The links of stress, substance use and socio-demographic factors with domestic violence during the Covid-19 pandemic in Portugal.

BACKGROUND: Lockdown, as a measure implemented to combat the coronavirus disease 2019 (COVID-19) pandemic, left many domestic violence (DV) victims trapped with their abusers. This study intends to explore the links between perceived stress, substance use and socio-demographic factors with DV experiences during COVID-19 pandemic in Portugal. METHODS: A cross-sectional study was carried out on a sample of 1062 participants over 16 years old, residing in Portugal. Data were collected through an online survey conducted between April and October 2020. The associations between potential factors and DV were investigated using bivariable analysis and multivariable logistic regression. RESULTS: The prevalence of DV reported was 13.75% (n = 146), disaggregated into psychological violence (13%, n = 138), sexual violence (1.0%, n = 11) and physical violence (0.9%, n = 10). Multivariable analyses confirmed that perceived financial difficulties (OR = 1.608; P = 0.019), use of medications to sleep or calm down (OR = 1.851; P = 0.002) and perceived stress (OR = 2.443; P = 0.003) were responsible for DV exposure during COVID-19 pandemic. Younger age (<25 years old) and consumption of alcohol were associated with a higher risk of DV victimization. CONCLUSIONS: Interventions aimed at preventing and confronting DV are necessary within the strategies to combat COVID-19 in Portugal, especially aimed at groups in vulnerable situations, during and after the pandemic.

Attitudes of Portuguese Judges and Victim Support Professionals Toward Intimate Partner Homicide Committed by Women.

This investigation analyzed the attitudes of Portuguese judges and victim support professionals toward intimate partner homicide committed by women. By administering an online survey disseminated by the Portuguese Superior Council for the Magistracy and the Commission for Citizenship and Gender Equality, we found that both groups of professionals are not always aligned in their attitudes toward domestic violence and intimate partner homicide, which could jeopardize the articulation between both sectors needed for an effective preventive intervention. However, most professionals of both groups tend to disagree that women provoke their aggressors or lie about their condition as victims of domestic violence and agree that there is a need for increased security and prevention of intimate partner homicides against female and male victims when reporting domestic violence.

Triarchic psychopathic traits versus self-control: Comparing associations with youth antisocial outcomes.

BACKGROUND: Psychopathy and low self-control are useful constructs for understanding antisociality/criminality. The triarchic model of psychopathy in particular is a recent and promising conceptualisation, composed of boldness, disinhibition, and meanness - three personality traits that have never been studied in tandem with low self-control. AIMS: To test relationships between the triarchic personality traits of boldness, disinhibition and meanness and low self-control with delinquent or antisocial acts. METHODS: In a cross-sectional, self-report study a schools' cohort of 14- to 18-year-olds (Mean 15.91 years, SD = 0.99 years) was recruited from regions in South Portugal and Lisbon, representative of the general population of this age in sex distribution and education. After parental consent, teenage volunteers in small groups completed psychopathy and self-control self-rating scales and then a questionnaire about their criminal or delinquent activities, all on one single occasion and in confidence from school staff or parents. Path analysis was used to test relationships. RESULTS: 567 young people, 256 (45%) of them girls, completed all ratings, 89% of those invited to do so. Low self-control had the strongest relationship with antisocial/criminal acts, followed by the disinhibition or meanness traits of the triarchic psychopathy construct. The boldness trait of the triarchic psychopathy construct had the weakest relationship. CONCLUSIONS: Our findings suggest that the most effective targets for intervention to prevent or limit antisocial behaviours by young people are likely to be self-control and disinhibition. Behavioural interventions that improve social skills and verbal problem-solving that encourage listening and waiting in response to environmental stimuli are likely to effect reduction of impulsive and aggressive reactions to others and so reduce conduct problems. Since disinhibition and self-control are such overlapping constructs, improvements in one area will generally facilitate improvements in the other area.

The Implication of the First Wave of COVID-19 on Mental Health: Results from a Portuguese Sample.

