Helena Carvalho

Clinical profiles of stigma experiences, self-esteem and social relationships among people with schizophrenia, depressive, and bipolar disorders

Some mental illnesses and certain mental health care environments can be severely stigmatizing, which seems to be related to decreased self-esteem and a deterioration of the quality of social relationships for people with mental illness. This study aims to identify clinical profiles characterized by clinical diagnoses more strongly associated with the treatment settings and related to internalized stigma, self-esteem and satisfaction with social relationships. It also aimed to analyze associations between clinical profiles and socio-demographic indicators. Multiple correspondence analysis and cluster analysis were performed on a sample of 261 individuals with schizophrenia and mood disorders, from hospital-based and community-based facilities. MCA showed four distinct clinical profiles allowing a differentiation among levels of: internalized stigma, social relationship satisfaction and self-esteem. Overall, results revealed that internalized stigma remains a pervasive problem for some people with schizophrenia and mood disorders. Particularly, internalized stigma and social relationships dissatisfaction and associated socio-demographic indicators appear to be a risk factor for social isolation for individuals with schizophrenia, which may worsen the course of the disorder. Our findings highlight the importance to develop structured interventions aimed to reduce internalized stigma, and exclusion of those who suffer the loss of their social roles and networks.

A precarização do emprego na Europa

This article examines the hypothesis of the emergence of a post-Fordist wage relationship, exploring one of this concepts components: the transformation of permanent employment into precarious employment. Based on Eurostat data, the article analyzes the evolution of the temporary work indicator in the last twenty years and the reasons that lead workers to accept this situation, according to a generational matrix. The article concludes that there has been a structural change to the extent that all countries have moved towards greater flexibilization of employment relations through liberalization of layoffs, expansion of temporary work, or a combination of the two.

Is it a (fe)male pain? Portuguese nurses' and laypeople's gendered representations of common pains

Although many studies have explored gender role expectations of pain behaviours in different cultures, only a few authors have tried to explore whether certain pains are more associated with the typical man or woman. Hence, this study aimed at exploring, among Portuguese laypeople and nurses, patterns of common pains more strongly associated with the typical man or woman, and their relationship with health‐care training and personal pain experiences.

Internalized stigma and quality of life domains among people with mental illness : the mediating role of self-esteem

Abstract Background: People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL). Aims: To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL. Method: In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated. Results: Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains. Conclusions: Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.

Toward an understanding of the quality of life construct: Validity and reliability of the WHOQOL-Bref in a psychiatric sample.

This study tested the psychometric properties of the WHOQOL-Bref by examining its construct validity, predictive validity and reliability in a psychiatric sample. The sample consisted of 403 participants recruited from mental health care facilities. Construct validity was assessed through confirmatory factor analysis (CFA) and item-domains correlations. Predictive validity was evaluated via multiple regressions. Internal consistency was analyzed by using Cronbachs alpha. Results from CFA second-order hierarchical model and item-domain correlational analyses supported the construct validity of the WHOQOL-Bref. A 5-domain model (psychological, physical, social relationships, environment and level of independence) demonstrated good-fit and adequate internal consistency. Multiple regression analyses of the domains with overall quality of life (QOL), general health and general QOL were supportive of predictive validity. This study found support for the multidimensionality of the WHOQOL-Bref which demonstrated appropriate properties for the assessment of QOL in psychiatric inpatients and outpatients. Thus, a valuable tool to be incorporated as part of the routine clinical evaluation, monitoring and an important indicator of treatment outcome and research. Our findings suggest a conceptual distinction between the physical domain and level of independence domain in this short version of the WHOQOL, as proposed by the WHOQOL-100.

The effects of austerity measures on quality of healthcare services: a national survey of physicians in the public and private sectors in Portugal

BackgroundThe European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery.MethodsA nationwide survey of physicians’ experiences was conducted in 2013–2014 (n = 3442). We used a two-step model to compare public and private services and look at the possible moderating effects of the physicians’ specialty and years of practice. Our data analysis included descriptive statistics, the independent t test, analysis of variance (ANOVA), multivariate logistic regression, General Linear Model Univariate Analysis, non-parametric methods (bootstrap), and post hoc probing.ResultsMainly in the public sector, the policy goal of maintaining quality of care was undermined by a lack of resources, the deterioration in medical residency conditions, and to a lesser extent, greater administrative interference in clinical decision-making. Differences in public and private services showed that the effects of the austerity measures were not the same throughout the health system. Our results also showed that physicians with similar years of practice and in the same medical specialty did not necessarily experience the same pressures.ConclusionsThe debate on the effects of austerity measures should focus more closely on health workers’ concrete experiences, as they demonstrate the non-linearity between policy setting and expected outcomes. We also suggest that it is necessary to explore the interplay between lower quality and the undermining of trust relationships in health.

