Proceedings of the 4th IPLeiria’s International Health Congress (2024)

P1 Prevalence of low back pain in surfers: associated factors

Beatriz Minghelli^1,2, Inês Sousa¹, Sara Graça¹, Sofia Queiroz¹, Inês Guerreiro¹

¹School of Health Jean Piaget – Algarve, Instituto Piaget de Silves, 8300-025 Silves, Portugal; ²Research in Education and Community Intervention, Piaget Institute, 1950-157 Lisbon, Portugal

Correspondence: Beatriz Minghelli (beatriz.minghelli@silves.ipiaget.pt)

Background

Paddling in surf consists on the movement that the surfer most performs during practice, and this repeated movement, associated with a spinal hyperextension posture, may predispose to the occurrence of injuries.

Objective

The aim of this study was to verify the prevalence of low back pain in surfers, and its associated factors.

Methods

The sample consisted of 50 Algarve surfers, 40 (80%) males, aged between 9 and 57 years (24.26 ± 12.41 years). The measurement instruments consisted on a questionnaire and on the use of the KINOVEA software for movement analysis. The questionnaire contained questions about the socio-demographic characteristics of the population and about the occurrence of low back pain (at the moment, over a 12-month period and during all surfing practice). Surfers were demarcated with a tape on D8 and at the base of the sacrum. Surfers were filmed while performing the paddling movement, in the sea, using their own boards. The movement movies recorded were analysed. A line was drawn between two points, while another line was projected on the board, establishing an angle. Data analysis was performed through the application of binary logistic regression, the method entered used as a binary outcome variable for the prevalence of low back pain during all surfing practice.

Results

8 (16%) surfers reported low back pain at the moment of data collection, 16 (32%) reported low back pain in the last 12 months, and 23 (46%) surfers reported that they had felt low back pain throughout all their surfing practice. Spinal hyperextension angles varied between 14^o and 38^o (23.04^o ± 4.73^o). Female surfers presented a higher risk of sustaining surfing-related injuries than males (odds ratio= 1.36; 95%CI: 0.33-5.55; p= 0.671), individuals who had surfed for less than five years were at 2.6 (95%CI: 0.82-8.20; p = 0.103) more risk than those who had surfed for more than 5 years, surfers with ages equal or upper to 18 years revealed 1.15 (0.38-3.49; p= 0.811) odds than younger surfers, those who didn’t participate in the championships had 1.57 (0.50-4.83; p= 0.442) more chances compared to those who participated, and surfers with an spinal hyperextension angulation above 23^o revealed 1.04 (0.34-3.19; p = 0.945) to be more likely to develop low back pain.

Conclusions

There was a high prevalence of low back pain in the surfers analysed. Thus, it is necessary to have a better biomechanical analysis of the paddle movement of surfing.

Keywords

Low back pain, Prevalence, Surf.

P2 Assessment risk of work-related musculoskeletal disorders according to the RULA method in Nurses

Paula C Santos^1,2, Sofia Lopes^1,3,4, Vanessa Silva¹, Pedro Norton⁵, João Amaro⁵, Cristina Mesquita^1,4

¹Department of Phisioterapy, School of Allied Health, Polytechnic Institute of Porto, 4050-313 Porto, Portugal; ²Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4050-313 Porto, Portugal; ³Escola Superior de Saúde de Vale de Sousa, 4585-116 Gandra, Portugal; ⁴Centro de Estudos do Movimento e Atividade Humana, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ⁵Centro Hospitalar de São João, 4200-319 Porto, Portugal

Correspondence: Cristina Mesquita (ctmesquita@ess.ipp.pt)

Background

In what concerns Occupational Health, the most recurrent injuries are musculoskeletal disorders, which are frequently associated with risk factors, such as, repetition of the task and handling of loads. Among health professionals, nurses are the most affected.

Objective

This study evaluates work-related musculoskeletal disorders (WMSDs) in nurses from a central hospital, using the Rapid Upper Limb Assessment (RULA) method.

Methods

This is an observational, cross-sectional study with a sample of 34 nurses from the surgery department. Collections were made through the observation of tasks performed by nurses when applying the RULA. The final score was associated with the need for intervention, for prevention of WMSDs varying between 1 and 7; no intervention is required and immediate intervention is required, respectively. Descriptive analysis of the partial and final scores, as well as the Mann-Whitney test, the Fisher exact test and the chi- square test were performed.

Results

The tasks with the highest risk were bed hygiene and transfers. Among the evaluated tasks, the majority of the final scores obtained were 6 and 7, which refers to a need for intervention soon or immediately, respectively. There were no significant associations between the risk of injury and gender, age or length of service.

Conclusions

It was concluded that most of the tasks performed by nurses presented a high final score, according to the RULA method, and the body segments with the highest risk are shoulders, neck and trunk, suggesting the need for immediate intervention.

Keywords

Musculoskeletal disorders, RULA, Occupational Health.

P3 After disaster: conceptualising the extent and length of the psychological impact

Alice Morgado (alice.morgado@northampton.ac.uk)

University of Northampton, Northampton, NN2 6JU, United Kingdom

Background

Psychosocial responses to disasters have been widely explored in psychological and psychiatric literature. However, some issues have not yet been clarified with regards to conceptualizing disasters and addressing the long-term effects of disasters through a perspective focused on developmental and positive psychology principles.

Objective

The aim of this study is to explore existing research regarding psychological dimensions of exposure to disaster.

Methods

A literature review was conducted focusing on disaster conceptualisations and long-term adaptive functioning of those who have and have not been identified as individuals at risk for adverse outcomes. Focusing on conceptions of disaster and trauma, the extent of the impact in different populations was also considered, along with existing knowledge regarding reactions to disaster and possible factors involved.

Results

There has been significant effort in designing immediate and short-term relief and assistance in disasters, addressing the most common effects of exposure to trauma [1-3]. Developmental considerations have outlined differential psychological outcomes through the lifespan [4-7]. An important body of research has focused on resilience in relation to trauma [8-11], nevertheless, studies regarding long-term consequences and adaptive functioning are still scarce [12]. Efforts seem to focus more on preventing relatively immediate severe symptoms of psychopathology [13, 14] rather than on promoting long-term psychological adjustment.

Conclusions

Research aimed at understanding the long-term psychological effects of exposure to disasters, looking at individuals who showed and did not show psychopathology following that incident seems a sensible topic to be developed. Aiming to understand how individuals in different life stages deal with adversity and to design interventions able to support individuals in dealing with the less visible long-term effects of trauma is equally important. In addition, to focusing on the absence of psychopathology, researchers should have in mind the promotion of positive development throughout the life-span.

Researchers should develop measures that assess exposure to disaster/trauma, taking into consideration not only the type of event, dates and duration, but also the type of exposure and involved stressors, attempting to capture disaster exposure in its complexity. At the same time, research should acknowledge the importance of the meaning that individuals attribute to an event and its consequences, more than the event itself [2, 3], and consider perceived individual, family and community resources in relation to it.

References

1. Briere, J & Elliott, D. Prevalence, characteristics, and long-term sequelae of natural disaster exposure in the general population. Journal of Traumatic Stress. 2000, 13: 661-679.

2. Norris, F H & Wind, L H. The experience of disaster: Trauma, loss, adversities, and community effects. In Y Neria, S Galea & F H Norris (eds.) Mental health and disasters. Cambridge: Cambridge University Press. 2010. pp.29-44.

3. Park, C L. Meaning making in the context of disasters. Journal of Clinical Psychology. 2016, 72: 1234-1246.

4. Gurwitch, R H et al. When disaster strikes: Responding to the needs of children. Prehospital and disaster medicine. 2004, 19:21-28.

5. Reijneveld, S A, Crone, M R, Verhulst, F C, & Verloove-Vanhorick, S P. The effect of a severe disaster on the mental health of adolescents: A controlled study. The Lancet. 2003, 362: 691-696.

6. Vernberg, E M, Hambrick, E P, Cho, B, & Hendrickson, M L. Positive psychology and disaster mental health: Strategies for working with children and adolescents. Journal of Clinical Psychology. 2016, 72: 1333-1347.

7. Wooding, S & Raphael, B. Psychological impact of disasters and terrorism on children and adolescents: Experiences from Australia. Prehospital and disaster medicine. 2004, 19: 10-20.

8. Bonanno, G A, & Gupta, S. Resilience after disaster. In Y Neria, S Galea, & F H Norris (eds.) Mental health and disasters. Cambridge: Cambridge University Press. 2010. pp.145-160.

9. Cox, R S, Perry, K E. Like a fish out of water: Reconsidering disaster recovery and the role of place and social capital in community disaster resilience. American Journal of Community Psychology. 2011, 48: 395-411.

10. Norris, F H, Stevens, S P, Pfefferbaum, B, Wyche, K F, & Pfefferbaum, R. Community resilience as a metaphor, theory, set of capacities, and strategy for disasterreadiness. American Journal of Community Psychology. 2008, 41: 127-150.

11. Schulenberg, S E. Disaster mental health and positive psychology – Considering the context of natural and technological disasters: An introduction to the special issue. Journal of Clinical Psychology. 2016, 72: 1223-1233

12. Juen, B. State of the art on psychosocial interventions after disasters. Communication at OPSIC (Operationalising Psychossocial Support In Crisis). Tel Aviv, 13th January, 2014.

13. Briere, J & Elliott, D. Prevalence, characteristics, and long-term sequelae of natural disaster exposure in the general population. Journal of Traumatic Stress. 2000, 13: 661-679.

14. North, C S. Current research and recent breakthroughs on the mental health effects of disasters. Current Psychiatry Reports. 2014, 16: 481-489.

Keywords

Disaster, Psychological impact, Trauma, Resilience, Development.

P4 Evaluation of Portuguese athletes knowledge regarding doping in sports

Marco Jardim¹, André Ruivo², Catarina Jesus³, David Cristovão

¹School of Helth, Polytechnic Institute of Setúbal, 2915-503 Setúbal, Portugal; ²Portuguese Sports Physiotherapy Interest Group, Portuguese Association of Physiotherapists, 2785-679 São Domingos de Rana, Portugal; ³Hospital de Loulé, 8100-503 Loulé, Portugal

Correspondence: Marco Jardim (marco.jardim@ess.ips.pt)

Background

Doping is no longer an exclusive issue in sports and has been recognized as a worldwide public health problem. A relevant part of doping violations has been discovered in athletes from all ages and every competitive level often motivated by their limited knowledge about doping in sports. Portuguese athlete’s knowledge about doping rules violations is far to be known and an accurate picture about their state of knowledge seems to be an important factor to develop effective educational anti-doping programs.

Objective

The purpose of this study was to evaluate the knowledge of Portuguese athletes towards doping in sports, regarding substances and methods on the prohibited list, health consequences, athletes’ rights and responsibilities and doping control procedures.

Methods

A cross sectional study was performed in several Portuguese sport institutions. A total of 374 non-professional athletes (83% response rate) were evaluated about knowledge on doping in sports. Self-administrated and pretested questionnaire was used to collect sociodemographic data and doping knowledge. Descriptive statistics were carried out to express athlete’s sociodemographic information and mean doping knowledge score. Chi square tests were used to assess the association between study variables and doping knowledge questions. Inferential statistics (Mann–Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables.

Results

Only 21% of the athletes demonstrated good global knowledge on doping. The overall mean knowledge on doping was 56.8 ± 13.8 were the highest mean knowledge area was observed on rights and responsibilities’ (62.7 ± 21.5), while the lowest was perceived on doping control procedures (54.0 ± 18.4). Higher global knowledge on doping was associated with female athletes, aged between 19-21 years with university educational level. No differences were found between team sports and individual sports athletes.

Conclusions

No national-level data had been reported so far and this study can provide useful information regarding gaps and trends about doping practices in the country. Doping knowledge among the participants was poor, particularly in terms of prohibited substances and doping control procedures. The results of this study suggest that educational anti-doping programs should be intensified and more effective amongst Portuguese sports populations.

Keywords

Public Health, Doping, Doping Knowledge, Sports Population, Education, Portugal.

P5 Do children with Specific Language Impairment (SLI) present implicit learning (IL) deficits? Evidence from an Artificial Grammar Learning (AGL) paradigm

Ana P Soares¹, Andreia Nunes¹, Paulo J Martins², Marisa Lousada³

¹Psychology Research Center, School of Psychology, University of Minho, 4710-057 Braga, Portugal; ²Center for Humanistic Studies of the University of Minho, University of Minho, 4710-057 Braga, Portugal; ³Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Ana P Soares (asoares@psi.uminho.pt)

Background

Specific Language Impairment (SLI) is a neurodevelopmental disorder involving language deficits in the absence of other associated condition [1]. The aetiology of SLI is hotly debated, ranging from representational deficits in grammar to impairments in the cognitive processes that underlie language acquisition. Recent research suggests that SLI difficulties may arise from implicit learning (IL) deficits, i.e. impairments in the cognitive mechanisms that allow children to extract the structural regularities present in the input and to generalize it to new contexts [2]. IL studies have been conducted mainly with adults and unimpaired children using the Serial Reaction Time Task (SRTT). The few studies conducted with language impaired children produced inconsistent results [3]. Since performance of this task involves a motor component that seems to be also impaired in SLI, it is critical to conduct studies using other tasks and paradigms.

Objective

To analyse if IL deficits are core in SLI using an Artificial Grammar Learning (AGL) task. The AGL task is particularly suited to study IL deficits in SLI because it mimics language acquisition more closely than SRTT and, in addition, avoids its motor component. In an AGL task, participants are firstly exposed to strings that conform the rules of an artificial-grammar (learning-phase). Then, they are asked to decide whether new strings conform or not these rules (test-phase). Performance is typically better to grammatical (G) than to non-grammatical (NG) strings, indicating that participants learned the grammar even without consciousness of it.

Methods

Fourteen Portuguese children participated in this study (M_age=4.86, SD=.66), 7 with a SLI diagnosis matched in age, sex, and non-verbal IQ with other 7 children with typical development (TD). All children were asked to perform a visual AGL task presented as a computer game. Written consent was obtained from all parents.

Results

Results showed that TD children outperformed SLI children in the test-phase. More hits were also observed for the G strings that revealed higher- than lower-similarity with the strings presented in the learning-phase. Furthermore, the analysis of children performance showed that while TD children revealed an increased number of correct responses and a decreased number of attempts to achieve a correct response in the learning-phase, SLI children did not.

Conclusions

Children with SLI reveal deficits in their IL abilities as indexed by a worse performance both in the learning and test phases of a visual AGL task. IL malfunctioning should be considered in the aetiology of the disorder.

References

1. Bishop DVM. What Causes Specific Language Impairment in Children? Curr Dir Psychol Sci. 2006;15(5):217–21.

2. Lum JAG, Conti-Ramsden G, Morgan AT, Ullman MT. Procedural learning deficits in specific language impairment (SLI): a meta-analysis of serial reaction time task performance. Cortex. 2014;51(100):1–10.

3. Ullman MT, Pierpont EI. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399–433.

Keywords

Specific Language Impairment, Implicit learning, Artificial grammar learning, Language impaired children.

P6 Fatal road accidents: behavior and the use of safety equipment

Christine B Godoy¹, Maria HPM Jorge², Jackeline G Brito¹

¹Faculty of Nursing, Universidade Federal de Mato Grosso. 78060-900 Cuiabá, Mato Grasso, Brazil; ²School of Public Health, Universidade de São Paulo, 01246-904 São Paulo, Brazil

Correspondence: Christine B Godoy (christineufmt@gmail.com)

Background

At present, road accidents represent the second major cause of death in Brazil, striking mainly the younger population [1, 2]. Several factors contribute to this reality, among them, the accelerated urbanization process with significant population growth and an increase in the number of vehicles in circulation; impunity for violators, lack of proper supervision; old vehicle fleet; poor maintenance of public roads; poor signage; alcohol and driving combination; non-use of safety equipment and improper behaviour of drivers of pedestrians and vehicles [3-6]. Considering that death is the maximum expression of a given problem in a society [7-8], learning about the factors associated to casualties from road accidents may direct prevention actions and contribute to higher effectiveness [9-10].

Objective

This study examines the factors related to fatal road accidents involving children, adolescents and youngsters in Cuiabá, the capital of Mato Grosso, in 2009.

Methods

This is a domestic survey descriptive in nature. In the first stage of the research, data were collected through Death Certificates (DO), in order to identify, mainly, victims and address. In the second stage of the study, a household survey was conducted with the families of the victims, in which information was collected on the use of safety equipment and behaviour of victims in traffic, according to the families' reports. The analysis has been done with the EpiInfo software.

Results

In the period and population studied, deaths occurred only due to land transport accidents (codes V01 to V89 of ICD10), generally referred to as traffic accidents, and there were no fatalities of other types of transport (such as air transport or by boat). We studied 22 deaths due to traffic accidents. Most of whom are male (86.4%). Among the motorcycle driver victims, not all were wearing a helmet (44.4%), many did not respect traffic signs (55.5%), and some used to combine alcohol consumption and driving (33.3%). Among the car driver victims, 85.7% were not using seat belts, and many used to combine alcohol consumption and driving (57.1%). The pedestrian victims were not using the Zebra crossing (50.0%) or respected the red light of the Pelican crossing (50.0%).

Conclusions

The results point to the need to intervene directly in risk factors in order to reduce road casualties.

References

1. Nukhba Z, Uzma RK, Junaid AR, Prasanthi P, Adnan AH. Understanding unintentional childhood home injuries: pilot surveillance data from Karachi, Pakistan. Inj Prev 2012; 18(Suppl 1): A97-A97.

2. Aguilera SLV, Moysés ST, Moysés SJ. Intervenções de segurança viária e seus efeitos nas lesões causadas pelo trânsito: uma revisão sistemática. Rev Panam Salud Publica 2014; 36(4): 1-13.

3. Wei Y, Chen L, Li T, Ma W, Peng N, Huang L. Self-efficacy of first aid for home acidentes among parents with 0 to 4 year old children at a metropolitan community health center in Taiwan. Accid Anal Prev. 2013; 52:182-7.

4. Fraga AMA, Fraga GP, Stanley C, Costantini TW, Coimbra R. Children at danger: injury fatalities among children in San Diego County. Eur J Epidemiol 2010;25(3):211–217.

5. Koizumi MS, Leyton V, Carvalho DG, Coelho CA, Mello Jorge MHP, Gianvecchio V et al. Alcoolemia e mortalidade por acidentes de trânsito no município de São Paulo, 2007/2008. ABRAMET – Associação Brasileira de Medicina de Tráfego 2010;28(1):25-34.

6. Mello Jorge MHP, Koizumi MS. Acidentes de trânsito como objeto de estudo da medicina de tráfego. O papel da epidemiologia. In: Moreira FDL (org). Medicina do Transporte. Rio de Janeiro: Arquimedes, 2010. P. 355-375.

7. Afzali S, Saleh A, Seif Rabiei MA, Taheri K. Frequency of alcohol and substance abuse observed in drivers killed in traffic acci¬dents in Hamadan, Iran. Arch Iran Med. 2013;16(1):240-242.

8. Andrade SSCA, Mello Jorge MHP. Estimativa de sequelas físicas em vítimas de acidentes de transporte terrestre internadas em hospitais do Sistema Único de Saúde. Ver Bras Epidemiol 2016; 19(1): 100-111.

9. Bravo MS. Aprender a dirigir aos 18 anos de idade: uma visão da psicologia nessa fase da adolescência. Boletim de Psicologia 2015; LXV(43): 147-155.

10. Ivers RQ, Sakash*taa C, Senserrickb T, Elkingtona J, Loa S, Boufousb S, Romea L. Does an on-road motorcycle coaching program reduce crashes innovice riders? A randomised control trial. Accident Analysis and Prevention 2016; 86(1): 40-46.

Keywords

Road accidents, External cause, Mortality, Risk factor.

P7 Education with resource to simulated practice: gains in the implementation of gastric intubation

Marta Assunção¹, Susana Pinto¹, Lurdes Lopes², Claudia Oliveira¹, Helena José^3,4

¹Institute of Health Sciences, Universidade Católica Portuguesa, 4200-374 Porto, Portugal; ²Iberoamerican University Foundation, 1990-083 Lisbon, Portugal; ³Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046- 851 Coimbra, Portugal; ⁴University of Lisbon, 1649-004 Lisbon, Portugal

Correspondence: Marta Assunção (martaassuncao@icloud.com)

Background

Patient safety is an important issue and a challenge in today’s health care practice to reduce adverse events [1]. A strategy to minimize this problem is the clinical simulation, as it is in this context, where doubt and error are allowed [2], without jeopardizing the integrity of the person [3].

Objective

To analyse the technical evolution of the students regarding the accomplishment of a nursing intervention i.e.: gastric intubation.

Methods

Quasi-experimental study without control group, using medium-fidelity simulators. An observation grid focused on nursing intervention was built for data collection: gastric intubation, with twenty-one items. Sampling was through accessibility. The inclusion criteria were: to be a registered nurse; studying in a course of the Centro de Formação de Saúde Multiperfil (CFS, Angola: Luanda), with a minimum of two years of professional experience and to participate in the three study moments. The study population consisted of 37 nurses, but 7 were excluded because they were not present in all phases of the study (n=30). The first moment of study occurred in laboratory context (in the CFS laboratories), in a realistic scenario, where a clinical situation was presented in which it was necessary to perform gastric intubation, based on the knowledge held by the student. In the second moment, students participated in a theoretical approach to the procedure and trained the procedure under simulated practice. On a third moment (few days after the 2nd moment) a second observation was made. We proceeded to analysis and comparison of data using descriptive statistics.

Results

56.7% of the participants were female. Age ranged from 28 and 52 years, the average was thirty-nine [39.27 (± 16.97)] years. 50% of students were from the province of Luanda, the rest from other provinces of Angola. 10% of the students did not obtain gains with the simulated practice, while 90% presented a positive evolution from the first to the second observation. The most significant changes were in the following actions: head positioning, flexion nullification and swallowing request.

Conclusions

Similar to what is mentioned in the literature, about the gains obtained from the simulated practice in realistic scenarios, in this study, gains were also observed in the performance of a nursing intervention. The use of simulated practice in nursing education, specifically with respect to the development of instrumental skills, contributes to successful teaching, which can translate into better performance and, subsequently, less risk to the patient.

References

1. World Health Organization. Patient safety curriculum guide: Multiprofessional edition. Geneva, Switzerland: WHO; 2011. Available from: http://apps.who.int/iris/bitstream/10665/44641/1/9789241501958_eng.pdf.

2. Teixeira CRS, Kusumota L, Braga FTMM, Gaioso VP, Santos CB, Silva VLS, et al. O Uso de Simulador no Ensino e Avaliação Clínica em Enfermagem. Texto Contexto Enferm (Florianópolis) [serial on the Internet]. 2011 [cited 2017 October 11]; 20: 187-93. Available from: http://dx.doi.org/10.1590/S0104-07072011000500024.

3. Ferreira C, Carvalho JM, Carvalho FLQ. Impacto da Metodologia de Simulação Realística, Enquanto Tecnologia Aplicada a Educação nos Cursos de Saúde. STAES [serial on the Internet]. 2015 [cited 2017 October 11]; 32-40. Available from: www.revistas.uneb.br/index.php/staes/article/view/1617/1099.

Keywords

Simulation training, Education, Nursing, Clinical Competence, Intubation, Gastrointestinal, Patient safety.

P8 Emotional labour in paediatric nursing: a propose model for practice guidance

Paula Diogo (pmdiogo@esel.pt)

Unidade de Investigação & Desenvolvimento em Enfermagem, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Health-disease processes experienced by children and youth, and their families, are often associated with intense emotionality and, simultaneously, entails a great emotional challenge for nurses in their care, requiring emotional labour of triple centrality: on the client, nurse and nurse-client relationship [1]. Nurses perform this emotional labour according to their personal resources and learning from the day-to-day experience of care [2]. Moreover, this emotional dimension of nursing care continues to be undervalued by health institutions, and by nurses themselves, so that emotional labour is not always the object of reflection and/or support in scientific evidence [3]. For this reason, conceptual models are needed to guide and strengthen nurses in their practice, especially when the context is peculiar as in paediatric care.

Diogo [1], presented an explanatory hypothesis of the process of therapeutic use of emotions in paediatric nursing, arguing that Emotional Labour in Paediatric Nursing translates into actions of positive transformation of emotional experience into interactions of care with the paediatric client, through five categories of intervention: 1) Promoting a safe and affectionate environment; 2) Nurturing care with affection; 3) To facilitate client emotional management; 4) to build stability in the relationship; 5) to regulate their own emotional disposition to care. This Emotional Labour Model in Paediatric Nursing was developed based on the nursing paradigm of transformation [4] whose central concept is Caring, supported by the Watson's Human Care theory [5], and theorizes about “personal knowing” [6]. This Model also integrates the principles of family-centred care and non-traumatic care in Paediatric Nursing, such as the holistic and humanized perspective on health. At the heart of the proposed Model is the Emotional Labour of Nursing conception [2].

References

1. Diogo P. Trabalho com as emoções em Enfermagem Pediátrica: Um processo de metamorfose da experiência emocional no ato de cuidar. 2ª ed. Loures: Lusodidacta; 2015.

2. Smith P. Emotional Labour of Nursing Revisited. Can nurses Still Care? 2ª ed. Hampshire: Palgrave Macmillan; 2012.

3. Diogo P, compilador. Investigar os Fenómenos Emocionais da Prática e da Formação em Enfermagem. Loures: Lusodidacta; 2017.

4. Kérouac S, Pepin J, Ducharme F, Duquette A, et al. El pensamiento enfermero. Barcelona: Masson; 1996.

5. Watson J. Nursing: The Philosophy and Science of Caring. Boulder: University Press of Colorado; 2008.

6. Fawcett J, Watson J, Neuman BH, Fitzpatrick JJ. On nursing theories and evidence. J Nurs Scholarsh. 2001; 33(2): 115-119.

Keywords

Emotions, Emotional Labour, Conceptual Model, Peadiatric Nursing.

P9 Cardiovascular risk factors in patients with ischemic and hemorrhagic stroke

Ilda Barreira¹, Matilde Martins², Leonel Preto², Norberto Silva¹, Pedro Preto³, Maria E Mendes²

¹Serviço de Urgência, Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal; ²Departamento de Enfermagem, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-146 Bragança, Portugal; ³Serviço de Ortotraumatologia, Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal

Correspondence: Leonel Preto (leonelpreto@ipb.pt)

Background

Stroke is the second worldwide most common cause of death and the main reason of functional disability [1]. Early identification and treatment of modifiable risk factors can reduce the risk of stroke. In stroke patients, the identification of cardiovascular risk factors is also important for preventing another stroke [2].

Objective

To assess the prevalence of cardiovascular risk factors in stroke patients.

Methods

Analytical and retrospective cohort study. Data were collected through electronic health records of all patients with stroke admitted to an emergency department for seven years (2010 to 2016). The research protocol has been approved by an ethics committee.

Results

Were analysed the electronic health records of 756 patients with ischemic stroke (78.6 ± 10.7 years) and 207 with intracerebral haemorrhage (76.1 ± 11.9 years). In ischemic stroke, the most common risk factors were hypertension (66.7%), hypercholesterolemia (30.7%), diabetes mellitus (26.5%), atrial fibrillation (25.4%), obesity (11.4%) and smoking (5.2%). In haemorrhagic stroke the most prevalent risk factors were hypertension (57.0%), diabetes (25.6%), dyslipidaemia (23.7%), atrial fibrillation (17.4%), obesity (15.5%) and smoking (9.2%).

Conclusions

Hypertension was more prevalent in ischemic stroke and is associated with type of stroke (χ² = 6.633, df = 1, p = 0.010). Atrial fibrillation also prevailed in thromboembolic events with statistical significance (p = 0.016). Diagnosis and control of cardiovascular risk factors is a fundamental objective for primary and secondary prevention of stroke.

References

1. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371(9624):1612-23.

2. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015;3(5):418-29.

Keywords

Prevalence, Cardiovascular risk factors, Ischemic stroke, Hemorrhagic stroke.

P10 Topical oxygen therapy in wound healing: a systematic review

João L Simões, Dilsa A Bastos, Raquel V Grilo, Marta L Soares, Sílvia S Abreu, Juliana R Almeida, Elsa P Melo

School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: João L Simões (jflindo@ua.pt)

Background

Oxygen is recognised as an essential element in the wound healing process and, it is suggested that the topical application of oxygen may be a promising therapy in wound care. Thus, the importance of oxygen in the tissue healing process is evident, namely in ATP synthesis; production of reactive oxygen species, which stimulate vascular endothelial growth factor synthesis; and microbial growth inhibition through the promotion of macrophage chemotaxis and increase of leukocyte activity. Moreover, oxygen increases the rate of collagen deposition, an important step in healing, which supplies the matrix for angiogenesis and tissue maturation. Thus, according to the P.I.C.O. review model for clinical questions, this systematic review intends to answer the research question “In chronic wounds, how does topical oxygen therapy affects wound healing?”. It was considered chronic wounds for “patient population or disease of interest”, topical oxygen therapy for “intervention or issue of interest” and wound healing for “outcome”. However, a “comparison intervention or group” and a “time frame” were not applicable.

Objective

The aim of this study was to conduct a systematic review of the current evidence for this therapy through the analysis of primary research studies published between January 2006 and December 2016.

Methods

Published literature was identified using Scopus, B-On, Scielo, Pubmed, Ebsco Host and Medline databases. Exclusion criteria and quality indicators were applied and a total of 11 articles with different designs were included in the review.

Results

The studies analysed emphasise the evidence of additional O₂ usage in wound care, since it reduces hypoxia and it allows triggering mechanisms which are essential for the healing process. The analysed literature presents the results of its effects in its various forms: pressurized, continuous and dissolved. Although there are still questions about the exact mechanisms of this treatment and it is necessary to carry out randomised studies, the current results suggest that this therapy plays an important role in restoring the O₂ balance in the wound bed, necessary for healing.

Conclusions

These findings show the potential of this therapy in promoting healing of chronic wounds and improving people’s quality of life. In addition, there are many other potential advantages related to its usage, such as low cost, apparent safety, no associated adverse effects and the possibility to submit a diversified population to this care at any health organisation or even at the patient’s home.

Keywords

Oxygen, Topical administration, Wound Healing, Wounds and Injuries.

P11 Microbiological characterization of bathing areas of a county in the Northern region

Joana Mendes, Marlene Mota, António Araújo, Cecília Rodrigues, Teresa Moreira, Manuela Amorim

Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

Correspondence: Manuela Amorim (mas@ess.ipp.pt)

Background

The management of bathing water aims at the protection of human health and the preservation, protection and improvement of the quality of the environment [1, 2]. In order to control the quality of these same waters for recreational use, microbiological indicators of faecal contamination are monitored, according to Decree-Law 135/2009 of June 3rd [1]. The microbiological indicators of faecal contamination used are Escherichia coli and Enterococcus spp. since they are commensals of the gastrointestinal flora of humans and most animals [3].

Objective

This study aimed to characterize the results of intestinal E. coli and Enterococcus parameters of inland bathing waters of a county in the northern region of Portugal during 2016.

Methods

A retrospective descriptive study was performed using database records from a northern laboratory. The microbiological parameters studied to characterize the inland bathing waters included CFU/100mL of E.coli and CFU/100mL of intestinal Enterococcus. The results were classified as “Bad”, “Acceptable”, “Good” or “Excellent”, according to the Decree-Law 135/2009 of June 3rd [1].

Results

We verified that in the total of 26 inland bathing waters under study, 6 (23.1%) obtained a quality equal to or greater than “Acceptable”. The remaining 20 bathing waters (76.9%) were classified as “Bad”. This result, in 17 samples was due to both parameters, intestinal Enterococcus and E. coli. In the other three, the “Bad” classification was only due to the Enterococcus results. The months with the highest counts of E. coli were September (45.69%), June (43.30%) and May (39.62%), and for Enterococcus were May (52.83%), June (52.58%) and July (32.35%).

Conclusions

In an initial study and applying criteria that will then have to be more extended in terms of time, there is a first tendency for most of the inland bathing waters under study to present “Bad” quality (76.90%). Since all bathing waters should have at least “Acceptable” quality and provisional data, these results indicate an urgent need to take measures in order to counteract this and increase the number of bathing waters classified as “Excellent” or “Good.” The different E.coli and intestinal Enterococcus counts observed in different months showed that climatic, environmental, social and urban factors could be involved in this differences and deserves attention in future studies [2, 4]. The quality of bathing water is fundamental in terms of public health. In this sense, the results of this study are worrisome, however these studies should be conducted in a longer time perspective.

References

1. Portugal. Decreto-Lei n.º 135/2009, de 3 de junho de 2009. Estabelece o regime de identificação, gestão, monitorização e classificação da qualidade das águas balneares e de prestação de informação ao público sobre as mesmas. Diário da República n.º 107/2009. 3460-3468.

2. Portugal. Decreto-Lei n.º 113/2012, de 23 de maio de 2012. Gestão da qualidade das águas balneares, e ao seu ajustamento ao quadro institucional resultante da publicação do Decreto-Lei n.º 7/2012, de 17 de janeiro, que define a orgânica do Ministério da Agricultura, do Mar, do Ambiente e do Ordenamento do Território, e do Decreto-Lei n.º 56/2012, de 12 de março, que define a orgânica da Agência Portuguesa do Ambiente, I.P.. Diário da República, 1ªa série, n.º 100. 2715-26.

3. Boehm AB, Sassoubre LM. Enterococci as Indicators of Environmental Fecal Contamination. In: Gilmore MS, Clewell DB, Ike Y, Shankar N, editors. Enterococci From Commensals to Leading Causes of Drug Resistant Infection. Boston: Massachusetts Eye and Ear Infirmary; 2014.

4. McMichael AJ. Environmental change, climate and population health: a challenge for inter-disciplinary research. Environmental Health and Preventive Medicine. 2008, 13(4):183-186.

Keywords

Inland bathing water, Fecal contamination indicators, Escherichia coli, Enterococci intestinal.

P12 Microbiological characterization of food handlers in school canteens

Diana Gomes, Teresa Moreira, Marlene Mota, Cecília Rodrigues, António Araújo, Manuela Amorim

Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

Correspondence: Manuela Amorim (mas@ess.ipp.pt)

Background

Food-borne substances are a major concern of Public Health, given that food can be the source of various hazards (biological, physical and chemical). Approximately 20% of outbreaks of foodborne illness are associated with the personal hygiene of food handlers. The personal hygiene of manipulators is one of the best ways to block bacterial contamination and its extension to new areas [1, 2].

Objective

To evaluate the microbiological profile of the hands of food handlers in school canteens of the northern region of Portugal during 2016 and to verify the efficiency of the hygiene processes.

Methods

Handlers and utensils were tested using a swab soaked in Maximum recovery diluent-Histidine Lecithin and Polysorbate (MRD-HLPS) rubbing against parts were food might get retained, following ISO 18593: 2004 [3]. The parameters evaluated were coliforms at 37ºC/24h, Escherichia coli at 44ºC/24h and coagulase positive Staphylococcus at 37ºC/48h, according to ISO 4832:2006 [4], ISO 16649-2:2001 [5] and ISO 6888-1:1999 [6], respectively. A statistical analysis of the results of the microbiological profile evaluation was carried out at the hands of the food handlers of public primary school canteens.

Results

Ours results of the microbiological profile of the hands of food handlers showed that 9.95% of samples analysed had bacterial contamination. Most of the samples with bacterial contamination were caused by the presence of coliforms, followed by coagulase positive Staphylococcus. Only one sample was registered with positive E. coli. It was not found a significant difference in the proportions of samples with bacterial contamination and positive for coliform bacteria and coagulase positive Staphylococcus, in the distribution line and in the kitchen, over the several months.

Conclusions

The food handler is an important and recognized source of bacterial contamination of foodstuffs [1, 2]. The results of the present study indicate the necessity to implement measures to control bacterial contamination in the hands of manipulators of school canteens, aiming at correcting possible flaws encountered. Food legislation, the Hazard Analysis and Critical Control Point (HACCP) system, and reference documents such as the Codex Alimentarius and the Food Code present guidelines to promote improved food hygiene and personal hygiene for handlers [2, 7].

References

1. Arduse L, Brown D. HACCP and Sanitation in Restaurants and Food Service Operations. Florida: Atlantic Publishing Company; 2005.

2. World Health Organization, Food and Agriculture Organization. Codex Alimentarius: Higiene dos alimentos. 3rd ed. Brasilia: Agência Nacional de Vigilância Sanitária; 2006.

3. International Organization for Standardization. ISO 18593:2004, Microbiology of food and animal feeding stuffs — Horizontal methods for sampling techniques from surfaces using contact plates and swabs; 2004.

4. International Organization for Standardization. ISO 4832:2006, Microbiology of food and animal feeding enumeration of coliforms — Colony-count technique; 2006.

5. International Organization for Standardization. ISO 16649-2:2001, Horizontal method for the enumeration of B-glucuronidase-positive Escherichia coli; 2001.

6. International Organization for Standardization. ISO 6888-1:1999, Horizontal method for the enumeration of coagulase-positive staphylococci (Staphylococcus aureus and other species); 2003.

7. Food and Drug Administration. Food Code. Virginia: United States Department of Health and Human Services; 2013.

Keywords

Food safety, Food handlers, Hand hygiene, Microbiological evaluation, Bacterial contamination.

P13 Exploring the effectiveness of digital psychoeducational interventions on depression literacy: a scoping review

Karin Panitz, Jennifer Apolinário-Hagen

Department of Health Psychology, Institute for Psychology, University of Hagen, 58097 Hagen, Germany

Karin Panitz (mail@hp-panitz.de)

Background

Depression is a huge burden requiring efficient strategies for prevention and treatment [1]. Psychoeducation can improve health literacy and help to reduce the stigma of help-seeking. In recent years, the Internet has been suggested as a way to deliver mental health interventions to a broader range of persons and to reduce barriers to seek help from face-to-face services. However, little is known about the effectiveness of digital psychoeducational interventions on health literacy and psychological outcomes, such as help-seeking intentions [2].

Objective

To derive practical implications for health professionals, this scoping review aimed to explore the effectiveness of different digital psychoeducational interventions strengthening depression literacy or knowledge (primary outcome), stigmatizing attitudes and on help-seeking attitudes, intentions and behaviour (secondary outcomes). This review is conceptualized as an update and expansion of previous research [2] with a focus on a broad range of interventions.

Methods

In May 2017, a systematic search through electronic databases (e.g. PsycINFO and PSYNDEX) was performed to identify longitudinal studies on the effectiveness of digital interventions targeting depression-related mental health literacy among adults published between 2007 and 2017 in peer-reviewed English journals.

Results

Overall, 19 Studies met the inclusion criteria, mostly stemming from Australia. The findings of 13 of the included 17 studies evaluating mental health literacy revealed significant increases in depression literacy. Pure dissemination of information via websites, e-mails or psychoeducational interventions yielded primarily positive findings. Both Internet-based Cognitive Behavioural Therapy and online game programs were found to be knowledge-enhancing, except for one study using a simulated dialogue. Findings on digital intervention targeting stigmatization in terms of individual, as well as perceived attitudes towards mental illness were inconsistent. Concerning perceived stigma, 4 of 8 studies showed positive results in reducing stigma, whereas other results were inconsistent. Likewise, the effects of interventions on help-seeking (n= 8 studies) with respect to attitudes (n= 5 studies), intentions (n= 6 studies) and behaviour (n= 4 studies) were inconclusive.

Conclusions

The evidence base on mental health literacy interventions is promising, but still limited. Various digital interventions are overall comparably effective in strengthening depression literacy and reducing stigmatizing attitudes. Given several limitations, future research should compare subpopulations to understand what works are best for whom in clinical practice. Furthermore, the comparability of knowledge levels of healthy and depressed persons should be considered. Finally, eHealth literacy of clients and health professionals should be explored and, where required, promoted with evidence-based information.

References

1. Kessler RC. The Costs of Depression. The Psychiatric Clinics of North America. 2012;35(1):1-14. doi:10.1016/j.psc.2011.11.005.

2. Brijnath B, Protheroe J, Mahtani KR, Antoniades J. Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review. Journal of Medical Internet Research. 2016;18(6):e165. doi:10.2196/jmir.5463.

Keywords

Depression, Mental health, Health literacy, eHealth, Review.

P14 Family nurse as a privileged caregiver of families of patient with wounds in domiciliary context: nurse’s perspective

Maria FMS Nunes¹, João L Simões², Marília S Rua²

¹Unidade de Saúde Familiar Flor de Sal, Agrupamento de Centros de Saúde do Baixo Vouga, 3800-039 Aveiro, Portugal; ²Escola Superior de Saúde, Universidade of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: João L Simões (jflindo@ua.pt)

Background

Population ageing is a reality that has contributed to the increase of chronic diseases and the number of dependent people with wounds, with the need of home care. This issue has implications in family dynamics. It is important to take care not only of the person with the wound but also of its family. These new health needs led to the reorganization of primary health care, where family nurses emerged as essential professionals.

Objective

The aim of this study is to know the perception of family nurses of ACeS Baixo Vouga about their care with families of patient with wounds, in domiciliary context, and the importance given to this nursing practice with families. On the other hand, to identify the factors that nurses consider as barriers or facilitators in their work with families.

Methods

It was made a quantitative, descriptive and correlational study. The instrument used for data collection was a questionnaire with two parts. The first part aimed to characterize the sample with the sociodemographic and professional data of the participants, while the second one was built with two questions and the scale of the Perception about Family Nursing. The sample consisted of 150 nurses working in primary health care, in USF or UCSP, of ACeS Baixo Vouga, ARSC. Data processing was made by a descriptive and inferential analysis using the Statistical Package for Social Sciences (SPSS) and a qualitative analysis through content analysis.

Results

The results for the subscale Perception of Family Nursing Practice (PFNP) showed that the nurses selected “often” in most of the questions. The PFNP isn’t affected by sociodemographic and professional variables. This subscale is only affected by the nurses’ formation variable. The nurses with curricular formation on family have higher level of applicability of the family nursing in practice. For the subscale Importance Assigned to Family Nursing (IAFN), the most relevant category was “important”. The IAFN is affected by sociodemographic, professional and formation variables. The group of nurses with a higher degree of education give more importance to family nursing.

Conclusions

Nurses attribute a higher level of importance on the nurse’s care with families of patient with wounds in the domiciliary context than on the applicability of the family nursing in practice. The characteristics of nursing care are the most relevant facilitator factor for family nursing practice. The characteristics of the institution are the most mentioned as a barrier factor.

Keywords

Family nurse, Family, Home care, People with wounds.

P15 Physical resilience as a key concept in the prevention of frailty in the elderly

Rafael Bernardes, Cristina L Baixinho

Lisbon Nursing School, 1700-063, Lisbon, Portugal

Correspondence: Rafael Bernardes (rafael.alvesbernardes@gmail.com)

Background

The concept of frailty has been presented in the literature in a variety of ways [1-5] and in close relation with negative health outcomes, such as gait difficulty, falls and weight loss [1, 5]. The correct assessment of frailty in the elderly and the design of an adequate care plan is essential for the provision of personalized care and assistance to caregivers [1-3]. Recent studies associate this concept with physical resilience, as a personal characteristic that determines the capacity to resist functional decline or restore physical health, being a central aspect in active aging [6].

Objective

Identify the characteristics of physical resilience that modify (positively or negatively) the fragility of the elder.

Methods

Integrative literature review (RIL) to answer the question “How can physical resilience influence frailty in the elder?”.

Results

Fragility, although a significant syndrome linked to the natural aging process, can be modified [2]. The contextual factors of each person, if well evaluated and controlled, can improve functionality not only physically but also cognitively and socially. Interventions that reduce vulnerability and adverse outcomes reduce the risk of hospitalization. The ability of an elderly person to withstand external stress is strongly related to the physiological reserve [5-6]. Taking into account that one of the main components of the fragility phenotype is sarcopenia, many of the interventions must be operationalized in order to prevent it [6]. The phenomenon of loss of functionality and muscle mass is not an isolated phenomenon [5] and produces negative functional outcomes such as difficulty in climbing stairs, getting up from a chair or bed and lifting heavy objects. The optimization of physical resilience can happen through the design of programs of physical exercise, nutrition, therapeutic reconciliation, psychoeducational support and support by health professionals.

Conclusions

Physical resilience is also influenced by factors common to frailty. The main constraint of physical resilience that affects fragility is the physiological reserve. Resilience can be quantified in three ways by determining functional trajectories: “resilient” (without functional changes after adverse events) or “resilient” (functional decline with subsequent recovery) by Physical Resilience levels: “fragile phenotype” vs “robust phenotype” and by determining “chronological age” versus “biological age”. This possibility of quantification “opens” the door for the development of interventions to treat fragility.

References

1. Anzaldi LJ, Davison A, Boyd CM, Leff B, Kharrazi H. Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study. BMC Geriatr. 2017;17:248. DOI 10.1186/s12877-017-0645-7.

2. Fairhall N, Langron C, Sherrington C, et al. Treating frailty-a practical guide. BMC Med. 2011;6,9:83.doi: 10.1186/1741-7015-9-83.

3. Bieniek J, Wilczynski K, Szewieczek J. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging. 2016;11:453-59. doi: 10.2147/CIA.S101369. eCollection 2016.

4. Bongue, B; Buisson, A; Dupre, C; Beland, F; Gonthier, R; Crawford-Achour, E (2017). Predictive performance of four frailty screening tools in community-dwelling elderly. BMC Geriatr 17(1):262. doi: 10.1186/s12877-017-0633-y.

5. Zaslasvky O, Cochrane BB, Thompson HJ, Woods NF; LaCroix A. Frailty: A Review of the First Decade of Research. Biol Res Nurs. 2013;15(4) 422-32. doi: 10.1177/1099800412462866.

6. Whitson HE, Duan-Porter W, Schmader KE, Morey MC, Cohen HJ, Colón-E CS. Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct. J Gerontol A Biol Sci Med. 2016;71(4):489-95. doi: 10.1093/gerona/glv202.

Keywords

Motor activity, Nursing, Sarcopenia, Frail elderly, Dependence.

P16 Safety Protocol for Nasolaringoscopic Evaluation of Swallowing: cultural and linguistic validation and adaption for European Portuguese language

Liliana Abreu¹, Pedro S Couto², Susana Mestre³

¹Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal; ²Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal^{; 3}University Hospital Center of Algarve, 8000-386 Faro, Portugal

Correspondence: Pedro S Couto (p.sa.couto@ua.pt)

Background

In practice, a Speech Therapist works with several neurological diseases that present changes in swallowing, especially after acute stroke. These changes, called dysphagia, can lead the patient to death by leading to malnutrition, dehydration, tracheal aspiration and recurrent pneumonia [1]. Since most of these cases are diagnosed in a hospital setting, it becomes increasingly important to create working tools that help health professionals to perform more rigorous therapeutic evaluations and interventions.

Objective

The present study aims to contribute to the cultural and linguistic validation and adaptation of the Protocol of Security of a Nasolaryngoscopy Evaluation of Swallowing (PSAND).

Methods

The study comprises two parts: a qualitative part, that corresponds to the translation and adaptation of the protocol to European Portuguese Language, and a quantitative part, where the psychometric characteristics of the protocol were studied. Further details about translation and adaptation of the protocol can be found in [2], specially the content validity procedures and its application in a pilot study. A severity assessment scale [3] was used for the functional evaluation of the swallowing safety by classifying the swallow of the subjects as normal, penetration or aspiration. For data collection, it was used the Portuguese adaptation of the PSAND and the nasolaryngoscope as evaluation tools. The content validity index (CVI) was calculated for the qualitative part, and t-student or qui-squared tests were used for comparison between severity groups.

Results

The sample consisted of twenty subjects, where all of them have an acute stroke as clinical diagnosis whether or not having dysphagia. The age of the inquired ranged from 31 to 85 years old, being 16 males. The results obtained by the panel of experts allowed us to conclude that all the parameters are relevant to the evaluation of swallowing and important to determinate a safe feeding for each case (CVI>0.80). Thus, by applying the PSAND, it was possible to study two groups: “Penetration” (13 patients) and “Aspiration” (5 patients). There were statistically significant differences (p < 0.05) between the two groups for the variables: dependent or independent feeding; poor oral control; lot of residues; reduction of laryngeal sensitivity; leaking of the bolus and difficulty in cleaning pharyngeal residues.

Conclusions

In summary, we can say that the application of this protocol is an asset to diagnose the presence of dysphagia in any clinical diagnosis, evaluate the swallowing function, verifying the risk of penetration and aspiration and classifying the Dysphagia Severity.

Acknowledgements

This work was supported in part by the Portuguese Foundation for Science and Technology (FCT-Fundação para a Ciência e a Tecnologia), through Center for Research and Development in Mathematics and Applications (CIDMA), within project UID/MAT/04106/2013.

References

1. Michou E, Hamdy E. Cortical input in control of swallowing. Current opinion in Otolaryngology & Head and Neck Surgery. 2009 June; 17:166-71.

2. Abreu, Liliana. Protocolo de Segurança na Avaliação Nasolaringoscópica da Deglutição (PSAND): contributo para a validação cultural e linguística do português Europeu [Master Thesis] [Portuguese]. Escola Superior de Saúde do Alcoitão. 2016.

3. Rosenbeck JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration Aspiration Scale. New York: Spring; 1996.

Keywords

Swallowing, Dysphagia, AVC, Evaluation, PSAND.

P17 Trend in obesity in an aging society: estimate of obese elderly in Brazil in 2030

Adriane Carvalho, Roger S Rosa, Scheila Mai, Rita Nugem, Ronaldo Bordin

Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90040-060, Brazil

Correspondence: Adriane Carvalho (adrianedasc@hotmail.com)

Background

Population aging and the increasing longevity of older people are increasingly relevant worldwide phenomena [1]. In addition, along with ageing, a significant increase in the prevalence of obesity among the elderly is also occurring [2,3].

Objective

To estimate the increase in the number of obese individuals, due exclusively to population aging in Brazil from 2014 to 2030.

Methods

The number of obese adult Brazilians was obtained by extrapolation of the prevalence estimated by VIGITEL (Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Inquiry) [4] in Brazilian capitals, in 2014, for the entire Brazilian population. The population projection for 2030 by age groups was obtained from IBGE (Brazilian Institute of Geography and Statistics) [5]. The prevalence obtained by VIGITEL in 2014 was applied to population projections by 2030, maintaining all other variables constant, with 95% confidence intervals (95% CI).

Results

The Brazilian adult population (18 +years) corresponded to 144.5 million people in 2014 of whom 15.5 million (10.7%) were 65 years of age or older. Obese adults accounted for 25.9 million (95% CI 24.9-27.0 million) of the entire adult population (17.9%), of which 3.1 million (95% CI 2.8-3.3 million) were elderly obese. The obese elderly corresponded to 11.9% of adults with obesity. In 2030, it is estimated that the Brazilian adult population will reach 175.2 million people, of whom 30.0 million (17.1%) are elderly. Obese will correspond to 31.4 million (95% CI 30.1-32.8 million) of adult Brazilians of whom 5.9 million (95% CI 5.4-6.4 million) will be obese elderly. That is, exclusively due to aging, it is expected an increase of 5.5 million obese for the entire population. An estimated 2.8 million more are obese in the age group of 65 and over. Therefore, it is expected that the percentage of 11.9% of elderly among obese adults in 2014 will rise to 18.9% in 2030.

Conclusions

Considering only the effect of aging with current levels of obesity prevalence, it is estimated that there will be an increase of almost 3 million obese people in Brazil by 2030. The impact of the increase in prevalence itself was not considered, which would make the prospect even more worrying due to the impact on chronic non-communicable diseases and in the use of health services.

References

1. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Estatuto do Idoso. Brasília: Ministério da Saúde, 2013.

2. Ferreira VA, Magalhães R. Obesidade no Brasil: tendências atuais. Rev Port Saude Publica. 2006;24(2):71-81.

3. Mártires MAR, Costa MAM, Santos CSV. Texto Contexto Enferm, Florianópolis. 2013 Jul-Set;22(3):797-803.

4. Malta DC, Bernal RI, Nunes ML, Oliveira MM, Iser BM, Andrade SC, et al. Prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis em adultos: estudo transversal, Brasil 2012. Epidemiol Serv Saúde, Brasília. 2014 Dez;23(4):609-22.

5. Instituto Brasileiro de Geografia e Estatística [homepage na internet]. Projeção da População do Brasil por sexo e idade: 2000- 2060 [acesso em 10 dez 2017]. Disponível em: https://ww2.ibge.gov.br/home/estatistica/populacao/projecao_da_populacao/2013/default_tab.shtm.

Keywords

Obesity, Aging, Tendencies, Population projection, Demography.

P18 Nursing interventions towards the hospitalized elderly patient with delirium – a systematic review of literature

Marta Bento, Rita Marques

Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal

Correspondence: Marta Bento (marsofia81@hotmail.com)

Background

Delirium is one of the most prevalent neuropsychiatric syndromes in the hospital setting, preferably in the elderly debilitated patients. It is a cognitive alteration of sudden onset, developing in a matter of hours or days; which is interspersed with periods of lucidity and also characterized by disturbances in attention, memory and behaviour. It is also identified by the worsening of the symptoms at night and by changes in the sleep-wake cycle. The presence of this syndrome, makes impossible a holistic care, upsetting an effectively communication, between patient and nurse or family. It may even be considered common for an elderly, given the age, to appear confused, but it should not be considered normal, so investing in concrete studies to specify these mental changes and determinate what interventions are more appropriate for this vulnerable group, is emergent. It is up to nurses, who are in a privileged position, the early recognition/intervention at this neurological condition. It is assumed as an emerging need, to implement non-pharmacological strategies, so that the occurrence of delirium decreases and thus avoids great suffering.

Objective

This study aimed to identify the nursing interventions directed to the hospitalized elderly, for the control and prevention of delirium.

Methods

Using the methodology recommended by the Cochrane Centre, this systematic review of literature was guided by the following research question: “What is the scientific evidence regarding nursing interventions directed to the hospitalized adult/elderly for the control of delirium?” Using a PICO framework as reference, a review of articles published between 2012 and 2017 was carried out. The research was conducted at B-ON and EBSCO host - Research Databases.

Results

In this bibliographic review 5 studies were selected, in common, they present tendentially, non-pharmacological strategies adopted by nurses with preventive character towards the predisposing and precipitating factors of delirium. The role of nursing in carrying out preventive actions was important in the maintenance of the sensorial balance (frequently reorientation, encouraging the use of visual and hearing aids improves patients ‘sensorium), optimizing circadian rhythm (minimizing night procedures, allowing periods of rest), assessing the local environment (limiting background noise and light) as well as in the mental status, pain, monitoring hydration, nutrition and stimulation of early mobility.

Conclusions

The implementation of nursing delirium preventive measures truth sensibilized professionals reveals to be effective in reducing the incidence of delirium. Research is imperative, to recognize and validate witch interventions may better control delirium and thus reduce its consequences.

Keywords

Delirium, Nursing interventions, Hospitalized adult patients, Evidence-based practice.

P19 Distribution of gama-chamber nuclear equipment is associated to the distribution of physicians in the state of Rio Grande do Sul, Brazil

Patrícia Silva, Roger S Rosa, Rita Nugem, Adriane Carvalho, Ronaldo Bordin

Federal University of Rio Grande do Sul, 90040-060 Porto Alegre, Rio Grande do Sul, Brazil

Correspondence: Patrícia Silva (patriciairan@ig.com.br)

Background

The use of effective technologies extends the resolution of health services. However, over-supply can create incentives for service over-use, which is not without risk to patients. Nuclear medicine equipment has been increasingly used. Knowing the associations with their spatial distribution can contribute to interventions aimed at reducing inequalities.

Objective

To dimension the association among mean number of equipment’s of gamma-chamber, population, Gross Domestic Product and number of physicians, by health region of Rio Grande do Sul, state of southern Brazil.

Methods

Observational and cross-sectional descriptive study based on public data from each one of the 30 health regions for 2013, the most recent year at the time of the survey (2016-2017). Data was managed in Microsoft Excel®. Pearson's linear correlation coefficient and multiple linear regression analysis were used with Statistica 12.5® software, at a significance level of 5%. The variable considered for outcome was monthly mean of gamma camera equipment (GamaC) and the predictor variables (I) population (POP), expressed in number of inhabitants; (II) Gross Domestic Product (GDP), expressed in the national coin (Real); and (III) the number of physicians registered in the CNES - National Register of Health Establishments (MED) by health region of the State Health Secretariat, in 2013.

Results

The predictive variables POP, GDP and MED were each one highly correlated with GamaC (R = 0.94, 0.92 and 0.98 respectively). Simple linear regressions with each independent variable were elaborated. It was found that POP, PIB and MED significantly affected the GamaC variable (adjusted R² of 0.89, 0.84 and 0.96 respectively). In the final model, where variables were standardized and GamaC was considered to be simultaneously dependent on the predictive variables POP, GDP and MED, the POP variable lost significance (p > 0.05). The variable PIB presented a negative coefficient (-0.54, p < 0.01), while the variable MED, a positive (1.27, p < 0.01).

Conclusions

Health regions of the state that had the highest number of physicians, had the highest mean number of scintigraphic chambers. The growth in the supply of medical equipment such as nuclear medicine improves the population's access to services, but the greater supply in Rio Grande do Sul state was associated more with better developed health regions, when considering the number of medical professionals available, than the gross domestic product or the number of residents in the territory.

Keywords

Nuclear medicine, Supply, Health needs, Demand of health services.

P20 Family experiences of the internalized person in situation of critical illness: integrative revision

Raquel MV Ramos, Ana CR Monteiro, Sílvia P Coelho

Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal

Raquel MV Ramos (raquel_mvr@hotmail.com)

Background

The admission of a patient to a critical health unit is usually traumatic for the family, having a major impact on their life, which can result in a moment of crisis, an anxiety enhancer. Fear of death, uncertainty of the future, emotional disturbances, financial worries, changing roles and routines, and the hospital environment are some sources that provide anxiety of a person's family in critical illness [1].

Objective

To know the existent evidence about Family Experiences of the Person hospitalized in Situation of Critical Illness.

Methods

Integrative literature review using databases CINAHL, MEDLINE, Nursing & Allied Health Collection: Comprehensive, Cochrane, Library, Information Science & Technology Abstracts, Medication with MeSH descriptors: “family”, “needs assessment” and “critical illness”. Were included all English-language articles, available in full text, with abstract and references available, between 2002 and 2017, excluding articles in the paediatrics area.

Results

In total, 7 were selected and 4 articles were analysed in full. From the literature, it emerges that the family of the person hospitalized in a critical illness has experiences and needs consequent to this situation, in which it is necessary an intervention from the professionals to support/to encourage during this traumatic transition of the familiar life [2]. The family has its own needs, and these must be met to effectively manage the situation of instability of the family member. Since the family directly influences the evolution of a person's condition in a critical illness situation, it is important to see the family also as a target of care, in a holistic view of caring [3]. The main areas of need experienced by the family are: information on the clinical situation, assurance of patient safety, support by health professionals and willingness to be close to the patient [2].

Conclusions

Health professionals should be aware that the family is also a target in care, and that, in a multidisciplinary team, nurses are the most qualified professionals to plan and develop interventions to meet and respond to the family needs of the person hospitalized in critical illness [4]. The team must be able to respond to the identified family needs, through interventions to attenuate and help them to live the moment of hospitalization, making it the least traumatic possible, involving the relatives in the care, through the clarification of doubts and by helping to manage emotions and expectations [3].

References

1. Leske J. Interventions to Decrease Family Anxiety. Critical Care Nurse.2002, 22 (6): R61-65.

2. Kinrade T, Jackson A, Tomnay J. The psychosocial needs of families during critical illness: comparison of nurses’ and family members’ perspectives. Australian Journal of Advanced Nursing. 2009, 27 (1): R82-88.

3. Henneman E, Cardin S. Family-Centered Critical Care: A Practical Approach to Making it Happen. Critical Care Nurse. 2002, 22 (6), R12-19.

4. Fortunatti C. Most important needs of family members of critical patients in light of the Critical Care Family Needs Inventory. Invest Educ Enferm. 2014, 32 (2): R306-316.

Keywords

Needs assessment, Family, Critical illness.

P21 Cannabidiol oil vs ozonized extra virgin olive oil in the upp treatment of category ii

Carla Jimenez-Rodriguez¹, Francisco J Hernández-Martínez², María C Jiménez-Díaz¹, Juan F Jiménez-Díaz³, Bienvenida C Rodríguez-De-Vera³

¹Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España; ²Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas, Islas Canarias, España; ³Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España

Correspondence: Carla Jimenez-Rodriguez (carlajimenezrodriguez@gmail.com)

Background

Pressure ulcers (UPP) Category II are shallow open wounds. The phytotherapeutic treatments for them are based on healing and antiseptic action. This effect is produced by cannabidiol oil. Also, extra virgin olive oil (EVOO) ozonized has repairing properties with germicidal power.

Objective

To determine the effectiveness of cannabidiol oil versus EVOO in the treatment of UPP.

Methods

Clinical trial with 60 users with UPP Category II. After the informed consent of the patients, data collection was done in September 2017. Criterion of inclusion: it was essential that each of the users had at least two chronic wounds with the same injury (Category II), in order to apply in each one a product. We excluded users with vascular disease or in situations of extreme severity. Each user included in the study was followed for 20 days. Skin assessment and initial risk assessment was performed with the Braden scale by the principal investigator and another investigator of the team. Subsequently, the skin condition of the patients was evaluated daily, before the application of the product, by the nurse who attended them. Additionally, the patients were evaluated every 7 days by two investigators. The SPSS 25.0 program was used for statistical calculations, considering a level of significance of p < 0.05.

Results

Average age 71.45 ± 1.27 years. Of a total of 137 chronic wounds, 56.93% were located in the lower limbs. Regarding the resolution of the wounds, no significant differences were found between the two products, since 68.61% of the lesions improve significantly using both products before 72 hours, and all of them heal at the most in 8 days. It did not appear topically on the skin, no allergic reaction due to the use of both products, ansd the application of cannabis oil on the wound was very well tolerated by patients (p < 0.37).

Conclusions

Cannabidiol oil is shown to be as effective as EVOO in the treatment of UPP Category II, both being a good alternative to traditional therapies. In addition, the moisturizing, emollient and anti-inflammatory properties of the two products preserve the perilesional skin in perfect condition. Cannabidiol oil achieves a more favourable analgesic response in patients during wound healing.

Keywords

Pressure ulcers, Cannabidiol oil, Extra virgin olive oil ozonized, Traditional therapies.

P22 Microbial colonization of experimental ulceras in the laboratory animal treated with cannabidiol oil

Carla Jiménez-Rodríguez¹, Carmelo Monzón-Moreno², Juan F Jiménez-Díaz², María-del-Carmen Jiménez-Díaz¹, Bienvenida-del-Carmen Rodríguez-de-Vera²

¹Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España; ²Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España

Correspondence: Carla Jiménez-Rodríguez (carlajimenezrodriguez@gmail.com)

Background

One of the most undesirable complications in the healing process is infection in the bed of wounds or ulcers.

Objective

To verify the microbial colonization of experimental ulcers in the laboratory animal treated with cannabidiol oil (CBD) applied topically.

Methods

Experimental study with a control group (with physiological saline to maintain hydration conditions and group with extra virgin olive oil (EVOO) to avoid bias with the oleic excipient), to check the mesophilic microbial colonization after the use of the applied CBD topically on experimental total skin ulcerative lesions in the adult male white rat, Sprague Dawley strain. Ten animals were used for each group under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. Subsequently, they are distributed in individual cages to prevent them from licking each other and with sufficient height to prevent the friction of the cutaneous ulcer with the passenger compartment. 0.15 ml of the respective product was applied daily to the ulcers. The microbiological analysis was carried out by studying the variation of the bacterial microbiota. The colony-forming units of each wound were determined by counting on a plate, after obtaining a total skin sample and a superficial sweep. The organic samples obtained were placed in sterile tubes containing 1 ml of physiological serum to which vortex was applied for 30 seconds, serial dilutions being made to the tenth of the samples subject to titration. Six plates of Tryptic Soy Agar (TSA) were then labelled, one for each dilution obtained, and 0.1 ml of each of these dilutions was added, spreading it on the surface of the plate by means of the sowing handle. Plates were incubated in an oven at 37° for twenty-four hours and then the colony forming units were counted.

Results

Two hundred fourteen different colonies were obtained. The majority genus was Staphylococcus. There was no difference in microbial colonization due to the products used in each group, i.e., physiological serum, EVOO and CBD.

Conclusions

The analysis of the mesophilic cutaneous microbiota shows a microbial colonization rich in gram-positive organisms, the majority being the presence of coagulase-negative staphylococci (CNS) that behave as opportunistic pathogens in skin continuity solutions.

