The effect of professional reintegration of stroke survivors on their quality of life: A scoping review: Professional Integration and QoL after stroke.

BACKGROUND: Professional reintegration is an indicator of recovery and a common goal for many stroke survivors. However, data on the effect of professional reintegration on the quality of life (QoL) of stroke survivors is scarce. AIMS: To assess and synthesize the available evidence, and identify the gaps on the effect of professional reintegration on the QoL of stroke survivors. METHODS: A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the effect of professional reintegration on QoL of stroke survivors. The main quantitative findings were synthesized and qualitative data was explored by thematic content analysis. RESULTS: The included studies, 7 quantitative, 1 qualitative, and 1 mixed-methods, were published between 2009 and 2021. The assessment of QoL was highly heterogenic but globally most studies reported a significant and positive association between return to work (RTW) and QoL, 3 to 36 months post-stroke. For some stroke survivors, being able to focus on their rehabilitation was more important for their QoL than RTW. CONCLUSIONS: The results highlight the importance of investing in professional reintegration after stroke to improve survivors' QoL. Further mixed-methods longitudinal research, performed in different countries and settings, with higher, homogeneous, and comparable samples, providing a broader approach to professional reintegration and the use of specific and standardized instruments to assess subjective domains of stroke survivors' QoL, is needed.

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery.

OBJECTIVES: The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth. METHODS: A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale. RESULTS: The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers. CONCLUSIONS FOR PRACTICE: The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

A scoping review on studies about the quality of life of informal caregivers of stroke survivors.

PURPOSE: To assess the available evidence regarding the quality of life (QoL) of informal caregivers of stroke survivors, by identifying the instruments used to assess QoL, and its associated characteristics. METHODS: A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the characteristics influencing the QoL of informal caregivers of stroke survivors. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized, and qualitative data were explored by thematic content analysis. RESULTS: The included studies, 56 quantitative, 1 qualitative, and 1 mixed methods, were published between 1999 and 2020. A high heterogeneity was found regarding the assessment of QoL, and the characteristics influencing it. Only one study used an instrument specifically designed to assess the stroke caregivers' QoL. The QoL of informal caregivers was inversely associated with physical and mental health of stroke survivors and caregivers, while stroke characteristics with a better prognosis, caregivers' positive relationships, and a more supportive and participative social context were positively associated to QoL. CONCLUSION: There is a need for standardizing the assessment of the QoL of informal caregivers of stroke survivors, as well as for investing in cross-country/cultural studies with robust mixed methods designs to allow a deeper understanding of the experiences of caregivers. Further research, policies, and practices should consider the diversity and complexity of the characteristics influencing QoL, to empower informal caregivers and improve their QoL.

Prematurity-related knowledge among mothers and fathers of very preterm infants.

OBJECTIVE: Empowering parents as health promoters may contribute to decrease the costs associated with prematurity. In Portugal, 8% and 1% of the births occurring in 2018 were preterm and very preterm, respectively. This study aimed to assess prematurity-related knowledge with regard to its prevalence, causes and consequences, according to sociodemographic, obstetric and offspring's characteristics, among mothers and fathers of very preterm infants. METHODS: Between May and July 2017, mothers and fathers of very preterm infants were invited to participate through the Portuguese association of parents for support to the premature baby, with 196 parents being included. Knowledge on prematurity (prevalence, causes and consequences) was collected through a structured online questionnaire. Reporting of this research follows STROBE guidelines for cross-sectional studies. RESULTS: Parents estimated a median prevalence of preterm and of very preterm delivery in Portugal of 15% and 8%, respectively. However, approximately 20% did not provide an estimate. More than 90% of the participants acknowledged placental complications, hypertensive disorders of pregnancy, multiple pregnancy and intrauterine growth restriction as causes of preterm delivery, whereas only 24.2% identified low socioeconomic status. Cardiac complications and respiratory morbidity were recognised as the main consequences of prematurity by more than 80% of the parents. Overall, parents with a higher socioeconomic status tended to provide correct responses more frequently than those with a low socioeconomic status. CONCLUSIONS: The results revealed the existence of knowledge gaps regarding the prevalence, causes and consequences of premature delivery. Understanding the main facilitators and barriers to the achievement of prematurity-related knowledge may contribute for the global improvement of preventing this condition. RELEVANCE TO CLINICAL PRACTICE: It is crucial to include the improvement of parents' knowledge about prematurity as a complementary dimension during the provision of medical care, with nurses playing a key role as main sources of information.

