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Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control.
Methods
The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n = 191) or control (n = 176) group and assessed at baseline, postintervention and 4 and 12 months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses.
Results
At 14 months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (−361.77, 28.51) and a QALY gain of 0.0064 (−0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group.
Conclusions
From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.
Mars exploration motivates the search for extraterrestrial life, the development of space technologies, and the design of human missions and habitations. Here, we seek new insights and pose unresolved questions relating to the natural history of Mars, habitability, robotic and human exploration, planetary protection, and the impacts on human society. Key observations and findings include:
– high escape rates of early Mars' atmosphere, including loss of water, impact present-day habitability;
– putative fossils on Mars will likely be ambiguous biomarkers for life;
– microbial contamination resulting from human habitation is unavoidable; and
– based on Mars' current planetary protection category, robotic payload(s) should characterize the local martian environment for any life-forms prior to human habitation.
Some of the outstanding questions are:
– which interpretation of the hemispheric dichotomy of the planet is correct;
– to what degree did deep-penetrating faults transport subsurface liquids to Mars' surface;
– in what abundance are carbonates formed by atmospheric processes;
– what properties of martian meteorites could be used to constrain their source locations;
– the origin(s) of organic macromolecules;
– was/is Mars inhabited;
– how can missions designed to uncover microbial activity in the subsurface eliminate potential false positives caused by microbial contaminants from Earth;
– how can we ensure that humans and microbes form a stable and benign biosphere; and
– should humans relate to putative extraterrestrial life from a biocentric viewpoint (preservation of all biology), or anthropocentric viewpoint of expanding habitation of space?
Studies of Mars' evolution can shed light on the habitability of extrasolar planets. In addition, Mars exploration can drive future policy developments and confirm (or put into question) the feasibility and/or extent of human habitability of space.
COVID-19, although a respiratory illness, has been clinically associated with non-respiratory symptoms. We conducted a negative case–control study to identify the symptoms associated with SARS-CoV-2-positive results in Portugal. Twelve symptoms and signs included in the clinical notification of COVID-19 were selected as predictors, and the dependent variable was the RT-PCR test result. The χ2 tests were used to compare notified cases on sex, age group, health region and presence of comorbidities. The best-fit prediction model was selected using a backward stepwise method with an unconditional logistic regression. General and gastrointestinal symptoms were strongly associated with a positive test (P < 0.001). In this sense, the inclusion of general symptoms such as myalgia, headache and fatigue, as well as diarrhoea, together with actual clinical criteria for suspected cases, already updated and included in COVID-19 case definition, can lead to increased identification of cases and represent an effective strength for transmission control.
Strenuous physical activity, sleep deprivation and psychological stress are common features of military field training. The present study aimed to evaluate the effects of supplementation with a synbiotic ice cream on salivary IgA, gastrointestinal symptoms, well-being indicators and gut microbiota in young military participants undergoing field training. Sixty-five military completed the study: one group was supplemented for 30 d with synbiotic ice cream containing: 2·1 × 108 CFU/g for Lactobacillus acidophilus LA-5 and 2·7 × 109 CFU/g for Bifidobacterium animalis BB-12 and 2·3 g of inulin in the 60 g of ice cream at manufacture, and the other with a placebo ice cream. Volunteers were evaluated at pre-supplementation (baseline), post-supplementation and after a 5-d military training. Bifidobacterium and Lactobacillus genera were measured in stool samples and both showed a higher differential abundance post-supplementation and training. Salivary IgA and gastrointestinal symptoms decreased at post-training in both groups (P < 0·05; main effect of time); however, supplementation with synbiotic did not mitigate this effect. Tenseness and sleepiness were decreased in the synbiotic-treated group, but not in the placebo group at post-military training (P = 0·01 and 0·009, respectively; group × time effect). The other well-being indicators were not affected by the synbiotic supplementation. In conclusion, 30 d of synbiotic ice cream supplementation containing inulin, L. acidophilus LA-5 and B. animalis BB-12 favourably modulated gut microbiota and improved tenseness and sleepiness in healthy young military undergoing a 5-d field training. These improvements may be relevant to this population as they may influence the decision-making process in an environment of high physical and psychological stress.
Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.
There is a significant difficulty in the engagement of people with dementia in therapeutic activities. Considering that stimulus attributes (e.g., content of a specific activity) seem to be determinant to achieve an expected engagement, innovative approaches are required.
Aim:
characterise the engagement of people with dementia in serious traditional multidimensional games (sTMG), comparing with conventional therapy (CT) sessions.
Methods:
Subjects with dementia were recruited in Alzheimer’s Portugal Foundation. Sociodemographic and clinical participants’ characteristics were collected, including classification of dementia severity using Mini-mental State Examination (MSE) and walking independence classification (dependent - someone needs supervision or human support to walk). Gerontologist, psychologist, occupational therapist and physiotherapist were invited to classify patients’ engagement in routine CT (i.e., cognitive therapy and exercise classes), according to 0 -10 scale (10 – successful engagement). Serious adaptations in TMG were implemented in 3 consecutive sessions (1 per week/ 45 min./session) and patient s engagement was rated in each session. Success index (number of subjects showing higher engagement in TMG/total participants) was calculated.
Results:
Thirteen participants (5 males; 79.23±8.39yrs; 15.76±9.22 MSE; 9 walk independently) were enrolled. Success index was 38%; comparing TMG with cognitive therapy and 31%, comparing to movement classes. Two patients with severe dementia and walking independency were more engaged in sTMG sessions (sTMG - 4;4; Cognitive therapy - 2;1; Exercises Classes). Four patients with moderate dementia and walking independency obtained worse engagement (sTMG –3;6;2;7; Cognitive therapy – 6;7;8;8 Exercises Classes – 4;6;7;9).
Discussion:
Our results showed that sTMG sessions had a positive impact in people with dementia, specifically in advanced/severe cases. In this respect, a previous study of Natalie et al., (2017) concluded that engagement was lower in cognitive activities for people with severe dementia, which can explain the higher engagement in sTMG sessions. Furthermore, Bier et al. (2008) enlightened that people with dementia in a moderate stage are characterised by emergent behavioural changes, which might difficult patients’ integration in new activities.
Conclusion:
sTMG had a positive impact in the engagement of people with dementia. Specifically, for patients at middle stage of dementia, future studies include longer sTMG protocols, possibly providing better patients’ integration.
Systemized research on the social representations of mental health in minority groups is scarce and it is even scarcer with Roma communities.
• Aim
This paper describes a research conducted from the perspective of social representations theory exploring the understanding of mental ill-health amongst Roma communities residing in the center region of Portugal (Coimbra).
• Methods
A qualitative ethnographic study was conducted. Data from observations, interviews with key informants, field notes and Focus groups were analyzed
Results
Findings suggest that the culturally-based conceptions of mental health and emotional well-being in these Roma participants have a holistic approach, without a clear separation between the concept of 'physical health” and 'mental health”.
In this study, the notion of mental health and emotional well-being was strongly associated with the family’s well-being, including the extended family, and not only with the individual well-being
Conclusions
Mental health promoting programs in Roma communities should integrate families in structural interventions and, an ecological approach.
Gypsies and Travellers have been described as one of the most marginalized minorities in society with poor living conditions which are known to have a negative effect on health. Published research on the mental health needs of the Roma population is sparse. Knowledge of Social representations of mental health is fundamental for improving mental illness prevention strategies and mental health education programmes targeted to Roma people.
Aim:
The aim of this research was to understand the Social representations of mental health among a group of Roma people in the center of Portugal (city of Coimbra).
Methods:
This study covered twenty Roma children aged 6 to 11, in a Basic school located in a Roma neighborhood, as well as a group of adults and Roma families. Qualitative methodologies were used in data collection: semi-structured interviews, analysis of documents and Focus Group techniques.
Results:
Findings suggest that social representations of mental health and emotional well-being in Roma participants have a strong holistic and integrative component. There is no marked cleavage between the concept of “physical health” and “mental health.” in this group, the notions of mental health and emotional well-being appear to be strongly associated with the welfare of the family - including extended family -, in addition to the individual's own emotional well-being.
