Hospital In Portugal Research Articles

Aggressiveness of Care at the End of Life of Children Dying with Cancer in Public Hospitals-A Nationwide Retrospective Cohort Study.

Background: Little is known about the aggressiveness of cancer care at the end of life (ACCEoL) for children with cancer in countries where palliative care (PC) is scarce. Objective: The aim of this study was to determine the frequency and time trends of ACCEoL in the pediatric population in a Western European country. Setting/Subjects: We conducted a retrospective cohort study analyzing children between 0 and 17 years who died of cancer in public hospitals in Portugal, from January 2010 to December 2015. Measurements: Hospital admissions during the last month of life were identified and we analyzed the length of stay and procedures performed. The ACCEoL was measured with a composite indicator. Results: We identified 300 children, with a median age of 9 years. A total of 58.7% were male and 31.3% had central nervous system tumors. We found at least one indicator of ACCEoL in 87.8% of patients. "More than 14 days spent in the hospital" (51.0%) and "more than one hospitalization" (43.3%) were the most frequent individual indicators. Infants and children with hematological malignancies had a numerically higher percentage of ACCEoL. We found no statistically significant differences in the frequencies of the ACCEoL among the subgroups. The prevalence of ACCEoL remained stable over the period. Conclusions: In our cohort about 9 out of 10 children with cancer experienced at least one indicator of ACCEoL, a rate higher than in countries with well-developed PC services. There is a need to improve the care in the last months of life for children with cancer.

Nontuberculous Mycobacterial Infections: A Retrospective Analysis From a Tertiary Hospital in Portugal

Nontuberculous Mycobacterial Infections: A Retrospective Analysis From a Tertiary Hospital in Portugal

Lived Experience of Parents with Technology-Dependent Children: A Phenomenological Study

Caring for technology-dependent children significantly impacts the family unit, a topic that has not been researched in Portugal. Understanding this impact can help nurses to improve their interventions. This study aimed to describe the lived experiences of parents with technology-dependent children using a qualitative descriptive design. We applied Giorgi’s approach to analyze 10 individual semi-structured interviews with parents recruited through a children’s hospital in Portugal. Our analysis identified two major themes: (1) Discovering a new parenthood: parent and caregiver, comprising two subthemes: Family reorganization and Learning to use a medical device; (2) Reconciling daily life with the needs of the technology-dependent children, comprising two subthemes: Importance of support systems and Experiencing difficulties. These results indicate that parents experience a wide range of concerns and challenges in managing medical devices, starting from the moment the need for a device is communicated and continuing through the process of learning and providing care. This journey involves significant changes in family dynamics and is marked by sacrifice and adaptation, supported by family, formal support systems, and healthcare professionals. Our findings provide valuable insights into the vulnerabilities faced by these parents and highlight how nursing care can enhance the quality of care for these families.

HIV-1 transmission clusters and drug resistance in men who have sex with men in Portugal

Abstract Introduction In 2022, 45.8% of diagnoses in the EU/EEA with known route of transmission were in Men who have Sex with Men (MSM). We aim to characterise HIV transmission clusters and transmission of drug resistance (TDR), as well as its determinants, using integrated sociodemographic, behavioural, clinical, and viral genomic data of MSMs newly diagnosed in Portugal between 2014 and 2019. Methods This study included data from 340 MSM who were diagnosed with HIV-1 infection. These individuals were newly diagnosed at 17 hospitals in Portugal between September 2014 and December 2019. Phylogenies were constructed and transmission clusters were identified with branch support ≥ 90% and 1.5% genetic distance. Logistic regression models were computed to examine the factors associated with clusters of transmission and with the presence of TDR. Results We identified 38 transmission clusters with 104 MSM, which included 26.6% of the total 305 MSM from our database used for cluster analysis. The overall prevalence of TDR was 8.2%. Only subtype C was significantly associated with TDR. 10.5% of the clusters had at least 1 drug resistance mutation (K103N, L90M or N88S). There was no significant difference in the prevalence of TDR between MSM inside and outside clusters. 50% of the clusters were composed of portuguese native MSM only, whereas 16% had exclusively migrant MSMs. No significant difference was found in the proportion of portuguese and migrant MSM inside and outside clusters. Factors associated with HIV-1 transmission clusters were age at diagnosis, district of residence, unprotected anal or vaginal sex with a woman, HIV testing frequency, presenter status and subtype. 87% of men engaged in sexual activity only with other men, while 13% with both men and women. Conclusions Specific subgroups of MSM are contributing to HIV dissemination in Portugal. Direct and precise prevention measures based on molecular epidemiology should be developed. Key messages • Specific subgroups of MSM are contributing to HIV dissemination in Portugal. • Direct and precise prevention measures based on molecular epidemiology should be developed.

