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The occurrence of pruritus in psoriasis was previously underestimated but is a significant burden. Secukinumab (SEC), a monoclonal anti-interleukin-17A antibody, efficiently controls signs of psoriasis, but the effect on pruritus and cutaneous neuroanatomy remained unknown. The primary objective of this study (NCT02362789) was to evaluate the superiority of SEC treatment vs placebo on pruritus intensity (visual analogue scale; VAS). Furthermore, the treatment-dependent course of pruritus in association with absolute Psoriasis Area Severity Index (PASI) score, as well as cutaneous histopathology and neuroanatomy, was assessed. Open-label SEC 300 mg s.c. was administered regularly until week 16. Patients who reached a ≥ 98% PASI reduction (PASI ≥ 98) were randomized to receive either placebo or SEC up to week 32. Punch biopsies were collected from lesional psoriatic (baseline, weeks 16 and 32) and non-lesional (baseline) skin for histopathological and neuroanatomical analyses. VAS scores improved significantly after open-label SEC treatment but relapsed upon placebo (29.92 ± 33.8) compared with SEC (12.30 ± 22.6; p = 0.036). After SEC-dependent improvement in PASI, histopathology, marker expression and neuroanatomy, relapse was observed with treatment discontinuation in all parameters except neuroanatomy. SEC was superior to placebo by efficiently controlling reduced pruritus intensity, clinically normalizing skin lesions, and reversing histopathological abnormalities. The neuroanatomy recovered upon SEC and remained stable even after withdrawal.

BackgroundChronic scratching imposes a major stress on the skin and can lead to itch intensity worsening, and consequently, patients may enter an itch–scratch cycle. This repetitive mechanical stress can result in lichenification, worsening of epidermal barrier function, and enhanced cutaneous inflammation. Furthermore, a reduction of intraepidermal nerve fibers was previously described in lichenification.AimThe aim of this study was to investigate the influence of chronic scratching on the epidermal neuroanatomy and on sensory changes, in particular the prevalence of hyperknesis and alloknesis in patients after mechanical, chemical, and electrical stimuli.MethodsAnalyses were performed on pruritic lichenified (chronically scratched), pruritic non-lichenified (not chronically scratched), and non-pruritic non-lesional (unaffected) skin areas of patients with inflammatory pruritus, i.e., atopic dermatitis (n = 35), and neuropathic pruritus, i.e., brachioradial pruritus (n = 34) vs. healthy matched controls (n = 64). Our fine-grained spatial skin characterization enabled specifically studying the differential effects of chronic scratching in inflammatory and neuropathic itch.ResultsAnalysis of intraepidermal nerve fiber density showed rarefaction of fibers in all three skin areas of patients compared with healthy controls in both diagnoses. Even more, the two pruritic areas had significantly less nerve fibers than the unaffected skin, whereas electrically induced itch was massively increased. Epidermal branching of the remaining nerve fibers in lichenified/chronically scratched skin was increased, particularly in patients with brachioradial pruritus, which may contribute to the pronounced local neuronal sensitivity. Hyperknesis and alloknesis were found to increase independently of lichenification.ConclusionOur results indicate that chronic scratching may not affect intraepidermal nerve fiber density but leads to a stronger branching pattern of intraepidermal nerve fibers, which may contribute to local hypersensitivity. The increased sensitivity in the pruritic areas suggests mechanisms of peripheral sensitization, whereas the increased sensation of electrically and chemically induced itch in unaffected skin indicates central sensitization for itch.

Human hands are complex structures essential for a variety of functions in everyday life. This study prospectively investigated the clinical features of hand pruritus and the resulting functional impairment and disease-related burden in 395 patients with chronic pruritus (210 females, median age 59 years). Moderate to very severe hand pruritus was reported by 91.2% of patients, while 79% perceived additional sensory symptoms, such as burning, pain or tingling. A long duration of pruritus occurred in most cases (>6 months: 71.4%). A considerable proportion of patients showed moderate to severe impairment in the use of their hands (40.2%), performance of daily activities (65.0%) and quality of life (45.2%). Disease severity and burden is particularly high when both the palms and the backs of the hands are affected, and when pain is present simultaneously. Pruritus located on the hands is impairing and burdensome due to the functional relevance of the hands in everyday life.

Chronic pruritus of unknown origin is established when no underlying origin for pruritus can be determined. This retrospective cohort study aimed to determine the clinical profile and disease-related burden of chronic pruritus of unknown origin. A total of 263 patients (female/male: 154/109, median age 55 years) were included. Moderate to severe itch intensities were recorded (median average itch: 5.5/10, n = 200; median worst itch: 7.5/10, n = 199). In most cases pruritus lasted longer than 1 year (77.6%), occurred daily (68.2%), occurred in attacks (72.8%), and was often accompanied by dysaesthesias, such as burning, tingling and stinging. Quality of life was moderately impaired, while 22.2% and 12.4% of patients showed pathological anxiety and depression scores. Scratch lesions were associated with higher intensities of itch and greater impairment of quality of life, while women were more burdened by the disease than men. Chronic pruritus of unknown origin may occur at any age and the majority of patients endure severe itch with substantial disease-related burden.

Central sensitization induces pain augmentation in chronic pain states. An analogous mechanism is speculated for chronic pruritus. This study compared patients with chronic pruritus (n = 79) of different origins (atopic dermatitis, chronic pruritus on non-lesional skin, chronic prurigo) and healthy controls (HC, n = 54) with regard to itch intensity and qualities of sensory symptoms after selective peripheral nerve fibre activation by electrical stimulation at 5 Hz (surrogate for C-fibre function) and 2,000 Hz (surrogate for Aβ-fibre function) using a Neurometer®. Electrically-induced itch was more intense in patients with chronic pruritus than in HC, but patients with chronic pruritus did not report “itch” more often than HC at 5 Hz. Stimulation at 2,000 Hz induced more pricking and tingling, but less throbbing in patients with chronic pruritus compared with HC. Treatment with cooling compound reduced clinical and experimental itch, but did not alter the distribution of sensory symptoms. These data show hyperknesis in chronic pruritus of various origins, arguing for common central sensitization mechanisms.

Chronic pruritus (CP) is often accompanied by paresthetic sensations like warmth, burning and stinging. The aim of this study was to analyze, whether divergent sensations are linked to structural and functional skin alterations in clinically diagnosed CP patients. Clinical responses to capsaicin, histamine, and to thermal and mechanical stimulation, intraepidermal nerve fiber density, and epidermal expression of transient receptor potential (TRP)-channels were investigated in healthy controls, and in CP patients, reporting either warmth (CP-W) or neuropathic sensations (CP-N). In CP-W, pinprick hyperalgesia and increased sensitivity to capsaicin were aligned with increased epidermal TRPV1 expression, while smaller histamine axon reflex erythema matched with significantly reduced intraepidermal nerve fiber density. CP-N showed earlier onset of sensations after capsaicin stimulation, significantly increased warmth detection threshold, and higher epidermal expression of TRPV4 compared to healthy controls. The present study contributes to the neurobiological understanding of the divergence of sensory sensations in CP, indicating new treatment targets.

