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BACKGROUND: This work aims to study the spatio-temporal evolution of a woman's age at menarche in the central region of Portugal. One of the concerns of the study is early or late menarches; thus, we consider percentile regression to build the respective curves as opposed to the more traditional mean regression approach. METHODS: We analysed the data from [Formula: see text] women born in the period 1920-1973 who attended a free breast cancer screening program between 1990 and 2019. Distributional regression models inside the package GAMLSS in R were considered. These methods allowed us not only to model the location (mean) of the specific probability distribution of the age at menarche, but also allowed for the scale (variance) parameter of this distribution to depend on covariates. Additionally, a spatial random-effect was considered in order to capture the correlation at the regional level. The obtained clustered spatial effects were analysed to assess geographical differences among the percentiles of the age at menarche by year of birth. RESULTS: A decreasing trend in the age at menarche (about 1.5 years in 5 decades) and regional differences for all the considered percentiles were found. Women living in the north-central areas of the central region of Portugal tend to have menarche at older ages. CONCLUSION: We obtained percentile estimates for the age at menarche by year of birth and region of residence and demonstrated that these two explanatory variables have an impact on the explanation about the decreasing trend in age at a woman's first menstruation.
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Etnicidade , Menarca , Humanos , Feminino , Portugal/epidemiologiaRESUMO
BACKGROUND: Healthy literacy is a determinant key children/teenager's health and health outcomes. The aim of this study to identify the parents' assessment about Health Education practice to children and teenagers. METHODS: We opted for a descriptive, quantitative and cross-sectional research, with a non-probabilistic convenience sample. The inclusion criteria were: being a parent who uses attending children health appointments in primary health care; being a parent who has a child hospitalized and is accompanying him/her in the pediatric hospital inpatient ward. A questionnaire survey was built with three sections: sample characterization, Health Education practices performed by nurses (5 questions) and a scale that measured Health Education Assessment Scale (HEAS), which contained 48 items and was validated. It was applied from September to December 2018. RESULTS: The survey was filled in by 113 parents. The results showed that 100% (n = 113) of the parents feel comfortable to talk with nurses about children/teenagers health; 79.6% (n = 90) consider that nurses have time availability for the doubts clarification; 61.9% (n = 70) point out that nurses identify child/teenager needs; Healthy eating" (60.2%; n = 68), the "National Vaccination Plan" (53.1%; n = 60) and "Harmful behaviors prevention" (46.9%; n = 53) are the most important topics; 56.6% (n = 64) of the parents, when in doubt, turn first to the pediatrician, and 66.4% (n = 75) considered that this practice was equal important, compared with other nursing interventions. DISCUSSION: This study shows that Health Education provided by nurses is based on the need's identification, with a perspective of involvement and participation, promoting health and conscious changes which reinforces the nurses' position as health educators.
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PURPOSE: To evaluate bone loss, prosthodontics and biological complications, and implant survival rates of internal conical connections (ICC) compared with internal non-conical connection (INCC) implants. METHODS: The systematic review was registered on PROSPERO (CRD42021237170). Meta-analysis was performed using standardized mean difference (SMD) for bone loss and risk ratio (RR) for implant survival and complication rates. Risk of bias analysis was evaluated using RoB 2.0, whereas the GRADE tool was used to evaluate the certainty of evidence. A systematic search of the PubMed, Web of Science, Embase, Cochrane, and ProQuest databases was performed independently by two reviewers for articles published up to March 2022. The search criteria had no language or publication date restrictions. Handsearching analysis was performed in the reference list of potential articles. RESULTS: Twelve randomized clinical trials, including 678 patients and 1006 implants (ICC [n = 476]; INCC [n = 530]), were included. Meta-analysis revealed that ICC demonstrated a lower risk for marginal bone loss (SMD: -0.80 mm; p = 0.004) and prosthodontics complications (RR: 0.16; p = 0.01) than INCC. However, both internal connections demonstrated no significant difference in implant survival rates (RR: 0.54; p = 0.10) and biological complications (RR: 0.90; p = 0.82). The overall risk of bias revealed some concerns and a low risk of bias for most of the included studies. However, the certainty of evidence of outcomes was considered low to moderate. CONCLUSION: ICC may be considered a more favorable treatment option than INCC owing to greater preservation of peri-implant bone tissue and a lower probability of prosthodontics complications. However, well-conducted studies with long-term follow-up are warranted.