Os métodos quantitativos no ensino superior: uma tipologia de representações

It is often concluded that higher levels of self-confidence in pupils in relation to their ability to interact with mathematics, associated to the perception of the latter’s greater utility contributed for pupils making positive representations of this discipline. One of the objectives of this article is to inspect if in the university context this linear trend is maintained in the relation between the two dimensions — affective and instrumental — which structure the representations of the disciplines of quantitative methods. A second objective consists in observing how students from different courses (from different scientific areas) create their representations about these disciplines. A questionnaire was applied to a sample of students from a university institution. The definition of patterns of representations was done through the use of Multiple Correspondence Analysis, and Categorical Regression was employed to identify explaining factors in the students’ profile. The results show that the space of the representations of quantitative methods in a university context is marked by heterogeneity, with a complexity that goes beyond this linear trend in the relation between the utility dimension and the affective dimension. Another conclusion is about the untenability of the thesis that points (at least in a non-university context) to the feminization of the lack of self-esteem and self-confidence to deal with disciplines from this scientific area. A further conclusion is that a course culture seems to exist, insofar as the courses tend to reflect a predominant pattern of representations of the quantitative methods.

To be or not to be an excellent football referee: different experts’ viewpoints

ABSTRACT Football is central to the lives of countless individuals around the globe. While most of the attention of those passionate about the sport is focused on the players, football referees are often just as important in shaping the outcome of the games. Therefore, research is increasingly examining the role of referees. Even so, our understanding of the factors that create an excellent football referee is still scarce. Based on our analysis of the opinions of 24 football experts, we demonstrate the multidimensionality of excellence in the performance of football referees. From a Categorical Principal Components Analysis (CatPCA), we were able to pinpoint that football referee excellence is shaped by three distinct dimensions: individual preparation, game preparation and game management. Additionally, we were able to see if these perceptions were different from individuals “within” the game versus those “outside” the game. Namely, we used CatPCA to graphically display the main correlations between the latent dimensions of football refereeing performance and the “inside” and “outside” perspective of the game. The findings of our work contribute towards the knowledge of the factors that shape football referee excellence, while also highlighting areas in need of additional research attention.

Trends and consequences of the technocratic paradigm of childbirth in Portugal: a population-based analysis of birth conditions and social characteristics of parents

OBJECTIVE The aim of this paper is to analyse the evolution of birth conditions in Portugal and to establish a correspondence between maternity care and the socio-economic characteristics of new mothers. METHODS A multivariate quantitative analysis (Multiple Correspondence Analysis and Cluster Analysis) was used, based on official quantitative data from different surveys. RESULTS There is a consistent trend to a technocratic model of birth in the Portuguese context, where socio-economic characteristics appear to influence fertility rates and birth conditions. The evolution of birth conditions in Portugal reveal the institutionalisation of birth, with a strong presence of doctors, a higher frequency of births on certain weekdays, an increase in the proportion of births in private hospitals and an increase in the frequency of caesarean sections. There is an association between higher social status and more medicalised forms of assistance in childbirth. Women with higher levels of education, aged between 30 and 39years and who were married tended to be distinguished from the population of Portuguese women as a whole by three factors: birth in a hospital, the standardisation of pregnancy duration and the presence of a doctor at the birth. Womens educational and professional status also appears to influence their adoption of alternative models of birth, however, such as home birth. DISCUSSION Limiting the study of childbirth to its medical aspects leaves important dimensions out of the analysis: womens perception of birth-related risks associated with the medicalised offer of maternity care, and the implications of this childbirth paradigm for health outcomes and for future care.

Psychometric assessment of the "child surgery worries questionnaire" among Portuguese children

Worries are common in surgical patients, especially in children. The present study analyzed the factor structure and the psychometric properties of a Portuguese version of the Child Surgery Worries Questionnaire (CSWQ-P) in a Portuguese sample of 490 children. Exploratory factor analysis, conducted via principal axis factoring with oblimin rotation, provided evidence for a four-factor structure of the 21 item questionnaire. A confirmatory factor analysis was also conducted, showing the good fit of this solution. The CSWQ-P proved to have one more subscale than the original Spanish version CSWQ. Correlations with the children’s trait anxiety provided evidence of convergent validity for the CSWQ-P. Females also scored higher on worries than males on all subscales. Psychometric properties of this revised version of the CSWQ provided support for use with young children, and indicate the CSWQ-P has value for use in healthcare practice and in clinical research.