Cocaine-induced stroke in a young patient / Acidente vascular cerebral induzido por cocaína em paciente jovem

The case report presented here addresses the relationship between cocaine use and stroke. A young adult patient arrived at a specialized unit with neurological deficits and a history of acute and long-term illicit drug use and presented no other comorbidities. In addition, he presented laboratory and serological tests without alterations. The only risk factor identified for stroke was, therefore, cocaine use. Thus, this work points to an eventual relationship between cocaine use and the case in question (AU).

O relato de caso apresentado neste trabalho, aborda a relação do uso da cocaína e o acidente vascular cerebral após um paciente adulto jovem chegar a uma unidade especializada com déficits neurológicos e histórico de uso de drogas ilícitas de forma aguda e de longa data, sem outras comorbidades constatadas. Além disso, apresentou exames laboratoriais e sorológicos sem alterações significativas. O único fator de risco identificado no caso em tela para o acidente vascular foi, portanto, o uso de cocaína. Assim, neste trabalho, enfatiza-se eventual relação entre o uso da cocaína com o caso em tela (AU).

Spatio-temporal trends of the age-at-menarche percentiles among Portuguese women since 1920.

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.

Health education provided by nurses to children and young people: parents' assessment.

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.

Sentimentos de estudantes de mestrado diante a morte da pessoa em situação crítica / Feelings of students in a master's in nursing program facing the death of patients in a critical situation

A morte faz parte do quotidiano da vida dos enfermeiros, principalmente quando lidam com pacientes em situação crítica. A forma como percecionam a morte pode ser relevante para uma prestação de cuidados humanizados. Objetivo: identificar quais os sentimentos de estudantes de um programa de mestrado perante a morte e a sua influência na prestação de cuidados a pacientes críticos. Método: Trata-se de uma pesquisa de abordagem qualitativa, aprovada pela comissão de ética da Universidade (Doc11/CE/2018 de 09/04/2018). Realizaram-se entrevistas a 11 estudantes, processadas por análise de conteúdo. Resultados: os principais sentimentos associados à morte dos pacientes foram: impotência, frustração/revolta, tristeza/angústia, aceitação, alívio e distanciamento. Conclusão: os estudantes criam barreiras emocionais para gerir o sofrimento dos pacientes com que lidam, sendo importante que estas não comprometam a qualidade dos cuidados. Os sentimentos dos estudantes perante a morte influenciam positivamente o cuidado ao paciente crítico, pois as vivências e experiência de vida permitem-lhes prestá-los com mais serenidade

Death is part of nurses' daily lives, especially when they deal with patients in critical situations. The way they perceive death may be relevant for providing humanized care. Objective: to identify the feelings of students of a master's program towards death and its influence on care provided to critical patients. Method: This is a study with a qualitative approach, approved by the ethics committee of the University (Doc11/CE/2018 of 09/04/2018). Interviews were carried out with 11 students, processed by content analysis. Results: the main feelings associated with the death of patients were: impotence, frustration/revolt, sadness/anguish, acceptance, relief, and distancing. Conclusion: students create emotional barriers to manage the suffering of the patients they deal with, and it is important that these do not compromise the quality of care. Students' feelings towards death positively influence critical patient care, as their experiences and life experience allow them to provide care more calmly.

The geography of the age at menopause in central Portugal since the early twentieth century.

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.

Is age at menopause decreasing? - The consequences of not completing the generational cohort.

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.

Occupational nursing in portugal: context and perspectives / Enfermería del trabajo en portugal: contexto y perspectivas / Enfermagem do trabalho em portugal: contexto e perspetivas

Objective: to know the perception of nurses at work regarding the areas of knowledge and intervention. Method: quantitative, descriptive and cross-sectional study. It involved a sample of 472 occupational nurses. A questionnaire was used as a data collection instrument, which took place between May and September 2017, based on the core areas of knowledge and competencies of the occupational nurse and on the scale of perception of the areas of knowledge and intervention of the occupational nurse. Results: Occupational Nursing was understood by the majority as a transitory professional activity, because it was exercised as a financial complement to the main activity or because they could not be placed in the area of professional practice of their preference. Conclusion: the professional practice in the areas of knowledge and intervention was devalued or not recognized and seen by the majority of nurses as transitory, because almost half aspire to work in the future in this area, but only on a part-time basis.

