Game4NurseSupervisor: Development of a board game for nursing mentoring.

AIM: To describe the stages of developing a board game prototype to promote knowledge about nursing mentorship. BACKGROUND: Clinical supervision in nursing is a vital strategy for the quality of care. The use of gamification through a board game can enhance knowledge about mentoring in nursing. DESIGN: We present a pilot study describing the development phases of the board game "Game4NurseSupervisor®." METHODS: The study comprised three phases. The first phase involved a modified e-Delphi study with experts to collect and validate the content to be integrated into the board game. The second phase focused on constructing the prototype of the board game. Finally, the third phase involved testing the prototype in sessions held in two healthcare units, followed by an evaluation through a questionnaire. RESULTS: The e-Delphi study, involving a panel composed of 59 experts, progressed through two rounds, resulting in 61 cards divided into four categories. The second phase involved constructing the board game, incorporating interactive elements such as "Game4NurseSupervisor®." In the third phase, 25 nurses, consisting of clinical practice nurses, participated in the testing phase and expressed satisfaction with the game. Highlighted benefits included reflective, playful, dynamic, interactive and educational aspects. CONCLUSIONS: The conclusions suggest that "Game4NurseSupervisor®" could be a valuable tool for promoting knowledge about nursing mentorship, providing an innovative and interactive approach to skill development. This study makes a valuable contribution by addressing a previously unexplored aspect of nurse mentor training: the potential of board games.

Mental health training programs for non-health professionals and volunteers working with asylum-seekers and refugees: scoping review.

OBJECTIVE: To identify and describe the mental health training programs for non-health professionals and volunteers who work, have worked, or would work with asylum seekers and/or refugees. METHOD: Scoping review following JBI methodology. Search carried out in MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, and websites of Clinical Trials, UNHCR, International Organization for Migration, WHO, Save the Children, International Migration, Integration and Social Cohesion in Europe, and International Federation of Red Cross and Red Crescent Societies. Studies written in English, Portuguese, French, Spanish and Swedish. RESULTS: Of the 8954 articles identified, 16 were included reporting on 11 training programs: Mind-Spring, PM+, MHFA, Cognitive-Behavioral Training for Community and Religious Leaders, EmpaTeach, Suicide Prevention Education Program, Teaching Recovery Techniques, Handbook for Teachers of Vietnamese Refugee Students, PFA, Psychosocial support of volunteers and CBP&MHPSS. CONCLUSION: Training programs from scientific literature focus on mental health disorders, while non-governmental organizations' documents focus on resilience and self-care. The current mental health training programs might be insufficient.

Effectiveness of Caregiver-Provided Individual Cognitive Interventions in Older Adults with Dementia.

Background: In a society increasingly committed to promoting an active life in the community, new resources are needed to respond to the needs of citizens with Alzheimer's disease and other forms of dementia. The potential of several individual cognitive interventions to be provided by caregivers has been explored in the literature. Objective: To synthesize the best available evidence on the effectiveness of caregiver-provided individual cognitive interventions in older adults with dementia. Methods: Systematic review of experimental studies on individual cognitive interventions for older adults with dementia. An initial search of MEDLINE and CINAHL was undertaken. Another search for published and unpublished studies was performed on major healthcare-related online databases in March 2018 and updated in August 2022. This review considered studies that included older adults with dementia, aged 60 years and over. All studies that met the inclusion criteria were assessed for methodological quality using a JBI standardized critical appraisal checklist. Data were extracted using a JBI data extraction form for experimental studies. Results: Eleven studies were included: eight randomized controlled trials and three quasi-experimental studies. Caregiver-provided individual cognitive interventions had several beneficial effects in cognitive domains, including memory, verbal fluency, attention, problem-solving, and autonomy in activities of daily living. Conclusion: These interventions were associated with moderate improvements in cognitive performance and benefits in activities of daily living. The findings highlight the potential of caregiver-provided individual cognitive interventions for older adults with dementia.

