Psychometric Properties of the Healthy Lifestyle Behaviors Scale in Portuguese Pregnant Women.

BACKGROUND: Pregnancy provides a privileged and opportune moment to implement interventions promoting healthy lifestyle behaviors and significantly improving perinatal outcomes. The Healthy Lifestyle Behaviors Scale (HLBES) can be used to assess health promoting behaviors, such as diet, physical activity, and mental health. PURPOSE: This study aimed to examine the psychometric properties of the HLBES in Portuguese pregnant women. METHODS: A methodological study was conducted on a convenience sample of 192 pregnant women receiving prenatal care. After cross-cultural adaptation, an exploratory factor analysis and internal consistency assessment were carried out to evaluate the psychometric properties of the scale. Data collected included the Healthy Lifestyle Beliefs Scale to assess the HLBES' criterion validity. RESULTS: Exploratory factor analysis with Varimax rotation yielded 2 subscales that explained 45.23% of the total variance. The scale revealed an overall internal consistency of 0.78 and a good criterion validity with the Healthy Lifestyle Beliefs Scale (r = 0.65, P < .01). CONCLUSION: Our results suggest that the HLBES is an instrument for reporting healthy lifestyle behaviors in Portuguese pregnant women; however, further studies are recommended. This scale can be used to not only describe healthy lifestyle behaviors in pregnant women but also to determine the effects of health promoting interventions.

Evaluating E-Health Literacy, Knowledge, Attitude, and Health Online Information in Portuguese University Students: A Cross-Sectional Study.

BACKGROUND: The main objective of the present study was to assess e-health literacy in a sample of Portuguese university students and its association with the level of knowledge and seeking for COVID-19-related information. METHODS: This cross-sectional online study was conducted on Portuguese university students. All students completed a questionnaire consisting of demographic characteristics, e-health Literacy Scale (eHEALS), and a questionnaire about knowledge, attitude, and health online information seeking. RESULTS: A total of 534 students (76.8% women), with a mean age of 24.3 years old (SD = 7.8), participated in this cross-sectional study, 53.0% of students were from non-health sciences. The mean score of eHEALS literacy was 28.8 (SD = 5.6). Most students (71.1%) classified the Internet as a useful, or very useful, tool in helping them make health related decisions. The use of the Internet as a tool to research health information for a period of two or more hours (OR = 1.9; CI 95% = 1.2; 3.4), to search online for health information on professional websites (OR = 2.3; CI 95% = 1.4; 3.6), to search in official media (OR = 2.3; CI 95% = 1.4; 3.9), and to study in the field of health sciences (OR = 1.6; CI 95% = 1.1; 2.6) increased the likelihood of having sufficient e-health literacy. CONCLUSION: From a public health perspective, there is a need to develop programs that increase health literacy among university students.

Atrioventricular block secondary to transient causes and long-term recurrence after an index event.

BACKGROUND: Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long-term recurrence are lacking. METHODS: Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. RESULTS: In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2-47.5 (p = .03)); greater serum potassium levels (OR 2.3; CI 95% 1.28-4.0 (p < .01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13-4.4 (p = .02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02-40.3 (p < .01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8-15.1 (p < .01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19-1.5 (p = .23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow-up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. CONCLUSIONS: Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow-up warrants a close follow-up or PPM implantation at index admission.

Translation, Adaptation, and Validation of the Portuguese Version of the Exercise of Self-Care Agency Scale.

Assessing a person's capacity to engage in self-care behaviours is another added value in identifying one's potential to care for oneself in the health domain that contributes to planning person-centred care. This study aimed to translate, adapt, and validate the Exercise of Self-Care Agency (ESCA) Scale by Kearney and Fleischer, revised by Riesch and Hauck for the Portuguese version, using a sample of 625 elderly people living at home in Portugal. A cross-cultural adaptation process follows the stages of translation, synthesis, back-translation, and consensual solution for the translation process and pretesting. Construct validity was tested using exploratory factor analysis, and factor structure was subjected to confirmatory factor analysis. Reliability was determined by analysing internal consistency, resorting to Cronbach's alpha coefficient. This resulted in an instrument formed of 29 items, keeping the factor structure conceptually aligned with the underlying theory. Cronbach's alpha coefficient values were 0.87 for the global scale and varied between 0.65 and 0.84 for the subscales. The final four-factor model showed an acceptable quality of fit. The Portuguese version of the ESCA shows appropriate validity and reliability for use in future research and health contexts.

