Millenium - Journal of Education, Technologies, and Health

Acute Stroke in northern Portugal: outcomes and characteristics of patients in a Medical-Surgical Emergency Department

Sandra Domingues — 2025-01-17

Introduction: Stroke is a leading cause of morbidity and long-term disability worldwide, significantly impacting health systems and personal lives. Disparities in European access to stroke care suggest an increased burden on individuals and society. Effective management of acute stroke in emergency departments is critical, requiring a rapid and coordinated response to optimize clinical outcomes.

Objective: Characterize the hospital approach to acute stroke patients attended through the Stroke Pathway (Via Verde AVC) protocol in a Medical-Surgical Emergency Department in northern Portugal.

Methods: Retrospective observational study of 1153 patients admitted through the Acute Stroke Care Pathway from 2019 to 2023. Data on patient demographics, clinical characteristics, treatments, and outcomes were collected from electronic medical records. Statistical analysis included chi-square tests, ANOVA, Kruskal-Wallis tests, trend analysis, and logistic regression.

Results: Stroke Pathway activations increased from 0.28% in 2019 to 0.31% in 2023 (p<0.05). Ischemic stroke was most common (64.8%, 95% CI: 62.1-67.4%). Thrombolysis rates increased from 21.96% to 27.27% (p<0.01), and thrombectomy from 4.67% to 21.21% (p<0.001). Age >70 years (OR 1.8, 95% CI: 1.3-2.5) and arrival within 3 hours (OR 2.3, 95% CI: 1.7-3.1) predicted reperfusion therapy. Female patients surpassed males in 2023 (51.01% vs 48.99%).

Conclusion: The Emergency Department demonstrated improvement in acute stroke care. Enhanced systematic data recording and new technologies are needed to optimize care. Future research should focus on long-term outcomes and quality-of-life measures.

Obstetric violence assessment scale: development and validation

Márcio Tavares — 2025-02-13

Introduction: Obstetric violence has been the subject of debate among health professionals and in the media.

Objective: Develop and validate an instrument to measure women's obstetric violence perception of labor and delivery experience.

Methods: Based on the recommendations of the WHO, a scale composed of 38 statements was elaborated. The evaluation of the metric properties of the developed scale was carried out through an exploratory and confirmatory factor analysis involving 615 women.

Results: The final version of the scale, composed of 10 items, presented adequate adjustment indexes. The best quality model is composed of two dimensions (emotional and physical) (X²(34) = 150.946; p < 0.001, X²df = 4.440; CFI = 0.93; TLI = 0.88; GFI = 0.95; RMSEA = 0.07, p <0.001). The results revealed that the scale presents adequate internal consistency, in which the evaluation of exploratory factor validity verifies a good correlation between the variables. After analyzing the invariance of the type of calving, there was no metric invariance; however, the scalar invariance is sustainable.

Conclusion: The results demonstrate that the scale is adequate to assess the perception of obstetric violence in the experience of labor and delivery.

Social value of research in pediatric interdisciplinary teams addressing special health needs

Jenifer Villa-Velásquez — 2025-02-05

Introduction: Ethical guidelines highlight the importance of social value in research. However, there is little analysis regarding what constitutes social value at a practical level, especially in contexts of care for special health needs.

Objective: To analyze the social value of research in interdisciplinary work teams of children with special health needs.

Methods: Integrative review, consulting the PubMed, Web of Science SCOPUS, CINAHL, and VHL databases in April 2024. Original articles in Portuguese, English, and Spanish were included without temporal discrimination. 21 articles were selected, and content analysis was performed. The elements present in the approach to social value were grouped according to reference points of this principle, according to Ezekiel Emanuel's perspective.

Results: The need to strengthen mechanisms to increase social value is evident through strong and continuous collaborative partnerships, with the purpose of generating greater impact in the implementation of interdisciplinary work.

Conclusion: The need to develop strategies that encourage collaboration between partners involved in research is confirmed, as well as to expand dissemination outside the academic field, thereby concretizing and increasing social value.

Effects of physiotherapy on pelvic function and quality of life in women with urinary incontinence – a systematic review

Elisabete Matos — 2025-01-03

Introduction: In recent years, pelvic floor physiotherapy, namely pelvic floor muscle training (PFMT) has shown a high importance in women with urinary incontinence (UI), optimizing pelvic function and quality of life (QoL).

