Diaphragmatic eventration as a first sign of Scimitar syndrome.

Diaphragmatic eventration is an anomaly of the diaphragm. In Scimitar syndrome, a curved-shaped anomalous pulmonary venous drainage is seen. Association between these conditions is rare. We present a newborn with diaphragmatic eventration, whose diagnosis of Scimitar syndrome was made after surgical repair. Scimitar syndrome is a congenital disorder often associated with other heart and lungs anomalies. Diagnosis can be fortuitous but with important prognostic features.

Occupational Goal Intervention Method for the Management of Executive Dysfunction in People With Treatment-Resistant Schizophrenia: A Randomized Controlled Trial.

IMPORTANCE: The occupational goal intervention (OGI) method has been proven effective in improving executive function (EF) in people with schizophrenia, but it has not yet been tested with those with treatment-resistant schizophrenia (TRS). OBJECTIVE: To test the efficacy of the OGI in people with TRS. DESIGN: Single-blind randomized controlled trial. SETTING: The Schizophrenia Program, Institute of Psychiatry, University of São Paulo General Hospital, Brazil. PARTICIPANTS: People with TRS according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, ages 18 to 55. Outcomes and Measures: Primary outcome: improvement in EF as measured by the Behavioural Assessment of the Dysexecutive Syndrome (BADS). SECONDARY OUTCOMES: improvement of functionality, as measured by the Direct Assessment of Functional Status-Revised (DAFS-BR), and improvement in autonomy in activities of daily living (ADLs), as measured by the Independent Living Skills Survey (ILSS-BR), administered to caregivers. The outcomes were measured at baseline, posttreatment, and follow-up. INTERVENTION: Participants were divided into two groups: OGI and craft activities (control). Each group participated in 30 sessions during 15 wk, with follow-up at 6 mo postintervention. RESULTS: The OGI group improved significantly compared with the control group, with medium to large effect sizes in posttreatment scores on the BADS and DAFS-BR. The ILSS-BR showed the highest effect sizes at posttreatment and follow-up. CONCLUSIONS AND RELEVANCE: The OGI method is effective for improving EF, occupational performance and ADLs in people with TRS. What This Article Adds: The OGI method is an important therapeutic tool for use in the occupational therapy clinic.

The Brief Negative Symptom Scale: Validation in a multicenter Brazilian study.

BACKGROUND: Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia. METHODS: The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS). RESULTS: Assessment of patients by both instruments revealed an excellent internal consistency (Cronbach's alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. CONCLUSION: The study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.

Children then, adults now: long-term outcomes-performance at 15, 20, and 25 years of cochlear implant use.

Motivation: Severe to profound sensorineural hearing loss interferes with a child's development at the cognitive, linguistic, academic, and social levels. Since the beginning of the pediatric auditory rehabilitation program through cochlear implantation in the Ear, Nose, and Throat (ENT) Service of the Coimbra Hospital and University Center (CHUC), Portugal, its mentors defended the early diagnosis of hearing loss followed by timely intervention, and this was considered the starting point to optimize (re)habilitation through this method. Three decades or so later, recently we conducted this study to evaluate the performance of patients implanted in the initial phase of the cochlear implantation program. Objectives: The study aimed to evaluate the performance of individuals with severe to profound congenital hearing loss who underwent pediatric cochlear implantation and have used the cochlear implant for at least 25 years, to analyze the beneficial effect of early intervention in improving performance results. Methods: The study sample is composed of 31 individuals with severe to profound congenital hearing loss and no other comorbidities, divided into two groups (Group 1: age at implantation was under 3 years; Group 2: age at implantation was over 3 years). All 31 subjects were evaluated at 15, 20, and 25 years of cochlear implant (CI) use with a comprehensive set of tests. In addition, data were collected regarding the academic level of each participant. The results of both groups were compared to find out if there is an effect of age at implantation on auditory performance, and if there is an improvement in the performance with CI over time (15, 20, and 25 years of use). Results: The results show that there is a positive effect, with statistical significance, of early implantation on auditory performance, and telephone use. In both groups, there is an increase in performance over time, but it tends to stabilize after 20 years of CI use. Discussion and conclusion: The results obtained in this work support the importance of early intervention in patients with severe to profound hearing loss who are cochlear implant users and show that CI is an effective and reliable method in the treatment of these patients, contributing to their improved socio-educational integration, and that the benefits last over time.

