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- Contributions for the validation of the European Portuguese version of the vascular quality of life-6 questionnaire for Peripheral Artery diseasePublication . Oliveira, Rafaela; Pedras, Susana; Pimenta, Rui; Silva, IvonePeripheral arterial disease (PAD) is an occlusive atherosclerotic disease of the arteries of the extremities of the body that affects more than 230 million people worldwide. The most common symptom is intermittent claudication, described as leg pain which occurs mainly while walking. The symptoms impair the ambulation and functional capacity of patients, leading to loss of mobility, disease deterioration, increased risk of other cardiovascu-lar diseases, and lower quality of life (QoL). Therefore, the aim of this study was to perform a cross-cultural adaptation and validation of the VascuQol-6 questionnaire for the Portuguese population to obtain a quick, sensitive, and easy-to-use way to assess the QoL of Portuguese patients diagnosed with PAD. The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) was adapted and translated into European Portuguese using standard validation methodology, including 115 patients with a mean age of 64.67 (7.23) years, with PAD with IC stable for more than three months; and ABI < 0.9 at rest. VascuQoL-6, SF-36, International Physical Activity Questionnaire (IPAQ), and the PAD Knowledge Questionnaire (PADKQ) were used. Reliability, con-struct validity analysis through convergent and discriminant validity, known-group validity, and responsiveness analysis were tested. The Cronbach’s alpha was 0.64 and the average inter-item correlation was 0.27, indicating acceptable internal consistency. VascuQoL-6 was positively associated with SF-36 Physical Component Summary and Mental Component Summary scores (r = 0.64, p < 0.01 and r = 0.42, p < 0.01, re-spectively). In turn, there was no significant correlation between VascuQoL-6 scores and the PADKQ or IPAQ. A statistically significant difference between groups according to IC severity [F(2.47) = 8.35, p < 0.001] was found. A paired samples t-test showed differences between VascuQol-6 scores before a walking program (M = 15.65, SD = 3.09), and after a walking program (M = 17.41, SD = 2.71), t(67) = 3.94, p ≤ 0.001. The VascuQoL-6 is a six-item instrument to assess the QoL associated with PAD with good psychometric properties, convergent and dis-criminant validity with SF-36, PADKQ and IPAQ. The instrument proved to have known group validity and responsiveness.
- Beer with probiotics: Benefits and challenges of their incorporationPublication . Santos, Diana; Barreiros, Luisa; Jesus, Ângelo; Silva, Ana Luísa; Martins, João Paulo; Oliveira, Ana Isabel; Pinho, Cláudia; Jesus, Ângelo; Oliveira, Ana Isabel; Barreiros, LuisaBeer is considered one of the most consumed beverages worldwide and a potential vehicle for probiotics. However, there are several technical challenges to overcome during the production and storage of beers, as probiotics must remain viable until the moment of consumption. Therefore, this work aims to discuss how the incorporation of probiotics improves or adds value to beer and which variables influence the viability of the process. This is a narrative review of the literature with research in the PubMed, Web of Science, and b-on databases for articles related to the incorporation of probiotics in beer and the variables that influence the process. The results demonstrated that the incorporation of probiotics into beer faces technical challenges such as probiotic selection, pH, the presence of alcohol, and beer’s production and storage temperatures. However, strategies such as immobilizing probiotics in alginate, alginate–silica, and durian husk powder, fermentation with the yeast Saccharomyces cerevisiae var. boulardii, and co-fermentation with probiotics permit us to overcome these barriers. Thus, incorporating probiotics into beer brings added value, potentially increasing antioxidant activity and phenolic compound content and providing unique flavors and aromas. Nevertheless, strict control of the technical conditions involved is necessary to ensure probiotic viability and the health benefits they confer.
