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Aim: To evaluate students' self‐perceived pedagogical outcomes when using a digital scenario‐based tool compared to traditional scenarios printed on paper. Design: This study used a within‐subjects experiment. Method: A digital platform for scenario development was developed, focusing on patients' regaining independence and returning home after an acute event. Students participated in two simulation activities, differing only in the type of scenario used and completed a questionnaire to evaluate their learning experience. Results: Students considered that the new scenario template provided a clearer understanding of the situation under analysis, allowing them to recognize the focuses of attention to be prioritized when formulating the intervention plan. No Patient or Public Contribution: A digital platform for a standardized process of scenario writing to help realistic simulation in nursing education is a novelty in this study and will likely contribute to substantial learning gains. [ABSTRACT FROM AUTHOR]

Juggling the demands of both work and family has become increasingly difficult, especially for dual-earner households; nevertheless, families have developed strategies to deal with work-family challenges. This paper uses couple level analyses ( APIM models) with 100 dual-earner couples to provide insight about partners' mutual influence on the use of work-family coping strategies. The results show that women's use of coping strategies is more associated with work-family conflict and work-family enrichment than men's coping. In addition, using partner coping, having a positive attitude towards multiple roles, using planning and management skills and avoiding having to cut back on professional responsibilities is associated with better outcomes (more enrichment and less conflict). Surprisingly, the use of childcare facilities is associated with women's conflict and partner effects were only found concerning the use of management and planning skills. These skills, however, have distinct effects for men and women's outcomes: their use by men reduces their own conflict but increases their wives', while their use by women decreases their own conflict and increases their own and their partner's enrichment. These results point to the fact that gender roles continue to be a hallmark of work-family issues. Our design and results point out the need for new interventions that take couple interdependences into account. [ABSTRACT FROM AUTHOR]

Background The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological processes and phonetic inventory). Considering that the ultimate goal of intervention for children with phonologically based SSD is to improve intelligibility, it is curious that intervention studies focusing on children's phonology do not routinely use intelligibility as an outcome measure. It is therefore important that the impact of interventions on speech intelligibility is explored. Aims This paper investigates the effectiveness of the two treatment approaches (phonological therapy and articulation therapy) using intelligibility measures, both in single words and in continuous speech, as the primary outcome. Methods & Procedures Fourteen children with phonologically based SSD participated in the intervention. The children were randomly assigned to phonological therapy or articulation therapy (seven children in each group). Two assessment methods were used for measuring intelligibility: a word identification task (for single words) and a rating scale (for continuous speech). Twenty-one unfamiliar adults listened and judged the children's intelligibility. Reliability analyses showed overall high agreement between listeners across both methods. Outcomes & Results Significant improvements were noted in intelligibility in both single words (paired t(6) = 4.409, p = 0.005) and continuous speech (asymptotic Z = 2.371, p = 0.018) for the group receiving phonology therapy pre- to post-treatment, but no differences in intelligibility were found for those receiving the articulation therapy pre- to post-treatment, either for single words (paired t(6) = 1.763, p = 0.128) or continuous speech (asymptotic Z = 1.442, p = 0.149). Conclusions & Implications Intelligibility measures were sensitive enough to show changes in the phonological therapy group but not in the articulation therapy group. These findings emphasize the importance of using intelligibility as an outcome measure to complement the results obtained with other severity measures when exploring the effectiveness of speech interventions. This study presents new evidence for the effectiveness of phonological therapy in improving intelligibility with children with SSD. [ABSTRACT FROM AUTHOR]

Purpose This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). Design A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. Methods Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. Findings Repeated measures revealed that CST increased cognition ( F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms ( F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. Conclusions CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. Clinical Relevance CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders' cognitive frailty. [ABSTRACT FROM AUTHOR]

Aims: This study aims to (1) analyse all self‐care–related interventions Portuguese nurses documented, (2) determine potential issues that may impair semantic interoperability and (3) propose a new set of interventions representing nursing actions regarding self‐care that may integrate any HER application. Background: As populations age and chronic diseases increase, self‐care concerns rise. Individuals who seek healthcare, regardless of context, need prompt access to accurate health information. Healthcare professionals need to understand the information in all places where care is provided, creating the need for semantic interoperability within electronic health records. Methods: A qualitative descriptive and exploratory study was conducted in two phases: (1) a content analysis of nursing interventions e‐documentation and (2) a focus group with fifteen registered nurses exploring latent criteria or insights gleaned from the findings of content analysis. The COREQ statement was used to guide research reporting. Results: We extracted 1529 nursing intervention sentences from the electronic health records and created 209 intervention categories. We identified the main issues with semantic interoperability in nursing intervention identification. Conclusion: According to the findings, nurses cooperate with clients, offering physical aid and encouraging them to overcome functional limitations to self‐care tasks hampered by their conditions. Implications for nursing policy and health policy: This article provides evidence to warn policy makers against decisions to use locally customised electronic health records, as well as evidence on the importance of policy promoting the adoption of a nursing ontology for electronic health records. And, as a result, the harmonisation and effective provision of high‐quality nursing care and the reduction of healthcare costs across nations. [ABSTRACT FROM AUTHOR]

There are several motives underlying the process of deciding to become an adoptive family. However, research exploring this issue is scarce and essentially focused on infertility as the main motivation. The present mixed‐method study aims to fill in this gap by exploring, retrospectively, the motives to adopt of 126 Portuguese adoptive parents. The Parents' Interview on the Adoption Process was used to identify the motives to adopt and describe the adoption decision‐making process. Seven main motives (biological issues, filling in a void/loneliness, adoption as a life project, expanding the family, philanthropy, contact with the child protection system and parenthood) were identified. These motives can be centred on the self, the child or both simultaneously and are characterized by dynamism, permeability and interconnection. Findings allowed for establishing conceptual considerations on motivations to adopt and recommendations for adoption practice. [ABSTRACT FROM AUTHOR]

