Psychological reactance and vaccine uptake: a longitudinal study.

OBJECTIVE: In most countries, vaccine uptake is a voluntary decision. If people experience threats to this freedom, for example, by pro-vaccination media campaigns or government pressure, psychological reactance may be induced. To regain freedom, the opposite behaviour (vaccine refusal) may become more attractive, forming a vaccination barrier. It remains unclear how state reactance fluctuates and how it relates to vaccination intention versus behaviour. Therefore, this pre-registered longitudinal study aimed to gain insight in the changes in state reactance during a COVID-19 vaccination programme and its relationship with vaccine uptake. METHODS: A representative sample of Dutch adults under 60 completed questionnaires before being eligible for vaccination, shortly before they were invited for vaccination, and after the opportunity for vaccination. RESULTS: Data were analysed using regression analyses (N = 1411). Reactance did not change as hypothesised, but remained stable over time. As hypothesised, reactance predicted lower subsequent vaccination intention. Controlling for intentions, however, reactance did not predict vaccine uptake. Furthermore, reactance predicted lower decision confidence about vaccination, except for people who strongly opposed vaccination. CONCLUSION: Reactance has a sustained role in anticipation of a vaccination decision. Although reactance seems to affect the process towards the decision, this does not determine the final choice.

Diabetes and impaired fasting glucose in a population-based sample of individuals aged 75 + years: associations with cognition, major depressive disorder, functionality and quality of life-the Pietà study.

OBJECTIVES: To investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL). STUDY DESIGN: Overall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer's Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD). RESULTS: IFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM. CONCLUSIONS: IFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.

Virtual reality training of lucid dreaming.

Metacognitive reflections on one's current state of mind are largely absent during dreaming. Lucid dreaming as the exception to this rule is a rare phenomenon; however, its occurrence can be facilitated through cognitive training. A central idea of respective training strategies is to regularly question one's phenomenal experience: is the currently experienced world real, or just a dream? Here, we tested if such lucid dreaming training can be enhanced with dream-like virtual reality (VR): over the course of four weeks, volunteers underwent lucid dreaming training in VR scenarios comprising dream-like elements, classical lucid dreaming training or no training. We found that VR-assisted training led to significantly stronger increases in lucid dreaming compared to the no-training condition. Eye signal-verified lucid dreams during polysomnography supported behavioural results. We discuss the potential mechanisms underlying these findings, in particular the role of synthetic dream-like experiences, incorporation of VR content in dream imagery serving as memory cues, and extended dissociative effects of VR session on subsequent experiences that might amplify lucid dreaming training during wakefulness. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Fluxos de atendimento em um centro obstétrico frente à pandemia da covid-19: relato de experiência / Flujos de atención en un centro obstétrico frente a la pandemia de covid-19: relato de experiencia / Flows of care in an obstetric center in the face of the covid-19 pandemic: experience report

RESUMO Objetivo: relatar o desenvolvimento e implementação de fluxos para atendimento de gestantes com suspeita ou confirmação de COVID-19 no Centro Obstétrico de um hospital público. Método: estudo descritivo, do tipo relato de experiência, realizado em um hospital público de Porto Alegre/RS, referência para atendimento de gestantes com COVID-19. Resultados: descreveram-se fluxos para atendimento à gestante com suspeita ou confirmação de COVID-19 nas seguintes situações: acolhimento e classificação de risco em obstetrícia; indução e/ou trabalho de parto ativo; e cirurgia cesariana. A aplicação dos fluxos descritos possibilitou a organização assistencial e contribuiu para a investigação e diagnóstico precoce de COVID-19, bem como para o controle da transmissão dessa doença em ambiente hospitalar. Considerações finais: a elaboração de fluxos para atendimento de gestantes, no contexto da pandemia de COVID-19, é demanda primordial para os serviços de saúde, a fim de organizar e qualificar a assistência, promovendo práticas baseadas em evidências científicas e evitando intervenções e restrições desnecessárias.

RESUMEN Objetivo: relatar el desarrollo y la implementación de flujos para la atención a las gestantes con sospecha o confirmación de COVID-19 en el Centro Obstétrico de un hospital público. Método: estudio descriptivo, del tipo relato de experiencia, realizado en un hospital público de Porto Alegre/RS-Brasil, referencia para atención de gestantes con COVID-19. Resultados: se describieron flujos para la atención a la gestante con sospecha o confirmación de COVID-19 en las siguientes situaciones: acogida y clasificación de riesgo en obstetricia; inducción y/o trabajo de parto activo; y cirugía cesárea. La aplicación de los flujos descriptos posibilitó la organización asistencial y contribuyó para la investigación y el diagnóstico precoz de COVID-19, así como para el control de la transmisión de esta enfermedad en ambiente hospitalario. Consideraciones finales: la elaboración de flujos para la atención de gestantes, en el contexto de la pandemia de COVID-19, es demanda primordial para los servicios de salud, a fin de organizar y calificar la asistencia, promoviendo prácticas basadas en evidencias científicas, evitando intervenciones y restricciones innecesarias.

