Assessment of cognitive functions in patients with multiple sclerosis applying the normative values of the Rao's brief repeatable battery in the Portuguese population.

BACKGROUND: The Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) is one of the most sensitive and used measures for detecting cognitive impairment in Multiple Sclerosis (MS). OBJECTIVE: The aim of this study was to adapt and validate this battery to the Portuguese population of MS patients. METHODS: The Portuguese version of the BRBN-T was applied to a stratified control national sample of 326 individuals considering sex, age, educational level and geographic location and also a clinical sample of 115 MS patients from several national hospitals. Through the exploration of its psychometrics properties, the Portuguese BRBN-T norms were produced. RESULTS: The normative data is presented as a regression-based formula to adjust test scores for gender, education and age, and the results reveal the BRBN-T has the ability to differentiate between MS patients and healthy participant's cognitive performance. CONCLUSION: This study demonstrated in our clinical population a good ability to detect cognitive impairment. Its clearly contributed to reinforcing the neuropsychological assessment in Portugal in patients with MS, by providing a new set of instruments, which can be used in the clinical practice, and in future studies. Moreover, it will allow a rigorous and precise support in relation to neuropsychological assessment for future longitudinal studies and clinical trials.

The Rough Journey to Success: Examining the Nonlinear Dynamics of Processes and Performance in Teams.

We build on Nonlinear Dynamic Systems (NDS) theory to examine if team performance change across a complete performance cycle is nonlinear, and if such change is related with team processes change over time. Participants were 214 teams enrolled in one management competition. The hypotheses were tested using nonlinear regressions and catastrophe modeling. The results of the nonlinear regression model support the hypothesis that change in team performance over time follows a cusp catastrophe distribution, R2Cusp = .93, F(5, 1065) = 16889.82, p < .001; and that team processes do function as asymmetry (transition and action processes) and bifurcation (interpersonal processes) factors. The results also suggest that the cusp catastrophe model (R2 = .68) explains team performance better than the linear (R2 = .05) and logistic models (R2 = .07). This study reiterates the importance of incorporating the NDS perspective within the teamwork literature to leverage our knowledge about the way teams perform over time.

To be or not to be an excellent football referee: different experts' viewpoints.

Football is central to the lives of countless individuals around the globe. While most of the attention of those passionate about the sport is focused on the players, football referees are often just as important in shaping the outcome of the games. Therefore, research is increasingly examining the role of referees. Even so, our understanding of the factors that create an excellent football referee is still scarce. Based on our analysis of the opinions of 24 football experts, we demonstrate the multidimensionality of excellence in the performance of football referees. From a Categorical Principal Components Analysis (CatPCA), we were able to pinpoint that football referee excellence is shaped by three distinct dimensions: individual preparation, game preparation and game management. Additionally, we were able to see if these perceptions were different from individuals "within" the game versus those "outside" the game. Namely, we used CatPCA to graphically display the main correlations between the latent dimensions of football refereeing performance and the "inside" and "outside" perspective of the game. The findings of our work contribute towards the knowledge of the factors that shape football referee excellence, while also highlighting areas in need of additional research attention.

Validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) in the Portuguese population with multiple sclerosis.

BACKGROUND: The validation of international cognitive batteries in different multiple sclerosis (MS) populations is essential. Our objective was to obtain normative data for the Portuguese population of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and assess its reliability. METHODS: The BICAMS was applied to 105 MS patients and 60 age, gender and education matched healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients after a 7-month interval. RESULTS: Most participants were women, with a mean age of 37, 21 years and a mean of 14,08 years of education. The vast majority of the MS patients (92.4%) had the relapsing remitting type, 58.1% were professionally active, mean disease duration was 6.52 years, median EDSS score was 1.5 (range: 0-6.0) and the median MSSS score was 2.01 (IQR range: 3.83). The MS group presented significantly higher scores of anxiety and depression than HC and 47,4% had fatigue. The MS group performed significantly worse than the control group across the three neuropsychological tests, yielding the following values: SDMT: t(165) = 3.77, p = .000; CVLT-II: t(165) = 2.98, p = .003; and BVMT-R: t(165) = 2.94, p = .004. The mean raw scores for Portuguese normative data were as follows: SDMT: 58.68 ± 10.02; CVLT-II: 60.47 ± 10.12; and BVMT-R: 24.68 ± 5.52. Finally, test-retest reliability coefficients for each test were as follows: SDMT: r = .90; CVLT-II: r = .71; and BVMT-R: r = .84. CONCLUSIONS: The Portuguese version of BICAMS here in described is a reliable monitoring instrument for identifying MS patients with cognitive impairment.

Assessment of phonemic verbal fluency in Portuguese patients with multiple sclerosis.