Objectives: We aim to assess the validity and reliability of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) and to add to its cross‐cultural adaptation process by translating, culturally adapting, and validating the MPIIQM into European Portuguese language in the population of Portuguese musicians. Methods: A Portuguese version of the MPIIQM (MPIIQM‐Pt) was created through a process of forward and back translation, pilot testing, and cultural adaptation by expert panel evaluation. The psychometric evaluation was performed in a validation sample of 134 musicians, at baseline and after 7 days. Results: The high degree of internal consistency and the substantial test–retest reliability coefficients were demonstrated for each subscale (α = 0.896 and ICC = 0.997 for "pain intensity," and α = 0.879 and ICC = 0.999 for "pain interference," respectively). Exploratory factor analysis indicated two‐factor structure (pain intensity and interference) that explained 75.5% of the variance. Both convergent and divergent validity are well demonstrated, confirming more than 90% of the previously defined hypotheses regarding correlations with other measures. Discussion: MPIIQM‐Pt is the first validated questionnaire to evaluate pain among Portuguese musicians. It showed excellent psychometric properties, both in terms of internal consistency, test–retest reliability, factor analysis, and construct validity. Therefore, it is a valid and reliable tool suitable for both research and clinical practice purposes. MPIIQM‐Pt will allow the development of more robust studies on pain among musicians and the improved assessment and monitoring of pain in this population, filling an important gap in this field of Pain Medicine. [ABSTRACT FROM AUTHOR]

Adequate nutritional intake in the first years of life is crucial for future health. The purpose of this study is to assess the adequacy of nutritional intake in Portuguese toddlers. The EPACI Portugal 2012 is a cross‐sectional study of a representative sample of toddlers (n = 2230), aged between 12 and 36 months. Data on diets were collected by trained interviewers. The current analysis included 853 children with full data from 3‐day food diaries completed by parents/caregivers. Intakes of energy, macro‐ and micronutrients were estimated through Statistical Program to Assess Dietary Exposure (SPADE). Nutritional adequacy was evaluated using Dietary Reference Values established by the European Food Safety Authority. A large proportion of children exceeded the recommended energy intake. The median daily protein intake was 4.7 g/kg/day, five times more than that recommended. About 9% and 90% of the children consumed a lower proportion of energy than the lower limit of the Reference Intake range for carbohydrates and fat, respectively. Around a third consumed less fibre and magnesium and 100% less vitamin D than the recommended Adequate Intake (AI). Almost a third consumed less vitamin A than the recommended Average Requirement (AR) and 86% of the children showed excessive sodium consumption. Portuguese toddlers consumed a low proportion of energy from fat, had energy and protein intakes above the recommendations and excessive intakes of sodium, and inadequate intakes of vitamin A. Every child consumed less than the recommended AI for vitamin D. [ABSTRACT FROM AUTHOR]

Background: Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non‐existent. Aim: To assess the nursing workload in a Portuguese ICU using the NAS. Study Design: Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six‐bed Portuguese ICU between 1 June–31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines. Results: The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team. Conclusions: The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety. Relevance to Clinical Practice: This was one of the first studies carried out with the NAS after its cross‐cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the 'administrative and management activities' related to the 'patient discharge procedures', the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse‐to‐patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU. [ABSTRACT FROM AUTHOR]

Background: The relevance of person‐centred care as an optimising approach to the quality of care provided to older adults has sparked the development of important instruments that measure this approach at residential care facilities and requires validation for the Portuguese population. Objectives: This study aims to adapt and validate the Person‐centered Care Assessment Tool (P‐CAT) to the Portuguese population. Methods: The P‐CAT assesses the level of person‐centred care provided by residential care facilities, according to staff. The process of adapting the P‐CAT to the Portuguese population includes its translation, backtranslation and a pilot study. To recruit participants for the validation study, we contacted the Portuguese residential care facilities with emails provided in the official registries, and the study was also divulged on social media. Results: The study had the participation of 573 staff members. The mean score of P‐CAT was 50.76 (SD = 7.65). The exploratory factor analysis showed three dimensions: the extent of care personalisation, the amount of organisational support and the degree of environmental accessibility. The results show good internal consistency for the total scale (α = 0.809) and good temporal stability in the test–retest assessed by intraclass correlation coefficient (0.893). Conclusions: This version of the P‐CAT for the Portuguese population has shown adequate psychometric properties and contributes to the study of care provided at residential care facilities in Portugal through self‐reporting from staff. Implications for practice: The availability of this instrument is useful for professional practice and research purposes and supports technical and scientific advancements that are necessary for the evolution of care frameworks. [ABSTRACT FROM AUTHOR]

Introduction: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. Methods: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18–64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. Results: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). Conclusions: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. Objectives: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. Methods: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25‐item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi‐square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. Results: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical‐surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). Conclusions: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence‐based tobacco cessation programs at the organizational‐level, including post‐discharge active quitting smoking support. Clinical relevance: Three‐quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this research was to identify the needs of older persons waiting for elective open‐heart surgery. Design: A qualitative exploratory design methodology, using Focus Groups. Methods: A purposive sampling technique was used. Three interviews were conducted with experienced nurses, individuals waiting for open‐heart surgery (≥65years) and individuals having had open‐heart surgery (≥65years); enrolling up to 17 participants from October 2019 to January 2020. Qualitative data analysis was conducted using the iteractive model and MaxQDA® software, and EQUATOR COREQ guidelines were followed. Results: Three themes were identified from the analysis of all three Focus Groups: (i) Needing health information; (ii) Needing emotional support; and (iii) Needing access to care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify which strategies are being adopted to deal with family restrictions in health units and assess nurses' perceptions of including families in nursing care during the current pandemic. Background: Due to the COVID‐19 pandemic, health organisations limited access for visitors. Introduction: Family centred care needs to be guaranteed, and alternatives for face‐to‐face interaction should be fostered. Therefore, there is an urgent need to rethink the family in nursing care during a pandemic. Methods: We conducted a descriptive exploratory mixed‐method study in Portugal using an electronic questionnaire. The study included 192 nurses recruited using a non‐probabilistic convenience sample. The study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results: A total of 41.1% of participants (n = 79) reported that visits to their services were not authorised, and 66.7% (n = 128) reported resorting to video calls because of the restrictions imposed. Regarding attitude assessment, the average score of the scale was 77.9 (SD = 10.0), ranging between 26 and 98. When analysing the different dimensions of the 'Families' Importance in Nursing Care ‐ Nurses Attitudes' scale, family data stand out as a burden. Conclusion: Although a large percentage of participants had a positive attitude towards families and tried to find strategies to maintain family centred care, many nurses still considered the family as a burden. The current COVID‐19 pandemic may have aggravated this perception. Implications for nursing practice, nursing policy and health policy: The continued implementation of family centred nursing practice is essential for child‐well‐being, including during the current pandemic. Therefore, having intervention policies with alternative forms of care is highly recommended. [ABSTRACT FROM AUTHOR]