ABSTRACT Objective: to report the development and implementation of flows to care for pregnant women with suspected or confirmed COVID-19 at the Obstetric Center of a public hospital. Method: a descriptive study, of the experience report type, carried out in a public hospital in Porto Alegre/RS, a reference for the care of pregnant women with COVID-19. Results: flows to care for pregnant women with suspected or confirmed COVID-19 were described in the following situations: reception and risk classification in obstetrics; induction and/or active childbirth; and cesarean surgery. The application of the described flows made it possible to organize assistance and contributed to the investigation and early diagnosis of COVID-19, as well as to control the transmission of this disease in a hospital environment. Final considerations: the elaboration of flows for the care of pregnant women, in the context of the COVID-19 pandemic, is a primary demand for health services, in order to organize and qualify the assistance, promoting practices based on scientific evidence and avoiding unnecessary interventions and restrictions.

Fostering students' creative thinking skills by means of a one-year creativity training program.

Creative thinking is among the most sought-after life and work skills in the 21st century. The demand for creativity, however, exceeds the degree to which it is available and developed. The current project aimed to test the effectiveness of a one-year creativity training program for higher education. The creativity of students following the training was measured before, halfway, and after the training. In addition to the within-subjects comparison across time, performance was compared to a matched control group. At each of the measurement points, different versions of seven well-validated creativity tasks (capturing divergent and convergent creative thinking skills) were employed. The creativity training increased students' ideation skills and, more importantly their cognitive flexibility. However, no difference in originality was observed. Finally, an increase in performance was observed for one of the convergent creativity tasks, the Remote Associate Test. Implications for educational settings and directions for future research are discussed.

Práticas assistenciais em partos de risco habitual assistidos por enfermeiras obstétricas / Prácticas asistenciales en partos de riesgo normal asistidos por enfermeras obstétricas / Care practices in normal-risk births assisted by obstetric nurses

Resumo Objetivo Comparar as práticas assistenciais em partos de risco habitual assistidos por enfermeiras obstétricas em um hospital público de Porto Alegre/RS no ano de 2013 - início do modelo colaborativo na instituição - com as práticas assistenciais realizadas no ano de 2016. Métodos Estudo transversal, retrospectivo, analítico, realizado no centro obstétrico de um hospital público de Porto Alegre/RS, com 186 parturientes de risco habitual com parto assistido por enfermeiras obstétricas no período de 2013 e 2016. Constituíram critérios de inclusão gestantes de risco habitual, durante o pré-natal e admissão hospitalar, com feto único, recém-nascido vivo, a termo (idade gestacional de 37 a 41 semanas) e em apresentação cefálica fletida. Foram excluídas parturientes que ingressaram na instituição em período expulsivo e as com informações incompletas em prontuário. Os dados provenientes do estudo foram agrupados sob a forma de banco de dados e analisados no Statistical Package for the Social Sciences (SPSS) versão 25.0. Para análise estatística foi utilizado o Teste Qui-quadrado de Pearson e o Teste Exato de Fischer, para comparar proporções. Resultados A comparação das práticas assistenciais nos anos estudados revelou redução de intervenções como tricotomia (-100,0%), uso de supositório retal (-85,8%), posição litotômica (-85,0%), uso de medicamentos para alívio da dor (-79,0%), analgesia epidural (-79,0%), uso de ocitocina (-73,3%), cateterização venosa (-60,5%), cardiotocografia (-51,1%), tonsura (-38,5%), bola obstétrica (-31,0%) e posição semissentada (-5,4%); e aumento percentual de práticas como a mudança de posição (+828,6%), rebozo (+167,3%), posição de cócoras (+100,0%), posição quatro apoios (+100,0%), posição lateral direita (+100,0%), posição lateral esquerda (+100,0%), uso de partograma (+43,3%), massagem terapêutica (+33,4%), clampeamento tardio do cordão umbilical (+37,3%), contato pele a pele (+33,2%), amniotomia (+16,7%) e dieta líquida (+11,5%). Conclusão Frente ao modelo predominante de assistência obstétrica no Brasil, centrado no médico obstetra e em práticas intervencionistas, o modelo colaborativo de assistência ao parto, com atuação das enfermeiras obstétricas, mostra-se como um caminho para a atenção às mulheres, com respeito à fisiologia do parto e ao protagonismo da mulher.