The social conditions created by the COVID-19 pandemic had a great potential to affect the mental health of individuals. Meta-analyses indicate a rise in these problems in these periods among general populations, patients and health professionals, even with substantial heterogeneous results. This paper examines mental health impacts specifically during the first wave of COVID-19. An online survey was conducted with a Portuguese convenience sample (N = 1.062) comprising questions about substance use, perceived stress, post-traumatic stress disorder and self-damage behaviors. The results concerning substance use show an extensive use of medication to sleep or calm down, especially among women and older respondents, a small percentage of alcohol consumers with a high pattern of use and less frequent cannabis consumption, even with a quarter of users who began only in the COVID-19 period. The rates of perceived stress and PTSD were higher compared with international prevalence estimations during the pandemic conditions. Both correlated measures were worse for women and young people. Another problematic issue was the rate of suicidal ideation, with a relevant proportion of starters during this period. These data reinforce the need to promote access to mental health services.

Investigating Sex-Related Moderation Effects and Mediation Effects of Self-Control on Delinquency Among Portuguese Youth.

Self-control refers to the ability to override impulses and behave in accordance with societal norms. Deficits in self-control are strongly associated with conduct problems, externalizing disorders, crime, and violence. The main aim of the present study is to investigate possible moderation and mediation effects related to self-control. A school sample of male (n = 257, M = 15.97 years, SD = .98 years) and female (n = 213, M = 15.79 years, SD = 1.03 years) youth from Portugal agreed to participate. Moderation analysis revealed that sex moderates the relationship between self-control and aggression, conduct disorder symptoms, and self-reported delinquency. Mediation analysis revealed that self-control mediates the relations between both triarchic psychopathic traits and dark triad traits, and the self-reported juvenile delinquency outcome. The findings suggest that self-control exerts significant effects on the criminal/antisocial-related variables examined among Portuguese youth.

Neurocognitive profiles in adolescents and young adults with congenital heart disease.

INTRODUCTION AND OBJECTIVES: The objectives of this study were to assess the neuropsychological performance (NP) of adolescents and young adults with congenital heart disease (CHD), comparing them with a group of healthy controls, to determine whether there are different neurocognitive phenotypes in CHD, and to identify their relation to sociodemographic, neonatal, clinical and psychological adjustment variables. METHODS: A total of 217 CHD patients (116 male, aged 15.73±2.68 years) and 80 controls (35 male, age 16.76±2.22 years) underwent an extensive neuropsychological assessment and analysis of psychological adjustment. RESULTS: CHD patients had significantly poorer NP than healthy controls in all neurocognitive domains. Three different phenotypes of NP in CHD patients were identified: non-impaired (NI), moderately impaired (MI) and globally impaired (GI). They differed in all dimensions of NP. The GI cluster showed fewer years of schooling (p=0.025) and lower neonatal indicators such as head circumference (p=0.019), 1-min Apgar score (p=0.006), birth weight (p=0.05) and length (p=0.034) than the NI cluster. In the MI and GI clusters, there were more cyanotic forms of disease, including tetralogy of Fallot and transposition of the great arteries. The GI cluster presented more difficulties with psychological adjustment, including social (p=0.038), attention (p=0.001) and aggressive (p=0.003) problems. CONCLUSIONS: CHD patients have poorer NP than controls. NP in the CHD group can be classified in three clusters that reflect different levels of neuropsychological functioning, which is sensitive to social, neonatal and psychological adjustment variables.

Impact of fetal development on neurocognitive performance of adolescents with cyanotic and acyanotic congenital heart disease.

