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1.
Front Microbiol ; 15: 1361626, 2024.
Article in English | MEDLINE | ID: mdl-38559357

ABSTRACT

Introduction: One of the biggest obstacles in diagnosing Implant-Associated Infections is the lack of infection criteria and standardized diagnostic methods. These infections present a wide range of symptoms, and their diagnosis can be hampered by the formation of microbial biofilms on the surface of implants. This study aimed to provide insight into the performance of sonication in the diagnosis of infections associated with Cardiac Implantable Electronic Devices, to help define a consensus on the algorithm for the microbial diagnosis of these infections. Methods: We carried out a systematic review with meta-analysis. The PRISMA methodology guidelines were followed, and an advanced search was carried out in PubMed and Web of Science, which enabled 8 articles to be included in the review, in which a meta-analysis was also carried out. QUADAS-2 was used to assess the risk of bias and effect measures were calculated to assess publication bias. Results: The overall sensitivity of the method was 0.823 (95% CI: 0.682-0.910) and the specificity was 0.632 (95% CI: 0.506-0.743). Discussion: These results suggest that sonication may offer advantages in diagnosing these infections. However, it is essential to approach these findings carefully and take into account the recommendations provided in the EHRA 2019 guidelines. This study highlights the importance of more effective diagnostic approaches for implantable medical device-associated infections to improve the quality of treatment and minimize the risks associated with these challenging medical conditions.

2.
Front Public Health ; 12: 1384122, 2024.
Article in English | MEDLINE | ID: mdl-38660356

ABSTRACT

Background: Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019. Methods: Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. Results: There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (-2,952 years/105 inhabitants) and neoplasms (-618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Conclusion: Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.


Subject(s)
Disability-Adjusted Life Years , European Union , Health Expenditures , Noncommunicable Diseases , Humans , European Union/economics , European Union/statistics & numerical data , Noncommunicable Diseases/economics , Noncommunicable Diseases/mortality , Noncommunicable Diseases/epidemiology , Health Expenditures/statistics & numerical data , Global Burden of Disease , Male , Female , Cost of Illness , Disabled Persons/statistics & numerical data
3.
Front Public Health ; 12: 1328001, 2024.
Article in English | MEDLINE | ID: mdl-38525337

ABSTRACT

Diabetes can cause several long-term complications. Knowledge about this disease can play an important role in reducing diabetes-related complications. In addition, the lack of awareness leads to misconceptions, which joined with inadequate knowledge, are relevant barriers to proper diabetes management. In this study, we aimed to assess the diabetes knowledge of a type 2 diabetes (T2D) population and identify major knowledge gaps, in order to prevent complications and to increase quality of life. In a cross-sectional, observational study in a convenience sample, we identified individuals diagnosed with T2D attending ambulatory visits from five health settings, older than 18 years, with a time diagnosis of at least 1 year, and attending multidisciplinary visits for at least 3 months. To assess the knowledge of T2D individuals, we applied the Portuguese version of the Diabetes Knowledge Test. The sample included a total of 1,200 persons, of whom almost half were female. The age range of the participants varied from 24 to 94 years old, and the mean age was 65.6 ± 11.4 years. Most of the sample had a level of education under secondary and lived with someone. In our sample, 479 (39.9%) were insulin-treated. The percentage of correct answers was 51.8% for non-insulin vs. 58.7% for insulin treated (p < 0.05). There were three items with a percentage of correct answers lower than 15%; the item with the lower value of correct answers was the one related to the identification of signs of ketoacidosis with only 4.4% of correct answers, the errors presented a random pattern; the item related to the identification of which food should not be used to treat low blood glucose with 11.9%, where 56.9% of the sample's participants considered that one cup of skim milk would be the correct answer (53.1% in non-insulin patients and 62.6% in insulin treated patients; p < 0.001). The item regarding the knowledge of free food presented a 13.3% of correct answers (10.8% non-insulin group vs. 17.1% insulin group; p < 0.01). Two of the three items with lower value of correct answers were related to glycemic control and health status monitoring, the other was related to diet and food.