Conclusions:
Mental health interventions with Roma community members must meet their social representations relating to mental health, access to mental health provision and contacts with mental health professionals,
Living alone, limited personal social networks are, according to theliterature, factors that contribute to experience loneliness. It is known thatthe last stage of the life cycle is strongly marked by generational loss, beingmarked in this phase, beyond the network shrinkage, reducing opportunities forrenewal along with lower energy to activate, mobilize and maintain active linksof the network (Sluzki, 1996).
Objectives
To determine the predictors of loneliness in a resident population in centralPortugal.
Methods
300 elderly people (mean age = 74.03/SD = ± 8.511) were surveyed. The sample wasassessed with the UCLA Loneliness scale, EQ5D, Lubben social networks and asmall sociodemographic questionnaire. The UCLA Loneliness presentedreliability, measured by the Cronbach's alpha coefficient (0.905).
Results
To determine loneliness predictors a binary logistic regression was performed, with seven independent variables “age”, “sex”, “seeyour family”, “having spouse”, “Lubben socialnetworks”, “level of education” and “EQ5 health”. Thefull model containing all predictors was statistically significant, c2(15, N = 300) = 86.801, p <0.001. The model as a whole explained 26.1% (Cox and Snell R2) and 39.2% (R2 Nagelkerke) variation and correctly classified84.3% of cases. Logistic regression showed that “age” (p = 0.055), “sex” (p = 0.091), “sees his family”(p = 0.023), “spouse” (p <0.001), “Lubben socialnetworks”(p = 0.027),“level of education ”(p = 0.038)and“ health EQ5 ”(p<0.001) were loneliness predictors.
Conclusion
Given these results social intervention for active citizenship, networked, withthe elderly population is suggested.
The nurse practice model at the family health strategy is characterized by direct involvement in the patient's health-disease recovery process, deconstruction of social stigma involving mental health disorders, and the restoration of patient autonomy their social ties. This descriptive study follows a qualitative approach to document and analyse practices performed by mental health nurses at the family health strategy (FHS) in Rio das Ostras, Brazil. The study identifies practices implemented by Mental Health Nurses at FHS and the nurses’ own reflection and analysis on these mental health practices. Data was collected through semi-structured interviews. All interviewed nurses had worked in the primary mental health care for at least one year at the FHS units in Rio das Ostras. Data was analysed, grouped, and coded according to two categories: 1) The nurses’ professional practices in mental health at the FHS, and 2) The nurses’ view on mental health practices at the FHS. Results show that the main activities in mental health at FHS involve working with the matricial team, continuing education, reception, home visits, referrals, therapeutic workshops and community therapy. Nurse perspectives on professional practices involve prevention, establishment of bonds with patient, and nurses’ training to deliver care to patients who are suffering. The bond with and care for the patient, family and community, is one of the FHS differentiators. In that vein, the study looks at the link between health care delivery, territory and population attended. The health care based on territoriality, allows increased patient and family confidence.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
An aurantiactinomyxon type is described from the marine naidid Tubificoides pseudogaster (Dahl, 1960), collected from the lower estuary of a Northern Portuguese River. This type constitutes the first of its collective group to be reported from Portugal, and only the fourth described from a marine oligochaete worldwide. Extensive morphological comparisons of new aurantiactinomyxon isolates to all known types without available molecular data are proposed to be unnecessary, given the artificiality of the usage of morphological criteria for actinosporean differentiation and the apparent strict host specificity of the group. Recognition of naidid oligochaetes as the hosts of choice for marine types of aurantiactinomyxon and other collective groups, suggests that the family Naididae played a preponderant role in the myxosporean colonization of estuarine communities. Molecular analyses of the type in study further infer its involvement in the life cycle of Paramyxidium giardi (Cépède, 1906) Freeman and Kristmundsson, 2018, a species that infects the kidney of European eel Anguilla anguilla (Linnaeus, 1758) and that has been reported globally, including from Portuguese waters. The low intraspecific difference registered in relation to Icelandic isolates of P. giardi (0.6%) is hypothesized to result from the emergence of genotypically different subspecies due to geographic isolation.
