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This pilot study examined the distribution of low vitamin D levels among ethnic minority adolescents in primary care to elucidate the clinical needs of this diverse population.A cross-sectional study was conducted using a retrospective patient chart review. Participants were a consecutive sample of 119 ethnically diverse adolescents aged 12-18 years, attending a primary care clinic, who had a wellness examination in 2018 and documented vitamin D levels on the basis of previously collected blood work.Sixty-one percent of adolescents had low vitamin D levels. Vitamin D deficiency increased with age, independently of ethnicity or gender.A significant number of ethnically diverse adolescents presented with low vitamin D levels. A need exists to raise awareness among clinicians regarding social determinants of health and culturally sensitive dietary practices to improve vitamin D levels and prevent long-term complications, focusing on adolescent at-risk ethnic groups.

Objective: Users of publicly funded voluntary HIV Counseling and Testing Centers (VCT C) in the Portuguese National Service have been found to have higher rates of HIV risk behavior than the general population, but data concerning the relationship between socio-demographic, behavioral, and cognitive variables, and Sexually Transmitted Infections (ST Is) in this specific population are limited. This study tests the impact of socio-demographic, behavioral and cognitive variables on ST Is in a sample of 168 users of VCT C. Methods: A cross-sectional study using structured questionnaires was conducted. Results: Being older, being gay or bisexual, and having more barriers towards safer sex (e.g., negative attitudes toward safer sex behavior) were associated with increased odds of having had a ST I diagnosis. We found significant differences between heterosexual and gay men for number of sexual partners, frequency of anal sex, exchanging sex for money or drugs, history of ST Is, AIDS knowledge, and risk beliefs about the partner, with gay men showing higher rates. Conclusions: ST Is education should target older, gay or bisexual individuals, and focus on information as well as on changing barriers towards safer sex and associated health beliefs.

Aim The aim of this study was to describe the overall sleep quality, sleep patterns and severity of sleep difficulties among nursing faculty using the Pittsburgh Sleep Quality Index (PSQI). Design Cross‐sectional descriptive and correlational study. Methods A survey of faculty recruited from Texas Board of Nursing approved colleges/schools was used. A purposive, convenience sample of 105 faculty completed the PSQI, a reliable and valid instrument, in an online setting. Data was collected from January 2019 through April 2019. Results Nursing faculty reported sleep difficulty across all components, with more problems in sleep latency, sleep disturbances and subjective sleep quality. Overall, 70.5% of participants were reportedly “poor” sleepers, a salient finding. Faculty experienced poor sleep quality across all academic ranks and age groups. Sleep latency and subjective sleep quality were components that presented higher in severity for the youngest faculty.

Introduction: This study examined the efficacy of a brief inpatient psychoeducational intervention on knowledge about acute coronary syndromes (ACS), control of risk factors, and adaptive health habits and lifestyle. The intervention was intended to facilitate rehabilitation after ACS and its short- and medium-term impact was assessed. Methods: One hundred and twenty-one patients with ACS, admitted to a central cardiology unit in Portugal, were randomized to an experimental group (EG, n=65) or a control group (CG, n=56). We used the Portuguese versions of the Knowledge Questionnaire and the Health Habits Questionnaire. Patients were assessed at hospital admission, hospital discharge and one- and two-month follow-up. Results: The intervention had a significant impact, increasing knowledge about ACS (F=500.834; p=0.000) in the EG, which was maintained at two-month follow-up, and changing health habits at two-month follow-up (F=218.129; p=0.000). The CG demonstrated decreased knowledge (F=3.368; p=0.069) during the same period. Conclusions: A brief inpatient psychoeducational intervention has a positive effect on knowledge about ACS, risk factor control and promotion of positive health habits, and is effective in improving cardiac rehabilitation. Resumo: Introdução: Este trabalho avaliou a eficácia de um programa de intervenção psicológica breve, na fase I da reabilitação cardíaca pós-síndroma coronária aguda (SCA), nos conhecimentos da doença e tratamento, controlo de fatores de risco e hábitos de saúde e estilo de vida. A intervenção foi realizada com vista a facilitar a reabilitação pós-SCA, tendo-se avaliado o impacto da mesma a curto e a médio prazo. Material e métodos: Foram aleatorizados 121 doentes com SCA, admitidos na Unidade Coronária de um hospital central, num Grupo Experimental (GE, n = 65) e Grupo de Controlo (GC, n = 56). As versões portuguesas do Questionário de Conhecimentos acerca da Doença e Tratamento e do Questionário de Hábitos de Saúde avaliaram os conhecimentos acerca da doença e tratamento e os hábitos e estilo de vida. Os doentes foram avaliados na admissão e alta hospitalar bem como um e dois meses após a alta. Resultados: Verificamos um aumento significativo dos conhecimentos sobre a SCA (F = 500,834; p = 0,000) no GE, o qual se manteve aos dois meses. Os resultados revelaram ainda efeitos significativos da intervenção na alteração dos hábitos de saúde no GE aos dois meses (F = 218,129; p = 0,000). O GC evidenciou uma diminuição do nível de conhecimentos (F = 3.368; p = 0,069) no mesmo período. Conclusões: Uma intervenção psicoeducativa breve aplicada no momento da hospitalização tem um efeito positivo no aumento do conhecimento sobre a SCA, controlo de fatores de risco e promoção de hábitos de saúde positivos, sendo eficaz na melhoria da reabilitação cardíaca. Keywords: Acute coronary syndrome, Brief hospital-based psychosocial intervention, Health education, Palavras-chave: Síndroma coronária aguda, Intervenção psicológica breve, Educação para a saúde

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

This study compares the efficacy of 2 psychoeducational interventions—ACCENT skills-based and didactic information only—to prevent HIV among Portuguese women. At posttest and follow-up, participants in both intervention groups (n = 127) were more knowledgeable about HIV than at baseline. Although both intervention groups showed an increase in self-reported condom use over time, differences were marginally stronger in the ACCENT group. Both intervention groups showed more positive results than the non-intervention control group (n = 33). The study suggests that HIV prevention interventions can produce significant changes when they target a set of knowledge, social, and cognitive variables relevant to sexual behavior change.