Psychological demands of health professionals in the initial phase of the COVID-19 pandemic.

Recent literature emphasizes how the specific stressors of the COVID-19 outbreak affect the general population and frontline professionals, including those conducting support or backup activities in health units, which can lead to vicarious traumatization. Vicarious traumatization has been used to describe negative emotional reactions in mental health professionals who assist or treat victims of traumatic events. Thus, the aim of this article is to report the actions used in the face of the psychological demands of professionals in a hospital, who were not on the frontline of COVID-19. We collected their sociodemographic information and checked the psychological impact using the depression, anxiety, and stress scale (DASS-21), which was followed by a psychoeducational program (topics related to COVID-19 control and prevention), and individual psychological care for the most severe cases. A total of 118 professionals participated in this study; they were between 20 and 67 years old. Mild to moderate anxiety was observed in 36.5% of the medical teams, 83.3% of the administrative staff, and 65.7% of general service workers, while stress symptoms were observed in 80.2%, 83.3%, and 59.9%, respectively. Depressive symptoms (35.3%) were more frequent in general service workers. The medical teams reported the benefits of primary psychological care, while the other professionals demanded more institutional support services related to the prevention and use of personal protective equipment. This study highlights relevant psychological demands that have repercussions on the daily lives of professionals. The psychoeducational program was considered positive regarding clarification actions. However, it was not perceived as effective in reducing fear, which may result from vicarious traumatization and requires other intervention modalities.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned.

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

Performance of Intergrowth 21st Growth Charts in the Diagnosis of Small and Large for Gestational Age in Term and Preterm Newborns.

INTRODUCTION: Birth weight is a major contributor to neonatal morbidity and mortality and is associated with chronic diseases in adulthood. This study aimed to evaluate the use of Intergrowth 21st instead of the Fenton & Kim 2013 growth charts in the diagnosis of small and large for gestational age in a group of Portuguese newborns. MATERIAL AND METHODS: We conducted an analytical and retrospective study to evaluate birth weight of term and preterm newborns using both growth charts. Groups studied: 'Term-weeks' and 'Term-days' (term newborns with gestational age in weeks and days, respectively), 'Preterm-weeks' and 'Preterm-days' (preterm newborns with gestational age in weeks and days, respectively). RESULTS: A total of 14 056 newborns were included, 6% preterm. Using the Intergrowth 21st growth charts, the groups 'Term-weeks' (n = 12 081), 'Term-days' (n = 1118), 'Preterm-weeks' (n = 617) and 'Preterm-days' (n = 240), classified as small for gestational age according to the Fenton & Kim 2013 growth charts were adequate for gestational age in 52.8%, 57.8%, 37.7% and 9.3% respectively; and 9.2%, 9.2%, 5.9% and 0.6% of adequate for gestational age newborns were large for gestational age, respectively. In the 'Pretermdays' group, 7.9% of adequate for gestational age newborns were small for gestational age and 22.2% of large for gestational age newborns were adequate for gestational age, all with gestational age below 231 days. DISCUSSION: The use of the Intergrowth 21st growth charts in this sample resulted in a lower number of newborns being classified as small for gestational age, except in very preterm newborns. CONCLUSION: Considering the results obtained, we suggest that Portuguese maternity hospitals use the Intergrowth 21st instead of the Fenton & Kim 2013 growth charts. However, more studies are needed to confirm these results.

[Hospital Inpatient Use in Mainland Portugal by Children with Complex Chronic Conditions (2011 - 2015)]. / Utilização do Internamento Hospitalar em Portugal Continental por Crianças com Doenças Crónicas Complexas (2011 ­ 2015).

