It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four different umbilical artery pH cutoffs were considered for fetuses' classification into acidemic or non-acidemic: 7.05, 7.10, 7.15, and 7.20. The area under the receiver operating characteristic curve (AUROC) was used to quantify the frequency bands' ability to distinguish acidemic fetuses. Bands referring to low frequencies, mainly associated with neural sympathetic activity, were the best at detecting acidemic fetuses, with the more severe definition (pH ≤ 7.05) attaining the highest values for the AUROC. This study shows that the power spectrum analysis of the fetal heart rate is a simple and powerful tool that may become an adjunctive method to CTG, helping healthcare professionals to accurately identify fetuses at risk of intrapartum hypoxia and to implement timely obstetrical interventions to reduce the incidence of related adverse perinatal outcomes.

Funding Acknowledgements Type of funding sources: None. Introduction Heart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index.  Results Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and self-care confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better self-care, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p < 0.000; SCMt with SCC: r = 0.272, p < 0.000 and SCMg with SCC: r = 0.670, p < 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p < 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them).  Conclusion The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Contexto/Introdução: Os programas de reabilitação cardíaca (RC), nas suas diferentes fases, permitem ao enfermeiro especialista em enfermagem de reabilitação (EEER), ter uma intervenção privilegiada no acompanhamento e cuidado à pessoa transplantada ao coração, desde a fase pré-operatória, no período de recuperação pós-operatório mediato e tardio. Contribui para a promoção da autonomia e autocuidado da pessoa e sua família, na adaptação à nova condição de saúde e no aumento da sua qualidade de vida, intervindo nas diversas alterações psicológicas e fisiológicas decorrentes do transplante, sendo a reabilitação cardíaca uma opção terapêutica vantajosa neste contexto. Objetivo: Analisar os ganhos em saúde potenciados pela Enfermagem de Reabilitação num Programa de Reabilitação cardíaca em domicílio. Estratégias/metodologia: Relato de caso de abordagem mista, com a integração de 7 casos. Foram incluídas Pessoas transplantadas ao coração que nunca integraram programa de reabilitação cardíaca (PRC), manifestando alterações na capacidade funcional. Foram definidas como variáveis as seguintes características dos doentes: tempo de transplante, idade, género e medidas antropométricas. Foram avaliados parâmetros fisiológicos como frequência cardíaca (FC), tensão arterial (TA), perceção subjetiva de esforço (PSE) pela escala de Borg modificada e teste de marcha de 6 minutos, em 2 momentos de consulta de seguimento, com 3 meses de intervalo. No primeiro momento, após avaliação foi prescrito PRC em modelo Home-based. Foram efetuados contactos telefónicos e por correio eletrónico para perceber as dificuldades sentidas, bem como nível de cumprimento do programa. A mensuração de resultados foi efetuada num segundo momento de contacto. Principais resultados: A integração no PRC proporcionou melhoria da capacidade de funcional, com 85,71% dos casos em estudo com incremento clinicamente significativo da distância no teste de marcha de 6 minutos, existindo uma melhoria da noção subjetiva de esforço em 57,14% das pessoas. Foram registadas melhorias do status dos diagnósticos de enfermagem comuns identificados, nomeadamente na Intolerância à atividade ausente; Autocuidado: atividade física não comprometido. Foi ainda registada melhoria do controlo de fatores de risco cardiovascular, como alimentação, stress, entre outros, todos os doentes alteraram parte do seu plano alimentar traduzindo-se em Adesão ao regime dietético não comprometida. No que se refere à qualidade de vida,100% dos doentes apresentam discursos favoráveis à melhoria da qualidade de vida relacionada ao programa e acompanhamento. Não foram verificados eventos adversos durante o programa. Conclusões: Neste estudo percebe-se que a participação em fase III de PRC é segura e traduz melhoria da capacidade funcional, maior capacidade de adesão ao regime dietético e controlo de fatores de risco cardiovascular, estando associada a discursos positivos da qualidade de vida. Descritores: Transplante cardíaco, Reabilitação cardíaca; Enfermagem de Reabilitação

The European Health Data Space (EHDS) proposal aims to establish a set of rules and governance frameworks to promote the use of electronic health data for both primary and secondary purposes. This study aims at analysing the implementation status of the EHDS proposal in Portugal, particularly the points concerning the primary use of health data. The proposal was scanned for the points that gave member states a direct responsibility to implement actions, and a literature review and interviews were conducted to assess the implementation status of these policies in Portugal This study found that Portugal is well advanced in the implementation of policies concerning the rights of natural persons in relation to the primary use of their personal health data, but also identified challenges, which include the lack of a common interoperability framework for the exchange of electronic health data.