Background: Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience. Objectives: To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies. Design: The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries. Setting and Participants: Eighteen peer leaders (aged 13–15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers. Measures: The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study. Results: The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries. Conclusion: The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size. Patient or Public Contribution: The peer leaders contributed to the design and implementation of the training and intervention. [ABSTRACT FROM AUTHOR]

Aims: To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)‐related death rates across Australia, Finland, Portugal and Turkey and to analyse the toxicology and causes of death across countries. Design Analysis of MDMA‐related deaths extracted from a national coronial database in Australia (2001–19) and national forensic toxicology databases in Finland (2001–17), Portugal (2008–19) and Turkey (2007–17). Presentation of MDMA use and seizure data (market indicators). Setting: Australia, Finland, Portugal and Turkey. Cases All deaths in which MDMA was considered by the forensic pathologist to be contributory to death. Measurements Information collected on cause and circumstances of death, demographics and toxicology. Findings A total of 1400 MDMA‐related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13–25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey. Conclusions: Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent. [ABSTRACT FROM AUTHOR]

Aims: (1) To identify and analyse diagnoses documented by nurses in Portugal within the scope of universal self‐care requisites; (2) to determine the main problems with nursing diagnoses syntaxes for semantic interoperability purposes; and (3) to suggest unified nursing diagnoses syntaxes within the scope of universal self‐care requisites. Background/Introduction: Ageing societies and the increase in chronic diseases have led to significant concern regarding individuals' dependence to ensure self‐care. ICNP is widely used by Portuguese nurses in electronic health records for documentation of nursing diagnoses and interventions. Methods: A qualitative study using inductive content analysis and focus group: 1. nursing e‐documentation content analysis and 2. focus group to explore implicit criteria or insights from content analysis results. Results: From a corpus of analysis with 1793 nursing diagnoses, 432 nursing diagnoses centred on universal self‐care requisites emerged from the content analysis. One hundred ten nursing diagnoses resulted from the application of new encoding criteria that emerged after a focus group meeting. Conclusion: Results reveal that nursing diagnoses related to universal self‐care requisites can emphasize the impairment or potentialities of the individuals performing self‐care. It also shows a lack of consensus on nominating the nursing diagnoses of people with a deficit in universal self‐care requisites, resulting in different diagnoses to express the same needs. Implications for nursing practice: Representation of most relevant nursing diagnoses within the scope of universal self‐care requisites. Implications for health policy: Incorporating standardized language into electronic health records is not enough for improving quality and continuity of care and semantic interoperability achievement. Electronic health records need to work with a nursing ontology in the backend to meet these requirements. [ABSTRACT FROM AUTHOR]

Objective: This study described the burnout experienced by physiotherapists during the COVID‐19 pandemic and analysed the role of possible factors of this occupational phenomenon. Methods: Cross‐sectional study based on a web‐based survey applied to physiotherapists living in Portugal. The survey included sociodemographic, health status and clinical practice questions. The Copenhagen Burnout Inventory (personal, work‐ and patient‐related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales and the Satisfaction with Life Scale were used. Results: A total of 511 physiotherapists (median 33 years old, 82% females) completed the survey. The participants worked mainly in private practice (50%) and wards (35%). During COVID‐19, 52% were working directly with patients, but only 18% were working with COVID‐19 patients. Personal (42%), work‐ (42%) and patient‐related burnout (25%) was observed. Three significant models explained personal‐ (R2 = 51%), work‐ (R2 = 31%) and patient‐related burnout (R2 = 16%). Lower levels of resilience and higher levels of depression and stress were significantly associated with personal, work‐ and patient‐related burnout. Being female and working directly with patients were additionally associated with both personal and work‐related burnout. Having health problems and working with COVID‐19 patients were only associated with personal burnout. Conclusions: More than 40% of physiotherapists experienced personal and work‐related burnout and 25% patient‐related burnout, with resilience, depression and stress having a relevant role in the three burnout dimensions. Early detection and management strategies need to be implemented to address physiotherapists' physical and psychological fatigue and exhaustion. [ABSTRACT FROM AUTHOR]

This study aimed to (1) estimate age‐at‐mid‐growth spurt (age‐at‐MGS) in Portuguese boys from two different regions—the Azores islands and Viana do Castelo, and (2) identify spurts in a variety of physical fitness (PF) components aligned by age‐at‐MGS in the two samples. A total of 176 (Azores, n = 91; Viana do Castelo, n = 85) boys aged 6 years old were followed annually to 10 years of age. Age‐at‐MGS and spurts in PF components (speed, explosive muscular strength, abdominal muscular strength, agility, and flexibility) were identified for each sample. The timing and intensities of the spurts were estimated using a non‐smooth mathematical procedure. In Azorean boys, age‐at‐MGS occurred at 7.8 years (6.99 cm y−1), whereas in Viana do Castelo it occurred at 7.9 years (6.20 cm y−1). Spurt in speed was attained 12 months after the MGS in both samples (0.53 and 0.35 cm y−1 in Azores and Viana do Castelo, respectively), whereas spurts in explosive muscular strength and flexibility occurred 12 months before the MGS and at the MGS (Azores: 21.59 and 5.52 cm y−1 and Viana do Castelo: 14.12 and 2.5 cm y−1, respectively). Agility and abdominal muscular strength peaked between 0 and 12 months after the MGS (Viana do Castelo: 0.37 m s−1 y−1 and 6.71 reps y−1 and Azores: 0.28 m s−1 y−1 and 19.36 reps y−1, respectively). Results indicate that developmental spurts in explosive strength and flexibility occur before, or are coincident with, the mid‐growth spurt in height, whereas spurts in speed, agility, and abdominal muscular strength occur after, or coincident with, the mid‐growth spurt in height. [ABSTRACT FROM AUTHOR]

