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- Impact of COVID-19 on medicine lecturers’ mental health and emergency remote teaching challengesPublication . Miguel, Carla; Castro, Luísa; Marques dos Santos, José Paulo; Serrão, Carla; Duarte, IvoneCOVID-19 has presented a novel pedagogical challenge in dealing with the sudden shift from classic instruction to emergency remote teaching (ERT). It had an impact on the well-being and mental health of lecturers, increasing burnout risk. A cross-sectional, quantitative, qualitative and analytical online study was conducted to collect participants’ sociodemographic data, responses to ERT open-ended questions and mental health assessments using relevant instruments (CBI for burnout, Resilience Scale, DASS for depression, anxiety and stress, SWLS for satisfaction with life). High personal burnout levels were found in 41.2% of participants, high work-related burnout in 37.3% and high student-related burnout in 15.7%. Satisfaction with life, sleep routine changes and stress were determinants for personal burnout; stress and resilience for work-related burnout; satisfaction of life and sleep routine changes for students-related burnout. Opportunities for pedagogical innovation were pointed out as the main advantages to ERT, while the main negative impacts were on practical lessons and social interaction. Students and lecturers’ safety and adequate institutional support might be insured, considering their expectations and needs, promoting mental health. Combining the advantages of online and traditional methods in a so-called “blended learning” approach, with close collaboration and communication between all those involved, appears to achieve better results.
- Machine learning models based on clinical indices and cardiotocographic features for discriminating asphyxia fetuses—Porto retrospective intrapartum studyPublication . Ribeiro, Maria; Nunes, Inês; Castro, Luísa; Costa-Santos, Cristina; Henriques, Teresa S.Perinatal asphyxia is one of the most frequent causes of neonatal mortality, affecting approximately four million newborns worldwide each year and causing the death of one million individuals. One of the main reasons for these high incidences is the lack of consensual methods of early diagnosis for this pathology. Estimating risk-appropriate health care for mother and baby is essential for increasing the quality of the health care system. Thus, it is necessary to investigate models that improve the prediction of perinatal asphyxia. Access to the cardiotocographic signals (CTGs) in conjunction with various clinical parameters can be crucial for the development of a successful model. This exploratory work aims to develop predictive models of perinatal asphyxia based on clinical parameters and fetal heart rate (fHR) indices. Single gestations data from a retrospective unicentric study from Centro Hospitalar e Universitário do Porto de São João (CHUSJ) between 2010 and 2018 was probed. The CTGs were acquired and analyzed by Omniview-SisPorto, estimating several fHR features. The clinical variables were obtained from the electronic clinical records stored by ObsCare. Entropy and compression characterized the complexity of the fHR time series. These variables' contribution to the prediction of asphyxia perinatal was probed by binary logistic regression (BLR) and Naive-Bayes (NB) models. The data consisted of 517 cases, with 15 pathological cases. The asphyxia prediction models showed promising results, with an area under the receiver operator characteristic curve (AUC) >70%. In NB approaches, the best models combined clinical and SisPorto features. The best model was the univariate BLR with the variable compression ratio scale 2 (CR2) and an AUC of 94.93% [94.55; 95.31%]. Both BLR and Bayesian models have advantages and disadvantages. The model with the best performance predicting perinatal asphyxia was the univariate BLR with the CR2 variable, demonstrating the importance of non-linear indices in perinatal asphyxia detection. Future studies should explore decision support systems to detect sepsis, including clinical and CTGs features (linear and non-linear).