Subject(s)
Diabetes Mellitus, Type 2 , Insulins , Humans , Female , Middle Aged , Aged , Young Adult , Adult , Aged, 80 and over , Male , Diabetes Mellitus, Type 2/therapy , Quality of Life , Cross-Sectional Studies , Blood Glucose
4.
EPMA J ; 15(1): 135-148, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38463621

ABSTRACT

Multidisciplinary team from three universities based in the "Centro" Region of Portugal developed diverse approaches as parts of a project dedicated to enhancing and expanding Predictive, Preventive, and Personalized Medicine (3PM) in the Region. In a sense, outcomes acted as a proof-of-concept, in that they demonstrated the feasibility, but also the relevance of the approaches. The accomplishments comprise defining a new regional strategy for implementing 3PM within the Region, training of human resources in genomic sequencing, and generating good practices handbooks dedicated to diagnostic testing via next-generation sequencing, to legal and ethical concerns, and to knowledge transfer and entrepreneurship, aimed at increasing literacy on 3PM approaches. Further approaches also included support for entrepreneurship development and start-ups, and diverse and relevant initiatives aimed at increasing literacy relevant to 3PM. Efforts to enhance literacy encompassed citizens across the board, from patients and high school students to health professionals and health students. This focus on empowerment through literacy involved a variety of initiatives, including the creation of an illustrated book on genomics and the production of two theater plays centered on genetics. Additionally, authors stressed that genomic tools are relevant, but they are not the only resources 3PM is based on. Thus, they defend that other initiatives intended to enable citizens to take 3PM should include multi-omics and, having in mind the socio-economic burden of chronic diseases, suboptimal health status approaches in the 3PM framework should also be considered, in order to anticipate medical intervention in the subclinical phase. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00353-9.

5.
Article in English | MEDLINE | ID: mdl-37998293

ABSTRACT

The Health Assessment Questionnaire Disability Index (HAQ-DI) was completed with five visual analog scales to assess systemic sclerosis (SSc) called Scleroderma HAQ (SHAQ). We performed a validation of the European Portuguese version of SHAQ for patients with SSc. Patients with different forms of SSc from five Hospital Centers were invited. The reliability of the Portuguese SHAQ was evaluated by internal consistency and by test-retest reliability. Content validity was checked by two rheumatologists and by a panel of patients. Construct validity was assessed by structural validity and by known-groups hypothesis tests. Criterion validity was addressed with selected dimensions from the UCLA GIT 2.0, the SF-36v2, and the EuroQoL EQ-5D-5L. A total of 102 SSc patients agreed to participate, 31 of which answered to the retest. HAQ-DI demonstrated high internal consistency reliability (α = 0.866) and SHAQ also showed high test-retest reliability (ICC 0.61-0.95). We evidenced the unidimensionality of all VASs. HAQ-DI scores were worse in males, patients older than 65 years, and individuals with a diffuse form of SSc. Criterion validity was mainly evidenced through the correlation between the HAQ-DI and SF-36v2 physical summary measure (r = -0.688) and EQ-5D-5L index score (r = -0.723). Likewise, the SHAQ overall disease severity VAS was also correlated with SF-36v2 physical summary measure (r = -0.628). Mental score correlations were smaller. With the exception of the Raynaud's VAS, all the other VASs correlated well with similar clinical variables. This paper provides evidence to demonstrate how reliable and valid the European Portuguese version of SHAQ is, to be used in SSc patients to assess the clinical severity under the perspective of patients.