Quality of life of parents of very preterm infants 4 months after birth: a mixed methods study.

BACKGROUND: Knowledge about parental quality of life (QoL) is paramount to family-centred and integrated healthcare on prematurity, but evidence is limited. We aimed to explore mothers' and fathers' perspectives about their QoL 4 months after a very preterm childbirth. METHODS: This is a cross-sectional mixed methods study using a convergent design. Parents of very preterm infants were systematically recruited at all level III neonatal intensive care units in the Northern health region of Portugal for one year. Four months after childbirth, 61 mothers and 56 fathers filled-in the World Health Organization Quality of Life - BREF Inventory, and 26 couples were interviewed. Linear regression models were computed to assess the association between participants' characteristics and the QoL. Qualitative data were thematically analysed. RESULTS: A quantitative analysis revealed that the perception of QoL was not significantly different by gender. QoL scores increased slightly from the environment (Mean (SD): 72.1 (14.2)) to the psychological domains (Mean (SD): 78.7 (14.4)). All scores were influenced by psychological characteristics. Socioeconomic position influenced both parents' perceptions concerning the environment domain, and maternal physical and psychological QoL. Infant-related factors were associated with overall QoL among women and with the physical, psychological, social and environment domains among men. Qualitative findings indicated accommodation mechanisms that intertwine the focus on constraining factors (surveillance, sleep disturbances, non-supportive healthcare policies, hygienization) with facilitating factors (social support, accessibility/quality of healthcare, opportunities for developing parental skills). These processes were anchored in child-centredness and a framework that construct hierarchies of hope and expectations about infant's health and development. CONCLUSIONS: To capture parental QoL using mixed methods raises awareness for developing intersectoral family-centred policies, integrated health services and focused-interventions to decrease the disempowering effects of surveillance and hygienization.

Quality of life among parents of preterm infants: a scoping review.

PURPOSE: To synthesize the body of knowledge on the factors influencing the QoL of mothers and fathers of preterm infants. METHODS: A scoping review was performed. Publications indexed in PubMed®, Web of Science™, CINAHL® and PsycINFO® were searched, targeting studies presenting original empirical data that examined parental perception on QoL after a preterm delivery. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized and qualitative data were explored by content analysis. RESULTS: The studies, 11 quantitative and 1 mixed methods, were derived mainly from the USA (n = 6). Heterogeneity across the studies was observed regarding the operationalization of QoL and the use of units of analysis (mothers, parents, families and caregivers). In a context where 40 out of 45 covariates were analysed by only one or two studies, results suggested that parental QoL after a preterm delivery is influenced by factors related with mother's characteristics, family issues and health care environment rather than infants' variables. Factors regarding fathers' characteristics and structural levels were not addressed. CONCLUSIONS: Standardizing the operationalization of the QoL when analysing mothers and fathers of preterm infants calls for a structured questionnaire adapted to their specific needs. Further research should include both mothers and fathers, invest in mixed methods approaches and be performed in different countries and settings for allowing integration and comparison of findings.

Health-related knowledge on hypertension among the Portuguese population: results from a population-based survey.

PURPOSE: Adequate knowledge on hypertension has been shown to improve awareness, adherence to treatment and control of the disease. We aimed to estimate the health-related knowledge about hypertension among the Portuguese population. MATERIALS AND METHODS: A representative sample of Portuguese-speaking dwellers in mainland Portugal (n = 1624), aged 16 to 79 years, was evaluated through face-to-face interviews conducted using a structured questionnaire. Health literacy was evaluated using the instrument Newest Vital Sign. RESULTS: The mean prevalence of hypertension in the Portuguese population estimated by the participants in this study was 45.4%. Salt intake and poor diet were reported as main causes of hypertension by 27.5% and 21.5% of the participants, respectively, whereas more than 85% acknowledged myocardial infarction and stroke as its main consequences. However, 31.2% of the participants were not able to identify a cause for high blood pressure, especially the older and those with worse scores for health literacy. The accurate interpretation of blood pressure values diminished with the increase of systolic and diastolic blood pressure figures provided as examples for interpretation, from approximately 80% for 95/60 mmHg to 50% for 180/100 mmHg. Women and participants with greater levels of education or a previous diagnosis of hypertension tended to interpret blood pressure values correctly more often. CONCLUSIONS: This study provided a quantitative estimate of the gaps in health-related knowledge about hypertension among the general population. Understanding the barriers that hinder the achievement of health-related knowledge on hypertension is expected to contribute for the global improvement of prevention and management of hypertension.

