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Healthcare workers are exposed to workplace violence such as physical assaults, psychological violence and threats of violence. It is crucial to understand factors associated with workplace violence to prevent and mitigate its consequences. This study aims to identify work-related factors that might influence workplace violence in healthcare settings. A cross-sectional study was developed between March and April of 2022 with healthcare workers. The Aggression and Violence at Work Scale was used to assess workplace violence, and psychosocial risks were assessed through the Health and Work Survey—INSAT. Statistical analysis using bivariate analysis was performed to identify the psychosocial risk factors related to physical violence, psychological violence and vicarious violence. Subsequently, a multiple linear regression was performed to identify the models that better explained the relationship between psychosocial risk factors and the three dimensions of violence. Psychological violence was frequently experienced by the healthcare workers. Significant associations were found between psychosocial risk factors and physical, psychological and vicarious violence, namely working hours, work relationships, employment relations, high demands and work intensity. These findings highlight the importance of taking into consideration work-related factors when designing interventions to prevent and address workplace violence in healthcare settings.

Introduction: Before the COVID-19 pandemic, research had shown high (and variable) prevalences of the use of Complementary and/or Alternative Medicine (CAM; eg., 70%), in adults and children, dependent, neverthless, on the type of practice. Objective: To characterize adults’ experience with conventional and non-conventional health (self-)care practices during the COVID-19 pandemic in Portugal. Method: After obtaining the necessary authorizations, between 1/10-27/11/2021, a total of 104 adults living in Portugal answered to a Google Forms questionnaire on health (self-)care practices. Results: As for the last time the participants performed any health (self-)care practice: - 47,6% evaluated the results they obtained as good and 14.3% as very good; - 59.5% were satisfied with that practice; - 27.1% considered it a non-conventional practice and 20% were not sure. In terms of health (self-)care practices: 65.2% reported using conventional and non-conventional practices. Among those who have ever used any non-conventional practice: - 50% did it using a professional and 33.9% by themselves and using a professional; - 48.4% use it rarely; - 17.9% started using it more frequently since the start of the COVID-19 pandemic; - 93.8% had never done it against the recommendation of a (conventional) health professional. Since the beginning of the pandemic: 11.2% had at least one appointment with a non-conventional health professional; and 4.1% had more appointments with non-conventional health professionals than with conventional health professionals. Regarding negative experiences with non-conventional practices, 89.7% never had any. Conclusions: Since: (a) participants were mostly satisfied with their last health (self-)care practice/its results, predominantly a conventional practice, even though the majority use both types of practices; (b) when using non-conventional practices, only a minority use it by themselves and the majority with some frequency; (c) its (generally rational) use did not increase considerably with the pandemic; and (d) few negative experiences were reported, these preliminary results are not alarming. Nevertheless, they do suggest a need to increase health care professionals’, non-conventional users’ and non-users’ knowledge about these practices to ensure patients’ safety.

"Ideally, all individuals should be involved in the sustainable development goals attainment. Even though frequently ignored, Psychology can have a considerable impact in this context. Psychology students can also make an important contribution as such. Additionally, an area in desperate need of attention, even before the hardships related to the COVID-19 pandemic, is violence prevention in healthcare settings. Consequently, the aim of this study is to present the rationale, process and results of a project on violence prevention in hospitals undertaken by Psychology undergraduates. The 61 students enrolled in a 3rd-year compulsory course enthusiastically accepted the challenge to develop a brief training session for violence prevention in a hospital setting as part of their grading system. The theme and the possibility to develop a training session were proposed and not imposed. A total of 22 work groups were formed: 4 decided to focus on patients, 4 on nurses, 3 on mental health professionals/psychiatrists, 2 on psychologists, 2 on obstetrics/gynecology; almost all of the remaining groups chose health professionals in general. Only 4 groups decided to take the challenge one step further and direct their training for outside of the class, via Zoom. The sessions were scheduled to begin on the 7th December 2021. Among the sub-themes chosen by the groups (with no constraints from the teacher), there is: burnout (3 groups), psychological well-being, depression, communication, resilience, and optimism. Globally, the groups were keen on complementing the psycho educational component with a skills training approach. Consequently, during undergraduates’ skills training, students can become more aware of the sustainable development goals and experience simple ways they can contribute to them (e.g., Goals 3, 4, 5, 8, 10, 16, and 17)."

