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INTRODUCTION: The rise of mental health problems in youth highlights the need for accessible and cost-effective psychological interventions. Blended interventions, which combine face-to-face and online sessions, can be an adequate response to the increase in demands for youth mental health services. Although this can be a promising approach, effective dissemination depends on the professionals´ acceptance. OBJECTIVES: This study aimed to explore the acceptability of and intention to use blended interventions by psychologists working with children with emotional disorders and to examine their predictors, including previous knowledge, expectancies (i.e., performance expectancy, effort expectancy, social influence, and facilitating conditions), and attitudes toward evidence-based practices. METHODS: The sample consisted of 76 Portuguese psychologists (Mage = 37.26 years, SD = 10.47; 92.1% female) working in youth mental health services. The participants completed an online protocol to evaluate the different dimensions included in the study. RESULTS: The results showed that most participants demonstrated moderate to high acceptability of blended psychological interventions for emotional disorders in youth and intend to use them in the future. Regression analysis showed that performance expectancy and positive attitudes toward evidence-based practices were significant predictors of acceptance of blended interventions and that social influence was a significant predictor of both acceptance of and intention to use blended interventions. CONCLUSION: These results emphasize the importance of sharing the findings of blended interventions, changing professionals' attitudes toward evidencebased practices, and collaborating more closely with organizations and institutions to advance standards that encourage the adoption of this intervention format.
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BACKGROUND: Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS: This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION: We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION: The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).
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Transtornos de Ansiedade , Emoções , Transtornos do Humor , Criança , Humanos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Portugal , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como AssuntoRESUMO
Social cognitive models suggest a crucial role played by perceived barriers in promoting healthy behaviors, including healthy eating. We aimed to develop a new questionnaire to assess parental perceived barriers to healthy feeding in young children and perform the instrument's preliminary psychometric evaluation. The initial pool of items was developed based on reviews and qualitative studies. First, we conducted an online, descriptive, cross-sectional study with 278 parents of 2-6-year-old children to examine its factorial structure and internal consistency. Then, a second study with 168 parents from a similar population assessed convergent/discriminant and known-groups validity. The exploratory factorial analysis confirmed the scale's theoretical structure. Five scales were found: Child-Related Barriers, Parent-Related Barriers-Vegetables and Fruit, Parent-Related Barriers-Added Sugars, Social Context-Related Barriers, and Cost-Related Barriers. All scales presented adequate reliability. We found weak to moderate, negative, and significant correlations between child- and parent-related barriers regarding vegetables and fruits, feeding practices to promote children's eating self-regulation, and food parenting self-efficacy. Additionally, parents who perceived their children as easy and well-regulated reported significantly fewer child-related barriers than parents with poorly self-regulated and inhibited children. The results support the instrument's preliminary psychometric adequacy regarding its validity and reliability and corroborate earlier empirical studies about the main parental barriers when promoting young children's healthy eating habits.
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Dieta Saudável , Comportamento Alimentar , Humanos , Criança , Pré-Escolar , Estudos Transversais , Reprodutibilidade dos Testes , Comportamento Alimentar/psicologia , Pais/psicologia , Poder Familiar/psicologia , Verduras , Inquéritos e Questionários , Hábitos , Relações Pais-FilhoRESUMO
CONTEXT: Patient-controlled analgesia (PCA) is commonly used for postoperative pain control. Although widely used, intravenous (IV) morphine PCA may not be suitable for all patients. Sufentanil sublingual tablet system (SSTS) PCA is a recent technique that has had success as a safe and effective alternative for acute pain management. AIMS: This study aims to compare both the efficacy and safety of SSTS PCA versus IV morphine PCA in postoperative pain control and the quality of recovery in adult patients following scheduled gynecological or orthopedic surgery. SETTINGS AND DESIGN: Open-label, parallel-group, randomized controlled trial with 54 patients. The primary outcome was postoperative pain control, while the secondary outcomes included adverse effects associated with two analgesic modalities, total opioid dose required, patient satisfaction, and impact on the quality of postoperative recovery. METHODS AND MATERIAL: Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was used in categorical variables. When distribution was normal, T-student (mean ± standard deviation) was used in continuous variables. In contrast, when distribution was not normal, the Mann-Whitney test (median (minimal-maximal)) was used. RESULTS: The results showed that there was a statistically significant difference in the total dose of opioid used by patients at 24 hours postoperatively, with patients receiving SSTS PCA requiring a higher total dose when compared to those receiving IV morphine PCA. However, there were no statistically significant differences in pain scores, adverse events, or patient satisfaction. CONCLUSIONS: The study suggests that both IV morphine and sublingual sufentanil are safe and effective for postoperative pain management.
