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The overall prevalence of inactivity among individuals aged 55 or older in Portugal is the highest in Europe therefore it's important to develop effective strategies to increase adherence to structured exercise programs by older adults (Picorelli et al., 2014a). The purpose of this paper is to characterise different perspectives on barriers and facilitators to the practise of physical exercise in a sample of the Portuguese elderly. Two groups of enrolled and non-enrolled in a community exercise program were recruited. Each group had 6 participants that were included in the study if they were ≥ 60 years of age. Two focus groups were conducted via Zoom and lasted ≤ 60 min. Participants were asked about five domains regarding physical exercise. Data analysis occurred in three phases by 2 trained and experienced examiners. While the enrolled group highlighted benefits (n = 6) and facilitators (n = 6), and shared strategies to overcome some barriers (n = 2) the non-enrolled group focused on the barriers (n = 6) instead and shared more excuses to justify their non-practice of physical exercise (n = 3). To overcome the barriers considered by the participants in the non-enrolled group, some education strategies focused on physical literacy might be crucial. The high number of barriers felt by the less active older people makes it more complicated for them to adopt and maintain an exercise program. Narratives-based methodologies are interesting methodologies to collect patient-centred perspectives about exercise practise and therefore design adequate programs. [ABSTRACT FROM AUTHOR]

Hospital efficiency analysis depends largely on the model specifications. This study discusses the importance of the case-mix index (CMI) to homogenize the sample of inpatient discharges. It proposes a new index where they are classified by service, since it is usual to have lack of data to compute the CMI and this can influence the credibility of results. Data from the Portuguese national diagnosis-related group (DRG) database was utilized. Three different approaches are developed in this paper, based on locally convex order-m method as well as on translog functions. The first one correlates the efficiency with different inpatients weighting schemes, by using the Nadaraya-Watson method. The second approach compares different frontiers that have been computed using the different weighting schemes. Finally, by using bootstrap, the paper investigates whether the inclusion of severity/ complexity-related variables in the model statistically modifies the results. It has been shown that, under the Portuguese healthcare framework, if the model is environment corrected (which should include epidemiological and main political/ structural health reforms variables), then the severity adjustment of inpatients is pointless. The employment of an inpatient-weighting scheme, such as the CMI, may introduce significant frontier shift, thus its absence is not recommended in productivity evolution analyzes. The CMI shifts the efficiency frontier, but not the relative position of units against it (the last scenario if exogenous variables are present). [ABSTRACT FROM AUTHOR]

There has been an increasing attention to the study of stress. Particularly, college students often experience high levels of stress that are linked to several negative outcomes concerning academic functioning, physical, and mental health. In this paper, we introduce the EuStress Solution, that aims to create an Information System to monitor and assess, continuously and in real-time, the stress levels of the students in order to predict burnout. The Information System will use a measuring instrument based on wearable device and machine learning techniques to collect and process stress-related data from the students without their explicit interaction. In the present study, we focus on heart rate and heart rate variability indices, by comparing baseline and stress condition. We performed different statistical tests in order to develop a complex and intelligent model. Results showed the neural network had the better model fit. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a serious and relatively prevalent problem in adolescence. Although several studies have identified risk factors for the aetiology and maintenance of NSSI, little is known about the impact of individual and contextual variables in such pervasive behaviors among adolescents. Objective: This paper aims to test whether specific internal traits characterized by shame, self-criticism and fear of self-compassion impact on NSSI, through their effect in daily peer hassles and depression. Methods: Participants are 782 adolescents with 12-18 years-old from middle and secondary schools (years of education's mean = 9.46). This study has a cross-sectional design. Self-report measures include external shame, self-criticism, fear of self-compassion, daily peer hassles, depressive symptoms and NSSI. Results: External shame, hated self and fear of self-compassion indirectly predict NSSI, through their effect in daily peer hassles and depression. The most pathological form of self-criticism (hated self) is strongly associated with NSSI. Conclusions: These findings contribute to clarification of the paths through which the belief that one is seen negatively by others, the hostile self-to-self relationship and the inability to direct compassion for self may increase NSSI. Daily peer hassles and current depressive symptoms seem to play an important role in the association between internal traits and NSSI. Preventive and intervention actions for reducing NSSI in adolescence should address not only interpersonal difficulties but also self-to-self relationship. [ABSTRACT FROM AUTHOR]

