Parental perspectives on Children's lifestyles: A Path for school health promotion.

The National School Health Program in Portugal advocates for healthy lifestyles. However, school health teams mostly focus their activities on educating children, whereas it is the families who are primarily responsible for managing children's lifestyles. Although the programme proposes interactive health education activities, such as meetings with the children's families, few parents participate in these activities. The project Gostar de Mim was created to bridge this gap by promoting healthy family lifestyles in school settings. The project used an evaluating instrument called the 'Parents' Booklet' packed with information. This study assessed the usefulness of the booklet in providing health information and planning family engagement. Based on the PRECEDE-PROCEED framework (PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation; PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development), this article focuses on the social and epidemiological assessment phases. We examined the health surveillance status of children aged 6-10 years (epidemiological phase) and description of health behaviours in different lifestyle dimensions (behavioural and environmental phase). The Parents' Booklet was used to identify parents' perspectives on their children's lifestyles. Data analysis of 568 Parents' Booklet (23 schools) use cases showed that the lifestyle priorities, in order, were 'sleep and rest' (95.6 %), 'energy balance' (100 %), 'oral/body healthcare' (95.6 %), 'alcohol, tobacco/other drugs' (73.9 %), 'consumerism' (91.3 %), 'leisure-time occupation' (91.3 %), and 'literacy and satisfaction at school' (86.9 %). Clearly, the Parents' Booklet was useful, as it made it possible to obtain information that allowed for participatory school health diagnosis and can guide community nursing actions that need to be developed in schools. Crucially, this tool can be useful for parents, enabling them to be more aware of their children's lifestyle via self-monitoring as well as increasing their participation in health education.

The stigma towards mental illness: Portuguese validation of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC).

Background: Stigma toward mental illness significantly contributes to a lower quality of healthcare that can be provided. There are few studies on this topic in Portugal, so validating a scale that can evaluate and study the stigma is paramount. The aim of this study was to validate the Opening Minds Stigma Scale for Portuguese healthcare professionals. Methods: A total of 503 participants were included in this study, and the majority was female (81.1%). The sample consisted mainly of psychologists (39.4%) and physicians (30.8%). Reliability and validity analyses were conducted and included exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results: Our results suggest that a 12-item model was the most appropriate (RMSEA = 0.026, SRMR = 0.057, CFI = 0.979, TLI = 0.973, GFI = 0.955) compared to our 15-item model and the original model. Items 8, 9 and 10 were removed. The 12-item scale's internal consistency was adequate (α = 0.71; ω = 0.72). Conclusion: The 12-item model of the scale showed good reliability and validity and is appropriate for use with Portuguese healthcare professionals.

Prevalence of stigma towards mental illness among Portuguese healthcare professionals: a descriptive and comparative study.

Background: Stigmatising attitudes among healthcare professionals can hinder access to healthcare, making it important to address this issue. This study aimed to investigate the prevalence of stigma related to mental illness among Portuguese healthcare professionals and to compare the results among mental health professionals, General Practitioners (GPs) and other health professionals. Methods: An online cross-sectional observational study was conducted in Portugal using Google Forms® to collect data. The data collection process lasted five months, from September 2023 to January 2024. Participants were recruited from various professional associations and Health Centre Groups, through a purposive sampling. The study used the Portuguese version of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) to measure stigma which assesses three dimensions: attitudes towards disclosure and help-seeking, attitudes towards people with mental illness, and attitudes towards social distance. Results: A total of 292 healthcare professionals participated in the study. In Portugal, healthcare professionals displayed low to moderate levels of stigma towards mental illness (M = 22.17, SD = 5.41). Mental health professionals demonstrated significantly lower levels of stigma (M=20.37, SD=5.37) compared to other healthcare professionals (M=24.15, SD=4.71), including GPs (M=23.97, SD=5.03). Additionally, having a close friend or relative with mental illness seemed to be related with lower levels of stigma for the dimension attitudes towards social distance (M=6.93, SD=2.50), compared to not having one (M=7.60, SD=2.56). On the other hand, a personal history of mental illness indicated higher levels of stigma for the dimension disclosure and help-seeking (M=8.95, SD=3.07), compared to having no history of mental illness (M=8.16, SD=2.67). Conclusion: This study indicates that Portuguese healthcare professionals have stigmatising attitudes towards mental illness, although at low to moderate levels. Training and frequent interaction with people with mental illness seem to be associated with lower levels of stigma. Personal experience of mental illness seems to follow the opposite path regarding disclosure and seeking help. Thus, further research is necessary to evaluate the effectiveness of anti-stigma measures and deepen the study of the concept of self-stigma in healthcare professionals.