"Research has shown the frequent use of complementary and alternative medicine (CAM), its potentialities and risks. Aim: To characterize adults’ knowledge and practices of CAM in order to identify the need to develop lifelong learning programs. After obtaining the necessary authorizations, between 1/10-5/12/2021, 115 adults living in Portugal, mostly women with a higher education degree, working full-time, with a monthly income perceived as medium, answered a Google Forms questionnaire on health (self-)care practices (HsCP). Most considered their health as good (44.3%), being satisfied with it (53%). The majority: took some care of their health (60.5%; 28.1% a lot); had no physical (56.1%) or psychological (78.3%) health problem diagnosed by a conventional health care professional. Regarding the extent to which the participants had knowledge of non-conventional health (self-)care practices (NCHsCP), most (39.5%) knew little about it (10.5% had no knowledge). The majority: had already looked for information about NCHsCP (55.8%), was interested in having (more) knowledge about it (77.2%), and had someone close to them who used and/or was using some non-conventional practice - NCP (57%). Only 14.2% had done training in some NCP and 5.3% considered it impossible to reconcile conventional and NCHsCP. The majority (65.8%) stated that knowledge about NCP is important to them as (future) health professionals (not applicable to 26.3%). As for the last time participants performed any HsCP, 30.2% considered it a NCP (19.8% were not sure). In terms of HsCP, 66.7% reported using conventional and NCP. Among those who have ever used any NCP: 47.1% did it with a professional and 34.3% by themselves and with a professional; 45.8% use it rarely; 93.2% had never done it against the recommendation of a (conventional) health professional. Among those regularly (at least once a year) accompanied by one or more conventional health care professionals, 54% had never talked about NCP. Regarding negative experiences with NCP, 89.8% never had any. The minor children of 13.9% had done some NCP (not applicable to 60.2%). Among the health care professionals, 80.2% had no course during their training mentioning NCP; in their professional experience, 64.2% had knowledge of situations in which conventional and NCP were used simultaneously; in the context of their professional activity: 51.9% had recommended, and 40.7% had referred someone to NCP. Even though these preliminary results are not worrying, they suggest adults living in Portugal would greatly benefit from lifelong learning programs focusing on the potentialities and risks of CAM."

Objetivos: Descrever o perfil do médico de família em Portugal, no que concerne à referenciação de crianças com problemas de comunicação e linguagem e identificar barreiras ao processo de referenciação. Tipo de estudo: Observacional, transversal e descritivo. Local: Região Centro, Lisboa e Vale do Tejo, Região Norte e Região Autónoma dos Açores. População: Médicos de família da região Centro, Lisboa e Vale do Tejo, região Norte e Região Autónoma dos Açores. Métodos: Construção e aplicação de um questionário on-line, com 35 questões com resposta em escala de Likert (0-5) e uma questão semiaberta. O questionário foi enviado a nível nacional, segundo um método de amostragem por redes. Foi assegurado o anonimato e a confidencialidade dos dados. Resultados: Participaram 55 médicos de família. Cerca de 40% dos inquiridos consideraram-se bastante satisfeitos com o processo de referenciação; 55% manifestaram-se pouco ou nada satisfeitos com a aprendizagem de conteúdos acerca do desenvolvimento de comunicação e linguagem durante o curso de medicina; 58% referiram que o encaminhamento para o Sistema Nacional de Intervenção Precoce na Infância ocorre com pouca ou nenhuma frequência. Foram identificadas seis barreiras ao processo de referenciação: constrangimentos com serviços; recursos humanos; burocracia; lentidão do processo; nível de conhecimentos relacionados com o processo de referenciação; atitude dos pais. Conclusão: Os resultados do estudo não permitem descrever o perfil do médico de família em Portugal, pelo que deve ser considerado um estudo piloto. Contudo, são indicativos da perspetiva dos médicos participantes acerca da referenciação de crianças com problemas de comunicação e linguagem, bem como das barreiras associadas a este processo. Objectives: To understand Portuguese family physicians’ profile on the referral process of children with language and communication problems and to know what barriers they identify to it. Type of study: Observational, transversal and descriptive. Local: Central Region, Lisbon and Tejo Valley, North Region and Autonomic Region of Azores Population: Family physicians of Central region, Lisbon, and Tejo Valley, North region and Autonomic Region of Azores Methods: An online survey was designed with 35 Likert (0-5) questions and a semi-open one. It was then sent to family physicians in Portugal according to a non-probabilistic sampling method. Ethical e confidential constraints were guaranteed. Results: Fifty-five family physicians participated. About 40% of these physicians told they were substantially satisfied with the referral process; 55% said they were not satisfied or not very satisfied with knowledge acquired about language and communication development during medicine course; 58% of them told referrals to the Nacional Early Intervention System in Infancy occurs seldom or never. Moreover, six barriers to the referral process were identified: service constraints; lack of human resources; bureaucracy; slow process; lack of knowledge about the process; parent attitudes. Conclusions: The results of this study do not allow us to fully describe the Portuguese family physicians’ referral profile of children with language and communication problems. However, some trends in this process were identified, as well as major barriers.

