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- Collaborative Practices in Mental Health Care: A Concept AnalysisPublication . Pinheiro, Eslia; Laranjeira, Carlos; Harmuch, Camila; Graça, José Mateus Bezerra; Ali, Amira Mohammed; Fekih-Romdhane, Feten; Yıldırım, Murat; Severo, Ana Kalliny; Franco, ElisângelaBackground/Objectives: Collaboration in mental health care is essential for implementing a model oriented towards the psychosocial rehabilitation of people based on multifaceted interventions involving different actors and sectors of society to respond to demands. Despite the benefits presented by the scientific evidence, there are still many barriers to collaborative care, and professionals continue to struggle in reorienting their conduct. The current situation demands organization and the framing of well-founded action plans to overcome challenges, which in turn requires a detailed understanding of collaborative practices in mental health care and their conceptual boundaries. A concept analysis was undertaken to propose a working definition of collaborative practices in mental health care (CPMHC). Methods: This paper used the Walker and Avant concept analysis method. This includes identifying the defining concept attributes, antecedents, consequences, and empirical referents. A literature search was carried out from November 2024 to February 2025 in three databases (Medline, CINAHL, and LILACS), considering studies published between 2010 and 2024. Results: The final sample of literature investigated consisted of 30 studies. The key attributes were effective communication, building bonds, co-responsibility for care, hierarchical flexibility, articulation between services, providers and community, monitoring and evaluating of care processes, and attention to the plurality of sociocultural contexts. Conclusions: This comprehensive analysis contributes to guiding future research and policy development of collaborative practices in mental health, considering the individual, relational, institutional, and social levels. Further research is possible to deepen the understanding of the production of collaborative practices in mental health in the face of the complexity of social relations and structural inequities.
- Development and Validation of an Educational Tool on Hypodermoclysis for Palliative Care ProfessionalsPublication . Sousa, Maria Vanessa Tomé Bandeira de; Laranjeira, Carlos; Pires, José Mateus; Bonfim, Isabela Melo; Graça, Luís Carlos Carvalho; Rolim, Karla Maria Carneiro; Bonates, Lara Anisia Menezes; Castro, Régia Christina Moura Barbosa; Fernandes, Ana Fátima CarvalhoBackground/Objectives: Hypodermoclysis has gained increasing recognition as a safe, effective, and minimally invasive method for administering medication and fluids in palliative care. Despite its advantages, its adoption remains limited, primarily due to a lack of structured training resources for healthcare professionals. This study aimed to develop and validate an educational tool for training clinical nurses in hypodermoclysis administration in palliative care. Methods: This is a methodological study with a multi-methods approach. Study development involved a needs assessment with 48 professionals, a literature review, and the creation of a manual enriched with visual aids. Results: The material was validated by expert judges, technical reviewers, and the target audience. Organized into 21 chapters, the manual comprehensively addresses technical, theoretical, and ethical dimensions of the practice. Content validation by 14 experts yielded an outstanding global Content Validity Index (CVI) of 0.95. An independent evaluation of visual design by four communication specialists produced consistently high scores (91–96%), classifying the material as “superior” in quality. Feedback from target users (12 nurses) highlighted the manual’s clarity, applicability, and relevance. All constructive suggestions were incorporated into the final version. Conclusions: The resulting manual demonstrates strong validity as an educational resource, with significant potential to standardize and enhance hypodermoclysis training in palliative nursing, promoting both safety and humanized care.