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Objectives: This study aims to (1) describe parents' knowledge and use of online resources to address children's mental health issues and the family's general internet and technology usage patterns; (2) examine parents' acceptance of blended interventions for children with emotional disorders (ED); and (3) analyse the predictors of parents' intention to use a blended intervention if their children experienced an ED. Method: The sample included 164 Portuguese parents (95.7 % mothers) of children between the ages of 6 and 13 years who completed an online survey. The study was disseminated through social networks, personal contacts of the researchers, and among parents participating in a randomized controlled trial investigating the efficacy of a psychological intervention for children with ED. Results: Only 4.3 % of parents knew about online psychological interventions for children, and only 1.2 % had used them before. Most parents (73.2 %) reported that they would choose face-to-face individual therapy as their first option if their child had any ED, followed by blended therapy (14.8 %). Regression analyses showed that higher levels of parents' intention to use a blended intervention were predicted by their perceptions of the utility or efficacy of this type of delivery format. Discussion/conclusion: These results suggest that although most parents show unfamiliarity with blended psychological interventions for children, they consider it a treatment modality to which they would resort if their children had emotional difficulties. Their intention to use such an intervention seems to be more likely if they perceive it as useful and effective.
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This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers' and children's mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers' and children's mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers' anxiety and between social isolation and confinement and carers' well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families' mental health, paying special attention to families with pre-existing psychosocial vulnerabilities.
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COVID-19 , Saúde Mental , Pandemias , Isolamento Social , Adolescente , Criança , Humanos , Cuidadores/psicologia , Europa (Continente)/epidemiologiaRESUMO
Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.
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Abstract Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.
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Parada CardíacaRESUMO
A parental child-centered feeding approach is likely to keep children's biological mechanisms activated while eating, protecting them in an obesogenic context. However, few feeding practice measures assess parents' behaviors to guide and prompt children to identify and respond appropriately to their signs of hunger and satiety. We aimed to develop and study the reliability, validity, and measurement invariance of a new scale to assess parental feeding practices to promote children's self-regulation of food intake. To pursue this aim, we conducted two descriptive, cross-sectional, online studies in Portugal in an online format; a total of 536 parents of 2- to 6-year-old children completed the evaluation protocol. Factorial analysis findings support the theoretical organization proposed for the scale. The confirmatory factorial analysis supported a first-order factor structure with two subscales, Prompting for eating self-regulation and Teaching about eating consequences, with eight items in total. Both scales presented good internal consistency and adequate temporal stability, with a significant, positive, and moderate relationship. The results showed metric invariance for the child's sex. Both types of practices were positively correlated with the child's enjoyment of food. Prompting for eating self-regulation showed negative associations with parents' emotional lack of control, children's satiety responsiveness, slowness in eating, and fussiness. Preliminary studies confirmed both the validity and reliability of the instrument and the adequacy of adopting a self-regulatory approach when assessing child-centered feeding practices. Combining this instrument with others that assess coercive practices can be beneficial to capture ineffective parents' behaviors on children's eating self-regulation.
