Proceedings of the 4th IPLeiria’s International Health Congress

Keynote lectures

S1 The role of practice-based research in stimulating educational innovation in healthcare

Sandra Hasanefendic (s.hasanefendic@vu.nl)

Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Background

Practice-based research is not uncommon in healthcare. In fact, the way nurses and doctors train is through extensive and intensive practice [1]. In other words, practice-based research has been used to gain new knowledge partly by means of practice and the outcomes of that practice [2]. Practice based research networks have also been gaining on importance in healthcare as ways of addressing research questions informed by practicing clinicians. They aim to gather data and improve existing practices of primary care [3], practice-based research is not only about gaining new knowledge via practice and improving existing practices.

Objective

In this presentation/paper I explain and highlight the role of practice-based research as an instrument for educational innovation in healthcare sciences.

Methods

I used interview excerpts and examples of projects related to healthcare at different universities of applied sciences in the Netherlands and Germany (also known as polytechnics in Portugal) to advance the role of practice-based research in educational innovation. This type of research is an integral part of teaching and curricular assignments in the healthcare settings in the Netherlands and Germany, and particularly at universities of applied sciences. I emphasized how practice-based research can improve and enrich the curricula, while at the same time, building necessary skills of future healthcare professionals and improving practices in already existing healthcare institutions.

Results

I show that practice-based research is in fact short term problem-oriented research which serves educational purposes by upgrading students’ and teachers’ skills and knowledge of the profession and dynamics in the work environment; which also has the potential to improve company products or design solutions and at the same time contribute to local and regional innovation in professions and profession related institutions [4-5]. Its role is multidimensional and dialectic insofar it serves multitude goals and is accomplished in dialogue among relevant stakeholders [6]. Practical suggestions for healthcare educators and practitioners in designing their curricula to incorporate the basic elements of this practice-based research are also offered in this presentation/paper.

Conclusions

Practice-based research is more than knowledge acquisition via practice. Its role and goals expand to enriching educational curricula with a more comprehensive engagement of external and professional stakeholders, at the same time contributing to student soft and professional skill development and solving stakeholder problems or optimizing services and products at local or regional levels.

References

1. Westfall JM, Mold J, Fagnan L. Practice-based research—“Blue Highways” on the NIH roadmap. Jama, 2007; 297(4): 403-406.

2. Andrews JE, Pearce KA, Ireson C, Love MM. Information-seeking behaviors of practitioners in a primary care practice-based research network (PBRN). Journal of the Medical Library Association, 2005;93(2):206.

3. Hartung DM, Guise JM, Fagnan LJ, Davis MM, Stange KC. Role of practice-based research networks in comparative effectiveness research. Journal of comparative effectiveness research. 2012;1(1):45-55.

4. Frederik H, Hasanefendic S, Van der Sijde P. Professional field in the accreditation process: examining information technology programmes at Dutch Universities of Applied Sciences. Assessment & Evaluation in Higher Education. 2017, 42(2): 208-225.

5. Hasanefendic S. Responding to new policy demands: A comparative study of Portuguese and Dutch non-university higher education organizations. [Doctoral Thesis]. Vrije Universiteit Amsterdam, the Netherlands. 2018.

6. Hasanefendic S, Heitor M, Horta H. Training students for new jobs: The role of technical and vocational higher education and implications for science policy in Portugal. Technological Forecasting and Social Change. 2016; 113: 328-340.

Keywords

Practice-based research, Short term, Problem oriented, Healthcare, Universities of applied sciences.

S2 Is sexuality a right for all? Sexual revolution in the old age

Francisco J Hernández-Martínez (francisco.hernandezmartinez@ulpgc.es)

Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, España

Background

“Do not you think your grandmother has sex? What happens with old gays? Why does a kiss between two elders tenderizes us and we do not think it is erotic” (interview, Ricardo Iacub, 2018). It still impacts us, and what do we do with it? Do we let it pass? Do we encourage them?

Throughout the centuries, sex has been postulated as the impulse that gives life to people. This word, of Latin origin, has always aroused much interest in society and in all stages of life; but it must be differentiated from “sexuality”, because it contemplates various aspects among which it is found; sex, identities and gender roles, eroticism, pleasure, intimacy, reproduction and sexual orientation [1-6]. Sexuality is a vital dimension that is present in all stages of life, at least since adolescence. It contributes significantly to health and quality of life and is, moreover, a right recognized by international organizations such as the World Health Organization (WHO) [4, 7-9]. Despite this, old age has traditionally been considered as a stage in which sexual needs would be absent, in which people are no longer interested or have the capacity to lead an active sexual life [3-8, 11]. Master and Johnson, two famous American sexologists, argued that older people should fight against a false belief, which considers that “sexual incompetence is a natural component of the aging process”. This belief limits access to sexuality due to fear of failure, to consider that it is no longer correct, that it can be sick or perverse. The same authors pointed out that many of their patients had gone to priests, rabbis, doctors or psychologists and that they had received the answer “it is logical at their age” [3, 7, 10]

The studies carried out, in our country and internationally, show that the majority of the elderly, and especially those who have a partner, are still sexually active until very old ages [6-9]. The keys to continue carrying and enjoying a quality sexual life in old age should be recognized and admitted at a social level, and among others, we should start; to be free of prejudices and stereotypes that condemn the elderly to lack of desire, or that associate sexuality in old age to something dirty or morally condemnable. Stop associating youth and sexuality. Do not assume the possible problems or difficulties that may appear as irreversible barriers. Age influences the decrease in sexual activity and interest, but not in satisfaction. It is demonstrated that sex and sexuality play an important role in healthy and full aging [1-3, 6-9, 11]. Taking into account these premises, throughout the presentation will present the results of a study conducted in the Canary Islands among people over 65 years, users of senior centers whose main objective was; obtain data on sexual activity, sexuality and whether age-related pathologies have affected their sexual relations. Against these prejudices, older adults need, want and seek some kind of loving exchange; “Old people want and need to talk about sex”, and also young people need to think that we have a lifetime to continue enjoying and experimenting with our sexuality.

References

1. Baudracco CP, Romero M. Derecho e Igualdad para la comunidad trans se llama Ley de Identidad de Género. En Derecho a la Identidad. Ley de Identidad de Género y Ley de Atención Integral de la Salud para Personas Trans. Buenos Aires: Federación Argentina LGBTTI; 2011.

2. Uchôa YS, Costa DA, Silva Jr. IAD, Saldanha ST, Silva ES, Freitas WMTM, Soares SS (2016). A sexualidade sob o olhar da pessoa idosa. Rev. Bras. Geriatr. Gerontol. 2016;19(6):939-949.

3. Iacub R. Erótica y Vejez. Perspectivas de Occidente. Ed. Paidós S.A.C.F. Buenos Aires. 2006.

4. Foucault M. Historia de la sexualidad, Buenos Aires: Ed. Siglo Veintiuno; 2010.

5. Grosman CP. et al. Los adultos mayores y la efectividad de sus derechos. Nuevas realidades en el derecho de familia. Rubinzal-Culzoni Editores. Buenos Aires; 2015.

6. Guadarrama R, Ortiz Zaragoza MC, Moreno Castillo YC, González Pedraza AA. Características de la actividad sexual de los adultos mayores y su relación con su calidad de vida. Revista de Especialidades Médico-Quirúrgicas. 2010;15(2):72-79.

7. Hernandez-Martínez FJ, Jiménez-Díaz JF, Rodriguéz-de-Vera BC, Quintana-Montesdeoca MP, García-Caballero A, Rodrigues A. Tapersex en ancianos: ¿Existe el placer después de?. En libro de Actos del XX Congreso de la Sociedad Española de Geriatría y Gerontología. Valladolid. 2013.

8. López Sánchez F. Sexualidad y afectos en la vejez. Madrid: Ediciones Pirámide; 2012.

9. Martín Hernández M, Renteria Díaz P, Sardiñas Llerenas E. Estados clínicos y autopercepción de la sexualidad en ancianos con enfoque de género. Revista Cubana de Enfermería, 2009;25(1-2).

10. Masters W, Johnson V. Incompatibilidad sexual humana, Inter Médica, Buenos Aires; 1976

11. Pérez Martínez VT. Sexualidad humana: una mirada desde el adulto mayor. Revista Cubana de Medicina General Integral. 2008:24(1).

Keywords

Active Aging, Sexuality, Elderly, Sexual activity and benefits.

S3 Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products – MIND&GAIT Project

João Apóstolo (apostolo@esenfc.pt)

The Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Nursing School of Coimbra, 3000-232 Coimbra, Portugal

Background

Frail older adults are more susceptible to falls, fractures, disability, dependency, hospitalization and institutionalization [1]. Physical and cognitive decline, associated with frailty, potentiate the development of geriatric syndromes and lead to a decrease in self-care, depressive vulnerability and a decrease in quality of life [2]. Adapted physical exercise and cognitive stimulation allow the maintenance of physical and cognitive capacities, which is reflected in an improvement on the functional status of the elderly and in a reduction of associated comorbidities [3].

Objective

To promote independent living in frail older adults by improving cognition and gait ability and using assistive products.

Methods

It is planned to develop a combined intervention that will be composed by a digital cognitive stimulation program and an adapted physical exercise program. It is also being developed an auto-blocking kit mechanism for rolling walkers as an assistive product that could be used during the physical exercise program. A randomized-controlled trial will be developed to test the efficacy of the combined intervention in frail older adults. At the same time, a web platform will be developed and it will be used as a repository, providing digital intervention’ materials and results.

Results

Through the implementation of a multidisciplinary strategy, significant benefits are expected in the prevention and maintenance of physical and cognitive decline of the frail older adults. It is hoped that for frail older adults the combined intervention and its digital components would be synonymous of autonomy and improvement of their quality of life, contributing to active aging. The project, being based and tested in clinical practice, will guide health professionals, caregivers and general public to promote the independence of this population.

Conclusions

Cognitive interventions and physical exercise have impact on cognitive decline, a condition that assumes more importance once it is related with frailty in older adults. This multidisciplinary strategy gives the opportunity to older adults to act actively in their health through the spontaneous performance of cognitive and physical exercises available on the web platform. The components of the combined intervention will allow better reintegration of this population into society of today’s world. By promoting research policies among educational institutions and health service delivery institutions, the MIND & GAIT project will make health care available to the frail elderly population more accessible to professionals, caregivers and general public.

Trial Registration

NCT03390478

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 co-promotion phase. We acknowledge The Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra, the Polytechnic Institute of Leiria, the Polytechnic of Santarém, Polythecnic of Coimbra 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. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A et al. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2018;16(1):140–232.

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

Keywords

Aged, Cognitive decline, Cognitive stimulation, Frailty, Physical exercise.

S4 Electronic health records in Portugal

Cristiana Maia (academia@spms.min-saude.pt)

Serviços Partilhados do Ministério da Saúde, 1050-189 Lisboa, Portugal

In the digital transformation Era, there is an increasing need to provide systems capable of offering functionalities that allow the user a quicker and easier access to healthcare related information’s. These digital services aim to provide access to more information, allowing the users to make better informed decisions.

In Portugal’s National Health Service Portal (SNS Portal www.sns.gov.pt), there are already several digital services available, the Citizen’s Area aggregates these services for the user.

Citizen’s Area main objectives is to facilitate communication and interaction between Citizens, Professionals and Health Institutions, allowing access to information in an integrated way, providing a better healthcare. Simple and accessible to all users, this area allows personal health information access in one place at any time, thus avoiding unnecessary commuting. This area has access monitoring and permission policy configurations, allowing the Citizen to view access history and configure access permissions to their health information, thus increasing control and management of their own personal health information.

Health Literacy is actively promoted though multiple initiatives, in dedicated areas accessible in SNS Portal and Citizen’s Area.

Keywords

Citizen’s Area, SNS Portal, Healthcare, Digital Services, Literacy.

S5 Economic crisis and inequalities in the Southern European health systems

Mauro Serapioni (mauroserapioni@ces.uc.pt)

Centro de Estudos Sociais, Universidade de Coimbra, 3000-104 Coimbra, Portugal

Background

Despite the overall increase in living standards and the introduction of universal health systems, many studies have identified persistent inequalities in all industrialized countries. The Southern European countries, namely Greece, Italy, Portugal and Spain, although the reforms of the 1970s and 1980s introduced universal national health services, social inequalities in health only became a critical issue in the late 1990s. However, the issue of health inequalities became a priority from 2010-2011, when (although with different degrees of severity) the four countries began to feel the first effects of the financial crisis. Various studies have identified the impact of the economic crisis on the most vulnerable population groups, with increasing rates of mental health disorders and a rise in suicides.

Objective

After a brief contextualization of the welfare state in southern European countries and a characterization of health systems in Greece, Spain, Italy and Portugal, the main health inequalities are described, identifying the potential inequity induced by the reform processes undertaken and the current austerity policies implemented.

Methods

The study resulted from a non-systematic literature review, based on the Scoping review proposal. A total of 74 publications were analysed.

Results and Discussion

The analysis has highlighted common characteristics and trends in the Southern European health systems, as well as some significant differences between them. In the four countries, the social gradient (particularly in education, income, and work status) is the principal determinant factor in health inequalities. Another key aspect is the steady increase in out-of-pocket spending in health as a percentage of total health spending in all four countries, markedly in Greece and Portugal. The analysis has identified potential inequalities induced by the reform processes, as result of new relations between the public and private sectors in services provision. Another example of how health systems produce inequalities is the rising proportion of users’ health expenses covered by co-payments and user fees. Geographic inequality in health is another critical issue, observed in all four Southern European countries. Finally, the recent debate in the international literature on the relationship between different welfare state regimes and health inequalities will be discussed.

Conclusions

The crisis and austerity policies have greatly increased the level of dissatisfaction with healthcare provision in these countries.

Keywords

Health Inequalities, Health Systems, Economic Recession, Southern European Countries.

S6 CBmeter- a new medical device for early screening of metabolic diseases

Maria P Guarino^1,2,3, Gabriel Brito^1,4, Marlene Lages¹, Rui Fonseca-Pinto^1,4, Nuno Lopes^1,4

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; ³Chronic Diseases Research Center, NOVA Medical School, 1150-082 Lisbon, Portugal; ⁴School of Technology and Management, Polytechnic Institute of Leiria; 2411-901 Leiria, Portugal

Correspondence: Maria P Guarino (maria.guarino@ipleiria.pt)

Background

Type 2 diabetes mellitus (T2DM) is a highly prevalent disease worldwide which is asymptomatic in about 44% of patients being critical to search for new ways of early diagnosis. Recent studies have demonstrated that the etiology of this disease may be associated with alterations in the function of the carotid body (CB), a chemosensor organ located within the bifurcation of the carotid artery. In animal models of metabolic syndrome, it was observed that the CBs are overactivated, underlying diseases such as obesity, hypertension and T2DM. This discovery provided a new paradigm in the neuroendocrinology field, suggesting that diagnostic function of the CBs has predictive value for the development of metabolic diseases. Despite this fact, it is not common in clinical practice to look at the CBs as organs associated with endocrine dysfunction and we believe this is probably due to the nonexistence of a user-friendly, portable medical device that diagnosis the function of the CBs.

Objective

The general aim of this work is to develop a novel device that evaluates the function of the carotid bodies - a CBmeter. We are also developing a standard test meal to be used as a physiological dynamic test during CBmeter utilization.

Methods

This medical device will synchronously assess several physiological variables: heart rate, respiratory rate, blood pressure variation, arterial pulse oximetry and circulating glucose, as well as the physiological responses to hyperoxia and meal ingestion. The results obtained will be analyzed using MatLab, in order to develop an algorithm with predictive value for early diagnosis of metabolic diseases. We are also developing a standard test mixed- meal to assess post-prandial glucose excursions with the CBmeter. The work is currently in the prototype development phase.

Results

A preliminary pilot-test performed with the prototype revealed that all the proposed variables are assessable with the CBmeter. The standardized test meal used in the pilot-test caused a glucose excursion curve that stabilized 30 minutes after ingestion, being suitable for metabolic evaluation with the CBmeter. Interstitial glucose variation was 16.6mg/dl glucose with a latency time of 21min. Heart rate did not vary significantly after the meal ingestion.

Conclusions

The CBmeter prototype is currently optimized to be used in a medical device clinical-trial with healthy volunteers. The mixed meal developed has proven to be suited in healthy volunteers to determine variations in CB-related cardiorespiratory parameters.

Acknowledgements

Project funded by FCT/SAICT-POL/23278/2016

Keywords

Carotid body, Diabetes, Early diagnosis, Medical device.

S7 Help to care for users and caregivers: Help2care

Maria dos Anjos Coelho Rodrigues Dixe^1,2 (maria.dixe@ipleiria.pt)

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

There are several studies showing that the family members providing care to their relatives need to acquire abilities that enable them to be competent in their performance, having the health care professionals an indispensable role in their training [1]. Empowering caregivers can help in reducing health care costs, improve the quality of life of both user and caregiver [2], their mental health [3] and greater satisfaction with their care [4]. The continued support to caregivers can help them in decision making in less serious heath situations and to use fewer health services [5].

The main aims are: to construct assessment instruments to evaluate the patient and caregivers needs and abilities concerning self-care; to develop a support manual accessible to all caregivers; to make videos that demonstrate technics and task procedures to support the caregiver in the caring process; to develop a digital platform where all the developed resources will be available (website and app) to support the care transition from the hospital to the residence integrating professionals from the hospital and from the primary healthcare services; to empower health professionals to use the caregivers’ and users’ self-care empowerment model.

This project will include participation of students, teachers, researchers and stakeholders throughout the project using an action research, where, as the materials are developed, the population target acceptance will be tested, justifying the corrections needed before moving to the next step, using a consistent methodology with an action and learning research process. Population: The population will be: dependent patients diagnosed with a chronic illness, total or partial dependency admitted to the Hospital and require caregiver after hospital discharge; Informal Caregivers whose dependent members of the family present the criteria laid up and Heath professional. To evaluate the patient and caregivers’ needs and capacity concerning self-care we will construct them (activity 1). During the pilot test period we will have, two kinds of metrics: Qualitative metrics available on (http://garyperlman.com/quest/). And quantitative monitoring metrics for the use of the mobile app, including retention rate, churn rate, daily active users (DAU), daily sessions per DAU and stickiness, and also access statistics per module/feature on the app.

The mains output will be: A training model of caregivers and users for self-care composed with: a caregiver’s. support manual; a digital platform and a manual with the empowerment model to be used by health professionals

Acknowledgements

The current abstract is being presented on behalf of a research group. It is also part of the Help2care - project: Help to care for users and caregivers, which is a Portuguese project with the support of COMPETE 2020 under the Scientific and Technological Research Support System, in the co-promotion phase. We acknowledge the Polytechnic of Leiria, the Polytechnic of Santarém, Polythecnic of Castelo Branco, Centro Hospitalar de Leiria and also to other members, institutions and students involved in the project.

References

1. Clarke DJ, Hawkins R, Sadler E, Harding G., McKevitt C, Godfrey M, Dickerson J, Farrin, A.J, Kalra L, Smithard D, Forster. A .Introducing structured caregiver training in stroke care: findings from the TRACS process evaluation study. BMJ Open. 2014;4:1-10.

2. Cheng HY., Chair SY, Chau JP. The effectiveness of psychosocial interventions for stroke family caregivers and stroke survivors: A systematic review and meta-analysis. Patient Education and Counseling. 2014;95:30-44.

3. Legg, LA, Quinn TJ, Mahmood F, Weir CJ, Tierney J, Stott DJ, Smith L.N, Langhorne P. Non-pharmacological interventions for caregivers of stroke survivors. The Cochrane Database of Systematic Reviews. 2014. 10. CD008179. Doi: 10.1002/14651858

4. Bakas T, Farran CJ, Austin JK, Given BA, Johnson EA, Williams LS. Content Validity and Satisfaction With a Stroke Caregiver Intervention Program. Journal of nursing Scholarship. 2009;41(4):368-375.

5. Pierce L, Steiner VL, Khuder SA, Govoni, AL, Horn LJ. The effect of a Web-based stroke intervention on carers' well-being and survivors' use of healthcare services. Disability and Rehabilitation. 2009;31(20):1676-1684.

Keywords

Transitions of care, Caregivers, Self-care, Users.

S8 TeenPower: e-Empowering teenagers to prevent obesity

Pedro Sousa^1,2 (pedro.sousa@ipleiria.pt)

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

Background

Adolescent obesity has reached epidemic proportions, being urgent to find effective prevention strategies. The core components of classic prevention programs have been unable to obtain the desired adherence. The solution may involve a more extensive and frequent contact with the healthcare team and the use of alternative communication channels and interacting/dynamic technologies with adolescents. TeenPower is a transdisciplinary practice-based action research project that aims to develop innovative interventions to promote healthy behaviors. This project is promoted by the polytechnics of Leiria, Santarém and Castelo Branco, Município de Leiria (City Council), as well as local schools and primary healthcare stakeholders, key partners in the development phase and in the implementation of the intervention program.

Objective

The main goal is the development, implementation and evaluation of a program for the promotion of healthy behaviors and prevention of obesity in adolescence, based on e-therapy and sustained by the case management methodology. The project is directed to the cognitive-behavioral empowerment of adolescents, through increased and interactive contact between adolescents and a multidisciplinary healthcare team. The use of Information and Communication Technologies (ICT) in the intervention can optimize resources and maximize impact, as a complement to conventional approaches.

Methods

The project includes the development of three complementary studies: (S1) evaluation of adolescents’ health status and cognitive-behavioral indicators, (S2) usability evaluation of the TeenPower platform and mobile app (S3) implementation and adherence evaluation to the TeenPower intervention program. Participants will be recruited from the school groups of Leiria, Santarém and Castelo Branco, aged between 12 and 16, with easy access to internet and smartphone/tablet (inclusion criteria). Intervention include behavioral, nutritional and physical activity counselling (online and face-to-face psycho-educative sessions). The e-therapeutic platform and mobile app (TeenPower) includes educational resources, self-monitoring, social support, interactive training modules and motivational tools. In addition to the case manager, the program will also have the direct support of an interdisciplinary team (nurse, nutritionist, exercise physiologist, among others).

Results

Expected results includes the delivery of the TeenPower intervention program, including an interactive application (web and mobile); scientific papers, communications and reports; workshops and conferences. We will evaluate adolescents’ health status and cognitive-behavioral indicators, evaluate Teenpower usability and program adherence.

Conclusions

The positive evaluation of the intervention program will stimulate the inclusion of ICT in the promotion of salutogenic behaviors and overweight prevention, creating technological interfaces that will allow customizing the intervention parameters and facilitating the monitoring and tracking.

Acknowledgements

The current abstract is presented on the behalf of a research group, the TeenPower research team. It is also part of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by 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 council), and also other members, institutions and students involved in the project.

Keywords

Adolescents, Obesity, Health promotion, e-health, Mobile.

S9 The Early Warning System for Basic School - SAPIE-EB in the promotion of school success, psychological health and career development

Pedro Cordeiro, Paula Paixão

Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, 3000-115 Coimbra, Portugal

Correspondence: Pedro Cordeiro (pedrcordeiro@gmail.com)

We present the “Sistema de Alerta Precoce do Insucesso Escolar no Ensino Básico (SAPIE-EB)”, a sophisticated early warning system that ealy flag the students’risk for school failure and ill-being, systematically monitor the students’ progress in the dimensions of and empirically assess the educational impact of the interventions in the dimensions of academic success, psychological health and career development. The SAPIE-EB is a user-friendly system that converts students’ raw data available at schools in knowledge, providing easy-delivered and intuitive reports on students’school failure, dropout and interventions, hereby allowing to deepen the knowledge about their causes and explanatory processes. The SAPIE-EB will be tested in 75 Portuguese basic schools. It is expected, with the implementation of the SAPIE-EB to reduce school retention in about 3% in a two-year interval period. Longitudinal research will attest the efficacy of the SAPIE-EB, from longitudinal quase-experimental research designs.

Keywords

Early Warning Systems, SAPIE-EB, School Success, Psychological Health, Career development.

Oral Communications

O1 Nursing professionals victims of verbal abuse by their coworkers from the same work unit

Maiara Bordignon, Inês Monteiro

School of Nursing, University of Campinas Campinas, 13083-887 Campinas, São Paulo, Brazil

Correspondence: Maiara Bordignon (bordignonmaiara@gmail.com)

Background

Violence among professionals of health teams has been exploited over the years with considerable attention to nursing [1-5]. The literature has also highlighted the impact of horizontal violence on the individual, unit and institution, such as, its negative influence on job satisfaction and possible harms to the safety culture, as well as to the wellbeing of professionals [3-5].

Objective

To present the frequency with which nursing professionals have suffered verbal abuse perpetrated by their coworkers, from the same work unit, during the last year and the professional categories involved in the abuse.

Methods

A cross-sectional study performed with a sample of 267 nursing professionals – registered nurse, nursing assistant/technician – working in Emergency units in Brazil. The experience of verbal abuse at work suffered by nursing professionals in the last 12 months was accessed using questions of a questionnaire about verbal abuse [6]. Data were described allowing to identify frequencies and professionals involved in the abuse. This study was authorized by institutions and approved by the Ethical Research Board of the university.

Results

Among the victims of verbal abuse, 23 (15%) nursing professionals reported that the last verbal abuse suffered was from coworkers of the same work unit, excluding abuses perpetrated by a boss or supervisor. At least twenty-one (91%) cases occurred in the emergency units that were part of the study and of these eighteen professionals indicated the perpetrator's profession, revealing that in nine (50%) cases the abuse was perpetrated by a coworker with the same profession, mostly registered nurse-to-registered nurse (5–56%). When the perpetrator's and the victim's profession were different (9–50%), the abuse occurred more frequently from nursing technician-to-registered nurse (3–33%). The presence of the doctor was identified in at least one situation of abuse occurred in the emergency units studied and was directed to a nursing technician. There was no report of verbal abuse perpetrated by other professionals of the nonmedical team and who did not participate in the nursing team.

Conclusions

Our study showed that in almost all instances verbal abuse occurred among the nursing staff professionals themselves. Organizational policies and strategies focusing on violence contributors factors in health care teams need to be structured to prevent violence among professionals, representing a challenge to health management.

Acknowledgements

Authors are grateful for the funding by grant#2016/06128-7, São Paulo Research Foundation (FAPESP), National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil.

References

1. Duffy E. Horizontal violence: a conundrum for nursing. Collegian. 1995;2(2):5-17.

2. McKenna BG, Smith NA, Poole SJ, Coverdale JH. Horizontal violence: experiences of Registered Nurses in their first year of practice. J Adv Nurs. 2003;42(1):90-96.

3. Longo J, Cassidy L, Sherman R. Charge nurses’ experiences with horizontal violence: implications for leadership development. J Contin Educ Nurs. 2016;47(11):493-499.

4. Purpora C, Blegen MA. Job satisfaction and horizontal violence in hospital staff registered nurses: the mediating role of peer relationships. J Clin Nurs. 2015;24(15-16):2286-94.

5. Armmer F, Ball C. Perceptions of horizontal violence in staff nurses and intent to leave. Work. 2015;51(1):91-7.

6. Bordignon M, Monteiro MI. Apparent validity of a questionnaire to assess workplace violence. Acta Paul Enferm. 2015;28(6):601-8.

Keywords

Workplace violence, Nurses, Nursing, Emergency Nursing.

O2 Social representations of violence on the elderly: an injustice and a badness

Felismina RP Mendes^1,2, Otília Zangão¹, Tatiana Mestre¹

¹Escola Superior de Enfermagem S. João de Deus, Universidade de Évora, 7004-516 Évora, Portugal; ²Centro de Investigação em Desporto, Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal

Correspondence: Otília Zangão (otiliaz@uevora.pt)

Background

In contemporary society, ageing is a phenomenon that marks all developed societies. Portugal is one of the most aged countries in Europe. Currently, Portugal shows a life expectancy at birth of 81.3 years, an average value in terms of EU [1]. Social representations allow access to lay forms of thought, fundamental for understanding social phenomena and their consequences, and for the construction of scientific knowledge itself [2]. The Social Representations conduct “the behaviors and the practices and, in this way, justify the positions taken and the behaviors” [3]. Analyzing the social representations of violence on the elderly, from the current and past conceptions and daily practices of the elderly, allows us to have access to the dominant constructions in society about the social phenomenon that is violence and the way it is socially and individually expressed by its main actors.

Objective

To analyze the social representations of a group of elderly people about violence on the elderly and the reasons why this violence occurs.

Methods

Exploratory and descriptive research with qualitative approach, supported by Theory of Social Representations. It was attended by 237 elderly people aged 65-96 years, from the project “Ageing Safely in Alentejo” from University of Évora. The Free Speech Association technique was used and data were processed through qualitative data analysis software. All ethical procedures of human research were followed. Thus, all necessary authorizations for the study were requested, such as informed consent to the elderly. All conditions of anonymity and confidentiality of the responses obtained were also guaranteed.

Results

In social representations of violence on the elderly, the words most evoked by the elderly were injustice, to which were added: mistreatment, badness, bad, lack of respect, sadness, horrible and abandonment. In social representations about the reasons that lead to violence on the elderly, the words such as: lack of respect, lack of education and badness were predominant. These terms refer to the social devaluation of the elderly and their role in today's society, as in the representations about violence.

Conclusions

The social representations of these elderly people about violence and their reasons points to the stereotypes associated with the prevalent ageism in our society, where the social devaluation of the elderly dominates the daily life conceptions and practices.

Acknowledgements

This study was carried out under the ESACA - Ageing Safely in Alentejo - Ref: ALT20-03-0145-FEDER-000007, financed by Alentejo 2020, Portugal 2020 and EU.

References

1. PORDATA. Esperança de vida à nascença: total e por sexo - 2015 [Internet]. 2003 [cited 2017 Out 23]. p. 1–4. Available from: https://www.pordata.pt/Europa/Esperança+de+vida+à+nascença+total+e+por+sexo-1260.

2. Dantas, M., Abrão, F., Freitas, C. & Oliveira, D. Representações sociais do HIV/AIDS por profissionais de saúde em serviços de referência. Revista Gaúcha Enfermagem. [periódico na Internet]. 2014 [cited 2017 Set 05]; 35 (4): 94-100. Available from http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/45860/3 2387.

3. Mendes, F., Zangão, M., Gemido, M., & Serra, I. Representações sociais dos estudantes de enfermagem sobre assistência hospitalar e atenção primária. Revista Brasileira de Enfermagem. [periódico na Internet]. 2015 [cited 2017 Set 18]; 69 (2): 343-350. Available from http://www.redalyc.org/pdf/2670/267045808018.pdf.

Keywords

Social representations, Violence, Elderly, Elderly health, Discrimination.

O3 Relationship between the use of new technologies and musculoskeletal symptoms in children and adolescents

Paula C Santos^1,2, Sofia Lopes^1,3,4, Rosa Oliveira¹, Helena Santos, Jorge Mota², Cristina Mesquita^1,4

¹Department of Phisioterapy, School of Allied Health Technologies, 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

Correspondence: Paula C Santos (paulaclara@ess.ipp.pt)

Background

Childhood and adolescence are determinants of musculoskeletal development, and the attitudes and habits adopted during these periods can have repercussions in adult life. The increasing use of technologies is becoming more worrying due to the sustained and prolonged postures due to the use of these devices and the consequent impact on musculoskeletal health.

Objective

This study analyzes the relationship between the use of new technologies with musculoskeletal symptoms (MSS) in children and adolescents.

Methods

Cross-sectional study with a sample of 460 students aged between 10 and 18 years. Data were collected through a questionnaire that included the Nordic Musculoskeletal Questionnaire.

Results

98.5% of students reported the used a mobile phone, 84.3% laptop and 52.4% tablet. Only 50.0% of the individuals who used mobile phones, 48.5% of the laptop and 31.1% of the tablet considered having a correct posture during the use of these technologies. We verified that the individuals with MSS showed more times of use of new technologies than individuals without MSS. There were differences in the time (min/day) of mobile phone and laptop use among children and adolescents, respectively 102.6 ± 121.47 vs 205.8 ± 175.89 (p < 0.001) and 74.0 ± 78.08 vs 117.9 ± 127.26 (p < 0.001).

Conclusions

Most students use new technologies in their daily lives, with less than half of them considering using these technologies in the right posture. It was also verified that individuals with MSS used more times new technologies than individuals without MSS. The time of use of new technologies increases with the age.

Keywords

New technologies, Musculoskeletal symptoms, Children and adolescents.

O4 An ecological approach to fall risk factors for preventive interventions design: a pilot study

Jorge Bravo¹, Hugo Rosado¹, Felismina Mendes³, Catarina Pereira²

¹Nursing Department, São João de Deus Superior Nursing School, University of Évora, 7000-811 Évora, Portugal; ²Health Sciences and Human Development Center, Health and Sports Department, Science and Technology School, University of Évora, 7000-671 Évora, Portugal; ³Health Sciences and Human Development Center, São João de Deus Superior Nursing School, University of Évora, 7000-811 Évora, Portugal

Correspondence: Jorge Bravo (jorgebravo@uevora.pt)

Background

Recent literature reinforces that interventions for fall prevention should include multimodal training [1]. However, even multimodal training tends to focus on exercises separately in single physical, cognitive or environmental hazards variables. An ecological approach to explain phenomena’s such as fall occurrence, underlines not only the accumulative effect of isolated variables but also interactions between different variables.

Objective

To reduce a set of correlated variables to a smaller number that may explain fall occurrence.

Methods

187 older adults aged 65 to 96 years were assessed for falling risk factors. Principal component analysis (PCA) was performed including data from the 6-minute walk test (6MWT) [2], Gait Scale [3], Fullerton Advanced Balance Scale (FAB) [4], body composition - fat body mass percentage (FBM %), Mini-Mental State Examination (MMSE) [5], Environmental Hazards Scale (EH) [6], health conditions (HC), time up and go test (TUG) [2] and the Epworth Sleepiness Scale (ESS) [7]. Factors with eigenvalues of at least 1.0 were retained and a varimax rotation was used to produce interpretable factors. A binary regression analysis was performed using the forward stepwise (conditional) technique to identify the most significant components explaining fall occurrence. Receiver operating characteristics (ROC) curves were used to assess the discriminative ability of the logistic model.

Results

Three principal components were identified. In component 1, the dominant variables concerned physical and cognitive fit (6MWT, Gait Scale, FAB, MMSE, TUG), in component 2 dominant variables concerned health and environmental conditions (FBM %, EH, HC), whereas in component 3, the dominant variable concerned alertness (ESS). These components explained cumulatively 37%, 56% and 70% of the variance in fall occurrence. Logistic regression selected components 1 (OR: 0.527; 95% CI: 0.328–0.845) and 2 (OR: 1.614; 95% CI: 1.050–2.482) as predictive of falls. The cut-off level yielding the maximal sensitivity and specificity for predicting fall occurrence was set as 0.206 (specificity = 72.7%, sensitivity = 47.7%, and the area of the ROC curve was computed as 0.660 (95% CI: 0.564-0.756).

Conclusions

This pilot study showed that multiple correlated variables for fall risk assessment can be reduced to three uncorrelated components characterized by: physical and cognitive fit; health and environmental conditions; and alertness. The first two were the main determinants of falls. Recommendations: Interventions for fall prevention should privilege multimodal training including tasks that work simultaneously physical fitness, cognitive fitness and alertness, considering participant’s specific health and environmental conditions.

Trial Registration

NCT03446352

References

1. Hafström A, Malmström EM, Terdèn J, Fransson PA, Magnusson M. Improved balance confidence and stability for elderly after 6 weeks of a multimodal self administered balance-enhancing exercise program: a randomized single arm crossover study. Gerontology and geriatric medicine 2016;2:2333721416644149.

2. Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. Journal of aging and physical activity 1999; 7(2): 12961.

3. Tinetti ME. Performance-Oriented Assessment of Mobility Problems in Elderly Patients. Journal of the American Geriatrics Society 1986; 34(2): 119-26.

4. Rose DJ, Lucchese N, Wiersma LD. Development of a multidimensional balance scale for use with functionally independent older adults. Archives of physical medicine and rehabilitation 2006; 87(11): 1478-85.

5. Guerreiro M, Silva AP, Botelho MA, Leitão O, Castro-Caldas A, Garcia C. Adaptação à população portuguesa da tradução do Mini Mental State Examination (MMSE). Revista Portuguesa de Neurologia 1994; 1(9): 9-10.

6. Tinetti ME, Speechley M. Prevention of Falls among the Elderly. New England Journal of Medicine 1989; 320(16): 1055-9.

7. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. sleep 1991; 14(6): 540-5.

Keywords

Principal component analysis, Falling risk, Physical fitness, Cognitive fitness, Environmental hazards.

O5 Relationship between smartphone use and musculoskeletal symptoms in adolescents

Paula C Santos^1,2, Cristina Mesquita¹, Rosa Oliveira, Raquel Azevedo, Sofia Lopes^1,3

¹Department of Physiotherapy, School of Allied Health Technologies, 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; ³North Polytechnic Institute of Health, 4585-116 Gandra, Portugal

Correspondence: Paula C Santos (paulaclara@ess.ipp.pt)

Background

We are currently facing a society of adolescents who are increasingly dependent on technology, in particular the smartphone, and this phenomenon can even lead to limiting situations in which the person’s physical well-being is called into question. Intensive use of the smartphone may contribute to a decrease in physical activity and generate musculoskeletal symptoms (MMS).

Objectives

To verify the existence of a relationship between the use of the smartphone and: 1) MMS; 2) vigorous, moderate and sedentary physical activity

Methods

An observational, analytical, cross-sectional study was conducted on a sample of 834 adolescents from five schools in the regions of Viseu, Vila Real and Porto. Data collection was performed through online questionnaires through the Qualtrics program, in order to perform the sociodemographic characterization of the sample and to determine behavioral habits related to health, as well as to the use of new technologies. Musculoskeletal symptoms were evaluated through the Portuguese version of the Nordic musculoskeletal questionnaire. (NMQ) and physical activity through the International Questionnaire of Physical Activity (IPAQ).

Results

The adolescents who used the smartphone for the most time referred MMS in the cervical (p < 0.001), thoracic (p = 0.017), lumbar (p < 0.001), shoulders (p < 0.001), wrists/hands (p = 0.003) and knees (p = 0.013). Adolescents who practice more vigorous physical activity (p = 0.023) use less smartphone, and those who have more time in sedentary physical activity (p = 0.008) use it more.

Conclusions

Adolescents who spend more time on smartphones refer more MMS. The use of the smartphone is associated with a more sedentary lifestyle, unlike the adolescents who practice vigorous physical activity that give less use to it.

Keywords

Smartphone, Physical Activity, Musculoskeletal Symptoms.

O6 Functional fitness and cognitive performance in independent older adults – fallers and non-fallers: an exploratory study

Jorge Bravo¹, Hugo Rosado¹, Felismina Mendes², Catarina Pereira³

¹São João de Deus Superior Nursing School, University of Évora, 7000-811 Évora, Portugal; ²Health Sciences and Human Development Center, São João de Deus Superior Nursing School, University of Évora, 7000-811 Évora, Portugal; ³Health Sciences and Human Development Center, Health and Sports Department, Science and Technology School, University of Évora, 7000-671 Évora, Portugal

Correspondence: Jorge Bravo (jorgebravo@uevora.pt)

Background

Actual research reinforces the importance of multimodal exercise programs for fall prevention; however remains unclear which components should be included in exercise programs, considering physical and cognitive components.

Objectives

This exploratory study aims to identify the associations between functional fitness (FF) and cognitive performance (CP) in independent older adults, regarding fallers and non-fallers.

Methods

63 males and 124 females (65-96 years) were selected based on the criteria of moderate or high functional independency (≥18 points) determined by responses to the 12-item of Composite Physical Functioning Scale [1]. FF was assessed by the Senior Fitness Test Battery [2]. A composite Z-score was created based on the individual scores for each fitness item. CP was assessed by the Mini-mental State Examination adapted for the Portuguese population [3]. Descriptive statistics were calculated for all outcome measurements and comparisons were performed using independent sample t-Tests. Multiple regression analyses were performed to test associations between FF and CP.

Results

T-test comparisons showed that females were more flexible than males (p < 0.05). Males were taller and heavier than females (p < 0.05). No differences were observed between these independent fallers and non-fallers sample. Multiple regression analyses were performed to understand the association of FF with CP in fallers and non-fallers. Agility was negatively associated with the MMSE score in fallers and non-fallers; however, after adjusting for gender, age and education, this association was not significant for non-fallers (p < 0.05). Lower body strength showed positive associations (p < 0.05) with the MMSE score exclusively in non-fallers, regardless the adjustments. Likewise, the upper body strength was positively associated with the MMSE score (p < 0.05) in non-fallers after adjusting for age, gender and education (p < 0.05). On the other hand, the upper body flexibility showed negative associations with the MMSE score (p < 0.05) however this association did not remain significant after adjusting for gender, age and education.

Conclusions

Independent older adults with higher agility scores were more likely to have an improved CP, whether they are fallers or non-fallers. Body strength, particularly improved lower body strength, is associated with higher CP in non-faller older adults, independently of age, gender and education. This exploratory study increases the spectrum of research in multimodal programs by suggesting that agility and strength training should be included in exercise prescription for fall prevention, in order to foment CP.

Acknowledgements

Study was funded by Horizon 2020, Portugal 2020 (ALT20-030145-FEDER-000007).

References

1. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. Journal of aging and physical activity 1998; 6(4): 363-75.

2. Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. Journal of aging and physical activity 1999; 7(2): 129-61.

3. Guerreiro M, Silva AP, Botelho MA, Leitão O, Castro-Caldas A, Garcia C. Adaptação à população portuguesa da tradução do Mini Mental State Examination (MMSE). Revista Portuguesa de Neurologia 1994; 1(9): 9-10.

Keywords

Aging, Physical fitness, Accidental falls, Cognitive aging.

O7 Association between endurance of the trunk extensor muscles and the risk of falling in community-dwelling older adults

Sofia Flora, Ana Tavares, Joana Ferreira, Nuno Morais

School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Sofia Flora (sofiiaflora@gmail.com)

Background

Falls in the elderly are a serious health problem and the result of the complex interaction between individual and environmental risk factors. Balance is considered a key factor for higher falling risk in this population [1, 2]; thus, assessment and preventive/rehabilitation programs targeting the balance control system are currently a clinical guideline [1]. Programs commonly include strength/power training of the lower limbs and trunk muscles and postural control exercises [1, 3]. Recently it has been shown that the elderly reach premature muscle fatigue during upright stance tasks [2], and that fatigue leads to poor balance control [4]. Muscular endurance hence appears to play an important role in the efficiency of the balance control system, particularly during performance of long lasting functional tasks. However, the association between muscle endurance and balance control measures has been overlooked, especially in the trunk muscles, despite its potential to assist clinicians and researchers to comprehensively screen falling risk factors and tailoring interventions accordingly.

Objective

The main purpose of this cross-sectional study was to determine the association between endurance of the trunk extensor muscles and the risk of falls in the elderly, considering possible co-factors such as age and BMI.

Methods

Community-dwelling adults ≥ 65 years were recruited from senior universities in the Centre region of Portugal. Exclusion criteria included severe physical/cognitive limitations that would prevent subjects from performing the testing protocol. Falling risk/balance was assessed using the Berg Balance Scale (BBS, score 0–56). Muscle performance was measured through the trunk extensor endurance test (in seconds). Simple and multiple linear regression analyses, using SPSS (v20), were conducted to predict the effects of muscle endurance, BMI and age on balance control. Statistical significance was set at 0.05.

Results

Fifty-nine volunteers (44 females, age = 71 ± 5 years, height = 1.60 ± 0.09 m, mass = 71.67 ± 14.35 kg, BMI = 28.02 ± 4.62 kg/m²) were included in the study. The largest correlation was found between the BBS score, and muscle endurance (ρ = 0.379), and BMI (ρ = -0.335). Muscle endurance predicted 7% of the BBS score (r²_a = 0.070, p = 0.024). When combined with BMI, muscle endurance accounted for ~16% (r²_a=0.162, p = 0.003) of the total variance of the BBS score. Unsurprisingly, when age was added to the previous model the predictive capacity increased, reaching ~21% (r²_a = 0.214, p = 0.01).

Conclusions

Endurance of the trunk extensor muscles and BMI predicted approximately 16% of the BBS score. Since these are modifiable factors, it is recommended that they should be routinely included in the screening of falling risk factors in the elderly and addressed accordingly in preventive programs.

References

1. Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015 Mar;99(2):281–93.

2. Pizzigalli L, Micheletti Cremasco M, Mulasso A, Rainoldi A. The contribution of postural balance analysis in older adult fallers: A narrative review. Journal of Bodywork and Movement Therapies. 2016 Apr;20(2):409–17.

3. Granacher U, Gollhofer A, Hortobágyi T, Kressig RW, Muehlbauer T. The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review. Sports Med. 2013 Apr 9;43(7):627–41.

4. Papa EV, Garg H, Dibble LE. Acute Effects of Muscle Fatigue on Anticipatory and Reactive Postural Control in Older Individuals. Journal of Geriatric Physical Therapy. 2015;38(1):40–8.

Keywords

Muscle Endurance, Balance, Elderly, Risk of falls, Trunk Extensor Muscles.

O8 ICF Core Set for Obstructive Pulmonary Diseases: validation of the environmental factors component through the perspective of patients with asthma

Cristina Jácome^1,2, Susan M Lage³, Ana Oliveira², Augusto G Araújo⁴, Danielle AG Pereira³, Verônica F Parreira³

¹Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; ²Laboratório de Investigação e Reabilitação Respiratória, Escola Superior de Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal; ³Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Minas Gerais, Brasil; ⁴Hospital Carlos Chagas, 35900-595, Itabira, Minas Gerais, Brasil

Correspondence: Cristina Jácome (cristinajacome@ua.pt)

Background

To optimize a patient-oriented approach in asthma management, health professionals need to consider all aspects of the patient’s actual context (physical, social and attitudinal). This context can be assessed using the Environmental Factors component of the International Classification of Functioning, Disability and Health (ICF) Core Set for Obstructive Pulmonary Diseases (OPD). The categories included in the Environmental factors component have been selected by respiratory experts, and have been validated from the perspective of physicians, physiotherapists and patients with chronic obstructive pulmonary disease. However, the validation from the perspective of patients with asthma will be essential to allow a more widespread application of the ICF in this population.

Objective

This study aimed to validate the Environmental factors component of the Comprehensive and Brief versions of ICF Core Set for OPD from the perspective of patients with asthma.

Methods

A cross-sectional qualitative study was conducted with outpatients with asthma using semi-structured individual interviews. Qualitative data were analysed through the meaning condensation procedure by two researchers with expertise in the ICF.

Results

Thirty-five participants (26 females; 41±13 years) were included. Eight (35%) categories contained in the Environmental factors component of the Comprehensive version of the ICF Core Set for OPD and 4 (100%) of those contained in the Brief version were confirmed by the participants. Additionally, 5 second level categories (Products and technology for employment; Flora and fauna; Natural environment and human-made changes to environment, unspecified; Domesticated animals; Support and relationships, unspecified) and 13 third level categories (Food; Drugs; General products and technology for personal use in daily living; General products and technology for employment; Assistive products and technology for employment; Design, construction and building products and technology for gaining access to facilities in buildings for private use; Plants; Animals; Temperature; Humidity; Indoor air quality; Outdoor air quality; Health services) not included in the Core Set were identified.

Conclusions

The Environmental factors component of the Brief ICF Core Set for OPD was fully supported by the perspective of patients with asthma, contrasting with only one third of the categories of the Comprehensive version. The categories included in the ICF Core Set that were not confirmed by the participants and the additional categories that were raised need to be further investigated in order to develop an instrument tailored to patients’ needs. This will promote more patient-centred assessments and rehabilitation interventions.

Keywords

Asthma, International Classification of Functioning, Disability and Health, Environmental factors, Patient’s perspective.

O9 Attachment, self-compassion and mental health in the use of the internet to establish intimate relationships

Sónia C Simões^1,2, Vanessa Vieira¹, Mariana Marques¹, Laura Lemos¹

¹Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; ²Centro de Estudos da População, Economia e Sociedade, 4150-171 Porto, Portugal

Correspondence: Sónia C Simões (soniasimoes@ismt.pt)

Background

Currently, to our knowledge, there is no research with Portuguese samples comparing the levels of attachment, self-compassion and psychopathological symptoms in subjects who use and do not use the Internet to establish intimate relationships.

Objective

The present study aimed to investigate how individuals, who use the Internet to establish intimate relationships, differ psychologically from individuals who do not use the Internet for this purpose.

Methods

We used the following scales: Experiences in Close Relationships (ERP), Self-Compassion Scale (SELFCS), Brief Symptom Inventory (BSI) and a short sociodemographic questionnaire. The sample consisted of 350 individuals of whom 284 used social networks to establish intimate relationships (I) and 66 did not use the Internet for this purpose (NI), with a mean age of 29.90 (SD = 7.41) for the I group and 30.72 (SD = 8.26) for the NI group. The majority of the sample was single in both groups (I: 83.5% vs. NI: 68.2%), heterosexual (I: 79.6% vs. NU: 93.9%), was attending or attended Higher Education (I: 66.5% vs. NI: 60.6%).

Results

We found that man used more, compared to woman, the Internet to establish intimate relationships, and that the individuals that used most the Internet for this purpose had a higher number of short-term intimate relationships, compared to the group of subjects that did not use the Internet for this purpose. We also found that individuals without a romantic relationship (single, separated/divorced or widowed) were who resorted to this type of online service. Differences between groups regarding attachment, self-compassion and psychopathology were not found. However, it is important to highlight the stronger associations between psychopathological symptoms (global severity index and BSI dimensions) with attachment and self-compassion in the group that did not use the Internet to establish intimate relationships, comparing to the group that reported using the Internet with this intention.

Conclusions

The results show the importance of deepening the research about the use of Internet to establish intimate relationships, since there are no studies concerning this area in Portugal.

Keywords

Self-compassion, Attachment, Psychopathology, Intimate relationships, Online dating.

O10 The obsessive-compulsive symptomatology: its relation with alexithymia, traumatic experiences and psychopathological symptoms

Sónia C Simões^1,2, Timóteo Areosa¹, Helena Espírito-Santo¹, Laura Lemos¹

¹Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; ²Centro de Estudos da População, Economia e Sociedade, 4150-171 Porto, Portugal

Correspondence: Sónia C Simões (soniasimoes@ismt.pt)

Background

Alexithymia has been reported more significantly in subjects with obsessive-compulsive disorder (OCD), since they have a hard time recognizing and describing their own emotions. It should also be noted that many individuals with OCD often report experiencing traumatic situations. However, to our knowledge there are no Portuguese studies on the relationship between OCD (or obsessive-compulsive symptomatology), traumatic experiences, and alexithymia, justifying the relevance of this study.

Objective

The following goals were outlined: 1) To study the relationship between psychopathological symptoms, alexithymia and traumatic experiences in clinical and non-clinical samples; 2) To study and compare the traumatic experiences, the levels of alexithymia, and the psychopathological symptoms in clinical and non-clinical samples; 3) Check the relations of variables such as age, gender, marital status, and literacy with the presence or absence of obsessive-compulsive symptomatology in order to identify potential confounding factors.

Methods

The total sample comprised 115 individuals aged between 18 and 64 years (M = 31.50; SD = 10.61). For the creation of the 2 groups in comparison, the Maudsley Obsessive Compulsive Inventory (MOCI) cut-off point was used, in which results above 10 indicated the presence of obsessive-compulsive symptomatology. The clinical group had 40 subjects, aged between 18 and 49 years (M = 27.03; SD = 7.68) and the nonclinical group had 75 subjects, aged between 18 and 60 years (M = 33.89; SD = 11.21). The research protocol included: MOCI, Traumatic Experiences Checklist (TEC), Toronto Alexithymia Scale and the Brief Symptom Inventory.

Results

The clinical sample presented more psychopathological symptomatology and higher values of alexithymia compared to the non-clinical sample. No differences were found between groups in the presence of traumatic experiences, but the clinical sample presented higher scores of sexual abuse and trauma in the family of origin. Finally, there was a greater number of statistically significant associations and of a stronger magnitude in the non-clinical sample among the studied variables, compared to the clinical sample, especially according to the TEC.

Conclusions

It was verified that traumatic experiences and alexithymia, in particular, might be factors associated with the onset of obsessive-compulsive symptomatology, being a future study area to understand if they will also be risk factors for developing OCD.

Keywords

Obsessive-compulsive symptomatology, Traumatic experiences, Alexithymia.

O11 Loss of group immunity against measles

João MG Frade^1,2, Carla Nunes³, João R Mesquita⁴, Maria SJ Nascimento⁵, Guilherme Gonçalves¹

¹Multidisciplinary Unit for Biomedical Research, Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Public Health Research Centre, National School of Public Health, Nova University, 1600-560 Lisboa, Portugal; ⁴Agrarian Superior School, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; ⁵Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal

Correspondence: João MG Frade (joao.frade@ipleiria.pt)

Background

Vaccination coverage rates higher than 95% contribute to the so-called group immunity effect with regard to measles vaccination [1]. However, to guarantee such immunity, it is important that those vaccine coverage rates also correspond to levels of seropositivity of measles antibodies (specific IgG antibodies levels > 150 mIU/ml) higher than 95% [2].

Objective

This study intends to evaluate from which moment, after having been vaccinated with MMR II (triple viral vaccine against mumps, measles and rubella), 95% of the individuals have specific IgG antibodies (Anti-Measles-IgG) <150 mIU/ml.

Methods

A cross-sectional study was conducted on 190 individuals, born in Portugal after 1990, with records of vaccine history documented in the Individual Record of Vaccination (IRV) and in the Individual Health Bulletin (IHB). Specific IgG antibodies to measles virus (Anti-Measles-IgG) were measured using the commercial immunoassay Siemens Enzygnost®Anti-Measles Virus/IgG.

Results

Data were grouped into three birth cohorts: born between 1990 and 1993, born between 1994 and 1995 and born between 2001 and 2004. It was found that those born between 2001 and 2004 were those that presented the highest levels of protection against measles, less than 2% of these individuals had levels of protection below the 150 mIU /ml. The cohort born between 1994 and 1995 was the one that presented the lowest protection against the disease, in which more than 50% of the individuals were below the protection threshold (150 mIU/ml). The cohort born between 1990 and 1993 is an intermediate cohort, where more than 50% of individuals are above protection threshold, but with a significant percentage of seronegative individuals. ANOVA analysis and Tukey's multiple comparison analysis showed a statistically significant difference among the 3 birth cohorts (p < 0.001). The use of mathematical modelling showed that at the end of 9 years, after individuals have received MMR II, more than 95% individuals no longer presented specific IgG antibodies against measles virus (Anti-Measles-IgG) above 150 mUI/ml (p < 0.0001).

Conclusions

The time elapsed since the last MMR II vaccination seems to be associated with protection against measles. Nine years after MMR II, more than 95% of individuals are seronegative for the Specific IgG antibodies to measles virus.

References

1. Gonçalves G, Frade J Nunes C, Mesquita J R, Nascimento MSJ, Persistence of measles antibodies, following changes in the recommended age for the second dose of MMRvaccine in Portugal. Vaccine 33, 2015: 5057–63.

2. Gonçalves G, Nunes C, Mesquita JR, Nascimento MSJ, Frade J. Measles antibodies in cord blood in Portugal. Possible consequences for the recommended age of vaccination. Vaccine 34, 2016: 2750–57.

Keywords

Immunity, Measles, Vaccination.

O12 Code Stroke in an emergency department - evaluation of results after 7 years of protocol implementation

Ilda Barreira¹, Matilde Martins², Leonel Preto², Norberto Silva¹, Pedro Preto³

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

Fibrinolysis reduces mortality and disability after an ischemic stroke, and its benefits are documented with level of evidence I [1]. The major goal of the Code Stroke (CS) is to treat the eligible cases by fibrinolysis, within the therapeutic window of 4.5 hours after symptom onset [2]. Thus, an emergency department must operate efficient mechanisms to receive, diagnose, treat or transfer patients with stroke [3].

Objective

The main objective was to evaluate the results of the CS protocol implementation in an Emergency Department (ED) of a hospital in the North of Portugal. As secondary objectives we aimed to: (I) Characterize the patients in sociodemographic and clinical variables; (II) Calculate the activation rate of CS protocol and the rate of fibrinolysis.

Methods

Retrospective descriptive analysis, using data from the Manchester triage system and other secondary source of information, of all patients with ischemic stroke, haemorrhagic stroke, and transient ischemic attack (TIA) admitted to the Emergency Department between January 1, 2010 and December 31, 2016. Socio-demographic data, care times, cardiovascular risk factors and other clinical variables were collected. The statistical analysis was performed by ANOVA, at 0.05 significance level.

Results

In the 7 years analysed, 1200 patients with cerebrovascular disease were admitted in the ED. Among these patients, 63.0% presented ischemic stroke, 17.3% haemorrhagic stroke and 19.8% TIA. The population was predominantly male (54.8%) and had a mean age of 77.4 (± 11.2) years. Stroke code was activated 431 times, covering 37.2% (n = 282) of ischemic stroke, and have received thrombolytic therapy 18.4% (n = 52) of these patients. Door-to-needle time was, in average, 69.5 minutes. Mean (± SD) NIHSS (National Institutes of Health Stroke Scale) score was 14.8 (± 5.2) before treatment, decreasing to 11.8 (± 6.0) at two hours post- fibrinolysis (p < 0.05). For all patients (N = 1,200), we obtained the following prevalence of risk factors: Hypertension (64.7%), dyslipidaemia (30.3%), diabetes (26.5%), atrial fibrillation 23.3%), obesity (12.9%), smoking (6.3%) and ischemic heart disease (5.9%). The 24-hour mortality rate was 0.9% for ischemic stroke, 10.6% for haemorrhagic stroke, and 0% for TIA.

Conclusions

High rates of activation protocol were obtained for acute ischemic stroke, but only 52 patients met the criteria for fibrinolysis. The high age and comorbidity of patients with ischemic disease and its origin, predominantly rural, may have influenced the therapeutic window and the eligibility criteria for fibrinolysis.

References

1. Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.

2. Baldereschi M, Piccardi B, Di Carlo A, Lucente G, Guidetti D, Consoli D, et al. Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review. Cerebrovasc Dis. 2012;34(3):182-90.

3. Alonso de Leciñana M, Egido JA, Casado I, Ribó M, Dávalos A, Masjuan J, et al. Guidelines for the treatment of acute ischaemic stroke. Neurologia. 2014;29(2):102-22.

Keywords

Stroke, Emergency Service Hospital, Fibrinolysis, Outcome and Process Assessment.

O13 SEMantic and PRAgmatic assessment platform for school-age children

Dulce Tavares, Eileen S Kay

Escola Superior de Saúde de Alcoitão, 2649-506 Alcabideche, Portugal

Correspondence: Dulce Tavares (mdtavares@essa.pt)

Background

Semantic and pragmatic skills are developed throughout life and are essential in the development of school and social learning. Upon entering school, learning to read and write is developed in two large areas of knowledge. The first implies capacities of recognition and decoding of written symbols of the word and vocabulary development and the second allows the understanding of what is read through inferential capacities and non-literal interpretation. Often, students with reading comprehension difficulties go unnoticed. It is easier to detect a child who reads slowly, syllable by syllable, or with mistakes than those who read fluently but without understanding the content. These difficulties only become evident when questions are asked about the text and when it is necessary to understand the questions of subjects such as mathematics or science. Thus, success to reach the National Curricular Plan can be compromised.

Methods

Material was developed to evaluate semantic and pragmatic skills in school-aged children. In semantics, aspects of syntagmatic and paradigmatic relations (lexical field, synonymy and antonyms) and paronymy are evaluated. In pragmatics, competences are evaluated such as inferences, comprehension of idioms and proverbs. This material will be placed on a platform that can be consulted and used by different professionals working with children. The items that constitute this material took into account the stages of language development and school level. The lexicon used is in the domain of European Portuguese.

Results

The 756 children who were assessed attended public and private schools in Portugal. The results show an increasing evolution of the lexical competences of the children, with significant differences between the different age groups in all tests. There were no significant differences between female and male except in the paronym test. Regarding the socio-professional level of the child's origin, it is verified that it is a differentiating factor of lexical competence because significant differences in all tests were observed regardless of the age of the child.

Conclusions

The authors concluded that it is of great importance to analyse lexical competence regarding the aspects of its organization, as it enables students to deal with academic tasks successfully, improving literacy as well as to be able to act in a systematic and productive way in the intervention with children with language disorders. The complexity and innovation of the pragmatic skills assessment (in European Portuguese) leads to this work to continue in development.

Keywords

Semantic, Pragmatics, Assessment, School age.

O14 Quality of Life in Portugal – what factors can determine the QoL in people with Intellectual Disabilities and a great need of supports?

António Rodrigo, Sofia Santos, Fernando Gomes

Faculty of Human Kinetics, University of Lisbon, 1495-687 Cruz Quebrada, Portugal

Correspondence: António Rodrigo (antoniorodrigo92@gmail.com)

Background

In Portugal, the Quality of Life (QoL) concept has become increasingly relevant, leaving aside a vision that only focus on the person’s limitations to one that emphasizes the quality of interactions between personal characteristics and environmental demands, within a socioecological model. This new paradigm changes the approach to evaluation and planning individualized supports, regarding adults with Intellectual and Developmental Disability (IDD). Research shows an emerging interest in analysing what personal and environmental factors have impact in QoL of persons with IDD. Therefore, our main goal is to analyse how individual characteristics influence QoL of people with intellectual disability with greater need of supports.

