Empathy of medical students and personality : evidences from the five factor model

The main aim of this study was to test hypothetical associations between personality dimensions and empathy scores in medical students. The Portuguese version of NEO-FFI was administered in order to characterize participants in terms of five personality traits: Neuroticism, Extraversion, Agreeableness, Openness to Experience and Conscientiousness. Self-reported empathy measures were obtained with the Portuguese version of the Jefferson Scale of Physician Empathy (JSPE-spv), a Likert-type questionnaire specifically developed for administration in health sciences settings that measures domains such as compassionate care and perspective taking. Correlation analysis, multivariate analysis of covariance and logistic regression analysis were conducted. The results confirmed positive associations between agreeableness, openness to experience and empathy and did not support our hypothesis of negative associations between neuroticism and empathy. It is suggested that that the personality of students should be taken into account in programs to enhance empathy in undergraduate medical education.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/ESC/ 65116/2006

Validation of a wireless bluetooth photoplethysmography sensor used on the earlobe for monitoring heart rate variability features during a stress-inducing mental task in healthy individuals

Heart rate variability (HRV), using electrocardiography (ECG), has gained popularity as a biomarker of the stress response. Alternatives to HRV monitoring, like photoplethysmography (PPG), are being explored as cheaper and unobtrusive non-invasive technologies. We report a new wireless PPG sensor that was tested in detecting changes in HRV, elicited by a mentally stressful task, and to determine if its signal can be used as a surrogate of ECG for HRV analysis. Data were collected simultaneously from volunteers using a PPG and ECG sensor, during a resting and a mentally stressful task. HRV metrics were extracted from these signals and compared to determine the agreement between them and to determine if any changes occurred in the metrics due to the stressful task. For both tasks, a moderate/good agreement was found in the mean interbeat intervals, SDNN, LF, and SD2, and a poor agreement for the pNN50, RMSSD|SD1, and HF metrics. The majority of the tested HRV metrics obtained from the PPG signal showed a significant decrease caused by the mental task. The disagreement found between specific HRV features imposes caution when comparing metrics from different technologies. Nevertheless, the tested sensor was successful at detecting changes in the HRV caused by a mental stressor.This work has been funded by National funds, through the Foundation for Science and Technology (FCT) - project UIDB/50026/2020 and UIDP/50026/2020; and by the projects NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). Bruno Correia was supported by a four-year Ph. D. grant from FCT, with the reference PD/BDE/135569/2018

Referenciação tardia da ambliopia anisometrópica: estudo retrospetivo dos diferentes subtipos de ambliopia

Introduction: Amblyopia requires a timely diagnosis and treatment to attain maximum vision recovery. Specialty literature is lacking on how early amblyopia is referred. We aimed to understand if there are mean age differences at first referral for ophthalmologic tertiary center consultation among non-amblyopic and different types of amblyopia, in a context of lack of population screening.Material and Methods: In this retrospective model, the sample corresponded to all children born in Braga Hospital during 1997 - 2012 (3 - 18 years-old), with an ophthalmologic consultation in 2014. Data was collected from the clinical records and children were divided in a non-amblyopic versus amblyopic group. The amblyopic group was subdivided in strabismic versus refractive (anisometropic/bilateral).Results: The sample had a total of 1665 participants, 1369 (82.2%) without amblyopia and 296 (17.8%) with amblyopia. Among amblyopia: 67.9% (n = 201) refractive, 32.1% (n = 95) strabismic. Within refractive amblyopia: 63.7% (n = 128) anisometropic and 36.3% (n = 73) bilateral. The mean age at first consultation was 6.24 ± 3.90 years-old: 6.39 ± 3.98 for non-amblyopic and 5.76 ± 3.58 for amblyopic. Among amblyopia subgroups, there were significant differences in mean age at first consultation (F3,1250 = 8.45; p < 0.001; η2 = 0.020). Strabismic and bilateral refractive amblyopia were referred earlier, when compared to non-amblyopia or anisometropic amblyopia (p < 0.05). Anisometropic amblyopia had the highest first consultation mean age: 6.92 ± 3.57 years-old.Discussion: Without specific pre-school screening, children with amblyopia were referred to their first ophthalmologic evaluation significantly later than desired, especially anisometropic amblyopia, with a postschool mean age for first consultation. Conclusion: Recognizing high-risk children is essential for earlier referral and helps minimize future visual handicap.Introdução: A ambliopia requer uma abordagem atempada para uma máxima recuperação visual. Não existe informação sobre a idade de referenciação da ambliopia. O presente artigo pretende perceber se há diferenças na idade média de referenciação para consulta terciária de Oftalmologia, entre não-amblíopes e amblíopes, num contexto sem rastreio implementado.Material e Métodos: A amostra correspondeu a todas as crianças nascidas no Hospital de Braga entre 1997 - 2012 (3 - 18 anos de idade), com consulta de Oftalmologia em 2014. A informação foi recolhida pelos registos clínicos, tendo sido criado o grupo não-amblíope e amblíope, dividido em estrábico e refrativo (anisometrópico/bilateral).Resultados: A amostra contemplou 1665 participantes, 1369 (82,2%) não-amblíopes e 296 (17,8%) amblíopes. Dentro das ambliopias: 67,9% (n = 201) refrativas e 32,1% (n = 95) estrábicas. Nas ambliopias refrativas: 63,7% (n = 128) anisometrópicas e 36,3% (n = 73) bilaterais. A média de idades na primeira consulta foi de 6,24 ± 3,90 anos, 6,39 ± 3,98 nos não-amblíopes e 5,76 ± 3,58 nos amblíopes. Dentro dos subgrupos de ambliopia, existiram diferenças significativas na idade na primeira consulta (F3,1250 = 8,45; p < 0,001; η2 = 0,020). As ambliopias estrábicas e as refrativas bilaterais foram referenciadas mais cedo, quando comparadas com não-amblíopes ou ambliopias anisometrópicas (p < 0,05). A ambliopia anisometrópica teve a maior média de idade na primeira consulta: 6,92 ± 3,57 anos de idade.Discussão: Sem um rastreio pré-escolar específico, os amblíopes foram referenciados para a primeira observação oftalmológica significativamente mais tarde do que o desejado, especialmente a ambliopia anisometrópica, com uma idade pós-escolar de média para a primeira avaliação oftalmológica