Gestação de Substituição em Portugal: Orientações para a prática clínica

Introdução: A aprovação na Assembleia da República, em dezembro de 2021, da lei aplicável à Gestação de Substituição, suscita a reflexão acerca dos aspetos práticos em que o regime se concretizará e das orientações necessárias para os profissionais de saúde envolvidos. Por esse motivo, foram definidos como objetivos: analisar um conjunto de recomendações para a prática clínica no âmbito da Gestação de Substituição em países com experiência no procedimento e promover uma discussão com peritos na área da Procriação Medicamente Assistida. Material e Métodos: Foi realizada uma análise documental das publicações e documentos oficiais sobre o tema que serviu de base para o estudo de desenho qualitativo baseado em grupos focais com diferentes profissionais -médicos e psicólogos- com experiência em Procriação Medicamente Assistida. A discussão foi concretizada através de sessões via Zoom®, realizadas separadamente com os dois grupos focais. Resultados: Na discussão os peritos fizeram as suas apreciações e propostas de melhoria em relação à versão inicial do documento resultante da análise documental. Conclusão: Obteve-se uma versão consolidada do conjunto de orientações para os profissionais de saúde com as dimensões a avaliar e acompanhar junto da gestante e parte beneficiária na Gestação de Substituição.

Introducción : La aprobación por el Parlamento portugués, en diciembre de 2021, de la ley aplicable a la Gestación Subrogada, plantea la reflexión sobre los aspectos prácticos en los que se implementará el esquema y las directrices necesarias para los profesionales de la salud involucrados. Por este motivo, se definieron los siguientes objetivos: analizar un conjunto de recomendaciones para la práctica clínica en el ámbito de la gestación subrogada en países con experiencia en el procedimiento y promover un debate con expertos en el campo de la Reproducción Médicamente Asistida. Material y Métodos : Se realizó un análisis documental de publicaciones y documentos oficiales sobre el tema, que sirvió de base para el estudio de diseño cualitativo basado en focus group con diferentes profesionales -médicos y psicólogos- con experiencia en Reproducción Médicamente Asistida. La discusión se realizó a través de sesiones via Zoom®, celebradas por separado con los dos focus group. Resultados : En la discusión, los expertos realizaron sus apreciaciones y propuestas de mejora respecto a la versión inicial del documento resultante del análisis documental. Conclusión : Se obtuvo una versión consolidada del conjunto de directrices para los profesionales de la salud con las dimensiones para evaluar y dar seguimiento a la madre sustituta y a los beneficiarios en la Gestación Subrogada.

Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals -physicians, and psychologists- with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results : In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion : A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.

Ethical principles in psychotherapy within a broad psychological and medical deontological framework: An international comparison / Principios éticos en psicoterapia dentro de un amplio marco deontológico psicológico y médico: una comparación internacional

Awareness of ethics codes and professional guidelines is crucial to a professional role in psychotherapy practice. Psychotherapy practice is increasingly heterogeneous, and there is much discussion about their effectiveness for clients. In some countries, psychotherapy is an autonomous profession. In others, is part of the professional features of psychologists and psychiatrists, and it is possible to find other health professionals working as psychotherapists in some countries. Considering that ethical principles are central to the performance of a profession, we intend to find connections between the ethical principles for psychotherapists and psychologists or psychiatrists. A critical review was done to promote an integrative vision of ethics codes in psychotherapy. Content analysis of the ethics codes in psychotherapy was per-formed. Confidentiality, competence, and integrity were the principles more frequently found. Psychotherapists seem to have a major concern with interpersonal relationshipsand are less linked to social responsibility. (AU)

