Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Disclosing Strain: How Psychosocial Risk Factors Influence Work-Related Musculoskeletal Disorders in Healthcare Workers Preceding and during the COVID-19 Pandemic.

Healthcare workers, particularly nurses, engage in a daily work routine that takes a toll on their emotional well-being, rendering them vulnerable to psychosocial risk factors. This research seeks to analyse the influence of psychosocial risk factors on the occurrence of work-related musculoskeletal disorders among nurses. An additional analysis was performed to understand the role of age in work-related musculoskeletal disorders and the perception of psychosocial risk factors. The study was conducted during two separate periods-pre-pandemic and pandemic times-involving a sample of 456 nurses from both public and private hospitals in Portugal. The INSAT-Health and Work Survey-was used as measuring instrument. The primary observations indicated a consistency between psychosocial risk factors and the occurrence of work-related musculoskeletal disorders. The findings revealed a significant exposure to psychosocial risk factors, with work pace, intensity, work relationships, and emotional demands exhibiting higher global average percentages during both periods, pre-pandemic and pandemic. Nonetheless, we find that the psychosocial risk factors change when we analyse the pre-pandemic and pandemic results. During the period before the pandemic, the psychosocial risk factors that were most commonly reported included the demanding pace of work, long working hours, and emotional demands. Through the pandemic, the most pronounced psychosocial risk factors were work relationships, employment relationships, and ethical and values conflicts. Therefore, research in this domain is essential to understanding psychosocial risk factors and assessing the less obvious links between work and health.

Unveiling the Path to Resilience: Prioritizing Mental Health, Sleep, and Nutrition in the Post-COVID Era.

The COVID-19 pandemic has disrupted daily life, impacting relationships, work, and education. This has led to increased stress, anxiety, and depression, along with altered sleep patterns and eating behaviors. Quarantine and isolation have worsened mental health, especially in children and the elderly, due to the loss of activities and physical contact. Sleep disorders and negative dreams perpetuate poor sleep quality, increasing the risk of health issues. Sedentary lifestyles and emotional effects contribute to unhealthy eating patterns and obesity, exacerbated by disrupted routines and limited outdoor activities. Addressing these challenges requires prioritizing mental health, promoting healthy sleep habits, and addressing obesity factors. The pandemic has profoundly affected human well-being, but resilience, mental health, sleep, and nutrition can enhance overall well-being and adaptability in the post-COVID era. This comprehensive opinion aims to raise awareness of the wide-ranging impacts of this pandemic on various aspects of human well-being and to emphasize the importance of implementing strategies that prioritize mental health, improve sleep habits, address eating behaviors, and foster resilience to navigate and thrive in the face of future challenges.

Healthcare Workers' Mental Health in Pandemic Times: The Predict Role of Psychosocial Risks.

Background: Healthcare workers perform an emotionally exhausting daily work activity, making them prone to occupational hazards, namely psychosocial ones. This study aims to assess the impact of psychosocial risk factors on healthcare workers' mental health. Methods: A cross-sectional study was developed between May and June of 2021 with 479 healthcare workers from Portuguese hospitals. The Depression, Anxiety and Stress Scale was used to assess mental health, and psychosocial risks were assessed through the Health and Work Survey - INSAT. Statistical analysis was performed to identify the psychosocial risk factors related to anxiety, depression, and stress. Subsequently, a multiple linear regression was performed to identify the models that better explained psychosocial risk factors' relationship with anxiety, depression, and stress. Results: Data showed a strong exposure to psychosocial risks. Work pace and intensity, work relationships, and emotional demands stood out with higher global average percentages for yes answers to "exposure and discomfort." The analysis of the ß values and p-values from the multiple linear regression shows that some cross-sectional psychosocial risks are predictors of anxiety and stress dimensions, and other psychosocial risks differ in the two mental health dimensions. However, it is important to highlight that healthcare workers still showed great joy and pleasure in performing their work activities. Conclusion: Support network development in the work environment is needed to prevent healthcare workers' emotional stress and promote their psychological well-being. Therefore, new research is essential to understand the psychosocial risks that affect healthcare workers and assess the less visible effects of work-health relationships.

New Insights on the Mediating Role of Emotional Intelligence and Social Support on University Students' Mental Health during COVID-19 Pandemic: Gender Matters.