O meu estilo de vida FANTASTICO: Tradução, adaptação e validação do questionário em pré-adolescentes portugueses / The FANTASTIC questionnaire: Translation, adaptation, and validation of the lifestyle assessment instrument in Portuguese preadolescents / Mi estilo de vida FANTASTICO: traducción, adaptación y validación del cuestionario en preadolescentes portugueses

Resumo Enquadramento: Os estilos de vida construídos na pré-adolescência influenciarão todo o desenvolvimento humano ao longo do ciclo vital. O seu diagnóstico constitui uma necessidade efetiva para a prestação dos cuidados de enfermagem ao nível da saúde escolar. Objetivo: Traduzir, adaptar e validar o questionário FANTASTICO para pré-adolescentes portugueses. Metodologia: realizou-se um processo de tradução e de adaptação do questionário com recurso à Técnica de Delphi. Foi criada uma base informática específica. Realizou-se um estudo exploratório para avaliar as propriedades psicométricas do instrumento. O processo desenvolveu-se entre janeiro e julho de 2019. Resultados: A versão traduzida e adaptada em painel de peritos, manteve os 30 itens do instrumento original. O estudo exploratório revelou que o instrumento apresenta um bom alfa de Cronbach total de 0,72. Conclusão: A versão portuguesa O Meu Estilo de Vida FANTASTICO (pré-adolescentes) constitui um bom instrumento de medida para avaliar os estilos de vida dos pré-adolescentes portugueses.

Abstract Background: Lifestyles built in pre-adolescence will influence all human development throughout the life cycle. Its diagnosis constitutes an effective need for the provision of nursing care in terms of school health. Objective: To translate, adapt and validate the FANTASTICO questionnaire for Portuguese pre-adolescents. Methodology: A process of translation and adaptation of the questionnaire was carried out using the Delphi technique. A specific computer base it was created. An exploratory study was carried out to evaluate the instrument's psychometric properties. The process took place between January and July 2019. Results: The translated version and adapted by an expert panel maintained the 30 items of the original instrument. The exploratory study revealed that the instrument has good psychometric properties with a total Cronbach's alpha of 0.72. Conclusion: The Portuguese version O Meu Estilo de Vida FANTASTICO (pre-adolescents) is a good measuring instrument to assess the lifestyles of Portuguese pre-adolescents.

Resumen Marco contextual: Los estilos de vida construidos en la preadolescencia influirán en todo el desarrollo humano a lo largo del ciclo vital. Su diagnóstico es una necesidad efectiva para la prestación de cuidados de enfermería en el ámbito de la salud escolar. Objetivo: Traducir, adaptar y validar el cuestionario FANTASTICO para preadolescentes portugueses. Metodología: Se llevó a cabo un proceso de traducción y adaptación del cuestionario mediante la técnica Delphi. Se creó una base de datos informática específica. Se realizó un estudio exploratorio para evaluar las propiedades psicométricas del instrumento. El proceso se desarrolló entre enero y julio de 2019. Resultados: La versión traducida y adaptada en panel de expertos mantuvo los 30 ítems del instrumento original. El estudio exploratorio mostró que el instrumento tiene un buen alfa de Cronbach total de 0,72. Conclusión: La versión portuguesa Mi Estilo de Vida FANTASTICO (preadolescentes) constituye un buen instrumento de medida para evaluar los estilos de vida de los preadolescentes portugueses.

Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care.

BACKGROUND: Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal. METHODS: We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing. RESULTS: Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety. CONCLUSIONS: The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

Community-Based Approaches to Increase COVID-19 Vaccine Uptake and Demand: Lessons Learned from Four UNICEF-Supported Interventions.

Vaccination is critical to minimize serious illness and death from COVID-19. Yet uptake of COVID-19 vaccines remains highly variable, particularly among marginalized communities. This article shares lessons learned from four UNICEF interventions that supported Governments to generate acceptance and demand for COVID-19 vaccines in Zambia, Iraq, Ghana, and India. In Zambia, community rapid assessment provided invaluable real-time insights around COVID-19 vaccination and allowed the identification of population segments that share beliefs and motivations regarding COVID-19 vaccination. Findings were subsequently used to develop recommendations tailored to the different personas. In Iraq, a new outreach approach (3iS: Intensification of Integrated Immunization) utilized direct community engagement to deliver health messages and encourage service uptake, resulting in over 4.4 million doses of COVID-19 and routine immunization vaccines delivered in just 8 months. In Ghana, a human-centered design initiative was applied to co-develop community-informed strategies to improve COVID-19 vaccination rates. In India, a risk communication and community engagement initiative reached half a million people over six months, translating into a 25% increase in vaccination rates. These shared approaches can be leveraged to improve COVID-19 vaccination coverage and close gaps in routine immunization across diverse and marginalized communities.