Subject(s)
Scleroderma, Systemic , Male , Humans , Reproducibility of Results , Portugal , Surveys and Questionnaires , Severity of Illness Index , Scleroderma, Systemic/diagnosis , Quality of Life , Disability Evaluation
6.
J Patient Rep Outcomes ; 7(1): 88, 2023 09 05.
Article in English | MEDLINE | ID: mdl-37668845

ABSTRACT

BACKGROUND: COVID-19 pandemic placed unprecedented pressure on societies and healthcare systems around the world. Over the last years, measures imposed in almost all countries dealing with the pandemic sent the entire world into an extensive crisis and thus into a deep global recession. Since the outbreak began, many European countries have faced three/four waves of pandemic. Portugal has mainly dealt with three waves (March/April'2020; October/November'2020; January/February'2021), the third being the deadliest one. The purpose of this article is to provide evidence on the impact of the COVID-19 on health-related quality of life (HRQol) and well-being (W-B) of Portuguese citizens. It aims to (i) characterize these outcomes during the COVID-19 pandemic; (ii) compare them to pre-COVID-19 Portuguese population; and (iii) identify the social determinants that may affect these outcomes during the COVID-19 pandemic. METHODS: This study used data from a survey that collected data on HRQoL, W-B, satisfaction with life, economic and labour impacts, access to healthcare, mental and physical health, amongst others. The survey was implemented by telephone to a representative random sample of 1,255 respondents from the general adult Portuguese population, stratified by sex, age group and region. Data was collected during the end of the second national lockdown. For comparison purposes, we have also used two other representative databases from the general Portuguese population: (i) data from before the pandemic (n = 1,006); and (ii) data from a survey conducted during the first lockdown, (n = 904). RESULTS: Looking at health and access to healthcare, 4% of citizens had their surgeries postponed or cancelled because of COVID-19, more than a quarter had medical appointments or complementary exams postponed or cancelled, with 7% over 65 years old with surgeries cancelled or postponed and 32% medical appointments. COVID-19 pandemic also impacted negatively on the HRQoL of citizens, especially in the first lockdown. Half of the respondents reported feeling nervous, anxious, or on edge, about 45% of citizens felt sad or depressed. Sleeping problems were reported for almost 39% of citizens, and loneliness is reported by 29% of citizens. For about 70-85% of citizens, these feelings were more so than before the pandemic. Citizens with fair/strong economic stability were the most economically affected by the pandemic. CONCLUSIONS: We provided evidence on the impact of COVID-19 on health and W-B of Portuguese citizens. Their health was worse than before the pandemic and the access to healthcare was highly affected.


Subject(s)
Access to Primary Care , COVID-19 , Health , Pandemics , Psychological Well-Being , Humans , COVID-19/epidemiology , Portugal/epidemiology , Quality of Life , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over
7.
Article in English | MEDLINE | ID: mdl-36901554

ABSTRACT

The purpose of this study was to assess how knowledge and empowerment impact the quality of life (QoL) of a person with type 2 diabetes, leading to better communication and disease management. We conducted a descriptive and observational study of individuals with type 2 diabetes. The Diabetes Empowerment Scale-Short Form (DES-SF), Diabetes Knowledge Test (DKT), and EQ-5D-5L were used, in addition to sociodemographic and clinical characteristics. Evaluating the variability in the DES-SF and DKT in relation to the EQ-5D-5L and identifying possible sociodemographic and clinical determinants were conducted using univariate analyses followed by a multiple linear regression model to test whether the factors significantly predicted QoL. A total of 763 individuals were included in the final sample. Patients aged 65 years or older had lower QoL scores, as well as patients who lived alone, had less than 12 years of education, and experienced complications. The insulin-treated group showed higher scores in DKT than the non-insulin-treated group. It was also found that being male, being under 65 years of age, having no complications present, and having higher levels of knowledge and empowerment predicted higher QoL. Our results show that DKT and DES are still determinants of QoL, even after adjusting for sociodemographic and clinical characteristics. Therefore, literacy and empowerment are important for the improvement of the QoL of people with diabetes, by enabling them to manage their health conditions. New clinical practices focused on education, increasing patients' knowledge, and empowerment may contribute to better health outcomes.