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Implantes Dentários , Humanos , Implantes Dentários/efeitos adversos , Implantação Dentária Endóssea/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Bases de Dados Factuais , Prótese Dentária Fixada por Implante/efeitos adversosRESUMO
BACKGROUND: Due to contradictory results in current research, whether age at menopause is increasing or decreasing in Western countries remains an open question, yet worth studying as later ages at menopause are likely to be related to an increased risk of breast cancer. Using data from breast cancer screening programs to study the temporal trend of age at menopause is difficult since especially younger women in the same generational cohort have often not yet reached menopause. Deleting these younger women in a breast cancer risk analyses may bias the results. The aim of this study is therefore to recover missing menopause ages as a covariate by comparing methods for handling missing data. Additionally, the study makes a contribution to understanding the evolution of age at menopause for several generations born in Portugal between 1920 and 1970. METHODS: Data from a breast cancer screening program in Portugal including 278,282 women aged 45-69 and collected between 1990 and 2010 are used to compare two approaches of imputing age at menopause: (i) a multiple imputation methodology based on a truncated distribution but ignoring the mechanism of missingness; (ii) a copula-based multiple imputation method that simultaneously handles the age at menopause and the missing mechanism. The linear predictors considered in both cases have a semiparametric additive structure accommodating linear and non-linear effects defined via splines or Markov random fields smoothers in the case of spatial variables. RESULTS: Both imputation methods unveiled an increasing trend of age at menopause when viewed as a function of the birth year for the youngest generation. This trend is hidden if we model only women with an observed age at menopause. CONCLUSION: When studying age at menopause, missing ages must be recovered with an adequate procedure for incomplete data. Imputing these missing ages avoids excluding the younger generation cohort of the screening program in breast cancer risk analyses and hence reduces the bias stemming from this exclusion. In addition, imputing the not yet observed ages of menopause for mostly younger women is also crucial when studying the time trend of age at menopause otherwise the analysis will be biased.
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Neoplasias da Mama , Menopausa , Viés , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Feminino , Humanos , Medição de RiscoRESUMO
Four stereoisomeric monoether derivatives, based on axially chiral (R)- or (S)-BINOL bearing a chiral (+)- or (-)-neomenthyloxy group were synthesised and fully characterised by NMR spectroscopy and X-ray crystallography. The respective tris-monophosphites were thereof prepared and fully characterised. The coordination ability of the new bulky phosphites with Rh(CO)2(acac), was attested by 31P NMR, which presented a doublet in the range of δ = 120 ppm, with a 1J(103Rh-31P) coupling constant of 290 Hz. The new tris-binaphthyl phosphite ligands were further characterised by DFT computational methods, which allowed us to calculate an electronic (CEP) parameter of 2083.2 cm-1 and an extremely large cone angle of 345°, decreasing to 265° upon coordination with a metal atom. Furthermore, the monophosphites were applied as ligands in rhodium-catalysed hydroformylation of styrene, leading to complete conversions in 4 h, 100% chemoselectivity for aldehydes and up to 98% iso-regioselectivity. The Rh(I)/phosphite catalytic system was also highly active and selective in the hydroformylation of disubstituted olefins, including (E)-prop-1-en-1-ylbenzene and prop-1-en-2-ylbenzene.