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Comportamento Infantil , Autocontrole , Humanos , Criança , Pré-Escolar , Comportamento Infantil/psicologia , Estudos Transversais , Reprodutibilidade dos Testes , Inquéritos e Questionários , Pais/psicologia , Comportamento Alimentar/psicologia , Poder Familiar , Ingestão de Alimentos/psicologiaRESUMO
Parents' emotion socialization practices are an important source of influence in the development of children's emotional competencies This study examined parental reactions to child negative emotions in a clinical sample using a cluster analysis approach and explored the associations between clusters of parents' reactions and children's and parents' adjustment. The sample comprised 80 parents of Portuguese children (aged 3-13 years) attending a child and adolescent psychiatry unit. Measures to assess parental reactions to children's negative emotions, parents' psychopathological symptoms, parents' emotion dysregulation, and children's adjustment were administered to parents. Model-based cluster analysis resulted in three clusters: low unsupportive, high supportive, and inconsistent reactions clusters. These clusters differed significantly in terms of parents' psychopathological symptoms, emotion dysregulation, and children's adjustment. A pattern characterized by high supportive reactions to the child's emotions was associated with higher levels of children's adjustment. On the other hand, an inconsistent reactions pattern was associated with the worst indicators of children's adjustment and parental emotion dysregulation. These results suggest the importance of supporting parents of children with emotional and behavioural problems so that they can be more responsive to their children's emotional manifestations.
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Relações Pais-Filho , Comportamento Problema , Adolescente , Criança , Análise por Conglomerados , Emoções/fisiologia , Humanos , SocializaçãoRESUMO
Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.
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Anestesia Obstétrica , Fístula Cutânea , Hipotensão Intracraniana , Adulto , Placa de Sangue Epidural/efeitos adversos , Placa de Sangue Epidural/métodos , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/terapia , Fístula Cutânea/etiologia , Feminino , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/terapia , Gravidez , Punção Espinal/efeitos adversosRESUMO
BACKGROUND: Caregivers' influence on young children's eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children's healthy diet should actively involve parents, focusing on their feeding behaviors and practices. METHODS: This work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2-6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children's intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents' dropout rates and the trajectories of parents' and children's outcomes are also objectives of this work. DISCUSSION: The SmartFeeding4Kids program relies on technological resources to deliver parents' self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children's food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents' attrition more effectively, besides being easy to disseminate and cost-effective. TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov ( NCT04591496 ) on October 19, 2020.
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Dieta Saudável , Poder Familiar , Criança , Pré-Escolar , Comportamento Alimentar , Humanos , Pais , Ensaios Clínicos Controlados Aleatórios como Assunto , VerdurasRESUMO
Glioblastoma multiforme (GBM) is the most aggressive and invasive malignant brain cancer. GBM is characterized by a dramatic metabolic imbalance leading to increased secretion of the pro-angiogenic factor VEGF and subsequent abnormal tumor vascularization. In 2009, FDA approved the intravenous administration of bevacizumab, an anti-VEGF monoclonal antibody, as a therapeutic agent for patients with GBM. However, the number of systemic side effects and reduced accessibility of bevacizumab to the central nervous system and consequently to the GBM tumor mass limited its effectiveness in improving patient survival. In this study, we combined experimental and computational modelling to quantitatively characterize the dynamics of VEGF secretion and turnover in GBM and in normal brain cells and simultaneous monitoring of vessel growth. We showed that sequestration of VEGF inside GBM cells, can be used as a novel target for improved bevacizumab-based therapy. We have engineered the VEGF nanotrapper, a cargo system that allows cellular uptake of bevacizumab and inhibits VEGF secretion required for angiogenesis activation and development. Here, we show the therapeutic efficacy of this nanocargo in reducing vascularization and tumor cell mass of GBM in vitro and in vivo cancer models.
