Search Results (26)

Background: Breast cancer is one of the most prevalent neoplasms among women, often requiring mastectomy, a procedure with a significant impact on functionality, self-esteem, and quality of life. Objective: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in the follow-up care of mastectomised women. Methods: A review was conducted according to the Joanna Briggs Institute methodology. The search included 11 articles published between 2019 and 2024 in Portuguese, English, and Spanish, available on the EBSCO platform (MEDLINE with Full TEXT, CINAHL). The descriptors used were (Mastectomy OR Breast Removal) AND (Rehabilitation Nursing OR Nursing Intervention). Results: The Rehabilitation Nursing Specialist interventions focused on education regarding upper limb mobilisation, medication administration, lymphedema prevention, strategies for performing Daily Life Activities with less effort and pain, implementation of rehabilitation plans with physical exercises, and emotional support in accepting body image changes. Hospital discharge planning and caregiver education also emerged as key elements to ensure continuity of care. Most studies (six) identify performing exercises to strengthen muscles and prevent lymphoedema as a very important intervention for nurses, followed by education on care for upper limb mobilisation and lymphoedema prevention (five) and emotional and social support (four), among other interventions. Conclusions: The Rehabilitation Nursing Specialist interventions are fundamental for promoting functionality, emotional well-being, and quality of life in mastectomised women, reinforcing the importance of a multidisciplinary, person-centred approach supported by scientific evidence. Full article

Background: Work-related injuries remain a considerable global burden; nevertheless, progress in occupational safety has been made in decreasing the time to return to work. This study aimed to assess the pooled incidence of Return to Work (RTW) among workers with occupational injuries and to identify the key factors influencing RTW outcomes. Methods: A systematic review was conducted by searching electronic databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus) to include eligible cohorts. Meta-analysis was undertaken using R software 4.5.1 with random-effects models, and heterogeneity was evaluated using the I² statistic. Results: This meta-analysis included 16 cohorts, with 4164 workers. A pooled analysis of 14 studies showed that 79% of workers successfully returned to their jobs after treatment for work-related injuries (95% CI: 0.67–0.88; p < 0.0001; I² = 97.5%). Meta-regression identified age as a significant moderator, with older workers showing a higher incidence of RTW. The mean time to RTW, pooled from 9 studies, was approximately 102 days, with no significant age association (p = 0.222). Regarding predictors, male workers had a significantly higher RTW rate than females (p < 0.0001). Married persons showed greater RTW rates (p < 0.0001). Also, workers with higher education levels were more likely to return to work (p = 0.0033). For injury type, lacerations were related to a greater RTW rate than crushing injuries. Conclusions: This meta-analysis underscored a significant overall return-to-work rate after work-related injuries, with age, sex, marital status, education level, and injury type affecting results. Advanced age and male sex were substantially correlated with increased return-to-work rates. These findings support the necessity for personalized rehabilitation programs and focused support to enhance work reintegration following occupational accidents. Full article

Background: Among the leading causes of work-related disability, musculoskeletal diseases (MSDs) profoundly affect productivity and quality of life. Workplace changes, equipment adjustments, and training courses, among other ergonomic interventions, seek to lower the frequency and degree of MSDs. This systematic review and meta-analysis evaluated whether ergonomic interventions help prevent and control MSDs in various workplace environments. Methods: A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library to identify relevant studies. Inclusion criteria included randomized controlled trials (RCTs) that evaluated ergonomic interventions against conventional conditions. Effect sizes were computed using mean differences and pooled using a random-effects model in case of heterogeneity. A uniform Excel sheet was used for data extraction. Revman software (Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. Results: This meta-analysis included 24 RCTs with 4086 workers with different occupations. A meta-analysis of 10 included studies demonstrated lower pain intensity with a mean difference in VAS score between ergonomic interventions and the control group of −0.28 (95%CI: −0.43, −0.14, p = 0.0001). Also, there was a significant reduction in reported MSD-related pain in the lower back with ergonomic interventions with an OR 0.53 (95%CI: 0.40–0.70, p < 0.00001). Moreover, there were statistically significant results for ergonomic interventions in the upper back, ankles, wrists, and neck. In contrast, there were no significant improvements in the thighs, arms, knees, shoulders, and elbows. Conclusions: Our findings support implementing ergonomic strategies as a practical approach to reducing work-related MSDs. However, further research is needed to improve intervention design and long-term effectiveness. Full article

