thus facilitating its use over long periods of time.