The aim of this article was to present the preliminary results of a training programme for family caregivers of people with dementia at an early to moderate stage living at home – 'Living Together With Dementia'. In this randomised controlled trial, 27 family caregivers who met the inclusion criteria were recruited from the neurology outpatient consultation clinic of a hospital in the north of Portugal and randomised into two groups (control and experimental) between October 2015 and March 2016. The programme 'Living Together With Dementia' was applied to the participants of the experimental group. The strategies used, overload, difficulties and satisfaction of the caregivers were assessed at three different stages (at the beginning and end of the intervention, as well as at follow‐up). For the data analysis, quantitative parametric measures were applied. The Health Ethical Commission of the Hospital Centre approved the study, and its protocol and Helsinki Declaration ethical principles were considered throughout the process. In the final assessment, an improvement in the overload and difficulties was confirmed, as was an increase in the caregivers' satisfaction level and an improvement in coping/problem‐solving strategies. In the follow‐up stage, the results tended to revert towards those of the initial assessment. The programme 'Living Together With Dementia' appeared to be a major contribution enabling family caregivers of people with dementia, although there is a need to develop an efficacy study using a more substantial sample. The programme contributed to a reduction in the overload and difficulties borne by the family caregivers of people with dementia at an early to moderate stage living at home and to increased caregiver satisfaction. [ABSTRACT FROM AUTHOR]

Aim: To assess the association of food neophobia (FN) with food preferences, dietary intake and dietary quality. Methods: A cross‐sectional study was conducted in a non‐probabilistic sample of 229 Portuguese adults, aged 18 to 84 years. FN was measured with the FN Scale. Dietary intake over the previous 12 months was assessed by a validated semi‐quantitative food frequency questionnaire. We defined a dietary pattern the Healthy Diet Indicator, to summarise the effects of overall dietary intake. Generalised linear models were performed to test associations in multivariate analyses (controlled for sex, age and education). Results: FN was negatively associated with a general liking for the act of eating (β^=−2.976,95%CI:−5.324;−0.993) and with reduced preferences for specific foods (fruit and vegetables, some types of meat and fish and traditional Portuguese dishes with blood). Those with higher FN showed a lower consumption of fruits and vegetables, but a higher consumption of milk and codfish, a popular Portuguese ingredient. However, FN did not affect the macronutrients and energy intake, as well as sodium, added sugars and fibre intake. Adherence to a healthy dietary pattern was not significantly associated with FN. Conclusions: FN was associated with a decreased consumption and preference for specific foods, but it had no impact on a healthy dietary pattern. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the self‐care dependency levels of the dependent person at the time of home discharge and its relationship between (1) the degree of dependency of each self‐care domain; (2) the previous dependency levels; and (3) the gender of the dependent person. It also aims to assess the relationship between the degree of dependency of each self‐care domain, the length of admission, the length of dependency and the age of the dependent person at the time of discharge. Methods: A cross‐sectional study was conducted. The sample comprised hospitalised adults and elderly in the medical services of a Portuguese hospital during the months of March, April and May of 2018. The data were collected by an interview conducted at the time of home discharge from the hospital medical ward. Results: The average age of dependent people of the sample is 80.7 years (±10.1) with the majority being women (51.7%), with no statistical difference in the mean age according to gender (U = 2205.500; p > 0.05). They were hospitalised on average 11.4 days (±33.2), most of them (44.0%) due to respiratory problems (85% of which were due to pneumonia). There were no statistically significant differences between the length of the hospital stay, the length of dependency and the participants' gender (U = 2200.500, p > 0.05; U = 1688.000, p > 0.05). Medication intake was the highest dependency domain amongst participants (41.3%), followed by instrumental activities of daily living (40.6%) and bathing (39.9%). Conclusion: The amount of support required may vary according to the domain that the person is dependent. Thus, it is important to use a robust and reliable assessment tool that will be able to assess the degree of dependency on the various domains of self‐care. [ABSTRACT FROM AUTHOR]

Parenting stress is related to the characteristics of both the child and the parents, as well as to parent–child interactions. In adoptive families, parenting stress has been identified as an indicator of the family's adjustment to adoption. The stress experienced by parents of adopted adolescents deserves special consideration, as adolescence is a critical period in the adoptees' developmental pathway. The present study aims to identify the adoptee, parents and family related predictors of the adoptive parents' parenting stress, exploring direct and indirect effects. Fifty Portuguese adolescents' adoptive parents participated in this study. Parenting stress was measured by the Stress Index for Parents of Adolescents, and the Strengths and Difficulties Questionnaire was used to evaluate the adoptees' (mal)adjustment, according to the parents' perspective. Variables related to the parents' experience of adoption were assessed resorting to the Parent's Interview about the Adoption Process. Results showed that parents' satisfaction and adoptees' adjustment were sequential mediators of the relationship between the parents' experience of family life and parenting stress. These findings provide new insights into adoption research in parenting stress, highlighting the importance of adoption‐related variables such as the parents' adoption experience within the family and family relationships. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives: The prevalence of burnout among medical doctors and its negative effect on empathy can influence therapeutic success. The aim of this study was to compare the levels of empathy and burnout between residents and specialists as well as to study the correlation between empathy and burnout. Methods: This is an exploratory study of a convenience sample of 104 doctors who work in health institutions in Greater Lisbon area in Portugal, covering central hospitals, district hospitals, and health centres. Each doctor filled in a questionnaire, which included the Maslach Burnout Inventory (MBI) and the Jefferson Scale of Empathy (JSE). Results: Participants were divided in two subgroups: 51% residents (n = 53) and 49% specialists (n = 51). A difference (p =.048) in JSE scores between residents (mean 116.4, SD 12.8) and specialists (mean 120.78, SD 12.84) has been identified. Furthermore, in all three MBI subscales (emotional exhaustion, depersonalization, and lack of personal accomplishment), the group of residents showed significantly higher mean scores. In general, empathy scores showed an inverse relationship between depersonalization (r = –0.390, p <.0001) and lack of personal accomplishment (r = –0.447, p <.0001). Finally, we found that an increase in MBI level is associated with a decrease in empathy levels. Conclusion: Our findings suggest that there is a significant difference in burnout subscales scores between residents and specialists and that these have a negative correlation with empathy level. These exploratory results draw attention to the importance of preventing burnout in hospital and health care centres professionals, in particular in residents, through the implementation of individual and organizational structured measures. [ABSTRACT FROM AUTHOR]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