Heterosexual encounters remain the primary route for HIV transmission in Africa. Safer sex behaviour is not adopted by many women due to several social and psychological factors. This paper aims to identify socio- demographic, marital and psychosocial predictors associated with current sexual activity and condom use in Mozambican women at sexual risk for HIV/AIDS. Women (173), patients at a public hospital and at risk for HIV infection, completed measures of condom use negotiation self-efficacy, perceived barriers against safer sex, current sexual activity and condom use. Having more than 6 years of education and being younger and single were significant predictors for current sexual activity and condom use. Regarding psychosocial factors, talking about AIDS with partners, condom use negotiation self-efficacy and fewer perceived barriers to safer sex were significant predictors for current sexual activity (intention to use and buy/get condoms). Condom use negotiation self-efficacy is a significant predictor for condom use. These results should be considered in new HIV prevention intervention design in Mozambique.Keywords: HIV prevention, Mozambique, sexual behaviours, women’s health

This study presents the adaptation and validation of a Portuguese version of the Work-Family Conflict and Family-Work Conflict scales for nurses. Participants were 310 female hospital-based nurses, from the northern region of Portugal. The assessment protocol included the Portuguese 10-item Work-Family Conflict and Family-Work Conflict scales to measure the mutual interference of the work and home domains. The Portuguese version resulted from a multi-step adaptation strategy, involving direct-translation, back-translation and a pre-test. Construct validity was assessed by exploratory principal components factor analysis and confirmatory analysis. The internal consistency reliability was calculated using Cronbach Alpha coefficients. The Cronbach Alpha coefficients for the Work-Family Conflict and Family-Work Conflict (0.91 and 0.85 respectively) indicate good reliability. The factor analysis produced two factors, explaining 69.3% of the variance, replicating the model proposed by the original authors. The confirmatory factor analysis showed a good model fit (NFI, TLI and CFI values >0.950). The RMSEA (

This study’s aim was to examine the impact of cooperative learner simulation order (LSO) on performance on a haptic intravenous (IV) simulator. Research has highlighted the value of cooperative learning in acquiring skills, but little is known about the processes that might contribute to outcomes. A convenience sample (N = 81) of students were randomized into LSO and then into IV teams. LSO reflected the sequencing pattern and who was to attempt the simulation first, second or third in their team. A randomized posttest only comparison group design was used to determine the impact of LSO on performance, operationalized as initial performance scores and number of attempts to earn a passing performance score. Linear mixed effects ANCOVAs were computed to determine the impact of LSO on performance outcomes, controlling for team size and prior experience. LSO was a significant factor in initial performance scores, explaining 21% of the variance. Past experience accounted for an additional 10% of variance in initial performance while team size explained 17% of variance in number of attempts. The impact of LSO, team size and past experience reflect team processes that relate to performance during learning and are important factors to consider when teaching in simulation.

Este estudo compara o ajustamento psicossocial a doenca em mulheres com cancro da mama submetidas a cirurgia de conservacao e mastectomia, prevendo diferencas entre os dois grupos. Procura ainda avaliar se ha diferencas no ajustamento ao longo de quatro momentos de avaliacao. A amostra foi constituida por 74 mulheres no estadio I-III da doenca submetidas a cirurgia. Todas as mulheres responderam a questionarios de baseline, antes da cirurgia, e foram seguidas longitudinalmente ate ao final dos tratamentos. As dimensoes do ajustamento psicossocial avaliadas foram o estado emocio - nal, as representacoes da doenca e a funcionalidade, nao se tendo verificado diferencas no ajustamento, para a grande maioria das variaveis psicossociais estudadas, em funcao do tipo de cirurgia. Contudo, encontramos diferencas significativas para as representacoes de doenca (compreensao da doenca) e para a funcionalidade (categoria lazer, sono e dimensao psicossocial), tendo os resultados sido mais favoraveis para as mulheres que realizaram uma mastectomia. Estes resultados sao inesperados uma vez que a cirurgia de conservacao pretende proporcionar um resultado cosmetico mais satisfatorio e com taxas de sobrevivencia equivalentes as da mastectomia, fazendo supor que se conseguiria obter um melhor ajustamento psicossocial. Os dados encontrados sugerem que o tipo de cirurgia nao parece predizer o ajustamento psicossocial. No entanto, considera-se que implicar as doentes na escolha do tipo de cirurgia, sempre que isso seja possivel, pode beneficiar uma compreensao mais ajustada acerca da doenca e do tratamento, com repercussoes mais favoraveis ao nivel emocional e da funcionalidade. The aim of this study was to examine psychosocial adjustment differences between breast cancer women who underwent a lumpectomy or mastectomy, predicting differences between the two groups. The participants were 74 Portuguese recently diagnosed breast cancer patients, recruited in the main Oncology Hospital of the North of Portugal. The study design is longitudinal with four-time points: before surgery (baseline); two weeks after surgery, during adjuvant treatments; and at the end of adjuvant treatment. The evaluated dimensions were emotional state, illness perception and illness functional limitations. We didn’t find differences for most of the variables, between the two groups. However, we find significant differences for comprehension (illness perception) and for leisure, sleep and psychosocial dimension (perceived functioning), with better adjustment for women who underwent mastectomy. These results are unexpected since conservation surgery aims to provide a more satisfying cosmetic outcome and survival rates equivalent to those of mastectomy, assuming a better psychosocial adjustment. The data suggest that the type of surgery doesn’t seem to predict the psychosocial adjustment. However, involving patients in choosing surgery type, whenever it is possible, can benefits a better understanding about the disease and the treatment, with more favourable repercussions on the emotional level and functionality. info:eu-repo/semantics/publishedVersion