Introdução: A comunicação apresenta-se gravemente afetada em crianças e jovens com multideficiência e surdocegueira, constituindo-se como uma área de intervenção prioritária. Objetivo: Analisar e sistematizar a literatura no que diz respeito a intervenção com comunicação aumentativa / alternativa com crianças e jovens com multideficiência e surdocegueira, considerando o modo de implementação e avaliação da eficácia destas intervenções. Método: Revisão sistemática da literatura baseada no PRISMA Statement. A pesquisa foi realizada nas bases de dados SciELO, LILACS, PubMed e B-On, até à data de 31 de maio de 2018, utilizando os termos “multideficiência”, “surdocegueira” e “comunicação aumentativa e alternativa”, em português e em inglês, combinados entre si. Resultados: Um total de nove artigos foram selecionados após cuidadosa análise e atendendo a rigorosos critérios de inclusão e exclusão. Conclusão: Algumas discrepâncias foram identificadas quanto ao modo de implementação e avaliação da eficácia de comunicação aumentativa e alternativa, tendo-se concluído que é necessário desenvolver mais investigação que evidencie o impacto do uso desta ferramenta relativamente aos múltiplos contextos naturais, funcionalidade comunicativa mais complexa, instrução de parceiros de comunicação, frequência da intervenção e percepções de pais / profissionais.

Purpose The patients with neurological disorders often report a different quality of life (QoL), which is in part explained by clinical–pathological or psychosocial variables. This study evaluated spirituality in patients with chronic brain pathologies, aiming to clarify its specificity and position to a multidimensional model of QoL. Methods A hundred and ninety-nine adult patients with epilepsy (E) (n = 88), mild cognitive impairment (MCI) (n = 32), ischemic vascular disorders (n = 29), tumors (n = 28), or multiple sclerosis (MS) (n = 22), and 66 healthy subjects were assessed using the World Health Organization Quality of Life (WHOQoL) 100, Spiritual, Religious and Personal Beliefs (SRPB), Beck Depression Inventory (BDI), and State–Trait Anxiety Inventory (STAI) for the QoL, spirituality, depression, and anxiety. The Multiple Ability Self-Report Questionnaire (MASQ) and neuropsychological tests evaluated the cognitive functions. Results Factor analysis of the SRPB, STAI, and BDI scores yielded four factors: Personal Meaning, Inner Freedom, Awe and Openness, and Mood. Quality of life and spirituality were very similar between the patient groups. In comparison with the controls, all of the patients showed worse QoL, spirituality, mood, and lexical-memory abilities, and the patients with MCI and brain vascular disorders (BVD) also revealed worse cognitive impairments. Trait anxiety, self-rated health, age, and the SRPB Inner independence and Hope and optimism facets predicted the patients' WHOQoL 100 total score; the spiritual, affective, and socioeconomic variables predicted many QoL domains, but diagnosis only affected the Physical domain. Anxiety, self-rated health, Hope and optimism, and Personal beliefs predicted the controls' WHOQoL 100 total score. Conclusions Spirituality, as marked by the meaning of self, inner independence, and transcendence, is distinct from mood. It cooperates, together with the affective states, to determine the QoL of the patients with chronic brain pathologies whereas diagnosis has a limited impact. These findings support a multidimensional cross-disease model for the QoL in neurological disorders.

Summary Objective Myofascial release (MFR) comprises a set of manual therapeutic techniques applied to many conditions, but specific evidence concerning its effects on body posture, muscle tension and voice has been lacking. Thus, the aim of this study was to verify the effects of MFR in teachers’ posture, muscular tension and voice quality. Study Design Randomized controlled trial – crossover. Methods Twenty-four teachers, after completing a Sociodemographic and Clinical Questionnaire and providing written informed consent, were randomly distributed into two groups designated Group 1 (G1; n = 12; received MFR first) and Group 2 (G2; n = 12; belong to control group first). All participants received treatment and were into control group, since, after a 14 day period, procedures were switched between groups. Photogrammetry, muscle tension assessed through palpation, algometry, aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were performed before and after interventions. Results Regarding voice, statistically significant differences were found when intervention was applied to both groups for maximum phonation time (MPT) (G1 P = 0.019; G2 P = 0.004). The acoustic variables did not differ. Concerning the auditory-perceptual analysis of voice statistically significant differences were found when intervention was applied in both groups for Grade in G2 (P = 0.046) and for Roughness in G1 (P = 0.025). Regarding the photogrammetry assessment statistically significant differences were found when intervention was applied to both groups in many parameters while as control group they did not. Concerning the algometry and muscle tension assessed through palpation statistically significant differences were found when intervention was applied in all muscles. Conclusions Findings indicated that MFR seems to be an effective therapy in improving MPT, two subscales (Grade and Roughness) of the GRABASH scale, muscle tension assessed through palpation and algometry. Regarding photogrammetry, MFR had an immediately effect in improvement of the posture, especially related with head.

