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

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

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

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

Conscientious Objection and Other Motivations for Refusal to Treat in Hastened Death: A Systematic Review.

BACKGROUND: Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in addition to CO, other factors that may lead the HCP not to want to participate in a certain procedure. Therefore, we can say that CO is a form of refusal of treatment based on conscience. Hastened death has become an increasingly reality around the world, being a procedure in which not all HCPs are willing to participate. There are several factors that can condition the HCPs' refusal to treat in this scenario. METHODS: With the aim of identifying these factors, we performed a systematic review, following the PRISMA guidelines. On 1 October 2022, we searched for relevant articles on Pubmed, Web of Science and Scopus databases. RESULTS: From an initial search of 693 articles, 12 were included in the final analysis. Several motivations that condition refusal to treat were identified, including legal, technical, social, and CO. Three main motivations for CO were also identified, namely religious, moral/secular, and emotional/psychological motivations. CONCLUSIONS: We must adopt an understanding approach respecting the position of each HCP, avoiding judgmental and discriminatory positions, although we must ensure also that patients have access to care. The identification of these motivations may permit solutions that, while protecting the HCPS' position, may also mitigate potential problems concerning patients' access to this type of procedure.

Trends in trust of professional groups in Portugal during COVID-19.

We repeated a Portuguese study, 5 months after a first evaluation, to observe any change in the average levels of trust of professional groups during the COVID-19 pandemic. From our sample of the Portuguese population, 1455 completed the questionnaire from June through September 2020, and 1156 during 2 months, February and March 2021. We found a trend toward higher trust of medical doctors, nurses, and researchers. Analysis of changes between the two pandemic periods (first and second lockdown) showed a statistically significant increase in trust in nurses (t = - 2.01; p = 0.04) and researchers (t = - 2.40; p = 0.02), and the opposite trend for journalists and politicians. This study shows a trend in increasing trust of the Portuguese people toward science-based activities during the COVID-19 pandemic.

Predictors of anaphylaxis to peanut and tree nuts in a Mediterranean population.

Background: Peanuts (PN) and tree nuts (TN) are major causes of anaphylaxis worldwide. We aimed to determine the clinical and demographic characteristics associated with anaphylaxis in patients sensitized to PN and/or TN in a Mediterranean population. Methods: We conducted a retrospective study, which included 198 patients allergic to PN and/or TN (allergy symptoms plus specific immunoglobulin E [sIgE] sensitization), evaluated in consultations from January 2015 to December 2020. Univariate analysis and multivariate logistic regression models were developed, including demographic, clinical, and laboratory data as independent variables, and anaphylaxis to each PN and/or TN as a dependent variables. Results: Anaphylaxis was associated with an earlier age of onset of allergy to PN, cashew and/or pistachio, and pine nut allergy but not to other TN allergies. Gender, atopic comorbidities, and cofactors were not associated with PN and/or TN anaphylaxis. Anaphylaxis to PN, cashew and/or pistachio, and pine nut were associated with reactivity to a fewer number of PN and/or TN foods. Although sIgE sensitization to lipid transfer proteins (LTP) was highly prevalent in our population, only seed storage protein (SSP) positivity was associated with anaphylaxis in PN allergy. The absence of pathogenesis-related protein family 10 sensitization correlated with PN and hazelnut anaphylaxis. A higher level of sIgE to almond extract predicted anaphylaxis but the level of sIgE to other PN and/or TN extracts did not predict it. Conclusion: The high prevalence of sensitization to the pan-allergen LTP did not seem to have a significant impact in PN and/or TN allergy severity in our study. Instead, other factors, such as early age of onset and positivity for SSPs, seem to strongly associate with anaphylaxis to specific PN and/or TN. These findings may contribute to individual risk assessment in these populations.

Trends in hastened death decision criteria: A review of official reports.

Voluntary euthanasia and physician assisted suicide has been legally performed in several countries. However, little is known about how decision-making occurs. We undertook this study to describe trends in officially reported cases of voluntary euthanasia or physician assisted suicide and to explore the decision-making procedures and understand relevant criteria. Thematic analysis of the official reports from several countries was performed. Differences in the number of reported deaths from hasten death practices between countries was found, with higher numbers in countries who performed voluntary euthanasia. Patients profiles follow the trends in the literature (the majority is aged between 70 and 89 years old, men die more often than women in most countries, most prevalent underlying disease is cancer, most people died at home). Despite there being little detail in the reports, decision is explored in the majority of countries and states (exploration of acceptable alternatives and verification of the voluntariness of the request). The importance of collecting data on this topic around the world and establishing a firm evidence-base to support professionals' practice is highlighted.

COVID-19 Pandemic: Effect on Confidence Levels of Portuguese Towards People of Different Professions.

BACKGROUND: The COVID-19 pandemic is emerging in a world where science is highly developed. Nevertheless, science is not the only resource that people resort to when they have difficulties. In this pandemic context, some professions became more relevant, including front-line professionals, such as medical doctors and nurses, and those who may have an indirect role. The aim of this study is to understand whether there is a strengthening of people's confidence, in politicians, journalists, science-based activities, and in more mystical dimensions. METHODS: A cross-sectional study was carried out to understand the levels of confidence of the Portuguese population in several professional groups, measured in two pandemic moments. Participants were recruited to participate in the study through online platforms. The sample was randomly collected from the Portuguese population. The sample was composed of 1455 Portuguese people with a mean age of 44 years, and 1080 were female. RESULTS: We found high levels of confidence in medical doctors and nurses, as well as in other health professions, science, and education. We detected the opposite trend for politicians and journalists. Measured in two pandemic moments, we found confidence levels in these professionals were lower in September than in July with statistical significance differences [(politicians (t = 3.15, p = 0.00); journalists (t = 2.49, p = 0.01)]. CONCLUSION: It is important to improve a joint action between politicians, journalists, health and science professionals to communicate measures to increase confidence from people. There is a need for the engagement of the population in the adoption of protective measures and contribute to easier control in pandemic situations.