Resumen Objetivo Comparar las prácticas asistenciales en partos de riesgo normal asistidos por enfermeras obstétricas en un hospital público de Porto Alegre/RS en el año 2013 —inicio del modelo colaborativo en la institución— con las prácticas asistenciales realizadas en el año 2016. Métodos Estudio transversal, retrospectivo, analítico, realizado en el centro obstétrico de un hospital público de Porto Alegre/RS, con 186 parturientas de riesgo normal con parto asistido por enfermeras obstétricas en el período de 2013 y 2016. Los criterios de inclusión fueron embarazadas de riesgo normal, durante la atención prenatal y admisión hospitalaria, con feto único, recién nacido vivo, a término (edad gestacional entre 37 y 41 semanas) y presentación cefálica flexionada. Se excluyeron parturientas que ingresaron a la institución en período expulsivo y las que tenían información incompleta en la historia clínica. Los datos provenientes del estudio se agruparon bajo la forma de banco de datos y se analizaron en el Statistical Package for the Social Sciences (SPSS) versión 25.0. Para el análisis estadístico se utilizó la prueba χ2 de Pearson y la Prueba exacta de Fisher para comparar proporciones. Resultados La comparación de las prácticas asistenciales durante los años estudiados reveló una reducción de intervenciones como tricotomía (-100,0%), uso de supositorio rectal (-85,8%), posición de litotomía (-85,0%), uso de medicamentos para aliviar el dolor (-79,0%), analgesia epidural (-79,0%), uso de oxitocina (-73,3%), cateterización venosa (-60,5%), cardiotocografía (-51,1%), tonsura (-38,5%), pelota obstétrica (-31,0%) y posición semisentada (-5,4%); y un aumento en el porcentaje de prácticas como el cambio de posición (+828,6%), rebozo (+167,3%), posición de cuclillas (+100,0%), posición cuatro apoyos (+100,0%), posición de lado derecho (+100,0%), posición de lado izquierdo (+100,0%), uso de partograma (+43,3%), masajes terapéuticos (+33,4%), pinzamiento tardío del cordón umbilical (+37,3%), contacto piel con piel (+33,2%), amniotomía (+16,7%) y dieta líquida (+11,5%). Conclusión Frente al modelo predominante de atención obstétrica en Brasil, centrado en el médico obstetra y en prácticas intervencionistas, el modelo colaborativo de atención al parto, con actuación de enfermeras obstétricas, demuestra ser un camino para la atención a las mujeres, respecto a la fisiología del parto y al protagonismo de la mujer.

Abstract Objective To compare the care practices in normal-risk births assisted by obstetric nurses in a public hospital in Porto Alegre, Brazil in 2013, when the collaborative model was first implemented in that institute, with care practices employed in 2016. Methods A cross-sectional, retrospective, analytical study conducted in the obstetric center of a public hospital in Porto Alegre, Brazil with 186 women at normal-risk labor assisted by obstetric nurses in 2013-2016. Inclusion criteria were pregnant women at normal risk during prenatal care and hospital admission, with a single fetus born alive at full term (gestational age, 37-41 weeks) with a well-flexed cephalic presentation. Parturients admitted to the institute during the expulsion phase and those with incomplete information in their medical records were excluded. Data from the study were grouped into a database and analyzed using Statistical Package for the Social Sciences software, version 25.0. Pearson's chi-square test and Fisher's exact test were used to compare proportions. Results The comparison of care practices revealed a reduction in interventions such as trichotomy (−100.0%), rectal suppository use (−85.8%), lithotomic position (−85.0%), use of pain-relief medication (−79.0%), epidural analgesia (−79.0%), oxytocin use (−73.3%), venous catheterization (−60.5%), cardiotocography (−51.1%), pubic-hair trimming (−38.5%), birth ball (−31.0%), semi-sitting position (−5.4%), and an increase in practices such as change in position (+828.6%), rebozo (+167.3%), squatting position (+100.0%), all-fours position (+100.0%), right lateral position (+100.0%), left lateral position (+100.0%), use of partograms (+43.3%), therapeutic massage (+33.4%), late umbilical-cord clamping (+37.3%), skin-to-skin contact (+33.2%), amniotomy (+16.7%), and liquid diet (+11.5%). Conclusion In the context of the predominant model of obstetric care in Brazil, centered on the obstetric physician and interventionist practices, the collaborative model of childbirth care with the active participation of obstetric nurses is a good way to take care of women giving birth, respecting the physiology of childbirth, and the woman's protagonism.

Novelty seeking is linked to openness and extraversion, and can lead to greater creative performance.