Measuring behavioral and social drivers of COVID-19 vaccination in health workers in Eastern and Southern Africa.

BACKGROUND: In 2021, twenty out of twenty-one countries in the Eastern and Southern Africa (ESA) region introduced COVID-19 vaccines. With variable willingness to uptake vaccines across countries, the aim of the present study was to better understand factors that impact behavioral and social drivers of vaccination (BeSD). Using the theory-based "increasing vaccination model", the drivers Thinking & Feeling, Social Processes, Motivation, and Practical Issues were adapted to the COVID-19 context and utilized in a cross-country assessment. METHODS: Data was collected on 27.240 health workers in Kenya, Malawi, Mozambique, South Africa and South Sudan. This was done by administering a survey of seven target questions via the UNICEF Internet of Good Things (IoGT) online platform between February and August 2021. RESULTS: Findings showed a gap between perceived importance and trust in vaccines: Most health workers thought Covid-19 vaccination was very important for their health, while less than 30% trusted it very much. The pro-vaccination social and work norm was not well established since almost 66% of all respondents would take the vaccine if recommended to them, but only 49% thought most adults would, and only 48% thought their co-workers would. Access was highlighted as a crucial barrier, with less than a quarter reporting that accessing vaccination services for themselves would be very easy. Women exhibited slightly lower scores than men across the board. When testing the associations between drivers in Kenya and South Africa, it appears that when target interventions are developed for specific age groups, social norms become the main drivers of intention to get vaccinated. CONCLUSIONS: The present study revealed various key relations with demographic variables that would help immunization programmes and implementing partners to develop targeted interventions. First, there is a serious gap between perceived importance of COVID-19 vaccines and how much trust people in them. Second, problems with access are still rather serious and solving this would strongly benefit those who demand a vaccine, Third, the role of social norms is the most important predictor of willingness when considering age differences.

Integrated analysis of online signals and insight generation about digital conversations on COVID-19 vaccines in Eastern and Southern Africa: a longitudinal analysis of social listening data.

BACKGROUND: During the COVID-19 pandemic, social listening programs across digital channels have become an integral part of health preparedness and response planning, allowing to capture and address questions, information needs, and misinformation shared by users. This study identifies key social listening trends around COVID-19 vaccines in Eastern and Southern Africa and analyses how online conversations about this issue evolved over time. METHODS: A taxonomy developed and refined in collaboration with social and behaviour change teams was used to filter online conversations into nine subtopic categories. The taxonomy was applied to online content tracked in 21 countries in Eastern and Southern Africa over the period December 1, 2020-December 31, 2021. Metrics captured included volume of posts or articles and related user engagement. Qualitative analysis of content was conducted to identify key concerns, information voids and misinformation. RESULTS: Over 300,000 articles and posts about COVID-19 vaccines shared by users or outlets geolocated in the region were analysed. These results generated over 14 million engagements on social media and digital platforms. The analysis shows how conversations about access and availability of vaccines represented the largest share of engagement over the course of the period. Conversations about vaccine effectiveness and safety represented the second and third largest share of engagement, with peaks observed in August and November 2021. Online interest in childhood vaccination increased over time as vaccine eligibility criteria expanded in some countries in the region. Conversations mentioning mandates and certificates peaked in the last quarter of 2021, as governments as private sector entities expanded vaccine requirements. CONCLUSIONS: Findings from this study show the importance of monitoring conversation trends over time and adjust social listening data collection systems to include emerging topics. The study also points to the need to consider concerns, information voids and misinformation around effectiveness and safety of vaccines in the context of overall concern for vaccine availability and access in Eastern and Southern Africa. This is fundamental to inform social and behaviour change strategies that promote vaccine demand effectively, without increasing public frustration over vaccine availability challenges and downplaying concerns around vaccine equity.