Intervenções de Enfermagem na Comunicação com a Família da Pessoa em Situação Crítica - Scoping Review / Nursing Interventions in Communication with the Family of the Critically Ill Person - Scoping Review

Pessoa em situação crítica internada em unidade de cuidados intensivos apresenta frequentemente limitações que interferem com o processo de comunicação, sendo na maioria das situações a família que assume o papel de interlocutor com a equipa interdisciplinar. Este processo é crucial tanto para o correto entendimento da situação clínica da pessoa, como também para o processo de tomada de decisão; assim torna-se essencial desenvolver estratégias e intervenções de enfermagem que facilitem e potenciem o processo de comunicação entre a família e a equipa interdisciplinar no contexto de cuidados intensivos. Com o objetivo de dar resposta à questão da comunicação com a família, foi realizada uma scoping review e desenvolvidos trabalhos nesse sentido, com o intuito de promover a segurança e qualidade dos cuidados relativamente à família da pessoa em situação crítica internada em Unidade de Cuidados Intensivos, que experiencia um processo de transição saúde-doença. O presente relatório aborda ainda a análise e reflexão crítica da aquisição e desenvolvimento de competências, comuns e específicas, do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica adquiridas em contexto de ensino clínico ? serviço de urgência e serviço de neurocríticos.

Tradução, Adaptação Cultural e Validação para a População Portuguesa do Nurse Self-Concept Questionnaire / Translation, Cultural Adaptation and Validation of the Nurse Self-Concept Questionnaire for the Portuguese Population

Enquadramento: O autoconceito profissional dos estudantes de Enfermagem é um processo contínuo que consiste na reflexão acerca da informação e crenças sobre o papel profissional, os valores e comportamentos, sendo uma atitude que eleva o sentido de identidade profissional. Um autoconceito profissional positivo está relacionado com a diminuição dos níveis de depressão e ansiedade e com o aumento da autoestima e da autoeficácia, criando a sensação de bem-estar e realização pessoal. Um bom autoconceito profissional traduz-se numa maior aptidão para lidar com os desafios apresentados e manter uma melhor adaptação ao quotidiano e à vida profissional, determinante na vida de um estudante. Deste modo, surge a necessidade de trabalhar, aprofundar e avaliar o autoconceito profissional dos estudantes de Enfermagem, prevenindo possíveis consequências como burnout, stress, diminuição da qualidade de vida e do bem-estar, bem como outros problemas de saúde mental. Objetivos: Traduzir, adaptar e validar o ?Nurse Self-concept Questionnaire? (NSCQ) para a população de estudantes de Enfermagem em Portugal, e aferir as suas propriedades psicométricas. Metodologia: Estudo metodológico realizado com uma amostra não probabilística de 216 Estudantes do Curso de Licenciatura em Enfermagem, acedida através da plataforma eletrónica Qualtrics. Foram avaliadas as propriedades psicométricas do instrumento. Foi realizada análise fatorial exploratória para verificar a validade de construto e, para verificar a sua fidelidade, foi realizada a análise de consistência interna, através do cálculo do coeficiente alfa de Cronbach. Resultados: O instrumento final designado como QAE (Questionário de Autoconceito dos/as Enfermeiros/as) é composto por 24 itens alocados em cinco dimensões, ?Autoconceito geral?, ?Relações com a equipa?, ?Liderança?, ?Comunicação-cuidado? e ?Conhecimento? que, em conjunto, explicam 67,71% da variância. Tanto as cinco dimensões como o total da escala apresentam índices de fiabilidade bons e muito bons, variando entre 0,775 e 0,927. A estrutura fatorial que emergiu da análise é coerente com a conceção teórica subjacente. Conclusão: A versão portuguesa do questionário NSCQ demonstrou ser um instrumento válido e fiável para avaliar o autoconceito profissional dos estudantes de Enfermagem. Contudo, é importante assegurar a continuidade dos estudos de análise das propriedades psicométricas do instrumento, considerando a utilização de amostras de maior dimensão e a realização de análise fatorial confirmatória.

Friend or Foe? A Thematic Analysis of Adult Friendships and Chronic Pain Adjustment.