OBJECTIVE: Novelty seeking (the tendency to explore things novel and unfamiliar) has been extensively researched in the clinical and health domains, but its effects on creative performance are largely unknown. We examined whether creativity-related personality traits (openness to experience and extraversion) are associated with novelty seeking, and whether novelty seeking is linked to, and facilitates, creativity. METHOD: In Study 1a (N = 230; Mage = 20; 64% females) and Study 1b (N = 421; Mage = 19; 65% females), we measured extraversion, openness to experience, novelty seeking, and divergent thinking. To provide causal evidence for the relation between novelty seeking and creativity, in Study 2 (N = 147; Mage = 27; 75% females), we manipulated people's motivation to seek novelty and then measured subsequent divergent thinking. RESULTS: In Studies 1a and 1b, we demonstrated that trait novelty seeking is associated with openness and extraversion, on the one hand, and divergent thinking on the other. In Study 2, the novelty seeking manipulation led to greater divergent thinking. CONCLUSIONS: We conclude that novelty seeking is linked to openness to experience and extraversion, and that it can lead to greater divergent thinking.

Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study.

BACKGROUND: The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS: Overall, 639 individuals (64% female, with a mean age of 81.1 ±â€¯5.2 and 2.6 ±â€¯2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS: The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION: Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.

Os fatores clínicos e físico-funcionais predizem quedas em idosos com deficit cognitivo? / Can clinical and physical-functional factors predict falls in cognitively impaired older adults?

OBJETIVO: Investigar a frequência de quedas, os fatores clínicos e físico-funcionais associados às quedas e à acurácia desses fatores para identificar risco de cair em idosos com deficit cognitivo. MÉTODO: Estudo transversal com idosos com deficit cognitivo identificado no Mini-Exame do Estado Mental. Variável dependente: histórico de queda nos 6 meses anteriores. Variáveis independentes: autorrelato de confusão mental, deficiência auditiva e visual, cansaço físico, fraqueza muscular, tontura, desequilíbrio corporal, insegurança para caminhar, diagnóstico de depressão, internações, quantidade de medicamentos de uso contínuo (formulário de pesquisa), massa muscular (circunferência de panturrilha), força de preensão palmar (dinamometria), capacidade funcional (Pfeffer) e mobilidade corporal (SAM-Br). Foi realizada estatística descritiva. Os grupos foram comparados com teste U Mann Whitney, os fatores de risco identificados por regressão logística uni e multivariada e a área sob a curva ROC (AUC) foi calculada para fatores associados. RESULTADO: 216 idosos com deficit cognitivo foram incluídos nas análises, dos quais 41,7% eram caidores. Análises de regressão multivariada indicaram que a queixa de deficit visual (OR=2,8; p=0,015) e de desequilíbrio corporal (OR=2,7; p=0,004) e a maior quantidade de medicamentos (OR=1,1; p=0,038) associaram-se às quedas. A AUC verificou fraca acurácia da quantidade de medicamentos para rastrear caidores (AUC=0,6 [0,5; 0,7]; p=0,028). CONCLUSÃO: os idosos com deficit cognitivo apresentaram alta frequência de quedas. As queixas de deficit visual, desequilíbrio corporal e polifarmácia foram preditoras de quedas. A rápida investigação desses fatores pode contribuir para a identificação de risco de cair de idosos com deficit cognitivo na prática clínica e em pesquisas. AU

OBJECTIVE: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. METHOD: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. RESULTS: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). CONCLUSION: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research. AU

What Enables Novel Thoughts? The Temporal Structure of Associations and Its Relationship to Divergent Thinking.

The aim of the current study is to enhance our understanding of cognitive creativity, specifically divergent thinking, by employing an interdisciplinary methodological approach. By integrating methodology from computational linguistics and complex systems into creativity research, the current study aims to shed light on the relationship between divergent thinking and the temporal structure of semantic associations. In complex systems, temporal structures can be described on a continuum from random to flexible-stable and to persistent. Random structures are highly unpredictable, persistent structures are highly predictable, and flexible-stable structures are in-between, they are partly predictable from previous observations. Temporal structures of associations that are random (e.g., dog-graveyard-north pole) or persistent (e.g., dog-cat-rat) are hypothesized to be detrimental to divergent thinking. However, a flexible-stable structure (e.g., dog-police-drugs) is hypothesized to be related to enhanced divergent thinking (inverted-U). This notion was tested (N = 59) in an association chain task, combined with a frequently used measure of divergent thinking (i.e., Alternative Uses Test). Latent Semantic Analysis from computational linguistics was used to quantify the associations, and methods from complex systems in form of Power Spectral Density analysis and detrended fluctuation analysis were used to estimate the temporal structure of those associations. Although the current study does not confirm that a flexible-stable (vs. random/persistent) temporal structure of associations is related to enhanced divergent thinking skills, it hopefully challenges fellow researchers to refine the recent methodological developments for assessing the (temporal) structure of associations. Moreover, the current cross-fertilization of methodological approaches may inspire creativity researchers to take advantage of other fields' ideas and methods. To derive a theoretically sound cognitive theory of creativity, it is important to integrate research ideas and empirical methods from a variety of disciplines.

