Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis

The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.

Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross-sectional study

AIMS AND OBJECTIVES

This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL.

BACKGROUND

Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021-March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL.

RESULTS

The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors.

CONCLUSIONS

Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society.

RELEVANCE TO CLINICAL PRACTICE

Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.

Assessment and Psychometric Properties of the 21-Item Depression Anxiety Stress Scale (DASS-21) among Portuguese Higher Education Students during the COVID-19 Pandemic

The COVID-19 pandemic has caused substantial disruptions in the lives of higher education students, with detrimental repercussions for academic performance and overall mental health. Therefore, we aimed to evaluate the prevalence of depression, anxiety, and stress symptoms among Portuguese higher education students during the first wave of the coronavirus pandemic and investigate DASS-21's psychometric characteristics and whether it functions effectively during a pandemic. A convenience sampling procedure was used to recruit 1522 participants (75.1% women and 79.2% undergraduate students) for this cross-sectional research. Participants completed an e-survey created using DASS-21. The results revealed a considerable prevalence of symptoms of depression [≥10] (N = 434, 28.5%), anxiety [≥7] (N = 551, 36.2%), and stress [≥11] (N = 544, 35.7%). Confirmatory factor analysis (CFA) revealed the scale's three-factor structure, which matched the three DASS-21 subscales. Subsequently, the heterotrait-monotrait (HTMT) correlation ratio evaluated the scale's discriminant validity, which was relatively good. Cronbach's alpha measured the internal consistency of the DASS subscales, which was excellent (Cronbach's α > 0.90). DASS-21 was shown to be a reliable and appropriate measure for assessing students' mental health. Furthermore, DASS-21 is recommended for use by academics and healthcare professionals in measuring students' psychological distress. Further validation studies of this scale are needed with larger and more representative samples.

Perceived Barriers to Providing Spiritual Care in Palliative Care among Professionals: A Portuguese Cross-Sectional Study

Spiritual care is an important dimension of palliative care (PC) and a facet of holistic care that helps ill people find meaning in their suffering and lives. This study aims to: (a) develop and test the psychometric properties of a new instrument, Perceived Barriers to Spiritual Care (PBSC); (b) explore participants' perceptions of how prevalent those (pre-identified) barriers are; and (c) examine the association of their personal and professional characteristics with those perceptions. A descriptive cross-sectional study was carried out using a self-reporting online survey. In total, 251 professionals registered with the Portuguese Association of Palliative Care (APCP) completed the study. The majority of respondents were female (83.3%), nurses (45.4%), had more than 11 years of professional experience (66.1%), did not work in PC (61.8%), and had a religious affiliation (81.7%). The psychometric assessment using PBSC provided sound evidence for its validity and reliability. The three most common perceived barriers were late referral for palliative care (78.1%), work overload (75.3%), and uncontrolled physical symptoms (72.5%). The least commonly perceived barriers were different spiritual beliefs among professionals (10.8%), differences between the beliefs of professionals and patients (14.4%), and the shame of approaching spirituality in a professional context (26.7%). The findings show there is some relationship between sex, age, years of professional experience, working in PC, having a religious affiliation, the importance of spiritual/religious beliefs, and responses to the PBSC tool. The results highlight the importance of advanced training in spirituality and intervention strategies. Further research is needed to properly study the impacts of spiritual care and establish outcome assessments that accurately reflect the effects of the various spiritual care activities.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

Workplace Stress in Portuguese Oncology Nurses Delivering Palliative Care: A Pilot Study

Oncology nurses often face complex end-of-life issues, underlining their need for specific training in palliative care. In this context, nurses experience several emotional and psychological dilemmas, which are often difficult to manage and result in high levels of workplace stress. This study aimed to determine the levels and work-related factors of workplace stress among oncology nurses. A descriptive baseline study was performed as part of a large four-phase study based on quantitative data collected from Portuguese oncology nurses. Of the 32 participating nurses, most were women, and the mean age was 42.69 ± 10.04 years. Overall, nurses revealed moderate levels of stress. Younger nurses with less professional experience had difficulties dealing with issues related to death and dying. This pilot study supported the development of a program of six Stress Management Training Workshops (SMTW) to reduce stress and increase adaptative strategies. Assessing workplace stress among oncology nurses should be the focus of intervention by managers and institutional leaders.