BACKGROUND: Chronic pain is a worldwide public health challenge. Despite chronic pain having biopsychosocial dimensions, its social contexts are less investigated. Although current evidence shows that chronic pain shapes and is shaped by interactions with romantic partners, research about friendships and chronic pain is scarce, and mostly focused on adolescents. AIM: Drawing upon theories on friendship and social support, this study aimed to investigate the role of adult friendships on chronic pain adjustment and, the effect of chronic pain on adult friendships. METHODS: This study drew upon a qualitative descriptive methodology. Sixteen adults with primary or secondary (non-cancer) chronic pain participated in individual semi-structured interviews, conducted using voice over internet protocol applications. Data analysis was guided by Clarke and Brown's guidelines for thematic analysis. RESULTS: The analysis of participants' (87.5% women; Mage = 43 years) stories revealed two themes. The first captured how friends promote/hinder adjustment to chronic pain by being: (1) (un)available and providing (un)needed support; and (2) (not)accepting and (not)accommodating to support life engagement. The second captured the negative effect of chronic pain on both parties' attitudes and behaviors towards the relationship, leading to smaller and more homogeneous friendship networks. CONCLUSIONS: This study stresses the relevance of including adult friends in interventions to reduce the negative effect of chronic pain on friendships, harnessing their power to promote chronic pain adjustment. The findings bring new insights on a topic that has rarely been investigated in the pain field, hence pointing out innovative directions for future research and practice.

Neonatal testosterone voids sexually differentiated microglia morphology and behavior.

The involvement of immunity in psychiatric disorders, such as anxiety, is typified by the morphologic adaptation of microglia, immune cells of the brain, to anxiogenic stimuli. We previously reported sexually differentiated microglia morphology in adult rodents, in brain locations implicated in anxiety, including the pre-frontal cortex. These physiologic differences likely drive sex-dependent patterns of microglia morphologic remodeling in response to varied stress conditions in different periods of life, that correlate with sex-dependent behavioral adaptation to anxiogenic stimuli. The time-window of appearance of sex differences in microglia, correlating with sex-specific behavioral performance in anxiogenic conditions are still unknown. In rodents, a postnatal peak of the sexual hormone testosterone is determinant for the so-called brain masculinization and sex-determined behavioral traits. In the present work we aim to clarify if differences in microglia morphology are present at birth or can be driven by postnatal testosterone and impacts on the ability to deal with an anxiogenic context. Differences in microglia morphology are not present at birth, but are observable at adolescence (increased complexity of male microglia, particularly in branches more proximal to the soma), when differences in behavior are also observed. Our data also show that adolescent females neonatally treated with testosterone exhibit masculinized microglia and behavior. Importantly, between adolescence and adulthood, a sex-determined shift in the pattern of complexity takes place and microglia from females become more complex. When testosterone is administered, this morphological effect is partially abolished, approximating microglia and behavior to the male phenotype.

A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration.

Background: The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters. Method: This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC). Results: The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies. Discussion: The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.

Nursing Professional Self-Concept: A Scoping Review Protocol.

Nurses are considered one of the largest professional groups in healthcare, generating positive health outcomes for people at various stages of life. A significant impact on the construction of the professional self-or professional self-concept-is considered to exist through the educational process, influenced by factors such as the family and societal expectations often presented by teachers, tutors, and peers. Improving professional self-concept in nursing can offer specific gains in personal, relational, social, and interpersonal communication skills, favoring evolution in the academic and clinical path. This scoping review aims to map the literature related to the state of knowledge regarding professional self-concept in nursing. This scoping review will follow JBI recommendations with the PCC mnemonic and report its findings through PRISMA-ScR using a specific instrument made by the researchers. Providing healthcare complying with high scientific standards requires the professional to have enough self-confidence in his work and skills. The explicit acknowledgement of professional self-concept is essential for any educational tutor or experienced mentor to promote mental health and academic and professional performance.

Foot and Ankle Disorders in Nurses Exposed to Prolonged Standing Environments: A Scoping Review.