Perineal massage and warm compresses–Implementation study of a complex intervention in health

ObjectivesTo determine the effect of using tailored and multifaceted strategies on the acceptability, appropriateness, feasibility and adoption of a perineal massage and warm compress intervention by midwives in a maternity ward of a tertiary hospital in Portugal. MethodsThe complex intervention in health was developed based on the Medical Research Council framework and guided by the Theory of Change. Tailored and multifaceted strategies, including dissemination, integration and implementing process strategies, were applied. A mixed-methods approach was adopted, with a combination of qualitative (semi-open interviews) and quantitative (surveys, audits and electronic health records) methods. Surveys were applied to assess the acceptability, appropriateness and feasibility of the intervention. In order to evaluate adoption of the intervention, data from interviews were introduced into NVivo Version 10 to perform thematic analysis, and each audit checklist criterion was analysed using McNemar's exact test to determine differences in paired proportion. ResultsThis study found high acceptability (mean±standard deviation 4.28±0.45), high appropriateness (4.32±0.47) and high feasibility (4.26±0.43) of the intervention by midwives. Differences were reported for most topics between interviews conducted before and after implementation of the intervention. Pre-intervention, the midwives reported that the main factor affecting the application of perineal protection techniques was the lack of continuous presence of the midwife. The birth position was the alternative birth position (hands and knees, side-lying, squatting and semi-sitting), avoiding the lithotomy position. Techniques used for perineal protection were warm compresses, hands-on techniques, hands-off techniques and spontaneous pushing; and the reasons given for performing an episiotomy were large (high-birthweight) baby, Kristeller manoeuvre, tense perineum and previous obstetric sphincter injury. Post-intervention, the midwives reported that the presence of a second person increases the safety of professionals and women and improves working relations. The technique used for perineal protection was autonomy to adapt the intervention with perineal massage and warm compresses. A comfortable birth position for woman was used, and the rate of episiotomy reduced (only performed in the case of fetal distress). Regarding audits, significant differences (p < 0.05) were found for all audit criteria (pre- and post-intervention), which means that midwives adopted the intervention into their clinical practice. ConclusionAcceptability, appropriateness, feasibility and adoption of the intervention by midwives were high. Thus, tailored and multifaceted strategies were effective to achieve the implementation outcomes.

Nursing Practice Environments in Hospitals: A Comparative Study between Portugal and Brazil.

