Secondary hypertension and aortic coarctation in a young adult: A case report.

Aortic coarctation is a rare cause of secondary hypertension (<1% cases) and can be challenging to detect due to its few clinical manifestations. Early diagnosis and treatment are important because patients with unmanaged aortic coarctation are at increased risk of cardiovascular complications and have a reduced life expectancy. We describe a case of secondary hypertension in a young adult female caused by aortic coarctation, first detected in a general practitioner setting, resulting in the need for a left subclavian-carotid bypass vascular surgery and a descending aortic stent vascular surgery. This case highlights the critical role that proximity medicine in general practice can have in improving the early detection of clinically silent conditions by routinely monitoring blood pressure and other vital parameters, and the increasing importance of medical imaging in assisting early diagnosis and guiding the surgical management of complex cases.

Identifying subgroups in heart failure patients with multimorbidity by clustering and network analysis.

This study presents a workflow for identifying and characterizing patients with Heart Failure (HF) and multimorbidity utilizing data from Electronic Health Records. Multimorbidity, the co-occurrence of two or more chronic conditions, poses a significant challenge on healthcare systems. Nonetheless, understanding of patients with multimorbidity, including the most common disease interactions, risk factors, and treatment responses, remains limited, particularly for complex and heterogeneous conditions like HF. We conducted a clustering analysis of 3745 HF patients using demographics, comorbidities, laboratory values, and drug prescriptions. Our analysis revealed four distinct clusters with significant differences in multimorbidity profiles showing differential prognostic implications regarding unplanned hospital admissions. These findings underscore the considerable disease heterogeneity within HF patients and emphasize the potential for improved characterization of patient subgroups for clinical risk stratification through the use of EHR data.

Appropriateness of prescribing profiles and intake adherence to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: analysis of a retrospective longitudinal study using real-world data from Northern Portugal (AF-React Study).

OBJECTIVES: This study aimed to assess the appropriateness of prescribing profiles and intake adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). DESIGN: Retrospective longitudinal study. SETTING: The study was conducted in the Regional Health Administration of Northern Portugal. PARTICIPANTS: The authors selected a database of 21 854 patients with prescriptions for NOACs between January 2016 and December 2018 and were classified with AF until December 2018. OUTCOME MEASURES: The appropriate dosage of NOAC for patients with AF divided into three categories: contraindicated, inconsistent and consistent, based on the 2020 European Society of Cardiology guidelines for AF. RESULTS: Dabigatran had a lower percentage of guideline-consistent doses (n=1657, 50.1%) than other drugs such as rivaroxaban (n=4737, 81.6%), apixaban (n=3830, 78.7%) and edoxaban (n=436, 82.1%). Most patients with an inconsistent dose were prescribed a lower dose than recommended based on their glomerular filtration rate (GFR). Among patients younger than 75 years with GFR >60 mL/min, 59.8% (n=10 028) had an adequate GFR range, while 27.8% (n=7166) of GFR measurements from patients older than 75 years old and 29.4% (n=913) of GFR measurements from patients younger than 75 years with GFR <60 mL/min were within an adequate time range. Adherence to NOACs varied across different drugs, with 59.1% (n=540) adhering to edoxaban, 56.3% (n=5443) to rivaroxaban, 55.3% (n=3143) to dabigatran and 53.3% (n=4211) to apixaban. CONCLUSIONS: Dabigatran had the lowest percentage of guideline-consistent doses. Patients younger than 75 years with GFR >60 mL/min had the highest percentage with an adequate GFR range, while other groups who require closer GFR monitoring had lower percentages within an adequate GFR range. Adherence to NOACs differed among different drugs, with greater adherence to treatment with edoxaban and less adherence to apixaban.

AF-React study: Prevalence of thrombotic events in patients with atrial fibrillation receiving NOACs - real-world data analysis from northern Portugal primary healthcare.