Validación para la población portuguesa de la “international consultation on incontinence questionnaire-urinary incontinence short form” (ICIQ-UI SF) / Validação para a população portuguesa do “international consultation on incontinence questionnaire-urinary incontinence short form” (ICIQ-UI SF) / Validation of the “International Consultation on Incontinence Questionnaire – Urinary Incontinence Short form (ICIQ-UISF) for the Portuguese population

Introducción: La Incontinencia urinaria puede considerarse una condición común asociada con el proceso de envejecimiento con síntomas extremadamente incapacitantes, siendo de dos a tres veces más frecuente en mujeres que en hombres. El uso de instrumentos validados para el diagnóstico inicial de la incontinencia urinaria es fundamental para obtener uniformidad y sistematización en la valoración de esta condición. Objetivo: Adaptar y validar el International Consultation Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) para la población portuguesa. Método: Dos traducciones independientes del ICIQ-UI SF fueron realizadas por traductores portugueses con fluidez en inglés. Después de armonizarlos, la traducción resultante fue retrotraduzida de forma independiente por dos traductores ingleses que hablan portugués con fluidez. La versión final del ICIQ-UI SF al portugués se aplicó a 90 usuarios de la consulta externa de urología, ingresados de urología y consulta de ginecología de un hospital ubicado en Gaia. Se evaluaron las propiedades psicométricas y la fiabilidad del cuestionario. Resultados: No se observaron cambios en el formato original del ICIQ-UI SF al final del proceso de traducción y adaptación del instrumento. La edad promedio de los participantes fue de 55 años. La consistencia interna fue alta, como lo demuestra el coeficiente alfa de Cronbach (0,85). El coeficiente de Pearson para las preguntas 3 y 4 fue de 0,88 y para las preguntas 4 y 5 fue de 0,82. La evaluación se consideró satisfactoria y estadísticamente significativa. Conclusión: La versión portuguesa del ICIQ-UI SF se validó con éxito, lo que permitió aplicarlo a la población portuguesa con confiabilidad y validez de constructo satisfactorias. (AU)

Introduction: Urinary incontinence can be considered a common condition associated with the aging process with extremely disabling symptoms, being two to three times more prevalent in women than in men. The use of validated instruments for the initial diagnosis of urinary incontinence is essential to obtain uniformity and systematization in the assessment of this condition. Objective: To adapt and validate the International Consultation Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) for the Portuguese population. Methodology: Two independent translations of the ICIQ-UI SF were performed by Portuguese translators fluent in English. After harmonizing them, the resulting translation was independently back translated by two English translators fluent in Portuguese. The final version of the ICIQ-UI SF into Portuguese was applied to 90 users of the outpatient urology, urology and gynecology inpatient clinic of a hospital located in Gaia. The psychometric properties and reliability of the questionnaire were evaluated. Results: No changes to the original format of the ICIQ-UI SF were observed at the end of the instrument's translation and adaptation process. The average age of participants was 55 years. Internal consistency was high, as demonstrated by Cronbach's alpha coefficient (0.85). Pearson's coefficient for questions 3 and 4 was 0.88 and for questions 4 and 5 it was 0.82. The evaluation was considered satisfactory and statistically significant. Conclusion: The Portuguese version of the ICIQ-UI SF was successfully validated, making it possible to apply it to the Portuguese population with satisfactory reliability and construct validity. (AU)

Introdução: A incontinência urinária pode ser considerada como uma condição comum associada ao processo de envelhecimento com sintomas extremamente incapacitantes, sendo duas a três vezes mais prevalente nas mulheres do que nos homens. A utilização de instrumentos validados para o diagnóstico inicial da incontinência urinária, é fundamental para obter uma uniformização e sistematização na avaliação desta condição. Objetivo: Adaptar e validar para a população portuguesa o International Consultation Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF)Metodologia: Foram realizadas duas traduções independentes do ICIQ-UI SF por tradutores portugueses, fluentes na língua inglesa. Após harmonização das mesmas, a tradução resultante foi retrotraduzida de forma independente por dois tradutores ingleses, fluentes em português. A versão final do ICIQ-UI SF para o português foi aplicado a 90 utentes da consulta externa de urologia, internamento de urologia e de ginecologia de um hospital, localizado em Gaia. Foram avaliadas as propriedades psicométricas e a confiabilidade do questionário. Resultados: Nenhuma alteração ao formato original do ICIQ-UI SF foi observada no final do processo de tradução e adaptação do instrumento. A idade média dos participantes foi de 55 anos. A consistência interna foi alta, como demonstrado pelo coeficiente de alfa de Cronbach (0,85). O coeficiente de Pearson para as perguntas 3 e 4 foi de 0,88 e para as perguntas 4 e 5 foi de 0,82. A avaliação foi considerada satisfatória e estatisticamente significativa. Conclusão: A versão para português do ICIQ-UI SF foi validada com sucesso tornando possível a sua aplicação na população portuguesa com satisfatória confiabilidade e validade de construto. (AU)

Healthy Lifestyle Beliefs Scale: Psychometric properties in Portuguese pregnant women.