Background: Assessing the elements of nursing practice environments is crucial, as investing in their improvement will enhance outcomes for nurses, patients, and organizations. Moreover, comparing practice environments from different countries improves the definition of cross-cutting guidelines that can be applied in various contexts. Thus, this study aims to evaluate nursing practice environments in hospitals in Portugal and Brazil. Methods: A multicenter and cross-sectional study was conducted in eight Portuguese and eight Brazilian hospitals. Five hundred eighty-two nurses completed a survey regarding their sociodemographic and professional attributes, as well as the Scale for the Environments Evaluation of Professional Nursing Practice. The data were subjected to comparative analyses between the two countries. We adhered to ethical requirements in both participating countries. Results: In Brazil, the Structure, Process, and Outcome components were considered favorable to the quality of care and well-being of nurses. In Portugal, nurses considered the Structure and Outcome components favorable and the Process component very favorable. Statistically significant differences were found between the two countries in several dimensions of the three subscales. The Structure and Outcome components scored significantly better in hospitals in Brazil, and the Process component scored better in Portuguese hospitals. Conclusions: These conclusions underscore the urgent need for investment in continuous training and a culture of evaluation that promotes continuous improvement. Additionally, promoting the involvement and participation of nurses could simultaneously contribute to the development of more sustainable health systems.

Pediatric Organ Donation: 16-Year Experience of PICU/ICU of a Third Level Hospital in Portugal, 2006-2021.

Although pediatric organ donation represents a small proportion of overall organ donation, children and adolescents make a significant contribution to the pool of donated organs. In this study 252 solid organs were collected from children and adolescent. Two hundred and two recipients benefited from 62 pediatric organ donors, with a recipient/donor ratio of 3.3.

Hospitals in Portugal from the nineteenth to the mid-twentieth centuries

Since the modern era, healthcare in Portugal has been provided primarily by hospitals, many of which were founded by the Sisters of Mercy and known as Misericordias. However, the creation of new hospitals in the nineteenth century and first half of the twentieth century did not necessarily yield improved patient care, since these institutions tended to be small, poorly equipped, and lacking in human and material resources. This study presents a reflection on developments in Portuguese hospitals from 1834 through to the first decades of the twentieth century, drawing on data on several institutions to identify changes and continuities in the healthcare offered.

Effectiveness of A Nurse-Led Multimodal Intervention in Preventing Blood Culture Contamination: A Before-and-After Study.

Blood culture is crucial for accurate and timely bacteremia diagnosis and guide antibiotic therapy. However, during culture sampling, contamination can occur, resulting in misdiagnosis, unnecessary antibiotic exposure, and prolonged hospitalization. This before-and-after intervention study aimed to evaluate the effectiveness of a multimodal intervention in preventing blood culture contamination. The study was conducted in a 170-bed hospital in Portugal and included a total of 23,566 blood cultures. Contamination rates were assessed in two phases: Phase 1 (before intervention, month 0) included 10,928 cultures, and Phase 2 (after intervention, month 6) included 12,638 cultures. During the study period, a multimodal intervention targeting the nursing staff was implemented, consisting of training actions, guideline updates, regular data monitoring and feedback, and introduction of a blood culture pack. Following the intervention, blood culture contamination decreased from 6.8% (Phase 1) to 3.9% (Phase 2). A comparative analysis revealed that the risk of contamination before the intervention was nearly four times higher in first culture, OR = 3.97 (CI 2.86-5.49). Our findings suggest that the multimodal intervention enhanced nurses' adherence to recommended practices, resulting in a reduced risk of blood culture contamination, earlier identification of infectious agents, and improved accuracy of antibiotic therapy.

Wastewater surveillance for antibiotic resistance genes during the late 2020 SARS-CoV-2 peak in two different populations.

The United States Centers for Disease Control and Prevention reported a rise in resistant infections after the coronavirus disease 2019 (COVID-19) pandemic started. How and if the pandemic contributed to antibiotic resistance in the larger population is not well understood. Wastewater treatment plants are good locations for environmental surveillance because they can sample entire populations. This study aimed to validate methods used for COVID-19 wastewater surveillance for bacterial targets and to understand how rising COVID-19 cases from October 2020 to February 2021 in Portugal (PT) and King County, Washington contributed to antibiotic resistance genes in wastewater. Primary influent wastewater was collected from two treatment plants in King County and five treatment plants in PT, and hospital effluent was collected from three hospitals in PT. Genomic extracts were tested with the quantitative polymerase chain reaction for antibiotic resistance genes conferring resistance against antibiotics under threat. Random-effect models were fit for log-transformed gene abundances to assess temporal trends. All samples collected tested positive for multiple resistance genes. During the sampling period, mecA statistically significantly increased in King County and PT. No statistical evidence exists of correlation between samples collected in the same Portuguese metro area.