Introduction: Anticoagulation is recommended for stroke prevention in patients with atrial fibrillation (AF). The guidelines suggest non-vitamin K antagonist anticoagulants (NOACs) as the primary therapy for anticoagulation in AF. Several patient-related factors increase the risk of thrombotic events: elderly individuals, a previous history of stroke, and chronic kidney disease. This study aims to determine the association between NOACs and other patient variables in AF and the occurrence of thrombotic events. Methods: The database included all adults with the code K78 (ICPC-2 code for AF) who received clinical care in Northern Portugal's Primary Health Care between January 2016 and December 2018 and were dispensed the same NOAC at the pharmacy. Results: The results indicate that 10.2% of AF patients on NOAC anticoagulation experienced a stroke. Furthermore, patients treated with apixaban and dabigatran had higher odds of experiencing a stroke compared to those treated with rivaroxaban. Among patients with the same age, gender, and CHA2DS2Vasc Score, apixaban was significantly associated with a higher likelihood of thrombotic events than rivaroxaban. Discussion: These results have not been previously reported in studies with real-world data; therefore, a more detailed analysis should be conducted to enhance the validity of these findings.

A Case of Acute Eosinophilic Pneumonia Associated With Non-steroidal Anti-inflammatory Drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and their gastric, cardiovascular, and renal adverse effects have been well documented. Although rare, NSAID-induced acute eosinophilic pneumonia (AEP) may occur. We report a case of AEP related to naproxen and celecoxib. The patient presented with dry cough and breathlessness two weeks after she started taking these drugs. The chest radiograph displayed bilateral opacities and she had peripheral eosinophilia. Bronchoalveolar lavage was performed at a time when blood eosinophilia was already decreasing and cell analysis revealed 63700 cells/mL with 9% eosinophil. After ruling out other possible etiologies, drug-induced AEP was diagnosed. The patient improved after drug discontinuation. When it comes to drug-induced AEP identifying a causative agent is essential as cessation of the drug is the mainstay of the treatment.

Burnout, resilience, and subjective well-being among Portuguese lecturers' during the COVID-19 pandemic.

Background: Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic. Methods: A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale. Results: The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout. Conclusion: Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.

The role of social support as a moderator between resilience and levels of burden of multimorbidity management among general practitioners: a cross-sectional study in Portugal.

BACKGROUND: Multimorbidity management poses significant challenges for general practitioners (GPs). The aim of this study is to analyse the role of resilience and social support on the burden experienced by GPs in managing patients with multiple health conditions in Portugal. METHODS: Cross-sectional quantitative study conducted among GPs in Portugal using an online questionnaire that included validated measurement tools: Questionnaire of Evaluation of Burden of Management of Multimorbidity in General and Family Medicine (SoGeMM-MGF), European Portuguese Version of the Resilience Scale (ER14), and the Oslo Social Support Scale-3 (OSSS-3) in Portuguese. A multiple linear regression analysis was conducted to examine the factors influencing the burden of managing multimorbidity. RESULTS: Two hundred and thirty-nine GPs were included, with 76.6% being female and a median age of 35 years. Most participants were specialists (66.9%) and had less than a decade of experience managing multimorbidity. Over 70% had not received specific training in multimorbidity. Female GPs and those with a higher proportion of multimorbid patients in the registries experienced higher burden levels. A multivariate regression model with moderation revealed that the effect of resilience on burden varied depending on the level of social support. Higher resilience was associated with higher burden in the "Poor Social Support" category, while it was associated with lower burden in the "Moderate Social Support" and "Strong Social Support" categories, although not statistically significant. CONCLUSIONS: The study highlights the importance of GPs' social support and resilience in managing the burden of multimorbidity, with poor social support potentially worsening the effects of high resilience.

Translation and cultural adaptation of MedStopper®-A web-based decision aid for deprescribing in older adults: A protocol.

BACKGROUND: Older patients are more likely to have medication-related problems, which are associated with changes in pharmacokinetics and pharmacodynamics, multimorbidity, and polypharmacy. Polypharmacy and inappropriate prescribing are well-known risk factors which commonly cause adverse clinical outcomes in older people. Prescribers struggle to identify potentially inappropriate medications and to choose an adequate tapering approach. METHODS/DESIGN: The goal of the study is to translate and culturally adapt MedStopper®, an original English language web-based decision aid system in deprescribing medication, to the Portuguese population. A translation-back translation method, with validation of the obtained Portuguese version of MedStopper® will be used, followed by a comprehension test. DISCUSSION: This is the first research in the Portuguese primary care setting that aims to provide a useful online tool for the appropriate prescription of older patients. The translated version in Portuguese version of the MedStopper® tool will represent an advance that seeks to continue improving the management of medications in the elderly. The adaptation into Portuguese of the educational tool provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients older than 65 that reliable and easier to use. TRIAL REGISTRATION: Retrospectively registered.