- Estatística espacial aplicada aos estudos de incidência de câncerPublication . Friestino, Jane Kelly Oliveira; Mendonça, Denisa; Oliveira, Pedro; Oliveira, Carla M.; Ferraz, Rosemeire de Olanda; Filho, Djalma de Carvalho Moreira; Oliveira, Carla MariaO Sistema de Informação Geográfica (SIG) como ferramenta em estudos epidemiológicos tem se tornado algo frequente na área da Saúde Coletiva. Em estudos sobre incidência de câncer, o uso da análise espacial ainda é incipiente no país, entretanto possuí grande potencial para auxílio nos modelos de planejamento em saúde. O objetivo deste trabalho é apresentar um método empírico de análise de padrões espaciais para os casos de incidência de cânceres considerados raros que acometem a população com idades entre 0 e 19 anos, discutindo a aplicabilidade da estatística espacial e as possíveis utilizações da interpretação da disposição espacial dos eventos. Utilizou-se o SIG para georreferenciar as taxas de incidências de casos de cânceres de alguns grupos da Classificação Internacional de Câncer Infantil (CICI), ajustadas por idade e sexo, segundo os Centros de Saúde de suas residências. Foram estimadas as razões padronizadas de incidência (Standardized Morbidity Ratio-SMR). Para controlar a instabilidade das taxas devido ao pequeno número de casos, foi feita uma suavização pelo método Empirical Bayes. Comparando as taxas anuais, suavizadas pelo referido método Bayesiano, constatou-se diferenças entre elas quanto à distribuição espacial, com concentração destas nas regiões Sudoeste e Noroeste do município de Campinas. Conclui-se que o uso de estatística espacial como ferramenta de apoio à decisão, permite identificar a distribuição de casos de cânceres do grupo da CICI, contribuindo para o planejamento em saúde.
- Sleep quality of heavy vhicles’ professional drivers: an analysis based on self-perceived feedbackPublication . Faria, Brígida Mónica; Lopes, Tatiana; Oliveira, Alexandra; Pimenta, Rui; Gonçalves, Joaquim; Carvalho, Victor; Faria, Brigida Monica; Pimenta, Rui; Oliveira, AlexandraSleep is a crucial biological need for all individuals, being reparative on a physical and mental level. Driving heavy vehicles is a task that requires constant attention and vigilance, and sleep deprivation leads to behavioral and physiological changes that can develop sleep disorders which can put lives at risk The main objectives of this study are to describe and evaluate sleep quality, excessive daytime sleepiness, circadian preference, and risk of suffering from obstructive sleep apnea in a population of Portuguese professional drivers. To fulfill the objectives, 43 Portuguese professional drivers, between 23 and 63 years old, answered validated questionnaires: Epworth Sleepiness Scale, Morningness–Eveningness, Stop-Bang Questionnaire, and Pittsburgh Sleep Quality Index. Results indicated that older drivers tend to experience higher daytime sleepiness (11 ± 3.4; p = 0.002) and obstructive sleep apnea risk (4.5 ± 1.5; p = 0.03). Regarding sleep quality, the majority of drivers were classified with poor sleep quality (74.4%). It was possible to infer statistical differences between groups based on body mass index (p = 0.037), the type of route (p = 0.01), and physical activity (p = 0.005). Drivers have an indifferent circadian preference and small-course drivers have a worse sleep health perception. Therefore, it is essential to implement prevention programs, promoting the basic rules for better sleep quality as well as identifying sleep disorders to minimize possible road accidents.
- Sociodemographic and clinical determinants of multimorbidity of underlying conditions that increase the risk of severe illness from COVID-19 in chronic adult individualsPublication . Prazeres, Filipe; Castro, Luísa; Teixeira, Andreia; Castro Guedes, Maria LuísaMultimorbid patients represent a special population of vulnerable individuals who suffer from two or more long-term conditions. They are a very prevalent group with an increased risk of death from COVID-19. The present study aimed to identify the sociodemographic and clinical determinants of multimorbidity of underlying conditions that increase the risk of severe COVID-19 in chronic adult individuals by analyzing data from the Portuguese National Health Survey 2019. The inclusion sample consisted of 7859 adult residents in Portugal who had at least one chronic condition. The health conditions considered for multimorbidity were CKD, COPD, heart conditions, diabetes mellitus, obesity, and smoking. In Portugal, approximately 6 out of every 10 individuals with chronic diseases suffer from one or more conditions that are on the list of those at increased risk of severe COVID-19 disease, and approximately 2 out of every 10 individuals have multimorbidity. Obesity and diabetes are the most frequent risk factors. Timely interventions (e.g., regular medical follow-up for preventive health services and health information) targeting multimorbidity in males and individuals with low educational levels, a poor health status, and low functionality may help to reduce the risk of severe COVID-19 and post-COVID-19 sequelae, and to improve health in a large proportion of the population.