Methods

The Portuguese version of the Escala San Martín, that focus on 8 QoL domains: Self-determination, Emotional Well-Being, Physical Well-Being, Material Well-Being, Rights, Personal Development, Social Inclusion and Interpersonal Relations was applied to 293 individuals with intellectual disabilities, over 18 years-old (32.31 ± 8.29), 128 females and 165 males. All participants were institutionalized. The dependent variables were the domains/QoL total scores and the independent variables were gender, diagnosis, age, comorbidities and tacking medication. A comparative study was carried out using either independent samples t-tests or the one-way analyses of variance (ANOVA).

Results

When comparing gender, age and medication consumption, no significant differences were found, with all groups presenting similar mean QoL scores. Regarding comorbidities, significant differences were found when comparing physical well-being (p < 0.001), rights (p < 0.001) and social inclusion (p = 0.001) domains, with higher mean QoL scores to those without comorbidities. Significant differences were also found regarding diagnosis, in all domains except for the material well-being. Higher mean scores were found in individuals with a mild intellectual disability diagnosis, when compared to those with severe or profound ID diagnosis.

Conclusions

The information about personal factors with impact in QoL will help to meet challenges and will allow a more adjusted person-centred planning. Discussion and implications for practice will be presented.

Keywords

Individualized supports, Intellectual and Developmental Disability, Quality of Life, Escala San Martín.

O15 Relationship between the levels of functional capacity and family functionality and depression in the elderly

Andréia WB Silva, Akemi Izumi, Giovanna G Vietta, Márcia R Kretzer

Universidade do Sul de Santa Catarina, 88137-270 Palhoça, Santa Catarina, Brasil

Correspondence: Andréia WB Silva (andreiawb@hotmail.com)

Background

Depression is one of the most prevalent mental health problems among the elderly [1]. Functional limitations and changes in family dynamics characterize important risk factors for the onset of depression [1,2].

Objective

To analyse the relation between levels of functional capacity and family functionality and depression in the elderly.

Methods

A cross-sectional study was conducted including one hundred and thirty-eight (138) elderly individuals. The presence of depression, the levels of capacity to perform Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) and family functionality were assessed, respectively, by the Geriatric Depression Scale (GDS), Katz Index of Independence in Activities of Daily Living, Lawton Scale and family APGAR. The Statistical Package for Social Sciences (SPSS) version 18.0 was used to enter and analyse data (p < 0.05). The present study was approved by the Research Ethics Committee of UNISUL.

Results

The most prevalent characteristics were the age between 60 and 69 years (62.3%), the female gender (52.9%), the white ethnicity (87.0%), having accomplished up to 8 years of schooling (75.8%), and being retired (80.4%). 67.4% of the elderly did not have a spouse, and 14.5% lived alone. Depression presented a prevalence in 43.5% of the participants, of whom 88.3% were mildly depressive and 11.7% were severely depressive. There was a high frequency of hypertension (64.5%), Diabetes Mellitus (37.7%), osteoarthritis (39.1%), heart failure (28.3%), chronic obstructive pulmonary disease (15.9%) and asthma (9.4%). When evaluating functional capacity, 1.4% and 12.3% of the participants were classified as dependent to perform BADL and IADL, respectively. Family dysfunction was observed in 12.3% of the elderly (5.1% moderate dysfunction and 7.2% high dysfunction). When testing associations between depression and sociodemographic characteristics, the results showed statistical differences when comparing gender and marital status. Women were 1,538 times more likely to have depression than men (p = 0.031), and individuals who had a spouse were 1,580 times more likely to suffer from the disease (p = 0.018). When associating depression with other comorbidities, arterial hypertension was 1.652 times more prevalent (p = 0.024). Statistical differences were also identified with heart failure (PR = 1.941, p = 0.001) and asthma (PR = 1.923, p = 0.012). The functional capacity for BADL and IADL did not differ statistically. Family dysfunction was significantly associated with depression, which was 1,969 times more frequent in dysfunctional families (p = 0.003).

Conclusions

Depression in the elderly is associated with the female gender, having a spouse, cardiovascular and respiratory morbidities and family dysfunction.

References

1. Lima AMP, Ramos JLS, Bezerra IMP, Rocha R, Batista HHMT, Pinheiro WR. Depressão em idosos: uma revisão sistemática da literatura. Rev Epidemiol Controle Infecç. 2016;6(2):97-103.

2. Bretanha AF, Fachinni LA, Nunes BP, Munhoz TN, Tomazi E, Thumé E. Sintomas depressivos em idosos residentes em áreas de abrangência das Unidades Básucas de Saúde da zona urbana de Bagé, RS. Rev Bras Epidemiol. 2015;18(1):1-12.

Keywords

Depression in the elderly, Functional capacity, Family functionality.

O16 Microbiological evaluation of hotel units swimming pools

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

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

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

Background

Swimming pools are currently operated by public and private entities for the development of sports, recreational and therapeutic activities [1]. For this reason, it is essential to guarantee the chemical and microbiological quality of the pool water, since they may be the origin of several pathologies [2].

Objective

The present research aimed to analyse data from the microbiological evaluation of indoor and outdoor swimming pool waters of Hotel Units of Mainland Portugal and Madeira in the year 2016, in order to verify the water quality.

Methods

A cross-sectional descriptive study was performed using database records from a northern laboratory. The microbiological parameters studied to characterize the indoor and outdoor swimming pool waters included CFU/mL of viable microorganisms at 37ºC/24h, CFU/100mL of total coliforms, CFU/100mL of Escherichia coli, CFU/100mL of Enterococcus spp., CFU/100mL of Pseudomonas aeruginosa, CFU/100mL of total Staphylococcus and CFU/100mL of coagulase producers Staphylococcus. The samples were characterized as conforming and non-conforming according to the reference intervals indicated in Regulatory Circular nº 14/DA of 21/08/2009 of Direção Geral de Saúde [1].

Results

Of the total of indoor pools (n = 610) analysed, 25.09% (n = 153) were classified as non-conforming, being the microorganisms viable at 37 ºC the most frequent cause of nonconformities (n = 105), followed by total coliforms and total Staphylococcus (n = 42 each). For the outdoor pools (n = 1982), 29.92% (n = 593) were also classified as non-conforming, once more being microorganisms viable at 37 ºC the most frequent cause of nonconformities (n = 420), followed by total coliforms (n = 154).

Conclusions

Indoor swimming pools have a lower frequency of nonconformities compared to outdoor swimming pools. The ambient temperature and the presence of soils around the pool influence the microbiological quality of the water [2]. These results also suggest that water treatment is not effective, indicating water pollution, being hygienic care other factor that influence the microbiological quality of the water [3]. The determination of these parameters is useful when microbiological monitoring is carried out constantly.

References

1. Direcção-Geral da Saúde. Normativa Circular Nº 14/DA de 21/08/2009. Programa de Vigilância Sanitária de Piscinas; 2009.

2. Rebelo H, Rodrigues R, Grossinho J, Almeida C, Silva M, Silva C, et al. Avaliação da qualidade da água de piscinas: estudo de alguns parâmetros bacteriológicos e físico-químicos. Boletim Epidemiológico Observações. 2014, 3(4):3-5.

3. World Health Organization. Guidelines for safe recreational water environments. Swimming pools and similar environments. Geneva: World Health Organization; 2006.

Keywords

Microbiological evaluation, Microbiological quality, Swimming pool waters, Fecal contamination indicators.

O17 Normative values of functionality and quality of life of the portuguese healthy older people

Cátia Paixão¹, Sara Almeida^1,2, Alda Marques^1,2

¹Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Alda Marques (amarques@ua.pt)

Background

The older population is increasing worldwide [1]. Since the average life expectancy is currently 71.4 years at birth and the healthy life expectancy is only 63.1 years, there is a need to enhance the focus on public health to promote health and healthy ageing [2, 3]. Measures of functionality and health-related quality of life (HRQoL) have been identified as predictors of healthy aging [4-6]. However, to interpret results from those measures, and compare them within a population or across populations, normative data are necessary [7-9].

Objective

To establish age and gender-related normative values for the Five Times Sit to Stand Test (5 STS), 10 Meter Walk Test (10MWT), and World Health Organization Quality of Life-Bref (WHOQoL-Bref) for Portuguese healthy older people.

Methods

An exploratory cross-sectional study was conducted. Participants were recruited from the community. Functionality was assessed with the 5STS [4, 10] and 10MWT [5, 11] and Health-related Quality of Life (HRQoL) with the WHOQoL-Bref (scores: 0-20 and 0-100) [6]. Descriptive statistics was used to determine normative scores by age decades (60-69; 70-79; 80-89 years) and gender. Differences between age and gender were explored with multiple comparison tests using the Bonferroni correction.

Results

118 older people (76.2 ± 8.9yrs; n = 79, 66.9% female) participated in this study. Mean scores of 5STS (9.4 ± 3.5s; 13.0 ± 4.9s; 16.7 ± 6.7s), 10MWT (5.4 ± 2.1s; 6.5 ± 3.1s; 12.4 ± 5.9s) increased with age. Mean scores of the different domains of the WHOQoL-Bref 0-20 scale: physical health (15.9 ± 2.6; 15.1 ± 2.2; 13.6 ± 2.3), psychological (15.6 ± 2.6; 15.0 ± 2.3; 13.9 ± 1.9), social relationships (15.8 ± 2.8; 14.6 ± 2.4; 13.5 ± 2.4), environment (16.4 ± 2.3; 16.0 ± 2.3; 15.1 ± 1.6) decreased with age. Similar findings were observed in the WHOQoL-Bref 0-100 scale: physical health (74.6 ± 16.4; 69.3 ± 13.5; 60.4 ± 14.2), psychological (72.6 ± 16.4; 68.4 ± 14.5; 61.8 ± 12.1), social relationships (73.6 ± 17.6; 66.4 ± 15.2; 59.6 ± 15.2) and environment (77.6 ± 2.3; 74.9 ± 14.6; 69.4 ± 10.2). Females showed worst results in all measures. Mean scores of most measures were significantly different among age decades and gender (p < 0.05).

Conclusions

This study provided normative values of 5STS, 10MWT and WHOQoL-Bref for the Portuguese healthy older people. These data may improve the utility of these measures for health professionals to screen people and develop tailored interventions to improve functionality and HRQoL in this population. Normative values of WHOQoL-Bref will also allow identifying vulnerable groups and describing the profile of HRQoL in Portuguese healthy older people living in the community.

Acknowledgements

This work was partial supported by Programa Operacional de Competitividade e Internacionalização (COMPETE), through Fundo Europeu de Desenvolvimento Regional (FEDER) and Fundação para a Ciência e Tecnologia (FCT) under the project UID/BIM/04501/2013.

References

1. WHO. Global health and aging. Geneva: World Health Organization. 2011.

2. Ageing H. Keystone for a Sustainable Europe–EU Health Policy in the Context of Demogrpahic Change. European Comission. 2007.

3. Fuchs J, Scheidt-Nave C, Hinrichs T, Mergenthaler A, Stein J, Riedel-Heller SG, et al. Indicators for healthy ageing—a debate. International journal of environmental research and public health. 2013;10(12):6630-44.

4. Marques A, Almeida S, Carvalho J, Cruz J, Oliveira A, Jácome C. Reliability, Validity, and Ability to Identify Fall Status of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in Older People Living in the Community. Arch Phys Med Rehabil. 2016;97(12):2166-73.

5. Marques A, Cruz J, Quina S, Regêncio M, Jácome C. Reliability, Agreement and Minimal Detectable Change of the Timed Up & Go and the 10-Meter Walk Tests in Older Patients with COPD. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2016;13(3):279-87.

6. Huang T, Wang W. Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing. Int J Nurs Stud. 2009;46(10):1313-9.

7. Rothstein JM, Echternach JL. Primer on measurement: an introductory guide to measurement issues, featuring the American Physical Therapy Association's standards for tests and measurements in physical therapy practice: Amer Physical Therapy Assn; 1993.

8. Bohannon RW, Andrews AW. Normal walking speed: a descriptive meta-analysis. Physiotherapy. 2011;97(3):182-9.

9. Mitrushina M, Boone KB, Razani J, D'Elia LF. Handbook of normative data for neuropsychological assessment: Oxford University Press; 2005.

10. Bohannon R. Reference values for the five-repetition sit-to-stand test: a descriptive metaanalysis of data from elders. Percept Mot Skills. 2006;103(1):215-22.

11. Bohannon R. Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997;26(1):15-9.

Keywords

Normative values, Functionality, Quality of Life, Portuguese healthy older people.

O18 Relationship between balance and functionality, gait speed, physical activity and quality of life in community-dwelling older people

Sara Almeida^1,2, Cátia Paixão¹, Alda Marques^1,2

¹Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Alda Marques (amarques@ua.pt)

Background

Balance is a modifiable risk factor for falls which represent a major public health problem for healthy ageing [1]. Predictors of healthy ageing in older people (i.e., functionality, gait speed, physical activity (PA) and health-related quality of life (HRQoL)) have been correlated with balance measures [2-5]. However, most balance measures do not assess the different components of balance hindering the design of interventions. To overcome this difficulty the Balance Evaluation System Test (BESTest) [6] and its short versions [7, 8] (new comprehensive measures of balance) were developed. Nevertheless, the relationship between the BESTest [6] and its short versions [7, 8] with functionality, gait speed, physical activity and health-related quality of life older people living in the community is still unknown.

Objective

To explore the relationship between the BESTest, Mini-BESTest and Brief-BESTest with functionality, gait speed, PA and HRQoL in community-dwelling older people.

Methods

An exploratory cross-sectional study was conducted. Community-dwelling older people (> 60 yrs) were recruited. Balance was assessed with the BESTest, Mini-BESTest and Brief-BESTest, functionality with the 5STS [9], gait speed with the 10MWT [10], PA with the Brief-PA questionnaire [11] and HRQoL with the WHOQoL-Bref [12]. Descriptive statistics was used to characterize the sample. Correlations were explored with the Spearman correlation coefficient. By convention, the interpreting size of a correlation coefficient was negligible (0.00-0.30), low (0.30-0.50), moderate (0.50-0.70), high (0.70-0.90) and very high (0.90-1.00) correlation [13].

Results

One hundred and eighteen older people living in the community (76.2 ± 8.9 years; n = 79, 66.9% female) participated in this study. On average participants were overweight, with high body mass index (male: 26.9 ± 4.2 kg/m²; female: 26.8 ± 4.3 kg/m²) and fat-free mass (male: 29.5 ± 6.3 %; female: 37.6 ± 6.2%). BESTest, Brief-BESTest and Mini-BESTest were I) low and negatively correlated with intense (-0.34; -0.37; -0.32, respectively) and moderate (-0.37; -0.37; -0.35, respectively) PA; II) moderate and negatively correlated with the 5STS (-0.51; -0.61; -0.59, respectively); III) moderate to high and negatively correlated with the 10MWT (-0.69; -0.77; -0.78) and IV) negligible to moderate and positively correlated with the WHOQoL-Bref domains (I-Physical health 0.46; 0.57; 0.53; II-Psychological 0.47; 0.52; 0.53; III-Social relationships 0.32; 0.36; 0.28; IV-Environment 0.46; 0.51; 0.46).

Conclusions

This study shows that there is a relationship between the BESTest and its short versions with functionality, gait speed and HRQoL in community-dwelling older people. Higher correlations were found in the short versions, especially with functionality measures. This is useful for clinical practice since these versions are simpler, require less material and are quicker to apply.

Acknowledgements

This work was partial supported by Programa Operacional de Competitividade e Internacionalização (COMPETE), through Funfo Europeu de Desenvolvimento Regional (FEDER) and Fundação para a Ciência e a Tecnologia (FCT) under the project UID/BIM/04501/2013.

References

1. WHO. Falls: fact sheet. Geneva; 2016.

2. Iwakura M OK, Shibata K, Kawagoshi A, Sugawara K, Takahashi H, et al. . Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:1505-14.

3. Ozcan A DH, Gelecek N, Ozdirenc M, Karadibak D. . The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health. 2005;5:90.

4. Spagnuolo D JS, Iwama Â, Dourado V. Walking for the Assessment of Balance in Healthy Subjects Older than 40 Years. Gerontology. 2010;56(5):467-73.

5. Nilsagård Y AM, Carling A, Vesterlin H. Examining the validity and sensitivity to change of the 5 and 10 sit-to-stand tests in people with multiple sclerosis. Physiotherapy Research International. 2017;22(4):e1681.

6. Horak F, Wrisley D, Frank J. The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits. Phys Ther. 2009;89(5):484-98.

7. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. Journal of rehabilitation medicine. 2010;42(4):323-31.

8. Padgett P, Jacobs J, Kasser S. Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct. Phys Ther. 2012;92(9):1197-207.

9. Goldberg A, Chavis M, Watkins J, Wilson T. The five-times-sit-to-stand test: validity, reliability and detectable change in older females. Aging Clin Exp Res. 2012;24(4):339-44.

10. Peters D, Fritz S, Krotish D. Assessing the Reliability and Validity of a Shorter Walk Test Compared With the 10-Meter Walk Test for Measurements of Gait Speed in Healthy, Older Adults. J Geriatr Phys Ther. 2013;36(1):24-30.

11. Marshall A, Smith B, Bauman A, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39(5):294-7.

12. Kluthcovsky A, Kluthcovsky F. O WHOQOL-bref, um instrumento para avaliar qualidade de vida: uma revisão sistemática. Revista de Psiquiatria do Rio Grande do Sul. 2009;31(3).

13. Mukaka M. A guide to appropriate use of Correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.

Keywords

Correlations, Balance, Healthy ageing predictors, Older people.

O19 Trends of hospitalization for chronic obstructive pulmonary disease in Brazil from 1998 to 2016

Bárbara O Gama, Andréia WB Silva, Fabiana O Gama, Giovanna G Vietta, Márcia R Kretzer

University of Southern Santa Catarina, Campus Pedra Branca, 88137-270 Palhoça, Santa Catarina, Brazil

Correspondence: Bárbara O Gama (barbara.oenning@hotmail.com)

Background

Chronic Obstructive Pulmonary Disease (COPD) is a major public health problem. In Brazil, it is the fifth largest cause of hospitalization in the public health system when analysing patients over 40 years of age.

Objective

To analyse the trend of hospitalization for COPD in Brazil from 1998 to 2016.

Methods

Trend analysis of hospitalization for COPD were based on data from the “Sistema de Informação Hospitalar do Departamento de Informática do Sistema Único de Saúde” (DATASUS). Simple linear regression analysis, p < 0.05. Approved by the Ethics Committee of the Universidade do Sul de Santa Catarina (UNISUL).

Results

In the period, 3,403,536 hospitalizations for COPD were analysed in Brazil, with a strong tendency to reduce rates (β= -6,257, p < 0.001), from 166.2/100,000 inhabitants in 1998 to 56.7/100,000 inhabitants in 2016. Among the Brazilian regions, there were higher hospitalization rates in the southern region, 461.8/100,000 inhabitants in 1998 and 133.1/100,000 inhabitants in 2016, followed by the central-west region, 222.2/100,000 inhabitants for 61,6/100,000 inhabitants. The region with the lowest rates of hospitalization was the northeast, with 69.6/100,000 inhabitants at 36.7/100,000 inhabitants. There largest decreases in the southern region (β= -19.4). The trend is decreasing in both sexes, with the largest reduction in male (β = -6,976), which has the highest admission rates at the beginning and end of the period (180.7 and 60.6/100.000 inhabitants, respectively). All age groups analysed showed a significant reduction tendency, with the largest decreases in the age groups above 60 years. In the age group of 80 years or more, there was reduction from 3370.1/100,000 in 1998 to 1535.3/100,000 inhabitants in 2016 (β = -101,198). In females, the reduction was from 2089.1/100,000 inhabitants to 548.4/100,000 inhabitants (β = -84,372).

Conclusions

The trend of hospitalization for COPD in Brazil is decreasing. The southern region has the highest rates, as does the male sex. The age groups of 60 and older in both sexes present the highest rates of hospitalization, with increase proportional to the increase in age. The results indicate a change in the profile of this disease, which can be attributed to a greater coverage of the family health strategy, better monitoring of diagnosed cases, and free access to medicines dispensed by the SUS (Sistema Único de Saúde), which reduce exacerbations of the cases.

Keywords

Chronic Obstructive Pulmonary Disease, Hospitalization, Trends.

O20 Temporal trend of hospitalization for acute myocardial infarction in the southern Brazilian states from 2008 to 2016

Jessica M Okabe, Bárbara O Gama, Pedro F Simão, Márcia Kretzer, Giovanna G Vietta, Fabiana O Gama

University of Southern Santa Catarina, Campus Pedra Branca, 88137-270 Palhoça, Santa Catarina, Brazil

Correspondence: Jessica M Okabe (jessica.okabe@gmail.com)

Background

Acute Myocardial Infarction (AMI) is responsible for high hospitalization rates in Brazil Southern regions and represents one of the major causes of morbidity and mortality.

Objective

To analyse the temporal trend of hospitalization for AMI in the southern Brazilian states from 2008 to 2016.

Methods

Ecological study of time series of hospitalization for AMI, with data from the Hospital Information System provided by the Department of Informatics of the Single System (CID 10 - code I 21.9) in the resident population of the States of Paraná (PR), Santa Catarina (SC) and Rio Grande do Sul (RS), according to sex and age group. Simple linear regression was performed, with p < 0.05. Study approved by the Research Ethics Committee of the Southern University of Santa Catarina.

Results

In the analysed period, there were 154,828 hospitalizations in the South region. There was an upward trend in rates, with an average annual increase of 4,261 hospitalizations per AMI/100,000 inhabitants. At the beginning of the period a rate of 82.65/100,000 inhabitants was registered and at the end a rate of 118.67/100,000 inhabitants. The same trend was observed in the three southern states. Paraná presented a rate of 15.57/100,000 in 2008, to 24.89/100,000 in 2016 (β = 1.064; p = 0.002). In Santa Catarina the rate ranged from 17.11/100,000 in 2008 to 28.23/100,000 in 2016 (β = 1.159; p < 0.001). Rio Grande do Sul presented the highest rates among states, from 21.98/100,000 in 2008 to 30.57/100,000 in 2016 (β = 1.156; p < 0.001). Both sexes had an upward trend (male β = 15.732; p < 0.001; female β = 8.553; p < 0.001), with a variation from 279.32 (2008) to 418.46/100,000 inhabitants (2016) among men; and from 165.76 to 238.05/100,000 inhabitants among women. It was observed that the age groups between 40-49 years and 70-79 years, in both sexes, presented an upward tendency of hospitalization rates. In the male age group between 40 and 49 years, the increase in hospitalization rate was 368.56/100,000 in 2008 to 475.21/100,000 in 2016 (β = 10.553; p = 0.01). Between 70-79 years there was an increase of 10791.40/100,000 to 12458.46/100,000 in this same period (β = 160.084; p = 0.04). In the female age group between 40-49 years the increase in hospitalization rate was from 168.11/100,000 in 2008 to 210.63/100,000 in 2016 (β = 5.184; p = 0.02). And between 70-79 years there was an increase from 4452.09/100,000 to 5130.12/100,000 in this same period (β = 78.868; p = 0.02).

Conclusions

The study showed an upward trend in hospitalization rates for AMI in the Southern Region, by sex and age groups above 30 years for both sexes. Males present the highest rates.

Keywords

Acute myocardial infarction, Trend, Hospitalization.

O21 Temporal trend of the incidence of tuberculosis in the state of Santa Catarina from 2001 to 2015

Rafaela F Abreu, Bárbara O Gama, Pedro F Simão, Giovanna G Vietta, Márcia Kretzer, Fabiana O Gama

University of Southern Santa Catarina, Campus Pedra Branca, 88137-270 Palhoça, Santa Catarina, Brazil

Correspondence: Rafaela F Abreu (rafaelafujii@hotmail.com)

Background

World Health Organization (WHO) declared Tuberculosis (TB) as a global public health emergency. TB control is a priority in Brazil.

Objective

To analyse the temporal trend of incidence of Tuberculosis in the State of Santa Catarina from 2001 to 2015.

Methods

Ecological study of time series of TB incidence trends selected from the SINAN (Information System for Notifiable Diseases) of the Ministry of Health in the population residing in the State, by sex, age group and macro-regions. Simple linear regression was performed, p < 0.05. Study approved by the Research Ethics Committee of the Southern University of Santa Catarina.

Results

From 2001 to 2015, 30,213 TB cases were confirmed in Santa Catarina, with a steady trend in incidence rates, with 31.2/100,000 inhabitants in 2001 and 32.0/100,000 inhabitants in 2015 (p = 0.27). The male gender presented the highest rates, showing a strong tendency to increase, with an increase of 0.456 per year, ranging from 42.24/100,000 inhabitants in 2001 to 47.55/100,000 inhabitants, in the year 2015 (p < 0.001). In the male groups, aged from 0 to 19 years and from 20 to 29 years, a significant trend occurred in the increase of incidence rates, with an increase of 0.159 and 0.606, respectively, of the rate (p = 0.02) per year. The age group from 40 to 49 years, in turn, showed a decreasing trend, with a reduction of 1.292 in the incidence rate per year (p = 0.001). In females, there was a reduction of 0.802 in the rate per year in the age group of 20 to 29 years (p = 0.003). The macro-regions of the Midwest, Foz do Rio Itajaí and Plateau Norte presented a reduction in TB incidence rates. In the macro-regions of Greater Florianópolis and South, the trend was increasing (p < 0.05).

Conclusions

TB incidence rates in Santa Catarina are stationary. Growing trend in males. Growing trend in the male age groups up to 29 years and decreasing between 40 and 49 years. Decreasing trend in the female age group from 20 to 29 years. Macro-regions located in the coastal range have an increasing tendency and the macro-regions located in the Centre West of the State, a decreasing trend.

Keywords

Tuberculosis, Trend, Incidence.

O22 Trauma, impulsivity, suicidality and binge eating

Ana C Ribeiro, Mariana Marques, Sandra Soares, Pedro Correia, Cidália Alves, Paula Silva, Laura Lemos, Sónia Simões

Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal

Correspondence: Ana C Ribeiro (anaclaudia_aac@hotmail.com)

Background

Binge eating is a public health problem with physical and psychological effects, throughout life. Several studies explored the association between some variables (e.g. shame) and binge eating symptoms, but it is important to continue exploring the contribution of other correlates.

Objective

Explore the association and the predictive role of traumatic experiences, impulsivity and suicidality with/to binge eating symptoms.

Methods

421 subjects from the general population and college students (women, n = 300, 71.3%) completed the Traumatic Events Checklist, the Binge Eating Scale, the Barratt Impulsiveness Scale and the Suicidality Scale.

Results

The values of punctual prevalence of binge eating symptoms were similar to those from recent national studies, having found a severe severity of 2.6% in the total sample (3.3% in women). In both genders, suicidality total score and the body mass index (BMI) associated with binge eating total score. Only in women this score correlated with sexual and family trauma total scores and with the total score of traumatic events. If in men suicidality total score associated with family trauma total score and with the total score of traumatic events; in women that score also correlated with sexual trauma total score. In men, binge eating total score associated to attentional impulsivity (one of the first order impulsivity factors) and, in women, to all the first order impulsivity factors (attentional impulsivity, motor and non-planning), and with all the second order impulsivity factors (psychological attention, cognitive instability, motor, self-control and cognitive complexity), with the exception of perseverance. In women, attentional impulsivity particularly associated with sexual and family trauma total scores and with the total score of traumatic experiences. In women, the BMI, suicidality and attentional impulsivity total scores were the binge eating total score predictors.

Conclusions

In a sample from the general population and college students, we found that it is salient and of importance for future interventions, mainly in women, the predictive role of BMI, suicidality and attentional impulsivity scores to binge eating symptoms, with traumatic events (a more distal correlate) revealing significant associations, but not predicting these symptoms.

Keywords

Traumatic events, Impulsiveness, Suicidality, Binge eating.

O23 Computerised respiratory sounds during acute exacerbations of chronic obstructive pulmonary disease

Ana Oliveira^1,2,3, Patrícia Rebelo^2,3, Lília Andrade⁴, Carla Valente⁴, Alda Marques^2,3

¹Faculty of Sports, University of Porto, Porto,4200-450 Portugal; ²Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ³Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Pulmonology Department, Baixo Vouga Hospital Center, 3810-501 Aveiro, Portugal

Correspondence: Ana Oliveira (alao@ua.pt)

Background

Timely treatment and adequate monitoring of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have shown to reduce hospital admissions and recovery time, while improving patients’ quality of life [1]. Nevertheless, this is challenging as AECOPD diagnosis/monitoring relies exclusively on patients’ reports of symptoms worsening [2]. AECOPD are characterised by an increased airway inflammation and obstruction, abnormal bronchial mucus and air trapping, which results in changes in lung acoustics [2,3]. Thus, changes in respiratory mechanics related with AECOPD may be successfully monitored by respiratory sounds, namely adventitious respiratory sounds (ARS, crackles and wheezes) [3]. Nevertheless, little is known on ARS changes during the time course of AECOPD.

Objective

To evaluate ARS changes during the time course of AECOPD.

Methods

25 non-hospitalised patients with AECOPD (16 males, 70.0 ± 9.8yrs, FEV1 54.2 ± 20.6% predicted) were enrolled. Patients were treated with pharmacological therapy. ARS at anterior and posterior right/left chest were simultaneously recorded at hospital presentation (T1) and at weeks 3 (T3) and 8 (T8). ARS (no. of crackles and wheeze occupation rate–%Wh) were processed, per respiratory phase, using validated algorithms [4,5]. Differences were examined with Friedman and Cochran tests and both tests were corrected with Bonferroni corrections.

Results

Significant differences were found in no. of inspiratory crackles (0.6 [0.1-2.2] vs. 0.5 [0.1-2.5] vs. 0.3 [0.0-0.9]; p = 0.008) in T1, T3 and T8 at posterior chest, namely participants presented more inspiratory crackles (p = 0.013) at T1 than at T8. Similar results were found for inspiratory %Wh (0.0 [0.0-12.3] vs. 0.0 [0.0-0.0] vs. 0.0 [0.0-0.0]; p = 0.019), namely, participants presented significantly more inspiratory %Wh at T1 than at T3 (p = 0.006). A significant higher number of participants presenting inspiratory wheezes was found at T1 than at T3 at the anterior chest (%Wh: 10 vs. 2 vs. 5; p=0.017) and a trend to significance was found at posterior chest (%Wh: 10 vs. 3 vs. 4; p = 0.052). No differences were found for the remaining variables.

Conclusions

Crackles and wheezes seem to be sensitive to monitor the course of AECOPD. Inspiratory crackles seem to persist until 15 days after the exacerbations (i.e., approximate time needed to resolve AECOPD [6]) whilst inspiratory %Wh significantly decreased after this period. This information may allow further advances in the monitoring of patients with COPD across all clinical and non-clinical settings, as respiratory sounds are simple, non-invasive population-specific and available by nearly universally means. Further studies with larger samples and including data collected before the AECOPD are needed to confirm these findings.

References

1. Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, and Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 169: 1298-1303, 2004.

2. The Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of 543 Chronic Obstructive Pulmonary Disease—2017 Report. The 544 Global Initiative for Chronic Obstructive Lung Disease, Inc.; 2017.

3. Gavriely N, Nissan M, Cugell DW, Rubin AH. Respiratory health screening using pulmonary function tests and lung sound analysis. Eur Respir Rev. 1994;7(1):35–42.

4. Pinho C, Oliveira A, Jácome C, Rodrigues JM, Marques A. Integrated approach for automatic crackle detection based on fractal dimension and box filtering. IJRQEH. 2016;5(4):34-50.

5. Taplidou SA, Hadjileontiadis LJ. Wheeze detection based on time-frequency analysis of breath sounds. Comput Bio Med. 2007;37(8):1073-83.

6. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha, JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000; 161(5): 1608-1613.

Keywords

Chronic Obstructive Pulmonary Disease, Acute exacerbations, Computerised respiratory sounds, Crackles, Wheezes.

O24 Trauma, self-disgust and binge eating

Sandra Soares, Mariana Marques, Ana C Ribeiro, Pedro Correia, Cidália Alves, Paula Silva, Helena E Santo, Laura Lemos

Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal

Correspondence: Sandra Soares (sandra.soares.93@hotmail.com)

Background

Binge eating disorder is finally recognized in the current Diagnostic and Statistical Manual of Mental Disorders-5. Additionally, international and national studies explored correlate binge eating symptoms, but it is important to evaluate the role of other variables for these symptoms, in the general population.

Objective

Explore the association and predictive role of traumatic experiences and of self-disgust with/in binge eating symptoms, exploring, also, the possible mediation role of self-disgust in the relation between traumatic experiences and those symptoms.

Methods

421 subjects from the general population and college students (women, n = 300, 71.3%) completed the Traumatic Events Checklist, the Binge Eating Scale and the Multidimensional Self-disgust scale.

Results

We found binge eating (BE) values similar to those from other national studies: mild to moderate BE (women: 6.3%; men: 5.0%) and severe BE (women: 3.3%; men: 0.8%). In men, BE total score positively correlated with defensive activation, cognitive-emotional and avoidance dimensions (self-disgust). Body mass index (BMI) positively correlated with BE total score and defensive activation (self-disgust) and negatively with family trauma. In women, BE total score positively associated with all self-disgust dimensions. Sexual trauma, family trauma, total of traumatic events and BMI positively associated with BE total score and all the self-disgust dimensions. In a hierarchical multiple regression analysis, BMI, total of traumatic events and the cognitive-emotional of self-disgust predicted BE total score. The cognitive-emotional (self-disgust) dimension mediated totally the relation between traumatic events and the BE total score.

Conclusions

In a sample from the general population and college students, BE values were similar to those from national studies. In women, sexual trauma, family trauma and total traumatic experiences (and all self-disgust dimensions) associated with BE. A higher BMI was associated with higher BE levels. In future interventions focusing on BE, in women, it seems important to consider the role of cognitive-emotional self-disgust in the relation between BE occurrence and distal traumatic events.

Keywords

Traumatic events, Self-disgust, Binge eating.

O25 New paediatric screening procedures: health promotion in primary care

Marisa Lousada^1,2, Ana P Mendes^3,4, Helena Loureiro^1,5, Graça Clemêncio⁶, Elsa Melo^1,5, Ana RS Valente¹

¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Center for Health Technology and Services Research, University of Aveiro, 3810-193 Aveiro, Portugal; ³Health Sciences School, Polytechnic Institute of Setúbal, 2914-503 Setúbal, Portugal; ⁴Centro Interdisciplinar de Investigação Aplicada em Saúde, Polytechnic Institute of Setúbal, 2914-503 Setúbal, Portugal; ⁵Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ⁶ACES Baixo Vouga, 3804-502 Aveiro, Portugal

Correspondence: Marisa Lousada (marisalousada@ua.pt)

Background

Screening procedures do not identify the specific disorder but allow a quick identification of children who may need a detailed assessment in speech therapy. Screening instruments are usually performed by different health professionals (e.g. pediatricians, nurses). The Child Health Program for primary care in Portugal determined that all 5-year-old children should be screened by nurses and general practitioners to conclude if they present a typical development suitable to school requirements. This screening is usually implemented through the Mary Sheridan test and there is no speech-language screening test used in primary care. Recently a Speech and Language Screening was validated for Portuguese children in kindergartens with excellent levels of specificity, sensitivity and reliability. RALF aims to quickly identify (5 minutes) children who may be at risk of speech-language impairment and need to be referred to a in depth assessment by a Speech-Language Therapist.

Objectives

This study aims to implement a new screening procedure in primary health care contributing to best practices. Specifically, the study aims to identify children with speech-language disorder that are undiagnosed due to the absence of a known condition such as neurological, hearing or cognitive impairment.

Methods

Ethical approval was granted by the Ethics Committee (UICISA) (ref.14/2016). A sociocultural questionnaire characterizing child and family background was fulfilled by caregivers to collect information about the child’s background (e.g., mother language; neurological, hearing, cognitive disorder) and child’s family background. Subject selection criteria included: Portuguese as native language and absence of a language disorder secondary to a known condition. The sample comprised 37 children whose parents returned informed consents. The screening was applied by 10 nurses in the Global Health Examination of 5 years old children in 2 health care centres.

Results

Twenty-one percent of children failed the screening. This illustrates the high level of speech-language difficulties (without any other associated condition) and is consistent with previous research studies. The children that failed the screening were already been referred to speech-language services for a detailed assessment.

Conclusions

This study highlights the importance of the implementation of a screening procedure in primary health care contributing to best practices.

Acknowledgements

Study supported by FEDER through POCI-01-0145-FEDER-007746 and FCT via CINTESIS, R&D Unit (ref. UID/IC/4255/2013).

Keywords

Screening, Speech and language, Health promotion.

O26 Practices on using wearables during aquatic activities

Henrique P Neiva^1,2, Luís Faíl¹, Mário C Marques^1,2, Maria H Gil^1,2, Daniel A Marinho^1,2

¹Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal

Correspondence: Henrique P Neiva (henriquepn@gmail.com)

Background

Several studies described the use of different sensors to detect the daily activity, movement and sleep patterns and physical activities [1]. These are easily available for all those who are interested in tracking physical activity and progresses to improve physical fitness and health-related parameters [1]. However, little is known about the people’s knowledge about this equipment and specially in some specific activities that have some restrictions, for instance those performed in-water.

Objective

The purpose of this study was to characterize Portuguese practices on the use of wearable technology during aquatic activities.

Methods

Swimming pools from the interior region of Portugal were selected randomly and their users completed a questionnaire consisting of 33 questions. The first part focused on the characterization of their motivations and usual in-water activities, and the second focused on their views on the value of the wearable technology, its use and suggestions for future development of those devices according to aquatic activities.

Results

Ten swimming pools were accessed, and 418 questionnaires were filled by people ranging from 18 to 79 years-old. About 79% of these subjects have heard about wearables for sport, but 65% never used them during exercise. At the time of the inquiries, 24% still used and 11% gave up using it mainly because of lack of interest or because the devices did not work well underwater. Among the non-users, most reported that they did not have the opportunity (53%), considering that they are not useful (17%), or complaining about the financial cost (15%). However, most of them (74%) would be interested in trying this type of equipment during aquatic activities. Interestingly, 71% did not consider doing more exercise after they have the equipment. From those subjects using wearables, only a few (n = 24) used during in-water exercise.

Conclusions

For future, the devices should be more comfortable, be more reliable, be water resistant, with longer battery life. Besides the usual feedbacks provided, they also would like to see some technical corrections evidenced by that technology. People seemed to know about the existence of wearables to monitor physical activity but are still reluctant because of their underwater reliability, cost, and opportunity to try them. These results evidenced a need for improving these technological devices according to subjects needs and the activities performed. Some suggestions were made according to the future development of these devices to use during in-water exercitation.

Acknowledgements

NanoSTIMA: Macro-to-Nano Human Sensing Towards Integrated Multimodal Health Monitoring and Analytics, NORTE-01-0145-FEDER-000016, co-financed by FEDER-NORTE2020.

References

1. Chambers R, Gabbett TJ, Cole MH, Beard A. The use of wearable microsensors to quantify sport-specific movements. Sports Med. 2015, 45(7): 1065-1081.

Keywords

Technology, In-water activities, Sensors.

O27 Does the recall of caregiver eating messages exacerbate the pathogenic impact of shame on eating and weight-related difficulties?

Sara Oliveira, Cláudia Ferreira

Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3000-115 Coimbra, Portugal

Correspondence: Sara Oliveira (sara.oliveira.uc@gmail.com)

Background

It has been recognized the central role of caregiver eating messages - restriction of food intake and pressures to eat - on later individual's eating behaviour, body image and weight status [1-3]. Additionally, shame is a painful emotion [4] also associated with the development and maintenance of body image and eating-related difficulties [5, 6], namely inflexible eating and concerns and maladaptive attitudes regarding body weight and shape [7].

Objective

The main aim of the present study was to test whether recalling caregiver eating messages [3] moderates the association of external shame [8] with inflexible eating rules [7] and with concerns and maladaptive attitudes regarding body weight and shape [9,10].

Methods

The sample comprised 479 Portuguese women, aged between 18 and 60 (M = 25.66; SD = 8.50), who completed validated self-report measures. The relationship between the study variables was accessed by Pearson product-moment correlation and the moderator effect was tested through path analysis.

Results

Results revealed that caregiver restrictive/critical messages played a significant moderator effect on the relationships of external shame with inflexible eating rules, and with concerns and maladaptive attitudes regarding body weight and shape. These findings suggested that caregiver restrictive/critical eating messages exacerbated the impact of shame on these psychopathological outcomes, with the tested model accounting for 17% and 29% of the variance of inflexible eating rules and body weight and shape concerns, respectively. In addition, pressure to eat caregiver messages was not correlated with all variables examined. A graphical representation of the moderation analyses allowed to understand that, for the same levels of external shame, women who recall more caregiver restrictive/critical eating messages tend to adopt more inflexible eating rules and present greater concerns and maladaptive attitudes regarding body weight and shape.

Conclusions

These findings appear to offer important clinical and investigational implications, highlighting the importance of the development of efficient parental intervention approaches as a refuge against maladaptive eating regulation strategies.

References

1. Abramovitz BA, Birch LL. Five-year-old girls’ ideas about dieting are predicted by their mothers’ dieting. J Am Diet Assoc. 2000; 100: 1157-1163. doi: 10.1016/S0002-8223(00)00339-4.

2. Birch LL, Fisher JO. Mother’s child-feeding practices influence daughters eating and weight. Am J Clin Nutr. 2000; 71: 1054-1061.

3. Kroon Van Diest A, Tylka T. The Caregiver Eating Messages Scale: Development and psychometric investigation. Body Image. 2010; 7:317-326. doi: 10.1016/j.bodyim.201006.002.

4. Gilbert P. What is shame? Some core issues and controversies. In: Gilbert P, Andrews B, editors. Shame: Interpersonal behavior, psychopathology and culture. New York: Oxford University Press; 1998. pp. 3- 38.

5. Goss K, Gilbert P. Eating disorders, shame and pride: A cognitive behavioural functional analysis. In: Gilbert P, Miles J, editors. Body shame: Conceptualization, research & treatment. Hove, UK: Brunner Routledge; 2002. pp. 219–255.

6. Hayaki J, Friedman M, Brownell K. Shame and severity of bulimic symptoms. Eat Behav. 2002; 3:73-83. doi:10.1016/S1471-0153(01)00046-0.

7. Duarte C, Ferreira C, Pinto-Gouveia J, Trindade I, Martinho A. What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire. Appetite. 2017; 114:146-154. doi: 10.1016/j.appet.2017.03.034.

8. Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The Other As Shamer Scale – 2: Development and validation of a short version of a measure of external shame. Personal Individ Differ. 2015; 74:6-11. doi: 10.1016/j.paid.2014.09.037.

9. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview of self report questionnaire? Int J Eat Disord. 1994; 16(4):363–370. doi:10.1002/1098-108X(199412).

10. Machado PP, Martins C, Vaz AR, Conceição E, Bastos AP, Gonçalves S. Eating Disorder Examination Questionnaire: psychometric properties and norms for the Portuguese population. Eur Eat Disord Rev. 2014; 22(6):448–453. doi:10.1002/erv.2318.

Keywords

Caregiver eating messages, External shame, Inflexible eating rules, Eating disordered, Women.

O28 How does shame mediate the link between a secure attachment and negative body attitudes in men?

Sara Oliveira, Cláudia Ferreira

Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3000-115 Coimbra, Portugal

Correspondence: Sara Oliveira (sara.oliveira.uc@gmail.com)

Background

Shame is a painful self-conscious and universal emotion [1] regarded as a central feature of the development and maintenance of body image difficulties [2]. Additionally, it’s known the association between attachment style and body concerns, among women [3]. Particularly, a secure attachment may promote a more favourable body image [4]. However, few studies have focused on mechanisms that may explain body image difficulties in men.

Objective

The present study tested a model which hypothesized that the impact of a secure attachment on the engagement in negative male body attitudes, namely attitudes towards their muscularity and body fat [5, 6], is carried by general feelings of shame [7], while controlling the effect of body mass index.

Methods

The sample comprised 133 men, aged between 18 and 60 years old (M = 28.83; SD = 10.24), who completed validated self-report measures. The relationship between the study variables was accessed by Pearson product-moment correlation and the mediator effect was conducted through path analysis.

Results

The tested path model explained 22% and 49% of negative male attitudes towards their muscularity’s and low body fat’s variance, respectively. Results demonstrated that a secure attachment presented a significant direct effect on attitudes towards body fat, and an indirect effect through external shame on attitudes towards muscularity. In fact, these findings seem to suggest that men who were secure in attachment tend to experience less general feelings of shame and, consequently, presented low negative body attitudes, namely in regards to their muscularity and body fat.

Conclusions

These data support the relevance of addressing shame experiences when working with men with body image related-difficulties, especially in a context of early adverse experiences in their attachment.

References

1. Gilbert P. What is shame? Some core issues and controversies. In: Gilbert P, Andrews B, editors. Shame: Interpersonal problems, psychopathology and culture. New York: Oxford University Press; 1998. pp.3–3.

2. Goss K, Gilbert P. Eating disorders, shame and pride: A cognitive behavioural functional analysis. In Gilbert P, Miles J, editors. Body shame: Conceptualization, research & treatment. Hove, UK: Brunner Routledge; 2002. pp. 219–255.

3. Sharpe TM, Killen JD, Bryson SW, Shisslak CM, Estes LS, Gray N, et al. Attachment style and weight concerns in preadolescent and adolescent girls. Int J Eat Disord. 1998; 23(1):39-44.

4. Cash T. Cognitive-behavioral perspectives on body image. In: Cash T, Pruzinsky T, editors. Body image: A handbook of theory, research, and clinical practice. New York: The Guilford Press; 2002. pp.38-36.

5. Tylka TL, Bergeron D, Schwartz JP. Development and psychometric evaluation of the Male Body Attitudes Scale (MBAS). Body Image. 2005; 2(2):161-175. doi: 10.1016/j.bodyim.2005.03.001.

6. Ferreira C, Oliveira S, Marta-Simões J. Validation and psychometric properties of Portuguese Version of Male Body Attitudes Scale-Revised (MBAS-R). Manuscript in preparation, 2017.

7. Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The Other As Shamer Scale – 2: Development and validation of a short version of a measure of external shame. Personal Individ Differ. 2015; 74:6–11. doi:10.1016/j.paid.2014.09.03.

Keywords

Secure attachment, External shame, Negative body attitudes, Men.

O29 Potential contamination of tourniquets used in peripheral venipuncture: preliminary results of a scoping review

Anabela S Oliveira¹, Pedro Parreira¹, Nádia Osório², Paulo Costa¹, Vânia Oliveira¹, Fernando Gama³, João Graveto¹

¹Health Sciences Research Unit: Nursing, 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, 3000-075, Portugal

Correspondence: João Graveto (jgraveto@esenfc.pt)

Background

Peripheral venipuncture constitutes one of the most frequent and invasive clinical procedures performed in healthcare settings [1-2]. In order to stop blood flow and promote vascular distension, the use of a tourniquet five to ten centimetres above the desired puncture site is recommended [3]. The irregular management of these specific medical devices, without complying with guidelines, constitutes a risk of microorganism dissemination [4-5].

Objective

To map the available evidence on the microbiological contamination of tourniquets used in peripheral venipuncture, identifying recurrent practices in their manipulation.

Methods

Scoping review based on the principles advocated by Joanna Briggs Institute [6]. The analysis of relevance of the articles, the extraction and synthesis of data was performed by two independent reviewers. The search strategy included all articles published until November 2017, written in Portuguese, Spanish, French and English.

Results

An initial total of 2,052 articles derived from the search conducted. Through Endnote software, 998 duplicates were removed. The remaining 1,054 articles were screened by title and abstract. Of these, 33 articles were included for full-text analysis by two independent reviewers. During this process, the reference lists of all included articles were screened, which resulted in the inclusion of 3 new articles. Ten studies were excluded due to absence of microbiological data inclusion and 6 were excluded due to lack of full-text access and author's reply. Overall, a total of 1,337 tourniquets belonging to nurses, nursing assistants, doctors, phlebotomists and lab workers were analysed for microorganism contamination. A small number of studies verified that the same tourniquets were used continuously by professionals between 3 days to 104 weeks. Preliminary results evidenced contamination rates varying between 9% and 100%, composed by diverse microorganisms such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterococcus and Acinteobacter baumannii. Several of the included studies described conflicting practices during tourniquet manipulation by health professionals, especially when focused on domains such as hand hygiene before and after tourniquet use, glove usage during venipuncture, tourniquet cleaning and disinfecting, sharing tourniquets with other professionals and storage conditions. The most cited reason for tourniquet replacement in clinical settings was due to their loss by health professionals.

Conclusions

As a contribution to clinical practice, it is expected that the mapping of the available scientific evidence regarding the potential contamination of these devices will appear as an informative contribution that supports the analysis of current practices in this field, promoting the implementation of quality assurance systems in health institutions.

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 C. Devices and dressings to secure peripheral venous catheters: A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 2017;67:12-19.

2. Oliveira AS. Intervenção nas práticas dos enfermeiros na prevenção de flebites em pessoas portadoras de cateteres venosos periféricos: um estudo de investigação-ação [PhD thesis]. Universidade de Lisboa; 2014.

3. Veigar B, Henriques E, Barata F, Santos F, Santos I, Martins M et al. Manual de Normas de Enfermagem: Procedimentos Técnicos. 2nd ed. Administração Central do Sistema de Saúde, IP; 2011.

4. World Health Organization. Decontamination and reprocessing of medical devices for healthcare facilities. Geneva, Switzerland: WHO Document Production Services; 2016.

5. Costa P. Gestão de material clínico de bolso por enfermeiros: fatores determinantes e avaliação microbiológica [Masters dissertation]. Nursing School of Coimbra; 2017.

6. 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

Tourniquets, Contamination, Peripheral venipuncture.

O30 Effects of a community-based food education program on nutrition-related knowledge in middle-aged and older patients with type 2 diabetes: a RCT

Carlos Vasconcelos^1,2, António Almeida¹, Maria Cabral³, Elisabete Ramos^3,4, Romeu Mendes^1,3,5

¹University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; ²Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; ³Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; ⁴Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; ⁵Public Health Unit, ACES Douro I – Marão e Douro Norte, 5000-524 Vila Real, Portugal

Correspondence: Romeu Mendes (romeuduartemendes@gmail.com)

Background

Peripheral Diabetes imposes an unacceptably high human, social and economic cost, especially on aging populations. Nutrition-related knowledge is of crucial importance to make healthier food choices, contributing for type 2 diabetes (T2D) control and related comorbidities prevention.

Objective

To analyse the effects of a food education program (FEP) on the nutrition-related knowledge (NRK) in middle-aged and older patients with T2D.

Methods

Forty-two individuals between 50 and 80 years old with T2D were recruited in primary health care institutions, to participate in Diabetes em Movimento®, a community-based exercise program (3 exercise sessions per week; 75 minutes each; during 9 months), developed in Vila Real, Portugal. Participants were randomized into two groups: a control group (CG; N = 19; exercise program only) and an experimental group (EG; N = 23; exercise program plus a FEP). The FEP was 16 weeks long and, on each week, a different nutrition-related theme was addressed. Each theme was driven through a theoretical session (15 minutes) and dual-task exercise strategies integrated in Diabetes em Movimento®'s sessions. The NRK was evaluated, before and after the 9-month intervention, using the Portuguese reduced version of Nutritional Knowledge Questionnaire (from 0 to 56 points; higher score, better knowledge).

Results

Thirty-six participants completed the study (CG, N = 16; EG, N = 20). The baseline score was 30.19 ± 6.10 (CG) vs. 29.40 ± 6.16 points (EG). After the intervention, the score was 31.31 ± 7.40 (CG) vs. 35.20 ± 5.68 points (EG). A significant time*group interaction effect was identified (p = 0.001; η2p = 0.290). Considering the FEP's sessions adherence level (< 50% vs. ≥ 50%), a significant time*group interaction effect was also identified (baseline, 29.78 ± 7.84 [< 50%] vs. 29.09 ± 4.76 [≥ 50 %]; after intervention, 32.78 ± 5.93 [50 %] vs. 37.18 ± 4.85 [≥ 50%]; p = 0.004, η2p = 0.370).

Conclusions

A community-based easy-to-implement food education program was effective in increasing NRK of middle-aged and older patients with type 2 diabetes and may contribute to better food choices. Program's adherence levels play a major role on knowledge acquisition.

Trial Registration

NCT02631902

Keywords

Type 2 diabetes; Food education program; Nutrition-related knowledge; Community-based intervention.

O31 Perception of oral antidiabetic agents adverse events and their impact on Health Related Quality of Life in type 2 diabetic patients

Rui S Cruz¹, Luiz M Santiago², Carlos F Ribeiro³

¹Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ³Department of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Rui S Cruz (ruic@estescoimbra.pt)

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 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 was 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

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

Conclusions

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

Keywords

Diabetes Medication, Therapy, Quality of Life.

O32 Third stage of waterbirth: observational study

Joyce CS Camargo^1,2, Vitor Varela³, Elisabete Santos³, Natalucia M Araújo², Kelly CMP Venâncio⁴, Manuela Néné⁵, Maria CLR Grande⁶

¹Abel Salazar Institute of Biomedical Sciences of the University of Porto, 4200-135 Porto, Portugal; ²School of Arts, Sciences and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil; ³São Bernardo Hospital, 2910-445 Setúbal, Portugal; ⁴College of Nursing, University of São Paulo, 05403-000 São Paulo, Brazil; ⁵Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1350-125 Lisboa, Portugal; ⁶Faculty of Psychology and Educational Sciences, University of Porto, 4200-135 Porto, Portugal

Correspondence: Joyce CS Camargo (joyce@usp.br)

Background

The placental-delivery, in waterbirth (WB), usually occurs while maternal wellbeing is monitored through clinical aspects, heart-rate and blood-pressure, as well as water-coloration. Adequate care should be taken in this period, with prevention of postpartum-haemorrhage(HPP), which is the main cause of maternal death in developing countries, and approximately ¼ of all maternal deaths worldwide [1].

Objective

To verify the outcome of the labour’s third stage at the Waterbirth-Project (PWB), in Setúbal, at São Bernardo’s Hospital located in Portugal. Study's question: What’s the maternal outcome of childbirth’s 3rd stage in PWB?

Methods

Observational-study, cross-sectional, descriptive based on ethical guidelines (CNPD-9885/2015) approved by the hospital, where delivery room’s infrastructure, protocol’s definition and technical and scientific training of the obstetric-team began in 2006. The PWB occurred between 2011-2014. 153 women, with a single pregnancy, gestational age ≥ 37 weeks with low-risk prenatal care participated in the PWB, signed an informed consent form about study’s benefits and risks, resulting in 90 waterbirths. Data were collected from the specific PWB forms in April 2016. Data management was developed in Excel® and SPSS® version 16.0 programs.

Results

In the PWB, 51.1% of women had placental waterbirth vs 48.9% out-of-water. The active management occurred in 7.7% vs 86.7% of physiological management, 92.3% of the women had physiological blood loss, and 7.7% had increased bleeding, controlled with uterotonics. These results corroborate with evidence: Swiss study [2], with 89 WB vs 279 out-of-water births, 57% had physiological defect in the water and the 3rd-Stage was significant (p < 0.01) in PA; English study [3] with 5,192 WB, with third physiological stage, 86.1% of which 55.8% were in water. For 3rd-Stage’s management [4]: 1. Active: administration of uterotonic (oxytocin [1], 1st choice) after birth, timely clamping of the umbilical cord and controlled cord traction. 2. Physiological: Spontaneous relief assisted by gravity and/or maternal effort. In order to evaluate PPH in WB, in addition to the clinical state of the puerperium, the coloration of the comparison to wine is analysed: 50-100 ml blood loss to the pink-Chablis; from 150-250 ml to bleed and 500-750 ml to Merlot-wine [5] or, study-site midwife’s puts-hand below the surface of the water horizontally. If visible hand, haemorrhage ≤ 500mL, if hand not-visible, haemorrhage > 500mL.

Conclusions

The 3rd-Stage’s management in WB is safe and according to the experience of the PWB, no adverse events were related to it. More studies are needed to support good clinical practices based on scientific evidence.

References

1. OMS. Recomendações da OMS para a prevenção e tratamento da hemorragia pós-parto. In: Saúde OMd, editor. 2014. p. 48.

2. Zanetti-Dallenbach RA, Lapaire O, Maertens A, Holzgreve W, Hosli I. Water birth, more than a trendy alternative: a prospective, observational study. Arch Gynecol Obstet. 2006;274(6):355-65.

3. Burns EE, Boulton MG, Cluett E, Cornelius VR, Smith LA. Characteristics, interventions, and outcomes of women who used a birthing pool: A prospective observational study. Birth. 2012;39(3):192-202.

4. ICM, FIGO. Prevention and Treatment of Post-partum Haemorrhage: New Advances for Low Resource Settings International Confederation of Midwives (ICM). International Federation of Gynaecology and Obstetrics (FIGO); 2006.

5. Harper B. Gentle Birth Choices. Revised Edition ©2005 Barbara Harper ed: Inner Traditions Bear and Company; 2005 August 09, 2005.

Keywords

Childbirth’s 3rd stage, Placental-delivery, Postpartum-haemorrhage, Waterbirth, Midwifery.

O33 Aqua apgar in waterbirth: cross-sectional study

Joyce CS Camargo^1,2, Vitor Varela³, Elisabete Santos³, Maria AJ Belli², Maryam MJ Trintinália², Manuela Néné⁴, Maria CLR Grande⁵

¹Abel Salazar Institute of Biomedical Sciences of the University of Porto, Portugal; ²School of Arts, Sciences and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil; ³São Bernardo Hospital, 2910-445 Setúbal, Portugal; ⁴Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1350-125 Lisboa, Portugal; ⁵Faculty of Psychology and Educational Sciences, University of Porto, 4200-135 Porto, Portugal

Correspondence: Joyce CS Camargo (joyce@usp.br)

Background

Waterbirth (WB) is the complete underwater fetal expulsion [1,2] with much discussion [3] about it. Aqua Apgar [4] is an index that evaluates the newborn’s vitality (NB) while still submerged in water until life’s first minute, developed by Cornelia Enning.

Objective

To know the neonatal outcome of the Waterbirth Project (PWB) at a Setubal’s (Portugal) Hospital, São Bernardo. Study’s Question: What is the neonatal outcome of new-borns born in PWB?

Methods

Cross-sectional study, observational, descriptive based on ethical guidelines (CNPD-9885/2015) approved by the hospital, whose delivery-room’s infrastructure, protocol’s definition and obstetric-team’s technical and scientific training began in 2006. The PWB occurred between 2011-2014. 153 women with single pregnancy, gestational age ≥ 37 weeks with low-risk prenatal care participated in the PWB and signed an informed consent form about study’s benefits and risks, resulting in 90 waterbirth. Data were collected from the specific PWB form in April 2016. Data management was developed in Excel® and SPSS® version 16.0 programs.

Results

The 1st minute’s Aqua Apgar and the 5th minute’s Apgar were superior to 7 in all the cases, with an average of 9.4 at the 1st minute and 9.9 at the 5th minute. A cross-sectional-study in Sydney [5] observed minor Apgar and may be due to disregarding that water-born NB manifest their vitality by moving the legs and arms, opening and closing their eyes and mouth and swallowing [4]. A cohort study in the UK [6] corroborates our study that NB of aquatic birth were less likely to have a low Apgar score in the 5th minute. The use of Aqua Apgar in our study allowed a coherent outcome in the NBs who is kept submerged in water until life’s first minute, with a soft transition to extra uterine life and with no negative repercussions on heart rate and absence of complication or neonatal hospitalization.

Conclusions

This study provides evidences that may support clinical decisions regarding delivery in water. Further studies on Aqua Apgar should be conducted to support evidence-based practices.

References

1. Nutter, E., Meyer, S., Shaw-Batista, J. & Marowitz, A. (2014). Waterbirth: an integrative analysis of peer – reviewed literature. Journal of Midwifery & Women’s Health. 59, (3), 286-319.

2. Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev 2009;(2):CD000111.

3. ACOG. American College of Obstetricians & Gynecologists. (2014). Immersion in water during labor and delivery (Committee Opinion No. 594). Retrieved from http://www.acog.org/ Resources_And_Publications/Committee_Opinions/ Committee_on_Obstetric_Practice/Immersion_in_ ater_During_Labor_and_Delivery 4.Garland D. Revisiting Waternirth: an attitude to care. 2011. Published by Palgrave Macmillan. ISBN 10: 0230273572 / ISBN 13: 978023273573

5. Bovbjerg M L; Cheyney M; Everson C. (2016). Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. J Midwifery Womens Health. Jan-Feb;61(1):11-20. doi: 10.1111/jmwh.12394. Epub 2016 Jan 20.

6. Dahlen HG, Dowling H, Tracy M, Schmied V, Tracy S. (2013). Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery;29(7):759-64.

Keywords

Aqua Apgar, Waterbirth, Midwifery, Apgar, Childbirth.

O34 Portuguese centenarians from Oporto and Beira Interior: distinctive health profiles?

Daniela Brandão^1,2, Oscar Ribeiro^1,3, Rosa M Afonso^1,4, Constança Paúl^1,5

¹Center for Health Technology and Services Research, 4200-450 Porto, Portugal^{; 2}Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal^{; 3}University of Aveiro, 3810-193 Aveiro, Portugal^{; 4}University of Beira Interior, 6201-001 Covilhã, Portugal^{; 5}Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal

Correspondence: Daniela Brandão (danielafsbrandao@gmail.com)

Background

In Portugal, the number of centenarians almost tripled over the last decade from 589 centenarians in 2001 to 1526 in 2011 [1], and recent projections point to the existence of 3,393 centenarians in 2013 [2]. Reaching the age of 100, though an important landmark, does not necessarily indicates successful aging as it is often accompanied by severe health and functional constraints. Understanding health trajectories of these long-lived individuals and studying the prevalence of diseases that are the most common causes of death is important for conveniently addressing their current caregiving needs.