Chronic postsurgical pain (CPSP) is a well-recognized potential complication with negative personal, social, and health care consequences. However, limited data exist on CPSP and on the course of pain over time after hysterectomy. Using data from a prospective cohort study on a consecutive sample assessed at 4 time points, presurgery (T1), 48 hours (T2), 4 months (T3), and 5 years postsurgery (T4), we sought to examine women's PSP trajectories using assessments of pain at T3 and T4. In addition, this study aimed to investigate presurgical and postsurgical risk factors associated with an unfavourable pain trajectory (PT). Based on pain data collected at T3 and T4, 3 distinct trajectories of PSP emerged: no CPSP (PT1; n = 88), prolonged PSP (PT2; n = 53), and CPSP (PT3; n = 29). Moreover, reported CPSP prevalence at 5 years was 17.1%. Multinomial logistic regression models controlling for age, presurgical pain, and type of hysterectomy tested for baseline and acute postsurgical predictive variables. Membership in PT2 and PT3 was predicted by presurgical anxiety (odds ratio [OR] = 1.131, P = 0.015; OR = 1.175, P = 0.009, respectively), emotional representation of the surgical disease (OR = 1.155, P = 0.034; OR = 1.213, P = 0.020, respectively), and pain catastrophizing (OR = 1.079, P = 0.043; OR = 1.143, P = 0.001, respectively). Furthermore, acute PSP intensity and frequency determined membership of women in PT3 (OR = 1.211, P = 0.033; OR = 3.000, P = 0.029, respectively), and postsurgical anxiety (OR = 1.182, P = 0.026) also played a key predictive role. This study identified factors that can be easily screened before and after surgery and are amenable to change through carefully designed timely and tailored interventions for women at risk of an unfavorable PSP trajectory posthysterectomy., This work was supported by 2 grants (SFRH/BD/36368/2007 and SFRH/BPD/103529/2014) from the Portuguese Foundation of Science and Technology, info:eu-repo/semantics/publishedVersion

Background: Young women make up most cases of HIV infection in Portugal (e.g., 26% in 2012), but their sexual behaviour, ability to recognize sexually transmitted disease (STD) risk in partners, and knowledge and practice of safe sex are underresearched. Methods: We studied these issues in a group of 177 women from Northern Portugal, together with their social, educational, and religious background. The women filled out several self-report questionnaires developed in the USA that have been adapted and validated for use in Portugal. They assess HIV knowledge, risk perception, and sexual risk behaviour. Results: We documented good knowledge about HIV transmission and prevention, although there are still some myths; 79.9% of the women knew that condoms prevent HIV transmission, but only 46% of them declared to use them regularly. Thus, knowledge does not imply adequate preventive behaviour. Women lacking higher education had poorer knowledge of HIV biology and of partner HIV risk. Despite being aware of HIV cases in their communities, most women deemed themselves at little risk, especially those lacking higher education, with many arguing that monogamy protects them, and, importantly, many preferring to ignore their partners’ current and past behaviour when assessing their exposure. Conclusion: These results point to important intervention targets for campaigns to curb STD infections among young women. RESUMO - Antecedentes: As mulheres jovens constituem a maioria das infeções por VIH em Portugal (por exemplo, 26% em 2012), mas o seu comportamento sexual, a capacidade de reconhecer o risco de IST em parceiros e o conhecimento e a prática de sexo seguro são pouco investigados. Métodos: Estudaram-se essas questões num grupo de 177 mulheres do Norte de Portugal, juntamente com seus antecedentes sociais, educacionais e religiosos. As mulheres em estudo preencheram vários questionários de auto relato desenvolvidos nos Estados Unidos da América e que foram adaptados e validados para uso em Portugal. Foi avaliado o conhecimento sobre o VIH, a perceção de risco e o comportamento sexual de risco. Resultados: Documentaram- se bons conhecimentos sobre a transmissão e a prevenção do VIH, embora haja alguns mitos; 79,9% das mulheres sabem que os preservativos impedem a transmissão do VIH, mas apenas 46% declara usá-los regularmente. O conhecimento não implica o comportamento preventivo adequado. As mulheres que não possuíam escolaridade de nível superior tinham um conhecimento mais pobre no que se refere à biologia do VIH e ao risco de VIH no parceiro. Apesar de estarem cientes dos casos de VIH em suas comunidades, a maioria das mulheres considerou-se com pouco risco, especialmente aquelas que não possuem ensino superior, argumentando que a monogamia as protege e, principalmente, muitas preferem ignorar o comportamento atual e passado de seus parceiros ao avaliar a sua exposição. Conclusão: Os resultados identificam importantes alvos de intervenção para as campanhas de prevenção de ISTs na população feminina. info:eu-repo/semantics/publishedVersion

O vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida (VIH/Sida) e uma das principais ameaças à vida humana, sendo que a vulnerabilidade da mulher é incontestável, principalmente em contextos desfavorecidos. Na África subsaariana as mulheres são as mais afetadas pelo VIH/Sida, numa proporção de infeção 4 vezes maior do que nos homens. Assim, é necessário aumentar o conhecimento dos fatores psicossociais e sociocognitivos ligados ao género, cultura e biologia que colocam a mulher em maior risco para o VIH/Sida. A literatura sugere que fatores como a vitimização, características da relação, problemas de saúde mental, história de cárcere e prostituição, nível de conhecimentos sobre a doença, crenças e competências relacionadas com a prática do sexo seguro, e a autoeficácia exercem influência sobre os comportamentos sexuais de risco para a infeção pelo VIH. A compreensão e análise destes fatores são essenciais no planeamento de estratégias interventivas mais realistas. O presente artigo apresenta uma revisão da literatura acerca dos fatores psicossociais e sociocognitivos que vulnerabilizam a mulher para o VIH/Sida, particularmente a mulher africana. São também levantadas questões de investigação que decorrem da análise da literatura neste domínio., HIV/AIDS is a major threat to human life and the vulnerability of women is undeniable, especially in disadvantaged settings. In sub-Saharan Africa, women are the most affected by HIV/AIDS, in a proportion of infection four times higher than men. Therefore, it is of the utmost importance to increase knowledge of which psychosocial and socio-cognitive factors may be related to gender, culture and biology thus placing women at greater risk for HIV/AIDS. The literature suggests that factors such as victimization, characteristics of the relationship, mental health problems, history of prison and prostitution; knowledge about HIV, beliefs and skills related to safe sex practices, and self-efficacy influence sexual risk behaviors linked to HIV infection. Examining these factors is essential to plan more realistic intervention strategies. This paper presents a literature review on the psychosocial and socio-cognitive factors that contribute to women's vulnerability to HIV/AIDS, particularly African women. The paper also addresses research questions that stem from the review of the literature in this field.

RESUMO - Este artigo descreve as propriedades psicométricas do Questionário dos Conhecimentos da Diabetes (QCD), desenvolvido por Sousa e McIntyre (2003) e que visa avaliar os conhecimentos que pessoas diagnosticadas com diabetes possuem sobre a sua doença e tratamento. O QCD tem como referencial teórico o modelo de autorregulação de Leventhal. O questionário foi aplicado a 249 indivíduos inscritos em centros de saúde do distrito do Porto, com diabetes mellitus tipo 2 diagnosticada há mais de 12 meses. Com a finalidade de determinar a fidelidade teste-reteste avaliou-se uma subamostra de 123 pessoas num segundo momento, com um intervalo de 30 dias. Os participantes possuíam uma idade 40 anos, eram maioritariamente do sexo feminino e encontravam-se não ativos profissionalmente. A versão final do QCD consiste em 20 questões agrupadas em 3 dimensões (Tratamento, controlo e complicações, Causas e Duração). Os resultados indicam que o QCD é fiável e válido para a população em estudo. ABSTRACT - This paper describes the psychometric properties of the Knowledge about Diabetes Questionnaire (QCD) developed by Sousa and McIntyre (2003) on the basis of the self-regulation model of Leventhal and colleagues. Its purpose is to assess the knowledge that diabetics have about their disease and treatment. The questionnaire was administered to 249 patients diagnosed with Type 2 Diabetes Mellitus for more than 12 months, enrolled in health centers in the Oporto district. In order to determine test-retest reliability, a second administration was conducted 30 days later in a subgroup of 123 patients. Participants were 40 years old, were mostly female and weren’t professionally active. The final version of the QCD consists of 20 items distributed by three dimensions (Treatment, control and complications, Causes and Duration). The results show that the QCD is reliable and valid in the population under study. info:eu-repo/semantics/publishedVersion

In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection. Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex. The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy. These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.

This chapter addresses two recent trends in the conceptualization of work stress: recognizing the temporal dynamics of work stress and combining existing theoretical models to increase predictive power and broaden understanding. The chapter illustrates these developments in educator stress research by presenting the results of testing a Dynamic Integrative Teacher Stress (DITS) model. The DITS model combines elements of the Job Demand-Control-Support, Effort-Reward Imbalance and Kyriacou’s models (coping resources) while accounting for the dynamic nature of work stress (temporal changes), personal and contextual factors. It is based on a real-time longitudinal study of teacher stress over two academic years. The study examines whether the model’s predicted independent and moderator effects on teacher strain are confirmed using Ecological Momentary Assessment (EMA) measures, testing effects at the between- and within-person levels. Longitudinal data generated using EMA via the Teacher Stress Diary over 2 years, supports the unique value of the model’s key concepts to predict teachers’ emotional stress responses (negative affect). Higher demand and over-commitment, and lower control, coping and reward, predicted higher emotional strain. The DITS model explained considerable unique variance in emotional strain and, as expected, the integrative model explained more variance than each component alone, suggesting that combined models may be a useful framework for future research and theory development. The model explained both between- and within-person changes in emotional strain. These results provide a more comprehensive and dynamic understanding of occupational stress in teachers than traditional survey studies, potentially benefitting intervention development to reduce teacher stress and promote educator and school sustainability.

This final chapter reviews the implications of applying an occupational health perspective to research, practice and policy on educator stress. It argues for the need to bring educator stress to the forefront of education research and practice in terms of explanatory models, research methodology, and intervention strategies. Applying models and methods of occupational health psychology to addressing the negative individual and organizational consequences of educator stress is one such avenue. The chapter outlines important areas for research that have the potential to expand knowledge and inform interventions directed at supporting quality teaching and student learning. The relation between educator stress and performance has seen fewer studies, especially in its relation to teaching effectiveness. The topic of school violence has merited public attention and policy development, although educator stress processes have not been included in the research or intervention efforts to address this important issue. An occupational health perspective emphasizes the importance of a systemic and preventive view of work stress, and thus expanding the research agenda to consider stress in school systems would greatly benefit comprehensive intervention and policy efforts. Expanding educator stress research and intervention with school leadership could better inform administrative practices with positive implications for the whole school organization. Knowledge on educator stress also draws implications for training and development of school leaders and teachers, bringing well-being to the center of improving schools and transforming them into healthy organizations.