The length of hospital stay (LOS) is an important measure of efficiency in the use of hospital resources. Acute Myocardial Infarction (AMI), as one of the diseases with higher mortality and LOS variability in the OECD countries, has been studied with predominant use of administrative data, particularly on mortality risk adjustment, failing investigation in the resource planning and specifically in LOS. This paper presents results of a predictive model for extended LOS (LOSE - above 75th percentile of LOS) using both administrative and clinical data, namely laboratory data, in order to develop a decision support system. Laboratory and administrative data of a Portuguese hospital were included, using logistic regression to develop this predictive model. A model with three laboratory data and seven administrative data variables (six comorbidities and age ≥ 69 years), with excellent discriminative ability and a good calibration, was obtained. The model validation shows also good results. Comorbidities were relevant predictors, mainly diabetes with complications, showing the highest odds of LOSE (OR = 37,83; p = 0,001). AMI patients with comorbidities (diabetes with complications, cerebrovascular disease, shock, respiratory infections, pulmonary oedema), with pO2 above level, aged 69 years or older, with cardiac dysrhythmia, neutrophils above level, pO2 below level, and prothrombin time above level, showed increased risk of extended LOS. Our findings are consistent with studies that refer these variables as predictors of increased risk. [ABSTRACT FROM AUTHOR]

Recently, policymakers have been developing some policies to improve environmental quality. Environmental taxes are the most important of these policies. This study examines the effects of transport taxes, economic growth, and fossil fuel energy consumption on air pollution within the Environmental Kuznets Curve (EKC) hypothesis framework. The study used data from 1994 to 2019 for the ten countries with the highest transport tax revenues. According to the results, while the EKC hypothesis is valid for Portugal and Switzerland, it is not valid for all other countries. Moreover, fossil fuel energy consumption seems to increase air pollution in all countries except the Netherlands and Switzerland. However, transport taxes increase air pollution in Brazil. Therefore, transport taxes are not effective in reducing air pollution. In this context, it was concluded that the structure of transport taxes should be improved or reformed. In addition, it has been underlined that those national decisions alone will not be sufficient to improve transport taxes or environmental taxes. Therefore, regulations to be made with international coordination will be more successful in combating environmental problems by preventing tax competition and increasing tax harmonization. [ABSTRACT FROM AUTHOR]

Columbiformes have a worldwide distribution, of which 166 species occur in Eurasia. They have been reported parasitized by coccidians recurrently in recent years; however, Eimeria labbeana (Labbé, 1896) Pinto, 1928, which is first Eimeria sp. from Columbiformes described in the late nineteenth century, is not taxonomically identified by its oocysts since the 1930s. In this context, the current study aimed to supplement the morphology of E. labbeana from Eurasian collared doves Streptopelia decaocto Frivaldszky, 1838 and from a common woodpigeon Columba palumbus Linnaeus, 1758 in Portugal, providing a preliminary genotypic characterization. Three of the four columbiforms were positive for oocysts identified as E. labbeana, which were morphologically revised as having micropyles, in addition to other minor adjustments. Oocysts from S. decaocto and C. palumbus were morphologically identical and equivalent in all morphometric aspects, besides having genotypic similarity of 99.5%. Phylogenetic analysis based on the mitochondrial cytochrome c oxidase subunit 1 gene resulted in a large clade with Eimeria spp. and Isospora spp. from different vertebrates and low similarity between Eimeria spp. from Columbiformes, whereas the phylogenetic analysis based on the small subunit ribosomal RNA gene resulted in well-supported monophyletic groups, including one with the coccidians of columbiform birds. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop the Health and Work Survey (INSAT) and examine the validity of the discomfort rating scale. Data were collected from 706 Portuguese workers from six economic sectors with the support of the Health and Work Survey (INSAT - Inquérito Saúde e Trabalho). The INSAT is a self-administered questionnaire to assessing working conditions, health and wellbeing, and to provide information to the occupational health systems in the organisations. For the survey instrument validation, the Rasch Partial Credit Model (PCM) was used to analyse item fit statistics. From the application of PCM, Person Separation Reliability was obtained (0.8761) and the value can be considered very good (>0.8). From the statistical analysis, the Overall Model fit information, given by Outfit Mean square/Infit Mean square, is between 0.5 and 1.5, meaning 'Productive for measurement' and 'acceptable fit overall'. The INSAT items can generate predictable response patterns. We recommend that the INSAT discomfort rating scale and some other items should be reviewed in future works. In any event, this tool proves to be useful in assessing the relationship between work and health and in evaluating key main risk factors, helping to prevent problems and improving occupational health systems. [ABSTRACT FROM AUTHOR]