Objective

The aim of this study is to present an overview of the sociodemographic and health-related characteristics of two distinct samples of Portuguese centenarians (predominantly rural vs. predominantly urban) and acknowledge potential dissimilarities.

Methods

A sample of 241 centenarians was considered (140 from the PT100 Oporto Centenarian Study and 101 from the PT100 Beira Interior Centenarian Study). Sociodemographic information, nature and number of diseases, functionality and physical health variables were collected.

Results

In both samples, most centenarians were female (89.3% in Oporto, and 86.1% in Beira Interior), and widowed (76.4% in Oporto, 91.1% in Beira Interior), and lived in the community (57.9% in Oporto, 49.0% in Beira Interior). Higher levels of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) dependency were found in the Oporto sample, as well as a higher percentage of bedridden centenarians (61.0% in Oporto vs. 38.1% in Beira Interior). Sensorial impairments and incontinence were the most frequent conditions reported in both samples; however, lower percentages of age-related illnesses were found in the Beira Interior sample. Considering the three most lethal diseases among the elderly population (heart disease, non-skin cancer and stroke), 60.0% of centenarians in Oporto escaped these conditions, whereas in Beira Interior this percentage increases to 85.4%.

Conclusions

This study provides a general overview about the health profile of Portuguese centenarians in two types of communities: one rural and with low population density, and another in an urban context. Our findings raise important differences between centenarians from the two samples, which reinforce the heterogeneity of this population, and the importance of environmental factors in how such an advanced age was achieved. Findings highlight the need for potentially distinctive health promotion initiatives in these two settings.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT) [PhD Grant for the first author - SFRH/BD/101595/2014]. The PT100 Oporto Centenarian Study was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – C/SAU/UI0688/2011 and C/SAU/UI0688/2014).

References

1. National Statistical Institute of Portugal, (INE). Censos - Resultados definitivos. Região Norte – 2011. Lisboa: Instituto Nacional de Estatística; 2012.

2. National Statistical Institute of Portugal (INE). Projeções de População Residente 2015–2080. Lisboa: Instituto Nacional de Estatística; 2017.

Keywords

Centenarians, Health, Functionality, Diseases, Portugal, Morbidity.

O35 Implementation of an educational program to promote functionality in medical wards: quasi-experimental study

João Tavares^1,2, Joana Grácio³, Lisa Nunes³

¹Nursing School of Coimbra, Coimbra, 3046-851, Portugal; ²Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329, Portugal; ³Coimbra Hospital and Universitary Centre, 3000-075 Coimbra, 3000-075, Portugal

Correspondence: João Tavares (enf.joaotavares@hotmail.com)

Background

Functional decline, diminished performance in at least one activity of daily living, is often of 30 to 60% among hospitalized older adults (OA) [1]. Quality nursing care is essential to prevent functional decline. A “new” theoretically based philosophy of care has been proposed: the Function Focused Care (FFC), which is geared toward optimization of function and physical activity during all personal/care related activities that occur throughout the hospital stay [2]. The FFC has demonstrated better outcomes at discharge and post-acute periods.

Objective

To evaluate the effect of an educational program for nurses in promoting the FFC among hospitalized OA.

Methods

This is a prospective quasi-experimental study developed in four internal medical units. These units were randomly selected in two units for case (intervention) and two for control. Participants were 117 OA and 94 registered nurses (RN). Intervention consisted in the development and implementation of an educational program about FFC to RN, lasting 10 hours, and a maintenance program, during 5 months. Further details about the program can be found in Tavares et al [3]. Implementation of FFC activities by RN was assessed through the FFC Behaviour Checklist, which was completed by the researchers through non-participant observation [4]. The measures for patients were the functional decline (DF) assessed by the Katz Index: difference between baseline and discharge (t0), discharge and follow-up of 3 months (t1) and baseline and follow-up (t2). For comparison of the case and control groups, an independent t-test was calculated.

Results

The patient’s sociodemographic and clinical characteristics showed no statistical differences between groups. The provision of FFC mean was 0.46 ± 0.22, indicating that RN promoted only 46% of total possible FFC activities. Significant statistical differences were found between case and control group (t(91)= -2.85; p= 0.01), with means of 0.52 ± 0.24 and 0.39 ± 0.19, respectively. No statistical difference was found between the promotion of FFC and the functional decline at t0 (U = 30.5, p = 0.15), t1 (t(38.82) = 6.293; p< 0.15) or t2 (t(83) = 2.49, p = 0.44).

Conclusions

Promotion of functionality is very low, which could be explained by the lack of impact in FD prevention. However, in the case group, more FFC activities were developed. These results suggest a positive impact of the educational program in OA care. The FFC can be seen as a challenge and opportunity for change, innovation, and creativity, in order to improve the effectiveness, efficiency, and quality of care of hospitalized OA.

References

1. Hoogerduijn JG, Schuurmans MJ, Duijnstee MSH, De Rooij SE, Grypdonck MFH. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs. 2007;16(1):46-57.

2. Burket TL, Hippensteel D, Penrod J, Resnick B. Pilot testing of the function focused care intervention on an acute care trauma unit. Geriatr Nurs. 2013;34(3):241-246.

3. Grácio J, Tavares JP de A, Nunes L, Silva R. Programa educacional para enfermeiros: eficácia de duas estratégias formativas. In: XI Congresso Internacional Galego-Português de Psicopedagogia, 2017; Braga: Universidade do Minho. Instituto de Educação. Centro de Investigação em Educação Universidade Minho, 2017; 540-541.

4. Tavares JP de A, Grácio J, Nunes L. Functional Focused care: content validity of Functional Focused Care Behavior Checklist. Eur Geriatr Med. 2016;7(supplement 1):S1-S282.

Keywords

Function focused care, Older adults, Hospitalization functionality, Educational program.

O36 Self-reported data and its relation to the standard and validated measures to predict falls

Anabela C Martins, Catarina Silva, Juliana Moreira, Nuno Tavares

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3026-854 Coimbra, Portugal

Correspondence: Anabela C Martins (anabelamartins@estescoimbra.pt)

Background

According to National Institute for Health and Care Excellence quality standards, the assessment of fall risk and preventing falls should be multifactorial and include self-reported questions like fall history, fear of falling (FoF), self-perception of functional ability, environment hazards, gait pattern, balance, mobility and muscle strength [1]. Concerning the self-reported data, some studies described subjectivity and difficulty in extracting reliable information when using such methods. History and number of previous falls are often used as golden standard in fall risk assessment studies [2]; however, these questions are source of misjudgement, in part, due to difficulty for an older person remember exactly how many times he/she had fallen in a past period of time.

Objective

The study aimed to compare self-reported questions and standard and validated measures for screening risk of fall to verify the confidence of the self-reported data.

Methods

506 community-dwelling adults aged 50+ years old (mean age 69.56 ± 10.29 years old; 71.7% female) were surveyed regarding demographics, history of fall, FoF, sedentary lifestyle, use of upper-extremities to stand up from a chair, by self-reported questionnaire; analysis of gait, balance and muscle strength, by standard and validated measures for screening risk of fall - 10 meters walking speed test [3], Timed Up & Go test [4] and 30 second sit to stand test [4], respectively. Independent samples t tests were performed to compare groups.

Results

33.2% of the sample reported at least one fall in the last year (fallers), 50% reported FoF, 46.4% sedentary lifestyle, 31.8% needed their upper extremities assistance to stand from a chair. Fallers demonstrated lower scores of gait velocity (p < 0.001), lower extremities strength (p < 0.001) and balance (p = 0.034) compared with non-fallers; who reported sedentary lifestyle also showed lower scores of gait velocity (p < 0.001), lower extremities strength (p = 0.001) and balance (p < 0.001) compared with non-sedentary. Simultaneously, who assumed FoF showed lower scores of gait velocity (p < 0.001), lower extremities strength (p < 0.001) and balance (p < 0.001) compared with who had no FoF. Finally, those who use the upper-extremities to stand up from a chair showed lower scores of gait velocity (p < 0.001), lower extremities strength (p < 0.001) and balance (p < 0.001) compared with those who do not.

Conclusions

The findings suggest that self-reported data like history of falls, sedentary lifestyle, FoF and use of upper extremities to stand up from a chair, obtained by simple questions, have emerged as reliable information on risk factors for falling and can be used to complete the fall risk screening.

Acknowledgements

Authors would like to thank all participants and centres, clinics and other entities hosting the screenings. Financial support from project FallSensing: Technological solution for fall risk screening and falls prevention (POCI-01-0247-FEDER-003464), co-funded by Portugal 2020, framed under the COMPETE 2020 (Operational Programme Competitiveness and Internationalization) and European Regional Development Fund (ERDF) from European Union (EU).

References

1. NICE, Nacional Institute for Health and Care Excellence. Falls in older people: assessing risk and prevention. Clinical Guideline, 2013 Available at: nice.org.uk/guidance/cg161 (faltam dados à referência)

2. Garcia AG, Dias JMDD, Silva SLA, Dias RC. Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: a study of comparison and agreement. Braz J Phys Ther. 2015; 19(3).

3. Fritz S & Lusardi M. White paper: “walking speed: the sixth vital sign”. J Geriatr Phys Ther. 2009; 32(2): 2-5.

4. Stevens JA. The STEADI tool kit: a fall prevention resource for health care providers. IHS Prim Care Provid. 2016, 39: 162-6.

Keywords

Self-reported data, Fall Risk Assessment, Community dwelling adults.

O37 Life after falling: which factors better explain participation in community dwelling adults?

Juliana Moreira, Catarina Silva, Anabela C Martins

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3026-854 Coimbra, Portugal

Correspondence: Juliana Moreira (juliana.moreira@estescoimbra.pt)

Background

Participation is defined by World Health Organization (WHO), as the person’s involvement in a life situation [1]. There are few studies exploring the association between participation restriction and being older, exhibiting more depressive moods, poor mobility, and a lack of balance confidence [2,3].

Objective

The objective of this study was to identify which factors, namely, age, functional capacity and self-efficacy for exercise have the best association with participation.

Methods

A sample of 168 community-dwelling adults (age ≥50 years), mean age 70.45 ± 10.40 years old (78.6% female), with history of at least one fall in the previous year, participated in the study. Measures included demographic variables, functional capacity, assessed by six functional tests: Grip strength, Timed Up and Go (TUG), 30 seconds Sit-to-Stand, Step test, 4 Stage Balance “modified” and 10 meters Walking Speed and two questionnaires (Self-efficacy for exercise and Activities and Participation Profile related to Mobility - PAPM). Descriptive and correlational statistics were performed to analyse data.

Results

Fifty-nine percent of participants presented restrictions in participation (34.8% mild restrictions, 17.4% moderate restrictions and 6.8% severe restrictions). Participation showed a strong correlation with 10 meters walking speed (r = -0.572) and TUG (r = 0.620) for a significance level p < 0.001. A moderate correlation was found between participation and 30 seconds Sit-to-Stand (r = -0.478), Step test (r = -0.436), Grip strength (r = -0.397), 4 Stage Balance test “modified” (r = -0.334), as well as, Self-efficacy for exercise (r = -0.401) and age (r = 0.330), for a significance level p < 0.001.

Conclusions

This study suggests that participation of individuals with history of fall is associated with functional capacity, self-efficacy for exercise and age. Previous studies have showed comparable findings [4,5,6], however, admitting the strong association between participation and 10 meters Walking Speed and TUG, it is essential to include these instruments in a comprehensive evaluation of the individuals who have suffered a fall in the past year to predict participation restrictions. The performance assessed, in few minutes, by these tests, will gather information about balance and mobility impairments, that associated with a quick assess of Self-efficacy for exercise [7] will outline the quality of life of persons with history of falls.

Acknowledgements

Authors would like to thank all participants and centres, clinics and other entities hosting the screenings. Financial support from project FallSensing: Technological solution for fall risk screening and falls prevention (POCI-01-0247-FEDER-003464), co-funded by Portugal 2020, framed under the COMPETE 2020 (Operational Programme Competitiveness and Internationalization) and European Regional Development Fund (ERDF) from European Union (EU).

References

1. WHO, World Health Organization. International Classification of Functioning, Disability, and Health. Geneva: Classification, Assessment, Surveys and Terminology Team, 2001

2. Liu J. The severity and associated factors of participation restriction among community dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF). BMC Geriatrics, 2017, 17:43.

3. Desrosiers J, Robichaud L , Demers L, Ge’linas I, Noreau L, Durand D. Comparison and correlates of participation in older adults without disabilities. Archives of Gerontology and Geriatrics, 2009, 49: 397–403.

4. Anaby D, Miller WC, Eng JJ, Jarus T, Noreau L, Group PR. Can personal and environmental factors explain participation of older adults? Disability and Rehabilitation, 2009;31(15):1275–82.

5. Rubio E, Lázaro A, Sánchez-Sánchez A. Social participation and independence in activities of daily living: across sectional study. BMC Geriatrics, 2009, 9:26.

6. Tomioka K, Kurumatani N, Hosoi H. Social Participation and the Prevention of Decline in Effectance among Community-Dwelling Elderly: A Population-Based Cohort Study. PLoS ONE, 2015, 10(9).

7. Martins AC, Silva C, Moreira J, Rocha C, Gonçalves A. Escala de Autoeficácia para o Exercício: validação para a população portuguesa. Conversas de Psicologia e do Envelhecimento Ativo, 2017, 126-141

Keywords

Participation, Community-dwelling adults, Falls, Functional capacity, Self-efficacy for exercise.

O38 History of fall and social participation profile among community dwelling older adults: is there any relation with frailty phenotype?

Mónica Calha, Anabela C Martins

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3026-854 Coimbra, Portugal

Correspondence: Mónica Calha (monicacalha@gmail.com)

Background

Ageing population is a worldwide phenomenon. The number of older frail people increases rapidly, which leads to a substantial impact on the economic, social and health systems. Cardiovascular Health Study data [1] estimated that, in a population with 65 years or more, 6.3% of aged adults have the frailty phenotype. According to Fried et al., frailty is a vulnerable condition characterized by the decline of biological reserves [2,3]. This happens due to deregulation of multiple physiological systems, which puts the individuals at risk by reducing the organism resistance to stressful factors, with a subsequent loss of functional homeostasis. One of the most significant aspects described in the literature is the fact that frailty is an important risk factor for falls. It is estimated that one in every three adults over 65 years fall each year. The frailty syndrome also compromises the social participation of aged adults.

Objective

To understand if adults with 65 years or over with frailty phenotype have history of falls in the period of the previous 12 months prior to the study and worst social participation, when compared to the ones who don't have this phenotype.

Methods

A sample of 122 community-dwelling adults (age ≥65 years), mean age 72.22 ± 6.44 years old (63.9% female), with history of at least one fall in the previous year participated in this cross-sectional study. Data were collected by a demographic, clinical and history of falls questionnaire, functional tests and the Activities and Participation Profile related to Mobility (PAPM).

Results

We verified that there are statistically significant differences in the history of falls between no-frailty (n = 24; mean number of falls = 1.92) and frailty/pre-frailty (n = 31; mean number of falls = 3.06) individuals (p = 0.036), as well as in the social participation score of both groups, with worse profile among the frailty/pre-frailty (0.821), when compared to no-frailty (0.276) (p = 0.000).

Conclusions

Adults with 65 years or over who present frailty or pre-frailty phenotype, when compared to no-frailty ones, have higher rate of falls in the previous 12 months and more restrictions in social participation. Physiotherapists benefit from this knowledge to understand needs of this population and to plan interventions focus on prevention of falls and strategies to promote participation as promising outcomes.

References

1 Etman, A., Burdorf, A., Van der Cammen, T.J.M., Mackenbach, J.P., Van Lenthe, F.J. (2012). Socio-demographic determinants of worsening in frailty among community-dwelling older people in 11 European countries. Journal of Epidemiology and Community Health; 66(12):1116-1121.

2 Eyigor, S., Kutsal, Y.G., Duran, E., et al. (2015). Frailty prevalence and related factors in the older adult - FrailTURK Project. American Aging Association; 37(3):1-13.

3 Tarazona-Santabalbina, F.J., Gómez-Cabrera, M.C., Pérez-Ros, P., et al. (2016). A Multicomponent Exercise Intervention that Reverses Frailty and Improves Cognition, Emotion, and Social Networking in the Community-Dwelling Frail Elderly: A Randomized Clinical Trial. Journal of the American Medical Directors Association; 17(5):426-433.

Keywords

Community dwelling adults, Frailty phenotype, Risk of falls, Social participation.

O39 Sexual assistance through the eyes of sex workers: one path to improve sexual lives of people with disabilities

Ana R Pinho¹, Fernando A Pocahy², Conceição Nogueira¹

¹Center for Psychology, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; ²Universidade do Estado do Rio de Janeiro, 20550900 Rio de Janeiro, Brazil

Correspondence: Ana R Pinho (mipsi20699@fpce.up.pt)

Background

Historically, people with disabilities have been seen as asexual and their sexual rights were often neglected. Nowadays, some progresses have been made but they still face multiple stereotypes and barriers that limit their social and sexual lives. Sexual assistance is a way of sexual expression in which trained individuals provide sexual services to clients with disabilities, improving their well-being in relation to sexuality. However, in Portugal the only way to access commercial sex is through sex workers who have no training to attend disabled clients.

Objective

To understand if sex workers see training as a useful aspect to be taken into account for improving psychological and sexual health of clients with disabilities and themselves.

Methods

An explorative study of qualitative approach, with 13 sex workers interviews analysed using the thematic analysis method proposed by Braun and Clarke (2006) [1].

Results

From the analysis of the interviews four themes have emerged. Sex workers theme focus on the life experiences and motivations to attend clients with disabilities. Clients theme characterizes who are the people with disabilities seeking commercial sex. Search for sex work theme deepens knowledge about how they get in touch with sex workers. Finally, the attendance theme explains the dynamics of the relationship established and the many obstacles they overcome in order to express their sexuality through commercial sex.

Conclusions

The main conclusions provide evidence of the use of commercial sex by people with disabilities who seek in this service sexual and emotional satisfaction. Certain relationship specificities tend to be experienced with feelings of embarrassment on the part of professionals. Based on the experiences and obstacles sex workers observed when working with people with disabilities, measures were pointed out to improve the psychological and sexual health of those involved in the situation, which highlights the need for training to serve this group of clients, as well as the need for legalization of sex work.

References

1. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3: 77-101.

Keywords

Sexual health, Sexual Assistance, Sex Work, Clients with Disabilities.

O40 Results of an intervention program for men who batter women: perceptions of accompanied men

Anne CLG Silva, Elza B Coelho

Department of Public Health, Federal University of Santa Catarina, 88040-900 Florianópolis, Santa Catarina, Brazil

Correspondence: Anne CLG Silva (anne_clg@hotmail.com)

Background

In intimate partner violence, man is the main perpetrator of violence, and it is essential to include him in interventions to decrease violence, because he can take responsibility for violence, seeking new forms of expression. However, intervention with men is criticized, such as: using resources that could be targeted to victims; the imposition of re-education measures rather than punitive measures; consider that men do not change their behaviour [1]. Nevertheless, it is within the framework of evaluation that we find one of the major shortcomings of batterer intervention programs, since the effects of participation of men in that, have been receiving little analysis [2].

Objective

This research aims to analyse the results of a batterer intervention program from the perspective of man accompanied by the program.

Methods

It is a case study conducted in a batterer intervention program with 86 men. It was used the Centres for Disease Control and Prevention Follow Up Questionnaire, adapted to be used in Brazil. Data were analysed according to content analysis techniques. This project was approved by the Human Research Ethics Committee of the Infantile Hospital Joana de Gusmão. Subjects were asked to agree through an informed consent.

Results

When asked about changes occurred after 3 months of follow-up in the program some men reported having not noticed any changes, which indicates that the program is not effective to all participants and the importance of longer follow-ups. However, most men cited changes in the way they act and perceive the division of tasks between men and women, thus participation in the program can be the starting point for rethinking and building new ways of expressing masculinity. And the changes cited go beyond the scope of the marital relationship, encompassing the relationship with the children, the abandonment of addictions and the desire to seek school education.

Conclusions

According to the data, attention to perpetrators of violence has a positive influence not only in the behaviour towards the partner, but also on the relationship with children and the abandonment of addictions. Although longer follow-ups - including the couple - are needed, the batterer intervention program may be a tool to decrease violence against women.

References

1. Antezana AP. Intervenção com Homens que Praticam violência contra seus cônjuges: reformulações teórico-conceituais para uma proposta de intervenção construtivista-narrativista com perspectiva de gênero. Nova Perspectiva sistêmica, 2012; 42:9-27.

2. Toneli MJF; Lago MCS; Beiras A; Climaco DA, organizadores. Atendimento a homens autores de violência contra as mulheres: experiências latino-americanas. Florianópolis: UFSC/CFH/NUPPE; 2010.

Keywords

Violence against women, Batterer intervention, Men, Program evaluation.

O41 Effectiveness of a reminiscence program on cognitive frailty, quality of life and depressive symptomatology in the elderly attending day-care centres

Isabel Gil¹, Paulo Costa², Elzbieta Bobrowicz-Campos², Rosa Silva³, Maria L Almeida¹, João Apóstolo⁴

¹Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046- 851 Coimbra, Portugal; ³Universidade Católica Portuguesa, Institute of Health Sciences, 4200-374 Porto, Portugal; ⁴Health Sciences Research Unit: Nursing, Portugal Center for Evidence-Based Practice: A JBI Centre of Excellence, 3046-851 Coimbra, Portugal

Correspondence: Isabel Gil (igil@esenfc.pt)

Background

Reminiscence is a therapeutic intervention based on the account of personal experiences that allows access to significant life events. Evidence suggests that this intervention is particularly beneficial for the elderly with neurocognitive disorders [1], especially with regard to psychosocial variables. In Portugal, this intervention is underused, and there is a need to study its applicability and efficacy.

Objective

To evaluate the effect of a reminiscence-based program (RBP) [2] on cognitive frailty, quality of life and depressive symptomatology in elderly people attending day-care centres. Evaluate professional's satisfaction with the program and identify obstacles in its implementation.

Methods

A quasi-experimental study with one group was carried out in four day-care centres in the central region of Portugal. The framing sample included 69 older adults aged ≥ 65 years. Of those, 28 (average age of 79.33 ± 7.35 years and average education of 3.29 ± 1.86 years) participated in the 7-week RBP, twice a week. Outcomes of interest were cognitive frailty indicators measured through the Montreal Cognitive Assessment (MoCA); quality of life measured using the short version of World Health Organization Quality of Life Scale-module for older adults (WHOQOL-OLD-8); and depressive symptomatology measured by the 10-item Geriatric Depression Scale (GDS-10). In addition, the eight professionals conducting the study were asked to identify obstacles to the successful implementation of the program, and to evaluate its structure, themes, contents, and the involvement of the elderly in each session.

Results

RBP was shown to have positive effects on the MoCA and WHOQOL-OLD-8 score (p < 0.05). Improvement in the GDS-10 score was observed; however, it was statistically non-significant. The structure of the program sessions was considered as mostly clear and perceptible (94%), and themes and contents as mostly pleasant and appropriate (94%). Positive feedback was obtained regarding the program capacity to involve the elderly in the activities proposed (87.5%). However, according to the professionals’ opinion, there is a need for ampler capacitation of the teams implementing RBP, better articulation with the institutions regarding the used space and activities schedule, and better articulation with the elderly to guarantee their commitment to the program.

Conclusions

Reminiscence was shown to be effective in improving cognition and quality of life, as well as potentially effective in decreasing depressive symptomatology. Therefore, it presents a therapeutic potential, contributing to the improvement of the care provided. It is also worth mentioning the good acceptance of the program which, however, implies the qualification of the professional teams for its implementation.

Acknowledgements

This study was developed within the context of the project “664367/FOCUS” (funded under the European Union’s Health Programme (2014-2020)) and project ECOG (funded by the Nursing School of Coimbra).

References

1. Thorgrimsen L, Schweitzer P, Orrell M. Evaluating reminiscence for people with dementia: a pilot study. The Arts in Psychotherapy. 2002;29(2):93-97.

2. Gil I, Costa P, Bobrowicz-Campos E, Cardoso D, Almeida M, Apóstolo J. Reminiscence therapy: development of a program for institutionalized older people with cognitive impairment. Revista de Enfermagem Referência. 2017;4(15):121-132.

Keywords

Reminiscence, Elderly, Cognition, Quality of life, Depressive symptomatology.

O42 Development and validation of a reminiscence group therapy program for older adults with cognitive decline in institutional settings

Isabel Gil¹, Paulo Costa², Elzbieta Bobrowicz-Campos², Rosa Silva³, Daniela Cardoso⁴, Maria Almeida¹, João Apóstolo⁴

¹Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046- 851 Coimbra, Portugal; ³Universidade Católica Portuguesa, Institute of Health Sciences, 4200-374 Porto, Portugal; ⁴Health Sciences Research Unit: Nursing, Portugal Center for Evidence-Based Practice: A JBI Centre of Excellence, 3046-851 Coimbra, Portugal

Correspondence: Isabel Gil (igil@esenfc.pt)

Background

Research has evidenced the positive impact of non-pharmacological therapies aimed at elderly people with cognitive decline in the institutional setting. Reminiscence Therapy (RT) emerges in this category as an enabling strategy, which favours moments of happiness, dignity and life purpose [1]. Nonetheless, studies centred in RT are limited in Portugal, with a clear absence of structured interventional programs, emerging the need to develop and validate well-defined and replicable RT programs [2].

Objective

We intend to construct and validate a RT program directed to elderly people with cognitive decline, to be implemented in institutional settings by healthcare professionals.

Methods

Guidelines for complex interventions development from the Medical Research Council were followed [3]. The program was conceptualized in four distinct phases: Phase I (Preliminary), the initial conceptualization of the program design and supportive materials; Phase II (Modelling), consisting in the conduction of interviews and focus groups with healthcare specialists; Phase III (Field Test), aiming at the evaluation of each program session; and Phase IV (Consensus Conference), to synthesize the contributions and analyse challenges that emerged in preceding phases.

Results

Based on the contributions of experts, healthcare professionals and the institutionalized elderly, a RT program divided into two strands was formed. The main strand includes 14 sessions, performed twice a week. The maintenance strand included seven weekly sessions. Each thematic session is related to the participants' life course, with a maximum duration of 60 minutes. The 4-phase conceptualization process resulted in the creation of a digital platform with audio-visual contents to aid professionals during each session; inclusion of an introductory section that contextualizes the therapeutic potential of RT; introduction of complementary activities that can be developed additionally in the institutional settings; reinforcement of multisensory stimulation throughout the program; introduction of a final moment of relaxation through abdominal breathing. The terminology used and visual presentation of the program were reformulated in order to improve user experience. The created program was considered by the elderly and healthcare professionals involved during the course of this process as pleasant and interesting, praising its structure, thematic contents and proposed activities.

Conclusions

The involvement of experts and potential users enabled the program to mirror the needs of the elderly with cognitive decline in an institutional setting. The RT program, structured and validated in the course of this study, demonstrated characteristics adjusted to the target population and setting. However, the effectiveness of the program should be tested in a future pilot study.

Acknowledgements

This study was developed within the context of the project ECOG, funded by the Nursing School of Coimbra.

References

1. Subramaniam P, Woods B. The impact of individual reminiscence therapy for people with dementia: systematic review. Expert Review of Neurotherapeutics. 2012;12(5):545-555.

2. Berg A, Sadowski K, Beyrodt M, Hanns S, Zimmermann M, Langer G et al. Snoezelen, structured reminiscence therapy and 10-minutes activation in long term care residents with dementia (WISDE): study protocol of a cluster randomized controlled trial. BMC Geriatrics. 2010;10(1).

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.

Keywords

Cognitive dysfunction, Aged, Program development, Reminiscence therapy.

O43 Short-term efficacy of a nursing psychotherapeutic intervention for anxiety on adult psychiatric outpatients: a randomised controlled trial

Francisco Sampaio^1,2,3, Odete Araújo^3,4, Carlos Sequeira^2,4, Teresa L Canut⁵, Teresa Martins^2,4

¹Psychiatry Department, Hospital of Braga, 4710-243 Braga, Portugal; ²Nursing School of Porto, 4200-072 Porto, Portugal; ³Center for Health Technology and Services Research, 4200-450 Porto, Portugal; ⁴School of Nursing, University of Minho, 4710-057 Braga, Portugal; ⁵Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, Barcelona University, 08907 Barcelona, Spain

Correspondence: Francisco Sampaio (fmcsampaio@gmail.com)

Background

Several efficacious treatments for anxiety are available, among which different forms of psychotherapy and pharmacotherapy [1]. However, literature favour more findings stemming from studies about the efficacy of psychotherapies/therapies provided by nurses [2,3] than those arising from studies about the efficacy of nursing psychotherapeutic interventions (interventions classified, for instance, on Nursing Interventions Classification) [4]. Moreover, no studies were found in literature about the efficacy of psychotherapeutic interventions on anxiety as a symptom.

Objectives

Evaluating the short-term efficacy of a psychotherapeutic intervention in nursing on Portuguese adult psychiatric outpatients with the nursing diagnosis “anxiety”.

Methods

A single-blind randomised controlled trial was conducted at a Psychiatry Ward Outpatient Service of a Hospital in the north of Portugal. Participants were psychiatric outpatients, aged 18-64, with nursing diagnosis “anxiety”, who were randomly allocated to an intervention group (n = 29) or a treatment-as-usual control group (n = 31). The interventions consisted in psychotherapeutic interventions for the nursing diagnosis “anxiety”, integrated in the Nursing Interventions Classification. One mental health nurse provided the individual-based intervention over a 5-week period (one 45-60 minutes weekly session). A treatment-as-usual control group received only pharmacotherapy (if applicable). The primary outcomes, anxiety level and anxiety self-control, were assessed with the outcomes “Anxiety level” and “Anxiety self-control”, integrated in the Nursing Outcomes Classification (Portuguese version) [5] respectively. Time frames for assessment were at baseline and post-test (6 weeks after).

Results

Patients from both groups presented improvements in anxiety levels, between the pre-test and the post-test assessment; however, analysis of means showed that patients of the intervention group presented significantly better results than those of the control group. Furthermore, only patients in the intervention group presented significant improvements in anxiety self- control. The psychotherapeutic intervention presented a very large effect size on the anxiety level and a huge effect size on the anxiety self-control. 22.8% and 40% of the outcomes related to the anxiety level and anxiety self-control, respectively, are predicted in the event of integrating the intervention group.

Conclusions

This study demonstrated the psychotherapeutic intervention model in nursing was efficacious in the decrease of anxiety level and improvement of anxiety self-control in a group of Portuguese adult psychiatric outpatients with pathological anxiety, immediately after the intervention. The results of the multiple linear regression and the very large effect size identified suggest that a significant part of the improvements could be directly attributed to the intervention.

Trial Registration Number

NCT02930473

References

1. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. 2013, 12: 137-148.

2. Asl NH, Barahmand U. Effectiveness of mindfulness-based cognitive therapy for comorbid depression in drug-dependent males. Arch Psychiatr Nurs. 2014, 28: 314- 318.

3. Hyun M, Chung HC, De Gagne JC, Kang HS. The effects of cognitive-behavioral therapy on depression, anger, and self-control for Korean soldiers. J Psychosoc Nurs Ment Health Serv. 2014, 52: 22-28.

4. Bulechek GM, Butcher HK, Dochterman JM, Wagner C. Nursing Interventions Classification (NIC). 6th ed. St. Louis: Elsevier; 2012.

5. Moorhead S, Johnson M, Maas ML, Swanson E. Nursing Outcomes Classification (NOC). 5th ed. St. Louis: Elsevier; 2013.

Keywords

Anxiety, Clinical nursing research, Nursing, Psychiatric nursing, Psychotherapy, Brief.

O44 “Art therapy” in acute psychiatry: a Portuguese case study

Clara Campos¹, Aida Bessa¹, Goreti Neves¹, Isabel Marques², Carlos Laranjeira³

¹Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal; ³Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal

Correspondence: Clara Campos (ccalmeidacampos@gmail.com)

Background

In the last few years, some researchers have focused on the valorisation of interventions that stimulate the use of art therapy in individuals with mental illness. This assessment is based on the assumption that biological programs (including psycho pharmaceuticals) should be increasingly inclusive, and therefore should include psychosocial approaches based on the recovery model. However, there is as yet no effective consensus on techniques and interventions that reveal greater effectiveness as well as systematization.

Objectives

a) Evaluate the effectiveness of a program of 3 sessions of “art therapy” in individuals with mental illness, in the change of emotional indicators, namely depression, anxiety, stress, and psychological well-being; b) analyse the meanings attributed by the person to his creative self-expression.

Methods

We chose a pre-experimental study, of mixed approach (quantitative and qualitative), with pre- and post-test design and without control group. Twelve male subjects mostly diagnosed with Schizophrenia and Mood Disorders, who were admitted to an acute psychiatry unit, participated in the study. The instruments used to collect information were: Depression, Anxiety and Stress Scale [DASS-21]; Subjective Well-Being Scale (EBEP-18 items) and a semi-structured interview.

Results

The main results suggest, after the evaluation between the pre- and post-test that there was an improvement in the dimensions anxiety, stress, self-acceptance, life goals and overall psychological well-being. The categories that resulted from the thematic analysis of the interviews (hope for the future, learning to manage difficulties and dealing with difficult emotions) revealed the usefulness of the program in the participant’s recovery process.

Conclusions

The inclusion of this type of psychosocial intervention in specialized clinical practice in Mental Health Nursing allows minimizing the impact of the disease in an organizational culture that should increasingly be oriented towards recovery.

Trial registration

NCT03575442

Keywords

Recovery, Art therapy, Mental Health Nursing.

O45 Nursing care at the postpartum home visit: the couple perspective

Bárbara Pinto¹, Marília Rua², Elsa Melo²

¹Unidade de Cuidados de Saúde Primários Estarreja I, Agrupamento de Centros de Saúde Baixo Vouga, 3860-335 Beduído, Portugal; ²Escola Superior de Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Bárbara Pinto (barbarapinto_41@hotmail.com)

Background

The birth of a child corresponds to a new stage in the family life cycle and implies a process of restructuring, adaptation to physical, psychological, family and social readjustments [1]. This transition predicts a change of roles of all the members of the family and the construction of a new personal, conjugal and familiar identity [2]. From institutions and health professionals, interventions are expected to successfully overcome these challenges. At this stage, the home visit imposes itself as an important intervention in Nursing care. Its accomplishment, by the family nurse, promotes individual and family empowerment and autonomy in healthy parenting.

Objectives

Understanding the couple's perception about nursing practices in the context of home visit postpartum, as a contribution to the transition to parenting.

Methods

The research was based on the phenomenological domain, in a qualitative approach and includes eleven couples experiencing parenthood for the first time, between October 2016 and January 2017, enrolled in the Family Health Unit of Barrinha. Data collection included semi-structured interviews were conducted in order to guarantee the narratives of the experiences and their deeper understanding. The information was analysed according to the technique of content analysis, using WEBQDA software.

Results

This study revealed that the birth of the first child is an event of individual and family development and growth, which implies adaptation to a set of changes and redefinition of roles, built on a day-to-day basis, and in close cooperation between the family and the nursing team. The approach in the home nursing visit was directed to the well-being of the new born and its mother, appearing to the family as a resource, not having the concern to explore the interaction and the reciprocity within the family. We highlight three dimensions: Postpartum home visit, that describes the experiences of the participants about the care operationalized in this visit; Family Nursing, which traces the way they understand the work of the family nurse in this transition and, lastly, the Postpartum parenting, which reports the mother perception about this stage of the life cycle.

Conclusions

The home visit and work philosophy by the family nurse contributed to the positive adaptation to parenthood and to approach the family and added value for improvement of the quality of health care, yet it was not assumed as a reality in the context of caring.

References

1. Walsh F. Processos normativos da família: diversidade e complexidade. 4 ed. Porto Alegre: Artmed; 2016.

2. Martins C, Abreu W, Figueiredo MC. Transição para a parentalidade: A Grounded Theory na construção de uma teoria explicativa de Enfermagem. Investigação qualitativa em saúde. 2017;2(2017):40-49.

Keywords

Family Nurse, Family, Puerperium, Home visit.

O46 Skills of occupational therapy students required for an effective relationship

María Y González-Alonso¹, Valeriana G Blanco¹, Reninka De Koker², Luc Vercruysee²

¹Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; ²Department of Occupational Therapy, University Odisee, 1000 Brussel, Belgium

Correspondence: María Y González-Alonso (mygonzalez@ubu.es)

Background

The acquisition of skills throughout the career facilitates the professional practice and satisfaction of the occupational therapist. In order to give direct attention to a situation of disability or risk, the professional must apply the best evidence-based strategy; and to establish a productive relationship with the client, the professional needs to learn to use interpersonal skills.

Objective

The objective of the study was to analyse how the perception of occupational therapy students changes their personal traits and challenges throughout their careers.

Methods

This is a descriptive, cross-sectional study of an intentional sample consisting of 183 students of occupational therapy. The study is part of the 2016-2017 academic course. An ad hoc questionnaire was prepared based on the collection of personal data and the perception of 29 skills that [1] proposed: The students should value the traits and challenges.

Results

Of the 183 students, 122 were from the first and 61 from the final year, 47.5% from Belgium and 52.5% from Spain. The profile of the sample was 85.8% women; 60.1% live with their family and 85.8% had not done work placements outside their country. Regarding the skills that defined them, the respondents indicated friendly, respectful and loyal, with an average of 22.4 skills. Regarding abilities that they felt they must achieve, they identified patient, firm and assertive with an average of 9.9. The first-year students self-evaluated more positively than those in their final year in respect to the different variables. Significant differences related to the course were only observed in two traits: empathetic and collaborative.

Conclusions

Occupational therapy students, those in both their first and final years, consider that they have a large number of relational skills which enable them to give an appropriate response to the events that occur in therapy. Empathy is the only trait which indicates differences depending on the independent variables studied. for improvement of the quality of health care, yet it was not assumed as a reality in the context of caring.

References

1.Taylor, R.R. The International relationship: Occupational Therapy and the use of self; Philadelphia: F.A. Davis; 2008.

Keywords

Occupational Therapy, Traits, Challenges, Interpersonal Relationships, Attitudes.

O47 Use of performance-enhancing substances in Portuguese gym/fitness users: an exploratory study

Ana S Tavares, Elisabete Carolino

Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal

Correspondence: Ana S Tavares (ana.tavares@estesl.ipl.pt)

Background

The use of performance-enhancing substances (PES) by competitive or recreational sports practitioners is a pertinent and current topic, particularly in the field of public health. People who use gyms come from diverse socio-demographic conditions, where the consumption of this type of substances is not only used for the purpose of improving physical performance, but also to obtain a more muscular physique, especially for men, and leaner, especially for women whose goal is faster weight loss [1]. In Portugal there are practically no studies on the use of PES outside competitive sport, highlighting a study developed in 2012 by the European Health & Fitness Association [2].

Objective

Investigate the prevalence and profile of PES users amongst a sample of Portuguese gym/fitness users.

Methods

Cross-sectional, quantitative and exploratory study, amongst a convenience sample of 453 Portuguese gym/fitness users, recruited, directly on social networks (Facebook) and by institutional email (via gyms). Data were collected via a structured on-line questionnaire. Statistical analysis was performed using SPSS 22.

Results

Among the 453 gym/fitness users (61.3% female; 38.7% male) who participated in the survey, 50 (11.1%) reported PES use (5.4% female; 19.5% male). The mean age of PES users was 34.96 years (Std. Dev. = 10.00). They were married, unemployed and with a low level of education (until 9 years = 41.7%). PES users showed more years of training (4 years) than no PES users. The main sports modalities of the respondents were cardio fitness (57.0%), bodybuilding (56.5%), stretching (27.8%) and localized (27.2%). PES use was suggested mostly by friends (51.9%), peers (30.8%) and by internet (30.8%). The most commonly consumed PES were diuretics (46.0%) and anabolic steroids (44.0%). Thirty percent of PES users reported side effects and the most commonly reported was acne (53.3%), agitation and tremors (40.0%). The main reason for using PES is the improvement of the physical condition (54.0%). Five-point three percent of non-PES users expressed an interest in using PES in the future.

Conclusions

This exploratory survey revealed the use of PES amongst Portuguese gym/fitness users and its increasing importance to investigate the psychosocial factors that may influence PES use in this specific population. Exploring these factors may improve the effectiveness of practical interventions and motivational strategies to reduce PES use among gym/fitness users.

References

1. European Health and Fitness Association. Fitness against doping: Relatório intercalar - principais resultados. Bruxelles; 2011.

2. European Health and Fitness Association. Executive summary of the final report for the Copenhagen Fitness Anti-Doping Conference. Bruxelles; 2012.

Keywords

Performance enhancing substances, Orevalence, Gym/fitness users.

O48 Identification of frailty condition of elderly people in the community

Inês Machado¹, 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: Inês Machado (inessantiago@live.ua.pt)

Background

Frailty is a geriatric syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death [1]. Current research is still under discussion regarding the nature, definition, characteristics and prevalence of frailty. Identify frail older adults (OA) has recently been recognized as an important priority, especially in community-dwelling OA.

Objective

Determine the prevalence of frail OA in a primary care (PC) settings and to assess the concurrent validation of the Portuguese version of Prisma7 (P7) with two other published and validated instruments: Frailty Phenotype (FF) and the Groningen Frailty Indicator (IFG).

Methods

This study was conducted in one PC unit in the north region of Portugal with a convenience sample of 136 OA (≥ 65 years). The questionnaire included: 1) sociodemographic, family and health variables; and 2) the frailty instruments P7, FF and IFG. OA were considered frail: ≥ 3 positive questions out of 7 for P7; ≥3 factors out of 5 for FF; and ≥ 4 dimensions out of 8 for IFG. Further details about these scales can be found in Machado. For the concurrent validity, methods based on correlation (Spearman Rank test) and agreement (Cohen's Kappa, sensitivity and specificity values) were used. For comparison of the two groups (frailty or non-frailty), an independent t-test was calculated. Finally, binary logistic regression model was considered to identify predictors of frailty.

Results

According to the characterization of P7, IFG and FF, the prevalence of frail OA was 7.4%, 19.9% and 26.5%, respectively. The agreement percentage between the instruments was moderate ranging from 68% to 77%, observing that the P7 is partially concordant with the other instruments. The P7 showed high specificity values, but low sensitivity values. Frail OA were characterized (p < 0.05) as being older, having worse health perception, lower physical capacity, slower walking velocity, higher IFG scores, and decreased hand grip strength. As predictors of frailty, in the multivariate model, older age (OR = 1.111) and better physical capacity (OR = 0.675) were significant (p < 0.01).

Conclusions

A sample of more robust people and a “synthetic” application of P7 (without explaining the questions) may have influenced the prevalence results presented. More studies are needed in order to further evaluate the psychometric properties of the various tools tested. The P7 should be used with caution in identifying frailty in PC, therefore we suggest the incorporation of another measure of frailty assessment.

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. Morley JE, Vellas B, van Kan GA, et al. Frailty Consensus: A Call to Action. Journal of the American Medical Directors Association. 2013;14(6):392-397.

Keywords

Frailty, Elderly, Instrument, Prisma7.

O49 Use of software in learning difficulties of reading: comparative analysis between digital environment and hybrid environment

Ana Sucena^1,2,3,4, Ana F. Silva^1,2

¹Instituto Politécnico do Porto, 4200-465 Porto, Portugal; ²Centro de Investigação e Intervenção na Leitura, Instituto Politécnico do Porto, 4200-465 Porto, Portugal; ³Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, 4710-057 Braga, Portugal; ⁴Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-465 Porto, Portugal

Correspondence: Ana Sucena (sucena.ana@gmail.com)

Background

The learning difficulties of the letter-sound relations are seen as a risk factor for future difficulties in learning to read [1]. Ideally, the identification of children at risk of failure to learn reading and writing should occur in the last year of pre-school or early in the first year, so that intentional programs can be implemented to promote basic reading skills [2,3,4]. The most promising reading learning support programs combine explicit phonological awareness training with highly structured reading instruction [5,6].

Objective

This study evaluated the impact of two early intervention programs on reading learning difficulties. A program exclusively in virtual environment and a hybrid program, comprising sessions in virtual environment and in real environment.

Methods

Participants were 57 children, attending the first year of schooling, native speakers of European Portuguese, identified as at risk of having learning reading difficulties. The children were divided into three groups: (a) virtual environment intervention - training with Graphogame software, (b) hybrid intervention - training using Graphogame software and real-time sessions of pre-reading and reading skills oriented by a technician from the CiiL team (Center for Research and Intervention in Reading) and (c) absence of intervention beyond that provided for in the regular system of education. The intervention programs were developed in a school context, with the virtual component (Graphogame) developed with daily periodicity, with duration between 10 to 15 minutes. The intervention in real environment was carried out once a week, with activities of 30 to 40 minutes, using materials of a playful character, created specifically for the present study. In both types of sessions, the groups consisted of two to five children. The participants were evaluated at the level of letter-sound relations, phonemic awareness, word reading and pseudo word reading.

Results

Both intervention environments produced significantly more positive effects than those obtained by the control group. Still, the software Portuguese Basis Graphogame is an effective tool, however, with a more positive effect when used in parallel with a face-to-face reading promotion session.

Conclusions

The early intervention in reading difficulties should promote the explicit training of phonemic awareness and letter-sound relations in order for the decoding process to be developed. Although the virtual environment – in this case the software Portuguese Basis Graphogame – is a highly effective tool, ideally, it should be combined with a real-environment intervention to ensure that the child effectively dominates letter-sound relationships and that trains intensively the decoding process.

References

1. Lyytinen H. State-of-Science Review: SR-D12 New Technologies and Interventions for Learning Difficulties: Dyslexia in Finnish as a Case Study. Foresight Mental Capital and Wellbeing Project: The Government Office for Science. London: UK. 2008.

2. Hatcher P, Hulme C, Snowling M. Explicit phoneme training combined with phonic reading instruction helps young children at risk of reading failure. Journal of Child Psychology and Psychiatry, University of York, UK. 2004, 45: R338-358

3. Wimmer H, Mayringer H. Dysfluent reading in the absence of spelling difficulties: A specific disability in regular orthographies. Journal of Educational Psychology. 2002, 94: R272-277

4. Saine N, Lerkkane M, Ahonen T, Tolvanen A, Lyytinen H. Computer-Assisted Remedial Reading Intervention for School Beginners at Risk for Reading Disability. Child Development. 2011, 82: R1013-1028

5. Hatcher P, Hulme C, Ellis A. Ameliorating early reading failure by integrating the teaching of reading and phonological skills: The phonological linkage hypothesis. Child Development. 1994, 65: R41-57

6. Hatcher P, Hulme C, Miles J, Carroll J, Hatcher J, Gibbs S, Smith G, Bowyer-crane C, Snowling M. Efficacy of small group reading intervention for beginning readers with reading-delay: a randomised controlled trial. Journal of Child Psychology and Psychiatry. 2006, 47: 820-827.

Keywords

Graphogame, Reading acquisition, Reading intervention.

O50 Consumption patterns of non-steroidal anti-inflammatory drugs and attitudes towards the medicine residues in north and central regions of Portugal

Andreia Carreira¹, Catarina Valente¹, Joana Tomé¹, Tânia Henriques¹, Fátima Roque^1,2, Márcio Rodrigues^1,2, Maximiano P Ribeiro^1,2, Paula Coutinho^1,2, Sandra Ventura^1,2, Sara Flores^1,2, Cecília Fonseca^1,2, André RTS Araujo^1,2,3

¹School of Health Sciences, Polytechnic Institute of Guarda, 6300-749 Guarda, Portugal; ²Research Unit for Inland Development, Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal; ³LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal

Correspondence: André RTS Araujo (andrearaujo@ipg.pt)

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications in the world because of their analgesic, antipyretic and anti-inflammatory properties [1–3]. However, their use is associated with the occurrence of serious adverse drug events, particularly gastrointestinal, cardiovascular and renal complications [3].

Objective

To assess the NSAIDs consumption pattern by the adult residents in the north and central regions of Portugal, as well as, to evaluate their individual's behaviour concerning the resulting residues after the use of the packages of medicines.

Methods

A questionnaire survey was administered to a sample of 400 pharmacy costumers in the districts of Aveiro, Leiria, Porto and Viseu between December 2015 and February 2016, with questions regarding the knowledge of NSAIDs consumption and their attitudes towards the medicine residues.

Results

In our study, the prevalence rate of NSAIDs use in the last 6 months was 74.3 % (95 % CI 70.0–78.6), showing a high level of consumption of this pharmacotherapeutic group. The most commonly used NSAID was ibuprofen (76.4 %), followed by diclofenac (36.0 %) and nimesulide (8.4 %). The most reported therapeutic indications were headaches (36.4 %), followed by back pain (33.3%), fever (24.6%) and flu (20.5%). Surprisingly, adverse drug events were reported by only 6.7 % of respondents. Even so, the most common adverse drug event was diarrhoea (4.0%). These results could be explained considering that NSAIDs use is episodic and limited to shorter periods and probably the respondents did not correlate the adverse effects of these medicines. Relatively to the destination of the packages of medicines that respondents no longer used, it was verified that 58% of the respondents claimed to deliver them in a pharmacy, 17.3% throw away in the common waste, 24.0% keep them at home, 0.5% put in sanitary sewers and 0.2% donate to charities.

Conclusions

According to these findings, it was evident the trivialization of NSAIDs consumption, being imperative to monitor their use and educate the users for its rational use. On another hand, it is important to maintain the incentive and to educate the population to adopt adequate attitudes regarding medicine residues recycling.

References

1. Cryer B, Barnett MA, Wagner J, Wilcox CM. Overuse and misperceptions of nonsteroidal anti-inflammatory drugs in the United States. Am J Med Sci. 2016, 352(5):472–80.

2. Green M, Norman KE. Knowledge and use of, and attitudes toward, non-steroidal antiinflammatory drugs (NSAIDs) in practice: A survey of ontario physiotherapists. Physiother Canada. 2016, 68(3):230–41.

3. Koffeman AR, Valkhoff VE, Celik S, W’t Jong G, Sturkenboom MCJM, Bindels PJE, et al. High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a populationbased cross-sectional study. Br J Gen Pract. 2014, 64(621):e191-8.

Keywords

Nonsteroidal anti-inflammatory drugs; Consumption patterns; Attitudes; Medicine residues.

O51 Allergic rhinitis characterization in community pharmacy customers of Guarda city

Hélio Guedes¹, Agostinho Cruz², Cecília Fonseca^1,3, André RTS Araujo^1,3,4

¹School of Health Sciences, Polytechnic Institute of Guarda, 6300-749 Guarda, Portugal; ²School of Health Sciences, Polytechnic Institute of Porto, 4200-072, Porto, Portugal; ³Research Unit for Inland Development, Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal; ⁴LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal

Correspondence: André RTS Araujo (andrearaujo@ipg.pt)

Background

Allergic rhinitis (AR) is a hypersensitivity reaction caused when inhaled particles contact the nasal mucosa and induce an immunoglobulin E -mediated inflammatory response resulting in sneezing, nasal itching, rhinorrhoea, nasal obstruction, or a combination of those symptoms [1]. The prevalence of AR is sometimes cited as 10% to 30% in adults [1]. It is increasingly recognized that the symptoms of AR often adversely impact the quality of life of the affected individuals and impose a significant health and socio-economic burden on the individual and society [2].

Objective

The aims of the present research were to estimate the prevalence of AR, determine the predominance of the symptoms, determine the impact on quality of life (QoL), as well as characterize the control strategies and treatment of AR in pharmacy customers of Guarda city.

Methods

An observational, cross-sectional and analytical study was conducted, and a questionnaire survey was developed and used as the data collection instrument. This included the Control of Allergic Rhinitis and Asthma (CARAT) test and the scale Quality of Life of the World Health Organization (WHOQOL-Bref). Data collection took place in community pharmacies in the city of Guarda between May and December of 2014.

Results

In the sample of 804 respondents, there was a predominance of females (66.3%) and the average age was 48.3 ± 16.5 years. The prevalence rate of AR was 13.1% (95 % CI 10.8–15.4). About 40% of the respondents with AR had no medical diagnosis. It was verified that there weren’t differences by gender in terms of quality of life (p = 0.929) or in the control of the AR symptoms (p = 0.168). On another hand, a high level of education (higher education) seemed to be a factor that contributed to a better quality of life (p = 0.001) and to a better control of symptoms (p = 0.019). It was also observed that a better control of the symptoms of AR was associated with a better quality of life (Pearson’s r = 0.292, p = 0.003).

Conclusions

The prevalence rate was estimated between 10.8% and 15.4%, which resulted from the medical diagnosis and the symptomatic diagnosis made through the data collection instrument. The results indicated that although the respondents do not have properly controlled the AR and suffer from associated comorbidities, they have a reasonable quality of life indexes.

References

1. Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol. 2014,4(S2):S18–20.

2. Maspero J, Lee BW, Katelaris CH, Potter PC, Cingi C, Lopatin A, et al. Quality of life and control of allergic rhinitis in patients from regions beyond western Europe and the United States. Clin Exp Allergy 2012, 42(12):1684–96.

Keywords

Allergic rhinitis; Community pharmacy customers; Quality of life.

O52 Weight transfer during walking and functional recovery post-stroke in the first 6 months of recovery – an exploratory study

Marlene Rosa^1,2 (marlene.rosa@ipleiria.pt)

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

Background

One of the most controversial abnormal patterns during walking in patients with stroke occurs during weight transfer (WT) of the paretic lower limb, however no perception of the knee patterns developed during stroke recovery exists.

Objective

To explore the importance of the knee kinematic pattern in the weight transfer (WT) walking period for functional recovery in the first 6 months post-stroke.

Methods

Inpatients with a first ischemic stroke (< 3 months), able to walk, were evaluated (T0) and revaluated 6 months post-stroke (T1). Patients were video-recorded in the sagittal plane while walking at their self-speed and the video was used to classify the knee pattern during WT. Walking speed, self-perceived balance, knee muscle strength and sensory-motor function of the hemiparetic lower limb were also assessed. Participants were stratified according to the knee pattern recovery. Comparisons between and within groups were conducted.

Results

Thirty-two patients (70.28 ± 10.19 years; 25.54 ± 3.26 Kg/m²) were included. Different groups were identified, according to the knee pattern: (1) normal at T0 and T1 (N = 10); (2) normal pattern only at T1 (N = 7); (3) acquisition/change in the knee pattern deviation (N = 7); (4) maintenance of the knee pattern deviation (N = 8). Modifications in the normal knee pattern might be developed to reach acceptable levels of functioning performance (p > 0.05, Groups 1/ 3). Speed and balance recovery was restricted when an abnormal knee pattern in WT was observed (Group 3 and 4), being worst when this pattern persisted (Group 4).

Conclusions

The knee pattern correction in WT might have benefits for stroke recovery. A further understanding of the causes for deviations in the knee pattern in WT will help establishing stroke treatment priorities.

Trial Registration

NCT02746835

Keywords

Weight transfer, Gait, Stroke, Knee patterns.

O53 Reference values of cardiorespiratory fitness field tests for the healthy elderly Portuguese

Patrícia Rebelo^1,2, Ana Oliveira^1,2,3, Alda Marques^1,2

¹Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; ³Faculty of Sports, University of Porto, 4200-450 Porto, Portugal

Correspondence: Patrícia Rebelo (patriciarebelo@ua.pt)

Background

Cardiorespiratory fitness (CRF) is recognized as an independent predictor of all age morbidity and mortality and is closely related with people’s functional capacity [1]. Recently, CRF has been described as a clinical vital sign, which highlights its role in health promotion and disease prevention [2]. The 6-min-walk test (6MWT), incremental shuttle walk test (ISWT), unsupported upper limb exercise test (UULEX) and the 1-min sit-to-stand test (1’STS) are worldwide tests to assess CRF. Reference values of these tests are however, lacking for the Portuguese elderly population. This hinders the interpretability and limits the confidence of clinical decision-making in the field of CRF.

Objective

To contribute for establishing reference values for the 6MWT, ISWT, UULEX and 1’STS in the Portuguese healthy elderly population.

Methods

A cross-sectional study was conducted with healthy elderly volunteers [3] recruited from the Centre region of Portugal. Each participant conducted two repetitions of the 6MWT, ISWT, UULEX and 1-min STS. The best repetition was considered for analysis. Descriptive statistics were used to determine reference values by age decade (61-70; 71-80; 81- 90) and gender. Two-way ANOVA was used to investigate significant effects for age/gender and their interaction. Values were presented as mean ± standard deviation or median [95%, Confidence Intervals].

Results

262 healthy people were enrolled (61.5% female; 75.0±0.5yrs), 125 completed the 6MWT (66.4% female; 75.1±0.7yrs), 83 the ISWT (57.3% female; 76.1±1.0yrs), 210 the UULEX (63.3% female; 75.7±0.6yrs) and 50 the 1’STS (54% female; 72.1±1.0yrs). Values decreased significantly along the decades and were statistically different between male and female (p < 0.05) across all tests. The following values were found for the I) 6MWT (61-70y: males - 519.7[484.7-554.7]m vs. females - 488.3[458.8-517.7]m; 71-80y: 461.0[389.5-532.5]m vs. 377.1[316.4-437.8]m; 81-90y: 294.0[226.5-361.6]m vs. 254.1[211.6-296.6]m); II) ISWT (61-70y: males - 515.0[304.2-725.8]m vs. females - 353.3[212.5-494.2]m; 71-80y: 428.8[299.9-557.6]m vs. 234.6.2[151.6-317.6]m; 81-90y: 131.8[45.3-218.4]m vs. 161.0[113.2-208.8]m); III) UULEX (61-70y: males - 9.6[8.5-10.7]min. vs. females - 8.3[7.4-9.2]min.; 71-80y: 8.5[7.1-9.9]min. vs. 6.6[5.4-7.8]min.; 81-90y: 5.8[4.4-7.1]min. vs. 4.7[3.9-5.9]min.) and IV) 1’STS (61-70y: males - 40.0[33.2-46.8]rep/min vs. females - 37.13[33.65-40.61]rep/min; 71-80y: 30.7[26.4-34.9]rep/min vs. 33.3[26.1-40.4]rep/min; 81-90y: 29.0[9.1-67.1]rep/min vs. 22.3[16.2-28.3]rep/min). Significant interactions between age and gender were only observed in the ISWT.

Conclusions

The population studied presented worse results in the 6MWT, similar results in the ISWT and better results in the 1’STS test comparing with international studies [4-6]. No studies were found for the UULEX test. These differences highlight the importance of using population specific reference values in CRF assessment. Further studies with larger and representative sample sizes are needed to confirm results.

References

1. Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, et al. Impact of cardiorespiratory fitness on all-cause and disease-specific mortality: Advances since 2009. Prog Cardiovasc Dis. 2017; 60(1):11-20.

2. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24)

3. Organization WH. World report on ageing and health: World Health Organization; 2015.

4. Casanova C, Celli B, Barria P, Casas A, Cote C, De Torres J, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. 2011;37(1):150-6.

5. Dourado VZ, Vidotto MC, Guerra RLF. Reference equations for the performance of healthy adults on field walking tests. J Bras Pneumol. 2011;37(5):607-14.

6. Strassmann A, Steurer-Stey C, Dalla Lana K, Zoller M, Turk AJ, Suter P, et al. Population-based reference values for the 1-min sit-to-stand test. Int J Public Health. 2013;58(6):949-53.

Keywords

Cardiorespiratory Fitness, Cardiorespiratory field tests, Reference values, Elderly population.

O54 Prevalence and factors associated with frailty in the elderly attended in ambulatory care

Clóris RB Grden¹, Luciane PA Cabral¹, Carla RB Rodrigues², Péricles M Reche¹, Pollyanna KO Borges¹, Everson A Krum²

¹Departamento de Enfermagem e Saúde Pública, Universidade Estadual de Ponta Grossa, 4748 Ponta Grossa, Paraná; ²Hospital Universitário Regional dos Campos Gerais, Universidade Estadual de Ponta Grossa, 84031-510 Ponta Grossa, Paraná

Correspondence: Clóris RB Grden (reginablanski@hotmail.com)

Background

The aging process, understood as dynamic and progressive, contributes to the reduction of physical reserves and a higher prevalence of pathological processes, predisposing the elderly to frailty [1]. Canadian researchers define frailty as a multifactor syndrome involving biological, physical, cognitive, and social factors [2], which contribute significantly to disability and hospitalization [3]. Considered a modern geriatric syndrome, it is related to physiological changes, diseases, polypharmacy, malnutrition, social isolation and unfavourable economic situation [4, 5].

Objective

The objective of this study was to identify the prevalence and factors associated with frailty in the elderly attended in outpatient care. A cross-sectional study was carried out with 374 elderly individuals in outpatient care between October 2015 and March 2016. Data collection was applied to the Edmonton Fragility Scale [2]. Data were analysed by Stata software version 12 and described by measures of frequency, mean and standard deviation (SD). Prevalence ratios (PR) were calculated to investigate associations between independent variables and frailty. The adjusted prevalence ratios were obtained by multiple Poisson regression analysis. It was started with a saturated model and the variables that were not statistically relevant were removed, since their exclusion did not modify the results of the independent variables that remained in the model. The statistical significance was p < 0.05. The study complied with national and international standards of research ethics involving human subjects and was approved by the Research Ethics Committee in Human Beings of the institution under registration CAAE: 34905214.0.0000.0105.

