Does trade credit facilitate access to bank finance?: an empirical evidence from Portuguese and Spanish small medium size enterprises

This paper examines if trade credit could be considered as a substitute and/or a complement to bank credit in order to assess the existence of credit rationing. Using a panel dataset of 468 and 7019 Portuguese and Spanish small medium size enterprises, in the period 1998-2006, and controlling for endogeneity problems by using GMM estimators, the results confirm the existence of credit rationing, since the substitution hypothesis is confirmed. This effect is particularly strong for firms that maintaining an exclusive relationship with one bank, which indicate a greater severity of adverse selection problems for those firms. Although the substitution hypothesis is confirmed, the results seem indicate that the substitution and complementary hypothesis are not mutually exclusive, especially for a specific group of firms: the younger and smaller firms. In line with the theories that emphasize the informational role of trade credit, due the informative advantage of suppliers, our empirical results confirm that trade credit allow the younger and smaller firms to improve their reputation, as trade credit reveals the private information of the supplier to the bank, in turn, banks can update their beliefs about customer default risk and agree to increase bank credit.O objectivo deste trabalho de investigação consiste em analisar se o crédito comercial obtido junto dos fornecedores e o endividamento bancário são considerados duas fontes de financiamento substitutas e/ou complementares. Usando uma amostra em dados painel de 468 e 7019 pequenas e médias empresas (PME) Portuguesas e Espanholas respectivamente, e recorrendo ao método de estimação GMM, para controlar potenciais problemas de endogeneidade, os resultados confirmam a hipótese de substituição, isto é, as empresas recorrem ao crédito junto dos fornecedores quando vêm restringido o seu acesso ao financiamento junto dos bancos. Este racionamento no acesso ao crédito bancário é particularmente relevante para as empresas que mantêm uma relação de monopólio (negoceiam com apenas um banco), o que indicia maiores problemas de selecção adversa e risco moral para estas empresas. Todavia, apesar de a hipótese de substituição ser confirmada, a evidência empírica aponta para o facto de que as hipóteses de substituição e complementaridade não serem mutuamente exclusivas, em particular para um grupo específico de empresas: as empresas mais jovens e mais pequenas. Em consonância com as teorias que enfatizam o conteúdo informativo veiculado pelo crédito comercial (qualidade da gestão, nível de risco do cliente), os resultados obtidos confirmam que o recurso ao crédito concedido pelos fornecedores ajuda as empresas mais jovens e mais pequenas a consolidarem a sua reputação no mercado de crédito. O montante de crédito comercial obtido pode ser visto como um sinal que veicula a informação privada detida pelo fornecedor aos bancos a baixo custo. Neste contexto, os bancos mostram-se mais predispostos a conceder crédito

