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The authors intend to briefly review the literature regarding the progress of substance misuse rates and harms, the support available and reflect on the current national situation. We aim to better understand the changes in policies and services, and their impact to see what can be learned from the Portuguese experience.
Methods
A narrative literature review was carried out by the authors using the keywords “addiction” “drugs policy” “Portugal” “drug use”. The authors declare no conflicts of interest.
Results
The end of the dictatorship in 1974, the reopening of borders, and the return of white Portuguese from former colonies, were all associated with a dramatic increase in substance misuse in Portugal. In the 1990's it is estimated that 0.5%-1% of the population was using heroin at the time, with extremely high rates of HIV and Hepatitis in intravenous drug users.
At the start of this period, healthcare services were poorly organized, resources for substance misuse services were limited, legislation was punitive, and there was a general understanding that drug addiction was a consequence of a moral failing. A change in paradigm occurred in the late 1990's and new legislation introduced in 2001, which along with the growth in services to support substance misusers dramatically reduced the rates and negative outcomes of substance misuse.
Of note, new HIV diagnoses due to injecting and overdose rates dropped significantly in the XXI century and decriminalization did not lead to an overall increase in substance misuse.
Conclusion
The pivotal shift in the understanding of the nature of addiction as an illness lead to a profound change in interventions to mitigate this overwhelming problem that affected Portugal by the end of the XX century. We hope that by sharing this experience this will improve interventions around the world to support substance misusers and public health.
This exploratory study investigated the effects of early v. delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition and cardiometabolic parameters in adults with overweight and obesity. Adults (20–40 years) were randomised to one of three groups for 8 weeks: early time-restricted eating (eTRE; 08.00–16.00) plus CR, delayed time-restricted eating (dTRE; 12.00–20.00) plus CR or only CR (CR; 08.00–20.00). All groups were prescribed a 25 % energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups and eleven in the dTRE group (n 37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared with baseline, significant decreases were observed in the body weight (eTRE group: −4·2 kg; 95 % CI, −5·6, −2·7; dTRE group: −4·8 kg; 95 % CI, −5·9, −3·7; CR: −4·0 kg; 95 % CI, −5·9, −2·1), fat mass (eTRE group: −2·9 kg; 95 % CI, −3·9, −1·9; dTRE group: −3·6 kg; 95 % CI, −4·6, −2·5; CR: −3·1 kg; 95 % CI, −4·3, −1·8) and fasting glucose levels (eTRE group: −4 mg/dl; 95 % CI, −8, −1; dTRE group: −2 mg/dl; 95 % CI, −8, 3; CR: −3 mg/dl; 95 % CI, −8, 2). In a free-living setting, TRE with a energetic deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.
This study evaluated the effect of fibroblast growth factor-2 (FGF-2) on the morphology, primordial follicle activation and growth after in vitro culture of domestic cat ovarian tissue. Ovaries (n = 12) from prepubertal domestic cats were collected and fragmented. One fragment was fixed for histological analysis (fresh control). The remaining fragments were incubated in control medium alone or with 10, 50 or 100 ng/ml FGF-2 for 7 days. After in vitro culture, the following endpoints were analyzed: morphology, activation by counting primordial and developing follicles, and growth (follicle and oocyte diameters). Treatment with 100 ng/ml FGF-2 maintained (P > 0.05) the percentage of normal follicles similar to fresh control. Follicle survival was greater (P < 0.05) after culture in 100 ng/ml FGF-2 than in 50 ng/ml FGF-2. The percentage of primordial follicles decreased (P < 0.05) and the percentage of developing follicles increased (P < 0.05) in all treatments compared with fresh tissue. The proportion of developing follicles increased (P < 0.05) in tissues incubated with 100 ng/ml FGF-2 compared with control medium and other FGF-2 concentrations. Furthermore, culture in 10 or 100 ng/ml FGF-2 resulted in increased (P < 0.05) follicle and oocyte diameters compared with fresh tissues and MEM+. In conclusion, FGF-2 at 100 ng/ml maintains follicle survival and promotes the in vitro activation and growth of cat primordial follicles.
This chapter provides an overview of the common medicines prescribed within mental health care and explores the ways in which personal narratives and social expectations can influence the experience of taking medicines. The chapter also looks at concepts and practices that influence the management of medicines and encourage safe and high-quality use of medicines. These concepts include consumer experience, concordance, and shared decision-making. Facilitating a positive experience of medicinal use requires quality communication and team work, whereby nurses, psychologists, occupational therapists, dietitians, medical practitioners and pharmacists work in partnership with the consumer and carer.