Objective: Evaluate the effects of pelvic floor physiotherapy on pelvic function and QoL in women with UI.

Methods: Computerized search in the databases Pubmed, Scopus, and Web of Science, using the combination of keywords: Physiotherapy; Urinary Incontinence; QoL,in accordance with PRISMA guidelines. The methodological quality was analysed using the Physiotherapy Evidence Database (PEDro) scale.

Results: Nineteen articles meeting the eligibility criteria were included with a total of 2253 participants and an arithmetic mean of 8.4/10 on the PEDro scale. PFMT interventions showed positive effects on QoL, as well as in decreasing involuntary urine loss and increasing pelvic floor muscle strength. In addition, PFMT combined with biofeedback, electrotherapy or Pilates training seemed to reveal significant effects.

Conclusions: PFMT is an effective treatment for UI in women. PFMT significantly improves QoL in women with UI, a determinant factor for physical, mental, and social conditions.

Care of preterm newborn’s sleep in the Neonatal Intensive Care Unit

Manuel Sousa e Cunha — 2024-01-03

Introduction: Sleep plays an important role in brain development and synaptic plasticity and has implications for neurodevelopment.

Assessment of NB’s behavioral states (sleeping and awake) is the first step to protecting sleep in premature babies and optimizing the neurodevelopment process.

Objective: The main objective of the present study investigation is to analyze the implementation of a bundle of care in the neonatal unit concerning preterm newborn sleep and its influence on the length of hospital stay.

Methods: This is an exploratory descriptive study carried out in a Portuguese NSCU. We describe the different standardized care strategies implemented, in response to the demands of Joint Commission International in patient care and also to the concerns of health professionals in this area.

Results: Applying care and strategies to improve sleep quality in the studied timeframe, we did not find significant differences in the profile of hospitalized patients, and this procedure did not lead to an increase in the length of hospital stay.

Conclusion: Professionals have a vital role in implementing strategies that promote sleep in premature babies in the NICU and in interventions that have a positive effect on the quality of sleep of these newborns. It is necessary to include and train parents in the effort to promote sleep development in the NSCU so that they maintain these interventions after hospital discharge.

Behaviors and strategies in clinical leadership in nursing: scoping review

Olga Moura Ramos — 2025-02-14

Introduction: Clinical leadership in nursing refers to the demonstration of informal leadership skills and behaviors by nurses in clinical practice. It contributes to the construction of innovative and structured healthcare models, which result in the continuous improvement of the quality of care and the satisfaction of health needs.

Objective: Mapping the scientific evidence on the behaviors of clinical nurse leaders and the strategies that promote clinical nursing leadership in healthcare organizations.

Methods: Scoping review according to the guidelines of the Joanna Briggs Institute. The search was completed in MEDLINE Complete, CINAHL Complete, Scopus, Web of Science, ProQuest and Repositório Científico de Acesso Aberto de Portugal. Primary studies published in Portuguese, English or Spanish were included.

Results: A total of 2407 records were identified, of which 24 were included in the review. 47 clinical leadership behaviors in nursing and 18 strategies to promote these behaviors were identified (strategies related to the nurse (n=3), the multi-professional team (n=5), the healthcare organization (n=8) and entities external to the healthcare organization (n=2)). Most of the behaviors are task-oriented (n=25), with behaviors related to clinical practice prevailing (n=18).

Conclusion: Leadership behaviors are associated with effective communication skills, decision making, clinical experience, support, mentoring, education and team building. Strategies should be defined to facilitate the development and enhancement of leadership behaviors in clinical practice.

Palliative care for patients with heart failure in critical care: scoping review

Fábio Pousinho — 2025-02-13

Introduction: Heart failure is a chronic disease that affects thousands of people around the world. At some stage of their illness, these people need critical care. Palliative care is essential throughout the illness.

Objetive: To map the evidence on palliative care for people with heart failure in critical care.

Methods: A scoping review was carried out according to the methodology proposed by the Joanna Briggs Institute. The search was carried out in the electronic databases MEDLINE Complete (via EBSCO); CINAHL (via EBSCO); Pubmed, Web-of-science and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP, via b-on).

Results: 10 sources of evidence were included in this review. The results were grouped into 2 categories - palliative care in the emergency department and palliative care in the intensive care unit. Eight subcategories were identified: identification of the need for PC; symptom control; communication, decision-making, and advance care planning; management of implantable cardiac devices and ventricular assistance; the dying process; culturally sensitive care; definition of prognosis; bioethical principles and informed consent.