Objetivo: conocer la percepción de las enfermeras en el trabajo con respecto a las áreas de conocimiento e intervención. Método: estudio cuantitativo, descriptivo y transversal. Involucró una muestra de 472 enfermeras de trabajo. Se utilizó un cuestionario como instrumento de recolección de datos, que tuvo lugar entre mayo y septiembre de 2017, basado en las áreas nucleares de conocimiento y competencias de la enfermera de trabajo y en la escala de percepción de las áreas de conocimiento e intervención de la enfermera de trabajo. Resultados: la Enfermería Ocupacional fue entendida por la mayoría como una actividad profesional transitoria, porque se ejercía como complemento económico de la actividad principal o porque no podían ubicarse en el área de práctica profesional de su preferencia. Conclusión: la práctica profesional en las áreas de conocimiento e intervención fue devaluada o no reconocida y vista por la mayoría de las enfermeras como transitoria, porque casi la mitad aspira a trabajar en el futuro en esta área, pero solo a tiempo parcial.

Objetivo: conhecer a perceção dos enfermeiros do trabalho no que respeita às áreas de conhecimento e intervenção. Método: estudo quantitativo, descritivo e transversal. Envolveu amostra de 472 enfermeiros do trabalho. Utilizou-se como instrumento de recolha de dados, que decorreu entre maio e setembro de 2017, questionário, alicerçado nas áreas nucleares de conhecimentos e competências do enfermeiro do trabalho e na escala de perceção das áreas de conhecimento e intervenção do enfermeiro do trabalho. Resultados: a Enfermagem do Trabalho foi entendida pela maioria como atividade profissional transitória, pelo facto de ser exercida como complemento financeiro à atividade principal ou porque não conseguiram colocação na área de exercício profissional da sua preferência. Conclusão: o exercício profissional nas áreas de conhecimento e intervenção foi desvalorizado ou não reconhecido e encarado pela maioria dos enfermeiros como transitório, pelo facto de quase metade ambicionar trabalhar no futuro nessa área, mas apenas em regime de tempo parcial.

Influence of the COVID-19 Pandemic in Higher Education Courses in the Health Field

It is a fact that no one expected what took place in the world as of the end of 2019. And yes, I am talking about the ill-fated, damned and inconvenient COVID-19, which quickly spread around the globe, having been declared a pandemic by the World Health Organization in March 2020.(1) In the face of such a threat, not virtual, but very real, the need existed to undertake various measures that could interrupt the transmission of the infection by implementing, for example, restrictions on the movement of people, social distancing, use of personal protective equipment, measures of respiratory protocol, social confinement, among others.(2) Education, namely, higher education, also suffered immensely the consequences of COVID-19, right from the start, because there was a cessation of all classroom teaching activity, practically all over the world, which caused major modifications/alterations in the teaching-learning process.(3) From the outset, closing of Higher Education Institutions, globally, caused severe changes in teaching-learning processes because measures of social distancing and circulation restrictions were imposed.(4,5)

A utilização da acupuntura no controlo da dor crónica em usuários com síndrome vertebral com irradiação / The use of acupuncture to control chronic pain in users with irradiated vertebral syndrome

Objetivos: a acupuntura é, cada vez mais, uma técnica utilizada, em usuários portadores de várias patologias, e, em especial, aquelas que são acompanhadas de dor crónica. Esta pesquisa teve como objetivo geral analisar o efeito da terapêutica não farmacológica de acupuntura e eletroacupuntura para o controle da dor crónica, em usuários com diagnóstico médico de síndrome vertebral com irradiação. Métodos: foi realizada uma pesquisa com dois momentos de avaliação ­ antes e após sessões de terapêutica não farmacológica de acupuntura e eletroacupuntura. Utilizou-se um questionário com variáveis de caracterização sociodemográfica e clínica, o Brief Pain Inventory (BPI)e Short Form 6 Dimensions (SF-6D). Resultados: participaram no estudo 43 usuários, tendo sido encontradas diferenças estaticamente significativas, do momento 1 para o momento 2 de avaliação, quer no domínio da severidade da dor (p<0,01), quer no domínio interferência da dor no funcionamento diário (p<0,01), assim como nas diferentes dimensões do SF-6D foram encontradas diferenças estatisticamente significativas. Conclusões: salienta-se que a terapêutica não farmacológica de acupuntura e eletroacupuntura em usuários com diagnóstico de síndrome vertebral com irradiação e dor crónica contribuiu para a diminuição da severidade da dor, da interferência da dor no funcionamento diário e melhoria da qualidade de vida relacionada com a saúde.

Aims: acupuncture is increasingly a technique used in users with various pathologies, and especially those who are accompanied by chronic pain. This research aimed to analyze the effect of non-pharmacological acupuncture and electroacupuncture therapy for the control of chronic pain in users with medical diagnosis of irradiation vertebral syndrome. Methods: a research was conducted with two evaluation moments: before and after non-pharmacological acupuncture and electroacupuncture therapy sessions. A questionnaire with variables of sociodemographic and clinical characterization, the Brief Pain Inventory and Short Form 6 Dimensions (SF-6D) was used. Results: forty-three users participated in the study, and statistically significant differences were found from moment 1 to moment 2 of evaluation, either in the pain severity domain (p<0.01) or in the pain interference domain in daily functioning (p <0.01), as well as in the different dimensions of SF-6D, statistically significant differences were found. Conclusions: non-pharmacological acupuncture and electroacupuncture therapy in users diagnosed with irradiation and chronic pain have contributed to decrease pain severity, pain interference in daily functioning and improvement of health-related quality of life.