Assessment in the mental health field is a dynamic process of learning, using experience and applying multiple sources of knowledge and evidence. This chapter presents an overview of assessment practices and processes undertaken within formal mental health care and discusses these within the context of consumer–health practitioner partnerships. We start by considering how assessment practices are a prominent feature of understanding a person’s situation and life context, and how these need to be based on the principles of person-centred, trauma-informed care and cultural safety. We discuss the importance of engagement and therapeutic relationships skills in ensuring consumers, carers and family members are meaningfully connected within a process for identifying the mental health problems the person is experiencing. Part of this awareness is reflecting on what it is like for a person to be assessed, and the power dynamics involved in naming experience, symptoms and diagnosis. The chapter then looks at the paradigm of comprehensive assessment, with specific discussions about strengths-based assessment, mental state examination and the roles of different health professionals.
Readers of this book will have thought deeply about how to collaborate with and support people with a mental illness, their families and carers. The preceding chapters have given considerable emphasis to a narrative approach. This final chapter discusses leadership, particularly for new entrants into mental health settings.Effective clinical care is person and family centred. It seeks to understand and involve consumers, carers and families in rich discussions about their needs, preferences and values. This understanding and involvement is combined with evidence-based practice to support consumers in their treatment and recovery goals.At the heart of the decision to take this approach has been the fundamental belief in human connectedness. By working through this text, readers have been challenged to think about how and when to move in new ways when working with resilient and vulnerable people, which is helpful across a range of practice settings when seeking to make a difference in the lives of people experiencing a mental illness. While this is important in providing a theoretical and practical basis for care, it is at the point of care that effective leadership is required.
While the health systems in Australia, New Zealand and other developed countries are regarded as some of the finest in the world, there is an ever-present need to ensure flexibility regarding cultural competence and responsiveness and cultural inclusivity across a range of practice settings. If current rates of immigration to Australia continue to grow, it is estimated that by 2050 approximately one-third of Australia’s population will be overseas-born (Cully and Pejozki, 2012).This chapter examines the mental health needs of people from refugee and immigrant backgrounds, with emphasis given to asylum seekers. Mental health issues that may affect these populations are explored, as is engagement between people of refugee and asylum seeker backgrounds and mainstream mental health services. This chapter seeks to deepen and broaden readers’ understanding of the effects of trauma among people of refugee background, and links this to strategies that might be used by mainstream mental health practitioners and services in response.
Suicide is a significant national and international public health issue. Each year an estimated 3300 Australians and approximately 650 New Zealanders die by suicide. While suicide is a behaviour not an illness, it can occur in the absence of mental illness. The determinants and precipitants of mental illness and suicide are interrelated and frequently associated with one another. The aim of this chapter is to discuss and describe demographic characteristics of suicide, key definitions and drivers of suicide, suicide risk factors, plus lived experience of suicide and suicide related harms through first person accounts. As with other forms of mental distress, people in suicide and self-harm crisis can be helped through compassionate and person-centred approaches.
This chapter reflects a coming together of key issues and themes embedded in everyday work with consumers and carers. In recent times, the definition of a carer has expanded to include immediate family and friends, and may also include extended family members such as grandparents and cousins. In transcultural and other contexts, it is important to use humanistic language in line with a recovery approach; for example, the terms ‘support person/people’ and ‘support networks’ may be preferable to the term ‘carer’ in mental health practice and mental health nursing. This approach provides a foundation for human connectedness, and sets the consumer narrative as central to mental health practice and mental health nursing, specifically.The chapter introduces students to a narrative-based understanding of mental health and trauma-informed mental health care, as well as key concepts in mental health and mental illness. It discusses mental health nursing as a collaborative, specialised field of nursing.
This chapter introduces the concept of mental illness, how it is diagnosed, and the main diagnostic classification systems used in health practice. The experiences and symptoms of people living with mental illness – according to criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 – are reviewed. It is emphasised that diagnostic criteria can be considered within an overall framework for conversation and engagement between practitioners, consumers, and carers, with the overarching aim of exploring and understanding the best response to distress and treatment approach to promote recovery processes. Criticisms towards diagnostic classification systems are also summarised. Finally, potential effects of the COVID-19 pandemic and its implication for people’s mental health are presented.