Adaptação de teste para rastreio de delirium em idosos admitidos em serviço de urgência / Adaptation of a delirium screening test for elderly adults admitted to emergency departments

OBJETIVO: O delirium é uma das síndromes mais frequentes em idosos admitidos nas unidades de urgência e, apesar de apresentar sintomas e sinais bem estabelecidos, ainda há falhas de diagnóstico. Dessa forma, o objetivo do estudo foi adaptar o Abbreviated Mental Test Score (AMT) como teste de rastreio para delirium em idosos admitidos em uma unidade de urgência. MÉTODOS: Estudo transversal realizado no serviço de urgência de um hospital universitário em Brasília, Brasil, no período de abril a junho de 2014. Foram avaliados 90 pacientes de ambos os sexos, com 60 anos ou mais de idade. O Confusion Assessment Method (CAM) Instrument foi estabelecido como padrão ouro para diagnóstico de delirium. Foram aplicadas questões do AMT em versão traduzida e adaptada culturalmente, com quatro modelos distintos e outros reduzidos, todos comparados ao CAM a partir da curva característica de operação do receptor (ROC) (significância < 0,05; H0: ASC = 0,5) e à reprodutibilidade interavaliadores a partir do índice Kappa, por meio do SPSS, versão 22.0.0.0. RESULTADOS: A prevalência de delirium foi de 25,6%. O melhor dos quatro modelos do AMT apresentou sensibilidade de 78,3%, especificidade de 85,1%, com boa reprodutibilidade interavaliador (Kappa = 0,793). O melhor modelo reduzido foi o com quatro questões, com sensibilidade de 82,6%, especificidade de 82,1% e Kappa de 0,746. CONCLUSÕES: A adaptação do AMT (completa e reduzida) mostrou-se adequada como alternativa para o rastreio breve de delirium em idosos admitidos em unidades de urgência quando comparada ao padrão ouro, principalmente para pacientes desacompanhados e sem déficit cognitivo prévio.

OBJECTIVE: Delirium is one of the most frequent syndromes among elderly patients admitted to emergency units and, despite presenting well-established symptoms and signs, there are still diagnostic failures. Thus, the aim of the study was to adapt the Abbreviated Mental Test (AMT) as a screening tool for delirium in elderly adults admitted to an emergency department. METHODS: This cross-sectional study was conducted at the emergency department of a university hospital in Brasília, Brazil between April and June, 2014. We evaluated 90 patients of both sexes, aged 60 years or older. The Confusion Assessment Method (CAM) Instrument was considered the gold standard for diagnosing delirium. The complete translated AMT, administered in four different culturally adapted models, as well as condensed models, were compared to the CAM receiver operating characteristics curve (significance < 0.05; H0: AUC = 0.5). Inter-rater agreement was evaluated with the kappa test, using SPSS version 22.0.0.0. RESULTS: The prevalence of delirium was 25.6%. The best of the four AMT models presented sensitivity and specificity of 78.3% and 85.1%, respectively, with good inter-rater reproducibility (Kappa = 0.793). The best condensed model included four questions, with sensitivity and specificity of 82.6% and 82.1%, respectively, and a kappa of 0.746. CONCLUSIONS: Compared to the gold standard, the adapted AMT (complete or condensed) was adequate as an alternative for quick delirium screening in elderly patients admitted to an emergency department, especially for unaccompanied patients with no prior cognitive deficit

Eye-Closure Enhances Creative Performance on Divergent and Convergent Creativity Tasks.

In today's world of rapid changes and increasing complexity, understanding and enhancing creativity is of critical importance. Studies investigating EEG correlates of creativity linked power in the alpha frequency band to creativity, and alpha-power has been interpreted as reflecting attention on internal mental representations and inhibition of external sensory input. Thus far, however, there is no direct evidence for the idea that internally directed attention facilitates creativity. The aim of the current study was to experimentally investigate the relationship between eye-closure-a simple and effective means to stimulate internally directed attention-and creativity. Moreover, to test whether the potential beneficial effect of eye-closure is specific for creativity, or whether it improves general cognitive functioning, the current study tested the effect of eye-closure on creativity and on working memory (WM). Participants completed four tasks to measure divergent and convergent creativity (Adapted Alternative Uses (AAU) Test, Remote Associates Test (RAT), Sentence Construction Test, and Word Construction Test), and one task to measure WM (Digit Span Test). For each task, participants had to perform two versions, one version with eyes open and one version with eyes closed. Eye-closure facilitated creative performance on the classical divergent and convergent creativity tasks (AAU Test and RAT). No effect of eye-closure was observed on the WM task. These findings provide a novel and easily applicable means to enhance divergent and convergent creativity through eye-closure.