- Burnout among physicians working in palliative care during the COVID-19 Pandemic in Portugal: a cross-sectional studyPublication . Gonçalves, José Vítor; Castro, Luísa; Nunes, Rui; Rêgo, Guilhermina; Castro Guedes, Maria LuísaPhysicians working in palliative care have a greater risk of burnout. Burnout has three dimensions: emotional exhaustion, depersonaliza-tion and reduction of personal accomplishments. Burnout is associated with different consequences for the professionals like less professional satisfac-tion and increase of overall levels of exhaustion. Burnout in healthcare professionals has an impact in the patients with increased probability of clinical erros. In order to monitor the quality of the care it is mandatory to assess overall levels of burnout. This study aimed to determine burnout levels and associated variables of physicians working in the Portuguese national network of palliative care. A cross-sectional, exploratory and quantitative design was employed and participants were sampled using convenience and snowball technique. The Copenhagen Burnout Inventory was used to determine burnout levels of physicians working in the Portuguese National Network of Palliative Care. The contributions of personal, work and COVID-19 variables were evaluated in three subclasses: work, personal and patient-related burnout. The results obtained enabled the identification of healthcare professionals at risk, comparison with previous results published and to assess the impact of COVID-19 in their non COVID-19 activity. Seventy-five physicians participated. Socio-demographic characterization was conducted and the levels of burnout and determinants were ex-plored. High levels of personal, work and patient-related burnout were present in 32 (43%), 39 (52%) and 16 (21%) physicians, respectively. The majority agreed that COVID-19 had an impact on their activities. Exclusive dedication to palliative care and type of palliative care unit were associated with lower levels of patient and work-related burnout. Weekly physical activity was associated with lower levels of work and personal burnout. Self-perceived health status was associated with lower levels of burnout for all subclasses. There was a high level of burnout among physicians working in the Portuguese National Network of Palliative Care. Measures to identify and prevent burnout are necessary in order to protect these professionals.
- The role of social support as a moderator between resilience and levels of burden of multimorbidity management among general practitioners: a cross-sectional study in PortugalPublication . Prazeres, Filipe; Castro, Luísa; Teixeira, Andreia; Castro Guedes, Maria LuísaMultimorbidity management poses significant challenges for general practitioners (GPs). The aim of this study is to analyse the role of resilience and social support on the burden experienced by GPs in managing patients with multiple health conditions in Portugal. Cross-sectional quantitative study conducted among GPs in Portugal using an online questionnaire that included validated measurement tools: Questionnaire of Evaluation of Burden of Management of Multimorbidity in General and Family Medicine (SoGeMM-MGF), European Portuguese Version of the Resilience Scale (ER14), and the Oslo Social Support Scale-3 (OSSS-3) in Portuguese. A multiple linear regression analysis was conducted to examine the factors influencing the burden of managing multimorbidity. Two hundred and thirty-nine GPs were included, with 76.6% being female and a median age of 35 years. Most participants were specialists (66.9%) and had less than a decade of experience managing multimorbidity. Over 70% had not received specific training in multimorbidity. Female GPs and those with a higher proportion of multimorbid patients in the registries experienced higher burden levels. A multivariate regression model with moderation revealed that the effect of resilience on burden varied depending on the level of social support. Higher resilience was associated with higher burden in the “Poor Social Support” category, while it was associated with lower burden in the “Moderate Social Support” and “Strong Social Support” categories, although not statistically significant. The study highlights the importance of GPs’ social support and resilience in managing the burden of multimorbidity, with poor social support potentially worsening the effects of high resilience.