BACKGROUND: Prolonged standing environments constitute an occupational risk factor for nurses, particularly for developing foot and ankle disorders. The definitions and potential relationship to hours spent walking or standing are poorly understood. This scoping review aimed to synthesize the main disorders found on nurses' ankles and feet, their prevalence, the influence of hours spent walking or standing, and gender differences. METHODS: This review followed a previously published protocol. Primary and secondary studies were retrieved from relevant databases from December 2020 to March 2021. Potential articles were collated to Mendeley, and two independent reviewers assessed the title and abstracts. Studies meeting inclusion criteria were included. Two researchers retrieved and reviewed the full text of these studies independently. A predetermined extraction tool was used to retrieve relevant data, summarized in a tabular and narrative format. FINDINGS: The most common disorder was pain, followed by numbness, burning feet, bunions, structural deformities, and calluses. Prevalence differed among studies, depending on settings and specific local policies. Discussion: Various foot and ankle disorders and related variables have been found, with clear gaps that may be addressed in the future. CONCLUSION/APPLICATIONS TO PRACTICE:: Few studies have focused on nurses' foot and ankle disorders. Mapping signs and symptoms may contribute to the future development of preventive interventions for nurses' workplaces.

Acute coronary syndrome and stress: Is there a relationship?

INTRODUCTION: Acute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS. METHODS: We carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed. RESULTS: A total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5±7.1. Females in the control group scored 16.6±6.3 on the PSS-10 and control males scored 13.4±6.5. The female population with ACS scored 22.8±9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4±6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission. CONCLUSIONS: ACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.

Revascularization strategies in STEMI and multivessel disease.

INTRODUCTION: The main treatment for ST-elevation myocardial infarction (STEMI) is the re-establishment of the coronary flow of infarct-related arteries. However, 50% of cases present multivessel disease (MVD), negatively affecting mortality. Complete revascularization (CR) is currently advocated since it reduces major adverse cardiovascular events (MACE). OBJECTIVE: Evaluation of the adopted revascularization strategy and its prognostic value in a Portuguese cohort of STEMI patients with MVD. MATERIAL AND METHODS: Retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes between 2010 and 2019. Patients were divided in two groups regarding revascularization strategy (complete versus incomplete) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. RESULTS: A total of 3500 patients were included. A CR strategy was performed in 21.8% of patients, who were younger and healthier. They also presented more hemodynamically stable and had less kidney dysfunction and anaemia. Their coronary anatomy was less complex, with a higher prevalence of 2-vessel and a lower proportion of chronic occlusions. In-hospital and 1-year adverse events were less frequent between patients with CR. CONCLUSION: In hemodynamically stable STEMI patients, CR substantially reduced in-hospital and 1-year all-cause mortality and MACE.

Overnutrition during Pregnancy and Lactation Induces Gender-Dependent Dysmetabolism in the Offspring Accompanied by Heightened Stress and Anxiety.

Maternal obesity and gestational diabetes predispose the next generation to metabolic disturbances. Moreover, the lactation phase also stands as a critical phase for metabolic programming. Nevertheless, the precise mechanisms originating these changes remain unclear. Here, we investigate the consequences of a maternal lipid-rich diet during gestation and lactation and its impact on metabolism and behavior in the offspring. Two experimental groups of Wistar female rats were used: a control group (NC) that was fed a standard diet during the gestation and lactation periods and an overnutrition group that was fed a high-fat diet (HF, 60% lipid-rich) during the same phases. The offspring were analyzed at postnatal days 21 and 28 and at 2 months old (PD21, PD28, and PD60) for their metabolic profiles (weight, fasting glycemia insulin sensitivity, and glucose tolerance) and euthanized for brain collection to evaluate metabolism and inflammation in the hypothalamus, hippocampus, and prefrontal cortex using Western blot markers of synaptic dynamics. At 2 months old, behavioral tests for anxiety, stress, cognition, and food habits were conducted. We observed that the female offspring born from HF mothers exhibited increased weight gain and decreased glucose tolerance that attenuated with age. In the offspring males, weight gain increased at P21 and worsened with age, while glucose tolerance remained unchanged. The offspring of the HF mothers exhibited elevated levels of anxiety and stress during behavioral tests, displaying decreased predisposition for curiosity compared to the NC group. In addition, the offspring from mothers with HF showed increased food consumption and a lower tendency towards food-related aggression. We conclude that exposure to an HF diet during pregnancy and lactation induces dysmetabolism in the offspring and is accompanied by heightened stress and anxiety. There was sexual dimorphism in the metabolic traits but not behavioral phenotypes.

