Communicating Risks and Food Procedures through a Visual Poster for Caregivers of Patients with Dysphagia in Inpatient Care: Usability and Impact.

Food-related procedures are a part of rehabilitation interventions for dysphagia. However, studies show that professional-caregiver communication is often lacking in dysphagia, risking caregivers' knowledge, understanding, and practice of those procedures, with negative consequences for patient safety and rehabilitation. The aim of this study was to evaluate caregivers' perspectives about the utility of a poster designed to communicate dysphagia-related risks and food procedures for caregivers of patients in inpatient care. The impact of caregivers' exposure to the poster on patients' dysphagia-related health was additionally explored. The poster was placed by the beds of a randomly assigned group of patients (n = 21). Their caregivers responded to a questionnaire about the poster's utility. In addition, to explore whether the caregiver exposure to the poster could already have some effect on patient dysphagia-related health, patient risk of aspiration, food swallowing capacity, nutritional status, and oral cavity health were assessed before and one month after placement of the poster, and the poster-exposed group was compared with a (randomly-assigned) non-exposed group (n = 21). Data were analyzed with descriptive statistics and generalized linear models based on analyses of covariance. All caregivers across various education levels reported noticing, reading, and understanding the poster (100%). Nearly all reported that the poster added new information to their knowledge (17 out of 21). In the additional analysis, the patients in the poster-exposed group showed greater improvements in the health outcomes, compared with the non-exposed group, although the effects were statistically non-significant within this study's one-month period. A poster with pictorial information was effective in increasing awareness about dysphagia-specific information among caregivers of patients in inpatient care and can be used as an augmentative means of information, with potential benefits for patient safety and rehabilitation.

The Pharmacy of the Future: Pharmacy Professionals' Perceptions and Contributions Regarding New Services in Community Pharmacies.

The use of information and communication technologies (ICTs) has revolutionized the provision of health services, often referred to as eHealth, benefiting community pharmacies that can offer new services in innovative formats, namely through telepharmacy. This study aimed to explore the perceptions of pharmacy professionals (i.e., pharmacists and pharmacy technicians) on the provision of new services. The study consisted of administering an online questionnaire to pharmacy professionals nationwide. The questionnaire was developed by the research team, based on focus group methodology, from which an inductive analysis led to the categories that made up the dimensions of the survey. Participants were 95 pharmacy professionals with a mean age of 33.69 years old (SD = 10.75). Almost 79% were women. The results show overall receptivity to the development of new services in community pharmacies. Suggestions for the development of the new services, conditions necessary for their implementation, potential obstacles, and strategies to promote adherence to the new services, among others, are identified. The knowledge thus acquired will help community pharmacies to develop innovative solutions in counselling, pharmacotherapy monitoring, and pharmacovigilance, for example, of herb/dietary supplement-drug adverse reactions and interactions. Based on this information, new services can become more accessible, namely through the use of ICTs.

Knowledge and Beliefs about Herb/Supplement Consumption and Herb/Supplement-Drug Interactions among the General Population, including Healthcare Professionals and Pharmacists: A Systematic Review and Guidelines for a Smart Decision System.

The increased consumption of a variety of herbs/supplements has been raising serious health concerns. Owing to an inadequate understanding of herb/supplement-drug interactions, the simultaneous consumption of these products may result in deleterious effects and, in extreme cases, even fatal outcomes. This systematic review is aimed at understanding the knowledge and beliefs about the consumption of herbs/supplements and herb/drug-supplement interactions (HDIs). The study follows the PRISMA guidelines. Four online databases (Web of Science; PubMed; Cochrane; and EBSCOhost) were searched, and a total of 44 studies were included, encompassing 16,929 participants. Herb and supplement consumption is explained mostly by the reported benefits across multiple conditions and ease of use. Regarding HDIs, most people take both herbs/supplements and prescription drugs simultaneously. Only a small percentage of participants have knowledge about their interaction effects, and many reported adverse interactions or side effects. Nevertheless, the main reason for stopping the prescribed drug intake is the perceived lack of its effect, and not due to interactions. Therefore, it is important to increase the knowledge about supplement use so that further strategies can be elaborated to better detect or be alert for whenever a potentially dangerous reaction and/or interaction may occur. This paper raises awareness regarding the need for developing a decision support system and ends with some considerations about the development of a technological solution capable of detecting HDIs and, thereby, aiding in the improvement of pharmacy services.