Chronic prurigo is a pruritic disease characterized by the development of pruriginous lesions due to scratching. The number of lesions is representative of the stage of the disease, while the presence of excoriations reflects the scratching activity. Aim of this study was to validate a new developed tool for the objective assessment of chronic prurigo. Investigator’s Global Assessment scales for stage and activity were completed for 187 patients with chronic prurigo, who also reported patient-reported outcomes for itch intensity and quality of life. To assess the reliability and objectivity of the Investigator’s Global Assessment, 5 independent raters completed the Investigator’s Global Assessment scales for 8 patients twice. The scores increased with increased intensity of pruritus. The Investigator’s Global Assessment stage scales correlated strongly with each other (Kendall’s-tau-b 0.62) and moderately with the Investigator’s Global Assessment activity scale (Kendall’s-tau-b 0.47). Intra-rater test–retest reliability was excellent for all items, while the congruence among raters was very good for Investigator’s Global Assessment – chronic prurigo activity (Kendall’s W 0.84) and good for Investigator’s Global Assessment stage scales (Kendall’s W 0.747). Investigator’s Global Assessment – chronic prurigo stage and activity are thus the best Investigator’s Global Assessment instruments for use in assessing chronic prurigo.

Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.

Chronic nodular prurigo presents with multiple pruriginous nodules and severe pruritus. This study aims to explore the treatment course and regimens in patients with chronic nodular prurigo and to analyse predictive factors contributing to therapeutic success. A total of 325 patients with chronic nodular prurigo (male 37.5%) were analysed concerning demographic data, pruritus intensity, medical history, psychological impairment, quality of life, treatment duration, regimens and outcome. These parameters were compared with 325 sex- and age-matched patients with chronic pruritus on non-lesional skin. Treatment success was dependent on duration and regime of treatment and independent of age, sex and initial itch intensity. Non-responders displayed a higher percentage of inflamed nodules, a higher portion of excoriated nodules and a higher impairment of quality of life and mood factors before initiation of treatment. Gabapentinoids and immunosuppressants proved to be the most successful therapeutic agents. Compared with patients with chronic pruritus, those with chronic nodular prurigo needed longer duration of therapy.

Chronic pruritus is a frequent global condition. The pathophysiology, underlying aetiology, clinical manifestation, associated burden and response to therapy of chronic pruritus varies from patient to patient, making clinical research and management of this condition challenging. There are still several unmet needs, such as the need to standardize translational research protocols, diagnostic and therapeutic procedures and to enhance the knowledge of the humanistic and economic burden associated with chronic pruritus. Basic and clinical research is of the utmost importance to target these matters. Clinical research has the potential to identify new relevant mechanisms in affected patients, which may lead to identification of novel therapy targets. This article discusses in depth current shortcomings in the daily care of patients with chronic pruritus and the challenges clinical researchers and physicians treating chronic pruritus face in addressing these matters.

Brachioradial pruritus (BRP) and notalgia paraesthetica (NP) represent 2 of the most common neuropathic itch syndromes. A total of 58 consecutive patients presenting at the Center for Chronic Pruritus, University Hospital Münster, were analysed with regard to clinical presentation, anatomical and morphological pathologies, impairment in quality of life, and response to treatment with topical capsaicin. Patients with BRP reported stinging and burning more often than those with NP. In the BRP group structural magnetic resonance imaging abnormalities more frequently correlated with localization of the symptoms compared with in patients with NP. In addition, intraepidermal nerve fibre density was decreased in lesional skin in patients with BRP, but not in those with NP, confirming the neuropathic origin in BRP. Topical capsaicin resulted in a significantly higher alleviation of itch and pain intensity and improvement in quality of life in patients with BRP compared with those with NP, which may reflect clinical and aetiological differences between the conditions.

Introduction Chronic pruritus (CP) is a symptom of dermatologic, neurologic, systemic and psychosomatic diseases. CP has a prevalence of ~20% in the general population and is therefore a significant burden on society, but the transition from acute pruritus to CP is not well understood. It probably involves interactions between biological and psychosocial factors and pruritus-specific risk factors as well as mechanisms shared with other persistent somatic symptoms addressed in other projects of the SOMACROSS Research Unit (RU). Here we aim to identify psychosocial and biological factors and their interactions which might be associated with the persistence of CP with and without immunologic/inflammatory origin, that is, atopic dermatitis and pruritus on non-inflamed skin. We expect that psychosocial factors relevant to the persistence of symptoms such as fatigue and pain may also show associations to CP.Methods and analysis In this prospective, exploratory observational study situated in Germany, three cohorts of 40 patients each with acute exacerbation of atopic dermatitis and chronic atopic dermatitis and 40 CP patients with unaffected skin will be recruited for a comprehensive translational investigation including pruritus-specific and the shared psychosocial assessments of the RU SOMACROSS. Pruritus-specific measures will include questionnaires, quantitative sensory testing, cutaneous nerve fibre morphology, skin barrier morphology, epidermal metabolism and pruritogen blood levels. Within 1 year, patients and 80 age-matched and sex-matched healthy controls will be examined at three time points, allowing cross-sectional comparison and a longitudinal investigation of predictive outcome factors in patients under treatment according to existing guidelines.Ethics and dissemination The study has been approved by the ethics committees of Hamburg (2020-10200-BO-ff) and Münster (2020-676 f-S), Germany. All participants are required to provide written informed consent. Findings will be disseminated through peer-reviewed publications, scientific conferences and involvement of relevant stakeholders, patients and the lay public.Trial registration number DRKS00026646.

Background: A cost-effective solution for the design of distributed energy storage systems implies the development of battery performance models yielding a suitable representation of its dynamic behaviour under realistic operation conditions. Methods: In this work, a lithium-ion battery (LIB) is tested to be further modelled and integrated into an existing energy management control system. This specific LIB (5.0 kW /9.8 kWh) is integrated with a commercial inverter and solar photovoltaic (PV) system (3.3 kWp) as part of a microgrid that is also encompassing other energy storage technologies at the University of Évora, Pole of INIESC – National Research Infrastructure for Solar Energy Concentration. A testing protocol fully characterizes the battery and the inverter efficiency to describe their performance better. Then, a battery model is built upon both the existent LIB description and experimental fitting regression. The model allows obtaining the voltage curve, the internal resistance (i.e., to describe instantaneous voltage drop/rise and transients), and the state of charge (SOC) and/or energy capacity based on the current input. The developed model is validated through the comparison with the experimental results. Results: The model approach presented a higher voltage RMSE (root mean square error) of 5.51 V and an MRE (maximum relative error) of 5.68 % in the discharge state. Regarding SOC, the MRE obtained was approximately 6.82 %. In the charge state, the highest RMSE voltage was 5.27 V, with an MRE of 6.74 %. Concerning SOC, the MRE obtained was approximately 6.53 %. Conclusions: The developed model is validated through the comparison with experimental results. Based on computational effort, simplicity of use and the associated model error, the approach is validated to the regular conditions of the commercial battery pack to be incorporated in the next research step, following a bottom-up modelling approach for an increasingly more complex smart grid.

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RESUMO As anomalias craniofaciais constituem um grupo diverso e complexo de defeitos congênitos impondo um significativo impacto sobre a qualidade de vida do indivíduo e de toda a sua família. Nesta realidade, o fonoaudiólogo apresenta-se como profissional indispensável no processo de reabilitação, todavia, a formação do mesmo não predispõe dos conhecimentos necessários para uma visão integral do portador da anomalia. Este estudo tem por objetivo, portanto, discutir a utilização das Tecnologias Digitais como instrumentos mediadores da aprendizagem de estudantes e profissionais, levando-se em consideração as mudanças nas interações sociais na sociedade contemporânea que contribuem para a constituição da subjetividade. Palavras-chave: Anomalia Craniofacial. Educação Permanente. Educação em Saúde. Tecnologia em Saúde. ABSTRACT Craniofacial anomalies constitute a diverse and complex group of birth defects that have a significant impact on the quality of life of individuals and their families. In this reality the speech therapist is presented as an indispensable professional in the rehabilitation process, however, the training of the same do not predispose the knowledge necessary for an integral view of the patient with the anomaly. Therefore, this study aims to discuss the use of Digital Technologies as mediators in the learning of students and professionals, taking into account the changes in social interactions in contemporary society that contribute to the constitution of subjectivity. Keywords: Craniofacial Abnormalities. Education Continuing. Health Education. Biomedical Technology.

