Estresse ocupacional e satisfação dos usuários com os cuidados de saúde primários em Portugal

The Portuguese primary healthcare sector has suffered changes due to a reform on the lines of the conceptual framework referred to by some authors as "New Public Management." These changes may be generating higher levels of occupational stress with a negative impact at individual and organizational levels. This study examines the experience of stress in 305 health professionals (physicians, nurses and clinical secretaries) and satisfaction with the services provided by them from 392 users. The population under scrutiny is taken from 10 type A and 10 type B Family Health Units (FHU). The results show that 84.2% of professionals report moderate to high levels of occupational stress with the nurses being those with higher levels. Users reported good levels of satisfaction, especially with the nursing services. There were no differences in stress level between type A and type B FHU, though there were at the level of user satisfaction of type B FHU users who show higher levels of satisfaction. It was seen that dimensions of user satisfaction were affected by stress related to excess work.info:eu-repo/semantics/publishedVersio

High-definition tDCS of the temporo-parietal cortex enhances access to newly learned words

Learning associations between words and their referents is crucial for language learning in the developing and adult brain and for language re-learning after neurological injury. Non-invasive transcranial direct current stimulation (tDCS) to the posterior temporo-parietal cortex has been suggested to enhance this process. However, previous studies employed standard tDCS set-ups that induce diffuse current flow in the brain, preventing the attribution of stimulation effects to the target region. This study employed high-definition tDCS (HD-tDCS) that allowed the current flow to be constrained to the temporo-parietal cortex, to clarify its role in novel word learning. In a sham-controlled, double-blind, between-subjects design, 50 healthy adults learned associations between legal non-words and unfamiliar object pictures. Participants were stratified by baseline learning ability on a short version of the learning paradigm and pairwise randomized to active (20 mins; N = 25) or sham (40 seconds; N = 25) HD-tDCS. Accuracy was comparable during the baseline and experimental phases in both HD-tDCS conditions. However, active HD-tDCS resulted in faster retrieval of correct word-picture pairs. Our findings corroborate the critical role of the temporo-parietal cortex in novel word learning, which has implications for current theories of language acquisition

Effects of Transcranial Direct Current Stimulation on Episodic Memory Related to Emotional Visual Stimuli

The present study investigated emotional memory following bilateral transcranial electrical stimulation (direct current of 1 mA, for 20 minutes) over fronto-temporal cortical areas of healthy participants during the encoding of images that differed in affective arousal and valence. The main result was a significant interaction between the side of anodal stimulation and image emotional valence. Specifically, right anodal/left cathodal stimulation selectively facilitated the recall of pleasant images with respect to both unpleasant and neutral images whereas left anodal/right cathodal stimulation selectively facilitated the recall of unpleasant images with respect to both pleasant and neutral images. From a theoretical perspective, this double dissociation between the side of anodal stimulation and the advantage in the memory performance for a specific type of stimulus depending on its pleasantness supported the specific-valence hypothesis of emotional processes, which assumes a specialization of the right hemisphere in processing unpleasant stimuli and a specialization of the left hemisphere in processing pleasant stimuli. From a methodological point of view, first we found tDCS effects strictly dependent on the stimulus category, and second a pattern of results in line with an interfering and inhibitory account of anodal stimulation on memory performance. These findings need to be carefully considered in applied contexts, such as the rehabilitation of altered emotional processing or eye-witness memory, and deserve to be further investigated in order to understand their underlying mechanisms of action

Factor graph based detection approach for high-mobility OFDM systems with large FFT modes

In this article, a novel detector design is proposed for orthogonal frequency division multiplexing (OFDM) systems over frequency selective and time varying channels. Namely, we focus on systems with large OFDM symbol lengths where design and complexity constraints have to be taken into account and many of the existing ICI reduction techniques can not be applied. We propose a factor graph (FG) based approach for maximum a posteriori (MAP) symbol detection which exploits the frequency diversity introduced by the ICI in the OFDM symbol. The proposed algorithm provides high diversity orders allowing to outperform the free-ICI performance in high-mobility scenarios with an inherent parallel structure suitable for large OFDM block sizes. The performance of the mentioned near-optimal detection strategy is analyzed over a general bit-interleaved coded modulation (BICM) system applying low-density parity-check (LDPC) codes. The inclusion of pilot symbols is also considered in order to analyze how they assist the detection process

Transcranial alternating current stimulation (tACS) at 40 Hz enhances face and object perception

Neurophysiological evidence suggests that face and object recognition relies on the coordinated activity of neural populations (i.e., neural oscillations) in the gamma-band range (> 30 Hz) over the occipito-temporal cortex. To test the causal effect of gamma-band oscillations on face and object perception we applied transcranial Alternating Current Stimulation (tACS) in healthy volunteers (N = 60). In this single-blind, sham-controlled study, we examined whether the administration of offline tACS at gamma-frequency (40 Hz) over the right occipital cortex enhances performance of perception and memory of face and object stimuli. We hypothesized that gamma tACS would enhance the perception of both categories of visual stimuli. Results, in line with our hypothesis, show that 40 Hz tACS enhanced both face and object perception. This effect is process-specific (i.e., it does not affect memory), frequency-specific (i.e., stimulation at 5 Hz did not cause any behavioural change), and site-specific (i.e., stimulation of the sensory-motor cortex did not affect performance). Our findings show that high-frequency tACS modulates human visual perception, and it is in line with neurophysiological studies showing that the perception of visual stimuli (i.e., faces and objects) is mediated by oscillations in the gamma-band range. Furthermore, this study adds insight about the design of effective neuromodulation protocols that might have implications for interventions in clinical settings

Managerial nursing competencies in the expansion of the Family Health Strategy

Abstract OBJECTIVE To relate the managerial competencies required of nurses with the process of change experienced in the expansion of the Family Health Strategy (FHS). METHOD A qualitative research conducted in primary health care in a southern Brazilian city, through interviews with 32 managerial and clinical nurses. The interviews were processed by IRAMUTEQ software. The resulting classes were examined under five managerial competencies to promote change. RESULTS The four classes obtained from data were: the Family Health Strategy expansion process; confrontations and potentialities; mobilization for the change; innovations in medical and nursing consultations. The classes were related to one or more competencies. CONCLUSION The expansion of the Family Health Strategy requires managerial competencies of implementing and sustaining change, negotiating agreements and commitments, using power and influence ethically and effectively, sponsoring and selling new ideas, and encouraging and promoting innovation