Keywords

Colonization, Microbial cannabidiol, Skin, Ulcer, Rat.

P23 The impact of dermatologic and cosmetic counseling - case study

Stefany Moreira¹, Ana Oliveira², Rita Oliveira^2,3, Cláudia Pinho², Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Stefany Moreira (fany_hill@hotmail.com)

Background

Community pharmacy professionals (CPPs) have been recognized as the most accessible and best-positioned health professionals for the provision of pharmaceutical counselling [1]. This happens due to the easy access to pharmacies, and because their interventions translate into: beneficial clinical results; satisfaction of users; reduction of costs and prevention of problems or negative reactions to medicines [1, 2]. The sale of dermatological products and symptoms associated with skin problems has a considerable impact on sales and advice requirements in pharmacies, respectively [3].

Objective

To demonstrate the importance of CPPs through the quantitative evaluation of the impact of dermatologic and cosmetic counselling; and to determine which dermatological/cosmetic areas affect most people and what motivates them to turn to this type of counselling.

Methods

Prospective, longitudinal and an observational case study. It took place in a pharmacy in the city of Porto, between January and April 2017. It had 3 phases: I) invitation (where were explained the objectives and the methodology); II) first Interview: Completion of PART I of the Questionnaire (description of the situation and the advice provided by the CPP); III) second Interview: Completion of PART II of the Questionnaire (evaluation of the result of the counselling).

Results

Of the 16 analysed situations: 62.50% were resolved and/or people were satisfied, 31.25% were in the process of improvement, and 6.25% were not resolved and/or people were not satisfied. The three most mentioned dermatological/cosmetic areas in the requests for counselling were: daily skin care (37.50%); marks, spots, comedones, pimples or signs on the skin (18.75%) and sun protection (12.50%).

Conclusions

CPPs have proven to be very valuable in providing counselling on dermatologic products and cosmetics, where, this had a positive impact. The dermatological/cosmetic area that most had expression among the requested situations was daily skin care.

References

1. Curley LE, Moody J, Gobarani R, Aspden T, Jensen M, McDonald M, et al. Is there potential for the future provision of triage services in community pharmacy? J Pharm Policy Pract. 2016;9(29):1-22.

2. Coelho RB, Costa FA. Impact of pharmaceutical counseling in minor health problems in rural Portugal. Pharmacy Practice. 2014 Oct;2(4).

3. Tucker R, Stewart D. Why people seek advice from community pharmacies about skin problems. Int J Pharm Pract. 2015;23:150-3.

Keywords

Community pharmacy professionals, Counselling, Dermatologic products, Cosmetics.

P24 Ability of clients for self-management of medication regime: specification of nursing diagnosis

Inês Cruz, Fernanda Bastos, Filipe Pereira

Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Inês Cruz (inescruz@esenf.pt)

Background

There is a growing concern to understand the experience of living with multiple morbidities and the need to manage a medication regime [1, 2] by people experiencing one or more health/disease transitions [3], in order to assist them in this process. Being human responses to different transitions the object of the Nursing discipline, these professionals must identify and represent the nursing care needs of clients in the Nursing Information Systems in use, which are a repository of the Discipline knowledge.

Objective

Identify and specify the nursing diagnoses centred on the ability for self-management of the medication regime, as a type of self-care in situations of health deviation.

Methods

Qualitative study. All nursing documentation customised in the Portuguese nursing information System - SAPE® (2012) and in Sclinico (2016) - was subject to content analysis. After conducting content analysis, the authors presented it to a group of 14 nursing experts in the field, to reach consensus.

Results

From the analysis of the national customisations, we infer a set of nursing diagnoses related to the person's abilities to manage the medication regime. These diagnoses focus on the potential to improve the ability for: self-management of the medication regime; self-management of the medication regime using devices; administering medication; administering subcutaneous medication; administering insulin; administering inhalant medication; administering oxygen therapy; self-monitoring in face of the medication regime; self-monitoring of capillary glycemia; self-monitoring heart rate in face of administering medication; self-monitoring blood pressure in face of administering medication; and self-monitoring urine.

Conclusions

The specified diagnoses reflect nursing care needs of people who are challenged to live with chronic illnesses, particularly at the level of skills they need to develop in order to manage the medication regime. It is necessary that nurses identify these needs to prescribe interventions that improve the ability of the person to administer medication, with or without the use of devices; by different routes; and to monitor some physiologic parameters related to the medication taken. We believe this will be a first contribution to the representation of the nursing knowledge in this area.

References

1. Meranus M, Engstrom G. Experience of self-management of medications among older people with multimorbidity. J Clin Nurs. 2015; 24: 2757-2764.

2. Duguay C, Gallagher F, Fortin M. The experience of adults with multimorbidity: a qualitative study. J Comorbidity. 2014; 411-21.

3. Meleis A, Sawyer L, Im E, Messias H, DeAnne K, Schumaker K. Experiencing transitions: an emerging middle-range theory. Advances in Nursing Science. 2000; 23 (1): 12-28.

Keywords

Self-management, Medication regime, Nursing diagnosis, Nursing information systems.

P25 Antioxidant activity of Artemisia annua L

Rita Vieira¹, Cláudia Pinho², Ana I Oliveira², Rita F Oliveira^2,3, Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Cláudia Pinho (clp@eu.ipp.pt)

Background

Tea infusions of Artemisia annua are known for their prophylactic and therapeutic efficacy against malaria [1]. However, recent studies have revealed that A. annua possess a variety of pharmacological activities such as antibacterial, cytotoxic and antioxidant [2, 3].

Objective

This study aims to evaluate antioxidant activity of A. annua plant obtained from two different manufactures, prepared using different solvents.

Methods

A. annua leaves (obtained from two manufactures) were extracted with two solvents (water and 70% ethanol), and antioxidant activity of the extracts were screened using superoxide and 1,1-diphenyl-2-picryl hydrazyl (DPPH•) radical scavenging, and metal chelating activity.

Results

The extracts tested not only showed ability to bind to iron ions but also demonstrated ability to inhibit free radicals. Results showed that antioxidant activity increased with increasing concentrations of the extracts studied. The IC50 values of A. annua aqueous extract (infusion), obtained from manufacture A, for DPPH and superoxide radical scavenging activities, and Fe²⁺ chelating activity, ranged from 29.3 to 176.6 μg/mL. For the hydroalcoholic extract, IC50 values ranged from 28.0 to 262.1 μg/mL (all above standards). The IC50 values of A. annua aqueous extract (infusion), obtained from manufacture B, for superoxide and DPPH radical scavenging activities, and Fe²⁺ chelating activity, ranged from 6.9 to 282.0 μg/mL. For the hydroalcoholic extract, IC50 values were 40.4, 46.8 and 50.5 μg/mL for Fe²⁺ chelating activity, superoxide and DPPH radical scavenging activities, respectively. Only the aqueous extract, obtained from manufacture B, showed an IC50 value (6.9 μg/mL), for the superoxide radical scavenging activity, lower than positive control (20.6 μg/mL - ascorbic acid).

Conclusions

This study confirms the differences in antioxidant activities using different solvents, suggesting that the solvent effect should be taken into account in the evaluation of the antioxidant potential of any sample. However, the origin of the plants including the pre- and post-harvesting practices can be also important for their chemical composition, resulting in different values for the same antioxidant assays and solvents.

References

1. van der Kooy F, Verpoorte R. The content of artemisinin in the Artemisia annua tea infusion. Planta Med. 2011, 77(15):1754-6.

2. Kim WS, Choi WJ, Lee S, Kim WJ, Lee DC, Sohn UD, Shin HS, Kim W. Antiinflammatory, Antioxidant and Antimicrobial Effects of Artemisinin Extracts from Artemisia annua L. Korean J Physiol Pharmacol. 2015, 19(1):21-7.

3. Singh NP, Ferreira JF, Park JS, Lai HC. Cytotoxicity of ethanolic extracts of Artemisia annua to Molt-4 human leukemia cells. Planta Med. 2011, 77(16):1788-93.

Keywords

Artemisia annua, Antioxidant activity, Solvent extraction, DPPH, Superoxide anion radical, Metal chelating activity.

P26 Swimming pool users and behaviors: practices and motivations

Daniel A Marinho^1,2, Luís Faíl¹, Mário C Marques^1,2, António Sousa^1,2, Henrique P Neiva^1,2

¹Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, University of Tras-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal

Correspondence: Daniel A Marinho (marinho.d@gmail.com)

Background

Health and sports professionals have recommended water-based exercises as an alternative to traditional dry-land exercise, leading to an increase in physical exercise performed in an aquatic context. The properties of the aquatic environment, combined with the resistance of the water during all movements, make it beneficial for health-related parameters and physical fitness [1]. However, research is needed to understand the practices of different populations, according to the specificity of some activities. Few is known about people’s practices in these particular activities.

Objective

The purpose of this study is to characterize Portuguese practices and motivations to use the swimming pools and to exercise in-water physical activities.

Methods

Subjects from the interior region of Portugal, swimming pool users, completed a questionnaire consisting of 33 questions. Those questions were focused on the characterization of their usual in-water activities, and main motivations.

Results

Until now, 418 swimming pool users answered the questions, ranging from 18 to 79 years old (44.7% females, 55.3% males). Most of them were active and only 67 subjects were retired from work. They used to practice aquatic actives for more than 2 years (60%), and the majority twice-a-week, preferring the evening time to attend the swimming pool. Among the various types of swimming pool use, it was verified that 31% perform water aerobics, 48% swimming classes and 31% free time schedules. More than half of the sample only performed aquatic activities (54%) and aimed to improve health (47%), physical fitness (31%) and 11% to relief stress. Curiously, only 1% wanted to learn how to swim. They classified the physical activities performed in-water in the last few weeks mostly of moderated/vigorous intensity. People who attend to swimming pools are persistent and committed with aquatic exercitation, practicing for more than two years. Although most of them participate in swimming or water aerobics lessons, there is still a considerable number of free-time users and swimming pools must be prepared for this fact. Interestingly, the majority attend to swimming pool to improve health and physical fitness.

Conclusions

This pilot study will be implemented in several other regions of the country and this would allow to understand the motivations and needs of users and to improve offers and support to other areas of research (i.e., development of technological devices).

Acknowledgements

This project was supported by the Project NanoSTIMA: Macro-to-Nano Human Sensing, Towards Integrated Multimodal Health Monitoring and Analytics, NORTE-01-0145-FEDER000016, co-financed by European Fund for Regional Development (FEDER) - NORTE 2020.

References

1. Barbosa TM, Marinho DA, Reis VM, Silva AJ, Bragada JA. Physiological assessment of head-out aquatic exercises in healthy subjects: a qualitative review. J Sports Sci Med. 2009, 8(2): 179-189.

Keywords

In-water activities, Questionnaire, Physical activity.

P27 Critical patient’s comfort:sStrategies to reduce environmental noise levels

Telma Ramos, Filipa Veludo

School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

Correspondence: Telma Ramos (telmaramos_24@hotmail.com)

Background

Noise may have harmful effects. For critically ill patients, highlights have main consequences cardiovascular disorders, reduction of arterial oxygen saturation, increase in gastric secretion, stimulation of the pituitary gland, sleep disturbance, immunosuppression and reduction of the cicatrisation process [1]. Noise has an overall negative impact on patients’ recovery. Identification and dissemination of strategies to reduce environmental noise empowers nurses towards changes in their professional practice.

Objective

Identify evidence in Literature of nursing care strategies to reduce environmental noise in critical patient care. Methods

This research was conducted in two phases. 1st Phase: Mediated by an integrative literature review (16/04/2017) we carried out data-base research through the Academic Search Complete; Complementary Index; CINAHL Plus with Full Text; Directory of Open Access Journals; Supplemental Index; Psychology and Behavioural; Sciences Collection; SPORTDiscus with Full Text; RCAAP; SciELO; Europeana; Business Source Complete; Education Source; IEEE Xplore Digital Library; MedicLatina; JSTOR Journals; PsycARTICLES; ScienceDirect. Descriptors: (TI (Noise*or sleep*) AND (Nurs*) AND (intervention or care or patient care or care plan* or critical care), non-temporal. Inclusion criteria: Primary, secondary, opinion/reflexion studies. Exclusion Criteria: Paediatrics context, REM, pharmacological intervention. From the initially 441 articles obtained, we excluded 391 by reading abstracts, 22 by summary and 15 by the complete text, concluding with 13 articles as final sample. 2nd Phase: Content analysis according to [2] in order to categorize results.

Results

We have identified 6 feasible categories for environmental noise reduction, which we present as main strategies: Behavioural changes (creation of awareness to the importance of the tone of voice and silent handling of equipment and materials); Material and Equipment management (mobile phones, televisions and radios volume configuration; determination of correct parameters for alarm configuration); Management of silence promotion care (implementation of periods of silence, avoid noisy tasks); Training in environmental noise (behavioural change programs and health education about negative effects of noise); Care quality control (usage of ear plugs); Others (infrastructural adaptations, encourage suppliers to produce more silent products).

Conclusions

This study systematizes strategies to be implemented by nursing professionals in order to reduce environmental noise within health structures and improve patient comfort. The implementation of a silence culture enables an adequate and essential physical environment to patient recovery [3]. Empower nurses with the identified strategies allows the improvement of people’s quality of life. The shortage of published research reflects the need of forward research.

References

1. Christensen, M. (2007). Noise levels in a general intensive care unit: a descriptive study, Nurse Critical Care, 12(4), 188-97.

2. Bardin, L. Análise de Conteúdo. Lisboa: Edições 70 Lda, 2016.

3. Nightingale F. Notas Sobre Enfermagem: o que é e o que não é. Loures: Lusociência; 2005.

Keywords

Noise, Comfort, Integrative literature review, Content analysis.

P28 Nurse-patients’ family interaction in ICU and the establishment of effective therapeutic partnerships: vulnerability experienced and clinical competence

Anabela Mendes (anabelapmendes@esel.pt)

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Background

When faced with a negative event such as the situation of a critical illness, nurses and patients’ family build their interaction on a daily basis [1-3]. The closeness and the joint interest in finding together the answer to their common issues motivates them for a common path, based on trust [4]. We find that nurses' clinical exercise time and their clinical competence can influence this process [5, 6].

Objective

To analyse how family perceives the interaction between nurses and the family. To diagnose how to build a daily basis interaction when facing a critical illness, and which steps highlight the existing confidence. Having Benner's theoretical framework as a support, we need to understand the relationship between the time spent in critical care and nurses’ clinical competence.

Methods

Qualitative study. Data collection through open interview to 12 family members, of an adult person hospitalized in ICU. The interviews content analysis was carried out according to the phenomenological approach suggested by Van Manen. The Software used for qualitative data analysis was Nvivo. This software showed the advantages of time saving and allowed to carefully explore the relationship between the data [7].

Results

Family members recognized how determinate the interaction with nurses to their daily life in the ICU was. They reported the careful construction of discourse and the effective presence with the sick person as nurses' strategy for interaction. The need to know better the situation and to discover what will happen, motivated families to start the interaction. Trust was revealed in founded solicitude and compassion. Families know that nurses are vulnerable to their suffering. During interaction, family members noticed that clinical competence is inherent to the nurse person and not related to the time of practice.

Conclusions

The co-existence compromises nurses and family in the construction of an effective therapeutic partnership. They recognized that the information they have from the sick person, arising from different circ*mstances, must be shared, considering professional ethics, beliefs and values and also the relevance for the therapeutic process. It is in interaction and for the interaction that they discover vulnerability, comfort and trust each other.

References

1. Curtis, J. Caring for patients with critical illness and their families: the value of integrated clinical team. Respiratory care. 2008, 53 (4): 480-487.

2. Mendes, A. A informação à família na unidade de cuidados intensivos: Desalojar o desassossego que vive em si. Lisboa : Lusodidacta, 2015.

3. Mendes, Aa. Sensibilidade dos profissionais face à necessidade de informação: a experiencia vivida pela família na unidade de cuidados intensivos. Texto Contexto Enferm. 2016, pp. 5(1):2-9 http://dx.doi.org/10.1590/0104-07072016004470014.

4. Benner, P., Kyriakidis, P. e Stannard, D. Clinical wisdom and interventions in acute and critical care. A Thinking-in-action approach. 2ª. New York : Springer publishing company, 2011. 1ª edição- 1999. 978-0-8262-0573-8.

5. Benner, P., et al., et al. Educating nurses. A call for radical transformation. San Francisco : The carnegie foundation for the advancement of teaching, 2010. 978-0-470-45796-2.

6. Benner, P., Tanner, C. e Chesla, C. Expertise in nursing practice. Caring, clinical judgement & ethics. New york : Springer publishing company, 2009. 978-0826 12544-6.

7. Forte, E., et al., et al. A Hermenêutica e o Software Atlas.ti: União promissora. Texto Contexto Enferm. 2017, 26(4).

Keywords

Family, Nursing, Intensive care, Interpersonal relations, Communication.

P29 Effectiveness of vein visualization technologies on peripheral intravenous catheterization: a systematic review protocol

Anabela S Oliveira¹, João Graveto¹, Nádia Osório², Paulo Costa¹, Vânia Oliveira¹, Luciene Braga⁴, Isabel Moreira⁵, Fernando Gama, Daniela Vidal, João Apóstolo⁶, Pedro Parreira¹

¹Health Sciences Research Unit, Nursing School of Coimbra, Coimbra, 3046-851, Portugal; ²Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, 3046-854, Portugal; ³Coimbra Hospital and Universitary Centre, 3000-075 Coimbra, Portugal; ⁴Federal University of Viçosa, Minas Gerais, 36570-900, Brazil; ⁵Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ⁶Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence, 3046-851 Coimbra, Portugal

Correspondence: Pedro Parreira (parreira@esenfc.pt)

Background

The insertion of a peripheral vascular catheter (PVC) is the most often invasive procedure performed in hospital settings [1-3]. During hospitalization, 33.0-96.7% of patients need to have a PVC inserted [4-6]. These devices are not risk-free, affecting patients’ safety and well-being. In fact, up to 72.5% of the PVCs are removed due to complications [6]. Healthcare professionals should consider using specific technologies that help to select the vein to puncture and reduce the number of attempts and catheter-related mechanical complications.

Objective

This review aims to identify and synthesize the effectiveness of the use of vein visualization technologies (near-infrared light or ultrasonography) in patients who need peripheral intravenous catheterization when compared with the traditional technique.

Methods

Methodology proposed by Joanna Briggs Institute [7]. A three-step search strategy was used in this review: (I) an initial limited search was undertaken followed by an analysis of the words contained in the title and abstract, and of the index terms used to describe the article; (II) a second search using all identified keywords and index terms was undertaken across all included databases; (III) the reference list of all identified reports and articles was searched for additional studies. Studies of quantitative evidence published between 1999 and 2017 were considered for inclusion in this review. This review included patients of all ages, in any clinical setting. However, studies where patients displayed a previous vascular access device in situ were excluded. The assessment of methodological quality, data extraction and synthesis will be conducted by two independent reviewers using standardized tools recommended by the Joanna Briggs Institute [7]. Any arising disagreements will be resolved through discussion or with a third reviewer.

Results

An initial limited search of MEDLINE via PubMed and CINAHL was undertaken, using specific terms such as: catheters; cannula; “vascular access devices”; “peripheral intravenous catheterization”; “peripheral venous catheterization”; “peripheral access”; “peripheral intravenous access”; “venous access”; NIR*; near-infrared*; infra-red*; light*; device*; machine*; ultrasonograph*; technolog*; sonography*; ultrasound*. Resultantly, 2,699 studies were retrieved, written in English, Portuguese, Spanish and French. Keywords and index terms are being identified in order to generate a more comprehensive search strategy (step two).

Conclusions

The critical analysis of existing data will contribute to the dissemination of the best evidence available on the subject. It is expected that this dissemination will be reflected in the definition of guidelines regarding PVC management and, consequently, in the optimization of current practices.

Acknowledgements

This protocol is part of the project “Transfer of technological innovations to nursing practice: a contribution to the prevention of infections”, funded from the European Regional Development Fund, by the Operational Program Competitiveness and Internationalization of PORTUGAL 2020.

References

1. Marsh N, Webster J, Mihala G, Rickard CM. Devices and dressings to secure peripheral venous catheters to prevent complications. Cochrane Database Syst Rev. 2015; 6:1-14.

2. Wallis MC, McGrail M, Webster J, Marsh N, Gowardman J, Playford EG et al. Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infection control and hospital epidemiology. 2014;35(1):63-8.

3. Webster J, Osborne S, Rickard C, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2015;8. Art. No.: CD007798.

4. Grüne F, Schrappe M, Basten J, Wenchel H, Tual E, Stützer H. Phlebitis Rate and Time Kinetics of Short Peripheral Intravenous Catheters. Infection. 2004;32(1):30-32.

5. Pujol M, Hornero A, Saballs M, Argerich M, Verdaguer R, Cisnal M et al. Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital. Journal of Hospital Infection. 2007;67(1):22-9.

6. Braga LM. Práticas de enfermagem e a segurança do doente no processo de punção de vasos e na administração da terapêutica endovenosa [PhD Thesis]. Universidade de Lisboa; 2017.

7. Peters M, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, ed. by. Joanna Briggs Institute Reviewer's Manual [Internet]. The Joanna Briggs Institute; 2017 [cited 14 December 2017]. Available from: https://reviewersmanual.joannabriggs.org/.

Keywords

Peripheral intravenous catheterization, Near-infrared light, Ultrasonography, Traditional technique.

P30 Falls Efficacy Scale-International: how does it “behave” with users of adult day care centres?

Daniela Figueiredo^1,2, Martina Neves¹

¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Daniela Figueiredo (daniela.figueiredo@ua.pt)

Background

The Falls Efficacy Scale-International (FES-I) is a highly reliable instrument to assess fear of falling among older adults. However, the majority of validation studies with the FES-I are conducted with independent and relatively healthy community-dwelling older people, which limits extrapolation to those receiving adult day care services. Reference to higher disability and frailty is common among adult day care users compared to non-users.

Objective

This study presents preliminary findings of the psychometric properties of the European Portuguese version of the FES-I in a sample of older users of day care centres.

Methods

A cross-sectional study with a convenience sample was conducted. Data collection included a socio-demographic questionnaire, and the Portuguese versions of the FES-I and the Activities-specific Balance Confidence Scale (ABC). Descriptive and inferential statistical analyses were performed.

Results

A total of 100 older people users of day-care centres (81.94 ± 6.43 years old; 77% female) have participated in the study. FES-I had excellent internal consistency (α = 0.970) and test-retest reliability (ICC2,1=0.979). A significant negative correlation was found between the FES-I and the ABC (rs = -0.828; p < 0.001), indicating good concurrent validity. FES-I scores were significantly higher among those who were older, female and less educated.

Conclusions

The FES-I seems to be a reliable and valid measure of fear of falling for older people who are clients of adult day care services. The findings are highly comparable with those previously found for non-users of day-care centres. FES-I can be also used to prevent risk of falls in this type of care settings.

Acknowledgements

This paper was supported by ERDF (European Regional Development Fund) through the operation POCI-01-0145-FEDER-007746 funded by the Programa Operacional Competitividade e Internacionalização – COMPETE2020 and by National Funds through FCT - Fundação para a Ciência e a Tecnologia within CINTESIS, R&D Unit (reference UID/IC/4255/2013).

Keywords

Falls Efficacy Scale-International, Older people, Adult day care, Fear of falling, Psychometric properties.

P31 Function-Focused Care: validation of self-effecacy, outcomes expectations and knowledge scales

Lénia Costa¹, Pedro Sá-Couto², João Tavares^3,4

¹Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal; ³Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ⁴Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal

Correspondence: Lénia Costa (leniacosta@ua.pt)

Background

The nursing assistant (NA) plays an important role in maintaining the health and independency of institutionalized older adults (OA) [1]. These professionals are required to help OA to achieve and maintain their highest level of function. The Function-Focused Care (FFC) is a philosophy of care that promotes the restoration and/or maintenance of physical function. In the institutional context it is relevant empowering NA to adopted this philosophy [2].

Objective

This study intends to analyse the perception of NA in relation to the FFC, through scales of self-efficacy, outcomes expectations and knowledge, as well as, the validity and reliability related properties.

Methods

Quantitative approach of a descriptive/correlational cross-sectional type. A self-report questionnaire consisting of sociodemographic and professional variables and the scales of self-efficacy, expectations and knowledge were applied. Further details about the scales used can be found in Costa [3]. The validation/reliability procedures for each scale consisted in the calculation of exploratory factor analysis, Cronbach's alpha, and in the intra-class correlation coefficient (ICC) for test/retest purposes. Correlation between the scales themselves, with feelings related to the care of elderly, and sociodemographic and professional variables were tested using the Spearman Rank test.

Results

The sample consisted of 73 NA (100% women) with a mean age of 46.4 (± 9.9) years from 5 different institutions. The scale of the self-efficacy showed a three-factor model with the total variance of 73.4%, Cronbach's alpha = 85.2% and ICC = 0.80. The scale of outcomes expectations presented one factor, Cronbach's alpha= 95.2% and ICC = 0.97. The scale of Knowledge obtained a percentage of correct answers only of 44.7%. It was not possible to develop predictive models to relate these scales in a pre-intervention situation. Also, the low correlation between the scales and feelings related to the care of OA (difficulty, gratification, physical overload and emotional overload) or sociodemographic and professional variables (age, years of experience, and self-knowledge), indicated a weak dependence between them. Finally, the institution variable showed not to be a confounding variable (that is, does not influence these results).

Conclusions

The Portuguese version of the scales analysed showed satisfactory data validity and reliability. These results suggest that the Portuguese version of these scales can be used to evaluate the FFC performed by the NA. These results point to the importance of implementing a FFC program in the institutions and analyse its impact on AO care and on NA.

Acknowledgements

This work was supported in part by the Portuguese Foundation for Science and Technology (FCT-Fundação para a Ciência e a Tecnologia), through CIDMA - Center for Research and Development in Mathematics and Applications, within project UID/MAT/04106/2013.

References

1. Gray-Stanley JA, Muramatsu, N. Work stress, burnout, and social and personal resources among direct care workers. Research in Developmental Disabilities. 2011; 32(3), 1065–74. http://doi.org/10.1016/j.ridd.2011.01.025

2. Resnick B, Boltz M, Galik E, Pretzer-Aboff I. Restorative Care Nursing for Older Adults. New York; Eds: Graubard A, Claire L (2nd ed); Springer Publishing Company; 2012

3. Costa, Lénia. Cuidado centrado na funcionalidade: validação das escalas de autoeficácia, expectativas e conhecimento [Master Thesis] [Portuguese]. Universidade de Aveiro. 2016

Keywords

Aging, Functionality, Function-focused care, Nursing assistant.

P32 Determinant factors for the development of student competencies in the context of clinical training: one ecological perspective

Marília Rua¹, Isabel Alarcão², Wilson Abreu³

¹Health School, University ofAveiro, 3810-193 Aveiro, Portugal; ²University of Aveiro, 3810-193 Aveiro, Portugal; ³Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Marília Rua (mrua@ua.pt)

Background

The growing complexity of health care settings, as well as the own care, require that training in this area is also a process thought, a dynamic perspective of integration/implementation of knowledge in each context, which is only possible if carried out in close collaboration between school and a real context of clinical practice [1]. In the light of bio-ecological perspective [2] the development of skills of the students in this context may be influenced by several factors related to the person, the process, context and time.

Objective

To understand the factors that influence the development of student’s skills in the clinical training.

Methods

We selected a qualitative methodology, using a case study [3] referring to the Nursing Degree, in University of Aveiro. Data emerged from narratives of students and supervisors about their experiences on clinical context.

Results

The final results allow us to conclude that the development of abilities occurs in an integrating way, combining synergistically different dimensions and important factors related to the PPCT model. For the Person - emerge the activities, the contact with suffering/death and affective-relational climate. For the Process, the proximal process is pointed out, as well as strategies of supervision. In these contexts, emerge, in the microsystem, the specificities of each context; in the mesosystem the importance goes to the multicontextual participation; in the exosystem, to the interinstitutional relationship and, at a macrosystemic, signs the influence of the policies of hospital management. With respect to time, the importance of the continuity of the proximal processes and the periodicity of the clinical teaching were observed.

Conclusions

The student’s skills development is a dynamic, dialectical and progressive process which implies: continuity over time; progressive interaction with people of context–process; contexts that establish themselves as important elements in the development of students' skills at different levels.

References

1. Rua M dos S. De aluno a enfermeiro - Desenvolvimento de Competências em Contexto de Ensino Clínico. Loures: Lusociência; 2011.

2. Bronfenbrenner U, Morris P. The Ecology of Developmental Process. In: Pedro JG, editor. Stress and Violence in Childhood and Youth. Lisboa: Faculdade de Medicina, Universidade de Lisboa; 1999. p. 21–96.

3. Yin R. Estudo de Caso. Planejamento e Métodos. 3a. Porto Alegre: Artemed Editora; 2005.

Keywords

Bioecological model, Student, Competencies, Clinical training.

P33 Phytochemical screening from Rosmarinus officinalis and Ginkgo biloba leaf extracts

Ana França¹, Diana Silva², Ana I Oliveira³, Rita F Oliveira^3,4, Cláudia Pinho³, Agostinho Cruz³

¹Farmácia Holon, Baguim do Monte, 4435-668 Gondomar, Portugal; ²Farmácia Higiénica, Fão, 4740-323 Esposende, Portugal; ³Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ⁴Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Ana França (anap981@gmail.com)

Background

Currently, drug therapy with oral antidiabetic agents, is capable of inducing normoglycemia levels able to decrease the risk of complications associated with diabetes mellitus. However, it is also known that the various existing oral antidiabetic agents may trigger a large number of adverse events, either alone or in combination. Some of these tolerability and security issues related to the oral antidiabetic are reported by patients and can influence negatively or satisfaction with treatment or glycaemic control, or the therapeutic adherence and maintenance. It is therefore very important the role of patients in monitoring of adverse events related to the use of the oral antidiabetic drugs in order to optimize treatment and improve the quality of life of patients with type 2 diabetes (DM2).

Objective

The aim of this study is to determine the prevalence of adverse events associated with use of oral antidiabetics and assessing their impact on Health-related Quality of Life (HRQoL) of diabetic patients tracked in primary health care.

Methods

A total of 357 DM2 patients were enrolled in observational and cross-sectional study, recruited in six Health Care Centres/Family Health Units (FHU) of the central region of Portugal. Data collection comprised three questionnaires to measure the prevalence of adverse events, the diabetes health profile (DHP-18) and EQ-5D-3L.

Results

The results show that the highest prevalence of adverse events is in the DipeptidylPeptidase-4 Inhibitors followed by Metformin+Sitagliptin (fixe dose) and Metformin+Vildagliptin (fixe dose) therapeutic classes. We also found that all the correlations between different variables are statistically significant (p < 0.001).

Conclusions

Thus, we conclude that patients who show greater number of adverse events tend to have poorer health profile, worse general health and also lower health related quality of life.

References

1. Begum A, Sandhya S, Ali SS, Vinod KR, Reddy S, Banji D. An in-depth review on the medicinal flora Rosmarinus officinalis (lamiaceae). Acta Sci Pol Technol Aliment. 2013;12(1):61–73.

2. European Medicines Agency. European Union herbal monograph on Ginkgo biloba L., folium. 2015.

3. Goh LM, Barlow PJ, Yong CS. Examination of antioxidant activity of Ginkgo biloba leaf infusions. Food Chem. 2003;82:275–82.

4. Kontogianni VG, Tomic G, Nikolic I, Nerantzaki AA, Sayyad N, Stosic-Grujicic S, et al. Phytochemical profile of Rosmarinus officinalis and Salvia officinalis extracts and correlation to their antioxidant and anti-proliferative activity. Food Chem. 2013;136(1):120–9.

Keywords

Rosmarinus officinalis, ginkgo biloba, phytochemical screening, leaf extract.

P34 Systematic review - how comfort and comfort in nursing are characterized

Ana R Sousa¹, Eliette Castela², Patrícia Pontífice-Sousa², Teresa Silveira

¹Centro Hospitalar de Setúbal, 2910-446 Setúbal, Portugal; ²Universidade Católica Portuguesa, 1640-023, Lisboa, Portugal

Correspondence: Ana R Sousa (anaritasousa00@gmail.com)

Background

Comfort is an important concept and a fundamental value of nursing. This is assumed to be a multidimensional, dynamic and intersubjective concept and the nursing intervention measures used to satisfy the specific comfort needs, thus comforting constitutes a competence of the nurse. Recognizing the importance of scientific evidence in practice, the importance of characterizing and understanding the ways and means of comfort centred on the needs of the client, an exploratory research was carried out with the purpose of knowing the meaning of comfort, as well as ways and forms of comfort, in order to define effective interventions that promote comfort.

Objective

To know how is evidenced the characterization of comfort and comfort in the nursing scientific literature.

Methods

Systematic review of the literature based on the recommendations of the Joanna Briggs Institute on the PICO strategy and PRISMA recommendations. The research was performed in databases CINAHL Plus, MEDLINE, Nursing & Allied Health Collection and MedicLatina, from January 2010 to November 2017, combining the following descriptors: Comfort * AND Nurs * AND research NOT Psyquiatric.

Results

Eleven studies were integrated in the review, which involved people with chronic and acute illness. Studies have shown that being socially accepted, being physically comfortable, feeling safe, being close to significant people are some of the characteristics that qualify comfort. Regarding comfort in nursing, the findings analysed demonstrate numerous comforting strategies, namely, effective and empathetic presence, touch, smile, family integration in the care process, among others.

Conclusions

The main results, while providing data that allow us to characterize comfort and comfort in nursing, also highlight the need to investigate the focus.

Keywords

Caracterization of the comfort term, Comfort care, Nursing care.

P35 Rotines of life and health of institutionalized young people

Tiago Machado¹, João Serrano¹, Sergio Ibanez², Helena Mesquita¹, Pedro Pires¹

¹School of Education, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Faculty of Sports Science, University of Extramadura, 10003 Cáceres, Spain

Correspondence: Tiago Machado (tiagomachadix@gmail.com)

Background

Today's society creates many limitations in the daily lives of children and young people and will have an impact on their well-being, health and quality of life. This is aggravated when we speak of institutionalized children. Objective

To study the leisure activities of young people institutionalized in Homes for Children and Youth and to know if these activities contribute to the development of healthy lifestyles.

Methods

A questionnaire was used as instrument, which was submitted to validation by specialists. The questionnaires were completed by the young people with the presence of the researcher. The sample consisted of 100 young people aged between 10 and 18 years old, belonging to 6 Homes for Children and Youth.

Results

In the period of free time we found that in the recreations the most accomplished activities were to talk with friends (86.4%), play in the sports fields (47.5%) and dating (23.3%). Most of the young people do not participate in school sports (76.7%). The most accomplished activities after school were: watching TV (100%), cleaning the Institution (96.2%), listening to Music (89.3%), studying (87.4%), playing on the computer and on Facebook (82.6%) and doing physical activity (table tennis, football, among others) (73.8%). Regarding the accomplishment of these activities, the young people reported doing them daily or at least 2 to 3 times a week. When asked if they would like to occupy their free time within the institutions otherwise, the young people were divided, even though the majority responded that they did not (53.4%). As young people are in an open regime, we asked them which activities were most frequently carried out, outside the institution, and they answered that it was a walk with their friends (87.4%), and that the frequency of this activity was daily or at least 2 to 3 times a week. When asked if they would like to take their free time away from institutions in a different way, most of the young people said no, given that their activities are their preference.

Conclusions

The results showed that the young people in the study carried out activities considered healthy, which contribute to their quality of life and well-being; however, we were able to verify that they present limitations, namely, in relation to physical activity, since most of the activities performed both inside and outside the institutions had low levels of intensity and frequency, being carried out sporadically.

Keywords

Life and health routines, Free Time and Leisure, Children and young people at risk.

P36 Evaluation of pain in patients intubated orotracheally: BPS and CPOT

Ana RPQ Pinheiro¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

Correspondence: Ana RPQ Pinheiro (queiroz.anarita@gmail.com)

Background

Pain is considered as a symptom of difficult assessment and characterization by health care providers who take care of orotracheal intubated patients (EOT) unable to communicate verbally, so their assessment is critical to an effective management of care and therapy. An EOT patient is exposed to a variety of painful procedures and, if the pain is not controlled, it can lead to multiple complications: physical (cardiovascular, neurological and pulmonary) and psychological (stress, anxiety and delirium), so nurses must have credible instruments for evaluation and monitoring.

Objective

This systematic literature review (RSL) aimed to identify the most reliable tool for pain assessment, by analysing the validity and reliability of the BPS and CPOT scales, as well as their ease of application.

Methods

Using the methodology recommended by the Cochrane Centre, this RSL was guided by the following research question: “Which is the most appropriate scale, BPS or CPOT, for pain assessment in patients unable to communicate verbally?” The seven included studies resulted from a research in EBSCO, using the terms “behavioural pain scale” and “critical care pain observation tool”, with Boolean operator “and”, in full text, published between 2007-2017.

Results

With a number of participants between 23 and 117, the 7 selected studies, all with quantitative nature, concluded that both scales are reliable and valid for the assessment of pain in this population [1-5]. [4] report that although BPS is more sensitive in identifying the patient's response, CPOT is a good alternative. It was also verified that both instruments are sensitive to painful procedures, with an increase in several indicators [1, 2, 6]. There was also a significant statistically correlation between the values of arterial tension and the performance of a painful procedure, (the higher the pain value, the higher the arterial tension) [5,6].

Conclusions

Both scales (BPS and CPOT) are suitable for the evaluation of pain in EOT patients and according to nurses, both are easy to apply and useful for care delivery [5, 7]. However, the literature does not show the most adequate scale, suggesting that other studies must be done.

References

1. Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Straaten HMO. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. Journal of Critical Care.

2015; 30: p. 167-172.

2. Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. Pain Medicine. 2015; 16: p. 1622-1628.

3. Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick, Jr RK. Validity and Sensitivity of 6 Pain Scales in Critically Ill, Intubated Adults. American Journal of Critical Care. 2015 Nov; 24(6): p. 514-523.

4. Darwish ZQ, Hamdi R, Fallatah S. Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation. AACN Advanced Critical Care. 2016 4-6; 27(2): p. 162-172.

5. Vadelka A, Busnelli A, Bonetti L. Comparison between two behavioural scales for the evaluation of pain in critical patients, as related to the state of sedation: an observational study. SCENARIO. 2017; 34(2): p. 4-14.

6. Damström DN, Saboonchi F, Sackey PV, Björling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011; 55: p. 379-386.

7. Fothergill Bourbonnais F, Malone-Tucker S, Dalton-Kischel D. Intensive care nurses’ assessment of pain in patients who are mechanically ventilated: How a pilot study helped to influence practice. Canadian Journal of Critical Care Nursing. 2016; 27(3): p. 24-29.

Keywords

Behavioral pain scale, Critical care pain observation tool, Pain rating scales, Nursing.

P37 Analgesic effect of the topical use of cannabidiol oil in experimental ulcers in the laboratory animal

María-del-Carmen Jiménez-Díaz¹, Carla Jiménez-Rodríguez¹, María-del-Pino Quintana-Montesdeoca², Juan F Jiménez-Díaz³, Francisco J Hernández Martínez³

¹Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España; ²Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España; ³Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas, Islas Canarias, España

Correspondence: María-del-Carmen Jiménez-Díaz (cjimenez@ujaen.es)

Background

Since ancient times the use of the Cannabis sativa L. plant has been known in topical form for the treatment of haemorrhages, inflammations, oedema, various pains, among others. In fact, tincture and cannabis extract were sold without restriction in European and American pharmacies until the beginning of the 20th century.

Objective

To study the analgesic effect of cannabidiol oil (CBD) applied topically to experimental ulcerative skin lesions in the laboratory animal.

Methods

Experimental study with control group (with physiological saline to maintain hydration conditions and group with extra virgin olive oil (EVOO) to avoid bias with the oleic excipient), to check the analgesic effect of CBD applied topically on ulcerative lesions. Experimental total skin in the adult male white rat, Sprague Dawley strain. Ten animals were used for each group under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. They were then distributed in individual cages to prevent them from licking each other and with sufficient height to prevent rubbing of the skin ulcer with the passenger compartment. 0.15 ml of the respective product was applied daily to the ulcers. The analgesic response was assessed by obtaining latency of withdrawal of the tail of the animal under thermal stimulus through the meter LE7106 Tail-flick®, Letica®, previous impregnation of the tail of the animals of the different products used by topical friction and, after waiting for 15 minutes, the tail of each of the animals is subjected to the emission of the infrared beam. Similar action was taken with the rest of the products studied, the EVOO and the CBD. The analgesic response was practiced twice, on different days. The statistical program SPSS 25.0 was used, considering a level of significance of p < 0.05.

Results

There was no significant difference between the products applied to the different animals. The highest average corresponded to the application of CBD in observation and measurement 1. In observation and measurement 2, no significant difference was detected and the average values were similar between EVOO and CBD.

Conclusions

The most favourable analgesic response was obtained under the influence of cannabidiol oil, which also presents a greater tolerance to pain as experimentation progresses.

Keywords

Analgesia, Cannabidiol, Skin, Ulcer, Rat.

P38 Polypharmacy in elderly patients in a community pharmacy

Sónia Lopes¹, Clara Rocha², Rui Cruz¹

¹Pharmacy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Complementary Sciences Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Sónia Lopes (soniabelina@gmail.com)

Background

The definition of polypharmacy isn’t consensual, but all authors refer it as the simultaneous use, and the chronic way, of several drugs by the same person. Polypharmacy affects mainly elderly and it’s due to the high number of chronic diseases in this population and consequent need to take medications to control them.

Objective

Characterization and quantification of polypharmacy in a rural elderly population; identification of the most prescribed pharmacotherapeutic classes; evaluation of connection between polypharmacy and elderly characteristics.

Methods

It carried out an observational, retrospective, transversal and analytical study in a Popular Pharmacy (Pombal). 230 individuals aged 65 years old or more were surveyed and the data collection was made through a questionnaire prepared for this purpose. Major polypharmacy was defined as the chronic consumption of at least 5 different drugs.

Results

The elderly took, on average, 6.20 ± 2.91 drugs daily. The prevalence of Major polypharmacy was 70.4%. The most prescribed pharmacotherapeutics groups were cardiovascular and Central Nervous System. There were statistically significant differences between age and number of medicaments taken, as well between number of drugs and the way to identify the medication, the knowledge of the therapeutics indications, the occurrence of mistakes or take outside advised time, and the self-perception of health state (p ≤ 0.05).

Conclusions

In view of the obtained results, it’s concluded that polypharmacy is very high in the Portuguese population under study. It’s the persons most aged who consume a greater number of drugs. The elderly with less academic qualifications are those who have more difficulty in identifying medication and respective therapeutic indications. It’s necessary to adopt strategies in order to reduce polypharmacy, having both the prescriber and the professionals of pharmacy, a preponderant role in this task.

Keywords

Polypharmacy, Elderly, Chronic medication.

P39 Salivary detection of the topical use of cannabidiol oil in experimental ulceras in the laboratory animal?

Bienvenida-Del-Carmen Rodríguez-De-Vera¹, Carla Jiménez-Rodríguez¹, María C Jiménez-Díaz², Juan F Jiménez-Díaz¹, Francisco J Hernández-Martínez³

¹Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España; ²Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España; ³Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas, Islas Canarias, España

Correspondence: Bienvenida-Del-Carmen Rodríguez-De-Vera (bienvenida.rodriguez@ulpgc.es)

Background

Cannabidiol (CBD) is a phytocannabinoid that does not refer to experiences contrasted with its topical use in ulcerative lesions and skin wounds.

Objective

To determine if the topical application of CBD in ulcers exerts a cumulative effect in the organism of the experimental animal, with undesirable effects at the level of the Central Nervous System (CNS), in a similar way to its general use.

Methods

Experimental study applying total skin ulcerative lesions in the adult male white rat, Sprague Dawley strain, with cannabidiol oil to check if it accumulates in the body and can be detected in salivary secretion. Ten animals were used under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. They were then distributed in individual cages to prevent them from licking each other, with sufficient height to prevent rubbing of the skin ulcer with the passenger compartment. 0.15 ml of cannabidiol oil was applied daily to the ulcers. The study of the body accumulation of the drug object of our study, the cannabidiol oil, was done by qualitative detection of the drug and its metabolites in the saliva of the experimental animal. This type of assay provided a preliminary analytical result using monoclonal Ab to selectively detect high levels of a specific drug which, if positive, would require complementing it with other chemical methods to quantify the accumulation of the product. The test, drogotest®, is made up of spongy collectors (chupa-chups) that, after being soaked for 3 minutes in the mouth of the animal treated with cannabidiol oil, allows to pour its contents by manual compression of the same through a strainer in collecting chamber. Finally, 3 drops of the fluid of the animal's saliva, contained in said collecting chamber, are poured over a detector sample in cassette wells that will show, or not, the presence of the drug in a time period of less than 10 minutes, by observation. direct visual with colour changes of the cassette sample.

Results

The detection by the drogotest® test of the general accumulation of cannabis in the organism of the animals studied was negative.

Conclusions

The benefit of the topical use of cannabidiol in ulcerative lesions is confirmed without the undesirable effects that cannabis causes in the CNS.

References

1. Grotenhermen F, Russo E, Navarrete R (eds). Cannabis y cannabinoides, farmacología, toxicología y potencial terapéutico. Sevilla: Castellarte; 2003.

2. Abanades S, Cabrero-Castel A, Fiz J, Farré M. Farmacología clínica del cannabis. Dolor 2005; 20: 187-98.

3. OMS. Serie Informes Técnicos, nº 478. El uso del Cannabis.

4. Fusar-Poli P et al. Distinct effects of (delta) 9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing. Arch Gen Psychiatry 2009; 66 (1): 95-105.

5. Pertwee RG. Cannabinoid receptors and pain. Prog Neurobiol 2001; 63: 569-611.

6. Walker JM, Huang SM. Cannabinoid analgesia. Pharmacol Ther 2002; 95: 127-35.

Keywords

Detection, Saliva, Cannabidiol, Skin, Ulcer, Rat.

P40 Humour and nurses’ stress: humour contributions on stress management. A literature systematic review

Maria I Santos¹, Rita Marques²

¹Health Sciences Institute, Catholic University of Portugal, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-125 Lisbon, Portugal

Maria I Santos (inescamiller@gmail.com)

Background

Nurses experience high levels of work-related stress due to their daily contact with critical situations, suffering, negative emotions and death. This stress overload imposes negative consequences at an individual and at an organizational level, with direct and indirect costs. On the contrary, humour seems to produce benefits to health, job satisfaction and group cohesion, when used in an adaptive way. There is scientific evidence that humour may establish an incisive coping strategy in the management of work-related stress that can be used by nurses for their own benefit.

Objective

The aim of the present study is to build a framework of a systematic review on the relationship between humour and nurses’ work-related stress.

Methods

Using the Cochrane Centre recommended methodology, this systematic review was guided by the following research question: What is the contribution of humour to nurses’ stress management? The research was performed through the EBSCO and Google Scholar search engines, in the bibliographic databases: CINAHL®Complete, MEDLINE Complete, Cochrane Controlled Trials Register, MedicLatina, Pubmed, Scielo and RCAAP, since 2007 to 2017, using the following conjugations of descriptors and Boolean operators: humour (OR humor) AND stress AND nurses (OR nursing) NOT children NOT patients NOT students.

Results

A sum of four articles, that respond to our research question, was selected. The empirical studies were developed in four different countries (USA, Canada, UK and Portugal) with diverse designs using either qualitative and quantitative approaches. The sample varied from 15 to 61 nurses. All studies demonstrated that humour expressions are used by nurses to deal with stressful situations [1-4].

Conclusions

The use of adaptive forms of humour promote detachment and reassessment of the situation contributing to stress management [3, 4]. It also strengthens interpersonal relationships, improves communication and group cohesion, and contributes to job satisfaction [1, 2]. Therefore, evidence shows that humour can be an effective tool in stress management. Moreover, one study points out that humour can also arise in response to stress, warning to an increased stress level [4]. Nevertheless, the reduced empiric evidence found suggests that this subject within Nursing Science is not yet highly established.

References

1. Scott T. Expression of humour by emergency personnel involved in sudden deathwork. Mortality. 2007, 12 (4): 350-364.

2. Dean R, Major J. From critical care to comfort care: the sustaining value of humour. Journal of Clinical Nursing. 2008, 17: 1088-1095.

3. Harris T. Caring and Coping. Exploring How Nurses Manage Workplace Stress. Journal of Hospice & Palliative Nursing. 2013, 15 (8): 446-454.

4. Santos M, José H, Capelas M. O Humor e o Stresse dos Enfermeiros que Cuidam com Pessoas em Fim de Vida. Revista Servir. 2016, 59 (4): 69-74.

Keywords

Humor/humour, Stress, Nurses.

P41 Socio-clinical relationships among nursing students in practice context

Laura Reis (laurareis@esenf.pt)

Porto Nursing School, 4200-072 Porto, Portugal

Background

It is in clinical context that the students attribute greater meaning to their peers. This fact is related to a set of new experiences that are significant for these actors. Supported by the literature consulted, we are led to say that they last even beyond the end of the course, unlike the relations established in the classroom.

Objective

Analyse the relationships established among students over two consecutive clinical studies.

Methods

The study was carried out with students from a group of the 2nd year of a Nursing Degree who were experiencing their first clinical experience in a hospital context, namely 10 weeks in an internal medicine service and 10 weeks in a surgery service. We chose an ethnographic study within the framework of the qualitative paradigm, in a longitudinal approach according to the logic of the case study. As a data collection technique, we used participant observation and semi-structured interviews.

Results

We verified that the relation established between students differed according to whether it was a first or a second clinical teaching. The knowledge that the group acquired about themselves and about the methodologies adopted by the tutors, was different in the different contexts. In the first medical school (medicine), despite the little knowledge that the students had among themselves, the established relationship was very cooperative and cordial, based on the spirit of help. This was due to a number of factors, namely, a first clinical experience, leading to a high need to share information and knowledge related to the context and clinical practices; the lack of knowledge about tutors; and the lack of safety in the care of patients. The relationships established in this space were, therefore, strong and cohesive. In the clinical teaching of surgery, the relation established was different, highlighting more divergences/heterogeneities. According to the students' opinion, this fact was related to the work methodology/distribution of students and the request of academic work by the teachers.

Conclusions

We verified that on the 2nd clinical teaching, the relationships established between students were influenced by interpersonal competition logics. As it is known, the need to form more restricted groups can lead to unleashing alliance dynamics and oppositions among students, giving rise to behaviours of competitiveness, or of helping others, or even to the development of individualized work. Another aspect that seems to have been strongly conditioning, were the methodological strategies adopted by the tutors of the different clinical contexts.

Keywords

Clinical supervision, Clinical teaching, Nursing students, Socio-clinical relations.

P42 Stress management in under graduation nursing students

Marco Oliveira, Andreia Santos, Rafaela Barbosa, Diana Portovedo, Isabel Oliveira

Escola Superior de Enfermagem da Cruz Vermelha Portuguesa, 3720-126 Oliveira de Azeméis, Portugal

Correspondence: Isabel Oliveira (ijoliveira@sapo.pt)

Background

Admission to higher education is seen by some students as an opportunity of growth, to explore new environments and build new relationships yet, other students, perceive it as potentially anxiogenic. Some of the stressful factors are: examinations, clinical teaching, academic results, a competitive environment and the experience of transition and adaptation to a new academic environment. Therefore, it is necessary to work on the causes of stress and promote coping strategies. Being such an important subject for under graduation students, that experiencing it so intensely, it is crucial that students are also an active part in promoting the efficient management of stress.

Methods

Thus, in order to contribute to the adoption of coping strategies and promote the efficient management of stress, a participatory action research in health was developed in a nursing school. The strategies were: the implementation of a student support line (peer support); monthly meetings, addressed to the student population, on topics related to stress and its management; tutorials for 1st year undergraduate students by 3rd and 4th year students, through a structured program of integration to the nursing school. The follow-up of the effectiveness of the activities was carried out through a questionnaire measuring stress levels. This research foresees an initial evaluation (before implementation), intermediate evaluations and a final one, to measure the achievement of the objectives initially stated.

Results

The preliminary findings show a mean of 8.52 and a standard deviation of 2.73 in the score of the domain Sleep/Stress of the Portuguese version of the Fantastic Lifestyle Assessment.

Conclusions

With the implementation of this participatory action research it is expected a reduction of stress levels, as well as enabling students to adopt coping strategies in order to manage their stress. On the other hand, it will allow a better integration of students, as well as a better academic development, both in theoretical evaluations and in clinical teaching, consolidating the relational skills, which are so important during the course of clinical teaching and later on in their professional life.

Keywords

Nursing students, Stress, Coping skills, Action research, Participatory.

P43 A contribution to the validation of the volume - viscosity swallow test (V-VST) – Portuguese version

Catarina Camões¹, Marília Dourado¹, Maria A Matos²

¹Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ²School of Health, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Marília Dourado (mdourado@fmed.uc.pt)

Background

The prevalence of swallowing disorders after stroke is well described in the literature [1,2]. The early identification of these alterations resorting to non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality among these patients [1,4]. The V-VST exhibits good psychometric properties, allowing the early identification of patients at risk of developing respiratory and nutritional complications. Its use also allows dietary preventive recommendations to patients until diagnosis confirmation, by instrumental examinations [2].

Objective

The goal of this study is to contribute to the validation of the V-VST –Portuguese version, in patients with subacute stroke.

Methods

In phase I, the V-VST- Portuguese version [3], as well as its instructions, was presented to a panel of experts constituted by six speech and language therapists, in order to assess its content validity. In phase II, after ethical approval, it was applied to thirty-three patients with subacute stroke, to analyse its psychometric properties, namely its internal consistency and reliability (inter and intra raters). Criterion validity was assessed through the simultaneous application of the 3Oz wst. Collected data were analysed with IBM SPSS version 24.0. Intraclass Correlation, Cronbach’s Alfa and Cohen's Kappa values were calculated.

Results

Results of phase I demonstrate a very good agreement between all members of the panel of experts as for constituent items of the V-VST (I-CVI/Ave = 0.95) as well as to its instructions (I-CVI = 0.83). Preliminary results of phase II, showed that the V-VST presents very good intraclass (ICC=0.816) and interclass correlation coefficients (ICC = 0.837). Values obtained from the comparison between the V-VST and 3Oz wst have given similar results (I- CVI = 0.83).

Conclusions

The V-VST - Portuguese version seems to be a valid, reliable and practical tool for assessing dysphagia in patients with subacute stroke. Further studies need to be done in the future.

Acknowledgements

We would like to thank to the Nutricia Portugal, to the Faculty of Pharmacy of the University of Coimbra as well as to all patients and members of the neurology C service of the Hospitalar and Universitary Center of Coimbra by all the support and availability showed during this study.

References

1. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Toll (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919-924.

2. Clavé P, Arreola V, Romea M, Medina L, Palomera E, Prat MS. Accuracy of the volume - viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008 Dec;27(6):806-815.

3. Nogueira DS, Ferreira PS, Reis EA, Lopes IS. Measuring Outcomes for Dysphagia: Validity and Reliability of the European Portuguese Eating Assessment Tool (P-EAT-10). Dysphagia. 2015;30(5):511-520.

Keywords

Deglution disorders, Bedside examination, Dysphagia, Aspiration.

P44 Strategies to improve hand hygiene practices: an integrative literature review

Ana C Mestre, Filipa Veludo, Susana Freitas

School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

Correspondence: Ana C Mestre (catarina-mestre@hotmail.com)

Background

Healthcare-associated infections (HAIs) are a global concern and pose a real threat to patient safety. Many of them preventable [1]. Knowing that hands of healthcare professionals are one of the main vehicles in the transmission of microorganisms, hand hygiene (HH) is recognized as the easier and most effective measure to prevent and reduce HAIs [2]. However, despite all evidence available and although 98% of healthcare professionals consider HH as the most important basic precaution in preventing HAIs, compliance is poor, remaining less than 40% [3,4].

Objective

To identify, in Literature, the most effective strategies to promote HH compliance.

Methods

An integrative review between September and October 2017 was fulfilled with the Boolean strategy: [(TI Title) hand hygiene AND (AB Abstract) nurse AND (AB Abstract) infection AND (AB Abstract) strategy OR compliance OR adherence] in CINAHL®, Science Direct and Academic Search Complete. A total of 396 articles were identified, initially. After applying the inclusion criteria: primary and secondary studies with a qualitative and quantitative approach available in full text in Portuguese, English, French and Spanish; and exclusion criteria: studies published before 2016, a sample of 12 articles was included for analysis.

Results

From a total of 12 articles analysed, 10 showed the importance of a multimodal approach to the improvement of HH practices with consequent increase in compliance to this behaviour. It stands out the combination of interventions addressing knowledge (education), awareness, context of action (reminders in the workplace) as well as the involvement and support of leaders and managers in building an institutional safety culture (social influence) as the most effective to ensure greater compliance to HH.

Conclusions

In order to improve HH practices and, consequently, adherence to this behaviour, the adoption of a multimodal strategy proved to be more successful when compared to single interventions. At an early stage, it is essential to understand the reasons that lead to non-adherence to HH and after that design interventions based on identified barriers. The approach should be global, including not only healthcare professionals but also leaders and managers.

References

1. WORLD HEALTH ORGANIZATION. WHO Guidelines on Hand Hygiene in Health Care. 2009. Accessed 20-11-2017. Available in http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf

2. DIREÇÃO-GERAL DA SAÚDE- Circular Normativa nº 13/DQS/DSD de 14/06/2010 (2010). Orientação de Boa Prática para a Higiene das Mãos nas Unidades de Saúde. Lisboa: Direção Geral de Saúde. Acccessed 20-11-2017. Available in: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/circular-normativa-n-13dqsdsd-de-14062010.aspx

3. Piras SE, Lauderdale J, Minnick A. An elicitation study of critical care nurses’ salient hand hygiene beliefs. Intensive and Critical Care Nursing. 2017;42:10–16.

4. Farhoudi F, Sanaei Dashti A, Hoshangi Davani M, Ghalebi N, Sajadi G, Taghizadeh R. Impact of WHO Hand Hygiene Improvement Program Implementation: A Quasi-Experimental Trial. Biomed Res Int. 2016;2016:7026169.

Keywords

Hand hygiene, Healthcare-associated infections, Multimodal strategy, Integrative literature review.

P45 Conception and implementation of a nursing intervention program for family caregivers

Ricardo Melo^1,2, Marília Rua², Célia Santos³

¹Centro Hospitalar de Gaia/Espinho, 4400-129 Gaia, Portugal; ²Escola Superior de Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

Correspondence: Ricardo Melo (rmcmelo@hotmail.com)

Background

The increase of longevity of people and prevalence of diseases resulting in situations of dependency [1], emerge a greater need for supportive care to meet the needs expressed [2]. Family caregivers are very important elements in caring for the family member with self-care dependency, at the home context [3, 4]. This is an exhausting process with serious consequences for the general state of health perceived by the caregiver, as well as for the manifested burden [3, 5, 6]. A structured and contextualized intervention program [7] aimed at the qualification and support of family caregivers is essential for the transition and adequate performance of the functions inherent in this role.

Objective

To develop and implement a Nursing Intervention Program with family caregivers of dependent persons, in a home context.

Methods

This process began with an integrative review of the literature, in order to discover the main needs evidenced by family caregivers. Electronic databases were used, namely EBSCO and B-on, with the following descriptors: Caregiver; Family Caregivers; Needs; Dependent. The second stage corresponded to the adaptation of the Intervention Program, with the use of the Delphi technique on a group of experts. The last phase corresponded to a quasi-experimental study, with pre- and post-intervention evaluation, with the implementation of the program on 70 family caregivers, using home visits.

Results

With the review of the literature were obtained 21 articles (ten quantitative studies, five qualitative studies, four systematic reviews of the literature, a review of the literature and a mixed study). The evidenced needs were organized by the Transition Theory: community and social resources; knowledge and preparation; personal meaning, beliefs and attitudes; and socioeconomic condition. The consensus technique allowed the structuring of a Nursing Intervention Program, with 93 interventions, divided in emotional and instrumental support. The implementation of the Intervention Program implied, on average, 6 home visits to the caregivers, emotional support provision and caregiver training.

Conclusions

A Nursing Intervention Program, with structured and contextualized interventions in the home context, with family caregivers of dependent persons, is a facilitator for the transition experienced by caregivers, but also an important instrument of the work developed by nurses. Thus, it provides the necessary emotional support and skills that enable caregivers to optimize care delivery.

References

1. INE - Instituto Nacional de Estatística IP. Censos 2011 Resultados Definitivos - Portugal. XV recenseamento geral da população; V recenseamento geral da habitação. Lisboa: Instituto Nacional de Estatística; 2012.

2. Figueiredo D. Cuidados Familiares ao Idoso Dependente. Lisboa: Climepsi Editores; 2007.

3. Imaginário C. O Idoso Dependente em Contexto Familiar: Uma Análise da Visão da Família e do Cuidador Principal. 2ª ed. Coimbra: Formasau; 2008.

4. Marques SCL. Os Cuidadores Indormais de Doentes com AVC Coimbra: Formasau - Formação e Saúde Lda.; 2007 Janeiro de 2007.

5. Martins T. Acidente Vascular Cerebral: Qualidade de Vida e bem-estar dos doentes e familiares cuidadores. Coimbra: Formasau – Formação e Saúde Lda.; 2006.

6. Sequeira C. Cuidar de Idosos com Dependência Física e Mental. Lisboa: Lidel; 2010.

7. ICN. CIPE Versão 2 - Classificação Internacional para Prática de Enfermagem Lisboa: International Council of Nurses; 2011.

Keywords

Family caregivers, Intervention program, Transition, Needs, Dependency.

P46 Antimicrobial activity of natural extracts and commercial elixirs in oral pathogens

Maria J Alves, Marta Pereira, Sara Fraga, Isabel Ferreira, Maria I Dias

Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal

Correspondence: Maria J Alves (maria.alves@ipb.pt)

Background

Although Streptococcus mutans has been responsible for decades as the etiological agent of dental caries, recent evidence indicates a high prevalence for S. mutans in dental biofilms where Candida albicans resides; which suggests that the interaction between these two species may mediate cariogenic development [1].

Objective

To evaluate the antimicrobial activity of three chemical elixirs of different commercial brands and two aqueous extracts obtained from plants (Chamomilla recutita L. and Foeniculum vulgare Mill.) in C. albicans and S. mutans.

Methods

Percent growth inhibition was quantified by measurement of optical density (OD) at 600 nm in a microplate reader.

Results

Both the extracts and the elixirs presented antimicrobial activity for the two microorganisms previously mentioned. Among the elixirs tested, the one with the highest antimicrobial activity for S. mutans was Colgate (100%), followed by Eludril and a white brand (≥ 99%). For C. albicans, the Eludril (100%) gave the highest activity, followed by Colgate (99%). A Chamomilla recutita extract (10 mg/ml) showed an inhibition percentage of growth of 96% for S. mutans very similar to that of the antibiotic (97%). The inhibition percentage of growth decreased for C. albicans (87%), although was higher than the antifungal fluconazole (84%).

Conclusions

The two extracts showed less antimicrobial activity compared to the elixirs, however, they had higher percentages of inhibition growth than the drugs tested for both microorganisms. The extract of Chamomilla recutita was the one that presented the highest antimicrobial activity for the two microorganisms tested comparatively with Foeniculum vulgare.

References

1. Metwalli KH, Khan SA, Krom BP, Jabra-Rizk MA. Streptococcus mutans, Candida albicans, and the Human Mouth: A Sticky Situation. PLOS Pathogens. 2013;9(10):1-5.

Keywords

Oral biofilm, Antimicrobial activity, Elixir, Foeniculum vulgare mill, Chamomilla recutita L.

P47 The effects of water walking on body composition – a study with children between 6 and 12 years old

Samuel Honório^1,2, João Oliveira³, Marco Batista^1,2, João Serrano^1,4, Jorge Santos³, Rui Paulo^1,2, Pedro Duarte-Mendes^1,2

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Arcozelo, Vila Nova de Gaia, Portugal; ²Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ⁴Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

Correspondence: Samuel Honório (samuelhonorio@hotmail.com)

Background

Aquatic activities have been recommended as frequent practice, due to the physical properties of water, especially because fluctuation and reduction of joint impact, with improvements in the body composition of children.

Objective

The present research aims to verify if there are differences in body composition in children aged between 6 and 12 years who practice swimming, complemented with water walking at the end of each session and those who only practice swimming.