INTRODUCTION: Due to epidemiological change, interest in complex chronic conditions has been increasing within the pediatric health system. As such, we aim to evaluate hospital inpatient care in the National Health Service (mainland Portugal) by pediatric patients (0 - 17 years) with complex chronic conditions. MATERIAL AND METHODS: Observational longitudinal retrospective epidemiological study using anonymized administrative data. We selected hospitalizations within the pediatric age limit, 2011 - 2015; healthy newborns and radiotherapy outpatients were excluded. A descriptive analysis of the admissions with complex chronic conditions was analysed by number of complex chronic conditions categories and by complex chronic conditions categories. Non-parametric tests were applied to length of stay, expense, and mortality. RESULTS: Out of 419 927 admissions, 64 918 (15.5%) contained at least one complex chronic conditions code. These admissions due to complex chronic conditions represented 29.8% of hospital days, 39.4% of expense and 87.2% of deaths. Compared to those without complex chronic conditions, expense was double (median €1467 vs €745) and mortality 40 times higher (2.4% vs 0.06%). Of these, 46% were planned (no complex chronic conditions 23.2%); 64.8% occurred in group III - IV hospitals (no complex chronic conditions 27.1%). Malignant was the most frequent category (23.0%); neonatal had the highest median length of stay (12 days, 6 - 41), median expense (€3568,929 - 24 602), and number of deaths (43.5% of total). DISCUSSION: As in other developed countries where the number of pediatric admissions is decreasing, in mainland Portugal we found an increase in the proportion of complex chronic conditions admissions, which are longer, costlier and deadlier (trends intensified in the presence of two or more complex chronic conditions categories). CONCLUSION: Complex chronic conditions are relevant in the activity and costs regarding pediatric hospitalizations in mainland Portugal. Recognizing this and integrating pediatric palliative care from the moment of diagnosis are essential to promote appropriate hospital use, through the development of effective and sustainable alternatives that meet the needs of children, families, and healthcare professionals.

Introdução: Fruto da mudança epidemiológica, o interesse pelas doenças crónicas complexas no sistema de saúde pediátrico tem vindo a crescer. Assim, pretendemos avaliar a utilização do internamento hospitalar do Serviço Nacional de Saúde (Portugal Continental) por doentes pediátricos (0 ­ 17 anos) com doenças crónicas complexas. Material e Métodos: Estudo epidemiológico observacional longitudinal retrospetivo (base de dados de morbilidade hospitalar anonimizada). Selecionámos episódios de internamento de doentes pediátricos, entre 2011 ­ 2015; excluímos recém-nascidos saudáveis e radioterapia ambulatória. Análise descritiva dos episódios de internamento de doentes pediátricos com doenças crónicas complexas, caracterizados por número e categoria de doenças crónicas complexas. Foram aplicados testes não paramétricos à duração de internamento, despesa e mortalidade. Resultados: Nos 419 927 episódios, constavam códigos de doenças crónicas complexas em 64 918 (15,5%). Estes episódios com doenças crónicas complexas representaram 29,8% dos dias de internamento, 39,4% da despesa e 87,2% dos óbitos. Custaram o dobro dos episódios sem doenças crónicas complexas (€1467 vs €745) e tiveram uma mortalidade 40 vezes superior (2,4% vs 0,06%). Do total, 46,0% foram programados (sem doenças crónicas complexas 23,2%); 64,8% ocorreram em hospitais grupo III ­ IV (sem doenças crónicas complexas 27,1%). Nos episódios com doenças crónicas complexas, a doença maligna foi a categoria mais frequente (23,0%); a maior demora mediana (12 dias, 6 ­ 41), despesa mediana (€3568,929 ­ 24 602) e mortalidade (13,4%) verificaram-se na categoria neonatais. Discussão: Esta análise mostrou que, embora o número absoluto de internamentos de doentes pediátricos esteja a diminuir em Portugal Continental, à semelhança de outros países desenvolvidos, os internamentos com doenças crónicas complexas têm vindo a aumentar proporcionalmente, sendo mais prolongados, onerosos e com maior probabilidade de morte do que os episódios sem doenças crónicas complexas (tendências acentuadas quando constam duas ou mais doenças crónicas complexas). Conclusão: As doenças crónicas complexas são relevantes na atividade e despesa do internamento hospitalar pediátrico em Portugal Continental. Este reconhecimento e a integração de cuidados paliativos pediátricos desde o diagnóstico são essenciais para adequar a utilização do hospital, desenvolvendo alternativas efetivas e sustentáveis que vão ao encontro das necessidades das crianças, famílias e profissionais.