Results

The results showed a predominance of female (67.4%), married (54.4%), with low educational level (55.1%), who lived with relatives (46.3%). The mean age of participants was 67.9 years. Regarding the clinical variables, 97% of the elderly reported having some type of disease, 92.3% used medication, 56.9% had no urine loss, 4.5% used walking sticks, 65.8% denied falls and 69.8% hospitalization. Regarding the fragility syndrome, the mean score was 5.9 points, with 40.1% elderly classified as fragile and 59.9% non-fragile. After multiple regression analysis, the variables that remained associated with the fragility were gender (p = 0.002), low education (p = 0.01), falls (p = 0.005), urinary incontinence (p = 0.000) (p = 0.001), medications (p = 0.02) and hospitalization (p = 0.001).

Conclusions

The study identified important factors associated with frailty in the elderly attending the outpatient clinic. Such results may support the development of gerontological care plans aimed at preventing functional decline and negative outcomes of the syndrome.

References

1. Maciel GMC, Santos RS, Santos TM, Menezes RMP, Vitor AF, Lira ALBC. Avaliação da fragilidade no idoso pelo enfermeiro: revisão integrativa. R. Enferm. Cent. O. Min. 2016, 6(3):2430-2438.

2. Rolfson D, Majumdar S, Tsuyuki R, Tahir A , Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006, 35(5):526-9.

3. Vermeiren S, Vella-Azzopardi R, Beckwée D, Habbig AK, Scafoglieri A, Jansen B, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc. 2016; 17(12): 1163.e1–1163.e17.

4. Morley JE, Vellas B, Kan GAV, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. JAMDA. 2013, 14(6):392-7.

5. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016, 31:3-10.

Keywords

Aged, Frail Elderly, Prevalence, Geriatric Nursing.

O55 Trend of mortality for acute myocardial infarction in state Santa Catarina, Brazil, for the period from 1996 to 2014

Pedro CM Morais¹, Aline Pinho², Daniel M Medeiros³, Giovanna G Vietta³, Pedro F Simão³, Bárbara O Gama³, Fabiana O Gama³, Paulo F Freitas³, Márcia R Kretzer³

¹Secretaria Municipal de Saúde de Palhoça, 88132-149 Palhoça, Santa Catarina, Brasil; ²Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, 88036-800 Florianópolis, Santa Catarina, Brasil; ³Universidade do Sul de Santa Catarina, Campus Pedra Branca, 88137-270 Palhoça, Santa Catarina, Brasil

Correspondence: Pedro CM Morais (pedromorais182@hotmail.com)

Background

Acute Myocardial Infarction (AMI) is a public health problem in the world and in Brazil, due to the high morbimortality rates observed. Despite major advances in treatment, AMI accounts for 30% of deaths in Brazil.

Objective

To analyse the mortality trend due to acute myocardial infarction in the State of Santa Catarina, from 1996 to 2014.

Methods

Ecological study of time series, based on the Database of the Mortality Information System, made available by the Department of Informatics of SUS (DATASUS). Selected deaths by AMI, ICD-10, code I21, of the resident population in the state, according to gender and age group. Performed simple linear regression. The Research Ethics Committee of the Southern University of Santa Catarina approved this study.

Results

There were 40,204 deaths from AMI between 1996 and 2014 in Santa Catarina, with small oscillations in mortality rates in the period, 40.33/100,000 inhabitants in 1996 and 36.58/100,000 in 2014 (β = -0.062, p = 0.546). There were higher rates in males, but stationary, with 49.41/100,000 inhabitants in 1996 and 45.62/100,00 in 2014 (β = -0.008; p = 0.949). The female sex presented a steady trend, with a rate of 31.19/100,000 inhabitants in 1996 and 27.49 / 100,000 in 2014 (β = -0,113; p = 0.224). The male and female age groups showed a decreasing and significant trend after 30 years. Male age group 60 and older presented high mortality rates, however, declining. It stands out that the male age group from 70 to 79 years of age presented a decrease in rates of -13,936 per year, with a variation from 626.51/100,000 inhabitants in 1996 to 379.21/100,000 inhabitants in 2014 (p > 0.001). In the male age group of 80 years or more the rate was 935.88/100,000 inhabitants in 1996 and 669.99/100,000 in 2014 (β = -12,267; p = 0.004). Female age group 70 and older presented high mortality rates. In the female age group of 70 to 79 years, there was a decrease from 399.60/100,000 inhabitants in 1996 to 193.78/100,000 in 2014 (β = -12,115; p < 0.001). The female age group aged 80 years and over, from 811.78/100,000 inhabitants in 1996, decreased to 497.81/100,000 in 2014 (β = -16,081, p < 0.001).

Conclusions

The trend of AMI mortality in Santa Catarina is stationary for both genres but decreasing significantly in the age groups over 30 years, with the greatest reductions over 70 years.

Keywords

Acute Myocardial Infarction, Mortality rate, Ecological study.

O56 Family nurse intervention in the mental adjustment of patients with arterial hypertension

Ana Alves¹, João Simões¹, Alexandre Rodrigues¹, Pedro Couto²

¹Escola Superior de Saúde da Universidade de Aveiro, 3810-193 Aveiro, Portugal; ²Departamento de Matemática, Universidade de Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Ana Alves (anamargaridamartins@ua.pt)

Background

The increase on life expectancy, and the raise of chronic condition, represents new challenges to the family nurse practitioner. Cardiovascular diseases are the main cause of death among the population, however the numbers have been declining in past years [1]. There is an important economic impact that is a result of the incapacity cause by such diseases, as well as the treatment-related costs. Arterial hypertension has been gaining some relevance, due to its prevalence, and because its epidemiological base studies reveal a lack of control sample. Considering this problematic, a study was conducted, that analyses the mental adjustment of patients with arterial hypertension and the impact of the family nurse practitioner during appointments for hypertension monitoring.

Objective

The objective was to evaluate the impact of the family nurse practitioner on the mental adjustment of patients that suffer from arterial hypertension, registered at the “HTA” program of the Personalised Healthcare Unit of Healthcare Centre of Sever do Vouga.

Methods

A quantitative study was conducted, meeting one of the cycles of the research-action method, since an initial analysis was conducted, followed by the implementation of the intervention, and then carried by a new evaluation. Thus, using the Mental Adjustment to Disease Scale, as an evaluation instrument, regarding mental adjustment, along with a sociodemographic and clinical characterization questionnaire, addressed to the participants. The ethical principles were followed during the entire course of the investigation.

Results

The participants in this study had and average age of 70.8 years, and being mostly females, diagnosed with for 8.4 years. To evaluate the internal consistency of MADS, it was calculated the Cronbach Alpha in moments 1 and 2, obtaining acceptable results, except for the subscale regarding fighting spirit. At moment 1 of the data collection, in the subscale regarding fighting spirit, all participants were classified as “fitted”, however for the remaining subscales, the participants were classified as “fitted” and “Not fitted”. The results obtained at moment 2, have revealed the impact from the conducted intervention, since the participants initially classified as “not fitted”, shifted to “fitted” at the 2nd moment.

Conclusions

Performing a balance of the internship, it can be claimed that the expected competences and objectives were achieved. Ultimately, we can withdraw the conclusion that the intervention developed for the mental adjustment obtained the expected results, since the participants classified as “not fitted” on the 1st moment, were classified as “fitted” during the 2nd assessment moments.

References

1. Trindade, I. D. (2016). Análise Pragmética da Comorbilidade Associada a Doentes com Hipertensão Arterial em Cuidados de Saúde Primários. Revista Portuguesa de Hipertensão E Risco Cardiocascular, 51, 40.

Keywords

Mental adjustment, Nursing Family, Arterial Hypertension.

O57 Family conferences – the two year experience of a palliative care support team (PCST) in a tertiary hospital

Júlia Alves, Joana Mirra, Rita F Soares, Margarida Santos, Isabel Barbedo, Sara Silva, Elga Freire

Equipa Intra-hospitalar de Suporte em Cuidados Paliativos, Departamento de Medicina Interna, Centro Hospitalar do Porto, 4099-001 Porto, Portugal

Correspondence: Júlia Alves (juliasousaalves@gmail.com)

Background

Family conference (FC) is an important work that represents an opportunity to evaluate family dynamics, provide anticipatory care and support feelings related to the loss of a loved one [1]. FC facilitates the communication between healthcare providers, patient and family and allows the discussion of different options and summarize consensus with the ultimate goal of problem solving, decision making and instituting a plan [2].

Objective

Describe the experience of FCs made by a PCST from 1 of January 2015 to 31 of December 2016.

Methods

Raw data from FCs registers was retrieved and a descriptive analysis was performed.

Results

We consulted 809 patients and 431 FCs were held (81% scheduled). In 56 FC the patient was present; when the patient was absent, most cases were due to clinical condition and in a minority the patient chose not to be present. Family members attending FCs were offspring in 67%, spouses in 23%, other relatives in 38% and the parents in 4% of cases. All meetings occurred in the presence of one physician and one nurse from the PCST. FCs were held because of patient discharge (88%), worsening of clinical condition (24%), family needs (59%), discussion of therapeutic goals (38%) and conspiracy of silence (1%). As a consultant team, the PCST is concerned with post-discharge and evaluates the needs of patients at home with the help of an ambulatory healthcare team or primary care team. Therefore, FCs have the objective of preparing families for patient discharge. During FC the main subjects of discussion were post-discharge healthcare referral (94%), objectives of healthcare (84%), clinical information about diagnosis and prognosis (42%), symptom control (47%), management of expectations concerning the illness (73%), nutrition (12%) and family needs (psychological support in 17% and nursing instructions 10%).

Conclusions

There is an increasing number of FC and more are being requested by the referral healthcare team. To facilitate the registry of FC a document was elaborated and soon it will be made a software. This registry will allow an easier analysis and strategy planning to improve interventions and healthcare quality provided.

References

1. Neto I. A conferência familiar como instrumento de apoio à família em cuidados paliativos. Revista Portuguesa de Clínica Geral. Vol.19 (2003), p.68-74.

2. Barbosa A, et al. Manual de Cuidados Paliativos. 2ªed. Lisboa (2010): Núcleo de Cuidados Paliativos, Centro de Bioética, Faculdade de Medicina da Universidade de Lisboa.

Keywords

Palliative care, Family, Health.

O58 Diabetes mellitus and polypharmacy in elderly population: what is the reality?

Claudia Oliveira¹, Helena José^2,3, Alexandre C Caldas¹

¹Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046- 851 Coimbra, Portugal; ³Centro de Formação de Saúde Multiperfil, Luanda, Angola

Correspondence: Claudia Oliveira (claudiajs.oliveira@gmail.com)

Background

Diabetes mellitus is a prevalent disease among the elderly and is listed as one of the leading causes of admissions and readmission [1]. Older people with diabetes represent a challenge, in terms of effective coordination and management in multiple areas. In this sense, older population needs to adhere to a medication regimen, sometimes complex. Polypharmacy is a reality and leads to unnecessary disease progression and complications, reduces functional abilities, increases hospitalizations, reduces the quality of life, increases health costs and even deaths [2]. Management of such phenomenon is extremely hard and requires awareness.

Objective

To identify the clinical profile of the older people with Diabetes mellitus in two Family Health Units in Faro (FHUs Farol and Al-Gharb).

Methods

Observational and descriptive study was performed, with people aged 65 years or above, living in the community and registered at the Health Centre of Faro (FHUs Farol and Al-Gharb). Three hundred and ninety-five patients were interview in terms of their medication regimen. For data collection, a sociodemographic questionnaire, Medication Regimen Complexity Index (MRCI) and chemical parameters (glycated haemoglobin (HbA1C) and capillary glycaemia) were used.

Results

The sample was composed of people aged 65 years and over [75.59 (±6.75)], with a maximum of 93 years (52.9% were women and 47.1% were men). Regarding the MRCI, an average of 15.63 (± 6.84), with a minimum of 5 and a maximum of 32 was found. We verified the existence of a high and statistically significant positive correlation (r = .897; p-value <.001) between the MRCI and the number of drugs prescribed. The study also showed that the increase of the number of drugs prescribed is related to advanced age. For HbA1C, an average of 7.09 (± 1.14), a minimum of 5.3 and a maximum of 12.4 was obtained. It was found that 57.47% of the patients had HbA1C value lower than 7%, 22.78% had values between 7%-7.9% and 19.75% had values higher than 7.9%. In relation to capillary glycaemia, we obtained a mean of 181.13 (± 66.54) with a minimum of 83 and a maximum of 500.

Conclusions

Medication non-adherence and polypharmacy are real problems with negative impact, and potentially fatal. High numbers of medications prescribed are nowadays more common. Unfortunately, the elevated rates of HbA1C and capillary glycaemia values demonstrate that disease management is not effective, so it is urgent to implement programs to help older people self-manage chronic condition.

References

1. Kirkman MS, Briscoe VJ, Clark N et al. Diabetes in Older Adults. Diabetes Care. 2012; 35(12): 2650-64.

2. Masnoon N, Shakib S, Kalisch-Ellet L, Caughey G. What is polypharmacy? A systematic review of definitions BMC Geriatrics. 2017; 17: 230.

Keywords

Medications Adherence, Patients, Aged, Polypharmacy, Diabetes Mellitus.

O59 Nurses' perception of Computerized Information Systems impact on the global nurses’ workload

Paulino Sousa¹, Marisa Bailas²

¹Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal^{; 2}Centro Hospitalar de São João, 4200-319 Porto, Portugal

Correspondence: Paulino Sousa (paulino@esenf.pt)

Background

Portugal has a story of almost two decades of computerized information systems use on health area, particularly in the nursing area, with the large-scale implementation of Computerized Information Systems to support nursing practice. We know that the use of electronic health information to support patient care will undoubtedly be responsible for a substantial time-spent on the overall workload of nurses. Too often, we are confronted with nurses’ opinions that the use of computerized information systems (CIS) has a great impact on the overall nurses’ workload (35 to 50% of the global nurses’ workload).

Objective

To identify the perception of nurses on the time spent on CIS in use in a hospital and his impact on the global nurses’ workload.

Methods

A cross-sectional survey was applied to collect data from 148 nurses that use CIS in a hospital (medical and surgical services). This allowed knowing the average percentage of nurses’ perception time spent on the use of SClinico® and other information supports, as well as their distribution by a set of nursing activities in use of the system.

Results

The results showed that nurses consider that time spent on information supports has an average of 42.4% on their total working time: 33.5% on the use of SClínico® (mode and median of 30%; SD ±16.25) and 8.9 % (mode and median of 5 %; SD ±6.67) on nursing records in other non-computerized structures (particularly on paper). These values are overlapping to those presented in some national and international studies. However, results are higher than the real-time shown in studies of Silva (2001) and Sousa and colleagues (2015). Nurses who underwent training processes on Nursing Information System in use (SClínico®) and on ICNP® have differences in time-spent perception on the use of CIS.

Conclusions

A permanent issue in the debate on the use of CIS is the time spent in its use, in particular in the processes of data access, care planning, and record keeping. Nurses have the perception that the time spent on CIS has, in fact, an essential part of nursing practice, but with a high impact on the workload of nurses. However, there are several national and international studies that point out in certain contexts for a lower “real-time” in the global nurses’ workload on the use of computerized information systems.

Keywords

Computerized Information Systems, Electronic health information, Nursing workload, Time spent.

O60 Pain in people 75 and older: association with activity patterns

Maria C Rocha, José G Sousa, Madalena G Silva

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

Correspondence: Madalena G Silva (madalena.gomesdasilva@gmail.com)

Background

The prevalence of pain amongst the elderly population (19.5% [1] to 52.8%[2]) may not be disregarded and varies depending on the age range and context. Regardless, pain in this population group has been associated with reduced functional capacity, changes in gait and sleep patterns, depression and reduced social participation [3]. Exercise has often been recommended as an intervention to manage pain in the elderly [4], however long-term adherence to exercise programs is limited [5]. Characterization of pain and exploring its associations with light intensity physical activity may provide a base for discussing alternative clinical interventions for the management of pain in this population group.

Objective

To characterize the presence, location and duration of pain in very old adults and investigate its association with light intensity physical activity.

Methods

A cross-sectional study was implemented with 65 participants aged above 75 years, without cognitive impairment, average age of 79.48 ± 4.98. Presence, location and duration of pain were assessed with the socio-demographic and clinical characterization questionnaire. Light intensity activity was characterized with an Activity Diary. Given de non-normal distribution, dichotomic nominal variables were analysed with the biserial point correlation, and Spearmen’s rho was used for the remaining.

Results

Two thirds (61.5%) of our sample was female, with a low educational level (64.6%). Eighty three percent (n = 54) reported experiencing pain, and from these, 45 (83.3%) had pain for more than one year. Pain was mainly localized in the knees (n = 30) and in the lower back (n = 27). Our sample spent an average of 5h46min per day in sedentary behaviour (< 1.5 METs) and 4h47min in physical activity of light intensity (> 1.5 and < 3 METs, Metabolic Equivalents). Physical activity of low intensity showed a non-significant association with the presence of pain (p = 0.622) nor with the duration of pain (p = 0.525).

Conclusions

We conclude that our sample had a very high prevalence of pain for more than one year, and that this is not associated with the time spent in light intensity physical activity. Further studies are required to provide a better understanding of the association of specific types and location of pain and light intensity physical activity, before it can be promoted as a clinical intervention strategy.

References

1. Satghare P, Chong SA, Vaingankar J, Picco L, Abdin E, Chua BY, et al. Prevalence and correlates of pain in people aged 60 years and above in Singapore: Results from the wise study. Pain Res Manag. 2016;2016.

2. Pereira LV, Vasconcelos PP de, Souza LAF, Pereira G de A, Nakatani AYK, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662–9.

3. Herr K. Pain assessment strategies in older patients. J Pain. 2011;12(3 SUPPL.):S3–13.

4. Tse MM, Vong SK, Tang SK. Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: A randomised controlled study. J Clin Nurs. 2013;22(13–14):1843–56.

5. Shubert TE, Goto LS, Smith ML, Jiang L, Rudman H, Ory MG. The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults. Front Public Heal. 2017;5.

Keywords

Pain, Activity, Older adults.

O61 Impact of the people with intellectual disability and proxies’ characteristics on quality of life assessment

Cristina Simões^1,2, Sofia Santos^2,3

¹Economics and Social Sciences Department, Portuguese Catholic University, 3504-505 Viseu, Portugal; ²Study Center for Special Education, Faculdade de Motricidade Humana, University of Lisbon, 1499-002 Cruz Quebrada, Portugal; ³Unidade de Investigação e Desenvolvimento em Educação e Formação, Instituto de Educação, University of Lisbon, 1649-013 Lisbon, Portugal

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

Background

The quality of life (QoL) assessment should include self-report measures in the field of intellectual disability (ID), which provide useful information for personalized support plans and give those with ID the opportunity to express their own perspectives regarding themselves and their individual contexts of life. Nevertheless, the communication and understanding limitations of people with ID can be a barrier to obtaining self-report perceptions. The inclusion of a proxy who knows the individual with ID well has been used to overcome the difficulties of the subjective assessments.

Objective

This proposal aims to explore the factors that could potentially explain the disagreements in QoL assessment of people with ID and their proxies.

Methods

Data were collected from 207 participants: 69 people with ID, 69 practitioners and 69 family members. QoL was assessed by the Portuguese version of the Personal Outcomes Scale. Paired-sample t tests were performed to examine the differences between the mean scores. Multiple regressions were calculated to analyse the determinants that could explain the directional mean difference between people with ID, support staff, and family members.

Results

The personal and environmental characteristics of people with ID (gender, diagnosis, living circumstances, and type of transportation) and the characteristics of practitioners (age, education level, relationship, health status of the person with the ID) had scores with a medium explanation of the disagreements between those participants. The education level of support staff and the health status of the person with the ID had largely explained the discrepancies between people with ID and key workers. Furthermore, the results revealed that four characteristics were major predictors of disagreement between people with ID and family members: the age of the person with ID, the type of transportation, the self-reported health status of the person with ID, and the health status of the person with the ID, as assessed by the family members. Finally, robust factors seemed to explain the discrepancies between practitioners and family members: living circumstances, self-reported health status of the person with the ID, education level of the key worker and education level of family members.

Conclusions

Among other factors, the health status was a major predictor of the different perceptions on QoL assessment. Findings showed that it was possible to predict differences among the three groups of respondents. Strictly speaking, the personal and environmental characteristics of people with ID and proxies predicted the disagreement among the participants.

Keywords

Quality of life, Intellectual disability, Self-report, Proxies, Predictors.

O62 Factors that influence the decision on how and when to use a “health kiosk”

João Rodrigues^1,4, Paulino Sousa², Pedro Brandão^3,4

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

Correspondence: João Rodrigues (joaorodrigues006@gmail.com)

Background

Health kiosks have been recognized as an effective way to develop knowledge and capabilities of citizens, which can improve the promotion of a healthy behaviour. But several have been the problems that have hindered the large-scale implementation and use of health kiosks, one of the most prominent being the limited acceptance of technology by citizens.

Objective

To identify factors that influence the decision on how and when to use a health kiosk

Methods

This kiosk appears as an innovative project, allowing to monitor anthropometric data (weight) and vital signs (heart rate, oximetry, and blood pressure) on a routine basis or prior to a medical appointment. This was an exploratory study, descriptive and correlational, of a cross-sectional study, with a mixed approach (quantitative and qualitative). In the elaboration of the instruments of data collection, we based on the Technological Acceptance Model (TAM). The analysis of the factors influencing the decision on how and when to use the “health check” was supported by the constructs: perceived utility, perceived ease of use, perceived credibility, and perceived knowledge.

Results

92 citizens accepted to participate in the study. But, 34 refused to use the kiosk (justifying their refusal): they considered “not having enough time to use the kiosk”, most of which verbalized that “they were afraid of losing their medical appointment if they did not hear the call”, “not feeling able to use it”, “not being able to use computers” or “not associating any utility in its use”. The kiosk was used by 58 people who had come to the Health Centre with different objectives: nursing appointment (41.4%), medical consultation (36.2%), administrative contact (13.8%) and the remaining were companions of other health care users (5.6%). Participants were mostly female (70.7%), with an average of 51.3 years (median 51.4, SD±17.6). They reported using technological devices: 94.8% used mobile phones (62.1% has “smartphones”) and 60.3% use computers. Only one participant had experienced prior “health kiosk” use. Users appreciated the utility (94.1%) and easy use (85.7%), as well as the credibility (94.6%) of the kiosk. The perceived knowledge was considered by 80.4% of participants as very good (5.4%) or good (75.0%).

Conclusions

TAM was crucial to understand the strength that some of its dimensions may have as factors that influence the decision on how and when to use the “health kiosk”. Among the citizens who used the health kiosk, mostly found it useful, easy to use, credible and secure.

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

Health kiosk, Technological Acceptance Mode, Monitoring.

O63 Delirium care: a survey into nursing perceptions and knowledge

Marta Bento¹, Rita Marques²

¹Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal^{; 2}Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, 1649-035 Lisbon, Portugal

Correspondence: Marta Bento (marsofia81@hotmail.com)

Background

Delirium is a reversible cognitive manifestation of sudden onset, developing in a matter of hours or days; characterized by a fluctuating course of disturbed attention, memory and perception [1]. Although common, this syndrome is often under-diagnosed and nursing staff are in the best position to recognize, prevent and monitoring delirium symptoms. The current approach to delirium care seems to be insufficient and nurses need to receive more support and guidance providing high quality care [2]. The education of nurses in all care settings can provide the foundation to address this massive international challenge.

Objective

The aim of the study is to assess nursing knowledge, in order to understand and perceive delirious adult/elderly patients.

Methods

In this exploratory study, we applied a questionnaire with closed questions and the sample consisted of 49 nurses working at an ER of a Central Hospital at Lisbon, during the month of December 2017. In order to safeguard ethical issues, we requested approval and informed consent to all participants in the study, with the anonymity and confidentiality of the data being ensured.

Results

The data yielded revealed that there was a high level of knowledge on the definition of delirium (93.8%) and also on the application of the Confusion Assessment Method (86.4%), although in this unit this instrument is not applied routinely. The analysis also reveals that there is a very high level of knowledge about the characteristics of a delirious patients and 100% of the nursing Staff recognize these patients, has not always aggressive. Furthermore, the dehydration and the poor nutrition were identified has risk factors for delirium (95.8% and 91.8%, respectively). On the contrary 63.3% (n = 31) of the respondents assumed that a patient with impaired vision isn’t at increased risk of delirium or neither 22.4% (n = 11) the risk for delirium increases with age 22.4% (n = 11). Equally important, 28.6% (n = 14) of the respondents did not know that patients with delirium present higher mortality rates.

Conclusions

Despite the literature assumes in same hospital settings nurses have insufficient knowledge of delirium-related information, the results of this study evidence an overall positively answered mean score, showing a high level of knowledge of delirium and its risk factors. Nurses have a key role to accurately recognizing and caring for delirious patients given the poor outcomes of untreated delirium.

References

1. American psychiatric association. Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Fifth Edition. Artmed; 2014. 976 p.

2. Zamoscik K, Godbold R, Freeman P. Intensive care nurses’ experiences and perceptions of delirium and delirium care. Intensive Crit Care Nurs. Junho de 2017;40:94–100.

Keywords

Delirium, Nursing, Knowledge, Risk factors.

O64 Nurses' satisfaction with the use of Health Information System in Funchal hospitals

Plácida Silva¹, Paulino Sousa², Élvio Jesus¹

¹Hospital Dr. Nélio Mendonça, 9004-514 Funchal, Portugal; ²Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal

Correspondence: Plácida Silva (placidasilva@hotmail.com)

Background

The evaluation of the Health Information System (HIS) is a fundamental activity to determine the success of the system and guarantee the continuity of its use. That is why it is important to know the true impact on the use and satisfaction of its users. In recent years, we have seen in Portugal different studies on nurses’ satisfaction with HIS use. However, none of the studies refers user satisfaction with the HIS structure that supports the practice of nurses in the Autonomous Region of Madeira (ARM).

Objective

To identify dimensions and level of nurses' satisfaction with the HIS in use.

Methods

A cross-sectional, exploratory and descriptive study was carried out in the ARM, in inpatient units of Funchal Hospitals. Data collection was supported by the application of the “User Satisfaction Questionnaire for Nursing Information Systems” based on DeLone & McLean Model of Information System Success (2003). This instrument uses a 5-point Likert scale structure with a semantic differential operationalized “1-unsatisfied” and “5-very satisfied”, in an increasing logic of level of satisfaction, in which there is no neutral intermediate point.

Results

The adherence rate of the study population was 50.5%, corresponding to a sample of 283 nurses. The exploratory factor analysis process was reduced to 5 factors, similar to previous studies which resulted in the following dimensions: 1) information sharing; 2) structure and content of information needed for decision-making; 3) support structures and HIS contributions; 4) Security, data protection and technical support; and 5) graphical data presentation. The dimension “satisfaction with access to necessary information for decision making” with an average value of 3.13 (Median 3, SD ±0.70), reports the area where the higher level of satisfaction is observed. The dimension “support structures and HIS contributions” has the lower average value of 2.81 (Median 2.8, SD ±0.64), The overall “nurses’ satisfaction with NIS in use” was 2.96 (±0.57), with a median of 3 on a Likert scale. This overall result reports a good level of nurses’ satisfaction with the HIS that they use.

Conclusions

This study allowed us to identify dimensions that incorporate the DeLone & McLean Model of Information System Success. At the same time, it has allowed us to identify factors that determine the level of satisfaction of the nurses with the HIS that they use and being able to determine the “use” and “intention to use them”.

Keywords

Health Information Systems, Nurses, Satisfaction, Evaluation.

O65 How prevalent are psycoactive substances among health students?

Sandra Ventura¹, André RTS Araujo¹, João Leitão1, Odília D Cavaco¹, Rui Correia², Maria J. Nunes²

¹Escola Superior de Saúde, Instituto Politécnico da Guarda, 6300-749 Guarda, Portugal; ²Centro de Respostas Integradas da Guarda, Administração Regional de Saúde do Centro, 6300-725 Guarda, Portugal

Correspondence: Sandra Ventura (scventura@ipg.pt)

Background

Consumption of psychoactive substances is widespread among young adolescents and young adults and constitutes a public health problem with significant consequences for individuals and societies throughout the world. The main consequences depend on the consumption pattern of the substance used and may result from the immediate or cumulative toxic effect of the substance consumed, from intoxication or psychoactive effects, or from addiction or addiction syndrome. Particularly alcohol and tobacco consumptions are the second and third risk factors of morbidity and mortality in Europe. Harmful use of alcohol, under acute and chronic conditions, can have serious developmental and social consequences, including violence, neglect and accidents, as well as health problems. Tobacco use also has negative consequences on health and social life.

Objective

In this context, the objective of this study was to characterize the consumption of psychoactive substances by students of the Superior Health School of the Polytechnic Institute of Guarda and to reflect on prevention strategies to be implemented to dissuade and reduce consumption among students.

Methods

A questionnaire was applied to the students and we collected 261 answers, from a total of 175 students of the Nursing Course and 88 of the Pharmacy Course.

Results

The results obtained indicate that the most consumed substances were, in descending order: alcohol, tobacco, psychoactive drugs and illicit substances. Regarding alcohol experimentation, it was found that 76.6% of nursing students and 85.2% of pharmacy students had already consumed alcohol. These data were higher than the national prevalence throughout life in 2015 (71%). The consumption of alcohol by nursing students (74.3%) and by pharmacy students (89.8%) was also higher than the consumption of Portuguese young people between 13 and 18 years old (62%). Tobacco consumption by nursing and pharmacy students were of 51.6% and 56.8%, respectively, both higher than the national data of 40%. The consumption of tobacco was of 39.3% by nursing students and 45.5% by pharmacy students, and it was also higher than the 30% reported for national consumption. Illicit substances were the least consumed, with a prevalence throughout life of 13.3% and 9.0%, respectively, by nursing and pharmacy students, inferior than the national data (19%). Cannabis was the illicit substance more consumed by either nursing and pharmacy students.

Conclusions

These results indicate that there is work to be done in the prevention and dissuasion of consumption of psychoactive substances by our student community.

Keywords

Psychoactive substances, Consumption, Prevalence, Prevention, Dissuassion.

O66 Diabetes Mellitus as a key indirect causal factor for pressure ulcer development

Pedro Sardo^1,2, Jenifer Guedes², José Alvarelhão¹, Elsa Melo¹

¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Centro Hospitalar do Baixo Vouga, 3810-501 Aveiro, Portugal

Correspondence: Pedro Sardo (pedro.sardo@ua.pt)

Background

Ensuring patient safety in healthcare is a challenge [1-6]. With the growing Diabetes Mellitus incidence, healthcare professionals and planners are encouraged to pay further attention to the major complications of this disorder [3]. According to EPUAP and EWMA [3], poor circulation and infection are among the most common complications that effect diabetic patients. A recent pressure ulcer conceptual framework [7, 8] identified Diabetes Mellitus as a key indirect causal factor (and poor perfusion as a direct causal factor) for pressure ulcer development and encourages the development of clinical studies that explore the correlation(s) between these specific risk factors and pressure ulcer development.

Objective

To identify the influence of Diabetes Mellitus on pressure ulcer development in adult patients admitted to medical and surgical wards in 3 Portuguese hospitals.

Methods

Cross sectional design survey developed on June 16th, 2015 with 236 adult patients admitted to medical and surgical wards in 3 Portuguese hospitals. The study was performed after Hospital Council Board and Ethics Committee approval (Reference Number 049688). Data were analysed using SPSS v25.0. Descriptive statistics were calculated for the sample characterization. Pressure ulcer risk, prevalence and incidence were calculated according to EPUAP statement [9]. Odds ratio (OR) was calculated by univariate logistic regression.

Results

This study included a sample of 236 participants with the median age of 76 years (Q1 = 62 years; Q3 = 83 years). The majority of the participants was male (56.8%), admitted trough the emergency service (80.9%) and stayed in medical units (60.2%). On the day of the survey, 121 (51.3%) participants were classified as “high risk of pressure ulcer development” (Braden Scale score ≤ 16); 45 (19.1%) participants had at least one pressure ulcer documented; 7 (3.0%) participants developed a new pressure ulcer since the admission in inpatient setting; and 67 (28.4%) participants had Diabetes Mellitus. Using a univariate logistic regression model, the odds of developing a pressure ulcer during the length of inpatient stay were significantly higher for the participants with Diabetes Mellitus with OR = 6.73 (95% CI:1.27-35.61, Nagelkerke R² = 0.103) compared to the other participants.

Conclusions

This study supports the pressure ulcer conceptual framework proposed by Coleman, Nelson [7] and Coleman, Nixon [8], showing that Diabetes Mellitus is a key (indirect) causal factor for pressure ulcer development in inpatient settings. However, further studies are needed in order to understand the influence of Diabetes Mellitus on skin and tissue (poor) perfusion and consequently on pressure ulcer development.

Acknowledgements

Thanks are due to “Centro Hospitalar Baixo Vouga, EPE” (Portugal), particularly to the Nursing Council Board, head nurses and to the nurses that recorded the data in the medical and surgical services of Águeda Hospital, Aveiro Hospital and Estarreja Hospital.

References

1. EPUAP, EWMA. Patient safety across Europe: the perspective of pressure ulcers.2017.

2. EPUAP, EWMA. The time to invest in patient safety and pressure ulcer prevention is now! 2017.

3. EPUAP, EWMA. Diabetic Control & Pressure Ulcers: fighting fatal complications and improving quality of life. 2017.

4. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients. Journal of Clinical Nursing. 2015;24(21-22):3165-76.

5. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital. Journal of Tissue Viability. 2016;25(2):75-82.

6. Sardo P, Simões C, Alvarelhão J, Simões JL, Machado P, Amado F, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. Journal of Tissue Viability. 2016;25(4):209-15.

7. Coleman S, Nelson EA, Keen J, Wilson L, McGinnis E, Dealey C, et al. Developing a pressure ulcer risk factor minimum data set and risk assessment framework. J Adv Nurs. 2014;70(10):2339-52.

8. Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222-34.

Keywords

Diabetes Mellitus, Nursing Assessment, Portugal, Pressure Ulcer, Risk Assessment

O67 Frailty syndrome in the elderly hospitalized in a teaching hospital

Luciane Cabral, Clóris Regina, Bruno A Condas, Péricles Reche, Danielle Bordim, Jacy Sousa

Departamento de Enfermagem e Saúde Pública, Universidade Estadual de Ponta Grossa, 4748 Ponta Grossa, Paraná, Brasil

Correspondence: Luciane Cabral (luciane.pacabral@gmail.com)

Background

In Brazil and in the world, the growth of the elderly population is an indisputable reality, so it is necessary to identify the factors that favour the sickness of this age group, with emphasis on the fragility, which can be defined as a syndrome which presents innumerable causes and is characterized by a set of clinical manifestations, such as decreased in strength, endurance and physiological function, collaborating to make the individual more vulnerable to addiction and/or death [1].

Objective

In view of the above, the present study aimed to evaluate the fragility syndrome of the elderly hospitalized in a teaching hospital.

Methods

A cross-sectional study, carried out with a convenience sample of 107 elderly patients admitted to the emergency room, at the medical, surgical and neurology clinic of the medical, surgical and neurology of a teaching hospital in the Campos Gerais region, from October 2016 to April 2017. Data collection included the application of the Mini Mental State Examination [2] for cognitive screening and Edmonton Fragility Scale [3], culturally adapted to the Portuguese language in Brazil [4]. Data were analysed using Stata®12 software. The association was verified through simple linear regression (Fisher's F and Student's t tests), significance level of p = 0.05. The project was approved by the Ethics Committee of the State University of Ponta Grossa (CAAE nº 34905214.0.0000.0105).

Results

The results showed a predominance of females (58.9%), married (61.0%), low schooling (71.0%), living with spouse (n = 42, 39.3%), considered their income satisfactory (50.5%). The mean age of participants was 70.3 years. Regarding clinical variables, 99.1% had a disease, 36.5% used medication and 50.5% reported hospitalization in the last 12 months. The fragility evaluation identified that 19.6% of the elderly were nonfragile, 24.3% apparently vulnerable, 26.2% had mild fragility, 15.9% moderate and 14.0% severe. It was found that any level of schooling used medication (p = 0.001), solitude (p = 0.001), loss of urine (p = 0.001) and hospitalization in the last 12 months (p = 0.001) and was associated with the fragility syndrome.

Conclusions

The importance of early detection of the syndrome is emphasized through the use of an instrument that is valid, reliable and easy to apply by the health team, such as the Edmonton Fragility Scale. The results presented can support the planning of health care, considering the characteristics and demands of the elderly who are hospitalized, thus contributing to improve the quality of care provided.

References

1. Morley JE, Vellas B, Kan GAV, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. JAMDA. 2013, 14(6):392-7.

2. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for granding the cognitive state of patients for the clinican. J PsychiatrRes. 1975, 12(3):189-98.

3. Rolfson D, Majumdar S, Tsuyuki R, Tahir A , Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006, 35(5):526-9.

4. Fabrício-Wehbe SCC, Cruz IR, Haas VJ, Diniz MA, Dantas RAS, Rodrigues RAP. Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community. Rev Latino-Am Enfermagem. 2013; 21(6):1330-6.

Keywords

Aged, Frail Elderly, Geriatric Nursing.

O68 Braden Scale accuracy tests

Pedro Sardo^1,2, Jenifer Guedes², José Alvarelhão¹, Elsa Melo¹

¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Centro Hospitalar do Baixo Vouga, 3810-501 Aveiro, Portugal

Correspondence: Pedro Sardo (pedro.sardo@ua.pt)

Background

Pressure ulcers management is a challenge [1-6]. Portuguese guidelines [7] encourage the implementation of regular pressure ulcer risk assessments through the application of the Braden Scale and the patients’ categorisation into two levels of risk (defined by cut-off point of 16). However, the development of pressure ulcer(s) is complex and multifactorial [8] and whenever the Braden Scale score falls below 18, each patient functional deficit and/or risk factor should be individually addressed [9].

Objective

To analyse the Braden Scale accuracy tests in adult patients admitted to general wards in a Portuguese hospital during one year, using different cut-off points.

Methods

The study was designed as a retrospective cohort analysis of electronic health record database from 6,552 adult patients admitted without any pressure ulcer in medical and surgical wards in a Portuguese hospital during 2012. All data were extracted after Hospital Council Board and Ethics Committee approval (Reference Number 049688). Braden Scale Accuracy Tests (BSAT) such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) were assessed [10].

Results

The study included 6,552 participants with a mean age of 64 years and 6 months. The majority of participants was male (52.6%); admitted trough emergency service (69.1%); in surgical (64.5%) units. During the length of stay 153 (2.3%) participants developed (at least) one pressure ulcer. Considering the cut-off point of 15, the BSAT showed: sensitivity of 50%(95%CI:42%-58%); specificity of 82%(95%CI:81%-83%); PPV of 6%(95%CI:5%-8%); NPV 99%(95%CI:98%-99%); and AUC of 66%(95%CI:61%-71%). Considering the cut-off point of 16, the BSAT showed: sensitivity of 63%(95%CI:55%-71%); specificity of 74%(95%CI:73%-75%); PPV of 5%(95%CI:4%-7%); NPV 99%(95%CI:98%-99%); and AUC of 69%(95%CI:64%-73%). Considering the cut-off point of 17 the BSAT showed: sensitivity of 78%(95%CI:71%-84%); specificity of 63%(95%CI:61%-64%); PPV of 5%(95%CI:4%-6%); NPV 99%(95%CI:99%-99%); and AUC of 71%(95%CI:67%-74%).

Conclusions

Although our BSATs follow the trend of the results found in a recent systematic review [11], they showed some of the limitations of the patients’ categorisation into two levels of risk according to a specific cut-off value. Like Braden [9], we believe that this assessment tool should be supplied with clinical judgment in order to identify patients’ specific risk factors that should be individually addressed with accurate preventive interventions. Furthermore, in order to develop evidence-based practice, we should create a minimum data set for pressure ulcer prevention, assessment and documentation [12-14] based on patients’ characteristics, international guidelines [15] and conceptual frameworks [12-14].

References

1. EPUAP, EWMA. Patient safety across Europe: the perspective of pressure ulcers. 2017.

2. EPUAP, EWMA. The time to invest in patient safety and pressure ulcer prevention is now! 2017.

3. EPUAP, EWMA. Diabetic Control & Pressure Ulcers: fighting fatal complications and improving quality of life. 2017.

4. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients. Journal of Clinical Nursing. 2015;24(21-22):3165-76.

5. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital. Journal of Tissue Viability. 2016;25(2):75-82.

6. Sardo P, Simões C, Alvarelhão J, Simões JL, Machado P, Amado F, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. Journal of Tissue Viability. 2016;25(4):209-15.

7. DGS. Escala de Braden: Versão Adulto e Pediátrica (Braden Q). Lisboa: Direção-Geral da Saúde; 2011.

8. Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011;20(5):364-75.

9. Braden BJ. The Braden Scale for Predicting Pressure Sore Risk: reflections after 25 years. Adv Skin Wound Care. 2012;25(2):61.

10. Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Continuing Education in Anaesthesia, Critical Care & Pain. 2008;8(6):221-3.

11. Park SH, Choi YK, Kang CB. Predictive validity of the Braden Scale for pressure ulcer risk in hospitalized patients. J Tissue Viability. 2015;24(3):102-13.

12. Coleman S, Nelson EA, Keen J, Wilson L, McGinnis E, Dealey C, et al. Developing a pressure ulcer risk factor minimum data set and risk assessment framework. J Adv Nurs. 2014;70(10):2339-52.

13. Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222-34.

14. Coleman S, Nelson EA, Vowden P, Vowden K, Adderley U, Sunderland L, et al. Development of a generic wound care assessment minimum data set. J Tissue Viability. 2017;26(4):226-40.

15. NPUAP, EPUAP, PPPIA. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Perth, Australia: Cambridge Media; 2014.

Keywords

Nursing Assessment, Portugal, Pressure Ulcer, Risk Assessment, Sensitivity and Specificity.

O69 Health literacy: the importance of experimental activities in the 1st cycle of basic education: report of an educational intervention on hand hygiene

Maria C Lamas^1,2,3, Carla Lago⁴

¹Escola Superior Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Escola EB1/JI Pícua, Agrupamento de Escolas de Águas Santas, 4425-143 Águas Santas, Maia, Portugal

Correspondence: Maria C Lamas (mariaceulamas@gmail.com)

Background

Primary school students usually have very little previous knowledge about a number of educational issues. So, it is important to create moments where the students can tell whatever they know about a subject, in order to make an additional scientific explanation. The program of the 1^st cycle of basic education aims to develop an attitude of permanent research and experimentation, and the part “The health of your body”, to produce knowledge and the application of norms of body hygiene [1]. However, the contents expressed in the textbooks for these levels of education do not justify the need for children to adopt these hygiene habits, which must be acquired as early as possible, to be a systematic routine throughout life. On the other hand, it allows to eradicate some of the alternative conceptions that some 1^st cycle students present on some issues [2], as the notion about the morphological view of microorganisms away from reality, idealizing them similar to animals [3,4,5]. There is evidence that children are able to learn about microorganisms at this age [3,4,5] and it is desirable that it occurs as early as possible, avoiding late conceptual changes that are difficult to reconstruct in their entirety [4]. For some authors [6,7], children should realize that the knowledge learned in the classroom can be applied in their daily lives.

Objective

In this context and with the purpose of promoting scientific and critical literacy, we developed an activity about hand hygiene because handwashing should be learned and be a properly reasoned behaviour.

Methods

The activities were developed by all 26 students in the class A, 2^nd grade of the School EB1/JI Picua. The students' age ranged from 7 to 8 years, with 54% (14) boys and 46% (12) girls. It started with the question “Handwashing: Why, When, How?”. According to the conceptions expressed by the students the appropriate theoretical contents were presented in a gradual and interactive way. This was followed by the experimental procedure with permanent monitoring and support based on the succeeding steps: role-playing stages for proper handwashing; applied activity; listing expected results; observation of cultures and microscopic observation of microorganisms, recording and reflection about the results achieved.

Results

All groups showed the expected results, i.e., higher microbial growth in the quadrants corresponding to unwashed hands.

Conclusions

Giving the results and the theoretical framework, the students learned proper concepts on the subject, which allowed them a better understanding of the world around them.

References

1. DGE - Direção Geral de Educação (2004). Organização Curricular e Programas. 1º Ciclo do Ensino Básico. Lisboa, Ministério da Educação e Ciência, 4ª edição.

2. Mafra, P., Lima, N., Carvalho, G. (2015). Microbiologia no 1º Ciclo do Ensino Básico: Uma proposta de atividade experimental sobre a higiene das mãos. Livro de atas do XI Seminário Internacional de Educação Física, Lazer e Saúde.

3. Byrne J, Sharp J. Children’s ideas about micro-organisms. School science review. 2006;88(322):71-79.

4. Byrne J. Models of Micro-Organisms: Children’s knowledge and understanding of micro-organisms from 7 to 14 years old. International Journal of Science Education. 2011;33(14):1927-1961.

5. Mafra, P. (2012). Os Microrganismos no 1.º e 2.º Ciclos do Ensino Básico: Abordagem Curricular, Conceções Alternativas e Propostas de Atividades Experimentais. Tese de Doutoramento. Braga: Universidade do Minho, Portugal.

6. Pro, A. (2012). Los cuidadanos necessitan connocimientos de ciências para dar respuestas a los problemas de su contexto. In Pedrinaci, E. (coord.), Caamaño, A. Cañal, P.; Pro, A. 11 ideas clave. El desarollo de la competência científica. Barcelona: Editorial Graó.

7. Lupión, T. e Prieto, T. (2014). La contaminación atmosférica: un contexto para ell desarollo de competências en el aula de secundária. Enseñanza de las Ciencias, 32 (1), 1-18.

Keywords

Hygiene, Handwashing, 1^st cycle, Monitored support, Microrganisms.

O70 Stand by me! Assessing the risk of falls in community –dwelling older adults

Luís PT Lemos¹, João Pinheiro², Edite Teixeira-Lemos^3,4, Jorge Oliveira^3,4, Ana P Melo⁵, Anabela C Martins⁶

¹Centro Hospitalar Tondela-Viseu, 3509-504 Viseu, Portugal; ²Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ³Escola Superior Agrária de Viseu, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; ⁴Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu Portugal; ⁵Laboratory Medicine Unit and Department of Quality and Risk Management, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁶Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra Portugal

Correspondence: Edite Teixeira-Lemos (etlemos2@gmail.com)

Background

About a third of community-dwelling adults age 65 and older fall each year. Accidental falls are a cause of fractures, traumatic brain injury, and even death. They can also lead to restrictions in participation, eventually resulting in loss of independence in normal activities of self-care. Falls in older adults are multifactorial and can be caused by medical conditions, cognitive impairment, medications, and home hazards. Therefore, a single identifiable factor may account for only a small portion of the fall risk in the community-dwelling elderly population, stressing the need for a multifactorial evaluation in this population.

Objective

Identify the risk of accidental falls in an independent elderly population by using functional tests that can be routinely applied in clinical practice and evaluate the influence of medication in the risk of falling.

Methods

The sample consisted of 108 individuals who attended a health care facility between October 2016-January 2017. Inclusion criteria: age 65-85, Functional Independence Measure (FIM) ≥ 120 and Timed Up and Go (TUG) ≤ 12s. Individuals with serious cognitive or motor impairment were excluded. A form was filled with sociodemographic data, daily medication and history of falls. Handgrip strength was measured. Fear of falling was assessed using the Activities-specific Balance Confidence (ABC) scale. Participation was evaluated using the Activities and Participation Profile related to Mobility (APPM). Informed written consent was obtained for all participants.

Results

The average age was 72.28±6.02. The majority of subjects were female (54.6%). Fallers were older, had lower ABC and handgrip strength. ABC showed strong negative associations with APPM. All of the functional parameters were affected by age, with older individuals performing worse than younger participants. Polypharmacy was identified in 41.7% and increased the risk of falls (OR = 3.597; CI 95% 1.174-11.024; p = 0.025). Individuals taking antidepressants showed an increased risk of falls (OR = 9.467; CI 95% 2.337-38.495; p = 0.002). Anti-arrhythmic drugs (p = 0.002), benzodiazepines (p = 0.015) and other CNS-acting medication (p = 0.039) negatively influenced ABC scores. APPM scores were higher in subjects who reported taking CNS-acting medication (p = 0.012) and anti-arrhythmic medication (p = 0.035).

Conclusions

Individuals with low balance confidence showed higher restrictions in participation related to mobility. All of the functional parameters evaluated in this study were affected by age. These results stress that a comprehensive and multifactorial evaluation of risk factors for falls in older people and the adoption of interventions tailored to this age group, which could include a reassessment of their usual medication, are necessary in order to reduce fall risk and fall-related injury.

Keywords

Accidental falls, Risk factors, Elderly, Community-dwelling, Polypharmacy.

O71 Trust requirements for the uptake of ambient assisted living digital advisory services

Soraia Teles^1,2, Ana Ferreira², Pedro Vieira-Marques², Diotima Bertel³, Constança Paúl^1,2, Andrea C Kofler⁴

¹Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto, 4050-313 Porto, Portugal; ²Center for Health Technology and Services Research, 4200- 450, Porto, Portugal; ³SYNYO GmbH, 1060 Vienna, Austria; ⁴Zurich University of Applied Sciences, Reidbach 8820 Wädenswil, Zurich, Switzerland

Correspondence: Soraia Teles (teles.s.soraia@gmail.com)

Background

For the last 10 years, Ambient Assisted Living (AAL) solutions have been conquering an important place in policies addressing economic and social challenges resulting from population ageing [1]. The AAL concept corresponds to a new paradigm building on ubiquitous computing devices and new interaction forms to improve older adults’ health, autonomy and security [2]. In spite of promising contributions of AAL solutions for ageing in place, low adoption by end users was reported [3-5]. This is thought to result from the intersection of technology features, user characteristics and attitudes [6]. Research has suggested that among attitudinal factors preventing adoption of these solutions there is a lack of trust, substantiated, among other factors, by user’s concerns about data security and privacy [5,7-10]. Digital advisory services for AAL solutions have to foster not only user’s trust on the advisory service per se, but also on AAL products and services and the web communication within a community.

Objective

To analyse stakeholders’ attitudes and requirements towards AAL digital advisory services, applying the findings to develop a pan-European advisory and decision-support platform for AAL solutions (ActiveAdvice).

Methods

A qualitative approach was used. Thirty-eight semi-structured interviews with AAL stakeholders– older adults and informal caregivers, businesses and government representatives– were conducted in six European countries (Austria, Switzerland, Belgium, Netherlands, Portugal and UK). The data was analysed using the matrix method [11].

Results

For the uptake of AAL digital advisory services, the level of user’s trust in the system seems to be critical. Features emerging as crucial to foment trust in digital advisory services were threefold: presence of security and privacy cues; personalization-related cues; and community features, including availability of client-to-client interactions and feedback given by reliable peers or experts. Older adults expressed their interest in becoming active in a digital community if provided an environment perceived as secure and, simultaneously, easy to use.

Conclusions

Building trust in AAL digital advisory services depends on multiple and complex user requirements. Security issues have shown to be of utmost relevance due to the nature of information exchanged, i.e. personal, health-related and sensitive data, and generational preferences, with privacy and security cues having primacy for ‘Baby Boomers’, as supported by previous research [12]. These findings stress the need for a paradigm shift towards user-centred and user empowering models and mechanisms for securing the interaction with systems (e.g. authentication mechanisms, access control models and visualization techniques; e.g. SoTRAACE model) [13].

Acknowledgements

The authors would like to acknowledge the co-financing by the European Commission AAL Joint

Programme and the related national agencies in Austria, Belgium, the Netherlands, Portugal,

Switzerland and the United Kingdom.

References

1. AAL Programme. Stategy 2014-2020 for the Active and Assisted Living Programme. 2014; Retrieved from: http://www.aal-europe.eu/wp-content/uploads/2015/11/20151001-AAL Strategy_Final.pdf.

2. Betchold U, Sotoudeh M. Assistive technologies: Their development from a technology assessment perspective. Gerontechnology. 2013;11(4):521-533.

3. Doyle J, Bailey C, Scanaill CN, van den Berg F. Lessons learned in deploying independent living technologies to older adults’ homes. Univ Access Inf Soc. 2013;13:191.

4. Michel JP, Franco A. Geriatricians and Technology. J Am Med Dir Assoc. 2014;15(12):860-2.

5. Peek ST, Wouters EJ, van Hoof J, Luijkx KG, Boeije HR, Vrijhoef HJ. Factors influencing acceptance of technology for aging in place: A systematic review. Int J Med Inform. 2014;83(4) :235-248.

6. Nedopil C, Schauber C, Glende I. AAL stakeholders and their requirement. 2013; Report by the Ambient and Assisted Living Association.

7. Damodaran L, Olphert W. User Responses to Assisted Living Technologies (ALTs) — A Review of the

Literature. Journal of Integrated Care. 2010;18(2):25-32.

8. Nordgren A. Personal health monitoring: ethical considerations for stakeholders. Journal of Information, Communication and Ethics in Society. 2013;11(3):156-173.

9. Olphert W, Damodaran L, Balatsoukas P, Parkinson C. Process requirements for building sustainable digital assistive technology for older people. Journal of Assistive Technologies. 2009;3(3):4-13.

10. Wright D. Structuring stakeholder e-inclusion needs. Journal of Information, Communication and Ethics in Society. 2010;8(2):178-205.

11. Nadin S, Cassell C. Using Data Matrices. In: Cassel C, Symon G, editors. Essential Guide to Qualitative Methods in Organizational Research. London: SAGE Publications Ltd ; 2011. p. 271–287.

12. Obal M, Kunz W. Trust development in e-services: a cohort analysis of Millennials and Baby Boomers. J. Serv. Manag. 2013;24(1):45–63.

13. Moura P, Fazendeiro P, Marques P, Ferreira A. SoTRAACE — Socio-technical risk-adaptable access control model. 2017 International Carnahan Conference on Security Technology (ICCST) [Internet]. IEEE; 2017 Oct; Available from: https://doi.org/10.1109/ccst.2017.8167835

Keywords

Ambient Assisted Living (AAL), Digital Advisory Services, Trust in Online Services, Data Security.

O72 Self-confidence for emergency intervention and nurses’ perceptions of importance 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 Intra-Hospital Emergency Team (IHET) has emerged to respond to situations of clinical deterioration of hospitalized patients, being nurses the fundamental links in the activation. During a situation of clinical deterioration with the need for IHET intervention, the actions of nurses in inpatient services depend on many factors. To facilitate the activation and effectiveness of this team, nurses must have self-confidence to carry out the activation of IHET. Nurses believe that IHET’s intervention is important in the pursuit for safe care and that the most important ingredient for the effective use of this team is the nurse.

Objective

This study aims to evaluate the level of self-confidence for emergency intervention of nurses and to identify the nurses’ perceptions of the importance of the IHET.

Methods

This correlational study included 129 nurses from the Centro Hospitalar de Leiria who answered a questionnaire about the perception of IHET importance and the self-confidence scale for emergency situations validated for the Portuguese population by Martins et al. (2014), which consists of 12 items with Likert type responses. Pearson correlation and t-student were used for data analysis.

Results

In this study, 84% were female nurses with a mean age of 39.70 ± 9.02 years, with an average professional experience of 16.97 ± 8.95 years, and the majority with training in the emergency area (94%). The mean self-confidence level of the nurses was 3.263 ± 0.571, for a maximum of 5 points. Regarding the nurses’ perception of importance of the IHET, a positive tendency was observed (results ranged from 3.426 ± 0.570 to 4.775 ± 0.419). A partial relation between the professional experience (r = 0.25; p = 0.004), the training (t = 6.143; p ≤ 0.0001) and the level of self-confidence (r = -0.205; p = 0.020) with the level of perception is highlighted.

Conclusions

In this study, regarding the self-confidence for emergency intervention, the nurses demonstrated confidence, albeit modestly. Likewise, they presented a tendency towards positive agreement regarding the importance of IHET. Of note, the higher the experience of the nurses, the greater the importance attributed to the IHET. Finally, it was verified that the higher the nurse's self-confidence index, the lower the feeling of insecurity in an emergency situation.

Keywords

Hospital Rapid Response Team, Nursing, Emergency situation, Perception of importance, Self-confidence in emergency

O73 Relationship between cognitive impairment and nutritional assessment on functional status in institutionalized Portuguese older adults

Catarina Caçador¹, Edite Teixeira-Lemos^2,3, Jorge Oliveira^2,3, Fernando Ramos¹, Manuel T Veríssimo^4,5, Maria C Castilho⁶

¹Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal; ²Agrarian School, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; ³Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; ⁴Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁵Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁶Laboratory of Bromatology, Pharmacognosy and Analytical Science, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal

Correspondence: Catarina Caçador (cacasabel@hotmail.com)

Background

Elderly are particularly vulnerable to nutritional change deficits. Malnutrition in elderly patients is frequently underdiagnosed [1] and it has a large number of negative consequences on health and quality of life [2]. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. Few studies have focused on the relationship between patient’s nutritional assessment and a severity of cognitive impairments, comorbidity and functional status in institutionalized older adults.

Objective

In the present study we evaluated the relationship between functional disability, cognitive impairment and nutritional status.

Methods

This was an observational study with data collected from residents living in institutions in the district of Viseu (centre of Portugal). Inclusion criteria were: subjects aged 65 or older, living in institutions, that voluntarily accepted to participate in the study. All of the 216 subjects studied underwent multidimensional geriatric assessment. A form was filled with sociodemographic data and the nutritional state was assessed with the Mini Nutritional Assessment (MNA), whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). The functional state was assessed by Barthel Index (BI). Statistical evaluations (p < 0.05) were based on Qui-square tests between Barthel Index (BI), Mini Mental State Evaluation (MMSE), Body Mass Index (BMI) and Mini Nutritional Assessment (MNA) scores. Statistical evaluations (p < 0.05) were based on Qui-square tests between BI, MMSE, BMI and MNA scores.

Results

A cognitive impairment in MMSE performance was displayed in 39.4% patients. Slight disability occurred in 69.4% of the residents, 24.1% were independent in activities of daily living and only 6.5% of the seniors had moderate dependence. There was a proportional increase of the cognitive impairment of the elderly (p ≤ 0.001) with increasing dependence. According to MNA, 27.8% of the elderly were at risk of malnutrition and 71.3% showed no nutritional problems. Statistical analysis showed that dependence increased the risk of malnutrition.

Conclusions

A close relationship between malnutrition and functional dependence has been obtained. Both tests, MNA and BI, are positively associated. The scores of BI can help to determine who may be at risk of poor nutrition.

References

1. Gariballa SE. Nutritional support in elderly patients. J Nutr Health Aging. 2000; 4: 25-7.

2. Pérez-Llamas F. Risk of desnutrition in the Spanish population. Evaluation of the current situation and need for a nutritional intervention. Med Clin(Barc) 2012; 139:163-4

Keywords

Elderly, Cognitive impairment, Functional status, Nutritional assessment, Malnutrition.

O74 The evaluation of nursing care provided by Integrated Continuing Care Teams

Carlos Vilela^1,2, Paulino Sousa², Filipe Pereira²

¹Institute of Health Sciences, Portuguese Catholic University, 1649-023 Lisboa, Portugal; ²Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Carlos Vilela (carlosvilela@esenf.pt)

Background

The evaluation of nursing care is an imperative for the continuous development of quality improvement and for the cyclical redefinition of action plans that correspond to the real needs of the population. In the specific case of the Integrated Continuing Care Teams (ICCT), inserted in the National Network of Continued Integrated Care of Portugal, it is justified the use of a panel of indicators of health gains “Sensitive to Nursing Care”, given the nature of the services provided in these units, which helps to measure the clinical results obtained.

Objective

1) To identify the main nursing care needs of ICCT clients; and 2) Identify health gains sensitive to nursing care related to those needs.

Methods

Based on the definition model of indicators “sensitive to nursing care”, we developed a quantitative study-exploratory, descriptive and correlational, using the analysis of the nursing documentation available in Information Systems in use, in a convenience sample of 217 cases, attended in four ICCT of the northern region of Portugal, from October 2012 to May 2013.

Results

From the analysis of 9,258 documented nursing diagnoses, it was possible to generate eight “types” of health gains indicators. Five related to the dependent person and three referring to the family caregiver (FC). Here the great incidence of the care provided in these ICCT was revealed, where the Gains in autonomy/independence in the universal requirements of self-care and Gains in knowledge of the FC were the most representative areas of the care provided. Then, came the domains of Gains in the evolution of nursing diagnoses of the dependent person (“others”) and Gains in knowledge of the dependent person. Approximately 10% of the results computed were in areas that focused on Gains in FC performance (11.20%), Gains in performance of dependent persons (10.43%) and Gains in the prevention of Ulcers of Pressure (9.32%). With an order of magnitude in the order of 3.30% emerged the field of indicators related to Gains in the evolution of nursing diagnoses centred on the Role of Care Provider.

Conclusions

Reflecting on these results allows a more effective approach to the representation of nursing care in the evaluation of quality and, certainly, a better redefinition of the panel of indicators at the national level, with “sensitivity” to the nursing work developed by ICCT.

Keywords

Healthcare Quality Indicators, Quality of Health Care, Home Care Services, Nursing Care, Nursing Care Management.