Methods

The sample consisted of 28 individuals aged 6 to 12 years and was divided into two groups: swimming group (SG) with 9 children and a swimming complemented with water walking group (SWWG) of 19 children. In this study, of twelve weeks with three moments of evaluation, with two sessions per week of 45 minutes each, we wanted to identify the benefits in body composition (weight, muscle mass, fat mass, body water, BMI, waist circumference and body percentiles). For that purpose, we used a bio-impedance scale Targa Z29777A, and an anthropometric tape to measure the waist circumference. The water walking activity occurred at the end of each session for 6 minutes, performed in straight line with the water level at the children’s chest. In terms of statistical procedures, we used the program Statistical Package for the Social Sciences version number 20 (SPSS 20.0). We used descriptive statistics (minimum, maximum, means and standard deviations), the Shapiro Wilk test for testing the normality of the sample, inferential statistics (non-parametric Mann-Whitney tests, Friedman's ANOVA, and for the calculation of the magnitude of the effect, the d-Cohen test).

Results

After data treatment, regarding the inter-group analysis (comparison between the swimming group and the swimming group with water walking) we observed that there were significant differences in the weight variable, that is, at the end of the 3 moments. Concerning intra-group differences (improvements in the swimming group and in the swimming with water walking group, in the three moments evaluated), the SWWG showed significant improvements in the variables of weight as well, muscle mass, fat mass, body water, body mass index (BMI) and body percentiles.

Conclusions

We have concluded that the practice of activities such as swimming and water walking has benefits in the analysed variables and that there are differences in the groups analysed; however, the two activities complemented (swimming and water walking) present much more significant improvements.

Trial Registration

NCT03519620

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

Keywords

Children, Water Walking, Swimming, Body composition, Bio-impedance.

P48 Health literacy level of students at the time of enrolment to health courses in higher education

Luis S Luis^1,2, Victor Assunção³, Henrique Luis⁴, Helena Melo⁵

¹School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Escola Superior de Saúde, Instituto Politécnico de Portalegre, 7300-074 Portalegre, Portugal; ⁴Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-003 Lisboa, Portugal; ⁵Escola Superior de Saúde Ribeiro Sanches, 1950-396 Lisboa, Portugal

Correspondence: Luis S Luis (luis.luis@ipleiria.pt)

Background

A good level of Health literacy is essential for effective communication between health professionals and patients. Health professionals training should provide them with a set of skills in this area that would allow them to communicate successfully with other health professionals and patients.

Objective

The goal of this study was to identify what level of health literacy students have when enrolled at the Universities and Polytechnic Institutes. Students from Nursing Degree courses (Portalegre School of Health Sciences and Ribeiro Sanches Health School) and from the Dental Hygiene Degree (Faculty of Dental Medicine of Lisbon and Portalegre School of Health Sciences), had their health literacy level assessed at enrolment, in the year of 2013/2014.

Methods

To evaluate the level of health literacy, the Portuguese version of the NVS (New Vital Sign) was administered to 42 dental hygiene students (6 males and 36 females) and 53 nursing students (14 males and 39 females).

Results

The total sample, composed of 95 students, was analysed for provenance to higher education level degree, it was verified that 83.5% came from high school, 6.6% entered by the process of “Maiores de 23”, and 9.9% through other enrolment processes. When analysing these data, by degree, most of the students at the Dental Hygiene degree (92.9%), accessed higher education through high school completion. This value was of 75.5% for Nursing students. Regarding the level of health literacy, it was observed that 72.63% of the students had high level of health literacy, 24.21% moderate health literacy level and 3.16% low health literacy level. There was a statistically significant difference between Nursing and Dental Hygiene students, with the former having a better health literacy (p = 0.007). At the time of entry to the University and Polytechnic, and when considering courses, collected data shows that, for the Degree in Dental Hygiene, 4.8% of the students had a low level of health literacy, 21.4% present a moderate level and 73.8% a high level of health literacy. When considering the Nursing Degree, these values were, respectively, 1.9%, 26.4% and 71.7%.

Conclusions

Students access higher education with a level of health literacy appropriate to the courses they intend to attend. The presented results are preliminary and part of a longitudinal study lasting three academic years, evaluating the evolution of health literacy levels of students throughout their training.

Keywords: Health literacy, Nursing School, Dental Hygiene School, Students.

P49 Nursing caring of vulnerable patients in emergency situations: what does the evidence say?

Marta Pacheco, Maria T Leal

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Correspondence: Marta Pacheco (mpacheco@campus.esel.pt)

Background

Critically ill patient’s (CIP) nursing care quality has improved significantly in the last years because of important technological improvements. In pre-hospital, emergency and intensive care settings, they contribute to the valuation of technical competencies over relational aspects. The emergent need to stabilize the CIP diverts the attention away from the psychological and emotional support, increasing anxiety and diminishing the patient’s cooperation, making the care experience increasingly hostile. Vulnerability arises in these settings [1] as a condition to be appreciated in a “harmonious conciliation between the technological expertise and the art of caring” [2], because it improves expectations and experiences, and increases the positive outcomes of the resuscitation process, giving greater visibility to the nurses’ work. To understand the experiences of patients who lived emergency situations, as well as nursing interventions that reduce vulnerability, will allow for better care of the CIP [3].

Objective

Our goal is to review the available evidence regarding nursing interventions that reduce vulnerability at emergency and resuscitation settings.

Methods

We performed an integrative review of the literature available from MEDLINE and CINAHL databases and grey literature, to answer the question: “Which nursing interventions promote the reduction of the CIP’s vulnerability in emergency setting?” [4].

Results

Nine qualitative and quantitative studies satisfied the search criteria and were included. These studies are from different countries and cultures and their analysis identified both the emergency setting and nursing interventions as elements that influence the CIP’s subjective experience of vulnerability. Vulnerability is a permanently present condition in the human being and the recognition of the mutual vulnerability by nurses is a way of preserving the value of caring.

Conclusions

The experience of CIP in emergency and resuscitation settings is influenced by organizational, environmental and caring factors. Being cared by competent professionals [5,6], using a therapeutic relationship and responding to the patient main needs are the most valued aspects that convey safety and a significant decrease in vulnerability. Communication and empathy [6], with explanation of clinical procedures, allows the development of trust and reduces vulnerability, facilitating patient collaboration in the care provided. Recognizing the vulnerability of CIP and its influence on collaboration, recovery and satisfaction in care, allows developing strategies and abolishing mechanized and merely technical behaviours. Vulnerability is a continually present condition in humans and the recognition of vulnerability of the professionals themselves [7] is a way to socially preserve the value of caring in an emergency context.

References

1. Mitchell M. General anaesthesia and day-case patient anxiety. J Adv Nurs. 2010;66(5):1059–1071.

2. Sá F, Botelho M, Henriques M. Cuidar da Família da Pessoa em Situação Crítica: A Experiência do Enfermeiro. Pensar Enferm. 2015;19(1):31–46.

3. Paavilainen E, Salminen-Tuomaala M, Kurikka S, Paussu P. Experiences of counselling in the emergency department during the waiting period: importance of family participation. J Clin Nurs. 2009;18(15):2217–2224.

4. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual: 2014 Edition [Internet]. Adelaide: The Joanna Briggs Institute; 2014. 197 p.

5. Baldursdottir G, Jonsdottir H. The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department. Hear Lung. 2002;31(1):67–75.

6. Wiman E, Wikblad K, Idvall E. Trauma patients’ encounters with the team in the emergency department: a qualitative study. Int J Nurs Stud. 2007;44(5):714–22.

7. Malone RE. Dimensions of vulnerability in emergency nurses’ narratives. Adv Nurs Sci. 2000;23(1):1–11.

Keywords

Vulnerability, Critically ill patient, Nursing care, Emergency department.

P50 Sedentary behavior of older people above 75: where, when and with whom

Marta Gameiro, Madalena G Silva

Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, 2910-761 Setúbal, Portugal

Correspondence: Marta Gameiro (marta.gameiro93@gmail.com)

Background

Sedentary behaviours are understood as activities with a low energy expenditure (<1.5 metabolic equivalent - METs) [1]. Even for those who comply with physical activity recommendations, prolonged time in sedentary behaviours is associated with an increased risk of chronic and cardiovascular diseases; decreased muscle mass, strength and power; decreased functional capacity and premature death in elderly people [2]. Older people spend long periods of time in sedentary behaviour [3]. A deeper understanding of what activities represent these behaviours, when and with whom they take place, becomes extremely relevant for health professionals who need to promote a reduction in sedentary time, among very older people in order to enhance health benefits.

Objective

To characterize the time spent in sedentary behaviour of older people in three urban day-care centres, as to the duration, type of activities, with whom and where they take place.

Methods

A cross sectional study was conducted with 54 participants, average age of 84.53 ± 5.35. An Activity Diary was used to characterize sedentary activity. Each activity noted in the diary was classified in METs, per the Compendium of Physical Activities: Classification of Energy Costs of Human Physical Activities. They were then clustered in four groups: sedentary activities; light intensity; moderate intensity and vigorous intensity activities. Time spent in activities within each group was summed, resulting in the total sum of sedentary, light, moderate, and vigorous intensity activities (min.week^-1). Relative and absolute frequencies, as well as mean/standard deviation, were used, to characterize sedentary behaviour.

Results

Our sample was mainly female (88.9%), widowers (70.4%), living alone (64.8%) and with a low educational background (61.1%). On a regular week, they spent an average of 6h20 min (2608.15 ± 930.67 min.week^-1) in sedentary behaviour. Half of this time is spent watching TV (50.2%), alone, in the afternoon and evening. Other activities are talking (11.73%), reading (6.7%), resting (6.4%) and playing board games (4.7%).

Conclusions

We conclude that our sample spent an average of 6h20min per day in sedentary activity, mainly in the afternoon and evening, watching television alone. In order to break sedentary patterns, clinical interventions need to tackle this particular period of the day, finding alternative strategies for a greater energy expenditure for very old people.

References

1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz ANNM, Strath SJ, et al. Compendium of Physical Activities: an MET intensities. Med Sci Sport Exerc. 2000;32(9):498–504.

2. Dunlop DD, Song J, Arntson EK, Semanik PA, Lee J, Chang RW, et al. Sedentary time in U.S. older adults associated with disability in activities of daily living independent of physical activity Dorothy. J Phys Act Heal. 2015;12(1):93–101.

3. Leask CF, Harvey JA, Skelton DA, Chastin SF. Exploring the context of sedentarybehaviour in older adults (what, where, why, when and with whom). Eur Rev Aging Phys Act. 2015;12(1):4.

Keywords

Sedentary behavior, Context, Very old people.

P51 Women’s perception on the role of family nurse in the transition to motherhood

Andreia Ferreira, João Simões, Helena Loureiro

Escola Superior Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Andreia Ferreira (aloferreira84@gmail.com)

Background

The study carried out has as its title “Women's perception on the role of family nurse in the transition to motherhood” and aims to understand the experiences of puerperal women in relation to the role of the family nurse, in promoting the transition to maternity, in the year 2016/2017, at USF Rainha Tereza.

Methods

The accomplishment of the empirical study was authorized by the ARS Centro Ethics Committee. It is part of a paradigm of qualitative nature, based on a descriptive phenomenological methodology, that intends to answer the research question: What is the perception of puerperal women regarding the interventions of the family nurse in the transition to motherhood? Eleven mothers for the first time, who were selected in a non-probabilistic manner and for convenience, according to previously established inclusion and exclusion criteria, participated in this study. Once the informed consent of all the participants was obtained, the information collection was obtained through the filling of a questionnaire of sociodemographic characterization and the conduction of a semi-structured interview, recorded in an audiographic record, was later transcribed and analysed by the webQDA program, through the Bardin content analysis technique.

Results

Evidence has led to the conclusion that motherhood, as a life cycle transition, is approached by the family nurse in a fragmented way. Women perceive that this health professional has an intervening role in the processes of “Being Woman” and “Being Mother”, but as far as “Being Wife”, the intervention still remains little exiguous. Nevertheless, it became clear that family nurses assume a primordial function in this transition and that this is essentially related to the role of health promoter attributed to it, by mothers for the first time.

Conclusions

In conclusion, the traineeship report sensitized the importance of relational skills in the delivery of care and the need to provide care in a holistic way, integrating the family as a partner in the perinatal follow-up.

Keywords

Women's Health, Maternal Health, Motherhood, Transition, Nursing.

P52 Self-perception of health status and physical condition of elderly people practitioners of hydrogymnastics

Carlos Farinha¹, João Serrano², José P Ferreira¹, João Petrica², Rui Paulo³, Pedro Duarte-Mendes², Marco Batista²

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-256 Coimbra, Portugal; ²Higher School of Education, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ³Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal

Correspondence: Carlos Farinha (cajo596@gmail.com)

Background

The researcher interest in self-perception of health status and physical condition of the elderly is determinant in an increasingly aging society and where one should seek to improve their quality of life.

Objective

To study the self-perception of health status and the impact of a physical activity program oriented during 4 months among an elderly population of practitioners of hydrogymnastics.

Methods

As instruments were used the questionnaire “mos short health survey – 36 items version 2 (SF-36)” translated and validated for the Portuguese version by Ferreira (2000), and the battery of Functional Tests Fitness Test. Questionnaires were filled by the elderly with the presence of the investigator and the physical fitness was evaluated following the protocol of proof. The sample was constituted by 83 elderly individuals over 55 years of age. In statistical terms we used a percentage analysis in the questionnaire and in the evaluation of the physical condition after application of the Kolmogorov-Smirnov test, we used the non-parametric test for two paired variables, Wilcoxon.

Results

According to the different dimensions studied (physical function, physical performance, pain, general health, vitality, social function and emotional performance), we found that the majority of the elderly presents limitations mainly in the most demanding tasks (lift weights, running, walk fast, more intense housework, among others); and that their state of health interfered in the performance of some daily activities, but not in the time spend in performing these same activities. The pains have not been strong in the last times and so, they consider their general health moderate and stable, interfering little in the development of their relationship and social activities. The elderly also said that they feel most of the time calm and tranquil and therefore they feel happy. As for physical fitness, there were improvements in the results in practically all the tests, between the 1st and 2nd evaluation, which showed a positive impact of the work developed during the 4 months.

Conclusions

Based on the results, we can conclude that the elderly of the study evidenced a perception of their health condition considered positive and that fits in the normal parameters for their age. The results of the physical activity program revealed improvements in physical fitness levels, between the beginning and the end of the program, aspect that is determinant for the health and autonomy of the elderly, as the investigation reveals.

Keywords

Gerontomotricity, Physical activity and health, Physical condition, Hydrogymnastics.

P53 Impact of dual-task on older adults’ gait spatiotemporal parameters

Nádia Augusto¹, Rodrigo Martins², Madalena G Silva¹, Ricardo Matias^1,3

¹Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, 2910-761 Setubal, Portugal; ²Red Cross School of Health, 1300-125 Lisbon, Portugal; ³Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal

Correspondence: Nádia Augusto (naa.fisio.augusto@gmail.com)

Background

The ageing process induces changes in gait, particularly in its automatic features [1]. Early detection of gait changes can be a key to ensure timely clinical intervention to prevent falls [2], since most of these occur while walking in dual-task situations [3]. Several studies using 3D kinematic analysis systems have suggested that changes in spatiotemporal parameters can be measured before these changes are noticeable [4,5]. However, their use has been confined to laboratories [6], which is difficult to transfer into clinical practice [7].

Objective

To study the effects of the introduction of a dual task, in spatial/temporal parameters, on the gait of older adults, with an ambulatory 3D kinematic analysis system.

Methods

An exploratory observational study was performed. Fifteen healthy older adults (age= 75.73 ± 6.03 years old) were recruited from a day centre. All participants were instructed to walk 10 meters in a single self-selected pace, and in a dual task (a verbal fluency task and an arithmetic task) condition. Seven spatiotemporal gait parameters were assessed with the Xsens MVN ambulatory system, based on 17 inertial sensors: stride velocity, stride length, stride width, cadence, stance time, swing time and double support time.

Results

The results of the Friedman test revealed statistically significant differences between the temporal parameters of single gait (stride velocity: χ²=11.200, p = 0.004; cadence: χ²=24.102, p = 0.000; stance time: χ²=20.133, p = 0.000; swing time: χ²=17.733, p = 0.000 and double support time: χ²=19.733, p = 0.000) and each of the two dual task conditions. No statistically significant differences were observed between the cognitive verbal fluency and the arithmetic conditions.

Conclusions

Our results suggest that spatiotemporal parameters of gait significantly change under both cognitive dual task conditions, and that these changes are detectable with the ambulatory 3D kinematic analysis system used. These findings strongly support the use of body-worn sensors, to early detect changes in gait patterns, promoting timely interventions to prevent falls.

References

1. Bridenbaugh SA. Kressing RW. Motor cognitive dual tasking: early detection of gait impairment, fall risk and cognitive decline. Z Gerontol Geriatr. 2015;48(1):15-21.

2. Bridenbaugh SA, Kressing RW. Quantitative gait disturbances in older adults with cognitive impairments. Curr Pharm Des. 2014;20(19):3165-3172.

3. Beauchet O, Annweiler C, Dubost V, Allali G, Kressig RW, Bridenbaugh S, Berut G, Assal F, Herrmann FR. Stops walking while talking: a predictor of falls in older adults?. European Journal of Neurology. 2009;16(7):786-795.

4. Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait Posture. 2007;26(1):113-119.

5. Bridenbaugh SA, Kressing RW. Laboratory Review: The Role of Gait Analysis in Seniors’ Mobility and Falls Prevention. Gerontology. 2011;57(3):256-264.

6. Aminian K, Najafi B, Büla C, Leyvraz PF, Robert P. Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. J Biomech. 2002;35(5):689-699.

7. Najafi B, Helbostad JL, Moe-Nilssen R, Zijlstra W, Aminian K. Does walking strategy in older people change as function of walking distance?. Gait Posture. 2009;29(2):261-266.

Keywords

Dual task, Spatiotemporal parameters, Gait, Older adults.

P54 Portuguese workers: perception of wellbeing at work in an industrial company

Marina Cordeiro^1,2, José C Gomes^1,2, Paulo Granjo³

¹School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal

Correspondence: Marina Cordeiro (marina.cordeiro@ipleiria.pt)

Background

People spend a long time working, but work can have a negative impact on wellbeing, especially in situations of poor working conditions and dissatisfaction [1, 2]. This may lead to negative consequences for the worker, company and society [2, 3], therefore, it’s important to recognize the wellbeing perception at work of Portuguese workers and which variables may influence it.

Objective

To determine worker’s perception of wellbeing at work and its relationship with sociodemographic and occupational characteristics.

Methods

A cross-sectional study, descriptive and correlational, was performed in a Portuguese industrial company. The non-probabilistic convenience sample was composed by 134 workers. Data was collected by a self-administered questionnaire including sociodemographic and occupational questions and the Perception of Wellbeing at Work Questionnaire (PWW). The study was approved by an ethical commission.

Results

The sample mean age was 38.58 years (SD=9.52; min=21; max=62), manly composed by female workers (77.6%), 44% concluded high school, 61.2% are married/living under common law, and 31.3% has 2 children. Workers worked in the company for about 107.15 months (SD=51.10), 88.1% had a Permanent Employment Contract (PEC), 87.3% works ≤ 40hours a week, 40.3% had as working schedule from 07h00 to 16h00 and 41% were production operators. PWW had a mean of 67.2 (SD=7.8), Adaptation and Adequacy to Work (AAW) dimension of 27.2 (SD=3.2), Organizational Characteristics (OC) of 19.2 (SD=3.9), Interpersonal Relationship (IR) of 11.2 (SD=1.7), Structure of work (SW) of 5.4 (SD=1.3) and Bound with the Institution (BI) of 4.2 (SD=1.6). There were no statistically significant differences (p > 0.05) between PWW and sociodemographic or occupational variables. However, statistically significant differences (p < 0.05) were found in IR according to gender (men with higher average) and the type of contractual affiliation (workers with Term Employment Contract [TEC] had better PWW in IR than those with PEC) and SW according to the workload (workers working ≤ 40 hours have higher PWW in SW). It was also found that IR was negatively correlated with age and with working time for the same function.

Conclusions

The sample presents moderate PWW, which assumes higher values in AAW and lower in BI. Older workers and those who have been working longer at the same function have a lower PWW in IR. Male workers and those with a TEC had a better PWW in the IR, and those who worked ≤ 40 hours per week had higher PWW in SW. These results may be useful for designing interventions to promote wellness at work.

References

1. International Labour Office. Psychosocial risks, stress and violence in the world of work. International Journal of Labour Research. 2016;8:1-131.

2. Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, Bryant RA, Christensen H, Mitchell PB. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occupational & Environmental Medicine. 2017; 74(4): 301-310.

3. Cottini E, Lucifora C. Mental Health and Working Conditions in Europe. ILRReview. 2013; 66(4): 958-988.

Keywords

Workplace, Mental health, Occupational health, Workers wellbeing.

P55 Informal caregivers of oldest old people

Sara Alves^{1, 2}, Constança Paúl^1,2, Oscar Ribeiro^2,3

¹Unidade de Investigação e Formação sobre Adultos e Idosos, Centro de Investigação em Tecnologias e Serviços de Saúde, Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ²Centro de Investigação em Tecnologias e Serviços de Saúde, Universidade do Porto, 4200-450 Porto, Portugal; ³Departamento de Educação e Psicologia, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Sara Alves (ssafalves@gmail.com)

Background

Living longer may lead to a long period of disability and frailty with increasing care demands. Informal caregivers, namely family members, play a very important role in the provision of care to very old individuals. Informal care represents crucial support but the available knowledge on this topic is still scarce in the Portuguese context.

Objective

To provide an overview of caregiving characteristics in a sample of dyads of informal caregivers and oldest old people (80+) from Porto.

Methods

A sample of 72 caregiving dyads was considered. Sociodemographic data, information on the caregiving experience (e.g. length of care, relationship with the person cared) and the disability level of care receiver (Activities of Daily Living – ADL’s and IADL’s, and comorbidities) were obtained.

Results

Informal caregivers had a mean age of 63.9 years (SD=9.95), were mostly women (76.4%), with children (70.8%), married (63.9%) and retired (50.0%). Time spent on caregiving was on average 9.73 hrs/day (SD=7.61) and the length of care was around 7 years (SD=6.15). Most of the sample had formal social support to help in the care provision: 54.2% receives support from home care services and 34.7% from day centres. Care receivers mean age was 92.0 years (SD=5.28), were mostly women (73.6%) and widowed (65.3%). Half of the care receivers (n=36; 50.0%) were completely dependent in ADL’s, 30.6% were moderately dependent, 16.7% severely dependent, and 2.8 % were independent. Most of the sample was severely dependent in IADL’s (95.8%). The mean number of comorbidities was 6.94 (SD=1.95), and the mean of medicines intake was 6.17 (SD=3.41).

Conclusions

This is an ongoing project but current data already shows that the amount of time spent on caring activities by women who are themselves in advanced age is very high, and probably exhausting due to the high level of functional dependency of the care recipients. A clear picture of tasks and probable exhaustion of the group of people taking care of very old people is crucial in order to plan which and how to deliver formal care to these dyads. Such planning is important for preventing/alleviating burden situations and raising the quality of life of care recipients and their families.

Acknowledgements

Project was approved by Ethical Commission of ICBAS.UP, approval number 188/2017 and by Portuguese Data Protection Authority (CNPD), approval number 1338/2017.

Keywords

Informal caregiving, Oldest old people, Disability.

P56 Comparison of antioxidant activity for Ginkgo biloba L. and Rosmarinus officinalis L

Diana Silva¹, Ana França², Cláudia Pinho³, Ana I Oliveira³, Rita F Oliveira^3,4, Agostinho Cruz³

¹Farmácia Holon, Baguim do Monte, Gondomar, Portugal; ²Farmácia Higiénica, Fão, Esposende, Portugal; ³Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ⁴Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Cláudia Pinho (clp@eu.ipp.pt)

Background

Natural antioxidant products have gained popularity worldwide and are increasingly being used to treat various diseases [1]. Leaves of Rosmarinus officinalis L. and Ginkgo biloba L. possess a variety of bioactivities, including antioxidant [2].

Objective

Therefore, the present study aims to evaluate in vitro antioxidant properties of aqueous and hydroalcoholic extracts of three different commercial brands of R. officinalis and G. biloba.

Methods

R. officinalis and G. biloba leaves from three different commercial brands were extracted with two solvents (water and 80% ethanol), and antioxidant activity of the extracts were screened using the superoxide anion and 1,1-diphenyl-2-picryl hydrazyl (DPPH•) radical scavenging, and metal ion chelating capacity.

Results

A comparison of both plant extracts in the DPPH assay and Fe²⁺ chelating activity indicated that R. officinalis showed lower IC₅₀ values comparing to G. biloba, ranging from 44.1-61.8 μg/mL (aqueous extracts) and 20.8-23.3 μg/ml (hydroalcoholic extracts) in the DPPH assay, and 93.1-329.0 μg/mL (aqueous extracts) and 33.4-71.0 μg/mL (hydroalcoholic extracts) in the Fe²⁺ chelating activity. For the superoxide radical scavenging activity, the hydroalcoholic extracts of R. officinalis showed the best IC₅₀ values, ranging from 5.1-15.5 μg/mL, with one brand showing and IC₅₀ value lower (5.1 μg/mL) than positive control (5.8 μg/mL - ascorbic acid). Results also showed that in both plants and brands, the highest antioxidant activity was found mainly in the hydroalcoholic extracts, for all the assays tested.

Conclusions

The findings of this study support the view that some medicinal plants are promising sources of potential antioxidants. The different brands and solvent types used in the present study may influence the chemical composition of the rosemary and ginkgo extracts obtained and therefore their antioxidant capacity.

References

1. Zhang A, Sun H, Wang X. Recent advances in natural products from plants for treatment of liver diseases. Eur J Med Chem. 2013;63:570-577.

2. El-Beltagi HS, Badawi MH. Comparison of Antioxidant and Antimicrobial Properties for Ginkgo biloba and Rosemary (Rosmarinus officinalis L.) from Egypt. Not Bot Horti Agrobo. 2013;41(1):126-135.

Keywords

Antioxidant activity, Ginkgo biloba, Rosmarinus officinalis, Solvent extraction.

P57 The skills of the wound navigator in the health care team

Raquel Silva, Filipa Veludo

School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

Correspondence: Raquel Silva (raklitasol@hotmail.com)

Background

Aging co-morbidities are the main reason for skin changes, requiring qualified professionals to assist the person with this problem [1,2]. In this sense, it emerges in the literature even the tenuous concept – wound navigator, which may enhance the approach to the person with wounds, often described as the tissue viability nurse.

Objective

Define the wound navigator and identify his skills.

Methods

Integrative literature review using electronic research (CINAHL®, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE®) and manual research in 12 specialty associations in tissue viability, with the following descriptors (wound OR tissue viability OR ulcer) AND (nurs*) AND (care OR role OR skills OR patient care team OR navigator OR manager OR multidisciplinary OR interdisciplinary OR tissue viability service OR interven* OR pratic*). Inclusion criteria were articles in Portuguese, English, Spanish or French, without temporal limitation, full texts and free access. Exclusion criteria were articles that do not address the study phenomenon. The research was conducted on 08/25/2017, where we obtained 601 articles from the databases and 145 from associations. The titles and abstracts of the publications were read, followed by reading the full text of the selected publications. The sample was defined by 19 articles (15 from databases and 4 from associations).

Results

Only one article defines wound navigator, as the health professional with knowledge in the specialty, who acts as a defender of the interests of the clients, which combines the needs felt by them; the objectives of the treatment and the health care treatment plan by referral [3]. It collects the results achieved from the practice and dissemination of research, in order to highlight their actions before the policy of health care [3]. The competences found in the remaining 18 articles were divided into 4 categories: quality (training, auditing, research and elaboration of norms and protocols) management (involvement in product choice, articulation with suppliers, promotion of change and ability to work in multi and interdisciplinary team), care (postgraduate knowledge, experience in the area of tissue viability, prescription of specialized care and treatments with advanced therapies) and leadership (communication, supervision and consulting).

Conclusions

There is little literature that precisely defines the wound navigator and his skills, therefore more research is needed to describe in detail. When the term is defined and its competences are known, it may through them formally develop teams with nurses specialized in the area, holders of the general and specific attributes identified.

References

1. Bianchi, J. Preventing, assessing and managing skin tears. Nurs Times. 2012;108(13):12,14, 16

2. Dutton, M.; Chiarella, M. e Curtis, K. The role of the wound care nurse: an integrative review. Community Wound Care. 2014; Vol. Supplement:S39-40, S42-7.

3. Moore, Z.; Butcher, G.; Corbet, L.P. et al. AAWC, AWMA, EWMA, Position Paper: Managing Wounds as a Team. J Wound Care. 2014;23(5): S1-S38.

Keywords

Tissue viability nurse, Skills, Role.

P58 Nursing interventions in the prevention and management of aggressive behaviors in psychiatric context

Aida Bessa¹, Isabel Marques², Amorim Rosa²

¹Centro Hospital e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-051 Coimbra, Portugal

Correspondence: Aida Bessa (bessaaida@gmail.com)

Background

Aggressive behaviour emerges in social interaction and is therefore considered as a process arising from the relationship between the person and the person’s physical, social and cultural environment over time. In these situations, where the person is experiencing transition processes that generate misaligned human responses, inducing processes of mental suffering as the manifestation of aggressive behaviours, the need to provide specialized nursing care emerges.

Objective

The aim of this study was to analyse the most relevant data from the studies about Nursing Interventions in the prevention and management of aggressive behaviours in the psychiatric context, according to the risk profile of the patients.

Methods

An integrative review of the literature was carried out, in libraries of national and international organizations, using the B-On search engine, PubMed database - from the question “What Nursing interventions in the prevention and management of aggressive behaviours in psychiatric context, according to the risk profile of the patients?” The following keywords were used: Nursing Interventions, Violence, Aggression, and Risk Psychiat*. 343 articles were considered, published in the period 2004-2016, in Portuguese, Spanish, French or English and with full text. After applying the inclusion and exclusion criteria, we obtained 10 articles that were analysed according to the previously defined protocol.

Results

Five articles addressed the prevention and management measures implemented to deal with the incidents of aggression, while all the others emphasize the implementation of interventions to prevent aggressive behaviour. Award-winning nursing interventions are non-restrictive (communicational and de-escalation techniques). Observation emerges as the first intervention, including risk assessment. Environmental and chemical containment arise among the containment measures.

Conclusions

It was concluded that the risk assessment of aggressive behaviours, upon stratification, followed by the implementation of preventive/management measures, adapted to the risk level, can be easily implemented in the routines of the services. It therefore contributes both to reducing the incidence and severity of these behaviours and to improving the management/reduction of coercive measures.

Keywords

Aggressive behaviors, Psychiatry Context, Prevention, Nursing Interventions.

P59 An advanced nursing practice model proposal to improve heart failure under mechanical circulatory support patients’ outcomes

Teresa Pessoa^1,2, Maria T Leal²

¹Departmento de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; ²Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Correspondence: Teresa Pessoa (teresapessoa@gmail.com)

Background

The use of left ventricular assist devices has grown rapidly in recent years for patients with end-stage heart failure (HF) [1]. HF under Mechanical Circulatory Support (MCS) patient-centred care assumes that nurses have professional competence, knowledge and ability to make decisions and prioritize care [2]. The ability of decision-making, and prioritization of multiple nursing interventions depends on clinical judgement and professional and personal experience [3].

Objective

To identify evidence-based nursing interventions that improve the outcomes of patients with HF under MCS and organize them in the form of an Advanced Nursing Practice Model.

Methods

Integrative literature review based on a systematic search of original articles and literature reviews published between January 1st, 2010 and August 31st, 2016, in MEDLINE, CINAHL and Cochrane databases and manual search on Google and ResearchGate. Studies related to adult HF patients with formal indication or under MCS in which the first author was a nurse, have been included. Studies related to patients under MCS devices such as intra-aortic balloon counterpulsation or venovenous extracorporeal membrane oxygenation have been excluded.

Results

From the 41 articles included, 43 categories emerged through content analysis. Those were grouped in four areas of care where nurses should intervene. The 15 nursing interventions included in the Model were not mutually exclusive, which makes that the same intervention can be applied to more than one area of care. There are no validated protocols to each intervention. The model was constructed based on the review results and on The Strong Model of Advanced Nursing Practice [4], Clinical Judgement [5] and Patient Centred Care [2] frameworks.

Conclusions

HF under MCS patients centred-care is complex and requires teamwork and relational skills. It depends on the best available evidence-based scientific knowledge, on stakeholders’ life experience and on context and environment specificity. Patient-related outcomes can be improved through the application of the proposed model. To make it operational, there is a need to standardize practices and to develop protocols, guidelines and training programs to improve advanced nursing practice.

References

1. Creaser JW, Rourke D, Vandenbogaart E, Chaker T, Nsair A, Cheng R, et al. Outcomes of biventricular mechanical support patients discharged to home to await heart transplantation. J Cardiovasc Nurs. 2015;30(4):E13–20.

2. McCormack B, McCance TV. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56(5):472–9.

3. Benner P, Tanner CA, Chesla CA. Expertise in nursing practice: caring, clinical judgment and ethics. 2nd ed. Springer Publishing Company. New York: Springer Publishing Company; 2009.

4. Ackerman MH, Norsen L, Martin B, Wiedrich J, Kitzman HJ. Development of a model of advanced practice. Am J Crit Care. 1996;5(1):68–73.

5. Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006;45(6):204–11.

Keywords

Heart failure, Mechanical circulatory support, Nursing interventions, Patient-related outcomes, Advanced nursing practice.

P60 Acute effects of aerobic exercise on motor memory consolidation in older people

André Ramalho¹, Pedro Duarte-Mendes¹, Rui Paulo¹, João Serrano^1,2, António Rosado³, João Petrica^1,2

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; ³Faculty of Human Kinetics, University of Lisbon, 1499-002 Lisbon, Portugal

Correspondence: André Ramalho (andre.ramalho@ipcb.pt)

Background

Scientific evidence suggests that an aerobic exercise session promotes improvements in the consolidation of motor memory in adults.

Objective

In this sense, the main purpose of this study was to investigate if an aerobic training session could improve motor memory consolidation in older people.

Methods

The participants of this study were 33 subjects of both genders (M = 68 years old; SD = 4.2 years old) divided in two groups: a control group and an experimental group. The participants performed a Soda Pop test before the aerobic training session (Baseline). The training session lasted 45 minutes and was composed of running exercises. After the training session, the motor memory consolidation was held in three different stages: Training; 1 hour after training; 24 hours after training. The Shapiro-Wilk test was applied to the normality distribution of data and One-way ANOVA test for parametric statistics.

Results

The results indicated that although the experimental group presented a better performance in motor memory consolidation, 1 hour after training and 24 hours after training, the differences were not significant (p ≥ 0.05).

Conclusions

Thus, it seems that an aerobic training session does not significantly improve motor memory consolidation in older people.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

Trial Registration

NCT03506490

Keywords

Aerobic exercise, Motor memory consolidation, Learning, Aging.

P61 Fundamentals of care in the critically ill person in ICU: an integrative literature review

Maria J Pires¹, Helga R Henriques², Maria C Durão³

¹Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; ²Departamento de Fundamentos de Enfermagem, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; ³Departamento de Enfermagem Médico-Cirúrgica, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Correspondence: Maria J Pires (m.joao.pires08@gmail.com)

Background

In the critically ill person, the priority of nursing interventions is, in most cases, exclusively directed to the management of the clinical situation, not valuing the fundamentals of care [1,2]. These universal activities are essential to the maintenance of life. They are present in each person, regardless of their health condition, whenever there is the necessary strength, will or knowledge [3,4]. In acute or chronic illness, injury or in the healthy person, the fundamentals of care may be disturbed, which motivate the nurses' intervention [3,5].

Objective

To know the evidence related to the fundamentals of care in the recovery of the critically ill person.

Methods

Integrative Literature Review, using a PICO model clinical question and carried out through the search of articles in MEDLINE, CINAHL and grey literature databases.

Results

We identified 1,268 results, of which 11 documents were selected to compose the final sample. The analysis of the documents showed that there is an invisibility of the fundamentals of care in ICU, caused by the predominance of biomedical model and technological care. Some studies, however, highlight the importance of nurses' intervention in patient recovery in areas of fundamentals of care, such as sleep [6], breathing, skin, nutrition, communication, patient and family education, mobilization, positioning and hygiene [7,8].

Conclusions

Fundamentals of care contribute to reducing complications during hospitalization of patients in the ICU, such as malnutrition, development of pressure ulcers or infection. The fundamentals of care are neglected in this context of care to the detriment of the technological care, reason why it is necessary to investigate this issue.

References

1. Feo R, Kitson A. Promoting patient-centred fundamental care in acute healthcare systems. Int J Nurs Stud. 2016;57:1–11.

2. Henneman EA. Patient Safety and Technology. AACN Advanced Critical Care, 2009;20(2):128–132.

3. Henderson V. Principios Básicos dos Cuidados de Enfermagem do CIE. Lusodidata, Ed. Loures; 2007.

4. Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. Defining the fundamentals of care. Int J Nurs Pract. 2010;16(4):423–434.

5. Clares JWB, Freitas MC, Galiza FT, Almeida PC. Necessidades relacionadas ao sono/repouso de idosos: estudo fundamentado em Henderson. Acta Paul Enferm. 2012;25(Número Especial 1):54–59.

6. Eliassen K, Hopstock L. Sleep promotion in the intensive care unit-A survey of nurses’ interventions. Intensive and Critical Care Nursing. 2011;27(3):138–142.

7. Shahin E, Dassen T, Halfens R. Pressure ulcer prevention in intensive care patients: Guidelines and practice. J Eval Clin Pract. 2009;15(2):370–374.

8. Curtis K, Wiseman T. Back to basics-Essential nursing care in the ED, Part 2. Australasian Emergency Nursing Journal. 2008;11(2):95–99.

Keywords

Critical patient, Fundamentals of care, Recovery, Safety.

P62 Adaptation and validation for the Portuguese population of the Quality of the Carer-Patient Relationship (QCPR) scale: preliminary results

Rosa Silva¹, Paulo Costa², Isabel Gil³, Hugo Neves^4,5, Nele Spruytte, João Apóstolo^2,5

¹Universidade Católica Portuguesa, Institute of Health Sciences, 4200-374 Porto, Portugal; ²The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ³Nursing School of Coimbra, Coimbra, 3046-851, Portugal; ⁴School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁵Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, 3000-232 Coimbra, Portugal

Correspondence: Rosa Silva (rcgsilva@porto.ucp.pt)

Background

The number of elderly with dementia is hastily increasing. The informal (family) carer are urged to perform more activities in order to maintain the elderly health needs. Assessing the quality of the relationship between the dyad (a family carer and a patient with dementia) is necessary to assure that care plans are well adjusted. The Quality of The Carer-Patient Relationship (QCPR), [1] emerges as a specific scale for assessing the quality of the bidirectional relation of the dyad.

Objective

To adapt the QCPR scale to Portuguese and determine its psychometric properties.

Methods

Phase (I), transcultural adaptation according to the international recommendations of the American Association of Orthopedic Surgeons [2], composed by four steps; Phase (II), a pilot study was conducted to assess the preliminary psychometric properties in the new cultural context, with a convenience sample composed by patients with dementia (n=30) and their caregivers (n=30). The factorial structure of the QCPR in this sample was evaluated through a confirmatory factorial analysis (CFA) with the AMOS software (v.24, SPSS Inc, Chicago, IL).

Results

Phase (I), the initial translations proved to be close to the original content (first step). Less consensual terminology was critically analysed and synthesized by the translators and elements of the research team (second step), resulting in the first version. The versions obtained in the back-translation process (third step) presented good semantic and idiomatic equivalence. After expert consensus (fourth step), the scale was revised in its entirety and punctually reformulated. This resulted in a second translated version, which maintained the original structure (an individualized questionnaire for each element of the dyad, with 14 items of the 5-point Likert-type scale response).

Phase (II), the CFA shows no violation of normality in all variables, with the presence of factorial weights below 0.5 in items 10 and 11 in the caregiver’s version, and in items 13 and 14 in the patient’s version. Regarding the quality of the adjustment of the model, both the caregiver’s version (χ²/df=1.304; CFI=0.922; GFI=0.731; RMSEA=0.097 P[RMSEA≤0.05]> 0.05; MECVI=6.739), as well as the patient’s version (χ²/df=1.152; CFI=0.955; GFI=0.760; RMSEA=0.069 P[RMSEA≤0.05]> 0.05; MECVI=6.475) present a model with questionable to good adjustment.

Conclusions

A strong and positive relation between both latent variables were contrary to what was expected to observe. The fact that only two observations evidenced conflict may indicate that there is a need to strengthen the number and diversity of participants sampled, in order to clarify these preliminary results.

Acknowledgements

This study is part of the project “Cognitive stimulation in the elderly: intervention in cognitive fragility and promotion of self-care”, funded by the Nursing School of Coimbra.

References

1. Spruytte N, Audenhove C, Lammertyn F, Storms G. The quality of the caregiving relationship in informal care for older adults with dementia and chronic psychiatric patients. Psychology and Psychotherapy: Theory, Research and Practice. 2002;75(3):295-311.

2. Beaton D, Bombardier C, Guillemin F, Ferraz M. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000;25(24):3186-3191.

Keywords

Patient-carer relationship, Quality of the relationship, Dementia.

P63 Association between Mediterranean diet and mood in young volunteers

Rafael Bravo¹, Nuria Perera¹, Lierni Ugartemendia¹, Javier Cubero², Ana B Rodríguez¹, Maria A Gómez-Zubeldia¹

¹Department of Physiology, Faculty of Science, University of Extremadura, 06071 Badajoz, Spain; ²Health Education Laboratory, Experimental Science Education Area, University of Extremadura, 06071 Badajoz, Spain; ³Department of Physiology, Faculty of Medicine, University of Extremadura, 06071 Badajoz, Spain

Correspondence: Rafael Bravo (rbravo@unex.es)

Background

Mediterranean diet (MD) is characterized by a high intake of vegetables, a moderate intake of fish and poultry and a low intake of meat and alcohol. MD is considered as a healthy dietary pattern in terms of morbidity and mortality. These benefits have been associated with the ingested levels of olive oil, fibber, non-simple carbohydrates and proteins obtained from vegetables.

Objective

In the last years, it has been reported that dietary patterns may influence on several psychological aspects like mood, anxiety or depression. Therefore, our aim was to elucidate whether MD may have a positive effect on the mood of young volunteers.

Methods

In this assay participated 52 male volunteers and 80 female volunteers. Participants filled the following scales: Mediterranean Diet Adherence Questionnaire (MDAQ), Beck’s Anxiety Inventory, Beck’s Depression Inventory, Ruminative Response Scale and the Well-Being Index (WHO-5). After data collection, every psychological variable was correlated with the score obtained in the MD Adherence Questionnaire.

Results

Related to male participants our results showed a negative correlation between MDAQ and Personal Dysfunction (p < 0.05). On the other hand, related to women, anxiety showed a negative correlation (p < 0.05) and well-being showed a positive correlation (p < 0.05), when correlated with MDAQ.

Conclusions

In our sample, we observed that MD may have positive effects on the mood of both young men and women.

Acknowledgements

Authors are gratefull to Junta de Extremadura (Fondos FEDER – GR 15051).

Keywords

Nutrition, Mediterranean diet, Mood.

P64 Health education, interprofessional collaboration and infection control in a house of support in souththern Brazil

Andressa T Hoffmann, Adriele Timmen, Alzira MB Lewgoy, Nadia M Kuplich, Ester D Schwarz

Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035903, Rio Grande do Sul, Brasil

Correspondence: Andressa T Hoffmann (athoffmann@hcpa.edu.br)

Background

Interprofessional collaboration can be understood as the interaction of professionals from different fields of knowledge aiming at a whole and broad health care. In this sense, health education constitutes a means-activity for the promotion of health, with a transforming role of individual practices [1,2]. The emergence of multidrug resistant (MDR) bacteria is a public health problem, and measures to prevent their spread are essential, together with awareness actions on infectious diseases and basic measures of personal and environmental hygiene.

Objective

To describe the interprofessional collaboration carried out by a group of professionals, in the areas of social work, nursing and pharmacy of the hospital infection control commission (HICC), with the staff and the children and relatives housed in a house of support from a university hospital, in Brazil.

Methods

Experiences reported from July 2016 to December 2017. After identifying the need for a theoretical deepening in prevention and control of infections, especially in the management of children and adolescents with MDR bacteria and their relationships, in the daily routine of the home, a joint planning of actions was started between the infection control team and the support house staff, focusing on health education. Initially, monthly meetings were made among professionals for reflection and problematization of learning and participatory observation, making feasible the situational diagnosis of the house. In these meetings, subjects such as hand hygiene, bacterial transmission, management of individuals with MDR bacteria, matrix-based strategies, hospital and house of support concepts were discussed, enabling a better understanding of the difference of care inside and outside the hospital. After the development and consolidation of concepts, house staff was encouraged to produce health education actions for their public.

Results

The performance of a theatrical play was carried out by both teams in June 2017, where it was identified the consolidation of contents by the professionals in the period of theoretical deepening. After this action, monthly workshops were started with the hosted public, carried out with the participation of both teams, in which issues related to the prevention and control of infections were discussed.

Conclusions

Health education and interprofessional collaboration enabled the development of the identity of the house of support, the strengthening of the team in topics of infection control, as well as the planning and carrying out of activities with the house's public. Such health promotion actions enabled employees and family members to become multipliers of good practices in infection prevention and control.

References

1. Matuda CG, Pinto NRS, Martins CL, Fazão P. Colaboração interprofissional na Estratégia Saúde da Família: implicações para a produção do cuidado e a gestão do trabalho. Ciência & Saúde Coletiva. 2015; 20(8):2511-2521.

2. Candeias NMF. Conceitos de educação e de promoção em saúde: mudanças individuais e mudanças organizacionais. Rev. Saúde Pública. 1997; 31(2):209-213.

Keywords

Heath education, Infection control, Interprofessional collaboration.

P65 Promotion of patient safety in nursing practice: what strategies?

Tânia Ferreira¹, Rita Marques²

¹Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisboa, Portugal

Correspondence: Tânia Ferreira (tania.vaf@gmail.com)

Background

Patient safety is a priority for World Health Organization (WHO). The organization considers it fundamental to develop a safety culture among health professionals in general and among nurses in particular, ensuring the safety and quality of the health care.

Objective

The purpose of this literature review (LR) was to identify nursing strategies for promoting patient safety.

Methods

Using the methodology recommended by the Cochrane Centre, this LR was guided by the research question: “What are the strategies that promote patient safety associated with nursing practice?” A research was carried out in scientific databases, in EBSCOhost (CINAHL® MEDLINE®) and SciELO, with publication dates between January of 2012 and December of 2017, with descriptors “patient safety”, “safety culture” and “nursing care”, having emerged 47 articles. After reading the title and abstract, 8 articles were selected to answer the research question.

Results

The identification of risks for people during nursing care and the incorporation of good practices and trust in teamwork, contribute to the improvement and development of a safety culture in health care [1,2]. The guarantee of satisfaction of the professional, the communication between professionals and institution, and the support to the team given by the administrations, are strategic factors for the assurance of patient safety [3, 4]. Nurses' perceptions about the safety culture of the patient and the intention to report adverse events are significant in promoting patient safety [5-7]. Coaching behaviour showed a significant and positive correlation with safety culture and coaching behaviours of team leaders were associated with higher degrees of perceived safety culture and stronger intentions to report adverse events [2,8]. Openness of communication and non-punitive responses to mistakes, as well as teamwork influence the patient's safety culture [5, 7].

Conclusions

Through this LR it was possible to perceive that the safety culture is an issue still underdeveloped in health organizations, where nurses have an essential role. Nursing practice is related to the professionals' perception of patient safety, which is related to a set of strategies that minimize the risks of adverse events.

References

1. Oliveira R, Leitão I, Silva L, Figueiredo S, Sampaio R, Gondim M. Estratégias para promover segurança do paciente: da identificação dos riscos às práticas baseadas em evidências. Esc Anna Nery. 2014; 18(1): 122-129.

2. Hwang J. What are hospital nurses’ strengths and weaknesses in patient safety competence? Findings from three Korean hospitals. International Journal for Quality in Health Care. 2015; 27(3): 232-238.

3. Rigobello MCG, Carvalho REFL, Cassiani SHDB, Galon T, Capucho HC, Deus NN. Clima de segurança do paciente: percepção dos profissionais de enfermagem. Acta Paul Enferm. 2012; 25(5): 728-35.

4. Mayeng LM, Wolvaardt JE. Patient safety culture in a district hospital in South Africa: Na issue of quality. Curationis. 2015; 38 (1).

5. Ammouri AA, Tailakh AK, Muliira JK, Geethakrishnan R, Al Kindi SN. Patient safety culture among nurses. International Nursing Review. 2015; 62: 102-110.

6. Costa TD, Salvador PTCO, Rodrigues CCFM, Alves KYA, Tourinho FSV, Santos VEP. Percepção de profissionais de enfermagem acerca de segurança do paciente em unidades de terapia intensiva. Rev Gaúcha Enferm. 2016; 37 (3).

7. Khater WA, Akhu-Zaheya LM, AL-Mahasneh SI, Khater R. Nurses’ perceptions of patient safety culture in Jordanian hospitals. International Nursing Review. 2015; 62: 82-91.

8. Ko Y, Yu S. The Relationships Among Perceived Patients’ Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study. J Patient Saf. 2015; 00.

Keywords

Patient safety, Safety culture, Strategies, Nursing.

P66 End of life person’s evaluation criteria in the decision making regarding artificial nutrition

Tânia Afonso¹, Filipa Veludo¹, Patrícia P Sousa¹, Sónia Santos²

¹Instituto de Ciências da Saúde, Escola de Enfermagem, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal; ²Unidade de Cuidados Intensivos Polivalente, Hospital Prof Doutor Fernando Fonseca, 2720-276 Amadora, Portugal

Correspondence: Tânia Afonso (tafonso3@gmail.com)

Background

Artificial nutrition at the end of life is assumed as a medical intervention, however for a large percentage of person’s and families is considered as basic care [1]. Thinking about artificial nutrition and the end of life person, such as the person with advanced, incurable and progressive disease, with a survival expectancy between 3 to 6 months [2] is often reflected on a set of issues. This is a controversial discussion, about the quality of life resulting of one of these means and ethical questioning [3]. It’s relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support.

Objective

Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses’ decision-making about artificial nutrition.

Methods

Literature Review (15-06-2017) with PRISMA guidelines for reviews [4] in Academic Search Complete, Complementary Index, CINAHL Plus with Full Text®, Psychology and Behavioural Sciences Collection, ScieELO, MEDLINE®, Directory of Open Access Journals, Supplemental Index, ScienceDirect, Education Source, Business Source Complete and MedicLatina. Inclusion/exclusion criteria: nurses who care for adult/elderly persons at the end of life, excluding nurses who care for children; articles about nurses’ intervention in nutrition care to the person at the end of life and the person’s evaluation criteria; full text; in French/Spanish/English/Portuguese; peer-reviewed; published between 2000-2017. A sample of 11 articles was selected.

Results

The evaluation criteria to be considered when making decisions on artificial nutrition are: the evaluation of symptoms/problems; emotional value of food; the meaning of the diet for the person at the end of life and definition of prognosis [3,5-6]. In every decision-making, it should be considered the existence of a clinical indication/treatment, a therapeutic objective and the informed consent of a user or legal guardian.

Conclusions

It is concluded that the decision on artificial nutrition should integrate the person at the end of life and family, be taken by an interdisciplinary team, considering the definition of the prognosis and the effectiveness of the treatment applied [3]. The intervention of the nurse is understood as a primordial one, based on the best evidence, in relation of proximity [5] considered, simultaneously, the principle of autonomy, beneficence, non-maleficence and justice. There is little evidence of end-of-life nutrition and new studies on the role of nurses within the interdisciplinary team are suggested.

References

1. Stiles E. Providing artificial nutrition and hydration in palliative care. Nursing Standard. 2013, 27: 35-42.

2. Barbosa A [et al.]. Manual de Cuidados Paliativos. Lisboa: Núcleo de Cuidados Paliativos, Centro de Bioética da Faculdade de Medicina da Universidade de Lisboa. 2010, 2ª edição;

3. Alves P. Intervenção do Enfermeiro que Cuida da Pessoa em Fim de Vida com Alterações do Comer e Beber. Pensar Enfermagem. 2013, 17(1): 17-30;

4. Moher D [et al.]. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. 2009, 151(4): 264-269;

5. Bryon E [et al.]. Decision-making about artificial feeding in end-of-life care: literature review. Journal of Advanced Nursing. 2008, 63(1): 2-14;

6. Holmes S. Withholding or withdrawing nutrition at the end of life. Nursing Standard. 2010, 25(14): 43-46.

Keywords

Nursing, Artificial nutrition, Therapeutic obstinacy, Integrative review.

P67 Psychometric properties of the Portuguese version of personal outcomes scale for children and adolescents: an initial research

Cristina Simões^1,2, Célia Ribeiro¹

¹Economics and Social Sciences Department, Portuguese Catholic University, 3504-505 Viseu, Portugal; ²Research Centre on Special Education, Faculdade de Motricidade Humana, 1495-687 Cruz Quebrada, Portugal

Correspondence: Cristina Simões (cristina-ferreira@iol.pt)

Background

The quality of life (QOL) assessment of children and adolescents has been particularly important in the field of intellectual disability (ID) during the past years. Special Education needs to use a systematic approach to the assessment of the QOL domains, in order to implement a social-ecological model and to promote full inclusion in all contexts of life. It is important to develop a scale that provides simultaneously self-report and report-of-others measures to gather information based on a multiperception strategy and to encourage person-centred planning.

Objective

This research aims to analyse the validity and reliability of the Portuguese version of the Personal Outcomes Scale for Children and Adolescents (POS-C).

Methods

Data were collected from 54 children and adolescents with ID (M_age = 12.48, SD = 2.93) and respective proxies (M_age = 46.59, SD = 5.68). After the cross-cultural adaptation stage, the validity (content, construct) and the reliability (test-retest, Cronbach’s alpha, inter-rater) properties of the POS-C were examined.

Results

All items of the POS-C were considered relevant by 10 experts, who agreed on a Portuguese version of the scale. The scores of the content validity index (CVI) of each item (≥ .80), the scale CVI-universal agreement (≥ .84), the scale CVI-average (≥ .99) and the Cohen’s kappa (≥ .44) showed suitable content validity of the scale. The total score from self-report and domains ranged from moderate (r = .42 in emotional well-being) to high (r = .82 in social inclusion). Regarding the report-of-others, the Pearson’s coefficients ranged from moderate (r = .49 in emotional well-being) to high (r = .85 in interpersonal relations). The test-retest scores were high in practitioners (r = .95) and in family members (r = .90). The internal consistency reliability of the self-report domains ranged from .41 (interpersonal relations) to .70 (self-determination), and in report-of-others ranged from .54 (physical well-being) to .79 (emotional well-being). The overall scale demonstrated good Cronbach’s alpha scores (α = .81 in self-report and α = .87 in report-of-others). The inter-rater of domains ranged from .47 (interpersonal relations) to .81 (personal development).

Conclusions

This initial research on the psychometric properties of the scale, introduces the POS-C as a useful measure of personal outcome scales for Portuguese children and adolescents with ID. POS-C is an important tool to improve personalized support plans, based on self-report and report-of-others measures.

Keywords

Quality of life, Intellectual disability, Cross-cultural adaptation, Validity, Reliability.

P68 Development and validation of a multi-domain digital cognitive stimulation program for older adults with mild to moderate cognitive decline

Filipa C Couto¹, Maria A Dixe^1,2,3, Jaime Ribeiro^2,3,4, Mónica Braúna^2,3, Luís Marcelino⁵, João Apóstolo⁶

¹The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, 3000-232, Portugal; ²School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴Research Centre on Didactics and Technology in the Education of Trainers, Department of Education and Psychology, University of Aveiro, Campus Universitário, Aveiro 3810-193, Portugal; ⁵Informatics Engineering Department, School of Technology and Management, Polytechnic of Leiria, Leiria, 2411-901, Portugal; ⁶The Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Nursing School of Coimbra, Coimbra, 3000-232, Portugal

Correspondence: Filipa C Couto (filipadccouto@gmail.com)

Background

Frail older adults present a decline on their cognitive function. Cognitive interventions are related to the maintenance of cognitive function and are associated with independence and well-being [1, 2]. A cognitive intervention could be considered as a complex intervention once it contains several interacting components [3]. The MIND&GAIT project expects the development of a structured digital cognitive stimulation program to be used with older adults with mild to moderate cognitive decline.

Objective

To develop and validate an elderly-friendly multi-domain digital cognitive stimulation program.

Methods

To develop the program, the research team followed Guidelines for complex interventions from The Medical Research Council. The development process comprises four phases [3]. The first phase corresponds to a Preliminary Phase (I), the second to a Modelling Phase (II), the third to a Field Test Phase (III) and the last to a Consensus Conference Phase (IV).

Results

The digital stimulation cognitive program has 8 individual sessions and 1 group session. The program has already passed for Phase I, which corresponds to an initial conceptualization of the program design and its support materials. At the moment, it is on Phase II, being presented to an experts’ panel to gather different opinions and evaluations from specialists in the area of cognitive interventions. Each session of the program will later be evaluated at Phase III. All the contributions and analysis resulted from the previous phases will be synthesized in phase IV. It is expected that the critical evaluation, provided by specialists in the area of cognitive interventions, will result in a well-founded and structured intervention to be applied in older adults with mild to moderate cognitive decline. The program’s construction, supported by guidelines and based in elderly-friendly digital components, intends to give a response to the challenge of an increasing aged population allying e-health. The program is to be used by health professionals and informal caregivers, in order to work as a possible way to prevent or minimize cognitive decline.

Conclusions

Cognitive interventions have impact on cognitive decline, a condition that assumes more importance once it is related with frailty in older adults. Although being a multidomain program, it also potentiates people for activities of daily living. As a complex intervention, this program allows health professionals and other people to apply nonpharmacological interventions which can represent the implementation of best practice towards the needs of an ageing population.

Acknowledgements

The current abstract is being presented on behalf of a research group. It is also part of the MIND&GAIT project Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products, which is a Portuguese project with the support of COMPETE 2020 under the Scientific and Technological Research Support System, in the copromotion phase. We acknowledge The Health Sciences Research Unit: Nursing (UICISA:E) of the Nursing School of Coimbra, the Polytechnic of Leiria and also to other members, institutions and students involved in the project.

References

1. Apóstolo J, Holland C, O'Connell MD, Feeney J, Tabares-Seisdedos R, Tadros G et al. Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA). Maturitas. 2016;83:83-93.

2. Mewborn CM, Lindbergh CA, Miller LS. Cognitive interventions for cognitively healthy, midly impaired and mixed samples of older adults: a systematic review and meta-analysis of randomized-controlled trials. Neuropsychol Rev. 2017;27(4):403-439.

3. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.

Keywords

Aged, Cognitive decline, Cognitive stimulation, Frailty, Complex intervention.

P69 Tele-enfermeiro evolution

Telmo Sousa¹, Pedro Brandão^1,4, Paulino Sousa^2,3, João Rodrigues^4,5

¹Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal; ²Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ⁴Instituto de Telecomunicações, 1049-001 Lisboa, Portugal; ⁵Administração Regional de Saúde do Norte, 4000-099 Porto, Portugal

Correspondence: Telmo Sousa (telmocatarina17@gmail.com)

Background

Despite the high technological growth envisaged in the health area, the use of technologies is still scarce when we refer to the Primary Healthcare (PHC). PHC care is very important because it allows for the implementation of proximity interventions, such as nursing home care, resulting in an improvement of the health of individuals, families, and communities. The system mentioned above is the one implemented in health centres called S-Clinic and developed by the Serviços Partilhados do Ministério da Saúde (SPMS). However, this process presents some problems, such as the time spent collecting patient data; the introduction of the intervention data into the system, and the lack of a support structure for the data records extracted from the patient by the nurse.

Objective

Combining technological evolution, the importance of PHC and the difficulty of the nursing process at home, we propose the development of an application for mobile devices, with the objective of allowing nurses to import patient data through information, data records of the interventions carried out in an electronic format, which are then exported to the system.

Methods

In this way, the application will facilitate the work of the nurse because it replaces the records on paper, thus allowing a better collection and structuring of the data, as well as the increase of the efficiency of the work activity, and reduction of the time spent for the collection and introduction of data in S-Clinic. We had to study the essential contents of the nursing process at home and implemented in the system, in order to create a data structure with the closest resemblance to S-Clinic. Then, to obtain this information a meeting was held with nursing experts to provide their knowledge in this area.

Results

In this meeting, the contents considered essential for a domicile were addressed, and the key points were: nursing focus or diagnosis and nursing intervention. The data model was implemented in order to cover all the contents. Some security measures that could be implemented have also been discussed, in order to protect data. After the application development was complete, a meeting was held with some of the nursing experts present at the first meeting to gather requirements, in order to evaluate the system.

Conclusions

The feedback was very positive, encouraging the research team to continue this development because they see a good solution for the future of the PHC at the home environment.

Acknowledgements

This article is a result of the project NanoSTIMA Macro-to-Nano Human Sensing: Towards Integrated Multimodal Health Monitoring and Analytics, Norte-01-0145-FEDER-000016, supported by Norte Portugal Regional Operational Programme (NORTE 2020), through Portugal 2020 and the European Development Fund.

Keywords

Nursing, Health information system, Digital health, Innovation, Development.

P70 Construction of parenthood - role of the family nurse

Andreia MJS Azevedo, Elsa MOP Melo, Assunção DL Almeida

School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Andreia MJS Azevedo (jarmelo.andreia@gmail.com)

Background

The birth of the first child is presented as the most challenging responsibility facing the family, requiring the adaptation of their interactions with singular and holistic impact. The first six months emerge as a transient, predictable and irreversible milestone. The transition to parenting is marked by the changes and repercussions that drive the child's growth and development, predating and precipitating others in the family life cycle. Supporting families in transition is the competence of nurses, namely, their intervention in the field of family health nursing, in the training for the construction of parenting.

Objective

Understand how parents build their parenting model during the first semester of life of the first child. Analyse parents' expectations and constraints/difficulties in the transition to paternity. Explore identity figures and resources mobilized by parents in the transition to parenthood.

Methods

We developed a phenomenological study of qualitative nature, with a non-probabilistic sampling of convenience that includes 11 subjects, parents with the first child to complete six months of life between October and December 2016, enrolled in USF Rainha D. Tereza. We conducted semi-structured interviews, obtaining the narratives of the experiences and their deepest understanding of them. We complied with ethical procedures and submitted the information collected to analysis using WEBQDA Software.

Results

We highlight the experience of parenting in the desire to be a parent, and in the expectations created in pregnancy, contributing to the parental model. This is determined by factors such as the characteristics of the child, the characteristics and previous experiences of the parents, and the family dynamics. Parents face difficulties in providing care for the child and reconciling parental, marital and familial and social roles. Faced with these difficulties, parents use human, community and monetary resources. We highlight the community resource in support of health care, which is valued by parents. The family nurse, when identified and recognized, is described as an effective and accessible resource in adapting to parenting.

Conclusions

The results obtained by the research carried out allowed us to acknowledge the experience of the transition to parenthood of the parents interviewed and to affirm the role of the family nurse, in their capacity to build their own model of parenting, as well as contributing with knowledge to be valued in nursing interventions.

Keywords

Nursing, Family, Transition, Parenthood.

P71 Antioxidant activity of the garlic (Allium sativum L.) submitted to different technological processes

Carla Sousa¹, Catarina Novo², Ana F Vinha^1,3

¹Unidade de Investigação em Energia, Ambiente e Saúde, Centro de Estudos em Biomedicina, Fundação Fernando Pessoa, 4249-004 Porto, Portugal; ²Universidade Fernando Pessoa, 4249-004 Porto, Portugal; ³REQUIMTE/LAQV, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto 4051-401 Porto, Portugal

Correspondence: Ana F Vinha (acvinha@ufp.edu.pt)

Background

Garlic has become extensively investigated by its benefits for health. Some therapeutic activities are attributed to the garlic, namely, antioxidant, hepatoprotective, anticancer and antitumor properties, among others [1-3].

Methods

Therefore, the total phenolic content (TPC) and the total flavonoid content (TFC) have been determined, as well as the antioxidant properties of extracts of the different forms of presentation/parts of the garlic existing in the market (bulb, in powder and in tablets/capsules), by the radical 2,2-diphenyl-1-picrylhydrazyl (DPPH•) method and by evaluation of the ferric reducing antioxidant power (FRAP). The scavenging capacity of the same extracts against reactive species (O₂^-•, H₂O₂, NO•) was also evaluated. Finally, the biological activity of the presentation forms of garlic existing in the market was compared with the one of the garlic peel, considered food waste, taking also into account some variables that can influence the properties of the bulb, that is, boiling and freezing.