In Portugal, cardiovascular diseases stand out among the main causes of morbidity, disability, and mortality, with an expectation of growth up to the year 2025. A descriptive, exploratory study was carried out with patients in a cardiac rehabilitation program from an institution in the northern region of Portugal; 103 participants were randomly selected for the study. The data collection took place from February to April 2017. The majority of respondents presented a low level of literacy (inadequate and problematic). The profiles of the participants were characterized by the predominance of married males, with a mean age of 69 years. The participants considered doctors and nurses as the professionals who contribute the most to the increase of their health literacy. These health professionals have the opportunity and the responsibility to increase the health literacy levels of patients. It is known that low levels of health literacy are a problem throughout the European Union. Portugal's general population reflects this reality, and this study contributed to the conclusion that cardiac rehabilitation patients also present worrying levels of health literacy. [ABSTRACT FROM AUTHOR]

This is a pilot study on the sensitive issue of how children and young people experience family contact in foster care, and the views of key adults in their lives on the same issue. There is a special focus on the children's experiences, opinions, and feelings. The study is a response to the relative scarcity of literature on family contact based on the experiences of children and adults in caring roles. This is a qualitative and exploratory study, with a sample of 10 children and young people in care in the district of Porto, aiming to identify key issues and areas for further examination. The results allow us to conclude that the possibility of maintaining contact is positively evaluated. However, perspectives on the relationships involved, and on the reactions to and difficulties associated with visits, revealed considerable disagreement among the actors. A possible set of implications drawn from the findings pointed out to the importance of developing a monitored cooperation that improves communication processes in order to take into account the children's and young people's views in the decision‐making process; and to develop more attentive and open working relationships with parents throughout the foster care placement. [ABSTRACT FROM AUTHOR]

The Personality Inventory for DSM‐5 (PID‐5) measures the maladaptive traits of the model for personality and its disorders, as proposed in section III of the DSM‐5. The current study aimed to examine whether the Portuguese PID‐5 distinguished non‐clinical participants (N = 1223, Mage = 36.73, standard deviation = 15.72) from clinical participants (N = 202, Mage = 43.82, standard deviation = 11.33) with respect to dysfunctional personality traits and to explore the PID‐5 factor structure in both samples. The PID‐5 scale medians were higher in the clinical sample than in the community sample. All analyses were statistically significant (p ≤ 0.001) with medium size effects. In the community sample, a five‐factor structure emerged, and the factors resembled the PID‐5 domains. However, in the clinical sample, a four‐factor structure was retained, in which the Psychoticism domain did not clearly emerge. The composition of the clinical sample along with its small size may account for these unexpected results. Overall, the results provide evidence of the PID‐5's ability to distinguish between psychiatric and community individuals and of the model's structural similarity in community samples, across studies and nationalities. More research is required to understand the Portuguese PID‐5 structure in clinical samples. © 2018 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Professional support of families that are under temporary protection, with the goal of reunification, is necessary for helping families re‐establish their family dynamics. Without this support, the conditions that contributed to child abuse and neglect will likely persist. In this context, the attitude of professionals towards positive parenting and child participation is a decisive factor. The quantitative study presented here contributes knowledge regarding these 2 variables. The study was conducted with 106 professionals who work in the child protection system. The results show a high degree of consensus among professionals regarding the following practices: (a) incorporating positive parenting into family reunification processes; (b) training the biological parents in parenting skills; and (c) promoting the active participation of children in foster care and reunification. Regarding the latter point, the study found that older and more experienced professionals are more open and inclined to promote participation in family reunification processes. The practical implications of the results invite us to review attitudinal competencies training for professionals working in child protection services, focusing on encouraging a positive attitude towards the parental competencies of the biological family and the active participation of children in foster care and reunification. These professionals' attitudes are a key factor in mediating the process of family reunification. [ABSTRACT FROM AUTHOR]

Abstract: The establishment of emotional bonds is one of the most important tasks of the adoptive family. Most research about attachment in adoption focuses on young adopted children, as opposed to adoptees in other stages of development. The present study aims at assessing the adopted adolescents' self‐perception of attachment relationships with their adoptive parents, by pairing them with a group of institutionalized adolescents and another one of adolescents in the community. One hundred sixty‐five adolescents (55 adopted, 55 in residential care, and 55 living with their birth family), aged 12 to 19, participated in this study. Data were collected using the Inventory of Parent and Peer Attachment to assess attachment relationships with parents on three dimensions: trust, communication, and alienation. The results showed that adoptees perceived their relationship with their parents in a similar way to peers in the community and presented higher results when compared to institutionalized adolescents in trust and communication and lower scores in alienation. The results highlighted the relevance of family context experiences and suggested that adoption can offer the possibility of building a secure attachment relationship, which is not the case in the context of collective care, as happens within institutionalized care. [ABSTRACT FROM AUTHOR]