Research on educator stress and its effects on health outcomes faces numerous methodological challenges that affect the design, execution and analysis of scientific investigations. The chapter begins with an overview of the statistical challenges associated with multilevel field studies, which are ubiquitous in research on educator stress. Secondly, we will examine the specific challenges posed by time in the study of stress and the various methods and models used to capture the many roles of time in stress research, including individualized developmental and dynamic models, and ecological momentary assessment (EMA). Finally, we conclude with an examination of the special challenges that arise in the study of event occurrence in multilevel settings, such as leaving the workforce, changing employers, or experiencing a medical incident. These challenges stem from the complex nature of the construct of stress, the time frame over which stress exerts its influences on behavior, health and emotional well-being the many levels at which occupational settings create and mitigate stress, and the many levels at which individuals experience stress and demonstrate its influence on health and work outcomes. The chapter provides an overview of some of the more salient methodological, measurement, and analysis related issues that affect the work reported on in this volume. Our goal is to provide the reader with a firm understanding of the more complex methods and analyses relevant to the study of educator stress in an effort to strengthen the readers’ ability to benefit from the science presented throughout the volume.

Background: Acute pain is an expected result after surgery. Nevertheless, when not appropriately controlled, acute pain has a very negative impact on individual clinical outcomes, impairing healing and recovery, and has clear consequences on health care system costs. Augmenting knowledge on predictors and potentially modifiable determinants of acute postsurgical pain can facilitate early identification of and intervention in patients at risk. However, only a few studies have examined and compared acute pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study was to compare THA and TKA in acute postsurgical pain intensity and its predictors. Methods: A consecutive sample of 124 patients with osteoarthritis (64 undergoing THA and 60 TKA) was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1, and acute postsurgical pain experience was examined at T2. Additionally, the same hierarchical regression analysis was performed separately for each arthroplasty type. Results: TKA patients reported higher levels of acute postsurgical pain compared with THA (t=8.490, p=0.004, d=0.527, 95% confidence interval, 0.196-0.878). In the final THA predictive model, presurgical pain was the only variable approaching significant results (t[57]=1.746, beta=0.254, p=0.086). In the final TKA predictive model, optimism was the only predictor of pain (t[51]=-2.518, beta=-0.339, p=0.015), with emotional representation ( t[51]=1.895, beta=0.254, p=0.064) presenting a trend toward significance. Conclusion: The current study is the first examining THA and TKA differences on acute postsurgical pain intensity and its predictors using a multivariate approach. Results from this study could prove useful for the design of distinct interventions targeting acute postsurgical pain management depending on whether the site of arthroplasty is the hip or the knee. Finally, the current results also support the argument that these two surgeries, at least with regard to acute pain, should be approached separately., This work was supported by two grants (SFRH/BD/36368/2007 and SFRH/BPD/103529/2014) from the Portuguese Foundation of Science and Technology, info:eu-repo/semantics/publishedVersion

Introduction: Acute coronary syndrome (ACS) is an important cause of mortality and significant personal and financial costs. Cardiac rehabilitation (CR) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity. However, adherence is low and appears to be influenced by psychosocial factors, such as patients’ cognitions and emotional state. The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS. Methods: One hundred and twenty-one patients with ACS, admitted to a coronary care unit in a central hospital, were randomized to an experimental group (EG, n=65) and a control group (CG, n=56). Portuguese versions of the HADS and BIPQ were used to measure emotional well-being and illness cognitions. Two 1 h 15 min sessions were conducted 2-3 days after hospital admission, and a 20-minute follow-up session took place one month after discharge. Patients were assessed at four different time points: pre-test, post-test, and at 1- and 2-month follow-up. Results: The intervention had significant effects on anxiety, depression and illness cognitions. Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group. For the EG, these changes were maintained or enhanced at 1- and 2-month follow-up, whereas for the CG there was a deterioration in psychosocial adjustment. Conclusions: These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with standard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis. Resumo: Introdução: A síndroma coronária aguda (SCA) é uma importante causa de mortalidade, com custos pessoais e financeiros consideráveis. Os programas de reabilitação cardíaca têm benefícios na redução da mortalidade e melhoria da capacidade funcional. Contudo, a adesão é baixa e depende de fatores como o estado emocional e as representações de doença. Neste trabalho, avaliou-se a eficácia de um programa de intervenção psicológica breve na fase I da reabilitação cardíaca da SCA. Material e métodos: Cento e vinte e um doentes com SCA, admitidos na unidade coronária de um hospital central, foram aleatorizados num grupo experimental (GE) (n= 65) e num grupo de controlo (GC) (n=56). Foram utilizadas versões portuguesas da HADS e IPQ-B para avaliar a adaptação emocional e as representações de doença. Foram efetuadas duas sessões de 1 h15 min, 2-3 dias após a admissão hospitalar, e uma avaliação de follow-up um mês após a alta hospitalar de 20 min. Os doentes foram avaliados em quatro momentos: pré-teste, pós-teste, um e dois meses follow-up. Resultados: Os resultados demonstraram um efeito positivo e significativo da intervenção. A ansiedade e depressão evidenciaram uma redução significativa e as representações de doença melhoraram significativamente no GE, comparativamente ao GC. No GE estas alterações mantiveram-se ou aumentaram no follow-up de um e dois meses, enquanto no GC houve uma deterioração no ajustamento psicológico. Conclusões: A intervenção psicológica breve durante a hospitalização por SCA, aliada ao tratamento médico convencional, pode ter efeitos positivos em termos de adaptação psicossocial, cujo impacto está amplamente demonstrado na reabilitação cardíaca e no prognóstico clínico. Keywords: Acute coronary syndrome, Hospital-based psychosocial intervention, Cardiac rehabilitation, Anxiety, Depression, Illness cognitions, Palavras-chave: Síndroma coronária aguda, Intervenção psicológica breve, Reabilitação cardíaca, Ansiedade, Depressão, Representações de doença

This work was supported by a grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology.