Mental health training programs for non-health professionals and volunteers working with asylum-seekers and refugees: scoping review / Programas de treinamento em saúde mental para profissionais, que não de saúde, e voluntários que trabalham com solicitantes de asilo e refugiados: revisão de escopo / Programas de formación en salud mental para profesionales no sanitarios y voluntarios que trabajan con solicitantes de asilo y refugiados: revisión de alcance

ABSTRACT Objective: To identify and describe the mental health training programs for non-health professionals and volunteers who work, have worked, or would work with asylum seekers and/or refugees. Method: Scoping review following JBI methodology. Search carried out in MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, and websites of Clinical Trials, UNHCR, International Organization for Migration, WHO, Save the Children, International Migration, Integration and Social Cohesion in Europe, and International Federation of Red Cross and Red Crescent Societies. Studies written in English, Portuguese, French, Spanish and Swedish. Results: Of the 8954 articles identified, 16 were included reporting on 11 training programs: Mind-Spring, PM+, MHFA, Cognitive-Behavioral Training for Community and Religious Leaders, EmpaTeach, Suicide Prevention Education Program, Teaching Recovery Techniques, Handbook for Teachers of Vietnamese Refugee Students, PFA, Psychosocial support of volunteers and CBP&MHPSS. Conclusion: Training programs from scientific literature focus on mental health disorders, while non-governmental organizations' documents focus on resilience and self-care. The current mental health training programs might be insufficient.

RESUMEN Objetivo: Identificar y describir los programas de formación en salud mental para profesionales no sanitarios y voluntarios que trabajan, han trabajado o gustarían de trabajar con solicitantes de asilo y/o refugiados. Método: Revisión de alcance según la metodología JBI. Búsqueda realizada en MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, y sitios web de ClinicalTrials, ACNUR, Organización Internacional para las Migraciones, OMS, Save the Children, Migración Internacional, Integración y Cohesión Social en Europa, y Federación Internacional de Sociedades de la Cruz Roja y de la Media Luna Roja. Estudios escritos en inglés, portugués, francés, español y sueco. Resultados: De los 8954 artículos identificados, se incluyeron 16 que informan sobre 11 programas de capacitación: Mind-Spring, PM+, MHFA, Capacitación cognitiva conductual para líderes comunitarios y religiosos, EmpaTeach, Programa de educación para la prevención del suicidio, Enseñanza de técnicas de recuperación, Manual para maestros de Estudiantes refugiados vietnamitas, PFA, apoyo psicosocial de voluntarios y CBP&MHPSS. Conclusión: Los programas de formación en la literatura científica se centran en los trastornos de salud mental, mientras que los documentos de las organizaciones no gubernamentales se centran en la resiliencia y el autocuidado. Los actuales programas de formación en salud mental pueden ser insuficientes.

Extension for Community Healthcare Outcomes (ECHO) Chronic Pain & Opioid Stewardship in Northwestern Ontario: A Thematic Analysis of Patient Cases.

Background: Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph's Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas. Aims: To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs. Methods: We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics. Results: Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs. Conclusion: Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs' knowledge and will guide future sessions.

Contexte: La douleur chronique est une maladie débilitante qui réduit la qualité de vie et diminue la productivité. En outre, elle est devenue une cause principale de consommation des ressources en soins de santé. Malgré cela, de nombreux médecins de famille canadiens ont reçu peu d'éducation conventionnelle sur la prise en charge de la douleur chronique, ce qui en fait l'un des domaines de pratique les plus difficiles en soins primaires.Le Projet de vulgarisation pour des résultats de santé communautaires ­ Gestion des opioïdes et de la douleur chronique du St. Joseph' s Care Group (projet ECHOSJCG) est un programme éducatif fondé sur les données probantes qui met les prestataires de soins de santé communautaires en relation avec une équipe interprofessionnelle par vidéoconférence pour en apprendre davantage sur la prise en charge de la douleur chronique dans les zones rurales, éloignées et mal desservies.Objectifs: Explorer les principaux points d'apprentissage à partir des cas présentés au projet ECHO-SJCG, recenser et analyser les thèmes et améliorer les futures sessions de développement professionnel continu pour les professionnels de la santé.Méthodes: Nous avons effectué une analyse thématique de quarante cas et points d'apprentissage clés à l'aide de la méthode de comparaison constante. Nous avons également résumé les statistiques descriptives pour le patient et le prestataire.Résultats: Quarante cas ont été présentés par 31 professionnels de la santé ayant reçu des suggestions axées sur l'évaluation et le diagnostic, la prise en charge des symptômes de douleur pharmacologique et non pharmacologique, la prise en charge interventionnelle, l'attention aux facteurs biopsychosociaux et l'orientation appropriée vers d'autres professionnels de la santé.Conclusions: Les cas du projet ECHO-SJCG permettent aux professionnels de la santé d'acquérir une large base de connaissances pour l'évaluation et la prise en charge de la douleur chronique dans leur pratique. Les thèmes recensés mettent en évidence les lacunes communes dans les connaissances des professionnels de la santé et orienteront les sessions futures.