Aim: To propose nursing clinical practice changes to improve the development of patient self‐management. Background: Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Introduction: Control of the disease's progression, the preservation of autonomy in self‐care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self‐management. Methods: A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. Results: The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision‐making process. The specific guidelines, the provision of material to support decision‐making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self‐management skills related to the awareness of the need for ‘change’, hope, involvement, knowledge and abilities. Discussion: The implemented changes have improved health‐related behaviours and clinical outcomes. Conclusion: To support self‐management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. Implications for nursing and/or health policy: The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives This study examined the main sources of strain and the presence of psychological distress in a sample of centenarians' children who assumed the role of primary caregivers. Method A sample of 43 children (M age = 67.10 ± 6.67 years; 90.7% female) caring for a centenarian parent was interviewed and asked about their overall caregiving experience. Information on caregiving burden (Zarit Burden Interview) and psychological distress (Hospital Anxiety and Depression Scale) was also obtained. Several characteristics of the caregiving dyads (e.g. age, co-residence) were tested to compare caregivers with and without anxiety and depressive symptoms. Qualitative data from the interviews were analysed for recurrent themes using thematic analysis. Results Main caregiving impacts concern social and leisure dimensions (role captivity), with important personal mid-life and late-life plans needing to be changed or postponed. Centenarians' children present higher levels of anxiety ( M = 6.95 ± 4.7) than depression ( M = 6.0 ± 4.1), and psychological distress was found to be significantly associated with high subjective burden, low life satisfaction, poorer perceived health, and perceived income inadequacy. Conclusion The significant levels of psychological distress, along with the loss of autonomy and incapacity to prosecute plans for retirement, reinforce the psychological demands of late-life caregiving. Paying attention to these relationships is imperative to promote adequate responses for these caregivers. [ABSTRACT FROM AUTHOR]

Background Understanding children's views of illness and health is vital to a child-centred approach in patient education and care. Paediatric healthcare providers should incorporate children's views of health and illness to enable children and their families to participate in self-management plans and achieve better health outcomes. However, there is limited scientific knowledge regarding the views of children with specific diseases. Method This comparative study investigated whether and in what ways the experience of having different chronic diseases influenced children's views of being ill and healthy. The participants were 82 children aged 8-13 years diagnosed with a chronic disease (31 had asthma, 27 had diabetes and 24 had cancer). A group of 81 healthy children participated as a comparison group. The 'draw-and-write' technique was used to collect the children's views, and the data were analysed using a previously validated coding system (inter-rater agreement of 93%) and subsequently quantified for the examination of any differences in relation to illness. Results Statistically significant differences were found in all dimensions of the children's conceptions of health and illness according to whether they had a chronic condition (effect sizes calculated with Cohen's d ranged from 0.35 to 1.22). Globally, the chronically ill children expressed a narrower definition of being healthy and ill than their healthy peers. Moreover, the comparison among the children with asthma, diabetes and cancer showed differences that seemed to reflect their specific experiences with their type of chronic disease and the associated treatments (effect sizes calculated with Eta-squared ranged from 0.07 to 0.25). Conclusions This study's findings can be used to guide education and clinical services tailored to ill children suffering from different chronic conditions. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between individual and school characteristics associated with the number of school days children comply with moderate-to-vigorous physical activity ( MVPA) recommendations. Sample comprises 612 Portuguese children, aged 9-11 years, from 23 schools. Time spent in MVPA was measured by accelerometry, while individual-level correlates were obtained by anthropometry and questionnaires. School-level variables were collected by questionnaire, and accelerometer wear time and season were also considered. Maximum likelihood estimates of model parameters were obtained via a multilevel analysis with children as level-1, and school as level-2. Children who spent more time in sedentary activities and girls were less likely to comply with MVPA/daily. More mature children and those who use active transportation to school were more likely to attain the PA recommendation. Furthermore, greater accelerometer wear time and spring season increased the chance to achieve the recommended MVPA. In terms of school-level correlates, a greater number of available facilities was negatively associated with children MVPA compliance. Given the set of variables, our results showed that individual characteristics seem to be more relevant for children's compliance rates with PA/day than school context variables, which should be taken into account in the implementation of school policies and practices. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine the point prevalence of eating disorders and picking/nibbling in elderly women. Methods This was a two-stage epidemiological study that assessed 342 women aged 65-94 years old. In Stage 1, the following screening measures were used to identify possible cases: the Mini-Mental State Examination, to screen and exclude patients with cognitive impairment; Weight Concerns Scale; SCOFF (Sick, Control, One, Fat, Food) Questionnaire; Eating Disorder Examination Questionnaire-dietary restraint subscale; and three questions to screen for picking/nibbling and night eating syndrome. Women selected for Stage 2 ( n = 118) were interviewed using the diagnostic items of the Eating Disorder Examination. Results According to the DSM-5, the prevalence of all eating disorders was 3.25% (1.83-5.7, 95% C.I.). Prevalence of binge-eating disorder was 1.68% (0.82-3.82, 95% C.I.), of other specified feeding or eating disorders was 1.48% (0.63-3.42, 95% C.I.), and of bulimia nervosa 0.3% (.05-1.7, 95% C.I.)]. Binge-eating episodes were reported by 5.62% of women. No cases of anorexia nervosa or night eating syndrome were identified. The prevalence of picking/nibbling was 18.9%. Picking/nibbling was associated with increased body mass index ( t(322) = −3.28, p < .001) and binge-eating episodes ( χ2(1) = 5.65, p < .017). Discussion Prevalence rates of eating disorders on elderly Portuguese women were comparable to those found on young women. Our data support the literature that suggests that binge-eating disorder is particularly prevalent in older adults. Picking/nibbling was the most prevalent eating behavior and we provide further evidence for its association with weight and disordered eating. [ABSTRACT FROM AUTHOR]