Neoplasia da mama: utilização de duplo bloqueio em terapêutica neoadjuvante

Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2021, Universidade de Lisboa, Faculdade de Farmácia.Introdução: O cancro da mama HER2-positivo era considerado de mau prognóstico até há cerca de duas décadas. Esta situação veio a alterar-se com a aprovação do trastuzumab, um agente anti-HER2, após ter sido demonstrado um aumento significativo da sobrevivência global e da sobrevivência livre de progressão na doença metastática, resultante da adição deste agente à quimioterapia citotóxica. Com a descoberta da possibilidade de heterodimerização entre recetores da família do HER2, foram aprovados novos fármacos, como o pertuzumab, que associado ao trastuzumab, veio proporcionar uma melhor taxa de resposta, em neoadjuvância. Neste estudo, pretende-se caracterizar a utilização de duplo bloqueio com trastuzumab + pertuzumab, em contexto neoadjuvante, no cancro da mama em estadio precoce e no cancro da mama localmente avançado e avaliar a resposta patológica completa (pCR) a esta terapêutica. Métodos: Estudo descritivo, observacional e retrospetivo, que incluiu doentes adultas diagnosticadas com cancro da mama HER2-positivo, submetidas à terapêutica com duplo bloqueio, seguidas e tratadas no Serviço de Oncologia do Hospital São Francisco Xavier, entre 2016 e 2021. Resultados: As doentes incluídas no estudo (n=24) apresentavam tumores HER2-positivos não metastizados, sendo a mediana de idades de 48 (26-69) anos. À data do diagnóstico, 14 (58,33%) apresentavam tumores operáveis, 6 (25,00%), tumores localmente avançados, 1 (4,17%) um tumor inflamatório, e 3 (12,50%), tumores designados “Não definido”. No momento da cirurgia, após receberem terapêutica neoadjuvante com duplo bloqueio associado a um taxano, 11 (45,83%) doentes tinham alcançado pCR. Destas 11, 7 (71,43 %) apresentavam recetores hormonais negativos. Quinze (62,5%) doentes realizaram mastectomia após terapêutica neoadjuvante. Das doentes em estudo, 75,00% apresentaram, pelo menos, uma reação adversa medicamentosa (RAM) durante o período de tratamento, sendo as mais frequentes: neutropenia (25,00%) e problemas gastrointestinais (41,67%). Conclusão: A percentagem de doentes que alcançaram a pCR encontra-se em consonância com a obtida no ensaio clínico Neosphere, demonstrando a mais-valia da utilização do duplo bloqueio. A ausência de recetores hormonais poderá estar associada à obtenção de uma maior taxa de pCR. Esta terapêutica não está associada à ocorrência significativa de RAM graves. A mastectomia continua a ser o tipo de cirurgia mais realizado.Background: HER2-positive breast cancer was considered to have a poor prognosis until about two decades ago. This situation has changed with the approval of trastuzumab, an anti-HER2 agent, after it was demonstrated that its addition to the cytotoxic therapy resulted in a significant increase in the overall survival and in the progression-free-survival in metastatic breast cancer. With the discovery of the possibility of heterodimerization among receptors of the HER2 family, new drugs, such as pertuzumab, were approved, which combined with trastuzumab, provided a better response rate in neoadjuvant therapy. In this study, we intend to characterize the use of dual blockade with trastuzumab + pertuzumab, in a neoadjuvant context, in early-stage breast cancer and locally advanced breast cancer and to evaluate the pathological complete response (pCR) to this therapy. Methods: An observational, descriptive, retrospective study was performed. It included adult patients diagnosed with HER2-positive breast cancer, undergoing dual blockade therapy, followed up and treated at Hospital São Francisco Xavier Oncology Service, between 2016 and 2021. Results: The patients included in the study (n = 24) had non-metastasized HER2-positive tumors, with a median age of 48 (26-69) years. At the time of diagnosis, 14 (58.33%) had operable tumors, 6 (25.0%) had locally advanced tumors, 1 (4.17%) had an inflammatory tumor, and 3 (12.50%) had tumors designated “Non defined”. At the time of surgery, after receiving dual blockade neoadjuvant therapy associated with a taxane, 11 (45.83%) patients had achieved pCR. Of these, 7 (71.43%) had negative hormone receptors. Fifteen (62.5%) patients underwent mastectomy after neoadjuvant therapy. Seventy-five per cent of the patients included in the study had at least one adverse drug rection (ADR) during the treatment period, the most frequent being: neutropenia (25.00%) and gastrointestinal effects (41,67%). Conclusion: The percentage of patients who achieved pCR is in line with the one obtained in the Neosphere clinical trial, demonstrating the added value of using dual blockade. The absence of hormone receptors may be associated with a higher pCR rate. This therapy is not associated with the occurrence of serious ADR. Mastectomy remains the most commonly type of surgery performed.Com o patrocínio do Hospital S. Francisco Xavier

The mediating role of life satisfaction in the relationship between depression, anxiety, stress and burnout among Portuguese nurses during COVID-19 pandemic

Background The COVID-19 pandemic had a large consequence on healthcare systems, increasing the risks of psychological issues in health professionals. Nurses, in particular, have been exposed to multiple psychosocial stressors and struggled with intensive work, insufficiency of resources and uncertainty in the face of an unknown disease. Life satisfaction might protect nurses from the consequences of chronic stress. The aim of this study was to explore the mediating role of satisfaction with life in the relationship between depression, stress, anxiety and burnout (personal, work-related, and client-related). Methods A cross-sectional, descriptive, correlational study design was performed, using an online questionnaire distributed via social networks. A total of 379 nurses completed the survey, comprising standardized measures of satisfaction with life, resilience (Resilience Scale), depression, anxiety, stress (Depression Anxiety Stress Scales), and burnout (Copenhagen Burnout Inventory Scale). A hierarchical regression model was estimated for each burnout dimension. Results Participants showed high levels of work, personal and client-related burnout, 57.3%, 57%, and 35.1%, respectively. More than 70% of the respondents had a normal level of depressive symptoms, 66.8% presented normal level of anxiety and 33.5% of the respondents reported mild, moderate, severe or extremely severe symptoms of stress. The results revealed that life satisfaction partially mediated the association between stress and personal burnout, depression and work-related burnout, and the association between anxiety and client-related burnout in nurses. Conclusions The COVID-19 pandemic brought added difficulties for nurses’ work conditions, whereby it became necessary to develop adaptative measures that reduce stressors in work environment and promote nurses’ life satisfaction.info:eu-repo/semantics/publishedVersio