Due to the demanding changes caused in the population by the COVID-19 pandemic, including a persisting experience of fear and social isolation, multiple studies have focused on the protective role of several psychological characteristics on mental health. Emotional intelligence and social support are commonly linked to mental health and well-being. The present study aims to analyze the mediator role of emotional intelligence and social support on university students' mental health, taking into consideration the role of gender differences. An online questionnaire was administered to a sample of 923 university students during the COVID-19 lockdown in Portugal. Significant gender differences were found on mental health symptoms, emotional intelligence, and social support. A double mediation model was computed to verify if gender influences on mental health were mediated by emotional intelligence and social support. The results show indirect effects of gender on mental health. However, as both mediators mediate in the opposite direction, the total indirect effects become null. Thus, a strong direct effect of gender on mental health remains. The results of the present study have theoretical implications on protective factors of mental health by gender and practical implications for psychological intervention in university counselling services.

Key factors of the functional ability of older people to self-manage medications.

Daily medication use can be affected by the gradual loss of functional ability. Thus, elderly patients are at risk for nonadherence due to functional decline, namely, decreases in cognitive skills and visual and manual dexterity. The main objective was to assess the ability of older people to self-manage their medication and to identify the main predictors for unintentional nonadherence. A cross-sectional study was conducted (2014-2017) in community centers and pharmacies. Functional assessment was performed with the Portuguese versions of the Drug Regimen Unassisted Grading Scale (DRUGS-PT) and the Self-Medication Assessment Tool (SMAT-PT). A purposive sample including 207 elderly patients was obtained. To identify the main predictors, binary logistic regression was performed. The average DRUGS-PT score was slightly lower than that in other studies. On the SMAT-PT, the greatest challenge for patients was identifying medications by reading labels/prescriptions. The main difficulties identified were medication memorization and correct schedule identification. The scores were higher with the real regimen than with the simulated regimen, underlining the difficulties for patients in receiving new information. Regarding the predictors of an older individual's ability to self-manage medications, two explanatory models were obtained, with very high areas under the curve (> 90%). The main predictors identified were cognitive ability, level of schooling and daily medication consumption.

Work intensification in the road transport industry: An approach to new working scenarios with automated vehicles.

BACKGROUND: The deployment of automated vehicles is causing transport systems to undergo a transition period. Notwithstanding such technology advancements, the work activity in road transport remains severe in terms of working conditions, given an ever-increasing work intensification scenario. OBJECTIVE: To analyze the drivers' point of view over factors that determine the intensification of their work, to take preventive measures for future working conditions with automated vehicles. METHODS: A sample of 336 Portuguese professional drivers answered the Health and Work Survey. RESULTS: Work at an intense pace (70.6%) or working beyond the assigned timetable (68.5%) were reported as conditions that may induce work intensification. The need to follow production norms/meet strict deadlines or feeling exploited at work doubles the risk of musculoskeletal disorders. Moreover, dealing with tense situations with the public, exposure to constant interruptions, and once again feeling exploited at work, are risk factors that increase, at least, four times as much the perception of generalized discouragement, anxiety, or irritability. CONCLUSIONS: The recommendations that emerge from our findings aim at ensuring that automation does not end up becoming a new source of work intensification.

Advanced EEG-based learning approaches to predict schizophrenia: Promises and pitfalls.

The complexity and heterogeneity of schizophrenia symptoms challenge an objective diagnosis, which is typically based on behavioral and clinical manifestations. Moreover, the boundaries of schizophrenia are not precisely demarcated from other nosologic categories, such as bipolar disorder. The early detection of schizophrenia can lead to a more effective treatment, improving patients' quality of life. Over the last decades, hundreds of studies aimed at specifying the neurobiological mechanisms that underpin clinical manifestations of schizophrenia, using techniques such as electroencephalography (EEG). Changes in event-related potentials of the EEG have been associated with sensory and cognitive deficits and proposed as biomarkers of schizophrenia. Besides contributing to a more effective diagnosis, biomarkers can be crucial to schizophrenia onset prediction and prognosis. However, any proposed biomarker requires substantial clinical research to prove its validity and cost-effectiveness. Fueled by developments in computational neuroscience, automatic classification of schizophrenia at different stages (prodromal, first episode, chronic) has been attempted, using brain imaging pattern recognition methods to capture differences in functional brain activity. Advanced learning techniques have been studied for this purpose, with promising results. This review provides an overview of recent machine learning-based methods for schizophrenia classification using EEG data, discussing their potentialities and limitations. This review is intended to serve as a starting point for future developments of effective EEG-based models that might predict the onset of schizophrenia, identify subjects at high-risk of psychosis conversion or differentiate schizophrenia from other disorders, promoting more effective early interventions.