O75 Psychosocial impact of the powered wheelchair on the social participation of its users

Inês Domingues¹, João Pinheiro¹, Anabela Martins², Patrícia Francisco²

¹Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ²Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Inês Domingues (inesfsdomingues@gmail.com)

Background

There is a growing prevalence of disability worldwide, which indicates an increasing number of persons who might benefit from assistive technologies. Several studies showed positive effects of the use of assistive technologies on activity and participation of adults with mobility impairments [1, 2], as well as on psychosocial factors [3, 4].

Objective

The purpose of this study is to assess the psychosocial impact of the powered wheelchair, evaluating its repercussions on the social participation of its users.

Methods

Design - Observational, descriptive, cross-sectional study; Setting – All data was collected from May to October 2017; Participants - 30 powered wheelchair users with mean age of 40.63 years old (60% male) with diverse medical conditions (SCI, TBI, CP, among others); Main outcome measures - Interviews were conducted by an independent researcher using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Activities and Participation Profile Related to Mobility (PAPM), in addition to demographic, clinical and wheelchair-related questions.

Results

Participants were quite satisfied with both the assistive technologies and the related services, with the lowest QUEST scores belonging to those who had been using their wheelchairs for a longer period of time. PAPM scores revealed significant restrictions in participation (6.7% of participants with mild restrictions, 56.7% with moderate restrictions and 36.7% with severe restrictions), with a worst participation profile also among the users who had the wheelchairs for a longer period. The most satisfied users were the ones with better performance in terms of social participation. PIADS scores showed a positive impact of the powered wheelchairs in all subscales, with the following average scores: total 1.37, competence 1.39, adaptability 1.32 and self-esteem 1.38. The psychosocial impact, in terms of adaptability, was higher among users who transitioned from a manual wheelchair to a powered wheelchair compared to those who already had a powered wheelchair previously (1.85 vs 1.10; p = 0.02).

Conclusions

There was an overall positive psychosocial impact of powered wheelchairs, and, therefore, an increase in the quality of life of the users. Adaptability to the device seems to be the most contributing factor to social participation.

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):211-8.

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. Buning ME, Angelo JA, Schmeler MR. Occupational performance and the transition to powered mobility: a pilot study. Am J Occup Ther. 2001;55(3):339-44.

Keywords

Assistive technologies, Powered wheelchair, Psychosocial impact, Social participation.

O76 Work and breastfeeding: mom’s double duty

Rita MF Leal¹, Amâncio AS Carvalho², Marília S Rua¹

¹School of Health, University of Aveiro, 3810-193 Aveiro, Portugal; ²School of Health, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal

Correspondence: Rita MF Leal (ritamariaferreiraleal@gmail.com)

Background

Work is known to be an obstacle to breastfeeding (BF) continuation [1–5].

Objective

To analyse if there is a relationship between the employment status of the mother, the age of the child when she returns to work, the level of difficulty in reconciling work with BF and BF duration.

Methods

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect from November 2015 to September 2016. Data was analysed using SPSS software.

Results

Most women had difficulties in reconciling work with BF (72.5%). Of these, 26.6% said that conciliating work and BF was “very difficult” or “difficult”, while 73.4% said they had “some difficulty” or “very little difficulty”. Job status (employed versus unemployed) did not present a statistically significant relationship with BF duration. As to the age of the child when the mother returned to work, we verified a statistically significant relationship (p = 0.001) with BF duration. The level of difficulty the mother experienced in reconciling her job with BF also presented a statistically significant relationship (p = 0.002) with BF duration.

Conclusions

The majority of mothers reported difficulties in reconciling work with BF. Women who returned to work before their child was 6 months old had shorter BF duration. This reinforces the need to explore family’s timely expectations, and plan strategies to promote an effective management of work and BF. In this context, we believe there is a need to establish in our culture jurisdiction policies that favour BF and work. Health professionals should act as mediators in the definition of family-oriented health policies. In this case, the extension of a parental leave for mothers up to 6 months postpartum, the existence of a place at work where breastfeeding mothers can extract and conserve their breastmilk or the existence of day-care centres in the workplace, in accordance to the Global Strategy for Infant and Young Child Feeding [6,7], may prolong BF duration and ease mothers difficulty in managing BF when returning to work.

References

1. Lynch S. Breastfeeding and the workplace. Community Pract. 2016;89(6):29–31.

2. Smith JP, McIntyre E, Craig L, Javanparast S, Strazdins L, Mortensen K. Workplace support, breastfeeding and health. Fam Matters. 2013;93:58–73.

3. Sriraman NK, Kellams A. Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals. J Women’s Heal. 2016;0:1–9.

4. UNICEF. From the First Hour of Life: Making the case for improved infant and young child feeding everywhere PartI: Focus on Breastfeeding [Internet]. New York; 2016. Available from: http://www.unicef.pt/docs/pdf_publicacoes/FromTheFirstHourOfLife-Part1.pdf

5. Rivera-Pasquel M, Escobar-Zaragoza L, González de Cosío T. Breastfeeding and Maternal Employment: Results from Three National Nutritional Surveys in Mexico. Matern Child Health J. 2015;19(5):1162–72.

6. World Health Organization, United Nations Children’s Fund. Global Strategy for Infant and Young Child Feeding. World Heal Organ [Internet]. 2003 [cited 2016 Dec 21];1–30. Available from: http://www.paho.org/english/ad/fch/ca/GSIYCF_infantfeeding_eng.pdf

7. IBFAN Portugal Rede Internacional Pró-Alimentação Infantil. Relatório de Portugal da Iniciativa Mundial Sobre Tendências do Aleitamento Materno (WBTi) Situação da Estratégia Global para a Alimentação de Lactentes e Criança [Internet]. 2015 [cited 2016 Aug 29]. Available from: http://www.worldbreastfeedingtrends.org/GenerateReports/report/WBTi-Portugal-2015.pdf

Keywords

Breastfeeding, Employment, Job, Parental leave.

O77 Health information shared in blogs by breast cancer survivors living in Portugal

Francisca MMC Pinto¹, Paulino AF Sousa^2,3, Maria RSP Esteves^4,5

¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Cooperativa de Ensino Superior Politécnico e Universitário, 4560-462 Penafiel, Portugal; ⁵Instituto de Investigação e Formação Avançada em Ciências e Tecnologias Saúde, 4560-462 Penafiel, Portugal

Correspondence: Francisca MMC Pinto (franciscampinto@gmail.com)

Background

Breast cancer survivors (BCS), and other cancer patients, are digital social networks users; have their personal blogs where share their life/disease experiences after being diagnosed for cancer [1, 2]. Research on blogging activity among BCS is scarce and suggests that is a multifaceted activity with several purposes: self-management of emotions, problem-solving, and sharing information [3]. But the question remains: what health information is share by BCS in blogosphere?

Objective

The present work reports the results of a study that explored personal blogs of BCS who lives in Portugal, with focus on written health information that was posted and/or commented.

Methods

A qualitative study design and thematic content analysis. Blog selection by snowball strategy that included 3 phases: I) phase 1: first 20 search results on Google, with Portuguese keywords “blogues cancro da mama”; II) phase 2 and 3: links to other blogs that are present on each blog selected on phase 1 and 2, respectively. Blogs included for analysis met all criteria for inclusion: I) personal blog of women self-identified with a breast cancer diagnosis; II) blogger profile allows to confirm residence in Portugal; III) blog is public domain; IV) blog must present data related to post-primary treatment phase. Data collection was done between March–November, 2017. The scope analysis started on first post after finish primary treatment for breast cancer and ended in blog’s last post at time we finished to read it.

Results

38 blogs were included for analysis. Results refer to health information shared by BCS in posts and commentaries between 2007-2017. Most of the information shared were uncertainties regarding: I) nutrition & physical exercise recommendations; II) management of long-term side effects of cancer treatment and comorbidities; III) management recurrence risk and psychological wellbeing; IV) treatment plans & health surveillance during survivorship; V) management of body image changes; VI) non-conventional therapies benefits & risks; vii) news about research on cancer. Less shared information regards to: I) return to work & social protection; II) general healthcare recommendations; III) community support to cancer patients; IV) genetics & heredity; V) sexuality; VI) infertility/fertility after breast cancer.

Conclusions

BCS use personal blogs to share difficulties, uncertainties and to search for information support to manage their health condition. Having access to useful information and education may help BCS manage uncertainty in illness, improve health literacy and self-efficacy to manage health condition. This study alerts health professionals to pay attention to BCS information and emotional needs.

References

1. Kim S, Chung D. Characteristics of cancer blog users. J Med Libr Assoc. 2007;95(4):445-50.

2. Damásio C, Nunes LM, Sobral JM. A Análise de Redes Sociais no estudo do processo da construção da ajuda mútua da pessoa com doença oncológica com blogue. REDES- Revista hispana para el análisis de redes sociales. 2014;25(1):153-89.

3. Koskan A, Klasko L, Davis SN, Gwede CK, Wells KJ, Kumar A, et al. Use and Taxonomy of Social Media in Cancer-Related Research: A Systematic Review. American Journal of Public Health. 2014;104(7):e20-e37.

Keywords

Breast cancer survivors, Blogs, Health information needs, Content analysis.

O78 Visual images spectrum android classification for diabetic foot ulcers

Ricardo Vardasca¹, Rita Frade^2,3, Rui Carvalho⁴, Joaquim Mendes^2,3

¹Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal; ²Porto Biomechanics Laboratory, Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal; ³instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial - Laboratório Associado de Energia, Transportes e Aeronáutica, 4200-465 Porto, Portugal; ⁴Clínica Multidisciplinar do Pé Diabético, Centro Hospitalar do Porto, 4099-001 Porto, Portugal

Correspondence: Ricardo Vardasca (ricardo.vardasca@fe.up.pt)

Background

According to the Portuguese Society of Diabetology, about 415 million (8.8%) of the worldwide population was diagnosed with Diabetes Mellitus in 2015. Being the Portuguese population incidence of 1 million people (13.3% of the total population), with a national annual total estimated cost of 1.7 billion euros with this condition. One in each four patients of DM develop Diabetic Foot Ulcer (DFU) in their lifetime, ending some in amputations and consequently in death [1]. Furthermore, the Directorate-General of Health estimated that in 2016, the prevalence of DFU was of 11.5% in the Portuguese population [2]. Throughout the years, DFU assessment tools have been created, such as: I) scales, which depend on visual examination being highly subjective; II) invasive methods that use manual procedures for depicting the shape, area, depth and volume of wounds, that are time consuming, susceptible to human errors and can lead to wound contamination [3]; or III) non-invasive methods such as optical based techniques which provide three-dimensional information about the lesion, which are expensive, time consuming and require user training [4]. Therefore, more objective measures are required.

Objective

This research study aims to create an objective and simple methodology based in a mobile application which incorporates an algorithm that characterises DFU ulcers providing information about its area and tissue colour composition.

Methods

An Android mobile application was developed, tested and evaluated in 200 diabetic foot ulcers, after signing the informed consent and the procedure being explained to patients. The study was approved by the ethical committee of Centro Hospitalar do Porto.

Results & Conclusions

The use of this new android mobile app showed a high correlation with the traditional clinical assessment (r² = 0.97), reducing subjectivity, avoiding wound contamination probability and smaller costs when compared to conventional solutions.

Acknowledgements

The authors gratefully acknowledge the funding of project NORTE-01-0145-FEDER- 000022 - SciTech - Science and Technology for Competitive and Sustainable Industries, cofinanced by Programa Operacional Regional do Norte (NORTE2020), through Fundo Europeu de Desenvolvimento Regional (FEDER) and of project LAETA - UID/EMS/50022/2013.

References

1. Sociedade Portuguesa de Diabetologia. Relatório Anual do Observatório Nacional da Diabetes. Diabetes: Factos e Números; 2016.

2. Direcção Geral de Saúde. Relatório do Programa Nacional para a Diabetes; 2017.

3. Plassmann P. Measuring wounds. Journal of Wound Care 4(6); 1995. 269-272.

4. Wang L, Pedersen PC, Strong DM, Tulu B, Agu E, Ignotz R, He Q. An Automatic Assessment System of Diabetic Foot Ulcers Based on Wound Area Determination, Color Segmentation, and Healing Score Evaluation. Journal of diabetes science and technology 10(2); 2016. 421-428.

Keywords

Android, Classification, Diabetic foot ulcers, Imaging, Wound assessment.

O79 Sleep disorders in elderly: is it a problem?

Vítor Moreira¹, Ângela Mota¹, Bárbara Santos¹, Olívia R Pereira^1,2, Xavier Costa^1,3

¹Departamento de Tecnologias de Diagnóstico Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 Bragança, Portugal; ²Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; ³Centro Hospitalar de Trás-os-Montes e Alto Douro, Unidade Hospitalar de Chaves, 5400-279 Chaves, Portugal

Correspondence: Olívia R Pereira (oliviapereira@ipb.pt)

Background

Sleep disorders are one of the most relevant clinical symptoms in adults, with increasing prevalence throughout life, reaching in large scale the elderly population.

Objective

The present study aimed to characterize sleep disorders in the elderly and its pharmacological therapy.

Methods

A cross-sectional study was performed through application of a questionnaire to 381 elderlies in pharmacies of Braga, Bragança and Porto cities. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

Results

Elders were most from female gender (60.1%), aged between 65 and 74 years (49.6%) and lived in rural areas (73.4%). Just 36.5% of the elderly practice physical exercise and an important amount of elderly drink coffee and tea (68.8% and 73.2%, respectively). Concerning sleep characteristics, the elders go to bed between 6 p.m. and 2 a.m. and about half of participants (52.8%) go between 10 p.m. and 12 a.m. Approximately one third had difficulty in falling asleep (38.1%), especially the elderly from the region of Bragança. During sleep, a large proportion of the elderly reported having sleep stops (78.2%) usually for 15-30 minutes and 26.5% reported waking up twice during the night. Taking into account that the time of delay to sleep is an important factor, in the present study, this was statistically related with the gender (p = 0.003) and with taking medication to sleep (p < 0.001). The same two factors are statistically related with “wake up during the night” (p = 0.046, p = 0.003, respectively). 40.7% of the surveyed elderly have been diagnosed with sleep disorders, mainly insomnia (19.7%) following by restless legs syndrome (3.4%), excessive drowsiness (2.9%) and sleep apnoea, sleep-walking and narcolepsy (about 1%). It is important to refer that among the elderly, that assume to suffer from sleep disorders, just 40.7% have been consulted by a physician. Of those who consulted a doctor, 21.3% of the elderly were advised to change their lifestyle habits, such as, to avoid heavy meals before bedtime, to establish a sleep routine, to lie down only when he/she is sleepy and to practice physical activity. Concerning the pharmacological therapy, 41.7% take medication for sleep disorders, 9% take medication without consulting a doctor, while 32.5% elderly people take medication after consulting a doctor. From these, the most used are benzodiazepines such as alprazolam (12.5%), diazepam (8.6%), lorazepam (4.5%) and brotizolam (3.7%).

Conclusions

Sleep disorders are frequent in the elderly population. It is necessary to raise awareness in this population group, which associates sleep problems to age.

Keywords

Sleep Disorders, Elderly, Pharmacological Therapy, Sleep and aging.

O80 Physical and mental health in community-dwelling elderly: functional assessment and implications to multidisciplinary clinical practice

Rogério Rodrigues¹, Zaida Azeredo², Sandrina Crespo¹, Cristiana Ribeiro¹, Isabel Mendes¹

¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Research in Education and Community Intervention, Piaget Institute, 1950-157 Lisbon, Portugal

Correspondence: Rogério Rodrigues (rogerio@esenfc.pt)

Background

Disability in old age may pose barriers to the achievement of goals and the ability to carry on roles that are important to a person. Knowledge about the functional disability in physical and mental areas in old people is crucial for the planning of interventions by the health technicians.

Objective

To evaluate functional physical and mental abilities of community-dwelling elderly for planning health care and the implementation of services.

Methods

Quantitative descriptive-correlational study of the project “The oldest old: Coimbra’s ageing study” PTDC/CS-SOC/114895/2009 [1]. Sample constituted by 202 elderlies from a population of 808 (three age groups: 65-74; 75-84 and ≥ 85 years old), obtained in a randomized and probabilistic trial, from the files of users of a Health Centre, after ethic commission approval. As instrument and method of data collection was used the QAFMI (Portuguese version of the Older Americans Resources and Services), to evaluate the functional status, in terms of physical and mental health. Data analysis: a) descriptive analyses on the most common pathologies, their limitation and medication consumption; b) functional evaluation using the score given by the computer software based on the model of QAFMI.

Results

As main results we point out, the pathologies with major interference in physical activities, which are chronic bronchitis, skin disease, arthritis or rheumatism, effects of stroke and circulation troubles. Related to the consumption of medication, it was observed that for the most cited pathologies (hypertension and cardiac problems) there is a great percentage of consumption. Others (arthritis or rheumatism) have a lower prescription. There was no statistically significant difference for physical health, in the comparative study between genders. There are differences between the age groups, with lower scores for the oldest. Related to mental functional abilities, there is a statistically significant difference for the diverse age groups, with an increase of impaired capacity for the oldest. For the whole of the sample gender differences exist, being worst scored the women.

Conclusions

Women and the oldest, in general, appear as the ones that present lower functional physical abilities. The classification by the QAFMI model, regarding the area of mental health, reports the approach of cognitive decline and perception of memory loss. Like in other studies, differences were found between genders, resulting in worse scores for women.

References

1. Rodrigues R. Os muito idosos: estudo do envelhecimento em Coimbra – Perfis funcionais e intervenção [eBook]. Coimbra: Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Enfermagem de Coimbra; 2014.

Keywords

Elderly, Community-dwelling, Functional assessment, Physical health, Mental health.

O81 Adherence to therapy in elderly

Ana Rodrigues, Clara Rocha, Jorge Balteiro

Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Jorge Balteiro (balteiro@estescoimbra.pt)

Background

In recent decades, the elderly population has grown significantly, leading to an increase in the number of chronic diseases and, consequently, to an increased need for polymedication for disease control. Polymedication means the use of multiple medications, which can cause adverse reactions/drug interactions that increase depending on the number of medications administered. In elderly with high number of pathologies associated or not with age, complex therapies are instituted which may lead to non-adherence to therapy. This situation can impair the aim of treatment, worsen the disease, add errors to diagnosis and treatment itself, or even lead to therapy failure.

Objective

The objective of the present study is to assess the adherence to therapy in elderly institutionalized during the day and investigate the main factors that influence it.

Methods

The study was conducted with the collection and processing of questionnaires, consisting of 3 parts: demographic characterization (e.g., age, gender, marital status); therapeutic characterization (amount of daily medications and treatment regimen) and evaluation of adherence to therapy by adapting the scale of measurement of adherence to treatment (MAT). The study sample was made up of 51 elderlies institutionalized during the day.

Results

It was observed that 98% of seniors join the instituted therapy: 37.3% showed a level of 5 therapeutic membership, approximately 49% showed a level of accession of 6 and only 14.9% expressed below. Of the factors studied as susceptible of influencing therapeutic membership, it was only found that oblivion is the conditioning factor associated with the recommended therapy (p = 0.047), affecting the levels of membership.

Conclusions

The results obtained allowed to conclude that the high levels of membership can be associated to the fact that the elderly were institutionalized during the day, having support available. Another possible explanation is the fact that the same live with family, being also accompanied during the night.

Keywords

Adherence to therapy, Elderly, Polymedication, MAT.

O82 Ionizing radiation effects in a bladder and an esophageal cancer cell lines

Neuza Oliveira¹, Mafalda Vitorino¹, Ricardo Santo², Paulo Teixeira^1,3,4, Salomé Pires^3,5, Ana M Abrantes^3,5, Ana C Gonçalves^5,6, Clara Rocha^7,8, Paulo C Simões⁹, Fernando Mendes^1,3,5, Maria F Botelho^3,5

¹Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal; ³Biophysics Institute-CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; ⁴Serviço de Anatomia Patológica, Cento Hospitalar Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁵Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal; ⁶Laboratory of Oncobiology and Hematology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal; ⁷Department Complementary Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ⁸Institute for Systems Engineering and Computers at Coimbra, 3030-290 Coimbra, Portugal; ⁹Radiation Oncology Department, Hospital and University Center of Coimbra, 3000-075 Coimbra, Portugal

Correspondence: Fernando Mendes (fjmendes@estescoimbra.pt)

Background

Oesophageal cancer (EC) and bladder cancer (BC) share the same embryonic origin (endoderm) and according to the latest numbers, EC is the eighth and BC is the ninth most frequently diagnosed cancers worldwide. Radiotherapy (RT) is currently used in the treatment of both types of cancer [1–4].

Objective

Assessment of the effects of ionizing radiation (IR) on cell lines of EC (OE19) and of BC (HT1376), namely viability and cell proliferation, characterisation of cellular death type and cell cycle, as well to establish survival factor and determination of the aggression model, after different radiation dose exposure to calculate half lethal dose (DL50).

Methods

Cell lines were cultured and exposed to single-shot doses of X-rays from 0.5 Gy to 12.0 Gy, except control cells (0.0 Gy). Cell viability and proliferation were assessed by trypan blue assay. The proliferation index determination was performed by immunocytochemistry trough Ki-67 expression. Flow cytometry was used to assess cell death type and cell cycle and the main morphological features of cell death were evaluated by May-Grünwald Giemsa stain. Clonogenic assays enabled assessment to differences in reproductive viability (capacity of cells to produce progeny) [5–11].

Results

Our results showed that IR induces cytotoxic and antiproliferative effects in OE19 and HT1376 cells in a dose-dependent manner and dose and time-dependent manner, respectively. Main types of cell death observed were apoptosis or necrosis. We also observed cell cycle arrest on G2/M phase and a decrease of the Ki-67 expression in both cell lines studied. The cell survival curves were established according to the quadratic linear model for both cell lines. For OE19 cell line the DL50 was 2.47 Gy and for HT1376 cell line was 3.10 Gy, accompanied by a decrease in the survival factor for both lines.

Conclusions

The direct effects of the DNA molecule that are unrepairable, activate multiple intracellular mechanisms on radio-sensitivity, such as cell death, namely by apoptosis and necrosis and cell cycle arresting G2/M phase. The increase radiation dose induces alterations in cell death, from apoptosis to necrosis. According to our results, OE19 is more radio-sensible than HT1376 cell line. This study demonstrates that molecular mechanisms underlying RT are important in oesophageal adenocarcinoma and bladder cancer therapeutic approaches.

Acknowledgements

The authors would like to thank to Institute for Biomedical Imaging and Life Sciences is a research Institution of the Faculty of Medicine, University of Coimbra and to Radiotherapy Service of the Centro Hospitalar e Universitário de Coimbra.

References

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-tieulent J, Jemal A. Global Cancer Statistics, 2012. CA a cancer J Clin. 2015;65(2):87–108.

2. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol. 2016;1–13.

3. Nassim R, Mansure JJ, Chevalier S, Cury F, Kassouf W. Combining mTOR Inhibition with Radiation Improves Antitumor Activity in Bladder Cancer Cells In Vitro and In Vivo: A Novel Strategy for Treatment. PLoS One. 2013;8(6).

4. Rubenstein JH, Shaheen NJ. Epidemiology, diagnosis, and management of esophageal adenocarcinoma. Gastroenterology. 2015;149(2):302–317.e1.

5. Mendes F, Sales T, Domingues C, Schugk S, Abrantes AM argarida, Gon??alves AC ristina, et al. Effects of X-radiation on lung cancer cells: the interplay between oxidative stress and P53 levels. Med Oncol. 2015;32(12):266.

6. Mendes F, Domingues C, Schugk S, Abrantes AM, Gonçalves AC, Casalta-Lopes J, et al. Single Shot Irradiation and Molecular Effects on a Diffuse Large B Cell Lymphoma Cell Line. J Cancer Res Treat. 2016;4(1):9–16.

7. Santo RP. Resposta Celular à Radioterapia – Estudo in vitro em linhas celulares do carcinoma da próstata Resposta Celular à Radiação Ionizante. Faculdade de Medicina da Universidade de Coimbra; 2017.

8. Tran WT, Iradji S, Sofroni E, Giles A, Eddy D, Czarnota GJ. Microbubble and ultrasound radioenhancement of bladder cancer. Br J Cancer. 2012;107(3):469–76.

9. Barbosa T V., Rosas MP, Costa AC, Rapoport A. Valor prognóstico do Ki-67 no carcinoma indiferenciado de grandes células de glândula salivar maior: estudo de 11 casos. Rev Bras Otorrinolaringol [Internet]. 2003;69(5):629–34. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992003000500007&lng=en&nrm=iso&tlng=pt

10. Ding Z, Yang H-W, Xia T-S, Wang B, Ding Q. Integrative genomic analyses of the RNA-binding protein, RNPC1, and its potential role in cancer prediction. Int J Mol Med. 2015;36(2):473–84.

11. Franken NAP, Rodermond HM, Stap J, Haveman J, Bree C Van. Clonogenic assay of cells in vitro. 2006;(October 2016).

Keywords

Esophageal cancer, Urinary Bladder Neoplasms, Radiotherapy, Ki-67 antigen.

O83 Sociodemographic characteristics and breastfeeding duration

Rita MF Leal¹, Amâncio AS Carvalho², Marília S Rua¹

¹School of Health, University of Aveiro, 3810-193 Aveiro, Portugal; ²School of Health, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal

Correspondence: Rita MF Leal (ritamariaferreiraleal@gmail.com)

Background

Sociodemographic characteristics have been related to breastfeeding (BF) duration. Research has shown interest in these factors which may even be predictive [1].

Objective

To analyse a correlation between sociodemographic characteristics (maternal age, level of education, marital status, number of older children, child gender, child’s year of birth) and breastfeeding (BF) duration.

Methods

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect. Data was analysed using SPSS software.

Results

Maternal age, marital status, child’s gender and child’s year of birth did not present a statistically significant relationship with BF duration. On the other hand, mothers educational level (p = 0.001) and the number of older children (p = 0.018) presented a statistically significant relationship with BF duration.

Conclusions

Our study did not establish a correlation between maternal age and BF duration which contradicts other findings [1–3] and can be explained by pregnancy and childbirth postponement nationwide [4]. In relation to mothers’ educational level, we verified a statistically significant relationship with BF duration, being that the mothers who detained a higher level of education, breastfed longer [1,5–7]. As for marital status, we did not verify a statistically significant relationship with BF duration, which is in line with a recent Portuguese study [5] but differs from other international studies [2,3] that refer that married mothers breastfeed longer. This difference can be explained by cultural differences and by the paradigmatic change of the women’s role, concept of marriage, and a diversity of forms of family life (great increase in unmarried couples). We also verified an increasing tendency in BF duration with the increase of the number of older children [6,7], but it was not lowest in primiparous women which contradicts other findings [6,7]. This may be clarified, once again, by the sociodemographic changes in the last decade in Portugal that include population ageing, an increasing tendency for families with an only child [4] and the great investment in parenthood and child well-being. Health care professionals should consider that sociodemographic characteristics are in constant change and so is its relation to health. These findings help health professionals to identify who may be most vulnerable to early weaning and allows them to explore expectations and develop a care plan accordingly.

References

1. Scott J a, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev. 1999;7(1):5–16.

2. Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth. 2004;31(4):285–92.

3. Ogbuanu C, Glover S, Probst J, Hussey J, Liu J. Balancing Work and Family: Effect of Employment Characteristics on Breastfeeding. J Hum Lact. 2011;27(3):225–38.

4. Delgado A, Wall K. Famílias nos Censos 2011: Diversidade e Mudança [Internet]. 1a edição. Instituto Nacional de Estatística, editor. Lisboa: Imprensa de Ciências Sociais; 2014 [cited 2016 Dec 13]. 239 p. Available from: http://repositorio.ul.pt/bitstream/10451/23625/1/ICS_SAtalaia_VCunha_KWall_SMarinho_VRamos_Como_ASITEN.pdf

5. Dias A, Monteiro T, Oliveira D, Guedes A, Godinho C, Alexandrino AM. Aleitamento materno no primeiro ano de vida : prevalência, fatores protetores e de abandono. Acta Pediátrica Port. 2013;44(6):6–11.

6. Caldeira T, Moreira P, Pinto E. Aleitamento materno: estudo dos factores relacionados com o seu abandono. Rev Port Clínica Geral Clin Geral. 2007;23:685–99.

7. Lopes B, Marques P. Prevalência do aleitamento materno no distrito de Viana do Castelo nos primeiros seis meses de vida. Rev Port Clínica Geral. 2004;20:539–44.

Keywords

Age, Breastfeeding, Education, Population characteristics, Population dynamics.

O84 Population analysis of cleft lip and/or palate patients treated in the Postgraduate Orthodontic Department of the Faculty of Medicine of the University of Coimbra

Ana Roseiro, Inês Francisco, Luisa Malo, Francisco Vale

Universidade de Coimbra, 3004-531 Coimbra, Portugal

Correspondence: Ana Roseiro (a-roseiro@hotmail.com)

Background

Cleft lip and palate is one of the most common dentofacial congenital anomalies, affecting on average 1:700 new-borns. Although the aetiology of this condition is not fully understood, it seems to be related with both genetic and environmental factors. This type of malformation may occur isolated or it could be associated with a syndrome. When compared with the general population, cleft lip and palate patients present in a larger number, a series of dental anomalies in number, size and tooth shape.

Objective

Analyse in a population of cleft lip and/or palate patients a number of anatomical and sociodemographic characteristics.

Methods

The study included 60 patients referred to the Postgraduate Orthodontic Department of the Faculty of Medicine of Coimbra by the Children’s Hospital during the year of 2015. All data related to patients was obtained through a meticulous and thorough orthodontic exam (medical history, cast models, intra and extra oral pictures and radiographic exams).

Results

Of the 60 patients included in the study, 65% were of male gender. Patients with 11 years of age were the most prevalent ones (5-22 years of range). The most common anomaly was unilateral lip and palate cleft (63%). Maxillary endognathy was present in 75% of the cases. 74% of the patients presented at least one dental agenesis being the upper lateral incisor the more common one.

Conclusions

Cleft lip and palate is more frequent in male individuals and seems to be associated with conditions like maxillary endognathy and dental agenesis, with orthodontic treatment being required in these patients.

Keywords

Cleft lip and palate, Dental agenesis, Maxillary endognathy.

O85 Drug use in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança

Ana Branco¹, Ana Coutinho¹, Ana Machado¹, Bárbara Alves¹, Miguel Nascimento^1,2, Olívia R Pereira^1,3

¹Departamento de Tecnologias de Diagnóstico Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 Bragança, Portugal; ²Serviços Farmacêuticos, Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal; ³Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal

Correspondence: Olívia R Pereira (oliviapereira@ipb.pt)

Background

The use of drugs during the gestational period is a subject of great concern, once the exposure of medicines may result in toxicities with possible irreversible lesions for the foetus. In fact, drugs in pregnancy have been restricted since the accident of thalidomide. In 1979 the U.S. Food and Drug Administration (FDA) adopted the classification of drugs as the risk associated with their use during pregnancy, these being classified into 5 classes (A, B, C, D and X).

Objective

The aim of the present study was to characterize the use of drug therapy in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança regions.

Methods

A cross-sectional study was performed through application of a questionnaire to 134 pregnant women in the Northeast (Mirandela, Macedo de Cavaleiros and Bragança regions) during consultation in a health centre. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

Results

The sample comprised a total of 134 pregnant women from the Northeast area, mostly with ages between 21 and 30 years or between 31 and 40 years (56.7% and 35.8%, respectively), holding secondary or higher education (48.5% and 42.5%, respectively) and employment (67.2%). About half of the pregnant (47.8%) were in the 3rd quarter of pregnancy. 78.4% (105 women) of the pregnant had used drugs during the pregnancy, 64.4% after medical prescription, and 71.6% have acquired the medication at the pharmacy. In detail, the medication most used was folic acid (64.2%, 86 of the pregnant women) which belongs to class A; paracetamol from class B (35.1%, n = 47), iodine (17.2%, n = 23) and iron (14.9%, n=20), both belonging to the class A. Less reported drugs have included metoclopramide (6.0%) and Vitamin D₃ (6.0%), from Class C and Class D, respectively. It is important to refer that 12.7% of the women had a chronic disease and 2.2% had an acute disease during pregnancy. Diseases more reported were asthma and diabetes.

Conclusions

In the present study, the use of drugs in pregnancy was independent of the education level, chronic or acute disease, locality, marital status, employment status, gestational period and health centre. The drugs most used by pregnant women belong to class A (18.5%), class B (25.9%) and class C (33.3%) and the less used belong to class D and X. Supplements such as folic acid, iodine and iron and the analgesic paracetamol were the most reported.

Keywords

Pregnancy, Drug therapy, Risk, Disease.

O86 Knowledge representation about self-management of medication regime in Portuguese Nursing Information Systems

Inês Cruz, Fernanda Bastos, Filipe Pereira

Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Inês Cruz (inescruz@esenf.pt)

Background

The use of a standardized language in nursing supports the nursing science and contributes to the management of the discipline's own knowledge [1, 2]. Nurses can control, practice, and teach only what they can name. The documentation of care in Nursing Information Systems in Portugal is based on the international classification for nursing practice (ICNP®) [3].

Objective

The purpose of this study is to describe and specify nursing diagnoses centred on the clients’ knowledge for self-managing the medication regime in chronic diseases.

Methods

Exploratory study. All nursing documentation, concerning all health centres and public hospitals, customized in the Portuguese nursing information System-SAPE® (2012) and in SClinico® (2016) was subject to content analysis. Content analysis of nursing documentation was based on ICNP® terminology. After conducting content analysis, the material was validated by a group of 14 nursing experts.

Results

A set of nursing diagnoses related to the person's knowledge on the medication regime management were specified. Knowledge refers to the development of the client's informational content about how to manage his medication regime. These diagnoses focus on the potential to improve knowledge about: self-management of the medication regime; medication regime; response to medication and side effects of medication; health services; complications and preventing complications of compromised self-management; and the use of devices to facilitate drug intake.

Conclusions

The specified diagnoses reflect nursing care needs that nurses document in the Portuguese nursing information systems, related to medication self-management. These results are contributes to the formalization of nursing science’s knowledge in the field of self-care of people living with chronic diseases.

References

1. Peace J, Brennan P. Formalizing Nursing Knowledge: from theories and models to ontologies. Connecting Health and Humans. 2009; 347-351.

2. Pereira F, Silva A. Information technologies and nursing practice: the Portuguese case. In Nursing and informatics for the 21st century: an international look at practice, education and HER trends. Weaver C, Delaney P, Weber, et al. AMIA. 2010; 435-441.

3. Cruz I, Bastos F, Pereira F, Silva A, Sousa P. Analysis of the nursing documentation in use in Portugal – building a clinical data model of nursing centered on the management of treatment regimen. Nursing Informatics. 2016. 225; 407-411.

Keywords

Self-management, Knowledge, Nursing Diagnoses, Nursing Information Systems.

O87 Illness perceptions, beliefs about medicines and medication adherence in hypertension

Teresa Guimarães, André Coelho, Anabela Graça, Ana R Fonseca, Ana M Silva

Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal

Correspondence: Teresa Guimarães (tguimaraes@estesl.ipl.pt)

Background

Hypertension constitutes the most prevalent modifiable cardiovascular risk factor and a major risk factor for cognitive decline and dementia. Antihypertensive medication is essential to minimize the consequences of the disease, stressing the need for a high adherence to treatment to achieve hypertension control. Illness perceptions and beliefs about medication have been identified as important determinants of treatment adherence.

Objective

To identify patients’ perceptions on hypertension and beliefs about antihypertensive medication and assess associations between these beliefs and medication adherence.

Methods

63 hypertensive patients, 69.8% females, 54-95 years (M = 69.02; SD=10.07), 96.8% diagnosed for more than one year and with antihypertensive medication prescribed completed the Revised Illness Perception Questionnaire (IPQ-R), the Beliefs about Medicines Questionnaire (BMQ-Specific) and a medication adherence measure (Medida de Adesão aos Tratamentos – MAT).

Results

Most of the patients perceived hypertension as a chronic (100%), cyclical (96.8%) condition, which can be controlled by medication (96.8%) and behaviour (90.5%), presented strong beliefs in the necessity of medication (96.8%), but also strong concerns about the consequences of taking it (87.3%). Patients reported a high level of adherence to medication (M = 5.41; SD = 0.55 on MAT, 7 as highest possible score) and low frequency of non-adherent behaviours. Significant positive correlations were found between necessity scale (BMQ) and hypertension timeline (acute/chronic) (rs(63)= 0.34; p < 0.01), treatment control (rs(63)= 0.43; p < 0.01), emotional representations (rs(63)= 0.50; p < 0.01) and between concerns scale (BMQ) and hypertension consequences (rs(63)= 0.26; p < 0.05); timeline (cyclical) (rs(63)= 0.46; p < 0.01), emotional representations (rs(63) = 0.32; p < 0.05). Significant negative correlations were found between concerns scale and personal (rs(63)= - 0.35; p < 0.01) and treatment (rs(63)= - 0.28; p < 0,05) control. We also found significant negative correlations between adherence (MAT) and hypertension timeline (cyclical) (rs(63)= -0.27; p < 0.05), consequences (rs(63)= -0.50; p < 0.01) and emotional representations (rs(62)= -0.37; p < 0.01).

Conclusions

Our findings suggest that illness perceptions play a key role in the way patients cope with their illness, through the development of patient’s beliefs concerning the necessity of medication and concerns about taking it, and also by directly influencing adherence to treatment. In our study, non-adherence is essentially unintentional (patients forget or are careless about treatment), what explains the lack of association between adherence and beliefs about medication, although we have found that, for the majority of subjects, concerns about taking medicines are outweighed by a belief in the necessity of the prescribed medication.

Keywords

Hypertension, Illness perceptions, Beliefs about medicines, Medication adherence.

O88 Self-determined motivation and life satisfaction of elderly for the supervised physical activity practice

Marco Batista¹, João Martinho¹, Jorge Santos¹, Helena Mesquita¹, Pedro Duarte-Mendes¹, Rui Paulo²

¹Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal

Correspondence: Marco Batista (marco.batista@ipcb.pt)

Background

The self-determination theory suggests that humans have several basic psychological needs that are innate, universal and essential to health and well-being, namely, autonomy, competence and relation perception. The wellness construct, measured by satisfaction with life is understood as a judgment process in which individuals generally estimate the quality of their lives based on their own criteria.

Objective

This study has as main objective to identify the motivations, basic psychological needs and satisfaction with the life of the Portuguese elderly for the practice of supervised Physical Activity; and to analyse the relations and comparisons between levels of practice, sex and institutional context.

Methods

A cross-sectional study was carried out with 62 elderly volunteers of both sexes (15 males and 47 females), institutionalized and non-institutionalized, belonging to the Municipality of Castelo Branco, with a mean age of 79.61 ± 9.34 years. The instruments used were the Behavioural Regulation in Exercise Questionnaire, the Basic Psychological Needs Scale Exercise and the Satisfaction with Life Scale.

Results

The results show that, apparently, the motivation that maintains the constant practice of physical activity supervised by the elderly focuses on the autonomous motivation. It can also be observed that, except for the amotivation, where women have higher levels of amotivation for the practice of supervised physical activity than men, that is, they may be more exposed to an absence of motivational orientation, there are no differences at the level of the remaining motivational variables, as well as the basic psychological needs and life satisfaction between the male and the female. The results showed that, in the supervised elderly, the satisfaction of the basic psychological needs leads to autonomously motivated behaviours, promoting high levels of satisfaction with life.

Conclusions

We can conclude that autonomous motivation and the satisfaction perception of basic psychological needs are externalized as factors of great importance, because they appear to be a catalyst for this population to remain active and, in a way, to “compromise” with This lifestyle.

Keywords

Self-determination theory, Satisfaction with life, Exercise, Well- being, Elderly.

O89 Application of the transcontextual model of motivation in the prediction of healthy lifestyles of active adults

Marco Batista¹, Marta Leytón², Susana Lobato³, Maria Aspano³, Ruth Jimenez-Castuera³

¹Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Universidad Pablo de Olavide, 41013 Sevilla, Spain; ³Universidad de Extremadura, 06071 Badajoz, Spain

Correspondence: Marco Batista (marco.batista@ipcb.pt)

Background

The Transcontextual Model suggests an original contribution to knowledge, and can illustrate human behaviour, interpreting the theory of self-determination, contrasting with the hierarchical model of motivation, as well as with the theory of planned behaviour, seeking to predict behaviours. The strength of this model lies in the integration of different motivational theories, such that an explanation is a predicted complement to the motivational processes that are inexplicable in theory by each component.

Objective

The present study was designed with the objective of testing an extension of the Transcontextual Model of motivation in predicting healthy lifestyles of active adults.

Methods

The study sample consisted in 560 Portuguese active adults of both genders, aged between 30 and 64 years (M = 44.86; DP = 7.14). The instruments used were the Behavioural Regulation in Exercise Questionnaire, the Basic Psychological Needs Scale Exercise, Questionnaire for Planned Behaviour and the Healthy Lifestyle Questionnaire. A structural equation model was elaborated with which the predictive relations between the analysed variables were examined. The indices obtained in the measurement model were: χ² = 527.193, p < .001; χ²/gl = 3.46; CFI = .94; IFI = .94; TLI = .93; GFI = .93; RMSEA = .60; SRMR = .43. The model goodness test showed the following adjustment indices: χ² = 728.052, p < .001, χ²/gl = 4.79, CFI = .91; IFI = .91; TLI = .90; GFI = .91; RMSEA = .075; SRMR = .070.

Results

The structural equations model showed that the perception of social relation positively and significantly predicts autonomous motivation. In turn, this positively and significantly predicts control perception, predicting this, positively and significantly, the intentions. Eating habits and rest habits were positively and significantly predicted by intentions, and tobacco consumption was predicted negatively and significantly by intentions.

Conclusions

From the conclusions reached in this study, it is important to emphasize the importance of fostering social relations, since this will favour autonomous motivation, promoting a greater behavioural control over the intentions of the practitioners, thus generating more healthy eating habits, rest habits and lower consumption of tobacco.

Keywords

Theory of planned behavior, Self-determination theory, Structural equations models, Exercise, Lifestyles.

O90 Symptoms management and adherence to antiretroviral medication - a nursing intervention

Eunice Henriques, Maria FM Gaspar

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

Correspondence: Eunice Henriques (eunice.henriques@esel.pt)

Background

The increase of new diagnoses of HIV infection in young males, especially those who have sex with men, and the high percentage of late diagnoses, particularly in middle-aged heterosexuals continues to be our major concerns. As AIDS is now considered a chronic disease, its effective and sustainable treatment relies naturally on self-management of symptoms as well as promoting adherence to therapy. This will reduce costs and promote well-being in the person's life.

Objective

To develop a nursing intervention program to enhance effectiveness in managing symptoms and consequently adherence to antiretroviral therapy in the person with HIV/AIDS. Specific Objectives: Validate and adapt the following instruments: “Revised Sign and Symptom checklist for Persons with HIV disease”; “Self-care symptom management for people living with HIV/AIDS; AACTG (Adult Aids Trial Group) Instruments; “HIV/AIDS Stigma Instrument - PLWA (HASI-P) ©”; I) to assess the frequency and intensity of the most common signs and symptoms associated with HIV infection among participants, as well as the strategies used; II) to evaluate the adherence to antiretroviral therapy (ART); and III) evaluate self-perception of stigma.

Methods

This is a quasi-experimental, study with pre and post intervention evaluation. Participants were selected at the HCC Day Hospital; HIV-infected, multi-stage, more than 18-year-old, to have ART for at least 6 months. We carried out the sociodemographic characterization and validation of the instruments. The intervention consisted in the application of a strategy manual for self-management of the most frequent symptoms.

Results

The 1st Study sample consisted of 374 individuals, 74.1% were males. The age varied from 20 years to 78. The average with 47.34 years. Of the 64 presented symptoms, the number of symptoms ranged from 0 to 53 by the same participant. The mean was 18.96 symptoms per person. The most frequent symptoms were: anxiety, fatigue, fear and worries and depression. Most do not use strategies, or they are not effective in managing these symptoms. Of the total number of respondents, 30% never stopped taking the medication and the same number failed to take the therapy in the last 3 months, the main reason is simple forgetting.

Conclusions

Most participants do not adequately manage the symptoms due to lack of knowledge of the appropriate strategies, indicating devaluation based on the belief of inevitability (pain). Most say they adhere to ART (70%), making more than 95% of the shots, which is not always consistent with viral load.

Keywords

Nursing intervention, Symptoms management, Adherence to antirretroviral medication.

O91 Aortic valve prosthesis: cardiovascular complications due to surgical implantation

Virginia Fonseca¹, Ana Rita Bento¹, Joana Esteves¹, Adelaide Almeida^1,2, João Lobato¹

¹Escola Superior de Tecnologia da Saúde de Lisboa, 1990-094 Lisboa, Portugal; ²Hospital da Luz, 1500-650 Lisboa, Portugal

Correspondence: Virginia Fonseca (virginia.fonseca@estesl.ipl.pt)

Background

Aortic stenosis represents the third most common cause of cardiovascular disease, with indication for surgical valve replacement with a biological or mechanical prosthesis in most symptomatic patients. Biological prostheses present a higher risk of reoperation due to valvular degeneration; however, do not require prolonged therapy. In spite of the long durability, mechanics prosthesis need chronic anticoagulant therapy. The surgical intervention for valvular replacement is not free of complications and can be grouped into three main categories: prosthesis complications, non-prosthesis related cardiac complications and non-cardiac complications.

Objective

To characterize the cardiovascular complications resulting from the implantation of biological or mechanical aortic valve prosthesis, by surgical procedure.

Methods

32 patients were evaluated in four follow-up moments. Cardiovascular complications resulting from the implantation of a valve prosthesis (biological or mechanical) were analysed, and also the value of the pre and post-surgical mean gradient, symptoms and cardiovascular risk factors. All the variables under study were characterized by descriptive statistics, except the mean gradient variable, for which the Friedman test was used.

Results

The most frequent complication detected in individuals who implanted biological aortic prosthesis in the first (18.75%), second (21.88%), third (21.88%) and fourth (9.38%) follow-up moments were arrhythmias and electrical conduction disturbances. There is a higher prevalence of Atrioventricular Block and Left Bundle Branch Block, in the first and second follow up moments that reverts in the last two. The complication with higher prevalence in the sample of individuals with mechanical prosthesis at the first (9.38%) and second (3.13%) follow-up moments were arrhythmias. At the third and fourth follow-up moments, the main complication was paravalvular leaks (9.38%). Statistically significant differences were detected in the mean gradient throughout the follow-up (χ_F²(4) = 12.122, p = 0.016).

Conclusions

The most frequent complications in individuals with aortic prosthesis were arrhythmias and paravalvular leaks. The structural deterioration of the biological valve prosthesis is the most commonly described complication, which may result in insufficiency of the valvular prosthesis and paravalvular leaks. However, electrical conduction disturbances after aortic valve replacement may occur through tissue manipulation of the conduction system. These disorders may be transient; however, certain patients require pacemaker implantation in the post-surgical period.

Keywords

Prosthetic valves, Aortic prosthesis complications, Biological prosthesis, Mechanical prosthesis.

O92 A Safe staff nursing model: relationship between structure, process and result variables

Maria J Freitas¹, Pedro Parreira²

¹Escola Superior de Enfermagem São Francisco das Misericórdias, 1169-023 Lisboa, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Maria J Freitas (mjbsfreitas@gmail.com)

Background

The need to adequate nursing resources to the real needs of patients, while maintaining a balance between the quantity and the skills, without neglecting the quality and safety, has been a concern for managers. The absence of a consensual methodology to support the operationalization of a safe staff nursing, was the starting point of this investigation.

Objective

Develop an explanation Model Safe Staff Nursing (SSN) and analyse the relationships between the Structure, Process and Results.

Methods

Cross-sectional and correlational study. Data collection was achieved through a three-sample questionnaire: nurses (629), chief-nurses (43) and patients (1,290), from 43 units of 8 Portuguese hospitals. A patient’s form was applied to assess the satisfaction with nursing care. The data collection instrument for nurses and chief- nurses consisted of three parts: the first characterizing the personal and professional variables, the second featuring the healthcare organization and the service on which the respondent work, and the third part was to obtain information about: overall satisfaction at work (Evaluation Scale of Overall Satisfaction at Work [1]), intended to abandon the Work (Intent Abandonment of Employment Scale [2]), quality nursing care and risk/occurrence of adverse events (Adverse Events Associated with Nursing Practices Scale [3]). The psychometric assessment study of the measuring instruments, performed by Factorial Exploratory Analysis and Confirmatory demonstrated adequate validity and reliability. For model validation, we used the technique Structural Equation Modelling.

Results

The relational structure of the model is statistically significant (χ²(421) = 2209.095; p = 0.000; χ²/gl = 5.247; GFI = 0.833; CFI =0.815; RMSEA = 0.082), being adequate to explain the impact of Structure variables over Results of SSN, and the Process variables over Results. The “Availability of nurses with the right mix of skills”, “Availability of nurses in adequate amount” and “Safe environment” (Structure-variables) explain 2% of the variable variance of “Provision of quality nursing care” (Process-variables), 15% of the variance “Patient satisfaction”, 94% of the variance “Risk and occurrence of adverse events on patients” (Results-Patients), 25% of the variance “Results-Nurses” and 100% of variance “Results-Organization”.

Conclusions

The Safe Staff Nursing Model clearly identifies the influence of SSN on the results obtained for patients, nurses and organizations. Warns are given for the need to give more attention to issues of SSN, in particular to the constitution of balanced teams, based on a mix that includes number and competencies of nurses, versus workload/patients nursing care needs, as a strategy for maximizing resources and promoting the sustainability of organizations.

References

1. Silva CF, Azevedo MH, Dias MR. Estudo Padronizado do Trabalho por Turnos: Versão Experimental. Bateria de escalas. Serviço de Psicologia Médica, Faculdade de Medicina da Universidade de Coimbra. Coimbra; 1994.

2. Meyer JP, Allen NJ, Smith CA. Commitment to organizations and occupations: Extension and test of a three-component conceptualization. J Appl Psychol 1993;78(4):538-51.

3. Castilho A, Parreira PM [InterSnet]. Design and assessment of the psychometric properties of an adverse event perception scale regarding nursing practices. Revista Investigação Em Enfermagem 2012;1(2):61–75.

Keywords

Health care allocation resources, Nursing human resources, Safe nursing supplies, Safe Staff Nursing.

O93 Engineered healthy food with nutritional and therapeutic advantages

Geoffrey Mitchell¹, Artur Mateus¹, Maria Gil², Susana Mendes²

¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Leiria, Portugal; ²Marine and Environmental Sciences Centre, Polytechnic Institute of Leiria, 2520-641 Peniche, Portugal

Correspondence: Geoffrey Mitchell (geoffrey.mitchell@ipleiria.pt)

Direct Digital Manufacturing is an emerging set of technologies, which are able to produce complex objects without the need for molds or specific tooling. The preparation of food for human consumption is a centuries old craft, which results in food with high sugar and salt levels leading to a poor health for many people and not contributing to the recovery of seriously ill-hospitalized patients. One of the key challenges is to tailor food to the individual to match their dietary requirement and metabolic characteristics. We believe that direct digital manufacturing is able to address these issues. To date the use of 3D printing for food has been restricted to the production of aesthetic shapes for chocolate and pasta products. We see the potential in a different way in which we can tailor the food to the individual incorporating where required drug-based therapies whilst retaining the requirements to be visually pleasing. In addition, it will be possible to guarantee all the organoleptic characteristics to which the consumer in general is familiar (such as smell, sound and texture). The mouth is the gateway for food and its acceptance requires specific taste triggers. We consider that by exploiting Direct Digital Manufacturing it will possible to optimize such taste triggers whilst retaining the nutritional balance and potential. Every consumer (in general) has challenges in chewing and swallowing and engineered food has the capability to achieve this, especially when coupled with a model of the processes of the mouth and the oesophagus, parameterized to the individual. Once the food reaches the digestive system, all of the foregoing topics are largely irrelevant, other than to consider where the nutritional or therapeutic agents are extracted. The challenge of the oral intake of insulin is the best-known situation, but the delivery of chemotherapeutics is another area of challenges. It is necessary to shield the toxic therapeutic from the taste sensors and the digestive system so that it reaches the critical area of the digestive system intact. We are developing a comprehensive food design and manufacturing system that will allow each of these challenges to be met. We expect the first use of such system will be to expedite the recovery of seriously ill patients in hospitals. As enhanced testing procedures become more widely available through technological developments a wider use in the home is expected.

Keywords

Engineered Food, Nutritional, Therapeutic.

O94 The influence of an eight month multicomponent training program in edlerlies gait and bone mineral mass

António M Monteiro^1,2, Filipe Rodrigues^2,3, Pedro Forte^2,3, Joana Carvalho⁴

¹Department of Sports Sciences, Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal; ²Research Center in Sports Sciences, Health and Human Development, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal; ³Department of Sports Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Research Centre in Physical Activity Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal

Correspondence: Filipe Rodrigues (ptfiliperodrigues@gmail.com)

Background

Aging induces neuromuscular changes and mass, strength, muscular resistance and power, motor coordination, so, reaction and movement speed reduction may be compromised [1]. These changes result in slower movements and functional limitations in gait and weight transfer activities [1]. Even more, the functional fitness decreasing due to aging, increases the risk of falls and bone fractures [2], reducing the elderly’s quality of life.

Objective

Thus, the aim of this study was to assess the influence of an eight months multicomponent training program in elderly’s gait and bone mineral mass (BMM).

Methods

Forty-nine elderlies were recruited for this research with 64.39 (± 6.33) years old, 11 males with 67.45 (± 4.93) and 38 females with 63.50 (± 7.47) years old. The subjects were community living persons of Bragança. All procedures carried out in this research were in accordance to the Declaration of Helsinki. The multicomponent training program followed the Carvalho et al. [1], recommendations. Each session time volume was between 50 to 60 minutes. The sessions were divided in five parts: 1) general warm-up; 2) walking with aerobic exercises; 3) 1 to 3 sets of exercises of muscular resistance with 12 to 15 repetitions; 4) Static and dynamic balance training; 5) An active recovery period with stretching and breading exercises. The elderlies gait was evaluated with Berg Balance Scale (BBS) and BMM with bioimpedance (Tanita, BC-545). The Wilcoxon-Mann-Whitney test allowed to assess the differences between pre and post 8 months of the training program in BBS and BMM. The tests were performed with a significant level of 5%.

Results

The BBS values pre and post the multicomponent training program for BBS were 47.33 and 50.33 respectively. In BMM, the pre and post values were 2.36kg and 2.39 kg. Despite the differences in BMM means, they were not significant between the two moments (F = 1.253; p = 0.706). However, the same did not occur in terms of BMS values (F = 1.967; p< 0.001), where gait values increased significantly in the second moment.

Conclusions

Although the multicomponent training program did not increase the BMM in the elderly subjects, gait values increased significantly. Thus, it is possible to conclude that, the training program significantly improved the elderlies’ gait and quality of life.

References

1. Carvalho J, Marques E, Soares JM, Mota J. Isokinetic strength benefits after 24 weeks of multicomponent exercise training and a combined exercise training in older adults. Aging Clin Exp Res. 2010;22(1):63-69.

2. Miyamoto ST, Lombardi Júnior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological research. 2004;37(9):1411-1421.

Keywords

Elderly, Bone, Gait, Multicomponent, Training.

O95 Perception of virginity among Portuguese and Cape Verdeans university students – crossborder study

Sónia Ramalho^1,2, Carolina Henriques^1,2, Caceiro Elisa¹, 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

Virginity can be defined as the attribute of a person who has never been subjected to any type of sexual intercourse. To be aware of the sexual behaviour and virginity of young people is fundamental that nurses construct health education intervention programs in this specific area.

Objective

To know the perception of Portuguese and Cape Verdean university students about virginity.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of sociodemographic data and the perception scale on the loss of the virginity by Gouveia, Leal, Maroco and Cardoso (2010) [1]. A sample composed by 108 young people from the Republic of Cape Verde and 141 young Portuguese participated in the study. All formal and ethical procedures were taken into account.

Results

Young Portuguese university students presented a mean age of 20 years and 73% of the young people reported having started their sexual life at 17.00 years old, on average. The majority of the young people (66.7%) started their sexual activity with their boyfriends, using protection/contraception (70.9%). Young college students from Cape Verde had a mean age of 21.26 years, 69.4% reported having started their sexual life, on average, at 17.37 years. The majority (63.0%) started their sexual activity with their boyfriend, using protection/contraception (62.0%). Portuguese young people showed high levels of agreement with the ideal associated with the genital vision of loss of virginity (Md = 18.95, X_max = 25.00, X_min = 11.00), while Cape Verdean students had lower levels of agreement (Md = 12.34, X_max = 24.00, X_min = 5.00), showing in 41.7% of the cases, disagreement that 'a lesbian woman, who has never had sex with a man, is virgin and a 38.0% disagreement with the statement that “men who only practice oral sex, or anal sex or other forms of sex, do not lose their virginity”.

Conclusions

The study shows that there is still considerable lack of knowledge in young people about the conceptualization of virginity and a very genitalized view of it in the Portuguese young people, in lower agreement with the perception of young Cape Verdeans.

Reference

1. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de percepção sobre a perda da virgindade. In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 73-82.

Keywords

Young, Sexuality, Virginity, Portugal, Cape Verde

O96 Influence of a specific exercise program in the institutionalized elderly balance

Cátia Guimarães¹, Margarida Ferreira¹, Paula C Santos³, Mariana Saavedra²

¹Institute of Research and Advanced Training in Health, Sciences and Technologies, Cooperativa de Ensino Superior Politécnico e Universitário, 4585-116 Gandra, Portugal^{; 2}Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal^{; 3}Department of Physical Therapy, School of Health, Polytechnic Institute of Porto, 4400-330 Vila Nova de Gaia, Portugal

Correspondence: Margarida Ferreira (margasufer@gmail.com)

Objective

To determinate the effectiveness of a specific exercise program on balance and functional capacity of the daily activities of institutionalized elderly.

Methods

A randomized controlled trial. A total of 21 elderly were selected from the Santa Casa da Misericórdia de Santo Tirso and randomly distributed into experimental (n = 11) and control groups (n=10). The experimental group performed a specific program of exercises (resistance training, balance, coordination and flexibility) during 4 weeks, while the control group wasn’t subjected to any intervention. The primary outcome was balance, as measured with a Performance Oriented Mobility Assessment scale (POMA), and the secondary outcome measure included functional capacity by the Timed Up & Go test. Evaluations were carried out at the beginning and end of the exercise program, for both groups. The data were analysed with Statistical Package for Social Sciences, version 22.0, for all test procedures, a probability of p< 0.05 was considered to be statistically significant. Statistical analyses of POMA and TUG were performed with use of independent and paired t-test. POMA and TUG score association were analysed via the Pearson correlation, after the intervention.

Results

In the pre-intervention, groups were homogeneous (p < 0.05). After intervention, there were no statistically significant differences between groups in terms of the total balance and dynamic balance subscale, except static balance subscale (p < 0.048). In the functional capacity test, the experimental group reduced significantly the functional activity time into intragroup (p < 0.001), however there were no significant differences between groups (p < 0.633). After intervention, the experimental group had a significantly strong negative association (p = 0.001).

Conclusions

The results of this study demonstrated that this specific exercise program was not effective in terms of the total balance and functional ability of institutionalized elderly.

Trial Registration

NCT03521752

Keywords

Balance, Institutionalized elderly people, Therapeutic exercise, Functional capacity.

O97 Assessment of pain and effectiveness of analgesia in patient undergoing haemodialysis

Luís Sousa^1,2, Cristina Marques-Vieira³, Sandy Severino^2,4, Cristiana Firmino², Ana V Antunes², Helena José⁵

¹Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal; ²Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; ³Escola de Enfermagem de Lisboa, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal; ⁴Agrupamento de Centros de Saúde Loures-Odivelas, Administração Regional de Saúde de Lisboa e Vale do Tejo, 2685-101 Sacavém, Portugal; ⁵Instituto Superior de Saúde Multiperfil, Clínica Multiperfil, Luanda, Angola

Correspondence: Luís Sousa (luismmsousa@gmail.com)

Background

Pain is the most common symptom in patient’s undergoing haemodialysis, due to comorbidity, although it is frequently underdiagnosed [1-2]. Pain in these patients is not valued in its entirety and does not consider the limitations resulting in their quality of life [3]. The Brief Pain Inventory short form (SF-BPI) is the most widely used instrument and has the most number of foreign language translations [4].

Objective

To evaluate the prevalence of chronic pain, and intradialytic pain in patient undergoing haemodialysis, as well as the effectiveness of analgesic therapy.

Methods

Cross-sectional, descriptive and observational study. A random sample consisting of 172 patients undergoing haemodialysis in two clinics in the region of Lisbon, Portugal. The Brief Pain Inventory, which analyses the influence of pain in a patient’s life, was only applied to evaluate chronic pain [5]. The Visual Analogue Scale was used to assess the intradialytic pain. Tests were administered during dialysis sessions from May to June 2015. Categorical variables were expressed as percentages and continuous variables were expressed as mean standard deviations or medians. This study was approved by the Ethics Committee of Diaverum (N 1/2015).