Parenting, child development and primary care - 'Crescer em Grande!' intervention (CeG!) based on the Touchpoints approach: a cluster-randomised controlled trial protocol

Introduction Despite support for parenting being already recognised as a priority, there remains a paucity of evidence on how to facilitate its adoption in regular visits of maternal and child health primary care (PC). We describe the protocol for a study to assess the effect of an innovative universal Touchpoints-based intervention - 'Crescer em Grande!' (CeG!) - when supporting the process of transition to parenthood and early infancy, at multiple PC units. Methods and analysis A cluster-randomised trial will be conducted in 12 PC units (clusters) from the Lisbon metropolitan area, Portugal. Participants will be a minimum of three family physicians and one nurse/unit, as well as 216 expecting parents and future babies until 18 months who are using the PC services. Sites will be randomised to either the CeG! or usual care. The CeG! will consist of: (1) the integration of the Touchpoints approach in PC maternal and well-child visits, with the support of 28 leaflets for parents to file in a folder; plus (2) training for PC providers on how to perform the CeG! into existing practice. Parents will be required to fill in questionnaires at point throughout their child's 18-month, mostly online. The primary outcome will be the self-perception of parental competence (Parenting Sense of Competence Scale). Other outcomes include: family functioning, couple dynamics, mental health, well-being/quality of life, psychological experience of pregnancy, attachment, child development. Acceptability, satisfaction and feasibility of CeG! will also be obtained from providers' and parents' perspectives. Costs associated with delivering the CeG! will be calculated. Study analyses will be under the principle of intention-to-treat. Ethics and dissemination Approval was obtained from the Ethics Committee of the Regional Health Administration. The results will be shared with participants and disseminated via peer-reviewed published papers, presentations at scientific and professional conferences. Trial registration number ISRCTN90692907info:eu-repo/semantics/publishedVersio

The influence of the pedagogical model on psychological variables in 1st year students from ESTSP-IPP

Introdução – A adaptação ao ensino superior reveste-se de experiências académicas que podem constituir fonte de stress para os estudantes. A implementação de novos modelos pedagógicos, no âmbito do processo de Bolonha, introduz novas variáveis cujo impacto, designadamente em termos de saúde, importa conhecer. Este estudo tem como objetivo analisar as associações entre modelo pedagógico (Problem Based Learning – PBL vs. modelos próximos do tradicional) e variáveis psicológicas (coping, desregulação emocional, sintomas psicossomáticos, perceção de stress e afeto). Metodologia – O estudo tem um design transversal. Foram usados os seguintes questionários online: Brief-COPE, Escala de Dificuldades de Regulação Emocional, Questionário de Manifestações Físicas de Mal-Estar, Escala de Stress Percebido e Escala de Afeto Positivo e Negativo. A amostra é constituída por 183 estudantes do primeiro ano (84% do género feminino) de cursos da Escola Superior de Tecnologia da Saúde do Porto – Instituto Politécnico do Porto (ESTSP-IPP). Resultados – Foram encontradas correlações significativas entre as variáveis demográficas e psicológicas. Considerando diferentes modelos pedagógicos, foram encontradas diferenças significativas nas variáveis psicológicas. Os principais preditores de stress na amostra foram: ser mulher, frequentar uma licenciatura no modelo PBL, ter maiores índices de desregulação emocional, apresentar mais sintomas psicossomáticos, menos afeto positivo e mais afeto negativo. Conclusão – As diferenças encontradas entre modelos pedagógicos são discutidas, possibilitando a reflexão sobre as implicações práticas e sugestões para futuras investigações.Introduction – Adapting to Higher Education is filled with academic experiences that might be stressful for students. The new pedagogical models brought about by the Bologna process put into play new variables that are important to look at, namely in terms of health. This research aims to analyze associations between the pedagogical model (Problem Based Learning vs more traditional approaches) and psychological variables (coping, emotional deregulations, psychosomatic symptoms, perceived stress and affect). Method – This study has a cross-sectional design. The following online questionnaires were used: Brief-COPE, Difficulties in Emotion Regulation Scale, Perceived Stress Scale, Manifestations of Physical Discomfort Questionnaire, and Positive and Negative Affect Schedule. The sample consisted in 183 first-year students (84% female) from School of Allied Health Sciences – Polytechnic Institute of Porto. Results – Significant correlations between demographic and psychological variables were found. Considering different pedagogical models, significant differences in psychological variables were found. The main predictors of stress in the sample were: being female, inclusion in the PBL model, higher indexes of emotional deregulation, more psychosomatic symptoms, lower positive affect and higher negative affect. Conclusion – Differences between pedagogical models are discussed, while reflecting on practical implications and suggestions for future research