Subject(s)
Diabetes Mellitus, Type 2 , Self-Management , Humans , Male , Female , Quality of Life , Surveys and Questionnaires , Health Behavior
8.
Eur J Health Econ ; 24(9): 1411-1420, 2023 Dec.
Article in English | MEDLINE | ID: mdl-36630005

ABSTRACT

OBJECTIVES: The EQ-5D-5L is a generic preference-based quality-of-life measure for which the corresponding Portuguese population value set was only recently developed. This study sought to establish EQ-5D-5L population norms for Portugal and to identify significant relationships with sociodemographic variables. METHODS: The research was based on a representative sample of Portugal's general population (n = 1006) aged 18 or older. The sample was stratified by gender, age group, and geographical region. The respondents were interviewed by telephone and asked to value their own state of health using both the EQ-5D-5L description system and the EuroQol-Visual Analogue Scale (EQ VAS). RESULTS: The estimated mean EQ-5D-5L index for Portugal's general population is 0.887 (standard error [SE] = 0.0051), and the EQ VAS score was estimated as 76.0 (SE = 0.640). One-third of the population reported being in the best health state (11111). Women, individuals 70 years old or more and people with low education or a chronic disease reported a lower EQ-5D-5L index score (p < 0.001). Residents in the Azores and the Algarve reported higher health utility scores. CONCLUSIONS: The EQ-5D-5L Portuguese population norms obtained can be used as reference scores. These norms are consistent with other countries' population norms. The findings facilitate clinical, economic, and policy decision-making processes and provide a fuller understanding of the Portuguese population's health-related quality of life.


Subject(s)
Health Status , Quality of Life , Humans , Female , Aged , Portugal , Educational Status , Visual Analog Scale , Surveys and Questionnaires
9.
J Virol ; 97(1): e0175222, 2023 01 31.
Article in English | MEDLINE | ID: mdl-36602368

ABSTRACT

Interleukin-27 (IL-27) is able to inhibit HIV-1 replication in peripheral blood mononuclear cells (PBMCs), macrophages, and dendritic cells. Here, we identify that IL-27 can produce opposing effects on HIV-1 replication in PBMCs and that the HIV-1 restriction factor BST-2/Tetherin is involved in both inhibitory and enhancing effects on HIV-1 infection induced by IL-27. IL-27 inhibited HIV-1 replication when added to cells 2 h after infection, promoting the prototypical BST-2/Tetherin-induced virion accumulation at the cell membrane of HIV-1-infected PBMCs. BST-2/Tetherin gene expression was significantly upregulated in the IL-27-treated PBMCs, with a simultaneous increase in the number of BST-2/Tetherin+ cells. The silencing of BST-2/Tetherin diminished the anti-HIV-1 effect of IL-27. In contrast, IL-27 increased HIV-1 production when added to infected cells 4 days after infection. This enhancing effect was prevented by BST-2/Tetherin gene knockdown, which also permitted IL-27 to function again as an HIV-1 inhibitory factor. These contrasting roles of IL-27 were associated with the dynamic of viral production, since the IL-27-mediated enhancement of virus replication was prevented by antiretroviral treatment of infected cells, as well as by keeping cells under agitation to avoid cell-to-cell contact. Likewise, inhibition of CD11a, an integrin associated with HIV-1 cell-to-cell transmission, abrogated the IL-27 enhancement of HIV-1 production. Our findings illustrate the complexity of the HIV-1-host interactions and may impact the potential therapeutic use of IL-27 and other soluble mediators that induce BST-2/Tetherin expression for HIV-1 infection. IMPORTANCE Here, we describe new findings related to the ability of the cytokine IL-27 to regulate the growth of HIV-1 in CD4+ T lymphocytes. IL-27 has long been considered a potent inhibitor of HIV-1 replication, a notion based on several reports showing that this cytokine controls HIV-1 infection in peripheral blood mononuclear cells (PBMCs), monocyte-derived macrophages, and dendritic cells. However, our present results are contrary to the current knowledge that IL-27 acts only as a powerful downregulator of HIV-1 replication. We observed that IL-27 can either prevent or enhance viral growth in PBMCs, an outcome dependent on when this cytokine is added to the infected cells. We detected that the increase of HIV-1 dissemination is due to enhanced cell-to-cell transmission with the involvement of the interferon-induced HIV-1 restriction factor BST-2/Tetherin and CD11a (LFA-1), an integrin that participates in formation of virological synapse.