Sleep habits in infants: the role of maternal education.

OBJECTIVE: Sleep disturbances are frequent in infants. Early development of sleep routines has a positive effect on sleep quality. The objective of this study was to assess the impact of maternal education on the development of infants' sleep habits (SHs). METHODS: This was an experimental, longitudinal study. Postnatal mothers were allocated into two groups: to receive (intervention group, IG), or not receive (control group, CG) information on sleep hygiene. Individual 15-min sessions were provided and a leaflet was handed to the IG. A questionnaire on infants' SHs was applied by telephone/e-mail at 1, 2, 4, and 6 months of age. RESULTS: At least three questionnaires were answered by 314 mothers. Results were adjusted for maternal age, education, and race. In the IG, infants acquired more independent sleep habits, an effect still present at six months; slept more frequently in their own beds; adjusted odds ratio (ORadj) 3.8, 95% confidence interval (CI) (1.1-13.5); fell asleep more frequently alone (ORadj, 4.29; 95% CI, 2.4-7.6); fell asleep more frequently in their own beds (ORadj, 6.1; 95% CI, 3.5-10.6) and needed less breast/bottle feeding to fall asleep (ORadj, 2.68; 95% CI, 1.5-4.6). The autonomy was greater in IG infants after night awakenings; also until six months they went back to sleep more frequently alone (ORadj, 3.88; 95% CI, 2-7.5) and needed less breast/bottle feeding (ORadj, 2.35; 95% CI, 1.3-4.3). No differences were found regarding the need for light, television or other routines to fall asleep or after night awakenings. CONCLUSION: Maternal education is positively associated with the adoption of autonomous SHs in infants. Early maternal education is an adequate prevention strategy to be considered in neonatal care.

Psychological demands of health professionals in the initial phase of the COVID-19 pandemic

Abstract Recent literature emphasizes how the specific stressors of the COVID-19 outbreak affect the general population and frontline professionals, including those conducting support or backup activities in health units, which can lead to vicarious traumatization. Vicarious traumatization has been used to describe negative emotional reactions in mental health professionals who assist or treat victims of traumatic events. Thus, the aim of this article is to report the actions used in the face of the psychological demands of professionals in a hospital, who were not on the frontline of COVID-19. We collected their sociodemographic information and checked the psychological impact using the depression, anxiety, and stress scale (DASS-21), which was followed by a psychoeducational program (topics related to COVID-19 control and prevention), and individual psychological care for the most severe cases. A total of 118 professionals participated in this study; they were between 20 and 67 years old. Mild to moderate anxiety was observed in 36.5% of the medical teams, 83.3% of the administrative staff, and 65.7% of general service workers, while stress symptoms were observed in 80.2%, 83.3%, and 59.9%, respectively. Depressive symptoms (35.3%) were more frequent in general service workers. The medical teams reported the benefits of primary psychological care, while the other professionals demanded more institutional support services related to the prevention and use of personal protective equipment. This study highlights relevant psychological demands that have repercussions on the daily lives of professionals. The psychoeducational program was considered positive regarding clarification actions. However, it was not perceived as effective in reducing fear, which may result from vicarious traumatization and requires other intervention modalities.

A pilot randomized controlled trial of the Occupational Goal Intervention method for the improvement of executive functioning in patients with treatment-resistant schizophrenia.