Plasma rich in growth factors (PRGF) technology as adjuvant to Ab Externo trabeculectomy.

Plasma rich in growth factors (PRGF) technology creates blood-derived products with growth factors that promote wound healing and regeneration. The goal of this study was to assess the potential role of PRGF products as wound modulators in trabeculectomy. Our premise is that due to PRGF's regenerative and antifibrotic properties, its use in trabeculectomy may produce a more physiological bleb, without altering IOP reduction. A retrospective, longitudinal study was conducted in a Hospital in Portugal. Patients with eyes with open angle glaucoma were included. Trabeculectomy was performed on all patients using PRGF membrane (mPRGF) under the conjunctiva, as adjuvant. Data regarding patients' demographics and number of medications used, was collected. Intraocular pressure (IOP) before surgery, 8days, 1month, 3month, 6month, 9month and 1year after surgery was recorded. Bleb morphology was classified according to Moorfields Bleb Grading System 6months after surgery. Nine eyes of 9 patients were enrolled. Mean age was 71 ± 5.1years old. Six were male. Mean IOP decreased from 24.0 ± 8.8mmHg pre-surgery to 12.9 ± 2.6mmHg at one year follow-up. The number of hypotensive drugs (mean ± SD) was 4.3 ± 0.9 preoperatively and 0.8 ± 1.1 at 1-year. Complete success was defined as IOP equal to or less than 21mm Hg without ocular hypotensive medications and qualified success as IOP equal to or less than 21mm Hg with medications. Complete success was 66.7% and qualified success was 100% at 1year follow-up. In our study, trabeculectomy with mPRGF demonstrated both safety and efficacy. Low values of bleb height (1.6 ± 0.8) were recorded. mPRGF could improve wound healing and produce a more well-tolerated, favourable bleb, avoiding antimetabolite complications.

Lung cancer risk associated with occupations in women: a pooling study.

Occupation is an important risk factor for lung cancer. This knowledge is mainly based on studies conducted on men, with the results being generalized to women. We aimed to identify the relationship between different occupations and lung cancer in women. Pooling study in which data were pooled from six case-control studies conducted at 13 Spanish hospitals and 1 hospital in Portugal. Each woman's longest held job was coded as per the ISCO-08. Results were adjusted for age, smoking, and exposure to residential radon. The study population comprised 1262 women: 618 cases and 644 controls. The reference group were white-collar workers. The adjusted multivariate analysis showed a higher risk of developing lung cancer among teaching professionals (odds ratio [OR]: 4.36; 95% confidence interval [CI] 1.73-11.02), cooks (OR: 3.59; 95% CI 1.52-8.48), domestic cleaners and helpers (OR: 2.98; 95% CI 1.54-5.78), homemakers (OR: 2.30; 95% CI 1.26-4.21) and crop farmers, livestock farmers and gardeners (OR: 2.06, 95% CI: 1.11-3.81). For adenocarcinoma, the highest risk was observed in teaching professionals, and for small-cell carcinoma, the highest risk was observed in cooks. Higher risks were observed for small-cell carcinoma compared to other histological types. Some occupations may be associated with an increased risk of lung cancer in women and this risk could vary by histologic subtype; however, further research is needed to confirm these associations. In any case, protection measures must be implemented in the workplace aimed at reducing the risk of lung cancer among women workers, and more studies exclusively focused on women are warranted.

Cross-Cultural Adaptation and Validation of an Attitude about Euthanasia Scale in Portuguese Older Adults with Mixed Anxiety-Depressive Disorder.