Subject(s)
Bone Marrow Stromal Antigen 2 , HIV Infections , Interleukin-27 , Humans , Integrins , Leukocytes, Mononuclear/metabolism , Viral Regulatory and Accessory Proteins
10.
Article in English | MEDLINE | ID: mdl-36674306

ABSTRACT

(1) Background: The UCLA GIT 2.0 questionnaire has been recognized as a feasible and reliable instrument to assess gastrointestinal (GI) symptoms in systemic sclerosis (SSc) patients and their impact on quality of life. The aim of this study was to create and validate UCLA GIT 2.0 for Portuguese patients with SSc. (2) Methods: A multi-center study was conducted enrolling SSc patients. UCLA GIT 2.0 was validated in Portuguese using reliability (internal consistency, item -total correlation, and reproducibility) and validity (content, construct, and criterion) tests. Criterion tests included EQ-5D and SF-36v2. Social-demographic and clinical data were collected. (3) Results: 102 SSc patients were included, 82.4% of them female, and with a mean sample age of 57.0 ± 12.5 years old. The limited form of SSc was present in 62% of the patients and 56.9% had fewer than five years of disease duration. Almost 60% presented with SSc-GI involvement with a negative impact on quality of life. The means for SF-36v2 were 39.3 ± 10.3 in the physical component summary and 47.5 ± 12.1 in the mental component summary. Total GI score, reported as mild in 57.8% of the patients, was highly reliable (ICC = 0.912) and the Cronbach's alpha was 0.954. There was a high correlation between the total GI score and EQ-5D-5L and SF-36v2 scores. (4) Conclusion: The Portuguese version of UCLA GIT 2.0 showed good psychometric properties and can be used in research and clinical practice.


Subject(s)
Gastrointestinal Diseases , Scleroderma, Systemic , Humans , Female , Adult , Middle Aged , Aged , Quality of Life , Reproducibility of Results , Portugal , Severity of Illness Index , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Scleroderma, Systemic/diagnosis , Psychometrics , Surveys and Questionnaires
11.
Front Public Health ; 11: 1294204, 2023.
Article in English | MEDLINE | ID: mdl-38288431

ABSTRACT

Background: The COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide. Methods: An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018-2022) were analysed. Results: During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual. Conclusion: The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.


Subject(s)
COVID-19 , Humans , Communicable Disease Control , Cost of Illness , COVID-19/epidemiology , Cross-Sectional Studies , Pandemics/prevention & control , Portugal/epidemiology , SARS-CoV-2 , Adolescent , Adult
12.
Front Bioeng Biotechnol ; 11: 1296444, 2023.
Article in English | MEDLINE | ID: mdl-38249801

ABSTRACT

Since the world first approved gene therapeutics, nucleic acid-based therapies have gained prominence. Several strategies for DNA-based therapy have been approved, and numerous clinical trials for plasmid DNA (pDNA)-based vaccines are currently in development. Due to the rising interest in pDNA for vaccination and gene therapy, plasmid manufacturing must become more effective. One of the most critical steps is downstream processing, involving isolation and purification procedures. To comply with the regulatory guidelines, pDNA must be available as a highly purified, homogeneous preparation of supercoiled pDNA (sc pDNA). This process undertakes several challenges, primarily due to the diversity of molecules derived from the producer organism. In this study, different resins were tested for the adsorption and selective polishing of sc pDNA. To identify optimal pDNA adsorption conditions, batch and column assays were performed with different resins while promoting electrostatic and hydrophobic interactions. The effect of ionic strength, pH, and contact time were evaluated and optimized. Additionally, static and dynamic binding capacities were determined for the selected resins. Analytical chromatography and agarose gel electrophoresis were used to assess the selectivity of the most promising resins toward sc pDNA isoform. Also, genomic DNA, endotoxins, and proteins were quantified to characterize the final sc pDNA quality. At the same time, the recovery and purity yields were evaluated by quantification of sc pDNA after the purification procedure. Overall, the results of the chromatographic assays using agmatine- and arginine-based resins have shown promising potential for sc pDNA polishing. Both resins demonstrated excellent binding capacity for pDNA, with agmatine outperforming arginine-based resin in terms of capacity. However, arginine-based resin exhibited a superior pDNA recovery yield, reaching a notable 52.2% recovery compared to 10.09% from agmatine. Furthermore, both resins exhibited high relative purity levels above 90% for the sc pDNA. The comprehensive characterization of the recovered sc pDNA also revealed a significant reduction in gDNA levels, reinforcing the potential of these prototypes for obtaining high-quality and pure sc pDNA. These findings highlight the promising applications of both resins in scalable pDNA purification processes for gene therapy and biopharmaceutical applications.