Schizophrenia is a chronic disabling mental disorder that involves impairments in several cognitive domains, especially in executive functions (EF), as well as impairments in functional performance. This is particularly true in patients with Treatment-Resistant Schizophrenia (TRS). The aim of this study was to test the efficacy of the Occupational Goal Intervention (OGI) method for the improvement of EF in patients with TRS. In this randomized, controlled, single-blind pilot study, 25 TRS patients were randomly assigned to attend 30 sessions of either OGI or craft activities (control) over a 15-week period and evaluated by the Behavioural Assessment of the Dysexecutive Syndrome (BADS) as the primary outcome and the Direct Assessment of Functional Status (DAFS-BR) as well as the Independent Living Skills Survey (ILSS-BR) as secondary outcomes, all adapted for the Brazilian population. The Positive and Negative Syndrome Scale (PANSS) was used for monitoring symptom severity. Results showed significant statistical differences, favoring the OGI group in terms of improvement on the BADS, both in subtests (Action Program and Key Search) and the total score. Improvements in EFs were observed by families in various dimensions as measured by different subtests of the ILSS-BR inventory. The OGI group showed no significant results in secondary outcomes (DAFS-BR) except in terms of improvement of communication skills. Although preliminary, our results indicate that the OGI method is efficacious and effective for patients with TRS.

Ecological restoration across the Mediterranean Basin as viewed by practitioners.

Restoration efforts in the Mediterranean Basin have been changing from a silvicultural to an ecological restoration approach. Yet, to what extent the projects are guided by ecological restoration principles remains largely unknown. To analyse this issue, we built an on-line survey addressed to restoration practitioners. We analysed 36 restoration projects, mostly from drylands (86%). The projects used mainly soil from local sources. The need to comply with legislation was more important as a restoration motive for European Union (EU) than for non-EU countries, while public opinion and health had a greater importance in the latter. Non-EU countries relied more on non-native plant species than EU countries, thus deviating from ecological restoration guidelines. Nursery-grown plants used were mostly of local or regional provenance, whilst seeds were mostly of national provenance. Unexpected restoration results (e.g. inadequate biodiversity) were reported for 50% of the projects and restoration success was never evaluated in 22%. Long term evaluation (>6years) was only performed in 31% of cases, and based primarily on plant diversity and cover. The use of non-native species and species of exogenous provenances may: i) entail the loss of local genetic and functional trait diversity, critical to cope with drought, particularly under the predicted climate change scenarios, and ii) lead to unexpected competition with native species and/or negatively impact local biotic interactions. Absent or inappropriate monitoring may prevent the understanding of restoration trajectories, precluding adaptive management strategies, often crucial to create functional ecosystems able to provide ecosystem services. The overview of ecological restoration projects in the Mediterranean Basin revealed high variability among practices and highlighted the need for improved scientific assistance and information exchange, greater use of native species of local provenance, and more long-term monitoring and evaluation, including functional and ecosystem services' indicators, to improve and spread the practice of ecological restoration.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

Herlyn-Werner-Wunderlich and Prader-Willi syndromes: more than a coincidence?

A neonate with a prenatal diagnosis of left renal agenesis was born at 33 weeks gestation. A postnatal abdominal ultrasound confirmed the absence of the left kidney and revealed two non-divergent hemiuteri, consistent with the diagnosis of Herlyn-Werner-Wunderlich syndrome. During admission, significant axial hypotonia was noted, warranting additional investigations. Brain ultrasounds and MRI were normal, as were a preliminary metabolic study and comparative genomic hybridisation array. DNA methylation testing confirmed the diagnosis of Prader-Willi syndrome. The baby was discharged after 70 days, breast feeding and with modest hypotonia improvement.

Neonatal McCune-Albright syndrome with systemic involvement: a case report.