El conocimiento de los códigos éticos y las directrices profesionales es crucial para desempeñar un papel profesional en la práctica de la psicoterapia. La práctica de la psicoterapia es cada vez más heterogénea y se discute mucho sobre su eficacia para los clientes. En algunos países, la psicoterapia es una profesión autónoma. En otros forma parte de las características profesionales de psicólogos y psiquiatras, y es posible encontrar a otros profesionales de la salud trabajando como psicoterapeutas en algunos países. Considerando que los principios éticos son centrales para el desempeño de una profesión, pretendemos encontrar conexiones entre los principios éticos para psicoterapeutas y psicólogos o psiquiatras. Se realizó una revisión crítica para promover una visión integradora de los códigos de ética en psicoterapia. Se realizó un análisis de contenido de los códigos de ética en psicoterapia. La confidencialidad, la competencia y la integridad fueron los principios más frecuentemente encontrados. Los psicoterapeutas parecen tener una mayor preocupación por las relaciones interpersonales y están me-nos vinculados a la responsabilidad social. (AU)

Informed consent in anesthesiology: An exploratory study / El consentimiento informado en anestesiología: un estudio exploratorio / Consentimento informado em anestesiologia: um estudo exploratório

Abstract: In the literature Informed consent (IC) assumptions is well established. However, the different stages and the conditions under which the IC for anesthetic practices is obtained, is scarce. The aim of the present study is to explore the phases and conditions of IC in anesthesiology. Anonymized clinical records of 325 patients submitted to anesthetic procedures at the Institute of Oncology of Porto were analyzed. A total agreement between the anesthetic techniques established in the IC and those performed, was reach with 270 patients. The importance of IC in clinical practice is discussed and an ideal process for IC is argued.

Resumen: El consentimiento informado (CI) está bien establecido en la literatura. Sin embargo, la información sobre las diferentes fases y condiciones en las que se obtiene el CI para las prácticas anestésicas es escasa. El objetivo del presente estudio es explorar las fases y condiciones de obtención de la CI en anestesiología. Se analizaron las historias clínicas anónimas de 325 pacientes sometidos a procedimientos anestésicos en el Instituto de Oncología de Oporto. Se alcanzó una concordancia total entre las técnicas de anestesia establecidas en el CI y las realizadas con 270 pacientes. Se defiende la importancia del CI en la práctica clínica y se discute un proceso ideal para obtenerlo.

Resumo: Na literatura o Consentimento Informado (CI) é bem estabelecido. Contudo, a informação sobre as diferentes fases e as condições em que o CI para práticas anestésicas é obtido, é escassa. O objetivo do presente estudo é explorar as fases e condições da obtenção do CI em anestesiologia. Foram analisados os registos clínicos anónimos de 325 pacientes submetidos a procedimentos anestésicos no Instituto de Oncologia do Porto. Foi alcançado um acordo total entre as técnicas anestésicas estabelecidas no CI e as realizadas, com 270 pacientes. A importância do CI na prática clínica é defendida e discute-se um processo ideal para a obtenção do CI.

Presumed consent for organ donation: an incoherent justification / Presunción del consentimiento para la donación de órganos: una justificación incoherente / Consentimento presumido na dação de órgãos: uma justificação incoerente

Abstract: 15. The difference between supply and demand of transplantable organs is a global problem, and one of the most discussed measures aiming to solve it is the implementation of a presumed consent (opt-out) policy in cadaveric organ donation. This type of system is controversial when it comes to its direct effects on organ donation rates as well as its ethical base. We aim to present the latest perspectives concerning the ethical implications of the policy, especially regarding consent: its need, the coherence of presuming it and the policy's capacity to fulfill its requirements. From a community perspective, we advocate a default change in societies with an opt-out system, with a strong population education in that direction. The potential rights of family objection are also approached as well as the differences between theoretical discussion and concrete application of public policy.

Resumen: 19. El desfase entre la oferta y la demanda de órganos para trasplantes es un problema mundial, y una de las medidas más discutidas para solucionarlo es la aplicación de una política de consientimiento presumido (opt-out) de la donación de órganos de cadáveres. Este tipo de sistema es controvertido teniendo en cuenta sus efectos directos sobre las tasas de donación de órganos, así como su base ética. Nuestro objetivo es presentar las últimas perspectivas sobre las implicaciones éticas, especialmente en lo que respecta al consentimiento: su necesidad, la consistencia de su presunción y la capacidad de cumplir sus requisitos. Desde el punto de vista comunitario, abogamos por un cambio por defecto en las sociedades con un sistema de opt-out, con una fuerte educación de la población a tal efecto. También se abordan los posibles derechos de la objeción familiar, así como las diferencias entre el debate teórico y la aplicación concreta de las políticas públicas.