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Neoplasias Encefálicas , Glioblastoma , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Humanos , Neovascularização Patológica/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/uso terapêuticoRESUMO
INTRODUCTION: Portugal has one of the highest vaccine coverage rates among European countries, associated with excellent vaccine convenience and confidence levels. Considering both the high rate of pediatric vaccination in Portugal and the excellent indicators of vaccine convenience established, an analysis of confidence and complacency indicators could help understand this positive example. This study aimed to characterize parental beliefs according to the intention to vaccinate a next child and identify cognitive and demographic predictors of that intention in a Portuguese sample. METHODS: We measured perceptions of vaccines' safety and efficacy, perceptions of the severity of vaccine-preventable diseases, beliefs related to conspiracy theories, attitudes towards immunization requirements, perceptions of social norms as predictors of the intention to vaccinate a subsequent child. We also inquired if parents had previously refused a recommended vaccine. The authors disseminated the questionnaire online to reach a diverse population of parents of 0-12 years old children. The final sample included 1,118 parents, 96.9% reported their intention to vaccinate the next child, and 3.6% had previously refused a vaccine. Two additional open-ended questions regarding motives to vaccinate or refuse a future baby's vaccination were answered by 886 parents. RESULTS: All the evaluated parental cognitive dimensions were significantly different between the group of parents who would vaccinate a next child and those who expressed the intention not to vaccinate. Beliefs about the safety and efficacy of vaccines and having fewer children were significant predictors of that intention. CONCLUSION: The vast majority of parents reported attitudes and beliefs favorable to pediatric vaccination with high consistency in all cognitive dimensions assessed. Concerns regarding pediatric vaccines' safety need to be sensitively and actively addressed by health providers to maintain excellent vaccination coverage rates.
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Web-based parent interventions designed to promote children's healthy eating patterns can enhance parents' engagement and facilitate behavior change. However, it is still unclear how much the existing programs focus on changing parental feeding practices, and if so, which behavioral methodologies are used and how effective these interventions are in changing these parental behaviors. This systematic review and meta-analysis studied randomized controlled trials of web-based interventions targeting parents of 0-12-year-old children, aiming to promote children's healthy diet or prevent nutrition-related problems and reporting parental feeding behaviors as one of the outcomes. We conducted an electronic search in four databases from the earliest publication date until February 2020. Of the 1271 records found, we retained twelve studies about nine programs, comprising 1766 parents that completed the baseline evaluation. We found recent interventions, mainly directed to parents of young children, with small, non-clinical samples, and mostly theory-based. The programs were heterogeneous regarding the type of intervention delivered and its duration. The most assessed parental feeding practices were Restriction, Pressure to eat, and Food availability/accessibility. The behavior change techniques Instruction on how to perform the behavior, Demonstration of the behavior, and Identification of self as role model were frequently used. Meta-analytic results indicated that most programs' effects were small for the evaluated parental practices, except for Food availability/accessibility that benefited the intervention group only when all follow-up measurements were considered. The development of high-quality and controlled trials with larger samples is needed to determine with greater certainty the interventions' impact on parental feeding behaviors. The more frequent inclusion of measures to evaluate parental practices to support children's autonomy and of self-regulatory strategies as intervention components should be considered when designing programs.
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Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Dieta , Comportamento Alimentar/psicologia , Intervenção Baseada em Internet , Poder Familiar/psicologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-NascidoRESUMO
BACKGROUND: Although the negative effects of the COVID-19 pandemic on mental health have attracted interest, little attention has focused on its positive effects and possible post-traumatic growth. AIMS: To assess anxiety, well-being and post-traumatic growth in carers of children aged 6-16 years in Portugal and the UK. METHOD: A cross-sectional online survey of volunteers conducted at the peak of the first wave of COVID-19 during lockdown (1 May to 27 June 2020). RESULTS: A total of 385 caregivers (Portuguese, n = 185; UK, n = 200), predominantly mothers (n = 341, 88.6%), completed the survey. The majority were working exclusively from home (n = 271, 70.4%), almost half reported a reduction in income (n = 174, 45.2%), most children were home taught (n = 358, 93%), and 75 (19.5%) identified a family member with suspected or confirmed COVID-19 infection. In total, 341 caregivers (88.6%) identified positives arising from COVID-19, most commonly related to the post-traumatic growth domains of improved relationships, a greater appreciation of life, discovering and embracing new possibilities, and positive spiritual change. A comparison of those who did (n = 341) and did not (n = 34) report any positives found a significant difference in well-being scores (t373 = 2.24, P = 0.025) but not in anxiety scores (t373 = 0.75, P = 0.45). CONCLUSIONS: Despite experiencing considerable adversity, examples of post-traumatic growth during the lockdown were common. Although the voluntary online nature of our survey is a limitation, our findings suggest that further research exploring post-traumatic growth following pandemics is warranted.