The objective of this study was to evaluate the predatory activity of the nematophagous fungus Duddingtonia flagrans on infective larvae of gastrointestinal nematodes from dairy heifers in different conditions (shaded and sunny) of a silvopastoral system (SPS) on an agroecological farm. Ten Jersey heifers were divided into two groups: treated (received pellets containing fungus); and control (received pellets without fungus). Twelve hours after fungus administration, faeces samples were collected for in vitro efficacy tests. The animals then remained for 8 h in the experimental pasture area. At the end of this period, 20 faecal pads (10 treated and 10 control) were selected. Pasture, faecal pad and soil collections occurred at intervals of seven days (d), totalling four assessments over 28 d. To evaluate the influence of the conditions shaded and sunny, we registered the condition of the location of each faecal pad per hour. After 12 h of gastrointestinal transit in dairy heifers, a reduction of 65% was obtained through the in vitro test. The treated group presented a lower number of infective larvae (L3) in the faecal pad and upper pasture. Differences in numbers of L3 were observed between the conditions (sunny and shaded) in the faecal pad of the control group; while in the treated group there were no differences between the conditions. The predatory activity of the fungus was efficient over time in the shaded and sunny conditions of an SPS, decreasing the parasite contamination during the pasture recovery time in a subtropical climate.
The purpose of the study was to verify the effect of 4 weeks of a high-fructose diet (HFD) associated with aerobic training on the risk factors for cardiometabolic diseases. Twenty-one young adults were randomised into three groups: HFD (HFD: 1 g/kg body weight of fructose/day), high-glucose diet (HGD: 1 g/kg body weight of glucose/day) and high-fructose diet and exercise (HFDE: 1 g/kg body weight of fructose/day + 3 weekly 60-minute sessions of aerobic exercise). Before and after the 4 weeks of the intervention, blood samples were taken and flow-mediated dilatation, insulin resistance index, pancreatic beta cell functional capacity index, insulin sensitivity index and 24-h blood pressure were evaluated. HFD showed an increase in uric acid concentrations (P = 0·040), and HGD and HFDE groups showed no changes in this outcome between pre- and post-intervention; however, the HFDE group showed increased uric acid concentrations from the middle to the end of the intervention (P = 0·013). In addition, the HFD group showed increases in nocturnal systolic blood pressure (SBP) (P = 0·022) and nocturnal diastolic blood pressure (DBP) (P = 0·009). The HGD group exhibited decreases in nocturnal SBP (P = 0·028) and nocturnal DBP (P = 0·031), and the HFDE group showed a decrease in 24-h SBP (P = 0·018). The consumption of 1 g/kg of fructose per day may increase uric acid concentrations and blood pressure in adults. Additionally, aerobic exercises along with fructose consumption attenuate changes in uric acid concentrations and prevent impairment in nocturnal blood pressure.
Patient-Reported Outcomes (PRO) are directly reported by the patient without interpretation of the patient's response by a clinician or anyone else and pertains to the patient's health, quality of life, or functional status associated with health care or treatment. It can provide patients’ perspectives regarding treatment benefit and harm, directly measure treatment benefit and harm beyond survival, and are often the outcomes of most importance to patients. This study aims to analyze outcomes reported by Brazilian women diagnosed with breast cancer and rank the most important attributes for these patients.
Methods
Observational study composed of interviews and questionnaires applied to a convenience sample of women diagnosed with breast cancer. The instruments were developed taking into account the literature on the topic and the expertise of specialists. The questionnaire was built with close-ended questions using multiple-choice and a Likert scale, in order to rank the attributes and outcomes found in the interviews.
Results
The total sample was composed of 65 women diagnosed with breast cancer. Twelve women were interviewed, in September 2020, to explore the main outcomes and preferences about their treatments, such as the most common side effects and the most impacted aspects of life after diagnosis and breast cancer treatment. Psychological, emotional, and sexual impacts were frequently described as aspects of life affected by the disease and its treatment. Fifty-three women, from all the five Brazilian regions, answered the survey applied in October and November 2020. Following an order of importance ranking, the following outcomes were chosen, respectively: overall survival, progression-free survival; and quality of life. The treatment effects that were considered less important, among this sample, were pain and adverse events.