Background: Stroke is a leading cause of death and disability, underscoring the importance of effective self-management programs to improve the quality of life for survivors. Objectives: This study investigates the impact of the ComVida (Bridges-PT) self-management program on self-efficacy, physical function, health-related quality of life, and emotional state of stroke survivors in Portugal. Methods: A quasi-experimental study was conducted with 28 participants from hospital and community settings. The ComVida program, combining personalized rehabilitation sessions and the use of a self-management workbook was implemented. Assessments were conducted at baseline, 6 weeks, and 12 weeks using the Stroke Self-Efficacy Questionnaire (SSEQ), the Stroke Impact Scale (SIS-16), Hospital Anxiety and Depression Scale (HADS), and Short Form Questionnaire-12 (SF-12v2). Results: Significant improvements were observed in self-efficacy, physical function, emotional state, and health-related quality of life over the study period. The SSEQ scores increased from 23.3 at baseline to 33.3 at 12 weeks, while SIS-16 scores improved from 47.5 to 67.2. Anxiety and depression levels, measured by HADS, also showed significant reductions, as did health-related quality of life, evaluated by the SF-12v2. Conclusions: The results suggest that the program may enhance self-efficacy, physical function, and emotional well-being in stroke survivors, highlighting its potential as a valuable component of post-stroke care in Portugal. Full article

Healthcare-associated infections (HAIs) represent a major challenge in patient safety that affects services disproportionally. This paper aimed to assess how the HAI prevalence varies between hospital services and what contextual characteristics may explain such variance. A cross-sectional study was conducted on adult patients in Portuguese hospitals, using data from the European point prevalence survey of HAI prevalence. The study variables included patient, structural, and process variables, tested as risk factors, with patients clustered in hospitals. Variables with a p-value ≤ 0.2 in univariate analyses were retested in a multivariable model. A total of 18,261 patients from 119 hospitals were included: 736 from 56 intensive care units (ICUs), 3160 from 72 surgical departments, and 8081 from 90 medical departments. The HAI prevalence was 7.9%, 5.9%, and 1.7%, respectively. In ICUs, only the number of devices was associated with the HAI prevalence. In surgical departments, age, comorbidities, being a specialized hospital, and a higher ratio of infection prevention and control (IPC) personnel were associated with higher SSI. The safety climate was associated with lower SSI. In medical departments, age and devices were positively associated, whereas a larger ratio of IPC nurses was negatively associated. These results may help implement targeted interventions to achieve optimal results in each department. Full article

Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions. Full article

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM^® SPSS^® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond. Full article

Vaccine hesitancy tends to exhibit geographical patterns and is often associated with social deprivation and migrant status. We aimed to estimate COVID-19 vaccination hesitancy in a high-vaccination-acceptance country, Portugal, and determine its association with sociodemographic risk factors. We used the Registry of National Health System Users to determine the eligible population and the Vaccination Registry to determine individuals without COVID-19 vaccine doses. Individuals older than five with no COVID-19 vaccine dose administered by 31 March 2022 were considered hesitant. We calculated hesitancy rates by municipality, gender, and age group for all municipalities in mainland Portugal. We used the spatial statistical scan method to identify spatial clusters and the Besag, Yorke, and Mollié (BYM) model to estimate the effect of age, gender, social deprivation, and migrant proportion across all mainland municipalities. The eligible population was 9,852,283, with 1,212,565 (12%) COVID-19 vaccine-hesitant individuals. We found high-hesitancy spatial clusters in the Lisbon metropolitan area and the country’s southwest. Our model showed that municipalities with higher proportions of migrants are associated with an increased relative risk (RR) of vaccine hesitancy (RR = 8.0; CI 95% 4.6; 14.0). Social deprivation and gender were not associated with vaccine hesitancy rates. We found COVID-19 vaccine hesitancy has a heterogeneous distribution across Portugal and has a strong association with the proportion of migrants per municipality. Full article

Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91–100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars). Full article

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people’s quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants’ perspectives focused on the following subjects: “Physical exercise program for the elderly in the community”, “Importance of physical exercise in the rehabilitation of the elderly in the community”, “People’s adherence to the programs”, “Gains in health resulting from the implementation of these strategies” and “Gains from group activities”. A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging. Full article