Intergenerationality Programs-Between Children and Older Adults-For Portuguese Population: A Scoping Review.

The aging process is characterized by diverse and complex changes in the individual's various dimensions, requiring continuous adaptation. In this sense, this transition can be faced from an active aging standpoint through strategies such as intergenerationality programs/projects, resulting in an active social participation and valorization that is so important to life in society. This review aimed to map existing programs/projects to promote interaction between children and older adults in Portugal to understand the extent and type of evidence available. A scoping review was developed guided by the JBI methodology and using PRISMA-ScR. The studies included six programs/projects promoting intergenerationality identified in Portugal, focusing their actions on promoting active aging and preventing problems associated with aging. The evaluated dimensions along the implementation of these programs were in the cognitive, motor, emotional and communicational domains, including parameters such as self-esteem, self-confidence, self-worth, well-being, loneliness and depression. These programs/projects present themselves as potential senior mental health promoters. However, other dimensions have been evaluated during these programs'/projects' applications.

The National Response to Patients with Acute Coronary Syndrome during the First Wave of the COVID-19 Pandemic in Portugal.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to changes in healthcare institutions and medical assistance. Non-SARS-CoV-2 related diseases were indirectly affected by the pandemic. Nonetheless, their treatment remains crucial. Cardiovascular conditions such as acute coronary syndrome (ACS) are common, and it was necessary to adjust medical assistance to these diseases during the pandemic. This study aimed to assess the national impact and healthcare system response during the first wave of the pandemic in patients admitted for ACS. MATERIAL AND METHODS: Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry between the 1st January 2016 and the 28th February 2021. Two groups were defined: the previous year to the SARS-CoV-2 pandemic (March, April, May and June 2019) (952 patients) and the first wave of the pandemic (March, April, May and June 2020) (642 patients). Clinical course, time until reperfusion, in-hospital outcomes and follow-up at one year were compared between both periods. RESULTS: There was a lower incidence of ACS between March and June 2020 compared with the same period in 2019, with a reduction of 32.6%. There were no statistically significant differences between the two periods regarding patient demographic characteristics (except for a higher prevalence of familiar cardi vascular history and chronic obstructive pulmonary disease in 2020 and higher prevalence of diabetes in 2019), clinical features, clinical management, in-hospital major adverse cardiac events, mortality and readmission at one-year follow-up. There was a trend towards longer delays until reperfusion, yet without statistical significance. The patients that developed ACS during the first wave of the SARS-CoV-2 pandemic were less often referred to percutaneous coronary intervention centers (p = 0.034) and were more frequently transferred to another hospital (p < 0.001). CONCLUSION: During the first wave of the SARS-CoV-2 pandemic there was a nationwide reduction in demand of healthcare services due to ACS events. Even though the Portuguese healthcare system was under strain and forced to divert resources and medical assistance towards the pandemic management, it was capable of responding adequately to ACS.

Long-term outcomes of non-contact multi-electrode balloon catheter mapping-guided ablation of ventricular arrhythmias originating from the outflow tract.