Conclusion: Critical care settings are the places where people with heart failure turn to for help with their illness. There are specific interventions for each context that can increase people's quality of life.

Continuing professional development of physical education teachers through collaborative professional reflection

Nataliia Mukan — 2025-01-17

Introduction: This paper explores the pivotal role of continual reflection and collaboration for physical education teachers in advancing their professional development. The study focuses on the effectiveness of Gibbs Model and Glatthorn's collegial growth paradigm in enhancing teachers' self-reflection abilities.

Objective: Assess the impact of collaborative group reflection on physical education teachers' professional development, utilizing Gibbs Model and Glatthorn's collegial growth paradigm. The study aims to measure changes in reflective practices and identify factors influencing teacher participation in collaborative reflection.

Methods: The research employed pre- and post-self-assessed reflective questionnaires, focus group discussions, and peer observations. A Likert scale questionnaire measured changes in reflective skills, while focus group discussions provided qualitative insights. Peer observation rubrics assessed various teaching criteria.

Results: Findings indicate collaborative group reflection as a valuable tool for professional development, despite challenges like time constraints. The study emphasizes leadership and peer support as positive outcomes. Quantitative analysis showed a significant increase in the level of reflection among participating teachers.

Conclusion: The paper underscores the importance of collaboration in fostering efficient reflection for professional development among physical education teachers. Recommendations include incorporating stages from Gibbs's Reflection Cycle and Glatthorn's collegial growth paradigm in professional development programs. Rigorous analysis, including the chi-square test for independence and content analysis, ensured the validity and reliability of the study's findings, facilitating a comprehensive interpretation of the results.

Exploring economic behavior among students: a review of key determinants

Bagus Shandy Narmaditya — 2025-02-13

Introduction: Understanding economic behaviour will be beneficial for students to manage their economy and finances while they are living apart from their parents.

Objective: This systematic literature review was provided to identify factors linked to the economic behaviour of students. Methods: The systematic review of the literature was performed according to the criteria of the Preferred Reporting Items for Systematic Reviews using PRISMA guidelines. This paper followed a systematic review process using two databases, including Scopus and Web of Science, from 2017 onward.

Results: The findings performed several factors that can predict students’ economic behaviour, including family education, economic literacy, digital literacy, education in schools, lifestyle, and psychological factors. This paper also mentioned that the economic behaviour of students can be proxied into three activities, covering consumption, entrepreneurship, and finance behaviour.

Conclusion: The study identified key factors of economic behaviour, which academics and policy researchers can use to determine variables to improve students' economic behaviour.

AI in research, education, and practice of structural and earthquake engineering - a reflection on impacts, challenges, and future directions

Tiago Ferreira — 2025-01-02

The fields of structural and earthquake engineering are critical in ensuring the safety and resilience of our built environment, particularly as global challenges such as urbanization, climate change, and disaster preparedness become increasingly urgent (Ferreira & Santos, 2024). In recent years, the integration of engineering with artificial intelligence (AI), machine learning (ML), and deep learning (DL) has begun to reshape traditional paradigms. These technologies offer new opportunities to automate processes, enhance predictive accuracy, and optimize designs, paving the way for more efficient, adaptive, and sustainable engineering practices.

Despite its transformative potential, the adoption of AI in structural and earthquake engineering remains relatively underutilized compared to other fields (Tapeh & Naser, 2023; Xie et al., 2020). Traditional mechanics-based methodologies continue to dominate the field, and it remains to be seen how AI-driven approaches will coexist with these established practices, particularly in the professional and educational contexts. Some skepticism surrounding AI’s perceived opacity—often viewed as a "black box" compared to the transparency of experimental, numerical, and analytical methods—further complicates its integration. However, AI’s unparalleled ability to process extensive datasets, execute computationally intensive tasks, and adapt to real-time conditions presents significant opportunities for innovation.

In this editorial, I aim to provide a concise yet comprehensive reflection on AI's current state and transformative potential in structural and earthquake engineering. By looking at its impacts across research, education, and practical implementation, I hope to highlight some opportunities and challenges for AI integration. Furthermore, I will emphasize pressing concerns, such as the importance of fostering interdisciplinary collaboration and addressing the significant environmental footprint of AI technologies—an aspect that, in my view, has not received the attention it deserves.