No sentido de identificar programas de treino de competências de comunicação e respetivas metodologias de avaliação para fisioterapeutas efetuou-se uma Revisão Sistemática da Literatura com base na Statement Preferred Reporting Items For Systematic Reviews And Meta-Analyses, pesquisando na PubMed, com as palavras-chave communication AND health AND (physical therap* OR physiotherap*), artigos completos, em português e inglês, publicados entre 30.09.2011 e 30.09.2018. Face à escassez de estudos identificados no âmbito da fisioterapia, incluíram-se artigos que apresentassem intervenção para profissionais/estudantes de saúde. Excluíram-se revisões sistemáticas da literatura, meta-análises e artigos de opinião. Foram selecionados 17 artigos, cinco dos quais no âmbito da fisioterapia, que relataram uma avaliação do treino e das competências bastante heterogénea. Conclui-se que talvez a heterogeneidade verificada seja reflexo da variedade de competências focadas e metodologias de treino adotadas. In order to identify communication skills training programs and their evaluation for physiotherapists, a Systematic Literature Review was carried out based on the Statement Preferred Reporting Items For Systematic Reviews And Meta-Analyses, researching at PubMed, with the keywords communication AND health AND (physical therap* OR physiotherap*), complete articles, in Portuguese and English, published between 30.09.2011 and 30.09.2018. In view of the scarcity of studies identified in the field of physiotherapy, articles that presented intervention for health professionals/students were included. Systematic literature reviews, meta-analyses and opinion articles were excluded. 17 articles were selected, five of which were selected in the field of physiotherapy, which reported an evaluation of training and skills quite heterogeneous. It is concluded that perhaps the heterogeneity verified is a reflection of the variety of focused skills and training methodologies adopted.

The interaction between muscle tension, posture, and vocal use is very complex as clinical research suggests that abnormal laryngeal posture can be associated with muscle adaptive changes, although specific evidence concerning body posture and voice disorders has been lacking. Thus, the aim of this study was to verify if there were differences in posture, muscle tension and voice between teachers with and without voice complaints.Cross-sectional study.Twenty-four teachers, 6 males and 18 females, were submitted to photogrammetry, muscle tension assessed trough palpation and algometry assessment. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into without voice complaints group (WVCG; n = 11) and voice complaints group (VCG; n = 13) based on Sociodemographic and Clinical Questionnaire completion.For auditory-perceptual analysis, VCG showed a significant higher values on GRBASH subscales Grade (p0.001) and Roughness (p = 0.011). The VCG showed statistically significant higher values on muscle tension of suprahyoids (p = 0.001), thyrohyoids (P = 0009) and cricothyroids muscles (p = 0.040) and statistically significant lower values on algometry of the cricothyroid (p = 0.023 left and p = 0.026 right), suprahyoids (p = 0.017 leftp = 0.018 right), thyrohyoids (p = 0.006 left and p = 0.007 right) and pharyngolaryngeal (p = 0.016 left and p = 0.021 right) muscles of both sides. Concerning the aerodynamic assessment of voice and acoustic analysis of voice, no statistically significant differences between the groups were found.Findings indicated statistically significant differences in muscle tension in laryngeal intrinsic muscles and auditory-perceptual analysis between teachers with and without voice complaints.

Objective In patients with brain lesion, awareness of cognitive deficits is an important aspect of disease awareness. Glioblastoma (GBM) and anaplastic astrocytoma (AA) can cause cognitive deficits, but, to date, awareness of these deficits has not been documented. This study aimed to test cognitive awareness in these patients after the end of treatment. Methods Fifty patients with GBM or AA were assessed using the Multiple Ability Self-Report Questionnaire (MASQ), State-Trait Anxiety Inventory (STAI), Self Rating Depression Scale (SRDS), and memory, attention, mental speed, abstract reasoning, and flexibility neuropsychological tests. Cognitive awareness was calculated as the concordance between the composite score of neuropsychological performance (PEC) and the total MASQ score. The controls were 48 healthy subjects. Analysis of variance and regression analysis compared subject groups and explored variables predicting perceived abilities. Results Patients with GBM or AA showed similar attention, memory, and executive deficits compared with controls. Cognitive awareness was fair/full in 64% of patients. In the entire patients group, the worst MASQ scores were associated with neuropsychological deficits, anxiety, depression, and glioma location in the right hemisphere . In patients with fair/full awareness, MASQ scores were related to affective status and neuropsychological performance, whereas, in those with scarce/no awareness, they were related only to affective status. Conclusions After treatment, many patients with GBM or AA are aware of their cognitive deficits. Anxiety, depression, and right hemisphere tumour exacerbate the perceived difficulties. This neurocognitive approach expands the behavioural phenotypes of high-grade gliomas and may have therapeutic implications over the course of the disease.