Results

The sample consisted mostly of men (61.6%) of Portuguese nationality (80.7%), the mean age was 60 years (± 14.4), and patients were under haemodialysis treatment for 72.6 months (± 54.4). Chronic pain occurs in 54.1% of patients and intradialytic pain in 75%. The causes of pain were musculoskeletal (69.3%), associated to vascular access (19.3%) and other causes (11.4%). Chronic pain was most commonly located in the legs (43.2%), followed by back (21.6%) and vascular access (19.3), head (8%), arms (4.5%), abdomen (2.3%) and, lastly, chest (1.1%). The percentage of patients that took analgesics for chronic pain was much higher (62.0%), of these 87.8% are non-opiates, 10.2% weak opiates and 2% strong opiates. The other therapeutic interventions referred were: rest (24.1%), massage and relaxation (6.3%), cryotherapy (1.3%), exercise (1.3%), while 5.1% reported doing nothing. The effectiveness of the treatment was successful for chronic pain, in 62.6% of the patients, there was a relief felt of over 50%.

Conclusions

Pain of musculoskeletal origin is a frequent symptom in our sample. The pharmacological management of chronic pain is the most applied intervention.

References

1. Pelayo Alonso R, Martínez Álvarez P, Cobo Sánchez JL, Gándara Revuelta M, Ibarguren Rodríguez E. Evaluación del dolor y adecuación de la analgesia en pacientes en tratamiento con hemodiálisis. Enferm Nefrol. 2015;18(4):253-259.

2. Calls J, Rodríguez CM, Hernández SD, Gutiérrez NM, Juan AF, Tura D, Torrijos J. An evaluation of pain in haemodialysis patients using different validated measurement scales. Nefrologia. 2009;29(3):236-243.

3. Ahís Tomás P, Peris Ambou I, Pérez Baylach CM, Castelló Benavent J. Evaluación del dolor en la punción de una fístula arteriovenosa para hemodiálisis comparando pomada anestésica frente a frío local. Enferm Nefrol. 2014;17(1):11-15.

4. Upadhyay C, Cameron K, Murphy L, Battistella M. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools. Clin Kidney J. 2014;7(4):367-372.

5. Sousa LM, Marques-Vieira CM, Severino SS, Pozo-Rosado JL, José HM. Validación del Brief Pain Inventory en personas con enfermedad renal crónica. Aquichan. 2016;17(1):42-52.

Keywords

Renal Insufficiency, Chronic, Renal Dialysis, Quality of life, Pain.

O98 Prevalence of musculoskeletal symptoms in nursing students

Cristiana Firmino^1,2, Luís Sousa^2,3, Joana M Marques^2,5, Fátima Frade², Ana V Antunes², Fátima M Marques⁴, Celeste Simões⁶

¹Hospital Cuf Infante Santo, 1350-070 Lisboa, Portugal; ²Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal; ³Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal; ⁴Escola de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; ⁵Centro de Medicina de Reabilitação de Alcoitão, 2645-109 Alcabideche, Portugal; ⁶Faculdade de Motricidade Humana / Instituto de Saúde Ambiental, 1495-687 Cruz Quebrada, Portugal

Correspondence: Cristiana Firmino (furtado.cristy@gmail.com)

Background

Musculoskeletal symptoms are the most common conditions in society, being indicated as one of the main factors of disability during the life cycle of an individual [1-2]. Students are exposed to the factors that can trigger these musculoskeletal symptoms [3], both during class periods and clinical teaching. Prevalence of musculoskeletal pain is higher in the cervical region among nursing students of 1st year and 2nd year, and lower back in nursing students of the 3rd and 4th years [4].

Objective

To determine the prevalence of musculoskeletal symptoms in nursing students.

Methods

Cross-sectional and descriptive study. One hundred and fifty-five (155) nursing students from two nursing schools in Lisbon participated in this study. The data collection instrument consisted on sociodemographic and health behaviour variables and the Nordic musculoskeletal questionnaire (NMQ). The NMQ consists of 27 binary choice questions (yes or no) [5]. The variables were expressed as percentages. This study was approved by the Ethics Committee of two nursing’s schools.

Results

83.23% of the sample are females, single (88.38%) and 32.26% are working students. 81.94% are non-smoking; 87.1% do not usually ingest alcoholic drinks; 65.81% use a backpack and 23.23% carry objects on their way to school. 49.03% spend between 2 and 4 hours on the computer and electronic devices and 42.58% spend more than 4 hours. 71% spend more than 4 hours seated during classes. 85.8% had no training prevention of musculoskeletal injuries. The prevalence of musculoskeletal symptoms by location of the aches, pain, discomfort and numbness were as following: 66.23% in the neck; 52.29% shoulders; 7.24% elbows; 39.47% wrists/hands; 20.53% upper back; 69.33% lower back; 15.33% hips/thighs, 32% knees and 22.82% ankles/feet.

Conclusions

The most frequent aches, pain, discomfort, numbness location are located on the neck, shoulders and lower back. The main causes related to musculoskeletal injuries are the transportation of weights, use of computer and electronic devices and to be seated for long periods of time. It is recommended the implementation of prevention strategies in order to reduce the occurrence of musculoskeletal injuries.

References

1. Abledu JK, Offei EB. Musculoskeletal disorders among first-year Ghanaian students in a nursing college. Afr Health Sci. 2015;15(2):444-449.

2. Alhariri S, Ahmed AS, Kalas A, Chaudhry H, Tukur KM, Sendhil V, Muttappallymyalil J. Self-reported musculoskeletal disorders and their associated factors among university students in Ajman, UAE. Southern Med J. 2016;5(S2):S61-70.

3. Martins AC, Felli VE. Sintomas músculo-esqueléticos em graduandos de enfermagem. Enferm Foco. 2013;4(1):58-62.

4. Nunes H, Cruz A, Queirós P. Dor músculo esquelética a nível da coluna vertebral em estudantes de enfermagem: Prevalência e fatores de risco. Rev Inv Enferm. 2016;II(14):28-37.

5. Mesquita CC, Ribeiro JC, Moreira P. Portuguese version of the standardized Nordic musculoskeletal questionnaire: cross cultural and reliability. J Public Health. 2010;18(5):461-466.

Keywords

Nursing Students, Musculoskeletal Pain, Prevalence, Cross-Sectional Studies.

O99 Eating habits: determinants of Portuguese adolescents’ choices

Susana Cardoso¹, Carla Nunes¹, Osvaldo Santos², Isabel Loureiro¹

¹Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal; ²Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal

Correspondence: Susana Cardoso (suscardoso@yahoo.com.br)

Background

Proper eating habits are crucial to a healthy life. It is important to understand the determinants of eating choices made at adolescence because this stage of life is paramount for the formation of lifelong enduring habits.

Objective

To identify determinants of eating choices based on adolescents' perception and characterizing them, in particular, to the level of relevance attributed by adolescents.

Methods

A cross-sectional study was carried out, based on a sample of 358 adolescents (14-18 years old) from two schools of Coimbra. First, a quantitative study was carried out using the scales: EHA (eating habits scale), TAA-25 (eating attitudes test) and GSQ (general self-efficacy scale). In a second step, a qualitative study was carried out with subgroups that were selected from the results of the first phase of the study. These subgroups presented opposite patterns of habits (group A: better eating habits - EHA≥160 and group B: worst habits - EHA≤125) and we moved into a grounded theory approach with semi-structured individual interviews.

Results

Gender emerges as a determinant of eating choices pattern, with girls assuming more adequate eating habits (t =3.84; p <. 0001; r²adjusted= .037, p< .0001). The perception of general self-efficacy assumes greater relevance for boys, functioning as a protective factor that reduces unhealthy options. Through multinomial regression models, we could see that gender and general self-efficacy have a big influence on eating habits. The ideals of beauty have influence on this effect. Resisting adversity has an important influence in the choices, being associated to self-regulation. The situations of risk to develop an eating behaviour disturbance appear mainly in the cases of adolescents presenting better habits (r_SP= .203; p < .001) and are more frequent in girls (t = 3.54; p < .0001; OR = 4.04). Through content analysis it was possible to identify determinant factors that were perceived by adolescents in both groups. The ones that were more often mentioned (in a decreasing order) were family influence, taste preferences, knowledge of healthy eating rules and availability. This was followed by determinants such as self-control capacity, feeling well or bad, peer influence, feeling hungry or full, developing a task or not, impulsiveness, time available and humour/stress.

Conclusions

The differences found between sexes can justify differentiated interventions. Our results also suggest the relevance to work on self-image. Family must be considered as an integrating part of the interventions in health education. Political measures taken by schools and government agents can also have a very important role in making healthy choices easier.

Keywords

Adolescents, Eating habits, Determinants.

O100 The influence of regular sports practice on motor skills and student’s physical fitness

Júlio Martins^1,2, João Cardoso¹, José Reis¹, Samuel Honório³

¹University of Beira Interior, 6201-001 Covilhã, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal; ³School of Education, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal

Correspondence: Samuel Honório (samuelhonorio@hotmail.com)

Background

Sports practice develops several motor skills that help practitioners not only in game, but also brings benefits to their physical fitness. Practitioners develop an effective motor response and quick solutions to daily situations.

Objective

Determine if the regular practice of sports influences or not motor skills, physical fitness and body composition of students. We wish also to identify the correlation between the performance of students in specific motor skills tests of football, physical fitness and body composition.

Methods

The sample consisted in 160 (divided in two groups of 80) male students, 12-year-old, living in Madeira and that practice football regularly. One group of students had an extracurricular physical activity beyond curricular physical activity (Federated Sports), and the other group entails students who only practice physical activities as a curricular activity (School Sport). Body composition (BMI and %BF) were also evaluated by Fitnessgram. To evaluate motor abilities the software Predictive Analytics Software – PASW was applied.

Results

After analysing the results, we became aware that students with extracurricular physical activities had better results in motor skills than students with curricular physical activities. This result is perhaps the less surprising in the set of all assessments due to the longer physical commitment of these students in relation to the students that only exercise in the context of curricular activities. Regarding physical fitness, students with extracurricular physical activity can have more students in HFZ (healthy fitness zone) than students with curricular physical activity. Regarding the arms extension and flexion, 26% of the students with curricular physical activity are above HFZ, achieving better performance than the students that have extracurricular physical activity. According to the skills measured, the students with extracurricular physical activities achieve a relatively higher average than students with curricular physical activities. Regarding body composition and after determining the BMI and %BF of each group, it appears that students with extracurricular physical activities achieve better results than those achieved by the students of curricular physical activities.

Conclusions

The regular practice of sports with curricular and extracurricular physical activities, seems to contribute to an improvement of physical fitness, motor skills and body composition of students, keeping them in a healthy fitness zone, thus preventing premature cardiovascular diseases, among others.

Keywords

Motor Skills, Physical Fitness, Body Composition, Federated Sports, School Sports.

O101 Promotion of language skills in children aged 5-6 years, without language disorders

Tiago Rodrigues, Catarina Mangas

School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Tiago Rodrigues (tiagoac.rodrigues@gmail.com)

Background

Language is a human faculty that enables communication with various interlocutors. This appears early and develops, exponentially, in the early years of life. For such, it is important that the surrounding environment is stimulating and allows the exchange of experiences with other speakers. The pre-school age is a milestone in the development, not only for stimulation, but also to identify deviant behaviours. In order to avoid future complications, professionals who deal with these children should prevent any language disorders. The speech and language therapist, being a health professional trained to deal with the areas of communication and language, has a prominent role in this preventive action. In Portugal, there aren't many references concerning prevention in language disorders. As such, it is necessary to promote a definite change in the present scenario, namely with innovative and stimulating materials to develop language.

Objective

Therefore, this is an exploratory-descriptive study, with a qualitative-quantitative paradigm and the general objective of this study was “to create and implement a Language Skills Promotion Program for 5-6 year-old children without any language disorders, in order to analyse their potential influence on their language skills”.

Methods

To this end, a 10-session program was build, evaluated and validated by a panel of experts. Before the beginning of the program, all the sample children were evaluated with a language test for preschool age. A sample of 12 children, divided equally in two groups, was selected and the program was applied by a Speech and Language Therapist only to one of these groups. At the same time, the Childhood Educator’s opinion was collected in order to understand the influence of the respective program on the children's language skills.

Results

The final results of the study show that children who participated in the program improved their language skills, which was not the case of the children who did not take part in that same study. These results prove that the investment in prevention actions, through the promotion of language skills, enhances the oral and written language skills of children, especially in terms of literacy, something that is indispensable for their educational success.

Conclusions

Finally, the study also emphasizes the importance of primary prevention actions, such as the application and development of programs to stimulate or organize information actions, with a view to promoting the health and the well-being of society in general.

Keywords

Child language, Child-rearing, Early intervention, Prevention, Speech therapy.

O102 The impact of a training program on the performance of nurses working at a chemotherapy ward

Joana M Silva, Isabel M Moreira, Anabela Salgueiro-Oliveira

Nursing School of Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Joana M Silva (joanamota19@gmail.com)

Background

Oral mucositis (OM) is the major complication reported by patients undergoing chemotherapy and/or radiotherapy, with a strong impact on their quality of life by compromising physical and psychological functions [1]. OM affects 40-76% of patients undergoing chemotherapy and up to 90% of patients undergoing radiotherapy [3,4]. Inadequate oral hygiene is a patient-related risk factor in which health professionals can intervene [5,7], namely nurses [6]. Oral examination allows diagnosing the different stages of OM and establishing an individualized care plan.

Objective

To assess the impact of a training program on the performance of nurses working at a chemotherapy ward regarding OM risk assessment and prevention in cancer patients.

Methods

This action-research study aimed to identify nurses' interventions in patients with or at risk for OM. Data were collected from the nursing records of 110 patients between October and November 2016 in order to analyse the nursing documentation pattern based on an evidence-based grid. Data were analysed using descriptive statistics. The discussion with the team nurses about the results obtained in the document analysis was used to design a three-session training program. The next step was to reanalyse the nursing documentation pattern with the purpose of identifying positive changes in the aspects under study. The study was approved by the Ethics Committee.

Results

The analysis of the documentation pattern showed that 31.8% of the patients were not asked about oral hygiene practices, although 25.7% of the sampled patients were in the 1st cycle of chemotherapy. A total of 21.9% of patients were not observed during oral hygiene care. Only 14.5% of patients were given instructions about the treatment of side effects, and only 12.5% of them were given instructions about oral hygiene care. Only 2.7% of the patients had their oral cavity/mucous membranes examined, and all of them were diagnosed with OM. The implementation of the training program led to the introduction of standardized records for oral cavity surveillance. Nurses showed high adherence levels to this practice and considered it very relevant in clinical practice.

Conclusions

The research results show that nurses do not perform a systematic diagnostic evaluation of patients’ oral cavity and that few patients receive instruction on oral hygiene care, which does not contribute to patient empowerment in this area. The implementation of the training program showed that nurses recognize the need for and are committed to changing practices in this area.

References

1. Yarbro CH, WujciK D, Gobel B H. Cancer Nursing: Principles and Practice. 8^th edition. Destin, Florida: Jones & Bartlett Publishers; 2016.

2. Eilers J, Harris D, Henry K, Johnson L. Evidence-based interventions for cancer treatment – Related mucositis: Putting evidence into practice. Clin J Oncol Nurs. 2016;18:80-96.

3. Peterson D, Boers-Doets C, Bensadoun R, Herrstedt J. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Annals of Oncology. 2015;26(Suppl 5):139-151.

4. Araújo S, Luz M, Silva G, Andrade E, Nunes L, Moura R. O paciente oncológico com mucosite oral: desafios para o cuidado de enfermagem. Rev. Latino-Am. Enfermagem. 2015;23(2):267-274.

5. Gondin F, Gomes I, Firmino F. Prevenção e tratamento da mucosite oral. Rev. enferm. UERJ. 2010;18(1):67-74.

6. Eilers J, Million R. Clinical update: Prevention and management of oral mucositis in patientes with cancer. Semin Oncol Nurs. 2011;27(4):e1-16.

7. Teixeira S. Mucosite oral em cuidados paliativos (Dissertação de mestrado em oncologia – Especialização em enfermagem oncológica). Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. 2010.

8. Kuhne GW, Quigley BA. Understanding and Using Action Research in Practice Settings. In Quigley BA, Kuhne GW, editors. Creating Practical Knowledge Trough Action Research: Posing Problems, Solving Problems, and Improving Daily Practice. San Francisco: Jossey-Bass Publishers. 1997. p. 23-40.

Keywords

Oral mucositis, Nursing care, Oncology.

O103 Styles of conflict management and patient safety

Anabela Almeida¹, Sara Cabanas², Miguel C Branco¹

¹Universidade da Beira Interior, 6200-001 Covilhã, Portugal; ²Centro Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal

Correspondence: Anabela Almeida (aalmeida@ubi.pt)

Background

Health is a demanding scenario of changes and successive adaptations that, very easily, allows the emergence of differences between the involved and conflicts between professionals. Ineffectively managed conflicts in health organizations reduce quality, compromise safety, and increase the costs of health care delivery, secondarily to the goals of being effective and efficient.

Objective

Thus, the general objective of the study is to investigate the relationship between the conflict management styles used and the level of patient safety climate among the clinical services professionals at Hospital Pêro da Covilhã of CHCB.

Methods

The research is of a quantitative nature, of a descriptive and correlational character and of a transverse nature. The sample is non-probabilistic, consisting of 137 health professionals who work at CHCB. The use of ROCI-II and SAQ allowed the evaluation of the styles of conflict management and the perceptions of attitudes of health professionals related to patient safety.

Results

The results show that professionals, in all relations with the opponent, opt preferentially for collaboration, with competition being the least common style of conflict management. There were no differences in the styles of conflict management used in relation to the opponent. The participants presented positive attitudes towards the patient's safety, and it was verified that the professionals perceived a lower security relative to the dimension of management's perception and greater in relation to the dimensions of job satisfaction and recognition of stress, which show the highest values. The relationship between conflict management styles and the security climate level was verified. There is an association between literacy and conflict management styles, and years of service and conflict management styles. Regarding the ordinal independent variables, all are associated with the perceptions of the security climate.

Conclusions

Gender, marital status, integration period, function and years of service, influence the conflict management styles used; and age, gender, choice of service, integration period, function, area of service and years of service, influence the perceptions of professionals' attitudes related to patient safety.

Keywords

Conflict, Conflict management, Patient safety, Safety climate.

O104 Influence of a rehabilitation nursing care program on quality of life of the patients undergoing cardiac surgery

José Moreira, Jorge Bravo

Department of Sports and Health, School of Science and Technology, University of Évora, 7000 Évora, Portugal

Correspondence: José Moreira (jafonsomoreira@gmail.com)

Background

Cardiac rehabilitation (CR) is fundamental in the treatment of patients undergoing cardiac surgery (CS) regarding the educational, physical exercise and quality of life dimensions. Considering the competences of Specialist Nurses in Rehabilitation Nursing (SNRN) and the current prevalence of risk factors associated with cardiovascular disease, it is essential to implement programs in this area.

Objective

To assess the impact of SNRN interventions on a CR program during hospitalization (phase I) and 1 month after CS (phase II).

Methods

Participants (n = 11) submitted to CS, of both sexes, between 25 and 64 years of age (61.09 ± 7.09 years), that according to the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation, met the criteria for low or moderate risk, class B for participation and exercise supervision, absence of signs/symptoms after CS, with a left ventricular ejection fraction greater than 40%. Supervised interventions were performed during hospitalization, pre- and post-cardiac surgery, and 1 month after hospital discharge. In phase II, a physical exercise program was fulfilled according to the norms of the American College of Sports Medicine, comprising 3 sessions of physical exercise per week lasting between 30 to 60 minutes, including heating, aerobic exercise and recovery/stretching. Hemodynamic data (blood pressure, heart rate, peripheral oxygen saturation, pain) and the Borg scale were recorded in the initial, intermediate and final periods of each session. The aerobic capacity was evaluated through the 6-minute Walk Test and the health-related quality of life using the Short Form Health Survey 36 (SF-36V2) questionnaire.

Results

Significant statistical improvements were observed in the time/walk relationship, such as the increase in the respective functional capacity (p = 0.05) and quality of life (in various domains). During the hospitalization, the subjective perception of the effort of session to session decreased in 81.82% of the participants. T-test for independent samples revealed that differences in resting heart rate (phase I) were not significant, however, the difference in distances was significant at a 95% confidence level.

Conclusions

Nursing rehabilitation care is essential to improve the quality of life of patients undergoing CS in a phase I and II rehabilitation program. The benefits of CR programs are evident when initiated early after CC, reinforcing the need to increase their implementation in the rehabilitation of cardiovascular disease. Although the reduced sample size, the results represent a basis for future studies with a larger number of participants and a longer intervention period after CC.

Trial Registration

NCT03517605

Keywords

Cardiac Rehabilitation, Quality of Life, Rehabilitation Nursing.

O105 Study of knee arthroplasty in the elderly population with agricultural activity

Carla Costa¹, Jorge Nunes^2,3, Ana P Martins⁴

¹Faculdade de Ciências da Saúde, Universidade da Beira Interior, 6200-506 Covilhã, Portugal^{; 2}Universidade da Beira Interior, 6200-001 Covilhã, Portugal^{; 3}Centro Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal^{; 4}Centro de Matemática e Aplicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal

Correspondence: Carla Costa (csofia_29@hotmail.com)

Background

Arthrosis is a major cause of pain, disability and loss of quality of life [1]. It affects the knee of elderly, overweight people and women frequently, and is influenced by articular overload, that occurs in Agriculture [2-9]. The majority of the individuals submitted to Total Knee Arthroplasty (TKA) refer significant decrease of knee pain and increase of knee functionality [1]. In this context, there are no studies on the recovery of elderly if they return to Agriculture after TKA.

Objective

Realize if elderly people between 65 and 80 years old, patients of Pêro da Covilhã Hospital, with Agricultural activity before surgery and submitted to TKA, with medial approach and posterior cruciate ligament sacrifice for the first time, can return to Agriculture and how long does it take; otherwise, identify the reasons for the interruption. Secondarily, analyse if Body Mass Index (BMI), gender, job, among others, influence this return.

Methods

This is an observational retrospective study with 38 patients between 65 and 80 years old submitted to TKA. Data was collected through clinical processes and patients self-report Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and analysed on SPSS and R software (statically significant p < 0.05).

Results

Of the 38 patients, 76.3% were female. Average age was 72.21 ± 4.50 and 75.13 ± 5.01 years old at the time of TKA and at the time of the questionnaire, respectively. On both moments the majority of the individuals had overweight or obesity. 84.2% returned to Agriculture (81.2% partially and 18.8 % fully), on average 6.34 ± 4.90 months after TKA. The median age at the surgery of the seniors who didn’t return to Agriculture is superior to the one of the seniors who returned (p = 0.025). The higher score in Stiffness and the lowest total score on WOMAC was seen in the individuals who returned four or more months after TKA (p = 0.0125 and p = 0.026, respectively).

Conclusions

The majority of the individuals between 65 and 80 years old, with Agricultural activity before surgery and submitted to TKA with medial approach and posterior cruciate ligament sacrifice, can return to Agriculture, in 6 months. Most of them don’t return fully. The most cited reason was surgery consequences. The median age at the time of TKA of the seniors who didn’t return is superior to the one of the seniors who returned. A worst score in Stiffness and a better Total score was seen in the seniors who took longer to return to Agriculture.

References

1. Surgeons TAA of O. Artroplastia total de joelho (Total Knee Replacement ). OrthoInfo. 2017. p. 1–10.

2. Saúde DDA. Programa Nacional Contra as Doenças Reumáticas. Lisboa; 2005.

3. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(4):507–515.

4. Alfieri FM, Silva NCOVE, Battistella LR. Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis. Einstein (São Paulo. 2017;15(3):307–12.

5. Toivanen AT, Heliövaara M, Impivaara O, Arokoski JPA, Knekt P, Lauren H, et al. Obesity, physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis-a population-based study with a follow-up of 22 years. Rheumatology. 2010;49(2):308–14.

6. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil. 2005;13(9):769–81.

7. Pua YH, Seah FJ, Seet FJ, Tan JW, Liaw JS, Chong HC. Sex Differences and Impact of Body Mass Index on the Time Course of Knee Range of Motion, Knee Strength, and Gait Speed After Total Knee Arthroplasty. Arthritis Care Res. 2015;67(10):1397–405.

8. Liljensøe A, Lauersen JO, Søballe K, Mechlenburg I. Overweight preoperatively impairs clinical outcome after knee arthroplasty: a cohort study of 197 patients 3–5 years after surgery. Acta Orthop. 2013;84(4):392–397.

9. Kennedy JW, Johnston L, Cochrane L, Boscainos PJ. Total knee arthroplasty in the elderly: Does age affect pain, function or complications? Clin Orthop Relat Res. 2013;471(6):1964–1969.

Keywords

Knee, Arthrosis, Elderly, Agriculture, Arthroplasty.

O106 Teachers Acceptance and Action Questionnaire Portuguese version (TAAQ-PT): factor structure and psychometric characteristics

Ana Galhardo^1,2, Bruna Carvalho¹, Ilda Massano-Cardoso¹, Marina Cunha^1,2

¹Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; ²Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal; ³Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Ana Galhardo (anagalhardo@ismt.pt)

Background

Teaching has the potential to provide high satisfaction levels but it is described as a demanding profession with multiple sources of stress. Teachers’ psychological well-being is essential not only for themselves abut also for students. Experiential avoidance of private events (e.g., thoughts, feelings, body sensations) has been pointed as a key construct linked to psychopathological symptoms. The Teachers Acceptance and Action Questionnaire (TAAQ) is a teacher-specific measure developed to target experiential avoidance related to the teaching activity.

Objective

The current study sought out to develop the Portuguese version of Teachers Acceptance and Action Questionnaire (TAAQ-PT), explore its factor structure and psychometric properties in a sample of Portuguese teachers teaching in the 1st, 2nd and 3rd basic cycles and secondary education.

Methods

A sample of 304 teachers, 256 women (84.2%) and 48 men (15.8%) was recruited through teachers’ professional associations. Participants completed online a sociodemographic and professional questionnaire and a set of self-report instruments: the TAAQ-PT, the Depression Anxiety and Stress Scale 21 (DASS – 21), the Utrecht Work Engagement Scale (UWES), and the Five Facet Mindfulness Questionnaire (FFMQ). TAAQ-PT confirmatory factor analysis was conducted and reliability and validity were estimated.

Results

The TAAQ-PT revealed a single factor structure. Correlated measurement errors were specified for items 5 and 7, 3 and 10, and 8 and 9 due to similar phrasing. The one factor model, which specified method effects between those items, fits the data well: χ²/gl = 1.55, CFI = .99, GFI = .97, RMSEA = .043, MECVI = .321. The TAAQ-PT presented a Cronbach alpha of .91. Additionally, composite reliability (CR) was calculated, and a value of .95 was found. The TAAQ-PT presented significant negative correlations with mindfulness facets (r = -.60; p <.01), and work engagement (r = -62, p <.01), and positive correlations with negative emotional symptoms of depression (r = .69; p <.01), anxiety (r = .63; p <.01) and stress (r = .70; p <.01).

Conclusions

Similar to the original version, confirmatory factor analysis revealed that the single-component model fits the data well. It showed good internal consistency, and correlations with other mental health measures suggested good convergent and discriminant validity. The TAAQ-PT was found to be a valid and reliable measure of experiential avoidance in teachers to be used in clinical and research contexts.

Keywords

Experimental avoidance, Teachers, Confirmatory factor analysis, Psychometric properties.

O107 Youth sports injuries according to health-related quality of life and parental instruction

Lara C Silva^1,2, Júlia Teles^2,3, Isabel Fragoso^1,2

¹Laboratory of Physiology and Biochemistry of Exercise, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal; ²Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal; ³Mathematics Unit, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal

Correspondence: Lara C Silva (laras@uatlantica.pt)

Background

Participation in physical activity involves a risk of injury that has a considerable public health impact [1]. Sports injuries are the major cause of morbidity among children and adolescents in developed countries [2]. They account for half of all injuries in school age children. The relationship between sports injuries, health-related quality of life (HRQoL) and parental instruction is still not clear.

Objective

Determine sports injuries biosocial predictors in Portuguese youth.

Methods

Information about HRQoL, parental instruction and sports injuries was assessed via three questionnaires; KIDSCREEN-52 [3,4], RAPIL II [5,6] and LESADO [1,7,8] respectively. They were filled by 651 subjects aged 10 to 18 years, attending four Portuguese community schools. Univariate analyses were used to verify significant differences between groups. Logistic, linear and multinomial regression analyses were used to determine significant biosocial predictors of injury, injury rate, injury type and body area injury location.

Results

Injury rate was higher in boys with lower scores in the school environment dimension of KIDSCREEN-52 (p = .022) and in girls was higher in those with lower scores in the moods and emotions dimension (p .001) and higher scores in the self-perception dimension (p < .001). Also in girls, upper limbs injuries were associated with higher scores in the moods and emotions dimension, and the spine and torso with lower scores (p = .037). Lower limbs injuries were associated with lower parents’ education and upper limbs (p = .046) and spine and torso (p = .034) injuries with higher parents’ education.

Conclusions

Surprisingly given the large number of injuries resulting from participation in sports and the associated high costs of health care, very few investigations have been conducted into biosocial variables and their relation to sports injuries. Injuries in the Portuguese youth were linked to three dimensions of KIDSCREEN-52 (moods and emotions, self-perception and school environment) and parents education level. Sports injuries usually result from the combination of several risk factors interacting at a given time [9]. Understanding the role of social and environmental factors related to sports injuries is needed, as they can be a part of this complex equation.

Acknowledgements

We would like to express our immeasurable gratitude to Ana Lúcia Silva and João Albuquerque for helping in data collection, and Carlos Barrigas for evaluating all x rays. We also thank to Escola Básica 2,3 Professor Delfim Santos, Agrupamento de escolas de Portela e Moscavide and Escola Secundária Quinta do Marquês, for making both their infrastructures and students available for the study and to all participants for their time and effort. Lara Costa e Silva, Ana Lúcia Silva e João Albuquerque were supported by a scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/77408/2011), (SFRH/BD/91029/2012), and PTDC/DES/113156/2009, respectively) and by the Interdisciplinary Center for the Study of Human Performance (CIPER).

References

1. Costa e Silva L, Fragoso I, Teles J. Prevalence and injury profile in Portuguese children and adolescents according to their level of sports participation. J Sports Med Phys Fitness. 2018 Mar;58(3):271-279.

2. Williams JM, Currie CE, Wright P, Elton RA, Beattie TF. Socioeconomic status and adolescent injuries. Soc Sci Med . 1997;44(12):1881–1891.

3. The Kidscreen Group. Description of the KIDSCREEN instruments. KIDSCREEN-52, KIDSCREEN-27 & KIDSCREEN-10 index. Health Related Quality of Life Questionnaires for Children and Adolescents. 2004. Report No.: EC Grant Number: QLG-CT-2000-00751.

4. Janssens L, Gorter JW, Ketelaar M, Kramer WLM, Holtslag HR. Health-related quality-of-life measures for long-term follow-up in children after major trauma. Qual Life Res. 2008;17(5):701–13.

5. Varela-Silva M, Fragoso I, Vieira F. Growth and nutritional status of Portuguese children from Lisbon, and their parents. Notes on time trends between 1971 and 2001. Ann Hum Biol. 2010;37:702–716.

6. Fragoso I, Vieira F, Barrigas C, Baptista F, Teixeira P, Santa-Clara H, et al. Influence of Maturation on Morphology, Food Ingestion and Motor Performance Variability of Lisbon Children Aged Between 7 to 8 Years. In: Olds T, Marfell- Jones M, editors. Kinanthropometry X Proceedings of the 10th Conference of the International Society for the Advancement of Kinanthropometry (ISAK). London: Routledge; 2007. p. 9–24.

7. Costa e Silva L, Fragoso MI, Teles J. Physical Activity–Related Injury Profile in Children and Adolescents According to Their Age, Maturation, and Level of Sports Participation. Sports Health. 2017;9(2):118–125.

8. Pires D, Oliveira R. Lesões no sistema musculo-esquelético em tenistas portugueses. Rev Port Fisioter no Desporto. 2010;4(2):15–22.

9. Powell J, Barber-Foss K. Injury patterns in selected high school sports: A review of the 1995-97 seasons. J Athl Train. 1999;34(3):277–84.

Keywords

Sports Injuries, Children and Adolescents, Health Related Quality of Life, Parental Instruction.

O108 The influence of moderate- to vigorous-intensity activity on the physical fitness of non-institutionalised elderly people

Fernanda Silva¹, João Petrica^1,2, João Serrano^1,2, Rui Paulo^1,3, André Ramalho^1,3, José P Ferreira⁴, Pedro Duarte-Mendes^1,3

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

As a result of the ageing process, there is evidence of a decline in physical aptitude (strength, endurance, agility and flexibility) associated with a lower performance in the activities of daily living [1]. Physical activity plays therefore a key role in maintaining the health and physical fitness of the elderly [2]. The recommendations on physical activity for health suggest that the elderly should perform at least 30 minutes of moderate- to vigorous-intensity activity per day [3, 4].

Objective

The aim of this paper is to accurately quantify physical activity time in the elderly and to verify the existence of differences regarding physical fitness levels between two groups of people: those who complied and those who did not comply with the Global Recommendations on Physical Activity for Health [4].

Results

This cross-sectional study sample includes 36 elderly individuals (72.28 ± 6.58 years old), both male and female, divided into two groups: the group which has fulfilled the recommendations (N = 16; 53.76 ± 24.39 minutes) and the group that has not fulfilled the recommendations (N = 20; 15.95 ± 7.79 minutes). Physical activity was assessed for 3 consecutive days and 600 minutes of daily recording, at least. The ActiGraph® GT1M Accelerometer was hence used. The “Functional Fitness Test” battery (Rikli and Jones) was used to assess the physical and functional autonomy of the elderly [5]. 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

On average, participants spent more time in sedentary activities than in physical activity. The group which has fulfilled the recommendations on physical activity has achieved better results on almost all physical fitness tests: 30 s chair stand (repetitions), arm curl (repetitions), 6-minute walk test (m), 8-foot up-and-go (s). However, no significant difference was found between the groups.

Conclusions

The results therefore suggest that only 44.4% of the evaluated participants complied with the Global Recommendations on Physical Activity for Health. Evidence also suggests that the adherence to these guidelines might have a positive influence on the physical fitness of the elderly, particularly muscular strength, endurance and agility, but not flexibility.

Acknowledgements

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

References

1. Tuna HD, Edeer AO, Malkoc M, Aksakoglu G. Effect of age and physical activity level on functional fitness in older adults. Eur Rev Aging Phys Act. 2009;6:99–106.

2. Nawrocka A, Mynarski W, Cholew J. Adherence to physical activity guidelines and functional fitness of elderly women, using objective measurement. Ann Agr Env Med. 2017;24:632-635.

3. 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

4. Department of Health. Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Department of Health; 2011. Available from: https://www.sportengland.org/media/2928/dh_128210.pdf.

5. Rikli R, Jones C. Development and validation of a funcional fitness test for community- residing older adults. J Aging Phys Activ. 1999;7:129-161.

Keywords

Physical fitness, Elder, Physical activity, Recommendation.

O109 Effects of strength and conditioning programs in strength and dynamic balance in older adults

Rogério Salvador^1,2, Luís Coelho^1,2, Rui Matos^1,2, João Cruz^1,2, Ricardo Gonçalves^1,2, Nuno Amaro^1,2

¹School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Life Quality Research Centre, 2001-904 Santarém, Portugal

Correspondence: Rogério Salvador (rogerio.salvador@ipleiria.pt)

Background

To independently accomplish their daily routines with no need of assistance, older adults require an optimal physical fitness. In fact, this lack of physical fitness may reduce older individuals’ quality of life, leading to dependence on personal daily assistance or even to becoming significantly more prone to fatal falls [1]. Prevention through physical activity programs, are used to slow down and delay these aging effects, by improving individuals’ agility, flexibility and body improved functionality. Most of these programs take place in in-water environment due to age limiting factors such as high-risk osteoporosis, reduced mobility, higher risk of fracture from falls, arthrosis and spinal disorders among other.

Objective

To assess the effects of two strength and conditioning programs in strength and dynamic balance in older adults.

Methods

One hundred elderlies (36 males and 64 females) aged 67.3 ± 5.2 years old enrolled the 5-year long intervention program and were assessed for lower body strength (LBS) and dynamic balance (DB). Two intervention programs were set up and subjects were included in each group according to their own will. Program A (n = 52; 24 males and 28 females; age 67.2 ± 5.2 y-o) consisted of 1 in-water session and 2 in dry-land sessions per week. Program B (n = 48; 12 males and 36 females; age 67 ± 5.2 y-o) consisted of 2 in-water sessions and 1 in dry-land session per week. 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 [2].

Results

Combined data from both programs showed that LBS and DB improved significantly at the end of the intervention programs: LBS from 18.3±3.2 reps to 18.8±3.1 reps (p=0.003; r=-0.295), DB 4.2±0.7 secs to 4.0±0.7 secs (p=0.017; r=-0.245). Program A significantly improved LBS from 19.1±2.8 reps to 19.9±2.7 reps (p=0.001; r=-0.465) but not DB 4.1±0.7 secs to 4.0±0.7 secs (p=0.083; r=-0.240). No differences were found neither in Program B LBS – 17.5±3.4 reps to 17.6±3.1 reps (p=0.462; r=-0.106) – nor DB - 4.2±0.6 secs to 4.1±0.6 secs (p=0.083; r=-0.250).

Conclusions

Strength and conditioning programs over a 5-year time span seem to substantially delay the negative effects of aging on LBS/DB in the elderly. No visible decline in the assessed parameters was observed. Our results may suggest different effects of in-water and dry-land programs. However, participants generally responded positively to both intervention programs.

References

1. World Health Organization. Falls Fact Sheet. Updated August 2017. http://www.who.int/mediacentre/factsheets/fs344/en/

2. Rosenthal R. Parametric measures of effect size. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 231-244.

Keywords

Elderly, Physical activity, Quality of life, Strength, Balance.

O110 Compassion attributes and actions in adolescents: are they related to affect and peer attachment quality?

Marina Cunha^1,2, Cátia Figueiredo¹, Margarida Couto¹, Ana Galhardo^1,2

¹Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; ²Cognitive and Behavioural Center for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal

Correspondence: Marina Cunha (marina_cunha@ismt.pt)

Background

Research has been showing potential benefits of compassion practice in various populations, nonetheless it is relevant to extend the assessment of compassion attributes and actions for adolescents and explore its relationship with other psychosocial adjustment constructs.

Objective

To explore association patterns between the various directions of compassion (self- directed, directed to others and receiving compassionate from others) and variables related to affect, social comparison and peers’ attachment to quality.

Methods

A total of 338 adolescents, aged between 12 and 18 years old, completed a set of self-report instruments to assess their compassionate attitudes and actions towards themselves and others (EAAC), peers attachment to quality (AQ-C), positive and negative affect (PANAS), and peers social comparison (SCS-A).

Results

Significant correlations were found in the expected direction between self-compassion, compassion for others and received from others and the study variables (positive and negative affect, social comparison and attachment style). Specifically, positive affect, positive peer comparison, and secure attachment style were positively associated with compassionate attributes and actions. Negative affect, in turn, showed a negative correlation with compassionate actions in the three analysed directions, and with compassionate attributes when considering receiving compassion from others. The avoidant unsecure attachment style revealed a negative association with compassionate attributes and actions in the different directions. Finally, the ambivalent insecure attachment style revealed a significant negative correlation with self-directed compassionate actions and with receiving compassion from others, regarding actions and attributes.

Conclusions

These findings suggest the importance of stimulating a compassionate mind in adolescents. In fact, the positive association between compassion and psychological and emotional adjustment variables point to the relevance of developing compassion skills during this developmental stage.

Keywords

Compassion attributes, Compassion actions, Adolescents, Positive and negative affect, Peer attachmet

O111 Association palmar grip strength with self-reported symptoms in the arm

Alice Carvalhais¹, Tatiana Babo, Raquel Carvalho¹, Paula Rocha, Gabriela Brochado¹, Sofia Lopes^1,2

¹Department of Technology Physiotherapy, Cooperativa de Ensino Superior Politécnico e Universitário, Polytechnic Institute of Health, 4585-116 Paredes, Portugal; ²Department of Physical Therapy, School of Health Technology, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

Correspondence: Gabriela Brochado (gabriela.brochado@ipsn.cespu.pt)

Background

World Health Organization (WHO) defined work-related musculoskeletal injuries as multifactorial diseases. These injuries are the main concern of public health and individual health, and are becoming increasingly frequent, in both developed and developing countries. Workers during working hours are often exposed to repetitive movements, the lifting and carrying heavy loads, verifying an increase in demand in terms of muscle strength in the upper limbs. The palmar grip strength provides an objective index of the functional integrity for the evaluation of upper limbs.

Objective

Verify that the palmar grip strength is associated with self-reported symptoms in the arm in industry worker’s electrical components.

Methods

An observational, analytical study was performed on a sample of 167 workers. The Nordic Musculoskeletal Questionnaire was applied and the palmar grip strength was measured using the hydraulic dynamometer. Descriptive statistics were used to analyse the prevalence of self-reported symptoms and the U test of Mann-Whitney, Kruskal-Wallis H test, Chi-square test and Fisher's exact test was used to analyse relationships between variables, with a 95% confidence level.

Results

The palmar grip strength was related to self-reported symptomatology in the dominant upper limb, shoulder regions (p = 0.018) and wrist (p = 0.005) in females. It was also found that the risk factors are not associated with palmar grip strength in individuals of both genders.

Conclusions

Palmar grip strength is associated with self-reported symptomatology in the shoulder and wrist of the dominant upper limb in female workers.

Keywords

Dynamometer, Palmar grip strength, Upper limb, Symptomatology auto referred.

O112 Social-skills as facilitators of a healthy lifestyle

Luisa Aires^1,2, Sara Lima³, Susana Pedras³, Raquel Esteves³, Fátima Ribeiro³, Assunção Nogueira³, Gustavo Silva^1,4, Teresa Herdeiro³, Clarisse Magalhães³

¹Instituto Universitário da Maia, 4475-690 Maia, Portugal; ²Centro de Investigação em Atividade Física Saúde e Lazer, Universidade do Porto, 4099-002 Porto, Portugal; ³Cooperativa de Ensino Superior Politécnico e Universitário, Polytechnic Institute of Health, 4585-116 Paredes, Portugal; ⁴Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Luisa Aires (luisa.aires@gmail.com)

Background

The Knowledge of behaviours and social-skills of adolescents can contribute to the construction of an effective school-based intervention to promote healthy lifestyles.

Objective

Identify homogeneous groups (clusters) according to lifestyle and social skills.

Methods

This cross-sectional study included 1,008 students from 5 elementary schools of Tâmega and Sousa region, mean age of 13.43 (SD = 1.1) and 50% of girls. A sociodemographic questionnaire “My Lifestyle” was used with 28 items composing 4 subscales: Physical Exercise (PE), Nutrition, Self-Care, Monitored Safety, Use of Drugs and Similar (UDS) (0.41< α <0.85). A “Social Skills Inventory for Teenagers” questionnaire (Social-Skills) was applied, including subscales: Empathy, Civility, Assertiveness, Self-Control, Affective Approach and Social-Development (0.64< α <0.90). Both questionnaires had 5 categories of answers from “almost always” to “almost never” or “rarely”. In order to identify homogeneous groups of students, according to lifestyle and social skills, it was performed a k-means cluster analysis

Results

For Lifestyle, mean scores were: UDS = 4.09, Self-Care = 4.07, PE = 3.86, Monitored Safety = 3.63 and Nutrition = 3.40. For Social-Skills, 50.7% had a highly elaborate repertoire of Social Skills, 11% had elaborate repertoire, 20.1% had good repertoire and 2.7% had lower average of social skills repertoire. It was decided to follow a three-cluster solution. Cluster 1 included students with a poor elaborated repertoire of social skills, but with good lifestyle indicators in all subscales. In cluster 2, students had a good repertoire of social skills, with good lifestyle indicators in all subscales, except for subscales of nutrition with poor indicators (38.7) and Monitored Safety (46.95). Cluster 3 included students with highly developed repertoire of social skills and the best lifestyle indicators.

Conclusions

Results revealed healthy practices in general, however students had the lowest scores in Nutrition, especially in sugar intake and absence of dietary plan. Students included in cluster 2 presented also the lowest results in Monitored Safety, especially about driving with alcohol. These students at risk of develop unhealthy lifestyle need special attention. The high profile of social skills in particular Affective Approach and Assertiveness, should be taking into account as a mechanism for intervention programs. In addition, relevance given to PE, should also be used as a good strategy to reinforce the accomplishment of healthy eating habits in all students. In another point of view, good indicators of lifestyles (cluster 1) can act as matrix to reinforce improvements in social-skills.

Keywords

Adolescents, Lifestyle, Social Skills.

O113 Palliative care: nursing student’s conceptions and motivations

Suzana Duarte, Vitor Parola, Adriana Coelho

Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Suzana Duarte (susanafcduarte@gmail.com)

Background

Palliative care (PC) is an inevitability in view of the demographic and epidemiological transition curves of Western society. The inclusion of a PC Curricular Unit (CU) in the Nursing Undergraduate Program (NUP) translates into the acquisition of competencies that allow caring for people and families in need of those carefulness. Although considering professional, institutional and family barriers, there is evidence that students apply, in clinical practice, the principles inherent of PC [1]. During clinical education, students are confronted with persons in need of PC, however without benefiting from such care. These experiences can form the basis, from which, it is possible to build the teaching-learning process of future nurses, regarding this theme.

Objective

To identify the conceptions and motivations for the frequency of the CU option of PC, by nursing undergraduate students'.

Methods

In the first class, nurses’ students were asked to anonymously write what they understood as PC and the motivation for attending this CU. The 210 responses collected over 5 years were subjected to content analysis [2].

Results

The PC conceptions reported were grouped into the categories: “Care for people in the final stages of life”, “Care to alleviate suffering” and “Comfort care”. The reasons for choosing the PC option were grouped in “Difficult and not tackled area”, “Area that arouses more interest” and “Previous Experiences”. It is verified that the concept of PC remains as care for people in terminal phase of life and in suffering. Some students report experiencing situations that would lead to PC, conditions of therapeutic obstinacy and end of life in circumstances of intense suffering. Students also mention the nurses ‘attempts to provide those carefulness, which is not well favoured for, in the hospital wards. Students indicate interventions that are intrinsic to palliative care, such as, communication, psychological support, coping with death and mourning, without any reference to the need for knowledge in other areas, namely pathology, pharmacology, or maintenance and healthcare technologies. The orientation of care for quality of life, family integration and management of symptoms is not considered.

Conclusions

There is a need to include in each NUP a PC CU, preferably after a period of clinical education in hospital wards. In this way it is possible to consider the previous experiences of the students, capitalizing them to the understanding of the fundamental principles of Palliative Care.

References

1. Bassah N, Cox K, Seymour J. A qualitative evaluation of the impact of a palliative care course on preregistration nursing students’ practice in Cameroon. BMC Palliat Care. 2016;15(1):37.

2. Bardin L. Análise de Conteúdo. 6th edition. Edições 70; 2013.

Keywords

Palliative Care, Nursing student’s, Motivations and conceptions.

O114 “As eat” effects of a physical exercise program and nutrition in obese and binge eating adults

Ana Barroco¹, José A Parraça¹, Nuno Pascoa¹, Daniel Collado-Mateo², Jose Adsuar³, Jorge Bravo¹

¹Department of Sports and Health, School of Science and Technology, University of Évora, 7000 Évora, Portugal; ²Instituto de Actividad Fisica y Salud, Universid Autonoma de Chile, Providencia, Chile; ³Universidad de Extremadura, 06006 Badajoz, Spain

Correspondence: José A Parraça (jparraca@uevora.pt)

Background

Overweight and Obesity are defined as an abnormal or excessive fat accumulation and present a health risk. Binge eating is a food disorder characterized by episodes of abusive food intake in the absence of regular compensatory behaviours such as vomiting or abuse of laxatives. Those who suffer from this disorder often increase their weight and fat mass by excessive intake of calories, thus becoming overweight or obese.

Objective

To determine the relation between the effects of an exercise and nutrition program, in overweight or obese adults (30-60 years) and binge eating, regarding body composition and physical fitness. The program also aimed to promote learning and self-control in the practice of physical activity and in the food choices of this population.

Methods

41 patients from USF Planície de Évora. Groups were randomly assigned: the experimental group (N = 23) and the control group (N = 18). The study lasted eight months and consisted of 47 practical sessions of one-hour group exercise, twice a week, one weekly self-help session, and three sessions of nutritional monitoring throughout the program. Practical sessions were structured with specific exercises aimed at improving the different components evaluated; namely in physical fitness (strength, cardiovascular endurance and flexibility) and body composition (fat loss).There were significant improvements in body composition, namely in the percentage of fat mass (40.75 (±6.46) to 37.44 (±7.06) p = .000), fat free mass (59.98 (±6.44) to 62.26 (±7.56) p = .001), of fat mass in the trunk (35.95 (±4.90) to 32.06 (±4.93) p = .000), in the Visceral index (12.00 (±3.42) to 10.88 (±2.97) p = .000) and in metabolic age (59.88 (±9.35) to 55.94 (±7.92) p =. 024). There were improvements in physical fitness, mainly in trunk flexibility (-0.18 (±9.72) to 8.93 (±10.06) p = .002) and in leg strength (0.10 (±0.03) to 0.13 (±0.02) p = .034) and arms (25.48 (±8.91) to 30.81 (±7.68) p = .000). Regarding weight, there is a tendency to significance, since there was a significant improvement (92.25 (±12.73) to 88.93 (±13.77) p = .056).

Conclusions

We conclude that the physical exercise and nutrition program allows improvements in physical fitness and body composition in the obese population suffering from binge eating.

Keywords

Exercise, Nutrition, Obesity, Body composition, Food addiction.

O115 Exploratory analysis of the association between motives for the practice of physical exercise and body composition

Roberta Frontini¹, Maria Monteiro², António Brandão², Filipe M Clemente^2,3

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Sports and Leisure, Polytechnic Institute of Viana do Castelo, 4900-347 Viana do Castelo, Portugal; ³Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Roberta Frontini (roberta_frontini@hotmail.com)

Background

Understanding what reasons lead individuals to start and maintain physical activity is extremely important to help individuals to engage and adhere to physical exercise. It allows exercise professionals to define the most appropriate actions to implement more suitable strategies and remove possible barriers to exercise. The decrease in body fat mass may be indirectly related to the motivation that the individual has for the practice of the physical exercise. Higher levels of motivation to lose weight may be related with higher adherence to, for example, the training plan and, consequently, be related to higher levels of body mass fat reduction.

Objective

This study aimed to analyse the association between body fat and motives to practice physical exercise.

Methods

The sample comprised 85 adults (38 males and 47 females) attending the gym, who completed a sociodemographic form and the Exercise Motivations Inventory - 2 (EMI-2). A multiple regression analysis was used to predict the value of a %body fat (%BF) based on the value of survey categories. The significance was set at p < 0.05. The statistical procedures were made in SPSS software (version 23.0, IBM, USA).

Results

A multiple regression analysis was run to predict %BF of the participants from social recognition, positive health, weight management, stress management, revitalization, enjoyment, challenge, affiliation, competition, health pressures, health avoidance, appearance, strength and endurance and nimbleness categories. These variables statistically significantly predicted %BF, F(14.70) = 2.249, p < 0.014, R² = 0.310. Only three variables (social recognition, positive health and weight management) added statistically significance to the prediction, p < 0.05. The unstandardized coefficient, B1, for social recognition is equal to 2.178, for positive health is equal to 4.860 and for weight management is equal to 2.490.

Conclusions

Social variables (specifically social recognition), positive health and weight management are important for body mass fat reduction, more than variables related, for example, with health concerns. It is important, in future studies, to understand what processes influence those relations. The results of our study reinforce the importance of these three variables for the reduction of body fat mass emphasizing that it may be important to take these issues into account not only to maintain the adherence of individuals, but also to promote the practice of physical exercise.

Keywords

Motivation, Physical exercise, Body fat, Social recognition, Positive health.

O116 Simulation as a pedagogical strategy in nursing teaching

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: Luís Ramos (luis_filipe-ramos@hotmail.com)

Background

Nowadays, the use of laboratories with specific equipment and classes with resource to simulated practice, are increasingly advocated, especially in graduation courses, whose practice is a crucial tool for students to apply in real life situations.

Objective

Therefore, we intended to know the perception of students and teachers of a 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 graduation course and to seven teachers who teach classes, with the resource of simulated practice, at Escola Superior de Saúde de Leiria.

Results

From the results we verified that for teachers, simulation is a pedagogical strategy in the development of the students’ competences, in a way that will translate in a provision of care based on the scientific knowledge, safety and humanism that is expected from a health professional. However, from the students’ perspective, we verified that the results indicate that the simulation is undoubtedly an added value, since the interviewees were able to approach the concept of simulated practice at several levels, also enabling to highlight the partnership between the pertinence and the contributions of the simulation and, finally, to mention several constraints and respective solutions.

Conclusions

As Goostone et al., (2013) [1] states, simulation is a pedagogical strategy that allows the student to acquire skills necessary for clinical practice, in a risk-free real environment, that is, students are faced with a clinical situation like what they would find in a real clinical environment, receiving feedback on their performance. Thus, it’s fundamental that there are teachers with the necessary training to implement this type of pedagogical strategy, as well as the necessary resources, associated to the will and commitment of the students. This triad is essential for the development of the students’ competencies as future professionals. In summary, the groups interviewed highlighted the importance of simulation, being able to answer to our research questions, complementing each other, once they recognized the importance of simulation in the health field.

References

1. Goodstone L, Goodstone M, Cino K, Glaser C, Kupferman K, Dember-Neal T. Effect of Simulation on the Development of Critical Thinking in Associate Degree Nursing Students. Nurs Educ Perspect. 2013;34(3):159-62.

Keywords

Simulation, Nursing, Education.

O117 Optimising protocol using dual in-situ hybridization to breast cancer in HER2 status

Paulo Teixeira^1,2,3, Maria F Silva^1,2, Paula C Borges¹, José M Ruivo², Diana Martins⁴, Fernando Mendes^1,3,5,6

¹Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal^{; 2}Pathologic Anatomical Service, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal^{; 3}Biophysics Institute, CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal^{; 4}Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal^{; 5}Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal^{; 6}Coimbra Institute for Clinical and Biomedical Research, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Paulo Teixeira (paulo.teixeira@estescoimbra.pt)

Background

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 20 to 30 % of breast cancer, as well as in others human cancers [1,2]. The Dual in-situ hybridization (DISH) assay is widely used to study HER2 status, and gives predictive and therapeutic information in invasive breast cancer, although it is dependent on pre-analytical variables, as ischemic time and fixation, among others [1,3].

Objective

The aim is to implement a HER2 DISH assay, contributing to its optimization and decrease of variability, clarifying the pre-analytical and analytical variables, with impact in tissue staining and morphology.

Methods

Forty-four (44) cases of invasive breast cancer cases previously scored with HER2 2+, were included in this study. Thin 4 μm paraffin sections were submitted to DISH. Unsuccessful cases were submitted to subsequent DISH protocols to attempt a valid result. Slides were evaluated according to staining and morphology integrity, by three independent observers proficient in this methodology, in a blind way, with a light microscope.

Results

From the 44 cases, 30 (68.2%) were readily validated, since 14 (31.8%) showed nuclear vacuolization and morphologic disruption leading to further tests with optimized protocols. Unsuccessful cases showed severe morphology damage and were reprocessed with further optimized protocols.

Conclusions

According to the obtained results, we can conclude that the pre-analytical variables with major impact on the standardization of the results were time of cold ischemic; unsliced operatory specimens and length of fixation. Analytical variables as time and temperature of cellular permeabilization can be changed to improve inadequate tissue preservation.

References

1. Meric-Bernstam F, Hung M-C. Advances in Targeting Human Epidermal Growth Factor Receptor-2 Signaling for Cancer Therapy. Clin Cancer Res. 2006;12(21):6326–30.

2. Brenton JD, Carey LA, Ahmed AA, Caldas C. Molecular Classification and Molecular Forecasting of Breast Cancer: Ready for Clinical Application? J Clin Oncol. 2005;23(29):7350–60.

3. Khoury T, Sait S, Hwang H, Chandrasekhar R, Wilding G, Tan D, et al. Delay to formalin fixation effect on breast biomarkers. Mod Pathol. 2009;22(11):1457–67.

Keywords

Dual in situ hybridization, Pre-analytical variables, Breast cancer, Optimization protocols.

O118 Psychometric properties update of AGITE – a medication self-management and adherence in the elderly questionnaire

Maria Almeida¹, Suzana Duarte¹, Hugo Neves^2,3

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Maria Almeida (mlurdes@esenfc.pt)

Background

As the human body ages, its function also tends to decline resulting in a higher risk of development of diseases. This leads to the presence of multiple and complex medications in the life of many older adults (OA). As the self-management and adherence behaviours of these medications require the development of competences, it is important to develop a quick and easy instrument to provide systematized data for the health professional that will allow a better decision-making process and a higher probability of developing interventions with impact in the medication-taking ability of the OA. With this purpose, AGITE was developed following a process of systematic literature review, content analysis and psychometric testing, resulting in a total of nineteen questions with a Likert scale approach. Previous studies demonstrated the need for further testing of its psychometric properties.

Methods

After application of the AGITE to 146 elders in day centres in Central Portugal, exploratory factorial analysis (EFA) using the eigenvalue criteria, and internal consistency (IC) through Cronbach’s Alpha were performed.

Results

From the EFA, using varimax rotation and screen plot analysis, an acceptable KMO of 0.653 was obtained, with no items being eliminated through analysis of anti-image matrix. A total of five dimensions emerged explaining 53.6% of the variance: “Engagement”, “Neglect and External Influences”, “Perceived Benefits”, “Healthcare Professionals Support”, and “Value assigned to Written Information”. Through analysis of the items of each dimension, higher scores of “Engagement” indicate a responsible attitude towards self-management and adherence, while higher scores of “Neglect and External Influences” demonstrate a tendency to cease medication, according to individual and non-professional external beliefs. Regarding the dimension “Perceived Benefits”, higher scores evidence how the elder positively perceives the effects of the medication, while higher scores of “Healthcare Professionals Support” are related with perceived importance of the healthcare professionals in the medication-taking ability. Higher scores of “Value assigned to Written Information” demonstrate a tendency to attribute significance to written data regarding medication. Overall the questionnaire dimensions demonstrate questionable to acceptable IC (0.6 < α < 0.8).

Conclusions

New analysis of the psychometric properties evidences the emergence of new dimensions, allowing for a wider understanding of the profile of the medication-taking ability of the elder population in Portugal. These new dimensions will provide a better analysis of this skill to the healthcare professional, allowing a more personalized intervention, with higher chance of success.

Keywords

Polypharmacy, Medication management, Elders.

O119 Emotional intelligence and fear of death in Spanish elders

Pedro Garcia-Ramiro¹, Juan FJ Díaz², Maria González-Melero¹, Maria DCP Jiménez¹, Antonio MP Jiménez¹, Francisco JR Peregrina¹

¹Universidad de Jaén, 23071 Jaén, Spain; ²Universidad Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain

Correspondence: Pedro Garcia-Ramiro (pgramiro@ujaen.es)

Background

Researchers, stakeholders and policy makers agree about the importance of the population ageing in modern societies. Emotional Intelligence (EI) has generated a broad interest in the scientific community in Spain [1]. Prestigious social scientists from different lines of research contribute to assess important theoretical and empirical topics on this construct [2]. Aging is a process during which important changes occur in different areas of development and emotional intelligence plays an essential role. Throughout the years, the subject of death has been conceived in different ways. People abstain from talking about it, and a conduct of avoidance can be observed manifesting itself in fear and anxiety [3].

Objective

The objective of this study was to examine the relationship between emotional intelligence and fear of death in an older population.

Methods

A Spanish sample of 384 older people aged 65 years and older (51.82% women; 71.23 ± 8.34 years of age), without cognitive impairment, were included in this descriptive and correlational study. Data on emotional intelligence and fear of death were obtained through the TMMS-24 and Collett-Lester scales, respectively.

Results

Structural equation modelling indicated that emotional intelligence exerted an influence on fear of death. The emotional perception component was positively correlated with the fear of death (r = 0.14; p < 0.05), while understanding and emotional regulation were negatively correlated with fear of death (r = -012; p < 0.001). The higher scores for fear of death were associated with the female gender, and singles. These aspects underscore the importance of the results of this study.

Conclusions

These findings show that high levels of emotional intelligence were associated with less fear of death. After controlling sociodemographic variables, the EI dimensions, emotional perception and emotional regulation, accounted for part of the variance in several fears of dead facets. These dimensions can have an important role in the fear of dead of older people.

References

1. Wilson CA, Saklofske DH. The relationship between trait emotional intelligence, resiliency, and mental health in older adults: the mediating role of savouring. Aging Ment Health. 2018;22(5):646-654.

2. Lloyd SJ, Malek-Ahmadi M, Barclay K, Fernandez MR, Chartrand MS. Emotional intelligence (EI) as a predictor of depression status in older adults. Arch Gerontol Geriatr. 2012;55(3):570-573.

3. Arca MG. Enfermería en el proceso de humanización de la muerte en los sistemas sanitarios. Enfermería Clínica. 2014;24(5):296-301.

Keywords

Emotional intelligence, Fear of death, Ageing, Older adults.

O120 Vitamin D in food supplements: are we taking too much?