This study investigates the influence of sex and a dietary transition on the gut microbiota of a local Portuguese pig breed. Three groups of male Alentejano pigs (n = 10 each) were raised between ~40 and 160 kg LW. Group C included pigs that were surgically castrated, while the I group included intact ones; both were fed with commercial diets. The third group, IExp, included intact pigs that were fed commercial diets until ~130 kg, then replaced by an experimental diet based on legumes and agro-industrial by-products between ~130 and 160 kg. Fecal samples were collected two weeks before slaughter. The total DNA was extracted and used for 16S metabarcoding on a MiSeq^® System. The dietary transition from a commercial diet to the experimental diet substantially increased and shifted the diversity observed. Complex carbohydrate fermenting bacteria, such as Ruminococcus spp. and Sphaerochaeta spp., were significantly more abundant in IExp (q < 0.05). On the other hand, castrated pigs presented a significantly lower abundance of the potential probiotic, Roseburia spp. and Lachnospiraceae NK4A136 group (q < 0.01), bacteria commonly associated with better gut health and lower body fat composition. Understanding the role of gut microbiota is paramount to ensure a low skatole deposition and consumers’ acceptance of pork products from non-castrated male pigs. Full article

This work aimed to examine the effects of sex on meat and fat quality traits from thirty Portuguese Alentejano (AL) pigs reared in outdoor conditions. These pigs were divided into three groups and fed ad libitum. From ~40 to 130 kg LW, castrated (C group) and intact animals (I and IExp) consumed commercial diets. Until slaughter (~160 kg), C and I pigs remained on commercial diets, and IExp changed to a more sustainable experimental diet with locally produced pulses and byproducts. Samples were collected from the Longissimus lumborum (LL), Psoas major (PM), and dorsal subcutaneous fat (DSF). At ~160 kg, the PM muscle of intact pigs presented lower intramuscular fat content than that of C pigs, while total collagen was higher. Additionally, PM myoglobin was lower and lightness (L*) was higher in intact pigs. Regarding DSF, moisture and total protein contents were higher and total lipids were lower in intact than in castrated pigs, while color parameters were not significantly different. Finally, antioxidant capacity measured in the LL muscle showed an overall lower value in intact pigs. However, lipid oxidation values were not significantly different between the experimental groups and only increased with storage time. Outdoor-reared intact AL pigs produced leaner and less saturated pork and fat compared to castrated ones. Despite the lower antioxidant activity observed in the LL muscles of intact pigs, the lipid oxidative stability of cooked meat was not different among the experimental groups. Full article

In this work, we studied the backfat transcriptome of surgically castrated (C), intact (I) and intact fed an experimental diet (IE) outdoor-reared male Alentejano (AL) pigs. The experimental diet was a high-fiber diet with locally produced legumes and by-products associated with a boar taint reduction effect. At slaughter (~160 kg), backfat samples were collected for total RNA sequencing. Intact pigs presented leaner carcasses, more total collagen, and more unsaturated intramuscular fat content than C animals. A total of 2726 differentially expressed genes (DEGs, |log₂ FC|> 0.58, q < 0.05) were identified between C and I with overexpressed genes related to muscular activity (MYH1, ACTA1) or collagen metabolism (COL1A1, COL1A2) in I pigs. Between C and IE, 1639 DEGs of genes involved in lipidic metabolism (LEP, ME1, FABP4, ELOVL6) were overexpressed in C. Finally, only 28 DEGs were determined between I and IE. Clustering results indicated a drastic influence of the testis in the transcriptome of subcutaneous fat of AL pigs, while the diet had a marginal effect. Diet can reduce stress by increasing satiety in animals, and could have induced an increase of skatole degradation due to the higher expression of the CYP2A19 gene in the IE group. Full article

This trial evaluated the effect of sex on the blood, growth, carcass, meat quality, and boar taint compounds in male Alentejano (AL) pigs (n = 30). From ~40 to 130 kg LW, castrated (C) and intact pigs (I and IExp groups) were fed commercial diets ad libitum. Between ~130 and 160 kg (slaughter), C and I pigs continued on commercial diets, while IExp were fed an experimental diet containing locally produced pulses and by-products aimed at reducing boar taint. At ~160 kg, blood urea levels were higher in IExp than C pigs, triacylglycerols were lower in both intact groups, and cortisol was lower in IExp. IExp pigs exhibited faster growth, improved feed conversion ratio, carcass higher commercial yield and leaner meat than C pigs. The loin intramuscular fat in intact pigs was lower, less saturated and more polyunsaturated, while total collagen was higher. Fat androstenone content was higher in intact pigs and skatole content was similar across treatments, although they were below threshold values for consumer detection. Finally, although boar taint compounds were low in intact AL pigs raised outdoors, adding pulses and by-products to the experimental diet did not result in a reduction in fat skatole content compared to pigs fed the commercial diet. Full article

Background: The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people’s quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. Methods: A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. Results: A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 “Floating so that staffing is equalised among units” is strongly associated with a shorter PU healing time. Conclusion: A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times. Full article