Association between Elevated Iodine Intake and IQ among School Children in Portugal.

The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven's Colored Progressive Matrices) were dichotomized to <50 ("below-average" IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food's tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO's criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11−2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.

At-distance neurocognitive rehabilitation during COVID-19 pandemic: A first glance of patients' perspectives about the process and an online platform.

Despite the use of digital communication technologies in neurocognitive rehabilitation has been widely used in face-to-face interventions, the difficulties of using ICT-based tools to provide rehabilitation services and the unfamiliarity of the neuropsychologists with internet interventions limited the use of these kinds of interventions in their clinical practices. The lockdown and mitigating measures associated with the COVID-19 pandemic, on the other hand, forced the use of at-distance and online interventions as a means to mitigate the impact of those measures on the mental health and rehabilitation processes of people with neurological disorders. Overall, little is known about the perspectives of patients with acquired neurological conditions about rehabilitation services delivered at distance. Therefore, the main goal of this study was to explore the perceptions that patients with neurological disorders have on at-distance online neurocognitive rehabilitation, namely during the COVID-19 pandemic. Sixteen patients with acquired neurological conditions attending an online neurocognitive rehabilitation program in a Portuguese rehabilitation center filled in an online questionnaire during the mandatory lockdown. The results of this study highlight the potential of delivering rehabilitation services at distance, presenting its advantages and limitations from patients' perspectives, as well as suggestions for improving both neurorehabilitation processes and the online rehabilitation platform used.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study.

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

Clinical Communication in Rehabilitation.

Rehabilitation can be a challenging process for both patients and health care professionals [...].

An international cross-sectional investigation on social media, fitspiration content exposure, and related risks during the COVID-19 self-isolation period.

With the global COVID-19 pandemic, governments from many countries in the world implemented various restrictions to prevent the SARS-Cov-2 virus's spread, including social distancing measures, quarantine, in-home lockdown, and the closure of services and public spaces. This led to an in-creased use of social media platforms to make people feel more connected, but also to maintain physical activity while self-isolating. Concerns about physical appearance and the desire to keep or reach a muscular and toned ideal body, might have further reinforced the engagement in fitness-related social media activities, like sharing progresses in training achievements or following more fitness contents on popular profiles. To better understand the underlying relation among these factors, the present study investigates 729 responses to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), the Self-Compassion Scale (SCS) and their association to social media usage and compares the results cross-culturally in five countries (Spain, Lithuania, United Kingdom, Japan, and Hungary). Findings highlight significant differences between males and females, espe-cially in regard to the time spent online (U = 477.5, p = 0.036). Greater levels of appearance anxiety were associated with the exposure to fitness-related contents on social media. These results strongly confirm the previously highlighted association between fitspiration media and body image anxiety predominantly in females. Clinical implications and future considerations in terms of prevention and treatment in a situation of global emergency are also discussed.

The role of alexithymia as a risk factor for self-harm among adolescents in depression - A systematic review.