Introdução: As pessoas com demência e os seus familiares deveriam ter acesso atempado a cuidados formais na comunidade (centros de dia, apoio domiciliário). O projecto EU-Actifcare investigou o acesso/utilização destes serviços em países europeus. Descrevemos a implementação do estudo de coorte e a avaliação inicial em Portugal, com foco nas necessidades de cuidados e recurso aos serviços. Material e Métodos: Selecionámos uma amostra de conveniência de 66 pessoas com diagnóstico de demência ligeira a moderada (residindo na comunidade sem cuidados formais relevantes) e respetivos familiares-cuidadores. A avaliação (clínico-funcional e social) incluiu os instrumentos Camberwell Assessment of Need for the Elderly e Resource Utilization in Dementia. Resultados: Identificámos necessidades não-cobertas dos doentes (média 1,1; DP = 1,7), principalmente de companhia (23% dos casos), sofrimento psicológico (20%) e atividades diárias (14%). Os familiares-cuidadores dedicavam 150 minutos/dia (mediana) à prestação de cuidados e 44% apresentavam necessidades não-cobertas de sofrimento psicológico. Quando havia problemas de acesso/utilização dos serviços de saúde e sociais na comunidade, estes estavam frequentemente relacionados com recusa ou desconhecimento de utentes/familiares. Discussão: A seleção dos participantes não foi fácil, pela especificidade dos critérios adotados. Não almejando representatividade nacional, recrutámos uma amostra típica de pessoas em estádios ligeiros a moderados de demência, em serviços e regiões diferentes. Nalguns casos, encontrámos necessidades não-cobertas e repercussões familiares que já justificariam respostas de serviços na comunidade, não fossem os problemas de acesso/utilização. Conclusão: Na área das demências, existem dificuldades no acesso atempado e utilização efectiva de cuidados formais, coexistindo com uma cobertura menor de necessidades específicas.

This work reports the synthesis of nanocomposite photocatalytic materials based on nitrogen-doped TiO2nano, SiO2 and different percentages of HY zeolite (0, 12, 25 and 50%). These materials were characterized by using Fourier transformed infrared spectroscopy, X-ray diffraction, N2 adsorption–desorption, UV-vis diffuse reflectance spectroscopy and scanning electron microscopy. The nanocomposites, which presented an energy band gap of about 3.03 eV, were immobilized on cotton fabric and their self-cleaning properties were investigated by decolourization of rhodamine B (RhB) dye in aqueous solution under simulated solar irradiation. The fabrics coated with the photocatalysts, containing and not containing zeolites, showed the same RhB decolourization (about 95%) after 5 h, excluding the situation where a large amount of HY (50%) was used in the nanocomposites. However, results obtained from high performance liquid chromatography analysis depicted that in the presence of the HY zeolite a more effective RhB degradation was achieved. In fact, even after the use of five consecutive cycles, the RhB decolourization remained high (about 85%). Generally, the photodegradation of RhB solution in the presence of cotton fabrics functionalized with TiO2nano, TiO2nano-SiO2 and TiO2nano-SiO2-0.25 HY resulted in the formation of products that exhibited a similar cytotoxic effect when compared to the untreated RhB solution and subjected to the same tested concentrations and incubation times. Keywords: Photocatalysis, Textile functionalization, TiO2-SiO2, HY zeolite, Rhodamine B, Cytotoxic

Abstract Background Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking. Methods AFIVASC is a multi-centre randomised controlled trial, with a 6-month intervention treatment and an additional follow-up of 6 months, that aims to estimate the impact of 6 months of moderate intensity physical activity on cognition (the primary outcome) at 6 and 12 months in subjects with VCI. Participants are community dwellers with criteria for VCI without dementia or who have had previous stroke or transient ischaemic attack (TIA). Patients may be self-referred or referred from a medical appointment. After confirming the inclusion criteria, a run-in period of 1 month is conducted to access adherence; only after that are subjects randomly assigned (using a computerised program blinded to clinical details) to two groups (intervention group and best practice usual care group). The intervention consists of three physical activity sessions of 60 min each (two supervised and one unsupervised) per week. The primary outcome is measured by the presence or absence of decline in cognitive status. Secondary outcomes include changes in neuro-cognitive measures, quality of life, and functional and motor status. Primary and secondary outcomes are evaluated at 6 and 12 months by investigators blinded to both intervention and randomisation. A required sample size of 280 subjects was estimated. Statistical analyses will include regression analysis with repeated measures. The study was approved by the Ethics Committee for Health of Centro Hospitalar de Lisboa Norte (ref. no. 1063/13) and by the Ethics Committee for Health of Centro Hospitalar do Porto CHP (ref. no. 2016.055(049-DEFI/048-CES)). Discussion We aim to show whether or not moderate physical activity has a beneficial impact on cognition, quality of life, motor, and functional status in people with vascular cognitive impairment, and to generate new insights on the applicability of implementing physical activity in this specific population. Trial Registration ClinicalTrials.gov, NCT03578614 July 6, 2018.

El uso Trichoderma spp. se ha incrementado en la actualidad para el control de hongos patógenos de plantas. En Venezuela los productos comerciales a base de Trichoderma son formulados casi exclusivamente a partir de esporas de T. Harzianum, pero muchos experimentos han reportado en la literatura un mejor desempeño de otras especies nativas no comerciales en comparación con los productos formulados en el país. En este trabajo, 4 especies nativas de Trichoderma Persoon fueron evaluadas en condiciones de laboratorio y en invernaderos comerciales para el control de la marchitez del Fusarium en una variedad de tomate tipo “cherry” de crecimiento indeterminado. Diferentes experimentos fueron realizados para evaluar el antagonismo, micoparasitismo, endofitismo, efecto de metabolitos secundarios producidos por Trichoderma y el efecto agronómico de esas especies en los invernaderos comerciales. Las especies evaluadas fueron: T. koningiopsis Samuels, Suárez & Evans, T. virens Mill., Giddens & Foster, T. spirale Bissett y T. harzianum Rifai. De todas estas, T. spirale mostró los mejores resultados en todos los experimentos. Trichoderma spirale fue capaz de inhibir el crecimiento de Fusarium hasta el 79% en placas de PDA; mientras que sus metabolitos secundarios redujeron el crecimiento del patógeno en un 64%. Por otro lado, mostró un efecto protector contra Fusarium en condiciones in planta en pruebas de laboratorio, reduciendo la enfermedad en 70%. También demostró un efecto positivo en el crecimiento de la planta, posiblemente la acción edofitica de T. spirale. En condiciones de invernadero T. spirale produjo los mejores resultados luego de 90 días post-transplante con el aumento del tamaño de las plantas, la producción de tomates por racimo junto con la protección de las plantas contra la marchitez del Fusarium. Los resultados obtenidos con la cepa nativa de T. spirale usada en este trabajo demostraron que este organismo posee un gran potencial como agente de control biológico

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Abstract Background People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals. Method Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports. Results Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives. Conclusion Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.