ST3GalIV drives SLeX biosynthesis in gastrointestinal cancer cells and associates with cancer cell motility.

Expression of sialyl Lewis X (SLeX) is a well-documented event during malignant transformation of cancer cells, and largely associates with their invasive and metastatic properties. Glycoproteins and glycolipids are the main carriers of SLeX, whose biosynthesis is known to be performed by different glycosyltransferases, namely by the family of ß-galactoside-α2,3-sialyltransferases (ST3Gals). In this study, we sought to elucidate the role of ST3GalIV in the biosynthesis of SLeX and in malignant properties of gastrointestinal (GI) cancer cells. By immunofluorescent screening, we selected SLeX-positive GI cancer cell lines and silenced ST3GalIV expression via CRISPR/Cas9. Flow cytometry, immunofluorescence and western blot analysis showed that ST3GalIV KO efficiently impaired SLeX expression in most cancer cell lines, with the exception of the colon cancer cell line LS174T. The impact of ST3GalIV KO in the biosynthesis of SLeX isomer SLeA and non sialylated Lewis X and A were also evaluated and overall, ST3GalIV KO led to a decreased expression of SLeA and an increased expression in both LeX and LeA. In addition, the abrogation of SLeX on GI cancer cells led to a reduction in cell motility. Furthermore, ST3GalVI KO was performed in LS174T ST3GalIV KO cells, resulting in the complete abolishment of SLeX expression and consequent reduced motility capacity of those cells. Overall, these findings portray ST3GalIV as the main, but not the only, enzyme driving the biosynthesis of SLeX in GI cancer cells, with a functional impact on cancer cell motility.

Characterization of an obese population: a retrospective longitudinal study from real-world data in northern Portugal.

BACKGROUND: Obesity is a serious and largely preventable global health problem. Obesity-related electronic health records can be a useful resource to identify and address obesity. The analysis of real-world data from T82-coded (International Classification of Primary Care coding, for obesity) primary care individuals can be an excellent national source of data on obesity's prevalence, characteristics, and impact on the National Health Service. METHODS: Retrospective longitudinal study, based on a database of electronic medical records, from the Regional Health Administration of northern Portugal. The study objectives were to determine the prevalence of obesity and to characterize an adult obese population in northern Portugal from a bio-demographic point of view along with profiles of comorbidities and the use of health resources. This study used a database of 266,872 patients in December 2019 and screened for diagnostic code T82 from the International Classification of Primary Care. RESULTS: The prevalence of obesity was 10.2% and the highest prevalence of obesity was in the 65-74 age group (16.1%). The most prevalent morbidities in patients with obesity as coded through ICPC-2 were K86 (uncomplicated hypertension), T90 (non-insulin-dependent diabetes), and K87 (complicated hypertension). Descriptive information showed that T82 subjects used more consultations, medications, and diagnostic tests than non-T82 subjects. CONCLUSIONS: Routine recording of weight and height deserves special attention to allow obesity recognition at an early stage and move on to the appropriate intervention. Future work is necessary to automate the codification of obesity for subjects under 18 years of age, to raise awareness and anticipate the prevention of problems associated with obesity. Practical strategies need to be implemented, such as the creation of a specific program consultation with truly targeted approaches to obesity.

Using Markov chains and temporal alignment to identify clinical patterns in Dementia.

In the healthcare sector, resorting to big data and advanced analytics is a great advantage when dealing with complex groups of patients in terms of comorbidities, representing a significant step towards personalized targeting. In this work, we focus on understanding key features and clinical pathways of patients with multimorbidity suffering from Dementia. This disease can result from many heterogeneous factors, potentially becoming more prevalent as the population ages. We present a set of methods that allow us to identify medical appointment patterns within a cohort of 1924 patients followed from January 2007 to August 2021 in Hospital da Luz (Lisbon), and to stratify patients into subgroups that exhibit similar patterns of interaction. With Markov Chains, we are able to identify the most prevailing medical appointments attended by Dementia patients, as well as recurring transitions between these. To perform patient stratification, we applied AliClu, a temporal sequence alignment algorithm for clustering longitudinal clinical data, which allowed us to successfully identify patient subgroups with similar medical appointment activity. A feature analysis per cluster obtained allows the identification of distinct patterns and characteristics. This pipeline provides a tool to identify prevailing clinical pathways of medical appointments within the dataset, as well as the most common transitions between medical specialities within Dementia patients. This methodology, alongside demographic and clinical data, has the potential to provide early signalling of the most likely clinical pathways and serve as a support tool for health providers in deciding the best course of treatment, considering a patient as a whole.

