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Objectives There is evidence that the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the mental health of pregnant women, such as an increase in the prevalence of depression. Given the negative consequences that depressive symptoms can pose for pregnant women, it is crucial to understand how cognitive processes influence women’s depressive symptoms during the COVID-19 pandemic among this specific vulnerable population. The present study aimed to examine the relationship between pregnant women’s dysfunctional attitudes toward motherhood and their depressive symptoms, considering the mediating roles of self-compassion and mindful self-care. Method A cross-sectional online survey was conducted in Portugal between October 2020 and April 2021. A sample of 244 pregnant women answered a set of questionnaires to assess dysfunctional attitudes toward motherhood, depressive symptoms, self-compassion, and mindful self-care. Results More dysfunctional attitudes toward motherhood were associated with higher levels of depressive symptoms, and this relation was mediated through self-compassion and mindful self-care. Conclusions These results highlight that self-compassion and mindful self-care are important psychological mechanisms and the importance of considering them in psychological interventions to prevent and/or treat depressive symptoms in pregnant women with dysfunctional attitudes toward motherhood during stressful events such as a pandemic.

In this study, we describe the relative contributions of and interactions between individual risk factors associated with ineffective pregnancy prevention among female adolescents in Portugal. Our sample consisted of 856 sexually experienced female adolescents (10-19 years) who did not intend to become pregnant. Of these, 379 were pregnant, and the residual (477) had never been pregnant. We used classification tree analysis to describe the interplay among a set of established sociodemographic, familial, reproductive, and relationship factors as predictors of ineffective pregnancy prevention. The tree model showed good predictive properties. Seven profiles predicted one-half to all the cases of ineffective pregnancy prevention. Ineffective pregnancy prevention was predicted by adolescents' grade level and different combinations of variables, specifically female age, age at the time of first sexual intercourse, religious beliefs, place of residence, maternal pregnancy before age 20, household structure in childhood, and partner's age difference. According to our findings, limiting assessments to the cumulative presence of risk factors may be insufficient to accurately identify adolescents at elevated risk of unwanted pregnancy, as the impact of any given risk factor may vary according to other factors. Our findings may contribute to the development of a risk assessment tool that may support healthcare providers' efforts to provide individualized risk assessment for adolescent patients and, thus, to better support pregnancy prevention.

To explore a wide range of factors associated with complete mental health (i.e., positive mental health - the presence of flourishing, and the absence of mental illness - depressive and anxious symptoms) among Portuguese pregnant women, during the COVID-19 pandemic.Quantitative cross-sectional study.Data were collected through an online survey placed on social media websites targeting pregnant Portuguese adult women between October 2020 and April 2021.The sample comprised 207 pregnant women.A multivariate logistic regression model showed that higher levels of self-compassion and higher engagement in mindful self-care practices increased the likelihood of reporting complete mental health during pregnancy.Promoting self-compassion and mindful self-care may be particularly important in pregnant women, as these psychological factors appear to contribute to complete mental health during COVID-19 pandemic.The COVID-19 pandemic represented a demanding period for pregnant women. Our findings highlight that targeting the promotion of self-compassion and mindful self-care practices during stressful periods could significantly contribute to their overall mental health.

Several studies have identified explicative factors for adolescents’ sexual risk behaviors and related outcomes such as unintended pregnancy, however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1–6 years after first sexual intercourse by increasing the adolescents’ likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.

A formative evaluation (consisting of two phases: a scoping literature review and a focus group with mental health professionals) was conducted to inform the design of a web-based intervention to prevent postpartum depression, in terms of its characteristics and content: the Be a Mom program. The results showed that the web-based intervention should be short-term, delivered postnatally, and grounded in cognitive-behavior therapy principles. Moreover, the intervention should include weekly sessions targeting basic contents: motherhood changes, reorganizations and emotional experience; cognitions, self-criticism, and self-compassion; parenting values, social support, and assertive communication skills; couple relationship, negotiation and conflict resolution skills; and postpartum depression signs and professional help-seeking. These results may improve the Be a Mom’s adequacy, implementation success, and effectiveness.