Introdução: A capacitação dos cidadãos no auxílio a vítimas em risco de vida é fundamental em qualquer sociedade. Objetivo: avaliar os conhecimentos sobre Suporte Básico de Vida dos trabalhadores de uma Câmara Municipal do norte de Portugal, antes e após a implementação do programa de intervenção “Capacitar para Salvar” e avaliar as competências demonstradas, após a participação no programa de intervenção. Materiais e Métodos: Trata-se de um estudo do tipo quase-experimental e longitudinal, onde foi utilizado um questionário, constituído por 2 partes (caraterização sociodemográfica e avaliação de conhecimentos) e uma grelha de avaliação de competências. No 1º momento foram avaliados os conhecimentos sobre Suporte Básico de Vida e implementado um programa de intervenção, sendo que no 2º momento, foram avaliados os conhecimentos e competências sobre Suporte Básico de Vida. Resultados: Participaram no estudo 97 trabalhadores. Os resultados mostraram que os trabalhadores possuem conhecimentos e competências insuficientes em Suporte Básico de Vida. Discussão e Conclusões: Verificaram-se diferenças estatisticamente significativas nos conhecimentos e competências em Suporte Básico de Vida. Implicações para a prática: implementação de estratégias que promovam a formação em Suporte Básico de Vida a todos cidadãos, quer ao nível da transmissão de conhecimentos, quer da formação prática. Como citar este artigo: Monteiro MJFSP, Pereira MCARS, Carvalho RMBC, Carril ÉSB, Carril MFB, Rodrigues VMCP. Capacitação de trabalhadores em suporte básico de vida. Rev Cuid. 2018; 9(2): 2117-26. http://dx.doi.org/10.15649/cuidarte.v9i2.505

Introduction: Patient satisfaction is an important measure of health care quality. Patients’ views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users’ perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. Material and Methods: The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants’ satisfaction. Results: Internal consistency of the questionnaire was high (α = 0.87). Participants’ age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. Discussion: The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. Conclusion: The Portuguese version of VOICE is a promising tool to assess service users’ perceptions of inpatient psychiatric care in Portugal.

Abstract Background Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. Methods A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site). Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. Results We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80–10.90) using the 10/66 DRG algorithm and 3.65% (95% CI 2.97–4.97) using DSM-IV criteria. Pure Alzheimer’s disease was the most prevalent dementia subtype (41.9%). The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Conclusions Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two approaches remains to be confirmed in the European context. We improved the evidence base to raise awareness and empower advocacy about dementia in Portugal, so that the complex needs of frail older people may be met in better ways.

Abstract Background As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4–7 experts (total N = 38). The interview guide addressed the topics “Complexity and Continuity of Care”, “Formal Services”, and “Public Awareness”. Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Abstract Background The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. Methods Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. Results Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 – for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 – for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values

Chronic pruritus is a complex multifactorial symptom associated with many different diseases that represents a diagnostic and therapeutic challenge for physicians. In order to better manage chronic pruritus, a detailed medical history, individualized diagnostic procedures and treatment approaches are necessary. Treatment should not only take itch into consideration, but also scratching-induced skin lesions and accompanying disorders such as anxiety, depression and insomnia. Various standardized questionnaires and scales have been developed to assist in the characterization and assessment of these parameters. Monodimensional scales (e.g. the visual analogue scale) represent a simple method for assessing pruritus intensity and are frequently used; however, they can easily be confounded and may indicate the level of satisfaction regarding the medical care provided rather than the itch course. The Dynamic Pruritus Score and Itch-Free Days questionnaire enable a closer assessment of patient responses to treatment. Because chronic pruritus has the potential to greatly impact the quality of life, it is important that physicians recognize it as a major issue. The Dermatology Quality of Life Index is an instrument that is used in a variety of dermatological conditions, but may be unsuitable for measuring pruritus of extracutaneous origin. The ItchyQol is a tool designed specifically for those suffering from pruritus. Additional tools, such as the Hospital Anxiety and Depression Scale, take psychiatric comorbidities into consideration. Recommendations from European (EADV-based Task Force Pruritus) and international (International Forum for the Study of Itch) expert groups focusing on assessment instruments for chronic pruritus are also provided in this article.

In the last decade, several works showed that even bryophytes from aquatic environments, if slowly dehydrated, can cope with desiccation in a response like the one from desert bryophytes. This led to the hypothesis that, if bryophytes from contrasting habitats can have similar responses, desiccation tolerance (DT) is partially inductive and not only constitutive as previously proposed and, therefore, colony morphology might be the key trait responsible for controlling dehydration rate essential for DT induction. Morphology and life form may be determinant traits in the adaptation of bryophytes to habitats with different water availabilities and corresponding predicted levels in the DT inducibility spectrum. Bryophytes from habitats with different water availabilities were dried as individual shoots and as a colony. The bryophyte Fontinalis antipyretica is fully aquatic presenting a streamer life form, while the three terrestrial species present turf life form with different sizes and degrees of space between individuals in the colony. Two species were collected under trees with moist soil presenting short turf (Tortella tortuosa) and long turf (Campylopus pyriformis) life forms. Another species was completely exposed to sun light with no surrounding trees and a tall turf life form (Pleurochaete squarrosa). We used chlorophyll a fluorescence parameter Fv/Fm (maximum potential quantum efficiency of Photosystem II) as a proxy to photosynthetic fitness throughout the contrasting dehydration rates (fast and slow). These bryophytes with different life forms were submitted to an X-ray computed microtomography (µ-XCT) to assess the three-dimensional inner structure and visualize locations for water storage. Shoots dried slow or fast according to the dehydration they were exposed to, as expected, but they presented similar dehydration rates across different species. However, the aquatic moss F. antipyretica, was unable to recover from fast drying, and after 24 h the recovery following slow drying was lower than the other species. The other three species presented full recovery after 24 h, either at the individual or colony level, and either from slow or fast drying. The only exception was the colonies of Campylopus pyriformis following fast drying that presented a slightly lower recovery, probably due to a looser colony structure.

This study aimed to evaluate the effect of diets containing increasing levels of citrus pulp on the physicochemical and microbiological characteristics of horses feces. Five mares, at an average age of 3.5 years old and body weight of 492 ± 44.5 kg were arranged in a 5 x 5 Latin Square. The experimental diet consisted of 60% coast-cross hay and 40 % of concentrate with increasing levels of citrus pulp (0, 7, 14, 21, and 28 %). To determine the fecal pH, samples were collected directly from the floor, immediately after defecation, in the first feces of the day at 07:00 a.m., and color and fecal consistency were evaluated. For microbiological analysis, an aliquot was reserved in plastic bags, frozen, and sent to the microbiological laboratory for further analysis. Lactic acid bacteria were counted for Lactobacillus spp. and Streptococcus spp. from fecal samples under anaerobic conditions. The diet produced differences (P0.05) on pH and on the number of Lactobacillus spp. and Streptococcus spp. The inclusion of up to 28% citrus pulp concentrates for horses did not promote change in the physicochemical characteristics and on the population of lactic acid-producing bacteria in feces. Keywords: byproducts; lactobacillus; nutrition; pH.