OBJECTIVE This investigation aimed to verify if there were any differences in autonomic nervous system function and voice parameters of teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS The Questionnaire of Autonomic Dysfunction was answered by 24 teachers, 6 males, and 18 females, whose heart rate variability was also assessed. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into two groups: without voice complaints (WVCG; n = 11) and with voice complaints (VCG; n = 13) based on the completion of the Sociodemographic and Clinical Questionnaire. RESULTS For auditory-perceptual analysis, VCG showed significantly higher values on GRBASH subscales Grade (P < 0.001) and Roughness (P = 0.011). Regarding the heart rate variability, it was found that in the VCG, the square root of the mean squared difference of successive RR intervals (RMSSD) and the percentage of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were significantly lower than in the WVCG (P = 0.023 and P = 0.032, respectively). The VCG presented a higher occurrence of neurovegetative symptoms directly related to voice, namely in fluctuating nose obstruction (P = 0.011), neck pain (while or after speaking) (P = 0.017) and in fatigability when speaking (P = 0.004). Concerning the aerodynamic assessment of voice, acoustic analysis of voice and neurovegetative symptoms not directly related to voice, no statistically significant differences between groups were found. CONCLUSIONS Findings indicated significantly lower values in RMSSD and pNN50 of teachers VCG when compared with teachers WVCG and that the teachers VCG presented a higher occurrence of neurovegetative symptoms directly related to voice than the ones WVCG.

Summary Objective The study aimed to verify the relation between autonomic nervous system (ANS) dysfunctions, voice, and dysphonia. Study Design The study is a systematic review. Methods According to the PRISMA flowchart, a search on Pubmed/Medline, SciELO, RCAAP, LILACS, Cochrane Library, PEDro, and Isi Web of Knowledge was performed up to April 2019 using the following key words: autonomic nervous system and voice or dysphonia. Inclusion criteria were full-text articles published in French, English, Portuguese, or Spanish, exploring the relationship between ANS and voice or dysphonia, in human adults. Exclusion criteria were additional treatments for voice disorders, literature reviews and meta-analysis, case studies, and opinion articles. All studies were analyzed using a modified version of the Newcastle-Ottawa scale. Results Nine papers met the inclusion criteria, all with high methodological quality. The review shows that ANS is related to voice and dysphonia. Individuals with dysphonia tend to show more symptoms of ANS dysfunction concurrent with laryngeal muscles activation and that heartbeat modulates the F0 of human voice. Conclusion Changes in ANS function are associated with voice as well as with dysphonia.

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A gestação é um período permeado por sentimentos/pensamentos ambivalentes pelos quais a Psicologia demonstra interesse. Os aspectos físicos/biológicos da gestação sempre foram temas centrais nos cuidados pré e pós-natais. Hoje, programas de cuidados pré-natais psicológicos oferecem espaço acolhedor com o objetivo, por exemplo, de promover a saúde das gestantes e prevenir depressão pós-parto. É possível incluir, também, os companheiros(as) e a família estendida num ambiente de diálogo sobre crenças, expectativas, riscos e anseios presentes nesta fase. Numa breve revisão da bibliografia constata-se que a Psicologia dedica especial atenção aos cuidados às gestantes. O objetivo deste estudo foi verificar, na literatura, se as gestantes surdas têm recebido esta mesma atenção. Realizou-se uma revisão sistemática da literatura, até o dia 31 de março de 2020. Foram consultadas as bases de dados PubMed, SciELO, EBSCO e BVS, sem uso de filtros tampouco limite quanto a data de publicação. Os termos MeSH/descritores utilizados foram pregnant women AND Psychology AND deaf*. Dentre os 52 artigos identificados, apenas 9 foram incluídos neste estudo, sendo que 8 deles não tinham como foco principal gestantes surdas e sim gestantes com deficiência. Gestantes com deficiência/surdez parecem, assim, excluídas tanto dos dados censitários, quanto dos serviços de saúde e das pesquisas científicas. Nesta amostra, apesar de pequena, depreendeu-se que estas mulheres são vítimas de preconceito e discriminação de diferentes instâncias da sociedade. No entanto, é possível constatar, também, que há um campo importante e necessário para a atuação da Psicologia voltado a essas mulheres, profissionais de saúde e familiares.