Práticas de prevenção de infeção dos enfermeiros na preparação e administração de terapêutica injetável / Infection prevention practices of nurses in the preparation and administration of injectable therapy

A preparação e administração de terapêutica injetável são uma prática diária da responsabilidade dos enfermeiros. Sendo a segurança do doente um dos focos prioritários da qualidade dos cuidados, é vital que se implementem procedimentos que visem os processos de melhoria continua. Os principais objetivos deste estudo são: Avaliar as práticas de prevenção da infeção na preparação e administração de terapêutica injetável, realizadas pelos enfermeiros; determinar a relação entre as práticas de prevenção da infeção na preparação e administração de terapêutica injetável, realizadas pelos enfermeiros e algumas variáveis socio académicas e profissionais

From Sound Perception to Automatic Detection of Schizophrenia: An EEG-Based Deep Learning Approach.

Deep learning techniques have been applied to electroencephalogram (EEG) signals, with promising applications in the field of psychiatry. Schizophrenia is one of the most disabling neuropsychiatric disorders, often characterized by the presence of auditory hallucinations. Auditory processing impairments have been studied using EEG-derived event-related potentials and have been associated with clinical symptoms and cognitive dysfunction in schizophrenia. Due to consistent changes in the amplitude of ERP components, such as the auditory N100, some have been proposed as biomarkers of schizophrenia. In this paper, we examine altered patterns in electrical brain activity during auditory processing and their potential to discriminate schizophrenia and healthy subjects. Using deep convolutional neural networks, we propose an architecture to perform the classification based on multi-channels auditory-related EEG single-trials, recorded during a passive listening task. We analyzed the effect of the number of electrodes used, as well as the laterality and distribution of the electrical activity over the scalp. Results show that the proposed model is able to classify schizophrenia and healthy subjects with an average accuracy of 78% using only 5 midline channels (Fz, FCz, Cz, CPz, and Pz). The present study shows the potential of deep learning methods in the study of impaired auditory processing in schizophrenia with implications for diagnosis. The proposed design can provide a base model for future developments in schizophrenia research.

Early myocardial changes induced by doxorubicin in the nonfailing dilated ventricle.

Several studies have demonstrated that administration of doxorubicin (DOXO) results in cardiotoxicity, which eventually progresses to dilated cardiomyopathy. The present work aimed to evaluate the early myocardial changes of DOXO-induced cardiotoxicity. Male New Zealand White rabbits were injected intravenously with DOXO twice weekly for 8 wk [DOXO-induced heart failure (DOXO-HF)] or with an equivolumetric dose of saline (control). Echocardiographic evaluation was performed, and myocardial samples were collected to evaluate myocardial cellular and molecular modifications. The DOXO-HF group presented cardiac hypertrophy and higher left ventricular cavity diameters, showing a dilated phenotype but preserved ejection fraction. Concerning cardiomyocyte function, the DOXO-HF group presented a trend toward increased active tension without significant differences in passive tension. The myocardial GSSG-to-GSH ratio and interstitial fibrosis were increased and Bax-to- Bcl-2 ratio presented a trend toward an increase, suggesting the activation of apoptosis signaling pathways. The macromolecule titin shifted toward the more compliant isoform (N2BA), whereas the stiffer one (N2B) was shown to be hypophosphorylated. Differential protein analysis from the aggregate-enriched fraction through gel liquid chromatography-tandem mass spectrometry revealed an increase in the histidine-rich glycoprotein fragment in DOXO-HF animals. This work describes novel and early myocardial effects of DOXO-induced cardiotoxicity. Thus, tracking these changes appears to be of extreme relevance for the early detection of cardiac damage (as soon as ventricular dilation becomes evident) before irreversible cardiac function deterioration occurs (reduced ejection fraction). Moreover, it allows for the adjustment of the therapeutic approach and thus the prevention of cardiomyopathy progression. NEW & NOTEWORTHY Identification of early myocardial effects of doxorubicin in the heart is essential to hinder the development of cardiac complications and adjust the therapeutic approach. This study describes doxorubicin-induced cellular and molecular modifications before the onset of dilated cardiomyopathy. Myocardial samples from doxorubicin-treated rabbits showed a tendency for higher cardiomyocyte active tension, titin isoform shift from N2B to N2BA, hypophosphorylation of N2B, increased apoptotic genes, left ventricular interstitial fibrosis, and increased aggregation of histidine-rich glycoprotein.

Healthcare Workers: Occupational Health Promotion and Patient Safety.