Resumo Foi nosso objetivo explorar o contributo simultâneo de fatores individuais, sociais e ambientais e das possíveis interações entre eles para a decisão de prosseguir uma gravidez adolescente à luz do atual quadro legislativo que despenaliza a interrupção da gravidez por opção da mulher, em Portugal. A amostra foi constituída por 276 adolescentes que engravidaram de forma não planeada e contactaram com os serviços de saúde dentro do prazo legal que lhes permitiria optar pela interrupção: 133 adolescentes que prosseguiram a gravidez e 143 que a interromperam. Os dados foram recolhidos entre 2008 e 2013 em 53 serviços de saúde de todas as regiões. Não ter ponderado as duas alternativas possíveis (prosseguimento/interrupção), pertencer a famílias de baixo nível socioeconómico e com história de maternidade adolescente, ter abandonado a escola e residir em áreas com maior densidade populacional e onde a população feminina é menos escolarizada foram fatores explicativos do prosseguimento da gravidez. A menor idade da adolescente associou-se com o prosseguimento apenas quando não foram ponderadas ambas as alternativas. O efeito da religiosidade local variou de acordo com o envolvimento religioso da adolescente. Estes resultados têm importantes implicações para a prática clínica e investigação na área da decisão reprodutiva na adolescência.Abstract The aim of the current study was to explore the simultaneous contribution of individual, social, and environmental factors, as well as the possible interactions between them to the decision to continue an adolescent pregnancy after the abortion on women´s demand has been legalized in Portugal. The sample consisted of 276 adolescents who became unintentionally pregnant and contacted with healthcare services within the legal period for induced abortion: 133 adolescents who chose to continue the pregnancy and 143 who chose to terminate the pregnancy. Data were collected between 2008 and 2013, in 53 healthcare centers of all country areas. Not having thought about both available options (i.e., continuing vs. terminating the pregnancy), belonging to families of low socioeconomic status and with adolescent pregnancy history, having dropped out of school and having lived in areas with higher population density and less educated females predicted the decision to continue the pregnancy. The lower the adolescents’ age, the more frequent was the decision to continue the pregnancy, but only when adolescents’ had not thought about both options. The effect of local religiosity differed according to the adolescents’ religious involvement. These findings have important implications for clinical practice and research on adolescents’ reproductive decisions.

Objectives The literature has been conceptualizing pregnancy occurrence as a multiphase event. However, the different combinations of decisions and behaviors leading to pregnancy that end in abortion remain unexplored in the literature. The aims of the study were to describe the reproductive and relational trajectories leading to pregnancy in women who decide to abort and to explore the differences in this process according to women’s age [adolescents ( Study design In this cross-sectional study, 426 women [246 adolescents (58.4%), 177 adults (41.6%)] who chose abortion were recruited. Data on reproductive and relational characteristics were collected through a self-report questionnaire at 16 healthcare services that provide abortion. The variables were introduced in trajectories according to the criterion of temporal sequence between them: age at first sexual intercourse, relationship type, pregnancy planning, use of contraception, identification of contraceptive failure, and occurrence of pregnancy. Results Seven trajectories leading to pregnancy were identified. The most frequent trajectory (30.8%) included women who 1) were involved in a long-term romantic relationship, 2) did not plan the pregnancy, 3) were using contraception, and 4) did not identify the contraceptive failure that led to pregnancy. Although this was the most frequent trajectory for both age groups, the remaining trajectories showed a different distribution. Compared to adolescents, adult women’s trajectories more frequently included casual relationships with non-use of contraception, or contraceptive use with no contraceptive failure identification. Conclusion Our study highlights the need to recognize the multiplicity of reproductive and relational trajectories leading to pregnancies that end in abortion and their specificities according to women’s age. These findings have important implications for abortion counselling and for the development of age-appropriate guidelines for preventive interventions, by drawing attention to prioritization of different contexts of intervention according women’s age.

Article Age at first sexual intercourse (AFSI) is the initial factor related to adolescents’ sexual life that may increase the risk of adolescent pregnancy. We explored the biological, social, cultural, and political predictors of AFSI addressing several gaps that prevent us from generalizing the results of past research to adolescent pregnancy prevention. We also explored the moderating effects of cultural variables on the links between social and political predictors and AFSI. Our sample consisted of 889 Portuguese female adolescents aged 12-19. Earlier age at menarche, non-intact family structure, maternal history of adolescent pregnancy, lower maternal emotional warmth, absence of religious involvement, and living in Portugal’s mainland and in a legal context penalizing abortion predicted earlier AFSI. School attendance predicted earlier AFSI among adolescents of European ethnic origin; adolescents of non-European ethnic origin presented the opposite, but non-significant, pattern. These findings suggest that, in addition to isolated characteristics, factors from different ecological contexts should be considered when planning interventions designed to foster healthy and informed transitions to sexual initiation and prevent the related risks of unwanted outcomes. We discuss implications for future research and practice.

Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. Methods: We recruited a nationally representative sample of 224 adolescents (

Introdução: Este estudo pretendeu caracterizar as trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência em Portugal, explorando a existência de especificidades regionais. Material e Métodos: O estudo decorreu entre 2008 e 2013 em 42 serviços de saúde públicos. A amostra, nacionalmente representativa, incluiu 459 grávidas com idades entre os 12 e os 19 anos. Os dados foram obtidos por autorrelato, através de uma ficha de caracterização construída para o efeito. Resultados: Independentemente de terem tido um (59,91%) ou múltiplos parceiros sexuais (40,09%), as adolescentes engravidaram de forma mais frequente numa relação de namoro, utilizando contraceção à data da conceção e tendo identificado a falha contracetiva que esteve na origem da gravidez (39,22%). A nível regional, outras trajetórias surgiram com elevada prevalência, refletindo opções como a decisão de engravidar (Alentejo/Açores), a não utilização de contraceção (Centro/Madeira) ou a sua utilização ineficaz sem que a falha contracetiva fosse identificada (Madeira). As relações de namoro revelaram-se maioritariamente duradouras (> 19 meses), com homens mais velhos (> 4 anos) e fora do sistema de ensino (75,16%); estes resultados foram particularmente expressivos quando a gravidez foi planeada. Discussão: O conhecimento gerado por este estudo reflete a necessidade de investir em abordagens preventivas que atendam às necessidades específicas das jovens de cada região e integrem a população masculina de maior risco. Conclusão: Os nossos resultados podem contribuir para o delineamento de políticas de saúde mais eficazes e para uma atuação multidisciplinar mais informada ao nível da educação sexual e do planeamento familiar nas diferentes regiões do país. Introduction: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents’ place of residence. Material and Methods: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). Results: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents’ partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. Discussion: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents’ needs in each region and should include high-risk male groups. Conclusion: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.

The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents' place of residence.Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459).Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents' partners were older than themselves (4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned.The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents' needs in each region and should include high-risk male groups.Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.Introdução: Este estudo pretendeu caracterizar as trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência em Portugal, explorando a existência de especificidades regionais.Material e Métodos: O estudo decorreu entre 2008 e 2013 em 42 serviços de saúde públicos. A amostra, nacionalmente representativa, incluiu 459 grávidas com idades entre os 12 e os 19 anos. Os dados foram obtidos por autorrelato, através de uma ficha de caracterização construída para o efeito.Resultados: Independentemente de terem tido um (59,91%) ou múltiplos parceiros sexuais (40,09%), as adolescentes engravidaram de forma mais frequente numa relação de namoro, utilizando contraceção à data da conceção e tendo identificado a falha contracetiva que esteve na origem da gravidez (39,22%). A nível regional, outras trajetórias surgiram com elevada prevalência, refletindo opções como a decisão de engravidar (Alentejo/Açores), a não utilização de contraceção (Centro/Madeira) ou a sua utilização ineficaz sem que a falha contracetiva fosse identificada (Madeira). As relações de namoro revelaram-se maioritariamente duradouras (19 meses), com homens mais velhos (4 anos) e fora do sistema de ensino (75,16%); estes resultados foram particularmente expressivos quando a gravidez foi planeada.Discussão: O conhecimento gerado por este estudo reflete a necessidade de investir em abordagens preventivas que atendam às necessidades específicas das jovens de cada região e integrem a população masculina de maior risco.Conclusão: Os nossos resultados podem contribuir para o delineamento de políticas de saúde mais eficazes e para uma atuação multidisciplinar mais informada ao nível da educação sexual e do planeamento familiar nas diferentes regiões do país.

In the beginning of the 21 st century we experienced a paradigm shift between the acute and infectious diseases to the chronic conditions, sustained by the aging of the population. Nevertheless, the education system for health professionals kept the traditional educational models. The main idea of the work here presented is to provide a literature review of the state of the art of information and communication technology (ICT) applied to Long-term and Palliative Care. We conducted an exhaustive investigation from Pubmed and Google Scholar using the Medical Subject Headings (MeSH) terms “information and communication technologies”, “e-Health”, “m-Health” and “long-term care”, “palliative care”. Currently, the existence of a critical mass of Internet users allows quickly diffusion of electronic communication in the medical practice, which translates as a new way to look at the doctor-patient relationship. It is important to define the various ways in which one can establish a doctor-patient communication, ensure the security and confidentiality of the information, create practical and "user friendly" interfaces that can be easily used by patients and ensure universal access to new technologies. Despite the existence of some literature on new information technologies applied to the health context, few papers trace the connection between these same information technologies and long-term and palliative care. We believe that the absence of literature on this theme relates to the emphasis of personal contact in such situations and the lack of quality records. More research is needed on this subject. © 2013 Published by Elsevier Ltd. Selection and/or peer-review under responsibility of CENTERIS/ProjMAN/HCIST.