There is some evidence of the relationship between spirituality and quality of life, but there are few bibliographic references on these constructs for patients suffering from mental illness; thus, this study was aimed at revealing the possible role of spiritual outlooks as a protective factor in these individuals. The sample consisted of 96 Portuguese psychiatric patients, selected from a psychiatric hospital and assessed based on parameters for quality of life, spirituality and mindfulness. The data support some theories about the nature of the spirituality. Spiritual beliefs are poorly correlated with the quality of life index, and there is a moderate association between these beliefs and some aspects of mindfulness. It is suggested that a spiritual outlook of psychiatric patients should be taken into account in psychological interventions. [ABSTRACT FROM AUTHOR]

The quality of family functioning has been considered an important predictor of adaptation in children with chronic conditions and their parents. Previous research suggests that beyond general family functioning, the specific experience of the family's condition management is paramount for understanding family members' adaptation. This study's first goal was to compare family functioning and parents' and children's adaptation outcomes across four chronic conditions: asthma, diabetes, epilepsy, and obesity. Secondly, we explored the mediating role of family life difficulties and parental mutuality, as two potential paths through which family cohesion is linked to family members' adaptation. A total of 263 parents of children (3-19 years old) with asthma ( n = 77), obesity ( n = 79), epilepsy ( n = 52) and diabetes ( n = 55) completed self-report measures of family cohesion, family life difficulty, parental mutuality, anxiety and depressive symptoms, and their children's health-related quality of life (HrQoL). The results showed that families of children with diabetes, obesity, and epilepsy were at higher risk of experiencing family difficulties and children's deteriorated HrQoL when compared to families of children with asthma. With regard to the links among study variables, although family cohesion had both a direct and indirect relationship with parental depressive symptoms, its links with parental anxiety symptoms and children's HrQoL were only indirect, through family life difficulty. These associations were consistent across the four clinical groups. These findings emphasize the relevance of family-centered interventions aimed at promoting family cohesion, parents' mutuality, and effective coping with the demands of pediatric chronic conditions. [ABSTRACT FROM AUTHOR]

The present study examines whether early experiences of threat, subordination and devaluation with family influence adolescents' negative emotional states and subsequently deliberate self-harm; and if this effect is conditioned by daily peer hassles. The sample consisted of 441 adolescents (57.6 % female) with ages between 13 and 18 years old from middle and high schools. Participants completed self-report instruments measuring early memories of threat, subordination and devaluation, daily peer hassles, negative affect and deliberate self-harm behaviors. Results from conditional process analysis showed that adolescents who feel devalued and experience threat and submission within family tend to endorse high levels of negative affect, which in turn accounts for increased endorsements on deliberate self-harm. Moreover, the impact of negative affect on deliberate self-harm is amplified by the presence of moderate and high levels of daily peer hassles. This study suggests the relevance of assessing and intervening on type of emotional memories (i.e., threat, subordination and devaluation), daily disruptions with peers and negative emotional states with adolescents who self-injure. These findings may be useful in the development of preventive and intervention programs for reducing deliberate self-harm in adolescence. [ABSTRACT FROM AUTHOR]

This study examined the direct and indirect links, via the caregiving burden, between parents' perceptions about the severity of their child's illness and its interference in his or her life and the parents' quality of life (QoL). The participants were 277 parents of children with malignant cancer, divided into two clinical groups according to treatment status: 126 parents of children on-treatment and 151 parents of children off-treatment. Self-reported questionnaires assessed parents' perceptions of illness severity and interference in the child's life, caregiving burden and QoL. Pediatric oncologists provided information about diagnosis, treatment status and intensity. Parents of children on-treatment reported more negative perceptions about the illness (severity and interference), higher levels of caregiving burden and worse QoL, when compared to parents of children off-treatment. Furthermore, parents' perceptions about their child's illness (severity and interference) were negatively linked to parents' QoL through caregiving burden. Additionally, the link between caregiving burden and parents' QoL was moderated by child treatment status, with stronger associations found for parents of children on-treatment. This study's findings are discussed in terms of their relevant implications for intervention with families in the pediatric cancer context. [ABSTRACT FROM AUTHOR]