BACKGROUND: Our aims were to evaluate the neurocognitive performance in adolescents with congenital heart disease (CHD) and to determine whether parameters of fetal development evaluated in neonates, such as head circumference, length, weight, and Apgar scores, are somehow related to their neurocognitive performance. METHODS: We evaluated 77 CHD patients (43 males) aged from 13 to 18 years old (mean = 15.04 ± 1.86), 46 cyanotic, 23 with tetralogy of Fallot (TF), 23 with transposition of the great arteries (TGA) and 31 acyanotic with ventricular septal defect (VSD) enrolled in this study. The control group included 16 healthy children (11 males) ages ranging from 13 to 18 years old (mean = 15.69 years ± 1.44 years). All assessment measures for CHD patients were once obtained in a tertiary hospital; the control group was evaluated in school. Neuropsychological assessment included Wechsler's Digit Test, direct and reverse (WDD and WDR) and Symbol Search, Rey's Complex Figure (RCF), BADS's Key Searching Test, Color-Word Stroop Test (CWS), Trail Making Test (TMT), and Logical Memory Task (LMT). We evaluated some fetal parameters, such as head circumference, weight and length assessed at birth, and neonatal parameters, such as Apgar scores at 1 and 5 minutes after birth. We also registered some surgical parameters, such as the age at first operation and the number of surgeries. RESULTS: CHD patients compared with control group showed lower scores on every test, except for logical memory task. Patients with VSD when compared with patients with TF and TGA showed better results in all neuropsychological tests, although the only significant differences were in RCF, copy (F = 4936; P = .010). Several correlations were apparent between fetal/neonatal parameters and neuropsychological abilities in each type of CHD. However, head circumference at birth stands as the main correlation with cognitive development later on in all kinds of CHD (WDD: rho = .339, P = .011; RCF, copy: rho = 0.297, P = .027; CWS, interference: rho = 0.283, P = .036; TMT-A: rho = -0.321, P = .017). We analyzed the predicting relevance of several variables to cognitive performance of adolescents with CHD and confirmed that "cyanosis" stands as the main predictor (â = -4.758; t = -2.622; P = .011). CONCLUSIONS: Adolescents with CHD have worse neuropsychological performance than the control group, mainly the cyanotic patients. Fetal circulation seems to have impact on cerebral and somatic growth, predicting cognitive impairment in adolescents with CHD.

[Long term psychosocial outcomes of congenital heart disease in adolescents and young adults].

OBJECTIVE: Congenital heart disease (CHD) is a chronic illness with a high frequency in the worldwide population, and is normally diagnosed at birth or in uterus. Because of better conditions in diagnosis and early medical and surgical treatment, patients have survival rates of 90% and go further and further in life, facing different challenges in life cycle. In this study, we tested the effects of different demographic, clinical and psychosocial variables on the perception of quality of life (QOL), on psychosocial adjustment (PSA) and psychiatric morbidity (PM) of adolescents and young adults with CHD. We aimed to evaluate QOL, PM and PSA of adolescents and young adults with CHD and to determine which variables (demographic, clinical, and psychosocial) play a role in buffering stress and promoting resilience and which ones have a detrimental effect. METHODS: The study enrolled 150 CHD patients (87 males and 63 females), 12 to 26 years (17.45±3.373 years). The participants were interviewed regarding social support, family educational style, self-image, demographic information and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed self-reports questionnaires for assessment of QOL (WHOQOL-BREF) and PSA (YSR/ASR). RESULTS: We found a 18.7% lifetime prevalence of psychopathology in our participants (25.4% in females and 13.8% in males). 57.1% had retentions in school (1.53±0.804 year). The perception of QOL of CHD patients is better compared to the Portuguese population in the social relationships, environmental, physical and general dimensions. However, it is worse in female CHD patients and patients with poor academic performance and social support as well as in patients with complex or cyanotic CHD, moderate-to-severe residual lesions and physical limitations, and undergoing surgery. All of these variables, except presence of cyanosis, are also associated to a worse PSA. CONCLUSIONS: Female patients and patients with poor academic performance and poor social support refer worse PSA and QOL.

Detecção de simulação com o uso do wisconsin card sorting test e do trail making test / Detection of malingering using the wisconsin card sorting test and the trail making test

Neste trabalho, tentamos identificar índices de simulação na avaliação neuropsicológica forense, através da avaliação dos padrões de resposta em provas neuropsicológicas. A amostra foi constituída por 56 sujeitos com traumatismo crânioencefálico. Todos se encontravam numa situação de possível recompensa monetária por incapacidade. Utilizamos os instrumentos Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Inventário de Sintomas Psicopatológicos (BSI), e a grelha de análise dos autos do processo. Cerca de 30% da amostra enquadrou-se no grupo de prováveis simuladores. Essa porcentagem é congruente com a literatura. Verificou-se uma grande homogeneidade entre os indivíduos com e sem indicadores de simulação, a nível sintomatológico e características sócio-demográficas, o que reforça a necessidade de desenvolvimento de métodos eficazes na detecção da simulação.(AU)