Psychological Responses and Strategies Towards the COVID-19 Pandemic Among Higher Education Students in Portugal and Switzerland: A Mixed-Methods Study

Background

The COVID-19 pandemic has caused overwhelming changes in individual and community daily-life, resulting from the public health measures implemented to contain it, and also from its psychological and socio-economic consequences. These shifts and consequences impacted the entire population, but some groups are more likely to be affected by these changes, including higher education students.

Objectives

a) to investigate mental health status and its determinants among higher-education students in Portugal and Switzerland; and b) to explore adjustment patterns used by these students to overcome the impact of the COVID-19 pandemic.

Methods

A cross-sectional study with a mixed-methods sequential explanatory design was conducted in two phases. First, an online survey was conducted among higher education students in Portugal and Switzerland, in Portuguese and French respectively. A convenience sampling method was used. Second, some participants from the first phase were invited to participate in four online focus group discussions (two in each country) using a maximum variation sampling method.

Results

The survey was answered by 1,880 students. Portuguese students revealed higher levels of stress and anxiety, but lower depression symptoms and less resilient coping compared to Swiss respondents. Hope was identified as an explanatory variable for mental health symptoms in students from both countries. In the focus groups (n = 27), 13 adjustment strategies were found, which were subdivided into three spheres: personal, social, and contextual.

Conclusions

The results suggest that the COVID-19 pandemic had a mild to moderate impact on most of the evaluated mental health variables. Nevertheless, the students reacted and mobilized positive short-term strategies, which need to be reinforced in order to prevent long-term psychological harm. In addition, our results can inform psychosocial interventions to minimize psychological impact, anxiety, depression, and stress due to sanitary crises or other population-wide problems or disasters.

A Clinical Decision Support System for Remote Monitoring of Cardiovascular Disease Patients: A Clinical Study Protocol

Introduction

Cardiovascular diseases (CVD) are the leading cause of death globally, taking an estimated 17. 9 million lives each year. Cardiac rehabilitation is shown to reduce mortality and hospital readmissions, while improving physical fitness and quality of life. Despite the recommendations and proven benefits, acceptance and adherence remain low. Mobile health (mHealth) solutions may contribute to more personalized and tailored patient recommendations according to their specific needs. This study protocol aims to assess the effectiveness of a user-friendly, comprehensive Clinical Decision Support System (CDSS) for remote patient monitoring of CVD patients, primarily on the reduction of recurrent cardiovascular events.

Methods and Analysis

The study will follow a multicenter randomized controlled design involving two cardiology units in the Center Region of Portugal. Prospective CVD patients will be approached by the healthcare staff at each unit and checked for eligibility according to the predefined inclusion/exclusion criteria. The CDSS will suggest a monitoring plan for the patient, will advise the mHealth tools (apps and wearables) adapted to patient needs, and will collect data. The clinical study will start in January 2023.

Discussion

The success of the mHeart.4U intervention will be a step toward the use of technological interfaces as an integrating part of CR programs.

Ethics and Dissemination

The study will undergo ethical revision by the Ethics Board of the two hospital units where the study will unfold. The study was registered in ClinicalTrials.gov on 18th January 2022 with the number NCT05196802. The study findings will be published in international peer-reviewed scientific journals and encounters and in a user-friendly manner to the society.

Building Bridges for "Palliative Care-in-Place": Development of a mHealth Intervention for Informal Home Care

Background

In Palliative Care (PC), family and close people are an essential part of provision of care. They assume highly complex tasks for which they are not prepared, with considerable physical, psychological, social and economic impact. Informal Caregivers (ICs) often falter in the final stage of life and develop distress, enhancing emotional burden and complicated grief. The lack of available and accessible in-person counselling resources is often reported by ICs. Online resources can promote early access to help and support for patient-IC dyads in palliative care. The primary aim of this research is to co-design, develop and test the feasibility of the Help2Care-PAL mHealth app that addresses the needs of ICs of palliative patients cared for at home. This Digital Health Intervention (DHI) in palliative care will be used for education, symptom management, communication and decision-making, to enhance Quality of Life (QoL) of patients and ICs, fostering anticipatory grief and the reach and efficiency of services.

