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Dignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10–18).
Five stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the original author's collaboration, (2) an expert committee provided feedback on the adapted version, (3) an initial consensus version of the DT-QF-Adol was created, (4) expert committee consult affirmed final consensus, and (5) validation stage with a sample of 17 adolescents followed in ambulatory psychology clinic.
DT's original author endorsed the final Portuguese DT-QF-Adol, reinforcing that it captures the fundamental dimensions of DT. There was 100% agreement on the final consensus version and defined age group (10–18 years old). Twenty adolescents were invited to participate, and 17 were included after informed consent was obtained; 53% were female. The average age was 12.7 years. The interviewed adolescents reported that the DT-QF-Adol was clear, and they did not identify any ambiguity or difficulty in answering any of the questions. They assumed that this information could positively affect the way parents and friends see and cared for them, permitting others to understand their concerns and preferences. Participants felt that the DT-QF-Adol could be a good starting point for a conversation with their loved ones. Although they did not consider vital for health professionals to access their answers, they strongly felt that the DT-QF-Adol might be essential to sick adolescents and they would recommend it to others.
Significance of results
We developed a DT-QF of nine questions for Portuguese adolescents (DT-QF-Adol), coined Protocolo de Perguntas da Terapia da Dignidade para Adolescentes — 10–18 anos. This tool can potentially be considered a good addition for pediatric palliative care.
Food insecurity (FI) is defined as uncertain access to healthy food in quantity and quality. We hypothesize that FI may be associated with greater health-care use and absenteeism because it may amplify the effect of diseases; also, FI may be associated with reduced health-care access because it reflects economic vulnerability. The present study estimates the association between FI and health-care use and access, and absenteeism.
Cross-sectional data collected in 2015–2016. Health-care use was measured as the number of consultations, taking any drug and having been hospitalized in the past year. Health-care access was measured by the suspension of medication and having fewer consultations due to financial constraints. Absenteeism was measured by the weeks of sickness leave. Binary variables were modelled as a function of FI using logistic regressions; continuous variables were modelled as a function of FI using negative binomial and zero-inflated negative binomial regressions. Covariates were included sequentially.
Non-institutionalized adults from the EpiDoc3 cohort (n 5648).
FI was significantly associated with health-care use before controlling for socio-economic conditions and quality of life. Moderate/severe FI was positively related to the suspension of medicines (adjusted OR = 4·68; 95 % CI 3·11, 6·82) and to having fewer consultations (adjusted OR = 3·98; 95 % CI 2·42, 6·37). FI and absenteeism were not significantly associated.
Our results support the hypothesis that FI reflects precariousness, which hinders access to health care. The greater use of health care among food-insecure people is explained by their worse quality of life and lower socio-economic condition, so that the specific role of poor nutrition is unclear.
This is the first work describing some biological aspects of the arrowhead dogfish, Deania profundorum. The specimens were captured in two surveys (2004–2005) between 151 and 1200 m off the Madeira archipelago (north-east Atlantic Ocean). A total of 351 females (36–110 cm) and 169 males (27–94 cm) were sampled. The smallest (27 cm) and the biggest (110 cm) specimens ever caught were recorded. Females were most abundant in the overall depths, apart from the middle range of 451–1050 m where the sex-ratio was 1:1. A vertical stratification by size occurred, since all the juveniles less than 40 cm length were caught deeper than 950 m. This species was sexually dimorphic with females growing to larger sizes than males and being larger at first maturity. All stages of maturity were found during the sampling period. Nineteen gravid females with six to 11 embryos (9–18 cm length) were found. The data obtained indicate that the Madeira slopes are a nursery and reproductive area for D. profundorum.
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