- Interventions based on biofeedback systems to improve workers’ psychological well-being, mental health and safety: a systematic literature reviewPublication . Ferreira, Simão; Rodrigues, Matilde A.; Mateus, Catarina; Rodrigues, Pedro Pereira; Rocha, Nuno Barbosa; Ferreira, Simão; Rodrigues, Matilde; Mateus, Catarina; Rocha, NunoIn modern, high-speed work settings, the significance of mental health disorders is increasingly acknowledged as a pressing health issue, with potential adverse consequences for organizations, including reduced productivity and increased absenteeism. Over the past few years, various mental health management solutions, such as biofeedback applications, have surfaced as promising avenues to improve employees' mental well-being. To gain deeper insights into the suitability and effectiveness of employing biofeedback-based mental health interventions in real-world workplace settings, given that most research has predominantly been conducted within controlled laboratory conditions. A systematic review was conducted to identify studies that used biofeedback interventions in workplace settings. The review focused on traditional biofeedback, mindfulness, app-directed interventions, immersive scenarios, and in-depth physiological data presentation. The review identified nine studies employing biofeedback interventions in the workplace. Breathing techniques showed great promise in decreasing stress and physiological parameters, especially when coupled with visual and/or auditory cues. Future research should focus on developing and implementing interventions to improve well-being and mental health in the workplace, with the goal of creating safer and healthier work environments and contributing to the sustainability of organizations.
- How useful is mixed reality in surgical treatment? - a Delphi StudyPublication . Magalhães, Renato; Lima, Ana Carolina; Marques, António; Pereira, Javier; Pereira da Silva Marques, António José; Magalhães, RenatoMixed reality (MR) is a tool that integrates elements from both the real and virtual worlds. Its potential applications are manifold, with promising developments observed in diverse fields, including healthcare, particularly in the context of surgical procedures. A number of studies have been conducted on mixed reality headsets, including the Microsoft HoloLens 2®, which may be employed in surgical training, planning, and navigation. It is imperative to ascertain whether medical professionals consider this technology indispensable in their professional lives. This study employs the Delphi method to assess the utility of MR in surgical settings and utilizes the Welphi online platform to facilitate this process. Furthermore, a PRISMA-like approach is employed to analyze the results of the initial round. The objective of this study is to examine the feasibility and advantages of mixed reality technology in surgical contexts. The findings are intended to inform and direct healthcare professionals, researchers, and developers in the advancement of mixed reality integration in surgical environments, with the ultimate goal of optimizing the quality and safety of treatments. A Delphi approach comprising of three rounds was implemented to ascertain consensus on the utility of MR surgical treatment. Participants were purposefully selected from experts with professional experience with technologies that provide a more immersive or interactive experience, such as virtual reality (VR), augmented reality (AR), 3D laparoscopy, robotics, and other similar technologies applied in the surgical field. The initial round of the study was designed to allow surgeons to provide their insights into the potential applications of MR in surgical procedures. This phase employed a structured approach, with open-ended questions organized into five distinct sections. In the second round, the questions were derived from the analysis of the first round and organized according to main and sub-topics for hierarchical structuring. In the third round, the questions were identical to those posed in the second round, including the percentage results obtained in the previous round. This afforded the experts the opportunity to review their previous responses. A consensus round was subsequently conducted. In the analysis, Kendall's tau-b coefficient for correlation analysis was employed and significant correlations between distinct aspects were identified. Twenty-two of the invited experts provided responses in both the initial and subsequent rounds, representing a 100% response rate. In the third round and consensus round, 20 experts participated, representing 91% response rate. The consensus round was conducted to present the results that had achieved a level of majority consensus of 95% on the usefulness of MR in surgical treatment. The objective was to have experts validate the results. The primary benefits of MR in surgery were identified as surgical navigation (with 75% of consensus), surgical planning (with 75% of consensus), and teaching and training (with 70% of consensus). According to the Delphi study, the areas where MR technology is most beneficial in surgical contexts are surgical navigation, training, and planning. However, the costs and investments required for implementation may present a potential limitation for the integration of this technology in surgical procedures. Moreover, it is of crucial importance to comprehend the ethical implications associated with this matter, which may have implications for the security of patients.
- Mixed reality in the operating room: A systematic reviewPublication . Magalhães, Renato; Oliveira, Ana; Terroso, David; Vilaça, Adélio; Veloso, Rita; Marques, António; Pereira, Javier; Pereira da Silva Marques, António José; Magalhães, RenatoMixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information, becoming a valuable tool for medicine, particularly for the operating room and surgical learning; A systematic review was conducted following the PRISMA guidelines to answer the research questions established using the PICO framework; Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes; Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The possibility of integration of distinct medical imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses need consideration. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.