INTRODUCTION: McCune-Albright syndrome is a rare sporadic disease characterized by fibrous bone dysplasia, café-au-lait skin spots and variable hyperfunctional endocrinopathies. McCune-Albright syndrome is caused by somatic postzygotic activating mutations in the GNAS gene that produce a broad spectrum of effects. CASE PRESENTATION: We report a case of McCune-Albright syndrome with multi-organ manifestations in the neonatal period. A newborn preterm black girl was referred to our Neonatal Intensive Care Unit at the age of 17 days for suspected extrahepatic cholestasis. On clinical examination she presented failure to thrive, jaundice, hypertension, marked hypotonia and café-au-lait spots on her back and lower limbs. An abdominal ultrasound excluded extrahepatic causes of cholestasis but revealed bilateral serpiginous adrenal hyperplasia. These clinical findings suggested a diagnosis of McCune-Albright syndrome with multi-organ involvement. Laboratory data confirmed adrenocorticotropic hormone-independent Cushing's syndrome, hyperthyroidism, cholestasis and elevated transaminases. Ventricular hypertrophy was demonstrated by echocardiography. The baby girl underwent medical treatment of Cushing's syndrome with metyrapone which was followed by a rapid recovery. A mosaic activating GNAS gene mutation was found on DNA extracted from a buccal swab sample. However, she died at 4 months due to a respiratory infection. CONCLUSION: In the neonatal period the diagnosis of McCune-Albright syndrome depends on having a high index of suspicion and café-au-lait spots may be the clue for the diagnosis.

Auditory rehabilitation after cochlear implantation in adults with hearing impairment after head trauma.

INTRODUCTION: In this paper, the authors analyze the auditory rehabilitation after cochlear implantation in adults with hearing impairment after head trauma, comparing their performance with that of other cochlear implant (CI) adult users who have post-lingual hearing impairment with other etiologies. METHODS: The participants were divided into two groups: group 1 (N = 14) composed of CI adult users who have acquired severe to profound hearing loss after head trauma; group 2 (N = 231) composed of CI adult users who have severe to profound hearing loss from other etiologies. Performance was assessed using the following tests: tonal audiometry, speech audiometry, consonantal phonemes identification test, 100 words test, 100 words through the telephone test, monosyllables test, numbers test, sentences test, and sentences through the telephone test. RESULTS: Average results from group 1 were lower when compared with those of group 2 in all the tests used. No statistically significant difference was found for most tests. Statistically significant difference was found for consonantal phonemes identification test, 100 words through the telephone test, monosyllables test (when analyzed regarding the phonemes correctly repeated), and sentences through the telephone test. DISCUSSION: The performance of the group of CI adult users who have acquired hearing impairment after head trauma was globally lower than that observed on the group of hearing impairment with other etiologies. However, the difference was not statistically significant for most tests. Despite this difference in performance, the results from the group of CI adult users who have acquired hearing impairment after head trauma show the effectiveness of auditory rehabilitation through cochlear implantation in these situations.

[European Portuguese EARS test battery adaptation]. / Adaptação da bateria de testes EARS ao Português Europeu.

INTRODUCTION: The use of adequate assessment tools in health care is crucial for the management of care. The lack of specific tools in Portugal for assessing the performance of children who use cochlear implants motivated the translation and adaptation of the EARS (Evaluation of Auditory Responses to Speech) test battery into European Portuguese. This test battery is today one of the most commonly used by (re)habilitation teams of deaf children who use cochlear implants worldwide. The goal to be achieved with the validation of EARS was to provide (re)habilitation teams an instrument that enables: (i) monitoring the progress of individual (re)habilitation, (ii) managing a (re)habilitation program according to objective results, comparable between different (re)habilitation teams, (iii) obtaining data that can be compared with the results of international teams, and (iv) improving engagement and motivation of the family and other professionals from local teams. MATERIAL AND METHODS: For the test battery translation and adaptation process, the adopted procedures were the following: (i) translation of the English version into European Portuguese by a professional translator, (ii) revision of the translation performed by an expert panel, including doctors, speech-language pathologists and audiologists, (iii) adaptation of the test stimuli by the team's speechlanguage pathologist, and (iv) further review by the expert panel. RESULTS: For each of the tests that belong to the EARS battery, the introduced adaptations and adjustments are presented, combining the characteristics and objectives of the original tests with the linguistic and cultural specificities of the Portuguese population. DISCUSSION: The difficulties that have been encountered during the translation and adaptation process and the adopted solutions are discussed. Comparisons are made with other versions of the EARS battery. CONCLUSION: We defend that the translation and the adaptation process followed for the EARS test battery into European Portuguese was correctly conducted, respecting the characteristics of the original instruments and adapting the test stimuli to the linguistic and cultural reality of the Portuguese population, thus meeting the goals that have been set.