The aims of the current study were to examine the indirect effect of the perceived impact of pregnancy on quality of life (QoL) through the severity of depressive symptoms among a sample of pregnant adolescents, and to explore whether adolescents’ satisfaction with support from their mothers (SM) or partners (SP) was a buffer of this effect. Demographic and pregnancy-related data were collected for 395 pregnant adolescents age 12–19 and were controlled for testing the proposed indirect effect. SM and SP were tested as moderators of the links between perceived impact of pregnancy and depressive symptoms and between depressive symptoms and QoL. A computational tool for path analysis-based moderation and mediation analysis as well as their combination was used to test indirect and interaction effects (PROCESS). A significant indirect effect of the perceived impact of pregnancy on QoL through the severity of depressive symptoms was found (0.51, CI = 0.29/0.78). There was no significant direct effect of the perceived impact of pregnancy on QoL after controlling for the severity of depressive symptoms. SM and SP buffered the indirect effect by weakening the association between a negative perception of the impact of pregnancy and higher severity of depressive symptoms. Identifying adolescents with a negative perception of the impact of pregnancy, improving the quality of their relations with their mothers and partners, and promoting satisfactory support from these figures may be extremely important to prevent and treat depressive symptoms and, in so doing, improve adolescents’ QoL during pregnancy.

Adolescent pregnancy appears today as an intricate tapestry where different dimensions interact. In our study we examined the associations between individual, sociodemographic, familial, and relational variables and their impact in the occurrence of pregnancy and adolescents’ adjustment to it. Participants were Portuguese pregnant and non-pregnant adolescents (N = 833). Ecological contexts were characterized, and individual and relational adjustment (depressive symptoms and quality of life; perceived quality of relationship with significant others – parents, romantic partner and friends) were evaluated. Differences between the ecologies of adolescents in both groups were identified. Familial and relational variables were significantly associated with both the risk of pregnancy and more difficulties in adjustment. Implications for preventive intervention are discussed.

Contexto: O protocolo de intervenção psicológica em situações de perda perinatal da Unidade de Intervenção Psicológica (UnIP) foi desenvolvido com o objectivo de promover a adaptação parental à perda perinatal, em termos da aceitação da perda e da restituição do equilíbrio emocional e das diferentes áreas de vida. Objectivo: Este estudo tem como objectivo explorar a percepção das utentes acerca do referido protocolo (consecução dos objectivos, importância e utilidade). Método: Foi realizado um estudo descritivo-correlacional, com uma amostra constituída por 37 participantes que beneficiaram do protocolo de intervenção psicológica, após a ocorrência de uma perda perinatal. Resultados: Os resultados sugerem que as utentes percepcionam o protocolo como útil e eficaz na consecução dos objectivos referidos; essa percepção é variável em função de algumas das suas características de aplicação. O protocolo de intervenção psicológica parece trabalhar de forma mais eficaz a dimensão de coping focado na perda, do que a dimensão de coping focado na restauração de rotinas. Conclusões: Apesar dos benefícios do protocolo, verifica-se uma lacuna na promoção do processo oscilatório entre as dimensões de coping focadas na perda e na restauração de rotinas. São discutidas implicações dos resultados para a aplicação do protocolo. Context: The Psychological Intervention Unit (UnIP) developed a psychological intervention protocol for cases of perinatal loss, with the aim of promoting parental adjustment to perinatal loss in terms of acceptance of loss and resumption of normal life functioning. Aim: The goal of this study was to explore women’s perceptions of the psychological intervention protocol (goal achievement, importance and usefulness). Method: Thirty-seven women, who received psychological intervention according to the protocol after the occurrence of a perinatal loss, participated in this descriptive-correlational study. Results: Results suggested that women perceived the intervention protocol as useful and effective in the attainment of its goals; this perception varied according to some characteristics of the intervention protocol. Results also showed that the psychological intervention protocol seemed to be more effective in promoting loss-focused coping than resumption of routines. Conclusion: Despite the benefits of the protocol, there is a gap in the encouragement of the alternating process between dimensions of loss-focused coping and coping focused on resumption of routines. Implications for the intervention protocol application are discussed. Resumen - Contexto: El protocolo de intervención psicológica en los casos de pérdida perinatal de la Unidad de Intervención Psicológica (UnIP) fue desarrollado con el objetivo de favorecer el ajuste de los padres a la pérdida perinatal (aceptación de la pérdida y la recuperación del equilibrio emocional). Objetivo: El presente estudio tiene como objetivo explorar la percepción de las pacientes sobre el protocolo de intervención (consecución de los objetivos, importancia y utilidad). Método: Se realizó un estudio descriptivo correlacional con una muestra de 37 participantes que recibieron el protocolo de intervención psicológica después de la ocurrencia de una pérdida perinatal. Resultados: Los resultados sugieren que las pacientes perciben el protocolo como útil y eficaz para conseguir los objetivos, y que la percepción es variable, dependiendo de ciertas características de su aplicación. El protocolo parece funcionar con mayor eficacia en la dimensión centrada en hacer frente a la pérdida que en la dimensión centrada en la restauración de las rutinas. Conclusiones: A pesar de los beneficios del protocolo, hay un vacío en el proceso de promoción oscilante entre las dimensiones centradas en la pérdida y en la restauración de las rutinas. Se analizan las implicaciones de los resultados para la aplicación del protocolo.