INTRODUCTION: Considering the suggested role of alexithymia in increasing the risk of self-harm, especially when depression is also present, and that rates of self-harm tend to peak in adolescence, the aim of this systematic review was to synthetize the most relevant research studies on this topic and provide an understanding on whether alexithymia can be considered as an important risk factor for non-suicidal self-harm among adolescents with depression. METHODS: Searches were conducted in PubMed, Web of Science, and PsycINFO, resulting in 290 records. After removal of duplicates, 273 records were left and after reading the titles and abstracts, 231 articles were excluded, leaving 42 articles that were read in full. Of these 42, nine articles were included in this review. RESULTS: The sample of this review consists of eight case-control studies and one cross-sectional and longitudinal survey. All nine studies concluded that the most important variables associated with self-harming behavior were depression and alexithymia, among all other variables assessed. The self-harming groups showed significantly higher scores on alexithymia (overall and particularly Factor 1- difficulties identifying feelings and differentiating them from bodily sensations), when compared to the control (no self-harming) groups, and the mean depression scores for self-harming groups were significantly higher than those for non-harming groups. All nine studies included in this review shared the limitation of self-reported information. CONCLUSION: These results indicate that alexithymia is a risk factor for non-suicidal self-harm among adolescents with depression, even when other variables were also inspected, and may be a prevention and therapeutic target in the future.

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines.

Introduction: Physical distancing under the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs (IPEDs) across 12 sport disciplines. Materials and methods: A large cross-sectional sample of the adult population (N = 2,295) was surveyed. The mean age was 33.09 (SD = 11.40). The number of male participants was 668 (30.0%). The use of IPEDs was assessed in conjunction with psychometric measures such as the Exercise Addiction Inventory (EAI) and the Appearance Anxiety Inventory (AAI). The participants were grouped into activity group (AG) and non-activity group (NAG) according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption. Results: The frequency of IPEDs use was higher among AG (34.6%) than NAG (14.6%), although AG participants reported less history of addictions (7.1%) than NAG (11.8%). The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs. Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the "non-excessive" levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic.

Empathy and Coping in Allied Health Sciences: Gender Patterns.

This study aimed to examine the patterns of associations between empathy and coping among undergraduate men and women studying at Allied Health Sciences. This cross-sectional study is part of a larger longitudinal study conducted in an Allied Health Sciences School. Participants were 183 undergraduate students from 12 training programs (e.g., Physiotherapy, Occupational Therapy, Speech Therapy). Their mean age was 20.79 years (SD = 2.64), and they were in their first, third, and fourth years of school. The instruments were the Brief-COPE and the Interpersonal Reactivity Index (IRI). Empathy correlated with coping strategies in both genders, though showing different patterns of association. First, distinct coping strategies were associated with the same empathy dimension (perspective taking) among women (positive reframing and self-blame) and among men (active coping). Second, the same three coping strategies appeared in both genders (seeking emotional or instrumental support and resorting to religion) but associated with different empathy dimensions (cognitive empathy among women and mostly emotional empathy among men). Third, among women (but not among men), two coping strategies (positive reframing and behavioral disengagement) were each simultaneously correlated with cognitive and emotional empathy in opposite directions. Fourth, emotional empathy correlated, only among women, with several coping strategies considered to be maladaptive (behavioral disengagement, denial and substance use). Among men, only one significant coping strategy was considered to be maladaptive (behavioral disengagement) and it was negatively correlated with cognitive empathy (perspective taking). Unlike in women, relationships between the empathic dimension of fantasy and coping strategies were non-significant among men. These distinct patterns of associations emerged despite significant differences in empathy by gender (fantasy, personal distress and empathic concern) and in coping strategies (instrumental support, emotional support, religion and venting). These results support the idea that the display of empathy might be associated with gender differences in the underlying empathy dimensions and in the coping strategies used to deal with stress in the undergraduate programs of Allied Health Sciences.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks.

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Recognizing Emotions through Facial Expressions: A Largescale Experimental Study.

Experimental research examining emotional processes is typically based on the observation of images with affective content, including facial expressions. Future studies will benefit from databases with emotion-inducing stimuli in which characteristics of the stimuli potentially influencing results can be controlled. This study presents Portuguese normative data for the identification of seven facial expressions of emotions (plus a neutral face), on the Radboud Faces Database (RaFD). The effect of participants' gender and models' sex on emotion recognition was also examined. Participants (N = 1249) were exposed to 312 pictures of white adults displaying emotional and neutral faces with a frontal gaze. Recognition agreement between the displayed and participants' chosen expressions ranged from 69% (for anger) to 97% (for happiness). Recognition levels were significantly higher among women than among men only for anger and contempt. The emotion recognition was higher either in female models or in male models depending on the emotion. Overall, the results show high recognition levels of the facial expressions presented, indicating that the RaFD provides adequate stimuli for studies examining the recognition of facial expressions of emotion among college students. Participants' gender had a limited influence on emotion recognition, but the sex of the model requires additional consideration.