Results

TPC was superior in the frozen chopped garlic sample, having the garlic tablets the lowest content. The cooked garlic presented an inferior value of TPC when comparing with the raw chopped bulb. These results indicate that cooking and freezing methods intervene directly with the total phenolic content, but in an opposite way. The extract of cooked garlic had the higher value of TFC, belonging the lowest tenor to garlic tablets. Radical DPPH• and FRAP methods allowed to verify that the cooked garlic extract evidenced a superior antioxidant activity. This result can be explained by cell wall rupture derived from heating, provoking antioxidant substance release, new and/or stronger antioxidant substance formation or oxidant enzymes inhibition [4]. The frozen chopped garlic extract presented the highest scavenging capacity of the three studied reactive species. In general, the higher the total phenolic content, the greater the capacity of inhibition of reactive species NO•, O₂^-• and H₂O₂.

Conclusions

This study has showed that the diverse forms of presentation/parts of the garlic possess high bioactive compounds content, and consequently antioxidant activity, presenting health benefits.

References

1. Banerjee SK, Mukherjee PK, Maulik SK. Garlic as an antioxidant: the good, the bad and the ugly. Phytother Res. 2003, 17(2): 97–106.

2. Naji KM, Al-Shaibani ES, Alhadi FA, Al-Soudi SA, D’souza MR. Hepatoprotective and antioxidant effects of single clove garlic against CCl4-induced hepatic damage in rabbits. BMC Complement Altern Med. 2017, 17: 411.

3. Oommen S, Anto RJ, Srinivas G, Karunagaran D. Allicin (from garlic) induces caspase-mediated apoptosis in cancer cells. Eur J Pharmacol. 2004, 485(1-3): 97-103.

4. Ali M, Mahsa M, Barmak MJ. Effect of boiling cooking on antioxidant activities and phenolic content of selected iranian vegetables. Res J Pharm Biol Chem Sci 2015, 6(3): 663-641.

Keywords

Allium sativum L., Bioactive compounds, Antioxidant activity, Reactive species.

P72 Influence of gamma irradiation in the antioxidant potential of pumpkin seeds and mung beans

Anabela Macedo¹, Carla Sousa², Ana F Vinha^2,3

¹Universidade Fernando Pessoa, 4249-004 Porto, Portugal; ²Unidade de Investigação em Energia, Ambiente e Saúde, Centro de Estudos em Biomedicina, Fundação Fernando Pessoa, 4249-004 Porto, Portugal; ³REQUIMTE/LAQV, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto 4051-401 Porto, Portugal

Correspondence: Ana F Vinha (acvinha@ufp.edu.pt)

Food conservation is a challenge for the food industry. The high respiration rate, the lack of physical protection to avoid water loss and the changes due to microbial attack are often associated with loss of food quality, contributing to deterioration through browning, weight loss and texture changes [1]. Furthermore, bacteria, moulds, enzymatic activity (mainly polyphenol oxidase) and biochemical changes can cause spoilage during storage [2]. The use of ionizing energy for preservation has been widely studied by the food industry. However, studies evaluating the effects of ionizing radiation are mostly available in cultivated species, being scarce the reports on wild species and food waste, considered add-value foods. In this regard, food technology is making progress towards increasing food preservation and contributing to a reduction of the incidence of food-related diseases. Previous studies assessing the potential of gamma irradiation as a suitable technique to increase natural products shelf-life were focused in nutritional and chemical parameters, including bioactive compounds and their antioxidant activity [3]. Many natural compounds found in edible food wastes (seeds) or grains (beans) present antioxidant activity. Among the most important natural antioxidants are phenolic compounds (flavonoids, phenolic acids and tannins), nitrogenous compounds (alkaloids, amino acids, peptides, amines and chlorophyll byproducts), carotenoids, tocopherols and ascorbic acid.

In the present work, the effects of gamma radiation dose (0, 0.5, 1.0, 1.5 and 5.0 kGy) on the chemical composition (total phenolics and total flavonoids) of pumpkin seeds and mung beans were evaluated. The antioxidant activity was studied using DPPH• and FRAP assays. It was observed a slight increase in the content of bioactive compounds, as well as in antioxidant activity, with irradiation doses below 1.5 kGy. Final results showed that irradiation may be a viable technique to guarantee the content of bioactive compounds, as well as their biological properties, including antioxidant activity.

References

1. Singh P, Langowski HC, Wanib AA, Saengerlaub S. Recent advances in extending the shelf life of fresh Agaricus mushrooms: a review. J Sci Food Agric. 2010, 90: 1393-1402.

2. Fernandes Â, Barreira JCM, Antonio AL, Bento A, Botelho ML, Ferreira ICFR. Assessing the effects of gamma irradiation and storage time in energetic value and in major individual nutrients of chestnuts. Food Chem Toxicol. 2011, 49: 2429-2432.

3. Antonio AL, Fernandes Â, Barreira JCM, Bento A, Botelho ML, Ferreira ICFR. (Influence of gamma irradiation in the antioxidant potential of chestnuts (Castanea sativa Mill.) fruits and skins. Food Chem Toxicol. 2011, 49: 1918-1923.

Keywords

Food conservation, Gamma irradiation, Pumpkin seeds, Mung beans, Antioxidants.

P73 The effects of swimming and swimming complemented with water walking on spirometry values

Pedro Duarte-Mendes^1,2, Samuel Honório^1,2, João Oliveira¹, João Petrica^1,3, André Ramalho^1,2, António Faustino¹, Rui Paulo^1,2

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Arcozelo, Vila Nova de Gaia, Portugal; ³Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

Correspondence: Pedro Duarte-Mendes (Pedromendes@ipcb.pt)

Background

Spirometry is a standard pulmonary function test that measures how an individual inhales or exhales volumes of air as a function of time. It is the most important and most frequently performed pulmonary function testing procedure, having become indispensable for the prevention, diagnosis and evaluation of various respiratory impairments. However, there have been only a few studies addressing the effect of physical activity on pulmonary function test results and investigating the association between body composition and respiratory parameters in sports activities [1-3].

Objective

The objective of this study was to verify if there are differences in spirometry values in children aged between 6 and 12 years who practice swimming complemented with water walking at the end of each session and those who only practice swimming.

Methods

In this study 28 subjects (mean age, 7.68 ± 1.16 years) participated and were divided into two groups: swimming group (SG) (N=9) and swimming complemented with water walking group (SWWG) (N=19). The study was performed in 12 weeks with 3 moments of evaluation (M1, M2 and M3), with two sessions per week of 45 minutes each, we wanted to identify the benefits in pulmonary function - Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and Peak Expiratory Flow (PEF). The water walking activity occurred at the end of each session for 6 minutes, performed in straight line with the water level at the children’s chest. The spirometry tests were realized with the microQuark Spirometer®. For the analysis of the results, we used descriptive statistics, the Shapiro Wilk test for testing the normality of the sample and for inferential statistics the Mann-Whitney tests, Friedman's Anova, and d-Cohen for the magnitude of effect.

Results

The results show, that from the inter-group analysis (comparison between the SG and the SWWG) we observe that there were significant differences in the FVC (M2 - p=0.025), VEF1 (M2 - p=0.01; M3 - p=0.008) and PEF (M1 - p=0.033; M2 - p=0.012; M3 - p=0.037) values. Concerning intra-group differences (improvement in the SG and the SWWG in the three moments evaluated), the SWWG showed significant differences in FVC (p= 0.003) and FEV₁ (p=0.008), and the SG showed significant differences in VEF₁ (p=0.034) and PEF (p=0.013).

Conclusions

These results show that “swimming” and “swimming complemented with water walking” show improvements in spirometry values in children. The swimming complemented with water walking group showed better results.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

Trial Registration

NCT03506100

References

1. Durmic T, Lazovic B, Djelic M, Lazic J, Zikic D, Zugic V, Dekleva M, Mazic S. Sport-specific influences on respiratory patterns in elite athletes. J Bras Pneumol. 2015, 41: 516-522.

2. Vaithiyanadane V, Sugapriya G, Saravanan A, Ramachandran C. Pulmonary function test in swimmers and non-swimmers- a comparative study. Int J Biol Med Res. 2012, 3, 1735-1738.

3. Lopes, M. d., Bento, P. C., Lazzaroto, L., Rodacki, A. F., & Leite, N. (2015). The effects of water walking on the anthropometrics and metabolic aspects in young obese. Rev Bras Cineantropom Desempenho Hum. 2015, 17, 235-237.

Keywords

Spirometry, Swimming, Water walking.

P74 Preliminary translation and validation of Movement Imagery Questionnaire – Children (MIQ-C) to Portuguese

Pedro Duarte-Mendes^1,2, Daniel Silva¹, João Petrica^1,3, Daniel Marinho^4,5, Bruno Travassos^4,5, João Serrano^1,3

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention 4411-801 Arcozelo – Vila Nova de Gaia, Portugal; ³Centro de Estudos em Educação, Tecnologias e Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ⁴Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁵Research Center in Sports Sciences, Health Sciences and Human Development, University of Tras-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal

Correspondence: Pedro Duarte-Mendes (Pedromendes@ipcb.pt)

Background

The ability to perform movement imagery has been shown to influence motor performance and learning in sports and rehabilitation. Imagery is a cognitive process that can play an important role in planning and execution of movements or actions. Several instruments have been developed in order to evaluate the ability of Imagery in adults such has the MIQ-3, with Portuguese Athletes [1]. However, none focused on imagery ability questionnaire for children with the three modalities (kinesthetic, visual internal and visual external imagery) for Portuguese children’s.

Objective

The objective of this study was to translate and validate preliminary, for the Portuguese children’s population, the Movement Imagery Questionnaire for Children [2], determining its initial psychometric qualities through an exploratory factor analysis model that supports it.

Methods

In this study 162 subjects of both genders (124 male, 38 female) with a mean age of 10.1 years (SD = 16) participated. For the development of the Portuguese adaptation of the evaluation instrument, a methodology was developed in two phases: (1) the translation phase and cultural adaptation of the questionnaire and (2) the application of the Exploratory Factor Analysis method of the instrument. In the statistical analysis of data, we used the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, to evaluate the quality of the correlations, and an exploratory factorial analysis (EFA) to determine the number of factors to be retained, the number of items associated with them and their internal consistency. The type of rotation adopted was the oblique rotation Promax.

Results

Initially it was found that the procedures of translation and adaptation originated a Portuguese version of MIQ - C similar to the original version. Secondly, we found that the psychometric qualities proved their suitability of adaptation performed (KMO=0.822, Bartlett test p=.000), demonstrating that its factor structure is the same as the original version (12 items grouped into 3 factors, with 4 items each factor), with quite acceptable levels of validity and reliability (Cronbach's alpha: 0.85 to MIQ - C, 0.79 for the kinesthetic imagery, 0.74 for the visual internal imagery and 0.76 for the visual external imagery).

Conclusions

The results showed that the Portuguese version of the Movement Imagery Questionnaire for Children, with the aim to assess the imagery ability in three modalities (kinesthetic, visual internal and visual external imagery) has quite acceptable indexes for its validation.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

References

1. Mendes P, Marinho D, Petrica J, Silveira P, Monteriro D, Cid L. Translation and Validation of the Movement Imagery Questionnaire – 3 (MIQ - 3) with Portuguese Athletes. Motricidade. 2016, 12, 149-158.

2. Martini R, Carter M, Yoxon E, Cumming J, Ste-Marie M. Development and validation of the Movement Imagery Questionnaire for Children (MIQ-C). Psychology of Sport and Exercise. 2016, 22: 190-201.

Keywords

Imagery, Translation and validation, Children, Exploratory factor analysis.

P75 New emerging point-of-care platforms for Clostridium difficile testing

Isabel Andrade¹, Chantal Fernandes^2,3, Teresa Gonçalves^2,3

¹Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Institute of Microbiology, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ³Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Isabel Andrade (imandrade@estescoimbra.pt)

Background

Since 2000, the incidence and severity of Clostridium difficile (C. difficile) infections have increased, justifying the need for expedite, sensitive and specific methods of diagnosis. The existing rapid diagnostic tests vary widely in terms of clinical usefulness, which is evaluated on its sensitivity, specificity, turnaround time (TAT), cost, and availability. Besides that, there is no generally accepted gold standard or single optimal approach for C. difficile testing. This has challenged various stakeholders to develop point-of-care (POC) platforms with the best test performance characteristics, easy to use, and with rapid TAT, a critical element of POC testing to improve the clinical management of this infectious disease. POC testing can be done at home, at the primary care level, by hospital staff in emergency or operating rooms, intensive care units, as well as in extreme environments, such as remote or low-resource settings, or in conditions following emergency crises or natural disasters.

Objective

To review current evidence regarding emerging POC platforms for C. difficile testing.

Methods

PubMed database was searched using keywords relevant to POC testing of C. difficile, since 2000, yielding a total of 10 articles included out of 17 initially identified/selected for full review.

Results

The findings show that during the last decade extensive research efforts were underway to develop stand-alone platforms suitable for POC testing of C. difficile infections. Multistep algorithms using the polymerase chain reaction test for C. difficile toxin gene(s) have the best test performance characteristics, and a trend seems to exist in favour of molecular tests in detriment of immunoassays, in POC platforms. A common feature to all POC devices is the rapid TAT, within seconds-minutes to a few hours, which is crucial for C. difficile infection management. Some of these POC devices enable to run either multiplex tests on a single sample, or multiple samples. Although the majority of these stand-alone POC platforms for C. difficile testing are still prototypes, they may be looked at as a step towards more rapid, miniaturized, portable and easier to use test devices with the potential to affect healthcare decisions at its earliest stage.

Conclusions

In conclusion, research efforts show an increasing number of technologies evolving for the development of POC platforms for C. difficile testing.

Keywords

Clostridium difficile, Point-of-care testing, Turnaround time, Stand-alone platform.

P76 Contributions for the validation of the Portuguese version of the Cohen-Mansfield Agitation Inventory (CMAI)

Rafael Alves¹, Daniela Figueiredo^2,3, Alda Marques^2,4

¹Psychiatric Hospital Centre of Lisbon, 1749-002 Lisbon, Portugal; ²School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ³Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Center for Health Technology and Services Research, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Rafael Alves (susanapupocorreia@gmail.com)

Background

Dementia represents one of the greatest health challenges due to its incidence and frequency, costs and impacts on the individual, family and society. The Diagnostic and Statistical Manual of Mental Disorders – V (DSMV) considers that the behavioural changes, i.e., the non-cognitive aspects of dementia, should be diagnosed, however, this is often not common practice. The identification and quantification of Behavioural and Psychological Symptoms of Dementia (BPSD) can be objectively assessed using the Cohen-Mansfield Agitation Inventory (CMAI). CMAI is a reliable and valid instrument used in clinical and research practice [3], however, it has never been validated for European Portuguese.

Objective

To contribute for the adaptation and validation of the CMAI for the European Portuguese population.

Methods

The study was conducted in two phases. The first phase consisted of the translation and cultural and linguistic validation of the CMAI according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The following methodology was used a) Translation, b) Reconciliation, c) Retroversion, d) Harmonization, e) Cognitive testimony/analysis and e) Spelling review. In phase 2, the internal consistency was calculated using the Cronbach's alpha. The intra- and inter-rater reliability was determined using the Intraclass Correlation Coefficient (ICC), using the intra-rater (1,1) and the inter-rater (2,1) equations. A factorial exploratory analysis of the construct validity was conducted with 101 people with dementia (83.3 ± 8.0 years; n=83; 82.2% female). Statistical analysis was performed with the Kaiser-Meyer-Olkin (KMO) test, on the behaviours manifested by more than 10% of the sample and only items weighing more than 0.4 were included in the extracted factors.

Results

The Portuguese version of CMAI revealed good reliability inter-rater (ICC> 0.4 for 22/29 items) and excellent intra-rater (ICC> 0.75 for 21/29 items) reliability and good internal consistency (α = 0.694). The factorial exploratory analysis was applied to 21 items that meet the criterion. An association in three factors “non-aggressive physical behaviour” (67.3%), “aggressive behaviour” (66.3%) and “verbal agitation behaviour” (63.4%) was found with a reasonable quality (KMO = 0.664) and reasonable internal consistency values (0.754; 0.633; 0.714).

Conclusions

This study contributed to the availability of a measurement instrument for the European Portuguese, that can be used in clinical or research contexts, with people with dementia. As a future study it is suggested to analyse the remaining validation processes (criterion and confirmatory factor analysis).

Keywords

Dementia, Instrument, BPSD, Agitation.

P77 Analysis of the activations of the Intra-Hospital Emergency Team

Marisa J Cardo¹, Pedro Sousa^2,3

¹Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Tecnhology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Marisa J Cardo (marisacardo@gmail.com)

Background

The safety of patients is extremely important, therefore the Intra-Hospital Emergency Team (IHET) has emerged to respond to situations of clinical deterioration of hospitalized patients. When the patient presents deterioration of his clinical condition, it requires being examined in a timely manner by a team that provides the highest level of care. That seems to be the better way to avoid the occurrence of critical events, such as mortality, cardiovascular arrest and unplanned admission in intensive care units.

Objectives

This study aims to determine the characteristics of the IHET activations of Centro Hospitalar de Leiria (CHL).

Methods

This exploratory study analysed the registrations of the activations occurred in the last half of 2011, totalling 325 records. Sociodemographic and clinical characteristics of the patients, and the characteristics of the activations were analysed using the chi-square test and ANOVA.

Results

This study showed IHET activations mainly for male patients (56%), with a mean age of 74.48 ± 13.34 years, with an admission diagnosis related to respiratory diseases (34%) and with the main activation criterion of worried professional (33%). Despite the lack of records on the presence of previous signs of clinical deterioration, it was found that only 27% of patients presented them. The relationship between the presence of previous signs of deterioration and the result of the activation stands out (χ² = 18.695; p ≤ 0.001).

Conclusions

It was found that the IHET was activated in a timely manner by nurses who were knowledgeable of their patients and with the capacity to predict critical events, which enabled the best possible outcomes.

Keywords

Hospital rapid response team, Nursing, Emergency situation, Clinical deterioration.

P78 Virtual assistant to facilitate self-care of older people with type 2 diabetes: preliminary study protocol

Mara P Guerreiro¹, Adriana Henriques¹, Isabel CE Silva¹, Anabela Mendes¹, Ana P Cláudio², Maria B Carmo², João Balsa², Susana Buinhas³, Nuno Pimenta⁴, Afonso M Cavaco⁵

¹Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; ²Instituto de Biossistemas e Ciências Integrativas, Universidade de Lisboa, 1749-016 Lisboa, Portugal; ³Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal; ⁴Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ⁵Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal

Correspondence: Mara P Guerreiro (mara.guerreiro@esel.pt)

Background

More than a quarter of people aged 60-79 years is diabetic [1]. The management of type 2 diabetes (T2D) includes diet, physical activity and, often, medicines; it requires daily self-care and constant lifestyle-related choices [2]. It has been estimated that glycaemic control is achieved in less than 50% of T2D patients due to low self-care behaviour [2]. Sustained hyperglycaemia causes complications and premature death, as well as significant costs [1]. Improving self-care and T2D management is therefore crucial.

Technology-based interventions, such as text messages, have successfully been used in T2D management; nevertheless, challenges remain, such as acceptability to users and attrition [3,4]. Relational agents, which are computational artefacts designed to establish rapport and trust by simulating face-to-face counselling in long-term interactions, may overcome such challenges. In particular, they have shown acceptability to older and low literacy patients in other contexts [5,6]. There is a paucity of research on the use of relational agents in older people with T2D.

Objective

To develop a viable prototype of a relational agent software to assist older T2D patients in self-care and to test its use in this patient group.

Methods

This is a mixed-method study, grounded in the Medical Research Council framework to develop and evaluate complex interventions [7]. The first stage - development of the optimal intervention – will comprise the definition of pre-requisites, content production (e.g. dialog creation guided by behaviour-change theories) and empowering existing virtual humans [8] with artificial intelligence. Users and health care professionals will be involved iteratively. The software is expected to run in a tablet, independently from internet connections, targeting adherence to physical activity, diet and medication-use, without assistance from health care professionals. The second stage will be a non-randomised, non-controlled feasibility trial. Eligible subjects enrolled in diabetes nursing consultations in primary care will be invited to participate. Main outcome measures include software use (timing and frequency, usability, patient satisfaction), reported self-care and reported medication adherence. Acceptability will be researched through focus groups. In both stages data will be analysed with the aid of SPSS; qualitative data will be transcribed verbatim and thematically analysed with NVIVO software.

Results

Data collection will start once ethical approval is obtained.

Conclusions

The study is expected to yield a software prototype to facilitate self-care of older T2D patients, with potential to become an effective, scalable and sustainable intervention.

Acknowledgements

The study is funded by Compete 2020 and FCT (024250, 02/SAICT/2016).

References

1. Sociedade Portuguesa de Diabetologia. Diabetes: Factos e Números - o ano de 2015.2016.

2. García-Pérez L-E, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013;4:175–94.

3. Arambepola C, Ricci-Cabello I, Manikavasagam P, Roberts N, French DP, Farmer A. The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials. J. Med. Internet Res. 2016;18.

4. Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, et al. Web 2.0 chronic disease self-management for older adults: A systematic review. J. Med. Internet Res. 2013;15:e35.

5. Bickmore T, Caruso L, Clough-Gorr K, Heeren T. “It”s just like you talk to a friend’ relational agents for older adults. Interact. Comput. 2005;17:711–35.

6. Bickmore TW, Pfeifer LM, Paasche-Orlow MK. Health Document Explanation by Virtual Agents. In: Pelachaud C, Martin J-C, André E, Chollet G, Karpouzis K, Pelé D, editors. Intell. virtual agents. Springer; 2007:183–96.

7. Möhler R, Köpke S, Meyer G. Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). Trials; 2015;16:1–9.

8. Cláudio AP, Carmo MB, Pinto V, Guerreiro MP. Virtual Humans for Training and Assessment of Self- medication Consultation Skills in Pharmacy Students. Proc. IEEE ICCSE 2015- 10th Int. Conf. Comput. Sci. Educ. 2015;175–80.

Keywords

Diabetes, Self-care, Relational agents, Technology, Elderly

P79 Use of maggot therapy in a hard-to-heal wound care unit: application and home follow-up protocol

Rodrigo C Ferrera¹, María AF Fernández¹, Pablo G Molina², Evelin B Lopez², Alberto P Paredes³, Adán A Ordiales^4,5

¹Nursing Department, University of Las Palmas de Gran Canaria, 35015 Canary Islands, Spain; ²Nursing Department, University of Valencia, 46010 Valencia, Spain; ³Hospital Clínico Universitario, 46010 Valencia, Spain; ⁴Hard-to-heal Nursing Care Unit, Hospital Clínico Universitario, 46010 Valencia, Spain; ⁵Nursing Department, University of Valencia, 46010 Valencia, Spain

Correspondence: Alberto P Paredes (alpe1591@gmail.com)

Background

Larval debridement therapy or “maggot” therapy or biosurgery is described as the use of worms for the removal of non-viable tissue. Debridement is achieved thanks to the action of proteolytic enzymes, which are secreted by these larvae, liquefying the protein material on the surface of the wound, which is subsequently used by the larvae as a nutritive material. Healthy tissues are not affected, making this method the most selective among those available. In addition, this therapy helps to fight infection and helps normalization and closure of injuries. Larval debridement has been successfully used in a large range of chronic hard-to-heal wounds with presence of non-viable tissue of many aetiologies such as pressure ulcers, venous or ischemic wounds or diabetic foot ulcers [1-5]

Objective

To ensure continuity in care in the aim of obtaining the best results from the use of larval debridement therapy, while allowing the administration of treatment in any healthcare context, especially at the patient's own home.

Methods

The procedure for the use of Maggot therapy has been elaborated and coordinated by the Nursing Unit of Ulcers and Complex Wounds of the Hospital Clínico de Valencia. This protocol includes the administrative process, selection of the size of the dressings and the procedure of application and care of the therapy itself. At the same time, an information brochure was prepared for family members, patients and care professionals with information about daily surveillance and application of the therapy.

Results

This protocol is in the process of being implemented, having been applied in several patients with different aetiology of hard-to-heal wounds within home follow-up care with successfully results.

Conclusions

The implementation of a protocol for the use of Maggots debridement therapy seems to be effective in ensuring continuity in the treatment and follow-up of patients with difficult healing wounds in a home care context.

References

1. Ballester Martínez L, Martínez Monleón E, Serra Perucho N, Palomar Llatas F. Utilización de la Terapia Larval en Heridas Desvitalizadas: Revisión Bibliográfica [Use of Maggots Therapy in Necrotic Wounds: Literature Review]. Enf Derm. 2016, 10: 27-33.

2. McCaughan D, Cullum N, Durnville J, VenUS II Team. Patient2s perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study. Health Expect. 2015, 18(4): 527-541.

3. Mudge E, Price P, Walkley N, Harding KG. A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Wound Repair Regen. 2014, 22(1): 43-51.

4. EWMA Document. Larvae debridement therapy. J Wound Care. 2013, 22(1): 522-525.

5. Whitaker IS, Twine C, Whitaker MJ, Welck M, Brown CS, Shandall A. Larval trerapy from antiquity to the present day: mechanisms of actions, clinical applications and future potential. Postgrad Med J. 2007, 83(980): 409-413.

Keywords

Maggot therapy, Wound care, Debridement, Home-care settings, Protocole.

P80 Adverse reactions and dietary supplements

Andreia Barros¹, Cláudia Pinho², Ana I Oliveira², Rita F Oliveira^2,3, Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Rita F Oliveira (rfo@ess.ipp.pt)

Background

Over the last years, the use of dietary supplements has increased substantially [1]. Although these products are considered as safe and can be beneficial, there are risks associated with some. Manufacturers are not required to demonstrate their safety and efficacy, so it is essential that consumers have good knowledge about dietary supplements [2]. The attribution of injury to a specific supplement can be challenging, especially because of the multiple ingredients, the variability in quality and content, as well as the vast underreporting of adverse reactions [3].

Objective

This study aims to identify the main adverse reactions and knowledge on reporting adverse events associated to the use of dietary supplements, by the population of Porto (Portugal).

Methods

A descriptive, cross-sectional study was performed through an anonymous, confidential and voluntary questionnaire to 404 adult participants from the municipality of Porto (Portugal). Data were analysed quantitatively using SPSS version 24.0.

Results

Of the 404 participants, 54.7% (221) were females and 45.3% (183) were males. Results revealed that 55.9% (226) of the participants were users of dietary supplements and the common reasons for consuming supplements were to improve memory, concentration and reduce fatigue. Of the 226 consumers of supplements, only 1.3% (3) identified adverse reactions after taking supplements with multivitamins and used for insomnia and anxiety. Of the 404 participants, 21.5% (87) referred to know that is possible to report an adverse reaction associated to dietary supplements, in Portugal, since 2014. Also, only 8.9% (36) referred to know which entity is responsible for the adverse reactions associated to supplements, and of these 36 participants only 5.6% (2) had correctly answered the name of the entity - Direção Geral da Alimentação e Veterinária (DGAV).

Conclusions

The findings of this survey indicate the need to provide knowledge on reporting adverse events associated with dietary supplements use. It is essential to provide adequate information to facilitate better understanding of the risks associated with the use of these products.

References

1. Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999–2012. JAMA. 2016, 316:1464–1474.

2. Axon DR, Vanova J, Edel C, Slack M. Dietary Supplement Use, Knowledge, and Perceptions Among Student Pharmacists. Am J Pharm Educ. 2017, 81(5): 92.

3. Felix TM, Karpa KD, Lewis PR. Adverse Effects of Common Drugs: Dietary Supplements. FP Essent. 2015, 436:31-40.

Keywords

Dietary supplements, Risks, Adverse reactions reporting, DGAV.

P81 Urinary tract infections and dietary supplements: counselling in pharmacy

Marta Novais¹, Cláudia Pinho², Ana I Oliveira², Rita F Oliveira^2,3, Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Rita F Oliveira (rfo@ess.ipp.pt)

Background

Urinary tract infections (UTIs) are some of the most common bacterial infections [1]. Treatment usually involves antibiotics, and recurrence is a major concern [2]. Therefore, identifying new and effective strategies, like the use of botanical dietary supplements, to control UTIs is a high priority. It is also important to provide health professionals with adequate knowledge related to the use of dietary supplements and other complementary and/or alternative medicines.

Objective

This study aims to evaluate the counselling practices by pharmacy professionals, working in Barcelos (Portugal), related to the use of botanical dietary supplements, in the prevention and/or treatment of urinary infections.

Methods

A descriptive, cross-sectional study was performed through an anonymous, confidential and voluntary questionnaire to a convenience sample of 108 pharmacy professionals from Barcelos (Portugal). Data were analysed using SPSS version 24.0.

Results

Of the 108 participants, 67.6% were females and 32.4% were males. The results showed that 96.3% of the professionals usually advise the use of dietary supplements for the prevention and/or treatment of lower urinary tract infections. The common reasons to recommend supplements include the efficacy and safety of these products, and the lower price. It was also observed that 64.8% of pharmacy professionals consider their knowledge sufficient to recommend dietary supplements for the prevention and/or treatment of urinary infections. Regarding the recommendations by professionals for the prevention of urinary tract infections, the products containing Vaccinium macrocarpon L. were the most recommended. On the other hand, products containing Arctostaphylos uva ursi L were the most recommended for the treatment of urinary tract infections. In general, the main plants sold by pharmacy professionals for the control of urinary tract infections included Vaccinium macrocarpon L., Arctostaphylos uva ursi L., Vaccinium myrtillus L., Equisetum arvense L. and Hibiscus sabdariffa L..

Conclusions

The findings of this study revealed that pharmacy professionals recommend dietary supplements for control of urinary tract infections and consider their knowledge sufficient to properly advise these products. Because evidence on the efficacy of dietary supplements is often scarce or controversial, providing consistent recommendations about these products to their patients can be challenging for healthcare professionals.

References

1. Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis. 2001, 183 (Suppl 1):S1-S4.

2. Guay DR. Contemporary management of uncomplicated urinary tract infections. Drugs. 2008, 68(9):1169-205.

Keywords

Urinary Tract Infections, Botanical Dietary supplements, Counseling, Pharmacy Professionals.

P82 Nurse’s intervention – end of life nutrition approach protocol

Tânia S Afonso¹, Filipa Veludo¹, Patrícia P Sousa¹, Dulce Oliveira²

¹Instituto de Ciências da Saúde, Escola de Enfermagem, Universidade Católica Portuguesal, 1649-023 Lisboa, Portugal; ²Unidade de Medicina Paliativa, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, Portugal

Correspondence: Tânia S Afonso (tafonso3@gmail.com)

Background

To know that nutrition in the present society is increasingly associated with life maintenance and comfort, helps us to understand the complexity of this subject when approached the end of life. Artificial nutrition remains controversial in a palliative context, given the questioning about the quality of life that offers [1]. Protocols help nurses in the decision-making process and increasing their competences.

Objective

To present an end-of-life nutrition approach protocol for palliative care.

Methods

This study is the result of three integrative literature reviews that intended to measure: which nursing interventions promote end of life nutrition in people without artificial nutrition criteria?; what are the evaluation criteria for the end-of-life person for the nurse’s decision-making of start, don’t start or suspending artificial nutrition?; does the nurse’s interventions towards the end-of-life reduce the risk of therapeutic obstinacy associated with artificial nutrition? Based in Buckman & Spikes Communication Protocol [2], the results were integrated in a protocol form and submitted to the opinion of 13 experts, from 18th October to 6th November 2017, and the respective changes were made. Inclusion criteria of experts were: being health professionals; palliative care experience and/or work development in nutrition subjects.

Results

Our experts have on average 37 years old; 10 carry out their activity in Palliative settings, 8 of these have advanced training in Palliative Care. Our protocol considers: I) setting - preparing the environment; II) perception - prior knowledge of the person/family information about nutrition, preferences and considerations regarding the future commitment of feeding and active listening, understanding what the person/family wants to know, especially as to the meaning of nutrition, what that moment represents and invite them to address the subject; III) knowledge - provide adequate information in phases, contextualizing the present symptoms in the disease process (prognosis) and discuss the evaluation criteria before starting artificial nutrition; IV) emotions – attend to the emotions and provide realistic hope; V) strategy – interventions from the patient’s needs are presented in an algorithm form, promoting oral feeding as long as possible. In all process, the person and family autonomy in decision making is preserved. At each step, we identified an element to avoid in the communication process [1,2].

Conclusions

The set of nurse’s interventions in end-of-life nutrition approach systematizes the elements to be considered in decision-making and guarantees the importance of nurses' contribution in risk reduction of therapeutic obstinacy.

References

1. Alves P. Intervenção do Enfermeiro que Cuida da Pessoa em Fim de Vida com Alterações do Comer e Beber. Pensar Enfermagem. 2013, 17(1): 17-30;

2. Baile W [et al.]. SPIKES — A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist. 2000, 5(4):302-311.

Keywords

Nursing, Nutrition, Spikes protocol, Communication, Palliative care.

P83 Associated factors with polymedication in elderly accompanied in the health strategy of the family of the city of Palhoça, Santa Catarina, Brazil

Fabrícia M Almeida¹, Mônica R Moraes¹, Giovanna G Vietta¹, Roberta TS Shirasaki², Ísis M Sousa², Pedro F Simão¹, Bárbara O Gama¹, Fabiana O Gama¹, Paulo F Freitas¹, Márcia Kretzer¹

¹Universidade do Sul de Santa Catarina, 88704-900, Tubarão, Santa Catarina, Brasil; ²Unidade Básica de Saúde Ponte do Imaruim, Palhoça, Santa Catarina, 88130-300, Brasil

Correspondence: Fabrícia M Almeida (fabricia_dani@hotmail.com)

Background

Aging implies in an increase in the number of morbidities, which requires medical treatment and may result in the use of multiple medications. Polymedication is associated with a risk of loss of quality of life, negative health outcomes and a risk of dependent mortality.

Objective

To evaluate the factors associated to polymedication in the elderly followed up in the Family Health Strategy of the city of Palhoça, Santa Catarina, Brazil.

Methods

A cross-sectional study carried out in the elderly accompanied by two Basic Health Units in Palhoça. Data collected between august and November 2017, using a questionnaire with sociodemographic and clinical data and the Geriatric Depression Scale (GDS). Polymedication was defined as the use of 5 or more drugs on an ongoing basis. Analysis by SPSS 20.0, with chi-square and Fisher's exact test, Prevalence Ratio (PR), Confidence Interval (CI) 95%, p < 0.005. The project was approved by the Research Ethics Committee of the Southern University of Santa Catarina.

Results

135 individuals were interviewed, with a mean age of 69.9 years and a standard deviation of 8 years, ranging from 60 to 97 years. The highest frequency was female (70.0%), white (81.3%), married (50.4%), and widowed (28.1%). About the occupation, 80.7% were retired and 54.6% received up to 250 Euros monthly. The schooling was predominantly until elementary school (74.6%), with 9.7% being illiterate, 4.5% with higher education and 0.7% with post-graduation. The majority (63.7%) did not practice physical exercise, 6.8% were smokers. The frequency of depression was 39.6%, with 5.2% categorized as severe depression. The use of drugs among the interviewees ranged from none (4.4%) to 25 different medications per day (0.7%), with 42.7% using 5 or more medications. Among those who reported the use of medication, 63% used antihypertensives, 32.6%, anti-depressants, 37.8%, anti-diabetics and 14.8% analgesics. Self-medication was identified in 23.9%. Polymedication had a significant association (p < 0.001) with the presence of arterial hypertension (RP = 2.85, CI 1.59-5.09), Diabetes Mellitus (RP = 2.31, CI 1.58-3.36), arthritis (RP = 1.60, CI 1.10-2.33), depression (RP = 1.87, CI 1.30-2.69), and cardiovascular diseases (RP = 2.29, CI 1.61 -3.26).

Conclusions

Polymedication in the elderly presented high prevalence and was associated with the presence of cardiovascular, endocrine, joint and depression diseases. A presence of symptoms of depression was present in 39.6% of the elderly.

Keywords

Polymedication, Associated factors, Comorbidity, Elderly.

P84 Lack of Vitamin D in elderly individuals: case study – Figueira da Foz

Ana Azul¹, Cristina Santos¹, António Gabriel², João P Figueiredo³, Ana Ferreira¹

¹Department of Environmental Health, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Department of Laboratory Biomedical Sciences, Coimbra Health School, 3046-854 Coimbra, Portugal; ³Department of Complementary Sciences, Coimbra Health School, 3046-854 Coimbra, Portugal

Correspondence: Ana Azul (ana.sofia.azul@hotmail.com)

Background

Nowadays, the increase of aging among world’s population is becoming a reality, due to the decrease of the fertility and mortality rates and to the consequent increase of the average life expectancy [1]. This population aging brings different health, economic and social needs, turning elderly dependent and making them living in an institutionalized way [2]. In turn, the institutionalization favours the decline of their physical and cognitive functions, which consequently, weakens the old-aged. For all this, it is very likely that this age group will have D vitamin lack, being considered a serious public health problem at a worldwide level. Therefore, its supplementation must be considered, since this age group has the tendency of staying shortly exposed to solar radiation, has little mobility and their bodies manifest a reduction of the ability of synthesis of this hormone [3-5].

Objective

This investigation intends to evaluate de existence of the lack of D vitamin in old-aged people who may be institutionalized and old-aged people in ambulatory from the region of Figueira da Foz.

Methods

Application of a questionnaire and collection of blood samples.

Results

With the purpose of evaluating the concentrations of 25(OH)D for each one of the studied groups, it was verified that the non-institutionalized group showed higher 25(OH)D values, when to compared to the institutionalized group. This result has shown to be statistically significant, with a p-value of 0.003. On the other hand, other variables were compared, as for example, feeding, sun exposure, chronic diseases and intake of vitamin supplements, to try to understand if they had any influence on the 25(OH)D levels. Nevertheless, concerning these parameters, no great differences were verified, because p-values were always higher than 0.005.

Conclusions

With this study, we conclude that the geriatric population presents a high lack of vitamin D, both the institutionalized group (although with higher values of 25(OH)D) and the ambulatory group.

References

1. Nogueira P, Afonso D, Alves MI, Vicêncio PO, Silva Jd, Rosa MV, et al. Portugal Idade Maior em números, 2014: A Saúde da População Portuguesa com 65 ou mais anos de idade. 2014. p. 223

2. Bárrios MJ, Fernandes AA. A promoção do envelhecimento ativo ao nível local: análise de programas de intervenção autárquica. Revista Portuguesa de Saúde Pública. 2014;32(2):188-96.

3. Jalal S, Khan NU. Frequency of Vitamin D Deficiency in Elderly Patients Visiting Tertiary Care Hospital in a Low Income Country. 2014;40:44-53.

4. Lanske B, Razzaque MS. Vitamin D and aging: old concepts and new insights. The Journal of nutritional biochemistry. 2007;18(12):771-7.

5. Zumaraga MP, Medina PJ, Rectoa JM, Abrahanc L, Azurinc E, Tanchoco CC, et al. Targeted next generation sequencing of the entire vitamin D receptor gene reveals polymorphisms correlated with vitamin D deficiency among older Filipino women with and without fragility fracture. 2017:98- 108.

Keywords

Aging, Vitamin D, Vitamin supplementation, Public health.

P85 Error prevention in nursing: strategies for a safety culture

Teresa Vinagre¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

Correspondence: Rita Marques (ritamdmarques@gmail.com)

Background

The Safety culture is becoming more and more linked to quality and excellence of care, being a crucial factor for health error prevention. Nursing assumes a crucial role in patient safety, being at forefront of patient care, and should protect patient interests and assure consolidation of strategies that guarantee safety.

Objective

Identify what are the strategies for an effective safety culture and to prevent errors in nursing.

Methods

Literature Review, following the recommended methodology of the Cochrane Centre, guided by the investigation question: What are the strategies for an effective safety culture and to prevent errors in nursing?

The study includes the analysis of articles found in EBSCO (CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Database of Systematic Reviews), in B-ON and in SCIELO, with the following descriptors: Nursing; Patient Safety; Errors, with the timeframe between 2012 and 2017. The sample resulted in 12 articles.

Results

The Team Work [1-5,8-12] and communication [1-6,8-11] where referenced in 75.0% of the studies as vital measures in an effective safety culture and error preventing in nursing, 66.7% reinforce the importance of error notification [1,2,4,7-11], 58.3% defend that continuous improvement/training is essential [1,2,4,5,9,11,12], 33.3% consider global safety perception [4,10-12] and the importance of trust in superiors and their compromise with their subordinates [4,10-12] as effective methods, 25.0% stand out the importance of error feedback to health professionals [5,10,11]. As an ending, less than 10% of the analysed studies refer work conditions [4], critical reflexion [6], supervision and existence of standards [3], conflict management [3], and assume the person as the centre of health care [3] as important strategies.

Conclusions

Many are the strategies used for an effective safety culture and error prevention in nursing, being the most significant, team work and communication, followed by error notification and continuous improvement/training. Besides the aspects mentioned above, in every article analysed two crucial factors where identified: the direct relation between the existence of a safety culture and the decrease of advert events in health and the need to make the system safer, instead of trying to change human conditions, as a mean to ensure safety and quality care provision.

References

1. MarinhoM, RadünzV, TourinhoF, RosaL, MisiakM. IntervençõesEducativas e seu Impacto na Cultura de Segurança: Uma Revisão Integrativa. Enferm Foco. 2016. 7 (2): 72-77.

2. Mendes C, Barroso, F. Promover uma cultura de segurança em cuidados de saúde primários. Rev Port Saúde Pública. 2014. 32 (2): 197-205.

3. SilvaE, RodriguesF.Segurançadodoenteeosprocessossociaisnarelação com enfermeiros em contexto de bloco operatório. Cultura de los Cuidados. 2016. 45: 134-145.

4. Paese F, Sasso G. Cultura de segurança do paciente na atenção primária à saúde. Texto e Contexto Enferm. 2013. 22 (2): 302-310.

5. MinuzzA, SalumN, Locks, M.Avaliaçãodaculturadesegurançadopaciente em terapia intensiva na perspectiva da equipe de saúde. Texto e Contexto Enferm. 2016. 25 (2): 1-9.

6. Araújo M, Filho W, Silveira R, Souza J, Barlem E, Teixeira N. Segurança do paciente na visão de enfermeiros: uma questão multiprofissional. Enferm Foco. 2017. 8 (1): 52-56.

7. Correia T, Martins M, Forte E. Processes developed by managers regarding the errors. Rev Enferm Referência. 2017. IV (12): 75-84.

8. Cavalcante A, Cavalcante F, Pires D, Batista E, Nogueira L. Cultura de segurança na percepção da enfermagem: Revisão integrativa. Rev Enferm UFPE On Line. 2016. 10 (10): 3890-3897.

9. Wang X, Liu K, You L, Xiang J, Hu H, Zhang L, Zheng J, Zhu X.The relationship between patient safety culture and adverse events: A questionnaire survey. Int J Nurs Stud. 2014. 51: 1114-1122.

10. Noord I, Wagner C, Dyck C, Twisk J, Bruijne M. Is culture associated with patient safety in the emergency department? A study of staff perspectives. Int J Qual Health Care. 2013. 26 (I): 64-70.

11. Ballangrud R, Hedelin B, Hall-Lord M. Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study. Intensive Crit Care Nurs. 2012. 28: 344-354.

12. Feng X, Bobay K, Krejci J, McCormick B. Factors associated with nurses’ perceptions of patient safety culture in China: a cross-sectional survey study. J Evid Based Med. 2012. 50-56.

Keywords

Nursing, Patient Safety, Errors.

P86 Error notification: a strategy for a safety culture

Teresa Vinagre¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

Correspondence: Teresa Vinagre (teresasousasoares@gmail.com)

Background

Errors are an inevitable condition of the human being, and one of the biggest contributors to morbidity and mortality around the world. Error notification is a scientifically proved strategy as being one of the most effective of a safety culture [1-8], being essential for the prevention and detection of factors that contribute for the error. The Operation Room (OR) is one of the most prone health services for the occurrence of adverse events/errors [3], hence being vital the fulfilment of studies regarding this issue, to contribute to an improvement in health care and assure patient safety.

Objective

To determine the error notification frequency in the OR; and to characterise the safety culture of the OR.

Methods

Exploratory study, with a quantitively approach. A survey was conducted with 9 closed questions to 33 nurse professionals that work in a OR in a Lisbon Hospital.

Results

54.6% of the adverse events that caused damage to the patient were always notified by the nurses, nevertheless, none of the participants pointed this regular notification for adverse events, that could have resulted in damage for the patient, but that did not. Of the several adverse events, 55.6% of the occurred cases were not notified, being the more frequent justification for not notifying them, the lack of time to notify. A negative correlation was obtained between professional experience and the error notification frequency, being this difference statistically significant (p < 0.05). Regarding the factors that contribute the most for error occurrence in OR, all of the participants mentioned the pressure for working fast, 87.0% referred the lack of human resources, 85.2% absence of motivation, 82.6% professional inexperience and workload overcharge and 65.2% of the participants considered fails in communication, as a factor preponderant to error. Patient safety perception by the nurse professionals of the OR was evaluated as “acceptable” by the majority of the participants.

Conclusions

It was evident the low notification frequency of adverse events/errors, and it was found that professional experience is inversely proportional to error notification. Error notification is a central aspect of health care, particularly in the OR, hence it is fundamental to educate teams for the setting of strategies that promote a safety culture. It is important to continuously train professionals as well as work on the errors, making them a learning opportunity to prevent new errors associated to the same causes, to achieve a quality safety culture.

References

1. Marinho M, Radünz V, Tourinho F, Rosa L, Misiak M. Intervenções Educativas e seu Impacto na Cultura de Segurança: Uma Revisão Integrativa. Enferm Foco. 2016. 7 (2): 72-77.

2. Mendes C, Barroso, F. Promover uma cultura de segurança em cuidados de saúde primários. Rev Port Saúde Pública. 2014. 32 (2): 197-205.

3. Paese F, Sasso G. Cultura de segurança do paciente na atenção primária à saúde. Texto e Contexto Enferm. 2013. 22 (2): 302-310.

4. Correia T, Martins M, Forte E. Processes developed by managers regarding the errors. Rev Enferm Referência. 2017. IV (12): 75-84.

5. Cavalcante A, Cavalcante F, Pires D, Batista E, Nogueira L. Cultura de segurança na percepção da enfermagem: Revisão integrativa. Rev Enferm UFPE On Line. 2016. 10 (10): 3890-3897.

6. Wang X, Liu K, You L, Xiang J, Hu H, Zhang L, Zheng J, Zhu X. The relationship between patient safety culture and adverse events: A questionnaire survey. Int J Nurs Stud. 2014. 51: 1114-1122.

7. Noord I, Wagner C, Dyck C, Twisk J, Bruijne M. Is culture associated with patient safety in the emergency department? A study of staff perspectives. Int J Qual Health Care. 2013. 26 (I): 64-70.

8. Ballangrud R, Hedelin B, Hall-Lord M. Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study. Intensive Crit Care Nurs. 2012. 28: 344-354.

Keywords

Nursing, Safety Culture, Error Notification.

P87 The use of ultrasound in peripheral venous catheterization

Bruno Santos¹, José Pinho², Rogério Figueiredo², Pedro Parreira², Luciene Braga³, Anabela Salgueiro-Oliveira²

¹Hospital Privado do Algarve, 8500-322 Alvor, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal; ³Universidade Federal de Viçosa, 36570-900 Viçosa, Minas Gerais, Brasil

Correspondence: Anabela Salgueiro-Oliveira (anabela@esenfc.pt)

Background

The insertion of peripheral vascular catheters (PVCs) is the most common procedure performed in clinical settings [1]. The traditional method for detection and selection of a venous access includes the use of a tourniquet, palpation, and observation. However, when veins are not visible or palpable, this may lead to successive puncture attempts, causing pain to the patient and discomfort to the nurse, which results in increased costs [2]. In this regard, nurses should consider using vascular visualization technologies that aid in vein identification and selection for difficult intravenous access [3]. However, these technological resources available today, are still underutilized in Portugal.

Objective

This study aims to explore an alternative method (ultrasound) for assistance of the traditional venous cannulation, in order to ensure the satisfaction of the patients and of the health professionals.

Methods

The search method used was the integrative literature review, which analysed relevant research that supports decision-making and the improvement of clinical practice [4]. The investigation question was formulated based on the PICO strategy: How important is the use of ultrasound technology by the nurses in patients with PVCs insertion needs? The search was conducted between 4 and 10 January, 2017, using the timeframe between 01-01-2011 and 31-12-2016, with the purpose of finding only primary scientific studies developed over the past 5 years, in English, Portuguese or Spanish. The search was conducted in the following databases: Medline, Cinahl, Psychology and Behavioural Sciences Collection, MedicLatina, ERIC, Business Source Complete, Library, Information Science & Technology Abstracts e Academic Search. We used two search strategies P1 and P2 with the following descriptors, respectively: Ultrasound AND Peripheral catheterization AND Cannulation; Ultrasound AND Peripheral catheterization AND ultrasound guided NOT Paediatric NOT PICC NOT Artery. We found 146 scientific articles and after reading the title, abstract and full text we retained 8 studies for analysis.

Results

The results found confirm the venous cannulation with assistance of ultrasonography has a higher success rate, when compared to the traditional venous cannulation. It was also possible to observe a decrease in: the numbers of attempts to puncture the vein; the time used in the procedure; the incidence of central venous catheter placement; and as a consequence, the reduction of possible complications. The patient also presented lower levels of pain and higher degrees of satisfaction.

Conclusions

The implementation of ultrasound in clinical settings, such as in nurses training programs, are important to perform ultrasound-guided PVCs placement and quality care.

References

1. Webster J, Osborne S, Rickard C, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2015;8. Art. No.: CD007798.

2. Aponte H, Acosta S, Rigamonti D, Sylvia B, Austin P, Samolitis T. The use of ultrasound for placement of intravenous catheters. AANA Journal. 2007;75(3):212-216.

3. Gorski L, Hadaway L, Hagle M, McGoldrick M, Orr M, Doellman, D. Infusion Nursing Standards of Practice. Journal of Infusion Nursing. 2016; 39(1S): 1-159.

4. Mendes K S, Silveira R C, Galvão C M. Revisão integrativa: Método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto e Contexto Enfermagem.2008;17(4):758-764.

Keywords

Peripheral venous cannulation, Ultrasound, Nurses.

P88 Nursing care in the person with intestinal elimination ostomy

Igor Pinto¹, Silvia Queirós¹, Célia Santos², Alice Brito²

¹Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

Correspondence: Igor Pinto (isp.igor@gmail.com)

Background

Performing an intestinal elimination stoma triggers changes in the physical, psychological, social, self-care and lifestyle of the person. The way this event is experienced is influenced by several factors. The literature suggests that a systematized nursing care, started in the preoperative period, which includes the postoperative period and continues after hospital discharge, is associated with a better level of adaptation and a higher quality of life of the person with intestinal elimination ostomy.

Objective

To identify the existing literature on nursing care programs and to map the respective interventions performed in the person proposed for the construction of a stoma or with an intestinal elimination stoma.

Methods

A literature review was performed in the Web of Science, CINAHL Plus with Full Text, CINAHL Complete and Scopus databases, based on the Joanna Briggs Institute for Scoping Reviews model, from inception to April 2017. Two independent reviewers performed the analysis of article relevance, extraction and synthesis of the data.

Results

A total of 1,728 articles was identified and only 17 were included for content analysis. It was not possible to find a program that contemplates all phases of perioperative and post-discharge intervention, with the studies focused essentially on one or two specific moments. Considering the interventions mentioned in the literature, the most stated were: stoma site marking; preoperative education; post-operative education; and nursing follow-up after hospital discharge. However, there is still no evidence to suggest timings, methodology and contents to guide the implementation of each of the interventions.

Conclusions

A systematized nursing care in the person with intestinal elimination ostomy, covering the perioperative period and follow-up after discharge, has a significant impact on the adaptation to the stoma, reduces complications, increases the perception of self-efficacy and also the quality of life. It is imperative to create and test an intervention program that contemplates all these phases and all the interventions mentioned in the literature. On the other hand, further studies should be carried out to determine the defining characteristics of these interventions, which help in the decision-making process and the nurses' performance.

Keywords

Ostomy, Nursing Care, Cecostomy, Colostomy, Ileostomy.

P89 Nurses competencies in catastrophes and disaster nursing

Patrícia MG Godinho, Maria T Leal

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Correspondence: Patrícia MG Godinho (p.guerra@campus.esel.pt)

Background

Disasters and catastrophes are unpredictable multi-victim events, leading to a sudden demand for emergency health care. An adequate response requires multidisciplinary professionals that must be experienced and specialized in the field. There is evidence that nurses are important in a catastrophic situation as key-elements that can contribute positively in these situations, because of their broad care-giving skills, that can be applied in a variety of disaster settings, with high levels of creativity, adaptability, and leadership [1]. Nevertheless, nurses need to be competent in disaster nursing, in order to make the difference [2].

Objective

To review the available evidence regarding nursing competencies/interventions that improve victims’ outcomes in the context of catastrophe or multi-victim emergencies.

Methods

We completed an integrative review of the literature available from MEDLINE and CINAHL databases and grey literature, to answer the question: “Which nursing competencies/interventions contribute to improve victims’ outcomes in the context of catastrophes or multi-victim emergencies?” [3].

Results

Eight articles, published between 2012 and 2016, satisfied the search criteria and were analysed. The number of participants varied between 16 and 620 nurses. Most of the articles demonstrate that nurses’ competencies have gaps in this field, due to lack of knowledge, training, and simulation, both in nursing education as in working contexts. One of the studies emphasized that nurses from military hospitals have a superior knowledge and preparation in catastrophes, when compared with nurses from civil hospitals, given their military training [4]. The academic training, and the implementation of catastrophe training in the nursing curriculum is also addressed in three of the analysed articles [4–6]. The fact that hospital administrations and nursing leadership fail as promoters of training and promotion of regular exercises and simulations of disasters, is also evidenced in three articles [5,7,8].

Conclusions

Globally, the results of this integrative review show that most nurses don’t have enough training in disaster nursing. They are not prepared to respond adequately in a mass-causality event. The recommendations are that both, in academic fields or at work contexts, regular training and simulations should be part of disaster preparedness.

References

1. World Health Organization, International Council of Nurses, editors. ICN Framework of Disaster Nursing Competencies. Geneva: ICN & WHO; 2009.

2. Loke AY, Fung OWM. Nurses’ Competencies in Disaster Nursing: Implications for Curriculum Development and Public Health. In: Kapur GB, Baéz AA, editors. International disaster health care: preparedness, response, resource management, and education. Oakville: Apple Academic Press; 2017. p. 185–203.

3. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual: 2014 Edition [Internet]. Adelaide: The Joanna Briggs Institute; 2014. 197 p. Available from: http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2014.pdf

4. Thobaity A, Plummer V, Innes K, Copnell B. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J. 2015 Aug;18(3):156–64.

5. Labrague LJ, Yboa BC, McEnroe-Petitte DM, Lobrino LR, Brennan MGB. Disaster Preparedness in Philippine Nurses. J Nurs Scholarsh. 2016 Jan;48(1):98–105.

6. Khalaileh MA, Bond E, Alasad JA. Jordanian nurses’ perceptions of their preparedness for disaster management. Int Emerg Nurs]. 2012 Jan;20(1):14–23.

7. Baack S, Alfred D. Nurses’ preparedness and perceived competence in managing disasters. J Nurs Scholarsh. 2013 Sep;45(3):281–7.

8. Li YH, Li SJ, Chen SH, Xie XP, Song YQ, Jin ZH, et al. Disaster nursing experiences of Chinese nurses responding to the Sichuan Ya’an earthquake. Int Nurs Rev. 2017 Jun;64(2):309–17.

Keywords

Disaster nursing, Nursing competencies, Catastrophe, Multi-victims emergencies, Mass causality events.

P90 Patient safety culture: the same functional typology, distinct cultures

Vanda Pedrosa (terapeutavandapedrosa@gmail.com)

School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Background

Fostering a culture of safety in health organizations should begin by evaluating the current culture. In Primary Health Care, patient safety becomes more important because a considerable proportion of safety incidents, detected in hospitals, originate from earlier levels of the system, from most of the interactions and from the largest volume of appointments of the functional units. At this level of health care, in family health units that provide accessible care, global and longitudinal follow-ups on the health process in a lifetime, enables greater health gains, and greater proximity to the patient. These are elementary health care units, based on multi-professional teams, composed by doctors, nurses and administrative staff. Still, many are on very different levels in terms of safety culture of the patient, although in all, the patient wants to have security.

Objective

Describe the patient's safety culture of health professionals from two family health units (USF), belonging to the same Health Centre, to understand the similarities and/or differences between them.

Methods

Qualitative study, with a semi-structured interview (to GPs and nurses), at two USFs, models A and B, of one Health Centre in the Lisbon area. Content analysis was supported by maturity levels of a patient safety culture, five maturity levels ranging from 1 (worst culture) to 5 (best culture).

Results

By adjusting the responses within a maturity level for the patient safety culture of the 2 functional units, it was observed that the culture oscillated between 1.8 values in the USF model A, close to a reactive culture, in which the organization only cares about safety when problems occur, and 4 values for USF B, close to a proactive culture, with patient safety measures, even without adverse events, close to the ideal, with an informed and worried team.

Conclusions

The functional units have the same typology, belong to the same Health Centre, but align the patient's safety culture with its greater and lesser complexity, respectively, model B and A. In other words, patient safety is not observed from the same perspective, although it operates in the same geographical area. There is a need for more and a better evaluation, information and training so that the safety culture develops.

Keywords

Functional units, Primary Health Care, Patient Safety Culture, Education and Training in Patient Safety.

P91 Online opinion leaders and weight loss: a literature review based model

Inga Saboia¹, Ana M Almeida²

¹Universidade Federal do Ceará, 60020-181 Fortaleza, Ceará, Brasil; ²Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Inga Saboia (guiguisaboia@gmail.com)

Background

Online opinion leaders shape the trends of the current Web 2.0 [1] and eHealth context [2]. In 2013, in the USA, 72% of the netizens sought out others with the same health problem [3]. This illustrates a scenario of a network among users that mutually influence health behaviours and health decisions, creating a new setting of an increasing digital literacy in health [4], in which the patient becomes an agent of their treatment. One of the most researched topics is weight control (3). The subject of this study is related to public health, specifically obesity, the epidemic of the 21st century [5].

Objective

This study pretends to build a model of analysis, based on a literature review. This model is expected to support a deeper understanding of the role of the opinion leaders on social networks, particularly the ones which sphere of influence acts on weight loss.

Methods

A literature review was conducted through a systematic mapping [6]. The handled databases were: Web of Science, Scopus, PubMed, and Google Scholar. The keywords were: Opinion leader OR Digital Influencer OR Powerful Patient OR Community AND Nutrition OR Obesity OR Weight AND Behaviour change, from 2012 to 2017.

Results

Opinion leadership relates to the degree in which an individual can influence others, according to their characteristics and practices, building interpersonal ties [7]. The opinion leaders types in the current Web 2.0 context are: professionals and non-professionals, being these last ones mainly patient opinion leaders (POLs) [8] or digital influencers [9]. POLs are patients who share content as support for others [8]. Besides these agents, we see the rise of health professionals who connect directly with their audience [9]. These have conquered the media by promoting the “right way to feed” and legitimating themselves through a scientific discourse [10]. Considering the digital influencers context, a dichotomy arises: they can be taken as a threat to public health, or as partners fostering the communication between doctors and patients [9]. Furthermore, social networks have also an important role in this scenario as they connect people with a common purpose (weight loss) [10-15].

Conclusions

This study identified two types of opinion leaders: health professionals, and nonprofessional ones. Both have different behaviours in social networks, but both have an important role in influencing the experience of their followers in weight loss.

Keywords

Online opinion leaders, Online social network, Digital influencers, Patient opinion leader, Digital literacy in health, Nutrition, Public health, Obesity, eHealth, Web 2.0.

P92 Pharmacotherapeutic follow-up in institutionalized elderly

Ana Grou¹, Carmen Monteiro², Jorge Balteiro¹

¹Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ²Farmácia Luciano e Matos, 3000-142 Coimbra, Portugal

Correspondence: Jorge Balteiro (balteiro@estescoimbra.pt)

Background

The pharmacotherapy follow-up is one of the best methods to diminish health problems and medicine therapy-associated morbidity. This procedure aims at improve the results obtained at the clinical level and optimize therapeutic plans.

Objective

This work aimed to perform the pharmacotherapy follow-up of elderly residents in long-stay institutions, identify their prevalent pathologies and trends in medicines consumption, as well as to identify and solve negative results of medication (NOM).

Methods

Pharmacotherapy follow-up procedures were applied to 38 elderly Residents in a Long-Stay Institution. The population analysed referred to suffer from a total of 212 pathologies. The majority of these concerned the circulatory system (n=45) and mental and behavioural disturbs (n=38). Daily, 273 medicines are consumed by this population and most of them target the nervous and cardiovascular systems (n= 93 and n=74, respectively).

Results

During the pharmacotherapy follow-up interviews 88 NOM were identified. Upon pharmacist intervention, 52 of the identified NOM were solved or placed under control. During this pharmacotherapy follow-up procedure 131 interventions were performed.

Conclusions

The establishment of pharmacotherapy follow-up is greatly advantageous for patients, particularly for elderly ones. This procedure optimized the results of the therapeutic plan, decreased the impact and solved NOM.

Keywords

Pharmacotherapy Follow-upk, Elderly Residents in Long-Stay Institutions, Negative Outcomes Associated with Medication Pharmacist Intervention.

P93 The person with ostomy of intestinal elimination: social representation of nurses

Joana Pinho, Tânia Jesus, Liliana Mota

Escola Superior de Enfermagem da Cruz Vermelha Portuguesa, 3720-126 Oliveira de Azeméis, Portugal

Correspondence: Liliana Mota (saxoenfermeira@gmail.com)

Background

During the surgical formation of an intestinal elimination ostomy, the person is challenged to develop a set of self-care skills to guarantee quality of life throughout the health/illness transition process, and the nurse should act as a facilitator in this process [1]. Nurses have an important role to prepare these patients to return back home. This study intends to extract the essence from the nurses' point of view, about people with ostomy of intestinal elimination.

Objective

To describe the social representation of nurses about the person with intestinal elimination ostomy.

Methods

We conducted a qualitative, descriptive-exploratory study. Data was collected with an online form. The online form had five questions focused in the aim of the study, and each participant answered each question with five words according to their perception. The sample was of convenience, non-probabilistic constituted by 64 nurses which answered to an online form. Data were collected during the month of November (2017) sending emails to all contacts of nurses in the data bases of the nursing school. Anonymity was preserved. Data analysis was computed in IRAMUTEQ. We performed a classic lexicographical analysis.

Results

Participants had on average 33.08 (± 8.83) years old (between 22 and 58 years). The majority (76.6%) belonged to the feminine gender and 84.4% of participants were graduated. When the nurses think in ostomy of intestinal elimination, they think in the characteristics of the stoma. The smell has an important role in this category. Focused in person with intestinal ostomy, nurses are centred in self-care. The nurses consider support (emotional and familiar) and the teachings, the most important necessities of the person with an intestinal ostomy. When they think in the care of these persons they are focused in capacity and knowledge. The preparation to return back home is centred in the acceptance of the disease and on the relationship between nurses and patient.

Conclusions

The social representation of nurses about the person with intestinal elimination ostomy is focused in emancipatory patterns of nursing. The person is the centre of care and the care plan is focused in helping the person to live with quality with this new condition. These results are an important contribute to enhance the practices and to demonstrate the relevance of nursing health/illness transitions of the person with intestinal elimination ostomy.

References

1. Mota M, Gomes G, Petuco V, Heck R, Barros E. Facilitadores do processo de transição para o autocuidado da pessoa com estoma: subsídios para enfermagem. Revista da Escola de Enfermagem USP. 2015. 49(1):82-88.

Keywords

Ostomy, Intestinal elimination, Social representation, Nursing.

P94 A synthesis of Portuguese studies regarding infertile patients

Joana Romeiro, Sílvia Caldeira

Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

Correspondence: Joana Romeiro (joana.m.romeiro@gmail.com)

Background

Infertility is clinically defined as the inability to conceive and to achieve successful clinical pregnancy after 12 months of regular and unprotected sexual intercourse [1]. In 2010, 48.5 million couples worldwide were reported to have fertility problems [2], affecting both genders in 40% of the cases [3]. Due to this high and broad prevalence, infertility is acknowledged as a public health issue with prioritized intervention [4]. The prevalence in Portuguese population was first known in 2009, when a study estimated that about 260-290 thousand individuals were infertile and approximately 9% to 10% of couples displayed some type of reproductive confinement [5]. These results triggered scientific interest in the study of Portuguese infertile patients and a synthesis of the published Portuguese studies regarding infertility seems important in understanding and caring for these patients.