Conclusions
Thinking about expanding the therapeutic quality of users, it is essential to take into account the experiences of patients. PRO is a trend in current research to achieve this goal, in order to influence the decisions of HTA agencies about the importance of valuing outcomes that affect patients' lives.
This study aims to evaluate the interaction effect of socio-economic environment (SEE) in the relationship between the eating location (EL) and diet quality, in children and adolescents. Data included Portuguese children and adolescents (3–17 years) from a National Dietary Survey Sample (IAN-AF 2015/2016, n 987). Dietary intake was obtained by 2-d food diaries (children) or 2–24-h-recall (adolescents). Participants were classified into four groups of EL: ‘Home’, ‘Other homes’, ‘School’ and ‘Restaurants’. Diet quality was measured as a higher adherence to a healthy eating pattern. A previous developed socio-economic classification was used, and participants were grouped as belonging to a low socio-economic environment (LSE) or middle-high socio-economic environment (MHSE). Linear regression models were used to evaluate the association between EL and diet quality, stratified by the SEE. A statistically significant interaction effect was found (P < 0·01) for the SEE in the association between EL and diet quality. After adjustment for potential confounders, in LSE, participants belonging to ‘Other homes’ (β = –2·07; 95 % CI:–3·70, –0·44) and ‘Restaurants’ (β = –3·31; 95 % CI: –5·08, –1·54) had lower scores in the diet quality score, comparing to ‘Home’. In MHSE, comparing with ‘Home’, ‘Restaurants’ showed lower diet quality (β = –1·56; 95 % CI:–2·65, –0·48), while the ‘School’ had better diet quality (β = 0·90; 95 % CI: 0·16, 1·64). The SEE influences the association between EL and diet quality and, belonging to more disadvantaged SEE, might represent a higher risk of unhealthy eating habits when eating out-of-home.
Pilot-Induced Oscillation (PIO), although an old issue, still poses a significant threat to aviation safety. The introduction of new systems in modern aircraft modifies the human–machine interaction and makes it necessary for research to revisit the subject from time to time. Given the need of aircraft manufacturers to constantly perform PIO tests, this study analysed the feasibility of using three different computational pilot models (Tustin, Crossover and Precision) to simulate PIO conditions. Three aircraft models with different levels of propensity to PIO (original, low propensity and high propensity) were tested, as well as two pilot gain conditions (normal and high). Data were collected for a purely longitudinal synthetic task through simulations conducted in MATLAB®. PIO conditions were detect using a tuned PIO detection algorithm (ROVER). Data were analysed in terms of both whether the pilot models triggered a PIO condition and for how long the condition was sustained. The results indicated that the three pilot models only provoked PIO conditions when high gain inputs were applied. Additionally, Crossover was the only pilot model to trigger a PIO for the three aircraft models. There were also significant differences between the pilot models in the total PIO time, as the Tustin model typically sustained the oscillatory condition for longer.
Generalized problematic internet use/GPIU has recently been associated with the impulsive-compulsive spectrum/ICS, but its mapping onto these behaviour dimensions is relatively unexplored.
Objectives
To compare patterns of internet use and scores of BIG-5 personality traits, perfectionism and psychological distress between groups with low/high levels of GPIU.
Methods
475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese versions of: GPIU Scale, Multidimensional Perfectionism Scale-13, NEO-FFI-20, Depression, Anxiety and Stress Scales and other questions about internet use. Chi-square and Mann-Whitney tests were performed using SPSS.
Results
Individuals with high levels of GPIU (median+2SD; n=18; 3.8%) spent significantly more time/day in online activities, exceeding what they have planned; had no other hobbies and used social networks to meet friends; reported that GPIU interfered with affective/work relationships and academic performance (all p<.05). There were no significant differences in the purposes of the internet use (e-mail, social networks, shopping, videogames, multimedia, sexual, work…), unless for general information searching and betting games (both p<.05). High-PGIU group also presented significant higher levels of neuroticism, negative (but not positive) perfectionism, depression, anxiety, and stress (all p<.001).
Conclusions
Our results indicate that unlike the purposes of internet use, personality, perceived interference and the associated cognitive-emotional processes and symptoms (psychological distress) may help distinguishing between functional vs. dysfunctional internet use. Considering the preponderance of processes over contents and the presence of certain dimensions, such as perception of uncontrollability, interference and social isolation we add more evidence to consider PGIU as falling within the spectrum of impulsive-compulsive disorders.