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BACKGROUND: Prevalence of fatty liver (FL) and nonalcoholic fatty liver disease (NAFLD) depends mainly on obesity, diabetes and genetic factors. FL and NAFLD prevalence was evaluated in Portuguese adult population and correlated with several risk factors and related mortality data, within the same period. MATERIALS AND METHODS: A cross-sectional, population-based multicenter study, voluntary and randomly selected in 834 Portuguese adults (18-79 years). Participants were evaluated after 12-hour fasting. Anthropometric data, past history including alcohol consumption, and associated diseases were registered. Blood samples were collected for biochemical testing. Dietary intake was evaluated using a semi-quantitative food frequency questionnaire. Presence of FL was evaluated using ultrasound, and NAFLD was diagnosed after exclusion of other causes for liver disease. RESULTS: Adjusted prevalence of FL and NAFLD was 37.8% and 17.0%, respectively. FL individuals were older, more frequently males, with increased probability of having obesity, diabetes or harmful alcohol consumption (HAC). NAFLD individuals were also older, but had a similar sex distribution and an increased probability of obesity and diabetes. In both groups, no differences were found regarding dietary pattern or physical activity. During the same time period, nonalcoholic steatohepatitis (NASH) liver-related deaths in Portugal were 0.105/100 000, while alcohol-related liver disease mortality was 6.790/100 000. CONCLUSION: The large spectrum of FL was present in more than one third of the population, although only less than half could be classified as NAFLD. Other significant risk factors, such as HAC, are probably implicated in FL, explaining the low NASH-related mortality compared with the high alcohol-related mortality during the same time period.
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Consumo de Bebidas Alcoólicas/epidemiologia , Diabetes Mellitus/epidemiologia , Fígado Gorduroso/epidemiologia , Hepatopatias Alcoólicas/mortalidade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Dieta/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Portugal/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Adulto JovemRESUMO
Studies addressing breast cancer risk factors have been looking at trends relative to age at menarche and menopause. These studies point to a downward trend of age at menarche and an upward trend for age at menopause, meaning an increase of a woman's reproductive lifespan cycle. In addition to studying the effect of the year of birth on the expectation of age at menarche and a woman's reproductive lifespan, it is important to understand how a woman's cohort affects the correlation between these two variables. Since the behavior of age at menarche and menopause may vary with the geographic location of a woman's residence, the spatial effect of the municipality where a woman resides needs to be considered. Thus, a Bayesian multivariate structured additive distributional regression model is proposed in order to analyze how a woman's municipality and year of birth affects a woman's age of menarche, her lifespan cycle, and the correlation of the two. The data consists of 212,517 postmenopausal women, born between 1920 and 1965, who attended the breast cancer screening program in the central region of Portugal.
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Envelhecimento/fisiologia , Biometria/métodos , Menarca/fisiologia , Modelos Estatísticos , Reprodução , Adolescente , Adulto , Teorema de Bayes , Criança , Pré-Escolar , Feminino , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Adulto JovemRESUMO
In the last 5 years the resident population of Portugal has increased 2.3%, along with a progressive ageing. This study aims assessing the social dependence and frailty, as well as social and familial support needs of the elderly. In an observational, cross-sectional community based study (EPEPP study), a total of 2,672 people, aged 55 or more, were submitted to an enquiry and several variables were studied among three age groups: 55-64 years old (37%), 65-74 years old (37%) and ≥ 75 years old (26%), encompassing a total of 57% women and 43% men. A questionnaire including items such as physical autonomy, locomotion, falls, health/medical complaints, instrumental autonomy, physical activity, health self-evaluation and emotional status was applied. The strong correlations among the studied scores allowed the identification of people groups with common characteristics when a principal component analysis was used: "autonomy" (scores of instrumental autonomy, locomotion and physical autonomy) and "perception of health and emotional status" (scores of health self-evaluation and emotional status), were present in the three age groups. The component analysis evidences that a good autonomy, a good perception of health and emotional status are determinant to a good quality of life in elderly. Although health status and self-rated health have a propensity to deteriorate with aging, older Portuguese consider their state of health satisfactory and tend to underestimate their decline. In what concerns the analysis of gender with the same age and in contrast to what has been reported, older women alike to men, experience a good mobility and health self-evaluation.