Distance to Natural Environments, Physical Activity, Sleep, and Body Composition in Women: An Exploratory Analysis.

A growing body of evidence indicates that living close to nature is associated with better health and well-being. However, the literature still lacks studies analyzing the benefits of this proximity for sleep and obesity, particularly in women. The purpose of this study was to explore how distance to natural spaces is reflected in women's physical activity, sleep, and adiposity levels. The sample consisted of 111 adult women (37.78 ± 14.70). Accessibility to green and blue spaces was assessed using a geographic-information-system-based method. Physical activity and sleep parameters were measured using ActiGraph accelerometers (wGT3X-BT), and body composition was assessed using octopolar bioimpedance (InBody 720). Nonlinear canonical correlation analysis was used to analyze the data. Our findings reveal that women living in green spaces close to their homes had lower levels of obesity and intra-abdominal adiposity. We also demonstrated that a shorter distance to green spaces seemed to correlate with better sleep onset latency. However, no relationship was found between physical activity and sleep duration. In relation to blue spaces, the distance to these environments was not related to any health indicator analyzed in this study.

Pro-Environmental Behaviors: Relationship With Nature Visits, Connectedness to Nature and Physical Activity.

PURPOSE: Examine the association of visits to the natural environment, connectedness to nature, physical activity, and the adoption of pro-environmental behaviors (PEBs) in individuals aged 18 years or older. DESIGN: Cross-sectional study. SETTING: City of Vila Real, located in the north of Portugal. SUBJECTS: We recruited 194 individuals (61 men and 133 women) aged 18-75 years. MESURES: A self-administered questionnaire was used to measure nature visits, connectedness to nature, PEBs, and demographic characteristics. Neighborhood green space was appreciated through a Simplified Land Occupation Map and physical activity was measured using ActiGraph accelerometers (wGT3X-BT). ANALYSIS: Correlations and nonlinear canonical correlation analysis were used to analyze the data. The coefficients of canonical and multiple correlations were calculated. RESULTS: Nature visits were associated with involvement in environmental volunteering (V = .317, P ≤ .05) among men. In these, higher levels of moderate-vigorous PA were associated with green travel behavior (η2 = .325, P ≤ .05). Connectedness with nature was related (P ≤ .05) to private sphere behaviors, such as purchase of eco-products (η2 = .191) and local/seasonal products (η2 = .186) in females and encouraging care and protection of natural environment (η2 = .336, P ≤ .01) in males. CONCLUSIONS: Nature visits, connection to nature, and physical activity levels were related to the adoption of PEBs in the private and public sphere, and these relationships differed between men and women.

Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal.

BACKGROUND: Lifestyle factors are widely recognized as modifiers and major risk factors for non-communicable diseases. Previous studies on the prevalence of multimorbidity in Portugal predict an unfavourable reality. The aim of the present study was to analyse 1) the prevalence of multimorbidity in Portugal and 2) the association of individuals' lifestyles and sociodemographic factors with multimorbidity. METHODS: A cross-sectional, population-wide study was conducted on a representative sample of the general population of Portuguese adults aged ≥ 20 years. Categorical variables were described by their respective absolute and relative frequencies (n (%)). All variables with a p-value < 20% were included in the multiple logistic regression model. The variables were removed one by one in descending order of p-value (p) until the model contained only significant variables. The results are presented using the odds ratio and 95% confidence intervals. P-values ​​ < 5% were considered significant. RESULTS: The prevalence of multimorbidity was 48.9% (n = 436), and the odds of multimorbidity increased 4% (p < 0.001) for each year of increase in age. Participants with reasonable general health status had higher odds of multimorbidity (Odds ratio (OR) = 3.04; p < 0.001), and those with poor or very poor general health status had even higher odds (OR = 9.14; p < 0.001). Compared to those who never smoked, participants who quit smoking ≥ 1 year presented an increase of 91% (p = 0.005) in the odds of multimorbidity. Individuals with no good-quality sleep, non-moderate screen time, or non-moderate stress level had higher odds of multimorbidity (OR = 1.98; OR = 1.88; OR = 2.22, respectively. p < 0.001). CONCLUSIONS: This study presented a new approach to multimorbidity in Portugal. Population-based, multidimensional lifestyle interventions are needed. It seems necessary to optimize and adjust measures to prevent non-communicable diseases to improve health in Portugal. In the future, longitudinal studies will be an asset to reinforce and clarify these conclusions.