Background Waist-to-height ratio ( WHtR) has been reported as a preferable risk related body fat ( BF) marker, although no standardised waist circumference measurement protocol ( WCmp) has been proposed. The present study aimed to investigate whether the use of a different WCmp affects the strength of relationship between WHtR and both whole and central BF in non-alcoholic fatty liver disease ( NAFLD) patients. Methods BF was assessed with dual energy X-ray absorptiometry ( DXA) in 28 NAFLD patients [19 males, mean (SD) 51 (13) years and nine females, 47 (13) years]. All subjects also underwent anthropometric evaluation including height and waist circumference ( WC) measurement using four different WCmp ( WC1, minimal waist; WC2, iliac crest; WC3, mid-distance between iliac crest and lowest rib; WC4, at the umbilicus) and WHtR was calculated using each WC measurements ( WHtR1, WHtR2, WHtR3 and WHtR4, respectively). Partial correlations were conducted to assess the relation of WHtR and DXA assessed BF. Results All WHtR were particularly correlated with central BF, including abdominal BF ( r = 0.80, r = 0.84, r = 0.84 and r = 0.78, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4) and central abdominal BF ( r = 0.72, r = 0.77, r = 0.76 and r = 0.71, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4), after controlling for age, sex and body mass index. There were no differences between the correlation coefficients obtained between all studied WHtR and each whole and central BF variable. Conclusions Waist-to-height ratio was found a suitable BF marker in the present sample of NAFLD patients and the strength of the relationship between WHtR and both whole and central BF was not altered by using different WCmp in the present sample of NAFLD patients. [ABSTRACT FROM AUTHOR]

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population-based birth cohort Generation XXI (Porto, Portugal, 2005-2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child-feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio-economic position (SEP) at 12 years, maternal socio-economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy-dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42-2.18; Snacking, OR = 1.73, 95% CI: 1.27-2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70-2.81; Snacking, OR = 2.22, 95% CI: 1.82-3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35-13.44, P-trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94-6.05, P-trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio-economic and demographic characteristics, accounting for one-third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups. [ABSTRACT FROM AUTHOR]

In outdoor activities, it seems reasonable that the longer children spend in spontaneous physical activity (PA), the higher the probability of being active. Indeed, the time spent outdoor has been identified as a variable consistently associated with the children’s PA. Outdoor playing, such as the organized sports practice, appears associated with healthier lifestyle standards. All the recommendations mention the importance of increasing daily PA practice in children and teenagers, but few studies highlight the relationship between outdoor play and the recommended PA levels. The purpose of this study is to investigate the relationships between the frequency of outdoor play, the frequency of the organized sports practice, and the compliance of the recommendations for PA practice in children in the inner city area of Porto. The sample of this study is composed of 422 individuals (mean age of 11.6 years). Two hundred and twenty-five of them were girls and 197 were boys from the sixth grade (elementary schools located in the inner city area of Porto). PA was objectively evaluated using accelerometers. Participants reported frequency of participation in different PA contexts, such as sports practice and outdoor play. The results show a predictor effect of participating in sports three or more times per week on compliance of PA guidelines. In conclusion, organized sports practice seems more effective than outdoor play to reach the recommended levels of PA in children. [ABSTRACT FROM PUBLISHER]

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Psychiatric patients report higher levels of victimisation and are at risk for further victimisation in different contexts, such as psychiatric institutions. Studies in this field tend to focus on hospital staff as victims, experiencing classic forms of victimisation (e.g. physical assault, threats, verbal abuse), through qualitative studies. This is a quantitative retrospective study that aims to know the occurrence of psychiatric victimisation and other adverse experiences in Portuguese psychiatric patients. Ninety-five psychiatric patients, between 20 and 79 years old ( M - 45.18, SD - 13.06), with a history of psychiatric hospitalisation answered the Experiences in Psychiatric Institution Inventory. Participants were recruited in four psychiatric hospitals. Inpatients were approached during their hospitalisation; outpatients were approached in scheduled appointment days. Only 23 (24.2%) participants reported no victimisation. Total Experiences of Self varied from 0 to 7 ( M - 1.75, SD - 1.72), Total Witnessed Experiences varied from 0 to 7 ( M - 1.17, SD - 1.64), and Total Global Experiences varied from 0 to 14 ( M - 2.92, SD - 3.01). These results show that victimisation and adverse experiences in psychiatric contexts are frequent and go beyond classic forms of victimisation. A deeper knowledge of these experiences and their impact in the mental health of psychiatric patients may promote quality of care provided and lead to more effective treatments, thus reducing the number and length of hospitalisations, and the financial burden for public health services. [ABSTRACT FROM AUTHOR]

Background It is important to assess young children's perceived Fundamental Movement Skill (FMS) competence in order to examine the role of perceived FMS competence in motivation toward physical activity. Children's perceptions of motor competence may vary according to the culture/country of origin; therefore, it is also important to measure perceptions in different cultural contexts. The purpose was to assess the face validity, internal consistency, test-retest reliability and construct validity of the 12 FMS items in the Pictorial Scale for Perceived Movement Skill Competence for Young Children (PMSC) in a Portuguese sample. Methods Two hundred one Portuguese children (girls, n = 112), 5 to 10 years of age (7.6 ± 1.4), participated. All children completed the PMSC once. Ordinal alpha assessed internal consistency. A random subsamples ( n = 47) were reassessed one week later to determine test-retest reliability with Bland-Altman method. Children were asked questions after the second administration to determine face validity. Construct validity was assessed on the whole sample with a Bayesian Structural Equation Modelling (BSEM) approach. The hypothesized theoretical model used the 12 items and two hypothesized factors: object control and locomotor skills. Results The majority of children correctly identified the skills and could understand most of the pictures. Test-retest reliability analysis was good, with an agreement ration between 0.99 and 1.02. Ordinal alpha values ranged from acceptable (object control 0.73, locomotor 0.68) to good (all FMS 0.81). The hypothesized BSEM model had an adequate fit. Conclusions The PMSC can be used to investigate perceptions of children's FMS competence. This instrument can also be satisfactorily used among Portuguese children. [ABSTRACT FROM AUTHOR]