Thermal mortars incorporating insulating aggregates are a possible solution to ensure good thermal performance and thermal comfort in buildings due to their low thermal conductivity coefficient. Under some circumstances, namely for particular in-service conditions in industrial applications and/or accidental actions (such as fire), it is important to quantify the retention of their properties after exposure to elevated temperatures, however this information is not yet available in the literature. This study aims to characterize the physical and mechanical behavior of thermal mortars incorporating expanded clay, granulated expanded cork and silica aerogel as aggregates after exposure to elevated temperatures. To this end, five types of mortars were produced in laboratory conditions—three thermal mortars, one reference sand mortar and one sand mortar with admixtures—and then exposed to different elevated temperatures (from 20 °C to 250 °C) in a thermal chamber. After thermal exposure, the following properties were assessed: bulk density; ultrasonic pulse velocity; dynamic elasticity modulus; dynamic shear modulus; Poisson coefficient; compressive strength; and thermal conductivity. The results obtained show that residual properties present a very high dependence on the reactions that take place in the cement paste when the mortars are exposed to elevated temperatures. After such exposure, all mortars with thermal insulating aggregates were able to maintain their insulating characteristics, but experienced internal damage and degradation of their mechanical properties. Results obtained also showed that insulating aggregates allowed to produce mortars with higher aggregate-cement paste compatibility at elevated temperatures compared to conventional mortars, resulting in less micro-cracking of the mortar, and leading to lower reductions in thermal conductivity with increasing temperature.

Este trabalho visa sistematizar e contextualizar considerações teóricas e práticas relevantes na dinâmica de gestão de talentos em um contexto de negócios, bem como observar na implementação na prática em pequenas e médias empresas no norte de Portugal. A primeira parte composta por uma revisão de literatura relacionada com o tema e na segunda parte desenvolveu-se um estudo qualitativo adaptado de Vroom, (1964, citado por Chiavenato, 2014) recorrendo a entrevistas em profundidade como instrumento de recolha de informação. Como resultados esperados pretendemos caracterizar, sistematizar e entender as melhores ideias, reflexões e práticas em gestão de talentos e seu impacto na inovação organizacional. A utilização de uma única fonte de recolha de informação junto dos responsáveis pela gestão da comunicação nas organizações através de entrevistas em profundidade, limitando a dialética de compreensão global das suas opiniões sobre o tema. Em termos práticos e operacionais permite compreender a dinâmica da eficiência individual dos colaboradores na estratégia organizacional e sistematizar considerações relevantes sobre esta temática. O seu principal contributo e valor consiste em analisar e compreender de forma mais eficiente a atitude dos gestores face à satisfação, envolvimento e comprometimento dos colaboradores e a sua relevância na performance e reputação organizacional.

Novel ecosystems have emerged through human intervention and are rapidly expanding around the world. Whether they can support animal wildlife has generated considerable controversy. Here we developed a new approach to evaluate the ability of a novel forest ecosystem, dominated by the exotic tree species Eucalyptus globulus, to support animal wildlife in the medium and long term. To evaluate this ability, we took advantage of the fact that species territory size decreases with increasing habitat quality, and we used territoriality of a raptor guild composed of Northern Goshawk (Accipiter gentilis), Eurasian Sparrowhawk (A. nisus) and Common Buzzard (Buteo buteo) as indicator. We compared the territoriality of these species in the novel ecosystem with that in other ecosystems found in the literature. Average distances between con-specifics in the novel ecosystem were similar, or even shorter, than those in other ecosystems. Average distances between Goshawk con-specifics were among the shortest described in the literature. All three species nested preferably in mixed stands abundant in large exotic trees, with high structural complexity and abundance of native species within the stand. Key factors supporting this diverse and dense raptor community were the special forest management system implemented in the study area and the agricultural matrix located close to forest plantations that complements the supply of prey. Our results suggest that forest management that promotes a complex and suitable forest structure can increase the ability of novel forest ecosystems to support wildlife biodiversity, particularly a diverse nesting community of forest-dwelling raptors and their preys. The results further suggest the suitability of territoriality for assessing this potential of novel ecosystems.

Prurido com seis ou mais semanas de duração é considerado crónico (PC). Pode ter como origem causas dermatológicas, sistémicas, neurológicas, psicossomáticas ou psiquiátricas ou advir de uma combinação de vários factores. Devido a processos de cronificação, nomeadamente sensibilização neuronal periférica e central, o prurido pode persistir apresar do tratamento da causa subjacente. Além disso, PC leva frequentemente a doenças reativas, como depressão, ansiedade ou distúrbios de sono, tendo como consequência um substancial decréscimo da qualidade de vida. Devido à multidimensionalidade do PC, esta condição representa um desafio importante para o médico assistente. A classificação do doente com PC de acordo com a apresentação clínica facilita a orientação dos procedimentos de diagnóstico necessários bem como ajuda a estabelecer uma estratégia terapêutica. A nível terapêutico uma abordagem por etapas é recomendada. Primeiramente devem-se iniciar medidas básicas como a aplicação de emolientes para a xerose cutânea, corticoesteróides tópicos para pele inflamada ou com escoriações bem como o uso de medicamentos anti-histamínicos. Caso a origem do PC seja conhecida, deve-se proceder, se possível, ao tratamento da causa subjacente. Se a causa permanecer desconhecida ou não for passível de tratamento, uma terapia sintomática multimodal com agentes tópicos e sistémicos é frequentemente necessária. Com o aumento do conhecimento dos mecanismos patofisiológicos subjacentes ao PC, novos fármacos tem sido desenvolvidos mostrando resultados promissores.

OBJECTIVES: to adapt and validate the Inventory of Family Protective Factors (IFPF) for the Portuguese culture. This instrument assesses protective factors that contribute to family resilience. Studies addressing resilience are embedded within the salutogenic paradigm, i.e. it addresses protective factors of individuals or groups without underestimating risk factors or vulnerability.METHOD: in order to assess the IFPF's linguistic and conceptual equivalence, the instrument was translated, retro-translated and the think-aloud protocol was used. We then verified the instrument's sensitiveness, reliability and validity of results to assess its psychometric characteristics. A factor analysis was performed of the principal components with varimax rotation of the scale's items and Cronbach's alpha coefficient was calculated for each dimension. A total of 85 families with disabled children, selected through simple random sampling, self-administered the instrument.RESULTS: the IFPF presents psychometric characteristics that are appropriate for the Portuguese population (Cronbach's alpha = .90).CONCLUSION: the IFPF was adapted and validated for the Portuguese culture and is an instrument to be used in studies intended to assess protective factors of family resilience.

This study aimed to assess the care received and the barriers faced by immigrants and Portuguese pregnant women in Portugal. This is an exploratory qualitative study, resorting to applying semi-structured interviews to 60 immigrant and 22 Portuguese women. Content analysis supported by QSR Nvivo10 program was used. The study was approved by an Ethics Committee. The results showed four categories related to affective dimensions-relational, cognitive, technical-instrumental and health care policy for pregnant women. As for the barriers in health care, these were mentioned by some of the expectant mothers, especially immigrant women. Almost all, both immigrant and Portuguese, pregnant women were satisfied with the health care.

Objetivo: Avaliar a percepção do homem colostomizado sobre o apoio social recebido; verificar a relação entre o apoio social percebido e as variáveis sociodemográficas, a informação prestada, o apoio efetivamente recebido, e a realização do ensino no hospital. Métodos: Trata-se de um estudo descritivo-correlacional, transversal, de abordagem quantitativa, com uma amostra de 112 homens portadores de uma colostomia há mais de um ano, em três unidades da região Norte de Portugal. Resultados: A média de idades dos inquiridos era de 59,9 anos, 67,9% encontrava-se não ativo perante o trabalho, 49,5% percepcionou o apoio social como suficiente, mas 36,2% apoio social insuficiente. A percepção do apoio social é menor nos sujeitos mais velhos (r = -0,166; p = 0,018). Conclusão: Este estudo permitiu perceber que o cônjuge é muito importante na vida do homem colostomizado, nomeadamente nos momentos de dificuldades inerentes à doença, sendo a sua principal rede de apoio.