The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic.

The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists' practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients' adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.

Neurophysiological Correlates of the Near-Miss Effect in Gambling.

The near-miss effect in gambling refers to a losing situation that is (or perceived to be) close to a win by the gambler. This effect is one of the many cognitive distortions that can occur during gambling games. The main objective of the present study was to analyze the electrophysiological correlates of the near-miss effect via an event-related potential (ERP) study examining four distinct gambling outcomes: win, full miss, near-miss before the payline, and near-miss after the payline. This study comprised 23 healthy voluntary participants (10 women) with ages ranging between 19 and 34 years (M = 22.5; SD = 3.65). All participants completed the South Oaks Gambling Screen and played a computerized slot machine, programed to induce the near-miss effect and specifically designed for an ERP study. By splitting the near-miss effect in two subtypes (before and after the payline), increased feedback-related negativity (FRN) was found for the near-misses after the payline in comparison to losses and also to near-misses before the payline. Results also indicated an increased P300 amplitude for the near-misses before the payline compared both with losses and with near-misses after the payline. The results suggest that both FRN and P300 present different sensitivities to near-miss subtypes, suggesting a payline effect that is not demonstrated when the data of near-misses before and after the payline are analyzed together. This is the first study to analyze the effect of the near-miss subtype in an ERP study and confirms the findings of previous behavioral studies.

An fMRI paradigm based on Williams inhibition test to study the neural substrates of attention and inhibitory control.

The purpose of this study is to present an fMRI paradigm, based on the Williams inhibition test (WIT), to study attentional and inhibitory control and their neuroanatomical substrates. We present an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioral performances of healthy participants from those of individuals with acquired brain injury. Stroop and Simon tests present similarities with WIT, but this latter is more demanding. We analyze the BOLD signal in 10 healthy participants performing the WIT. The dorsolateral prefrontal cortex, the inferior prefrontal cortex, the anterior cingulate cortex, and the posterior cingulate cortex were defined for specified region of interest analysis. We additionally compare behavioral data (hits, errors, reaction times) of the healthy participants with those of eight acquired brain injury patients. Data were analyzed with GLM-based random effects and Mann-Whitney tests. Results show the involvement of the defined regions and indicate that the WIT is sensitive to brain lesions. This WIT-based block design paradigm can be used as a research methodology for behavioral and neuroimaging studies of the attentional and inhibitory components of executive functions.

Study of behavioural and neural bases of visuo-spatial working memory with an fMRI paradigm based on an n-back task.

The goal of this study was to propose a new functional magnetic resonance imaging (fMRI) paradigm using a language-free adaptation of a 2-back working memory task to avoid cultural and educational bias. We additionally provide an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioural performances of healthy participants from those of individuals with working memory deficits. Ten healthy participants and nine patients presenting working memory (WM) deficits due to acquired brain injury (ABI) performed the developed task. To inspect whether the paradigm activates brain areas typically involved in visual working memory (VWM), brain activation of the healthy participants was assessed with fMRIs. To examine the task's capacity to discriminate behavioural data, performances of the healthy participants in the task were compared with those of ABI patients. Data were analysed with GLM-based random effects procedures and t-tests. We found an increase of the BOLD signal in the specialized areas of VWM. Concerning behavioural performances, healthy participants showed the predicted pattern of more hits, less omissions and a tendency for fewer false alarms, more self-corrected responses, and faster reaction times, when compared with subjects presenting WM impairments. The results suggest that this task activates brain areas involved in VWM and discriminates behavioural performances of clinical and non-clinical groups. It can thus be used as a research methodology for behavioural and neuroimaging studies of VWM in block-design paradigms.

Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes.