Isabel M Costa, Alexandra Figueiredo, Deolinda Auxtero

Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal

Correspondence: Alexandra Figueiredo (alexandra.f@netcabo.pt)

Background

Over the last years, an increase in vitamin D (VitD) supplements intake has been observed. Evidence has suggested multiple effects of VitD beyond bone homeostasis. Low VitD levels are associated with numerous disorders including diabetes, cancer, cardiovascular disease, Parkinson's disease, among others. Consumers have the general misperception that “vitamin” denotes something harmless and vital, disregarding its potentially harmful effects. Although vitD toxicity is uncommon, case reports attributed to vitD supplementation have raised. Being a fat-soluble vitamin, excessive supplementation may result in body accumulation and toxicity. It increases intestinal calcium absorption and plays a central role in its homeostasis. Thus, most symptoms of toxicity result from hypercalcemia. Adverse effects include gastrointestinal disorders (anorexia, diarrhoea, nausea, vomiting), muscle and joint pain, cardiac complaints, hypertension, central nervous system effects and renal disorders (polyuria, polydipsia).

Objective

The aim of this study was to evaluate whether VitD3 (cholecalciferol) daily dose indicated on food supplements (FS) labels coincided with the recommended daily allowance (RDA) for this vitamin defined by the European Union Directive.

Methods

Labels of 110 FS sold in Portuguese pharmacies, supermarkets or health shops were examined. Selection criteria included: oral solid pharmaceutical forms for adults, containing vitD in its composition, as stated in the label, regardless of the purpose of the FS.

Results

66.4% of FS presented vitD label doses above RDA and four of them indicated a daily dose ≥ the tolerable upper intake level defined by EFSA (UL=100 μg/day). In the majority of the FS evaluated, vitD label dose far exceeded RDA value and some exceeded UL defined by EFSA.

Conclusions

At present, the safety of FS and the authenticity of label information is exclusively ensured by the economic operators who place FS on the market. Since FS are usually taken without any medical supervision or counselling and attending the potential adverse effects of vitD excess, it is imperative that the daily doses of vitD present in FS are reviewed attending to RDA values. Authors also suggest that FS should be under the same quality control of pharmaceuticals, regarding FS consumers health.

Keywords

Vitamin D, Food Supplements, Recommended Daily Allowances, Tolerable Upper Intake Level.

O121 Functional ability and risk of falling - a base for exercise prescription

Sílvia Vaz, Anabela Martins, Carla Guapo, Sara Martins

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Sílvia Vaz (leontina_vaz@hotmail.com)

Background

Falls are currently considered one of the most common and serious public health problems [1, 2]. Faced with this problem, it becomes necessary to explore which factors can better predict the risk of falls in individuals living in the community [3], so that, preventive measures can be considered.

Objective

To identify fall risk indicators and to relate them to exercise prescription levels; to relate the history of falls, the functional capacity (measured through the Timed Up & Go, 10-meter walking speed test, Step test) and the fall risk factors and propose a guide based on those relations to address exercise prescription.

Methods

Descriptive and exploratory study. Two hundred community dwelling adults aged 55 or older were assessed, integrating two sub-samples, a Portuguese and a Polish. Study participants were assessed for socio-demographic data, history of falls, fear of falling, exercise, sedentary lifestyle, hearing problems and/or dizziness, visual problems, alcohol consumption, exercise self-efficacy and confidence in activities of the daily life (FES-Portuguese version). Functional capacity was assessed by three golden measures for the risk of fall: the Timed Up and Go (TUG), the 10-meter walking speed test and the Step Test (15s). The statistical design included descriptive analyses, inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson’s correlation coefficient).

Results

Fall incidence was 39.5% and 45.3% in the total and Portuguese samples, respectively. TUG, 10-meter walking speed test and step test can distinguish those with history of falls from those without, with statistically significant differences (p ≤ 0.05). Taking more than 4 different medications per day, fear of falling, hearing problems and/or dizziness and the need for help getting up from a chair were correlated to the history of falls, the TUG, the walking speed and the step test (p ≤ 0.05). The sedentary lifestyle and the use of assistive devices were associated with worst performance in the functional tests (p < 0.05) in the Portuguese sample. TUG, 10-meter walking speed test and step test were correlated with exercise self-efficacy.

Conclusions

The incidence of falls is higher than literature has reported and it is inversely associated with the functional capacity of community-dwelling adults aged over 55 years old. Data from this study is a valuable basis for exercise prescription, taking into account the levels of risk and the components of exercise prescription.

References

1. Gschwind Y, Kressig R, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatrics. 2013;13(1):105.

2.NICE. Falls in older people overview. NICE Pathways. 2016;1-13.

3. Avin K, Hanke T, Kirk-Sanchez N, McDonough C, Shubert T, Hardage J, Hartley G. Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association.Physical Therapy. 2015;95(6):815-834.

Keywords

Risk of fall, Functional capacity, Prevention of falls, Exercise prescription, Self-efficacy.

O122 The impact of the FIFA 11+ on physical performance of amateur futsal players: short and long term effects

Mário Lopes¹, Daniela Simões², João M Rodrigues^3,4, Rui Costa^1,5, José Oliveira⁶, Fernando Ribeiro^1,7

¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Santa Maria Health School, 4049-024 Porto, Portugal; ³Institute of Electronics and Informatics Engineering of Aveiro, 3829-193 Aveiro, Portugal; ⁴Department of Electronics, Telecommunications and Informatics, University of Aveiro, 3810-193 Aveiro, Portugal; ⁵Center for Health Technology and Services Research, University of Aveiro, 3810-193 Aveiro, Portugal; ⁶Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁷Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Mário Lopes (mariolopes77@ua.pt)

Background

The effects of the FIFA 11+ on physical performance parameters has demonstrated controversial results.

Objective

The aim of this study was to observe the short and long-term effects of the FIFA 11+ on performance in male amateur futsal players.

Methods

Seventy-one (71) male futsal players from six amateur clubs were randomized to an intervention (N = 37, age: 27.0 ± 5.1 years) or a control group (N = 34, age: 26.0 ± 5.1 years). The intervention group was submitted to 10 weeks of FIFA 11+ injury prevention program, 2 sessions/week, followed by a 10-week follow-up period, while the control group performed regular futsal warm-ups during the training sessions. During the follow-up period both groups performed only regular warm-ups during their training sessions. Physical performance was assessed by measuring agility (T-test), sprint (30-meter sprint), flexibility (sit and reach) and vertical jump performance (squat jump).

Results

Differences between groups were found at baseline for training exposure, body mass index, body weight, flexibility and sprint. The results of the effect of the FIFA 11+ on the sit and reach, speed, jump performance and agility did not show differences pre-post intervention after adjustment for the baseline differences, as well as for the 10-week follow-up.

Conclusions

The current study has shown no short and long-term performance enhancement in sprint, flexibility, agility and jump performance after the FIFA 11+ in male amateur futsal players.

Keywords

Prevention program, Warm-up, Injury, Neuromuscular training, Amateur male players.

O123 Effects of aquatic fitness in older women conditioning: an 8-week program

Pedro Morouço¹, Sandra Amado^1,2,3, Susana Franco⁴, Fátima Ramalho⁴

¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, 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; ⁴Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal

Correspondence: Pedro Morouço (pedro.morouco@ipleiria.pt)

Background

There are several evidences in the literature demonstrating a high positive association between increased levels of exercise and improved health, specifically in older adults [1]. As such, in recent years there has been a large number of studies examining the benefits imposed by different types of exercise (e.g. resistance training [2], and aquatic fitness [3]). However, in addition to the benefits imposed, it is crucial that the exercise is motivating and challenging.

Objective

It was aimed to examine the possible effects on conditioning induced by 8-weeks of aquatic fitness, in female older adults.

Methods

Fourteen women (64.3 ± 7.3 years old) enrolled in bi-weekly aquatic fitness of 45’ sessions for 8 weeks. Before and after the 8 weeks, participants performed the Senior Fitness Test [2], hand-grip strength and body measures. All participants were volunteer, informed consent was obtained and all procedures were in accordance to Helsinki Declaration. Sessions were instructed by a CSCS®.

Results

Significant and meaningful improvements were observed in lower body strength (p < 0.001; d = 1.22), lower body flexibility (p < 0.001; d = 3.54), aerobic endurance (p < 0.001; d = 1.35), dynamic balance (p < 0.001; d = 1.53) and hand grip strength (p < 0.001; d = 2.02). Significant, but moderate improvements were observed in body mass (p = 0.021; d = 0.72) and hip circumference (p = 0.048; d = 0.59).

Conclusions

Eight weeks of aquatic fitness induced extensive benefits in older women conditioning, suggesting that this activity is able to promote an increase in life quality. The present results corroborate previous studies, demonstrating that aquatic exercise is a reliable approach for improved health in the elderly.

Acknowledgements

This research was supported by the European Regional Development Fund (FEDER), through COMPETE2020 under the PT2020 program (POCI-01-0145-FEDER-023423), and by the Portuguese Foundation for Science and Technology (UID/Multi/04044/2013).

References

1. Taylor D. Physical activity is medicine for older adults. Postgrad Med J. 2014;90:26-32.

2. Martins WR, Safons MP, Bottaro M, Blasczyk JC, Diniz LR, Fonseca RMC, et al. Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial. BMC Geriatr. 2015;15(1):99.

3. Bartolomeu RF, Barbosa TM, Morais JE, Lopes VP, Bragada JA, Costa MJ. The aging influence on cardiorespiratory, metabolic, and energy expenditure adaptations in head-out aquatic exercises: Differences between young and elderly women. Women Health. 2017;57(3):377–391.

4. Rikli RE, Jones CJ. Senior fitness test manual. 2^nd edition. Human Kinetics; 2013.

Keywords

Exercise, Health, Aging, Physical Fitness.

O124 Predicting social participation in the community-dwelling older adults

Carla Guapo, Anabela C Martins, Sara Martins, Sílvia Vaz

Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Sílvia Vaz (leontina_vaz@hotmail.com)

Background

Nowadays, active ageing is both a complex scientific term and a goal for most people, but also an undeniable political objective [1]. Participating socially helps to develop the feeling of belonging to a community and allows everyone to see each individual contribution in upholding the community [2-4].

Objective

Characterize the profile of community-dwelling adults aged 55 or older, regarding social participation, functional capacity (walking speed, grip strength, lower limb strength, static and dynamic balance) and personal factors (age, gender, BMI, confidence/fear of falling and perception of general health); verify the relationship between social participation and functional capacity as well as participation and personal factors; and find, among all the variables, which can be the best predictors of social participation.

Methods

Descriptive, exploratory and cross-sectional study. The sample is composed of 150 Portuguese community-dwelling older adults. The statistical design included descriptive analyses (measures of central tendency and dispersion); inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson’s correlation coefficient; multivariate: linear multiple regression, moderated linear multiple regression and hierarchical linear multiple regression). The level of significance was α =0.05, with a 95% confidence interval.

Results

The results have shown that this sample was composed mostly by women, mean age approximately 69 years old. Statistically significant associations between social participation and all study variables: Age (r = 0.301, p = 0.00), BMI (r = 0.169, p = 0.039), Grip strength (r = -0.318, p = 0.00), Pressure platform Hercules® (r = -0.337, p = 0.00), perception of general health (r = 0.468, p = 0.00), Timed Up & Go (r = 0.668, p = 0.00), T10M (r = -0.576, p = 0.00), Test Step (r = -0.456, p=0.00) and Fall Efficacy Scale (r = 0.768, p = 0.00). Regression analysis shows that the confidence in performing activities of the daily living without fear of falling, health perception and dynamic balance, measured by Timed Up & Go test, as a whole, are responsible for 65.5% of the variance of social participation (R² = 0.655; p < 0.001). Using a second model we have seen that a sizeable part of the variance percentage related to the participants’ social participation, 55%, is due once again to dynamic balance and health perception, followed by age (R² = 0.549; p < 0.001).

Conclusions

The Timed Up & Go test and the unique question on health perception: “In general, would you say that your health is excellent, very good, good, satisfactory or poor?” account for a significant percentage of the variance in social participation in elderly individuals. Incorporating these two factors into the physical therapist's clinical practice takes very little time and greatly benefits the decision-making process and planning of interventions.

References

1. Fernandez-Ballesteros R, Zamarron MD, Diez-Nicolas J, Lopez-Bravo MD, Molina MA, Schettini R, Productivity in Old Age. Research on Aging. 2011;33(2):205–226.

2. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta- analytic review. PLoS Medicine. 2010;7(7):e1000316.

3. Korpershoek C, van der Bijl J, Hafsteinsdottir TB. Self-efficacy and its influence on recovery of patients with stroke: A systematic review. Journal of Advanced Nursing. 2011;67(9):1876–1894.

4. Nayak N, Mahajan P. Walking Capacity and Falls-Efficacy Correlates with Participation Restriction in Individuals with Chronic Stroke: A Cross Sectional Study. International Journal of Physiotherapy. 2015;2(1):311.

Keywords

Active ageing, Elderly, Social participation, Functional capacity, Functioning.

O125 Motor development in children from 11 to 44 months old: influence of the variable “presence of siblings”

Miguel Rebelo¹, João Serrano¹, Daniel Marinho^3,4, Rui Paulo^1,2, Vivian Corte¹, Pedro Duarte-Mendes^1,2

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Vila Nova de Gaia, Portugal; ³Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Research Centre in Sports, Health and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Miguel Rebelo (miguelrebelo7@hotmail.com)

Background

Motor development presupposes a set of life-long processes of change. These processes occur mostly during the first years of the child’s life, having each child different developmental rhythms [1]. Motor skills are fundamental to our day-to-day life, representing the key to the child's development [2]. As such, it is important to know the different factors that influence the development of motor skills during childhood. According to bibliography, the presence of siblings may be an important factor, because this relationship provides a basis for learning and socialization opportunities in various contexts [3].

Objective

The main goal of this study was to verify if there were differences in the development of motor skills (global and fine) through the scales of the PDMS-2, comparing children that have or do not have siblings.

Methods

In this study 91 children of both sexes participated (30.20 ± 10.56 months). Two groups were created: the sibling group, consisting of 48 children (31.06 ± 10.76 months) and the non-sibling group, consisting of 43 children (29.23 ± 10.37 months). Motor skills were assessed using the PDMS-2 test battery scales4. The evaluation was performed during 4 months, 3 times a week and individually (approximately 30 minutes for each child). For the data analysis, we used descriptive and inferential statistics. The Kolmogorov-Smirnov test was applied to test normality, and the Mann-Whitney test was applied to independent samples.

Results

The sibling group achieved, on average, better results in all motor skills (global and fine). However, there were only statistically significant differences in fine motor skills (p = 0.016), where the sibling group had the best results (average = 52.29) compared to the non-sibling group (average = 38.98).

Conclusions

These results show that the presence of siblings in the family context positively influences motor development, providing cooperative activities through play and challenges that improve cognitive, social, emotional and physical development.

Acknowledgements

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

References

1. Barreiros J, Neto C. O Desenvolvimento Motor e o Género. Lisboa: Faculdade de Motricidade Humana ; 2005.

2. Leonard HC, Hill EL. The impact of motor development on typical and atypical social cognition and language: a systematic review. Child and Adolescent Mental Health. 2014;19(3):163-170.

3. Brody GH. Siblings’ direct and indirect contributions to child development. Current Directions, Psychological Science. 2004;13(3):124–126.

4. Folio R, Fewell R. Peabody Developmental Motor Scales-2. Austin: TX: Pro-Ed; 2000.

Keywords

Motor Development, Family Context, PDMS-2.

O126 Childhood obesity in the urban parishes of Coimbra municipality

Margarida Pereira, Cristina Padez, Helena Nogueira

Research Centre for Anthropology and Health, University of Coimbra, 3000-456 Coimbra, Portugal

Correspondence: Margarida Pereira (mmiguel06@gmail.com)

Background

Childhood obesity is a major public health concern worldwide and Portugal has one of the highest rates of childhood obesity among the European countries. It is known that childhood obesity is particularly high in urban settings. Thus, a deeper understanding of the impact of such areas in children weight is needed. Evidence suggests that parents’ perception of the neighbourhood safety might determine children weight once unsafety perceptions of the neighbourhood prevent children from playing outside.

Objective

This work main goal was to examine the impact of parents’ safety perception of the neighbourhood in children’s weight status regarding the localization of the neighbourhood (urban centre or urban periphery).

Methods

Weight (kg) and height (cm) of 1,493 children from Coimbra municipality were measured and BMI (weight/height²) was calculated to use IOTF cut-off points to classify children in “normal” or “obese”. Parents provided their parish of residence as well as their weight, height and number of schooling years. They also responded to a questionnaire regarding their neighbourhood perceptions and physical activity engagement of their children. The sample was analysed separately, i.e., chi-square tests were computed to children living in parishes from the urban centre and posteriorly to children living in parishes from the urban periphery.

Results

This study results showed proportionality between overweight or obese children residing in the urban centre, mainly girls, with low socioeconomic status and obese parents that strongly agree that their neighbourhood is unsafe to walk in during the day. Except for mother weight status, none of the variables analysed differentiated normal from overweight or obese children living in the urban periphery, regarding the chi-square tests.

Conclusions

Overall, parents’ perceptions of the environment might impact children’s weight status. However, even within the same urban area, perceptions of neighbourhood safety change. The aspects that influence children weight status differ according to the parishes they live in - urban centre or peripheric parishes. For example, parents from a significant proportion of overweight or obese children living in the urban centre parishes perceives their neighbourhood environment as unsafe to walk during the day, however, no differences were found between normal and overweight or obese children from the peripheric parishes. This should be held in consideration when developing healthy urban planning strategies.

Acknowledgements

Work funded by the Foundation for the Science and Technology (PTDC/DTP-SAP/1520/2014 and grant SFRH/BD/133140/2017).

Keywords

Childhood Obesity, Urban Settings, Neighbourhood, Safety Perceptions.

O127 Cardiovascular causes of disqualification from competitive sports: young vs. veteran athletes

Ana P Silva, Virgínia Fonseca, Carolina Diniz, Daniel Pereira, Rodrigo Sousa, João Lobato

Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-094 Lisboa, Portugal

Correspondence: Ana P Silva (ana.silva@estesl.ipl.pt)

Background

Cardiovascular disease is the most common cause of disqualification from competitive sports. The pre-participation screening is fundamental in order to detect these diseases and is based on clinical history and physical examination in addition to a 12-lead electrocardiogram. Additional tests are requested only for those with any abnormality in the initial evaluation [1-2]. According to previous studies, the most common cardiovascular diseases that disqualify young athletes are different from those associated to veteran athletes: congenital arrhythmias vs. subclinical coronary disease, respectively [3-5].

Objective

To analyse and compare, amongst young and veteran athletes, the cardiovascular causes of disqualification from competitive sports, consecutively screened at a sports medicine unit in a decade (2007-2017).

Methods

Descriptive-comparative retrospective study. The study population consisted of all case files from athletes disqualified from competitive sports due to cardiovascular disease during the 2007-2017 period. A sample of 58 case files was divided into group A (young athletes, < 35 years, n_A= 36) and group B (veteran athletes, ≥ 35 years, n_B=22). It was evaluated the clinical history, sport disciplines, symptoms and cardiovascular diseases. Descriptive statistics and statistical inference (Chi-squared distribution) were applied for the characterization and comparison of the study variables.

Results

Both sample groups consisted mainly in male athletes (group A 94.4%, group B 100%). The most referred symptom in group A was palpitations (16.7%), whereas in group B was chest pain (36.4%). There was a significant association between relevant cardiovascular history and veteran athletes. The most frequent cardiovascular diseases in group A were hypertrophic cardiomyopathy (19.4%), arterial hypertension (11.1%), left ventricle noncompaction (8.3%) and great vessel transposition (8.3%). Arterial hypertension (50%) and coronary disease (45.4% were the most frequent diseases that disqualified the practice of competition sports in veteran athletes. It’s important to emphasize that some veteran athletes presented simultaneously more than one cardiovascular cause of disqualification.

Conclusions

The most frequent cardiovascular diseases in groups A and B matched those found in literature [3-5]. The prevalence of hypertrophic cardiomyopathy and coronary disease in the respective groups may be associated with a higher awareness towards the dangers of these particular diseases in the practice of competition sports. The data in this study confirms the key role of pre-participation screening for the identification of cardiovascular diseases that can cause sudden cardiac death during sport.

References

1. Corrado D, Pelliccia A, Bjørnstad H, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. European Heart Journal. 2005;26:516-524.

2. Despacho no 25 357/2006. D.R. no 238 de 13.12.2006 - 2a Série, (2006).

3. Abbatemarco J, Bennett C, Bell A, Dunne L, Matsumura M. Application of Pre-participation Cardiovascular Screening Guidelines to Novice Older Runners and Endurance Athletes. SAGE Open Medicine. 2016;4:1–8.

4. Pescatore V, Basso C, Brugin E, Bigon L, Compagno S, Reimers B et al. Cardiovascular causes of disqualification from competitive sports in young athletes and long term follow-up. European Heart Journal. 2013;34(sup 1):1783.

5. Corrado D, Basso C, Schiavon M., Thiene G. Screening for Hypertrophic Cardiomyopathy in Young Athletes. The New England Journal Of Medicine. 1998;339:364-69.

Keywords

Cardiovascular diseases, Competitive sports, Pre-participation screening.

O128 Bioethics, health promotion and sustainability: interfaces in higher education

Ivani N Carlotto, Maria AP Dinis

Energy, Environment and Health Research Unit, Energy, Environment and Environmental & Public Health Research Laboratories, Fernando Pessoa University, 4249-004 Porto, Portugal

Correspondence: Ivani N Carlotto (ivani.carlotto@gmail.com)

Background

Universities are essential institutions for health promotion (HP) [1]. As they have their own ethos and distinct cultures, they may act as potential enhancers of the conceptual frameworks of HP and interdisciplinary values such as equity, social justice and sustainable growth [2]. Bioethics, as a transversal discipline, seeks to ethically analyse and systematize such values, strengthening the synergy between health and sustainability [3]. Bioethics is a reflexive, mutually shared and interdisciplinary tool whose goal is to promote health and sustainability in an integrated and coherent way, adapting life actions in their equitable and inclusive characters.

Objective

1) Identify how bioethics takes place in daily life and how it is possible to establish links between scientific and ethical knowledge, in order to avoid negative impacts on people's lives; 2) Describe the appropriate bioethical tools (principles) for intervention in the context of higher education (HE), HP and sustainability.

Methods

Exploratory-descriptive methodology using a quanti-qualitative approach [4]. Sample: University teachers from Rio Grande do Sul/Brazil, random sample, probabilistic sampling by convenience, CI = 95%, n = 1400 persons. The research was approved by the Research Ethics Committee of the Hospital de Clínicas of Porto Alegre (HCPA)/Brazil, Ethics Committee of the Universidade Fernando Pessoa (UFP)/Porto-Portugal, receiving the approval number CAAE 55066616.8.0000.5327/Plataforma Brasil/Brazil. The interviews were carried out after receiving the informed consent from the participants, taking into account the assumptions of the National Health Council Brazil (NHC) 466-2012.

Results

Beyond the principalistic formulation - charity, non-maleficence, justice and respect for autonomy [5], certain subjacent referentials, such as, solidarity, shared commitment, and health environment/sustainability were evoked, causing a positive impact on HP, individual and collective well-being, quality of life, inclusion and social justice in the University environment.

Conclusions

HE upholds a fundamental role in HP for their faculty teachers. Universities act as places for investigation and learning in a way that it invigorates HP activities [6]. Bioethics, as a transdisciplinary activity, seeks to help building qualified actions in health, which uphold and promote well-being, cohesion, inclusion, sustainability and social justice, with the respective conceptual clarity that resides therein [2, 7].

References

1. Dooris M, Doherty S, Cawood J, Powell S. The Healthy Universities approach: Adding value to the higher education sector. In: Health promotion settings: Principles and practice. London: Sage; 2012. p. 153-169.

2. Dooris M, Doherty S, Orme J. The application of salutogenesis in universities. In: The Handbook of Salutogenesis. England: Springer; 2017.

3. Garrafa V. Da bioética de princípios a uma bioética interventiva. Bioética. 2005;13:125-134.

4. Prodanov CC. Metodologia do trabalho científico: métodos e técnicas da pesquisa e do trabalho acadêmico. Novo Hamburgo: Feevale; 2013.

5. Beauchamp TL, Childress JF. The principles of biomedical ethics. New York: Oxford;1979.

6. Organização PanAmericana de Saúde [http://www.paho.org/]. Regional program on bioethics. [Accessed in 02 may 2017]. Available in http://www.paho.org/ hq/index.php?option=com_content&view=article& id=5582%3A2011-regional-program-onbioethics&ca tid=3347%3Abioethics&Itemid=4124&lang=es

7. Carlotto IN, Dinis MAP. Bioética e promoção da saúde docente na educação superior: uma interface necessária. Revista Saber & Educar. 2017;23:168-179.

Keywords

Bioethics, Health Promotion, Higher Education, Sustainability.

O129 Pilot program to develop clinical skills in counseling-based motivational interview (CBMI) to prevent obesity in Chile

Ricardo Cerda¹, Daniela Nicoletti¹, Macarena P Lillo³, Margarita Andrade, Patricia Galvez¹, Lorena Iglesias¹, Denisse Parra², Magdalena C Coke, Natalia Gomez¹

¹Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile; ²Department of Nursing, Faculty of Medicine, University of Chile, Santiago, Chile; ³School of Journalism, Faculty of Communication and Letters, University Diego Portales, Santiago, Chile

Correspondence: Ricardo Cerda (rcerdarioseco@gmail.com)

Background

To influence mediator variables of behavioural change in health and the adherence to treatment in an individual context, health professionals and users must develop a help-based relation mediated by effective communication. At the same time, health professionals must trigger processes in the users that allow them to recognize and develop intrinsic motivation towards change. In this sense, a pilot program is proposed for training CBMI for primary health care (PHC) nutritionists that develops knowledge and tools to foster behavioural change in users. The pilot project was developed as part of the Chilean health program “Vida Sana”.

Objective

Describe a training pilot program to develop clinical skills in CBMI, for PHC nutritionists, to prevent obesity in Chile.

Methods

A training program was built comprised by 34 face-to-face hours and 8 hours of accompaniment at the workplace for 13 Nutritionists. The program was based on a constructivist approach centred on the development of skills in the following sequence: critical analysis for regular practice, adherence comprehension and behavioural change, communication skills, motivational interviewing skills, skill integration in a simulated and real situation. The program employed psychometric scales for motivation, beliefs and self-efficacy for CBMI, video analysis, observations performed at the Centre for Clinical Skills at the Facultad de Medicina de la Universidad de Chile and accompaniment at PHC centres.

Results

Participant knowledge increased on average 5.25 to 20.85 (p = 0.008). The average of total points did not vary at the beginning or at the end (74 pts). Effective beliefs increased from 61.3 to 68.7 (p < 0.05) and self-efficacy from 1617 to 1851 (p < 0.05). Observation and video analysis showed that Nutritionists went from delivering information to open and strategic inquiring during the course. Accompaniment showed that skills were deepened and the level of satisfaction improved with practice.

Conclusions

This is an innovative program that incorporates CBMI and defines a methodology centred on reflection, practice and accompaniment in real and simulated situations. It is necessary to evaluate the effects in indicators that measure user behaviour and the effect and impact on adult obesity. This training program represents a tool to promote behavioural change and adherence in PHC to prevent obesity.

Acknowledgements

The project was financed by CONICYT: FONIS SA16I0122.

Keywords

Behavior Change, Motivational Interview, Professional Education, Obesity, Nutritionists Skills.

O130 Childhood body fat and motor competence in elementary school (5 to 9 years old)

Francisco Campos¹, Ricardo Santos¹, Mariana Temudo¹, Kátia Semedo¹, Diogo Costa¹, Ricardo Melo¹, Fernando Martins^1,2

¹Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal; ²Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Francisco Campos (francicampos@gmail.com)

Background

Obesity rates have increased globally in the last decades, justifying the denomination “public health epidemic”. According some studies [1], in Portugal, childhood overweight and obesity affects about 31.5% of elementary school children, with higher values for girls, except between 7.5 and 9.0 years old. Overweight and obesity are strictly related with childhood motor competence [2]. To access overweight and obesity, among others, is recommended the body fat percentage (BFP), classified by age and gender by McCarthy centiles of BFP [3].

Objective

The main objectives of this investigation are: 1) to characterize childhood elementary school overweight/obesity and compare it by gender and age; 2) to correlate childhood elementary school overweight/obesity with motor competence.

Methods

Data was collected from 604 children’s between 5 to 9 years old (7.40 ± 1.16 years old; 295 female) of the 10 elementary schools from the “Agrupamento de Escolas de Montemor-o-Velho” (Coimbra-Portugal), using: a) the electrical bio-impedance (model BC-533®) method, to access BFP; and b) a battery of physical tests [shifting platforms and lateral jumps (stability); shuttle run and standing long jump (locomotion); throwing velocity and kicking velocity (manipulation); and handgrip strength] to access motor competence [3]. Data analysis was conducted using IBM SPSS software (version 24.0) for a statistical significance of 10%.

Results

In this study case, only 58.8% (n = 355) of the elementary school children had normal weight, and 41.2% showed overweight/obesity [overweight: 17.0% (n = 103); obesity: 24.2% (n = 146)]. There were no significant statistical differences (p = 0.519) between genders (Mann-Whitney). By age (Kruskal-Wallis), there were significant statistical differences (p = 0.001), specially between the 5 years old (Md=2) [p=0.016 (7 years old; Md=1); p=0.003 (8 years old; Md=1); p=0.021 (9 years old; Md=1)] and the 6 years old (Md=2) [p=0.005 (7 years old; Md=1); p=0.001 (8 years old; Md=1); p=0.013 (9 years old; Md=1)]. For Md interpretation, normal weight is classified by 1, overweight by 2 and obesity by 3. The Spearman test (r) allowed to verify significant statistical correlations, two positive [shuttle run (p=0.001; r=0.136); handgrip (p=0.002; r=0.123)] and three negative [lateral jump (p=0.001; r=-0.174); standing long jump (p=0.001; r=-0.249); throwing velocity (p=0.072; r=-0.073)].

Conclusions

It is important to take into account the current recommendations and concerns of the WHO [4] (healthy eating habits, physical activity regular practice), improving body composition and motor competence in childhood from an early age, resulting probably in healthier adults and minimizing possible social problems concerning public health.

Acknowledgements

This work is funded by FCT/MEC through national funds and when applicable cofounded by FEDER - PT2020 partnership agreement under the project UID/EEA/50008/2013 and by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07-CT62-FEDER-005012; ID: 64765).

References

1. Venâncio P, Aguilar S, Pinto G. Obesidade infantil… um problema cada vez mais atual. Revista Portuguesa de Medicina Geral e Familiar 2012;28:410-416.

2. Luz C, Cordovil R, Almeida G, Rodrigues L. Link between motor competence and Health related fitness in children and adolescents. Sports 2017;5(41):1-8.

3. McCarthy H, Cole T, Fry T, Jebb S, Prentice A. Body fat reference curves for children. International Journal of Obesity 2006;30:598-602.

4. Inchley J, Currie D, Jewell J, Breda J, Barnekow V. Adolescent obesity and related behaviours: trends and inequalities in the WHO. Copenhagen: WHO; 2017.

Keywords

Body Fat Percentage, Elementary School, Motor Competence, Obesity, Overweight.

O131 Working pregnant woman affectivity assessment regarding psychological requirements of the work

Maria S Medina, Valeriana G Blanco

Universidad de Burgos, 09001 Burgos, Spain

Correspondence: Valeriana G Blanco (vguijo@ubu.es)

Background

The labour situation of the pregnant woman has special connotations, both physical and psychological and this may influence work performance and perceived welfare, therefore also interfering in the development of different emotions.

Objective

Aware of this, the present work has as an objective to evaluate the relationship between the psychological requirements of the work of pregnant women and affectivity.

Methods

It had a convenience sample of 165 pregnant working women living in Burgos (Spain). The study has a cross-cutting nature and the data collection was carried out with the PANAS questionnaire for affectivity rating, ISTAS for psychological demand and an ad hoc questionnaire to collect identification data. The criterion variables were: work psychological requirements (EP), positive affectivity (AP) and negative affectivity (AN).

Results

The results show that pregnant women have high unfavourable exposition levels for health regarding variables of psychological requirements.

Conclusions

The relation between variables showed significant relation between the EP and AN variables, concluding that pregnant women with a friendly exposition level of psychological requirements (EP) have a lot of positive affectivity (AP) and less negative. Pregnant women that had an unfavourable psychological exposition level (EP) had more negative affectivity (AN).

Keywords

Working pregnant woman, Affectivity assessment, Psychological requirements of the work.

O132 The perception of social support and adherence to medication, on the person with COPD

Sílvia Vieira¹, Celeste Bastos^1,2, Lígia Lima^1,2

¹Nursing School of Porto, 4200-072 Porto, Portugal; ²Center for Health Technology and Services Research, University of Porto, 4200-450 Porto, Portugal

Correspondence: Sílvia Vieira (silvia_vieira3@hotmail.com)

Background

COPD (Chronic Obstructive Pulmonary Disease) is a chronic and incapacitating disease, characterized by the presence of persistent respiratory symptoms and a gradual decrease in energy [1-3]. The person with COPD has to cope with a complex therapeutic regimen and with the progressive worsening of the clinical condition [3], which may compromise their capacity for self-care. Therefore, people with COPD need support to manage the disease and the therapeutic regimen [4-6].

Objective

The study aims were to study people with COPD perception about their social support, as well as their level of adherence to medications and to analyse the association between perceived social support and adherence to medication.

Methods

This is a quantitative, descriptive and cross-sectional study, with a sample of 45 adults diagnosed with COPD, admitted to medical service at a hospital in the northern part of Portugal, between February and May 2017. Participants mean age was 71 years (SD = 11.9), they were mostly male (86.7%), married (72.7%) and had a low level of education. The measures used were: a sociodemographic and clinical questionnaire, the Social Support Scale (SSS) and Reported Adherence to Medication Scale (RAMS).

Results

The results showed that the study participants perceived a positive social support (M = 3.5, SD = 0.8). The higher scores were found for the dimension of family and affective support (M = 3.9, SD = 1.0), and the lowest scores were found in the financial support dimension (M = 2.7, SD = 1.0). In relation to the treatment of COPD, most participants reported high adherence levels (M = 12.5, SD = 4.4). A positive association was found between perceived social support and medication adherence (r = 0.46, p = 0.001).

Conclusions

Our results support the importance of social support in adherence to medication, on the person with COPD. The study also suggests the existence of a group of patients more at risk, in terms of lack of social support and non-adherence to medication, pointing out the need to develop nursing interventions focused on the promotion of self-management of COPD.

References

1. Global Initiative for Chronic Obstructive Lung Diseases. Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for Health Care Profissionals (2017 Report). Global Inititative for Chronic Lung Disease, Inc., 2017.

2. Criner G, Bourbeau J, Diekemper R, Ouellette D, Goodridge D, Stickland M, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest 2015;147(4):894-942.

3. Wedzicha J, Miravitlles M, Hurst J, Calverley P, Albert R, Krishnan J, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3). pii: 1600791.

4. Korpershoek Y, Bos-Touwen I, de Man-van Ginkel J, Lammers J, Schuurmans M, Trappenburg J. Determinants of activation for self-management in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:1757-66.

5. Halding A, Grov E. Self-rated health aspects among persons living with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2017 Apr 12;12:1163-1172.

6. Fotokian Z, Mohammadi Shahboulaghi F, Fallahi-Khoshknab M, Pourhabib A. The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease. Plos One 2017;12(4):e0174028.

Keywords

COPD, Chronic obstructive pulmonary disease, Medication adherence, Social support.

O133 The organizational commitment of health professionals (doctors, nurses and auxiliaries) in two public hospitals in Cape Verde

Jacqueline Delgado¹, António Nunes^1,2, Amélia Nunes¹

¹Universidade da Beira Interior, 6201-001 Covilhã, Portugal; ²Núcleo de Estudos em Ciências Empresariais, 6200-209 Covilhã, Portugal

Correspondence: António Nunes (anunes@ubi.pt)

Background

The organizational commitment (OC) has its origin in the “Side bets” theory, representing the result of the accumulation of bets, which can be lost in a situation where the interruption of an activity occurs [1] The terms are understood as the maintenance of the belonging to the organization, being something of value in which the individual invested [2]. That is, while the individual works, creates bonds, commits himself and goes investing in the organization. The three-dimensional model [3] identifies the three dimensions of OC: the affective commitment, which consists in the feeling or desire to participate in the organization; the continuance commitment, which consists in the obligation to remain in the organization; and finally, the normative commitment, which consists in the worker's need to remain in the organization.

Objective

The objective of this study is to measure the OC levels, in its several dimensions, on the health professionals (physicians, nurses and auxiliaries) in two public hospitals in Cape Verde, considering the importance of sociodemographic variables (age, gender, marital status and academic qualifications) and Working context (work income, seniority in the company, type of contract and Hierarchical position) for the CO levels revealed.

Methods

The study used a quantitative methodology to evaluate the impact of sociodemographic and professional context variables on OC levels. In order to measure OC, we used the scale of three components: affective, normative and calculative [3], adapted for the Portuguese language in 2008 [4]. The sample consisted of 224 health professionals.

Results

The scale presented good levels of internal consistency (Cronbach's alpha of 0.85), with median OC values correlating positively with age; simultaneously, low OC levels were identified in higher education levels and High values of OC were identified in lower education levels. Finally, OC levels were also significantly higher for the less qualified professionals, auxiliaries showed the highest levels while the doctors showed the lowest levels of OC.

Conclusions

It is emphasized the positive and statistically significant relationship between age and OC, implying higher OC levels in the higher age groups, as identified in previous studies [5-8]. The inverse relation between OC levels and levels of academic qualifications, as identified by other authors [2-3, 5,8-9], is also a subject of interest. As well as the fact that the lower levels of OC appear in the most qualified professions: doctors and nurses, a not treated aspect in the literature and that characterizes the health professionals of Cape Verde.

References

1. Becker HS. Notes on the concept of commitment. Am J Sociol 1960;66(1):32-40.

2. Meyer JP, Allen NJ. Testing “side-bet theory” of organizational commitment: some methodological considerations. J Appl Psychol 1984;69(3):372-378.

3. Meyer JP, Allen NJ. A three-component conceptualization of organizational commitment. Hum R manage R 1991;1(1):61-89.

4. Nascimento JL, Lopes A, Salgueiro MDF. Estudo sobre a validação do “Modelo de Comportamento Organizacional” de Meyer e Allen para o contexto português. Comp.Org Gestão; 2008.

5. Mathieu JE, Zajac DM. A review and meta-analysis of the antecedents, correlates, and consequences of organizational commitment. Psychol Bull 1990;108(2):171.

6. Addae HM, Praveen KP, Velinor N. Role stressors and organizational commitment: public sector employment in St Lucia. Int J Manpow 2008;29(6):567-582.

7. Allen NJ, Meyer JP. The measurement and antecedents of affective, continuance and normative commitment to the organization. J Occup Organ Psychol 1990;63(1):1-18.

8. Angle HL, Perry JL. An empirical assessment of organizational commitment and organizational effectiveness. Adm Sci 1981;Q:1-14.

9. Mowday RT, Steers RM, Porter LW. The measurement of organizational commitment. J Vocat Behav 1979; 14 (2):224-247.

Keywords

Organizational commitment, Health professionals, Physicians nurses and auxiliaries, Cape verde (Africa).

O134 Sleep quality and food intake of high school students

Ana SC Carvalho¹, Adília P Fernandes², Josiana A Vaz², Ana B Gallego³, Matilde S Veja³

¹Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal; ²Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-146 Bragança, Portugal; ³Universidad de León, 24071 León, Spain

Correspondence: Ana SC Carvalho (ana.s.coelho@hotmail.com)

Background

Poor sleep quality is associated with increased food intake and poor diet quality [1]. People with lack of sleep show a positive correlation between free time and food intake and also experience hormonal and brain changes that drive the intake of food with high calorific value [1-3]. In addition, scientific research has shown a healthy and balanced diet to positively influence the quality of sleep [1].

Objective

The present study was set out to assess the sleep quality of high school students in Bragança county, and its association with food intake.

Methods

The study used non-experimental, analytical and transversal methodology, of epidemiological character and with a quantitative approach. It was intended to carry out the study in a population of 862 high school students. However, due to consent being required from both legal guardians and students, a smaller sample of 345 students was obtained. The data was collected in May 2017 through a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), validated for the Portuguese population.

Results

Throughout the study and following PSQI analysis, it was concluded that 39.71% (n = 137) of participants showed poor quality of sleep (PSQI > 5 points). The correlation between sleep quality and food intake was assessed and a statistically significant association was found between the quality of sleep and the intake of snacks (X² = 17.144; p = 0.000), sugary products (X² = 18.603; p= 0 .000), fast-food (X² = 12.353; p = 0.002) and ready meals (X² = 14.852; p = 0.000). The risk of suffering from poor sleep quality is higher in young populations who frequently eat snacks ([OR]: 2.811; 99%), sugary products ([OR]: 1.901; 95%), fast-food ([OR]: 4.000; 99%) and ready meals ([OR]: 5.621; 95%) in comparison with young populations who rarely eat this sort of food. The sleep quality is also significantly related with the number of meals young people have in a day (X² = 7.580; p = 0.023). The risk of having poor quality sleep is 2.240 times higher in young people who rarely eat 4-6 meals a day.

Conclusions

A correlation between sleep quality and food intake in the sampled students was seen. The risk of having poor quality of sleep is higher in students who frequently eat a high calorie diet and also in students who rarely have 4-6 meals a day. There are several connections between sleep quality and eating habits. Sleep promotion and its connection with standard diets should be included as an essential part of community empowerment for health-promoting lifestyles [1,4,5].

References

1. McNeil J, Doucet E, Chaput JP. Inadequate Sleep as a Contributor to Obesity and Type 2 Diabetes. Canadian Journal of Diabetes. 2013;37:103-108.

2. Dewald JF, Meijer AM, Oort J, Kerkhof GA, Bogels SM. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 2010;14:179–189.

3. Paiva T. Bom Sono, Boa Vida. Cruz Quebrada: Oficina do Livro; 2008.

4. Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation 2012;126(14):1770-1779.

5. Direção Geral da Saúde Programa Nacional de Saúde Escolar. Lisboa: Ministério da Saúde de Portugal; 2015.

Keywords

Sleep Quality, Food intake, Balanced diet.

O135 Education matters!!! The link between childhood obesity and parents’ level of education

Ricardo Melo¹, Ana Inácio¹, Mariana Pereira¹, Miguel Santos¹, Simão Sousa¹, Francisco Campos¹, Fernando Martins^1,2

¹Applied Sport Sciences Research Unit, Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal; ²Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Ricardo Melo (ricardo.es.melo@gmail.com)

Background

Obesity is a public health problem in most developed countries [1,2]. In Portugal this scenario is very serious because it stands as one of the European countries with more obese children [3,4], which is associated to poor eating habits, low level of physical activity, and sedentary lifestyles [2].

Objective

The objectives of this investigation are: I) to determine the prevalence of overweight/obesity in elementary school children; II) to compare children’s levels of body mass by age and gender; III) to verify correlations between children’s levels of body mass and family socio-demographic characteristics.

Methods

The sample was composed by 294 children between 5-9 years old (M ± SD = 7.35 ± 1.18 years old; 147 female) of the 10 elementary schools from the “Agrupamento de Escolas de Montemor-o-Velho (AEMMV)” (Coimbra-Portugal). Data was collected from September to December 2017. Family socio-demographic characteristics data were collected using a survey questionnaire applied to parents of participating children. Weight was evaluated using a Tanita Body Composition Monitor (model BC-420 SMA). Height was calculated using a stadiometer. Body Mass Index (BMI) was calculated using the formula weight/height². The definition of underweight (level 1), normal weight (level 2), overweight (level 3) and obesity (level 4) was based on the tables in use by the Portuguese Directorate-General for Health [5], which correlates BMI with percentile tables. Data analysis was conducted using IBM SPSS (version 24.0, Chicago, USA) and a statistical significance of 10.0% was defined.

Results

Results of this study show that 17.7% of the evaluated children are overweight and 16.3% are obese (34.0% are overweight/obese). No significant statistical differences were observed by gender (Mann-Whitney = 10416; p = 0.529) or by age (Kruskal-Wallis test = 4.01; p = 0.405). Results of Spearman correlation test (r) also evidence not existing significant statistical relations between levels of body mass and parents’ age (mother: r = -0.031; p = 0.608; father: r = 0.015; p = 0.797) or with household composition (r = -0.040; p = 0.499). However, a negative correlation exists between body mass levels and parents’ education (mother: r = -0.136, p = 0.019; father: r = -0.158, p = 0.006) evidencing that the higher the level of education of the parents the lower the prevalence of high levels of body mass (overweight/obesity).

Conclusions

Despite policies to tackle obesity are being implemented, results of this study show a high prevalence of overweight/obesity children’s in the AEMMV. Results also confirm that parents' education is a strong social health determinant [1]. This study suggests that public authorities need to implement more efficient programs (e.g. nutrition and physical activity) at schools and community to promote active and healthier lifestyles.

Acknowledgements

This work is funded by FCT/MEC through national funds and when applicable cofounded by FEDER - PT2020 partnership agreement under the project UID/EEA/50008/2013 and by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07-CT62-FEDER-005012; ID: 64765). The authors also would like to thank to: Agrupamento de Escolas de Montemor-o-Velho, Câmara Municipal de Montemor-o-Velho, and Unidade de Cuidados na Comunidade de Montemor-o-Velho.

References

1. OECD [internet]. Obesity Update 2017. Retrieved from https://www.oecd.org/els/healthsystems/Obesity-Update-2017.pdf

2. WHO [internet]. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002–2014 2017. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0019/339211/WHO_ObesityReport_ 2017_v3.pdf

3. Padez C, Fernandes T, Mourão I, Moreira P, Rosado V. Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 19702002.Am J Human Biology. 2004;16 (6):670-678.

4. Venâncio P, Aguilar S, Pinto G. Obesidade infantil… um problema cada vez mais atual. Revista Portuguesa de Medicina Geral e Familiar 2012;28:410-416.

5. Divisão de Saúde Materna, Infantil e dos Adolescentes da Direcção Geral da Saúde. Actualização das Curvas de Crescimento. Circular Normativa Nº: 05/DSMIA; 2016.

Keywords

Body Mass Index, Education, Health, Obesity, Overweight.

O136 Relationship between the -1562 C/T polymorphism in the MMP-9 gene and multiple sclerosis

Ana Valado¹, Maria J Leitão², Lívia Sousa³, Inês Baldeiras⁴

¹Departamento de Ciências Biomédicas Laboratoriais, Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ²Centro de Neurociências e Biologia Celular, 3004-504 Coimbra, Portugal; ³Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁴Faculdade de Medicina, Universidade de Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Ana Valado (valado@estescoimbra.pt)

Background

Matrix metalloproteinases (MMPs), particularly MMP-9, have showed an association with the influx of inflammatory cells into the CNS, disruption of the blood brain barrier and demyelination in Multiple Sclerosis (MS). The transcriptional activity of the MMP-9 gene is influenced by the -1562 C/T polymorphism in the promoter region of the gene, and the T alelle has been suggested as a genetic risk factor for MS.

Objective

To investigate the presence of the -1562 C/T polymorphism in the MMP-9 gene in healthy controls and MS patients and its association with clinical course of the disease.

Methods

Whole blood DNA was extracted from 169 patients (143 RRMS, 20 SPMS, 6 PPMS) and 186 controls, and the presence of the polymorphism was detected by PCR-RFLP. Quantification of MMP-9 was performed in 96 patients and 63 controls by ELISA. Data from patients was analysed for associations between the polymorphism distribution and clinical factors (gender, age at onset, disease duration, EDSS score and disease course).

Results

The -1562 T allele was present in 39 patients and 41 controls, with no significant difference between groups (p = 0.533). However, in MS patients, but not in controls, more women presented with the -1562 T allele than men (p = 0.014). In patients, the distribution of the polymorphism was not significantly associated with age at onset (p = 0.759), disease duration (p = 0.309), progression of the disease (p = 0.121) or disability status (p = 0.180). The levels of MMP-9 in serum were significantly higher in MS patients compared to controls (p = 0.001). There was also an increase in serum MMP-9 values in controls that carried the T allele (p = 0.003), but not in MS patients.

Conclusions

The -1562 C/T polymorphism, at least in our population, does not seem to be a susceptibility risk factor for MS. However, in patients, there seems to be an association between the T allele with the female gender.

Keywords

-1562C/T polymorphism, MMP-9, MS.

O137 Falls prevention in older people living in nursing homes in Northern Portugal

Isabel Lage, Odete Araújo, Manuela Almendra, Fátima Braga, Rui Novais

School of Nursing, University of Minho, 4704-553 Braga, Portugal

Correspondence: Odete Araújo (odete.araujo@ese.uminho.pt)

Background

Falls in older people are the leading cause of injury-related mortality and morbidity. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 [1]. A fall can have significant adverse outcomes including injury, hospitalization and admission to long term care, development of fear of falling, activity restrictions and social isolation [2, 3].

Objective

The aim of this study was to describe the risk of falling in older people living in nursing homes in northern Portugal.

Methods

A descriptive correlational study was conducted in this research. A total of 833 participants (mean age 83 years) were recruited from 14 nursing homes in Northern Portugal. The statistical analysis of the data was performed using Statistical Package for Social Sciences (SPSS®) version 22.0, with descriptive and inferential statistical analysis with a significance level of 0.05.

Results

The results showed that the older men have less probability of falling in comparison with older women (OR = 0.581). In addition, older people able to walk independently and talk also have less probability of falling (OR = 0.431, OR = 0.360). In opposition, older people with walking difficulties or using technical aids have high risk of falling (OR = 1.944 e OR = 1.518).

Conclusions

These findings support the idea that ongoing assessment could be more important than the admission assessment, in identifying risk factors for falls in older people after institutionalization, in order to prevent falls.

References

1. NICE. Falls: assessment and prevention of falls in older people. UK: NICE accredited; 2013.

2. Pellicer García B, Juárez Vela R, Delgado Sevilla D, Redondo Castan LC, Martínez Abadía B, Ramón Arbués E. [Prevalence and profile of the elderly home care valid suffering in a private residence falls]. Revista de enfermería. 2013;36(12):8-16.

3. Yingfeng Z. Falls in older people in long-term care. Lancet. 2013;381 (9873):1179.

Keywords

Falls, Older people, Nursing homes.

O138 “+ COOLuna” – intervention program of physiotherapy in schools at ACeS Baixo Vouga

Vitor Ferreira^1,2, Ana Oliveira¹, Maritza Neto¹, Marta Santo¹

¹Agrupamento de Centros de Saúde do Baixo Vouga, 3800-159 Aveiro, Portugal; ²School of Health, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Vitor Ferreira (vitorfontesferreira@gmail.com)

Background

Musculoskeletal pain in children is one of the most common reasons to seek medical attention. The most common musculoskeletal pain conditions are nonspecific or idiopathic and include regional pain in the spine, with a high prevalence [1]. Multifactorial causes are indicated, like social, psychological, physiological and environmental factors [2, 3]. Within the environmental factors, the carriage of schoolbags is pointed out as a factor that contributes to the high prevalence of musculoskeletal pain [3-5]. However, some studies report that the weight of schoolbags has little influence on the perception of pain, mainly in the spine [6, 7]. Nevertheless, musculoskeletal pain in childhood can persist throughout adolescence and increases the risk of experiencing chronic pain in adulthood [8-10]. At this phase, adolescents undergo a period of accelerated muscle-skeletal growth and development, with spinal structures being sensitive to external aggressions [11].

Objective

The aim of this study was to evaluate musculoskeletal pain due to schoolbag carriage in terms of prevalence, intensity and predisposing risks factors in students of 5th grade in schools of the range of community health centres of Aveiro region, during the school year of 2016-2017.

Methods

A cross-sectional study was design. The presence, intensity and duration of pain was assessed using a body chart and numeric rating scale for pain. Predisposing risk factors was assessed by means of an ad hoc questionnaire.

Results

A total of 960 children (male 51.1%: female 48.6%) with a mean age of 10.4 years (± 7.6) were included. The majority had backpacks (96.6%) and 82.4% (n = 775) carried the backpack over 2 shoulders. The mean schoolbag weight (4.9 ± 1.3 kg) represented a mean % body weight (%BW) of 13.0% (± 4.8). Only 29.3% carried schoolbags that were ≤ 10 %BW. The majority (79.9%) carried schoolbags to school for ≤ 15 min. The prevalence of musculoskeletal pain was reasonable (37.8%), and in the region of spine was low (16.0%). Multiple linear regression model indicated that pain is only explained by the number of hours of physical activity (negative correlation: r = -0.367) in 12.4% (R² = 0.124; p = 0.001, SEE = 0.143).

Conclusions

This study highlights the need to consider the multifactorial nature of musculoskeletal pain in children, and also the need to reinforce protective factor of physical exercise in future prevention programs dedicated to children.

References

1. Swain MS, Henschke N, Kamper SJ, Gobina I, Ottova-Jordan V, Maher CG. An international survey of pain in adolescents. BMC public health. 2014;14:447.

2. Paananen MV, Taimela SP, Auvinen JP, Tammelin TH, Kantomaa MT, Ebeling HE, et al. Risk factors for persistence of multiple musculoskeletal pains in adolescence: a 2-year follow-up study. European Journal of Pain. 2010;14(10):1026-32.

3. Stinson J, Connelly M, Kamper SJ, Herlin T, Toupin April K. Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best practice & research Clinical rheumatology. 2016;30(3):468-82.

4. Iyer SR. An ergonomic study of chronic musculoskeletal pain in schoolchildren. Indian journal of pediatrics. 2001;68(10):937-41.

5. Noll M, Candotti CT, da Rosa BN, Loss JF. Back pain prevalence and associated factors in children and adolescents: an epidemiological population study. Revista de Saúde Pública. 2016;50:31.

6. Aprile I, Di Stasio E, Vincenzi MT, Arezzo MF, De Santis F, Mosca R, et al. The relationship between back pain and schoolbag use: a cross-sectional study of 5,318 Italian students. The spine journal : official journal of the North American Spine Society. 2016;16(6):748-55.

7. Dianat I, Sorkhi N, Pourhossein A, Alipour A, Asghari-Jafarabadi M. Neck, shoulder and low back pain in secondary schoolchildren in relation to schoolbag carriage: should the recommended weight limits be gender-specific? Appl Ergon. 2014;45(3):437-42.

8. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine (Phila Pa 1976). 2006;31(4):468-72.

9. Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinanen-Kiukaanniemi S. Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine (Phila Pa 1976). 2004;29(15):1662-9.

10. Hakala P, Rimpela A, Salminen JJ, Virtanen SM, Rimpela M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Bmj. 2002;325(7367):743.

11. Goodburn EA, Ross DA. A Picture of health? : a review and annotated bibliography of the health of young people in developing countries / undertaken World Health Organization; 1995.

Keywords

Physiotherapy, Schoolbags, Musculoskeletal pain, Children.

O139 Looking over Portuguese school-aged children lifestyles: results from a pilot study

Goreti Marques, Ana R Pinheiro, Fátima Ferreira, Daniela Simões, Sara Pinto

Escola Superior de Saúde de Santa Maria, 4049-024 Porto, Portugal

Correspondence: Goreti Marques (goreti.marques@santamariasaude.pt)

Background

Childhood obesity is considered one of the new epidemics of the 21st century. This study is part of a largest project regarding the improvement of healthy lifestyles in school-aged children, through a transdisciplinary team.

Objective

To describe food consumption and sport activities of Portuguese school-aged children.

Methods

An exploratory/descriptive pilot-study was conducted with third grade school-aged students from two Portuguese primary schools. Data were collected during through a self-filling form focusing on socio-demographic variables, sport activities and anthropometric measures (sex, age, house hold composition, practice of at least 60 minutes/week of sport activities outside school, weight, height). A booklet was used during five consecutive days to register food consumption. The study was previously approved by an Ethics Committee, and by the National Data Protection Commission (NDPC no.1704/2015). The informed consent of the child’s legal representative was signed. Data were analysed using the SPSS®-version 24.0.

Results

Preliminary results included 109 school-aged children (mean age = 7.5 years old; mean weight = 28.50 kg; mean height = 131.60 cm). Regarding the Body Mass Index (BMI), 65.1% of the children were considered to have normal weight, 11.9% overweight, and 8.3% obesity; underweight emerged in 14.7% of children. The consumption of fruit/vegetables was significantly greater (p < 0.05) in underweight children when compared with normal weight and overweight/obese children. The average consumption of fat/oil, and sugary/salty products seemed smaller in underweight children and greater in overweight/obese children, while the consumption of dairies/meat/fish/eggs, cereals and their derivatives, tubers and water seemed similar; however, statistically significant differences were not found (p > 0.05). Most children (77.1%) performed at least 60 minutes/week of sport activities outside school (66.7% practice only one type, 25.0% practice two, and 8.3% practice three different sports per week). Food consumption was not significantly different between children that practiced at least 60 min/week of sports outside school comparing to the children who didn’t.

Conclusions

Though most children have normal weight, data show important abnormalities in BMI. The consumption of fruit/vegetables appears to be increased in underweight children and decreased in overweight/obese children, which highlights the need for more detailed research. Food consumption does not seem to differ depending on the practice of outside-school sports. Further stages must bring the development of a transdisciplinary healthcare program to improve healthy lifestyles among school-aged children.

Acknowledgements

This work was funded by project NORTE-01-0145-FEDER-024116.

Keywords

Childhood obesity, Food consumption, Sport activities, Health promotion.

O140 Dating violence in university context: practices, beliefs and impacts on the health of victims

Sofia Neves^1,2, Ana Sousa,¹ Joana Topa^1,2, Janete Borges¹

¹Instituto Universitário da Maia, 4475-690 Maia, Portugal; ²Centro Interdisciplinar de Estudos de Género, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, 1300-663 Lisboa, Portugal

Correspondence: Sofia Neves (asneves@ismai.pt)

Background

Dating violence is an obvious and worrying social and health problem with serious consequences for its victims. It is characterized as a pattern of coercive and abusive tactics employed by one partner in a relationship to gain power and control over the other partner. It can take many forms, including physical violence, coercion, threats, intimidation, isolation, and emotional, sexual or economic abuse and occurs in the context of intimate heterosexual or homosexual/lesbian relationships. This kind of violence seems to be supported on conservative and traditional gender norms and stereotypes.

Objective

The main objective of this study is to characterize university students' beliefs and practices regarding dating violence, identifying the impacts of this type of violence on the psychological, physical, sexual and social health of their victims.

Methods

Were used self-administered questionnaires and a socio-demographic survey for data collection: Gender Belief Inventory (Maia University Institute and Interdisciplinary Centre for Gender Studies, version for research, 2017) and the Inventory on Violent Youth Relations (University Institute of Maia and Interdisciplinary Centre for Gender Studies, version for research, 2017). These were applied to 200 university students (142 females and 55 males), aged 18-44 (M = 20.54; SD = 4.435) who were attending the Maia University Institute. Data analysis was performed using the statistical program IBM- Statistics Package for the Social Sciences (version 24).

Results

The results showed that 12.8% of students reported having been victims of some act of violence by someone with whom they maintain or maintained a relationship of intimacy. Men were identified as the main perpetuators, with women having the highest rates of victimization. With regard to the type of violence perpetuated, psychological and social violence appear as the most experienced by students. With regard to gender social beliefs, this study reveals that these students maintain conservative and traditional gender beliefs that continue to perpetuate violence. Regarding the impact of dating violence, there was awareness among respondents of the implications of this violence on the health of the victims.

Conclusions

This study shows that despite the efforts that have been made in the implementation of policies and projects to prevent gender violence, this has not been enough to finish its practice. The commitment to the implementation of gender equality programs in school education seems fundamental in order to prevent this public health problem.

Keywords

Dating Violence, University Students, Beliefs, Practices, Implications to health.

O141 Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)

Ana Sargento^1,2, Ana Querido^3,4, Henrique Carvalho², Isa Santos², Catarina Reis^2,5, Marisa Maximiano^2,5, Manuela Frederico⁶, Sandra Oliveira^7,8, Susana Leal^7,9

¹Center for Applied Research in Management and Economics, School of Technology and Management, 2411-901 Leiria, Portugal; ²School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, 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; ⁵Center for Research in Informatics and Communications, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ⁷School of Management and Technology, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal; ⁸Center for Health Studies and Research, University of Coimbra, 3004-504 Coimbra, Portugal; ⁹Life Quality Research Centre, 2001-904 Santarém, Portugal

Correspondence: Ana Sargento (ana.sargento@ipleiria.pt)

Background

Increasing healthcare costs is a concern of all developed countries. In Long-Term Healthcare (LTH) this is reinforced by population ageing and corresponding prevalence of chronic diseases. Thus, it is fundamental to accurately measure costs and outcomes in healthcare, improving value created for patients, i.e., patient-centred health outcomes per monetary unit of cost [1, 2]. TDABC methodology applied to healthcare allows identifying the cost for each clinical condition in the full cycle of care, mapping processes, activities, resources and allocated time [3–5]. It has been mostly applied in acute-care settings, partly due to complexity of defining chronic condition [6].

Objective

This paper focuses on the cost component of a larger on-going research project (CARE4VALUE), aiming to enhance value creation in LTH providers and applied to a partner LTH unit. Specifically, the main objective is to define clinical conditions in the context of LTH, as a first step in the implementation of TDBAC.

Methods

Mixed qualitative and quantitative methods were applied, including: 1) three focus groups conducted with the health team of the LTH unit (physician, nurses, physiotherapist, psychologist, social assistant) to select, discuss and validate the criteria to define clinical conditions; 2) construction of a composite indicator and testing it over a sample of anonymized clinical data from 21 patients; 3) structured observation of processes taken throughout the full cycle of care of patients in different conditions. Qualitative data was submitted to content analysis and validated among participants. Quantitative data used in the composite indicator, based on validated scales, was subject to normalization, aggregation and sensitivity analysis.