Resumo: 23. A diferença entre a oferta e a procura de órgãos para transplantação é um problema global, e uma das medidas mais discutidas com vista à sua resolução é a implementação de uma política de consentimento presumido (opt-out) na doação de órgãos de cadáver. Este tipo de sistema é controverso ponderando os seus efeitos diretos nas taxas de doação de órgãos, bem como da sua base ética. O nosso objetivo é apresentar as últimas perspetivas relativas às implicações éticas, especialmente no que diz respeito ao consentimento: a sua necessidade, a coerência da sua presunção e a capacidade em cumprir os seus requisitos. Numa perspetiva comunitária, defendemos uma mudança de default nas sociedades com um sistema opt-out, com uma forte educação da população nesse sentido. Os direitos potenciais da objeção familiar também são abordados, bem como as diferenças entre a discussão teórica e a aplicação concreta da política pública.

A saúde mental das crianças e dos adolescentes: considerações epidemiológicas, assistenciais e bioéticas / La salud mental de los niños y adolescentes: consideraciones epidemiológicas, de asistencia y bioéticas / Mental health of children and teens: epidemiological, assistance and bioethicalconsiderations

Neste trabalho são apresentados aspectos epidemiológicos relativos a crianças e adolescentes com problemas de saúde mental, no mundo e no Brasil; os transtornos mais comuns nesta faixa etária; e a gênese de tais transtornos, cuja ênfase recai no ambiente familiar, no qual se constata forte associação entre a violência doméstica e a ocorrência de tais distúrbios. É discutida a crise de oferta de serviços de saúde para crianças e adolescentes com problemas de transtorno mental, bem como a carência de profissionais treinados para lidar com este grupo especial de pacientes. Os aspectos bioéticos envolvidos na assistência também são discutidos, com destaque para o estado de vulnerabilidade desses pacientes com relação ao exercício da autonomia. Ao final, se considera que para abarcar o princípio bioético da justiça urge implantar e implementar serviços de saúde mental comunitários, especializados no atendimento a crianças e adolescentes, principalmente em regiões carentes, bem como na periferia das grandes cidades.

En este trabajo son presentados aspectos epidemiológicos relativos a los niños y adolescentes con problemas de salud mental en el mundo y en Brasil, los trastornos más comunes en este franja de edad, y la etiología de tales trastornos, con énfasis en el entorno familiar, en el cual se encuentra una fuerte asociación entre la violencia doméstica y la ocurrencia de tales perturbaciones. Se hace una discusión de la crisis en el suministro de servicios de salud para niños y adolescentes con trastornos mentales en nuestro país y la escasez de profesionales preparados para trabajar con este grupo de pacientes. Se discuten también los aspectos bioéticos involucrados en la asistencia para expresarse, con énfasis en la vulnerabilidad de estos pacientes con relación el ejercicio de la autonomía. Finalmente se considera que para abarcar el principio bioético de la justicia, es urgente implantar e implementar servicios comunitarios de salud mental especializadosen el atendimiento a los niños y adolescentes, especialmente en las regiones carentes de nuestro país y la periferia de las grandes ciudades.

This paper examines the Epidemiological aspects of children and adolescents with mental health problems in the world and in Brazil, this age range most common disorders , the etiology of such disorders, with emphasis on family environment, finding a strong association between domestic violence and the occurrence of such disturbances. It addressed the crisis in health services supply for children and adolescents with mental disorders in Brazil, and the lack of professionals trained to deal with this group of patients. Bioethics aspects involved in assistance are discussed also, with emphasis on these patients? vulnerability in exercising their autonomy. It finishes by considering that to encompass the bioethic principle of justice, it is imperious to establish and toimplement community mental health services, specialized in assisting children and adolescents, particularly in poor regions as well as at the periphery of large cities.