The objective of this study was to identify indicators of malingering in forensic neuropsychological assessment by identifying response patterns in neuropsychological tests. The sample was composed by 56 subjects diagnosed with a cranioencephalic trauma. All subjects were in a situation of monetary reward if incapacity was proven. The instruments used were the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Brief Symptom Inventory (BSI), and a legal process data file. Approximately 30% of the studied sample was identified as probable malingerers. This percentage is consistent with the literature. We identified a high level of homogeneity of psychological symptoms and socio-demographic features in the group of subjects with indicators of malingering and in the group without such indicators. These results reinforce the necessity to develop efficient methods to detect malingering.(AU)

Detecção de simulação com o uso do wisconsin card sorting test e do trail making test / Detection of malingering using the wisconsin card sorting test and the trail making test

Neste trabalho, tentamos identificar índices de simulação na avaliação neuropsicológica forense, através da avaliação dos padrões de resposta em provas neuropsicológicas. A amostra foi constituída por 56 sujeitos com traumatismo crânioencefálico. Todos se encontravam numa situação de possível recompensa monetária por incapacidade. Utilizamos os instrumentos Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Inventário de Sintomas Psicopatológicos (BSI), e a grelha de análise dos autos do processo. Cerca de 30% da amostra enquadrou-se no grupo de prováveis simuladores. Essa porcentagem é congruente com a literatura. Verificou-se uma grande homogeneidade entre os indivíduos com e sem indicadores de simulação, a nível sintomatológico e características sócio-demográficas, o que reforça a necessidade de desenvolvimento de métodos eficazes na detecção da simulação.

The objective of this study was to identify indicators of malingering in forensic neuropsychological assessment by identifying response patterns in neuropsychological tests. The sample was composed by 56 subjects diagnosed with a cranioencephalic trauma. All subjects were in a situation of monetary reward if incapacity was proven. The instruments used were the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Brief Symptom Inventory (BSI), and a legal process data file. Approximately 30% of the studied sample was identified as probable malingerers. This percentage is consistent with the literature. We identified a high level of homogeneity of psychological symptoms and socio-demographic features in the group of subjects with indicators of malingering and in the group without such indicators. These results reinforce the necessity to develop efficient methods to detect malingering.

Long term psychosocial outcomes of congenital heart disease (CHD) in adolescents and young adults.

BACKGROUND: Congenital heart disease (CHD) is a chronic illness with a high frequency in the worldwide population, and is normally diagnosed at birth or in uterus. Because of better conditions in diagnosis and early medical and surgical treatment, patients have survival rates of 90% and go further and further in life, facing different challenges in life cycle. In this study, we tested the effects of different demographic, clinical and psychosocial variables on the perception of quality of life (QOL), on psychosocial adjustment (PSA) and psychiatric morbidity (PM) of adolescents and young adults with CHD. OBJECTIVES: We aimed to evaluate QOL, PM and PSA of adolescents and young adults with CHD and to determine which variables (demographic, clinical, and psychosocial) play a role in buffering stress and promoting resilience and which ones have a detrimental effect. METHODS: The study enrolled 150 CHD patients (87 males and 63 females), 12 to 26 years (M: 17.45±3.373 years). The participants were interviewed regarding social support, family educational style, self-image, demographic information and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed self-reports questionnaires for assessment of QOL (WHOQOL-BREF) and PSA (YSR/ASR). RESULTS: We found an 18.7% lifetime prevalence of psychopathology in our participants (25.4% in females and 13.8% in males). 57.1% had retentions in school (M: 1.53±0.804 year). The perception of QOL of CHD patients is better compared to the Portuguese population in the Social Relationships, Environmental, Physical and General Dimensions. However, it is worse in complex forms of CHD, in cyanotic patients, in moderate-to-severe residual lesions, in patients submitted to surgery and in patients with physical limitations. All of these variables, except presence of cyanosis, are also associated to a worse PSA. Social Support is very important in improving QOL of patients in all dimensions as well as academic performance. CONCLUSIONS: Female patients and patients with poor academic performance and poor social support refer worse PSA and QOL.