13.
Oncologist ; 27(3): e251-e264, 2022 03 11.
Article in English | MEDLINE | ID: mdl-35274725

ABSTRACT

BACKGROUND: Gynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened oncofertility awareness, knowledge about fertility attitudes and decisions of young patients with gynecologic cancer is scarce. The aim of this systematic review was to highlight what is currently known about knowledge, attitudes, and decisions about fertility, fertility preservation, and parenthood among these patients. METHODS: Peer-reviewed journals published in English were searched in PubMed, Web of Science and EMBASE from January 1, 2000 to July 1, 2020. Childbearing, fertility, fertility preservation, pregnancy, and parenthood attitudes/decisions after gynecologic cancer from women's perspective were evaluated. RESULTS: A total of 13 studies comprised the review. Most of the women valued fertility preservation procedures that could be regarded as a means to restore fertility. A unique feature identified was that fertility preservation was seen also as a way to restore gender identity perceived to be lost or threatened during diagnosis and treatment. Fertility counseling was suboptimal, with wide variability among studies reviewed. Comparisons between gynecologic cancers and other cancer types about fertility counseling rates were inconclusive. The potential negative impact of impaired fertility on patients' mental health and quality of life was also documented. CONCLUSIONS: Fertility and parenthood were important matters in patients' lives, with the majority of patients expressing positive attitudes toward future childbearing. Results confirm that the inclusion of patients with gynecologic cancer in research studies focusing on this topic still remains low. Additionally, the provision of fertility counseling and referral by health professionals is still suboptimal.


Subject(s)
Fertility Preservation , Genital Neoplasms, Female , Female , Fertility , Fertility Preservation/methods , Gender Identity , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/therapy , Humans , Male , Pregnancy , Quality of Life
14.
PLoS Comput Biol ; 17(7): e1009167, 2021 07.
Article in English | MEDLINE | ID: mdl-34264938

ABSTRACT

What humans do when exposed to uncertainty, incomplete information, and a dynamic environment influenced by other agents remains an open scientific challenge with important implications in both science and engineering applications. In these contexts, humans handle social situations by employing elaborate cognitive mechanisms such as theory of mind and risk sensitivity. Here we resort to a novel theoretical model, showing that both mechanisms leverage coordinated behaviors among self-regarding individuals. Particularly, we resort to cumulative prospect theory and level-k recursions to show how biases towards optimism and the capacity of planning ahead significantly increase coordinated, cooperative action. These results suggest that the reason why humans are good at coordination may stem from the fact that we are cognitively biased to do so.


Subject(s)
Decision Making/physiology , Models, Biological , Psychomotor Performance/physiology , Theory of Mind/physiology , Computational Biology , Humans , Risk , Social Behavior , Uncertainty
15.
OTJR (Thorofare N J) ; 41(4): 299-308, 2021 10.
Article in English | MEDLINE | ID: mdl-34111990

ABSTRACT

Performance Assessment of Self-Care Skills (PASS) is a performance-based scale developed in the United States. Because of cultural differences, a Portuguese version was developed, then validated in the Portuguese population and tested ensuring reliability. The objective of this study was to create and test psychometric properties of a Portuguese version of PASS. A linguistic validation on older adults with physical/cognitive disabilities enabled us to validate P-PASS. Some original tasks were changed. Data were analyzed by PASS constructs (independence-safety adequacy), age, and gender. Construct validity (known-group analyses, factor analyses), with 98 individuals yielded excellent results. Reliability between two observers for 30 participants yielded almost perfect agreement for all three constructs. Independence scores were highest, followed by safety and adequacy. Men presented greater independence, as well as participants <60 years. We obtained results comparable with the original version. Conclusion. P-PASS is valid and reliable for the Portuguese population, enabling effective assessment of function and measurement of health outcomes.