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Atividades Cotidianas , Envelhecimento , Nível de Saúde , Expectativa de Vida/tendências , Qualidade de Vida , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Autorrelato , Distribuição por SexoRESUMO
Breast cancer risk is believed to be associated with several reproductive factors, such as early menarche and late menopause. This study is based on the registries of the first time a woman enters the screening program, and presents a spatio-temporal analysis of the variables age of menarche and age of menopause along with other reproductive and socioeconomic factors. The database was provided by the Portuguese Cancer League (LPCC), a private nonprofit organization dealing with multiple issues related to oncology of which the Breast Cancer Screening Program is one of its main activities. The registry consists of 259,652 records of women who entered the screening program for the first time between 1990 and 2007 (45-69-year age group). Structured Additive Regression (STAR) models were used to explore spatial and temporal correlations with a wide range of covariates. These models are flexible enough to deal with a variety of complex datasets, allowing us to reveal possible relationships among the variables considered in this study. The analysis shows that early menarche occurs in younger women and in municipalities located in the interior of central Portugal. Women living in inland municipalities register later ages for menopause, and those born in central Portugal after 1933 show a decreasing trend in the age of menopause. Younger ages of menarche and late menopause are observed in municipalities with a higher purchasing power index. The analysis performed in this study portrays the time evolution of the age of menarche and age of menopause and their spatial characterization, adding to the identification of factors that could be of the utmost importance in future breast cancer incidence research.
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Biometria/métodos , Neoplasias da Mama/epidemiologia , Programas de Rastreamento , Menarca , Menopausa , Modelos Estatísticos , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/fisiopatologia , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Análise de RegressãoRESUMO
INTRODUCTION: The act of caring for a dependent elderly victim of cerebrovascular accident exerts different impacts on caregivers. Knowledge of their socioeconomic level by health professionals supports the planning and implementation of actions appropriate to the reality of the elderly and their caregivers. OBJECTIVE: To determine whether socioeconomic status predicts informal caregivers' state of mind (depression). DESIGN: Cross-sectional, descriptive study in the Dão Lafões sub-region. PARTICIPANTS: Non-probabilistic sample of 636 informal caregivers, aged 17-85 years (mean = 50.19±14.30). MEASURING INSTRUMENTS: The Beck Depression Inventory and the Graffar Socioeconomic Level Scale. RESULTS: We found class III (middle class family/reasonable socioeconomic status) was the most common (40.4%), class IV (upper lower class family/low socioeconomic level) with 37.7%. A majority of the sample (62.9%) does not have depressive symptoms, with their presence observed in 37.1% of informal caregivers, in which 24.3% are men and 39.6% women. The results sustain that socioeconomic level (P=.004) in the total sample predicts state of mind, inferring that caregivers with poorer socioeconomic status have a worse state of mind. CONCLUSIONS: The evidence found from the research show that informal caregivers with depressive symptoms have a poorer socioeconomic status, so that it is compulsory to consider these variables when planning interventions whose primary focus of attention is aimed at caregivers and elderly cerebrovascular accident victims experiencing situations of transition.
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Cuidadores/psicologia , Depressão/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Acidente Vascular Cerebral , Adulto JovemRESUMO
The tourism sector is presently facing new challenges resulting from the increasing digitalization of society. Boosted by industry 4.0, new tourism dynamics are emerging. Nonetheless, the real significance of this revolutionary trend and its implications still lack further development. Aiming to assess the state-of-the-art about the digital transformation on the tourism sector, triggered by the 4.0 paradigm, the present study followed a systematic literature review approach, adopting the PRISMA protocol guidelines. A total of 44 manuscripts were considered relevant for analysis. The findings illustrate that the 4.0 paradigm is being embraced from three main perspectives: the visitor-technology interaction and its influence on decision-making, the digital competencies in tourism students, and the technology penetration in different sub-sectors of the supply chain. However, studies conceptualizing the 4.0 paradigm in the tourism sector are lacking, beyond empirical research on areas such as digital skills, pros and cons of industry 4.0 technologies, and spatial consequences.
