[A Cognitive Behavioural-Based Intervention in Reducing Test Anxiety in High School Students: A Pilot Cluster Randomized Controlled Trial]. / Intervenção de Base Cognitivo-Comportamental na Redução da Ansiedade Perante os Testes em Alunos do Ensino Secundário: Estudo Piloto Aleatorizado e Controlado Por Clusters.

INTRODUCTION: School-age test anxiety is an important risk factor for school performance. Notwithstanding, few studies seek to identify which strategies are effective in improving test anxiety. The aim of this study was to assess whether a cognitive-behavioural intervention for high school students could significantly reduce test anxiety. MATERIAL AND METHODS: Two-arm, cluster-randomized controlled, unblinded, parallel, trial. Participants were 10th grade students from Alves Martins High School in Viseu, Portugal. Students were randomized at class level to receive a cognitive-behavioural-based intervention combined with mindfulness, psychoeducation, and relaxation techniques, or to a control group with no intervention. Participants' anxiety levels were measured using the Test Anxiety Questionnaire. The analysis of the effect of the intervention was carried out on an intention-to-treat basis at the class level, using multilevel mixed effects models and Bayesian modelling. RESULTS: The intervention had a significant effect in reducing test anxiety (d = 0.81, 95% CI 0.45;1.17, Bayes factor = 31.3). Male gender was an independent risk factor for smaller reductions in anxiety levels. The intervention was more effective in reducing the worry component of test anxiety (d = 0.76, 95% CI 0.41;1.11, Bayes factor = 19.9) than the emotionality component (d = 0.63, 95% CI 0.31;0.95, Bayes factor = 6.6). CONCLUSION: A cognitive-behavioural intervention specifically designed to reduce test anxiety, using a combination of mindfulness, psychoeducation and relaxation techniques, was effective in reducing test anxiety levels. TRIAL REGISTRATION: Retrospectively registered on clinicaltrials.gov (NCT05481099) in 08/01/2022.

Introdução: A ansiedade face aos testes é um importante fator condicionante da performance escolar. Contudo, são escassos os estudos que procuram identificar quais as estratégias eficazes na sua melhoria. Este estudo teve como objetivo testar a eficácia de uma intervenção cognitivo-comportamental na redução da ansiedade face aos testes em alunos do ensino secundário. Material e Métodos: Estudo experimental, aleatorizado por clusters (turmas), controlado, sem ocultação, com dois grupos paralelos, com alunos do 10.º ano da Escola Secundária Alves Martins em Viseu, Portugal. Os alunos foram aleatorizados ao nível da turma para receber uma combinação de técnicas cognitivas e comportamentais, de mindfulness, psicoeducação e técnicas de relaxamento, ou para um grupo controlo sem intervenção. Os níveis de ansiedade dos participantes foram medidos através do Questionário de Ansiedade face aos Testes. A análise do efeito da intervenção foi realizada na base de intenção de tratar ao nível da turma recorrendo a modelos de efeitos mistos multinível e modelação bayesiana. Resultados: A intervenção teve um efeito significativo na redução da ansiedade face aos testes (d = 0,81, IC 95% 0,45;1,17, fator de Bayes = 31,3). Pertencer ao sexo masculino revelou-se um fator de risco independente para uma menor redução nos níveis de ansiedade. O efeito da intervenção foi mais pronunciado na redução da preocupação face aos testes (d = 0,76, IC 95% 0,41;1,11, fator de Bayes = 19,9) quando comparado com a emocionalidade (d = 0,63, IC 95% 0,31;0,95, fator de Bayes = 6,6). Conclusão: Uma intervenção especificamente desenhada para reduzir a ansiedade face aos testes, usando uma combinação de técnicas cognitivas e comportamentais de mindfulness, psicoeducação e técnicas de relaxamento, foi eficaz na redução dos níveis de ansiedade. Registo do Estudo: Estudo registado a posteriori (registo retrospetivo) em ClinicalTrials.gov com o número NCT05481099 em 01/08/2022.

Autoavaliação de médicos sobre sua formação em Medicina do Adolescente / Physicians' self-assessment on their training in Adolescent Medicine