Objective

To review scientific health empirical research in the study of Portuguese infertile patients.

Methods

Literature review based on search conducted in December 2017. A total of 12 scientific data bases were searched: CINAHL with full text, MEDLINE with full text, MedicLatina, Academic Search Complete, Pubmed, Web of Science, LILACS, SciELO, RCAAP, and across ESENFC; Nursing School of Lisbon and Nursing School of Porto databases. No date limit has been applied. Studies considered eligible for inclusion were primary studies in Portuguese samples of male or female individuals and/or in couples having reproductive impairment, available in a full-text format, published on peer-reviewed journals in English, Spanish or Portuguese language.

Results

A total of 2,052 results have been identified and 101 papers were included. Empirical research regarding infertile couples started to be published in 1995. Until current date, 2013 was the year with the highest publication score (13.8%) with psychological aspects of the infertile experience being the most explored (57.4%) in comparison with other health aspects, like for instance related to nursing (2.9%), and psychiatry (0.9%). Primary studies were also published in international journals (53.4%) as original papers (62.3%), and in a thesis format (37.6%).

Conclusions

Although the developments in health research regarding infertile couples, a significant gap in the knowledge remains, particularly concerning other health disciplines (despite psychology). This seems to be a global tendency in healthcare, and further investigation is needed to fully acknowledge this phenomenon and consequently allow the provision of an effective patient-centred care to these patients.

References

1. Zegers-Hochschild F, Adamson G D, Mouzon J de, Ishihara O, Mansour R, Nygren K van der, Poel S. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Human Reproduction, 24(11), 2683–2687.

2. Mascarenhas M N, Flaxman S R, Boerma T, Vanderpoel S, Stevens G A. National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLOS Medicine. 2012, 9(12), 1–12.

3. NICE. Fertility, Assessment and treatment for people with fertility problems. 2013. National Institute for Health and Care Excellence.

4. Centers for Disease Control and Prevention. National Public Health Action Plan for the Detection, Prevention, and Management of Infertility. U.S. Department of Health and Human Services. 2014. Retrieved from http://www.cdc.gov/reproductivehealth/infertility/pdf/drh_nap_final_508.pdf

5. Carvalho, J. L. S., & Santos, A. Estudo Afrodite, Caracterização da Infertilidade em Portugal (p. 74). Porto: Faculdade de Medicina da Universidade do Porto, Sociedade Portuguesa de Medicina da Reprodução, KeyPoint. 2009.

Keywords

Infertility, Health, Evidence-based, Review.

P95 Knowledge and consumption of vitamins and food supplements in sportspeople and physical exercise in Coimbra

Adriana Ferreira, Clara Rocha, Jorge Balteiro

Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Jorge Balteiro (balteiro@estescoimbra.pt)

Background

The demand for healthy lifestyles, the concern with health and well-being, and the relentless pursuit of the trend of the “ideal body” has been increasing in recent years, as well as the prevalence of supplement use, as a compensation for an unbalanced diet and search for physical/psychic intensity.

Methods

In order to evaluate the consumption and knowledge about vitamin and dietary supplements in Coimbra, a sample of 333 individuals practicing sports was studied.

Results

The study lasted for nine months. The collection of information was carried out through a questionnaire. The study found that 201 (60.4%) subjects have consumed supplementation, with a prevalence of higher consumption in males (73.3%). Supplement use was higher between 33 and 40 years old individuals. The most consumed type of vitamin supplement was multivitamins with minerals (44.3%) and the food supplement was protein (69%). The most cited reason for the consumption of supplements was “physical and/or intellectual fatigue” (50.5%). The daily frequency of supplementation was high (33.7%), with the highest expenditure on consumption of supplements varying from 10 to 20€, monthly. The place of purchase and the source from which subjects obtained knowledge about supplements was the Internet. As for knowledge on the subject, it was noted that it has been classified as “insufficient” (45.8%) by respondents.

Conclusions

In Portugal, the prevalence of supplementation consumption is still unknown, so it becomes necessary to raise awareness among the population, about potential risks associated with improper supplementation, special diets and unbalanced exercise.

Keywords

Vitamins supplements, Food supplements, Consumption, Knowledge.

P96 Stability of paediatric oral diazepam suspensions

Patrícia Marinho¹, Patrícia Correia²

¹Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

Correspondence: Patrícia Marinho (patriciampmarinho@gmail.com)

Background

Currently, hospital pharmacies prepare formulations that aim to adjust the medication to the needs of each patient when the pharmaceutical industry is not able to respond to those needs [1]. One of the formulations produced in the hospital pharmacy is the diazepam suspension 0.4 mg/ml for paediatric use, obtained from diazepam tablets. However, the use of tablets or powders in oral liquid formulations may alter the stability of the active ingredients. Therefore, these formulations should be submitted to stability studies [2]. Nevertheless, the information on the stability of manipulated oral suspensions is scarce [3], so this study is relevant.

Objective

The main goal of this study is to validate a method of diazepam quantification in suspensions. Additionally, we aim to evaluate the stability of diazepam in suspensions during 30 days, after the suspension preparation, establishing an expiration date.

Methods

The quantification method of diazepam in oral suspensions arose from the adaptation of the method described in Portuguese Pharmacopoeia [4], for the same active ingredient in tablets. After the method’s validation, the stability of diazepam was evaluated weekly, during 30 days, and the first analysis was done immediately after the preparation of the suspension. During the study period, suspensions were stored under suitable cold conditions (4°C).

Results

With an accuracy, evaluated by the mean recovery of 80%, and a precision, evaluated by the variation coefficient, varying between 6.1 and 11.5%, the method proved to be practicable. Two suspension’s samples were prepared with a similar diazepam concentration (0.43 mg/ml). The stability study of those suspensions showed that diazepam concentration decayed linearly, and that diazepam suspensions lose about 70% of their active principle within 30 days. Moreover, given the limits indicated by the Portuguese Pharmacopoeia [4] for diazepam tablets, it was verified that these suspensions only comply with these limits after 7 days, and that within the established period of validity these limits are no longer met.

Conclusions

Despite all limitations, the adapted method proved to be practicable and the results that followed have pointed to the possible instability of diazepam, when included in this oral suspension formulation. Given the dosage limits set for diazepam tablets [4] and knowing in advance that the validity period usually attributed to the suspension is 15 days, the results point to a new shelf-life of approximately 7 days. However, for a more consistent period of validity to be established, a more detailed stability study is required.

References

1. Patel VP, Desai TR, Chavda BG, Katira RM. Extemporaneous dosage form for oral liquids. Pharmacophore, 2011, 2(2), 86-103.

2. Schlatter J, Bourguignon E, Majoul E, Kabiche S, Balde I B, Cisternino S, Fontan J E. Stability study of oral paediatric idebenone suspensions. Pharmaceutical Development and Technology, 2016, 22(2), 296-299

3. Ensom M H H, Kendrick J, Rudolph S, Decarie D. Stability of Propranolol in Extemporaneously Compounded Suspensions. The Canadian Journal of Hospital Pharmacy, 2013, 66(2), 118–124.

4. INFARMED. Farmacopeia Portuguesa. 8ª edição. 2008, 1925-1926; 2224-2225.

Keywords

Diazepam suspensions, Chemical stability, Validation tests, Dosing method, Expiration date.

P97 First-time grandparents and transition to grandparenthood: integrative review of the literature

Sónia Coelho¹, Rogério Rodrigues², Isabel Mendes²

¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046- 851 Coimbra, Portugal; ²Nursing School of Coimbra, 3046-051 Coimbra, Portugal

Correspondence: Rogério Rodrigues (rogerio@esenfc.pt)

Background

Nowadays families become smaller but at the present time a family involves several generations (even if they do not live together). The family members’ roles change and the role of the grandparents in the transition of first-time parents to grandparenthood needs to be understood.

Objective

To systematize an integrative review of the literature related to the transition to grandparenthood in contemporary Western societies.

Methods

We conducted an integrative review of the literature, in electronic databases (EBSCO®, b-On® and Web of Knowledge®) in order to answer the question: “How is experienced the transition to grand-parenting?” The search was limited to articles published between 2006-2016 years, with the descriptors “grandparents” and “transition" in English, French, Portuguese or Spanish.

Results

After analysing the abstracts of 179 articles, excluding repetitions, and those who did not respond to the original question, we obtained 13 articles to include in the integrative review. The level of the methodological approach was level 4. Only descriptive and qualitative studies (non-experimental) were included. The results of the literature review on the topic were grouped into five themes: grand-parenting and gender; become a grandfather/grandmother; parenting and the transition process; role and health; parenting and intergenerational relations.

Conclusions

It was found that the transition to Grandparenthood is studied in risk situations, and more studied in women than in men. Grandparenthood can be seen as a transition or as an adaptive process; as the search for the meaning of life; opportunity for personal growth; a normative event that has emotions and positive and negative cognitions. The process of becoming a grandparent can be considered an event of great social impact. Grandparents see their grandchildren as their extension in time and this gives them a more positive view of aging. The perception that grandparents have of themselves may be important in promoting a positive and healthy aging.

Keywords

Grandparenthood, Grandparents, Transition.

P98 Intestinal microbiota - impact on host health

Nastasia Fernandes, Alice Nunes, Maria José Alves

Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal

Correspondence: Nastasia Fernandes (nastasia-ar1000@hotmail.com)

Background

At present it is known that in addition to establish and maintain a normal intestinal health, the intestinal microbiota can exacerbate a multitude of diseases, ranging from colorectal cancer to autoimmune and allergic diseases [1]. The interest in studying the human microbiome, its diversity and human-microorganism interactions has been developing in the last years, as such it has been made available immense information in this area.

Objective

Bibliographic review of the intestinal microbiota: constitution, what affects it, and its influence in the triggering of some pathologies.

Methods

A comprehensive search was performed on the PubMed search, being obtained from this review 112 articles from which 67 were used.

Results

The intestinal microbiota is considered a “superorganism” and is extremely complex. It is composed of a great diversity of microorganisms, which varies among individuals; however, it is essentially dominated by two phyla, the Bacteroidetes and the Firmicutes. It is dynamic and can be affected by several factors such as diet [2], breastfeeding [3], use of antibiotics [4,5] and type of delivery [6,7]. When an imbalance of the microbiota occurs, known as dysbiosis [1,8], the host is affected, being related to pathologies such as allergies, obesity and Crohn's disease. Some studies [9,10-14] have demonstrated that the microbiota participates in the maturation of the immune system and as such is predominant in the response to infectious processes. On the other hand, the intestinal microbiota seems to play a fundamental role in the prevention of allergies [15-26]. Inappropriate colonization after birth and excessive hygiene during childhood, may promote greater allergic reactions. Rats without bacteria have been shown to present more severe allergic reactions [22-26]. Regarding obesity, several authors [27-30] have demonstrated that changes in microbiota are strongly related to the establishment of obesity. It has been demonstrated that the type of microbiota influences obesity; rats with higher amounts of Firmicutes compared to the amount of Bacteroidetes, present greater capacity to promote fat deposition. On the other hand, a switch to a less caloric diet produced a change in the microbiota that led to a decrease in Firmicutes and an increase in Bacteroidetes. These results are surprising and suggest that future obesity control may originate from the type of intestinal microbiota.

Conclusions

Intestinal microbiota is of great relevance because it protects against external factors and the development of certain pathologies. It is therefore important to keep the population informed so that a microbiota considered “normal” can be maintained from childhood to adulthood.

References

1. Parnell JA, Reimer RA. Prebiotic fiber modulation of the gut microbiota improves risk factors for obesity and the metabolic syndrome. Gut Microbes. 2012;3(1):29-34.

2. David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-563.

3. Cox LM, Blaser M. J. Antibiotics in early life and obesity. Nat Rev Endocrinol. 2015;11(3):182-190.

4. Clemente JC, Ursell LK, Parfrey LW, Knight R. The impact of the gut microbiota on human health: an integrative view. Cell. 2012;148(6):1258-1270.

5. Jernberg C, Löfmark S, Edlund C. Long-term impacts of antibiotics exposure on the human intestinal microbiota. Microbiology. 2010;156(Pt11):3216-3223.

6. Adlerberth I, Strachan DP, Matricardi PM, Ahrne S, Orfei L, Aberg N, et al. Gut microbiota and development of atopic eczema in 3 European birth cohorts. J Allergy and Clin Immunol. 2007;120(2):343–50.

7. Gronlund MM, Lehtonen OP, Eerola E, Kero P. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J. Pediatr Gastroenterol Nutr. 1999;28(1):19–25.

8. Blumberg R, Powrie F. Microbiota, Disease, and Back to Health: A Metastable Journey. Sci Transl Med. 2012;4(137):137rv7.

9. Swidsinski A, Loening-Baucke V, Lochs H, Hale LP. Spatial organization of bacterial flora in normal and inflamed intestine: a fluorescence in situhybridization study in mice. Word J Gastroenterol. 2005;11(8):1131- 1140.

10. Hartstra AV, Bouter KE, Backhed F, Nieuwdorp M. Insights into the role of the microbiome in obesity and type 2 diabetes. Diabetes Care. 2015;38(1):159-65.

11. Chow J, Lee SM, Shen Y, Khosravi A, Mazmanian SK. Host-bacterial symbiosis in health and disease. Adv Immunol. 2010;107:243–274.

12. O'Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep. 2006;7:688–693.

13. Purchiaroni F, Tortora A, Gabrielli M, Bertucci F, et al. The role of intestinal microbiota and the immune system. Eur Rev Med Pharmacol Sci. 2013;17(3):323-33.

14. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol. 2009;9:313–323.

15. Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002;347:911-20.

16. Pelucchi C, Galeone C, Bach JF, La Vecchia C, Chatenoud L. Pet exposure and risk of atopic dermatitis at the pediatric age: a metaanalysis of birth cohort studies. J. Allergy Clin Immunol. 2013;132(3):616622.e7.

17. Stiemsma LT, Turvey SE. Asthma and the microbiome: defining the critical window in early life. Allergy Asthma Cli Immun. 2017;13:3.

18. Chieppa M, Rescigno M, Huang AY, Germain RN. Dynamic imaging of dendritic cell extension into the small bowel lumen in response to epithelial cell TLR engagement. J Exp Med. 2006;203(13):2841–52.

19. Ignacio A, Morales CI, Camara NO, Almeida RR. Innate sensing of the gut microbiota: modulation of inflammatory and autoimmune diseases. Front Immunol. 2016;7:54.

20. Round JL, Lee SM, Li J, Tran G, Jabri B, Chatila TA, et al. The Toll-like receptor pathway establishes commensal gut colonization. Science. 2011;332(6032):974-977.

21. Hessle C, Hanson LA, Wold AE. Lactobacilli from human gastrointestinal mucosa are strong stimulators of IL-12 production. Clinical and Experimental Immunology. 1999;116(2):276-282.

22. Herbst T, Sichelstiel A, Schar C, Yadava K, Burki K, Cahenzli J, et al. Dysregulation of allergic airway inflammation in the absence of microbial colonization. Am J Respir Crit Care Med. 2011;184(2):198–205.

23. rompette A, Gollwitzer ES, Yadava K, Sichelstiel AK, Sprenger N, NgomBru C, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nat Med. 2014;20(2):159– 66.

24. Schuijs MJ, Willart MA, Vergote K, Gras D, Deswarte K, Ege MJ, et al. Farm dust and endotoxin protect against allergy through A20 induction in lung epithelial cells. Science. 2015;349(6252):1106–10.

25. Kumar H, Lund R, Laiho A, Lundelin K, Ley RE, Isolauri E, et al. Gut microbiota as an epigenetic regulator: pilot study based on wholegenome methylation analysis. MBio. 2014;5(6):e02113–4.

26. Thorburn AN, McKenzie CI, Shen S, Stanley D, Macia L, Mason LJ, et al. Evidence that asthma is a developmental origin disease influenced by maternal diet and bacterial metabolites. Nat Commun. 2015; 6:7320.

27. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(7122):1027–1031.

28. Bäckhed F, Ding H, Wang T, Hooper LV, Koh GY, Nagy A, et al. The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci U S A. 2004; 101:15718–23.

29. Schwiertz A, Taras D, Schäfer K, Beijer S, Boss NA, Donus C, Hardt PD. Microbiota and SCFA in lean and overweight healthy subjects. Obesity (SilverSpring) 2010;18:190–195.

30. Bäckhed F, Manchester JK, sem*nkovich CF, Gordon JI. Mechanisms underlying the resistance to diet- induced obesity in germ-free mice. Proc Natl Acad Sci U S A. 2007; 104:979–84.

Keywords

Intestinal microbiota, microbioma, immune system, dysbiosis, obesity, allergies, Crohn's disease.

P99 Effects of aging on neuromuscular activity during the performance of a ballistic motor skill

António M Vencesbrito^1,2,3,4, Mário A Rodrigues-Ferreira^1,2,3

¹Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ²Unidade de Investigação do Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ³Centro de Investigação em Qualidade de Vida, 2040-413 Rio Maior, Portugal; ⁴International Martial Arts and Combat Sports Scientific Society, Rzeszów, Poland

Correspondence: António M Vencesbrito (abrito@esdrm.ipsantarem.pt)

Background

Human aging leads to a progressive decline of biological functions that affects the neuro-muscular systems. Sport practice is associated with health maintenance and a better quality of life in older people.

Objective

The aim of this study was to investigate the effects of aging on the neuromuscular reaction time and electromechanical delay during the performance of the karate frontal kick (Mae-Geri).

Methods

Participated in this study 9 elite karate athletes (age, 21.0 ± 2.47 years; height, 175 ± 6.53 cm; weight, 72.0 ± 9.25 kg) and 9 veteran karate practitioners (age, 54.0 ± 3.87 years; height, 176 ± 4.72 cm; weight, 76.0 ± 9.17 kg). Surface electromyography was recorded from rectus femoris (RF) and vastus lateralis (VL) portions of the quadriceps femoris, long head of the biceps femoris (BF), tibialis anterior (TA) and lateralis gastrocnemius (GA). Kinematic analysis was performed with the Ariel Performance Analysis System (APAS, Ariel Dynamics-2003). The neuromuscular reaction time was defined as the time interval between the auditory stimulus and the onset of electrical activation of a muscle, while the electromechanical delay was the time interval between the onset of the electric activity of a muscle and the beginning of joint movement. Student t-test (two-tailed) was used to analyse the differences between groups, with a significance level of p < 0.05 (SPSS 17.0).

Results

It was observed a tendency to a longer neuromuscular reaction time of the TA in veteran karate practitioners than among elite karate athletes (136.00 ± 58.80 vs 122.00 ± 45.94 ms, p = 0.566), although a significantly shorter neuromuscular reaction time was found in the RF in veteran karate practitioners (137.00 ± 27.93 vs 184 ± 51.55 ms, p = 0.030). Veteran karate practitioners presented a significantly longer RF electromechanical delay than elite karate athletes (127.00 ± 59.11 vs 39.00 ± 47.68 ms, p = 0.003).

Conclusions

The results of the study showed that with the aging process there is an increase in the electromechanical delay, although no negative impact on the neuromuscular reaction time has been observed. Therefore, continuous sport practice in veteran karate practitioners seems to attenuate the effects of aging on neuromuscular systems.

Keywords

Neuromuscular reaction time, Electromechanical delay, Electromyography, Karate.

P100 Nutritional status in institutionalized elderly: is it influenced by polymedication and length of stay?

Maria A Marques^1,2, Ana Faria^3,4, Marisa Cebola^2,5

¹Santa Casa da Misericórdia de Alvaiázere, 3250-115 Alvaiázere, Portugal; ²Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; ³Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁴Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ⁵Escola Superior Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal

Correspondence: Maria A Marques (mariaanfm@gmail.com)

Background

Aging is frequently associated with conditions, like malnutrition, that may affect the elderly health status and quality of living. Malnutrition has a high prevalence in institutionalized elderly [1]. Polymedication is also frequent in older individuals, impairing appetite and possibly contributing to the development of malnutrition [2].

Objective

The aim of this study was to identify nutritional risk in institutionalized elderly and establish a relationship between length of stay in the institution, pharmacotherapy and presence of malnutrition.

Methods

Day of admission, number of medications and sociodemographic data were collected from the patient’s medical file. Malnutrition and nutritional risk were assessed using the Mini Nutritional Assessment (Short Form) (MNA-SF).

Results

Seventy-eight individuals, mainly female (59.0%), with a mean age of 81.7 years (SD= 10.2) were evaluated. Mean length of stay was 6.4 years (SD= 7.8). MNA-SF classified 32 individuals (41.0%) at risk of malnutrition and 20 (25.6%) as malnourished. According to the elderly Body Mass Index (BMI) classification, 28 were at risk of malnutrition and 23 were malnourished (35.9% and 29.7%, respectively), showing a positive correlation with MNA-SF results (p < 0.05). The female gender presented an overall higher risk of malnutrition (p < 0.05). Those who were more dependent to feed themselves were at risk of malnutrition or malnourished (p < 0.05). Fifty-seven of the subjects (73.0%) were under polymedication, with a mean number of daily medications of 7.5 (SD= 3.4). A higher number of regular medications is correlated with higher BMI (p < 0.05). No association was found between length of stay or number of drugs taken and malnutrition.

Conclusions

In this population, a high prevalence of risk of malnutrition was identified, particularly in the female gender. Although previously described, a correlation between polypharmacy and malnutrition was not found. A closer look to type of medication might be necessary. In this sample, a very long length of stay was also found. Nutritional intervention in this population should be prompt since admission and regularly provided, preventing the development of malnutrition and comorbidities.

References

1. Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care. 2012;15(1):29–41.

2. Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. Janeiro de 2012;15(1):1–6.

Keywords

Malnutrition, Elderly, Polypharmacy .

P101 Food safety and public health in canteens of public and private educational establishments and in private institutions of social solidarity

Cristina Santos¹, Esmeralda Santos²

¹Department of Environmental Health, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Agrupamentos de Centros de Saúde do Baixo Mondego, 3150-195 Condeixa, Portugal

Correspondence: Cristina Santos (cristinasofiasantos@gmail.com)

Background

To promote and guarantee hygiene and food safety is nowadays a requirement in any service involving the provision of food, as a means of ensuring the promotion of a high level of protection and consumer confidence. These changes boosted the growth of the catering industry. However, they also require the evolution of techniques, so as to enable catering and catering companies to offer food of quality [1-3]. Most cases of food poisoning are due to poor hygiene habits. Structural failures and ignorance or neglection of good hygiene and food safety practices may also lead to food contamination [4,5].

Objective

The sample consisted of canteens of public and private educational establishments and of public and private social solidarity institutions, totalling 26 canteens and 127 professionals. Data collection was performed using a diagnostic sheet of the structural conditions and operation of the facilities.

Results

Measurements of polar compounds in canteens indicated good quality, except for one of the measurements that indicated a less satisfactory quality. In the evaluation of food temperature, it was found that there are some foods that are served in the “danger zone” (< 65°C). School cafeterias (without food confectionery) had, in majority, deficient conditions of installation because they were rooms of activities where the meals were served. For this reason, there were no water baths or meal service facilities.

Conclusions

With this work it was concluded that there are deficiencies regarding the structural and operating conditions of canteens/refectories, which could be filled by the construction/enlargement of spaces. Regarding the evaluation of the quality of the oils and temperature of the meals, there were flaws, with possible repercussions on the quality of the meals served. It is also important to develop skills for the elaboration of menus suited to the different age groups and the confection of healthier diets. Emphasis can be placed on the training of manipulators in order to raise awareness of the repercussions of their role and responsibilities in preventing contamination. Ensuring and promoting food safety is nowadays a requirement of any institution, where food is produced or distributed, as a means of ensuring the promotion of high levels of confidence and safeguarding of the consumer’s health.

References

1. Baptista P, Antunes C. Higiene e Segurança Alimentar na Restauração. Vol. I. Guimarães: Forvisão – Consultoria em Formação Integrada; 2005.

2. Baptista P, Antunes C. Higiene e Segurança Alimentar na Restauração. Vol. II. Guimarães: Forvisão – Consultoria em Formação Integrada; 2005.

3. Afifi HS, Abushelaibi A. Assessment of personal hygiene knowledge, and practices in Al Ain, United Arab Emirates. Food Control. 2012;25:249-253.

4. Associação da Restauração e Similares de Portugal. Higiene e Segurança Alimentar – Código de boas práticas para a restauração pública; 2006.

5. Lima VT. Educação nutricional na escola. In: Seminário de Alimentação ESCOLAR, 3, 1999, ITAL. Resumos. Campinas, São Paulo. p.61.

Keywords

Public Health; Food Safety; Canteens; Promoting Food Safety.

P102 Evaluation of the correlation between height and health of the spine in the student population in the age group of 16 - 19 years old - evaluation with spinal mouse^®

Alexandra Monteiro, Nelson Azevedo, João Silva, Liliana Rodrigues, Gilvan Pacheco

Instituto Superior de Saúde do Alto Ave, 4720-155 Amares, Portugal

Correspondence: Nelson Azevedo (nelsonjaze@gmail.com)

Background

The increasing number of postural deviations observed in the student population leads to changes in the spine' normal curvature, which translates into a greater vulnerability to mechanical stress and traumatic injuries. Although the causes of these postural deviations are diverse and difficult to analyse, the present study decided to investigate whether the height of the students may be one of the factors influencing the appearance of postural alterations detected by the non-invasive evaluation method of the Spinal Mouse®.

Objective

Analyse differences in the incidence of postural changes in a sample of students aged 16-19 years with different heights (cm).

Methods

Eighty-five (85) students aged 16-19 years from Amares High school (Braga) were selected and submitted to a non-invasive postural evaluation by the Spinal Mouse® device, which showed the presence of hypomobility, normal mobility and hypermobility at the sagittal plane in three zones of the vertebral spine (sacral, thoracic and lumbar), as well as an overall tilt in three distinct positions: orthostatic, flexion and extension. Data analysis was performed using the statistical program IBM® SPSS® (Statistical Package for the Social Sciences), version 25. In the statistical tests performed, it was considered as levels of significance, the values of 0.05 (significant) and of 0.01 (extremely significant).

Results

The results indicate statistically significant differences (Kruskal-Wallis test, H) in the incidence of postural deviations (sagittal plane) in the sacral zone in flexion position (H = 6.629, p-value = 0.036), in general slope in flexion position (H = 6.738, p-value = 0.046), in the thoracic zone in the extension position (H = 11.390, p-value = 0.003) and in the lumbar zone in the extension position (H = 6.738, p-value= 0.034) for the different height groups considered (“<159 cm”, “159 - 177 cm” and “> 177 cm”).

Conclusions

Through the results we can conclude that there is a significant relationship between postural changes and students' height. In this way, it is fundamental to equate the ergonomic model of the school support material in order to adjust to different postures.

Keywords

Spine, Postural changes, Adolescent height, Ergonomics, Spinal Mouse.

P103 The contribution of a Portuguese innovation to prevent complication in venous catheterization

Inês Cardoso¹, Anabela Salgueiro-Oliveira¹, Arménio Cruz¹, José M Martins¹, Liliana Sousa¹, Sara Cortez², Filipa Carneiro³, Pedro Parreira¹

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Muroplás - Indústria de Plásticos, 4745-334 Muro, Trofa, Portugal; ³Innovation in Polymer Engineering, University of Minho, 4800-058 Guimarães, Portugal

Correspondence: Inês Cardoso (inescardoso@esenfc.pt)

Background

Venous catheterization is one of the most frequent procedures in nursing clinical practice. Despite the procedure’s importance for healthcare quality, it has some risks and complications such infiltration, bloodstream infection and phlebitis. Healthcare associated infections are considered a worldwide problem, having a considerable impact on the patients’ and community’s health and economy [1,2]. According to the European Centre for Disease Prevention and Control, prevalence of this type of infections is 6.0% and 10.6%, in Europe and in Portugal, respectively. Bloodstream infections, related with venous catheters, have one of the lowest prevalence, but they may lead to serious consequences [2].

Objective

Explore the procedure of venous catheterization as a risk factor for infection. Explore the role of an innovation as a contribution to the implementation of a prevention measure, in the practice of flushing.

Methods

A literature review involved search in EBSCOhost databases, including articles up to 2017. Some terms used were “infection”, “venous catheter”, “catheterization”, catheter-related infection” “complication” “prevention” “management” “practices”, “flushing”. Articles regarding haemodialysis and urinary catheters were excluded. Guidelines of the societies regarding infusion nursing practices were also included.

Results

Catheterization is considered a risk factor because it creates a possibility for microorganisms to access to the bloodstream. The implementation of an insertion protocol is not enough to eliminate microorganisms and avoid the formation of a biofilm. Integrated in maintenance procedures, flushing contributes to reduce the risk of complications. Studies concluded that the use of an adequate technique of flushing may reduce the biofilm and the probability of infection [3]. Infusion Nurses Society [4] and the Royal College of Nursing [5] include it as a procedure to prevent complications of the infusion therapy. Despite the recommendations, the implementation of this practice is not consistent. To explain lack of adherence, one of the reasons pointed out is the complexity of the task [6]. These results support the development of a Medical Device (MD) (double chamber syringe) that may contribute to the adherence of the flushing practice.

Conclusions

It is important to create strategies to improve adherence to guidelines in clinical context, particularly regarding healthcare associated infections. The development of a MD that may simplify the accomplishment of a good practice, such as, flushing in venous catheter to prevent complication, is proposed in this project.

Acknowledgements

Work funded by the FEDER fund, through the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), project POCI-01-0247-FEDER-017604.

References

1. World Alliance for Patient Safety. The Global Patient Safety Challenge 2005-2006 “Clean Care is Safer Care”. Geneva, World Health Organization; 2005.

2. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare- associated infections and antimicrobial use in European acute care hospitals. ECDC; 2013.

3. Ferroni A, Gaudin F, Guiffant G, Flaud P, Durussel JJ, Descamps P, et al. Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices. Medical Devices. 2014;7:379-383.

4. Royal College of Nursing. Standards for infusion therapy (4th ed.). London: Royal College of Nursing; 2016.

5. Infusion Nurses Society. Infusion therapy standards of practice. Journal of Infusion Nursing. 2016;39(1S):S1-160.

6. Keogh S, Shelverton C, Flynn J, Davies K, Marsh N, Rickard C. An observational study of nurses’ intravenous flush and medication practice in the clinical setting. 2017;3(1):3-10.

Keywords

Venous catheter, Infection, Prevention, Flushing.

P104 Patient safety culture: evaluation of multiprofessional teams

Luciane PA Cabral¹, Daniele Brasil¹, Andressa P Ferreira², Clóris RB Grden¹, Caroline Gonçalves¹, Guilherme Arcaro²

¹Departamento de Enfermagem e Saúde Pública, Universidade Estadual de Ponta Grossa, 4748 Ponta Grossa, Paraná, Brasil; ²Hospital Universitário Regional dos Campos Gerais, 84031-510 Ponta Grosa, Paraná, Brasil

Correspondence: Luciane PA Cabral (luciane.pacabral@gmail.com)

Background

Patient safety is an essential constituent of the quality of care, and assumes absolute relevance for managers, health professionals, family members and patients, in an attempt to provide a safe care.

Objective

The aim of the study was to evaluate the characteristics of the Patient Safety Culture among professionals of an Intensive Care Unit, through the application of the Hospital Survey on Patient Safety Culture (HSOPSC) instrument.

Methods

The study population consisted of 2% (n= 1) resident physicians; 2% (n= 1) nutritionists; 2% (n= 1) administrative assistants; 5% (n= 3) general service aiders; 7% (n= 4) social workers; 8% (n= 5) dentists; 17% (n= 10) nurses; 18% (n= 11) therapists and 40% (n= 24) nursing technicians. Of these 77% (n= 46) were females and 23% (n= 14) males. When questioned about whether their errors were recorded on their functional sheets or used against them in future opportunities, the data became alarming. When questioned about the conduct of their supervisor or boss, it was noted that a considerable number of respondents opted to abstain from comments, marking the option “I do not agree or disagree”. In the issue that addresses the communication in the service, the results were partially satisfactory. Regarding the frequency of reported events, there is a lack of notifications in the sector. When questioned about how patient safety is in the industry 3% (n= 2) considered it excellent, 63% (n= 38) very good and 33% (n= 20) regular. Regarding the general information of the interviewees, which were cited in the introduction of the results, in the open question, only 5% (n= 3) of respondents answered.

Conclusions

The study allowed the evaluation of patient safety characteristics from the perspective of the multi-professional team of an Intensive Care Unit, indicating that there are many aspects to improve in several dimensions on the patient's culture. However, there are areas with greater fragility, that need a closer look, such as the lack of notifications on the part of the team, issues on the supervisor/chief of the sector and mainly fear of punitive culture.

Keywords

Patient, Safety, Multi-professional.

P105 Innovation in nursing in the creation of medical devices: a Portuguese case study

Pedro Parreira¹, Inês Cardoso¹, Liliana Sousa¹, Arménio Cruz¹, José Martins¹, Sara Cortez², Filipa Carneiro³, Luciene Braga⁴ Anabela Sousa-Salgueiro¹

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Muroplás - Indústria de Plásticos, 4745-334 Muro, Trofa, Portugal; ³Innovation in Polymer Engineering, University of Minho, 4800-058 Guimarães, Portugal; ⁴Federal University of Viçosa, 36570-900 Viçosa, Minas Gerais, Brazil

Correspondence: Pedro Parreira (parreira@esenfc.pt)

Background

The administration of intravenous medication is a frequent practice in health units (approximately 90% of hospitalized patients experience intravenous medication). Venous catheterization (peripheral or central) allows the administration of medication directly into the bloodstream through an inserted catheter. Although the flushing procedure is desirable between and after the administration of intravenous medication, this procedure is often not observed.

Objective

In order to reduce this problem, a consortium with complementary experience and skills was created between: Muroplás company, Innovation Polymers Engineering Centre (PIEP) and the Coimbra Nursing School (ESEnfC). The consortium developed the “DUO SYRINGE”, a new Medical Device consisting in a sequential-release double-chamber syringe. The benefits of this new device are several: a greater adherence to flushing by health professionals, a higher level of patient safety and a significant reduction of complications.

Methods

After a literature review regarding disease control and prevention, mainly sustained by the Infusion Nurses Society and Royal College of Nursing guidelines, we established important characteristics for this new MD. A focus groups with nurse experts identified and validated the technical characteristics of the device. After developing the preliminary geometry of the syringe through three-dimensional modelling (3D), a new expert panel of end users evaluated the usability of the MD alpha version sustained in Technology Acceptance Model. In the future, we also intend to carry out laboratory tests for safety validation and to perform clinical studies in a hospital environment.

Results

We identified a set of characteristics that the MD should incorporate, namely syringe size, volume of the two chambers, cannon syringe configuration, and plunger configuration. There was an alignment between literature review and the experts panel opinion.

Conclusions

Clinical practice creates daily new challenges to Nursing and it is crucial to create responses that promote better quality of health care. Identifying problems, creating technological partnerships with companies and technological centres allows to innovate through the development and creation of new MDs. The clinical research with MD allows the evaluation of safety, making clinical practice more effective and safe. This is a new challenge placed to the health professionals. It is desirable to display the intellectual capital available to generate innovations for citizens, reverting in gains to the quality of care.

Acknowledgements

This work is funded by the FEDER fund through the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020) within project POCI-01-0247- FEDER-017604.

Keywords

Medical Device, Nursing, Innovation, Syringe.

P106 Nursing home care: nurses' perspective

Tatiana Antunes¹, Teresa Capelo¹, Anabela Salgueiro-Oliveira¹, Luciene Braga², Pedro Parreira¹

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Federal University of Viçosa, 36570-900 Viçosa, Minas Gerais, Brazil

Correspondence: Anabela Salgueiro-Oliveira (anabela@esenfc.pt)

Background

Nursing home care is a trend of the current society, due to the aging of the population and shorter hospitalization times, for economic reasons and also to prevent infections. In addition, it represents a high potential for improving the quality of care by enabling self-care of patients in their life contexts, involving their families and taking advantage of existing social support networks.

Objective

Analyse the scientific production, in the last seven years, concerning domiciliary nursing care, attending to the nurse’s perspective.

Methods

The search method used was the integrative literature review. The investigation question was formulated based on the PICO strategy: What is the nurse’s perspective about nursing home care? The search was conducted between 22 and 26 May, 2017, in the following databases: SciELO, Medline with full text, CINHAL with full text, Academic Search Complete, Complementary Index. We only looked for primary scientific studies, published in the last six years, in English, Portuguese or Spanish. The selected descriptors were: Home care nursing OR Domiciliary Care Or Home visits) AND Self-care AND Nurse. We accessed 1,293 scientific articles. After reading title, abstract and full text we retained 9 studies for analysis.

Results

The mobilization of different nursing competencies is important because of patient’s profile and difficulties associated with the contexts where they perform nursing care [1]. Nurses should demonstrate availability, sensitivity, education, creativity and attend to the care needs of the person and family [2]. The care process success depends on the relationship between nurse and patient and/or family [3]. The unpredictability, the lack of in house resources, distance and work overload are some of the difficulties manifested by the nurses [2, 4].

Conclusions

Nurses who provide nursing home care, due to the limited resources they face, will have to carry out a rigorous planning of care, mobilize and inform patients and families about social support networks, as well as to promote self-care.

References

1. Sherman H, Forsberg C, Törnkvist A. The 75-year-old persons’ self-reported health conditions: a knowledge base in the field of preventive home visits. Journal of Clinical Nursing. 2012;21:3170-3182.

2. Consoni E, Salvaro M, Ceretta L, Soratto, M. Os desafios do enfermeiro no cuidado domiciliar. Enfermagem Brasil. 2015;14(4):229-234.

3. Gago E, Lopes M. Cuidados domiciliares – interação do enfermeiro com a pessoa idosa/família. Acta Paulista de Enfermagem. 2012;25(1):74-80.

4. Rodrigues A, Soriano J. Fatores influenciadores dos cuidados de enfermagem domiciliários na prevenção de úlceras por pressão. Revista de Enfermagem Referência. 2011;3(5):55-63.

Keywords

Patients, Home nursing care.

P107 Knowledge on pharmacogenomics: gaps and needs of educational resources

Andreia Pinho, Marlene Santos

Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

Correspondence: Marlene Santos (mes@estsp.ipp.pt)

Background

Pharmacogenomics is a science that aims to predict the contribution of genes in an individual's response to the administration of a drug, in order to increase the therapeutic effect and minimize any Adverse Drug Reaction (ADR). The professionals must have knowledge on the subject, however the studies point to a lack of information of the future health professionals, about concepts and applications of Pharmacogenomics.

Objective

To compare the study plans of Pharmacy, Pharmaceutical Sciences and Medicine courses at a national level and to find out the existence of topics related to Pharmacogenomics, and to verify the knowledge of the students of the Degree in Pharmacy of Escola Superior de Saúde (ESS) of Porto on the topic “Pharmacogenomics”, identifying gaps and needs of educational resources among students of this course.

Methods

A questionnaire-type study was carried out, the first one being applied to the Coordinators of the three courses, at a national level, and another applied to the ESS Pharmacy students about their knowledge about Pharmacogenomics.

Results

The courses have an hourly schedule for Pharmacogenomics between 2.5 hours in Pharmacy and 60 hours in Pharmaceutical Sciences. The students' knowledge of this subject went from 15.91% in the first year, to 95.92% and 97.3% in the 3rd and 4th years, respectively. Between 76% and 86% of the students were not able to identify drugs or drug metabolizing enzymes whose activity is influenced by genetic variations. Comparing the 3 courses it can be stated that the workload in the curricular plans is reduced, being especially evident in the course of Pharmacy. There is a significant increase in knowledge about Pharmacogenomics as the years of undergraduate studies progress, and the difference between the 3rd and 4th year is not significant, since this subject is taught only on the 2nd year.

Conclusions

The knowledge passed on to undergraduate students and future health professionals is reduced, with an insufficient workload, and does not take place uniformly at a national level. In the case of ESS Pharmacy, there was an increase of knowledge as the degree progresses, despite the few contents taught regarding Pharmacogenomics. In the future, it may be useful to create supplementary courses and trainings for students on this subject.

Keywords

Pharmacogenomics, Knowledge, Students, Curricular plan

P108 Influence of the rs776746 CYP 3A5 gene polymorphism on response to immunosuppressant tacrolimus in patients undergoing liver transplantation: a systematic review

Cristiana Rocha, Marlene Santos

Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

Correspondence: Marlene Santos (mes@estsp.ipp.pt)

Background

Hepatic transplantation is a lifesaving therapy that has been increasing over the years in Portugal. Its success is due largely in part to the use of immunosuppressants, like tacrolimus, the first-line immunosuppressant drug for people undergoing liver transplantation. It is a drug with narrow therapeutic window and great inter-individual variability. This variability is explained in part by polymorphisms of the CYP3A5 gene, which encodes the CYP3A5 metabolizing enzyme. The rs776746 polymorphism affects the CYP3A5 gene and gives rise to a non-functional metabolizing enzyme. The CYP3A5 gene is expressed in both the liver and the gut, that is, the metabolism of tacrolimus is affected by the transplanted liver (donor) genotype, as well as by the gut (receptor) genotype. The identification of polymorphisms becomes important especially in the period immediately after transplantation in order to avoid acute rejection of the organ.

Objective

The objective of this work was to review the influence of rs776746 polymorphism of the CYP3A5 gene on pharmaco*kinetics of tacrolimus.

Methods

A systematic review was conducted through the Pubmed database search, from 2000 to 2017. Articles that meet the study query and the inclusion and exclusion criteria were included for review.

Results

We selected 23 articles that discuss the influence of the rs776746 polymorphism on the pharmaco*kinetics of tacrolimus. The evidence suggests that individuals with the CYP3A5*3 (non-expressing) allele have a decreased metabolism of tacrolimus and, consequently, lower blood concentrations of the drug compared to individuals carrying the CYP3A5*1 (expressing) allele. The receptor genotype plays a more important role in the first days after transplantation and the donor genotype becomes more important later when the transplanted organ begins to function properly.

Conclusions

This review concluded that regarding hepatic transplantation it is important to identify both the polymorphisms affecting the metabolism of tacrolimus in the donor and recipient genotypes for a more effective dose adjustment, especially in the critical period immediately after transplantation.

Keywords

Transplant, Liver, Polymorphism, rs776746, Tacrolimus, CYP3A5.

P109 The FITWORK European Project - good practices to develop physical activity programs at work

Maria Campos, Alain Massart, Carlos Gonçalves, Luís Rama, Ana Teixeira

Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-156 Coimbra, Portugal

Correspondence: Maria Campos (mjcampos@fcdef.uc.pt)

Background

Workplace physical demands have widely changed in the last century. Nowadays, most of the jobs in the European Union (EU) have a low overall energy demand. In this context, the FITWORK project aims to develop good practices to support ergonomics and health by implementing physical activity programs, addressed to reduce specific ergonomic risks at the workplace. This 2-year project (2017-2018) is co-funded by the Erasmus+ Programme of the European Union and coordinated by Instituto de Biomecánica of Valencia (IBV) Spain. The partners are the University of Coimbra (UC); Romtens Foundation, Romania; Eindhoven University of Technology (TU/e); the European Network for Workplace Health Promotion (ENWHP) and KOMAG, Poland (http://fitwork.eu/).

Objective

Therefore, the general objective of the project is to promote physical activity at work, awareness of workers and health and safety professionals on the significance of health-enhancing physical activity attending to job demands. To meet this objective, FITWORK will identify good practices in occupational risk prevention through physical activities, including motivational aspects, and best practices for implementing workplace health promotion programs (WHPP).

Methods

The workout programs are being implemented in two different organizations, with experimental group and control group, during six months at the Institute of Mining Technology KOMAG, Poland and INNEX S.R.L, Italy, with the following aims: I) to identify and evaluate the worksites and the professional risks within each organization; II) to adapt the WHP Programme to every worksite: identify the most appropriate exercises to carry out in each worksite and when the workers have to perform them; III) to monitor and collect data using specific instruments and report periodically about the development of the programme; IV) to give recommendations related to good practice and aspects for improving the implementation of the program.

Results

The primary purposes of the analysis of the results are to validate the effect of the designed physical activity programs and to elaborate good practices guidelines in developing and implementing WHP Programs.

Conclusions

There is evidence that behaviour changes are ignited by a complex co*cktail of perceived benefits other than health alone, but a lack of evidence still exists on the effectiveness of health promotion activities on productivity, absenteeism or wellbeing. Hence, the desired impact of this European Project is to raise awareness and to engage stakeholders and target groups, sharing solutions and know-how with professional audiences.

Keywords

FITWORK, Job demands, Workplace, Physical activity programs, Erasmus+ Programme.

P110 Adventitious respiratory sounds to monitor lung function in pulmonary rehabilitation

Cristina Jácome^1,2, Joana Cruz^2,3,4, Alda Marques^2,5

¹Center for Health Technology and Information Systems Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; ²Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁵Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Cristina Jácome (cristinajacome@ua.pt)

Background

Peak expiratory flow (PEF) has been traditionally used to monitor lung function in patients with chronic obstructive pulmonary disease (COPD) before pulmonary rehabilitation (PR) sessions. However, PEF mainly reflects changes in large airways and it is known that COPD primarily targets small airways. Adventitious respiratory sounds (ARS - crackles and/or wheezes), are related to changes within lung morphology and are significantly more frequent in patients with acute exacerbations of COPD. Thus, ARS may be also useful for the routine monitoring of lung function during PR programs.

Objective

This study explored the convergent validity of ARS and PEF in patients with COPD.

Methods

Twenty-four (24) stable patients (66 ± 9 years; FEV1 71 ± 19% pred) participating in a PR program were included. Assessments were conducted immediately before one PR session. Presence of ARS (crackles and/or wheezes) at posterior right chest was first assessed by a physiotherapist using a digital stethoscope (ds32a, ThinkLabs, CO, USA). Resting dyspnoea was collected using the modified Borg scale (0-10) and PEF with a peak flow meter (Micro I, Carefusion, UK). Independent t-tests, Pearson and point-biserial correlations were used.

Results

ARS were present in 5 participants (20.8%). Patients with ARS had a lower PEF than patients without ARS (294 ± 62 l/min vs. 419 ± 128 l/min; p = 0.048). PEF was negatively correlated with presence of ARS (r = -0.41; p = 0.048). Resting dyspnoea was negatively correlated with PEF (r = -0.41; p = 0.039), but not with ARS (r = 0.21; p = 0.32).

Conclusions

Findings suggest that both ARS and PEF offer complementary information before a PR session, but that ARS provide additional information on the patents’ respiratory status. Further research correlating ARS and PEF with patients’ performance and progression during PR is needed to strengthen the usefulness of assessing these parameters in PR.

Keywords

Peak expiratory flow, Adventitious respiratory sounds, Crackles, Wheezes, Pulmonary rehabilitation.

P111 Health care services and their influence on the autonomy and quality of life of the elderly

Keila CR Pereira, Silvania Silva, Jefferson L Traebert

Universidade do Sul de Santa Catarina, 88137-272, Palhoça, Santa Catarina, Brasil

Correspondence: Keila CR Pereira (keilarausch@gmail.com)

Background

Primary Care (PA) performance can be assessed by Ambulatory Care-Sensitive Conditions (ACSC) [1]. They are health problems whose morbidity and mortality can be reduced through resolute and comprehensive care. The performance and access to the health system can delay the hospitalizations of the elderly with all the risks arising from it [2,3].

Objective

Analyse the impact of actions of health care of the elderly on primary care in the ICSAB rate.

Methods

Ecological study of the information on the hospitalizations of people over 60 years of age was obtained by hospital admission authorizations (HAA) from the Hospital Information System (HIS), from all municipalities in the state of Santa Catarina (SC) from 2008 to 2015. For the definition of the Primary Care Sensitive Conditions (PCSC), the official report published by the Ministry of Health was used [4]. The crude PCSC rate was calculated by the ratio between the number of PCSC in the elderly and the reference population for the period multiplied by 10,000. Next, the PCSC hospitalization rates for the elderly were standardized by age using the direct method, using the world population [5] as the standard. To soften the historical series, as a function of the oscillation of the points, was calculated the moving average centred in three groups. The analysis was performed through the Joinpoint program, version 4.3.1, used to calculate the variation of the rates of hospitalization of elderly people by age-adjusted PCSC, in the period from 2008 to 2015, resulting in the behaviour of the rate in the period studied for each municipality of Santa Catarina.

Results

The analysis showed that for each percentage point of increase in the elderly population rate, one percentage point increases in the annual rate of hospitalization rate for PCSC in the elderly (R² = 0.025). The variables of the performance of attention to the elderly did not show association in the hospitalizations.

Conclusions

The individual's lifestyle may be more determinant for a healthy aging than access to services when the individual has aged. In order for services to effectively act as a reducer of hospitalizations in the elderly they must be offered before the establishing of the aging process in the individual.

References

1. Caminal J, Starfield B, Sanchez E, Casanova C, Morales M. The role of primary care in preventing ambulatory care sensitive conditions. Eur J Public Health. 2004 Sep;14(3):246-51

2. Santos M. Epidemiologia do envelhecimento. In: Nunes I M; Ferreri R E L; Santos M. Enfermagem em geriatria e gerontologia. Rio de Janeiro: Guanabara Koogan, 2012. pp. 4-8.

3. Silveira R E, Santos A S, Sousa M C, Monteiro T S A. Gastos relacionados a hospitalizações de idosos no Brasil: perspectivas de uma década. Gestão e Economia em Saúde, São Paulo, 2013. Dec;11(4):514-520.

4. BRASIL. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. – 2012. Brasília.

5. Doll R, Payne P, Waterhouse J. Cancer Incidence in Five Continents: A Technical Report. Berlin: Springer-Verlag (for UICC), 1966.

Keywords

Aged, Primary Health Care, Health Promotion, Healthy Aging, Life Style.

P112 Morphological and functional cardiac changes in TAVI follow-up – evaluation through transthoracic echocardiography

Virginia Fonseca, Ana Costa, Inês Antunes, João Lobato

Escola Superior de Tecnologia da Saúde de Lisboa, 1990-094 Lisboa, Portugal

Correspondence: Virginia Fonseca (virginia.fonseca@estesl.ipl.pt)

Background

Aortic Stenosis is a valvular disease with increasing prevalence. Transcatheter aortic valve implantation (TAVI) is a treatment option for patients who cannot undergo surgical valve replacement [1,2,3,4].

Objective

The aim of this study was to describe and compare morphological and functional cardiac changes, through transthoracic echocardiography, in the follow-up after TAVI.

Methods

Patients, with ages between 63 and 85 years old, submitted to TAVI were evaluated by transthoracic echocardiography between 24h to 72h and 1 to 4 months after the procedure. The study variables selected were perivalvular regurgitation, maximum velocity and gradient, left ventricular (LV) function and dimensions, and left atrium (LA) diameter. Statistical analysis of the study variables was made using descriptive statistics, Shapiro-Wilk test, Wilcoxon's test and McNemar test. The results were considered statistically significant when p value < 0.05.

Results

It was registered a significant increase in maximum velocity and gradient (p=0.004 and p=0.010, respectively) from the first to the second echocardiogram. There weren’t significant differences in LV ejection fraction, LV telediastolic and telesistolic volumes and in LA diameter. LV índex mass decreased comparing to the first echocardiogram (from 157.92 to 142.28 g/m2), however, this difference wasn’t statistically relevant. The prevalence of regurgitation (80%) was unchanged between evaluations.

Conclusions

Transcatheter valve aortic implantation is a relatively new procedure for aortic stenosis treatment, with morphological and functional changes in the heart [3] The studied variables didn’t demonstrate any significant changes, with the exception of maximum velocity and gradient. LV mass decreased in average 15.71 g/m2, and from a clinical perspective, can have an impact in the patient’s prognostic.

References

1. Pereira E, Silva G, Caeiro D, Fonseca M, Sampaio F, Fonseca C, et al. Cirurgia cardíaca na estenose aórtica severa: o que mudou com o advento do tratamento percutâneo? Revista Portuguesa de Cardiologia. 2013 Oct;32(10):749–56.

2. Gavina C, Gonçalves A, Almeria C, Hernandez R, Leite-Moreira A, Rocha-Gonçalves F, et al. Determinants of clinical improvement after surgical replacement or transcatheter aortic valve implantation for isolated aortic stenosis. Cardiovascular ultrasound. 2014;12:41.

3. Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, et al. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology. Elsevier Inc.; 2012;59(13):1200–54.

4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who 10 Cannot Undergo Surgery. New England Journal of Medicine. 2010 Oct 21;363(17):1597–607.

Keywords

TAVI, Transcatheter aortic valve implantation, Aortic stenosis, Transthoracic echocardiography.

P113 Literacy of family caregivers of people with Alzheimer's disease

Rui Moreira¹, Lia Sousa², Carlos Sequeira³

¹Centro Hospitalar de São João, Pólo Valongo, 4440–563 Valongo, Portugal; ²Centro Hospitalar de São João, 4200-319 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

Correspondence: Rui Moreira (ruijorgelm@gmail.com)

Background

Increasing population ageing is bringing with it a higher incidence and prevalence of Alzheimer's disease. In addition to incapacitating the sick person this disease has destabilising effects on the family, particularly because they are the caregivers. Therefore, it is important to know how informed family caregivers are about Alzheimer’s disease.

Objective

To characterise family caregivers of people with Alzheimer's disease and identify their level of knowledge about the disease.

Methods

A quantitative, transversal and descriptive study was carried out. For this, 52 caregivers who are relatives of people with Alzheimer's disease were identified through a convenience sample from both private homes and day-care centres in the North region of Portugal. A questionnaire was administered that contained the sociodemographic characterisation of the caregivers as well as questions that dealt with different facets of the disease, ranging from pathophysiology to intervention strategies. The questionnaire was designed for this study, underpinned by consistent theoretical bases, and was sent to five experts for evaluation. These experts were nurses with experience in gerontology/Alzheimer's disease. The questions are essentially closed, with the only open question coming at the end, relating to the difficulties experienced by the family members in caring for the patient.

Results

Focusing on aspects related to literacy, the main results indicate that although 87% of these caregivers know how to define Alzheimer's disease, only about 30% understand what underlies it, while about 50% show some difficulties in identifying risk factors. Most of them (75%) are able to list symptoms of the disease but only half know how to keep the sick person active. It should be noted that only 38% can identify ways to preserve memory and that about 30% of family caregivers are unaware of the purpose of the medication.

Conclusions

It was found that there is considerable uncertainty among family caregivers about several facets of Alzheimer's disease. There was also some lack of knowledge about existing resources and support. The study also highlights the fact that the family members questioned do not often ask nurses for information relevant to the care process.

Keywords

Health literacy, Family caregivers, Alzheimer’s disease.

P114 Positive effects of a health promotion program in sedentary elderly with type 2 diabetes

Luís Coelho^1,2, Nuno Amaro^1,2, João Cruz^1,2, Rogério Salvador^1,2, Paulino Rosa^1,2, Ricardo Gonçalves^1,2, Rui Matos^1,2

¹School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-091 Leiria, Portugal; ²Life Quality Research Centre, 2001-904 Santarém, Portugal

Correspondence: Luís Coelho (coelho@ipleiria.pt)

Background

Diabetes is projected to be the 7th leading cause of death by 2030 by WHO (2017) [1]. Physical Activity along with a healthy diet and medication is one of the crucial options to prevent and control diabetes. About 40% of the Portuguese population aged 25 to 79 years-old presents a condition of diabetes or intermediate hyperglycaemia (Observatório Nacional da Diabetes, 2016) [2].

Objective

To examine the impact of a health promotion program in sedentary elderly with type 2 diabetes.

Methods

The program consisted on a 30-minute daily walking routine and a weekly educational session regarding healthy behaviours for 8 weeks. All participants were medicated with insulin and anti-diabetics. Twenty-six elderly diabetics (16 male and 10 female) aged 70.1 ± 8.0 years old, were assessed for Body Mass (BM), Body Mass Index (BMI), Systolic and Diastolic Blood Pressure (SBP, DBP respectively), Waist Circumference (WC), and Capillary Glycaemia (CG). Wilcoxon test was used on inferential analysis for repeated measures (pre-post). Significance level was kept at 5%. The effect size for this test was calculated by dividing the z value by the square root of N, being N the number of observations over the two times points [3].

Results

All parameters measured values decreased significantly from initial to final moments: BM from 80.8 ± 8.9 kg to 78.2 ± 9.0 kg (p=0.000; r=-0.512), BMI 30.2 ± 3.8 kg/m² to 29.1 ± 3.1 kg/m² (p=0.000; r=-0.543), SBP from 143.4 ± 10.9 mmHg to 134.3 ± 10.4 mmHg (p=0.002; r=-0.426), DBP from 79.5 ± 8.6 mmHg to 75.3 ± 8.7 mmHg (p=0.035; r=-0.292), WC from 100.9 ± 7.8 cm to 96.7 ± 6.7cm (p=0.000; r=-0.584), CG from 182.5 ± 56.3 mg/dl to 124.1 ± 17.7 mg/dl (p=0.000; r=-0.588).

Conclusions

The inclusion of physical activity and the awareness of engaging in healthy behaviours seem to complement the medication-based therapeutic in sedentary elderly with type 2 diabetes. Although the physical activity assessment was self-reported, sport sciences can play an important role in the prescription and monitoring of exercise in clinical patients. Multidisciplinary interventions in community health programs are recommended in order to achieve stronger and consistent results. These should include medical practitioners, physiologists and nutritionists.

References

1. World Health Organization. Diabetes Fact Sheet. Updated November 2017. http://www.who.int/mediacentre/factsheets/fs312/en/.

2. Diabetes: Factos e Números – O Ano de 2015 − Relatório Anual do Observatório Nacional da Diabetes. Sociedade Portuguesa de Diabetologia. Depósito Legal n.º: 340224/12 ISBN: 978-989-96663-2-0.

3. Pallant J. SPSS Survival Manual: A Step by Step Guide to Data Analysis using SPSS for Windows (3rd ed.). Milton Keynes, UK: Open University Press: 2007.

Keywords

Health promotion, Type 2 diabetes, Active life styles, Elderly.

P115 Prevalence of childhood obesity

Fátima Frade¹, Joana M Marques¹, Luis Sousa¹, Maria J Santos¹, Fátima Pereira¹, Dora Carteiro¹, João MG Frade^2,3,4

¹Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴Multidisciplinary Unit for Biomedical Research, Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal

Correspondence: Fátima Frade (ffrade@uatlantica.pt)

Background

The prevalence of obesity in children and adolescents has been increasing worldwide [1, 2], having impact on children's physical, psychological and social well-being [3, 4].

Objective

To identify the prevalence of childhood obesity worldwide.

Methods

A systematic review of the literature began with the question: “What is the prevalence of childhood obesity worldwide?” The research was carried out on the EBSCO host, Google Scholar and B-On, on the scientific databases Medline/Pubmed, LILACS, CINAHL, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina and SciELO. The inclusion criteria were: full-text articles, in English, Portuguese or Spanish, published from 2013 to 2017. The Boolean equation used was: (Pediatric Obesity) OR (Overweight) AND (Children) AND (Prevalence). One hundred twenty-two (122) articles were found, of these, 24 were selected after comprehensive reading.

Results

Globally, in 2016, there were 41 million children under 5 years of age who were overweight or obese and 340 million children and adolescents aged 5 to 19 years were overweight/obese [5]. In 2013, in the European region the prevalence of overweight/obese people was 31.6%, with 17.7% corresponding to pre-obesity and 13.9% to childhood obesity [6, 7]. In China, the prevalence of overweight people doubled from 13% in 1986, to 27.7% in 2009. In the United States, 31.8% of children were overweight or obese [8]; in New Zealand, 31.7% were overweight and obese, and 2.5% were severely obese [9]. In Mexico City, 30.8% of adolescents, 24.2% of school-age children, 14.5% of latent and 11.5% of children in preschool age were overweight and obese [2]. In Brazil, 30.59% of the children/adolescents studied were overweight, obese or severely obese [8].

Conclusions

Childhood obesity is one of the Public Health problems worldwide, it becomes urgent to monitor the problem properly and implement preventive measures to reduce this risk.

References

1. Viveiro C, Brito S, Moleiro P. Sobrepeso e obesidade pediátrica: a realidade portuguesa. Rev Port Saúde Pública. 2016;34(1):30-37.

2. Wollenstein-Seligson D, Iglesias-Leboreiro J, Bernárdez-Zapata I, BravermanBronstein A. Prevalencia de sobrepeso y obesidad infantil en uno hospital privado de la ciudad de México. Rev Mex Pediatr. 2016;83(4):108-114.

3. Vásquez-Guzmán M, González-Castillo J, González-Rojas J. Prevalencia de período de sobrepeso y obesidade en escolares. Rev Sanid Milit Mex. 2014;68(2):64-67.

4. Salinas_Martínez A, Mathiew-Quirós, Hernández-Herrera R, GonzálezGuajardo E, Garza-Sagástegui M. Estimación de sobrepeso y obesidad en preescolares – Noramtividad nacional e international. Rev Med Inst Mex Seguro Soc. 2014;52(Supl 1):S23-S33.

5. World Health Organization - WHO. Obesity and Overweight. [online] 2013. [cited 2013 May 15]. Available from: http://www.who.int/ mediacentre/factsheets/fs311/en/.

6. Wijnhoven T, van Raaij J, Breda J. WHO European Childhood Obesity Surveillance Initiative: Implementation of Round 1 (2007/2008) and Round 2 (2009/2010). Copenhagen: WHO Regional Office for Europe,2014. Disponível em: www.euro.who.int/__data/assets/pdf_file/0004/258781/C OSI-report-round1-and-2_final-for-web.pdf

7. Kulaga Z, Gurzkowska B, Grajda A, Wojtylo M, Gózdz M, Litwin M. The prevalence of owerweight and obesity among Polish pre-school-aged children. Dev Period Med. 2016;XX,2:143-149.

8. Cabrera T, Correia I, Oliveira dos Santos D, Pacagnelli F, Prado M, Dias da Silva T, Monteiro C, Fernani D. Analisys of the prevalence of owerwight and obesity and the level of physical activity in chilfren and adolescents of a soudwestern city of São Paulo. JHGD. 2014;24(1):67-66.

9. Farrant B, Utter J, Ameratunga S, Clark T, Fleming T, Simon D. Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-Being. J Pediatr. 2013;25:1–7.

Keywords

Prevalence, Pediatric Obesity, Overweight, Children.

P116 The urgency for a nursing intervention towards sexual education at Cape Verde: university students’ perception

Sónia Ramalho^1,2, Carolina Henriques^1,2, Elisa Caceiro¹, Maria L Santos¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Sónia Ramalho (sonia.ramalho@ipleiria.pt)

Background

We know today that knowledge about sexuality is essential for young people to live in a society that allows to develop healthy attitudes and behaviours. To that end, health professionals, namely nurses, should be able to Educate for Sexuality in order to contribute for the improvement of affective-sexual relationships among the young; contribute to the reduction of possible negative occurrences resulting from sexual behaviours, such as early pregnancy and sexually transmitted infections (STIs), and contribute to conscious decision-making in the area of health education/sex education [1-4].

Objective

To evaluate young people's knowledge about sexuality.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data, and a questionnaire consisting of twenty questions related to the anatomy of the reproductive system, contraceptive methods and sexually transmitted infections was applied. One hundred and eight (108) young people from the Republic of Cape Verde participated in the study. All formal and ethical procedures were taken into account.

Results

The results show that in a sample of 108 university students, 81.5% female, with a mean age of 21.26 years; 1.9% reported having already been forced by a stranger, family member or older person to have sex, and 10.2% reported having had sex after a party, under the influence of alcohol or drugs. As far as knowledge is concerned, it can be said that the level of knowledge of young people regarding the sexual health aspects is satisfactory, safeguarding that the most erroneous questions were those related to: male anatomy (40.7%) and hormonal physiology of women (25.9%). It was found that 32.4% of the university students did not know/did not answer the questions related to female hormonal processes and their functioning when associated with an oral contraceptive.

Conclusions

It is essential to know what young people know about sexuality, so that specific nursing interventions can be designed to meet their sexual education needs.

References

1. Barbosa A, Gomes-Pedro J. Sexualidade. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2000.

2. López F, Fuertes A. Para compreender a sexualidade. Lisboa: Associação para o Planeamento da Família; 1999.

3. Epstein D, O’Flynn S, Telford D. Innocence and Experience: Paradoxes in sexuality and education. In: Richardson D, Seidman S, editors. Handbook of Lesbian and Gay Studies. Thousand Oaks, CA: Sage; 2002. p 271-311.

4. Louro GL. Um corpo estranho: Ensaios sobre sexualidade e Teoria Queer. Belo Horizonte: Autêntica Editores; 2004.

Keywords

Young people, Knowledge, Sexuality.