Factors associated with willingness to donate embryos for research among couples undergoing IVF.

Between 2011 and 2012, 213 heterosexual couples undergoing fertility treatments in a Portuguese public fertility centre were systematically recruited to assess factors associated with willingness to donate embryos for research. Data were collected by questionnaire. Most couples (87.3%; 95% CI 82.1 to 91.5) were willing to donate embryos for research, citing benefits for science, health and infertile patients. Almost all couples (94.3%; 95% CI 89.8 to 96.7) reached consensus about the decision. Willingness to donate was more frequent in women younger than 36 years (adjusted OR 3.06; 95% CI 1.23 to 7.61) and who considered embryo research to be very important (adjusted OR: 6.32; 95% CI 1.85 to 21.64), and in Catholic men (adjusted OR 4.16; 95% CI 1.53 to 11.30). Those unwilling to donate reported conceptualizing embryos as children or living beings and a lack of information or fears about embryo research. Men with higher levels of trait anxiety (adjusted OR 0.90; 95% CI 0.84 to 0.96) were less frequently willing to donate. Future research on embryo disposition decision-making should include the assessment of gender differences and psychosocial factors. Ethically robust policies and accurate information about the results of human embryo research are required.

Self-reported psychosocial factors among in vitro fertilization patients interviewed alone or with the partner.

The purpose of this study was to compare the sociodemographic and psychosocial characteristics reported by female in vitro fertilization (IVF) patients interviewed alone or with the partner in heterosexual couples. During 12 months (2011-2012), all patients undergoing IVF or intracytoplasmic sperm injection at one public reproductive medicine unit, in Portugal, were interviewed on the day of the diagnosis of pregnancy, being recruited 221 women interviewed with the partner and 92 interviewed alone. Interviewers collected data on sociodemographic and obstetric characteristics; and anxiety, depression, social support and partner relationship were collected by self-administered questionnaires. χ2 test was used to assess the independent association between the categorical variables and being interviewed alone or with the partner. For continuous variables, mean or median differences were compared by the t-test or the Mann-Whitney test, according to data distribution. No statistically significant differences were found in the self-reporting of depression, anxiety, social support and partner relationship or in sociodemographic and obstetric characteristics between women interviewed alone or with the partner. Although women interviewed alone were older and more frequently had children than women interviewed with the partner, no significant associations were observed. Thus, having a male partner present in the research setting during a self-administered questionnaire seems not to influence women's responses to psychosocial measures. Other outcomes and settings need to be evaluated to support evidence-based guidelines for research on infertility.

Patients' views on the embryo storage time limits.

The establishment of the length of embryo storage has been based on socio-political criteria. There are different regulations, guidelines and health care policies worldwide. This mixed-methods study aimed to assess the opinion of patients about the embryo storage time limit, and the perception of the criteria underlying the establishment of the storage period offered to them. Between August 2011 and December 2012, 534 IVF patients from Portugal participated in a quantitative questionnaire and 34 couples were interviewed. Overall, 38% of participants preferred the duration of 4-5 years, 38% extended it beyond 5 years and 23% indicated 3 years. Having experienced at least one previous cycle was directly associated with agreeing with a duration of storage longer than 5 years, for both women and men. Having children was inversely associated with longer duration of storage, among women. One-third of the 34 interviewed couples stated that their knowledge concerning embryo storage was insufficient. Nevertheless, all the interviewees reported at least one possible reason for the legal establishment of the storage period offered to them, highlighting financial costs and decreased embryo quality. There are misconceptions and gaps in awareness of cryopreservation, which may shape patients' opinions. Accurate information regarding policy on storage of embryos is needed.