Underdiagnosis of delirium in the elderly in acute care hospital settings: lessons not learned.

BACKGROUND: Delirium is a common and poorly diagnosed cause of behavioral change in elderly. This study aimed to estimate the prevalence, diagnostic accuracy and factors associated with the onset of delirium in the elderly admitted to an urgency unit. METHODS: Cross-sectional study including clinically stable subjects aged ≥60 years between April and June of 2014. Diagnosis of delirium based on the Confusion Assessment Method (CAM, gold standard) was compared to the subjective assessment made by physicians on duty as recorded in the medical chart. Association of sociodemographic, psychological/behavioural, and clinical variables with delirium was assessed using multivariate analysis. RESULTS: A sample of 110 participants with a mean age of 72.7 ± 8.3 years was studied. Of these, 56.4% were men and 28.2% had a diagnosis of delirium on CAM. Significant associations were observed between delirium and male gender (P-value = 0.019), poor or very poor self-perception of health (P-value = 0.033), previous diagnosis of dementia (P-value = 0.001), previous history of stroke (P-value = 0.014), and acute bacterial infection (P-value = 0.008). Physician diagnosis had a sensitivity of 35.5%, specificity of 100%, and accuracy of 81.8% to detect delirium. Rate of misdiagnosis was 64.5%. CONCLUSION: Delirium was underdiagnosed in this urgent care hospital setting.

Transcutaneous vagus nerve stimulation (tVNS) enhances divergent thinking.

Creativity is one of the most important cognitive skills in our complex and fast-changing world. Previous correlative evidence showed that gamma-aminobutyric acid (GABA) is involved in divergent but not convergent thinking. In the current study, a placebo/sham-controlled, randomized between-group design was used to test a causal relation between vagus nerve and creativity. We employed transcutaneous vagus nerve stimulation (tVNS), a novel non-invasive brain stimulation technique to stimulate afferent fibers of the vagus nerve and speculated to increase GABA levels, in 80 healthy young volunteers. Creative performance was assessed in terms of divergent thinking (Alternate Uses Task) and convergent thinking tasks (Remote Associates Test, Creative Problem Solving Task, Idea Selection Task). Results demonstrate active tVNS, compared to sham stimulation, enhanced divergent thinking. Bayesian analysis reported the data to be inconclusive regarding a possible effect of tVNS on convergent thinking. Therefore, our findings corroborate the idea that the vagus nerve is causally involved in creative performance. Even thought we did not directly measure GABA levels, our results suggest that GABA (likely to be increased in active tVNS condition) supports the ability to select among competing options in high selection demand (divergent thinking) but not in low selection demand (convergent thinking).

Práticas assistenciais em partos de risco habitual assistidos por enfermeiras obstétricas em um hospital público de Porto Alegre / Care practices in high-risk births attended by obstetric nurses in a public hospital in Porto Alegre

Trata-se de um estudo transversal, retrospectivo, de caráter analítico, com abordagem quantitativa, realizado no centro obstétrico de um hospital público de Porto Alegre/RS, no período de março a agosto de 2017. Os objetivos do estudo foram caracterizar as práticas assistenciais, os desfechos obstétricos e neonatais em partos de risco habitual assistidos por enfermeiras obstétricas em um hospital público de Porto Alegre e comparar as práticas assistenciais realizadas no ano de início do modelo colaborativo (2013) com as práticas assistenciais realizadas em 2016. A amostra foi constituída por 564 parturientes de risco habitual com parto assistido por enfermeiras obstétricas no período de 2013 a 2016. Os dados foram coletados dos prontuários das parturientes e analisados por meio do software SPSS versão 16.0. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Grupo Hospitalar Conceição (nº 16278). Entre as parturientes a maioria era branca (73,2%), com média de idade de 25,6 anos, com escolaridade predominante de ensino fundamental (61%) e ocupação do lar (51,2%). A média de idade gestacional foi de 39 semanas. O motivo de internação mais prevalente foi o trabalho de parto com presença de bolsa íntegra (68%). Foram encontradas elevadas frequências de práticas assistenciais benéficas para as mulheres: presença de acompanhante no trabalho de parto e parto (97%), uso de partograma (92,7%), administração de dieta líquida por via oral (88,8%), uso de tecnologias obstétricas não invasivas (100%) e posições verticais no parto (73,1%) e para os recém-nascidos: clampeamento tardio do cordão umbilical (88,3%) e contato pele a pele por uma hora ou mais (93,4%) em partos assistidos por enfermeiras obstétricas no hospital estudado, cujas práticas estão, em sua maioria, em conformidade com as recomendações do Ministério da Saúde e da Organização Mundial da Saúde.No entanto, os achados deste estudo sugerem que existem práticas assistenciais que carecem de avanços, como a adequação do número de toques vaginais em relação à duração do trabalho de parto e a redução da prática de amniotomia, a qual, apesar de não ser realizada de maneira rotineira, foi uma prática com aumento percentual de 40% no período estudado. A comparação das práticas assistenciais nos anos de 2013 e 2016 revelou redução de intervenções desnecessárias: tricotomia (-100%), tonsura (-43,8%), uso de supositório retal (-85,8%), cateterização vesical (-73,1%), cateterização venosa (-58,9%), uso de ocitocina (-70,2%), uso de agentes sistêmicos para alívio da dor (-78,7%), analgesia peridural (-69,6%) e episiotomia (-63,9%) e crescimento percentual de práticas consideradas benéficas para as mulheres e os recém-nascidos: presença de acompanhante no trabalho de parto e parto (+3,1%), uso de partograma (+33,7%), administração de dieta líquida por via oral (+11,9%), posições verticais no parto (+100%), clampeamento tardio do cordão umbilical (+39,5%) e contato pele a pele por uma hora ou mais (+31,8%). Frente ao modelo predominante de assistência obstétrica no Brasil, que é centrado no médico obstetra e no cuidado medicalizado e intervencionista, o modelo colaborativo de assistência ao parto mostra-se como um caminho para a atenção às mulheres de risco habitual, com respeito à fisiologia do parto e ao protagonismo da mulher, capaz de promover a redução de intervenções desnecessárias por meio da realização de práticas assistenciais que resultam em desfechos obstétricos e neonatais favoráveis.