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The use of information technologies in the field of biomedical data management has grown considerably and is today one of the main fields of use of these technologies. There are several advantages arising either to an individual's health or to public health, particularly because access to clinical data become available anywhere access via the Internet or individual health card. This card will contain personal data accessible from a terminal card reader, identical to the citizen card. This work focuses on the development of an ontology of universal data structure so that the information is accessible and organized in the same way, regardless of the system that use them. In this context there is the need to incorporate security mechanisms, the respect of ethical principles underlying the management and maintenance of clinical data, ensuring maximum confidentiality. To develop the proposed ontology, for the treatment of clinical data of children and youth is used as reference bulletin health in Portugal. Using this structure, it follows the clear and unambiguous identification of the fields required for registration of clinical information, standardized in a relational model. To ensure the confidentiality of data, identification of the individual is only the number of national health system and are not recorded on the card personal data such as name, address or contact forms.
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Confidencialidade/ética , Prontuários Médicos , Adolescente , Criança , Humanos , InternetRESUMO
Developing accurate models for groundwater control is paramount for planning and managing life-sustaining resources (water) from aquifer reservoirs. Significant progress has been made toward designing and employing deep-forecasting models to tackle the challenge of multivariate time-series forecasting. However, most models were initially taught only to optimize natural language processing and computer vision tasks. We propose the Wavelet Gated Multiformer, which combines the strength of a vanilla Transformer with the Wavelet Crossformer that employs inner wavelet cross-correlation blocks. The self-attention mechanism (Transformer) computes the relationship between inner time-series points, while the cross-correlation finds trending periodicity patterns. The multi-headed encoder is channeled through a mixing gate (linear combination) of sub-encoders (Transformer and Wavelet Crossformer) that output trending signatures to the decoder. This process improved the model's predictive capabilities, reducing Mean Absolute Error by 31.26 % compared to the second-best performing transformer-like models evaluated. We have also used the Multifractal Detrended Cross-Correlation Heatmaps (MF-DCCHM) to extract cyclical trends from pairs of stations across multifractal regimes by denoising the pair of signals with Daubechies wavelets. Our dataset was obtained from a network of eight wells for groundwater monitoring in Brazilian aquifers, six rainfall stations, eleven river flow stations, and three weather stations with atmospheric pressure, temperature, and humidity sensors.
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Introduction: The presence of post-traumatic stress disorder (PTSD) symptomatology in firefighters is an ever-pressing issue that requires close attention for adequate interventions. The present study investigated PTSD and global psychopathology prevalence in a sample of highly risk-exposed Portuguese firefighters, collected after the widespread deadly wildfires in 2017 that ravaged the country. Following an action research approach, the aim of this study was to depict this sample and examine the impact of cumulative adverse experiences on their mental health, which is a phenomenon worth attention. Method: From an initial sample of 283 firefighters who manifested interest in participating, a total of 139 firefighters from the Coimbra District, of whom 130 unequivocally experienced a potentially traumatic/adverse event as a firefighter, completed BSI (to obtain indicators on psychopathology), QEPAT (an inventory of adverse events possibly experienced as a firefighter), and PCL-5 (a measure of PTSD symptomatology) through an online survey during the year 2018 by the Regional Medical Organization, as proposed and supervised by the local Centre for Prevention and Treatment of Psychological Trauma (CPTTP). Results: We found a global prevalence of 8.6% of possible PTSD and 14.4% of possible psychopathology (n = 139). When considering only firefighters who unequivocally reported a potentially traumatic/adverse event as a firefighter (n = 130), 9.2% present possible PTSD, and 13.8% present possible global psychopathology. This sample experienced a mean of 28 adverse events during firefighting work. Linear regressions (n = 118) demonstrated that the perceived severity of the most traumatic event reported and the experience of more adverse events were both related to an increase in PTSD symptomatology. Global psychopathology was associated with PCL-5 scores, with an emphasis on paranoid ideation, hostility, depression, anxiety, and phobic anxiety. Discussion: The severe wildfires of 2017 did not impact PTSD scores in this sample (collected the year after), suggesting that cumulative adverse events are more important than particular episodes. However, the number of reported events was related to PTSD scores. These results can be used to develop interventions that target all firefighters by addressing risk and protective factors. This action research study motivated specialized aid for firefighters involved in this study.