Special issue: “Resiliance and Health” : 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st-25th August 2012

The aim of this study was to examine the joint role of demographic, clinical, and psychological variables 30 as predictors of acute postsurgical pain in women undergoing hysterectomy due to benign disorders. A 31 consecutive sample of 203 women was assessed 24 hours before (T1) and 48 hours after (T2) surgery. 32 Baseline pain and predictors were assessed at T1 and postsurgical pain and analgesic consumption at 33 T2. Several factors distinguished women who had no or mild pain after surgery from those who had mod- 34 erate to severe pain, with the latter being younger, having more presurgical pain, and showing a less 35 favorable psychological profile. Younger age (odds ratio [OR] = 0.90, P < .001), presurgical pain 36 (OR = 2.50, P, Fundação para a Ciência e a Tecnologia (FCT), The authors gratefully acknowledge the contributions of Falko Sniehotta, PhD, and Justin Presseau, PhD, for suggestions. The authors also thank all of the women who agreed to participate in this study.

The relationship between war exposure and PTSD has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure, psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes., The authors wish to thank the Fundação para a Ciência e Tecnologia, grant POCTI (POCTI/ESP/39515/2000), for financing this project. The authors are also grateful for the collaboration of the Associação Portuguesa de Veteranos de Guerra and their aid with the data collection.

This paper presents the psychometric properties of the job descriptive index (JDI) and job in general (JIG) instruments in a Portuguese sample of health professionals from hospitals and health centers. Demographic and professional correlates of job satisfaction are also investigated. The sample consists of 1,314 health professionals including physicians, nurses, administrators, and diagnostic technicians. The results show high internal consistency coefficients for the scores on the JDI subscales and the JIG scale, ranging from .75 to .90. The data supported the 5-factor structure of the JDI scales. The factor analyses and the correlation coefficients did not support the distinction between an overall job satisfaction measure and the evaluation of the satisfaction with the present work. The results offer empirical support for the Portuguese adaptation of the JDI and JIG scales. Level of education emerged as the most important demographic correlate of job satisfaction facets and global satisfaction, and supervisory role as the most significant professional correlate.

This article reports the development and exploratory testing of a school-based intervention programme designed to enhance levels of physical activity in adolescents. The intervention is based on social cognitive theory (SCT), self-regulation theory (SRT) and planning as evidence-based mediators of physical activity changes. Two classes, paired on socio-economic variables, were selected from each of eight Portuguese schools and randomly assigned to an intervention or control group (N = 291). Primary outcome was 'moderate to vigorous physical activity' (International Physical Activity Questionnaire) measured pre and post intervention and at three and nine months follow-up. SCT, SRT and planning variables were secondary outcomes measured pre and post intervention. At post test, participants in the intervention group reported 18 min per week more physical activity (PA), adjusted for pre-intervention, age and sex, than those in the control group (95% confidence interval -10 to 46; p = 0.249). This difference increased to 33 min (95% CI-4 to 71; p = 0.082) at three months and to 57 min (95% CI 13 to 101, p = 0.008) at nine month follow-up. Moreover, the intervention resulted in changes of some of the theoretical target variables, including outcome expectancies and coping planning. However, no evidence was found for the changes in theoretical moderators to mediate the intervention effects on behaviour. Implications for theory and for future research are discussed.

Objective: To describe the knowledge of the diabetic patient about his/her disease, the treatment and the impact on the therapeutic adherence. Methods: A qualitative cross-sectional study, with an observational and correlational design, carried out with a convenient sample population of 133 type 2 diabetic patients assisted at a Health Care Centre of Great Porto, Portugal. The hypothesis estimated that there would be a direct relationship between the knowledge about the disease and the adherence to treatment. Results: The diabetic patients presented good knowledge about their illness. The dimension in which they showed greater knowledge was that of “treatment” (M = 0.81). Regarding the dimensions “identity” and “causes”, the patients showed less knowledge (M = 0.51 and M = 0.54, respectively). The results partially confirmed the hypothesis. Although the results indicate that the knowledge and non-knowledge about diabetes are significantly correlated with some behaviors of self care (like the adherence to physical exercise and to glucose test), the hierarchical regression showed that knowledge is the only predictor in behaviours of adherence to glucose testing (sr = 0.31, p = 0.026). Regarding the effect of gender and age, the findings suggest that women show higher non-knowledge about diabetes and the elderly adhere more to diet counselling. Conclusions: Health care professionals should be alert to those areas of knowledge where the diabetic patients showed to be less informed, as well as to some socio-demographic factors such as gender and age, for they may influence in the adherence to different components oftreatment.

This paper aims to test the direct predictors of the theory of planned behaviour (TPB), action planning and coping planning as predictors of changes in physical activity (PA) in 157 adolescents (mean age: 12). TPB measures, the Action Planning and Coping Planning Scales (APCPS) and the International Physical Activity Questionnaires were measured at baseline, 2- and 5-month follow-up. Hierarchical regression analyses were conducted regressing PA at Time 2 or Time 3 onto TPB and APCPS at baseline or Time 2, respectively. Past behaviour accounted for a significant 25-51% of the variance in PA in Step 1 of all three analyses. In Step 2, TPB accounted for an additional 3-10% with intention as a significant predictor. While no main effects for action planning or coping planning (Step 3) were found, all three analyses resulted in a significant amount of incremental variance accounted for by the interaction of action planning and coping planning (Step 4). Results suggest that the combination of high levels of action planning and coping planning is associated with increases in PA. Implications for theory of behaviour change in adolescents are discussed.