It is about a cross-sectional, retrospective, analytical, with quantitative approach study, performed at obstetrical center of a public hospital from Porto Alegre/RS, between March and August 2017. The objectives of the study were to characterize care practices, obstetric and neonatal outcomes in habitual risk childbirth assisted by obstetric nurses in a public hospital in Porto Alegre and to compare the care practices carried out in the year of beginning the collaborative model (2013) with the care practices carried out in 2016. The sample consisted of 564 parturients of habitual risk with childbirth assisted by obstetric nurses from 2013 to 2016. The data were collected from parturients medical records and analyzed by SPSS software version 16.0. The Research Ethics Committee at the Grupo Hospitalar Conceição approved the Project (nº 16278). Among the parturients, the majority were caucasian (73,2%), with an average age of 25.6 years, had attended primary school (61%) and were homemakers (51,2%). Mean gestational age was 39 weeks. The most prevalent reason for hospitalization was labor with amniotic sac intact (68%). Were found high frequencies of assistance practices beneficial to the woman's: presence of companion in labor and birth (97%), use of partogram (92,7%), oral liquid diet offering (88,8%), use of obstetric technologies noninvasive (100%) and vertical positions in childbirth (73,1%) and for newborns: late delayed umbilical cord clamping (88,3%) and skin-to-skin contact until one hour or more (93,4%) on childbirths assisted by obstetric nurses on the studied hospital, are the practices are, in their majority, in accordance with the recommendations of the Ministry of Health and World Health Organization. However, the findings of this study suggest that exist assistance practices that need advances, like the adequacy of the number of vaginal touches in relation of the duration of the labor and the reduction of the practice of amniotomy, which although not routinely performed, was a practice with a percentage increase of 40% in the studied period. The comparison of assistance practices in the years of 2013 and 2016 revealed a reduction of unnecessary interventions: trichotomy (-100%), tonsure (-43,8%), use of rectal suppository (-85,8%), bladder catheterization (-73,1%), venous catheterization (-58,9%), use of oxytocin (-70,2%), use of systemic agents for pain relief, (-78,7%), epidural analgesia (-69,6%) and episiotomy (-63,9%) and percentage growth of practices considered benefic for woman's and newborns: presence of companion in labor and birth (+3,1%), use of partogram (+33,7%), oral liquid diet offering (+11,9%), vertical positions in childbirth (+100%), late delayed umbilical cord clamping (+39,5%) and skin-to-skin contact until one hour or more (+31,8%). Against the predominant model of assistance in Brazil, that is centered on the obstetrician and in the medicalized and interventionist care, the collaborative model of childbirth assistance shows up as a path to the attention to woman's with habitual risk, with respect to the physiology of childbirth and the woman's protagonism, able to promote the reduction of the unnecessary interventions by means of the realizations of assistance practices which result in favorable obstetric and neonatal outcomes.

Happy creativity: Listening to happy music facilitates divergent thinking.