Trasplante cardíaco. Experiencia de 15 años del Instituto de Cardiología Infantil / Heart transplantation. Experience of 15 years of the Instituto de Cardiología Infantil

El trasplante cardíaco es el tratamiento de elección para la insuficiencia cardíaca cuando no existe otra alternativa terapéutica que prolongue la expectativa de vida. En el año 1996 se inicia en Uruguay el Programa de Insuficiencia Cardíaca y Trasplante del Instituto de Cardiología Infantil, al realizar el primer trasplante cardíaco en un niño de 14 años. Tres años después se inicia el programa de trasplante cardíaco en adultos. Nuestro objetivo es mostrar la experiencia de trabajo en esta área. Efectuamos un análisis descriptivo de los trasplantes cardíacos realizados en 15 años, en lo que se refiere a distribución etaria, indicaciones, protocolo inmunosupresor, técnica quirúrgica, complicaciones a corto, mediano y largo plazo,y curva actuarial de sobrevida. Resultados: se realizaron 76 trasplantes cardíacos: 23 en niños y 53 en adultos. Referente a la etiología que motivó el trasplante: en niños menores de 1 año, 100% correspondió a cardiopatías congénitas; entre 1 y 10 años, 50% correspondió a miocardiopatía dilatada idiopática, 40% a cardiopatías congénitas y 10% a tumores; entre 11 a 17 años, 50% a cardiopatías congénitas y otro 50% a miocardiopatía dilatada idiopática. En adultos, 51% correspondió a miocardiopatía dilatada idiopática y 37% a miocardiopatía isquémica; el resto a etiología valvular y cardiopatías congénitas. Las complicaciones fueron: rechazo celular en 25%, infección bacteriana en 30%, un caso de tuberculosis peritoneal (1,3%) y tres casos (3,9%) de reactivación de citomegalovirus. Dos casos (2,6%) con complicación tumoral y en otros dos casos enfermedad vascular del injerto, en estos últimos se efectuó el retrasplante a los siete y cinco años, respectivamente, con buena evolución posterior. La sobrevida según curva actuarial a los diez años es de 70% para los adultos y de 45% paralos niños.

The cardiac transplant is the treatment of choice for the cardiac insufficiency when there is not another therapeutic alternative that prolongs the life expectancy. On December 1996 we begin the program of Cardiac Insufficiency and Transplants of the Institute of Pediatric Cardiology, achieving the first cardiac transplant in a 14-year-old child in Uruguay. Three years later we put in practice the program of cardiac transplant in adults. The objective is to show our experience in the area of cardiac transplantation. We carry out a descriptive analysis of the cardiac transplants done in 15 years, concerning age distribution, indications, immunosuppressant protocol, surgical technique, complications to short, medium and long term and actuarial survival curve.Results: 76 cardiac transplants were done: 23 in children and 53 in adults. Regarding the etiology that led to the transplant: in children under 1 year, 100% were congenital heart disease, between 1 and 10 years, 50% were idiopathic dilated cardiomyopathy, 40% to 10% congenital heart disease and tumors; 11 to 17 years 50% to congenital heart disease and 50% to idiopathic dilated cardiomyopathy. In adults, 51% were idiopathic dilated cardiomyopathy and ischemic cardiomyopathy 37%, the rest for valvular and congenital heart disease etiology. Complications included cellular rejection in 25%, bacterial infection in 30%, a case of peritoneal tuberculosis (13%) and three cases of reactivation of cytomegalovirus (3,9%) Two cases of tumor involvement (26%). Two cases with graft vascular disease, who received a retransplant at seven and five years after transplantation, with good performance later. The actuarial survival curve according to the ten years is 70% for adults and 45% for children.Conclusion: cardiac transplantation remains a valid therapeutic alternative in patients with terminal heart failure.