As experiências do parto e nascença moldam profundamente as vidas de mulheres, casais e famílias. O objeto deste estudo é entender os sentidos atribuídos ao parto e nascença, das mulheres portuguesas e imigrantes no Portugal, e a identificação dos sentidos e sentimentos vivenciados pelas mulheres que se tornaram mães. É um estudo qualitativo, recorrendo às entrevistas semiestruturadas e analises de conteúdo, sendo estes para 30 mulheres imigrantes e 22 portuguesas, suportado pelo Nvivo10. Os resultados indicam que o sentido do parto, as dores do parto e a nascença são diversos e ambivalentes, de acordo com as experiências de cada mulher. As dores do parto presentam sentidos diferentes, sendo eles divididos entre necessários ou horríveis, mas recompensadores... Palavras-Chave: Experiências; Parto; Dor; Nascença.

Gestational trophoblastic disease comprises a heterogeneous group of lesions arising from abnormal proliferation of trophoblastic cells. An elevation of human chorionic gonadotropin after evacuation of a molar pregnancy should suggest the hypothesis of a persistent gestational trophoblastic neoplasia. We present a rare case of coexistence of choriocarcinoma and placental-site trophoblastic tumor in the same tumor, whose diagnosis was made based on the correlation of morphological, microscopic and immunocytochemical studies, due to the difficulty in diagnosing these mixed tumors based on conventional histology only.

The subject of this paper is the carved wooden pulpits of the Church of Our Lady of Pena in Lisbon, Portugal. The fact that these objects were not gilded (as the rest of the carved wooden decoration in the church) raised the reinforced interest in their analysis. Besides the historical and stylistic approach, the text covers aspects of the materiality of the pulpits, including the wooden support and a grayish white layer. Analytical techniques such as optical microscopy complemented with the use of dyes to map the possible presence of binder materials constituting the white layer applied on the wooden support, scanning electron microscopy with energy dispersive X-ray spectrometry, X-ray diffraction, X-ray fluorescence spectrometry and micro-Fourier transformed infrared spectrometry were used to identify the components of paint materials.

Short-term forecasts of direct normal irradiance (DNI) from the Integrated Forecasting System (IFS) and the global numerical weather prediction model of the European Centre for Medium-Range Weather Forecasts (ECMWF) were used in the simulation of a solar power tower, through the System Advisor Model (SAM). Recent results demonstrated that DNI forecasts have been enhanced, having the potential to be a suitable tool for plant operators that allows achieving higher energy efficiency in the management of concentrating solar power (CSP) plants, particularly during periods of direct solar radiation intermittency. The main objective of this work was to assert the predictive value of the IFS forecasts, regarding operation outputs from a simulated central receiver system. Considering a 365-day period, the present results showed an hourly correlation of ≈0.78 between the electric energy injected into the grid based on forecasted and measured data, while a higher correlation was found for the daily values (≈0.89). Operational strategies based on the forecasted results were proposed for plant operators regarding the three different weather scenarios. Although there were still deviations due to the cloud and aerosol representation, the IFS forecasts showed a high potential to be used for supporting informed energy dispatch decisions in the operation of central receiver units.

OBJECTIVES: This study's objective consisted of the construction and validation of a scale to identify the representation of human vulnerability in the health field. METHOD: its development was divided into three steps: a bibliographic review and exploratory interviews were conducted to establish the items and their subsequent aggregation into dimensions; evaluation by an expert committee; and pre-test. The scale's psychometric properties were evaluated based on its application to a sample of individuals (nurses, physicians, and senior nursing and medical undergraduate students). Validity, reliability, and internal consistency tests were performed. RESULTS: the scale obtained consists of four dimensions (knowledge of intrinsic vulnerability, knowledge of extrinsic vulnerability, experience of vulnerability, and perception of vulnerability in patients). The scale presents good internal consistency with high Cronbach's alpha coefficient values. CONCLUSION: The Representation of Human Vulnerability in Health Workers Scale is easy to apply and presents reliable psychometric properties. It is an innovative tool that can be used in the development of studies addressing human vulnerability.OBJETIVOS: El objetivo de este estudio consistió en la construcción y validación de una escala para la "Representación de la vulnerabilidad humana en la salud". MÉTODO: Se realizaron los siguientes pasos: Revisión bibliográfica y entrevistas exploratorias que llevaron a la formulación de Ítems y posterior agregación en dimensiones; evaluación por un comité de especialistas y un pre examen. Las propiedades psicométricas de la escala fueron evaluadas a partir de su aplicación a una muestra de 342 individuos: enfermeros, médicos y estudiantes (estos últimos finalistas en enfermería y medicina). Fueron hechos estudios de validez, de fiabilidad y consistencia interna. RESULTADOS: Se obtuvo una escala constituida por cuatro dimensiones (Conocimiento de la vulnerabilidad Intrínseco, conocimiento de la Vulnerabilidad extrínseco, experiencia de la vulnerabilidad y percepción de situaciones de vulnerabilidad en los pacientes) con buena consistencia interna traducidas con valores de coeficiente "Alpha de Cronbach" muy elevados. CONCLUSIONES: La "Escala de Representación de la Vulnerabilidad Humana" demostró ser de fácil aplicación y reveló propiedades psicométricas fiables, que la presentan como un instrumento innovador que permite hacer estudios generalizados sobre un tema tan importante como es el de la vulnerabilidad humana.OBJETIVOS: construir e validar uma escala da representação da vulnerabilidade humana em saúde. MÉTODO: para o desenvolvimento do estudo foram percorridas as etapas - revisão bibliográfica e entrevistas exploratórias para a formulação de itens e posterior agregação em dimensões, avaliação por comitê de especialistas e pré-teste. As propriedades psicométricas da escala foram avaliadas em uma amostra com 342 indivíduos (enfermeiros, médicos, estudantes finalistas de enfermagem e medicina). Foram realizados os testes de validade, fiabilidade e de consistência interna. RESULTADOS: a escala proposta tem quatro dimensões: conhecimento da vulnerabilidade intrínseca, conhecimento da vulnerabilidade extrínseca, experiência de vulnerabilidade e perceção de situações de vulnerabilidade nos doentes, com boa consistência interna, traduzida por valores de coeficiente de alpha de Cronbach elevados. CONCLUSÃO: a Escala da Representação da Vulnerabilidade Humana é de fácil aplicação e propriedades psicométricas confiáveis. É um instrumento inovador e pode ser utilizado para o desenvolvimento de estudos sobre a vulnerabilidade humana.

Fístulas carotídeo-cavernosas são raras. São classificadas nos tipos direto e indireto. Fístulas diretas têm uma comunicação anormal entre a artéria carótida interna e o seio cavernoso. Nas formas indiretas a conexão se faz entre os ramos meningeos da carótida interna e/ou externa e o mesmo seio. O propósito deste artigo é o de atualizar os conceitos anatômicos, clínicos, diagnósticos e terapêuticos desta situação.Carotid cavernous fistulae are an uncommon disease. They are classified as direct or indirect. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. Indirect forms have an abnormal bypass between the meningeal branches of the internal and/or external carotid arteries and the same sinus. The purpose of this article is to provide an overview of the anatomy of the envolved area and the clinical findings, diagnostic evaluation and treatment.