Parental sense of competence is one of the central dimensions targeted on psychosocial interventions aimed at supporting at‐risk families. Researchers and practitioners need reliable instruments to assess the parental role adapted for these families. Although the parental sense of competence (PSOC) scale has been frequently used to assess this construct, there is still no adapted version for Portuguese parents. In this study, the reliability, validity and factor structure of the PSOC scale is examined with a clinical sample of 146 mothers from at‐risk families receiving psychosocial interventions for family preservation from Child Protective Services. Results show that the Portuguese version of the PSOC measures three distinct constructs with acceptable psychometric properties: efficacy, dissatisfaction and controllability. As expected, the obtained factors were significantly and positively related to parenting alliance and family cohesion, and negatively associated with parenting stress. In sum, the proposed Portuguese version shows reliability and validity evidences to measure three relevant dimensions of parental self‐evaluation, and it constitutes a cost‐ and time‐effective instrument suited for at‐risk mothers. [ABSTRACT FROM AUTHOR]

This research explores the simultaneous role of two Self--Other relations in the elaboration of representations at the micro- and ontogenetic levels, assuming that it can result in acceptance and/or resistance to new laws. Drawing on the Theory of Social Representations, it concretely looks at how individuals elaborate new representations relevant for biodiversity conservation in the context of their relations with their local community (an interactional Other) and with the legal/reified sphere (an institutional Other). This is explored in two studies in Portuguese Natura 2000 sites where a conservation project calls residents to protect an at-risk species. Study 1 shows that (i) agreement with the institutional Other (the laws) and meta-representations of the interactional Other (the community) as approving of conservation independently help explain (at the ontogenetic level) internalisation of conservation goals and willingness to act; (ii) the same meta-representations operating at the micro-genetic level attenuate the negative relation between ambivalence and willingness to act. Study 2 shows that a meta-representation of the interactional Other as showing no clear position regarding conservation increases ambivalence. Findings demonstrate the necessarily social nature of representational processes and the importance of considering them at more than one level for understanding responses to new policy/legal proposals. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate residential child care staff satisfaction with their involvement in the Webster‐Stratton Incredible Years Basic Parent Programme (IY). In an exploratory, not randomized study, 27 professionals from two different short‐term Portuguese residential child care centres (IG1, n = 15; IG2; n = 12) completed weekly IY evaluations and an overall satisfaction questionnaire at the end of their participation in the IY intervention. The weekly level of satisfaction was assessed with regard to each of the programme's components (content, DVDs, group leaders, group discussion). At the last session, they filled out a questionnaire aimed to evaluate the levels of satisfaction regarding the programme overall, the teaching format, the group leader(s) and the usefulness of specific educational techniques they learned. Data indicated that residential staff carers were highly satisfied with the weekly sessions and with the overall usefulness of the intervention programme. Results are discussed in terms of implications and future research directions. [ABSTRACT FROM AUTHOR]

The job of health professionals, including nurses, is considered inherently stressful, and thus, it is important to improve and develop specific measures that are sensitive to the demands that health professionals face. This study analysed the psychometric properties of three instruments that focus on the professional experiences of nurses in aspects related to occupational stress, cognitive appraisal and mental health issues. The evaluation protocol included the Stress Questionnaire for Health Professionals (SQHP), the Cognitive Appraisal Scale (CAS) and the General Health Questionnaire ‐ 12 (GHQ ‐ 12). Validity and reliability issues were considered with statistical analysis (i.e.   confirmatory factor analysis, convergent validity and composite reliability) that revealed adequate values for all of the instruments, namely a six ‐ factor structure for the SQHP, a five ‐ factor structure for the CAS and a two ‐ factor structure for the GHQ ‐ 12. In conclusion, this study proposes three consistent instruments that may be useful for analysing nurses' adaptation to work contexts. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Previous research revealed that mouth movements influence attitudes. Covert subvocal articulations inducing muscular contractions resembling ingestion movements were preferred over expectoration-like movements, unveiling a relationship between vocal muscles' wandering and motivational states such as approach and avoidance. These findings, explained in terms of embodied cognition, suggest that specific movements are directly connected to, and more importantly, automatically activate concordant motivational states. The oral approach-avoidance effect was replicated using the original stimulus set and a new set of stimulus developed for Portuguese. Results from two high-powered (total N = 407), independent replications, revealed that the preference for inward words (over outwards) exists in both sets but to a greater extent in the pool phonetically adapted for Portuguese. [ABSTRACT FROM AUTHOR]

Familial amyloid polyneuropathy ( FAP) is a chronic debilitating multi-organic disorder, mainly assessed using ordinal-based impairment measures. To date, no outcome measure at the activity and participation level has been constructed in FAP. The current study aimed to design an interval activity/participation scale for FAP through Rasch methodology. A preliminary FAP Rasch-built overall disability scale (pre- FAP-RODS) containing 146 activity/participation items was assessed twice (interval: 2-4 week; test-retest reliability) in 248 patients with Val30Met FAP examined in Porto, Portugal, of which 65.7% have received liver transplantation. An ordinal-based 24-item FAP-symptoms inventory questionnaire ( FAP-SIQ) was also assessed (validity purposes). The pre- FAP-RODS and FAP-SIQ data were subjected to Rasch analyses. The pre- FAP-RODS did not meet model's expectations. On the basis of requirements such as misfit statistics, differential item functioning, and local dependency, items were systematically removed until a final 34-item FAP-RODS© was constructed fulfilling all Rasch requirements. Acceptable reliability/validity scores were demonstrated. In conclusion, the 34-item FAP-RODS© is a disease-specific interval measure suitable for detecting activity and participation restrictions in patients with FAP. The use of the FAP-RODS© is recommended for future international clinical trials in patients with Val30Met FAP determining its responsiveness and its cross-cultural validation. Its expansion to other forms of FAP should also be focus of future clinical studies. [ABSTRACT FROM AUTHOR]

Aim Examine metrics and policies regarding nurse workforce across four countries. Background International comparisons inform health policy makers. Methods Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom ( UK) and the United States ( US). Workforce policy context was explored. Results Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. Limitations There are differences as well as variation in the overall impact of the global financial crisis in these countries. Conclusion Future supply of nurses in all four countries is vulnerable. Implications for nursing and health policy Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries. [ABSTRACT FROM AUTHOR]