Cognitive networks detect structural patterns and emotional complexity in suicide notes.

Communicating one's mindset means transmitting complex relationships between concepts and emotions. Using network science and word co-occurrences, we reconstruct conceptual associations as communicated in 139 genuine suicide notes, i.e., notes left by individuals who took their lives. We find that, despite their negative context, suicide notes are surprisingly positively valenced. Through emotional profiling, their ending statements are found to be markedly more emotional than their main body: The ending sentences in suicide notes elicit deeper fear/sadness but also stronger joy/trust and anticipation than the main body. Furthermore, by using data from the Emotional Recall Task, we model emotional transitions within these notes as co-occurrence networks and compare their structure against emotional recalls from mentally healthy individuals. Supported by psychological literature, we introduce emotional complexity as an affective analog of structural balance theory, measuring how elementary cycles (closed triads) of emotion co-occurrences mix positive, negative and neutral states in narratives and recollections. At the group level, authors of suicide narratives display a higher complexity than healthy individuals, i.e., lower levels of coherently valenced emotional states in triads. An entropy measure identified a similar tendency for suicide notes to shift more frequently between contrasting emotional states. Both the groups of authors of suicide notes and healthy individuals exhibit less complexity than random expectation. Our results demonstrate that suicide notes possess highly structured and contrastive narratives of emotions, more complex than expected by null models and healthy populations.

Impact of COVID-19 pandemic on the mental health of healthcare workers during the first wave in Portugal: a cross-sectional and correlational study.

OBJECTIVES: The COVID-19 pandemic has had a negative impact on the mental health of healthcare workers (HCWs) worldwide. This study aims to identify the degree to which sociodemographic variables and indicators of subjective well-being and psychological resilience are associated, positively and negatively, with the outcomes of burnout, stress, depression and anxiety among Portuguese HCWs observed during the first wave. It also aims to evaluate the strength of association of these variables and indicators with each outcome. DESIGN: Cross-sectional quantitative study. The statistical methods used are simple logistic model, multiple logistic regression model and -2*log-likelihood statistic. SETTING: Portuguese HCWs living in Portugal and working in the Portuguese healthcare system. PARTICIPANTS: The study included 1535 professionals, with a mean age of 38 years. PRIMARY AND SECONDARY OUTCOMES MEASURES: Psychological variables were measured by Copenhagen Burnout Inventory, the Resilience Scale, the Depression, Anxiety and Stress Scales and the Satisfaction with Life Scale. RESULTS: High levels of personal (55%; n=844), work-related (55.1%; n=846) and client-related burnout (35.4%; n=543) were found. Additionally, participants expressed substantial levels of depression (28.7%; n=441), stress (36.4%; n=558) and anxiety (33.1%; n=508). About 1202 participants (78.3%) demonstrated moderate-to-high levels of resilience. Profession, work regime during the pandemic, having a health problem, resilience and satisfaction with life are independent variables significantly associated with the outcomes of burnout, stress, depression and anxiety. Satisfaction with life was the independent variable that had a major association with all outcomes. CONCLUSIONS: Governments and hospital administrations should take action to promote resilience and satisfaction with life as these variables are protective relating to mental health problems. Interventions as educational sessions, psychological support at work, programmes promoting resilience and coping mechanisms and better work conditions may improve mental health. The implementation of measures to protect healthcare students from developing prejudicial outcomes seams very adequate and important.

Safety Climate Evaluation in Primary Health Care: A Cross-Sectional Study.