Summary Objective The study aimed to systematize the associations between posture, voice, and dysphonia in order to support future research directions and possible clinical interventions. Study Design The study is a systematic review. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart, a search on PubMed/Medline, SciELO, RCAAP, LILACS, Cochrane Library, PEDro, and Isi Web of Knowledge was performed from their inception through January of 2017 using the key words “posture” and (“voice” or “dysphonia”). The inclusion criteria were full-text journal articles in French, English, Portuguese, or Spanish, exploring the relationship between posture and voice or dysphonia, in adult human beings. The exclusion criteria coupled treatments for voice disorders, literature reviews and meta-analyses, case studies, opinion articles, and studies linking breathing with posture without assessing voice. Studies were analyzed using a modified version of the Newcastle–Ottawa Scale (NOS). Results Twelve papers met the inclusion criteria with high methodological quality through the NOS. The review shows that a correct posture is necessary for an efficient voice production; however, the relation between dysphonia and posture seems to be contradictory. Conclusion An effective posture allows a subject in a static posture or while moving to more easily shift the tension between muscles, allowing for a free movement of the larynx without blockages and with benefits to voice production.

This study analyzed the subjective facets of quality of life (QoL) and their relation to the type of brain tumor (BT) and phase of disease. Two hundred and ninety-one patients with pinealoblastoma, medulloblastoma, low-grade glioma, anaplastic astrocytoma, or glioblastoma were evaluated. With respect to 110 healthy controls, patients in the phases of radiotherapy/chemotherapy, stable disease, or tumor recurrence were significantly more anxious and depressed compared with patients in the early postoperative period. All patients were impaired in mental flexibility and memory, with preservation of abstract reasoning. The Functional Living Index-Cancer (FLIC), previously validated in cancer and BT patients, yielded six subjective factors (disease perception, affective well-being, role and leisure, personal base, nausea, sharing). None of the FLIC factors were predicted by tumor type, which only related to the physical and cognitive performances and mood scores. Affective well-being, role and leisure, and sharing were predicted by the phase of disease. Personal base, including self-perception and confidence, was independent on tumor progression and treatment. To conclude, QoL encompasses different subjective aspects, which vary in relation to the phase of disease and clinical burden. However, some person-related facets appear independent on tumor progression and treatment, indicating individual resources. Knowing this may guide tailored interventions supporting QoL.

Epilepsy is one of the most common neurological pathologies in the world, with important repercussions in the individuals' Quality of Life (QOL). In this way, the goal of treatment surpasses the total remission of seizures, since it also prioritizes the improving the QOL of individuals with epilepsy. The QOL has been associated with some important modifying factors, for its promotion. In this way, with the present study we pretend to identify whether Adherence to Therapy, Coping Strategies and Spirituality are predictors of QOL of individuals with epilepsy. The SF-36 v1.0, the Measure Treatment Adherence, The COPE-R and The Spirituality Assessment Scale in Health Contexts were administered to 94 individuals with epilepsy diagnosis between four and forty-nine years. The relation between the variables was analysed through multiple linear regression model.

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The Bologna Process emphasizes university students’ communication skills, namely in the Health field. Teachers’ conceptions tend to vary with age and are important in the development of students’ conceptions. Aims – To analyse the importance and satisfaction that university teachers attribute to several communication skills and their relation with age. Methodology – A total of 79 university teachers, between 29 and 82 years of age (M=41.89; SD=9.99), mainly women (69.6%), answered to a Sociodemographic Questionnaire and the Importance (IS) and Satisfaction Scales (SS) of the Communication Skills Questionnaire (QCC). Results – Between 1 and 4 of the participants attributed to 11 of the 26 items of the IS and to 7 of the 26 items of the SS the minimum score possible. There was also at least one participant that attributed the maximum score possible to allitems of the IS (between 8 and 51 participants) and of the SS (between 6 and 46 participants). The skill “thank” was considered the most important and satisfactory. Age was not statistically correlated with the items from the IS. There were linear statistically significant correlations between age and: “answer questions” (r(78)=.27, p≤.02) and “ask for feedback in social interaction” (r(78)=.30, p≤.008) from the SS. Since key skills for health professionals (e.g., “disagree”, “refuse requests”, “make requests”, and “paraphrase”) had scores that suggest low importance, it is considered important to change the importance perception of university teachers that does not seem to change with age. Important skills for the teachers’ work (e.g., “refuse requests”, “ask for a change in behaviour”) had some of the lowest satisfaction means, suggesting a need for training.