Foreign Body Granuloma in the Tongue by a Pequi Spine.

Substances considered foreign to the human organism can penetrate it due to local trauma, initially causing an acute inflammatory response against these substances, involving a neutrophilic infiltrate that, when it fails to deal with these foreign bodies, ends up generating a granulomatous inflammatory response. Granuloma formation has been associated with a variety of conditions. The correct clinical and imaging diagnoses are extremely important for the dentist to choose an appropriate therapeutic approach, aiming at the best possible treatment. This work is aimed at describing a case report of a foreign body granuloma, formed on the tongue, from the penetration of a pequi spine, in a 76-year-old patient, in whom, after an imaging diagnosis with ultrasound, surgical removal of the lesion was performed, and the piece was sent for histopathological examination, which confirmed the initial diagnostic hypothesis of a foreign body granuloma. The initial diagnosis of foreign body granulomas is challenging. For this reason, more sophisticated means of diagnosis such as tomography and magnetic resonance become important in the diagnosis, as they can show with greater clarity and reliability the nature of the lesion and its relationship with adjacent anatomical structures. In the case in question, an ultrasound examination was chosen, which was extremely important as an aid to diagnosis, considerably improving surgical planning. In addition, after surgical removal, the result of the histopathological analysis is essential to determine the definitive diagnosis, as it determines the granulomatous characteristic of the lesion.

Measuring progress against cancer in the Azores, Portugal: Incidence, survival, and mortality trends and projections to 2025.

BACKGROUND: Measuring progress against cancer is more accurate when trends in incidence, survival, and mortality are interpreted simultaneously. Our study aims to analyze how these key metrics have evolved over time in the Azores, Portugal. METHODS: Data for incident cases diagnosed in 1997-2016 and followed up through December 31, 2017 were obtained from the Azores Cancer Registry. Data for cancer deaths that occurred in 1991-2016 were obtained from Statistics Portugal. To estimate temporal trends, we applied a joinpoint model to age-adjusted rates. We estimated five-year net survival within the framework of relative survival using the Pohar-Perme estimator and predicted the number of cases and deaths in 2025. RESULTS: In men, incidence and mortality decreased for stomach, larynx, and prostate cancer. In women, mortality decreased for breast and cervical cancer. Five-year relative survival improved for several cancers, with the most pronounced improvements for prostate cancer in men and colorectal cancer in women (24.1 and 27.9 percentage point absolute increase, respectively). Conversely, incidence and mortality increased for colorectal cancer in men and lung cancer in women. The incidence and mortality burdens are both expected to increase in 2025. CONCLUSION: Overall, progress against cancer in the Azores has been mixed, and much of the progress has been driven by advances in treatment. Statistics for lung cancer in women and colorectal cancer in men are a call to action for policymakers. Reducing tobacco use and tackling the obesity epidemic are the two public health priorities for cancer control within the region.

Parents' Perspectives on the Health Education Provided by Clinicians in Portuguese Pediatric Hospitals and Primary Care for Children Aged 1 to 10 Years.

This study aimed to analyze parents' perspectives of the health education practice provided by health professionals to children and parents. This is a descriptive research with a qualitative approach, based on the conceptual framework of health education provided by health professionals to children/young people and families. The selection took place by non-probabilistic sampling of convenience, and was developed with parents/users of health units for pediatric hospitalization and primary health care in northern Portugal. Data were collected using semi-structured interviews with 20 parents from March to April 2019, and were analyzed using the content analysis technique. Health education was understood to enhance health, and the evaluation was carried out according to planning and partnership. The most frequent topics were food, the national vaccination plan, and accident prevention. The evaluation shown is very positive, pointing to the nurse as the professional of choice for this practice and thus contributing to the visibility of nursing. We can state that the perspectives of parents about the health education carried out by health professionals show a practice that values health; is adaptable to the complexity of the binomial child and parents; is capable of influencing health determinants with sustainability, efficacy, and effectiveness; and gives visibility to nurses' positions as health educators.