The perception of the existence of deficits in patient safety, the associated costs and the limitation of resources have made it essential to define improvement strategies. Important concepts have emerged, such as safety climate, which evaluates the perceptions of safety status held by professionals in relation to their organization. The aim of this study is to characterize the safety climate in primary health care (PHC) using the Safety Attitudes Questionnaire (SAQ)-Short Form 2006 PT and to assess associations between SAQ-Short Form 2006 PT scores and demographic and professional characteristics. A cross-sectional study was conducted in all public PHC units in the northern region of Portugal. Data were collected through an online questionnaire shared via institutional emails and by means of a snowball approach. Descriptive and inferential statistical analysis were performed. Statistical significance set at p ≤ 0.05. A total of 649/7427 (8.7%) responses were included in the analyses. The mean and median total SAQ-Short Form 2006 PT scores were 69.23 (SD = 15.73, range 22.22-100.00) and 71.53 [59.03; 79.86], respectively. This is the first study to assess the safety climate in PHC in Portugal. The median obtained total SAQ-Short Form 2006 PT score was 71.53 [59.03; 79.86], which is below the threshold of ≥75, indicating safety deficits.

Portuguese Family Physicians' Perceptions on Pain Management-A Qualitative Study Protocol.

Pain is an important cause of disability and constitutes the main reason people seek medical care, especially in general practice. Nevertheless, nearly half of adult Europeans with chronic pain receive inadequate pain treatment. Limited knowledge about pain among physicians is recognized as a key barrier to treatment. This is due to the well-known insufficiency in pain education at both undergraduate and postgraduate levels. There is a scarcity of research exploring the perceptions of family medicine physicians on these issues. This study aims to evaluate the perceptions of these professionals concerning medical education, as well as their knowledge, skills, and preparedness to manage chronic pain and collect suggestions for improvement. A qualitative exploratory study will be performed using synchronous virtual focus groups and purposive sampling. Eligible participants will be 3rd- and 4th-year family medicine residents and family medicine specialists with at least five years of practice. Sample size and number of focus groups will depend on data saturation. A semi-structured guide will be used. A thematic categorical analysis will be conducted after verbatim transcription of the audiofiles. This protocol has been approved by the Health Ethics Committee.

The impact of teleworking in psychologists during COVID-19: Burnout, depression, anxiety, and stress.

Background: The COVID-19 pandemic has forced mental health professionals to adapt quickly. The pandemic has created multiple new tasks for the psychologist. In addition to the various stressors closely linked to the COVID-19 pandemic, psychologists were forced to make their services more flexible. Teleworking was a way of continuing to work. Objective: This study aimed to identify the impact of working pattern on the levels of burnout, depression, anxiety, and stress. Methods: This was a cross-sectional study based on an online questionnaire applied to eighty-three Portuguese psychologists. Data were collected from May 9 to June 8, 2020, a period comprising the declaration of a national calamity and then state of emergency, and the subsequent ease of lockdown measures. The Copenhagen Burnout Inventory Scale and Depression Anxiety and Stress Scale were used. Univariate multiple linear regression models were estimated for each mental health outcome. Results: Significant differences were found between psychologists working in the workplace and in teleworking at the personal burnout, work-related burnout, client-related burnout, depression, and stress. In multiple linear regression, teleworking, not working, and being unmarried was significantly associated with higher levels of depression. Teleworking was significantly associated with higher stress scores and client-related and work burnout. Conclusions: This exceptional time of sudden, mandatory, and high-intensity teleworking, required rapid adaptation, giving rise to new stressors that might have been responsible for burnout levels in psychologists.

Contribution of Home Gardens to Sustainable Development: Perspectives from A Supported Opinion Essay.

Home gardening has a long history that started when humans became sedentary, being traditionally considered an accessible source of food and medicinal plants to treat common illnesses. With trends towards urbanization and industrialization, particularly in the post-World War II period, the importance of home gardens as important spaces for growing food and medicinal plants reduced and they began to be increasingly seen as decorative and leisure spaces. However, the growing awareness of the negative impacts of agricultural intensification and urbanization for human health, food quality, ecosystem resilience, and biodiversity conservation motivated the emergence of new approaches concerning home gardens. Societies began to question the potential of nearby green infrastructures to human wellbeing, food provisioning, and the conservation of traditional varieties, as well as providers of important services, such as ecological corridors for wild species and carbon sinks. In this context. and to foster adaptive and resilient social-ecological systems, our supported viewpoint intends to be more than an exhaustive set of perceptions, but a reflection of ideas about the important contribution of home gardens to sustainable development. We envision these humble spaces strengthening social and ecological components, by providing a set of diversified and intermingled goods and services for an increasingly urban population.