OBJETIVOS: Caraterizar como os especialistas e residentes de Pediatria e de Medicina Geral e Familiar consideram que abordam os adolescentes, identificar as suas habilitações em Medicina do Adolescente, averiguar que tópicos dessa área os médicos gostariam de ver abordados em futuros treinamentos e comparar as percepções dos médicos das duas especialidades em relação à sua experiência na prática em saúde do adolescente. MÉTODOS: Estudo transversal com base em inquérito enviado via correio eletrônico a 241 médicos da área de influência de um hospital de nível II, tendo-se incluído especialistas e residentes de Pediatria e de Medicina Geral e Familiar de centros de saúde do concelho de Viseu, Portugal. Utilizaram-se os testes Qui-quadrado ou teste Exacto de Fisher para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Um total de 113 médicos completou o inquérito, sendo 74% do gênero feminino, com uma mediana de anos de prática de 12 anos (intervalo interquartil 5-30, mínimo 2 anos, máximo 38 anos). O grupo de Pediatria tinha mais formação em Medicina do Adolescente (57%) do que o grupo de Medicina Geral e Familiar (25%) (p=0,007). Mais médicos com formação específica em Medicina do Adolescente consideravam-se preparados para a entrevista ao adolescente (51%, vs. 28% dos que não tinham formação específica, p=0,03). Os médicos Gerais e de Família orientavam mais os adolescentes sobre consumo de substâncias, contracepção e doenças sexualmente transmissíveis, enquanto os médicos de Pediatria identificavam mais adolescentes com depressão. A maioria dos médicos avaliou-se como tendo conhecimentos insuficientes em Medicina do Adolescente, sendo o treino insuficiente a barreira mais frequentemente referida. Cinquenta e sete por cento dos médicos de Pediatria, 78% dos médicos Gerais e de Família e 84% dos que não tinham formação específica em Medicina do Adolescente, considerando as duas especialidades, gostariam de aprofundar os seus conhecimentos nessa área. CONCLUSÕES: Este estudo permitiu identificar que áreas de conhecimento sobre Medicina do Adolescente estão deficitárias na formação dos pediatras e dos médicos gerais e de família. A maioria dos médicos, principalmente os que não tiveram formação em Medicina do Adolescente, mostraram-se interessados em preencher essa lacuna.

AIMS: To characterize the way in which General and Family physicians and Pediatricians consider approaching adolescents, identify their qualifications in Adolescent Medicine, ascertain which topics of this specialty these physicians would like to see addressed in future training, and to compare the perceptions of physicians of both specialties with respect to their experience in adolescent health practice. METHODS: Cross-sectional study based on a survey sent by e-mail to 241 physicians in the area of influence of a level II hospital, including specific training interns or experts in Pediatrics and General and Family Medicine from health centers of the municipality of Viseu, Portugal. Chi-square tests or Fisher's exact test were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: A total of 113 physicians completed the survey, of them 74% female, with a median of 12 years of practice (interquartile range 5-30, minimum 2 years, maximum 38 years). The Pediatrics group had more training in Adolescent Medicine (57%) than the General and Family Medicine group (25%) (p=0.007). More physicians with specific training in Adolescent Medicine considered themselves prepared for the adolescent interview (51%, vs. 28% of those who did not have specific training, p=0.03). Family and General practitioners guided adolescents more about substance use, contraception, and sexually transmitted diseases, while Pediatrics doctors identified more adolescents with depression. Most physicians rated themselves as having insufficient knowledge in Adolescent Medicine, with insufficient training being the most frequently referred barrier. Fifty-seven percent of Pediatrics doctors, 78% of General practitioners and 84% of those with no specific training in Adolescent Medicine, considering the two specialties, would like to deepen their knowledge in this area. CONCLUSIONS: This study allowed identifying which areas of knowledge on Adolescent Medicine are deficient in the training of Pediatricians and General practitioners. Most physicians, especially those with no training in Adolescent Medicine, showed interest in filling this gap.

Improving the attitudes of primary care practitioners toward adolescent care: a pre-post intervention pilot study.

Background Investing in adolescent health is among the most cost-effective health measures. Primary care practitioners are ideally positioned to deliver such interventions. However, several barriers hinder them from engaging with adolescents. Objective To pilot test the impact of a 1-day training session on adolescent health on the attitudes of primary care practitioners toward adolescent care. Subjects Participants were family physicians and nurses enrolled in a 1-day training session on adolescent health. Methods A non-randomized, pre-post intervention study with no control group. Data on barriers for providing care to adolescents, preferred pediatric age group and attitudes toward adolescent care were collected immediately prior. Participants' attitudes were measured again immediately after training. Results Most participants reported they preferred to attend pediatric groups other than adolescents. The most frequently reported barriers were: excessive amount of time needed and lack of training. Participants reported positive pre-training attitudes, with mean scores above the midpoint of the scale in all dimensions. Significant positive improvements were observed after training in Adequacy, Self-esteem and Satisfaction. Subgroup analysis showed that at baseline, professionals who preferred to work with adolescents had significantly more positive attitudes in Adequacy, Self-esteem and Satisfaction. After training there was a general improvement in attitudes in both groups, with attenuation of the differences between them. Conclusion Participation in a 1-day tailored educational intervention on adolescent health had a positive impact on the attitudes of primary care practitioners, regardless of their preferred age group. This improvement may lead to more active engagement with adolescents and substantial health gains.

[Cryptorchidism in adolescence]. / Criptorquidia na adolescência.

INTRODUCTION: An early investigation and management op cryptorchidism are essential for the diagnosis of associated pathologies, because intra-abdominal testis are associated with infertility and neoplasic risk. The authors describe a case of late presentation of cryptorchidism associated with genetic disorder. CASE REPORT: Adolescent male with 17 years old, referred to Adolescent Clinic for short stature and bilateral cryptorchidism. Hypertension, short stature and bilateral cryptorchidism were detected in clinical evaluation. Bone age is coincident with chronological age and testosterone was slightly below normal values. The study of secondary hypertension was negative. He underwent bilateral orchidopexy, and histological analysis revealed severe bilateral testicular atrophy. The karyotype showed 45,X[15]/46,X,+mar.ish der(Y)(SRY+)[117] mosaicism. COMMENTS: With this case report the authors intend to enhance the need of early management of cryptorchidism and short stature, in order to improve the prognosis.