P117 Cape Verde young university students: determinants of whether or not to have sex

Carolina Henriques^1,2, Sónia Ramalho^1,2, Elisa Caceiro¹, Maria L Santos¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Carolina Henriques (carolina.henriques@ipleiria.pt)

Background

In Cape Verde there is still no national study regarding the sexual behaviour of its youth, however, data provided by the Cape Verde Association for Family Protection (VERDEFAM) [1], tells us that more than half of Cape Verde adolescents and youngsters start their sexual lives before the age of 16 and the determinants of having or not having sex are not known. In this study, we tried to make some efforts to know some determinants of whether or not to have sex in young Cape Verde university students.

Objective

To know the determinants of whether or not to have sex in young Cape Verde university students.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data and the motivation scale for having or not having sex by Gouveia, Leal, Maroco and Cardoso (2010) [2]. Ninety-eight (98) university students from the Republic of Cape Verde participated in the study. All formal and ethical procedures have been taken into account.

Results

Youngsters had a mean age of 21.25 years (SD = 2.76), 62.2% started sexual activity with their boyfriend, and 64.3% used the condom as contraceptive method. Considering the determinants of having sex, the young people that participated in the study considered not important to have sex: “because my partner wanted” (51.9%), “to please my partner” (56.6%), “to seduce” (64.8%), “for curiosity” (53.7%) and “for fun or to play” (72.2%). In turn, they consider very important not to have sex: for fear of venereal diseases (24.1%); fear of AIDS (37%); fear of pregnancy (28.7%); lack of opportunity or inability to find a partner (25%) and because they did not know their partner long enough (46.3%).

Conclusions

The Cape Verde youth that participated in the study emphasizes the importance of health-related and safe relationships, not emphasizing both the desire of the other and pleasure for pleasure, factors that are strongly associated with the determinants of whether or not to have sex.

References

1. Cape Verdean Association for the Protection of the Family (VERDEFAM). Recovered from http://www.verdefam.cv/

2. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de Motivação para fazer e para não fazer Sexo. In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 84-99.

Keywords

Young; Sex; Determinants; Cape Verde.

P118 Attitude of Cape Verdean young university students towards sexuality

Carolina Henriques^1,2, Sónia Ramalho^1,2, Maria L Santos¹, Elisa Caceiro¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Carolina Henriques (carolina.henriques@ipleiria.pt)

Background

Cape Verde, a country with about 500,000 inhabitants, has a markedly young population, a fact that places special responsibility on the role of local health professionals, in the contexts of sexual and reproductive health, where sexuality issues are included.

Objective

To evaluate the attitudes of Cape Verdean university students towards sexuality.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data and the sexual attitudes scale of Gouveia, Leal, Maroco and Cardoso (2010) [1]. One hundred and eight (108) university students from the Republic of Cape Verde participated in the study. All formal and ethical procedures have been taken into account.

Results

The results show that participants of this cross-border research had a mean age of 21.26 years (SD = 2.93), were mostly female (81.5%) and started their sexual activity with a mean age of 17.37 years (SD = 1.31). As far as sexual attitudes are concerned, 11.1% agrees that “one does not have to be committed to the person to have sex with her/him”; 18.5% agree that “casual intercourse is acceptable”; 76.9% totally disagree with “I would like to have sex with many partners”; 74.1% disagree completely that “it is right to have sex with more than one person during the same time period” and 36.1% agree that “sex is primarily a physical activity”. 10.2% of young people agree that “sex, by sex alone, is perfectly acceptable”, 33.3% agree that “sex is primarily a bodily function, just like eating”. Regarding the permissiveness of university students in relation to occasional/non-engaging sex, they present a significant level of agreement (M = 14.44, Sd = 3.66, Xmax = 24.00) which relates to instrumentality (M = 11.93, SD = 2.62, Xmax = 19.00).

Conclusions

Data shows that young Cape Verdean university students seek to have sexual relations with respect for their partner, although they agree with sex without commitment, closely associated with the vision of the sexual act as a corporal function response.

References

1. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de Atitudes Sexuais–Versão adolescentes (EAS-A). In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 58-72.

Keywords

Youth, Sexuality, Attitudes, Cape Verde.

P119 Central auditory processing and sleep deprivation

Diogo Garcia, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Diogo Garcia (diogojorge04@gmail.com)

Background

Auditory Processing is a natural process of taking in sound through the ear and having it travel to the language area of the brain to be interpreted. Sleep deprivation may influence this process.

Objective

To evaluate the impact of sleep deprivation, for a 24-hour period, on central auditory processing in healthy young adults.

Methods

Fourteen (14) healthy young adults were selected, 9 of which (64.3%) were female and 5 (35.7%) were male, aged 18-29 years. The subjects were submitted to audiological evaluation using tonal audiometry and the threshold of 1 in 1 dB was obtained in the frequencies of 250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz, alternating disyllabic dichotic listening test Staggered Spondaic Words Test (SSW). The evaluation of central auditory processing, as well as the determination of the auditory threshold was performed in two situations: without sleep deprivation and after 24 hours of sleep deprivation.

Results

At the level of the Audiogram, the reduction of the auditory thresholds after sleep deprivation in the frequencies of 500Hz and 1000Hz, around 3dB, increased in the frequency of 250Hz and 4000Hz, between 1 and 9dB, and remained in the right ear in frequencies of 2000Hz and 8000Hz. In the right ear, none of the differences found were statistically significant. In the left ear the auditory threshold increased at the frequency of 2000Hz about 5dB, and decreased in the frequencies of 250Hz, 500Hz, 1000Hz, 4000Hz and 8000Hz between 1 and 8dB, without statistically significant differences. In the SSW, there was a slight decrease in the percentage of correct answers in both ears, as well as in the percentage of total hits, after sleep deprivation. In none of the ears there were statistically significant differences in SSW results before and after 24 hours of sleep deprivation.

Conclusions

The results demonstrate that there are no statistically significant changes before and after 24h of sleep deprivation, both at the level of the Auditory Threshold and in the SSW.

Keywords

Central Auditory Processing (PAC), Sleep Deprivation, Staggered Spondaic Words Test (SSW), Audiological Evaluation.

P120 Missed nursing care: incidence and predictive factors - integrative literature review

Ivo CS Paiva^1,2, Isabel M Moreira¹, António FS Amaral¹

¹Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Department of Internal Medicine and Palliative Care, Portuguese Oncology Institute of Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal

Correspondence: Ivo CS Paiva (ivocsoarespaiva@gmail.com)

Background

The increasing complexity and demand in health care, together with patients’ changing needs, put into evidence the need for nurses to focus their interventions on people’s real needs, thus rethinking their role. In this context, unfinished, delayed, or missed nursing care (MNC), which is a strong indicator of health care quality, can compromise quality care and patient safety.

Objective

To identify the most common MNC, as well as its predictors and strategies to prevent its occurrence.

Methods

A systematic literature review was conducted on studies available in the EBSCOhost and B-on databases. Twenty-four articles were selected based on predefined criteria. All articles were published between 2012 and 2017.

Results

The studies showed that nurses and patients have different perceptions about MNC. Autonomous interventions related to early mobility and walking, repositioning every 2 hours, or oral and body hygiene are more often missed than interdependent interventions. [1-5]. Medication administration within 30 minutes of prescription, planning and update of care plans, vital signs monitoring, and treatment effectiveness assessment also emerged as MNC [5-7]. Predictive factors are associated with the patient (health status/workload) [2, 5]; the nurse (interruptions by other professionals or patients’ relatives) [4, 8]; the materials or equipment (late deliveries) [9], or the hospital’s health care policies (management/leadership and staffing) [10]. The nurse-patient/family communication emerged as MNC, whereas the nurse-other health professional communication emerged as a predictive factor because teamwork and its effectiveness are compromised [2, 11]. Nurses’ personal interests and moral sense can influence the occurrence of MNC. Therefore, the strategies used to reduce the incidence of MNC should be adjusted to the needs of each setting [2, 5].

Conclusions

Although MNCs are being explored internationally, it is an understudied topic in Portugal, which may be explained by the punitive error reporting culture. The findings cannot be generalized due to the diversity of studies. Thus, the phenomenon of MNC and its impact on patient/family prognosis should be explored in different settings, with the purpose of achieving excellence in health care and ensuring that people recognize the importance of health care.

References

1. Bruyneel K, Li B, Ausserhofer D, Lesaffre E, Dumitrescu I, Smith H, etal. Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences with Care in Europe. Med Care Res Rev. 2015;72(6):643-664.

2. Chapman R, Rahman A, Courtney M, Chalmers C. Impact of teamwork on missed care in four Australian hospitals. J Clin Nurs. 2017;26(1-2):170-181.

3. Cho S, Kim Y, Yeon K, You S, Lee I. Effects of increasing nurse staffing on missed nursing care. Int Nurs Rev. 2015;62(2):267-274.

4. Kalisch B, Xie B, Dabney B. Patient Reported Missed Nursing Care Correlated With Adverse Events. Am J Med Qual. 2014;29(5):415-422.

5. Papastavrou E, Charalambous A, Vryonides S, Eleftheriou C, Merkouris A. To what extent are patients' needs met on oncology units? The phenomenon of care rationing. Eur J Oncol Nurs. 2016;21:48-56.

6. Ball J, Murrels T, Rafferty A, Morrow E, Griffiths P. ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014, 23:116-125.

7. Schubert M, Ausserhofer D, Desmedt M, Schwendimann R, Lessafre E, Li B, Geest S. Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals - A cross sectional study. Int J Nurs Stud. 2013;50(2):230-239.

8. Cho S, Mark B, Knafl G, Chang H. Yoon H. Relationships Between Nurse Staffing and Patients’ Experiences, and the Mediating Effects of Missed Nursing Care. J Nurs Scholarsh. 2017;49(3):347-355.

9. Moreno-Monsiváis M, Moreno-Rodríguez C, Interial-Guzmán M. Missed Nursing Care in Hospitalized Patients. Aquichán. 2015;15:318-328.

10. Dehghan-Nayeri N, Ghaffari F, Shali M. Exploring Iranian nurses’ experiences of missed nursing care: a qualitative study: a threat to patient and nurses' health. Med J Islam Repub Iran. 2015;29:276.

11. Bragadóttir H, Kalisch B, Tryggvadóttir G. Correlates and predictors of missed nursing care. J Clin Nurs. 2017;26(11-12):1524-1534.

Keywords

Missed Nursing Care, Delayed Nursing Care, Unfinished Nursing Care.

P121 The meaning of the family for future family nurses

João MG Frade^1,2, Carolina Henriques^1,2, Célia Jordão¹, Clarisse Louro¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Carolina Henriques (carolina.henriques@ipleiria.pt)

Background

The family must be understood as a natural context of growth, involving the notion of complexity, of blood and/or affective bonds, generating love, but also suffering. The systemic view of the family considers the family as a whole, in which its members interact with one another, being that the imbalance of the system can cause imbalance in the individual and vice versa. The Family Nurse can be the reference professional, ensuring for the specialized accompaniment of the family, as a care unit, throughout the life cycle.

Objective

To know the perception about “family” and “family health nursing” by future family nurses.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data, and open questions regarding conceptual understanding of family and family health nursing. A total of 13 nurses participated in the study to develop skills in the field of family health nursing. All formal and ethical procedures have been taken into account.

Results

Nurses report that they (100%) never attended before any training course in the field of family health nursing, recognizing the importance of knowing who the family members are (92.3%). 38.5% disagrees that the presence of family members alleviates their workload and 23.1% state that the presence of family members makes them feel that they are being evaluated. Mostly, the family is defined as a group of people with a common link (n= 10). Family health nursing is seen as: caring for the family; personalizing and integrating the nursing care provided to the person and to the family; the existence of a family nurse who knows all its members; the one that equates the care to the individuals according to the characteristics of the family; a health support of the group; a nurse that focuses mainly on the patient and on the family, in partnership with the respective family doctor.

Conclusions

Given the data obtained, it is understood that the conceptualization of family and family health nursing should be clarified so that nurses can focus on the internal dynamics of the families and their relationships, family structure and functioning. This can be as such, that the relationship of the different subsystems, of the family as a whole and with the surrounding environment, generates changes in the intrafamilial processes and in the interaction of the family with the environment.

Keywords

Family, Nurses, Family nursing.

P122 The dizziness in patients with cochlear implants

Ana Rosado, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Ana Rosado (anarnamoradorosado@gmail.com)

Background

The cochlear implant (CI) is a surgical method widely used today for the (re)habilitation of individuals with bilateral, severe to profound sensorineural hearing loss. Due to the proximity between the cochlea and the surrounding structures without vestibular system, and a delivery endolymphatic fluid, there may be a relationship between this form of (re)hearing activation and vestibular dysfunctions presented after a cochlear implant placement surgery.

Objective

Through a systematic review of the literature, we intend to determine the post-surgical vestibular changes existing in individuals submitted to CI placement, as well as to understand the procedures involved in this evaluation.

Methods

Scientific articles were searched according to the search engines B-on, PubMed, Scielo and ScienceDirect, obtaining a total of 48 articles. After applying the inclusion criteria, 12 articles were analysed in more detail, 4 of which were selected to integrate this systematic review of the literature.

Results

After a systematic review of all articles, we found data reporting a decrease in the amplitude of the response wave vestibular evoked myogenic potential (cVEMP), an increase in average scores in the Dizziness Handicap Inventory (DHI), and an alteration of the classification of the caloric response (normal → hyporeflexia and/or hyporeflexia → arreflexia), in the postoperative period. However, it is not possible, to conclude that these vestibular changes are directly related to the placement of the CI. The use of a protocol evaluating vestibular function at the pre- and post-surgical periods was not verified, nor was the anatomical relationship between the cochlea and the vestibule and semi-circular canals (SSC).

Conclusions

We conclude that the studies directed to the vestibular evaluation during the protocol of placement of CI are reduced and without conclusions on the long term, since this follow up was done within a short time after its placement. There is a lack of a basic protocol, which helps the health professionals involved in the process to evaluate the vestibular system, as well as the sensitization of these to the possible influence of the CI insertion surgery in this system.

Keywords

Audiology, Vestibular Disorders, Dizziness, Cochlear Implant, cVEMP.

P123 Practice of episiotomy during labour

Manuela Ferreira¹, Onélia Santos², João Duarte¹

¹Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ²Centro Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal

Correspondence: Manuela Ferreira (mmcferreira@gmail.com)

Background

The World Health Organization (WHO, 1996) recommends the use of limited episiotomy since no credible evidence that its widespread use or routine practice has a beneficial effect.

Objective

To demonstrate scientific evidence of the determinants of the practice of selective episiotomy in women with normal/eutocic delivery; to identify the prevalence of episiotomy; and analyse the factors (sociodemographic variables, variables related to the new-born, contextual variables of pregnancy and contextual delivery) that influence the practice of episiotomy.

Methods

The empirical study I (part I) followed the systematic methodology of literature review. A search of studies published between January 2008 and December 23, 2014, was made in the databases: EBSCO, PubMed, Scielo, RCAAP. The studies found were evaluated taking into account the inclusion criteria previously established. Two reviewers assessed the quality of the studies to include using a prospective, randomized and controlled grid for critical evaluation. After critical evaluation of the quality of the study, 4 research articles that obtained a score between 87.5% and 95% were included.

The empirical study II (part II) is part of a quantitative, cross-sectional, descriptive, retrospective study, developed in the Obstetrics Service of Hospital Cova da Beira, according to a non-probability sampling process for convenience (n = 382). Data collection was executed by consulting medical records of women aged ≥ 18 years who had a vagin*l delivery with a live foetus after 37 weeks of gestation.

Results

Evidences that episiotomy should not be performed routinely and that should be limited to specific clinical situations were found. While performing selective episiotomy, when compared to routine episiotomy, a lower risk of trauma of the posterior perineum was associated with less need for suturing and fewer healing complications. Studies carried out on a sample of 382 women, aged between 18-46 years, which did not carry episiotomy in 41.7% of the cases, pointed to the relevance of selective episiotomy. Among the sample, a significant number of women with eutocic delivery (80.5%), with suture (95.0%), grade I lacerations (64.9%), perineal pain (89.1%) were subjected to episiotomy (58.3%). Among the group of women undergoing episiotomy (91.4%), most of the babies born presented a normal weight (92.3%).

Conclusions

In view of these results and based on the available scientific evidence recommendations given for several years, that a more a selective use of episiotomy should be made; it is suggested that health professionals should be more awake to this reality, so we can override the resistance and barriers against the selective use of episiotomy.

Keywords

Eutocic Childbirth, Selective Episiotomy, Routine episiotomy.

P124 RNAO’s Best Practice Guidelines in the nursing curriculum – implementation update

Ana V Antunes¹, Olga Valentim¹, Fátima Pereira¹, Fátima Frade¹, Cristiana Firmino¹, Joana Marques¹, Maria Nogueira¹, Luís Sousa^1,2

¹Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; ²Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal

Correspondence: Ana V Antunes (vantunes@uatlantica.pt)

Background

In the last 30 years Nursing Education in Portugal went through several changes which directly impacted on the professional development model and on the recognition of nurse’s scope of practice. Since the Declaration of Bolonha, nursing students are provided with a more practical and profession oriented nursing training [1, 2]. As our professionals’ skills become more recognized in the global health market, also our need to improve education and professional development rises. The best way to enhance the quality of practice education provided to undergraduate nursing students and to improve clinical outcomes is by enriching the academic curriculum with evidence-based nursing practices (EBNP) [3]. The Best Practice Guidelines Program (BPGP) was developed by the Registered Nurses Association of Ontario (RNAO) to support EBNP [4].

Objective

Provide an update on the process of implementation of RNAO’s Best Practice Guidelines (BPGs) in the nursing curriculum.

Methods

The implementation process was supported by the RNAO’s Toolkit for Implementing Best Practice Guidelines (BPGs) [5]. It is a comprehensive resource manual, grounded in theory, research and experience, that provides practical processes, strategies and tools to both Providers, Educational Institutions, Governments, and others committed to implement and evaluate BPGs.

Results

The BPGs selection and implementation brought together some of the suggested activities from the six steps of the manual. It resulted in the selection of three clinical guidelines (Engaging Clients Who Use Substances [6]; Prevention of Falls and Fall Injuries in the Older Adult [7]; Primary Prevention of Childhood Obesity [8] and a Healthy Work Environments Guideline (Practice Education in Nursing, [9]). We considered two main areas to intervene, in order to address the challenge of generating scientific evidence for nursing practice: the academic and the clinical setting (partner institutions, where students undertake their clinical practice). The implementation process included three fundamental players from both settings: professors, nursing students and clinical nursing instructors. To evaluate our performance and measure the improvements, we created structure, process and outcome indicators for each guideline. Data collection tools were first used in the curricular units that precede clinical teaching, and results will be processed and analysed.

Conclusions

Professors, students and partner institutions were successfully engaged in the initiative. We are investing in an action plan to embed the evidence-based practice culture, through an orientation program for clinical nursing instructors. The strategy is to strengthen the relationship with providers in order to standardize evidence-based procedures and improve both nurses’ education and quality of care.

References

1. Hvalič-Touzery S, Hopia H, Sihvonen S, Diwan S, Sen S, Skela-Savič B. Perspectives on enhancing international practical training of students in health and social care study programs-A qualitative descriptive case study. Nurse Educ Today. 2017;48:40-47.

2. Arrigoni C, Grugnetti AM, Caruso R, Gallotti ML, Borrelli P, Puci M. Nursing students’ clinical competencies: a survey on clinical education objectives. Ann Ig. 2017;29(3):179-188.

3. Drayton-Brooks SM, Gray PA, Turner NP, Newland JA. Building clinical education training capacity in nurse practitioner programs. J Prof Nurs. 2017;33(6):422-428.

4. Athwal L, Marchuk B, Laforêt, Fliesser Y, Castanza J, Davis L, LaSalle M. Adaptation of a Best Practice Guideline to Strengthen Client‐ Centered Care in Public Health. Public Health Nursing. 2014 Mar 1;31(2):134-43.

5. Registered Nurses’ Association of Ontario (RNAO). Toolkit: Implementation of best practice guidelines (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario. 2012.

6. Registered Nurses’ Association of Ontario (RNAO). Engaging Clients Who Use Substances. Toronto, ON: Registered Nurses’ Association of Ontario. 2015.

7. Registered Nurses’ Association of Ontario (RNAO). Prevención de caídas y lesiones derivadas de las caídas en personas mayores. (Revisado). Toronto, ON: Asociación Profesional de Enfermeras de Ontario. 2015.

8. Registered Nurses’ Association of Ontario (RNAO). Primary Prevention of Childhood Obesity (Second Edition). Toronto, ON: Registered Nurses’ Association of Ontario. 2014.

9. Registered Nurses’ Association of Ontario (RNAO). Practice Education in Nursing. Toronto, ON: Registered Nurses’ Association of Ontario. 2016.

Keywords

Evidence-Based Nursing, Nursing Education, Substance-Related Disorders, Accidental Falls, Pediatric Obesity.

P125 Swimming practice and hearing disorders

Mara Rebelo, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Mara Rebelo (mararebelo@hotmail.com)

Background

Health assessment, promotion and prevention are a crucial pillar in the face of emerging trends and threats. In fact, disease prevention is surely the way to go. This is not to say that we should neglect the treatment of disease, but rather that we must make a clear bet on its prevention according to our daily behaviour and the circ*mstances in which we live. The practice of swimming is recommended, especially for children, since it presents benefits, namely in the treatment of respiratory diseases, allergic problems and in the improvement of motor coordination and/or postural problems. However, during swimming lessons, children are exposed to numerous harmful risk factors to the middle ear and the outer ear. Therefore, preventive measures are essentially the eviction of some factors that increase the associated risks.

Objective

To analyse possible audiological changes in swimming children, aged between 3 and 10 years. It is also intended to sensitize educators about the risk factors associated with possible hearing loss, even if temporary.

Methods

The sample consisted of 56 students from the School Group of Benedita - Municipality of Alcobaça. All children underwent: otoscopy, tympanogram and tonal audiogram of screening, after the prior authorization of their legal representatives for their participation in the study.

Results

Among the 112 otoscopies performed were: 85.7% without alterations in the right ear and 83.9% in the left ear. Of the 56 individuals participating in the sample, it was verified that 17.9% had audiological alterations, of which 20.7% were swimming practitioners and 14.8% did not practice swimming. Of the 29 swimming practitioners, 6.9% had a type B tympanogram, of which 7.1% in the 3 to 5 age group, and 6.7% in the 6 to 10 age group.

Conclusions

It seems unlikely that swimming practice is directly related to the increase of middle ear secretions, and possible auditory alterations, given the minimal differences observed between swimmers and non-swimmers. Swimming practice beyond the malefic factors can to some extent be associated with beneficial factors, both in promotion and in the prevention of middle ear health.

Keywords

Hearing Loss, Swimming, Children, Middle ear infections, Audiological changes.

P126 The impact of physical activity on spirometric parameters in non-institutionalised elderly people

Fernanda Silva¹, João Petrica^1,3, João Serrano^1,3, Rui Paulo^1,2, André Ramalho^1,2, José P Ferreira⁴, Pedro Duarte-Mendes^1,2

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Centro de Estudos em Educação, Tecnologias e Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ³Research on Education and Community Intervention, 4411-801 Arcozelo – Vila Nova de Gaia, Portugal; ⁴Research Unit for Sport and Physical Activity, University of Coimbra, 3040-248 Coimbra, Portugal

Correspondence: Fernanda Silva (f.m.a.s_298@hotmail.com)

Background

Physical activity decreases as a result of the ageing process. Therefore, the elderly tend to spend more time adopting sedentary behaviours [1]. The respiratory system also undergoes progressive involution with age, resulting in anatomical and functional alterations [2]. The positive relationship between physical activity and spirometric parameters has been thus confirmed [3]. It is recommended that the elderly should accumulate at least 30 minutes of moderate- to vigorous-intensity physical activity per day [4].

Objective

The aim of this paper is to verify the existence of differences regarding spirometric values between two groups of people: those who complied and those who did not comply with the Global Recommendations on Physical Activity for Health [4].

Methods

The current study included 36 participants of an average age of 72.28, both male and female (SD= 6.58). The group which has fulfilled the recommendations included 16 elderly individuals (53.76 ± 24.39 minutes); the group which has not fulfilled the recommendations included 20 elderly individuals (15.95 ± 7.79 minutes). Physical activity was assessed using accelerometry (ActiGraph®, GT1M model, Fort Walton Beach, Florida, EUA). Data were recorded for three consecutive days and 600 minutes of daily recording, at least. Spirometry tests were performed using the Cosmed® Microquark spirometer. The following parameters were analysed: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Peak Expiratory Flow (PEF) and Expiratory Volume in one second and Forced Vital Capacity rate (FEV1/FVC). In order to analyse data, descriptive and inferential statistics were used. The Shapiro-Wilk test was applied to assess normality, whereas the Mann-Whitney test and the t-Test were used for independent samples.

Results

The group which has fulfilled the recommendations on physical activity has achieved better percentage spirometric values in VEF1, PEF e VEF1/FVC. However, significant differences were only found in VEF1/FVC% (p= 0.023).

Conclusions

The results therefore suggest that compliance with the Global Recommendations on Physical Activity for Health is associated with better VEF1/FVC% values in non-institutionalised elderly people.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

References

1. Matthews CE, Moore SC, Sampson J, Blair A, Xiao Q, Keadle SK, Hollenbeck A, Park Y. Mortality Benefits for Replacing Sitting Time with Different Physical Activities. Med Sci Sports Exerc. 2015;47:1833-1840.

2. Lalley PM. The aging respiratory system-Pulmonary structure, function and neural control. Respir Physiol Neurobiol. 2013;187:199-210.

3. Nawrocka A, Mynarski W. Objective Assessment of Adherence to Global Recommendations on Physical Activity for Health in Relation to Spirometric Values in Nonsmoker Women Aged 60-75 Years. J Aging and Phys Act. 2016;25:123-127.

4. WHO. Global Recommendations on Physical Activity for Health. Switzerland: World Health Organization; 2011. Available from: http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf

Keywords

Accelerometry, Recommendations on physical activity, Elder, Spirometry.

P127 Predictors of abandonment of exclusive breastfeeding before 6 months

Cristiana Afonso, Cristiana Lopes, Fernanda Pais, Suzi Marques, João Lima

School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Cristiana Afonso (cristiana_oa@hotmail.com)

Background

The World Health Organization (WHO) recommends exclusive breastfeeding up to 6 months of age, considering its nutritional, immunological, psychological and economic benefits. However, according to the Inquérito Alimentar Nacional e de Atividade Física, only about 46% of the children were exclusively breastfed for less than 4 months and only 21.6% for 6 months or more.

Objective

This study aimed to identify the predictors that most influence mothers in the decision to not to exclusively breastfeed until 6 months.

Methods

A review of the literature on the main determinants of exclusive breastfeeding was carried out, and an inquiry was then compiled with the identified predictors. In this context, mothers who had not breastfed or had not exclusively breastfed until 6 months of age were asked to choose the determinant that best suited their situation. The inquiry was made available through several online platforms, some of which aimed at childcare. It was considered inclusion criteria to be a mother.

Results

A total of 1,685 mothers were questioned, 1,644 (97.57%) of whom breastfed and 866 (51.39%) exclusively breastfed up to 6 months. The predictors most frequently identified by mothers who had not breastfed or had not breastfed exclusively until 6 months (819 mothers) were “work-constrains related to work schedule to breastfeeding” (33.1%), “milk drying” (27.1%), “few daily periods of breastfeeding” (12.9%), “personal condition” (11.5%), “missing or few conditions for breastfeeding at work” (11.2%).

Conclusions

This work allowed the identification of the predictors of non-breastfeeding or of its non-exclusivity until 6 months, observing a strong contribution of the working conditions to this problem. Knowledge of this reality may be important to develop policy measures to act against this trend.

Keywords

Exclusive breastfeeding, Predictors, Inquiry.

P128 Auditory training in children and youngsters with learning disabilities

Mariana Araújo, Cristina Nazaré

Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Mariana Araújo (mariana_msda@hotmail.com)

Background

Hearing has a fundamental role in the learning process, and studies had showed that some children and youngsters, with normal hearing, could present auditory processing disorders with possible implications in the learning process. It is also known that not all learning problems are due to auditory processing disorders and all cases of auditory processing disorders do not lead to learning problems. Studies also point out that an adequate and personalized auditory training may be a viable option in the rehabilitation of auditory information processing in the central nervous system (brain neuroplasticity training), being the early assessment and intervention important to minimize the associated consequences, such as the possible difficulties on the learning process.

Objective

To analyse the influence that auditory training has on the improvement of auditory processing disorders of children and youngsters, with learning disabilities.

Methods

For this purpose was conducted a systematic literature review with search of scientific papers on electronic databases B-on, PubMED, ScienceDirect and SciELO with keywords such as auditory training, auditory processing, auditory processing disorders, learning disabilities, learning difficulties, children and youngsters (in Portuguese, English or Spanish). For this review were established inclusion criteria such as: publication type and date (original articles available since 2007); sample (in accordance with our purpose) and tests used (to evaluate and training the auditory processing).

Results

After the search strategies five articles in accordance with the pre-established inclusion criteria were selected from out of the 127 found.

Conclusions

The auditory training is effective in the rehabilitation of auditory processing disorders in children and youngsters with learning disabilities, and studies showed that a specific diagnosis of the abilities affected is fundamental, in order to achieve the perfect and most efficient training plan for each individual, as well as, a continuous re-evaluation to adjust the training. Since it is a complex interaction between those disorders it is still necessary to carry out further studies in this area that should try to establish some guidelines and try to clarify the plan of the auditory training program.

Keywords

Auditory training, Auditory processing disorders, Learning disabilities, Children, Youngsters.

P129 Inadequated environmental sanitation diseases (IESDs) in Porto Alegre – RS/ Brasil

Rita C Nugem¹, Roger S Rosa², Ronaldo Bordin³, Caroline N Teixeira⁴

¹Health Services and Performance Research, Claude Bernard Lyon University, 69100 Lyon, France; ²Department of Social Medicine, Medical School, Rio Grande do Sul Federal University, 90040-060 Porto Alegre, Brazil; ³Administration School, Rio Grande do Sul Federal University, 96201-900 Rio Grande do Sul, Brazil; ⁴Fundação Hospitalar Getúlio Vargas, 93210-020 Sapucaia do Sul, Rio Grande do Sul, Brazil

Correspondence: Rita C Nugem (rcnugem@gmail.com)

Background

Countries in Europe and North America managed to control and eradicate most of the infectious-parasitic diseases that occurred in the first half of the twentieth century [1]. Nevertheless, infectious and parasitic diseases are still present in certain metropolitan areas of Brazil, despite the increased prevalence of chronic diseases. This work aims to present the general aspects of the situation of diseases related to inadequate environmental sanitation (IESDs) and of the sanitation policy of Porto Alegre.

Objective

The general objective was to examine the public policy for environmental sanitation in Porto Alegre, and, the specific objectives were: I) to analyse the relationship between indicators of poverty and inadequate environmental sanitation and the occurrence of diseases related to inadequate environmental sanitation; and, II) to present the situation of IESDs and the sanitation policy of Porto Alegre.

Methods

The method was qualitative and quantitative, with data collection and analysis of public policies. The period analysed was from 2008 to 2012. Data were obtained from Health Information Systems, DATASUS website of the Ministry of Health, along with a set of basic indicators from the Porto Alegre’s Observatory. The indicators were classified according to the specific objectives: poverty(P); environmental sanitation(S); diseases(D). Pearson's linear correlation coefficient was used for statistical analysis to test the associations between poverty and basic sanitation indicators with IESDs indicators.

Results

The results showed that the biggest problems related to IESDs occur in the poorest regions, which are: Restinga, Parthenon, Nordeste, Lomba do Pinheiro, Gloria, Ilhas and Extremo Sul. The higher concentration of Dengue was found in the Parthenon region; Leptospirosis in the regions of Restinga, Extremo Sul, Lomba do Pinheiro, Norte and Eixo Baltazar; Hepatitis A in the regions of Ilhas, Nordeste, Humaitá /Navegantes, Centro, Lomba do Pinheiro, Norte, Leste and Parthenon. Regarding the public policy for Environmental Sanitation in Porto Alegre, we concluded that there are some urban policies, but the subject needs greater systemic view directed to the most specific problems of the city. About the Sanitation Plans, we concluded that the regions that need the sanitation, at most - a sewage collection network - have a lower footage for infrastructure installation, such as, the region of Ilhas. The sanitation basic plan (Water) gives various information about areas that need the implementation of infrastructures of universal supply, however there is still no date of when that will be possible.

Conclusions

Finally, infectious and parasitic diseases are a reality in Porto Alegre. Still at the XXI century, there are about 1,200 annual hospitalizations in health services (SUS) and are responsible for about 750 deaths per year in the capital city.

References

1. Carvalho EMF, Lessa F, Gonçalves FR, Silva JAM, Lima MEF, Melo Jr, SW. O processo de transição epidemiológica e iniquidade social: o caso de Pernambuco. RASPP Rev. Assoc. Saúde Pública de Piauí. 1998;1(2):107-119.

Keywords

Environmental sanity, Health, Hydric disease, Sanitation, Public policy.

P130 Lateralization of the visual word form area in patients with alexia after stroke

Inês Rodrigues^1,2, Nádia Canário, Alexandre Castro-Caldas³

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal

Correspondence: Inês Rodrigues (ines.rodrigues@ipleiria.pt)

Background

Knowledge of the process by which visual information is integrated into the brain reading system promotes a better understanding of writing and reading models.

Objective

This study aimed to use functional Magnetic Resonance Imaging (fMRI) to explore whether the Blood-oxygen-level dependent (BOLD) contrast imaging patterns, of putative cortical region of the Visual Word Form Area (VWFA), are distinct in aphasia patients with moderate and severe alexia.

Methods

Twelve chronic stroke patients (5 patients with severe alexia and 7 patients with moderate alexia) were included. A word categorization task was used to examine responses in the VWFA and its right hom*olog region. Patients performed a semantic decision task in which words were contrasted with non-verbal fonts to assess the lateralization of reading ability in the ventral occipitotemporal region.

Results

A fixed effects (FFX) general linear model (GLM) multi-study from the contrast of patients with moderate alexia and those with severe alexia (FDR, p = 0.05, corrected for multiples comparisons using a Threshold Estimator plugin (1000 Monte Carlo simulations), was performed. Activation of the left VWFA was robust in patients with moderate alexia. Aphasia patients with severe reading deficits also activated the right hom*olog VWFA.

Conclusions

This bilateral activation pattern only in patients with severe alexia could be interpreted as a result of reduced recruitment of the left VWFA for reading tasks due to the severe reading deficit. This study provides some new insights about reading pathways and possible neuroplasticity mechanisms in aphasia patients with alexia. Additional reports could explore the predictive value of right VWFA activation for reading recovery and aid language therapy in patients with aphasia.

Keywords

Stroke, Aphasia, Alexia.

P131 Sexuality in women with oncological pathology

Filomena Paulo¹, Manuela Ferreira²

¹Centro Hospitalar Tondela-Viseu, 3509-504 Viseu, Portugal; ²Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal

Correspondence: Filomena Paulo (filopaulo@live.com.pt)

Background

It is a challenge for current nursing to care for women with oncological pathology, in what a nursing philosophy of care is concerned, and whose main focus of care are women in their multidimensionality and not the disease itself.

Objective

To identify some determinant factors of physical well-being, quality of life and sexuality in women with oncological disease.

Methods

The methodology that guided the research was an integrative review (IR) of literature. A survey was carried out in the databases: LILACS, SCIELO, Google Academic, BDENF and B-ON, between 2012 and 2016, starting from the previously defined inclusion criteria. The selected studies were subsequently evaluated. 71 articles emerged from this research study strategy. After reading all the abstracts of the articles, 27 were selected, including integrative review articles, systematic reviews of cross-sectional studies and descriptive and exploratory studies, whose contents were of interest to this review.

Results

After analysing the articles, it was concluded that sexual health and treatments are important aspects for the quality of life of women with oncological disease and that radical mastectomy has repercussions on body image and sexual function, since it affects self-esteem and the feeling of femininity and sexuality. Factors such as hair loss, gain or loss of weight, chronic fatigue, nausea, pain, stress, feeling of not being a complete woman, decreased arousal, lack of interest or dissatisfaction are determinants for a woman's sexual activity.

Conclusions

Integrative care for women with oncological pathology is a challenge for health professionals. The strategies to be adopted involve the inclusion of women's sexuality in the nursing care plan, without taboos or prejudices, because the evidence identifies the need for intervention in this field to improve, effectively, the quality of life of these women.

Keywords

Sexuality, Woman, Oncology, Integrative care, Quality of life.

P132 Patient compliance to arterial hypertension treatment: integrative review

Diana Tavares¹, Célia Freitas², Alexandre Rodrigues³

¹USF Salinas – Agrupamento de Centros de Saúde do Baixo Vouga, Portugal; ²Center for Research in Health Technologies and Services, Aveiro University, Higher School of Health, 3810-193 Aveiro, Portugal; ³Center for Health Studies and Research of the University of Coimbra, Aveiro University, Higher School of Health, 3810-193 Aveiro, Portugal

Correspondence: Diana Tavares (diana.marsilia@ua.pt)

Background

Cardiovascular diseases are the main cause of worldwide mortality, and hypertension is an important public health problem [1]. Nonadherence to treatment influences the health of the patient and can generate several complications. In this way, health care providers are confronted with the best strategies to promote effective management of the disease, together with patients and families. The nursing consultation seems to be a privileged setting for assisting patients for healthy behaviour changes with a personalized intervention adjusted to the needs of each one [2, 3].

Objective

To analyse the factors that promote or inhibit adherence to treatment and to identify the nursing interventions that determine treatment adherence.

Methods

We conducted an integrative literature review with qualitative and quantitative studies through electronic databases Scielo, Scopus, Medline, LILACS and B-on, using the following selected research discriminators, “adherence”, “patient”, “hypertension” and “nursing care” from the DeCs and MeSH for articles published between 2011 and 2016. The PICOD [4, 5] method and the QualSyst [6] tool were used to evaluate the research question and the quality of the articles, respectively.

Results

In this research 372 articles were found, and 10 were selected, corresponding to 2,565 hypertensive patients over 18 years old, of whom 64% were female. Despite the differences found in the methodologies of these studies, the results indicated a poor adherence to the treatment [7]. The analysis resulted in two major categories that explain patients' adherence to the treatment of hypertension, namely the factors that influence adherence and nursing interventions. The most significant factors that inhibit adherence are complex drug regimens, lack of knowledge, and poor physical activity. The nursing interventions that enhance adherence were the adoption of continued educational strategies.

Conclusions

Patient adherence is a complex issue with a huge burden for the health system because it not only implies the change of patient behaviours, but also other factors like the involvement of caregivers and families. Considering the factors described in this review, the nursing consultation, through the definition of educational strategies, seems to increase patient adherence to treatment. In future research, guidelines will be suggested that aim to increase adherence to treatment.

References

1. Direção-Geral da Saúde. Doenças Cérebro-Cardiovasculares em Números 2015 [Internet]. 2016 [cited 2016 Mar 18]. Available from: https://www.dgs.pt/em-destaque/portugal-doencascerebro-cardiovasculares-em-numeros-201511.aspx

2. Organização Mundial da Saúde [OMS]. Adherencia a los tratamientos a largo plazo [Internet]. Genebra; 2004 [cited 2016 Feb 20]. p. 127–32. Available from: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=18722&Itemid=

3. Organização Mundial da Saúde [OMS]. A global brief on HYPERTENSION [Internet]. World Health Day 2013. Geneva; 2013 [cited 2016 Feb 22]. Available from: http://www.who.int/iris/handle/10665/79059

4. The Joanna Briggs Institute. Reviewers’ Manual [Internet]. 2011th ed. Vol. 53, Adelaide: The Joanna Briggs Institute; 2011 [cited 2016 Oct 5]. Available from: http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2011.pdf

5. Ramalho A. Manual para redacção de Estudos e Projectos de Revisão Sistemática com e sem metanálise – Estrutura, funções e utilização na investigação em enfermagem. Coimbra: Formasau - Formação e Saúde, Lda; 2005.

6. Kmet LM, Lee RC, Cook LS. Standard quality assessment criteria for evaluating primary research from a variety of fields. HTA Initiat [Internet]. 2004;13(February). Available from: http://gateway.nlm.nih.gov/MeetingAbstracts/103140675.html%5Cnpapers3://publication/uuid/C9499D35-AE13-428E-960B-68727C1B1833

7. Organização Mundial da Saúde. Adherence to long-term therapies: evidence for action. 2003.

Keywords

Patient compliance, Nursing care, Hypertension.

P133 Didactic material as an intervention strategy in homecare for families of patients with mental disorders

Luísa FT Ferreira¹, Ednéia AN Cerchiari¹, Simara S Elias¹, João B Almeida²

¹Mato Grosso do Sul State University, 79804-970 Mato Grosso do Sul, Brazil; ²Centro Universitário Salesiano de São Paulo, 13467-600 Americana, São Paulo, Brazil

Correspondence: Luísa FT Ferreira (luisaftf@gmail.com)

Background

On a daily basis, we have discussed and reflected about health education on public care as a way of interaction between health care professional and patients, with the purpose of, not only to inform, but also to exchange knowledge and experiences.

Objective

To elaborate and validate a Practical Guide of Care for family members of patients with mental disorders: guidelines and highlights.

Methods

This is a qualitative, descriptive, ongoing study with relatives of intern patients with mental disorder of a university hospital in Brazil, starting in August 2014 and finishing by October 2018.

Results

Five families, a total of 9 people, were interviewed through a semi-structured questionnaire. In order to create the Practical Guide, the methodological steps of the Popular Education process of Paulo Freire were used to analyse the data, as following: Thematic investigation; Thematic and Problematization. The Practical Guide of Care for Families of Patients with Mental Disorders: Guidelines and Highlights, was created in 2015 and published in 2017, containing 32 pages printed on coloured on couché paper with watercolour pictures and information arranged in short and direct texts, related to the home care of patients with mental disorders. The guide validation process began in January 2018 and is going along with professional judges that were chosen by their expertise, with one of each area: physician, psychiatrist, psychologist, nurse, social worker, pharmacist and occupational therapist. For collecting data, an instrument adapted from the Oliveira’s (2006) [1] study was used, allowing apparent and content evaluation. The instrument has affirmations about the evaluated material and was developed based on a Likert scale. The data collected will be analysed through simple statistics and organized through tables, respecting the ethical aspects proposed by Resolution 466/2012 of the National Health Council, regarding research with humans. An apparent and content evaluation with the relatives of the patients will also take place.

Conclusions

We expect that the final product of this study, the Validated Practical Guide, will provide support for adoption of increasingly effective strategies for the home treatment of patients with mental disorders.

References

1. Oliveira VLB, Landim FLP, Collares PM, Santos ZMSA. Modelo explicativo popular e profissional das mensagens de cartazes utilizados nas campanhas de saúde. Texto Contexto Enferm. 2007;16(2):287-293.

Keywords

Teaching materials, Public health education, Mental Disorder.

P134 Family health in Leiria council: study of some determinants

Marta Serrano, Rodrigo Correia, André Branco, Luís Mousinho, Teresa Kraus^1,2

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Teresa Kraus (teresa.kraus@ipleiria.pt)

Background

Family is the main responsible unit for personal development, and any change on a member causes alterations to the entire family [1]. The binomial family-determinants has an impact in education, socialization, in healthcare, on believes and values of the family, as well as in the well-being and health of its members.

Objective

To characterize the families according to its composition, family cohesion and adaptability, protective factors, health state and its determinants. Identify points of intervention on the community and family.

Methods

This is a quantitative, correlational and transversal study, whose data was collected in February and March 2017, in the council of Leiria, by the application of a questionnaire which evaluated sociodemographic data, family functioning, family protective factors, and the participants’ mental health, resorting to MHI5 [2], FACES IV and to the inventory of protective factors [3].

Results

The sample (N=224) had an average age of 40.7 years, the participants were mainly females (58.9%) residing in the countryside (69.9%). The family composition went from the nuclear type (the most common), as well as a couple, single parent, celibate, extended family and even a reconstituted family. Most of the participants consider their family function as reasonable, are satisfied with the quality of their communication and perceive family protection. However, these consider having few gratifying experiences. The majority of the sample claimed to have a good family health state, furthermore 25.0% showed signs and symptoms of severe depression and 13.4% was going through some chronical disease. As for the determinant factors, most of the respondents seemed to have a good access to health care, unlikely to transportation and social services. Around 80.0% denied daily tobacco or alcohol consumption and the religious activities were the most popular among the participants.

Conclusions

The results of this study allow to identify two major focus of community attention in the council of Leiria: the accessibility and regular function of social services; the early diagnosis and treatment of the family/person with depressive symptoms, with prevention of new cases; and the knowledge and integration of care related to the person living with chronical disease. Associated with the Calgary Model and with the Dynamic Model, the philosophy of care expressed in the Competency for Proactive Unconditional Care guides the discovery of meaning and promotes rewarding relationships, even during apparently negative experiences [4].

References

1. Hanson S. Enfermagem de Cuidados de Saúde à Família: Teoria, Prática e Investigação. 2nd edition. Loures: Lusociência; 2005.

2. Ribeiro JLP. Mental Health Inventory: Um estudo de adaptação à população portuguesa. Psicologia, Saúde & Doenças. 2001;2(1):77-99.

3. Augusto C, Ferreira O, Araújo B, Rodrigues V, Figueiredo M. Adaptation and validation of the Inventory of Family Protective Factors for the Portuguese culture. Revista latino-americana de enfermagem. 2014;22(6):1001-1008.

4. Kraus T, Dixe M, Rodrigues M. Dor, Sofrimento e Sentido de Vida: Desafio Para a Ciência, a Teologia e a Filosofia. In Lehmann O, Kroeff P, editors. Finitude e Sentido da Vida: Logoterapia no embate com a tríade trágica. São Paulo: Evangraf; 2014. p. 193-237.

Keywords

Family, Family health, Health determinants.

P135 Simulation as a pedagogical strategy in nursing teaching: teachers’ perspective

Cláudia Chambel¹, Catarina Carreira¹, Catarina Pinheiro¹, Luís Ramos¹, Catarina Lobão^1,2

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Catarina Carreira (cataricacarreira01@hotmail.com)

Background

Currently, classes with the resource of simulated practice have become fundamental to the nursing degree. In this way, teachers who teach classes with the resource of simulated practice feel obliged to prepare their students for clinical situations and there is a need to increase their training on new teaching strategies, such as simulation. Consequently, it becomes important for the development of students' competences, being therefore essential to deepen knowledge in this area.

Objective

We intend to know the perception of teachers of the nursing graduation course on the use of simulated practice as a pedagogical strategy.

Methods

To achieve our objective, we developed a research study using a qualitative approach and a semi-structured interview applied to seven teachers who teach classes with the resource of simulated practice in Escola Superior de Saúde de Leiria.

Results

From the results of our study, we verified that for the teachers, the simulation is a pedagogical strategy important in the creation of scenarios, a facilitator of the learning process that contributes to the increase of the security, confidence, satisfaction, motivation and development of technical and non-technical competences, for the formation of professional identity, management of autonomy, development of critical thinking and standardization of nursing care. Throughout the interviews they identified constraints in the use of simulation, such as: economic and material resources, realism, time available for training resourcing to simulators and the constitution of classes, since the number of students is considered excessive, and the personality of the students is also called into question. To overcome the constraints mentioned above, teachers appeal for the acquisition of material, in sufficient numbers to respond to the constitution of the classes and the desired realism. They affirm that the practical classes should have a superior workload, with unfolding of the classes, thus increasing the time given to debriefing.

Conclusions

Our results agree with the opinion of Gomes & Germano (2007) [1], Guhde (2011) [2] and Amendoeira, et al., (2013) [3], when they affirm throughout their studies that simulated practice allows a better articulation of the theoretical content with the practice, facilitating the learning of the contents taught in theory, via a consequent reflection of previous learning in the context of clinical practice, with the development of students' competences. In summary, the teachers interviewed highlight the importance of simulation, to answer to our research question, once they recognize the importance of simulation in the health field.

References

1. Amendoeira J, Godinho C, Reis A, Pinto R, Silva M, Santos J. Simulação na Educação em Enfermagem. Conceitos em Transição. Revista da UIIPS. 2013;2:212-228.

2. Gomes C, Germano R. Processo Ensino/Aprendizagem no Laboratório de Enfermagem: visão dos estudantes. Revista Gaúcha de Enfermagem. 2007;28(3):401-408.

3. Guhde JA. Nursing Students' Perceptions of the Effect on Critical Thinking, Assessment, and Learner Satisfaction in Simple. J Nurs Educ. 2011;50(2):73-78.

Keywords

Simulation, Nursing, Trainning.

P136 Simulation as a pedagogical strategy in nursing teaching: students’ perspective

Cláudia Chambel¹, Catarina Carreira¹, Catarina Pinheiro¹, Luís Ramos¹, Catarina Lobão^1,2

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Cláudia Chambel (simulacaoenfermagem@gmail.com)

Background

Nowadays, students increasingly recognize the importance of using simulated practice as an excellent pedagogical strategy, since it leads to experience situations very similar to reality, in an environment free of risks and penalties, which allows reflection and eventually to be repeated within useful time, thus leaving them readier to practice, in clinical situations.

Objective

We intend to know the perception of students of the nursing degree, on the use of simulated practice as a pedagogical strategy.

Methods

To achieve this, we developed a research study using a qualitative approach and a semi-structured interview applied to six students of the nursing degree of Escola Superior de Saúde de Leiria.

Results

From the results achieved we verify that the students indicate that the simulation is a pedagogical strategy, that facilitates the learning process and contributes to safety, confidence, satisfaction, motivation and development of technical and non-technical skills, with the recreation of scenarios closer to reality. However, they identify some constraints in the use of simulation, such as; economic resources for the acquisition of more recent and sophisticated material; realism, because the available material doesn’t allow feedback; time available for simulated practice and the constitution of classes (since they consider that the number of students is excessive and also the different personality of the students, because some students can’t take advantage of this strategy).

To overcome the constraints mentioned above, nursing students appeal for the acquisition of new and recent material, in sufficient number to overcome the heterogenic constitution of the classes and the desired realism. They affirm that practical classes should contribute more to the workload of the degree and should receive more attention from the teacher (either reducing the number of students or allowing the practical classes to be taught by two teachers simultaneously).

Conclusions

Our findings are in line with studies which states that high fidelity simulation facilitates the students' learning and acquisition of competencies, and results in increased motivation, satisfaction, critical thinking, and clinical decision-making. Also, Batista, Pereira and Martins (2014) [1] point out that in order for the simulated practice to reach its maximum exponent of realism, it is necessary equipment, environmental conditions similar to clinical practice and a high-fidelity simulator. In summary, the students interviewed highlight the importance of simulation in the health field.

References

1. Batista R, Pereira M, Martins J. Simulação no Ensino de Graduação em Enfermagem: Evidências Científicas. Série Monográfica Educação e Investigação em Saúde: A simulação no ensino de Enfermagem. 2014; pp. 65-81.

Keywords

Simulation, Nursing, Trainning.

P137 Partnership between nurses and security forces to reinforce literacy in the use of child safety seats

Rosa Moreira¹, Anabela Almeida²

¹Hospital Center Cova da Beira, 6200-251 Covilhã, Portugal; ²Research Unit in Business, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Anabela Almeida (aalmeida@ubi.pt)

Background

In Portugal the low literacy in health is recognized. Literacy in health is not only related to education, it arises from a convergence of factors involving education, cultural and social factors and health services. According to data provided by the World Health Organization and World Bank, if awareness is not raised and if global behavior does not change, road traffic injuries will increase dramatically by 2020, becoming the third leading cause of death around the world [1]. Nurses assume that they can be real agents of change and have a role to play in helping to shape the behavior of parents/other educators and to train them in the correct use of child safety seats (CSS).

Objective

The aim of this study was to evaluate whether the partnership between nurses from the Cova da Beira Hospital Center and the regional security forces generated better results in the effective use of CSS of parents or other carers during car transport and whether there is a gap between them and parents who have never been targeted by the team of nurses and security forces.

Methods

A cross-sectional descriptive-correlational study with a quantitative approach, whose participants are the children and their educators from 1st cycle schools in the counties of Fundão, Covilhã and Belmonte. Sample collected by accidental or convenience method, not random. The interview and the observation occur at the same moment with the driver of the vehicle that carries the child and is the subject of stop operation.

Results

The stop operations had a strong pedagogical and informative component, where the drivers were clarified about the data found during the observation, thus offering a good training opportunity in an informal context. In this study, 83% of the sample was for the first time benefiting from a stop operation promoted by the PROVIDAS and it was possible to conclude that drivers who have already been subject to the supervision of PROVIDAS make fewer errors in the use of CSS in relation to drivers who had never been audited by this team.

Conclusions

The results suggest to the positive influence of the training and pedagogical activity of nurses and the importance of the partnership with security forces in the effective use of CSS. Drivers were found to have made more mistakes without connection to the PROVIDAS in relation to drivers had contact with PROVIDAS and security forces.

References

1. Fundación Gonzalo Rodríguez. Manual de Buenas Prácticas: Cómo Abordar la Seguridad de los Niños como Pasajeros de Vehículos. Uruguay: Fundación Gonzalo Rodríguez; 2010.

Keywords

Child safety seats, Health literacy, Partnership.

P138 Physical activity and body image in physiotherapy students

Paula C Santos¹, Rafael B Pereira¹, Sofia MR Lopes¹, Cristina C Mesquita²

¹School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal; ²Center for Research and Rehabilitation, School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

Correspondence: Cristina C Mesquita (ctmesquita@ess.ipp.pt)

Background

There is a decrease in the physical activity of future physiotherapists, due to readjustments after admission to college. The high levels of sedentarism, cause diverse physical consequences, especially in terms of corporal image perception. This fact is due to a multidimensional construction of several psychosocial factors, which include motivational factors and behavioural changes.

Objective

To characterize the level of physical activity and satisfaction with body image among students of the first year of graduation in physiotherapy. Analyse the influence of initiating a graduation degree, in terms of physical activity and perception of corporal image and to also identify the main barriers to regular practice of physical activity.

Methods

An analytical cross-sectional study was carried out on a sample of 60 students (13 males and 47 females) from the first year of the physiotherapy degree at Escola Superior de Saúde do Porto (ESS-P), excluding those who had already attended a graduation degree. A sample characterization questionnaire and the International Questionnaire on Physical Activity (IPAQ) - Short Version were administered through the Qualtrics platform. For the anthropometric measurements and body composition, the Tanita BC-545NTM scale and a Seca stadiometer were used. Satisfaction with body image was assessed through the Body Shape Questionnaire. The questionnaire score and the Body Mass Index (BMI) were calculated. Data and its treatment was performed in the SPSS software, with a level of significance α = 0.05.

Results

About 20% individuals of the total sample were physically inactive and 56.7% were moderately active, there were differences in the level of activity between male and female; males were more in a “very active level” than females (61.5 vs 14.9%; p = 0.008). To start a graduation degree leads to a decrease in the regular practice of physical activity (78.3 vs 40.0%; p = 0.001 before and after, respectively). The main barriers identified for the regular practice of physical exercise were: 71.7% inadequate schedules; 30.0% laziness and 20.0% fatigue. About satisfaction with body image, only females were dissatisfied (30% vs 0%; p < 0.001). Starting a graduation degree made the perception of body image worse in 46.7% of the sample, without differences in gender.

Conclusions

There is a high percentage of students physically inactive and dissatisfied with body image, being this process more notorious among the female gender. Being admitted to a graduation degree has shown to influence negatively the level of physical activity and body satisfaction. Inadequate schedules are the main barrier to the practice of a physical activity.

Acknowledgements

We thank all the students of the first year of the degree in Physiotherapy of ESS-Porto of the 2016/2017 school year for the readiness and willingness to collaborate in the present study.

Keywords

Physical Activity, Students, Higher Education, Physiotherapy, Body Image.

P139 Physical activity and stress vulnerability in physiotherapy students

Cristina C Mesquita¹, Elsa S Rodrigues², Sofia MR Lopes², Paula CR Santos²

¹Center for Research and Rehabilitation, School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal; ²School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

Correspondence: Paula CR Santos (pcs@ess.ipp.pt)

Background

International and national recommendations in Health, consider adopting an active lifestyle as fundamental. Due to the decrease in physical activity observed in students of higher education, it became fundamental to raise awareness and promote healthy behaviours. Physiotherapy students are future healthcare professionals who are experts in movement, with a primary role in health promotion. Physical activity has benefits in physical well-being, stress reduction, and academic performance.

Objective

Characterize the physical activity level of first year physiotherapy students and its influence on stress vulnerability, as well as to analyse the evolution of physical exercise practice in the transition to higher education.

Methods

Cross-sectional analytical study of 60 first year physiotherapy students from Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-PP). The level of physical activity was evaluated through the International Physical Activity Questionnaires (IPAQ) and the vulnerability to stress with the Stress Vulnerability Assessment Scale (23QVS). The 23QVS is a self-assessment tool, consisting of 23 questions and allows assessing the vulnerability of an individual to stress. The higher the final score, the more vulnerable the individual is to stress, considering that the value 43 is the value above which an individual is considered vulnerable to stress. The Qualtrics software was used to fill in the questionnaires and the SPSS program for data analysis, with significance of α=0.05.

Results

Forty percent (40%) of the students practiced physical exercise, 18.3% were considered insufficiently active, with significant differences between genders, with males being more active (61.5 vs. 14.9, p = 0.003). (78.3% vs. 40.0%, p <0,001). It was verified that 40% of the individuals obtained a value of > 43 in the 23 QVS, showing more vulnerability to stress, being the greater proportion among the feminine gender. Nevertheless, statistically significant differences were not identified between genders (p = 0.074). Physical activity did not present a statistically significant relationship with stress vulnerability (p = 0.134; r_S = -0.195).

Conclusions

More than half of the students did not practice physical exercise and about a fifth were considered insufficiently active. The male gender had a higher level of physical activity. A large percentage of students showed excessive stress vulnerability. Starting higher education led to a decrease in the practice of physical exercise. There was no relationship between the level of physical activity and vulnerability to stress.

Acknowledgements

We thank all the students of the first year of the degree in Physiotherapy of ESS-Porto of the 2016/2017 school year for the readiness and willingness to collaborate in the present study.

Keywords

Physical Activity, Health Promotion, Stress, Academic Success.

P140 Representations of dementia experienced in the first person: a hermeneutic analysis

Carlos Laranjeira¹, Helena Quaresma²

¹Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-051 Coimbra, Portugal

Correspondence: Carlos Laranjeira (calaranjeira@sapo.pt)

Background

The global incidence of dementia has been growing exponentially in recent decades. As a chronic disease, it poses as a threat to physical and social existence, amputating or redefining the roles we assume as socially integrated individuals, leading to a heavy deconstruction on the everyday world.

Objectives

a) Describe the representations of the person with dementia on the disease, after the diagnosis; b) understand the process of adjustment of the person with dementia, from the lived experience.

Methods

The methodological option was an empirical research study of the qualitative type, of phenomenological-interpretative nature and inspired by the hermeneutic philosophy of Paul Ricoeur. Seven people with mild dementia were interviewed, most diagnosed with Alzheimer's disease, with a mean of 71 years old. For each participant, two interviews were conducted in a natural setting [residence], with data collection occurring between July and October 2017.

Results

The main focus of the present analysis focused on the identity of the person with dementia. Two main themes were created, taking into account the factors that may influence their (de)construction. The first theme “life in suspense” aims to describe knowledge and representations about dementia. Regarding the analysis of the lived experience, it was represented by the second theme “map the transition process - living on the edge of the cliff”.

Findings from this study indicate that disease representations are useful frameworks for developing an understanding of how people with dementia try to manage the threats posed by disease as they negotiate the day-to-day process. The development of disease representations reflects an understanding that the progressive decline imposed by dementia is linked to a set of consequences that are circ*mscribed in the personal, relational, and transcendental dimensions.

Conclusions

In summary, the person with dementia faces several challenges, the first one stems from the need to manage the treatment; the second arises from the need to create and assign meaning to their social roles and finally the need to deal with the emotional consequences that arise from the process of disease by providing the person with adaptive strategies that promote their adjustment. In fact, this study, in addition to revealing the lived experience of the person with dementia, has the potential to contribute to the improvement of nursing care in mental health.

Keywords

Mild dementia, Lived-experience, Hermeneutic, Illness representation.

P141 The institutionalized elderly person: representations of happiness and well-being

Magda Guerra, Carlos Laranjeira, Zaida Azeredo

School of Health, Jean Piaget Institute, Research in Education and Community Intervention, 3515-776 Viseu, Portugal

Correspondence: Magda Guerra (magdasantosguerra@gmail.com)

Background

Population aging in developed and developing countries is an unequivocal reality and poses multiple challenges to their communities and political entities. The societies aim at prolonging the lives of their citizens but also at an improvement of their quality of life; however, the constraints of the elderly population are diverse and it is sometimes necessary to institutionalize them. The elderly persons will have to become familiar with a set of new situations such as a new space, routines and unknown people with which they will share their life. The often-negative connotations associated with these institutions may not be appropriate to reality, because of the changes that have taken place in social policy in recent times.

Objective

We sought to know which representations the institutionalized elders have about their happiness and well-being.

Methods

The sample consisted of 13 elderly people institutionalized in a Nursing Home of Viseu, aged between 77 and 94, with 4 to 12 years of institutionalization, an option for some, due to their own volition; while for others, due to decision of another (children/nephews). It is a qualitative study, using the semi-structured interview. The results were analysed according to content analysis, with a priori categorization.

Results

Happiness for most of the elderly depends on a number of factors, such as being healthy, being well with oneself, being cherished at home, living with others, escaping from loneliness, not starving oneself, being loved and loving, possessing money for oneself and for others and fun. Most elderly people have confirmed that they feel good about themselves, yet two elderly people do not feel well because of sadness and illness. Their memories of the past relate to marriage, family constitution, strength to work and conviviality with friends; whereas, in the present, relate to happiness, a sense of general well-being, not being alone and living with other institutionalized elders.

Keywords

Elderly, Institutionalization, Happiness, Well-being.

P142 Prevention of ventilator associated pneumonia- evidence in oral care

Ana Sousa^1,2,3, Cândida Ferrito⁴

¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Centro Hospitalar S. João, 4200-319 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ⁴Escola Superior de Saúde, Instituto Politécnico de Setúbal, 2914-503 Setúbal, Portugal

Correspondence: Ana Sousa (sabrinasousa72@hotmail.com)

Background

Ventilator-associated pneumonia (VAP) is the most important nosocomial infection in intensive care units (ICUs), with an estimated incidence rate of 50% and the major cause of mortality and morbidity in ICUs [1,2]. Inadequate oral care develops an important role in this setting allowing various organisms to flourish in oral cavity and cause infections [1]. Many VAP prevention guidelines include oral care, but they don’t specify its demandings.

Objective

The aim of this study is to describe evidence-based VAP prevention oral care in ICU, in terms of products, frequency and technique.

Methods

Integrative review. Research was conducted on B-on, PUBMED, and RCAAP between 24 and 28 December 2015, including guidelines and original articles from the last 5 years. We found 256 documents and after analysing their abstract and methodological quality, nine documents were selected. Data were compiled in a chart in terms of grade of evidence, acceptance and applicability.

Results

We found inconsistent results regarding the use of an antiseptic solution in oral care, though there were meta-analysis which indicated the benefit of chlorhexidine mostly in cardio-thoracic surgical patients [2-4]. We also found evidence that tooth brushing reduces oral bacterial colonization and may reduce VAP when used with chlorhexidine [5,6]. There is no consensus regarding the adequate concentration of chlorhexidine. Some studies, thought, find an association with the use of chlorhexidine 2% and the incidence of Acute Respiratory Distress Syndrome [7]. Because of this potential risk, we do not recommend the use of this type of concentration, as more randomized controlled trials are needed. We found evidence in VAP prevention oral care comprising suctioning, tooth and gums wash and rising with 15 mL chlorhexidine 0.12%. This procedure should be performed at least 2 times a day. Secretions removal and moisturization should occur between 2 to 4 times a day [1-9].

Conclusions

This review allowed us to describe the adequate oral care in ICUs in order to potentially reduce VAP. As limitation of this study, we can find the lack of high grade of evidence concerning most recommendations. More randomized controlled trials are needed to support the impact of each intervention separately.

References

1. Munro CL, Grap MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004;13(1):25-33.

2. Eom JS, Lee MS, Chun HK, Choi HJ, Jung SY, Kim YS, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control. 2014;42(1):34-37.

3. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and metaanalysis. Lancet Infect Dis. 2011;11(11):845-854.

4. Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8:Cd008367.

5. Munro, C. L., Grap, M. J., Jones, D. J., McClish, D. K., & Sessler, C. N. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults.American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses. 2009; 18(5), 428–438.

6. Roberts N, Moule P. Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. Nursing in Critical Care. 2011;16(6):295-302.

7. Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014;174(5):751-761.

8. Kornusky J, Schub E. Oral Hygiene: Performing for an Intubated Patient. CINAHL. 2015; Nursing Guide.

9. Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M. Prevention of ventilatorassociated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Critical Care. 2011;15(3):R155.

Keywords

ICU, Oral care, Chlorhexidine, Tooth brushing, Ventilator-associated pneumonia.

P143 Assessing preferences and features for a mobile app to promote healthy behaviors in adolescence: an exploratory study

Pedro Sousa^1,2, Roberta Frontini¹, Maria A Dixe^1,2, Regina Ferreira^3,4, Maria C Figueiredo^3,4

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³School of Health Sciences, Polytechnic Institute of Santarém, 2005-075 Santarém, Portugal; ⁴Indicators Monitoring Unit in Health, Polytechnic Institute of Santarém, 2005-075 Santarém, Portugal

Correspondence: Pedro Sousa (pedro.sousa@ipleiria.pt)

Background

A mobile application (TeenPower) to promote healthy behaviours in adolescents is being created. To better tailor the features and digital content of the mobile app, it was important to understand some of the characteristics of the devices more frequently used by the adolescents. Moreover, it was important to understand which contents are essential for health-professionals who frequently work with these adolescents. This data is extremely important during the conception and planning phase of the creation of the mobile app.

Objective

This study has two main aims. Firstly, to characterize and assess the devices frequently used by adolescents, as well as the preferences of adolescents for the mobile app. Secondly, to understand what features are more important for health-professionals who work closely with adolescents to promote healthy behaviours.

Methods

Two samples were recruited. A sample of 15 adolescents (M = 15.20; SD = 0.68) with the characteristics of the future users of the mobile app was recruited. A sample of 11 health-professionals who work closely with adolescents was also recruited. Both samples answered 2 questionnaires specifically created for the purpose. Five-point Likert scales and open questions were used. The instruments comprised questions regarding the type of devices frequently used by adolescents, the content that both, adolescents and health-professionals, consider more important regarding the promotion of healthy behaviours, and the reasons adolescents consider to use mobile apps.

Results

All adolescents use smartphones, but only 20% of the sample frequently use lifestyle and health apps, with the majority (93.3%) using social networks. The majority of the sample referred that food suggestions (93.3%) and physical activity suggestions (93.3%) should be included in the app. Adolescents also referred what reasons and features would influence them to use a health mobile app. Health-professionals (90.9% nurses and 9.1% psychologists) referred that the app should have food suggestions (90.9%) and physical activity suggestions (90.9%). They all referred that they would advise an adolescent to use a health-related app, with 81.8% referring that they would feel comfortable giving advices through a mobile app.

Conclusions

The results of our study help us tailor and choose the most important features present in the TeenPower app. Understanding what content may be more appealing for adolescents may also help the creation of future content for prevention programs.

Acknowledgements

The current abstract is being presented on behalf of the research group of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by the FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (City Hall), and also other members, institutions and students involved in the project.

Keywords

Adolescents, e-Health, Preferences, Prevention, TeenPower.

P144 Epidemiological and clinical characterization of men who age with HIV/AIDS in Teresina-Piauí, Brasil

Keila MGS Fortes¹, Maria LS Fortes², João GO Freitas², Lucas S Terto³

¹Municipal Health Foundation, 64002-595 Piauí, Brazil; ²Federal University of Piauí, 64049-550 Piauí, Brazil; ³University Center UniNovaFAPI, 64073-505 Piauí, Brazil

Correspondence: Lucas S Terto (terto_7@hotmail.com)

Background

AIDS is not a “young-only disease” as many older people still evaluate [1]. People with a more advanced age range are starting to appear in the settings of those living with HIV/AIDS [2]. Many causes are attributed: sociocultural changes, especially in sexuality; resistance in using condoms; healthcare innovations; access to antiretroviral therapy and other innovations in clinical areas [3]. Among men aged 60 years and over, in the last decade, there has been an increase in the rate of detection [4], which raises the need for public policies aimed at this reality.

Objective

To investigate epidemiological and clinical characteristics of men housed in a shelter for people living with HIV/AIDS.

Methods

Descriptive study of epidemiological and clinical information on people living with HIV/AIDS, housed in a shelter in Teresina-Piauí, Brazil. Data were collected from 28 selected records, with the following criteria: male, aged 50 years or older. The following variables were considered: age group, educational level, place of residence, time of antiretroviral therapy and clinical manifestations. The data were typed in an Excel 2007 spreadsheet, analysed through percentage differences and discussed, with reference to documents and also articles in which there was content about the proposed theme.

Results

Regarding the age of the group, ages were between 50 and 64 years old, with predominance of individuals aged from 50 to 60 years old. The majority of the elderly presented a low educational level (79.75%), coming from cities with less than 50,000 inhabitants of other states of Brazil (53.57%), who seek Teresina for treatment and follow-up of their health, shelter to receive food, nursing, social and spiritual assistance and, in some cases, family reintegration. Most used antiretroviral drugs since 10 to 20 years ago, with 7.15% using it for more than 30 years. The clinical manifestations detected were: Lung Cancer, Hepatitis B and C, depression, dermatitis, tuberculosis, neuropathy and leishmaniasis.

Conclusions

This study draws attention to the increase in the detection of HIV in men aged 50 years and over, especially those aged 60 years or older, inhabitants of cities of low demographic density in Brazil, with several clinical manifestations, low educational level, which makes difficult the access to preventive information on sexual health, and under the use of antiretrovirals, from more than ten years ago. The study points towards the need for more research on HIV infection among the elderly, to help to implement more effective public policies for this group.

References

1 Gorinchteyn J. Sexo e AIDS Depois dos 50.1st edition. São Paulo: Ícone; 2010.

2 Okuno MFP, Gomes AC, Meazzini L, Júnior GS, Junior DB, Belasco AGS. Qualidade de Vida de Pacientes Idosos Vivendo Com HIV/AIDS. Cad. Saúde Pública, Rio de Janeiro. 2014;30(7):1551-1559.

3 Serra A, Sardinha, AHL, Pereira ANS, Lima SCVS. Percepção de Vida dos Idosos Portadores do HIV/AIDS atendidos em Centro de Referência Estadual. Saúde em Debate, Rio de Janeiro. 2013;37(97):294-304.

4 Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico - AIDS e DST. Ano V, Nº 1. 2015-2016.

Keywords

Old men, AIDS, Health care.

P145 Assessing digital contents for health promotion and obesity prevention in adolescence

Rita Luz¹, Pedro Sousa^1,2, Roberta Frontini², Andreia Silva¹, Briana Manual¹, Cláudia Ramos¹, Mónica Ruivo¹, Rúben Abreu¹, Tiago Pozo¹, Ana E Sardo¹, Francisco Rodrigues¹, Luís Fernandes¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Rita Luz (ritafluz@gmail.com)

Background

The TeenPower project is an e-Health multidisciplinary program to promote healthy behaviours and prevent obesity in adolescents. In this study we focus in two of the components present in the platform: stress management and interpersonal relationships. It is important to focus on stress while designing prevention programs for adolescents, given that literature has associated higher levels of stress with obesity in youth. Moreover, interpersonal relationships were also found to influence obesity-related behaviours. Online sessions were specifically created to address those issues on the mobile app. This digital content (videos and posters) should not only be appealing for the adolescent but also scientifically valid and correct.

Objective

The main aim of this study was to assess the scientific quality and adequacy of posters and videos created for the TeenPower mobile app, regarding stress management and interpersonal relationships.

Methods

Digital resources in video and poster format were created. Contents regarded stress management and interpersonal relationships. Videos were 2 minutes long and posters included infographics and written content with adequate language for adolescents. These resources were developed by students of health, sports and design, in collaboration with health-professionals and researchers. The sample included adolescents with the sociodemographic characteristics of the future users of the mobile app, and health-professionals working in this field. A questionnaire was developed and validated for the purpose, based on the questionnaire create by Junior and colleagues.

Results

Results regarding the concept idea, information, construction of scenes and characters, dialogues, visual and audio style, and quality and relevancy of the information were obtained. Moreover, adolescents answered regarding the attractiveness and adequacy of the content, and health-professionals answered regarding the scientific accuracy of the content information. Both samples suggested content improvements.

Conclusions

The digital content of the mobile app regarding stress management and interpersonal relationships is adequate and appealing for both adolescents and health-professionals. The assessment of digital content is crucial to understand the acceptability of the contents for future users. Digital contents and online sessions are extremely important, given that adolescents use new technologies on a daily basis. Furthermore, it is important to note that digital contents may have the potential to enhance the adherence to programs, promoting healthy behaviours and preventing obesity.

Acknowledgements

The current abstract is being presented on behalf of the research group of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by the FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (City Hall), and also other members, institutions and students involved in the project.

Keywords

Adolescents, e-Health, Obesity, Health promotion, Digital contents.

P146 Assessing digital content in the TeenPower project: development and validation of a questionnaire

Roberta Frontini¹, Pedro Sousa^1,2, Rita Luz², Ana Duarte², Beatriz Sismeiro², Maria Moreira², Romeu Machado²

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Roberta Frontini (roberta_frontini@hotmail.com)

Background

The TeenPower project aims to develop a program to promote healthy behaviours and prevent obesity in adolescents. It is a multidisciplinary project with an important e-Health component. Therefore, including valid digital content may help to maximize and optimize the impact of the program. Given that over the years digital resources had a great evolution, there is a growing concern regarding the acceptance of the digital content by the target public. Thus, to assess the digital resources of the TeenPower project, there was the need to develop and validate a questionnaire that could accurately assess the quality and adequacy of the digital content of the TeenPower mobile app.

Objective

Develop and validate a questionnaire to assess the quality and adequacy of the videos and posters of the TeenPower.

Methods

Two scales were developed based on the questionnaire created by Junior and colleagues [1]: one for adolescents (12-16 years old) and one for health-professionals. The questionnaire for adolescents comprised 18 items answered on a 5-point Likert scale and 2 open questions (to assess the video content); as well as 11 items answered on a 5-point Likert scale and 2 open questions (to assess the poster content). The questionnaire for health-professionals comprised 17 items answered on a 5-point Likert and 2 open questions (to assess the video content); as well as 11 items answered on a 5-point Likert scale and 2 open questions (to assess the poster content). The sample included adolescents with the sociodemographic characteristics of the future users of the mobile app, and specialized health-professionals. Exploratory factor analyses and analysis of internal consistency through Cronbach's alpha were performed.

Results

Data regarding the concept idea, the construction of scenes and characters, the dialogues, visual and audio style and the quality and relevance of the information was obtained. Data regarding the acceptance and comprehension of the content and digital form of the app was obtained from adolescents. The quality and rigorousness of the scientific information was validated by health-professionals.

Conclusions

The questionnaire presented good psychometric qualities with adequate values for internal consistency and factorial analysis. Given that nowadays there is a vast offer of digital content related to health, there is a concern to use not only appealing content for future users, but also valid and scientifically correct information. This questionnaire may be an important tool to understand the acceptability and quality of the scientific content of the videos and posters.

Acknowledgements

The current abstract is being presented on behalf of the research group of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by the FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (City Hall), and also other members, institutions and students involved in the project.

Keywords

Adolescents, e-Health, Validation, Questionnaire, Digital content.

P147 Implementation process of “Engaging Clients Who Use Substances” guideline in a nursing school curriculum

Olga Valentim¹, Maria José Nogueira¹, Luís Sousa^1,2, Vanessa Antunes¹, Sandy Severino^1,3, António Ferreira⁴, Luís Gens⁴, Luís Godinho⁵

¹School of Health Sciences, Atlântica University, 2730-036 Barcarena, Portugal; ²Hospital Center Lisbon Central, Curry Cabral Hospital, 1050-099 Lisbon, Portugal; ³Health Center Groupings Loures-Odivelas, Regional Health Administration Lisboa e Vale do Tejo, 2685-101 Sacavém, Portugal; ⁴Hospitaller Order of São João de Deus, Telhal Health House, 1600-871 Lisboa, Portugal; ⁵Psychiatry Department, Garcia da Orta Hospital, 2805-267 Almada, Portugal

Correspondence: Olga Valentim (ommvalentim@gmail.com)

Background

Nursing research has led to knowledge which has contributed to improving health care and to reduce costs. The implantation of guidelines ensures the transfer of the best evidence for clinical practice [1]. Substance-related problems can occur at any age, but usually begin in adolescence [2]. The Guideline Engaging Clients Who Use Substances developed by the Registered Nurses' Association of Ontario (RNAO), provides evidence-based recommendations related to the assessment and interventions for people over 11 years of age, who use substances, may be at risk of, or have a substance use disorder [3].

Objective

To present the experience of the guideline implementation process of the RNAO’s Engaging Clients Who Use Substances, in the curriculum of the nursing degree (CLE) of the Atlantic Health School (ESSATLA).

Methods

Implementation procedures indorsed by the RNAO were followed, involving teachers, students and nurses from several clinical practice contexts. First, an analysis and reflection were made considering ESSATLA's CLE curriculum, Unit Sheets and the Engaging Clients Who Use Substances guideline recommendations. Afterwards, a guideline implementation plan was designed to fit the CLE, based on structure, process and outcome indicators. Teachers and clinical tutor train was performed and some guideline topics were included in several units: establishing therapeutic relationships [4] and person- and family-centred care [5].

Results

To date, guideline implementation process results include several outcomes: seminar meetings held with all stakeholders involved in the guideline’s implementation process; a partnership training project - Partnership training seminars; a workshop scheduling plan; Portuguese translation of the “Engaging Clients Who Use Substances” in process (teacher and nursing expert stakeholder collaboration); didactic materials to support content implementation in the nursing curriculum; student evaluation tools and instruments; three students included the topic of substance use in their end-of-course monograph project; some students in the clinical practice of the elderly did a in-service training session on this subject.

Conclusions

The implementation of this guideline in the CLE curriculum has empowered students to become more confident and competent to care for substance abusers, namely regarding screening, the assessment process and intervention in substance use disorders. It also meets the expectations of the stakeholders involved, empowering their performance based on scientific evidence.

References

1. Silva AG. Implementación de guías de buenas prácticas clínicas elaboradas por Registered Nurses Association of Ontario (RNAO) en el curriculum de Enfermería Universidad de Chile. MedUNAB. 2015;17(3):182-9.

2. Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências (SICAD). Relatório Anual 2015: A Situação do País em Matéria de Drogas e Toxicodependências. Lisboa: SICAD. 2016.

3. Registered Nurses’ Association of Ontario (RNAO). Engaging Clients Who Use Substances. Toronto, ON: Registered Nurses’ Association of Ontario. 2015.

4. Registered Nurses’ Association of Ontario (RNAO). Establishing Therapeutic Relationships. Toronto, ON: Registered Nurses’ Association of Ontario. 2002.

5. Registered Nurses’ Association of Ontario (RNAO). Person and family centred care Toronto, ON: Registered Nurses’ Association of Ontario. 2015.

Keywords

Substance-Related Disorders, Evidence-Based Nursing, Nursing Education.

P148 An overview of vitamin B in food supplements

Isabel M Costa, Alexandra Figueiredo, Deolinda Auxtero

Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal

Correspondence: Isabel M Costa (imargaridac@gmail.com)

Background

Over last decade, sales of vitamins have had a significant increase worldwide. Besides the growing of self-diagnosis and self-medication by consumers, these products are also often consumed without any control or medical supervision, during extended periods of time, due to the general misperception that natural indicates harmless. Despite its beneficial effects, excess intake of vitamin is not innocuous. Although vitamin B6 is a co-factor for several enzymatic reactions, involved in numerous metabolic and physiological processes, overdoses may produce neurological disturbances, including sensory neuropathy.

Objective

The aim of this study was to check food supplements (FS) labels in terms of vitamin B (vitB) dosages, compared to the recommended daily allowances (RDA) defined by European Union Directive for these vitamins. A total of 80 FS sold in Portuguese pharmacies, supermarkets or health shops and on the internet were examined for indicated daily intake and dosage of vitamin B1, B2, B3, B5, B6, B7 and B12. Selection criteria included: oral solid pharmaceutical forms for adults, containing vitB in its composition, as stated in the label, regardless of the purpose of the FS.

Results

Results showed FS label doses above RDA: 70.0% (vitB1), 75.0% (vitB2), 67.4% (vitB3), 51.1%, (vitB5), 74.3% (vit B6), 45.7% (vitB7) and 60.3% (vit B12). Thirty-three (33) FS contained all the studied VitB, six of which with all vitamins above RDA. Four (4) FS (5.7%) indicated a daily dose of vitB6 ≥ the tolerable upper intake level defined by EFSA (UL=25 mg/day).

Conclusions

The majority of FS presented vitB far above defined RDA. Although reports of toxic events due to vitamins are scarce, it is crucial that the daily doses present in FS are reviewed ensuring for the safety of these products. Authors also consider that FS should be under the same quality control of pharmaceuticals, safeguarding the health of the consumers.

Keywords

Vitamin B, Food Supplements, Recommended Daily Allowances.

P149 Is the International Physical Activity Questionnaire (IPAQ-sf) valid to assess physical activity in patients with COPD? Comparison with accelerometer data

Joana Cruz^1,2,3, Cristina Jácome^3,4, Alda Marques^3,5

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; ⁵Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Joana Cruz (joana.cruz@ipleiria.pt)

Background

The International Physical Activity Questionnaire short form (IPAQ-sf) is primarily designed for physical activity (PA) surveillance, presenting good psychometric properties in people with an age range of 15-69 years. However, studies conducted in older people have shown conflicting results, suggesting that it may not be adequate for this population. Therefore, the use of the IPAQ-sf for the assessment of PA in patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), in which patients are frequently older, remains unclear.

Objective

To preliminary evaluate the validity and test-retest reliability of the IPAQ-sf in patients with COPD.

Methods

This exploratory cross-sectional study included 10 patients with COPD (71.6 ± 7.3 years old, 7 males, FEV1=77.2 ± 20.7% predicted). Participants completed the IPAQ-sf on two occasions separated by 1 week and wore an accelerometer (Actigraph GT3X+) for 7 consecutive days. The following statistical analyses were conducted: 1) Pearson’s correlation coefficient (r) to assess correlations between the results obtained from the IPAQ-sf (PA in METs-min/week; sitting time in min/day) and the accelerometer (PA: total moderate-to-vigorous physical activity [MVPA] per week and recommended MVPA per week – i.e., MVPA conducted in bouts of at least 10-min as internationally recommended [1]; sedentary time in min/day); 2) percentage of agreement (%agreement) and Cohen’s kappa to assess the agreement between categorical scores obtained from the two measures (i.e., ‘sufficiently’ and ‘insufficiently’ active patients); 3) Intraclass Correlation Coefficient (ICC2,1) and 95% limits of agreement (LoA) to assess test-retest reliability and agreement.

Results

Significant correlations were found between IPAQ-sf METs-min/week and total MVPA (r=0.729, p=0.017), but not between METs-min/week and recommended MVPA (r=0.346, p=0.327) or between IPAQ-sf sitting time and accelerometer-based sedentary time (r=-0.383, p=0.308). Agreement between the IPAQ-sf and accelerometer-based data, in identifying ‘sufficiently’ and ‘insufficiently’ active patients, was low (total MVPA: kappa=-0.538, %agreement=20%; recommended MVPA: kappa=-0.087, %agreement=50%). Test-retest reliability of the IPAQ-sf was poor to moderate (PA: ICC2,1=0.439 [-0.267→0.838]; sedentary time: ICC2,1=0.511 [-0.178→0.864]) and the agreement was low (PA: LoA: -10361→4548 METs-min/week; sedentary time: LoA: -194→148 min/day).

Conclusions

Findings suggest that the IPAQ-sf has limited validity and reliability in the assessment of PA in patients with COPD. Further research with a larger sample is needed to support these findings.

References

1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, etal. Med Sci Sports Exerc. 2011;43(7):1334-1359.

Keywords

Accelerometry, Chronic obstructive pulmonary disease, Psychometric properties, Physical activity, Self-report measure.

P150 Concurrent validity of the Portuguese version of the brief physical activity assessment tool

Joana Cruz^1,2,3, Cristina Jácome^3,4, Nuno Morais^1,2,5, Ana Oliveira^3,6, Alda Marques^3,6

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; ⁵Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Joana Cruz (joana.cruz@ipleiria.pt)

Background

Physical activity (PA) is recognised as an important health enhancing behaviour and should be routinely assessed in clinical practice to identify insufficiently active people. Activity monitors, such as accelerometers, provide objective assessment of free-living PA being the preferred assessment method in research settings. However, they are too expensive to be used in resource-constrained clinical settings. Several PA questionnaires have already been validated to the European Portuguese but some of them take too long to complete, hence unfeasible for use in clinical practice. Shorter PA assessment tools are, therefore, needed.

Objective

To explore the relationship between the Portuguese version of a short PA questionnaire, the Brief physical activity assessment tool (Brief-PA tool), and the International Physical Activity Questionnaire short form (IPAQ-sf), which is a valid and reliable PA assessment tool already tested in the Portuguese population. A secondary aim was to explore the test-retest reliability of the Brief-PA tool.

Methods

The Brief-PA tool [1] consists of 2 questions which assess the frequency and duration of moderate and vigorous PA undertaken in a ‘usual’ week. The total score is obtained by summing the results of the two questions (range 0-8). People with a score ≥ 4 are considered ‘sufficiently active’. Since the tool is not available in Portuguese, a linguistic adaptation was conducted using the forward- and back-translation method. Then, 86 healthy volunteers (49.5±18.1 years, age range 20-69; 53 female) completed the Brief-PA tool and the IPAQ-sf. A sub-sample (n=56, 43.1±18.1 years, 37 female) completed the Brief-PA tool one week later. Spearman’s rank correlation coefficient (ρ) was used to assess correlations between the Brief-PA total score with IPAQ-sf results (MET-min/week). Percentage of agreement (%agreement) and Cohen’s kappa were used to assess the agreement between categorical scores obtained from the two measures (i.e., ‘sufficiently’ and ‘insufficiently’ active) and test-retest reliability of the Brief-PA tool.

Results

Significant correlations were found between the Brief-PA tool and the IPAQ-sf (ρ = 0.721, p < 0.001). The Brief-PA tool identified 34.8% sufficiently active participants while the IPAQ-sf identified 59.3%. Agreement between measures was moderate (%agreement=70.9%, kappa=0.450). Test-retest reliability of the Brief-PA tool was substantial (%agreement=89.3%, kappa=0.755).

Conclusions

The Brief-PA tool seems to be valid and reliable for assessing PA in the Portuguese adult population, although the agreement with the IPAQ-sf was only moderate. Further research assessing the validity of the Brief-PA tool with objective measures is needed.

References

1. Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39(5):294-297.

Keywords

Concurrent validity, Daily living, Physical activity, Self-report measure.

P151 Effect of an exercise program on risk of fall in a community dwelling older adults

Sara Martins, Anabela Martins, Carla Guapo, Sílvia Vaz

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Sara Martins (ftsaramartins@gmail.com)

Background

Falls are a problem among the elderly population. It is known that currently about 30% of people over 65 years fall every year. The European Union estimates a cost of € 281 per inhabitant per year and a cost of € 25 billion per year in health care [1] which translates into a significant economic impact. The World Health Organization (WHO) [2] argues that it is possible to reduce these costs through prevention and health promotion strategies. For this, it is important to raise awareness, evaluate risk factors and identify and implement intervention programs.

Objective

To test the effect of an exercise program on the prevention of risk of fall.

Methods

This study, which lasted 4 months, was experimental, prospective. The experimental group (EG) performed an exercise program and the control group (CG) maintained their usual routine. For the measurement and evaluation of the variables under study, were used: a sociodemographic data questionnaire, the self-efficacy for exercise scale, the Portuguese version of the falls efficacy scale (FES), the 10m walking speed (WS), the Timed Up & Go test (TUG), step test and the Hercules® Force Platform (static balance). A significance level of 5% (p ≤ 0.05) was considered for all comparisons.

Results

After intervention, there were differences in walking speed (p < 0.001), FES (p < 0.001), static balance (p < 0.001), and self-efficacy for exercise (p = 0.004), with EG scoring higher than CG.

Conclusions

This exercise program integrated activities of daily living (ADL), muscle strengthening, balance and flexibility exercises, complemented by walking, showed improvements in static balance and walking speed. There was also a change in the behaviour regarding confidence in the performance of the ADL and perception of ability to learn and integrate exercise in daily life, thus contributing to decrease the risk of fall.

Acknowledgements

To the Penacova Health Center - ARS CENTRO for opening their facility to the program implementation and for the collaboration provided by all professionals.

References

1 Active ageing through preventing falls: “Falls prevention is everyone’s business”. European Stakeholders Alliance for Active Ageing through Falls Prevention. Prevention of Falls Network for Dissemination (ProFouND).; 2015.

2 Global recommendations on physical activity for health. Switzerland.: World Health Organization (WHO); 2010.

Keywords

Prevention, Active Ageing, Fall, Fall Risk, Exercise Programs.

P152 Nutritional impact of food waste in a school cafeteria

Ana Braga¹, Ana Pedrosa¹, Fabiana Estrada¹, Matilde Silva¹, Ana Sousa¹, Cidália Pereira^1,2, João Lima^1,3, Vânia Ribeiro^1,2

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Ana Braga (anabraga423@gmail.com)

Background

In Portugal, it is estimated that about 31% of food waste occurs in the last stage of the food production chain and that about 13% of the food served is not consumed [1]. Food waste contributes to an inadequate nutritional intake, since part of the served food is being discarded, therefore its evaluation is important [2].

Objective

To evaluate the nutritional impact of food waste in relation to nutritional requirements in a food unit of the Social Services of the Polytechnic of Leiria.

Methods

Food waste was determined by the aggregate component weighing method, being evaluated at lunch and dinner periods of a randomly chosen day. The data were collected in the cafeteria and snack bar that served the largest number of meals. Only non-fractioned dishes were considered in this analysis. The nutritional impact of food waste was evaluated considering the nutritional requirements of a typical costumer of the food services - an average energy value of 2000 kcal and the percentages corresponding to the two evaluation moments of the day, corresponding to 55% of the Total Energy Value (TEV), 30% to lunch and 25% to dinner [3, 4].

Results

It was produced 288.9 kg of food, being 40.3 kg of plate waste. The average amount of food served per meal was 329 g and an average of 50 g per meal was plate waste. It can be concluded that about 14% of the total food produced was discarded as plate waste, which represents around 123 meals. When evaluating the nutritional impact of food waste, it was observed that the average waste per person was 84 kcal, which represents about 15.3% of the energy value of meals. It was also observed that 2.4 g of lipids, 5.6 g of protein and 9.6 g of carbohydrates were wasted, per meal, which is the equivalent to about 13.1%, 20.4% and 14.0%, respectively, of the needs of the typical costumer of the food services.

Conclusions

Based on these results, we can observe a food waste impact of about 10% of the nutritional requirements of an individual, being imperative the reinforcement of periodic evaluation of consumption and plate waste in school meals, attending that food waste is a decisive factor in terms of energy and nutritional adequacy [5]. On the other hand, it is still necessary to develop actions to raise the awareness among the student community about the nutritional impact of food waste on the health of the population.

References

1. Baptista P, Campos I, Pires I, Vaz S. Do Campo ao Garfo. 2012.

2. Figueira J. Influência da satisfação com as refeições escolares no desperdício alimentar, em crianças do 4º ano de escolaridade. 2012.

3. Afonso C, Santos MCT, Morais C, Franchini B, Chilro R, Rocha A. Sistema de planeamento e avaliação de refeições escolares - SPARE. Rev Aliment Humana. 2011;17(1–3):37–46.

4. Jorge IN de SDR. Tabela da Composição de Alimentos. 2007.

5. Bergman EA, Buergel NS, Englund TF, Femrite A. The Relationship of Meal and Recess Schedules to Plate Waste in Elementary Schools. J Child Nutr Manag. 2004;28(2).

Keywords

College, Dining, Lunch, School Meals, Rests.

P153 Food insecurity and obesity paradox: nutritional intervention strategies

Carla C Correia¹, Ana L Baltazar², José Camolas¹, Manuel Bicho¹

¹Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal; ²Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Carla C Correia (carlacamposcorreia@gmail.com)

Background

The economic crisis in the recent years has triggered social disparities in Europe, which are shown in people’s food insecurity levels and public health. Food insecurity occurs when the consumer’s physical, social and economic access to adequate and nutritional food are scarce or non-existent. Food insecurity is associated to chronic diseases, such as obesity, type 2 diabetes, dyslipidaemia, hypertension, and a poor health status, due to unbalanced food habits and sedentary lifestyles. In this low socioeconomic position, people need social and nutritional intervention to improve their habits and their health, in general.

Objective

Analyse and discuss the existing strategies to further intervene at the paradox “food insecurity versus obesity”.

Methods

A scientific narrative of the state of art was performed according to PRISMA standards and in snowball, inserting scientific articles, official documents and books applied to the European population, from 2007-2017.

Results

The access of each person to a health and nutritive diet should be a right guaranteed by any country. The strategies to deal with the impact of food insecurity in health status should be multidisciplinary, addressing economic, psychologic, social and physiological issues, together with the health, social, education, agriculture and economic sectors. The prices are an important determinant for people’s choices. Food marketing control and agriculture and local markets supports are strategies to facilitate the access to healthy food. It’s important to implement monitoring programs in primary health care and schools to develop nutrition and physical activity projects at a local level, to alert the professionals to food insecurity issues and the relation with obesity, and to intervene timely in pregnancy and family planning appointments, as means to prevent diseases related to food insecurity.

Conclusions

Chronic diseases bring us high costs to health systems and some questions about their sustainability. An adequate and timely intervention should consider food education and health lifestyles promotion, so that the integration of nutritionists into food assistance programs is emergent.

Keywords

Food insecurity, Chronic diseases, Social disparities, Nutritional intervention.

P154 Numerical methodology to support a medical device development

Filipa Carneiro¹, Lourenço Bastos¹, Ângelo Marques¹, Rita Marques¹, Jordana Gonçalves¹, Andreia Vilela¹, André Maia², Sara Cortez², Anabela Salgueiro-Oliveira³, Pedro Parreira³, Bruno Silva¹

¹Innovation in Polymer Engineering, Universidty of Minho, 4800-058 Guimarães, Portugal; ²Muroplás – Indústria de Plásticos, S.A., 4745-334 Trofa, Portugal; ³Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Filipa Carneiro (f.carneiro@piep.pt)

Background

The use of numerical simulations as part of product development process allows the existence of virtual prototypes that can be tested quickly and cheaply. These computational tools facilitate and improve the design optimization and the materials selection, to match the pre-defined product requirements, during the development process, for use in health contexts [1].

Objective

Development and validation of a numerical methodology to support an innovative syringe, predicting its mechanical and flow behaviour, during the syringe loading and patient administration; as also the injection molding process of its constituent components. This methodology aims to optimize the geometries of the syringe’s components, creating in this way an iterative process for product development based on numerical simulations.

Methods

This numerical methodology was implemented using software for fluid dynamics, mechanical behaviour and injection process, respectively. To study the fluid-structure interaction (FSI), during syringe loading and patient administration of medicines and washing solutions, the fluid dynamics output served as structural simulations input. Material properties were experimentally determined. The FSI numerical models were validated by comparison with experimental tests on a single chamber syringe. Afterwards, the same numerical models were implemented in new innovative syringe concepts. The injection molding processes of these concepts were also numerically evaluated.

Results

Validation of the numerical simulations using a simple case of a single chamber syringe, where the numerical solution is compared with an experimental case. Development and application of an iterative process for product development, based on numerical simulations. Optimization of an innovative product design that fulfils all the specifications and requirements predefined.

Conclusions

This iterative process based on numerical simulations is a powerful tool for product development that allows obtaining fast and accurate results, without the strict need of prototypes. An iterative process can be implemented, consisting on consecutive constructions and evaluations of new concepts, to obtain an optimized solution, which fulfils all the predefined specifications and requirements. The prior validation of the numerical methodology with a reference model, is an extremely important step to guarantee the reliability of the numerical model applicability in the development of medical devices.

Acknowledgments

Work funded by the FEDER fund, Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), project POCI-01-0247-FEDER-017604.

References

1. Oliveira RF, Teixeira SFCF, Silva LF; Teixeira JCF, Antunes H. Development of new spacer device geometry: a CFD study (Part I), Computer Methods in Biomechanics and Biomedical Engineering. 2012;15(8):825-833.

Keywords

Numerical simulation, Fluid-structure interaction, Injection process, Syringe.

P155 The impact in burden of care provided by informal caregivers of patients with mental illness

Catarina Tomás^1,2, Ana Querido^1,2, Marina Cordeiro^1,2, Daniel Carvalho³, João Gomes³

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Santo André Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal

Correspondence: Catarina Tomás (catarina.tomas@ipleiria.pt)

Background

Psychiatric disease is one of the most incapacitating conditions, creating the need for continuous care, generating burden in family members [1, 2]. Recent research has revealed some tasks developed by family caregivers like preparing meals, help in daily living activities and in-house maintenance which contributes to enhance burden.

Objective

To understand the correlation between provided care and burden in informal caregivers of patients with mental illness and to analyse the impact of the care provided in caregivers’ burden.

Methods

This is a cross-sectional correlational study. Data was collected in a sample of 113 caregivers, in 2015, using a face-to-face interview which comprised sociodemographic questions, the type of care provided and the Zarit Burden Interview (Portuguese version by Sequeira [3]). Ethical procedures were taken into account during research according to the Helsinki Declaration.

Results

Sample was mostly composed by females (70.8%), aged between 20 and 81 years old (Mean=49.85; SD=14.25), married (74.3%), wives (15.9%) and mothers (17.7%) of the patients. Depressive disorders (36.3%) were the most common mental problems of their sick relatives. Most caregivers categorized themselves has primary (39.8%) and secondary caregivers (42.5%) providing total care most frequently (Mean=26.58; SD=31.20). The majority of these caregivers presents no burden (62.8%), scoring the mean 38.31 (SD=22.54). Total burden is correlated with the provision of total care (R=0.340; p=0.000) and support (R=0.216; p=0.022). This kind of care provision is also correlated with impact of giving care (R=0.355; p=0.000), interpersonal relations (R=0.360; p=0.000) and perceptions of self-efficacy (R=0.275; p=0.003). Burden is 11.5% explained by the total care provided (F=14.330; p=0.000) and 6% by support provided (F=11,542; p=0,000). Additionally, 25.3% of burden is explained by care in dressing and shoeing (F=37.288; p=0.000), 5% by preparing the meals (F=23.724; p=0.000) and 4.8% by support to accomplish patient professional demands. All factors of burden were influenced by total care provided (p<0.005).

Conclusions

A medium range of burden was found in this sample of caregivers of patients with mental illness inquired. By considering themselves has secondary caregivers they provide regularly or occasionally care depending on their relative’s needs. Nevertheless, they provide total care frequently. There was a positive and significant correlation found between burden and care provided, with an impact of this care in the caregiver’s burden. Intervention in caregivers of patients with mental illness should address this relation, providing support and developing their skills to improve the care provided and preventing caregivers’ burnout.

References

1. Albuquerque E, Cintra A, Bandeira M. Sobrecarga de familiares de pacientes psiquiátricos: comparação entre diferentes tipos de cuidadores. J Bras Psiquiatr. 2010;59(4):308-316.

2. Eloia S, Oliveira E, Eloia S, Lomeo R, Parente J. Sobrecarga do cuidador familiar de pessoas com transtorno mental: uma revisão integrativa. Saúde Debate. 2014;38(103):996-1007.

3. Sequeira C. Adaptação e validação da Escala de Sobrecarga do Cuidador de Zarit. Revista Referência. 2010;2(12):9-16.

Keywords

Family caregivers, Care provided, Mental disorders, Burden.

P156 Levels of physical activity and sedentary behavior in school-time of elementary school children

Mariana Lima¹, Ana Soares¹, Andreia Santos¹, Fernando Martins^1,2, Rui Mendes^1,3

¹Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal; ²Telecommunications institute, University Beira Interior,6200-161 Covilhã, Portugal; ³Center for Research on Sport and Physical Activity, University of Coimbra, 3040-248 Coimbra, Portugal

Correspondence: Mariana Lima (asms.mecl@gmail.com)

Background

Zimmo et al. (2017) [1], concluded that in what concerns the physical activity (PA) of children in elementary schools (ES), only 39% of the children reached the recommended values of moderate (M) and vigorous (V) PA (30 or more daily minutes), and showed that children spend most of their school time involved in sedentary activities (SB).

Objective

The aims of this study were I) the description of PA (light, moderate and vigorous levels) and sedentary behaviours (SB) of ES boys and girls in relation with the time spent in each level of PA; II) to determine the average time children spend on each level of PA during 4 weekdays (9:00 a.m. to 5:30 p.m., Monday to Thursday) and, III) to compare the MVPA developed by children during formal physical education sessions, with other weekdays.

Methods

Forty (40) voluntarily children with 7.9 ± 0.6 years (30 girls and 10 boys) were authorized by their parents to participate in the study. PA was assessed using a three-axial accelerometer (ActiGraph® wGT3X-BT) during to 7.5 daily hours of school period. For classifying moderate-to-vigorous physical activity (MVPA) a cut-off point of 818 counts per 5s was used.

Results

The average duration of MVPA was 36.51 ± 13.50 min per day. Only 35% of the participating children reached the recommended school-based MVPA of 30 min or more, per day. Children spent on average 71.74 ± 6.37% of their school time on SB. MVPA of girls were lower (31.9 ± 8.9 min/day) than boys (51.3 ± 16.1 min/day, ES = 1.76, p=0.004). Our results showed that the percentage of MVPA on the day of the physical education lesson (11.4 ± 3.8%) was higher, when compared to other weekdays (7.5 ± 2.6%).

Conclusions

We objectively assessed PA during school hours among elementary school-children. This study found that children spend the majority of their school time in SB and many of them do not perform sufficient time of being physically active at school. The low participation of girls in MVPA and the lesser time spend in MVPA on weekdays without physical education lessons are relevant data to reflect and implement strategies to increase the time of physical activity during school-time, which corresponds to one third of the daily life of children.

Acknowledgements

Research partially supported by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07- CT62-FEDER- 005012; ID: 64765).

References

1. Zimmo L, Farooq A, Almudahka F, Ibrahim I, Al-Kuwari M. School-time physical activity among Arab elementary school children in Qatar. BMC Pediatrics. 2017;17(1):76.

Keywords

Physical activity, Motor development, School-time, Accelerometer, Physical education.

P157 Labor pain relief: sterile water injection vs finger ischemic compression technique on the lumbosacral region

Ana Moulaz (anamoulaz@gmail.com)

Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal

Background

Nowadays there is an overvaluation about the pain of giving birth. Therefore, Brazil presented 56% of caesareans and Portugal 33.1% in 2016. In order to assist women when giving birth, analgesia has been a strong ally to enable delivery without pain. There are non-pharmacological techniques for pain control in obstetrics. There is, the Sterile Water Injection on the Michaelis Triangle which causes immediate pain relief in the lumbosacral region. Physiologically, sterile water doesn’t act as a local anaesthetic and doesn’t inhibit the fibres that report visceral pain; however, causes a release of the C fibres and A-delta fibres associated with somatic pain. Distilled water stimulates A-delta fibres and subjugates the visceral pain reported by the C fibres, which fails to notify visceral pain, modulating afferent patterns of pain. In this way, it silences the C fibres and releases endorphins. Based on this mechanism, an experimental study has been done applying the finger ischemic compression technique to the same region, in Brazil in 2014, to characterize the technique as a tool to pain control.

Objective

To compare the technique of sterile water injection with the experiment of finger ischemic compression in the lumbosacral.

Methods

A Comparative study between those techniques through a systematic review of literature based on the Clinical Practice Guide on Normal Childbirth Care, by the Basque Government, about sterile water injection and the finger ischemic compression technique (Nursing Residency Program in Obstetrics, in Brazil in 2015). This study compares the effect versus time duration of analgesia between them.

Results

The analysis of 292 studies showed that the sterile water injection into the Michaelis triangle decreased lumbar pain during delivery by approximately 60%, and the effect remained for up to 2 hours. In the finger ischemic compression experiment, there was a pain level reduction by 66%, remaining for 4 hours. However, in both cases, patients referred an intense burning during application.

Conclusions

This study contributes to pain control in obstetrics, as the two methods lead to a significant reduction of the pain level. However, finger ischemic compression had a longer duration of analgesia, when compared to sterile water injection. The injection in obstetrics is already recommended as an effective method for pain control and there is a need for further research on the finger ischemic compression experiment, to also consolidate the technique as a method of pain management.

Keywords

Labor pain relief, Obstetrics, Giving birth, Non-pharmacological techniques, Analgesia.

P158 Microencapsulation of phytosterols and/or other bioactive ingredients for minimizing cardiovascular risk

Pedro Vieira¹, Isabel Andrade², Rui Cruz¹

¹Pharmacy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Complementary Sciences Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Pedro Vieira (pedromdvieira96@gmail.com)

Background

Several bioactive ingredients such as phytosterols, resveratrol, curcumin and catechin have shown efficacy in the prevention of chronic diseases, namely in cardiovascular diseases, one of the leading causes of death in the world. Besides all the potentialities, many of these bioactive ingredients present the disadvantage of instability and sensitivity to environmental factors (e.g. light and oxygen) and are also characterized by low water solubility due to its lipophilicity. Microencapsulation of bioactive compounds emerges as a strategy to improve their stability, avoiding adverse conditions and promoting their bioavailability. It includes a set of several techniques that allows the coating of these ingredients through a protective film, to guarantee its protection and to modulate its release at the target cells. Many techniques of microencapsulation and different materials can be used, the choice depends on the intended application, particle size, the release mechanism and on the physicochemical properties of both active material to be encapsulated and encapsulating agent.

Objective

To review the available research in this field of expertise.

Methods

A research was conducted using Google Scholar, PubMed and Elsevier databases, in Portuguese, English or Spanish languages over the last 10 years, and using as keywords Microencapsulation; bioactive compounds; phytosterols; cardiovascular risk.

Results

The search retrieved 10 studies. The findings demonstrated not only the potential of the compounds in the reduction of cardiovascular risk, through the action on risk factors, but also the increase of their activity due to the increase of their bioavailability, achieved through microencapsulation. The research also revealed a wide range of materials that can be used, while the choice of method must take into account several factors such as its cost and necessary equipment, as well as the quality of the microcapsules formed. The microencapsulation process has a wide range of advantages, namely the ability to increase gastrointestinal absorption of the bioactive compounds encapsulated, and in addition, while the conversion of those compounds into the powder form is enhanced, their stability increases and their handling is facilitated.

Conclusions

The use of microencapsulation avoids some undesirable characteristics, proving to be an alternative to increase the bioavailability of the bioactive compounds. Future studies should address the exploration of newer encapsulating methods and materials.

Keywords

Microencapsulation, Bioactive compounds, Phytosterols, cardiovascular risk.

P159 A weighted decision making approach for a new medical device concept selection

Marta Gomes¹, Ângelo Marques¹, Ricardo Freitas¹, Anabela Salgueiro-Oliveira², Pedro Parreira², Alberta Coelho³, Sara Cortez³, Bruno Silva¹, Filipa Carneiro¹

¹Innovation in Polymer Engineering, Universidty of Minho, 4800-058 Guimarães, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ³Muroplás – Indústria de Plásticos, S.A., 4745-334 Trofa, Portugal

Correspondence: Filipa Carneiro (f.carneiro@piep.pt)

Background

The development of an innovative syringe results, at an early stage, in several preliminary concepts that should be compared and analysed to select the most promising one. Making the selection decision is a very important task that should be structured and well-founded. Decision making methods can be applied to help in the selection process, leading to more informed and better decisions.

Objective

To apply a weighted decision matrix, in order to select the most promising concept for an innovative syringe.

Methods

To select the most suitable concept for the device to be developed, it is mandatory to define the specifications that it must obey, considering the functional requirements of the product and the requirements for the production process. Not all the specifications have the same importance in concept selection, and so this was analysed trough a weighted decision matrix. Based on the identified specifications, it was defined the corresponding criteria, which must be evaluated and weighted regarding their relative importance to each of the other criteria. These weights were summed for each criterion. As experts from different areas were involved, it was decided that each expert group should weigh, considering their experience. As expected, different matrixes were obtained and results were managed to achieve only one weight matrix which included the opinion of all the groups. A final weighted matrix with all the criteria and its weight for concept selection was obtained. Each concept of the syringe was evaluated according to these defined criteria and calculated it weighted sum. It was selected the concept with the highest weighted sum of all the defined criteria.

Results

By analysing the proposed weighting table of the specifications, and considering the defined relative weight, it was verified that the most relevant specifications are the cost, the number of operations to be performed and the possibility of error. Based on this, the concept with better weighted performance was selected for further detailed development.

Conclusions

A weighted decision matrix has showed to be a very effective tool to assist the development of new products for use in health, particularly in cases where there are many concepts and many criteria of varying importance to be considered.

Acknowledgments

Work funded by the FEDER fund, Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), project POCI-01-0247-FEDER-017604.

Keywords

Weighted decision matrix, Medical device, Product design.

P160 Vestibular symptoms in sensorineural hearing loss

Maria Araújo¹, Luís Rama²

¹Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-256 Coimbra, Portugal

Correspondence: Maria Araújo (ines@estescoimbra.pt)

Background

The type of aetiology of hearing loss is directly related with the embryonic and physiological interactions of the anatomical structures of the auditive and vestibular systems. The proximity between both system structures can evolve simultaneously audition and balance, mainly in individuals with peripheral pathologies.

Objective

To characterize and evaluate the vestibular symptoms in individuals with bilateral severe and profound hearing loss.

Methods

The information was gathered with resource to two questionnaires: one for anamnesis and the Dizziness Handicap Inventory (DHI). The sample was constituted by 28 adults with severe and profound sensorineural hearing loss, between 19 and 64 years old (15 females and 13 males). 42.9 % of the sample had idiopathic aetiology, 10.7 % had meningitis and the same percentage with the aetiology of measles.

Results

Seventy-five percent 75% had tinnitus, being 33% bilateral. Regarding vertigo symptoms, 53.6% reported at least one episode, describing it as a rotatory vertigo (66.7%), with the length of minutes (33.3%) to days (26.7%). Regarding DHI, the functional sub scale is the one that perceives more difficulties when performing daily tasks, as a consequence of vertigo and/or unbalance (5.7 ± 8.5), followed by the physical sub scale (4.8 ± 6.8).

Conclusions

The study has shown that the major part of the sample had already faced symptoms as tinnitus, vertigo and/or unbalance.

Keywords

Hearing Loss, Vestibular symptoms, Tinnitus, Vertigo.

P161 Men’s prenatal experience in the transition to fatherhood

Catarina Silva¹, Cristina Martins², Cândida Pinto³

¹Agrupamento de Centros de Saúde do Alto Ave, 4810-503 Guimarães, Portugal; ²Nursing School, University of Minho, 4700-057 Braga, Portugal; ³Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Catarina Silva (catsilva@gmail.com)

Background

Pregnancy is a demanding period in terms of psychological reorganization in the transition to fatherhood [1,2]. The involvement of men in this period is associated with their own psychological well-being as well as the whole household [3]. This is a transition with implications for the couple, for the father/child relationship, and child development [4]. Contemporary fatherhood emphasizes the involvement of men and greater affective contact with their children, in addition to their traditional role as a financial provider [5].

Objective

This study sought to understand the experiences of men as they transition to fatherhood during the prenatal period, aiming to contribute to a complete assistance to the family and improving the health gains of the family.

Methods

Qualitative research paradigm. Exploratory, descriptive, cross-sectional and retrospective study, with the participation of 10 men experiencing, for the first time, the pregnancy of their partners, in the last trimester, in a common-law marriage and with gestation without maternal-foetal pathology. Data collection was performed using the semi-structured interview. The data was analysed with the content analysis technique, with semantic categorization and an inductive approach.

Results

Through content analysis three themes emerged, “experiencing transition”, “development of father identity” and “(de)construct bridges to transition.” The results revealed a male experience of pregnancy characterized by an enormous psychic and emotional depth. Men accept and try to actively engage in the pregnancy process and experience a panoply of positive and negative feelings and emotions, sometimes ambivalent. The prenatal period triggers the development of paternal identity. During this process, expectant fathers revaluate their personal values, reflect on their own fathering experiences and reshape their view of the world and themselves. Despite their proactive role in the fatherhood journey, they find obstacles and not bridges to their transition. The fact that they feel peripheral in prenatal care services makes it more difficult to embrace fatherhood and may compromise overcoming the transition process.

Conclusions

This study provided insight on the complex nature of this developmental transition and showed fragile environments in the approach of the expectant fathers to the prenatal care services. This reality encourages healthcare professionals to think critically about how fatherhood transition can be facilitated by practices which promote smoother transitions and benefit the family as a whole.

References

1. Condon J, Boyce P, Corkindale C. The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Aust N Z J Psychiatry. 2004;38(1-2):56-64.

2. Genesoni L, Tallandini M. Men's Psychological Transition to Fatherhood: An Analysis of the Literature, 1989-2008. Birth. 2009;36(4):305-318.

3. Plantin L, Olukoya A, Ny P. Positive Health Outcomes of Fathers' Involvment in Pregnancy and Childbirth Paternal Support: A Scope Study Literature Review. Fathering: A Journal of Theory, Research, and Practice about Men as Fathers. 2011;9(1):87-102.

4. Bawadi H, Qandil A, Al-Hamdan Z, Mahallawi H. The role of fathers during pregnancy: A qualitative exploration of Arabic fathers’ beliefs. Midwifery. 2016;32:75-80.

5. McGill B. Navigating New Norms of Involved Fatherhood. J Fam Issues. 2014;35(8):1089-1106.

Keywords

Fathers, Parenting, Pregnancy, Qualitative research.

P162 Diffuse large b-cell lymphoma, which treatment options are available?

Mariana Carvalho¹, Fernando Mendes^2,3,4, Salomé Pires^2,4, Ricardo Santo^2,7, Nicole Eicher⁸, Ricardo Teixo^2,4, Rui Cruz¹

¹Pharmacy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Biophysics Unit, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal; ³Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra Health School, 3046-854 Coimbra, Portugal; ⁴Center of Investigation in Environment- Genetics and Oncobiology, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal; ⁵Immunology Institute, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁶Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal; ⁷Faculty of Sciences and Technologies, University of Coimbra, 3004-504 Coimbra, Portugal; ⁸Biomedical Laboratory Sciences Department, University of Applied Sciences, 6711 Gratz, Austria

Correspondence: Fernando Mendes (fjmendes@estescoimbra.pt)

Background

Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive subtypes of non-Hodgkin's lymphoma (NHL). The current therapy for DLBCL is the combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). R-CHOP-14 and R-CHOP-21 are two subtypes of R-CHOP, which differ in their treatment, like CHOP-14 that has better results within high dosage in advanced stages, while CHOP-21 has better efficiency and better overall survival in elderly patients. These treatments have increased the survival of patients, though about 40% of patients there is still a failure rate of treatment. New approaches for relapsed DLBCL are outlined here, for example the understanding of the new drugs role, individualized treatments and dosage regimes.

Objective

To review the treatments available for DLBCL and all the developments of novel treatments, particularly in DLBCL recurrence variants of treatment with R-CHOP and in patients over 80 years.

Methods

A research was conducted using Google Scholar and PubMed databases, in English languages over the last 5 years, and using as keywords: Diffuse large B-cell lymphoma (DLCBL) treatment; rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulphate, prednisone (R-CHOP); cyclophosphamide, doxorubicin hydrochloride, vincristine sulphate, prednisone (CHOP).

Results

The treatment of this pathology has advanced over time starting with CHOP and later incorporating rituximab with lower relapse and upturn survival rates. Currently, about 80% to 90% of patients in early stage of DLBCL remain free of the disease after treatment with R-CHOP and radiotherapy consolidation. Concerning elderly patients (> 80 years), the addition of rituximab, namely, a reduced dose R-CHOP provides a good compromise between toxicity and the efficiency of overall survival. The survival of patients with DLBCL with more than 66 years has improved substantially since the introduction of rituximab. However, finding the optimal dose for older patients without associated toxicity is an important focus for further research.

Conclusions

The DLBCL is a heterogeneous disease, both clinically and biologically. Although, DLBCL therapy results have improved significantly over the past decades with the introduction of new specific therapeutic antitumor strategies.

Keywords

Diffuse large B-cell lymphoma, Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Novel treatments.

P163 Mistreatment to elderly in family context

Maria FP Ribeiro (fatima.ribeiro@ipsn.cespu.pt)

School of Health of Vale do Sousa, North Polytechnic Institute of Health, 4760-409 Vila Nova de Famalicão, Portugal

Background

The evidence about the increasing number of elderly people who, in their everyday lives, are abused and the implications that these events have on the practice of health professionals, plus the need for new «powers» bear alone the importance of the subject of this study. This issue of great sensitivity imposes a multifactorial attention to the social, educational, clinical and ethical domains. This involves the concerted action by all health professionals whose mission passes through contacting with seniors.

Objective

To identify signs of elder abuse and typology of abuse in a family context.

Methods

Exploratory study and empirical work, constituted by a sample of four hundred (400) elderly, enrolled in a ACES in the north of the country, in order to identify signs of abuse. In this study, a questionnaire was used to collect information about indicators of abuse in the elderly [1]. For processing and analysis, we’ve recurred to technics of descriptive and inferential statistics using factor analysis.

Results

The analysis made allowed us to sort indicators of abuse, by type of abuse, in the following order: neglection (64.8%), emotional/psychological (26.6%), economic (21.6%) and physical abuse (7.1%).

Conclusions

The results of this study suggest the emergence and necessity of early screening for signs and/or symptoms indicative of risk factors that may lead to the installation of maltreatment. The role of health professionals proves to be of prime importance and helps fighting this phenomenon.

References

1. Carney MT, Kahan FS, Paris Barbara EC. Questions to Elicit Elder Abuse (QEEA), 2003. Translated and adapted into Portuguese by Alves, JF; Sousa M. 2005.

Keywords

Abuse, Elderly, Mistreatment, Prevention.

P164 Guidelines and training a role to play for learning health organizations? The HAIs example

Sandra Oliveira^1,2, Sofia Ferreirinha³, Carla Cordiro³, António Lopes⁴

¹Polytechnic Institute of Santarém, 2001-902 Santarém, Portugal; ²Center for Health Studies and Research, University of Coimbra, 3004-504 Coimbra, Portugal; ³District Hospital of Santarém, 2005-177 Santarém, Portugal; ⁴Hospital Center of the Medio Tejo, 2304-909 Tomar, Portugal

Correspondence: Sandra Oliveira (sandra.oliveira@esg.ipsantarem.pt)

Background

International projections estimate that, in 2050, 390,000 people will die annually in Europe, as a direct consequence of Healthcare Associated Infections (HAIs) [1]. In Portugal, we estimate that 5 in 100 patients could have acquired HAIs during hospitalization [2]. Research based on practice guidelines was published, and despite evidence that good practice strategies are sufficient to reduce the rate of HAIs, hospitals struggle to comply [3]. Investigation of organizational solutions that may contribute to reduce the rate of HAIs is much needed.

Objective

This exploratory study has the following objectives: (1) to identify if the legal standards are known by health professionals of acute services of Portuguese hospitals, detect training actions or courses as well as the most common subjects taught in formal training actions; (2) to recognize the strategies implemented in the hospitals; (3) to analyse whether there are differences between knowledge and implementation of practices in hospitals; (4) to study the suggestions made by the health professionals.

Methods

Through a quantitative and qualitative approach, using quantitative data analysis and content analysis procedures, this study explores the different perspectives given by the health professional groups. The design of the study involved a literature review, study of the legal standards and conduction of informal interviews to field experts, with the aim of producing a list of topics to assess the level of implementation of the legal norms. A focus group method was used to encourage participants to exchange experiences and perspectives. These interactions allowed the collection of more detailed information and an in-depth exploration of the opinions of the participants [4][5]. The focus group also served as a pre-test to the questionnaire. A convenience sample of four acute services of Portuguese Hospitals was selected. The questionnaire was distributed in the hospitals after receiving the accordance of the Administration Board and Ethical Commission of the institutions involved. Participation in the study was voluntary and ranged all the health professionals of the medical and surgery services.

Results

The results suggest that, although aware of the legal norms, when we control for differences between groups, we find differences between health professional groups. Health professionals recognize and value the existence of training, mainly under the responsibility of the Health Institutions, but do not consider it effective.

Conclusions

This research highlights the importance of spreading knowledge and training in healthcare organizations, notably through the identification of the need for new approaches of training as well as for new training areas.

References

1. Direção Geral de Saúde 2016.

2. OPSS Acesso aos cuidados de saúde. Um direito em risco?. Relatório de Primavera Observatório Português dos Sistemas de Saúde (OPSS). Lisboa; 2015.

3. Zingg W, Holmes A, Dettenkofer M, Goetting T, Sicca F, Clack L, et al. Hospital organization, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis. 2015;15(2):212-224.

4. Kitzinger J. Introduction focus groups in qualitative research. In: Mays N, Pope C., editors. Health care. London: Blackwell; 1996. p. 36–45.

5. Morgan DL. Focus groups as qualitative research. 2nd Edition. Outstand Oaks, CA: Sage; 1994.

Keywords

Guide lines, HAIs, Training and Health Organizations.

P165 Barriers, obstacle, difficulties or challenges in development of health partnerships in community intervention projects: a systematic review

Odete Alves¹, Paula C Santos^2,3, Lídia Fernandes⁴, Paulo Moreira^5,6

¹Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal; ²Physical Therapy Department, Health School, Polytechnic Institute of Porto, 4200-465 Porto, Portugal; ³Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁴School of Health, Polytechnic Institute of Viana do Castelo, 4900-314 Viana do Castelo, Portugal; ⁵Center of Administration and Public Policies of the University of Lisbon, 1300-663 Lisbon, Portugal; ⁶University Atlântica, 2730-036 Oeiras, Portugal

Correspondence: Odete Alves (odetemaalves@hotmail.com)

Background

Engaging communities in authentic partnerships is increasingly accepted as best practice in community intervention projects, despite the many barriers or challenges to doing so.

Objective

The purpose of this study is to identify barriers, obstacles, difficulties or challenges in development of health partnerships in community intervention projects of some countries.

Methods

We conducted a systematic review using the following data sources: PubMed, B-on, Medline and EBSCOhost. We searched articles from September 2006 through January 2016. A standard form was used to extract data using the key words in the search: Health Partnerships AND Community Health AND Primary Health Care. The articles were selected according to inclusion and exclusion criteria. In the end, we grouped these results based on the six categories used by the Wilder Research Centre: Environment; Membership; Process and structure; Purpose; Communication; Resources, which includes leadership and power.

Results

From the research conducted, 844 articles emerged, which were submitted to the filter, which implied references to at least one of the keywords: Barriers OR Obstacle OR Difficulties OR Challenges. According to the inclusion criteria, a total of fifty-six articles was found. Of these articles, forty-four dealt with factors relating to Environment, which included factors related to community, geography, culture, religious faith and hom*ophily, and politics. Regarding the characteristics of the members that influence the development of the partnership, the relationship between the partners is key and this was commented in fifty-three articles. Factors relating to the process of collaboration were found in a total of forty-six articles, while factors related to structural elements were mentioned in forty articles. Thirty-one articles identified the factors relating to objectives, vision and mission. Another factor that was highly discussed was communication, appearing in a total of thirty-four articles. Factors relating to resources were given great importance in the literature, appearing in forty-eight articles. In twenty-three articles, the subject of leadership and factors relating to power were mentioned. The literature reviewed highlighted that factors such as relationships, commitment, communication, funding and structure, are key in the long-term sustainability of the partnership. This topic appeared in fifteen articles.

Conclusions

The systematic literature review identified a set of barriers, obstacles, difficulties or challenges for the development of health partnerships in community intervention projects. In each of the categories we present the factors that are related to them and that can positively or negatively influence the development of those collaborations.

Acknowledgements

We are very grateful to Dr. Alcino Maciel Barbosa for his insightful comments on an earlier draft of this project and to Caroline Esteves for her contributions in this paper.

Keywords

Barriers, Obstacle, Difficulties, Challenges, Partnerships.

P166 Parental perception of child body image: retrospective analysis of two studies

Graça Aparício^1,2, Patrícia Nascimento³, Madalena Cunha^1,2, João Duarte^1,2

¹Escola Superior de Saúde de Viseu, Instituto Politécnico de Viseu, 3500-843 Viseu, Portugal; ²Centro de Estudos em Educação, Tecnologias e Saúde, 3504-510 Viseu, Portugal; ³Centro de Saúde de Seia, 6270-468 Seia, Portugal

Correspondence: Graça Aparício (gaparicio5@hotmail.com)

Background

Childhood obesity is a major problem in Portugal and studies show that parents are concerned about their children's overweight, but their perception of children's nutritional status is not always adequate or is even distorted.

Objective

The general objective was to explore the parental perception of their children's body image in two studies, study A [1] and study B [2].

Methods

Cross-sectional and retrospective study using two samples, from study A (792) and study B (1424) totalizing 2,216 pre-school children, with mean age = 4.51 years old (SD= 0.97), living in the region of Viseu and Dão (study A) and Viseu, Lamego, Vila Real, Évora and Leiria (study B). The original authors performed the children's anthropometric evaluation and the nutritional classification based on NCHS reference (CDC, 2000). A Sociodemographic Characterization Questionnaire for Children and Parents was used and the Parental Perception of Children's Body Image Assessment [3].

Results

In Study A, overweight was 31.3% (including 12.4% obesity) and 2.7% underweight. In study B was 34.3% overweight (17.4% obesity) and 5.5% underweight, with significant differences (Chi-square= 21.355; p= 0.000). In study B, parents were significantly more concerned about their children nutritional status (UMW = 498564.000, p = 0.000) and a higher percentage of parents pointed the representative pre-obesity images (27.5%) and obesity (0.6%), compared to study A, where more children in the normal and low-weight group (56.3% and 20.4% respectively) were selected. A significant difference of means from the parental perception of the child's body image was found between studies (UMW = 528960.500; p = 0.037), showing a closer perception to the higher values of BMI, i.e., parents presented a less distorted perception of their children's body image, when they have higher BMI values.

Conclusions

The results indicate more accuracy of the parental perception of the children body image and an oncoming to their real nutritional status in the latest study. This may be the first step towards their recognition of their children's overweight that is critical to prompting family action, and consequently preventing and treating childhood obesity.

References

1. Aparício G, Cunha M, Duarte J, Pereira A. Olhar dos pais sobre o estado nutricional das crianças pré-escolares. Millenium 2011;(40):99-115.

2. Aparício G, Cunha M, Duarte J, Pereira A, Bonito J, Albuquerque C. Nutritional status in preschool children: Current trends and concerns. Atención Primaria 2013;(45)(Espec cong 1):94-200.

Keywords

Parents, Weight perception, Body image, Pediatric obesity.

P167 Informal caregivers of mental health patients: burden and care provided

Daniel Carvalho¹, Catarina Tomás^2,3, Ana Querido^2,3, Marina Cordeiro^2,3, João Gomes¹

¹Santo André Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Daniel Carvalho (drscarvalho@gmail.com)

Background

Families and informal caregivers play an important role in providing care for mental health patients [1]. Family caregivers of these patients usually are overloaded with caring activities [2], being more vulnerable to psychological disturbance and burden due to the care provided [3].

Objective

To characterize the care provided; access the burden experienced by informal caregivers of mental health patients and identify its determinants.

Methods

Cross-sectional correlational study, with a non-probabilistic sample of 113 Portuguese relatives and caregivers of mental health patients. Data were collect in the first semester of 2015. Caregivers were interviewed about sociodemographics, type of care (wholly compensatory, partially compensatory, supervision), time spent in self-care daily activities and its intensity (0-7) and with the Portuguese version of the Zarit Burden Interview [4]. Ethical procedures, according to Helsinki Declaration, were taken into account.