Spousal care and pain among the population aged 65 years and older: a European analysis

Background:Spousal care is the most important source of informal care inold age.Nevertheless, despite the growing importance of this issue, the association betweenproviding spousal care inside the household and pain remains unexplored in Europe.Objective and Methods:This study aims to estimate the prevalence of pain reportedby spouse caregivers aged 65 plus that provide care inside the household and toinvestigate the association between providing spousal care and pain. Data from 17European countries that participated in wave 6 of the Surveyof Health, Aging andRetirement in Europe (SHARE) is used. The analyses are basedon 26,301 respondentsaged 65 years and older who provide informal care inside the household to theirspouse/partner exclusively (N=1,895) or do not provide any informal care (inside oroutside the household) (24,406). Descriptive statistics and multilevel logistic regressions(individual-level as level 1, and country as level 2) were performed.Results:Overall, spouse caregivers report pain more often (63.4%) than theirnon-caregiver‘s counterparts (50.3%). Important differences in the prevalence of painamong spouse caregivers were found between countries, withPortugal (80.3%), Spain(74.6%), France (73%), Italy (72.4%), and Slovenia (72.1) showing the highest prevalenceof pain, and Denmark (36%), Switzerland (41.5) and Sweden (42.3%), the lowest. Resultsfrom multilevel logistic regressions show that European individuals aged 65+who providespousal care have an increased likelihood of reporting pain(OR 1.30; CI=1.13–1.48).Conclusion:Our results suggest that in Europe, spouse caregivers aged 65+are atgreater risk of experiencing pain. Therefore, European policymakers should considerspouse caregivers as a health priority group, and take measures to ensure they receivecomprehensive health and socio-economic supportVS/2009/0562; Fundação Calouste Gulbenkian; PINFRA/22209/2016; SHARE-DEV

Clarifying changes in student empathy throughout medical school: a scoping review

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.info:eu-repo/semantics/publishedVersio

The use of multiple correspondence analysis to explore associations between categories of qualitative variables in healthy ageing

In pressPopulation studies are often characterized by a plethora of data that includes quantitative to qualitative variables. The main focus of this study was to illustrate the applicability of multiple correspondence analysis (MCA) in detecting and representing underlying structures in large datasets used to investigate cognitive ageing. Principal component analysis (PCA) was used to obtain main cognitive dimensions (based on the continuous neurocognitive test variables) and MCA to detect and explore relationships of cognitive, clinical, physical and lifestyle categorical variables across the low-dimensional space. Altogether the technique allows to not only simplify complex data, providing a detailed description of the data and yielding a simple and exhaustive analysis, but also to handle a large and diverse dataset comprised of quantitative, qualitative, objective and subjective data. Two PCA dimensions were identified (general cognition/executive function and memory) and two main MCA dimensions were retained. As expected, poorer cognitive performance was associated with older age, less school years, unhealthier lifestyle indicators and presence of pathology. Interestingly, the first MCA dimension indicated the clustering of general/executive function and lifestyle indicators and education, while the second association between memory and clinical parameters and age. The clustering analysis with object scores method was used to identify groups sharing similar characteristics within each of the identified dimensions. Following MCA findings, the weaker cognitive clusters in terms of memory and executive function comprised individuals with characteristics contributing to a higher MCA dimensional mean score (age, less education and presence of indicators of unhealthier lifestyle habits and/or clinical pathologies). MCA provided a powerful tool to explore complex ageing data, covering multiple and diverse variables, showing not only if a relationship exists between variables but also how they are related, offering at the same time statistical results can be seen both analytically and visually.EC -European Commissio