- Coronary septic embolism presenting as acute myocardial infarction. A case report of a singular manifestation of infective endocarditisPublication . Carvalho, Mariana Ferreira; Gonçalves, Carolina; Santos, Beatriz Saldanha; Morais, João; Søholm, Helle; Galyavich, Albert; Rroku, Andi; Luo, EltonBackground Acute ST-elevation myocardial infarction (STEMI) complicated by infective endocarditis (IE) presents a unique challenge in clinical management, especially when associated with septic embolism leading to coronary artery occlusion. Case summary The current clinical report describes the case of a 72-year-old male with a history of arterial hypertension, dyslipidaemia, and severe obstructive sleep apnea. The patient presented with anterior STEMI due to an embolic occlusion in the left anterior descending (LAD) artery, secondary to IE. Coronary angiography revealed embolic occlusion at the LAD origin, and balloon angioplasty without stent placement was performed, considering the embolic and infectious nature of the occlusion. Despite targeted interventions, including broad-spectrum antibiotics and support for cardiogenic shock, the patient's condition deteriorated, leading to cardiac arrest and subsequent death on the fourth day of hospitalization. Conclusion This case emphasizes the critical need for adapting STEMI management in the presence of IE. It highlights the importance of considering IE in STEMI differential diagnosis and adjusting intervention strategies accordingly.
- Effect of Preventive Exercise Programs for Swimmer’s Shoulder Injury on Rotator Cuff Torque and Balance in Competitive Swimmers: A Randomized Controlled TrialPublication . Tavares, Nuno; Vilas-Boas, João Paulo; Castro, Maria AntónioBackground: Over the season, competitive swimmers experience a progressive imbalance in rotator cuff strength, predisposing them to a significant risk factor for a swimmer’s shoulder injury. Objectives: Verify the effectiveness of two 12-week preventive programs on the shoulder rotators’ peak torque and conventional/functional ratios. Design: A care provider- and participant-blinded, parallel, randomized controlled trial with three groups. Participants: Competitive swimmers aged 16 to 35 years with no prior clinical issues related to their shoulders. Interventions: Twice a week, over 12 weeks, the two experimental groups performed five exercises where the only difference was executing the program with weights or elastic bands, and the control group performed a sham intervention. Main outcome measures: The concentric and eccentric peak torque of the internal and external rotators of the dominant shoulder were assessed before and after the intervention using an isokinetic dynamometer Biodex System 3, at 60°/s, 120°/s, and 180°/s. Results: Among the experimental groups, only one test indicated a reduction (p ≤ 0.05) in rotator peak torque, while the control group showed a decrease (p ≤ 0.05) in five tests. Swimmers who completed the prevention programs demonstrated less imbalance in conventional/functional ratios than controls. Conclusions: Implementing a 12-week preventive program minimizes the progressive shoulder rotational imbalance over the season in competitive swimmers. Clinical Trial Registration number: NCT06552585.
- Designing a mobile app to promote healthy behaviors and prevent obesity: analysis of adolescents’ preferencesPublication . Frontini, R.; Sousa, P.; Dixe, M. A.; Ferreira, R.; Figueiredo, M. C.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.
- Compreensão Leitora em Pessoas com Trissomia 21 – Revisão de EscopoPublication . Barradas, Beatriz; Correia, Maria Rodrigues; Taveira, Luísa; Rodrigues, Inês TelloO objetivo deste trabalho foi analisar os fatores que influenciam a compreensão leitora nas pessoas com Trissomia 21. Revisão de escopo elaborada de acordo com as diretrizes da Prefered Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa foi realizada nas bases de dados PubMed Central, LILACS, SciELO e via EBSCOHost. Os registos foram analisados por dois investigadores independentes. Os descritores utilizados foram: síndrome de Down e Reading combinados com termos de linguagem natural e operadores booleanos. O nível de evidência foi realizado segundo a classificação de Oxford Centre for EvidenceBased Medicine, e a qualidade metodológica através do Methodological Index for Non-Randomized Studies. A pesquisa resultou em um total de 637 estudos, dos quais sete foram incluídos. A qualidade metodológica dos estudos não comparativos variou entre baixa e média, enquanto a dos estudos comparativos, variou entre médio e alto risco de viés. A compreensão leitora encontra-se alterada nas pessoas com Trissomia 21. A compreensão auditiva foi o fator com mais impacto, existindo outros como a consciência fonológica, a memória de trabalho, a leitura isolada e o vocabulário. Os fatores que demonstram influência na compreensão leitora são heterogéneos, mas devem ser considerados para uma intervenção adequada.