Social trajectory and body image satisfaction in childbearing women.

Advantaged socioeconomic position (SEP) is associated with lower body image satisfaction (BIS) among women. However, motherhood and social trajectory (an individual's path from childhood SEP to adulthood SEP) could change this relationship. We aimed to assess the association between social trajectory and BIS immediately before getting pregnant in primiparous and multiparous mothers of a birth cohort. The birth cohort Generation XXI was assembled after delivery, in Porto, in 2005-2006. This analysis includes 5,470 women. Women's and their parents' education were used as indicators of adulthood and childhood SEP, respectively. Social trajectory was classified as stable-high, upward, stable-low, downward, according to both education variables. BIS was assessed with Stunkard silhouettes immediately after birth as the difference between perceived body size before the index pregnancy and ideal body size. Odds ratios (OR) between social trajectory and BIS were computed using multinomial logistic regression (women satisfied with body image were the outcome reference category), adjusting for age and prepregnancy body mass index. In primiparous women, no association was found between childhood SEP, adulthood SEP or social trajectory and feeling too small or too large regarding their ideal figure. Multiparous women with a downward social trajectory presented a higher likelihood of dissatisfaction [too small: adjusted OR 2.21, 95 % confidence interval (95 % CI) 1.10-4.46; too large: adjusted OR 1.64, 95 % CI 1.07-2.51]. Downward social trajectory was associated with a higher likelihood of dissatisfaction with body image in multiparae, while there was no effect among primiparae.

Awareness and motives for use and non-use of preimplantation genetic diagnosis in familial amyloid polyneuropathy mutation carriers.

OBJECTIVE: To assess awareness of preimplantation genetic diagnosis (PGD) and to identify the reasons surrounding its use and non-use by familial amyloidotic polyneuropathy (FAP) carriers. METHOD: Between January and May 2013, a self-administered questionnaire was applied to a representative sample of Portuguese FAP carriers, aged between 18 and 55 years and followed at the Northern surveillance unit. Odds ratios (OR) and respective 95% confidence intervals (95% CI) were estimated using multivariate logistic regression. RESULTS: Those who reported being aware of PGD (75.4%) were younger (age ≥ 35 years: OR = 0.51; 95% CI 0.26-1.01), had higher household income (>€1000/month: OR = 2.18; 95% CI 1.14-4.14), and were less likely to have children (OR = 0.35; 95% CI 0.16-0.76) and to have an individual diagnosis after 2001 (OR = 0.40; 95% CI 0.20-0.80). The main reasons for use of PGD were to avoid offspring suffering (48.9%), more frequently reported by men, more educated and wealthier, and the ability to raise a healthy child (39.4%). The main reasons for non-use of PGD were financial costs (29.6%), technical distrust (29.1%), and the time to get pregnant (17.3%). CONCLUSION: The results reveal the importance of cognitive dimensions and mutation carriers' socioeconomic position in the assessment of PGD, highlighting the need to disseminate accurate information and improve accessibility to this technique.

Stressful life events and heart disease and stroke: A study among Portuguese older adults.

The link between stressful life events (SLE) and cardiovascular diseases (CVD) remains underexplored. This study aimed to examine the association between SLE and the diagnosis of heart disease or stroke, among older adults. Data from 678 participants from the population-based cohort EPIPorto, with ≥60 years and complete information regarding SLE and heart disease or stroke, were analysed. Stressful life events were measured through the 'Stressful Life Events Screening Questionnaire'. A previous diagnosis of heart disease or stroke was self-reported. Adjusted odds ratios (OR) with the respective 95% confidence intervals were computed through logistic regression. Almost a fourth of the participants never experienced any SLE throughout life, 30.0% experienced at least one event, 17.5% experienced two and 27.7% had experienced three or more SLE. A dose-effect association between SLE and the diagnosis of heart disease or stroke was observed, statistically significant for those who had at least 3 types of SLE, independently of confounders (≥3SLE vs. 0SLE: OR = 2.00; 95% CI: 1.12-3.57). This cross-sectional study suggests that cumulative exposure to different types of SLE during the life course was associated with a higher likelihood of having a diagnosis of heart disease or a stroke at a later age. Future longitudinal studies should better deepen this association, particularly by evaluating which type of SLE is more related to a higher prevalence of heart disease and stroke, and how the timing of the SLE influence this relation.