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The use of robots to map disaster-stricken environments can prevent rescuers from being harmed when exploring an unknown space. In addition, mapping a multi-robot environment can help these teams plan their actions with prior knowledge. The present work proposes the use of multiple unmanned aerial vehicles (UAVs) in the construction of a topological map inspired by the way that bees build their hives. A UAV can map a honeycomb only if it is adjacent to a known one. Different metrics to choose the honeycomb to be explored were applied. At the same time, as UAVs scan honeycomb adjacencies, RGB-D and thermal sensors capture other data types, and then generate a 3D view of the space and images of spaces where there may be fire spots, respectively. Simulations in different environments showed that the choice of metric and variation in the number of UAVs influence the number of performed displacements in the environment, consequently affecting exploration time and energy use.
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This paper reviews the available research on the predictors of parental engagement in preventive and therapeutic psychological interventions that target mental health problems in children. Based on previous literature, seven predictors concerning parental motivation to engage are considered: perceived child problems, perceived parenting, attributions of problems, self-efficacy, expectations about treatment, perceived obstacles and global motivation to engage. PRISMA guidelines for systematic review were used to conduct the literature search. Thirty-seven studies that examined prospective relations between parental cognitions evaluated at the beginning of the intervention and parental engagement during the intervention were included. Most studies focused on the parents' perception of the child's problems and of parenting, with fewer studies examining the role of the other parental cognitions. The results suggest that the psychological dimensions proposed in motivational models may play an important role in understanding parental engagement in preventive and therapeutic psychological interventions.
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Cognição , Transtornos do Neurodesenvolvimento , Relações Pais-Filho , Pais/psicologia , Adulto , Criança , Humanos , Modelos Psicológicos , Motivação , Transtornos do Neurodesenvolvimento/psicologia , Transtornos do Neurodesenvolvimento/terapia , Poder Familiar/psicologia , Prognóstico , AutoeficáciaRESUMO
BACKGROUND: Previous research has focused on parenting styles and parental behaviors associated with children's anxiety. Parental beliefs about their child's anxiety have scarcely been studied, in spite of their probable influence in parents seeking help. The present study intended to fil that gap, by exploring what parents think about their children's anxiety and whether these cognitions are related or not to their use of professional help. METHOD: In-depth semistructured interviews were conducted with 48 parents (50% fathers) of children (9-12 years old) with anxiety problems. Theoretical thematic analysis was performed on the transcripts. RESULTS: Three dimensions were derived from the analysis, concerning (a) the causes of child's anxiety, (b) the impact of anxiety in the child's functioning, and (c) the evolution of anxiety. Most parents perceived the child's anxiety as a permanent condition, attributing it to external and parental factors and considering that the anxiety problems have a negative impact on the child's well-being. Plus, parents who had previously sought professional help for the child's emotional problems tended to believe that anxiety could improve with child's or parents' efforts and with professional guidance, contrarily to those who had not. Implications for research and clinical practice are discussed. CONCLUSION: The present study highlighted important parental beliefs about their children's anxiety that might influence their attitudes and decisions (e.g., seek for professional help). Other parental cognitions should be investigated in order to understand parenting in the context of childhood anxiety.