BACKGROUND: Executive dysfunction occurs in 15% to 20% of multiple sclerosis (MS) patients and verbal fluency tests are frequently used to assess this deficit. The Word List Generation (WLG) is one of the most used measures in MS. This study aims to compare the performance of WLG of MS patients and healthy controls and to analyze the influence of clinical and demographic factors on the performance of MS patients. METHODS: One hundred and nine MS patients and an age- and gender-matched group of 138 healthy controls were evaluated with WLG Portuguese version, as well as other tests from the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T), subtests from WAIS, a phonemic fluency test (M, R, and P), and measures of psychological symptomatology and cognitive fatigue. The MS group (70.6% females) was mainly diagnosed with RRMS (89.2%). RESULTS: The MS group performed significantly lower than healthy controls on the WLG. In the MS group, this performance was significantly correlated with the level of education. Significant differences were found between the two groups regarding cognitive fatigue, with MS patients reporting higher levels than healthy controls. However, this variable was not related to the performance on the WLG for MS patients. CONCLUSIONS: This study suggests that MS is associated with large levels of cognitive decline on the phonemic verbal fluency tests. These results are consistent with other studies and highlight the importance of verbal fluency and cognitive speed measures in the neuropsychological assessment of MS. Deficits on this task seem to be highly related to the level of education of the patient rather than other demographic and clinical factors.

Development of the Referee Shared Mental Models Measure (RSMMM).

The concept of shared mental models refers to the shared understanding among team members about how they should behave in different situations. This article aimed to develop a new shared mental model measure, specifically designed for the refereeing context. A cross-sectional study was conducted with three samples: national and regional football referees (n = 133), national football referees and assistant referees and national futsal referees (n = 277), and national futsal referees (n = 60). The proposed version of the Referee Shared Mental Models Measure (RSMMM) has 13 items that are reflected on a single factor structure. The RSMMM presented good validity evidence both based on the internal structure and based on relations to other variables (presenting positive associations with team work engagement, team adaptive performance, and team effectiveness). Such promising psychometric properties point to an optimistic outlook regarding its use to measure shared mental models in futsal and football referee teams.

Working conditions and high emotional exhaustion among hospital nurses.

BACKGROUND: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. OBJECTIVE: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. METHODS: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). RESULTS: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). CONCLUSION: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.

INTRODUÇÃO: Os trabalhadores da saúde estão expostos a muitos estressores diferentes no ambiente de trabalho, alguns deles relacionados com as condições do trabalho dos mesmos. Enquanto a experiência do estresse parece depender da percepção individual, algumas características das unidades de internação podem influenciar a ocorrência de exaustão emocional entre os enfermeiros. O objetivo do presente estudo é identificar características das unidades de internação relacionadas à ocorrência de níveis elevados de exaustão emocional entre profissionais da saúde, a saber, enfermeiros. MÉTODOS: O presente estudo transversal, exploratório e descritivo foi realizado com 108 enfermeiros (83,8% do sexo feminino e com média de 33 anos de idade) alocados em unidades de internação (enfermarias e terapia intensiva) de um hospital universitário em Portugal. Foi administrada a subescala de exaustão emocional do Maslach Burnout Inventory­Human Services Survey (MBI-HSS) e coletados os seguintes dados relativos às unidades de trabalho dos participantes: (1) índice de fatalidade, (2) número de óbitos, (3) déficit de enfermeiros por comparação às diretrizes nacionais, (4) taxa de ocupação e (5) proporção de pacientes idosos internados (>65 anos de idade). RESULTADOS: Identificamos uma associação positiva entre níveis elevados de exaustão emocional e elevado número de óbitos (p=0.012), elevada taxa de mortalidade (p=0.036) e elevada proporção de pacientes idosos (p=0.025). CONCLUSÃO: O número de óbitos, elevada proporção de pacientes idosos e elevada taxa de fatalidade em unidades de internação apresentaram associação com níveis elevados de exaustão emocional entre enfermeiros. Estes achados sugerem que a caracterização das condições objetivas de trabalho em unidades de internação parece ser um aspecto importante a ser levado em conta em programas focados em riscos psicossociais.

Verbal Selective Reminding Test (six-trial administration): Regression-based norms for a portuguese version.

The Verbal Selective Reminding Test (VSRT) is a widely used measure to evaluate verbal learning and memory associated with different neurological conditions. The goal of this study was to extend the use of the six-version trial of this test to the Portuguese population, through the production of adjusted normative data. The normative sample consists of 309 healthy participants aged between 20 and 70, with an educational level ranging from 4 to 23 years of formal. Gender, education, and age effects were explored. In addition, the reliability of the test was also analyzed and normative data produced. Gender, age, and education were significantly associated with VSRT performance. The test revealed excellent inter-rater reliability and good test-retest reliability. The normative data is presented as a regression-based formula to adjust test scores for gender, education and age. The correspondence between adjusted scores and percentile distribution was calculated. Since a test with appropriate norms is fundamental to an appropriate assessment of memory functioning, the normative data produced in this study improves the applicability of VRST for both clinical and research proposes in the Portuguese population. Further studies might also explore the adequacy of these norms for other Portuguese-speaking countries.