INTRODUCTION: The outflow tract (OT) regions of the ventricles are a common location of origin for idiopathic ventricular arrhythmias (VA). Non-contact mapping (NCM) with a multi-electrode balloon catheter Ensite-Array enables three-dimensional reconstruction of the geometry of the cardiac chambers and accurate mapping of the propagation map, based on a single beat analysis, facilitating the ablation and contributing procedure success. OBJECTIVE: Assessment of the feasibility and long-term outcomes following NCM-guided OT VA ablation. METHODS: Single center retrospective analysis of patients admitted for symptomatic OT VA ablation. Demographic and clinical characteristics of patients, procedure data and long-term outcomes were assessed. RESULTS: Fifty-eight patients (79.3% female, age 43.9±17.6 years) were considered, 89.7% without structural heart disease. In 85.7% of the cases left ventricle ejection fraction (LVEF) was preserved (LVEF≥50%), 8.6% had mild systolic dysfunction (LVEF 40%-49%) and 5.7% had moderate systolic dysfunction (LVEF 30%-39%). Twenty-four-hour Holter recording documented sustained VA episodes in 12.1% of the patients, non-sustained VA in 31.0%, and >10 000 premature ventricular complex (PVC)/24 h in 56.9%, with an ECG suggesting right ventricular OT origin in 84.5%. There was total elimination of PVC in 87.9% cases and a significant reduction in 3.4%. During a mean follow-up of 5.5 years, 87.9% patients remained asymptomatic without medication, 12.1% underwent re-ablation due to symptomatic PVC recurrence, and two cases underwent a third successful intervention. CONCLUSION: Non-contact mapping-guided multi-electrode balloon catheter VA ablation is a highly effective and safe procedure, with a low rate of long-term recurrence.

Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction patients: A Portuguese registry.

INTRODUCTION: Brain natriuretic peptide (BNP) is a highly sensitive and specific biomarker for the extent of myocardial infarction that is strongly related to short- and long-term prognosis in patients with acute coronary syndromes. OBJECTIVE: To assess the prognostic value of BNP levels in a Portuguese cohort of ST-elevation myocardial infarction (STEMI) patients. METHODS: We performed a retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 2019. Patients were divided into three groups according to BNP level (<100 pg/ml, 100-399 pg/ml and ≥400 pg/ml) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. For sample homogenization, propensity score matching and pairwise matching with a tolerance level of 0.005 were performed. RESULTS: A total of 1650 patients were included, of whom 21.5% presented high BNP levels (≥400 pg/ml). These were older and had more comorbidities, lower admission systolic blood pressure and hemoglobin, higher heart rate, Killip class and creatinine, worse left ventricular systolic function and severe coronary anatomy. Higher BNP was associated with more in-hospital complications, in-hospital mortality and adverse outcomes at one year. CONCLUSION: BNP levels during the index hospitalization were a powerful prognostic biomarker for all-cause mortality and major adverse cardiac events in patients admitted with STEMI to Portuguese hospitals.

Early and late new-onset of atrial fibrillation in acute coronary syndromes: Their differences in mortality and cardiac event.

Background: In a stressful situation like acute coronary syndrome (ACS), the occurrence of the first episode of atrial fibrillation is more frequent. The impact of the timing occurrence of AF new-onset (nAF) in the setting of ACS is still debatable. Methods: Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 29 851 patients admitted for ACS between 1/10/2010 and 4/09/2019. The group with early nAF - nAF in the first 48 h of hospitalization; and late nAF - patients with nAF after the first 48 h of in-hospital admission. Results: New-onset AF was identified in 1067 patients, nonetheless, just 38.1% had late nAF. The group with late nAF presented more cardiovascular comorbidities and worse left ventricular ejection fraction. Late nAF patients received more anti-arrhythmic therapy, and early nAF had a higher beta-block prescription. Early nAF had higher rates of in-hospital complications, on the other hand, late nAF group exhibited more mortality and readmission at one year follow-up. Multiple logistic regression revealed that symptoms onset to the first medical contact time, admission hemoglobin <12 g/dl, right bundle branch block at admission, and diuretic therapy during the hospitalization for ACS were predictors of late nAF in ACS. Conclusions: The ACS population could be divided by the timing of nAF occurrence into the two groups with different characteristics, therapeutic approaches, and outcomes. Late nAF patients had a worse prognosis at 1 year follow-up, however, the early nAF group had more major adverse cardiac events during the hospitalization for ACS.