A (des)educação contraceptiva dos jovens universitários / La (des)educación contraceptiva de jóvenes universitarios / Contraceptive (mis)education among young adults in Higher Education

Resumo Objetivo: Investigar o impacto que o mais recente enquadramento legal da educação sexual teve na vivência da sexualidade de jovens universitários segundo comportamentos protetores, profiláticos e de vigilância em saúde sexual e reprodutiva. Métodos: Trata-se de um estudo de natureza quantitativa, transversal e descritivo, com uma amostra não probabilística de conveniência, constituída por 365 universitários do norte de Portugal. Foi critério de inclusão os estudantes frequentarem o 1° ano de licenciatura, procurando recrutar estudantes mais jovens, que já foram abrangidos em todo o Ensino Secundário pela Lei 60/2009 de 06 de agosto, relativa à educação sexual em meio escolar. Utilizámos um questionário na coleta de dados, que analisámos recorrendo à estatística descritiva e inferencial com um nível de confiança de 95%. Resultados: A procura pelos serviços de saúde, no âmbito da saúde sexual e reprodutiva é baixa, apenas 28,7% frequenta as consultas de planejamento familiar, sendo o sexo feminino quem mais reporta este fato (Χ2 = 41,085 e p<0,000); o recurso aos serviços de saúde da universidade é ainda menor (13,7%), também a procura é maior pelo sexo feminino em relação masculino (11,2% versus 2,5%). Dos estudantes sexualmente ativos, 29,6% não faz uma utilização sistemática de métodos contraceptivos, estando este comportamento mais presente no sexo masculino (Χ2 = 9,950 e p=0,002). Conclusão: Comportamentos protetores no âmbito da sexualidade estão pouco presentes, devendo a intervenção junto dos jovens ultrapassar a genitalidade para uma visão holística e integradora da sexualidade.

Resumen Objetivo: Investigar el impacto del más reciente marco legal de la educación sexual en la vivencia de la sexualidad de jóvenes universitarios según comportamientos de protección, de profilaxis y de control de la salud sexual y reproductiva. Métodos: Se trata de un estudio de naturaleza cuantitativa, transversal y descriptiva, con muestreo no probabilístico por conveniencia, constituido por 365 universitarios del norte de Portugal. Fue un criterio de inclusión que los estudiantes estuvieran cursando 1° año de licenciatura, para reclutar estudiantes más jóvenes que hayan pasado toda la enseñanza secundaria regidos por la Ley 60/2009 del 06 de agosto, relacionada con la educación sexual en medio escolar. En la recolección de datos utilizamos un cuestionario que analizamos a través de la estadística descriptiva e inferencial, con un nivel de confianza del 95%. Resultados: En el ámbito de la salud sexual y reproductiva, la demanda de servicios de salud es baja, solo el 28,7% asiste a consultas de planificación familiar, y quien más reporta este hecho es el sexo femenino (Χ2 = 41,085 y p<0,000). Este porcentaje es aún menor en quienes recurren a los servicios de salud de la universidad (13,7%), la demanda también es mayor en el sexo femenino con relación al masculino (11,2% versus 2,5%). De los estudiantes sexualmente activos, el 29,6% no utiliza métodos contraceptivos de forma sistemática, y este comportamiento está más presente en el sexo masculino (Χ2 = 9,950 y p=0,002). Conclusión: Los comportamientos de protección en el ámbito de la sexualidad están poco presentes, y la intervención con los jóvenes debe ir más allá de la genitalidad, hacia una visión holística e integradora de la sexualidad.

Abstract Objective: To investigate how the current law on sex education has affected the sex life of young adults in Higher Education on the basis of protective, prophylactic, and sexual and reproductive health surveillance behaviors. Method: This was a quantitative cross-sectional descriptive study with a non-probability sample of convenience consisting of 365 Higher Education students from Northern Portugal. We included students attending the first year of Teaching Degree programs, therefore, younger students who would have had their Secondary Education under Law no. 60/2009 (August 6) would be included (this Law currently regulates sex education in schools). Data were collected using a questionnaire, which was submitted to descriptive and inferential statistical analysis with a confidence level of 95%. Results: For sexual and reproductive health, health services are rarely sought: only 28.7% of respondents have participate in family planning appointments, and women reported seek it more often (Χ2= 41.085 and p<0.000) than men. The university's health services are even more rarely sought (13.7%), and women also seek it more often than men (11.2% versus 2.5%). Of participants, 29.6% of sexually active students do not systematically use contraceptive methods, and this behavior is more prevalent among men (Χ2= 9.950 e p=0.002). Conclusion: Protective sexual behaviors are rarely present. The study recommends any interventions targeting young adults that should go beyond genital anatomy and need to introduce a holistic and integrating viewing of sexuality.

Scale of adverse events associated to nursing practices: a psychometric study in Portuguese hospital context.