On 25 May 2023, the Portuguese parliament approved the decriminalisation of euthanasia for incurable illnesses. As the experiences of other countries show us, it will be a matter of time before mental disorders are addressed. Studying the phenomenon, particularly in vulnerable groups, in advance is essential for proper law drafting. Therefore, instruments that allow an objective assessment and comparison between groups must be available. This study aims to explore the validation of Faria's attitude about euthanasia scale in Portuguese older adults with mixed anxiety-depressive disorder. A sample of 114 older adults with mixed anxiety-depressive disorder collected by convenience in the Psychiatry Department of Senhora da Oliveira Hospital in Portugal was included. The pre-final version of the scale was tested in a small group with good results. The validity of the internal structure was analysed using exploratory factorial analysis. The internal consistency study verified reliability. For construct validity, we assessed the correlation with other validated scales measuring attitudes toward euthanasia, cognitive performance, personality and empathy. The attitude about euthanasia scale showed good internal consistency. One factor was retained in the principal component analysis. Significant correlations verified construct validity. The results support the scale's usefulness and validity. This study makes available a unique instrument to assess the overall tendency of the attitudes towards euthanasia from the European-Portuguese perspective, which can be used, for example, to compare Portuguese with Brazilian older adults suffering from the same disorder. Furthermore, the adapted scale paves the way for other cross-cultural translations, adaptations, validations, and comparative analyses.

Dealing with uncertainty in healthcare performance assessment: a fuzzy network‐DEA approach with undesirable outputs

AbstractData Envelopment Analysis (DEA) is currently the most widely used nonparametric method for assessing system performance. However, the DEA standard approach ignores the unit's structure and assumes that the data are exact and reliable. In healthcare, these assumptions may not always hold true. To address these issues, a new approach was developed, which transformed the data into fuzzy trapezoidal numbers and used a network framework. The study was conducted using data from Portuguese public hospitals, including 18 variables related to efficiency, quality, and access. The data were then applied using a slack‐based fuzzy network‐DEA model that could handle undesirable outputs. Due to significant operational and environmental differences between hospitals in Portugal, a subsampling frontier approach based on exogenous variables was used. The results suggest that there is potential to improve hospital efficiency in Portugal by around 20%, particularly in light of the COVID‐19 pandemic. Additionally, variations in performance were observed depending on the size of the hospital.

16P Is systemic inflammation related to adjuvant chemotherapy toxicity in colorectal cancer? A real-world data analysis from a local hospital in Portugal

16P Is systemic inflammation related to adjuvant chemotherapy toxicity in colorectal cancer? A real-world data analysis from a local hospital in Portugal

Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder.

This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance.

#675 Application of ANCA-associated vasculitis Histopathological Classification and Renal Risk Score for prediction of end-stage kidney disease