- Lurie Control Systems Applied to the Sudden Cardiac Death Problem Based on Chua Circuit DynamicsPublication . Pinheiro, Rafael F.; Colón, Diego; Antunes, Alexandre; Fonseca-Pinto, RuiSudden cardiac death (SCD) represents a critical public health challenge, emphasizing the need for predictive techniques that model complex physiological dynamics. Studies indicate that the “V-trough” pattern in sympathetic nerve activity (SNA) could act as an early indicator of potentially fatal cardiac events, which can be effectively modeled using a modified version of Chua’s chaotic system, incorporating the variables of heart rate (HR), SNA, and blood pressure (BP). This paper introduces a Chua circuit with delay, and proposes a novel control design technique based on Lurie-type control systems theory combined with mixed-sensitivity H∞ (S/KS/T) methodology. The proposed controller enables precise regulation of HR in Chua’s circuit, both with and without delay, paving the way for the development of advanced devices capable of preventing SCD. Furthermore, the developed theory allows for the project of robust controllers for delayed Lurie systems within the single-input–single-output (SISO) framework. The presented theoretical framework, supported by numerical simulations, demonstrates the effectiveness of the conceptualization, marking a considerable advance in the understanding and early intervention of SCD through robust and nonlinear control systems.
- Use and Acquisition of Communicative Functions and Communicative Forms by Portuguese European Toddlers with and without Hearing ImpairmentPublication . Lima, Etelvina; Cruz-Santos, AnabelaPurpose: The purpose of this study was to identify and compare communicative functions and forms in toddlers without (age group 8 to 18 months) and with hearing impairment (age group 13 to 18 months).Methods: Participants were 37 toddlers with normal hearing, 4 toddlers with hearing impairment.Results: The results indicate an increase in the average of the communicative functions conveyed along the increase of the age groups. There is an association between the age group and the type of communicative functions taught. Although there is no relationship between the hearing impairment condition and the average use of communicative functions, the two groups make different use of the type of communicative functions as well as the communicative forms.Conclusion: Is of paramount importance to understand the relationships between communicative forms and communicative functions in the assessment and intervention of communication skills in toddlers. In the case of toddlers with hearing impairment is fundamental to be aware that is not the frequency but the type of communication skills that they establish with their interlocutors.
- Development and validation of a comfort-measuring scale for elderly individuals with chronic conditionsPublication . Marques, Rita; Veludo, Filipa; Sousa, Patrícia Pontífice; Dixe, Maria dos AnjosBackground Ageing is associated with chronic diseases and successive losses, which affect the comfort experienced by the elderly. Hence, in that population, comfort must be viewed as a need, and health care professionals (particularly nurses) should promote it through their interventions. This work aimed at developing a scale to assess comfort in elderly individuals with chronic conditions and determining the aforesaid scale’s psychometric characteristics (validity and reliability), while ascertaining the comfort levels experienced by the participants. Methods Our sample comprised 454 chronically ill elderly individuals, either hospitalized, or in residential care/at home. As regards descriptive statistics, we calculated various summary measures. Validity was appraised via exploratory factor analysis, considering the main components. We performed varimax rotation and factor extraction (in which factors with eigenvalues > 1 were extracted). Reliability was established by calculating internal consistency, using Cronbach’s alpha. For each scale item, we examined the corrected item-test correlation. Additionally, we calculated skewness and kurtosis, also carrying out a confirmatory factor analysis. Results The exploratory factor analysis produced a scale with 38 items and five factors, which fitted the data and explained a variance of 61.355%. The values of the Kaiser-Meyer-Olkin test and the Bartlett’s test (sphericity) were 0.943 and 12055.962, respectively (both with p < 0.001). Our model was substantiated by the confirmatory factor analysis (χ² = 2884.242; df = 660; RMSEA = 0.086; CFI = 0.811; TLI = 0.798; SRMR = 0.066) and the Cronbach’s alpha coefficient was 0.959. The summary measures showed that, overall, the participants experienced good comfort levels (Mean = 3.64; SD = ±0.676), revealing higher comfort levels in the “Spirituality and meaning of life” dimension (Mean = 3.79; SD = ±0.742) and lower comfort levels in the “Normality of life” dimension (Mean = 3.39; SD = ±0.922). Conclusion The scale demonstrated suitable psychometric properties, ensuring its validity and reliability in assessing comfort in elderly individuals with chronic conditions. Its five-factor structure enables a comprehensive evaluation, highlighting key comfort dimensions. These findings support targeted interventions, aiding healthcare professionals in improving care and informing evidence-based practices and health policies to enhance well-being. Implications for nursing and health policy By measuring comfort levels in chronically ill elderly individuals, it is possible to plan/improve the comforting care provided by the involved professionals (namely nurses).