OBJECTIVE: to contribute to the validation study of the Scale of Adverse Events associated with Nursing Practices in the hospital context. METHOD: cross-sectional study, in public hospital units, in the central and northern regions of Portugal. The exploratory factor analysis of the Scale of Adverse Events associated to Nursing Practices was conducted with a sample of 165 nurses and the confirmatory factorial analysis was made with a sample of 685 nurses. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples to confirm the stability of the factorial solution. RESULTS: the global sample consisted of 850 nurses aged between 22 and 59, mostly licensed professionals. The model had a good overall fit in the subscales (Nursing Practices: χ2/df = 2.88, CFI = 0.90, GFI = 0.86, RMSEA = 0.05, MECVI = 3.30; Adverse Events: χ2/df = 4.62, CFI = 0.93, GFI = 0.95, RMSEA = 0.07, MECVI = 0.39). There was a stable factor structure, indicating strong invariance in the subscale Nursing Practices and structural invariance in the subscale Adverse Events. CONCLUSION: the refined model of the Scale of Adverse Events associated with Nursing Practices revealed good fit and stability of the factorial solution. The instrument was adjusted to evaluate the perception of nurses about adverse events associated with health care, precisely nursing care, in the hospital setting.

The relationship between human vulnerability and health care: a study with professionals and students in the health area / A relação entre a vulnerabilidade humana e o cuidar em saúde: um estudo com profissionais e estudantes da área da saúde

There are, currently, many appeals for the adoption of more humane health care and are, thus, based on the "Caring" paradigm. One of the ways pointed out is the appreciation of the understanding of human vulnerability, especially when it is associated with the disease. Therefore, this study consists of understanding how the representation of human vulnerability of health care providers influences their practice of caring. The Human Vulnerability Representation Scale (HVRS) and the adapted Caring Attributes Scale (CAS) were applied to a sample of 1213 in health caregivers (doctors, nurses, medical students, and nursing students). Descriptive statistics (frequencies, measures of central tendency) and inferential analysis were performed (non-parametric tests, Spearman correlation coefficient). The results confirm a positive relationship between the two variables in the study because the caregivers with higher averages in the human vulnerability representation scale have higher averages in the scale of the caring attributes. That is, the greater the representation of human vulnerability, the greater the value of caring. This reality holds true for all dimensions of the scales. The experience of vulnerability allows the professional to better understand the patient, facilitates the development of empathy, and rouses caregivers to the need of improving the quality of care. It was concluded that the representation of human vulnerability may be the instrument for adopting the "Caring" paradigm. Thus, it would be important, in the near future, to develop interventions related to vulnerability capable of transforming future caregivers into humanization vehicles

Existem, na atualidade, muitos apelos para a adoção de cuidados de saúde mais humanos e, por isso, assentes no paradigma do "Cuidar". Um dos caminhos apontados passa pela valorização da compreensão da vulnerabilidade humana sobretudo quando ela surge associada à doença. Assim, este estudo consiste em perceber de que modo a representação da vulnerabilidade humana dos cuidadores de saúde influencia a sua prática do cuidar. Aplicou-se a Escala de Representação da Vulnerabilidade Humana em cuidadores de saúde (ERVH) e a Escala dos Atributos do Cuidar adaptada (CAQ) a uma amostra composta por 1213 cuidadores (médicos, enfermeiros, estudantes de medicina e estudantes de enfermagem). Foi realizada análise estatística descritiva (frequências, medidas de tendência central) e inferencial (testes não paramétricos, coeficiente de correlação Spearman). Os resultados confirmam uma relação positivas entre as duas variáveis em estudo pois os cuidadores com médias mais elevadas na escala da representação da vulnerabilidade humana têm médias mais elevadas na escala dos atributos do cuidar. Ou seja, quanto maior a representação da vulnerabilidade humana, maior a valorização do cuidar. Esta realidade é válida para todas as dimensões das escalas. A experiência da vulnerabilidade permite ao profissional uma melhor compreensão do doente, facilita o desenvolvimento da empatia e desperta os cuidadores para a necessidade da melhoraria da qualidade dos cuidados. Concluiu-se que a representação da vulnerabilidade humana pode ser o motor para a adoção de um paradigma baseado no "Cuidar", pelo que, seria importante, no futuro próximo, desenvolver intervenções relacionadas com a vulnerabilidade capaz de transformar os futuros cuidadores em veículos humanização

Williams-Beuren Syndrome: What Orthodontists Need to Know / Síndrome de Williams-Beuren: Lo que los Ortodoncistas Deben Saber

ABSTRACT: Williams-Beuren syndrome is a rare disease with manifestations such as cardiovascular changes, distinct facial features, mental retardation, and learning disabilities. Oral manifestations are not commonly described and can often be misdiagnosed. This report describes the case of a male patient diagnosed with Williams-Beuren syndrome presenting classic clinical features that affect the face as a convex profile, with maxillary protrusion and mandibular retrusion, a discreetly acute nasolabial angle, passive labial sealing, and an open mandibular angle characteristic of Class II skeletal pattern. In addition, the patient has oral manifestations such as the absence of some dental elements, a Class II of Angle 1st division, dental cross bite, and atresic arches. The periodontal condition presents with generalized gingivitis. Knowledge about the possible manifestations of Williams-Beuren syndrome is important to improve the ability of orthodontists to better serve these patients.