Introdução: A utilização de instrumentos de avaliação em saúde adequados é fundamental na gestão da prestação de cuidados. A escassez, em Portugal, de instrumentos específicos para a avaliação do desempenho de crianças utilizadoras de implantes cocleares motivou o trabalho de tradução e de adaptação da bateria de testes EARS (Evaluation of Auditory Responses to Speech) para o português europeu. Esta bateria de testes é hoje um dos instrumentos mais comummente utilizados por equipas de (re)habilitação de crianças surdas com implantes cocleares em todo o mundo. O objetivo a atingir com a validação do EARS foi fornecer às equipas de (re)habilitação um instrumento que permita: (i) monitorizar a evolução individual da reabilitação; (ii) gerir um programa de (re)habilitação de acordo com resultados objetivos, comparáveis entre diferentes equipas de (re)habilitação; (iii) obter dados comparáveis comequipas internacionais; e (iv) melhorar a adesão e a motivação da família e restantes profissionais no ambulatório.Material e Métodos: No processo de tradução e de adaptação da bateria de testes, os procedimentos adotados foram os seguintes: (i) tradução da versão inglesa para português europeu por um tradutor profissional; (ii) revisão dessa tradução realizada por um painel de especialistas constituído por otorrinolaringologistas, terapeutas da fala e técnicos de audiologia; (iii) adaptação dos estímulos de teste pela equipa de terapeutas da fala; e (iv) nova revisão por parte do painel de especialistas.Resultados: São apresentados, para cada um dos instrumentos que compõem a bateria EARS, as adaptações introduzidas, conciliando as características e os objetivos originais dos instrumentos com as particularidades linguísticas e culturais da população portuguesa.Discussão: São discutidas as dificuldades encontradas durante o processo de tradução e de adaptação e as soluções adotadas. São feitas comparações com outras versões da bateria EARS.Conclusão: Considera-se que o processo de tradução e adaptação da bateria de testes EARS para o português europeu foi realizado de forma apropriada, respeitando as características dos instrumentos originais e adequando os estímulos de teste à realidade linguística e cultural da população portuguesa, cumprindo assim os objetivos propostos.

Hepatic subcapsular haematoma in a premature newborn.

Subcapsular haematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. It is a catastrophic condition that can be caused by maternal, placentar or fetal factors. A high index of suspicion is essential for early identification and stabilisation of babies with such a pathology. In a newborn with hypovolemic shock and abdominal distension, haemoperitoneum should be suspected and, along with exclusion of other aetiologies, supportive therapy should be instituted. The hepatic subcapsular haematoma has a non-specific presentation, and should be considered in very low birth weight infants with hypovolemic shock. Abdominal ultrasonography is the investigation of choice. It can delineate the lesion well, differentiate it from neoplasms, rule out rupture and aid in serial follow-up. We report a premature newborn who had this uncommon condition in the early neonatal period and survived without sequelae.

Cognitive training for schizophrenia in developing countries: a pilot trial in Brazil.

Cognitive deficits in schizophrenia can massively impact functionality and quality of life, furthering the importance of cognitive training. Despite the development of the field in Europe and in the United States, no programmes have been developed and tested in developing countries. Different cultural backgrounds, budget restrictions, and other difficulties may render treatment packages created in high income countries difficult for adoption by developing nations. We performed a pilot double-blind, randomized, controlled trial in order to investigate the efficacy and feasibility of an attention and memory training programme specially created in a developing nation. The intervention used simple, widely available materials, required minimal infrastructure, and was conducted in groups. The sample included seventeen stable Brazilians with schizophrenia. Sessions were conducted weekly during five months. The cognitive training group showed significant improvements in inhibitory control and set-shifting over time. Both groups showed improvements in symptoms, processing speed, selective attention, executive function, and long-term visual memory. Improvements were found in the control group in long-term verbal memory and concentration. Our findings reinforce the idea that cognitive training in schizophrenia can be constructed using simple resources and infrastructure, facilitating its adoption by developing countries, and it may improve cognition.