- The Arabic Version of the Patient Health Questionnaire‐2 (PHQ‐2): Psychometric Evaluation Among Mothers of Children With Intellectual DisabilitiesPublication . Ali, Amira Mohammed; Al-Dossary, Saeed A; Aljaberi, Musheer A.; El-Gazar, Heba Emad; Laranjeira, Carlos; Khatatbeh, Haitham; Zoromba, Mohamed Ali; Alamer, Rasmieh; Amer, Faten; Pakai, Annamaria; Fekih-Romdhane, Feten; Lidoriki, EiriniAim: Mothers of children with intellectual disabilities are particularly vulnerable to mental distress due to demanding and exhausting caregiving. However, in the Arab world, they are seldom screened for depression because of limited diagnostic resources. Addressing the urgent need for brief and reliable screening tools, this study evaluated the psychometric properties of the Arabic version of the Patient Health Questionnaire-2 (PHQ-2) among 85 Saudi mothers. Design: A cross-sectional study. Methods: The construct, convergent, and divergent validity of the PHQ-2 was examined through a latent variable model (LVM), while its cutoff score was examined through receiver-operating characteristic (ROC) curve analysis. Results: The unidimensional PHQ-2 (item loadings > 0.7) was positively predicted by stress and negatively predicted by high mood and happiness, supporting its convergent and divergent validity. The PHQ-2 effectively predicted low mood, poor sleep quality, nightmares, high stress, low general physical health, and willingness to join a psychological support program (area under the curve [AUC] range = 0.72–0.84, p values < 0.001). The best balance between sensitivity and specificity was achieved at the PHQ-2 threshold ≥ 2.5, while the cutoff ≥ 3.5 demonstrated a higher positive predictive value (PPV) for all outcomes (range = 30.0–78.8 vs. 23.0–70.8). Conclusions: The PHQ-2 is a brief, valid tool, which at cutoffs ≥ 2.5 and ≥ 3.5 can reliably detect clinically significant depression and related psychological and physical adverse effects. Mothers scoring ≥ 3.5 may require a clinician-based examination for depression, and they may benefit from specific mental health literacy interventions. However, the results should be interpreted with caution given convenience sampling, a small sample size, and elevated distress levels in the current population. These limitations highlight the need to replicate the study with larger, randomly selected samples from more diverse populations. Implications for Practice: Nurses can efficiently screen for depression and its mental/physical sequelae, as well as monitor response to treatment using only two items. The study provided two well-interpreted cutoffs of the PHQ-2, with real-world implications for mental health screening in under-resourced settings. Reporting Method: The study adhered to STROBE guidelines. Patient or Public Contribution: No patient or public contribution. Copyright © 2025 Amira Mohammed Ali et al. Nursing Research and Practice published by John Wiley & Sons Ltd.