RESUMEN: El síndrome de Williams-Beuren es una enfermedad rara con manifestaciones tales como cambios cardiovasculares, diversas características faciales, retraso mental y problemas de aprendizaje. Las manifestaciones orales no se describen comúnmente y con frecuencia se pueden diagnosticar erróneamente. Este informe describe el caso de un paciente masculino diagnosticado con síndrome de Williams-Beuren que presentaba características clínicas clásicas que afectaban la cara como un perfil convexo, con protrusión maxilar y retrusión mandibular, un ángulo nasolabial discretamente agudo, sellado labial pasivo y un ángulo mandibular abierto característico del patrón esquelético clase II. Además, el paciente presentaba manifestaciones orales tales como, ausencia de algunos elementos dentales, una clase II de Angle 1ª división, mordida dental cruzada y arcos acrílicos. La condición periodontal se presentaba con gingivitis generalizada. El conocimiento sobre las posibles manifestaciones del síndrome de Williams-Beuren es importante ya que mejora la capacidad de los ortodoncistas para atender mejor a estos pacientes.

Capacitação de trabalhadores em suporte básico de vida / Training workers in basic life support / Capacitación de trabajadores en soporte básico de vida

Resumo Introdução A capacitação dos cidadãos no auxílio a vítimas em risco de vida é fundamental em qualquer sociedade. Objetivo avaliar os conhecimentos sobre Suporte Básico de Vida dos trabalhadores de uma Câmara Municipal do norte de Portugal, antes e após a implementação do programa de intervenção "Capacitar para Salvar" e avaliar as competências demonstradas, após a participação no programa de intervenção. Materiais e Métodos Trata-se de um estudo do tipo quase-experimental e longitudinal, onde foi utilizado um questionário, constituído por 2 partes (caraterização sociodemográfica e avaliação de conhecimentos) e uma grelha de avaliação de competências. No 1º momento foram avaliados os conhecimentos sobre Suporte Básico de Vida e implementado um programa de intervenção, sendo que no 2º momento, foram avaliados os conhecimentos e competências sobre Suporte Básico de Vida. Resultados Participaram no estudo 97 trabalhadores. Os resultados mostraram que os trabalhadores possuem conhecimentos e competências insuficientes em Suporte Básico de Vida. Discussão e Conclusões Verificaram-se diferenças estatisticamente significativas nos conhecimentos e competências em Suporte Básico de Vida. Implicações para a prática: implementação de estratégias que promovam a formação em Suporte Básico de Vida a todos cidadãos, quer ao nível da transmissão de conhecimentos, quer da formação prática.

Abstract Introduction Training citizens to help victims in life-threatening situations is fundamental in any society. Objective to evaluate the knowledge on Basic Life Support by workers in a Municipal Council of the north of Portugal, before and after implementing the intervention program "Train to Save" and assess the skills shown after participating in the intervention program. Materials and Methods This was a quasi-experimental longitudinal study, using a questionnaire, which comprised two parts (sociodemographic characterization and evaluation of knowledge) and a skills-assessment grid. In the first moment, knowledge on Basic Life Support was evaluated and an intervention program was implemented; the second moment evaluated the knowledge and skills on Basic Life Support. Results The study had the participation of 97 workers. The results revealed that the workers had insufficient knowledge and skills in Basic Life Support. Discussion and Conclusions Statistically significant differences were verified of knowledge and skills in Basic Life Support. Implications for the practice: implementation of strategies that promote training in Basic Life Support for all citizens at knowledge transmission level and in practical formation.

Resumen Introducción La capacitación de los ciudadanos en la ayuda a las víctimas en riesgo de vida es fundamental en cualquier sociedad. Objetivo evaluar los conocimientos sobre Soporte Básico de Vida de los trabajadores de una Cámara Municipal del Norte de Portugal, antes y después de la implementación del programa de intervención "Capacitar para Salvar" y evaluar las competencias demostradas, después de la participación en el programa de intervención. Materiales y Métodos Se trata de un estudio de tipo cuasi-experimental y longitudinal, donde se utilizó un cuestionario, constituido por 2 partes (caracterización sociodemográfica y evaluación de conocimientos) y una plantilla de evaluación de competencias. En el 1° momento fueron evaluados los conocimientos sobre Soporte Básico de Vida e implementado un programa de intervención, siendo que en el 2º momento fueron evaluados los conocimientos y competencias sobre Soporte Básico de Vida. Resultados Participaron en el estudio 97 trabajadores. Los resultados mostraron que los trabajadores poseen conocimientos y competencias insuficientes en Soporte Básico de Vida. Discusión y Conclusiones Se verificaron diferencias estadísticamente significativas en los conocimientos y competencias en Soporte Básico de Vida. Implicaciones para la práctica: implementación de estrategias que promuevan la formación en Soporte Básico de Vida a todos los ciudadanos, tanto en el nivel de la transmisión de conocimientos como en la formación práctica.

