RCAAP Repository

Este trabalho teve como principais objectivos: conhecer as competências dos estudantes, do último ano da licenciatura em enfermagem, na área dos cuidados paliativos e, conhecer que tipo de conhecimentos são administrados nas escolas de enfermagem, na área dos cuidados paliativos. Metodologia: Um estudo descritivo foi efectuado a uma amostra não probabilística de 303 estudantes de enfermagem, que responderam a um questionário constituído por várias questões relativas às competências dos estudantes, às unidades curriculares que lhes foram leccionadas na área dos cuidados paliativos, tendo ainda sido caracterizados os dados formativos dos inquiridos. Resultados: Os estudantes quando terminam o curso de enfermagem, apresentam na sua maioria, competências na área dos cuidados paliativos, à excepção de algumas áreas, como sejam as temáticas específicas dos cuidados paliativos: modelos organizativos, articulação entre cuidados continuados e paliativos, comunicação de más notícias, utilização da conferência familiar, o luto imediato, estratégias para lidar com a morte, a perda e o luto e, por fim, a formação. Através da descrição dos conteúdos programáticos leccionados, podemos igualmente destacar que não estão a ser transmitidos alguns conteúdos mais especificos da área dos cuidados paliativos, como sejam: a conferência familiar, as estruturas e modelos dos cuidados paliativos, as capacidades pedagógicas, apoio no luto imediato e técnicas de transmissão de más noticias. Mais de metade da amostra refere que lhe foram leccionados conteúdos, ao longo do curso de enfermagem, na área dos cuidados paliativos, distribuidos por diversas unidades curriculares e anos do curso. Da mesma forma, uma grande parte dos estudantes referiram ter ensínos clínicos onde contactaram com doentes paliativos ou desenvolveram acções paiativas, em diversos serviços e anos de curso. Os estudantes, na sua maioria, consideram que a formação ministrada durante o curso de enfermagem, na área dos cuidados paliativos, não é suficiente para desenvolverem acções paliativas.

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

Social media can ease the access to a large number of contacts, thus enabling social movements to reach a critical mass (Valenzuela 2013; Lovejoy and Saxton 2012). Recently, social movements, mainly in the form of street protests that have been taking place all over the world (Egypt, US, Spain, Portugal, etc.). were amplified through social media, which has acted as a mobiliziogand organizingvehicle for them (Valenzuela 2013; Lim 2012). Social media can emerge as an alternative space for users (activists), complementing traditional protests rooted in public/physical urban spaces, as discussion forums, informal learning networks and other spaces of exchanging and learning in social collectives. However, according to Lim (2014), although they may have been figuratively exalted in the social media spaces, these social movements have materialized specially in the streets. Most of these movements are non-formal networks, unstructured, voluntary associations (Callahan 2013); and most disregard political parties, distrust the traditional (mainstream) media, do not recognize any formal ]eadership and reject any formal organization; they tend to search for support for collective discussion and decision—making on the Internet and in local assemblies (Castells 2013).

O género é reconhecidamente importante nos assuntos ambientais, porém, o debate para estabelecer um nexo entre género e ambiente é mais recente, o desenvolvimento sustentável tem sido alterado sobretudo, de abordagens mais essencialistas para outras mais construtivas (PULEO, 2004; NIGHTINGALE, 2006). Independentemente da perspectiva, importa compreender até que ponto as vivências do feminino e do masculino influem nos interesses e na relação com os temas ambientais e desse conhecimento retirar ilações para uma melhor gestão do território e governança ambiental.

A pesquisa situa-se de modo amplo no processo de formação dos adultos, centrando-se em particular, no Curso de Licenciatura em Enfermagem (CLE), estabelecendo como objeto de estudo o processo de construção da identidade profissional pelos estudantes de enfermagem ao longo da sua formação inicial. Pretende-se lançar alguma luz sobre o modo como estes sujeitos desenvolvem a sua identidade profissional, adotando uma perspetiva que privilegia o seu próprio ponto de vista. Os eixos teóricos que suportam o estudo e concorrem para a definição do objeto de estudo articulam-se em torno, por um lado da própria problemática do estudo das identidades, por outro das diversas mutações identitárias ocorridas ao longo do processo de profissionalização da enfermagem, e finalmente, da experiência vivida do estudante de enfermagem. Metodologicamente optou-se por um estudo de natureza qualitativa com uma abordagem de cariz etnográfico, realizado longitudinalmente ao longo dos quatro anos de duração de um CLE, numa Escola Superior de Enfermagem da Região de Lisboa. Da amostra fizeram parte 30 estudantes do curso, e como técnicas de recolha de dados procedeu-se à entrevista semiestruturada, ao questionário, à observação, aos incidentes críticos e à consulta de documentação. Da análise, discussão dos dados e subsequentes conclusões resulta o reforço da ideia de que a construção identitária é um processo dinâmico, de natureza relacional e permanentemente inacabado, e de que os ensinos clínicos se destacam como contextos incontornáveis na construção da identidade profissional dos estudantes, secundarizando outros momentos da formação inicial como o contexto escolar. Por fim avança-se com uma proposta teórica de tipologia da construção identitária profissional por estudantes de enfermagem.