Subject(s)
Self Care , Aged , Humans , Male , Portugal , Psychometrics , Reproducibility of Results , Surveys and Questionnaires
16.
BMC Fam Pract ; 22(1): 81, 2021 04 28.
Article in English | MEDLINE | ID: mdl-33910526

ABSTRACT

BACKGROUND: This paper is focused on two indicators which may be considered as proxies of individuals' well-being: self-assessed health and burnout intensity. There is little research relating these concepts with the type of the primary healthcare setting, its urbanization density and the region. The aims of this work are threefold: (i) to find determinant factors of individual health status and burnout, (ii) to find possible differences across different types of health care units, differently urbanized areas, and different administrative regions, and (iii) to verify if there are differences in between GPs and nurses. METHODS: Data was gathered from an online questionnaire implemented on primary health care. A sample of 9,094 professionals from all 1,212 primary health care settings in Portugal mainland was obtained from an online questionnaire filled from January and April 2018. Statistical analyses include the estimation of two ordered probits, one explaining self-assessed health and the other the burnout. RESULTS: The individual drivers for good health and lower levels of burnout, that is, better well-being, are estimated for GPs and nurses. Main findings support that, first, nurses report worst health than GPs, but the latter tend to suffer higher levels of burnout, and also that, 'place' effects arising from the health unit settings and regional location are more significant in GPs than in nurses. However, urbanization density is not significantly associated with health or burnout. CONCLUSIONS: A set of policy recommendations are suggested to improve the healthcare workforce well-being, such as improving job satisfaction and income. These policies should be taken at the health care unit level and at the regional administrative level.


Subject(s)
Burnout, Professional , Burnout, Professional/epidemiology , Cross-Sectional Studies , Health Status , Humans , Job Satisfaction , Portugal/epidemiology , Primary Health Care , Surveys and Questionnaires
17.
BMC Neurol ; 21(1): 58, 2021 Feb 06.
Article in English | MEDLINE | ID: mdl-33549045

ABSTRACT

BACKGROUND: Migraine Disability Assessment Scale (MIDAS) is a useful tool to measure headache-related disability. Modified MIDAS with 4-week recall period reduces recall bias and improves accuracy of the results. This study aimed at validating mMIDAS in Portuguese. METHODS: Studied population consisted of adult migraine patients attending a headache outpatient clinic. Reliability was assessed by internal consistency and reproducibility in a 3-week test-retest. Content validity was evaluated by two expert panels. Construct validity was tested by comparing mMIDAS-P index in socioeconomic and clinical patient groups and scale unidimensionality was evidenced by factor analysis. Criterion validity was tested using EQ-5D-5L and HADS. RESULTS: Ninety-two patients, 88% female, mean age of 44 years, participated. They had, in average, 9.7 headache days in previous month, pain averaging 7.5/10. About 69.9% were on a migraine prophylactic treatment, and 42.4% had severe disability; 29.4 and 13.0% showed, respectively, moderate/severe anxiety and depression. Content validity showed that mMIDAS-P is simple and clinically useful. It did not show to be determined by patient's sociodemographic characteristics and it was correlated with depression scale and EQ-5D-5L. Test-retest demonstrated high reproductive reliability and good internal consistency. CONCLUSION: mMIDAS-P is valid and reliable. We strongly recommend it for clinical and research use.