Tinnitus is commonly defined as an aberrant perception of sound without external stimulus. It’s a chronic condition with consequences on the QOL. The coping strategies used were not always effective and coping was identified as a predictor of QOL in individuals with tinnitus, which reinforces the idea that in health the use of effective coping styles should be promoted. This work intend to verify relations between coping strategies assessed by BriefCope in subjects with tinnitus and variables such as gender, age and severity of tinnitus measured by THI and the Visual Analogue Scale and also hearing and hyperacusis. The results indicate that there are any statistically significant relationships between the variables assessed in relation to the results of BriefCope except in the Visual Analogue Scale.These results, indicating no relationship between almost all variables, reinforce the need for further study of coping strategies use by these patients. &nbsp

BACKGROUND: Chronic illnesses are diseases of long duration and generally of slow progression. They cause significant quality of life impairment. The aim of this study was to analyse psychosocial predictors of quality of life and of subjective well-being in chronic Portuguese patients. METHODS: Chronic disease patients (n = 774) were recruited from central Portuguese Hospitals. Participants completed self-reported questionnaires assessing socio-demographic, clinical, psychosocial and outcome variables: quality of life (HRQL) and subjective well-being (SWB). MANCOVA analyses were used to test psychosocial factors as determinants of HRQL and SWB. RESULTS: After controlling for socio-demographic and clinical variables, results showed that dispositional optimism, positive affect, spirituality, social support and treatment adherence are significant predictors of HRQL and SWB. Similar predictors of quality of life, such as positive affect, treatment adherence and spirituality, were found for subgroups of disease classified by medical condition. CONCLUSIONS: The work identifies psychosocial factors associated with quality of life. The predictors for the entire group of different chronic diseases are similar to the ones found in different chronic disease subgroups: positive affect, social support, treatment adherence and spirituality. Patients with more positive affect, additional social support, an adequate treatment adherence and a feel-good spirituality, felt better with the disease conditions and consequently had a better quality of life. This study contributes to understanding and improving the processes associated with quality of life, which is relevant for health care providers and chronic diseases support. This study was supported by a grant from the Fundação para a Ciência e Tecnologia (PTDC/PSI/71635/2006, PTDC/PSI/ 73175/2006, SFRH/PROTEC/49284/2008)

Chronic diseases are long-lived, slow progression and induce changes in the lives of people, who are confronted with a set of factors that have a negative impact on their quality of life (QoL). The QoL is a concept involving essential components of human  Instituto Politecnico do Cavado e do Ave, Escola Superior de Tecnologia; Campus do IPCA Lugar do Aldao, 4750-810, Vila Frescainha S. Martinho BCL; Telf. 253 802 260; Fax. 253 823 127 PREDITORES DE AJUSTAMENTO EM PESSOAS COM DOENCA CRONICA 221 quality: physical, psychological, social, cultural and spiritual. After diagnosis and with stable disease, patients try to find new ways to deal with their new condition. This study aimed to identify predictive psychosocial factors (optimism, positive and negative affect, treatment adherence, social support and spirituality) QoL (general well-being, physical health, mental health) and subjective well-being (SWB) in people with chronic diseases. The sample of 774 subjects [30 % diabetes, 27.1 % cancer, 17.2 % diabetes, 12 % epilepsy, 11.5 % multiple sclerosis and 2.2 % gravis, 70.5 % female, age M(SD)=42.9(11.6), education M(SD)=9.6(4.7) years diagnosed M(SD)=12.8(9.7), disease classification M(SD)=6.6(2.8)], was recruited from the Portuguese central hospitals. Applying Structural Equation Modeling and adjusting for sociodemographic and clinical variables, it was found that more optimistic people, more active and with a better treatment adherence, have better overall well-being, better mental health and better subjective well-being; better treatment adherence contributes to better physical health, better social support reflected in better mental health, people with more spirituality have better physical health and better mental health. These findings contribute to the development of a therapy that can help to better adaptation of treatment protocols to meet the needs of patients.