- Do surrogates predict patient preferences more accurately after a physician-led discussion about advance directives? A randomized controlled trialPublication . Martins, Catarina Sampaio; Sousa, Iva; Barros, Cláudia; Pires, Alexandra; Castro, Luísa; Santos, Cristina da Costa; Nunes, RuiCaregivers frequently assume the role of surrogate decision-makers but often are unable to accurately predict patients’ preferences. This trial aims to find if the use of the Advance Directives documents as a communication tool, improves the agreement between patients and caregivers. This trial occurred in a palliative care service of a Portuguese hospital center. A prospective, single-blinded, controlled, randomized trial, enrolling patients and caregivers as a dyad was conducted. Participants individually fulfilled an Advance Directive document, in which patients reported their end-of-life preferences and caregivers reported their decisions as patients’ health surrogates. Dyads were randomly assigned to the Intervention or the Control group, in which the physician respectively promoted an open discussion about patients’ Advance Directives or evaluated patients’ clinical condition. Caregivers’ Advance Directives as surrogates were collected one month later. Proportions of agreement and Cohen’s κ were used to access agreement and reliability, respectively, between the dyads. Results from 58 dyads were analyzed. We observed an improvement in agreement between the caregivers’ answers and the patients’ wishes on two-thirds (8/12) of the answers, in the Intervention group, contrasting to one-quarter (3/12) of the answers, in the Control group, despite statistical significance in differences wasn´t obtained. Although not reaching statistical significance, the results suggest that discussions of advance directives with physicians may lead to better prepared surrogates.
- O Impacto da COVID-19 nos farmacêuticos portugueses: fadiga e exaustão emocionalPublication . Vaz, Inês Ribeiro; Serrão, Carla; Teixeira, Andreia; Castro, Luísa; Duarte, IvoneOs farmacêuticos são um dos grupos de profissionais de saúde que esteve envolvido no combate à pandemia por COVID-19 desde a primeira hora, mantendo em funcionamento um serviço essencial à população: as farmácias. Tendo em conta as lacunas que se fizeram sentir no sector no início da pandemia, fosse por falta de material de proteção individual e de desinfeção, fosse por falta de orientações claras quanto ao estabelecimento de planos de contingência, este foi um grupo muito exposto à pressão e ao escrutínio público. Importava, assim, estudar de que forma estes profissionais de saúde percecionaram a sua saúde mental durante este período, para que no futuro sejam delineadas estratégias para a sua proteção.
- Systematic review of intrapartum fetal heart rate spectral analysis and an application in the detection of fetal acidemiaPublication . Castro, Luísa; Loureiro, Maria; Henriques, Teresa S.; Nunes, InêsIt is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four different umbilical artery pH cutoffs were considered for fetuses' classification into acidemic or non-acidemic: 7.05, 7.10, 7.15, and 7.20. The area under the receiver operating characteristic curve (AUROC) was used to quantify the frequency bands' ability to distinguish acidemic fetuses. Bands referring to low frequencies, mainly associated with neural sympathetic activity, were the best at detecting acidemic fetuses, with the more severe definition (pH ≤ 7.05) attaining the highest values for the AUROC. This study shows that the power spectrum analysis of the fetal heart rate is a simple and powerful tool that may become an adjunctive method to CTG, helping healthcare professionals to accurately identify fetuses at risk of intrapartum hypoxia and to implement timely obstetrical interventions to reduce the incidence of related adverse perinatal outcomes.
- Torus-breakdown near a heteroclinic attractor: a case studyPublication . Castro, Luísa; Rodrigues, AlexandreThere are few explicit examples in the literature of vector fields exhibiting observable chaos that may be proved analytically. This paper reports numerical experiments performed for an explicit two-parameter family of SO(2)⊕Z2𝕊𝕆(2)⊕ℤ2-symmetric vector fields whose organizing center exhibits an attracting heteroclinic network linking two saddle-foci. Each vector field in the family is the restriction to S3𝕊3 of a polynomial vector field in R4ℝ4. We investigate global bifurcations due to symmetry-breaking and we detect strange attractors via a mechanism called Torus-Breakdown. We explain how an attracting torus gets destroyed by following the changes in the unstable manifold of a saddle-focus. Although a complete understanding of the corresponding bifurcation diagram and the mechanisms underlying the dynamical changes is out of reach, we uncover complex patterns for the symmetric family under analysis, using a combination of theoretical tools and computer simulations. This article suggests a route to obtain rotational horseshoes and strange attractors; additionally, we make an attempt to elucidate some of the bifurcations involved in an Arnold tongue.
- Current practices in home mechanical ventilation for chronic obstructive pulmonary disease: A real-life cross-sectional multicentric studyPublication . Ribeiro, C.; Vieira, A. L.; Pamplona, P.; Drummond, M.; Seabra, B.; Ferreira, D.; Liberato, H.; Carreiro, A.; Vicente, I.; Castro, Luísa; Costa, P.; Carriço, F.; Martim, T.; Cravo, J.; Teixiera, N.; Grafino, M.; Conde, S.; Windisch, W.; Nunes, R.Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥ 20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.