Paced Auditory Serial Addition Test (PASAT 3.0 s): Demographically corrected norms for the Portuguese population.

The main goal of this study was to produce adjusted normative data for the Portuguese population on the Paced Auditory Serial Addition Test (PASAT 3.0 s), the version used in the Brief Repeatable Battery of Neuropsychological Tests developed by the National Multiple Sclerosis Society. The study included 326 community-dwelling individuals (199 women and 127 men) aged between 20 and 70 (mean = 40.33, SD = 14.40), who had educational backgrounds ranging from 4 to 23 years of schooling (mean = 12.28, SD = 4.39). Age, gender and qualifications revealed differences in explaining their performance on the PASAT 3.0 s. Men had significantly better performance on the PASAT 3.0 s than women, even though this represents a small effect size r = 0.18. Demographically corrected normative data was developed and important information regarding performance on the PASAT 3.0 s test is provided. Results are discussed and presented in tables and a formula is presented for computing age, gender and education adjusted T-scores for performance on the PASAT 3.0 s. These results should be considered as useful reference values for clinicians and investigators when applying the PASAT 3.0 s to assess cognitive function like information processing speed in different pathologies.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation.

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

Condições de trabalho e exaustão emocional elevada em enfermeiros no ambiente hospitalar / Working conditions and high emotional exhaustion among hospital nurses

INTRODUÇÃO: Os trabalhadores da saúde estão expostos a muitos estressores diferentes no ambiente de trabalho, alguns deles relacionados com as condições do trabalho dos mesmos. Enquanto a experiência do estresse parece depender da percepção individual, algumas características das unidades de internação podem influenciar a ocorrência de exaustão emocional entre os enfermeiros. O objetivo do presente estudo é identificar características das unidades de internação relacionadas à ocorrência de níveis elevados de exaustão emocional entre profissionais da saúde, a saber, enfermeiros. MÉTODOS: O presente estudo transversal, exploratório e descritivo foi realizado com 108 enfermeiros (83,8% do sexo feminino e com média de 33 anos de idade) alocados em unidades de internação (enfermarias e terapia intensiva) de um hospital universitário em Portugal. Foi administrada a subescala de exaustão emocional do Maslach Burnout Inventory­Human Services Survey (MBI-HSS) e coletados os seguintes dados relativos às unidades de trabalho dos participantes: (1) índice de fatalidade, (2) número de óbitos, (3) déficit de enfermeiros por comparação às diretrizes nacionais, (4) taxa de ocupação e (5) proporção de pacientes idosos internados (>65 anos de idade). RESULTADOS: Identificamos uma associação positiva entre níveis elevados de exaustão emocional e elevado número de óbitos (p=0.012), elevada taxa de mortalidade (p=0.036) e elevada proporção de pacientes idosos (p=0.025). CONCLUSÃO: O número de óbitos, elevada proporção de pacientes idosos e elevada taxa de fatalidade em unidades de internação apresentaram associação com níveis elevados de exaustão emocional entre enfermeiros. Estes achados sugerem que a caracterização das condições objetivas de trabalho em unidades de internação parece ser um aspecto importante a ser levado em conta em programas focados em riscos psicossociais.

BACKGROUND: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. OBJECTIVE: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. METHODS: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory­Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). RESULTS: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). CONCLUSION: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation / Validação da BRBN-T: adaptação do Selective Reminding Teste do Word List Generation

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

Objectivo Este estudo tem como objectivo a adaptação do Selective Reminding Test (SRT) e do Word List Generation (WLG)para a população portuguesa, no decurso da validação da Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) para doentes com esclerose múltipla (EM).Método 66 sujeitos saudáveis (54.5% sexo feminino), foram recrutados da comunidade e voluntariaram-se para, participar neste estudo.Resultados Uma combinação de procedimentos da Teoria Clássica dos Testes (TCT) e da Teoria de Resposta ao Item (TRI) foi aplicada à análise e seleção dos itens. Para cada lista do SRT foram selecionadas 12 palavras e para o WLG foram escolhidas 3 letras, que constituem a versão final destes testes para a população Portuguesa.Conclusões A combinação da TCT e da TRI maximizou a tomada de decisão na seleção de itens na adaptação do SRT e do WLG para uma língua e cultura diferentes (o Português). A relevância deste estudo prende-se com a produção de testes de avaliação neuropsicológica fidedignos, que podem ser utilizados na monitorização rigorosa da evolução da EM, efeitos da terapêutica e reabilitação cognitiva.