Fístulas carotídeo-cavernosas são raras. São classificadas nos tipos direto e indireto. Fístulas diretas têm uma comunicação anormal entre a artéria carótida interna e o seio cavernoso. Nas formas indiretas a conexão se faz entre os ramos meningeos da carótida interna e/ou externa e o mesmo seio. O propósito deste artigo é o de atualizar os conceitos anatômicos, clínicos, diagnósticos e terapêuticos desta situação.

Objectives: in this study, two research tools were validated to study the impact of technological influence on health professionals' care practice. Methods: the following methodological steps were taken: bibliographic review, selection of the scales, translation and cultural adaptation and analysis of psychometric properties. Results: the psychometric properties of the scale were assessed based on its application to a sample of 341 individuals (nurses, physicians, final-year nursing and medical students). The validity, reliability and internal consistency were tested. Two scales were found: Caring Attributes Questionnaire (adapted) with a Cronbach's Alpha coefficient of 0.647 and the Technological Influence Questionnaire (adapted) with an Alpha coefficient of 0.777. Conclusions: the scales are easy to apply and reveal reliable psychometric properties, an additional quality as they permit generalized studies on a theme as important as the impact of technological influence in health care.

FUNDAMENTO: A síndrome de baixo débito cardíaco no perioperatório de cirurgia cardíaca pode incidir em cerca de 10 a 15% dos pacientes; desse total, 2% necessitam de suporte mecânico para adequado controle hemodinâmico. OBJETIVOS: Descrever a mortalidade de pacientes que necessitaram utilizar balão intra-aórtico (BIAo) no trans ou pós-operatório de cirurgia cardíaca, identificando variáveis pré-operatórias associadas a pior desfecho, assim como descrever as complicações pós-operatórias e a sobrevida em médio prazo. MÉTODOS: Estudo de coorte retrospectivo incluindo 80 casos consecutivos entre janeiro/2009 e setembro/2011. Os pacientes possuíam, em média, 62,9 ± 11,3 anos e 58,8% eram do sexo masculino. Na amostra, 81,3% dos pacientes eram hipertensos, 50% tinham infarto do miocárdio prévio e 38,8%, insuficiência cardíaca NYHA III/IV. A principal cirurgia realizada foi a revascularização miocárdica isolada (37,5%). RESULTADOS:A mortalidade hospitalar nesta série foi de 53,8% (IC95%: 42,7-64,9), sendo o tempo de isquemia > 90 minutos preditor independente de mortalidade em análise multivariada (RR 1,52 IC95%: 1,04-2,22). Em relação às complicações, 71,3% (IC95%: 61,2-81,4) dos pacientes apresentaram ao menos uma complicação adicional no período perioperatório, sendo a isquemia do membro inferior observada em 5% dos pacientes. A sobrevida em 1 ano foi de 43,6%, observando-se um platô na curva de sobrevida após uma queda acentuada inicial, relacionada à mortalidade hospitalar. CONCLUSÕES: Os pacientes que necessitam do BIAo compõem um grupo de muito alto risco para morbidade e mortalidade; seu emprego, entretanto, permite recuperar muitos pacientes de uma evolução que seria invariavelmente fatal, tendo os pacientes com alta hospitalar uma boa sobrevida em médio prazo.BACKGROUND: About 10% to 15% of patients undergoing cardiac surgery may develop low cardiac output syndrome in the perioperative period; of this total, 2% require mechanical support for adequate hemodynamic control. OBJECTIVE: To describe the mortality rates of patients who required the use of IABP in the perioperative or postoperative period of cardiac surgery, identifying preoperative variables associated with a worse outcome, as well as to describe the postoperative complications and medium-term survival. METHODS: Retrospective cohort study including 80 consecutive cases between January/2009 and September/ 2011. The patients had on average 62.9 ± 11.3 years and 58.8% were male; 81.3% were hypertensive, 50.0% had prior myocardial infarction and 38.8% has NYHA III/IV heart failure. The mainsurgery performed was isolated coronary artery bypass grafting (37.5%). RESULTS: Hospital mortality was 53.8% (IC 95%: 42.7-64.9), and cross-clamp time > 90 minutes was an independent predictor of mortality in multivariate analysis (OR 1.52 CI 95%: 1.04-2.22). 71.3% of patients (CI 95%: 61.2-81.4) had at least one additional complication in the perioperative period, with lower limb ischemia observed in 5.0% patients. One-year survival was 43.6%, with a plateau in survival rates after a sharp initial drop, related to hospital mortality. CONCLUSION: Patients who require IABP comprise a group of very high risk for morbidity and mortality. IABP use, however, enables the recovery of many patients from an evolution that would invariably be fatal, and patients discharged from hospital have a good medium-term survival.

Contexto: a falência dos estados de providência obriga a que seja efetuada uma reflexão e análise cuidada de todo o campo da saúde para que a sua sustentabilidade seja possível. Em Portugal verifica-se, como em toda a Europa, um progressivo envelhecimento da população, consequência do aumento da esperança média de vida e da baixa natalidade. Objetivos: avaliar o impacto da polimedicação nas verbas diárias de internamento imputadas a uma unidade de longa duração e manutenção. Método: tratou-se de um estudo de caso, de natureza exploratória, junto de 65 utentes, admitidos na Unidade de Longa Duração e Manutenção Dona Elvira da Câmara Lopes da Santa Casa da Misericórdia da Póvoa de Lanhoso. Resultados: existe polimedicação major nesta população, nomeadamente, uma média de 6 medicamentos prescritos por utente. Fazendo o cálculo, em função de 10 EUR de verba diária atribuída, obtém-se a percentagem significativa de 37% de impacto na verba imputada pelo Estado. Conclusão: é preciso compreender os padrões de prescrição noutros contextos, assim como, conhecer as razões/motivos que levam à prescrição de mais do que um fármaco.Contexto: el fracaso de los Estados sociales obliga a que se entame una reflexión y un cuidadoso análisis de todo el campo de la salud para que su sostenibilidad sea posible. En Portugal hay, como en otras partes de Europa, un progresivo envejecimiento de la población, consecuencia de la mayor esperanza de vida y baja tasa de natalidad. Objetivos: evaluar el impacto de la polimedicación en los gastos diarios de ingreso imputados a una unidad de hospitalización de Largo Plazo y de Mantenimiento. Método: se realizó un estudio de caso de carácter exploratorio, con 65 usuarios, ingresados en la unidad de hospitalización a Largo Plazo y de Mantenimiento - Dona Elvira da Câmara Lopes de la Santa Casa da Misericórdia da Póvoa de Lanhoso. Resultados: hay una mayor polimedicación en esta población, es decir, un promedio de 6 medicamentos recetados por paciente. Haciendo el cálculo, por cada 10 EUR de gastos diarios atribuidos, se obtiene el porcentaje significativo de 37% del impacto sobre el presupuesto asignado por el Estado. Conclusión: es necesario comprender los patrones de prescripción en otros contextos, así como conocer las razones/motivos que llevan a prescribir más que un medicamento.Context: the financial situation of welfare states obliges them to undertake a careful analysis and reflection of the whole field of health to ensure that their sustainability is possible. In Portugal there is, as elsewhere in Europe, a progressive aging of the population, a consequence of increased life expectancy and low birth rate. Objectives: to evaluate the impact of polypharmacy in daily sums charged to a long-term care and maintenance unit. Method: this was an exploratory case study with 65 users admitted to the Long-term Care and Maintenance Unit - Dona Elvira da Câmara Lopes of Santa Casa da Misericórdia da Póvoa de Lanhoso. Results: there is major polypharmacy in this population, including an average of six prescription drugs per patient. Calculation, based on a daily allowance of 10 EUR, gives a high percentage impact of 37% on the budget allocated by the state. Conclusion: it is necessary to understand prescribing patterns in other contexts as well as to ascertain the reasons/motives that lead to prescribing more than one drug.