Healthy lifestyle during pregnancy influences the pregnant woman's and child's physical and mental health, impacting perinatal outcomes. Healthy lifestyle beliefs are predictors of lifestyle behaviors, requiring a valid and reliable instrument to assess them during prenatal care. The 16-item Healthy Lifestyle Belief Scale (HLBS) measures a person's beliefs about their ability to live a healthy lifestyle. This study aimed to examine the psychometric properties of a Portuguese version of the HLBS among pregnant women. A methodological study was developed in two phases: cross-cultural adaptation and evaluation of the psychometric properties of the Portuguese version in a nonprobability sample of 192 Portuguese pregnant women. The exploratory factor analysis suggested three subscales, which explained 53.8% of the total variance. Cronbach's α was 0.83 for the overall scale and for the subscales ranged between 0.71 and 0.81. The HLBS is a reliable and valid instrument to assist health professionals in assessing the ability of Portuguese pregnant women to adopt a healthy lifestyle. Assessing healthy lifestyle beliefs potentially contributes to the development of health behavior interventions in pregnant women and consequently improves perinatal outcomes through evidence-based practices.

Conservative approach of a paediatric tracheal rupture.

A girl was brought into the emergency room after a non-penetrating cervical trauma. On physical examination, a rapidly progressing chest subcutaneous emphysema was denoted. The child was immediately intubated and mechanical ventilation was initiated. The CT-scan revealed a rupture to the posterior wall of the trachea and a pneumomediastinum. The child was transferred to the paediatric intensive care unit. A conservative approach was chosen, including tracheal intubation as a bypass through the tracheal injury, sedation to reduce the risk of further tracheal trauma and prophylactic antibiotic therapy. Twelve days after the incident, a bronchoscopy demonstrated the integrity of tracheal mucous and the child was successfully extubated. Three months after hospital discharge she was asymptomatic. In this clinical case, the conservative approach presented a successful outcome, avoiding the risks associated with surgery.

Diagnosing congenital cytomegalovirus infections using archived dried blood spots: A 15-year observational study, Portugal.

BACKGROUND: Cytomegalovirus (CMV) is a leading cause of congenital infections. Dried blood spots (DBS) collected in the first week of life (Guthrie cards) have been used in the diagnosis of CMV infection outside the three-week window period following birth. The present work summarizes the results of a 15-year observational study in which DBS from 1388 children were used for a late diagnosis of congenital CMV infection. METHODS: Three groups of children were studied: (i) symptomatic (with symptoms at birth or late sequelae) (N = 779); (ii) born to mothers with serological profile of primary CMV infection (N = 75); (iii) without any information (N = 534). A highly sensitive method of DNA extraction (heat-induced) from the DBS was used. CMV DNA was detected by a nested PCR. RESULTS: In total CMV DNA was detected in 7.5% (104/1388) of children. Symptomatic children showed a low rate of CMV DNA detection (6.7%) than children born to mothers with serological profile of primary CMV infection (13.3%) (p = 0.034). Sensorial hearing loss and encephalopathy were the two clinical manifestations with the highest CMV detection rate (18.3% and 11.1%, respectively). Children whose mothers had a confirmed primary infection showed a higher rate of CMV detection (35.3%) when compared with children whose mothers had a not confirmed primary infection (6.9%) (p = 0.007). CONCLUSION: The present work emphasises the importance of testing DBS in symptomatic children even a long time after symptoms onset and in children born to mothers with serologic diagnosis of maternal primary CMV infection when they miss the diagnosis during the three-week window following birth.

Psychological burden in Portuguese university students during the COVID-19 pandemic.

Background: University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators. Methods: We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated. Results: From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses. Conclusions: Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.

Validation of the "international consultation on incontinence questionnaire urinary incontinence quality of life".