Summary: Age modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF). For older individuals, the risk of HF increases as SES increases. For younger individuals, risk of HF increases as SES decreases. Our study may help decision-makers to better direct the implementation of political decisions. Introduction: The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear. The objective of this study is to evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES. Methods: From the Portuguese Hospital Discharge Database, we selected hospitalizations (2000-2010) of patients aged 50+, with HF diagnosis (codes 820.x, ICD9-CM), caused by traumas of low/moderate energy, excluding bone cancer cases and readmissions for aftercare. Municipalities were classified according to SES (deprived to affluent) using 2001 Census data. A spatial Bayesian hierarchical regression model (controlling for data heterogeneity and spatial autocorrelation), using the Poisson distribution, was used to quantify the relative risk (RR) of HF, 95 % credible interval (95%CrI), and analyze the interaction between age and SES after adjusting for rural conditions. Results: There were 96,905 HF, 77.3 % of which were on women who, on average, were older than men (mean age 81.2 ± 8.5 vs 78.2 ± 10.1 years) at admission ( p < 0.001). In women, there was a lower risk associated with better SES: RR = 0.83 (95%CrI 0.65-1.00) for affluent versus deprived. There was an inverse association between SES and HF incidence rate in the youngest and a direct association in the oldest, for both sexes, but significant only between deprived and affluent in older ages (≥75 years). Conclusions: Interaction between SES and age may be due to inequalities in lifestyles, access to health systems, and preventive actions. These results may help decision-makers to better understand the epidemiology of hip fractures and to better direct the available funding. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to present new empirical evidence regarding the psychometric properties of the short-form UCLA Loneliness Scale (ULS-6) among Portuguese older people. The study included 1,154 persons (60 % women and 40 % men), aged 60-90 ( M = 71.26; SD = 6.66). The psychometric properties of the ULS-6 were analysed by means of confirmatory factor analysis, internal consistency, and criterion-related validity methods. Confirmatory factor analysis supported a unidimensional structure of the measure with adequate values of various fit indices. The ULS-6 presented satisfactory psychometric properties, with a high level of internal consistency. Furthermore, the ULS-6 showed a negative relationship with self-esteem, satisfaction with life, and positive affect; and a positive one with negative affect. The results confirm that the ULS-6 provides a brief, psychometrically sound measure of loneliness that is appropriate for use among older adults. [ABSTRACT FROM AUTHOR]

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In the last 5 years the resident population of Portugal has increased 2.3 %, along with a progressive ageing. This study aims assessing the social dependence and frailty, as well as social and familial support needs of the elderly. In an observational, cross-sectional community based study (EPEPP study), a total of 2,672 people, aged 55 or more, were submitted to an enquiry and several variables were studied among three age groups: 55-64 years old (37 %), 65-74 years old (37 %) and ≥75 years old (26 %), encompassing a total of 57 % women and 43 % men. A questionnaire including items such as physical autonomy, locomotion, falls, health/medical complaints, instrumental autonomy, physical activity, health self-evaluation and emotional status was applied. The strong correlations among the studied scores allowed the identification of people groups with common characteristics when a principal component analysis was used: 'autonomy' (scores of instrumental autonomy, locomotion and physical autonomy) and 'perception of health and emotional status' (scores of health self-evaluation and emotional status), were present in the three age groups. The component analysis evidences that a good autonomy, a good perception of health and emotional status are determinant to a good quality of life in elderly. Although health status and self-rated health have a propensity to deteriorate with aging, older Portuguese consider their state of health satisfactory and tend to underestimate their decline. In what concerns the analysis of gender with the same age and in contrast to what has been reported, older women alike to men, experience a good mobility and health self-evaluation. [ABSTRACT FROM AUTHOR]