The mechanisms involved in kidney disturbances during development, induced by vitamin D3 deficiency in female rats, that persist into adulthood were evaluated in this study. Female offspring from mothers fed normal (control group, n=8) or vitamin D-deficient (Vit.D-, n=10) diets were used. Three-month-old rats had their systolic blood pressure (SBP) measured and their blood and urine sampled to quantify vitamin D3 (Vit.D3), creatinine, Na+, Ca+2 and angiotensin II (ANGII) levels. The kidneys were then removed for nitric oxide (NO) quantification and immunohistochemical studies. Vit.D- pups showed higher SBP and plasma ANGII levels in adulthood (P<0.05) as well as decreased urine osmolality associated with increases in urinary volume (P<0.05). Decreased expression of JG12 (renal cortex and glomeruli) and synaptopodin (glomeruli) as well as reduced renal NO was also observed (P<0.05). These findings showed that renal disturbances in development in pups from Vit.D- mothers observed in adulthood may be related to the development of angiogenesis, NO and ANGII alterations.
Mullets inhabit a wide range of habitats from tropical to temperate regions and play a critical role in their ecosystems. This commercially important fish group constitutes a significant source of food in several geographic regions, and the production of some species for consumption is an increasing trend. About 64 myxosporean species have been reported in mullets, some of which are cryptic, as is the case of Myxobolus exiguus, and M. muelleri. This paper provides, for the first time, a detailed and critical revision of the data available for myxobolids reported in mullets, determining the species that have bona fide mugiliform fish hosts, in accordance with the original species descriptions, the available molecular data and the currently accepted taxonomic and phylogenetic criteria. Phylogenetic analyses using Bayesian inference and maximum-likelihood methodologies suggest that the evolutionary history of myxobolids with bona fide mugiliform fish hosts reflects that of its vertebrate hosts, while reinforcing known evolutionary factors and old systematic issues of the clade of myxobolids. A comprehensive morphological, ultrastructural and molecular redescription is also provided for the cryptic species M. exiguus, from infections in the visceral peritoneum of the thinlip-grey mullet Chelon ramada in the River Minho, Portugal.
Here we evaluated the effect of fermented milk supplemented with whey protein (approximately 80 % protein), probiotic (Bifidobacterium animalis subsp. lactis BB12) and pomegranate juice (Punica granatum L.) on the physical performance, intestinal motility and villi structure, inflammatory markers and intestinal microbiota of rats under high-intensity acute exercise. In all, twenty-four Wistar rats were separated into groups: control (Ctrl), supplemented (Supp), exercised (Exe) and exercised and supplemented (Exe+Supp). Rats in the Supp groups received fermented milk during 6 weeks by oral administration. At the end of the supplementation period, the Exe groups were submitted to high-intensity acute exercise on a treadmill. We found that intense acute exercise caused changes in the intestinal villi interspace, changes in the proportion of Lactobacillus species and an increase in Clostridium species, as well as a decrease in intestinal motility. Supplementation increased intestinal motility, and maintained the intestinal villi interspace and the natural microbiota proportions of the exercised rats. Physical performance was not improved by fermented milk supplementation. We conclude that the fermented milk containing whey protein, B. animalis (BB12) and pomegranate juice can re-establish intestinal microbiota and protect the animals from the undesirable effects of intense acute exercise.
Bismuth triiodide (BiI3) has been studied aiming the development of lead-free photovoltaic materials. It can also be used as X-ray detectors due to the high density of its elements (bismuth and iodine). We investigate the mechanical stress, hardness, and elastic properties of BiI3 thin films deposited by thermal evaporation. The stress was determined by the bending beam technique using the Stoney equation. The films are tensile with stress of approximately 27 MPa. The hardness and the elastic modulus were determined by nanoindentation technique using a Berkovich diamond tip. The hardness of the films is approximately 0.8 GPa and the reduced Young´s modulus is ∼28 GPa for maximum penetration depth of 10% of the film thickness.