Objective: To describe the knowledge of the diabetic patient about his/her disease, the treatment and the impact on the therapeutic adherence. Methods: A qua...

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After surgery, patient reports or health care professional evaluations of heightened acute pain intensity should lead to extra analgesia provision, which is designated by rescue analgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient but rather on clinical decisions, which should be based on pain management guidelines. There is a general lack of studies focusing on pain-related decision-making regarding RA provision.This study aimed to examine which pre and post-surgical factors, beyond acute post-surgical pain intensity, might influence clinical decisions on RA administration after major joint arthroplasties (MJA).A consecutive sample of 110 patients undergoing MJA was fully assessed 24 hours before (T1) and 48 hours after (T2) surgery. Before surgery, baseline demographic, clinical, and psychological variables were evaluated and after surgery the main outcome was RA provision, with acute post-surgical pain intensity being also registered.Prospective observational cohort study.Central hospital in northern Portugal.Logistic regression analysis revealed that RA provision, after MJA, is influenced by a patient-related psychological factor, pain catastrophizing (OR = 1.143; 95% CI 1.044 - 1.253, P = 0.004), above and beyond acute post-surgical pain intensity. Additionally, the type of arthroplasty (OR = 2.806; 95% CI 1.002 - 7.857, P = 0.050) also affected RA provision. Other patient-related factors such as gender, previous pain states, pre-surgical optimism, and post-surgical anxiety did not reveal any predictive role in RA administration.This is a single-site study, only confined to MJA patients.The findings of this study shed light on the importance of psychological factors in determining RA provision following MJA. This encourages further reflection on acute post-surgical pain management by health care providers, namely by raising clinicians' awareness about the factors that influence patient-provider interactions, as well as their impact on decision-making regarding RA provision. A global assessment of patients, wherein psychological variables are taken into account, is warranted in order to improve the quality of surgical pain management. Finally, these findings provide support for the design of acute post-surgical pain management interventions directed at clinicians, in order to augment professionals' awareness about the potential influence of patient-related psychological factors on RA decisions.

Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4-6 months (T3) after surgery. Hierarchical logistic regression analyses were performed to identify predictors of moderate and severe levels of PPSP. Four to six months after TKA and THA, 54 patients (58.7%) reported none or mild pain (Numerical Rating Scale: NRS 3). In the final multivariate hierarchical logistic regression analyses, illness representations concerning the condition leading to surgery (osteoarthritis), such as a chronic timeline perception of the disease, emerged as a significant predictor of PPSP. Additionally, post-surgical anxiety also showed a predictive role in the development of PPSP. Pre-surgical pain was the most significant clinical predictive factor and, as expected, undergoing TKA was associated with greater odds of PPSP development than THA. The findings on PPSP predictors after major joint arthroplasties can guide clinical practice in terms of considering cognitive and emotional factors, together with clinical factors, in planning acute pain management before and after surgery., This work was supported by a Project grant (PTDC/SAU-NEU/108557/2008) and by a PhD grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology, COMPETE and FEDER. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

This chapter addresses the history of health psychology, examining its intellectual roots as well as its formalization as a field of inquiry and practice in the United States and internationally. Attention is paid to the development of journals, organizations, credentialing, and education and training opportunities throughout the world. Keywords: health psychology; clinical health psychology; behavioral medicine; medical psychology; behavioral health

This study aims to examine the joint role of demographic, clinical, and psychological variables as predictors of acute postsurgical pain and anxiety in patients undergoing total knee arthroplasty and total hip arthroplasty. A consecutive sample of 124 patients was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1 and several postsurgical pain issues, anxiety, and analgesic consumption were evaluated at T2. Hierarchical linear regression analyses were performed to identify predictors of acute pain and anxiety following surgery. In the final multivariate model, presurgical optimism emerged as the main significant predictor of postsurgical pain intensity. Presurgical optimism also had a significant role in the prediction of postsurgical anxiety, together with presurgical anxiety level and emotional representation of the condition leading to surgery (osteoarthritis). A significant positive correlation between postsurgical anxiety and acute pain was also confirmed. The present study enhances our understanding of predictors of acute pain and anxiety following total knee arthroplasty and total hip arthroplasty by showing the relevance of psychological factors, over and above other potential clinical predictors. These findings could be used to develop targeted interventions aimed at acute postsurgical pain and anxiety management following major joint arthroplasties., This work was supported by a Project grant (PTDC/SAU-NEU/108557/2008) and by a PhD grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology, COMPETE and FEDER.