This is a descriptive cross-sectional study. The sample consisted of 235 nurses from two intensive care units in Porto (Portugal). The purpose of this study was to identify stressors for nurses working in intensive care units. The data was collected using the following: i) a questionnaire (for socio-demographic variables, physical aspects of work and variables related to the work context; ii) Interpersonal Work Relations Scale; iii) Nurse Stress Index. Nurses in the early phase of their career have higher stress levels ( = 81). An inadequate physical work structure leads to higher stress levels (X = 83). The worse the interpersonal relations are, the higher stress levels nurses feel (Spearman correlation coefficient =-0.331). Nurses who have a bad relationship with their work superiors view the dimension "Support and Organizational Involvement" as a stressor (Student's t test, pSe trata de un estudio de tipo descriptivo y transversal, en total la muestra fue constituida con 235 enfermeros pertenecientes a dos unidades de terapia intensiva de la ciudad del Porto (Portugal), con el objetivo de conocer algunos factores generadores de estrés de enfermeros que trabajan en unidades de terapia intensiva. En la recolección de datos se utilizó: 1) un cuestionario de auto llenado (para las variables sociodemográficas, para los aspectos físicos del servicio y para las variables relacionadas con el contexto de trabajo); 2) la Escala de las Relaciones Interpersonales en el Trabajo; y 3) la Nurse Stress Índex. Se identificó que los enfermeros en inicio de carrera tiene niveles de estrés más elevados ( o = 81); que una estructura física inadecuada conduce a niveles de estrés más elevados (X=83); que cuanto peor es la relación interpersonal, mayores son los niveles de estrés (Coeficiente de correlación de Spearman =-0,331); que los enfermeros que establecen una mala relación con los jefes perciben la dimensión "Apoyo y envolvimiento organizacional" como fuente generadora de estrés (t-Student, pTrata-se de estudo do tipo descritivo e transversal, englobando amostra com 235 enfermeiros, pertencentes a duas unidades de terapia intensiva da cidade do Porto, Portugal, e teve como objetivo conhecer alguns fatores geradores de estresse em enfermeiros que trabalham em unidades de terapia intensiva. Na recolha de dados, utilizou-se: i) questionário de autopreenchimento (para as variáveis sociodemográficas, para os aspectos físicos do serviço e para as variáveis relacionadas ao contexto de trabalho); ii) a escala das relações interpessoais no trabalho e iii) a nurse stress index. Pelos resultados, observa-se que enfermeiros, em início de carreira, têm níveis de estresse mais elevados ( ou = 81); estrutura física não adequada conduz a níveis de estresse mais elevados (X=83); quanto pior é a relação interpessoal maiores são os níveis de estresse (coeficiente de correlação de Spearman=-0,331). Os enfermeiros que estabelecem má relação com as chefias percepcionam a dimensão apoio e envolvimento organizacional como fonte geradora de estresse (teste t de Student, p

OBJECTIVO: A satisfação do cliente tem vindo a afirmar-se como uma das áreas prioritárias na avaliação da qualidade nos cuidados de saúde. O principal objectivo desta investigação é conhecer o nível de satisfação dos pacientes dos serviços privados de radiologia. MATERIAIS E MÉTODOS: Tratou-se de um estudo exploratório e descritivo numa amostra de 213 pacientes do Conselho de Vila Real (Portugal). RESULTADOS: A maior parte dos pacientes efectuou exames de mamografia; mais de 50% dos inquiridos esperou mais de uma semana desde o dia da marcação até ao dia em que ia efectuar o exame. Os inquiridos encontram-se satisfeitos com a qualidade da maioria dos serviços prestados, expressando vontade em voltar e recomendar os serviços a outras pessoas. Referiram a existência de lacunas na relação e comunicação, organização dos serviços, informação e apoio e organização do espaço físico. CONCLUSÃO: Este estudo é importante na monitoração e garantia da qualidade e para expressar a percepção dos clientes.OBJECTIVE: Patients' satisfaction is now one of the most relevant aspects when evaluating the quality of healthcare services. The purpose of this study was to know the users' satisfaction levels in radiology private services. MATERIALS AND METHODS: Our empirical research followed an exploratory and descriptive approach. It reflects a sample of 213 patients in Vila Real (Portugal). RESULTS: The majority of patients who came to our services had mammographies done; over 50% of the interviewees claimed having had to wait more than a week to get an appointment. The users have expressed their wish to return, to recommend the services to other people, and also mentioned the existence of a few weak points in terms of communication, organization, information and support provided. CONCLUSION: This study was important because it allowed us to become aware of the users' points of view and also of any possible improvement points in terms of the quality of the service provided.

OBJETIVO: O objetivo deste estudo consiste em rever os casos submetidos a tratamento cirúrgico por duas técnicas: trapezectomia com ou sem ligamentoplastia e artroplastia com implante. MÉTODOS: Foram avaliadas 52 mãos tratadas cirurgicamente por rizartrose entre 1995 a 2008: 32 trapezectomias com ou sem ligamentoplastia (grupo A) e 20 artroplastias com implante (grupo B). Follow-up médio: grupo A - 72 meses, grupo B - 23 meses. Não houve resultados significativamente diferentes quanto à dor, atividades da vida diária, mobilidade e força. No estudo radiográfico, a altura escafometacarpiana foi mais preservada no grupo B. O tempo médio de recuperação foi de 10 semanas no grupo A e de 4,5 no grupo B. Foram registradas quatro complicações: um caso de algoneurodistrofia no grupo A e 2 casos de luxação e um caso de fratura do trapézio no grupo B. RESULTADOS: O resultado das próteses superam o tratamento tradicional da rizartrose com trapezectomia com ou sem ligamentoplastia pela rápida recuperação que proporcionam. CONCLUSÃO: Contudo, a sua aplicação deve ser criteriosa, pois existe potencial de complicações relacionadas com os implantes.OBJECTIVE: The aim of this study was to review cases that underwent surgical treatment using two techniques: trapeziectomy with or without ligamentoplasty and arthroplasty with implant. METHODS: Fifty-two hands that were surgically treated for rhizarthrosis between 1995 and 2008 were evaluated: 32 cases of trapeziectomy with or without ligamentoplasty (group A) and 20 with implant arthroplasty (group B). The mean follow-up for group A was 72 months and for group B, 23 months. There were no significantly different results with regard to pain, activities of daily living, mobility or strength. In the radiographic evaluation, it was found that the scaphometacarpal height was better preserved in group B. The mean time taken to achieve recovery was 10 weeks in group A and 4.5 in group B. Four cases with complications were recorded: one case of algoneurodystrophy in group A and two cases of dislocation and one case of fracture of the trapezium in group B. RESULTS: The results from prostheses were better than the results from the traditional treatment for rhizarthrosis using trapeziectomy with or without ligamentoplasty because of the rapid recovery that prostheses provide. CONCLUSION: However, prostheses should be applied carefully, because there is a potential for complications relating to the implants.