Methods

This study will use an iterative co-design process and convergent mixed-methods design, following the MORECare consensus for developing a complex intervention. Construction of the DHI will follow four main phases: (I) a needs assessment (a cross-sectional survey, individual interviews with ICs and focus groups with professionals with community palliative care experience); (II) design and co-production of mHealth materials and interventions to support ICs; (III) the development of a mHealth app; and (IV) usability and feasibility of the mHealth app. The Help2Care-PAL platform seeks to build resources from the perspectives and needs of both family dyads and nursing professionals working in the field of community palliative care. User-centeredness will be ensured by the active participation of patient-IC dyads and professionals of the palliative care community.

Discussion

This mixed-method study will offer new insights on needs and expectations of patient-IC dyads and nurses in community palliative care regarding caregiving preparedness and online health resources. Through the implementation of an adaptive digital tool, we aim to improve access to palliative care family support, which is highly linked with the wellbeing of patients and especially new ICs.

Mental Health and Psychological Impact during COVID-19 Pandemic: An Online Survey of Portuguese Higher Education Students

The COVID-19 pandemic has had significant psychological impact on vulnerable groups, particularly students. The present study aims to investigate the mental and psychological impact of the COVID-19 pandemic and associated factors in a sample of Portuguese higher education students. An online cross-sectional study was conducted among 1522 higher education students selected by convenience sampling. The survey assessed mental health symptoms as well as sociodemographic variables, health-related perceptions, and psychological factors. Results were fitted to binary and multivariable logistic regression models. The overall prevalences of stress, anxiety, and depression were 35.7%, 36.2%, and 28.5%, respectively. Poor mental health outcomes were related with being female, having no children, living with someone with chronic disease, facing hopelessness, and lacking resilient coping. Future studies focusing on better ways to promote mental health and wellbeing among students are warranted. It is necessary to gather more evidence on the post-pandemic mental health using robust study designs and standardized assessment tools.

Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review

Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.

Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.

Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.

Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.

Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.

Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review

Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.

Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.

Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.

Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.

Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.

Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review

Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.

Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.

Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.

Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.

Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.

Designing a mobile app to promote healthy behaviors and prevent obesity: analysis of adolescents' preferences

To ensure that adolescents adhere to programmes promoting healthy behaviors, these programmes must be appealing and interesting. This study aims to characterize and assess the devices, operating system and type of mobile apps frequently used by adolescents; understand the features that mHealth apps should have to be appealing; comprehend the facilitators and barriers for adolescents to use mHealth apps. The sample comprised 165 adolescents (12-18 years) from the main population, recruited in 2018. Most participants used smartphones and the Android system. Food and physical activity suggestions were considered the most important features for an mHealth app. 62.6% had never tried an mHealth app. For those who had tried one, 26.0% stated it was to improve health status/lifestyle. Their favorite feature was physical exercise tips/plans (41.8%). Adolescents pointed out that the reasons that made them keep using the app were utility and interest (35.7%). Regarding possible barriers, 48.4% reported a lack of a senseof need/practical utility, and 18.8% considered notifications as their least favorite feature. Lack of interest was pointed out for 38.2% as the main reason for stopping use. Results provide practical information for the planning, design, and implementation of future mHealth apps for the promotion of healthy behaviors - an important implication for future research in this area.

An Interregional, Transdisciplinary and Good Practice-Based Approach for Frailty: the Mind&Gait Project

Social facilities such residential structures and day-centres increasingly seek integrated, structured, adapted, creative, dynamic and economic strategies to prevent frailty. The arising need of an aged and frail population requires innovative interventions and products to prevent cognitive and physical decline. The interregional MIND&GAIT project aims to promote independent living in frail older adults by improving cognition and gait ability by using assistive products. This transdisciplinary strategy within a 24-months period expects as project' deliverables: i) a structured and good practice-based combined intervention (CI) consisting of a cognitive stimulation programme and a physical exercise programme; ii) an auto-blocking mechanism for rolling walkers with biofeedback acquisition (ABMRW); iii) a randomized clinical trial to assess CI' effectiveness; and iv) a web-platform to be used as a repository that will support and disseminate the intervention materials, covering the action-line of translational research. Positive benefits are expected in prevention and maintenance of frail older adults' capacities. Preliminary results showed positive effects on the improvement of cognitive and physical functions, functionality and depressive symptomatology. The interregional geographical coverage induced by MIND&GAIT underlines the potential replicability of the project extension to the community in the Centro and Alentejo regions of Portugal. MIND&GAIT network supports actions and provides learning opportunities and emergence of locally-embedded support systems towards social innovation for older adults.