The purpose of the present study was to explore the relation of work-related risk factors and well-being among healthcare workers and the impact on patient safety, using the Health and Work Survey (INSAT) and Mental Health Continuum - Short Form (MHC-SF). A sample of 361 Portuguese healthcare workers participated in this study. The results indicate some significant work-related risk factors: for emotional well-being, Impossible to express myself (ß = -0.977), Not having recognition by superiors (ß = -1.028) and Have to simulate good mood and/or empathy (ß = -1.007); for social well-being, Exposed to the risk of sexual discrimination (ß = -2.088), Career progress is almost impossible (ß = -1.518), and Have to hide my emotions (ß = -2.307); finally for psychological well-being Exposed to the risk of sexual discrimination (ß = -2.153), Career progress is almost impossible (ß = -1.377), and Have to simulate good mood and/or empathy (ß = -3.201). The results showed high levels of well-being despite the exposure of several risk factors at workplace. Regarding the work-related risk factors, the study showed that most of the participants are exposed to several risk factors at workplace (ranging from environmental risk factors, biological to physical), although psychosocial risk factors (work relations with superiors and colleagues, employment relations, and emotional demands) are the ones that most impact on well-being.

A national e-Delphi towards the measurement of safe medication practices in Portuguese hospitals.

OBJECTIVES: To determine the face and content validity of items for measuring safe medication practices in Portuguese hospitals. METHODS: 128 items were drafted from content analysis of existing questionnaires and the literature, employing preferred terms of the WHO International Classification for Patient Safety (Portuguese version). A two-round e-Delphi was convened, using a purposive multidisciplinary panel. Hospital-based experts were asked to rate the relevance of items on a 7-point Likert scale and to comment on their clarity and completeness. RESULTS: The response rate was similar in both rounds (70.3% and 73.4%, respectively). In the first round 91/128 (71.1%) items reached the predefined level of positive consensus. In the second round 23 additional items reached positive consensus, as well as seven items newly derived by the panel. CONCLUSIONS: Most items have face and content validity, indicating relevance and clarity, and can be included in a future questionnaire for measuring safe medication practices in Portuguese hospitals.

Utilização de antibióticos na unidade de pronto atendimento (UPA) do município de Franco da Rocha - SP / Use of antibiotics in the emergency care unit (UPA) of the municipality of Franco da Rocha - SP

A rede de atenção às urgências e emergências no Sistema Único de Saúde surgiu para reordenar a atenção à saúde em situações de urgência e emergência de modo coordenado pela atenção básica. A Unidade de pronto Atendimento (UPA) compõe a Rede, sendo um estabelecimento de saúde de complexidade média...(AU)

Laughter catches attention!

In social interactions, emotionally salient and sudden changes in vocal expressions attract attention. However, only a few studies examined how emotion and attention interact in voice processing. We investigated neutral, happy (laughs) and angry (growls) vocalizations in a modified oddball task. Participants silently counted the targets in each block and rated the valence and arousal of the vocalizations. A combined event-related potential and time-frequency analysis focused on the P3 and pre-stimulus alpha power to capture attention effects in response to unexpected events. Whereas an early differentiation between emotionally salient and neutral vocalizations was reflected in the P3a response, the P3b was selectively enhanced for happy voices. The P3b modulation was predicted by pre-stimulus frontal alpha desynchronization, and by the perceived pleasantness of the targets. These findings indicate that vocal emotions may be differently processed based on task relevance and valence. Increased anticipation and attention to positive vocal cues (laughter) may reflect their high social relevance.

Is laughter a better vocal change detector than a growl?

The capacity to predict what should happen next and to minimize any discrepancy between an expected and an actual sensory input (prediction error) is a central aspect of perception. Particularly in vocal communication, the effective prediction of an auditory input that informs the listener about the emotionality of a speaker is critical. What is currently unknown is how the perceived valence of an emotional vocalization affects the capacity to predict and detect a change in the auditory input. This question was probed in a combined event-related potential (ERP) and time-frequency analysis approach. Specifically, we examined the brain response to standards (Repetition Positivity) and to deviants (Mismatch Negativity - MMN), as well as the anticipatory response to the vocal sounds (pre-stimulus beta oscillatory power). Short neutral, happy (laughter), and angry (growls) vocalizations were presented both as standard and deviant stimuli in a passive oddball listening task while participants watched a silent movie and were instructed to ignore the vocalizations. MMN amplitude was increased for happy compared to neutral and angry vocalizations. The Repetition Positivity was enhanced for happy standard vocalizations. Induced pre-stimulus upper beta power was increased for happy vocalizations, and predicted the modulation of the standard Repetition Positivity. These findings indicate enhanced sensory prediction for positive vocalizations such as laughter. Together, the results suggest that positive vocalizations are more effective predictors in social communication than angry and neutral ones, possibly due to their high social significance.