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Within the last decade, childhood obesity has become a serious problem, especially during the COVID-19 pandemic. This research paper aimed to examine whether body mass index (BMI) was higher during the pandemic (2020-2022) than in the pre-pandemic period (2012/2013-2019) using trends related to sex, urban-rural area, and physical activity (PA). This study included data from physical examinations of an entire population of primary school children from Split-Dalmatia County (Croatia) over a period of 10 years. There were 103,804 students from the first, fifth, and eighth grades who participated in the analysis. During the pandemic, the BMI of all the students increased, except for eighth-grade girls. Generations of eighth graders have had significantly different BMIs throughout the past decade. We found that first graders were overweight and obese in urban areas, while in rural areas, this problem was experienced by upper grades. Girls were more overweight and obese in the first and eighth grades, but boys experienced this more in the fifth grade. Reduced PA influenced an increase in BMI in both sexes, especially in girls. During the pandemic, this situation became worse. This study could be useful to experts for the creation of new policies for Split-Dalmatia County and surrounding regions that are similar economically and culturally.
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COVID-19 , Obesidade Infantil , Criança , Feminino , Masculino , Humanos , Índice de Massa Corporal , Estudos Retrospectivos , Pandemias , Croácia/epidemiologia , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , COVID-19/epidemiologia , Estudantes , Instituições AcadêmicasRESUMO
This work aims at studying the spatio-temporal evolution of the age at menopause in central Portugal since the early twentieth century. We analyzed [Formula: see text] women that had already reached the menopause within a free breast cancer screening program between 1990 and 2018 and born in the period 1910-1960. One of the concerns was about early or late menopause thus we considered percentile regression to build the respective percentile curves inside the package GAMLSS in R. In order to capture the correlation at the regional level, a spatial random-effect was considered. The obtained clustered spatial effects were analyzed to assess geographical differences among the percentiles of the age at menopause by year of birth. An increasing trend in the median age at menopause and regional differences for all the considered percentiles were found. From 47.1 years in 1910 to 49.59 years in 1960 (about 2.49 years in 5 decades). Early and premature menopause (below percentile 5%) occur in the interior north (north-eastern). Late menopause (above percentile 95%) occur predominantly in the central-north and central-south areas.
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Neoplasias da Mama , Menopausa , Gravidez , Humanos , Feminino , Portugal , Parto , Neoplasias da Mama/epidemiologia , GeografiaRESUMO
AIM: This study aimed to analyze the nurse's evaluation of the health education practice to children and parents. METHODS: This is a descriptive and transversal research with a quantitative approach. The selection took place by non-probabilistic convenience sampling, and was developed with nurses on health units for pediatric hospitalization and primary health care in northern Portugal (Trás-os-Montes and Alto Douro Hospital Center, EPE, Northern Regional Health Administration, Northern Local Health Unit, EPE.). Data were collected using a questionnaire with a sample of 311 nurses in the second semester of 2018. RESULTS: 77.5% (n = 241) of nurses perform health education daily; 65% (n = 202) prepare according to the identified needs; the "Identification of children/young and parents' health priorities" was considered to be the most facilitating element (n = 279; 89.7%); the most difficult element was the "Fear of confidentiality breach by the children/young and parents" (74.6%; n = 232); and 65.9% (n = 205) of nurses considered this practice to have equal importance compared to other nursing interventions. It was also found that academic/professional qualifications and the place of professional practice influence the importance that nurses attribute to HE practice. CONCLUSIONS: We can state that there is an appreciation of the binomial child and parents for a better identification of needs, and of the importance attributed to the current legal guidelines (letting themes leading to good health practices be addressed by nurses), which translates into a practice capable of influencing the determinants of health, which promotes health-enhancing behaviors and thus both leads to health gains and reinforces the nurse's position as health-promoting agents.
