Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis.

Autism is more frequently diagnosed in males, with evidence suggesting that females are more likely to be misdiagnosed or underdiagnosed. Possibly, the male/female ratio imbalance relates to phenotypic and camouflaging differences between genders. Here, we performed a comprehensive approach to phenotypic and camouflaging research in autism addressed in two studies. First (Study 1 - Phenotypic Differences in Autism), we conducted a systematic review and meta-analysis of gender differences in autism phenotype. The electronic datasets Pubmed, Scopus, Web of Science, and PsychInfo were searched. We included 67 articles that compared females and males in autism core symptoms, and in cognitive, socioemotional, and behavioural phenotypes. Autistic males exhibited more severe symptoms and social interaction difficulties on standard clinical measures than females, who, in turn, exhibited more cognitive and behavioural difficulties. Considering the hypothesis of camouflaging possibly underlying these differences, we then conducted a meta-analysis of gender differences in camouflaging (Study 2 - Camouflaging Differences in Autism). The same datasets as the first study were searched. Ten studies were included. Females used more compensation and masking camouflage strategies than males. The results support the argument of a bias in clinical procedures towards males and the importance of considering a 'female autism phenotype'-potentially involving camouflaging-in the diagnostic process.

Symptom provocation in obsessive-compulsive disorder: Validation of the Braga Obsessive Compulsive image set (BOCIS).

Symptom provocation paradigms are paramount to understand a heterogeneous disorder as obsessive-compulsive disorder (OCD). The main aim of our work was to develop and validate an open-access set of OCD-related images comprising three main subtypes: washing, checking, and symmetry. Twenty-six OCD patients and 25 controls provided valence and arousal ratings for a set of OCD-related, aversive, and neutral images. Linear mixed model analyses were used to estimate the main effects of group, image category, and group-image category interaction in image ratings. All main effects were found to be significant for both arousal and valence ratings, except for the group in arousal ratings. Path analysis confirmed our hypothesis that the OCI-R subscales influenced the subjective ratings of the corresponding image categories, particularly among patients. Independent samples t-tests were performed for each OCD picture to compose the set. Arousal demonstrated a greater capacity to distinguish controls and patients, thus sustaining our choice of using these ratings for the final Braga Obsessive-Compulsive Image Set (BOCIS). Our study demonstrated that the stimuli of the BOCIS reliably portray OCD-like triggers for washing, checking and symmetry subtypes. Its open-access availability will facilitate significant progress in both clinical and research settings.

How Long Does Adaption Last for? An Update on the Psychological Impact of the Confinement in Portugal.

During the first COVID-19 related confinement in Portugal, there was a decrease in the levels of psychological symptoms measured by the Depression, Anxiety and Stress Scale 21 (March to April 2020). Upon experiencing a new period of restraints in 2021, the psychological impact of this sample was assessed again (N = 322, two more time points). It was expected that the psychological symptoms evidenced in February 2021 would be at similar levels to those found in April 2020, leading to a transfer of adaptation. Contrary to our hypothesis, in the second confinement in Portugal there were higher levels of depression and stress symptoms than at the beginning of the pandemic. On the other hand, the maximum level of anxiety was observed in March 2020. It seems that our perception of the threats in 2021 was not the same as at the onset of COVID-19, or that knowledge was not disseminated to the general population to increase their mental health literacy and help them cope with the imposed challenges.

s ganhos da intervenção de enfermagem de reabilitação as pessoas em cuidados intensivos com necessidade de limpeza das vias aéreas e utilização de insuflador-exsuflador mecânico / The gains of the rehabilitation nursing intervention for people in intensive care who need to clean the airways and use a mechanical insufflator-exsufflator

A limpeza das vias aéreas nos doentes sob ventilação mecânica, invasiva ou não invasiva é uma intervenção fundamental que deverá ser realizada regularmente, não só para evitar a acumulação de secreções, como para prevenir adversidades que podem resultar da mesma. As intervenções mais relevantes neste tipo de doentes consiste na utilização do dispositivo Insuflador-Exsuflador Mecânico, vulgarmente conhecido por Cough Assist®. A eficácia da Reeducação Funcional Respiratória associada à utilização do mesmo apresenta ganhos, nomeadamente quando o doente não colabora, quando apresenta diminuição da força muscular ou não consegue apresentar tosse eficaz, havendo uma diminuição no indice de dispneia avaliado pela Escala de Borg. A revisão integrativa da literatura tornou evidente os ganhos que existem para a pessoa em cuidados intensivos, com utilização do MI-E associado à limpeza das vias aéreas, ao nível da perfomance ventilatória, da permeabilidade das vias aéreas, da diminuição das complicações e da taxa de mortalidade.

Airway clearance among patients undergoing invasive or non-invasive mechanical ventilation is a crucial intervention that must take place on a regular base, not only to avoid secretion accumulation but also to prevent further complications resulting from that accumulation. The most relevant interventions on this type of patients rely on the use of the Mechanical Insufflator-Exsufflator device usually known as Cough Assist®. The efficacy of Respiratory Functional Re-education in association with the use of this device has shown benefits, mainly with non-collaborative patients, patients showing decrease of muscular strength or failing to produce effective cough, resulting in a decrease in the dyspnea index assessed by Borg's Scale. The integrative literature review has made evident the existing gains in ventilatory performance, airway permeability, decreasing complications and mortality rates on patients in intensive care, when using Mechanical Insufflator-Exsufflator associated with airway clearance.