Background: People with Multiple Sclerosis (pwMS) search for information online about various aspects of living with their disease, but details about patterns of searching and outcomes are unclear. This means that opportunities to leverage online resources to support pwMS, and to enhance shared decision making, may be missed. We aimed to do a systematic review of the literature on digital information searching by pwMS. Methods: We performed a systematic search for studies assessing online information seeking of pwMS in MEDLINE and JSTOR databases. Studies were screened and selected by two investigators. All study designs were included, risk of bias was assessed using the Critical Appraisal Skills Programme qualitative checklist. Reports were assessed for the proportion of patients searching information online about MS, type of information sought, online tools used by patients, perceived quality of the information acquired, and impact of online searching in pwMS. Results: We identified 5 studies, including 10,090 patients. Most pwMS search for information online (53.8-82 %), which they rarely discuss with physicians. The most common topics are treatment, general disease information, symptoms, lifestyle recommendations, prognosis, and coping strategies. Patients that are younger, have a shorter disease duration, primary progressive MS, and during periods of disease worsening, are more likely to use online resources. Online information is perceived as low quality by pwMS. Conclusions: Online information search is prevalent among pwMS. Despite concerns with the quality of the available information, only a minority of pwMS will discuss the information found with their physician. These findings highlight the importance of developing and providing quality online information resources for pwMS.

For decades, the immune system has been associated with host protection against infectious pathogens or tumors, while also contributing to autoimmunity. Notwithstanding, this paradigm is now changing, with recent studies highlighting novel roles for immune mediators in the maintenance of steady-state tissue homeostasis. In this perspective, we review some of the latest findings featuring immune modulators of the nervous system pathophysiology, with a special focus on interleukin (IL)-17.

Este livro de artista documenta parte de uma exposição intitulada "Sob o mesmo tecto", realizada por Teresa Palma Rodrigues e Ema M especificamente para a Casa d'Avenida, Setúbal, em 2023

Subsyndromal delirium (SSD) in the Intensive Care Unit (ICU) is associated with an increased morbidity with unknown post-discharge functional and cognitive outcomes. We performed a prospective multicenter study to analyze the mental status of patients during their first 72 h after ICU admission and its trajectory, with follow-ups at 3 and 6 months after hospital discharge. Amongst the 106 included patients, SSD occurred in 24.5% (n = 26) and was associated with the duration of mechanical ventilation (p = 0.003) and the length of the ICU stay (p = 0.002). After the initial 72 h, most of the SSD patients (30.8%) improved and no longer had SSD; 19.2% continued to experience SSD and one patient (3.8%) progressed to delirium. The post-hospital discharge survival rate for the SSD patients was 100% at 3 months and 87.5% at 6 months. At admission, 96.2% of the SSD patients were fully independent in daily living activities, 66.7% at 3-month follow-up, and 100% at 6-month follow-up. Most SSD patients demonstrated a cognitive decline from admission to 3-month follow-up and improved at 6 months (IQCODE-SF: admission 3.13, p < 0.001; 3 months 3.41, p = 0.019; 6 months 3.19, p = 0.194). We concluded that early SSD is associated with worse outcomes, mainly a transitory cognitive decline after hospital discharge at 3 months, with an improvement at 6 months. This highlights the need to prevent and identify this condition during ICU stays.

The occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00-13:00/16:00-19:00 and 08:00-12:00/16:00-20:00 respectively (p=0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe epilepsy, the most common drug-resistant epilepsy.

The aim of the present study was to evaluate the correlation between the end of an Oxford sleep resistance (OSLER) test session and a neurophysiological marker of sleep onset in Parkinson's disease (PD) patients. Single center study was conducted in PD patients with excessive daytime sleepiness [Epworth sleepiness scale (ESS) >9]. The OSLER test was conducted with a concomitant electroencephalography (EEG), electromyography (mentalis), right and left electroculogram, and video monitoring. Neurophysiological (NP) sleep onset was defined according to AASM criteria (2005). Five PD patients with mean ESS of 14 (10-16) were included. OSLER test duration was shorter than 40 min in all patients (mean duration 20 min and 39 s). No patient fulfilled neurophysiological criteria to sleep onset at the time of OSLER test termination. In 13 OSLER sessions that ended before 40 min, eight had microsleeps in the last 30 s before the end of the test. NP monitoring showed signs of sleepiness in all patients. In PD patients, the early termination of an OSLER test session may not correspond to NP criteria of sleep onset. However, in all PD patients with abnormal OSLER results, there were EEG signs of sleepiness, which do not exclude the potential utility of OSLER test to evaluate the risk of falling asleep.

Este livro de artista documenta parte de uma exposição intitulada "Sob o mesmo tecto", realizada por Teresa Palma Rodrigues e Ema M especificamente para a Casa d'Avenida, Setúbal, em 2023

Background: Sleep may be disrupted in Multiple Sclerosis (MS), but the prevalence of chronic insomnia disorder (CID) using standard diagnostic criteria is unknown. Objectives: To determine the prevalence of CID in an MS population, the frequency of CID subtypes, associated factors and impact on quality of life (QoL). Methods: Multicentre, hospital-based cross-sectional study. An adapted version of the Brief Insomnia Questionnaire was applied to a consecutively recruited MS population. The influence of demographic, MS-related features, fatigue, medical and psychiatric comorbidities, nocturnal symptoms, other sleep disorders, dysfunctional beliefs about sleep in CID was evaluated. The relation between CID and QoL was analysed. Results: Of 206 MS patients, 22.3% fulfilled criteria for CID, with initial insomnia in 11.7%, maintenance insomnia in 11.2% and terminal insomnia in 10.2% of patients. CID was more frequent in female patients, those with nocturnal symptoms, medical comorbidities, higher levels of anxiety, depression and fatigue. Multivariable analysis identified female sex, medical comorbidities, anxiety and fatigue as independent factors for CID. CID patients had a significantly lower self-reported QoL. Conclusions: CID is prevalent in MS patients and associated with psychiatric and medical comorbidities, as well as fatigue. It has a negative impact on QoL.