Does emotion change auditory prediction and deviance detection?

In the last decades, a growing number of studies provided compelling evidence supporting the interplay of cognitive and affective processes. However, it remains to be clarified whether and how an emotional context affects the prediction and detection of change in unattended sensory events. In an event-related potential (ERP) study, we probed the modulatory role of pleasant, unpleasant and neutral visual contexts on the brain response to automatic detection of change in spectral (intensity) vs. temporal (duration) sound features. Twenty participants performed a passive auditory oddball task. Additionally, we tested the relationship between ERPs and self-reported mood. Participants reported more negative mood after the negative block. The P2 amplitude elicited by standards was increased in a positive context. Mismatch Negativity (MMN) amplitude was decreased in the negative relative to the neutral and positive contexts, and was associated with self-reported mood. These findings suggest that the detection of regularities in the auditory stream was facilitated in a positive context, whereas a negative visual context interfered with prediction error elicitation, through associated mood changes. Both ERP and behavioral effects highlight the intricate links between emotion, perception and cognitive processes.

Development and Validation of a Health and Work Survey Based on the Rasch Model among Portuguese Workers.

The purpose of this study was to develop the Health and Work Survey (INSAT) and examine the validity of the discomfort rating scale. Data were collected from 706 Portuguese workers from six economic sectors with the support of the Health and Work Survey (INSAT - Inquérito Saúde e Trabalho). The INSAT is a self-administered questionnaire to assessing working conditions, health and wellbeing, and to provide information to the occupational health systems in the organisations. For the survey instrument validation, the Rasch Partial Credit Model (PCM) was used to analyse item fit statistics. From the application of PCM, Person Separation Reliability was obtained (0.8761) and the value can be considered very good (>0.8). From the statistical analysis, the Overall Model fit information, given by Outfit Mean square/Infit Mean square, is between 0.5 and 1.5, meaning "Productive for measurement" and "acceptable fit overall". The INSAT items can generate predictable response patterns. We recommend that the INSAT discomfort rating scale and some other items should be reviewed in future works. In any event, this tool proves to be useful in assessing the relationship between work and health and in evaluating key main risk factors, helping to prevent problems and improving occupational health systems.

Salience in a social landscape: electrophysiological effects of task-irrelevant and infrequent vocal change.

In a dynamically changing social environment, humans have to face the challenge of prioritizing stimuli that compete for attention. In the context of social communication, the voice is the most important sound category. However, the existing studies do not directly address whether and how the salience of an unexpected vocal change in an auditory sequence influences the orientation of attention. In this study, frequent tones were interspersed with task-relevant infrequent tones and task-irrelevant infrequent vocal sounds (neutral, happy and angry vocalizations). Eighteen healthy college students were asked to count infrequent tones. A combined event-related potential (ERP) and EEG time-frequency approach was used, with the focus on the P3 component and on the early auditory evoked gamma band response, respectively. A spatial-temporal principal component analysis was used to disentangle potentially overlapping ERP components. Although no condition differences were observed in the 210-310 ms window, larger positive responses were observed for emotional than neutral vocalizations in the 310-410 ms window. Furthermore, the phase synchronization of the early auditory evoked gamma oscillation was enhanced for happy vocalizations. These findings support the idea that the brain prioritizes the processing of emotional stimuli, by devoting more attentional resources to salient social signals even when they are not task-relevant.

Will I be able to do my work at 60? An analysis of working conditions that hinder active ageing.

BACKGROUND: Most developed countries have considered population ageing as one of the economic challenges that need to be overcome. Managing ageing has led to consideration of a number of policies where it is essential to increase the employment rate for older workers. OBJECTIVE: This study aims to analyze the working conditions which tend to be perceived as hindering continuity in the workplace at the age of 60. PARTICIPANTS: 1234 workers from different sectors and socio-professional categories (52% men and 48% women; 64.5% younger than 45 years old). METHODS: A quantitative overview was adopted with the use of logistic regression models. The INSAT was used (Work and Health Questionnaire). RESULTS: Apart from factors of great physical constraint, other less visible aspects play a role in the idea of workers not being able to continue to work by the age of 60, namely factors linked to work organizational options and relationships with others. CONCLUSIONS: Working conditions have a great influence in the idea of inability to perform the same type of work at 60. This notion does not only apply to older workers. In fact, even younger workers under certain working conditions hold the same view, thus raising social concerns that should be taken into account by public policies.