Abstract Background and Aims Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic autoimmune disease predominantly characterized by inflammation of small-sized blood vessels along with the presence of circulating ANCA. The kidney is frequently involved and, even though immunosuppressive therapy has dramatically improved the outcome of AAV patients, a significant proportion of patients progress to end-stage kidney disease (ESKD). Therefore, establishing and validating tools to predict renal outcomes in patients with AAV is crucial. Here we analyzed the application of two tools in predicting kidney survival in a Portuguese single-center cohort with AAV. Method We conducted a retrospective cohort study at a tertiary-care hospital in Portugal (Hospital de São João, Porto), from December 2010 to June 2023. Patients with a kidney biopsy-proven AAV were included. Serological ANCA-negative patients and patients with overlap syndromes, such as AAV in combination with anti-glomerular basement membrane disease, were excluded. Based on electronic records, information on demographics and clinical variables were collected. Kidney biopsies were reviewed to calculate: Berden histopathological classification and the Brix Renal Risk Score (RRS). Kidney survival was defined as the time from diagnosis to the need for kidney replacement therapy. A Kaplan-Meier analysis was performed to compare kidney survival based on the mentioned classifications. Results Fifty-one patients were enrolled, 78% (n = 40) of whom were positive for myeloperoxidase (MPO). The majority were men (61%, n = 31) with a mean age of 65 (± 12) years and a mean serum creatinine of 4.59 mg/dL (± 2.74) at diagnosis. During a median follow-up of 39 (IQR, 7-84) months, 20 patients (39%) progressed to end-stage kidney disease (ESKD), 10 patients (20%) died with preserved renal function and 21 patients (41%) did not need hemodialysis. Concerning Berden classification, 13 patients with a crescentic class, 4 patients with a mixed class and 3 patients with a sclerotic class developed ESKD. After 48 months of follow-up, renal survival was 100%, 90%, 61% and 26.7% in the focal, mixed, crescentic and sclerotic class groups, respectively. Berden classification did not correlate with kidney survival (p = 0.211). Concerning RRS, 10 patients in the high-risk group and 5 patients in the medium-risk group developed ESKD. After 48 months of follow-up, renal survival was 100% in the low-risk group, 85.7% in the medium-risk group, and 41.6% in the high-risk group. A correlation was established between kidney survival and RRS score (p = 0.003). Conclusion In our cohort RRS was predictive of ESKD, contrary to Berden histopathological classification. The information derived from these risk models strongly add to standard biochemical and clinical data. Patients with higher risk of ESKD need close follow-up and a tailored treatment plan regarding preparation for renal replacement therapy.

#2979 Patients referred to nephrology consultation from African countries of Portuguese official language: a Portuguese single-center cohort study

Abstract Background and Aims Chronic kidney disease (CKD) is a main cause of morbidity and mortality worldwide, with African population being at increased risk. Nevertheless, access to treatment for CKD is restricted in African countries resulting in premature death. The latest statistics point to an annual referral to Portugal of around 900 patients from those countries for medical reasons—of which only 5% corresponds to Nephrology referrals. However, this protocol is burdened with high social and economic impact, consuming 50% of the funds budgeted by the Portuguese government (estimated at 3 million euros annually). The aim of this study was to describe the clinical characteristics, reasons for the referral and outcomes of patients from African Countries of Portuguese Official Language (ACPOL) to a nephrology consultation in a tertiary hospital in Portugal under a cooperation protocol. Method Single-center retrospective analysis of 131 African patients referred to our nephrology department between 2014 and 2023. Results Only 84 patients (64%) ended up being evacuated from their country of origin and attended the nephrology consultation in Portugal. The mean age was 46 ± 14 years and 55% were male. Thirty-two patients were from Guinea-Bissau (38%), 24 from São Tomé and Príncipe (29%), 22 from Cape Verde (26%), and 6 from Angola (7%). The motives for referral to a tertiary center were advanced CKD in 58 patients (69%), nephrotic syndrome in 21 patients (25%), and hemodialysis (HD) vascular access dysfunction in 5 of the cases (6%). In the group of patients referred with advanced CKD the mean eGFR was 16 ± 10 ml/min, all patients had hypertension, 20% had diabetes and 9% presented heart failure. More than half (56%) needed hospitalization with urgent need of dialysis and all patients started HD with a central venous catheter. During the follow-up, four patients died (5%), two patients (2.3%) transitioned to peritoneal dialysis and 70% were on kidney transplant waiting list. Patients referred with nephrotic syndrome had a mean eGFR of 71 ± 49 ml/min/1,73 m2 and a median urine albumin/creatinine ratio (uACR) of 6.9 [IQR 4.7-8.8] g/g. Kidney biopsy was performed in 90% of the cases, with membranous nephropathy (37.5%) and focal segmental glomerulosclerosis (25%) being the two most frequent diagnosis. Only two patients returned to their origin country; the remaining prolonged their stay due to unavailability of resources for appropriate treatment in their country of origin. Conclusion These data emphasize the inequality in access to healthcare in African countries and highlights the urgent need for investment, especially in CKD, as it contributes to serious consequences in these patients’ survival and morbidity. With the cooperation protocol, Portugal provides the possibility for these patients to be evacuated and treated in specialized nephrology departments, improving their outcomes. However, our study shows that there is still a lot to be done since just over 60% of referred patients manage to reach Portugal. The entire evacuation process remains extremely delayed, a fact shown by the need for patients to start urgent HD and that more than half of them require hospitalization upon arrival at the nephrology department, with a high economic burden.