Next year, the biopsychosocial model will reach her 40th birthday!Engel(1), in 1977, took a major step in favor of the health personnel and their patients, when he advocated that the dominant model of disease, the biomedical model, was insufficient. He proposed a biopsychosocial model useful for research, teaching, and health care. Nevertheless, even today, its advocates do not implement this model routinely, much less universally. Mc Inerney(2), in 2015, emphasized that “medical professionals will need to be familiar with the research identifying the health risks associated with different behavioural and social conditions and not just the biological illness itself. Therefore, it is no longer sufficient for clinicians to state that treatment is successful in terms of its effect on a specific biological illness, but it is now also necessary to know whether the treatment gives significant improvement over the way in which a person lives.” Analyzing the biopsychosocial model, Borrell-Carrió, Suchman and Epstein(3)argued that “it may be that the content and emotions that constitute the clinician’s relationship with the patient are the fundamental principles of biopsychosocial-oriented clinical practice, which then inform the manner in which the physician exercises his or her power”. They added that “the physician’s skills should be judged on their ability to produce greater health or to relieve the patient’s suffering—whether they include creating an adequate emotional tone, gathering an accurate history, or distinguishing between what the patient needs and what the patient says he or she wants”. “Mindfulness, the habits of attentive observation, critical curiosity, informed flexibility, and presence, underlies the physician’s ability to self-monitor, be vigilant, and respond with compassion”. One criticism to the biopsychosocial model is that it is not an adequately guiding: “reminding us to pay attention to three aspects of illness. Then the question becomes: how do we choose? How do we prioritise one aspect versus another? … The biopsychosocial model, as classically advanced, does not guide us on how to prioritise. Consequently, prioritisation happens on the run, with each person’s own preferences, and the model devolves into mere eclecticism, passing for sophistication”(4). Sulmasy(5), in 2002, presented a more comprehensive model of care and research that takes account of patients in the fullest possible understanding of their wholeness—as persons grappling with their ultimate finitude. One may call this a biopsychosocial-spiritual model of care. In other words, this biopsychosocial-spiritual model is not a dualism in which a soul accidentally inhabits a body. Rather, in this model, the biological, the psychological, the social, and the spiritual are only distinct dimensions of the person, and no one aspect can be disaggregated from the whole. Each aspect can be affected differently by a person’s history and illness, and each aspect can interact and affect other aspects of the person. Consequently, when caring for people at the end of their lives, this new model suggests that the patient comes to the clinical encounter with a spiritual history, a manner of spiritual/religious coping, a state of spiritual well-being, and concrete spiritual needs. Katerndahl e Oyiriaru(6) developed and validated an instrument to assess each dimension in terms of its specific symptoms and functional condition in primary health care users and obtained promising results. If these brief notes suggest that there has been no stagnation around the biopsychosocial-spiritual model, it is important, however, to stress that there is a long way to go and much to be done. It is worthwhile to continue exploring the potentialities and limitations to this model in a critical way, which is not always the case. Only by knowing the model limitations, we will be able to train health personnel with a holistic and spiritual view. By any means and wherever we go, we do not walk in the direction of words attributed to Leonardo da Vinci: “Poor is the pupil who does not surpass his master”. We must collaborate daily to improve the model that has been shaping our practice in the last 40 years …

Epilepsy is a chronic disease and the world’s most common serious neurological disorder (International League Against Epilepsy ILAE, 2003a; Jacoby, 2002). Epilepsy is the name for a group of functional disorders of the brain, characterised by repetitive seizures, caused by abnormal, excessive electric discharges of the nerve cells or neurones in the brain (ILAE, 2003b). Between 5% (ILAE, 2003b) and 11% of the population experience at least one seizure at some point (Hauser & Hesdorffer, 1990), but not everybody who experiences an epileptic seizure will develop epilepsy. A diagnosis of epilepsy requires that the patient has had a minimum of two unprovoked seizures (ILAE, 2003b). Nowadays, the new generation of antiepileptic drugs and treatment adherence (i.e., proper use of pharmacological agents and compliance to life style orientations) guarantee that the majority of patients do not have seizures and can maintain a normal life, with a low cognitive and aesthetic impact of the disease. Nevertheless, epilepsy therapy may be prolonged and a cure not always attainable. The prognosis for seizure control is very good, and with appropriate therapy approximately 75% of patients with epilepsy become seizure free (ILAE, 2003a). Epilepsy is, nonetheless, a chronic disease, i.e., a disorder that persists for an extended period and affects a person’s ability to function normally. Seizure control (caused by pharmacological treatment or surgery, for instance) does not necessarily mean absence of epilepsy. The impact of epilepsy may be greater than that of some other chronic conditions, partly because of the unpredictability of seizures, and partly because of the associated stigma. In fact, research indicates that seizure disorders are often associated with a variety of psychological and social problems, as well as malaise (Collings, 1990, 1995; Jacoby et al., 1996) and social and political isolation. Thus, as any other chronic illness, epilepsy has the potential to induce profound changes in a person’s life, resulting in negative effects on quality of life (QOL) and wellbeing (de Ridder et al., 2008). In this context, improvement of the psychosocial health of people with epilepsy is a relevant issue for researchers and clinicians, making it important to understand psychosocial dimensions associated with the disease that facilitate epilepsy patients’ adjustment. Psychosocial health depends on adjustment to epilepsy. It is a process that has a start and an end point: it can be assessed by the results, or as an end point, and can be viewed by its positive side (positive adjustment) and not as an adjustment disorder.