OBJECTIVE: To Validate the International Consultation on Incontinence Questionnaire Quality of Life for the Portuguese population. Urinary incontinence is a highly prevalent condition with a negative impact on people's quality of life. The International Consultation on Incontinence Questionnaire Quality of Life was adapted in order to have a standardized structure that allows the assessment of the impact of urinary incontinence on quality of life. METHOD: An observational cross-sectional study was carried out with two hundred and twenty participants recruited at the Centro Hospitalar de Vila Nova de Gaia/Espinho and at the Centro Hospitalar Universitário de São João during the period from September 2019 to January 2020. The psychometric properties of the questionnaire were assessed. For internal consistency, the standardized Cronbach's alpha coefficient was calculated. In order to obtain construct validity, an exploratory factor analysis was performed using varimax rotation to extract the main components. RESULTS: The Portuguese version of the questionnaire has 21 items distributed by the three factors found, maintaining the items proposed in the original version. The result of standardized Cronbach's alpha coefficient, α=0.906 overall, confirms the internal consistency of the Portuguese version of the instrument. Pearson's correlation analysis was performed between each item and the item assessing the impact on quality of life in the form of a scale, verifying a positive correlation in all items. CONCLUSIONS: The Portuguese version of the questionnaire proved to be reliable and valid in the study carried out for clinical and research use.

Validation of the "international consultation on incontinence questionnaire urinary incontinence quality of life" / Validación de la "consulta internacional sobre incontinenciacuestionario de incontinencia urinaria módulo de calidad de vida" / Validação do "international consultation on incontinence questionnaire urinary incontinence quality of life module"

ABSTRACT Objective: To Validate the International Consultation on Incontinence Questionnaire Quality of Life for the Portuguese population. Urinary incontinence is a highly prevalent condition with a negative impact on people's quality of life. The International Consultation on Incontinence Questionnaire Quality of Life was adapted in order to have a standardized structure that allows the assessment of the impact of urinary incontinence on quality of life. Method: An observational cross-sectional study was carried out with two hundred and twenty participants recruited at the Centro Hospitalar de Vila Nova de Gaia/Espinho and at the Centro Hospitalar Universitário de São João during the period from September 2019 to January 2020. The psychometric properties of the questionnaire were assessed. For internal consistency, the standardized Cronbach's alpha coefficient was calculated. In order to obtain construct validity, an exploratory factor analysis was performed using varimax rotation to extract the main components. Results: The Portuguese version of the questionnaire has 21 items distributed by the three factors found, maintaining the items proposed in the original version. The result of standardized Cronbach's alpha coefficient, α=0.906 overall, confirms the internal consistency of the Portuguese version of the instrument. Pearson's correlation analysis was performed between each item and the item assessing the impact on quality of life in the form of a scale, verifying a positive correlation in all items. Conclusions: The Portuguese version of the questionnaire proved to be reliable and valid in the study carried out for clinical and research use.

RESUMEN Objetivo: Validar la Consulta Internacional sobre Incontinencia Cuestionario de Calidad de Vida para la población portuguesa. La incontinencia urinaria es una condición altamente prevalente conun impacto negativo en la calidad de vida de las personas. Se adaptó el International Consultationon Incontinence Questionnaire Quality of Life para tener una estructura estandarizada que permita evaluar el impacto de la incontinencia urinaria en la calidad de vida. Método: Se realizóunestudio transversal observacional condoscientosveinte participantes reclutados en el Centro Hospitalar de Vila Nova de Gaia/Espinho y en el Centro Hospitalar Universitário de São João durante el período de septiembre de 2019 a enero de 2020. Las propiedades psicométricas delcuestionario. Para la consistencia interna se calculó el coeficiente alfa de Cronbach estandarizado. Para obtener la validez de constructo se realizó una nálisis factorial exploratorio mediante rotación varimax para extraer los componentes principales. Resultados: La versión portuguesa del cuestionario tiene 21 ítems distribuidos por los tres factores encontrados, manteniendo los ítems propuestos en la versión original. El resultado del coeficiente alfa de Cronbach estandarizado, α=0,906 global, confirma la consistencia interna de la versión portuguesa del instrumento. Se realizó el análisis de correlación de Pearson entre cada ítem y el ítem que evalúa el impacto en la calidad de vida en forma de escala, verificándose una correlación positiva en todos los ítems. Conclusiones: La versión portuguesa delcuestionario demostró ser confiable y válida en el estudio realizado para uso clínico y de investigación.