Health-related outcomes of structured home-based rehabilitation programs among older adults: A systematic literature review.

The aging population reveals the need to develop self-care interventions that promote autonomy and well-being. The current systematic review aimed to assess the association between the implementation of structured home-based rehabilitation programs to promote self-care in older adults and health-related outcomes among people aged 60 years or older. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed. Three electronic databases (MEDLINE, CINAHL and Psychology and Behavioral Sciences Collection) were searched. Randomized experimental studies, that implemented a home-based rehabilitation program to promote self-care in older adults, and were published between 2019 and 2024, were retrieved. Data on health-related outcomes were collected. Eight studies were included; all eight studies implemented a monitored, progressive and customized rehabilitation program. The studies varied greatly regarding the sample size, the duration of the intervention, the rehabilitation program implemented and the instruments used. The implementation of structured home-based rehabilitation programs may contribute to improve physical and psychological health-related outcomes among older adults by promoting functional capacity, self-care and knowledge.

Programmes Addressed to Informal Caregivers' Needs: A Systematic Literature Review.

BACKGROUND: Addressing informal caregivers' needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities. METHODS: Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers' needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis. RESULTS: The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive-behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers' psychological outcomes were scarce. CONCLUSIONS: This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers' needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers' educational support and the implementation of cognitive-behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers' physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory.

Cardiovascular risk profile of mothers of a Portuguese birth cohort: a survey 4 years after delivery.

OBJECTIVES: The aim of this study is to estimate the prevalence of smoking, low fruit and vegetable intake, sedentariness, overweight/obesity, abdominal obesity, hypertension, dyslipidemia and diabetes mellitus in mothers of a Portuguese birth cohort, 4 years after delivery. METHODS: A birth cohort was assembled at public maternities of Porto (2005-2006). Children and mothers were reevaluated 4 years later. In this analysis, 5435 women were included. Socioeconomic characteristics, smoking, diet and exercise were self-reported. Anthropometrics and blood pressure were measured. A subgroup of 2483 randomly selected women provided a fasting venous blood sample for lipid and glucose measurements. RESULTS: Overall, 25.3% women smoked, 71.5% consumed <5 portions of fruit and vegetables per day, 81.3% were sedentary, 31.4% were overweight, 21.3% obese and 31.8% had abdominal obesity. The prevalence of hypertension, dyslipidemia and diabetes mellitus was 8.7%, 18.5% and 0.9%, respectively. At least one risk factor from each of the 3 groups (adverse lifestyles, adiposity and cardiometabolic comorbidities) was observed in 17.4% of women. Except for smoking, all risk factors were associated with unemployment, lower education and lower income. CONCLUSIONS: The high prevalence of unfavorable lifestyles and adiposity, and the aggregation of risk factors emphasize the adverse cardiovascular risk profile at a young age.

Long-term maintenance of smoking cessation in pregnancy: an analysis of the birth cohort generation XXI.

INTRODUCTION: Pregnancy affords opportunities for health promotion and disease prevention. We worked with a population-based cohort of women who gave birth in Portugal to quantify the proportion of women who quit smoking during pregnancy, the proportion of these women who continued to abstain 4 years after delivery, and the determinants of these outcomes. METHODS: A birth cohort was assembled in public maternity units of Porto, Portugal, in 2005-2006, and all women were reevaluated at an average of 4 years after delivery. A total of 5,420 mothers were included in the analysis. Smoking status at baseline and at follow-up was ascertained by interview. Adjusted prevalence ratios and 95% CIs were computed using robust Poisson regression. RESULTS: Overall, 47.4% of women who smoked ceased smoking and 41.7% reduced cigarette consumption during pregnancy. Four years after delivery, 32.1% of those who stopped smoking during pregnancy continued to abstain. Older women, first-time mothers, light smokers, those who were living with a partner at the time of follow-up, those who became pregnant again after the index pregnancy, those who breast fed for more than 52 weeks, and those with a child diagnosed with asthma and/or rhinitis were more likely to abstain from smoking. CONCLUSIONS: Approximately half of all women stopped smoking during pregnancy and, among these, approximately one third continued to abstain 4 years after delivery. The high proportion of relapse may be attributable to poor awareness or skepticism regarding the adverse effects of secondhand smoke on children or physiological and psychological dependence on nicotine.