Subject(s)
Disability Evaluation , Language , Migraine Disorders , Surveys and Questionnaires , Translating , Adult , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Migraine Disorders/epidemiology , Portugal , Reproducibility of Results
18.
Cancer Med ; 9(20): 7375-7380, 2020 10.
Article in English | MEDLINE | ID: mdl-32864852

ABSTRACT

Oncofertility has evolved over the years, with a prodigious amount of research documenting the importance of fertility for young patients with cancer, and the potential impact that fertility impairments due to cancer treatments has on their Quality of Life (QoL). Multiple professional bodies and scientific societies have included fertility as an integral part of clinical management. Clinical guidelines advocate that health professionals have the duty to discuss the risk of infertility and fertility preservation options as early as possible and refer to fertility specialists when appropriate. Collectively, fertility decisions are regarded as difficult for both patients and providers. Since providing fertility-related information is vital for better decision making, researchers and policy makers have concentrated their efforts in developing educational tools to aid decisions and guidelines to optimize the delivery of this information, focusing mainly on patients-providers and largely neglecting the role and influence that partners play in this process. Here, we reflect on the importance of partners in fertility decisions, with a focus on the provision of fertility-related information that is also geared towards partner. We highlight the need to involve partners in fertility discussions, and that their needs should be taken into account in both clinical guidelines and in the development of educational tools, for an optimal decision-making process.


Subject(s)
Fertility Preservation/statistics & numerical data , Fertility Preservation/trends , Fertility , Neoplasms/epidemiology , Adult , Age Factors , Clinical Decision-Making , Decision Support Techniques , Disease Management , Evidence-Based Medicine/methods , Evidence-Based Medicine/statistics & numerical data , Evidence-Based Medicine/trends , Female , Humans , Neoplasms/diagnosis , Neoplasms/therapy , Practice Guidelines as Topic , Public Health Surveillance
19.
Health Policy ; 124(7): 751-757, 2020 07.
Article in English | MEDLINE | ID: mdl-32487443

ABSTRACT

This paper aims to contribute to the discussion on health workforce migration, notably by testing an analytical model of the individual drivers for a professional to decide to emigrate. A large database was obtained from all primary health care units on mainland Portugal. A professional satisfaction survey was conducted and information on social-economic, labour and job satisfaction characteristics, including burnout, was obtained. Results showed that healthcare professionals who reported intention to emigrate are mostly male, young, not married, and more educated; they consider their income insufficient for their needs, and show higher levels of burnout at work and professional dissatisfaction. This profile is slightly different for GPs and nurses. The results obtained contribute to the discussion on what motivates primary health care professionals, including GPs and nurses, to emigrate. They also provide insight into the design of policy measures that may mitigate the intention of these healthcare professionals in general to emigrate.


Subject(s)
Emigration and Immigration , Job Satisfaction , Cross-Sectional Studies , Delivery of Health Care , Female , Health Personnel , Humans , Male , Portugal , Primary Health Care , Surveys and Questionnaires
20.
Int J Qual Health Care ; 32(2): 93-98, 2020 Apr 27.
Article in English | MEDLINE | ID: mdl-32047931

ABSTRACT

OBJECTIVE: To determine the factors that explain the levels of patient satisfaction and the role of geographical characteristics. DESIGN: Questionnaires to patients of Primary Health Care (PHC) units in Portugal Mainland distributed to each unit according to their size; codes were distributed to guarantee single responses; the questionnaire was anonymous and confidential. SETTING: Primary Health Care units in Portugal Mainland. PARTICIPANTS: Primary health care patients. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Overall patient satisfaction. RESULTS: The main results indicate that the most significant dimension explaining overall patient satisfaction index is the satisfaction regarding general practitioner (GP) care, and the two other most significant explanatory variables of satisfaction are to be enrolled in a GP list and education. The bigger is the size of a PHC unit the lower is satisfaction. In rural areas, the level of satisfaction is higher than in urban areas. Comparing to the Lisbon metropolitan area, all other regions show a higher satisfaction in access dimension. CONCLUSIONS: These results contribute to the creation of strategic information relevant to the evaluation of the various models of Primary Health Care, to the commissioning and definition of health policies.


Subject(s)
Patient Satisfaction/statistics & numerical data , Primary Health Care/statistics & numerical data , Educational Status , Female , Humans , Male , Portugal , Primary Health Care/organization & administration , Rural Health Services , Surveys and Questionnaires , Urban Health Services
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