Versão portuguesa da escala de satisfação dos pacientes com os cuidados do médico de família ­ SatMF17: validação psicométrica / Portuguese version of the user satisfaction scale with the care of the family physician ­ SatMF17: psychometric validation

OBJETIVOS: Avaliar as propriedades psicométricas da escala de satisfação dos pacientes com os cuidados do médico de família (SatMF17). MÉTODOS: Estudo metodológico, em que participaram usuários inscritos em Unidades de Saúde Familiar e Unidades de Cuidados de Saúde Personalizados do Agrupamento de Centros de Saúde Marão e Douro Norte. Os critérios de inclusão dos usuários foram: ser paciente inscrito numa das duas unidades referenciadas, ter mais de 18 anos e menos de 65 anos, saber ler e escrever e ter tido, pelo menos no último ano, uma consulta em uma das duas unidades. A escala SatMF17 é constituída por 17 itens, respondidos por meio de uma escala tipo Likert que varia entre 1 (mau) e 5 (excelente), em que o somatório varia entre 17 e 85. A coleta dos dados foi realizada no período compreendido entre janeiro e junho de 2016. O paciente que preenchesse os critérios de inclusão quando da chegada à unidade de saúde era convidado a participar do estudo pelo assistente administrativo. Após apresentação e explicação dos objetivos do estudo e assinatura do termo de consentimento, era oferecido o questionário ao paciente, que ao final do autopreenchimento o inseria em um envelope. Para análise dos dados foram utilizados os recursos estatísticos coeficiente alfa de Cronbach, análise fatorial exploratória, critérios de Kaiser-Meyer-Olkin, teste de esfericidade de Bartlett e coeficiente de correlação de Pearson. RESULTADOS: A amostra incluída foi de 284 pacientes, sendo 159 (56,0%) participantes do gênero feminino. A média de idade situou-se nos 41,2 anos, variando entre 18 anos e 65 anos. A análise fatorial exploratória em componentes principais e rotação varimax revelou uma solução fatorial de dois fatores com autovalores superiores a 1, os quais explicam em conjunto 72,48% da variância total da satisfação dos pacientes com os cuidados do médico de família. CONCLUSÕES: A escala SatMF17 é confiável e válida e pode ser utilizada em populações com características semelhantes, constituindo um instrumento de utilidade prática para avaliar a satisfação dos pacientes com os cuidados do médico de família.

AIMS: To evaluate the psychometric properties of the satisfaction scale of patients with the care of the family physician (SatMF17). METHODS: Methodological study, in which users enrolled in Family Health Units and Personalized Health Care Units of the Marão and Douro Norte Health Centers. The criteria for inclusion of the users were: to be a patient enrolled in one of the two referenced units, to be over 18 and under 65 years old, to be able to read and write and to have had, at least, one visit in the last year in one of the two units. The SatMF17 scale consists of 17 items, answered by a Likert scale ranging from 1 (bad) to 5 (excellent), in which the sum ranges from 17 to 85. The data collection was carried out in the period between January and June 2016. The patient who met the inclusion criteria upon arrival at the health unit was invited to participate in the study by the administrative assistant. After a presentation and explanation of the objectives of the study, and signing of the consent term, the questionnaire was offered to the patient, who at the end of self-completion inserted it into an envelope. For statistical analysis, the statistical resources were Cronbach's alpha coefficient, exploratory factorial analysis, Kaiser-Meyer-Olkin criteria, Bartlett's sphericity test and Pearson's correlation coefficient. RESULTS: The sample included had 284 patients, of whom 159 (56,0%) were female. The mean age was 41,2 years, ranging from 18 years to 65 years. The exploratory factorial analysis in main components and varimax rotation revealed a factorial solution of two factors with eigenvalues greater than 1, which together explain 72,48% of the total variance of patient satisfaction with the care of the family doctor. CONCLUSIONS: The SatMF17 Scale is reliable and valid and can be used in populations with similar characteristics, constituting an instrument of practical utility to evaluate the satisfaction of patients with the care of the family doctor.