- Equity in the access of chinese immigrants to healthcare services in PortugalPublication . Nunes, Rui; Aparício, Sandra Lopes; Castro, Luísa; Duarte, IvoneThe aim of this study was to identify the barriers that Chinese immigrants face when accessing the Portuguese National Health Service. An observational, cross-sectional and quantitative study was carried out via a bilingual Portuguese/Mandarin self-completed paper questionnaire was applied. The study population consisted of individuals with Chinese nationality who were residing in mainland Portugal for at least one year and aged 18 years or over. A total of 304 individuals answered the questionnaire. The results show that 284 (93.4%) of the participants had already sought healthcare in Portugal. The participants identified language difficulties and health professionals’ lack of knowledge of Chinese cultural habits as the most significant barriers to accessing healthcare in Portugal. Of a total of 165 participants who sought healthcare in China, confidence in treatment outcomes and health professionals’ knowledge of Chinese cultural habits were the reasons given by 151 (91.5%) individuals. This study reveals the existence of linguistic and cultural barriers that can condition the access of the Chinese immigrant population to healthcare systems.
- Burnout and depression in portuguese healthcare workers during the COVID-19 pandemic—The mediating role of psychological resiliencePublication . Serrão, Carla; Duarte, Ivone; Castro, Luísa; Teixeira, AndreiaDuring the COVID-19 pandemic, healthcare workers (HCW) have been exposed to multiple psychosocial stressors. Resilience might protect employees from the negative consequences of chronic stress. The aim of this study was to explore the mediating role of resilience in the relationship between depression and burnout (personal, work-related, and client-related). A cross-sectional study was performed using an online questionnaire distributed via social networks. A survey was conducted comprising standardized measures of resilience (Resilience Scale-25 items), depression (subscale of Depression Anxiety Stress Scales-21 items), and burnout (Copenhagen Burnout Inventory Scale 19 items). A total of 2008 subjects completed the survey, and a hierarchical regression model was estimated for each burnout dimension. The results revealed that depression had not only a directed effect on personal, work- and client-related burnout, but also an indirect small effect on it through resilience. Psychological resilience played a partial mediating role between depression and all burnout dimensions. This partial mediation suggests that there may be other possible variables (e.g., social connection, self-compassion, gratitude, sense of purpose) that further explain the associations.
- The mediating role of life satisfaction in the relationship between depression, anxiety, stress and burnout among Portuguese nurses during COVID-19 pandemicPublication . Martins, Vera; Serrão, Carla; Teixeira, Andreia; Castro, Luísa; Duarte, IvoneBackground The COVID-19 pandemic had a large consequence on healthcare systems, increasing the risks of psychological issues in health professionals. Nurses, in particular, have been exposed to multiple psychosocial stressors and struggled with intensive work, insufficiency of resources and uncertainty in the face of an unknown disease. Life satisfaction might protect nurses from the consequences of chronic stress. The aim of this study was to explore the mediating role of satisfaction with life in the relationship between depression, stress, anxiety and burnout (personal, work-related, and client-related). Methods A cross-sectional, descriptive, correlational study design was performed, using an online questionnaire distributed via social networks. A total of 379 nurses completed the survey, comprising standardized measures of satisfaction with life, resilience (Resilience Scale), depression, anxiety, stress (Depression Anxiety Stress Scales), and burnout (Copenhagen Burnout Inventory Scale). A hierarchical regression model was estimated for each burnout dimension. Results Participants showed high levels of work, personal and client-related burnout, 57.3%, 57%, and 35.1%, respectively. More than 70% of the respondents had a normal level of depressive symptoms, 66.8% presented normal level of anxiety and 33.5% of the respondents reported mild, moderate, severe or extremely severe symptoms of stress. The results revealed that life satisfaction partially mediated the association between stress and personal burnout, depression and work-related burnout, and the association between anxiety and client-related burnout in nurses. Conclusions The COVID-19 pandemic brought added difficulties for nurses’ work conditions, whereby it became necessary to develop adaptative measures that reduce stressors in work environment and promote nurses’ life satisfaction.