Disfunción ventricular transitoria y reversible posdrenaje de derrame pericárdico en el postoperatorio de cardiopatía congénita / Transient and reversible ventricular dysfunction after drainage of pericardial effusion in postoperative congenital heart disease

Analizamos la evolución poscorrección quirúrgica de una comunicación interauricular, en una paciente de 7 años de edad que presenta dos complicaciones. Una inicial, dada por el acúmulo de líquido en la cavidad pericárdica, que se manifiesta por sintomatología inespecífica (fiebre, decaimiento, inapetencia), que requiere sospecha y diagnóstico temprano evacuando el derrame y administrando antiinflamatorios no esteroideos y corticoides, para evitar la reproducción del derrame. Y una segunda posdrenaje del derrame, dada por falla ventricular significativa que requiere tratamiento enérgico mediante inotrópicos, diuréticos y asistencia ventilatoria mecánica, logrando su reversibilidad sin secuelas. Se describe la evolución clínica, electrocardiográfica y ecocardiográfica. Se recalca la necesidad de sospechar clínicamente en forma temprana esta entidad, en todo postoperatorio de cirugía cardíaca por cardiopatía congénita, que presente este tipo de síntomas y signos, de manera de indicar la pericardiocentesis en forma oportuna y evitar la progresión al taponamiento cardíaco.

Ventana aortopulmonar asociada a interrupción del arco aórtico. Descripción de tres casos clínicos / Aorto-pulmonary window associated to interrupted aortic arch. Description of three clinical cases

La asociación de ventana aortopulmonar (VAP) con interrupción del arco aórtico (IAA) es un hallazgo excepcional dentro del grupo de cardiopatías congénitas ductus dependientes. Presentamos nuestra experiencia reciente de tres casos clínicos (edades: tres días, cuatro días y cuatro meses) que ilustran distintas modalidades de presentación clínica y anatómica, que a su vez condicionan diferentes tácticas de tratamiento quirúrgico e influyen en la evolución postoperatoria. Todos los pacientes recibieron el tratamiento médico convencional, incluyendo la infusión de prostaglandina. El diagnóstico ecocardiográfico se confirmó en todos los casos con aortografía de contracorriente, la cual demostró en todos los pacientes IAA tipo A y VAP tipo I en los dos primeros, tipo II en el tercero. En un caso se procedió a interponer un segmento de vena cava superior izquierda para corregir la IAA, cerrando la VAP mediante ligadura, sin circulación extracorpórea (CEC). En el segundo caso, también sin CEC, se utilizó la arteria carótida izquierda para restituir la continuidad del arco aórtico, cerrando la VAP por ligadura simple. En el tercer caso, se reparó la IAA mediante anastomosis término-terminal ampliada y luego bajo CEC se interrumpió la VAP con cierre directo de la aorta y parche de pericardio autólogo en la pulmonar. El caso 1 tuvo una evolución tormentosa, requiriendo plicatura frénica y reparación de úlcera gástrica. En controles posteriores se demostró una obstrucción significativa del arco aórtico, que requirió angioplastia con buen resultado en el corto término. El caso 2 evolucionó sin complicaciones. El caso 3 falleció en postoperatorio inmediato. Se trataba de un paciente de diagnóstico tardío, con resistencia vascular pulmonar elevada.

Transplante cardíaco en pediatría: a propósito del primer caso en Uruguay / Heart transplantation in children: apropos of the first case in Uruguay

En diciembre de 1996, el Instituto de Cardiología Infantil realizó el primer trasplante cardíaco exitoso en Uruguay. Un paciente de sexo masculino de 14 años, multioperado, con insuficiencia cardíaca terminal, fue sometido a trasplante cardíaco ortotópico. Se utilizó la técnica de anastomosis bicaval. El resultado fue muy satisfactorio y a los 18 meses del procedimiento el paciente se encuentra asintomático, realizando vida normal, con medicación monofármaco (ciclosporina), biopsia sin elementos de rechazo y cateterismo cardíaco normal. Se discuten las indicaciones y limitaciones de la técnica. Se concluye que el trasplante cardíaco constituye una opción terapéutica válida en nuestro país, para un grupo creciente de pacientes