Impact of outpatient adaptation to home mechanical ventilation on health-related quality of life in patients with COPD: the OutVent study.

Home mechanical ventilation (HMV) is indicated in patients with severe hypercapnic COPD. Initiation of HMV commonly occurs during an inpatient period, but there has been increasing interest for outpatient adaptation. This study aimed to evaluate the outpatient initiation and adaptation of HMV and its impact on health-related quality of life (HRQoL) in patients with severe COPD. A single-group pre-test-post-test study was conducted in an outpatient ventilation clinic of a tertiary hospital in Portugal. Patients with severe COPD and symptoms of chronic respiratory failure with daytime partial pressure of carbon dioxide (P CO2 ) ≥50 mmHg in a stable condition or with persistent hypercapnia ≥53 mmHg >14 days following an exacerbation with mechanical ventilation were included. After 3 months of HMV, patients completed the severe respiratory insufficiency (SRI), the S3-noninvasive ventilation (S3-NIV) and a patient experience questionnaire. 53 patients (73.6% male, median 71 (p25-p75 61-77) years), with a median forced expiratory volume in 1 s of 35 (29-40)% and a median baseline P CO2 of 53.5 (51.9-56.5) mmHg completed the study. At 3 months patients had a median HMV usage of 6.5 h and decreased their P CO2 by 6.0 mmHg. After 3 months, there was a significant improvement in the SRI summary scale (+5.7), above the minimal clinically import difference of five. Patients who used HMV for more than 5 h had higher S3-NIV total score (6.8 versus 5.7, p=0.04) and S3-NIV sleep and NIV-related side effects subscore (7.1 versus 5.7, p=0.03). Our findings might indicate that outpatient initiation and adaptation of HMV has a positive impact in short-term HRQoL in patients with COPD and that this approach is perceived as a positive experience by the patients.

Disclosing Strain: How Psychosocial Risk Factors Influence Work-Related Musculoskeletal Disorders in Healthcare Workers Preceding and during the COVID-19 Pandemic.

Healthcare workers, particularly nurses, engage in a daily work routine that takes a toll on their emotional well-being, rendering them vulnerable to psychosocial risk factors. This research seeks to analyse the influence of psychosocial risk factors on the occurrence of work-related musculoskeletal disorders among nurses. An additional analysis was performed to understand the role of age in work-related musculoskeletal disorders and the perception of psychosocial risk factors. The study was conducted during two separate periods-pre-pandemic and pandemic times-involving a sample of 456 nurses from both public and private hospitals in Portugal. The INSAT-Health and Work Survey-was used as measuring instrument. The primary observations indicated a consistency between psychosocial risk factors and the occurrence of work-related musculoskeletal disorders. The findings revealed a significant exposure to psychosocial risk factors, with work pace, intensity, work relationships, and emotional demands exhibiting higher global average percentages during both periods, pre-pandemic and pandemic. Nonetheless, we find that the psychosocial risk factors change when we analyse the pre-pandemic and pandemic results. During the period before the pandemic, the psychosocial risk factors that were most commonly reported included the demanding pace of work, long working hours, and emotional demands. Through the pandemic, the most pronounced psychosocial risk factors were work relationships, employment relationships, and ethical and values conflicts. Therefore, research in this domain is essential to understanding psychosocial risk factors and assessing the less obvious links between work and health.