Rapidly involuting congenital haemangioma – uncommon diagnosis

Os hemangiomas congénitos rapidamente involutivos (RICH) são tumores vasculares raros, que se caraterizam por um desenvolvimento completo ao nascimento e por uma regressão, habitualmente total e espontânea, entre seis a dezoito meses. O diagnóstico é clínico, por vezes auxiliado por exames de imagem e biópsia. Descreve-se o caso de um recém-nascido de termo, fruto de uma gestação vigiada com ecografias obstétricas sem alterações, que apresentava ao nascimento, na face anterior da coxa esquerda, uma massa de 5x4,5cm, mole, depressível, acinzentada, com algumas telangiectasias periféricas e halo periférico esbranquiçado, sem frémito palpável ou ulceração. Hemodinamicamente estável, sem trombocitopenia. A ecografia e a ressonância magnética apoiaram a suspeita clinica de RICH, que foi corroborada imunohistologicamente. Após 15 meses verificou- -se regressão espontânea e completa do tumor. O conhecimento da clínica, evolução e prognóstico deste raro hemangioma é fundamental para o diagnóstico e seguimento adequados, evitando intervenções desnecessárias, assim como para tranquilização dos cuidadores.info:eu-repo/semantics/publishedVersio

A influência do modelo pedagógico em variáveis psicológicas de estudantes do 1º ano da ESTSP-IPP

Introdução – A adaptação ao ensino superior reveste-se de experiências académicas que podem constituir fonte de stress para os estudantes. A implementação de novos modelos pedagógicos, no âmbito do processo de Bolonha, introduz novas variáveis cujo impacto, designadamente em termos de saúde, importa conhecer. Este estudo tem como objetivo analisar as associações entre modelo pedagógico (Problem Based Learning – PBL vs. modelos próximos do tradicional) e variáveis psicológicas (coping, desregulação emocional, sintomas psicossomáticos, perceção de stress e afeto). Metodologia – O estudo tem um design transversal. Foram usados os seguintes questionários online: Brief-COPE, Escala de Dificuldades de Regulação Emocional, Questionário de Manifestações Físicas de Mal-Estar, Escala de Stress Percebido e Escala de Afeto Positivo e Negativo. A amostra é constituída por 183 estudantes do primeiro ano (84% do género feminino) de cursos da Escola Superior de Tecnologia da Saúde do Porto – Instituto Politécnico do Porto (ESTSP-IPP). Resultados – Foram encontradas correlações significativas entre as variáveis demográficas e psicológicas. Considerando diferentes modelos pedagógicos, foram encontradas diferenças significativas nas variáveis psicológicas. Os principais preditores de stress na amostra foram: ser mulher, frequentar uma licenciatura no modelo PBL, ter maiores índices de desregulação emocional, apresentar mais sintomas psicossomáticos, menos afeto positivo e mais afeto negativo. Conclusão – As diferenças encontradas entre modelos pedagógicos são discutidas, possibilitando a reflexão sobre as implicações práticas e sugestões para futuras investigações.Introduction – Adapting to Higher Education is filled with academic experiences that might be stressful for students. The new pedagogical models brought about by the Bologna process put into play new variables that are important to look at, namely in terms of health. This research aims to analyze associations between the pedagogical model (Problem Based Learning vs more traditional approaches) and psychological variables (coping, emotional deregulations, psychosomatic symptoms, perceived stress and affect). Method – This study has a cross-sectional design. The following online questionnaires were used: Brief-COPE, Difficulties in Emotion Regulation Scale, Perceived Stress Scale, Manifestations of Physical Discomfort Questionnaire, and Positive and Negative Affect Schedule. The sample consisted in 183 first-year students (84% female) from School of Allied Health Sciences – Polytechnic Institute of Porto. Results – Significant correlations between demographic and psychological variables were found. Considering different pedagogical models, significant differences in psychological variables were found. The main predictors of stress in the sample were: being female, inclusion in the PBL model, higher indexes of emotional deregulation, more psychosomatic symptoms, lower positive affect and higher negative affect. Conclusion – Differences between pedagogical models are discussed, while reflecting on practical implications and suggestions for future research