OBJECTIVE: This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients. METHODS: A sample of 104 patients undergoing general ambulatory surgery was randomly assigned to the intervention (IG) and the control (CG) groups. Before surgery, the IG received personalized information through an empathic patient-centered interview. The CG received standardized information on surgical procedures. Anxiety was assessed before and after the preoperative interview and after the surgery. Wound healing, post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery. RESULTS: The two groups were identical at baseline regarding anxiety, socio-demographic and clinical characteristics. After the patient-centered intervention, the IG showed lower levels of preoperative anxiety (p<0.001) and pain (p<0.001), better surgery recovery (p<0.01) and higher levels of daily activity (p<0.001) and of satisfaction with the information received (p<0.01) than the CG. The IG also showed better wound healing (tissue type, p<0.01; local pain, p<0.01). CONCLUSION: An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery, wound healing and patient satisfaction. PRACTICE IMPLICATIONS: This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical contexts.

Teaching communication skills in clinical settings: comparing two applications of a comprehensive program with standardized and real patients.

BACKGROUND: Communication is important for the quality of clinical practice, and programs have been implemented to improve healthcare providers' communication skills. However, the consistency of programs teaching communication skills has received little attention, and debate exists about the application of acquired skills to real patients. This study inspects whether (1) results from a communication program are replicated with different samples, and (2) results with standardized patients apply to interviews with real patients. METHODS: A structured, nine-month communication program was applied in two consecutive years to two different samples of healthcare professionals (25 in the first year, 20 in the second year). Results were assessed at four different points in time, each year, regarding participants' confidence levels (self-rated), basic communication skills in interviews with standardized patients, and basic communication skills in interviews with real patients. Data were analyzed using GLM Repeated-Measures procedures. RESULTS: Improvements were statistically significant in both years in all measures except in simulated patients' assessment of the 2008 group. Differences between the two samples were non-significant. Differences between interviews with standardized and with real patients were also non-significant. CONCLUSIONS: The program's positive outcomes were replicated in different samples, and acquired skills were successfully applied to real-patient interviews. This reinforces this type of program structure as a valuable training tool, with results translating into real situations. It also adds to the reliability of the assessment instruments employed, though these may need adaptation in the case of real patients.

[Virtual reality and rehabilitation: why or why not? A systematic literature review]. / Realidade virtual na reabilitação: por que sim e por que não? Uma revisão sistemática.

Regardless of the health domain involved, the process of rehabilitation remains a challenge for professionals, patients and their families. In an attempt to overcome the limitations of traditional interventions, the technology of Virtual Reality (VR) has been increasingly applied to rehabilitation and begins to provide important tools which, however, generate debate and divergent positions. In order to examine VR's contributions to the field of rehabilitation in terms of its advantages and limitations, this study presents a systematic review of scientific literature in this area and provides a hierarchical model describing and systematizing the nature of the studies reviewed and their main subjects. The literature review focused on scientific papers indexed, until November 2010, in the ISI Web of Knowledge databases. Two independent researchers analyzed the included papers in NVivo 9 and the developed model was applied to the recoding of the material. A total of 963 articles were identified, of which 288 titles and abstracts were reviewed, after application of the exclusion criteria. The model indicates, as central categories in the literature: Type of Article (Empirical, Theoretical); Project Background; Type of Approach (Assistive Technology; Augmented Reality; Traditional Approaches; Virtual Reality). This last category (VR) was exhaustively decomposed so that its applicability, effects and future trends could be documented. Results suggest that VR's advantages include: its possible application to a variety of fields, cognitive functions, behaviors, neurological disorders and physical disabilities; its characteristics and respective consequences; and its potential to overcome limitations of traditional interventions. On the side of the limitations, papers address: VR's side effects, causes for the limitations, and suggested precautions. The results show promising trends in the use of VR technology in the field of rehabilitation, with implications for its future implementation. Results further indicate the need for continuing research that evaluates VR's applicability to rehabilitation in general and (neuro)cognitive rehabilitation in particular.