Impact of risk factors on hypertensive disorders in pregnancy, in primiparae and multiparae.

BACKGROUND: Hypertensive disorders complicating pregnancy increase the risk of adverse obstetric and perinatal outcomes. AIM: To assess the impact of age, education, family history of cardiovascular disease, pre-pregnancy overweight/obesity and weight gain during pregnancy on hypertensive disorders, among primiparae and multiparae. SUBJECTS AND METHODS: In a birth cohort study, puerperae were consecutively recruited at public maternity units of Porto, Portugal (2005-2006). The study included 6952 women with singleton births and complete data. Hypertensive disorders included chronic hypertension, gestational hypertension or pre-eclampsia/eclampsia. RESULTS: Overall, hypertensive disorders affected 4.6% of single pregnancies and were associated with older age, lower education, family history of cardiovascular disease and excessive weight before and during pregnancy, similarly in primiparae and multiparae. Approximately 50% of cases among primiparae and 70% among multiparae were attributable to the joint effect of pregnancies after 34 years of age, education below 12 years, family history of cardiovascular disease and excessive weight before and during pregnancy. CONCLUSION: The risk factors explained a high proportion of hypertensive disorders during pregnancy. Excessive weight before and during pregnancy had a very large contribution. The substantial joint effect of the risk factors suggests that interventions focusing on these risk factors should be part of pre-conceptional and pre-natal care.

Professional reintegration among professionally active Portuguese stroke survivors: a multicentric study.

PURPOSE: To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. MATERIALS AND METHODS: A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. RESULTS: On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. CONCLUSIONS: Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.

The amount of professionally active people affected by stroke events is rising worldwide, with increasing numbers of survivors with restricted occupational participation.Higher age and lower socioeconomic status appear to be main determinants for no return to work and so, a special attention should be given to this particular group of stroke survivors.Vocational and social support after stroke is highly needed to help in the reintegration of a professionally active life.Social and community support after stroke should be offered as soon as possible after stroke to promote a successful professional reintegration.

A rapid literature review on the health-related outcomes of long-term person-centered care models in adults with chronic illness.

Introduction: The strong association between age and the increasing prevalence of chronic diseases, makes it imperative to promote self-care throughout life. Systematic knowledge on the health findings of person-centered care models may contribute to designing effective healthcare strategies to promote empowerment for self-care in long-term care. Objective: To assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness. Methods: A rapid review of the literature was performed following the Cochrane rapid review methodology. The electronic databases CINAHL, MedicLatina, MEDLINE, and Psychology and Behavioral Sciences Collection were searched for randomized experimental studies, published between 2017 and 2022, that implemented interventions based on person-centered models to promote self-care in adults aged ≥18 years with chronic diseases and needing long-term health care. Verification of the eligibility of the articles and the extraction of data were performed by two independent investigators. Quantitative data on the health-related variables assessed were collected and, through narrative synthesis, health outcomes were grouped into individual, institutional and societal levels. Results: Eight studies, mostly conducted in European countries, were included. All satisfied more than 60% of the methodological quality score. A large variability among studies was found regarding the number of participants, the data collection period and duration of the intervention, the samples selected and the care model implemented. A high number of health-related outcomes (n = 17) were analyzed in the studies, using 52 different instruments. The main health-related outcomes were multidimensional, with implications at the individual, institutional and societal levels. The promotion of overall health and wellbeing (n = 4), the implementation of patient-centered care models (n = 1), the positive and more frequent interactions with health professionals (2), the decrease on staff psychosocial distress (n = 1), and the absence of added costs (n = 1), while improving family caregivers' skills (n = 1) were the main health-related outcomes described. Conclusion: There is a need to develop robust experimental studies focused on the views and experiences of all stakeholders and conducted in different countries and cultures. Short-, medium- and long-term health outcomes should be measured using internationally accepted and validated scales for chronic patients.