Objective: To describe the knowledge of the diabetic patient about his/her disease, the treatment and the impact on the therapeutic adherence. Methods: A qualitative cross-sectional study, with an observational and correlational design, carried out with a convenient sample population of 133 type 2 diabetic patients assisted at a Health Care Centre of Great Porto, Portugal. The hypothesis estimated that there would be a direct relationship between the knowledge about the disease and the adherence to treatment. Results: The diabetic patients presented good knowledge about their illness. The dimension in which they showed greater knowledge was that of “treatment” (M = 0.81). Regarding the dimensions “identity” and “causes”, the patients showed less knowledge (M = 0.51 and M = 0.54, respectively). The results partially confirmed the hypothesis. Although the results indicate that the knowledge and non-knowledge about diabetes are significantly correlated with some behaviors of self care (like the adherence to physical exercise and to glucose test), the hierarchical regression showed that knowledge is the only predictor in behaviours of adherence to glucose testing (sr = 0.31, p = 0.026). Regarding the effect of gender and age, the findings suggest that women show higher non-knowledge about diabetes and the elderly adhere more to diet counselling. Conclusions: Health care professionals should be alert to those areas of knowledge where the diabetic patients showed to be less informed, as well as to some socio-demographic factors such as gender and age, for they may influence in the adherence to different components of treatment. Objetivo: Descrever o conhecimento do paciente diabético sobre a doença, o tratamento e a repercussão na adesão. Métodos: Estudo quantitativo tipo transversal, observacional, correlacional, desenvolvido com uma população amostral por conveniência de 133 diabéticos assitidos em um Centro de Saúde na Zona do Grande Porto, Portugal. A hipótese previa que haveria uma relação direta entre o conhecimento acerca da doença e a adesão ao tratamento. Resultados: Os diabéticos apresentaram bons conhecimentos sobre a sua doença. Verificou-se que a dimensão na qual estes evidenciaram maiores conhecimentos foi a referente ao “tratamento” (M=0,81). Quanto às dimensões “identidade” e “causas”, os diabéticos apresentaram menos conhecimentos (M=0,51 e M=0,54, respectivamente). A hipótese foi comprovada parcialmente. Embora os resultados indiquem que os conhecimentos e desconhecimentos acerca da diabetes se correlacionam significativamente com alguns comportamentos de auto cuidado, como a adesão ao exercício físico e o teste da glicose, a regressão hierárquica mostrou que somente o conhecimento é preditor nos comportamentos de adesão ao teste à glicose (sr = 0,31; p = 0,026). Quanto ao efeito do sexo e da idade, verificou-se que as mulheres demonstram maior desconhecimento acerca da diabetes e que as pessoas mais idosas aderem mais à alimentação aconselhada. Conclusões: Os profissionais de saúde deverão estar atentos às áreas do conhecimento em que o diabético apresentou ser menos informado, bem como a alguns fatores sócio-demográficos como o sexo e a idade, pois estes poderão influenciar a adesão aos diferentes componentes do tratamento.

Persistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical and psychological risk factors in the development of persistent postsurgical pain (PPSP) after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before (T1), 48 hours (T2), and 4 months (T3) after surgery. Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (NRS >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals towards specific intervention targets such as anxiety (pre- and postsurgical), pain catastrophizing, emotional representations, and acute pain control after surgery., We declare that none of the authors have any financial or other relationships that might lead to a conflict of interest. This work was supported by a grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology.

O Inventário de Fontes de Estresse Acadêmico no Curso de Medicina (IFSAM) foi desenvolvido para caracterizar as principais fontes de estresse acadêmico dos estudantes da Faculdade de Medicina da Universidade do Porto (FMUP) e a intensidade com que são experienciadas. O inventário (31 itens) foi construído por meio de entrevistas semiestruturadas a estudantes (n = 80) dos seis anos da licenciatura. Suas propriedades psicométricas foram testadas num estudo com 251 estudantes dos seis anos do curso (160 do sexo feminino e 91 do sexo masculino). A validade de constructo foi avaliada mediante análise fatorial que resultou numa solução de cinco fatores ("exigências do curso", "exigências humanas", "estilos de vida", "competição" e "adaptação") com 54,8% da variância explicada e boa representatividade do constructo. O IFSAM total evidencia ainda uma boa fidelidade, com um coeficiente de consistência interna de.88. Os resultados revelam que o IFSAM apresenta boas características psicométricas na amostra, podendo constituir um instrumento útil na avaliação das fontes e intensidade de estresse acadêmico do curso de Medicina noutras instituições. The Inventory of Academic Sources of Stress in Medical Education (IASSME) was developed to characterize the main sources of academic stress for students at the School of Medicine, University of Porto (FMUP), as well as the intensity with which they experience such stress. The 31-item inventory resulted from semi-structured interviews with students (n = 80) from all six years of medical school. The inventory's psychometric properties were tested on 251 students from the six years (160 females and 91 males). Construct validity was assessed by means of factor analysis, resulting in a five-factor solution ("course demands", "human demands", "lifestyle", "academic competition", and "academic adjustment"), with a total of 54.8% of the total variance explained as well as good representation of the construct. The total inventory showed good reliability and internal consistency of 0.88. Based on the findings, the IASSME displayed good psychometric characteristics in this sample and can be a useful instrument for assessing sources of academic stress and their intensity in other medical schools.

Different studies have demonstrated that there are significant changes in the health and habits/life-style of university students, and it seems that Medical students also reveal a significant vulnerability to the adoption of health risk behaviours. The present study aims to (1) characterize the main sources of academic stress of the Medical School students of the University of Porto as well as the intensity with which they are experienced, (2) investigate the variations in academic stress and psychosocial variables, due to gender, year of course and displacement from home and (3) contribute, for the first time, to the understanding of stress and life-style of medical students in Portugal. The empirical study included a sample of 251 students from all 6 years of the course (160 females and 91 males), evaluated by the following instruments: (1) The Inventory of Sources of Academic Stress in Medical Education (ISASME), and the Portuguese versions of (2) the Brief Personal Survey (BPS), (3) the General Health Questionnaire 12 (GHQ-12), and (4) the Interpersonal Behaviour Survey-Brief (ICIBrief). In terms of overall levels of stress (GHQ-12), a prevalence of 58.2% of clinically significant stress symptoms was found, with the students from the basic cycle and those who are living away from home, presenting higher levels of stress. In terms of life-style, 47% of the students revealed health risk behaviours, with eating habits, physical exercise, alcohol and drug consumption, and body image being the main problem areas. Gender and year of course seem to have a significant influence on the variables studied, being the female students those who present higher levels of academic stress, stress responses (pressure/overload, physical distress, anxiety, anger/frustration, inefficiency, depression and loss of control), and low levels of coping confidence; the students of the basic cycle reveal higher levels of stress in managing their life-style (academic stress), general stress symptoms and stress responses. This study calls attention for the need of preventive intervention with medical students in order to prevent negative consequences of stress and improve their life-style by promoting individual and social resources.