The original Profile of Mood States (McNair et al. 1971) is composed of 65 items to measure six affect dimensions. There is a Portuguese shorter version (POMS-27) for the perinatal period (Bos et al. 2013), which reduced the number of items (adjectives) down to 27. Although briefer, it still covers relevant mood states with good psychometric properties, being considered a good alternative to use during this demanding and busy period.
Objectives
To test if PoMS-27, composed of four dimensions (Depression, Anxiety, Vigour, Fatigue) and one second-order factor (Negative Affect, composed by the former two) is valid and reliable to be used with pregnant women from Brazil.
Methods
After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PoMS-27 and the Brazilian recently validated versions of Perinatal Depression Screening Scale and Perinatal Anxiety Screening Scale (PDSS; PASS; Barros et al. 2021). SPSS and AMOS software were used.
Results
After deleting two items (20 and 22) and some errors were correlated, CFA indicated that the PoMS-25 four-dimensional model presented an acceptable fit (χ2=3.163; RMSEA=.079, CFI=.868, TLI=.849). The Cronbach alphas of the dimensions were: Depression (.82), Anxiety (.86), Negative Affect (.89), Fatigue (.80) and Vigor (.50).
Conclusions
Within this psychometric study we found useful, valid and reliable measure of negative and positive affect for Brazilian pregnant women. From now on we will denominate it Profile of Mood States-25Br
The Internet Addiction Test (IAT) is a 20-item, self-reported questionnaire that measures the presence and severity of Internet addiction which is an increasing problem in adolescents. Although a Portuguese version IAT has been validated in adults, its psychometric properties have never been evaluated before, in adolescents.
Objectives
To analyse the reliability and construct and concurrent validity of the IAT in a Portuguese adolescent sample.
Methods
772 adolescents (53.5% girls), mean aged 13.21±2.246, answered the Portuguese versions of the IAT and the Portuguese versions of validated scales to evaluate: Cyberbullying, Game Addiction, Agressivity and Anxiety, Depression Scales. To study the temporal stability, 377 (60.5% girls) respondents answered the questionnaires again after approximately four-six weeks. The total sample was aleatory splitted to realize the exploratory and the confirmatory factor analyses.
Results
Exploratory and confirmatory factor analyses supported a second order two-factor structure - “Isolation and Social Commitment” and F2-“Negligence and Functional Commitment”. The χ2/df value was 2.260 and had a significant p value; it had the lowest RMSEA score = .074 (p< .001) and it had the highest TLI (.980) and CFI (.905). IAT mean scores were no different between genders [Girls=29.25±18.775 vs. Boys: 30.85±17.929, p=.405]. The Cronbach’s alphas were > .85. Pearson correlation between the test and the re-test was r=.660. The IAT, video game addiction (r=.434), Cyberbullying (r=.383), anxiety (r=.209) and depression (r=.263) were significantly correlated (p<.001).
Conclusions
The Portuguese IAT has good reliability and validity, showing to be an adequate instrument for measuring Internet Addiction symptoms in Portuguese Adolescents.
Burnout occurs in every stage of a medical graduation and career. In the first years of graduation, is affects 35-45% of medical and dentistry students. This has severe consequences, such as: higher levels of suicidal ideation, substance abuse, medical errors and medical neglect; lower levels of empathy and self-compassion - essential to the quality of healthcare. Students with certain personality traits (e.g., neuroticism and, particularly, perfectionism) are more vulnerable to emotional dysregulation when facing stressors of daily life. Our recent studies proved that mindfulness and self-compassion can attenuate the effect of perfectionism on psychological distress.
Objectives
To present the rational, materials, methodology and preliminary results of our project COMBURNOUT, aimed to develop, implement and assess the efficacy of a mindfulness and self-compassion-based intervention to prevent burnout in medical and dentistry students.
Methods
Students with high levels of burnout, psychological distress and perfectionism will be randomly assigned to intervention (8 weekly sessions) or control groups. The sessions will be composed by psychoeducation about burnout, mindfulness and self-compassion practices, within and between sessions. The follow up will include three assessment moments until a year after the intervention.
Results
We expect that the experimental group will present significantly lower levels of burnout, psychological distress and perfectionism, and higher levels of emotional regulation skills.
Conclusions
The facilitators training and the manualization are guaranties of standardization and sustainability. If the positive impact of COMBURNOUT is verified, we intend to provide the program to medical/dentistry students from all over the country.