Impact of COVID-19 pandemic on the mental health of healthcare workers during the first wave in Portugal: a cross-sectional and correlational study

Objectives The COVID-19 pandemic has had a negative impact on the mental health of healthcare workers (HCWs) worldwide. This study aims to identify the degree to which sociodemographic variables and indicators of subjective well-being and psychological resilience are associated, positively and negatively, with the outcomes of burnout, stress, depression and anxiety among Portuguese HCWs observed during the first wave. It also aims to evaluate the strength of association of these variables and indicators with each outcome. Design Cross-sectional quantitative study. The statistical methods used are simple logistic model, multiple logistic regression model and −2*log-likelihood statistic. Setting Portuguese HCWs living in Portugal and working in the Portuguese healthcare system. Participants The study included 1535 professionals, with a mean age of 38 years. Primary and secondary outcomes measures Psychological variables were measured by Copenhagen Burnout Inventory, the Resilience Scale, the Depression, Anxiety and Stress Scales and the Satisfaction with Life Scale. Results High levels of personal (55%; n=844), work-related (55.1%; n=846) and client-related burnout (35.4%; n=543) were found. Additionally, participants expressed substantial levels of depression (28.7%; n=441), stress (36.4%; n=558) and anxiety (33.1%; n=508). About 1202 participants (78.3%) demonstrated moderate-to-high levels of resilience. Profession, work regime during the pandemic, having a health problem, resilience and satisfaction with life are independent variables significantly associated with the outcomes of burnout, stress, depression and anxiety. Satisfaction with life was the independent variable that had a major association with all outcomes. Conclusions Governments and hospital administrations should take action to promote resilience and satisfaction with life as these variables are protective relating to mental health problems. Interventions as educational sessions, psychological support at work, programmes promoting resilience and coping mechanisms and better work conditions may improve mental health. The implementation of measures to protect healthcare students from developing prejudicial outcomes seams very adequate and important.info:eu-repo/semantics/publishedVersio

Professional Quality of Life Among Physicians and Nurses Working in Portuguese Hospitals During the Third Wave of the COVID-19 Pandemic

Background: In the last 2 weeks of January 2021, Portugal was the worst country in the world in incidence of infections and deaths due to COVID-19. As a result, the pressure on the healthcare system increased exponentially, exceeding its capacities and leaving hospitals in near collapse. This scenario caused multiple constraints, particularly for hospital medical staff. Previous studies conducted at different moments during the pandemic reported that COVID-19 has had significant negative impacts on healthcare workers’ psychological health, including stress, anxiety, depression, burnout, post-traumatic stress symptoms, and sleep disturbances. However, there are many uncertainties regarding the professional quality of life of hospital nurses and physicians. To address gaps in previous research on secondary traumatic stress, we focused on healthcare workers working in hospitals affected by a major traumatic event: the third wave of COVID-19. Objectives: The aim of the present study was to identify the contribution of personal and work-related contextual variables (gender, age, parental status, occupation, years of experience, working with patients affected by COVID-19) on professional quality of life of healthcare workers. Methods: Cross-sectional study with a web-based questionnaire given to physicians and nurses working in a hospital setting. A total of 853 healthcare professionals (276 physicians and 586 nurses; median age 37 years old) participated in the survey assessing professional quality of life compassion satisfaction, secondary traumatic stress, and burnout. Factors of professional quality of life were assessed using regression analysis. Results: Most of the participants showed moderate (80%; n = 684) or high (18%; n = 155) levels of compassion satisfaction, whereas the majority of them experienced moderate levels of burnout (72%; n = 613) and secondary traumatic stress (69%; n = 592). The analyzed variables demonstrated no differences between professionals who were directly or not involved in the care of COVID-19 patients. Parental status was found to be a significant factor in compassion satisfaction. Female gender was significantly associated with more susceptibility to secondary traumatization. Factors that may potentially contribute to burnout include years of professional experience and the number of work hours per week. Conclusion: The COVID-19 pandemic has created a new challenge for the healthcare system. Burnout and secondary traumatic stress can lead to medical errors and impact standards of patient care, particularly compromising compassionate care. It is therefore recommended that hospitals develop psychoeducational initiatives to support professionals in dealing with barriers to compassion.info:eu-repo/semantics/publishedVersio

Objectivos Académicos e Variáveis Psicológicas em Estudantes da ESTSP-IPP: O Papel do Coping e da Regulação Emocional na Experiência com Diferentes Modelos Pedagógicos

Comunicação apresentada no 9º Congresso Nacional de Psicologia da Saúd