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Intention to leave is influenced by the commitment and individual and structural factors. It is a critical dimension in health systems due to the shortage of professionals and the potential impact on the quality of care. The present paper: (i) characterizes organizational commitment and intention to leave; (ii) analyzes the relationship between structural factors (such as, work environment and nurse staffing), individual factors (age), and nurses' organizational commitments and intention to leave; and (iii) analyzes the differences in the intention to leave and in the organizational commitment according to service specialty, nurses' specialization, and contractual relationship in Portuguese public hospitals. A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals units. The results show a high affective and continuance commitment of nurses with the hospital, and a reduced tendency of the intention to leave. A significant positive association was also found between the intent to leave and individual/structural factors. Organizational commitment and intention to leave levels are satisfactory, despite the influence of several factors, such as nurse staffing, work environment, or other opportunities for professional development. The results identify particularly sensitive areas that, through adequate health and management policies, can reduce nurses' intentions to leave and promote the sustainability of the health system.
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Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Estudos Transversais , Hospitais , Humanos , Intenção , Satisfação no Emprego , Recursos Humanos de Enfermagem Hospitalar/psicologia , Reorganização de Recursos Humanos , Portugal , Inquéritos e QuestionáriosRESUMO
Complex systems in biology, climatology, medicine, and economy hold emergent properties such as non-linearity, adaptation, and self-organization. These emergent attributes can derive from large-scale relationships, connections, and interactive behavior despite not being apparent from their isolated components. It is possible to better comprehend complex systems by analyzing cross-correlations between time series. However, the accumulation of non-linear processes induces multiscale structures, therefore, a spectrum of power-law exponents (the fractal dimension) and distinct cyclical patterns. We propose the Multifractal detrended cross-correlation heatmaps (MF-DCCHM) based on the DCCA cross-correlation coefficients with sliding boxes, a systematic approach capable of mapping the relationships between fluctuations of signals on different scales and regimes. The MF-DCCHM uses the integrated series of magnitudes, sliding boxes with sizes of up to 5% of the entire series, and an average of DCCA coefficients on top of the heatmaps for the local analysis. The heatmaps have shown the same cyclical frequencies from the spectral analysis across different multifractal regimes. Our dataset is composed of sales and inventory from the Brazilian automotive sector and macroeconomic descriptors, namely the Gross Domestic Product (GDP) per capita, Nominal Exchange Rate (NER), and the Nominal Interest Rate (NIR) from the Central Bank of Brazil. Our results indicate cross-correlated patterns that can be directly compared with the power-law spectra for multiple regimes. We have also identified cyclical patterns of high intensities that coincide with the Brazilian presidential elections. The MF-DCCHM uncovers non-explicit cyclic patterns, quantifies the relations of two non-stationary signals (noise effect removed), and has outstanding potential for mapping cross-regime patterns in multiple domains.
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Fractais , Meteorologia , Fatores de Tempo , Projetos de Pesquisa , BrasilRESUMO
The rupture of the Fundão mining dam (Doce river basin, Brazil) caused a wide range of negative impacts. Yet, assemblage-level implications to estuarine and coastal fishes remain unclear, partly due to the lack of pre-disaster information. Based on monthly otter trawl surveys, we analyzed spatial and seasonal variability in univariate (total biomass, biomass of species vulnerable to exploitation, rarefied richness and evenness) and multivariate (species composition and trophic composition) indicators of fish biodiversity in the Doce river delta, eastern Brazil. We determined the independent and interactive effects of environmental, seasonal and spatial variables on species composition to test whether environmental alterations provoked by mine tailings could affect assemblage's organization. Most indicators present idiosyncratic spatiotemporal patterns, suggesting they have complementary roles in revealing changes in fish biodiversity. Environmental variables, including those affected by the Fundão dam collapse such as turbidity, dissolved oxygen and pH, were much more important than seasonal and spatial predictors in explaining the variation in fish species composition. These findings highlight the potential from mine tailings to disrupt local ichthyofauna and indicate a preponderant role of environmental conditions in assemblage structuring. Given the lack of data prior to rupture, our results may be used as a baseline against which to assess temporal trends in fish biodiversity relative to changes detected in less disturbed estuarine and coastal assemblages.