RESUMO Objetivo: Validar o International Consultationon Incontinence Questionnaire Quality of Life para a população portuguesa. A incontinência urinária é uma condição com elevada prevalência e com impacto negativo na qualidade de vida das pessoas. O International Consultationon Incontinence Questionnaire Quality of Life foi adaptado de forma a ter uma estrutura estandardizada e que permite avaliar o impacto da incontinência urinária na qualidade de vida. Método: Foi realizado um estudo observacional do tipo transversal com duzentos e vinte participantes recrutados no Centro Hospitalar de Vila Nova de Gaia/Espinho e no Centro Hospitalar Universitário de São João durante o período de setembro de 2019 a janeiro de 2020. Foram avaliadas as propriedades psicométricas do questionário. Para a consistência interna foi calculado o coeficiente alfa de Cronbach padronizado. Para obter a validade do constructo foi realizada uma análise exploratória fatorial por rotação varimax para extração dos principais componentes. Resultados: A versão portuguesa do questionário tem 21 itens distribuídos pelos três fatores encontrados mantendo, no entanto, os itens propostos na versão original.O resultado de coeficiente alfa de Cronbach padronizado, α=0,906 global, confirma a consistência interna da versão portuguesa do instrumento. Foi realizada a análise da correlação de Pearson entre cada item e o item de avaliação do impacto na qualidade de vida em forma de escala verificando-se uma correlação positiva em todos os itens. Conclusões: A versão portuguesa do questionário, mostrou-se confiável e válida no estudo realizado para utilização na clínica e na investigação.

Pediatric Acute Liver Failure in Sickle Cell Disease.

Introduction: Sickle cell intrahepatic cholestasis (SCIC) is one of the rarest and the most severe acute hepatic manifestations of sickle cell disease (SCD) and it can rapidly progress to acute liver failure. It is associated with a high mortality rate, demanding prompt recognition and management. Case Presentation: We report a case of a 7-year-old boy with a history of homozygous HbS SCD who presented to the emergency department with fever, increasing abdominal pain, and jaundice. His course was complicated by acute liver injury (AST 9,472 IU/L, ALT 2,683 IU/L, total bilirubin 15.4 mg/dL; conjugated bilirubin 8.69 mg/dL, hypoalbuminemia 2.6 g/dL, and persistent hypoglycemia), with acute liver failure (coagulopathy not corrected by vitamin K administration with INR 3.26, decreased factors V 10% and VII 28%, and West Haven grade I hepatic encephalopathy associated with mild hyperammonemia of 71 µmol/L). After excluding other causes of acute liver failure, the patient was diagnosed as having SCIC and was successfully treated with manual exchange transfusion. Conclusion: This case reinforces that exchange transfusion is an effective treatment for SCIC and that it should be introduced promptly to prevent fulminant and potentially fatal liver failure.

Introdução: A colestase intra-hepática falciforme (CIHF) é uma das manifestações hepáticas agudas mais raras e graves da doença de células falciformes (DCF), que pode progredir rapidamente para falência hepática aguda. Associa-se a uma elevada taxa de mortalidade, que exige identificação e intervenção imediatas. Caso clínico: Descreve-se o caso de um rapaz de 7 anos com DCF, homozigótico para a HbS, que recorreu ao serviço de urgência por febre, dor abdominal de agravamento progressivo e icterícia. Verificou-se evolução para lesão hepática aguda (AST 9,472 UI/L, ALT 2,683 UI/L, bilirrubina total 15.4 mg/dL; bilirrubina conjugada 8.69 mg/dL, hipoalbuminemia 2.6 g/dL, hipoglicemia persistente), com falência hepática aguda (coagulopatia não corrigida por administração de vitamina K com INR 3.26, diminuição dos fatores V 10% e VII 28%, assim como encefalopatia grau I (critérios de West Haven) e hiperamoniemia ligeira 71 µmol/L). Após exclusão de outras etiologias de falência hepática aguda, o doente foi diagnosticado com CIHF e realizada exsanguineo-transfusão manual, com sucesso. Discussão/Conclusão: Este caso reforça que a exsanguineotransfusão é uma terapêutica eficaz na CIHF, que deve ser instituída precocemente para prevenir falência hepática fulminante e potencialmente fatal.

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study.

OBJECTIVE: To measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women. METHODS: An online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: The prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC. CONCLUSION: Pregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.