Scale of adverse events associated to nursing practices: a psychometric study in Portuguese hospital context / Escala de eventos adversos associados às práticas de enfermagem: estudo psicométrico em contexto hospitalar português / Escala de eventos adversos asociados a las prácticas de enfermería: estudio psicométrico en contexto hospitalaria portugués

Objective to contribute to the validation study of the Scale of Adverse Events associated with Nursing Practices in the hospital context. Method cross-sectional study, in public hospital units, in the central and northern regions of Portugal. The exploratory factor analysis of the Scale of Adverse Events associated to Nursing Practices was conducted with a sample of 165 nurses and the confirmatory factorial analysis was made with a sample of 685 nurses. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples to confirm the stability of the factorial solution. Results the global sample consisted of 850 nurses aged between 22 and 59, mostly licensed professionals. The model had a good overall fit in the subscales (Nursing Practices: χ2/df = 2.88, CFI = 0.90, GFI = 0.86, RMSEA = 0.05, MECVI = 3.30; Adverse Events: χ2/df = 4.62, CFI = 0.93, GFI = 0.95, RMSEA = 0.07, MECVI = 0.39). There was a stable factor structure, indicating strong invariance in the subscale Nursing Practices and structural invariance in the subscale Adverse Events. Conclusion the refined model of the Scale of Adverse Events associated with Nursing Practices revealed good fit and stability of the factorial solution. The instrument was adjusted to evaluate the perception of nurses about adverse events associated with health care, precisely nursing care, in the hospital setting.

Objetivo contribuir para o estudo de validação da Escala de Eventos Adversos associados às Práticas de Enfermagem, em contexto hospitalar. Método estudo transversal, em unidades hospitalares públicas, das regiões centro e norte de Portugal. A análise fatorial exploratória da Escala de Eventos Adversos associados às Práticas de Enfermagem foi desenvolvida em uma amostra de 165 enfermeiros e a análise fatorial confirmatória em uma amostra de 685 enfermeiros. Estimou-se a confiabilidade, consistência interna e validade de construto. A invariância do modelo foi avaliada em duas subamostras para confirmar a estabilidade da solução fatorial. Resultados amostra global de 850 enfermeiros, com idades entre 22 e 59 anos, maioritariamente licenciados. Modelo com bom ajustamento global nas subescalas (Práticas de Enfermagem: χ2/df=2,88; CFI=0,90; GFI=0,86; RMSEA=0,05; MECVI=3,30; Eventos Adversos: χ2/df=4,62; CFI=0,93; GFI=0,95; RMSEA=0,07; MECVI=0,39). Estrutura fatorial estável, identificandose invariância de medida forte na subescala Práticas de Enfermagem e, na subescala Eventos Adversos, invariância estrutural. Conclusão o modelo refinado da Escala de Eventos Adversos associados às Práticas de Enfermagem revelou boa qualidade de ajustamento e estabilidade da solução fatorial. O instrumento revelou-se ajustado para avaliar a percepção dos enfermeiros acerca dos eventos adversos associados aos cuidados de saúde, nomeadamente aos cuidados de enfermagem, em contexto hospitalar.

Objetivo contribuir para el estudio de validez de la Escala de Eventos Adversos asociados a las Prácticas de Enfermería, en contexto hospitalario. Método estudio transversal, en unidades hospitalares públicas, de las regiones centro y norte de Portugal. El análisis factorial exploratorio de la Escala de Eventos Adversos asociados a las Prácticas de Enfermería fue desarrollada en una muestra de 165 enfermeros y el análisis factorial confirmatorio en una muestra de 685 enfermeros. Se estimó la confiabilidad, consistencia interna y validez de constructo. La invariancia del modelo fue evaluada en dos sub-muestras, para confirmar la estabilidad de la solución factorial. Resultados muestra global de 850 enfermeros, con edades entre 22 y 59 años, mayoritariamente licenciados. Modelo con buen ajuste global en las sub-escalas (Prácticas de Enfermería: χ2/df=2,88; CFI=0,90; GFI=0,86; RMSEA=0,05; MECVI=3,30; Eventos Adversos: χ2/df=4,62; CFI=0,93; GFI=0,95; RMSEA=0,07; MECVI=0,39). Estructura factorial estable, identificándose invariancia de medida fuerte en la sub-escala Prácticas de Enfermería y en la sub-escala Eventos Adversos, invariancia estructural. Conclusión o modelo refinado da Escala de Eventos Adversos asociados a las Prácticas de Enfermería reveló buena calidad de ajuste y estabilidad de la solución factorial. El instrumento se reveló ajustado para evaluar la percepción de los enfermeros acerca de los eventos adversos asociados a los cuidados de salud, nombradamente a los cuidados de enfermería en el contexto hospitalario.