Creativity can be considered one of the key competencies for the twenty-first century. It provides us with the capacity to deal with the opportunities and challenges that are part of our complex and fast-changing world. The question as to what facilitates creative cognition-the ability to come up with creative ideas, problem solutions and products-is as old as the human sciences, and various means to enhance creative cognition have been studied. Despite earlier scientific studies demonstrating a beneficial effect of music on cognition, the effect of music listening on creative cognition has remained largely unexplored. The current study experimentally tests whether listening to specific types of music (four classical music excerpts systematically varying on valance and arousal), as compared to a silence control condition, facilitates divergent and convergent creativity. Creativity was higher for participants who listened to 'happy music' (i.e., classical music high on arousal and positive mood) while performing the divergent creativity task, than for participants who performed the task in silence. No effect of music was found for convergent creativity. In addition to the scientific contribution, the current findings may have important practical implications. Music listening can be easily integrated into daily life and may provide an innovative means to facilitate creative cognition in an efficient way in various scientific, educational and organizational settings when creative thinking is needed.

Smoking-related warning messages formulated as questions positively influence short-term smoking behaviour.

Research demonstrated that by reformulating smoking warnings into questions, defensive responses in smokers are reduced and smoking-related risk perception increases. We explored whether these positive outcomes can be generalised to actual behaviour. Participants saw either a movie presenting subheadings with smoking-related questions or statements. Afterwards, the time was measured until participants lit their first cigarette. Smokers who were presented with questions about the harms of smoking waited longer before lighting up a cigarette than smokers who were presented with statements. Presenting questions instead of the statements seems to be an effective means to prolonging smokers' abstinence.

Creativity-the unconscious foundations of the incubation period.

Creativity is one of the most important assets we have to navigate through the fast changing world of the 21st century. Anecdotal accounts of creative individuals suggest that oftentimes, creative discoveries result from a process whereby initial conscious thought is followed by a period during which one refrains from task-related conscious thought. For example, one may spend an embarrassing amount of time thinking about a problem when the solution suddenly pops into consciousness while taking a shower. Not only creative individuals but also traditional theories of creativity have put a lot of emphasis on this incubation stage in creative thinking. The aim of the present article is twofold. First, an overview of the domain of incubation and creativity is provided by reviewing and discussing studies on incubation, mind-wandering, and sleep. Second, the causes of incubation effects are discussed. Previously, little attention has been paid to the causes of incubation effects and most findings do not really speak to whether the effects should be explained by unconscious processes or merely by consequences of a period of distraction. In the latter case, there is no need to assume active unconscious processes. The findings discussed in the current article support the idea that it is not merely the absence of conscious thought that drives incubation effects, but that during an incubation period unconscious processes contribute to creative thinking. Finally, practical implications and directions for future research will be discussed.

Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: the Pietà study.

A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood. OBJECTIVE: The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype. METHODS: This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables. RESULTS: Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-ε4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups. CONCLUSION: No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

Um alcance educacional mais elevado constitui um fator protetivo contra o declínio cognitivo em idosos. Todavia, os elementos subjacentes a esta associação ainda são pouco compreendidos. OBJETIVO: O principal objetivo deste estudo foi comparar indivíduos analfabetos com comprometimento cognitivo com analfabetos cognitivamente normais, de acordo com aspectos demográficos, morbidades, hábitos de vida e genótipo APOE. MÉTODOS: Este é um estudo transversal da amostra de participantes analfabetos (n=174) do Estudo Pietà, um levantamento de base comunitária sobre envelhecimento cerebral bem sucedido, conduzido em Caeté (MG), Brasil. Os sujeitos foram categorizados em três grupos diagnósticos: cognitivamente normais, comprometimento cognitivo não demência e demência. Os grupos foram então comparados conforme variáveis selecionadas. RESULTADOS: Indivíduos com demência eram mais idosos e apresentaram uma maior prevalência de relato de acidente vascular encefálico ou ataque isquêmico transitório. Os três grupos não se mostraram diferentes em relação à demografia, prevalência de comorbidades, nível socioeconômico, perfil ocupacional prévio e frequência do alelo APOE-ε4. A avaliação qualitativa de hábitos de vida, como o consumo de bebida alcoólica, fumo e engajamento em atividade física também foi semelhante entre os grupos. CONCLUSÃO: Não encontramos associações entre comprometimento cognitivo/demência e as variáveis investigadas nesta amostra comunitária de idosos analfabetos.

Warning labels formulated as questions positively influence smoking-related risk perception.

Research on warning labels printed on cigarette packages has shown that fear inducing health warnings might provoke defensive responses. This study investigated whether reformulating statements into questions could avoid defensive reactions. Smokers were presented with either warning labels formulated as questions, textual warning labels, graphic warning labels, or no warning labels. Participants' smoking-related risk perception was higher after exposure to warning labels formulated as questions or no warning labels than after exposure to textual or graphic warning labels. These results indicate that reformulating statements into questions can avoid defensive responses elicited by textual- and graphic warning labels.