This study investigated the relationships between methane (CH4) emission and fatty acids, volatile metabolites (V) and non-volatile metabolites (NV) in milk of dairy cows. Data from an experiment with 32 multiparous dairy cows and four diets were used. All diets had a roughage : concentrate ratio of 80 : 20 based on dry matter (DM). Roughage consisted of either 1000 g/kg DM grass silage (GS), 1000 g/kg DM maize silage (MS), or a mixture of both silages (667 g/kg DM GS and 333 g/kg DM MS; 333 g/kg DM GS and 677 g/kg DM MS). Methane emission was measured in climate respiration chambers and expressed as production (g/day), yield (g/kg dry matter intake; DMI) and intensity (g/kg fat- and protein-corrected milk; FPCM). Milk was sampled during the same days and analysed for fatty acids by gas chromatography, for V by gas chromatography–mass spectrometry, and for NV by nuclear magnetic resonance. Several models were obtained using a stepwise selection of (1) milk fatty acids (MFA), V or NV alone, and (2) the combination of MFA, V and NV, based on the minimum Akaike’s information criterion statistic. Dry matter intake was 16.8±1.23 kg/day, FPCM yield was 25.0±3.14 kg/day, CH4 production was 406±37.0 g/day, CH4 yield was 24.1±1.87 g/kg DMI and CH4 intensity was 16.4±1.91 g/kg FPCM. The observed CH4 emissions were compared with the CH4 emissions predicted by the obtained models, based on concordance correlation coefficient (CCC) analysis. The best models with MFA alone predicted CH4 production, yield and intensity with a CCC of 0.80, 0.71 and 0.69, respectively. The best models combining the three types of metabolites included MFA and NV for CH4 production and CH4 yield, whereas for CH4 intensity MFA, NV and V were all included. These models predicted CH4 production, yield and intensity better with a higher CCC of 0.92, 0.78 and 0.93, respectively, and with increased accuracy (Cb) and precision (r). The results indicate that MFA alone have moderate to good potential to estimate CH4 emission, and furthermore that including V (CH4 intensity only) and NV increases the CH4 emission prediction potential. This holds particularly for the prediction model for CH4 intensity.
Non-typhoidal Salmonella is an important burden, particularly in developing countries of the African region. We report for the first time in Angola, a sub-Saharan African country with commercial/travel relationships with Europe, an unexpectedly high occurrence of Salmonella (n = 12/63, 19%) from a high diversity of sources, particularly farm and wild animals. The detection of diverse serotypes (n = 12), involving putative new S. enterica subsp. salamae serotypes, is also of note, reinforcing the need for a comprehensive surveillance in Angola critical to identify animal/food/environmental sources of salmonellosis with impact on animal health, local people, tourists and exported products.
To evaluate the clinical and histopathological factors affecting the prognosis of patients with squamous cell locoregional advanced laryngeal cancer.
Methods:
A retrospective chart review was conducted of 121 patients with locoregional advanced laryngeal cancer, primarily treated with surgery from 2007 to 2011. Disease-free survival and overall survival rates were analysed as oncological outcomes. Prognostic variables, namely gender, pharyngeal invasion, pathological assessment of tumour and nodal stage, adjuvant therapy, margin status, nodal extracapsular extension, tumour differentiation, lymphovascular and perineural invasion, and predominant growth pattern, were also analysed.
Results:
One-year and three-year disease-free survival rates were 81.3 per cent and 63.5 per cent, respectively. One-year and three-year overall survival rates were 88.3 per cent and 61.4 per cent, respectively. Multivariate analysis showed that nodal extracapsular extension (p < 0.05) and an infiltrative growth pattern (p < 0.05) were associated with disease progression. Nodal extracapsular extension (p < 0.05) was associated with higher mortality.
Conclusion:
Nodal extracapsular extension and an infiltrative growth pattern were the main prognostic factors in locoregional advanced laryngeal cancer. The presence of pharyngeal invasion, pathologically confirmed node-positive stage 2–3 disease, close or microscopic positive margins, and lymphovascular and perineural invasion have a negative impact on prognosis.