Results

Caregivers were mainly females (n=80), with a median age of 51 years, married (n=84), with 12 years of education (n=33) and patients-mothers (n=20). These patients had majorly depressive disorders (36.3%). Caregivers cared for their relatives from 0 up to 54 years (Median=3.25; Mean=7.86; SD=10.78). Most of them (42.5%) corresponded to someone who provided care occasionally. Nevertheless, they provided a wholly compensatory care in most areas of patient self-care daily activities (Mean=26.58; SD=31.20). Preparing and providing meals (Mean=3.54; SD=3.29), Organizing medication (Mean=3.57; SD=3.16) and its administration (Mean=3.30; SD=3.29) was the most frequent self-care provided. Intensity of wholly compensatory care provided was higher in female (t=-2.950; p=0.004) older (r=0.215; p=0.022) relatives, who took full responsibility for caring (p<0.001), living with the patient (t=-2.762; p=0.007). Most caregivers revealed no burden (62.8%; Mean=38.31; SD=22.54). Burden was higher in females (t=-2.869; p=0.005), older (r=0.259; p=0.006) and among primary or secondary caregivers (p<0.001). Impact of giving care, interpersonal relations and perceptions of self-efficacy were also higher in older females with lower education relatives, primary caregivers and caregivers that perspective gravity of their relative illness higher.

Conclusions

The caregivers inquired were mainly secondary and provided total care in all areas. The burden presented by those was low, and they provided care especially in preparing meals and organizing and administering medicines. In this sample, care provided and burden were higher in older female caregivers, low educated and with a high perspective of gravity of their relative illness. Intervention among these caregivers is needed, promoting knowledge, improving skills and providing support, which can allow to reduce the psychological consequences of the needed assistance by the relatives.

References

1. Pakenham K. Caregiving tasks in caring for an adult with mental illness and associations with adjustment outcomes. Int J Behav Med. 2012;19(2):186-198.

2. Martins S, Bandeira M, Nascimento E. Sobrecarga de familiares de pacientes psiquiátricos atendidos na rede pública. Rev Psiq Clín. 2007;34(6):270-277.

3. Cabral L, Duarte J, Ferreira M, Santos C. Anxiety, stress and depression in family caregivers of the mentally ill. Atención Primaria. 2014;46(5):176-179.

4. Sequeira C. Adaptação e validação da Escala de Sobrecarga do Cuidador de Zarit. Revista Referência. 2010;2(12):9-16.

Keywords

Informal caregivers, Mental health, Burden, Family care.

P168 Your PEL - promote and empower for literacy in health in young people: from investigation to action

Hélia Dias¹, José Amendoeira¹, Ana Spínola¹, Maria C Figueiredo¹, Celeste Godinho¹, Clara André¹, Filipe Madeira¹, Manuela Ferreira², José C Quaresma³, Mónica Ferreira⁴, Teresa Simões⁵, Rosário Martins⁶, António Duarte¹, Madalena Ferreira¹, Marta Pintor¹

¹Escola Superior de Saúde de Santarém, Instituto Politécnico de Santarém, 2005-075 Santarém, Portugal; ²Escola Superior de Saúde de Viseu, Instituto Politécnico de Viseu, 3500-843 Viseu, Portugal; ³Escola Superior de Saúde de Leiria, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal; ⁴Agrupamento de Escolas da Chamusca, 2140-052 Chamusca, Portugal; ⁵Agrupamento de Escolas da Golegã, Azinhaga e Pombalinho, 2154-909 Golegã, Portugal; ⁶Unidade Cuidados na Comunidade Chamusca Golegã, Agrupamento de Centros de Saúde Lezíria, 2140-078 Chamusca, Portugal

Correspondence: Hélia Dias (helia.dias@essaude.ipsantarem.pt)

Background

The “Your PEL - Promote and empower for literacy in health in young people” project focus on a health approach, supported by the new technologies, including three different areas: feeding, harmful consumption and sexuality. It is based on scientific evidences of health promotion, on which the need to refocus the action on the results implies the development of appropriate interventions [1, 2]. It is a multi-regional project outlined in the national strategy of smart specialization, in a partnership between IPSantarém – ESSS and ESGT, IPLeiria – ESSL e IPViseu – ESSV, the Agupamento de Escolas da Chamusca, the Agrupamento de Escolas da Golegã and ACES Lezíria – UCC Chamusca/Golegã. The students’ participation reveals itself in the project construction, framed in the curricular program and valued by the knowledge mobilization and by the skill gaining on real context.

Objective

Develop a tool for impact evaluation of health education programs for school in the feeding, harmful consumption and sexuality areas, at ages between 12 to 15 years old and monitoring the health determinants and the effectiveness of the developed strategies.

Methods

A research-action study divided in three phases: I) construction of the data collection tool and web communication platform; II) evaluation of the intervention needs of the students, development and implementation of the intervention program using the web platform; and III) evaluation of the impact of the program developed. The valuation of the knowledge generated by the project is based on a plan of actions different from the diffusion and dissemination of results, involving the institutions plots and adapted to the very essence.

Results

The project strategic impact is situated at two levels. One, evaluated after execution, corresponding to the expected results: tool development for impact measurement of the program and intervention program creation, supported by the web platform. The other, longer in time, that will be evaluated by health gains of the populations in the future.

Conclusions

The project’s relevance and originality support themselves on scientific evidence, reviling the monetarization as an essential component of the promotional health program [3, 4], valorising the innovation and sustentation of the action on the results, including more suitable interventions for the young population on a school environment. The scientific and technological knowledge impact generated and disseminated by the project will contribute for regional and national valorisation, on a logic translation of knowledge.

References

1. Amendoeira J, Carreira T, Cruz O, Dias H, Santiago MC. Programas de educação sexual em meio escolar: Revisão sistemática da literatura”, Revista da UIIPS. 2013;1(4):198-211.

2. André C, Amendoeira J. Intervention programs for the prevention of smoking in children and adolescents: A systematic literature review. Atención Primaria. 2013;45(Especial C):23.

3. Matos M, Simões C, Camacho I, Reis M. A Saúde dos Adolescentes Portugueses em tempos de recessão. HBSC; 2015. Acedido em:www.aventurasocial.com

4. Ministério da Saúde. Plano Nacional de Saúde - Orientações estratégicas para 2012-2016. Lisboa, Portugal: DGS; 2012.

Keywords

Health promotion, Empowerment, Health literacy, Young population.

P169 Effects of education on functional health: mobility and musculoskeletal back pain in the elderly

Gustavo Desouzart^1,2,3, Cristina Farias³, Sandra Gagulic^1,2,3

¹Research in Education and Community Intervention, Piaget Institute, 1950-157 Lisbon, Portugal; ²Piaget Institute, 1950-157 Lisbon, Portugal; ³Health School of Viseu, Piaget Institute, 3515-776 Viseu, Portugal

Correspondence: Gustavo Desouzart (gustavodesouzart@gmail.com)

Background

The bio-psycho-social changes that seniors undergo determine the importance of promoting a better quality of life, simultaneously with the extension of life expectancy. In what concerns this theme, a new concept of aging emerges, “the active aging” [1,2].

Objective

The aim of the study is to evaluate the effects of a functional health education program on the functional capacity of a group of elderly.

Methods

This is an experimental study, with a sample of 20 elderly people aged 67-91 years (mean of 80.70 ± 5.99), who attended day centres and were enrolled in the “Atividade Sénior” Program. This Program was developed by the social responsibility of the Viseu city council and is very important among the community, to promote physical activity in the population. Elders were randomly assigned to Experimental (n=10) and Control (n=10) groups. During this study all individuals maintained the physical activity training of the “Atividade Sénior” Program, where the experimental group had a training with aerobic, flexibility and strength components, associated with stimulation. The exercise program lasted 12 weeks with a frequency of 3 times a week, with each session lasting 30 minutes. The study was pre and post-tested, with the following scales: Timed Up and Go (TUG), to check the functional capacity [3] and the Visual Analogue Scale (VAS) to check pain level [4], with the use of body chart for identifying the site of pain. The study was submitted to the International Ethics Committee in accordance with the guidelines of the World Health Organization (WHO).

Results

In the study population, 80% of the elderly indicated some type of back pain. Of these, 50% indicated that the pain is chronic and 81.2% indicated that the main location is low back pain. At the beginning of the study participants had a mean pain according to the VAS of 5.70; the experimental group with a mean pain score of 7.10 and the control group with an average of 4.30. After 12 weeks, the participants presented a reduction in pain level (3.78), the experimental group with a significant reduction to 3.38 (p= 0.034), and the control group also with a reduction to 3.70 (p= 0.529). Regarding the functionality, according to the TUG, the experimental group obtained the mean initial time of 21.10 +10.06 and the final time of 16.32 ± 7.80 (p= 0.043), compared to the control group (p= 0.436).

Conclusions

The implemented program demonstrated that physical exercise in general allows global improvements in the elderly population of day centres, and the specific implementation of a functional mobility physiotherapy program has allowed significant results. Then there is the awakening to this theme.

Acknowledgements

Authors would like to thank those responsible for the senior activity program of the Municipal Council of Viseu, as well as to thank participants, local promoters and day centres.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) registration number: ACTRN12617001170314.

References

1. Desouzart G, Matos R, Melo F, Filgueiras E. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work. 2016;53(2).

2. WHO AA. A policy Framework. Geneva, Switz World Heal Organ. 2002.

3. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. Oxford University Press; 2002;82(2):128–137.

4. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. PAIN®. Elsevier; 2011;152(10):2399–2404.

Keywords

Functional health, Senior activity, Back pain.

P170 The Practice Environment Scale of the Nursing Work Index (PES-NWI): validation to primary health care

Eva Menino¹, Maria A Dixe^2,3, Clarisse Louro², Francisco Stefanie⁴

¹Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal; ⁴Posto Saúde da Junta de Freguesia de Penha de França, 1170-070 Lisboa, Portugal

Correspondence: Eva Menino (eva.guilherme@gmail.com)

Background

The environment of nurses' professional practice and the adequacy of resources are structural factors that are related to the results and quality of care. The validated PES scale for the Portuguese population is adequate to evaluate the conditions for nursing practice, and it was validated in Portugal in hospital settings but not in primary health care. This study proposes to make content validation for primary health care and its psychometric validation, having obtained previous authorization of the author for this validation.

Objective

Validation of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for Primary Health Care.

Methods

The original scale was submitted to a panel of 5 experts. We decided to keep items with levels of agreement greater than 75%, after analysing and after making the changes suggested, we submitted the scale to a second round by the same panel of experts. The new version was used to determine its psychometric characteristics and its revalidation.

Results

The PES version adapted for primary health care presents a Cronbach value of 0.905, meaning a very good internal consistency, with reasonable correlation values for each item with the total of the scale (0.315-0.685). In the analysis through the matrix of main components, only factorial loads above 0.30 were considered, so it was necessary to regroup the items by factors, other than the original scale. Considering the KMO value of 0.797, which indicates that there is a good correlation between the variables, and with a Bartlett test (1407.494, p < 0.001), we could infer that the variables are significantly correlated and consequently we can confirm the validity of the adapted scale. Between the original scale and the one obtained, we identified factors that focus on the same areas, but there was a change in the items that make up these factors. These changes are expected and show greater adequacy regarding the differences between primary and hospital health care. There are differences regarding the items that portray the nurse's functions, which is in line with the evidence that shows that the community context is generally more favourable for nurses to perform autonomous functions.

Conclusions

It is considered essential to use valid instruments to evaluate the characteristics of the nursing practice environment in Primary Health Care, since it is the first “door” to access to health services, with nurses having a central role in this context.

Keywords

Public Health Nursing, Continuous quality management, Validation studies.

P171 Elaboration of an IAP prevention clinical practice guideline using the ADAPTE methodology

Ana Sousa^1,2,3, Cândita Ferrito⁴, José A Paiva²

¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Centro Hospitalar S. João, 4200-319 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ⁴Escola Superior de Saúde, Instituto Politécnico de Setúbal, 2914-503 Setúbal, Portugal

Correspondence: Ana Sousa (sabrinasousa72@hotmail.com)

Background

Intubation associated pneumonia (IAP) is the most frequent health care associated infection in Intensive Care Units (ICU), causing increased length of stay, multiple health and economic costs and antibiotic resistance [1-4]. The impact of this infection motivated this study.

Objective

Elaborate a Clinical Practice Guideline (CPG).

Methods

Using the ADAPTE methodology, we performed the following sequence of steps: Configuration (definition of the study area, objectives and research questions), Adaptation (search for guidelines and other relevant documents, quality selection and assessment of currency, acceptability and applicability and elaboration of recommendations); Finalization (production of the final document, implementation and statistical data collection in terms of feedback by users about its contributions and final result). We evaluated the document regarding its quality through the application of the AGREE II instrument and its clarity, content and applicability through the presentation of the CPG draft and the application of a questionnaire to all its users in three ICUs. These results were processed using the Statistical Package for the Social Sciences system.

Results

After assessment of evidence grade, applicability and acceptability, we included in the CPG eight recommendations: avoid endotracheal intubation; daily sedation assessment and reduction; daily ventilator weaning; change ventilator circuit only when visibly soiled; head of bed elevation of 30-45º; early exercise and patient mobilization; maintenance of endotracheal tube cuff pressure between 20-30 cm H₂O; oral hygiene care with chlorhexidine 0.12% or 0.20% [5-9]. Regarding the application of the AGREE II, the CPG obtained a rating of 7 in all domains, which corresponds to a high quality. The questionnaire obtained a total of 82 responses, which corresponds to a rate of 45.6% of the respondents. All of the health care professionals stated that CPG’s objective is clear, relevant and agree with the content and the adequacy of the recommendations. Regarding applicability, 89% of the respondents stated that is applicable.

Conclusions

There is a lack of systematization and adequacy concerning CPG’s elaboration. This methodology allowed us to find the most recent recommendations regarding IAP prevention and adapt to a specific scenario successfully according to quality and user’s evaluation. We can find a limitation of the study in the fact that the evidence supporting some of the recommendations included in the CPG is moderate, and there is a shortage of experimental studies that assess the impact of implementing each individual recommendation. In the next phase

References

1. Agbaht K, Díaz E, Muñoz E, Lisboa T, Gómez F, Depuydt PO, et al. Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: a study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia. Crit Care Med. 2007;35:2064-2070.

2. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.

3. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care-associated pneumonia., 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.

4. Tejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care. 2006;21:56-65.

5. Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35 Suppl 2:S133-54.

6. Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8:Cd008367.

7. Bo, Lulong & Li, Jinbao & Tao, Tianzhu & Bai, Yu & Ye, Xiaofei & S. Hotchkiss, Richard & H. Kollef, Marin & Crooks, Neil & Deng, Xiaoming. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014; 10.

8. Paiva et al. “Feixe de Intervenções” de Prevenção de Pneumonia Associada à Intubação. Departamento da Qualidade na Saúde da Direção-Geral da Saúde. Direção-Geral da Saúde. 2015; 021/2015.

9. National Guideline C. Prevention of ventilator-associated pneumonia. Health care protocol. 2011.

Keywords

ADAPTE, Clinical Practice Guideline, Health Care Associated Infection, Intubation-associated pneumonia, ICU.

P172 The factorial analysis of a quality of life scale for people addicted to drugs in methadone programs

Paulo Seabra¹, José Amendoeira², Luís Sá¹, Olga Valentim³, Manuel Capelas¹

¹Interdisciplinary Research Health Center, Portuguese Catholic University, Health Sciences Institute, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Health Center, Polytechnic Institute of Santarém, Health School, 2005-075 Santarém, Portugal; ³Portuguese Catholic University, Health Sciences Institute, 1649-023 Lisbon, Portugal

Correspondence: Paulo Seabra (pauloseabra@ics.lisboa.ucp.pt)

Background

The evaluation scale of drug users Quality of life (QoL) in a substitution program with methadone, was developed with 21 items, two subscales, “family and economic situation” (11 items) and “personal satisfaction” (10 items) [1]. Concerning their reliability, in the validation study for the Portuguese population in 2005 (n=236) was obtained an Alfa of Cronbach of 0.88 and in a recent study in 2011(n=308) of 0.93 [1].

Objective

To determine a scale factorial structure and its psychometric properties.

Methods

Methodological study. Participants – 180 drug users participated, aging an average of 41 years (SD=7.58 [24-69]), mostly men (73.3%), single (55.6%) and with children (52.8%), from 3 outpatients drug units. Data analyses - The correlation matrix of the items was evaluated through exploratory and confirmatory factorial analysis. The factorial load as well as the internal consistency estimated the dimensionality.

Results

In the reliability analysis with 21 items was found an Alfa of Cronbach of 0.89, all communalities >0.40, KMO=0.88 (p<0.001) and 58.42% of explained variance by 5 factors. When extracted item 18 (item-total correlation 0.16), all items assumed an item-total correlation > 0.20; alpha increased (α=0.90) and KMO increased to 0.88 maintaining the stability of the Bartlett test; communalities maintained above 0.40; total variance explained by the 5 factors increased to 60.4%, but 5 factors diverged from theoretical matrix and 10 items weighed in more than one factor. Through confirmatory analysis (excluding item 18) forcing for the 2 original scale factors, we verified that 4 items had commonalities <0.30. The total variance explained after the spin fell to 43.11% and 4 items weighed in more than one factor. We explored with 3 factors, KMO maintained in 0.88, Bartlett test remained within criteria, total variance explained after de rotation stayed 49.6%. Although this structure presents 3 items weigh in more than one factor, justifies its maintenance by underlying the theoretical model. Alpha is higher to initial (α=0.90). The extraction of any item will weaken scale consistency. The most stable structure was with 3 renamed factors: 1- Personal satisfaction and self-care (8 items) (38.5% explained variance); Social Family situation (8 items) (7.4%); 3- Socio professional and economic situation (4 items) (6.5%). The fidelity of the scale is reinforced by the internal consistency of its subscales, factor 1 α=0.85; factor 2 α=0.79; factor 3 α=0.72 and by the correlation between them (0.51-0.67; p<0.01).

Conclusions

Good internal consistency. Factorial analysis supported by the theoretical matrix. Good discriminant capacity by differences pointed out in some variables.

References

1. Murcho N, Pereira P. A qualidade de vida dos doentes toxicodependentes em programas de substituição com metadona no Algarve: Um estudo comparativo da sua situação em 2003 e 2008. Rev Investig em Enferm. 2011;(23):57–64.

Keywords

Quality of Life, Substance related disorders, Assessment, Nursing, Methadone.

P173 Occupational sedentary lifestyle and overweight among workers of a higher education institution – Coimbra

Sónia Fialho¹, Anabela Martins², João Almeida³

¹Dietetics and Nutrition Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Physiotherapy Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ³Environmental Health Department, Coimbra Health School, 3046-854 Coimbra, Portugal

Correspondence: Sónia Fialho (sonia.fialho@estescoimbra.pt)

Background

In the last decades, with the introduction of changes in the work processes and with the innovation inherent to new technologies, there has been an increase of the sedentary labour lifestyle, where the worker remains sitting for long periods of time in a working day. Sedentary behaviour is associated with an increased risk of developing chronic diseases such as obesity, type II diabetes, cardiovascular diseases, and these diseases are the main cause of mortality and morbidity in Portugal.

Objective

This study aims to evaluate the relationship between sedentary work and overweight in teaching and non-teaching workers.

Methods

The Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was applied and then calculated the percentage of the activity for each domain (sitting, standing, walking) by the number of hours worked per day. Data on age, gender and body mass index, between December 2017 and January 2018, were collected from a sample of 58 adult men and women in full-time employment at the time of the study. To study the correlation between the percentage of the occupational sitting by the number of working hours per day and overweight, authors analysed the information with SPSS Statistics.

Results

In the present study, 39 of the individuals were females and 19 males, aged between 31 and 62 years. In the analysis done to the OSPAQ, 44 (75.8%) individuals spend more than 50% of their working day in the sitting position. In relation to the BMI, considering the purpose of the study and according to the classification of the World Health Organization, 32 (55.2%) of the individuals presented a BMI ≥ 25. Pearson correlation revealed that there is no association between the sitting time and the BMI ≥ 25 (p> 0.05).

Conclusions

With this study it was possible to verify that there are individuals with a sedentary lifestyle associated to their work day. Although in this study there is no association between occupational sitting and BMI ≥ 25, despite there are studies that demonstrate a significant association between these two parameters. A further study, including other criteria, is in progress, involving the anthropometric level, such as body fat, waist circumference and physical activity assessments.

References

1.Yang L, Hipp JA, Lee JA., Tabak RG, Dodson EA, Marx CM, Brownson RC. Work-related correlates of occupational sitting in a diverse sample of employees in Midwest metropolitan cities. Preventive Medicine Reports. 2017;6:197-202.

2. Chau J, Van der Ploeg H, Dunn S, Kurko J, Bauman A. Validity of the occupational sitting and physical activity questionnaire. Medicine & Science in Sports & Exercise. 2012;44(1):118-125.

3. Lin T, Courtney TK, Lombardi DA, Verma SK. Association between sedentary work and BMI in a U.S. national longitudinal survey. American Journal of Preventive Medicine. 2015;49(6):117-123.

4. Mummery WK, Schofield GM, Steele R, Eakin EG, Brown WJ. Occupational sitting time and overweight and obesity in Australian workers. American Journal of Preventive Medicine. 2005;29:91-97.

Keywords

Health promotion, Sedentary behaviour, Body mass index, Workplace.

P174 Oral health assessment among elderly stroke patients

Nélio Veiga^1,2, Ricardo Figueiredo¹, António Coelho¹, André Almeida¹, Gonçalo Lopes¹, Salvatore Bellantone¹

¹Health Sciences Institute, Portuguese Catholic University, 3504-505 Viseu, Portugal; ²Center for Interdisciplinary Health Research, Portuguese Catholic University, 3504-505 Viseu, Portugal

Correspondence: Nélio Veiga (nelioveiga@gmail.com)

Background

Oral hygiene can become a very difficult task for patients who have suffered a stroke, due to motor and cognitive complications and lack of coordination, which usually accompany the post-stroke period. Many of these patients require support from caregivers to properly hygiene the oral cavity as well as, their prostheses.

Objective

Characterization of oral health among elderly who have suffered a stroke.

Methods

A cross-sectional observational study was carried out in institutionalized elderly individuals aged between 60 and 98 years old. Data collection was carried out in two households in the city of Viseu, Portugal: Fundação Dona Mariana Seixas and Viscondessa House of São Caetano. Due to health limitations of the study participants, in terms of speech and cognitive problems, the final sample consisted of 30 participants. Data collection was achieved through the application of a questionnaire.

Results

Of the final sample, 20 elderlies had at least one stroke episode, representing 67% of the sample. Of these 20 elderlies, 5 reported having had cognitive or speech sequelae, while the remaining 15 reported that the main sequel was motor dysfunction. Of a total of 30 institutionalized elderly, 19 had total absence of dental pieces, corresponding to 63% of the sample. However, the remaining 37% reported multiple dental losses due mainly to dental caries and periodontal problems. These problems may be associated with deficient oral hygiene of the participants, where 18 affirm that they perform dental or denture brushing only once a day, while 40% said they did not take care of their own oral hygiene.

Conclusions

Within the limitations of this study, it is possible to conclude that stroke is a constant among the Portuguese population and that patients who have suffered from stroke have a lower oral hygiene.

Keywords

Stroke, Oral hygiene, Elderly, Oral health, Dysfunction.

P175 The daily life of people with human immunodeficiency virus in an island space: what trends?

Gilberta Sousa¹, Maria A Lopes², Vitória Mourão³

¹Universidade da Madeira, 9000-034 Funchal, Madeira, Portugal; ²Escola Superior de Enfermagem Lisboa, 1600-190 Lisboa, Portugal; ³Universidade de Lisboa, 1649-004 Lisboa, Portugal

Correspondence: Gilberta Sousa (gfranca@uma.pt)

Background

Human immunodeficiency virus/acquired immunodeficiency virus (HIV /AIDS) infection continues to haunt the lives of millions of people and, despite the progress made in the treatment of HIV/AIDS, it is estimated that 36.7 million people in the world living with HIV in 2017 [1]. In the year 2016 and until June 30, 2017, 1,030 new cases of HIV infection were reported, corresponding mostly (99.7%) to individuals aged ≥ 15 years. Portugal has had the highest rates of new cases of HIV and AIDS infection in the European Union [2]. We found that it is not possible to stop the HIV epidemic only with medical interventions. It is vital to address in everyday life the underlying social issues that prevent people from accessing interventions for prevention, diagnosis and treatment of infection, including unequal human rights, stigma and discrimination. When a person is stigmatized or unable to access services as a result of discrimination, the health of the entire community is threatened and epidemic HIV transmission continues to expand rather than to contract [3].

Objective

To understand how people live with HIV/AIDS, everyday life in an island space.

Methods

Qualitative study, grounded theory [4], in-depth interviews were carried out, in a convenience sample, to seropositive adults of any sexual orientation who wished to talk about their experience. Data analysis included initial coding, grouping of codes, identification of categories/subcategories and memos. Fulfilled ethical requirements and assent of an ethics committee were obtained.

Results

Participants were between the ages of 25 and 67 and had primary education as well as secondary education. The analysis of the data gave rise to three categories: “living with fear”, “surviving” and “facing fear”. The data are discussed in the light of the theory of transitions [5] of how to live everyday life in an island space.

Conclusions

We hope that the findings help in understanding the daily lives of people with HIV/AIDS, because in order to overcome this transition they have to reconfigure their way of living, especially when living on an Island. Realize how they face and fight in the daily life against stigma; what are the most demanding situations they face and what strategies they use. The strategies used and suggested will give subsidies to the health system and nursing professionals towards the design of new programs that will enable each patient to respond to their individual needs with the resources that each one has.

References

1. UNAIDS, Right to Heath - My health, My right. 2017. Available in: http://www.unaids.org/sites/default/files/media_asset/RighttoHealthReport_Full_web% 2020%20Nov.pdf

2. PORTUGAL. Ministério da Saúde. Instituto Nacional de Saúde Doutor Ricardo Jorge, IP, Infeção VIH/SIDA: a situação em Portugal a 31 de dezembro de 2016/Departamento de Doenças Infeciosas do INSA. Unidade de Referência e Vigilância Epidemiológica; Programa Nacional para a Infeção VIH/SIDA. Direção-Geral da Saúde. - Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge, IP, - (Documento VIH/SIDA; 148). 2017.

3. PEPFAR. President’s Emergency Plan for AIDS Relief. U.S. Department of State Office of the U.S. Global AIDS Coordinator and Health Diplomacy 2017. https://www.pepfar.gov/documents/organization/267809.pdf

4. Charmaz K. Constructing Grounded Theory. 2nd edition. London: Sage Publications Limited; 2014.

5. Meleis AI, Sawyer LM, Im EO, Hilfinger Messias DK, Schumacher K. Experiencing Transitions: An Emerging Middle-Rang Theory. ANS Adv Nurs Sci. 2000;23(1):12-28.

Keywords

People with HIV/AIDS, Theory of transitions, Everyday life, Stigma, Nursing.

P176 Validation of the nursing diagnosis of impaired walking in elderly

Cristina Marques-Vieria^1,2, Luís Sousa^3,4, Débora Costa⁵, Cláudia Mendes⁵, Lisete Sousa^5,6, Sílvia Caldeira^1,2

¹Lisbon School of Nursing, Institute of Health Sciences, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Center for Health, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ³Curry Cabral Hospital, Central Lisbon Center Hospital, 1069-166 Lisbon, Portugal; ⁴Atlântica School of Health, 2730-036 Barcarena, Portugal; ⁵Faculty of Science, Lisbon University, 1749-016 Lisbon, Portugal; ⁶Statistics and Applications Center, Lisbon University, 1749-016 Lisbon, Portugal

Correspondence: Cristina Marques-Vieria (cristina_marques@ics.lisboa.ucp.pt)

Background

The increase in longevity causes restriction of activity in the elderly, causing changes on the execution of daily activities and consequently on the quality of life [1]. Walk is an activity that requires using a variety of skills and can be highly complex particularly for the elderly people [2]. The nursing diagnosis impaired walking is part of NANDA International since 1998 and requires further validation to improve the clinical evidence [3].

Objective

To validate the nursing diagnosis impaired walking in a sample composed of elderly.

Methods

Observational, cross-sectional and quantitative study. After the first research phase of systematic literature review several defining characteristics and related factors of the diagnosis impaired walking have been listed.2 Then, the translation, linguistic and cultural adaptation of the nursing diagnosis was conducted, and finally, the clinical validation of the diagnosis using the clinical validation model of Richard Fehring [4], in a sample of elderly and counting on the collaboration of registered nurses and rehabilitation nurses to collect the data and fill the questionnaires, which comprised demographic data, the defining characteristics, related factors and falls efficacy scale international [5]. The study was approved by the ethical committee of SESARAM. E.P.E (Madeira Island Healthcare System).

Results

In the systematic literature review 17 defining characteristics and 34 etiological factors of impaired walking have been identified. A European Portuguese version was obtained to validate in a sample of 126 elderly, whose average age was 73.86 years, mostly female, with the primary school, in a situation of retirement, widowed and with history of falls. The prevalence of “impaired walk” was 64.3% according to the expert's opinion and 67.5% according to the elderly. All defining characteristics and related factors have been validated. The most sensitive defining characteristic was nine (e.g. impaired ability of gait speed) and also four related factors (fear of falling, physical deconditioning, medication and feminine gender).

Conclusions

This study justifies the need to review the defining characteristics and related factors of impaired walking. The identification of the most sensitive defining characteristics facilitates nurses’ clinical reasoning and interventions towards effective nursing outcomes.

References

1. Marques-Vieira CM, Sousa LM, Carias JF, Caldeira SM. Nursing diagnosis “impaired walking” in elderly patients: integrative literature review. Rev Gaucha Enferm. 2015;36(1):104-111.

2. Marques-Vieira CM, Sousa LM, Sousa LM, Berenger SM. The nursing diagnosis impaired walking in elderly: systematic literature review. Texto & Contexto Enferm. 2016;25(3):e3350015.

3. Herdman HT, Kamitsuru S, editors. Nursing Diagnoses: Definitions & Classification 2018-2020. Oxford: Wiley-Blackwell; 2017.

4. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung. 1987;16(6):625-629.

5. Marques-Vieira CM, Sousa LM, Severino S, Sousa L, Caldeira S. Cross-cultural validation of the falls efficacy scale international in elderly: systematic literature review. J Clin Gerontol Geriatr. 2016;7(3):72-76.

Keywords

Nursing, Nursing Diagnosis, Walking, Gait, Validation studies.

P177 Validation of the nursing diagnosis risk for falls in elderly

Cristina Marques-Vieria^1,2, Luís Sousa^3,4, Débora Costa⁵, Cláudia Mendes⁵, Lisete Sousa^5,6, Sílvia Caldeira^1,2

¹Lisbon School of Nursing, Institute of Health Sciences, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Center for Health, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ³Curry Cabral Hospital, Central Lisbon Center Hospital, 1069-166 Lisbon, Portugal; ⁴Atlântica School of Health, 2730-036 Barcarena, Portugal; ⁵Faculty of Science, Lisbon University, 1749-016 Lisbon, Portugal; ⁶Statistics and Applications Center, Lisbon University, 1749-016 Lisbon, Portugal

Correspondence: Cristina Marques-Vieria (cristina_marques@ics.lisboa.ucp.pt)

Background

Falls and their consequences are critical for for elderly well-being quality of life, for caregivers, and for health care providers [1]. The nursing diagnosis risk for falls is listed in NANDA International since 2000 [2]. This diagnosis seems particularly important in planning effective nursing care for the community-dwelling elderly.

Objective

To validate the nursing diagnosis risk for falls in a sample of elderly.

Methods

Observational, cross-sectional and quantitative study conducted in three phases. The first phase, corresponded to a systematic literature review to identify the risk factors of risk for falls [3]. The second phase consisted of the translation, linguistic and cultural adaptation of the nursing diagnosis for European Portuguese language. The third, was the clinical validation of the diagnosis using the clinical validation model of Richard Fehring [4], in a sample of elderly and counting on the collaboration of registered nurses and rehabilitation nurses to collect the data and fill the questionnaires, which comprised demographic data, the risk factors and falls efficacy scale international [5]. The study was approved by the ethical committee of SESARAM. E.P.E (Madeira Island Healthcare System).

Results

A total of 50 risk factors of risk for falls have been identified in the systematic literature review. A European Portuguese version was obtained and submitted to the clinical validation in a sample of 126 elderly, whose average age was 73.86 years, mostly female, with the primary school, in a situation of retirement, widowed and with history of falls. The prevalence of risk for falls was 68.3% in the expert's opinion and 63.5% in the opinion of the elderly. All risk factors have been validated. The most sensitive risk factor was history of falls, comorbidities, feminine gender, polymedication, difficulty with gait, and drugs.

Conclusions

This study found the main risk factors for falls in a sample of community-dwelling elderly. The identification of the most sensitive risk factors may support nurses’ clinical reasoning and interventions for effective fall prevention.

References

1. Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Systematic Reviews. J Geriatr Phys Ther. 2017;40:1-36.

2. Herdman HT, Kamitsuru S, editors. Nursing Diagnoses: Definitions & Classification 2018-2020. Oxford: Wiley-Blackwell; 2017.

3. Sousa LM, Marques-Vieira CM, Caldevilla MN, Henriques CM, Severino SS, Caldeira SM. Risk for falls among community-dwelling older people: systematic literature review. Rev Gaucha Enferm. 2017;37(4):e55030.

4. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung. 1987;16(6 Pt 1):625-629.

5. Marques-Vieira CM, Sousa LM, Severino S, Sousa L, Caldeira S. Cross-cultural validation of the falls efficacy scale international in elderly: systematic literature review. J Clin Gerontol Geriatr. 2016;7(3):72-76.

Keywords

Nursing, Nursing Diagnosis, Risk for falls, Fear of falling, Validation studies.

P178 Teachers and professors’ mental health: prevalence of self-reported psychological symptoms

Ana Querido^1,2, Catarina Tomás^1,2, Daniel Carvalho³, Marina Cordeiro^1,2, João Gomes³

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Santo André Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal

Correspondence: Ana Querido (ana.querido@ipleiria.pt)

Background

The work of teaching professionals is recognized to be demanding, involving dynamic interactions with students, parents, colleagues and school authorities [1]. Teaching has been ranked as one of the most stressful profession and its nature is applicable to all professional teaching roles. Several research reports have consistently documented physical and psychological symptoms experienced by teaching professionals. Several physical complains and psychosomatic symptoms such as lower back pain, headache, voice disorders and anxiety are frequently faced by teaching professionals, both in secondary and higher education, especially in women [1-5]. Presence of psychopathology symptoms in teachers are related to their rating of children mental health behaviors [6], as well as determinants to professional burnout. Therefore, identification of psychological symptoms among teachers is relevant in secondary and higher education.

Objective

To identify the prevalence of self-reported psychological symptoms; Characterize the symptoms by its dimension and determine the differences in psychological symptoms between high school teachers and higher education professors.

Methods

Cross-sectional correlational study, with a non-probabilistic sample of 96 Portuguese teaching professionals. Data were collected using an on-line questionnaire composed by sociodemographic questions and the Portuguese version of Brief Symptom Inventory (BSI) - 53 items covering nine symptom dimensions: Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation and Psychoticism; and three indices of distress: Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST). Ethical procedures were taken into account.

Results

Teaching professionals were mostly women (70.8%), aged between 30 and 62 years old (Mean=44.8; SD=7.86), 43.8% with a bachelor degree, 27.1% diagnosed with a mental disease, and 41.1% acquainted with mental health patients. Professors (37.5%) were from different fields, including health, engineering, arts, communication, social sciences, marketing and sports. High school teachers (62.5%) were mainly from sociology, philosophy and mathematics. The most scored dimension was Obsession-Compulsion in high school teachers (Mean=1.03; SD=0.75). Globally high school teachers revealed more symptoms of distress than higher education professors. Significant differences between groups were found in Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety, Phobic Anxiety, Psychoticism, GSI and PST (p < 0.05). In the 53 BSI items, the PST was low (Mean=19.09; SD=12.70).

Conclusions

Prevalence of symptoms were high in the samples of teaching professionals, although they experienced psychological distress in low intensity. Differences between high school teachers and higher education professors were highlighted in this study. Therefore, there is a need for intervention among high school teachers to minimize the impact of detecting mental disorders in students, as well as preventing professional absents and burn-out.

References

1. Au DWH, Tsang HWH, Lee JLC, Leung CHT, Lo JYT, Ngai SPC, et al. Psychosomatic and physical responses to a multi-component stress management program among teaching professionals: A randomized study of cognitive behavioral intervention (CB) with complementary and alternative medicine (CAM) approach. Behav Res Ther. 2016;80:10–16.

2. Chan AHS, Chong EYL. Subjective Health Complaints of Teachers From Primary and Secondary Schools in Hong Kong. Int J Occup Saf Ergon. 2010;16(1):23–39.

3. Ferreira RC, Silveira AP da, Sá MAB de, Feres S de BL, Souza JGS, Martins AME de BL. Transtorno mental e estressores no trabalho entre professores universitários da área da saúde. Trab Educ e Saúde. 2015;13(suppl 1):135–155.

4. Seibt R, Spitzer S, Druschke D, Scheuch K, Hinz A. Predictors of mental health in female teachers. Int J Occup Med Environ Health. 2013;26(6):856-869.

5. Zamri EN, Moy FM, Hoe VCW. Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia. PLoS One. 2017;12(2):e0172195.

6. Kokkinos CM, Kargiotidis A. Rating students’ problem behaviour: the role of teachers’ individual characteristics. Educ Psychol. 2016;36(8):1516–32.

Keywords

Mental health, Psychological symptoms, Teachers, Teaching professionals.

P179 Generating high vegetable liking among young children to promote healthy eating: results from an intervention at a kindergarten school

Cátia Braga-Pontes^1,2, Ana Pinto Moura³, Luís Cunha⁴

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Sciences and Technology Departament, Open University of Portugal, 4200-055 Porto, Portugal; ⁴Department of Geosciences, Environment and Spatial PlanningsFaculty of Sciences, University of Porto, 4485-661 Vila do Conde, Portugal

Correspondence: Luís Cunha (lmcunha@fc.up.p)

Background

Fruit and vegetables have always played a prominent role in dietary recommendations because of their high concentration of vitamins, minerals, phytochemicals and because they are a great source of fibre [1,2]. Recent data show that in general, the population should at least double consumption of fruit and vegetables in order to reach the 400g/day recommended by World Health Organization (WHO) [3]. In Portugal, the data presented by the National Food Survey in 2017 showed that 68.9% of children do not consume more than 400g/day of fruit and vegetables, highlighting a lower consumption of vegetables compared to fruit [4].

Objective

The purpose of this study was to evaluate the impact of a food intervention, with exposure combined with a tangible reward, on food neophobia, liking and intake of different vegetables, at the kindergarten school environment, in the South of Portugal.

Methods

Children (n=82) aged 2 to 5 years old, from different classes, were randomly assigned by class to intervention (n=68) or control group (n=16) and the intervention lasted nine weeks. Children food neophobia [5] and eating behaviour [6,7] were evaluated by parents at the beginning of the intervention. Mother’s food neophobia [8] was also measured. In each week, children attended an educative session about the vegetable they would eat at lunch (carrot, bell pepper, broccoli, tomato, cucumber, purple cabbage, spinach, arugula and beet), being rewarded with a sticker when eating the vegetable. Assessments of intake and liking were recorded at baseline sessions and after each exposure, using ASTM’s pictorial scales for children [9]. Children at control group were exposed at the same experiment after the intervention group during the subsequent nine weeks.

Results

Children from both groups presented high levels of liking for the different vegetables, with this being modulated by the children’s traces of personality and eating behaviour.

Conclusions

Exposure to the different vegetables with a playful approach yields high liking scores for a range of vegetables, indicating that such an approach has good potential to overcome vegetables avoidance by young children.

Trial Registration

NCT03513081

References

1. Rodriguez-Casado A. The Health Potential of Fruits and Vegetables Phytochemicals: Notable Examples. Critical reviews in food science and nutrition. 2016;56(7):1097-107.

2. Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Advances in Nutrition. 2012;3(4):506-16.

3. Pem D, Jeewon R. Fruit and Vegetable Intake: Benefits and Progress of Nutrition Education Interventions- Narrative Review Article. Iranian Journal of Public Health. 2015;44(10):1309-21.

4. Lopes C, Oliveira A, Severo M, Alarcão V, Guiomar S, Mota J, et al. Inquérito Alimentar Nacional e de Atividade Física. Porto: Universidade do Porto; 2017.

5. Pliner P. “Development of measures of food neophobia in children”. Appetite 1994;23(2):147-163.

6. Wardle J, Guthrie C A, Sanderson S, Rapoport L. Development of the Children's Eating Behaviour Questionnaire. J Child Psychol Psychiatry 2001;42(7):963-970.

7. Viana V, Sinde S. O Comportamento Alimentar em Crianças: estudo de validação de um questionario numa amostra portuguesa (CEBQ). Análise Psicológica 2008;1(XXVI):111-120.

8. Pliner P, Hobden K. Development of a scale to measure the trait of food neophobia in humans. Appetite 1992;19(2):105-120.

9. ASTM. E 2299-03. Standard Guide for Sensory Evaluation of Products by Children. United States, ASTM International; 2008.

Keywords

Children, Food Neophobia, Playful intervention, Vegetables.

P180 The limitations of medicinal package leaflets

Ana P Izidoro¹, Patrícia Correia²

¹Farmácia Rainha, 5140-067 Carrazeda de Ansiães, Bragança, Portugal; ²Escola Superior de Saúde do Porto, 4200-072 Porto, Portugal

Correspondence: Ana P Izidoro (anaizi_20@outlook.pt)

Background

It is known that, in order to solve most of the existing health problems, it is often fundamental that a pharmacological approach exists. For this reason, patients must be adequately informed about their health status and about the medicines they are using. One of the most important resources of medicines information, available for patients, is the information leaflet. It provides a set of understandable information and should contribute to the appropriate and safe use of information, complementing the information given by health professionals. However, the content appears to be quite complex or too technical and the text is very dense and with a reduced font size, making it intimidating and difficult to read.

Objectives

The main objectives of this study are: to identify if users read the information leaflet and whether reading frequency is associated with the importance they attribute to it; and to identify the limitations attributed by the respondents to information leaflets and possible relationships with the socio-demographic characteristics of the population.

Methods

This was a transversal and inferential descriptive observational study, which took place between March and November, 2017, based on the application of a questionnaire in the form of an interview to 320 Bragança residents. Various data were collected, particularly with regard to the frequency of reading the information leaflets, the importance attributed to the same or each section, and existing limitations.

Results

Regarding the possible relationships between the data obtained, it was verified that there is sufficient statistical evidence to affirm that there is an association between the reading frequency of the information leaflet and the importance attributed to it, but the same cannot be trusted as to the association between the limitations attributed to the information leaflets and the socio-demographic characteristics of the respondents.

Conclusions

In sum, these associations and the fact that most respondents have indicated, as the main limitation in reading information leaflets, the use of very technical language, may mean that the information leaflet is not being developed in order to promote reading by part of the youngest or the oldest, which are the groups presenting the major reading difficulties.

Keywords

Information leaflet, Illiteracy, Information, Limitations, Adherence to therapy.

P181 Eating habits and perception of body image in higher education students

Helena Catarino^1,2, Clementina Gordo¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Helena Catarino (helena.catarino@ipleiria.pt)

Background

The transition to higher education is one of the risk factors in the adoption and maintenance of healthy lifestyles [1] and, at this stage, many students develop concerns related to eating habits, their body [2] and body image.

Objective

This correlational study had two main objectives, namely, to characterize eating habits and the perception of body image among higher education students; and to relate eating habits to the students’ perception of body image.

Methods

We used a questionnaire to collect socio-demographic and anthropometric data, an eating habits scale [3] and the body shape questionnaire [4]. The non-probabilistic convenience sample consisted of 386 students, with mean age of 21.94 years (SD = 5.30), of which 82.9% were females.

Results

According to WHO Body Mass Index classification, 72.3% of the students presented normal weight, 14% pre-obesity and 6.2% moderate thinness. From the point of view of the concerns related with body image, the majority, 54.7% presented no distortion of body image. However, the remaining 45.3% presented distortion of body image and among these, 16.6% presented severe distortion. From the point of view of eating habits, the results show that the sample had adequate eating habits. The majority of respondents ate 5 (36.3%) or 4 (32.6%) meals per day and for the four dimensions of the eating habits scale (quality, quantity, variety and food adequacy), the scores varied between a minimum of 2 and a maximum of 5, where the highest mean value was found at the level of food variety (M = 3.62, SD = 0.53) at the lowest mean value observed was found at the level of food quality (M = 3.40, SD = 0.56). The correlations between the dimensions of the eating habits scale (quality, quantity, variety and food adequacy) and students' perceptions of body image are statistically non-significant (respectively, r = 0.099; r = 0.011; r = -0.046; r = -0.038 and p > 0.05).

Conclusions

Although the results show that these students have adequate eating habits, it is important to continue to study the food culture of the populations, to identify individuals at risk, to intervene from the point of view of promoting the acquisition of healthy eating habits, and to study the factors underlying the distortion of body image and its influence on students' physical and mental well-being.

References

1. Soares A, Pereira M, Canavarro J. Saúde e qualidade de vida na transição para o ensino superior. Revista Psicologia, Saúde & Doenças. 2014;15(2):356-379.

2. Tekin C, Bozkir C, Nese Karakas N, Gunes G. The relation between the body perceptions and eating habits of the students in Inonu University. Anals of Medical Research. 2017:24(1):1-9.

3. Marques A, Luzio F, Martins J, Vaquinhas M. Hábitos alimentares: validação de uma escala para a população portuguesa. Escola Anna Nery Revista de Enfermagem. 2011;15(2):402-409.

4. Pimenta F, Leal I, Maroco J, Rosa B. Validação do Body Shape Questionnaire (BSQ) numa amostra de mulheres de meia-idade. Atlas do 9º Congresso Nacional de Psicologia da Saúde. Lisboa: Placebo Editora; 2011.

Keywords

Eating habits, Body image, Students.

P182 Psychosocial impact of the assistive technologies for mobility on the participation of wheelchair’s users

Anabela Martins¹, João Pinheiro², Patrícia Francisco¹, Inês Domingues²

¹Physiotherapy Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Anabela Martins (anabelacmartins@estescoimbra.pt)

Background

Recognizing that assistive technology (AT) for mobility play an important role in their users’ participation, it will be useful to rehabilitation professionals and services to assess if the perceived psychosocial impact of such devices and associated services, systems and policies contributes to enhance lifelong capacity and performance [1-3]. To build comprehensive rehabilitation services, information on a person’s experience in every aspect of his/her life is essential, as well as the role of AT on functioning and, particularly, in participation.

Objective

To study the psychosocial impact of manual and powered wheelchairs on the participation of their users.

Methods

From May to December 2017, sixty AT users (30 powered and 30 manual wheelchairs), aged 28-66 (mean 46.63 ± 10.66) years old, 53.3% female, with mix diagnosis, were interviewed using the Psychosocial Impact of Assistive Devices Scale (P-PIADS), the Activities and Participation Profile related to Mobility (PAPM) and demographics, clinical and questions about AT use and training.

Results

The participation profiles revealed that 6.7% of the participants present no restrictions, 20.0% mild, 35.0% moderate and 38.3% severe restrictions in social participation. All subscales (competence 1.50, adaptability 1.45, self-esteem 1.15) and P-PIADS total (1.38) were positive and moderately correlated to the activities and participation profile. Age and type of wheelchair and training of AT as an intervention do not influence statistically the participation, however, number of years on a wheelchair does. In general, training experiences were described as occurring in a clinical setting base, in terms of to enhance the capacity for handing the new device, with less attention to users’ performance in the community and at home, reducing the barriers and promoting a facilitator environment.

Conclusions

These results encourage the authors to keep studying the impact of AT for mobility on participation, namely the manual and powered wheelchairs, to develop robust evidence for rehabilitation, giving a contribution to the efforts of the Global Cooperation on Assistive Technology Initiative, and create support for Rehabilitation 2030 A Call for Action4.

References

1. Salminen AL, Brandt A, Samuelsson K, Toytari O, Malmivaara A. Mobility devices to promote activity and participation: a systematic review. J Rehabil Med. 2009;41(9):697-706.

2. Lofqvist C, Pettersson C, Iwarsson S, Brandt A. Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use. Disabil Rehabil Assist Technol. 2012;7(3):211-218.

3. Martins A, Pinheiro J, Farias B, Jutai J. Psychosocial Impact of Assistive Technologies for Mobility and Their Implications for Active Ageing. Technologies. 2016;4(3):28.

4. Gimigliano F, Negrini S. The World Health Organization “Rehabilitation 2030: a call for action”. Eur J Phys Rehabil Med 2017;53:155-68.

Keywords

Assistive Technologies, Wheelchair, Psychosocial impact, Social participation.

P183 Unconventional therapies in nursing - innovating the practice

Maria I Santos (marirene_mps@hotmail.com)

Higher School of Health, Polytechnic Institute of Santarém, 2005- 075-Santarém, Portugal

Background

The use of unconventional therapies by Nurses was transmitted to us as nursing students, in various clinical teaching contexts. The disciplinary and professional coherence of these therapies, as well as the therapeutic efficacy they present, legitimizes, from the perspective of nurses, the innovation they constitute in the practice of care.

Objective

To understand the process of integrating nonconventional therapies into nursing practice, in the dimensions: identification of therapies in use; meanings assigned and used strategies evaluated by nurses and patients.

Methods

Grounded Theory was used, in the constructivist perspective of Kathy Charmaz. The main data collection techniques were the intensive interview and participant observation. Participants were 15 nurses from 9 public hospitals, from the district and central levels, from the north, central and south of the country, and a team of 10 nurses and 17 users of a pain service from an oncology hospital.

Results

From the results we point out: nurses innovate their practice of care through the use of nonconventional therapies of environmental, manipulative, mental-cognitive, energetic and relationship nature. The physical, social and normative environments condition the practice of these therapies; the modes of action evidence the importance they confer to the ethical aspects and the (re)combination of several techniques, result in innovative and individualized care. Nurses evaluate these therapies as very effective in various health/illness situations, emphasizing their contribution to well-being.

Conclusions

Conclusions and implications of the study: nurses identify a sense of high conceptual and professional coherence of nonconventional therapies with nursing, considering that they innovate and considerably increase the repertoire of practice. The innovation of Nursing practices, through the integration of these therapies, contributes to the well-being of the people cared for and enables them to better manage their health, which is relevant in an aging society.

Keywords

Unconventional therapies, Nursing, Innovation practices, Well-being.

P184 Translation and cultural adaptation of English Modified DABS (EMDABS) Scale for Portuguese language

Pedro JC Luz^1,2 (pedrojcluz@gmail.com)

¹Hospital Professor Doctor Fernando Fonseca, 2720-276 Lisbon, Portugal; ²Lisbon Nursing School, 1600-190 Lisbon, Portugal

Background

The occurrence of aggressive episodes by clients in the contexts of mental health settings are recurrent, being imperative to adapt staff interventions to stabilize the psychopathological state of the client, consequently reducing the risk of injury. The de-escalation technique prevents the escalation of aggressiveness, allows a relationship of trust to be established by demonstrating understanding of the client’s problems and concerns [1]. The same authors performed the psychometric validation of the English modified De-Escalating Aggressive Behaviour Scale (EMDABS). This scale aims to evaluate the education/training and de-escalation skills of health professionals, based on seven items: “valuing the client; reducing fear; inquiring about client’s queries and anxiety; providing guidance to the client; working out possible agreements; remaining calm; risky”. The scale revealed a high level of consistency between the seven items of the de-escalation α=0.901.

Objective

This study aims to translate and effect the cultural adaptation of the EMDABS scale to the Portuguese language in order to improve nursing de-escalation techniques.

Methods

The translation and cultural adaptation of this instrument followed a methodological sequence: translation of the scale into Portuguese; focus group discussion; retroversion to English and pre-testing [2]. The study was authorized by the hospital ethics committee. The participants of the focus-group agreed to participate freely and clarified.

Results

The first translation was carried out by two teachers, born in Portugal and fluent in English, with a Degree in Modern Languages and Literatures. Conceptual translation was privileged instead of literal translation, promoting the conservation of simple and accessible language characterized by the original instrument. The translation was evaluated by a focus group (6 professionals) with experience in the field, all participants speak Portuguese and are fluent in English, having evaluated the translation obtained and suggested necessary changes. The translation was then back-translated into the English language, by a Clinical Psychologist, from South Africa, with English native language, fluent in Portuguese, with experience in the field, as well as in the translation of evaluation instruments. This professional had no previous contact with antecedent versions of this instrument. The Pre-testing was applied to a group of ten nurses to evaluate the adequacy of the structure and items of this scale, as well as to validate eventual difficulties in filling it.

Conclusions

In the pre-test, the instrument showed a good internal consistency and the participants did not present filling difficulties. The next step is to determine the psychometric properties of the scale.

References

1. Mavandadi V, Bieling P, Madsen V. Effective ingredients of verbal de-escalation: validating an English modified version of the De-Escalating Agressive Behaviour Scale. J Psychiatr Ment Health Nurs. 2016;23(6-7):357-68.

2. Waltz C, Strickland O, Lenz E. Measurement in Nursing and Health Research (4th. Ed.). New York: Springer Publishing Company; 2010.

Keywords

Aggressive behavior, Cultural adaptation, De-escalation, Mental illness, Nursing interventions.

P185 Supporting informal caregivers of people dependent in self-care

Maria A Dixe^1,2, Ana CS Cabecinhas², Ana JCF Santos², Marina G Silva², Maura R Domingues², Ana Querido^1,2

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Maria A Dixe (maria.dixe@ipleiria.pt)

Background

Informal caregivers (IC) are crucial in care provision to dependent patients, frequently aged and suffering from chronic diseases. Therefore, besides helping the dependent people carrying out daily activities, they should also provide them support and assistance in dealing with self-care difficulties.

Objective

This quantitative exploratory descriptive study aims to: identify self-care needs in which the person is dependent, and the dependency degree; identify socio-demographic characteristics and ICs support to care for a dependent-person; identify the type, quality of information provided to the IC and the health-professional who delivered the information; assess the perception of ICs regarding their abilities to care for dependent-patients.

Methods

An intentional sample of thirty-three dyads of dependent-patients (at least in one self-care daily activity) and their caregivers participated in this study. Participants were referred by the hospital health-care team of a hospital service, at the time of discharge. Dependent-people clinical and sociodemographic data were collected from clinical files. ICs answered a structured interview composed by sociodemographic and professional data, type of support in caring for dependent-people, ability of ICs to care for the dependent-person and to promote self-care. This study was approved by the ethic committee of the hospital where the study was conducted (nº 24/2017).

Results

The majority of dependent-persons were female (60.6%) with a mean age of 81.6 (±11.3) years. Regarding self-care activities, the majority of persons were dependent and did not take part in preparing medication (66.7%), preparing food for ingestion (51.5%), nor in obtaining objects for the bath (51.5%). Caregivers were mostly women, mean age of 61.4 (±12.1) years old. Regarding family ties, is mostly a son/daughter (39.4%) or a spouse (33.3%) who takes care of their family member on average for 63.9 (±93) months. Nurses were the main providers of information, nonetheless most of the caregivers were not provided with information about auxiliary equipment (79.3%) nor economic support available (71.0%). ICs feel less competent in caring for a dependent-person regarding ability to transfer. Ability to dress was the area in which the dependent-person presented the highest degree of dependence. Regarding “feeding”, ICs refer the identification of signs of malnutrition and dehydration as the main difficulty.

Conclusions

Supporting families in acquiring practical problem-solving skills in every day’s life, in the management of resources and of emotional needs of the dependent-person should be promoted by health-professionals at the beginning of hospitalization, in order to take good care of the family member and of oneself.

Acknowledgments

The current abstract is being presented on the behalf of the Help2Care research project. This study was funded by COMPETE 2020 under the Scientific and Technological Research Support System, in co-promotion. We acknowledge CiTechCare, Polytechnic Institute of Leiria, Polytechnic Institute of Santarém, Centro Hospitalar de Leiria, Polytechnic Institute of Castelo Branco and also all other members, institutions and students involved in the project.

Keywords

Capacity, Informal caregiver, Self-care, Dependent-person, help2care project.

P186 Absenteeism on nurses in primary health care

Rosa M Freire¹, Rosário Vieira², Elisabete Borges¹

¹Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ²Agrupamento de Centros de Saúde Tâmega II Vale do Sousa Sul, 4560-682 Porto, Portugal

Correspondence: Rosa M Freire (rosafreire@esenf.pt)

Background

The Primary Health Care reform and the introduction of Health Centre Groupings brought changes in the management standards in force until then. The new model care reorganized and changed work contexts and human resources. The new organizational paradigm requires adaptation of the professionals to this new reality. In any situation of change people reacts with resistance in greater or lesser intensity. Also changes in organizations can create resistances that can manifest themselves with absenteeism. In health organizations the absenteeism of nurses constitutes a complex problem and needs to be valued and monitored by nursing managers [1].

Objective

To identify the presence and causes of absenteeism and analyse the relationship between absenteeism and demographic and professional variables.

Methods

Quantitative, exploratory and cross study was used as methodology. A sociodemographic/professional questionnaire and questions related to absenteeism were used for the collection of data. The sample was composed by 109 nurses working at primary health care units of northern Portugal. The sample was composed by 77.1% of females, 54.1% aged more than 36 years, 72.5% married, 82.6% working on fixed schedules, 51.4% with nearly 14 years of job experience (varied between 7 and 33 years), and 81.7% considered their job as stressful.

Results

Of all nurses, 66% admitted to having been absent from service in the last year: 28.4% due to their own illness and 16.5% due to their relatives’ illness. Statistically, there were found significant differences in the association between the variables of to have children (p = 0.007), place of work (p = 0.045) and absenteeism. We also found that nurses with children and those who work in Health Family Units are the ones that are absent from work most frequently.

Conclusions

We believe that the results can induce the development, implementation and evaluation of preventive measures, aiming at the promotion and protection of nurses' health. In this regard, they can be crucial for the management of human resources and for strategic planning of the ACeS, in particular, in grounded decision-making.

References

1. Sancinetti TR, Soares AVN, Lima AFC, Santos NC, Melleiro MM, Fugulin FMT, et al . Nursing staff absenteeism rates as a personnel management indicator. Rev. esc. enferm. USP. 2011;45(4):1007-1012.

Keywords

Nurse, Absenteeism, Primary health care, Management in nursing.

P187 Assessment and intervention in a family with a care dependent person and mental illness: a case study

Inês Esteves, Isabel Bica

Health School, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

Correspondence: Isabel Bica (isabelbica@gmail.com)

Background

Mental illness can have profound repercussions in family dynamics, since it is a serious illness and generates great stress. The assessment and intervention of a family with psychosocial problems requires the nursing team to use models that allow the design of care oriented both for data collection and for the planning of interventions in domiciliary context.

Objective

To analyse the care needs in a family with mental illness using the Dynamic Model of Family Assessment and Intervention (MDAIF).

Methods

The case study focused on the process of family intervention developed with a family in a domiciliary context in Primary Health Care, according to MDAIF. The following data collection instruments were applied: genogram, ecomap, FACES II, Graffar and Family Apgar Scales.

Results

The family consists of a middle-aged couple, childless, lower middle class (grade IV, Graffar, 1956). The woman is the main care provider of her husband, with mental illness. They have an extensive network of community support, namely in Social Solidarity Institutions, Recreational Associations, the extended family and the Community Care Unit (health team). As a couple, they show good cohesion and adaptability facing everyday problems (Faces II Scale) and perceive their family as highly functional (score 10 - Apgar Scale), despite the perception of communicational difficulties and emotional expression. After the interventions of the nursing team, in the different dimensions of the MDAIF, gains were obtained in the knowledge and capacity of income management, heating system of the residential building, management and knowledge about the mental illness, communication and marital satisfaction and the role of caregiver. In this way, the caregiver has been trained in knowledge and skills in the field of care for the dependent person and with mental pathology, in order to maximize their health, as well as in the care and importance of the satisfaction of her own needs.

Conclusions

The valuation of caregiver perspectives is essential for the adjustment of the formal responses of the nursing team. Empowerment of family caregivers - as well as being able to express themselves and be an active element in the healthcare process, as well as the articulation of formal and informal responses constitute challenges for health professionals. The support provided by the health team to the caregiver and dependent patient has proved to be effective not only in improving family functioning but also in reducing stress, burnout and isolation of the caregiver.

Keywords

Caregiver, Family, Nursing, Primary health care.

P188 Elderly people, physical therapy services and human resources: current and future challenges

Carla Leão^1,2 (carlaleao@sapo.pt)

¹Escola Superior de Saúde, Universidade Atlântica, 2730-036 Barcarena, Portugal; ²Instituto Português de Relações Internacionais, 1000-155 Lisboa, Portugal

Background

The aging process implementation in Portugal, and the consequent increase in the number of elderly people is evident and constitutes an increasing process. Undeniably, the elderly people are the main users of health services and specifically physiotherapy services. The economic and financial crisis that affected Portugal, has imposed restrictions on the health system and specifically on the National Health Service (NHS) [1]. Considering this scenario, we have put as a guiding question: Are, in Portugal, physiotherapy health services and human resources included in the health system at NUTS III regional level, and essentially in the NHS, proportional to the number of elderly people and respond to their current and future needs? [NUTS III - Nomenclature of territorial units for statistics (NUTS) with level III corresponding to the territorial division constituted by 30 regions, according to the division of 2013].

Objective

We aim to understand the current and future numbers of the elderly people at the regional level (NUTS III); to know the current number of physiotherapy services and human resources at the same regional level; to prospective the future physical therapy services and human resources, considering the health political trends related to services and human resources; and to assess if these services and human resources respond to the needs of the current and future elderly people.

Methods

For this purpose, we performed a statistical analysis at the regional level NUTS III, considering the indicators - number of elderly people and physical therapy services and human resources. We used the data from the Statistics National Institute, the Health Regulatory Body, the Portuguese Physiotherapists Union and the Portuguese Association of Physiotherapists.

Results

The results showed that at the regional level (NUTS III), physiotherapy services and human resources are scarce and there is no proportionality between the number of elderly people and the physiotherapy services and human resources. With the increasing number of elderly people and the restrictive political trend, we assume that, if the political trends continue, proportionality will remain non-existent.

Conclusions

In this way, we conclude that current and future physiotherapy services and human resources do not respond to the needs of the current and future elderly population, and there is a need to adapt physiotherapy services and human resources to the current and future demographic reality, in order to achieve better levels of healthy life expectancy.

References

1. Rodrigues T F, Martins M R O (Coordenadores). Envelhecimento e saúde. Prioridades políticas num Portugal em mudança. Lisboa. CEPESE/Instituto Hidrográfico. 2014.

Keywords

Portugal, Elderly people, Physical therapy services, Physical therapy human resources.

P189 Ultrasound evaluation of subcutaneous tissue and relation with the evaluation of fat mass in women with cellulitis

Alexandra André, João P Figueiredo, Óscar Tavares, Catarina Bulamarqui, Catarina Frade

Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Alexandra André (alexandra.andre@estescoimbra.pt)

Background

Ultrasound (US) is an easily accessible imaging modality that allows the evaluation of various structures. Despite the potential of this technique there are a few studies referring to subcutaneous tissue analysis with US. This allows the evaluation of altered tissues such as gynoid lipodystrophy, a very common alteration in female. the better the characterization, location, definition of the affected areas and the degree of severity of LDG, the greater the success of treatment. In this study US and densitometry was performed to evaluate the thickness of the subcutaneous tissue and the body mass composition, such as lean mass and fat mass.

Objective

The aim was, by using two different images modality, to evaluate the subcutaneous tissue in normal weight and overweight, as well as the possible relation with the percentage of fat in women with cellulite.

Methods

The study was performed in 25 individuals aged between [18-60] years old. Some inclusion and exclusion criteria were done. The images were performed in the midpoint between the great trochanter and the medial aspect of the gluteal region and the thighs in the proximal third, particularly in the proximal and lateral portion of the thigh, between the great trochanter and the knee joint.

Results

Spearman's correlation tests for a correlation between bone mineral density and fat mass with subcutaneous cell tissue thickness at a rho = 1 p-value must be less than or equal to 0.005%. Thus, with the results obtained, we verified that there is no possible correlation between measurements of bone mineral density, fat mass and subcutaneous cellular tissue of the gluteal and thigh regions. There were no significant differences in the variances between groups.

Conclusions

Ultrasonography has sensitivity to evaluate subcutaneous cellular tissue as well as deformations that may exist in it. We concluded that the percentage of fat measured by bone densitometry does not correlate with the thickness of subcutaneous tissue, with the percentage of fat being higher in overweight women but the thickness of subcutaneous tissue varies from woman to woman. The only possible relationship is between the bone mineral density and the thickness of the subcutaneous tissue of the right gluteus that leads to force that the greater the thickness the subcutaneous cellular tissue, the greater the bone mineral density, because although they are structurally different both respond to the stimuli of atrophy and hypertrophy.

Keywords

Subcutaneous tissue, Ultrasound, Dexa.