The use of canonical correlation analysis to assess the relationship between executive functioning and verbal memory in older adults

Executive functioning (EF), which is considered to govern complex cognition, and verbal memory (VM) are constructs assumed to be related. However, it is not known the magnitude of the association between EF and VM, and how sociodemographic and psychological factors may affect this relationship, including in normal aging. In this study, we assessed different EF and VM parameters, via a battery of neurocognitive/psychological tests, and performed a Canonical Correlation Analysis (CCA) to explore the connection between these constructs, in a sample of middle- aged and older healthy individuals without cognitive impairment (N = 563, 50+ years of age). The analysis revealed a positive and moderate association between EF and VM independently of gender, age, education, global cognitive performance level, and mood. These results confirm that EF presents a significant association with VM performance.This work was funded by the European Commission (FP7): “SwitchBox” (Contract HEALTH-F2-2010-259772) and co-financed by the Portuguese North Regional Operational Program (ON.2–O Novo Norte) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). P.S.M. is supported by a “MyHealth” project (Contract DoIT-13853) doctoral fel- lowship and N.C.S. by a “SwitchBox” project post-doctoral fellowship

Clinical virtual simulation in nursing education: randomized controlled trial

In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple "lecturers" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Background: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.European Regional Development Fund through the operation POCI-01-0145-FEDER-023342 funded by the Programa Operacional Competitividade e Internacionalização-COMPETE2020 and by Portuguese National Funds through Fundação para a Ciência e a Tecnologi

Discriminant power of socio-demographic characteristics and mood in distinguishing cognitive performance clusters in older individuals: a cross-sectional analysis

Objectives: Identification of predictors of cognitive trajectories has been a matter of concern on aging research. For this reason, it is of relevance to infer cognitive profiles based on rapid screening variables in order to determine which individuals will be more predisposed to cognitive decline. Method: In this work, a linear discriminant analysis (LDA) was conducted with socio-demographic variables and mood status as predictors of cognitive profiles, computed in a previous sample, based on different cognitive dimensions. Data were randomly split in two samples. Both samples were representative of the Portuguese population in terms of gender, age and education. The LDA was performed with one sample (n D 506, mean age 65.7 § 8.98 years) and tested in the second sample (n = 548, mean age 68.5 § 9.3 years). Results: With these variables, we were able to achieve an overall hit rate of 65.9%, which corresponds to a significant increment in comparison to classification by chance. Conclusion: Although not ideal, this model may serve as a relevant tool to identify cognitive profiles based on a rapid screening when few variables are available.European Commission (FP7): ‘SwitchBox’ [contract number HEALTH-F22010-259772]; Portuguese North Regional Operational Program (ON.2 O Novo Norte) under the National Strategic Reference Framework (QREN); European Regional Development Fund (FEDER).info:eu-repo/semantics/publishedVersio

A new measure to assess pain in people with haemophilia: the Multidimensional Haemophilia Pain Questionnaire (MHPQ)

People with haemophilia (PWH) experience acute pain during joint bleeds and might develop chronic pain due to joint degeneration. However, there is a lack of standardized measures to comprehensively assess pain in PWH. This study aimed to develop a multidimensional questionnaire for haemophilia-related pain, the Multidimensional Haemophilia Pain Questionnaire (MHPQ), and to present initial validation data among adults.The questionnaire distinguishes between acute/chronic pain and queries about pain locations, duration, frequency, triggering factors, intensity, interference, strategies, specialists for pain management and satisfaction with treatment. An initial version was tested with 16 patients to ensure item comprehensibility and face validity. The final version was answered by 104 adults, with 82 (78.8%) reporting haemophilia-related pain in the previous year (mean age = 43.17; SD = 13.00). The non-response analysis revealed good item acceptability. Exploratory and confirmatory factor analysis (EFA/CFA), reliability (internal consistency, test-retest, inter-item and item-total correlations) and convergent validity were analysed for the intensity and interference dimensions of the questionnaire. A combined EFA with these two constructs supported a 2-factor structure distinguishing intensity (α = 0.88) from interference items (α = 0.91). CFA was tested for the interference dimension, demonstrating suitability for this sample. Item-total correlations were >0.30 on both dimensions and most inter-item correlations were 0.30).This questionnaire is a comprehensible tool, achieving a thorough assessment of relevant pain dimensions. The MHPQ can help guide treatment recommendations by highlighting relevant topics and contributing to more effective, integrated treatments.This work is supported by a grant from the Novo Nordisk HERO Research Grant 2015. P. R. Pinto has a post-doctoral grant (SFRH/BPD/ 103529/2014) from the Portuguese Foundation of Science and Technology.info:eu-repo/semantics/publishedVersio