Results

One consensual outcome of the focus groups was that, in LTH, the disease or cause of entrance is less relevant to costs than the overall complexity of the patient, entailing psychical, social, spiritual and psychic-mental dimensions. Accordingly, a multidimensional classification model of patients in four complexity levels was delivered, after being validated and receiving consensus from the LTH team. Additionally, it will include a logging tool and dashboard to integrate separate patient-centred information and aid patient classification in complexity conditions.

Conclusions

The completion of this step allowed progressing in the design and implementation of the cost model, which, in turn, will support value measurement, and enhancing of the focus LTH unit. Besides, all involved professionals stated that their engagement in this phase of the project generated exceptional opportunities for interdisciplinary meetings and debate, contributing to closer ties between different areas of LTH.

References

1. Porter ME, Kaplan RS. How to pay for health care. Harv Bus Rev. 2016 Jul-Aug;94(7-8):88-98, 100, 134.

2. Schupbach J, Chandra A, Huckman RS. A Simple Way to Measure Health Care Outcomes. Havard Bus Rev [Internet]. 2016; Disponível em: https://hbr.org/2016/12/a-simple-way-to-measure-health-careoutcomes

3. Crott R, Lawson G, Nollevaux MC, Castiaux A, Krug B. Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach. Eur Arch Oto-Rhino-Laryngology. 2016;273(9):2621–2628.

4. Alaoui S El, Lindefors N. Combining time-driven activity-based costing with clinical outcome in cost-effectiveness analysis to measure value in treatment of depression. PLoS One. 2016;11(10): e0165389.

5. Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: A systematic review of the literature. Health Policy (New York). 2017;121(7):755–763.

6. Nolte EE, McKee M. Caring for people with chronic conditions : a health system perspective. Eur Obs Heal Syst Policies Ser. 2008;XXI:259.

Keywords

Long-term healthcare, Time-Driven Activity Based Costing (TDABC), Clinical conditions, Patient-centered data, patient complexity.

O142 Effects of aerobic land-based and water-based exercise training programs on clinical and functional parameters in older women

Rafael Oliveira^1,2, Carlos T Santamarinha³, João Brito^1,2

¹Research Unit in Quality of Life, Sport Sciences School of Rio Maior, Polytechnic of Santarém, 2040-413 Rio Maior, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal; ³City Hall of Esposende, 4740-223 Esposende, Portugal

Correspondence: Rafael Oliveira (rafaeloliveira@esdrm.ipsantarem.pt)

Background

In Portugal, most exercise training programs are offered by municipalities, seasonally, by 8 to 10 months.

Objective

The aim of the study was to access the clinical and functional effects of the application of different fitness exercise training programs, which included aerobic fitness group classes, with calisthenics exercises and water-based exercise, for nine months, to older women.

Methods

In the study, 96 active older women participated. They were divided in four exercise groups: 2xland-based group (GA, n=21; age 71.46±9.75 years; body weight 72.44±11.85 kg; height 153.82±5.83cm); 2xwater-based group (GB, n=9; age 70.10±9.98 years; body weight 70.48±10.92 kg; height 153.68±5.64cm); group of 1xland plus 2xwater-based (GC, n=7, age 71.35±8.32 years; body weight 73.42±11.20 kg; height 154.39±5.01cm), group of 2xland plus 2xwater-based exercise (GD, n=39, age 71.46±7.38 years; body weight 71.70±11.66 kg; height 154.23±6.82 cm). Clinical parameters were also accessed, such as, fast glucose, triglycerides, rest blood pressure, rest heart rate frequency (FCR) and functional parameters [1]: resistance of upper and lower limbs, agility and aerobic capacity. The training intensity of the programs was moderate, 10-14 on the “Rate of Perceived Exertion” scale [2], run accordingly [3]. It was use inferential statistic through T-test to compare baseline vs post-training.

Results

After nine months of intervention, the main results were at fast: glycemia (GA=116.0±12.11 vs 101.50±13.36 mg/dL; GC= 120.43±15.34 vs 100.47±11.65 mg/dL; GD = 127.29±36.60 vs 111.23±29.18 mg/dL); triglycerides (GA= 288.13±136.78 vs 158.13±47.24 mg/dL; GC= 295.94±112.92 vs 153.63±101.96 mg/dL; GD= 244.79±122.41 vs 144.98±69.27 mg/dL), FCR (GD=71.34±11.26 vs 66.31±8.68 bpm); aerobic capacity (GB= 541.88±51.03 vs 605.0±31.12 m ; GD=127.29±174.06 vs, 111.23±131.65 m), in resistance of lower limbs (GA=16.57±5.19 vs 18.90±5.07 repetitions; GB=14.89±5.21 vs 19.11±4.83 repetitions ; GD=20.54±5.38 vs 22.87±6.39 repetitions) and agility (GA= 7.94±3.52 vs 8.82±2.91 seconds; GB=8.86±4.09 vs 6.53±2.40 seconds; GC=7.90±4.56 vs 6.81±3.78 seconds; GD 6.13±1.66 vs 5.48±1.87 seconds), p < 0.05 for all. Also, it was observed that there were correlations between aerobic capacity and triglycerides; fast glucose and triglycerides.

Conclusions

The results showed a positive effect in all exercise training programs offered by municipality of Esposende, for clinical and functional parameters in older women. Groups of land-based exercise, at least twice a week, seam to lead to better results. The study supports the role of physical exercise to improve hemodynamic, lipid profile and functional parameters as reported previously by another similar study [4]. In addition, this study also revealed efficiency to improve clinical parameters that were not studied yet.

References

1. Rikli R, Jones C. The development and validation of a functional fitness test for community-residimg older adults. J Aging Phys Activ. 1999;7:129-161.

2. Borg G. Phychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377-381.

3. American College of Sports Medicine, ACSM. ACSM’s Guidelines for exercise testing and prescription (9th ed). Philadelphia: Lippincott Williams and Wilkins; 2013.

4. Oliveira R, Santa-Marinha C, Leão R, Monteiro D, Bento T, Rocha RS, Brito JP. Exercise training programs and detraining in older women. J Hum Sport Exerc. 2017;12(1):142-155.

Keywords

Older women, Water-based exercise, Land-based exercise, Functional capacities, Clinical parameters.s

O143 The influence of emotional intelligence in stigmatizing attitudes toward mental illness of undergraduate nursing students

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

Health care professionals share the general public’s attitude towards people with mental illness, being generalized the harmful beliefs and the subsequent negative attitudes to these patients [1]. A significant correlation between emotional intelligence and mental illness stigma has been found.

Objective

To analyse the correlation between emotional intelligence and stigmatizing attitudes towards mental illness and to access the influence of this intelligence in those stigmatizing attitudes, among undergraduate nursing students.

Methods

It was performed a cross-sectional correlational study. Data was collected from a non-probabilistic sample of nursing students from a health school of the centre region of Portugal, using a questionnaire with sociodemographic questions, the Wong and Low Emotional Intelligence Scale (1-5) [2] and the Community Attitudes Toward the Mentally Ill Scale (40-200) [3]. Ethical procedures were taken into account during research according the Helsinki Declaration.

Results

Most of the nursing students inquired (N=335) were female (N=263). The sample had an average age of 21.69 years (SD=4.64), distributed by all levels of nursing graduation. Some (n=25) had already suffered from mental illness, mainly (N=17) humour disorders, and 41.2% referred to have regular contact with mental health patients in their lives. These nursing students showed a good emotional intelligence (Mean=3.62; SD=0.41), being higher in self-emotional appraisal (Mean=3.73; SD=0.58) and others’ emotional appraisal (Mean=3.85; SD=0.49). Stigmatizing attitudes towards mental illness are medium-low (Mean=122.15; SD=5.02), being more intense in authoritarianism (Mean=23.92; SD=4.44) and social restrictiveness (Mean=20.87; SD=4.94). Emotional intelligence is positively correlated with attitudes in community mental health ideology (R=0.133; p=0.015). Other’s emotional appraisal ability of emotional intelligence is correlated with attitudes regarding benevolence (R=0.276; p=0.000), community mental health ideology (R=0.221; p=0.000), authoritarianism (R=-0.156; p=0.005) and social restrictiveness (R=-0.254; p=0.000). Other’s emotional appraisal ability can explain some of the attitudes regarding authoritarianism (R²=0.024; F=8.138; p=0.005), benevolence (R²=0.076; F=27.136; p=0.000), social restrictiveness (R²=0.065; F=22.560; p=0.000) and community mental health ideology (R²=0.049; F=16.862; p=0.000). Regulation of emotions also influences benevolence attitudes (R²=0.016; F=16.578; p=0.000).

Conclusions

Postgraduate nursing students have good emotional intelligence and low stigmatizing attitudes towards mental illness. A significant correlation was found between emotional intelligence and stigmatizing attitudes, mostly positive, and an influence of this type of intelligence in the four areas of this kind of attitudes. These results enhance the importance of developing emotional intelligence, specially the ability of other’s emotional appraisal, in a way to improve attitudes toward mental illness.

References

1. Poreddi V, Thimmaiah R, Pashupu D, Ramachandra, Badamath S. Undergraduate Nursing students’ attitudes towards mental illness: Implications for specific academic education. Indian J Psychol Med. 2014;36(4):368-372.

2. Querido A, Tomás C, Carvalho D, Gomes J, Cordeiro M. Measuring emotional intelligence in health care students – revalidation of WLEIS-P. In: Proceedings of the 3rd IPLeiria’s International health Congress; 2016 maio 6-7; Leiria, Portugal. London: BMC Health Services Research; 2016. p. 87.

3. Taylor S, Dear M. Scaling community Attitudes Toward the Mentally Ill. Schizophrenia Bulletin. 1981, 7(2): 225-240.

Keywords

Mental health, Stigma, Nurse students, Emotional intelligence.

O144 Functional decline in older acute medical in-patients

Cecília Rodrigues¹, Denisa Mendonça², Maria M Martins³

¹Centro Hospitalar do Porto, 4099-001 Porto, Portugal; ²Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

Correspondence: Cecília Rodrigues (ceciliarodrigue@gmail.com)

Background

Older patients hospitalised for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes.

Objective

The aim of this study was to compare basic self-care needs in older acute medical in-patients between 2 weeks before hospitalization and discharge.

Methods

Single-centred, observational, and prospective cohort study. Data were collected between May and September 2017 and included 91 patients, aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Performance in basic activities of daily living (BADL) at home (self-reported), at hospital admission (observed) and at discharge (observed) was collected. Functional status of the elderly patients at 2 weeks before hospitalization (baseline), at hospital admission, and at discharge was measured by the Katz Index. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline.

Results

Pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the patients, respectively. Patients were independent on average in 3.63, 1.41 and 1.90 BADL 2 weeks before admission, at hospital admission and at discharge, respectively. In-hospital functional improvement occurred in 36.3% of the patients.

Conclusions

Due to their attitude to observe, support and guide patients and their 24 hours patient supervision, nurses play a key role in strategies to prevent functional decline in older patients. An adequate planning of nursing care that includes interventions to promote and maintain mobility, in the logic of self-care, can be a valuable contribution in the prevention of functional decline and in the reconstruction of independence in self-care, after a generative event of dependence.

Keywords

Functional decline, Elderly, Hospital outcomes.

O145 Validation of the Weight Focused Feelings Scale in a sample of overweight and obese women participating in a community-based weight management programme

Cristiana Duarte¹, Marcela Matos,² James Stubbs¹, Corinne Gale³, Liam Morris⁴, Paul Gilbert^3,5

¹School of Psychology, Faculty of Medicine and Health, University of Leeds, LS2 9JT, Leeds, United Kingdom; ²Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal; ³College of Life and Natural Sciences, University of Derby, Kedleston Road, DE22 1GB, Derby, United Kingdom; ⁴Nutrition and Research Department, Slimming World, Clover Nook Road, DE55 4RF, Derbyshire, United Kingdom; ⁵Mental Health Research Unit, Kingsway Hospital, DE22 3LZ, Derby, United Kingdom

Correspondence: Cristiana Duarte (c.duarte@leeds.ac.uk)

Background

A significant body of literature suggests that negative emotions may undermine self-regulation of eating behaviour during/subsequent to weight loss attempts by influencing loss of control of eating behaviour [1]. Negative feelings related to body weight and shape seem to play a role in eating problems, with some studies suggesting that binge eating may occur as a means of momentarily avoiding/reducing negative affects related to body weight and shape [2, 3]. Recent evidence suggests that positive emotions may also relate to overeating in healthy and obese adults [4-6]. Nonetheless, research on emotions and eating focuses primarily on negative emotions and there is a lack of measuring relating positive emotions to eating.

Objective

The current study aimed to test the factorial structure and psychometric properties of the Weight Focused Feelings Scale (WFFS), an 11-item measure that assesses negative and positive feelings linked to body weight and shape.

Methods

2,236 women attending a community-based weight management programme participated in this study. Mean (SD) participants age was 41.71 (12.34) years and BMI was 31.62 (6.10) kg/m². Data was randomly split in two independent data sets to conduct an Exploratory Factor Analysis (EFA) in 1,088 participants, and a Confirmatory Factor Analysis (CFA), in 1,148 participants.

Results

Results of the EFA indicated a two-factor structure: negative feelings (7 items) and positive feelings (3 items). Items presented factorial loading above .49 on the first factor, and above .64 on the second factor. The CFA confirmed the plausibility of this 2-factor model (X²₍₄₁₎ = 283.771: p < .001; CFI = .96; TLI = .95; PCFI =.72; RMSEA = .07 [.06 to .08]). Standardized Regression Weights ranged from .55 to .68 in the Negative affect subscale; and .75 to .90 in the Positive affect subscale. Items' Squared Multiple Correlations ranged from .30 to .81. The subscales presented Composite Reliability values of .93 and .88, respectively. The two subscales were associated, in the expected direction, with measures of depressive, anxiety and stress symptoms, psychological wellbeing, shame, dietary disinhibition, restraint and susceptibility to hunger, and body mass index (BMI).

Conclusions

The WFFS is a valid measure to assess body weight and shape-related negative and positive emotions. This measure may be useful for future model testing examining the differential role of negative and positive emotions in eating behaviour and weight management.

References

1. Singh M. Mood, food and obesity. Frontiers Psychol. 2014;5:925.

2. Duarte C, Pinto-Gouveia J, Ferreira C. Ashamed and fused with body image and eating: Binge eating as an avoidance strategy. Clin Psychol Psychother. 2017;24(1):195-202.

3. Heatherton T, Baumeister R. Binge eating as escape from self-awareness. Psychol Bull 1991;110(1):86-108.

4. Bongers P, Jansen A, Havermans R, Roefs A, Nederkoorn C. Happy eating. The underestimated role of overeating in a positive mood. Appetite 2013;67:74-80.

5. Cardi V, Leppanen J, Treasure J. The effects of negative and positive mood induction on eating behaviour: A meta-analysis of laboratory studies in the healthy population and eating and weight disorders. Neuroscience & Biobehavioral Reviews in Cardiovascular Medicine 2015;57:299-309.

6. Evers C, Adriaanse M, Ridder DTD, Witt Huberts JC. Good mood food. Positive emotion as a neglected trigger for food intake. Appetite 2013;68:1-7.

Keywords

Negative and Positive emotions, Body weight and shape, Eating behavior, Factorial Analysis, Psychometric analysis.

O146 Nurses’ perceptions of barriers for implementing EBP in a central hospital in the north of Portugal

Ana IC Teixeira^1,2,3,4, António L Carvalho^3,4, Cristina Barroso⁴

¹Centro Hospitalar São João, 4200-319 Porto, Portugal; ²Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

Correspondence: Ana IC Teixeira (enf.anat@gmail.com)

Background

Evidence based practice (EBP) is defined as an integration of best research evidence with clinical expertise and patient values in clinical decision making [1, 2]. Research confirms positive outcomes when implementing EBP: patient safety; improved clinical outcomes; reduced healthcare costs and decreased variation in patient outcomes [3]. Considered as a standard of care, EBP has benefits for nurses, patients, general population, health care systems, as well as for research and education. Authors describe several types of obstacles to the use of research in practice: characteristics of the adopter, organization, innovation and communication [1]. Individual barriers include lack of knowledge and how to critique research studies; lack of awareness; colleagues not supportive of practice change and nurses feeling a lack of authority to change practice. Organizational barriers include insufficient time to implement new ideas; lack of access to research; and lack of awareness of available educational tools related to research [3]. The most important factor related to nurses’ EBP is support from their employing organizations to use and conduct research. Programme implementation is most likely to be successful when it matches the values, needs and concerns of practitioners. Concerning the development and implementation of competence for EBP, firstly, is important to identify the barriers.

Objective

Our objective is to explore and describe nurse’s perceptions of these barriers in our context.

Methods

This study is part of a larger one, namely: “Clinical Supervision for Safety and Care Quality” (C-S2AFECARE-Q). To answer our research question a convenience sampling strategy was employed to distribute 500 questionnaires to nurses working in a central hospital in the north of Portugal. Data was collected between April and July 2017. They returned 260 questionnaires, 98 of these with the answer to the following question: “In your opinion, which are the barriers for the implementation of EBP in your context?”. Data analyses were based on content analysis proposed by Bardin (1977).

Results

Barriers were allocated into categories: Organization; Leaders and Management; Professionals and evidence [4]. Nurses reported perceived barriers in all these levels. In the organization’ barrier, they identified lack of organizational culture; lack of support from management and outdated and unquestioned routines. They also reported insufficient support from the leaders. In individual terms, they identified negative attitudes, such as lack of motivation, resistance to change, lack of time and inadequate knowledge and skills.

Conclusions

Our results are consistent with other authors’ findings [5]. Nurses are clearly aware of the barriers in their context.

References

1. Munten G, van den Bogaard J, Cox K, Garretsen H, Bongers I. Implementation of Evidence-Based Practice in Nursing Using Action Research: A Review. Worldviews Evid Based Nurs. 2010;7(3):135-157.

2. Ubbink D, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open Journal. 2013;3:e001881.

3. Black AT, Balneaves LG, Garossino C, Puyat JH, Qian H. Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians. J Nurs Adm. 2015;45(1):14-20.

4. Jylhä V, Oikarainen A, Perälä M, Holopainen A. Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. World Health Organization; 2017 [cited 2018 Jan 18]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/publications/2017/facilitating-evidence-based-practice-in-nursing-and-midwifery-in-the-who-european-region-2017.

5. Pereira RPG, Cardoso MJ, Martins MA. Atitudes e barreiras à prática de enfermagem baseada na evidência em contexto comunitário. Revista de Enfermagem Referência. 2012;3(7):55-62.

6. Solomons N, Spross JA. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Journal of Nursing Management. 2011;19(1):109-120.

Keywords

Nursing, Evidence-Based Practice, Barriers, Hospital health care.

O147 Patient identification, patient safety and clinical audit

Cecília Rodrigues, Manuel Valente

Centro Hospitalar do Porto, 4099-001 Porto, Portugal

Correspondence: Cecília Rodrigues (ceciliarodrigue@gmail.com)

Background

The correct identification of the person under health care in an institution is a basic principle of a patient safety culture and quality of care provided. Failures associated with patient identification processes are the cause of medication errors, transfusions, complementary diagnostic and therapeutic screenings, invasive procedures performed on wrong persons, and other incidents of high severity.

Objective

Identify if all hospitalized patients have identification wristbands and check if the name is correct and readable.

Methods

In a 580-bed adult teaching hospital, between January and December 2017, on random days of each month, patients were audited for identification by wristband by a team of nurses with experience in clinical audit.

Results

In the 12 months studied, 161 audits were performed, resulting in 3,539 patients audited. From the total patients audited, 3,406 (96.2%) were correctly identified with wristbands. There were 133 failures: 113 patients had no identification wristband, 19 patients had an identification wristband, but the name was unreadable and 1 patient had a wristband with the wrong name. The rate of correctly identified patients increased progressively over the months: in the first month (January 2017) 89.3% of patients were correctly identified with a wristband; in December 2017, the rate of correctly identified patients was 95.0%. The partial results of this audit were disclosed in general risk management meetings with clinical services in March, June and September 2017.

Conclusions

Given the potential negative implications of the absence of identification of the person undergoing health care, these results indicate that there is a clear opportunity for improvement in patient identification. Clinical audit has proved to be an instrument for improving quality and safety, particularly in improving the identification of patients.

Keywords

Patient safety, Patient identification, Clinical audit.

O148 Demographic differences in quality of life in elderly population of Tâmega e Sousa

Sara S Lima^1,2, Raquel Esteves^1,2, Clarisse Magalhães^1,2, Fátima Ribeiro^1,2, Lurdes Teixeira^1,2, Ana Teixeira^1,2, Fernanda Pereira^1,2

¹Cooperativa De Ensino Superior Politécnico Universitário, 4585-116 Gandra, Paredes, Portugal; ²Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, 4585-116 Gandra, Paredes, Portugal

Correspondence: Sara S Lima (ssofialima@gmail.com)

Background

Aging population is associated with an increase in pathologies of prolonged evolution, making necessary to redirect and reorganize social and health structures, in order to meet the specific needs of the elderly population.

Objective

To characterize the demographic profile of the elderly population of the region of Tâmega e Sousa regarding quality of life as well as functionality level and social support; and to find differences in quality of life according to gender and age.

Methods

This cross-sectional study included 200 participants, 67% women with a mean age of 72 years old (SD=5.3). A sociodemographic questionnaire, SF-36 to assess quality of life (physical and mental dimension), Barthel Index to assess functionality level and Satisfaction with Social Support Scale to assess satisfaction with social support were used.

Results

For mental quality of life the mean score was 59.69 (SD=12.78) and 49.80 (SD=16.38) for physical quality of life. Satisfaction with social support was positively associated to both mental (r=.476, p<.001) and physical quality of life (r=.457, p<.001) as well as with functionality level (r= .386, p<.001; r=.458, p<.001, respectively). There were differences in mental (t(195)= -2.998, p=.003) and physical quality of life (t(195)= -3.358, p=.001) according to gender and according to age, i.e., the youngest participants (< 71 years old) showed high mental (t(197)=-33.552, p<.001) and physical (t(197)=2.466, p=.015) quality of life.

Conclusions

The results highlight the role of social support and level of functionality in the quality of life of this population, emphasizing the need to foster the integration of this population into social programs and leisure time as well as to promote physical activity in order to improve the level of functionality. Physical activity improves independent living, reduces disability, and improves the quality of life of the elderly. Contrary to the literature, programs should be constructed taking into account that men presented worse quality of life and should be directed to the older ones, as expected. Therefore, results show the importance to implement multidisciplinary programs, tailored, with older people profiles, allowing the development of an integrated social and health response to the elderly population of this region.

Keywords

Aging, Eldely people, Quality of Life, Social Support, Functionality, Social and health structures.

O149 Healthy lifestyles & literacy for health in work context- what trend?

Otilia Freitas^1,2, Gregório Freitas^1,2, Clementina Morna^1,2, Isabel Silva^1,2, Gilberta Sousa^1,2, Rita Vasconcelos³, Luís Saboga-Nunes^4,5, Estudantes Enfermagem¹

¹Center for Health Technology and Services Research, University of Madeira, 9020-105 Funchal, Madeira, Portugal; ²Higher School of Health, 9020-105 Funchal, Madeira, Portugal; ³Faculty of Exact Sciences and Technology, University of Madeira, 9020-105 Funchal, Madeira, Portugal; ⁴institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisboa, Portugal; ⁵Institute of Sociology, University of Freiburg, 79098 Freiburg, Germany

Correspondence: Otilia Freitas (omsfreitas@uma.pt)

Background

In the National Plan for Occupational Health (PNSO) - 2nd Cycle 2013/2017, goals are established to increase health gains and guarantee the value of the workers’ health in groups of employers by those responsible for governance and society in general. One of the specific objectives is to promote health and work practices and healthy lifestyles at the workplace, concerning private sector companies and Public Administration [1].

Objective

To describe health lifestyles and health literacy of workers of a company of the tertiary sector of Região Autónoma da Madeira, Portugal.

Methods

Descriptive exploratory study, with a non-probabilistic convenience sample of 118 workers, with mean age of 45 years, predominantly male (88.1%). We used a sociodemographic data collection instrument, the FANTASTIC Lifestyle Questionnaire [2] (αC 0.725) and the European Questionnaire on Literacy for Health, Portuguese version [3], (αC of 0.97). A favourable opinion was obtained from an ethics committee and the ethical procedures inherent to this type of study were respected.

Results

It was found that 11.9% of the respondents presented a general level of Good (73 to 86), 55.9% of Very Good (85 to 102) and 32.2% of Excellent (103 to 120) lifestyle. Regarding general health literacy, 56.70% of the respondents had limited literacy levels, being 7.20% inadequate and 49.50% problematic. The trend towards limited literacy, observed in general literacy, remained in all three domains. Thus, in the area of Health Care, 48.3% of the respondents had limited levels of literacy, being 8.47% inadequate and 39.83% problematic. Concerning disease prevention, 44.06% of the respondents showed limited levels of literacy, being 11.86% inadequate and 32.20% problematic. In terms of health promotion, 47.46% of the respondents showed limited levels of literacy, being 11.02% inadequate and 36.44% problematic. There is a positive (ρ = 0.277) and statistically significant correlation between the general lifestyle score and the overall health literacy score (p value = 0.002).

Conclusions

The results suggest the importance of an intervention with integrated activities and promoters of healthy lifestyles and of health literacy, focusing strategically on health education in the work context, aiming to raise awareness among the target population.

References

1. DGS. Plano Nacional de Saúde Ocupacional 2013/2017. https://www.dgs.pt/saudeocupacional/programa-nacional4.aspx.

2. Saboga-Nunes L, Sorensen K, Pelikan J, Cunha M, Rodrigues E, Paixão E. Cross-cultural adaptation and validation to Portuguese of the European Health Literacy Survey (HLS-EU-PT). Atencion Primaria. 2014;46(1):13.

3. Silva AMM, Brito IS, Amado J. Adaptação e validação do questionário “Estilo de Vida Fantástico”: resultados psicométricos preliminares. Referência. 2011;3:650.

Keywords

Healthy lifestyles, Health literacy, Work context, Nursing.

O150 3rd pressure ulcer prevalence study in community setting - CSAH-USIT

Manuela Dias, Ana Rocha

Unidade de Saúde da Ilha Terceira, Centro de Saúde de Angra do Heroísmo, 9700-121, Açores, Portugal

Correspondence: Manuela Dias (maria.mm.dias@azores.gov.pt)

Background

Pressure ulcers are a problem to health care institutions and professionals. In Azores Islands, there are few prevalence studies in community settings and the results point to prevalence rates of 18.5%, according to the Nursing Scientific Investigation Group (ICE) [1] in 2006, and of 26.49% according to Rodrigues and Soriano [2], in 2010. The National Security Patient Plan 2015-2020 [3] recommends that all health institutions should supervise this problem every six month, so “Gabinete de Saúde Comunitária” is already conducting the 3rd Pressure Ulcer Prevention Study.

Objective

This study aims to examine the prevalence rate of pressure ulcers in patients living at home, to characterize those patients as well as the most severe ulcers.

Methods

This was a descriptive cross-sectional study using a quantitative approach with a questionnaire, which took place during November’s first week, in 2017. The population was the one attending Angra Health Centre, assisted by nurses, in a community setting. Data was analysed using Excel 2007. The study was performed after the Health Centre’s approval. A sample of 26 patients, with pressure ulcers, 54% female, with a medium age of 79.09 years participated in the study. Most of the patients (46.15%) belonged to the age group between 80-89 years.

Results

The study reported a prevalence rate of 7.58%. There was a ratio of pressure ulcers per participant with pressure ulcer of 1.5, where the sacrum/coccyx was the main critical area. Most of the pressure ulcers recorded was category II (42.31%), with an evolution situated on 4.42 months. 77% had high risk of pressure ulcer development according to the Braden Scale; 92.31% of the patients had prevention devices on bed and only 31.25% had them on sitting chairs. Upon analysis of the three studies, we noticed that the prevalence rate had increased, the medium age decreased, with the largest group belonging to the group between 80-89 years old. There was also an increased number of the sacrum/coccyx localization in this group.

Conclusions

This study allowed us to analyse, briefly, the pressure ulcer context, in which nurses spend a large amount of time caring and showing some strategies for recovery. Targeting those findings should be implemented in some of these community settings, in order to improve the health quality of the patient.

References

1. Gomes LM. Prefácio In Grupo ICE. Investigação Científica em Enfermagem, Enfermagem e úlceras de pressão: Da reflexão sobre a disciplina às evidências nos cuidados. Angra do Heroísmo: Grupo ICE. 2008; p. 8-13.

2. Rodrigues A, Soriano J. Fatores influenciadores dos cuidados de enfermagem domiciliários na prevenção de úlceras por pressão. Revista de Enfermagem Referência. 2011;III(5):55-63.

3. Diário da República. Plano Nacional para a Segurança dos Doentes 2015-2020., 2.ª série — N.º 28 — 10 de fevereiro de 2015.

Keywords

Pressure Ulcer, Prevalence, Community settings, Nursing.

O151 Relationship between health literacy, electronic health literacy and knowledge of sexually transmitted diseases in workers of a Portuguese hospital

Alice Gonçalves¹, Anabela Martins², Clara Rocha³, Diana Martins^1,4, Isabel Andrade³, Margarida Martins⁵, Paula Vidas⁶, Paulo Polónio⁷, Fernando Mendes^1,8,9,10

¹Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Department of Physiotherapy, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ³Department of Complementary Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ⁴Institute for Research and innovation in Health Sciences, University of Porto, 4200-135 Porto, Portugal; ⁵Emergency Service, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁶Cardiology Service, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁷Laboratory Medicine Hospital, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁸Biophysics Institute, Center for Neuroscience and Cell Biology-Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁹Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ¹⁰Coimbra Institute for Clinical and Biomedical Research, University of Coimbra, 3094-001 Coimbra, Portugal

Correspondence: Alice Gonçalves (alicebvb@gmail.com)

Background

Health literacy (HL) can be defined as the individual capacity of obtaining and understanding information, making appropriate decisions about health. An adequate level of HL is fundamental for risk awareness and behaviour change, as well as for disease prevention. Electronic health literacy (eHL) can be useful in promoting health, but it demands the capacity of judgment towards the obtained information and the ability to work with new technologies. Due to the high prevalence of sexually transmitted diseases (STDs) in the general population, it’s important to evaluate and relate these health concepts.

Objective

To evaluate and relate levels of HL and eHL with STD knowledge of professionals of a Portuguese Hospital.

Methods

149 individuals from different professional categories, working at a medium size Portuguese Hospital, answered an anonymous questionnaire, composed of four parts: socio-demographic data, STDs knowledge, and the Portuguese version of both Newest Vital Sign (to assess the functional HL) and eHEALS (to assess the eHL).

Results

Altogether 66.0% of the sample had the possibility of an adequate HL; 59.2% of those individuals were health professionals and 76.3% had a high knowledge on STDs. 72.4% were female and 27.5% male, showing similar possibility of an adequate HL (66.7% and 61.0%, respectively). Concerning the individuals with the possibility of an adequate level of HL, 27.5% were 31-40 years old and 90.6% held a higher education degree, while 7.3% had only completed high school. In general, “I know what health resources are available on the Internet” and “I have the skills I need to evaluate the health resources I find on the Internet” had the highest mean (3.99) and “I feel confident in using information from the Internet to make health decisions” had the lowest with 3.08.

Conclusions

Individuals with higher education, especially in health sciences, have higher probability of an adequate HL. Age may also be an interfering factor, since the youth nowadays, has more access to information early in life. Our results also show that 50% of the studied population had the possibility of an adequate level of HL and a high knowledge in STDs, which is an average percentage for people who work at this hospital. This can be changed, using specific education procedures, such as lectures or seminars, to increase HL and knowledge on STDs.

References

1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health;12(1):80.

2. Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2):e9.

3. Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. J Med Internet Res. 2006;8(4):e27.

Keywords

Health literacy, eHealth literacy, Risk behaviour, Health professionals.

O152 Stigmatizing attitudes toward mental illness in future health professionals

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

Health professionals, like nurses, still have concerns and negative attitudes towards people with mental illness, despite development of mental health services [1]. Final year students were found to be less stigmatizing [2], being important to pay special attention to the education of these professionals and on-the-job training [1].

Objective

To access the levels of stigmatizing attitudes towards mental illness, and to characterize the determinants of these attitudes, developed by health students.

Methods

A quantitative, cross-sectional correlational study was performed. A non-probabilistic sample of health students from a school in the centre region of Portugal was considered, and data was collected with a questionnaire with sociodemographic questions, a question about perception on their knowledge about mental health (scoring 0 to 5) and the Community Attitudes Toward the Mentally Ill Scale (scoring 40 to 200) [3]. Ethical procedures were taken into account during research, according to the Helsinki Declaration.

Results

The students inquired (N=636) were representative of five health degrees, namely, Dietetics, Nursing, Physiotherapy, Speech Therapy and Occupational Therapy, mostly female (82.1%), with an average age of 21.35 (SD=4,29; Median=20). A low percentage (6.6%) had already suffered from a psychiatric disease, mainly humour disorders (4.1%) and 37.6% had regular contact with a patient with mental illness in their lives. The sample had medium-low levels of stigmatizing attitudes towards mental illness (Mean=122.72; SD=5.19), being these negative attitudes more relevant in authoritarianism (Mean=24.17; SD=4.34) and social restriction (Mean=20.53; SD=4.93) areas. Male students showed more positive attitudes towards authoritarianism (p=0.004) and social restriction (p=0.007) and females towards Benevolence (p=0.016) and Community Mental Health Ideology (0.004). Nursing students had more frequent stigmatizing attitudes and physiotherapy students showed better attitudes (p=0.021). Students who have had mental illness had more stigmatizing attitudes in general (p=0.039), regarding all areas (p<0.005) except for Community Mental Health Ideology. Students who had regular contact with a mental health patient, had more stigmatizing attitudes in general (0.031) and in authoritarianism (p=0.039).

Conclusions

It was found medium-low levels of stigmatizing attitudes towards mental illness among the health students inquired. There was also evidence that having a mental disorder or having regular contact with mental health patients can increase stigmatizing attitudes of health students. This highlights the importance of intervention in these students, not also to improve attitudes towards mental health patients, but also to decrease the self-stigma that was also identified by these results.

References

1. Ihalainen-Tamlander N, Vähäniemi A, Löyttyniemi E, Suominen T, Välimäki M. Stigmatizing attitudes in nurses towards people with mental illness: a cross-sectional study in primary settings in Finland. Journal of Psychiatric and mental Health Nursing. 2016;23(6-7):427-437.

2. Mas A, Hatim A. stigma in mental illness: attitudes of medical students towards mental illness. Med J Malaysia. 2002;57(4):433-444.

3. Taylor S, Dear M. Scaling community Attitudes Toward the Mentally Ill. Schizophrenia Bulletin. 1981;7(2):225-240.

Keywords

Mental health, Stigma, Health students, Attitudes.

O153 Psychological symptoms and mental health stigma in teaching professionals

Catarina Tomás^1,2, Ana Querido^1,2, Marina Cordeiro^1,2, Daniel Carvalho³, João M 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

Teaching professionals are recognised to be submitted to a daily stress, partly due to dynamic interactions associated with the teaching role, which leads to experiences of psychological and psychosomatic symptoms [1]. Facing mental health problems influences stigma towards mental illness. In this situation they are predisposed to accept preconceptions leading to internalized stigma [2]. Research has referred teachers as having negative attitudes towards mental illness [3]. Considering that there is little known about teacher professionals in secondary and higher education [4], this study addresses mental health stigma and psychological symptoms in these settings.

Objective

To characterise psychological symptoms and mental health stigma in teaching professionals; identify the differences between high-school and higher education teachers stigma; correlate psychological symptoms and mental health stigma.

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 socio-demographic information, the Portuguese version of Brief Symptom Inventory (BSI) and he Attribution Questionnaire to Measure Mental Illness Stigma (AQ27) [5]. Ethical procedures were taken into account during research, according to the Helsinki Declaration.

Results

Teaching professionals were mostly women (70.8%), aged between 30 and 62 years old (Mean=44.8; SD=7.86), 27.1% diagnosed with a mental disease and 41.1% referred contact with mental health patients. Teaching professionals revealed low levels of global psychological symptoms. Higher scores were found in Obsession-Compulsion (M=0.88; SD=0.73). A moderate level of stigma was found in the global sample (M=3.63; SD=0.74). Stigmatizing helping attitudes and behaviour were higher (M=6.50, SD=1.86). Although no difference was found in total stigma between groups, higher education professors rate responsibility higher than high-school teachers (M=3.06, SD=1.08 vs M=2.55, SD=0.97; p=0.02). Significant positive correlations were found between total stigma and psychological symptoms in Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety and Psychoticism (p < 0.01).

Conclusions

Teaching professionals experience low intensity of several psychological symptoms, and reveal medium stigma towards mental illness. High-school teachers revealed higher psychological distress compared to higher education professors but no differences were found in stigma. The higher the psychological distress, the higher the stigma is expected to be towards people with mental illness. Therefore intervention towards mental health is needed, addressing psychological distress in order to minimize mental health stigma.

References

1. Au DWH, Tsang HWH, Lee JLC, Leung CHT, Lo JYT, Ngai SPC, et al. Psychosomatic and physical responses to a multicomponent 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.Hamann J, Bühner M, Rüsch N. Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services. Psychiatr Serv. 2017;68(8):783–788.

3. Basar MCZ. The beliefs of teachers toward mental illness. Procedia - Soc Behav Sci. 2012;47:1146–1152.

4. Ketchen SL, Gaddis SM, Heinze J, Beck K, Eisenberg D. Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities. J Am Coll Heal. 2015;63(6):388–396.

5.De Sousa S, Marques A, Curral R, Queirós C. Stigmatizing attitudes in relatives of people with schizophrenia: a study using the Attribution Questionnaire AQ-27. Trends Psychiatry Psychother. 2012;34(4):186-197.

Keywords

Mental health, Psychological symptoms, Stigma, Teaching professionals.s

O154 Exploring quality of life in individuals with cognitive impairment and chronic mental health difficulties in the context of supported employment services

Ana R Jesus, Cristina Silva, João Canossa Dias, Karina Sobral, Mário Matos, Patrícia Sá, Rui Moreira, Sara Coutada, Sara A Oliveira, Telma Antunes

Associação para a Recuperação de Cidadãos Inadaptados da Lousã, 3200-901 Lousã, Portugal

Correspondence: Sara A Oliveira (saraoliveira.atalaia@gmail.com)

Background

The complex combination of many broad factors may have adverse effects in health with an impact on several areas. Quality of life (QoL) is a useful concept measuring the health state experienced by individuals. Perceived physical health, psychological well-being, social relationships, and environmental factors are QoL’s main dimensions (WHOQOL Group, 1995). In the field of employment, evidence-based supported employment is one of the most effective approaches. Thus, A.R.C.I.L’s Centre of Resources for Employment and Open Labour Market Inclusion started to include workers according to their preferences, mainly individuals with cognitive impairment and chronic mental health difficulties. In Portugal, few studies explored QoL in individuals with cognitive impairment and chronic mental health difficulties, particularly from the individual’s own perspective.

Objective

This study aims to explore differences in QoL between individuals with cognitive impairment and chronic mental illness, attending supported employment services given by the Centre of Resources for Employment and Open Labour Market Inclusion. Moreover, from baseline to 6 months, the outcomes from individuals self-reported QOL will be analysed.

Methods

The sample was composed by adults (N = 169; 52.1% women and 47.9% men), aged 18-64 years-old, with a mean age of 41.34 (SD = 11.33), who attended supported employment services. All participants had a previous diagnosis of cognitive impairment and/or chronic mental illness. QoL was assessed by WHOQOL-Bref (N=169 at baseline; N=51 at 6 months follow-up).

Results

Results from independent t-test revealed significant gender and age differences between individuals QoL, with men reporting better physical and psychological QoL when compared to women. Younger participants (age ≤ 40 years-old) also presented better QoL (in all domains, except in social relations) when compared to older participants. All differences reflected small to moderate effect sizes. Overall QoL, as well as its physical and environmental dimensions were significantly and negatively associated with participants’ age. Finally, after attending six-months of supported employment services 29.4% of participants increased global QoL, 35.3% increased their physical and psychological QoL, 37.3% showed an improvement in their social relationships and 55% reported feeling better in their environment.

Conclusions

Overall, results suggest that individuals with cognitive impairment and chronic mental illness, attending supported employment services, have perceived a positive QoL at the 6-month follow-up. As the supported employment services are still on-going, future studies would have to be conducted to explore results in a larger sample and to measure impact in people’s health and living conditions.

Keywords

Quality of Life, WHOQOL-Bref, Supported employment services, Cognitive impairment, Chronic mental illness.

O155 Characterization of pediatric medicines use in pre-scholar and primary school children

Isabel C Pinto^1,2, Luís M Nascimento^2,3, Ana Pereira⁴, Ana Izidoro⁵, Cátia Patrocínio⁶, Daniela Martins⁷, Margarida Alves⁸

¹Departamento de Tecnologias de Diagnóstico e Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; ²Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; ³Unidade Local de Saúde do Nordeste, 5300-253 Bragança, Portugal; ⁴Farmácia D'Izeda, 5300-592 Izeda, Bragança, Portugal; ⁵Farmácia Rainha, 5140-067 Carrazeda de Ansiães, Portugal; ⁶Farmácia Confiança, 5300-178 Bragança, Portugal; ⁷Farmácia Holon, 2870-225 Montijo, Portugal; ⁸Farmácia da Ponte, 5370-390 Mirandela, Portugal

Correspondence: Isabel C Pinto (isabel.pinto@ipb.pt)

Background

Parents or other caregivers usually resort to the use of medication without prescription in their children, which can be considered as a facilitative process of drug intoxication. The child is not an adult in small size, which necessarily has implications for the use of drugs to ensure safety and effectiveness.

Objective

To examine the use of paediatric medicines and of associated factors, in children of pre-school and of the 1st cycle of basic years of education in the city of Bragança, in the Northeast of Portugal.

Methods

This cross-sectional, descriptive and correlational study was based on a questionnaire applied to 371 parents or guardians of children of pre-school and 1st cycle of basic education in the city of Bragança, in the academic year 2014/2015. Statistical analysis was performed on the SPSS program, v. 20.0. It was used descriptive statistics; correlations were accessed using Spearman and qui-square tests, considering the significance level of 5%.

Results

The results revealed that 86% of parents use drugs without prescription, of these 49% resort to this practice under the influence of ancient medical guidelines and 28% under the influence of information transmitted in the pharmacy. Mostly parents (53%) resort to self-medication to relieve fever or treatment of influenza symptoms (14%) of their children. No statistically significant factors related to the use of non-prescription medication in children were found.

Conclusions

Paediatric self-medication is a common practice, especially made based on old medical guidelines. No explanatory factors have been found for this paediatric self-medication.

Acknowledgements:

The authors thank Fundação para a Ciência e a Tecnologia (FCT, Portugal) and the infrastructure FEDER under the PT2020 program for financial support to CIMO (UID/AGR/00690/2013).

Keywords

Children, Pediatric medicines use, Pediatric self-medication, Pre- scholar children, Primary school children.

O156 Sleep and perimenopause: contributions to its management

Arminda Pinheiro (aanes@ese.uminho.pt)

Higher School of Education, University of Minho, 4710-228 Braga, Portugal

Background

There are large geographical differences in the prevalence of menopausal symptoms. Given the differences in study methodologies, it has been difficult to establish comparisons. In middle-aged women, sleep disorders are quite prevalent problems and are sometimes attributed directly to the menopausal transition. Based on the conceptual framework proposed by Meleis and Schumacher, we consider that recent changes in the sleep pattern are an indicator of the transition process, assuming that they can interfere with quality of life, and that we can try to identify the conditions/factors associated with this change.

Objective

To evaluate sleep disorders and related factors in perimenopausal women.

Methods

This was a cross-sectional study, correlational; with a non-probabilistic convenience sample, in which 600 Portuguese perimenopause women (45–55 years) were requested to complete: the Menopause Rating Scale (MRS), Scale of attitudes and beliefs about menopause and the Satisfaction Scale Social Support; Self-Esteem Scale. Semi-structured interviews collected: socio-demographic and socio-economic data; lifestyle data; psychological data - global health perception; stressful life events; perception of the recent change of body image; have life projects and data on health history. Physical examination included: blood collection for determination of follicle stimulating hormone (FSH) and estradiol (E2), weight, height, and abdominal measurements. Women signed informed consents after exhibition of the study objectives and after guaranteeing anonymity and confidentiality.

Results

In this study 43.5% of the women reported having no problems with sleep; 18.2% light intensity problems; 10.2% moderate intensity and 28.2% very intense problems. In relation to the influence of the different factors included in the final model on the probability of a woman having reported uncomfortable sleep problems, the logistic regression Forward: LR revealed that the conditions of socio-demographic and socioeconomic factors: level of education (b_{basiceducation}=0.933, X²_wald(1)=4.386, p=0.035, OR=2.222), the conditions of the psychosocial factor: attributed meaning menopause (b_{positivemeaning}=-0.504;X²_wald(1)=6.262; p=0.012; OR=0.604), satisfaction with social support (b_familyupport=-0.154, X²_wald(1)=10.849, p=0.001, OR=0.857), attitudes and beliefs regarding menopause(b_{changeshealthaging}=-0.207;X²_wald(1)=10.634, p=0.001, OR=0.813), attitudes(b_{physicalchanges}=0.130, X²_wald(1)=5.282; p=0.022; OR=0.878); have projects (b_{donothaveprojects}=-0.662;X²_wald(1)=9.907; p=0.002; OR=0.516) and the condition of the lifestyle factor: number of feed (b_numberoffeed=- 0.285, X²_wald(1)=10.658, p<0.001, OR=0.752), presented a statistically significant effect, significant difference on the Logit of the probability of a woman having referred problems, according to the adjusted Logitmodel(G²(10)=173.916; p<0.001;X²_wald(8)=6.484; p= 0.593;R²_CS=0.252;R²_N=0.342;R²_MF=0.218).

Conclusions

Problems with sleep can be considered a negative indicator of processes in perimenopausal women. The model suggests some modifiable factors, specifically: eating habits, attitudes, beliefs and meaning attributed to menopause, and importance of satisfaction with family social support. These aspects should be included in the initial nursing assessment and risk evaluation of women who cross this period, in the sense of adequately managing nursing interventions.

Keywords

Problems, Sleep, Menopause.

O157 Preschooler’s executive and socio-emotional functioning: effects of two intervention programs- Psychomotor therapy and Creative Dance

Andreia Sarnadinha¹, Catarina Pereira^1,2,3, Ana C Ferreira^1,2,3, Jorge Fernandes^1,2,3, Guida Veiga^1,2,3

¹Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal; ²Comprehensive Health Research Center, University of Évora, 7000-671 Évora, Portugal; ³Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Andreia Sarnadinha (asarnadinha@gmail.com)

Background

The preschool years represent a critical time period for the development of children’s executive functioning and socio-emotional competences [1] and therefore it is the ideal period for the stimulation of these competencies [2, 3]. Interventions with children in preschool age should privilege spontaneity, creativity and play as a method of learning and stimulation [4, 5]. Psychomotor therapy and Creative Dance are two therapeutic approaches based on these principles [5, 6]. However, to date, no research has been done comparing the effects of Psychomotor therapy and Creative Dance.

Objective

The aim of this study was to examine the feasibility and the impact of two intervention programs, Psychomotor therapy versus Creative Dance, on the executive and socio-emotional functioning of pre-schoolers.

Methods

Fifty preschool children (M = 4.04 years; SD = 0.67) were divided into two intervention groups and a control group. An experimental group participated in 24 Psychomotor therapy sessions, mainly involving sensorimotor activities and games with rules. The other experimental group participated in 24 Creative Dance sessions. The control group maintained daily life activities. Cold executive functions, hot executive functions, externalized and internalized behaviours and aggressiveness were evaluated.

Results

The intervention programs were well tolerated by pre-school aged children. No significant differences were found in terms of intra- and inter-observer comparisons, except in the control group (p < 0.05). Cold executive functions were negatively correlated to reactive aggressiveness (r = -0.408, p = 0.003).

Conclusions

The results suggest that both programs were feasible and well tolerated in this age group, but their benefits were not evident. Increased working memory was associated with decreased levels of reactive aggression. This study alerts to the need for further research focused on pre-schoolers’ executive and socio-emotional functioning, particularly on the effects of interventions programs.

References

1. Papalia DE, Olds SW, Feldman, RD. O mundo da criança. Lisboa: McGraw-Hill; 2001.

2. Diamond A, Lee K. Interventions shown to aid executive function development in children 4–12 years old. Science, 2011;333(6045):959–964.

3. León CBR, Rodrigues CC, Seabra AG, Dias NM. Funções executivas e desempenho escolar em crianças de 6 a 9 anos de idade. Revista Psicopedagogia. 2013;30(92):113-120.

4. Vygotsky LS. A formação social da mente. São Paulo: Martins Fontes; 2010.

5. Traverso L, Viterbori P, Usai MC. Improving executive function in childhood: evaluation of a training intervention for 5-year-old children. Front Psychol. 2015;6:525-536.

6. Gilbert AG. Creative dance for all ages: a conceptual approach. Australia: Shape America; 2015.

Keywords

Executive functions, Mental health, Mind-body therapies, Psychomotor intervention.

O158 Impact of a 10 km race on inflammatory and cardiovascular markers: comparison between trained and untrained recreational adults

Margarida Carvalho¹, Andreia Noites², Daniel Moreira-Gonçalves^3,4, Rita Ferreira⁵, Fernando Ribeiro⁶

¹Hospital de Santa Maria, 4049-025 Porto, Portugal; ²Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, 4200-072 Porto, Portugal; ³Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁴Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; ⁵Mass Spectrometry Group, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal; ⁶School of Health Sciences and Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Margarida Carvalho (margarida.carvalho.ft@gmail.com)

Background

Previous studies have found that trained athletes had lower changes in circulating levels of inflammatory biomarkers and cardiovascular stress than untrained athletes, upon prolonged or exhausting exercise. Particularly, recreational runners with less training showed higher risk of cardiac injury and dysfunction after a marathon. Presently, we are observing a steadily growing number of young and older adults engaging in running events without having a professional orientation or training, emphasizing the need to assess biochemical markers that allow the evaluation of the acute changes imposed in these recreational athletes.

Objective

To compare the immediate and 24-hour effects of a 10-km run on inflammatory and cardiovascular biomarkers between recreational athletes, with and without specific running training.

Methods

18 recreational athletes (38.5 ± 14.5 years), 10 men and 8 women, were recruited and divided in a trained and untrained group. Venous blood samples were taken prior to the 10km race (48 hours before), immediately after (within 30 minutes), and 24 hours after the race. The following biomarkers were analysed by slot blotting assay: vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), high sensitive C-reactive protein (hsCRP), ghrelin, matrix metalloproteinase-2 (MMP-2) and MMP-9.

Results

The trained group completed the race in 50.3 ± 13.0 minutes per comparison to the 66.8 ± 5.6 minutes of the untrained group (p = 0.003). A significant increase in circulating levels of hsCRP, ghrelin, VEGF and MMP-9 was observed immediately after the race in both groups; the levels of these biomarkers returned to baseline 24h post-race. A significant increase in IL-6 was also detected after the race in both groups, which returned to baseline levels at 24 hours post-race in the untrained group. Regarding MMP-2 levels, a significant increase was detected after the race only in the untrained that returned to baseline levels at 24 hours post-race.

Conclusions

The impact of a 10-km race in the inflammatory and cardiovascular markers assessed in this study was different between recreational athletes, with and without specific training.

Keywords

Biomarkers, Cardiovascular system, Exercise, Inflammation, Running.

O159 The health of the informal caregiver of dependent person in self-care

Maria A Dixe^1,2, Ana CS Cabecinhas², Maura R Domingues², Ana JCF Santos², Marina G Silva², 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 (ana.querido@ipleiria.pt)

Background

Caring for a caregiver should be a constant concern and a responsibility of all health professionals, so that those who give care do not end up being uncared-for.

Objective

This correlational study had the following main aims: to assess the level and prevalence of burden of the informal caregiver of a person dependent in self-care; to determine the relationship between the levels of burden and the informal caregiver's perception of their level of competence to be a caregiver.

Methods

Participants in this study were 33 informal caregivers of self-care dependent-persons in at least one activity of daily living, to whom a structured interview was performed at the time of hospital discharge. The interview included socio-demographic and professional data, perception of the informal caregiver on their level of competence to be a caregiver, and the Portuguese version of the Zarit Burden Interview [1]. This study was approved by the National Data Protection Commission and the ethics 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 old, with the majority being dependent on all self-care activities. The mean age of caregivers was 61.4 ± 12.1 years old, mainly females. The family relationship was mostly a son/daughter (39.4%) or a spouse (33.3%), taking care of the patient on average at 63.9 ± .93 months. It was possible to verify that all caregivers had previous experience of caregiving to a family dependent. We also verified that the 33 caregivers presented a mean of 53.9 ± 15.8 on the emotional burden scale (maximum possible value of 110) which corresponds to little burden. We can also mention that 30.3% of the caregivers present no burden, 30.3%, present mild burden and 39.4% present intense burden. Regarding the relationship between caregiver burden, we verified that higher levels of informal caregivers burden were related to lower levels of perception of their competence to satisfy the needs related to the hygiene of the dependent-person (rs=.-0.514; p> 0.05).

Conclusions

Caring of a dependent-person may lead to health risks to the caregiver. Even though the sample size is small, it was possible to verify that a considerable number of caregivers presented intense emotional burden. Therefore, it is necessary that health professionals develop interventions to prevent caregiver burden.

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.

References

1. Sequeira CA. Adaptação e validação da Escala de Sobrecarga do Cuidador de Zarit. Revista Referência. 2010;2(12):9-16.

Keywords

Emotional burden, Informal caregiver, Self-care, Dependent-person, help2care.

O160 Growth and puberty in adolescent artistic gymnasts: is energy intake a question of concern?

Rita Giro¹, Mónica Sousa², Inês T Marques³, Carla Rêgo³

¹Universidade do Porto, 4099-002 Porto, Portugal; ²Escola Superior de Saúde, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal; ³Centro da Criança e do Adolescente, Hospital CUF Porto, 4100-180 Porto, Portugal

Correspondence: Rita Giro (aritagiro@gmail.com)

Background

Whether high-intensity training during childhood and adolescence compromises the growth and pubertal development of artistic gymnasts, remains a question for debate. However, when coupled with low energy availability, this hypothesis strengthens [1].

Objective

To characterize growth, sexual maturation, total energy intake and training aspects of competing artistic gymnasts and check for associations.

Methods

Convenience sample of 22 competing artistic gymnasts (13.8 ± 1.9 years) of both sexes. Anthropometric evaluation and body composition assessment were performed (InBody230™). Tanner stage was determined in all athletes and age of menarche and regularity of menses were assessed in females. Total energy intake was quantified (3-day food record) and its inadequacy verified according to the recommendations [2]. Athletes' training habits were also characterized.

Results

Females showed significantly higher body fat (15.9 ± 3.2 vs 7.2 ± 3.6) and lower skeletal muscle mass (45.7 ± 2.1 vs 51.1 ± 3.0) percentages than males (p < 0.05). No differences were found between genders for any of the additional variables in the study (p ≥ 0.05). Mean age of menarche was 12.6 (± 1.3) years. Short stature was detected in 12.6% of the female gymnasts (z score < -2), but no cases of low weight-for-height (z score <-2) were observed. All athletes presented total energy intakes below the recommendations. A high training frequency and intensity (median: 6 days/week, in a total of 20.8 hours) were reported, as well as an association of both training frequency (ρ=+0.765; p=0,016) and training intensity (ρ=+0.727; p=0,026) with a later onset of menarche.

Conclusions

Our data suggests metabolic adaptation to chronically insufficient energy intakes in these athletes which, in accordance with growing evidence, might play a role in growth and pubertal delay.

Acknowledgements

Authors would like to thank and recognise the contribution of Cristina Côrte-Real and Manuel Campos to the development of the investigation.

References

1. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-497.

2. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for energy. EFSA Journal. 2013;11(1):3005.

Keywords

Athletes, Energy availability, Health, Nutrition assessment, Paediatrics.

O161 Communication effectiveness in nursing teams

António Calha¹, Liliana Grade³, Olívia Engenheiro⁴, Sandra Sapatinha⁵, Eva Neto²

¹Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal; ²Centro Hospitalar do Algarve, 8000-386 Faro, Portugal; ³Unidade Local de Saúde Baixo Alentejo, 7801-849 Beja, Portugal; ⁴Hospital Espírito Santo, 7000-811 Évora, Portugal; ⁵Unidade Local de Saúde Norte Alentejano, 7300-074 Portalegre, Portugal

Correspondence: António Calha (antoniocalha@hotmail.com)

Background

The communication processes established among nurses are influential factors of the quality and effectiveness of care.

Objective

This research had as main objective to identify how nurses evaluate the different dimensions of the communicative process of the service in which they carry out their professional activity and what are the main obstacles to the proper functioning of the communication process.

Methods

This is eminently a quantitative study of correlational nature. For the collection of data, a questionnaire was used with closed-ended questions. 75 nurses from four health services (Neonatology, Medicine II, Emergency and Basic Emergency) were surveyed.

Results

Five indices were elaborated to measure the different facets of the communicative process: Communication efficiency (α = 0.82); Information sufficiency (α = 0.84); Information timing (α = 0.85); Explicitness of the message (α = 0.90) and practical applicability (α = 0.087). Similarly, five indices were computed in order to measure the nature of the information: Information of a clinical nature (α = 0.88); Organizational information (α = 0.89); Service information (α = 0.91); Team information (α = 0.92) and Personal information (α = 0.93). All indices had a variation range between 1, corresponding to the worst possible appraisal and 5, corresponding to the best possible appraisal. The results show that it is organizational information that nurses (M = 2.96) do worse in the communicative process, especially in the timely manner in which information arrives to them (M = 2.76). The results obtained through a Kruskal-Wallis test allowed to identify differences regarding the consideration of conflict as an obstacle to the communication process (χ²_KW(3)= 30.01, p= 0.000) and overvaluation of personal and professional relations (χ²_KW(3)= 12.60, p= 0.006).

Conclusions

The research identifies some communication weaknesses in the clinical context related mainly to the way information of organizational nature is disseminated in the services.

Keywords

Communication, Efficiency, Nursing, Teams.

O162 Factors affecting interpersonal conflict in nursing teams

António Calha¹, Marília Ferreira², Sílvia Alminhas², Telmo Pequito²

¹Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal; ²Hospital Espírito Santo, 7000-811 Évora, Portugal

Correspondence: António Calha (antoniocalha@hotmail.com)

Background

Teamwork is one of the foundations of nursing, exposing the profession to the vulnerabilities of the dynamics of group functioning. In this context, skills of conflict management in working teams are particularly relevant.

Objective

This research aimed to: I) identify how often nurses deal with conflict situations; II) identify the main causes of conflict mentioned by nurses and, III) assess the strategies adopted to deal with conflicting situations.

Methods

This is an exploratory, quantitative and correlational research. For the collection of data, a questionnaire was used with closed-ended questions. The sample consisted of a total of 35 nurses from the emergency department of a Hospital of the Portuguese NHS.

Results

Five indexes were computed in order to evaluate the different strategies to deal with conflict situations: I) commitment strategy (α = 0.745); II) avoidance strategy (α = 0.699); III) accommodation strategy (α = 0.745); IV) confrontation strategy (α = 0.618) and collaboration strategy (α= 0.698). All indices had a variation that ranged between 1, corresponding to the less frequent possible appraisal and 5, corresponding to most frequent possible appraisal. Most of the nurses reported that they were rarely involved in situations of conflict, however, 57.1% stated that they sometimes observed those situations. Results show that nurses mostly indicated the use of two strategies to deal with conflict: accommodation (M= 3.11) and confrontation (M= 3.07). Data analysis revealed that the strategy of accommodation had a statistically significant positive correlation coefficient in relation with the incompatibility of personalities (rs= 0.400, p < 0.05) and a negative correlation coefficient in relation with the scarcity of material (rs= -0.358, p < 0.05) as cause of conflict.

Conclusions

The results obtained allow us to conclude that the nature of the conflict determines the way it is managed by nurses. The data reveal, in particular, that the scarcity of material resources strengthens the confrontation in the nursing team, contributing to the degradation of the organizational environment. Thus, conflict management is an essential skill and tool that nurses can, and should, use as a basis of sustainability and development of nursing practice.

Keywords

Interpersonal conflict, Team work, Nursing, Emergency service.

O163 Numerical modelling of electrical stimulation on scaffolds for tissue engineering

Paula Pascoal-Faria^1,2, Pedro C Ferreira¹, Abhishek Datta^3,4, Nuno Alves¹

¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2411-091 Leiria, Portugal; ²School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Soterix Medical Inc., 10001 New York, New York, United States of America; ⁴City City College of New York, 10031 New York, New York, United States of America

Correspondence: Paula Pascoal-Faria (paula.faria@ipleiria.pt)

Preliminary experimental in vitro studies on tissue engineering applications have shown the advantage of using different type of stimuli, namely, mechanical, electrical, magnetic or its combination to enhance cell behaviour. In these studies cells proliferation and differentiation change significantly when electrical stimulation is applied on cells placed inside scaffolds systems within a bioreactor. We established an ambitious research program on numerical modelling of stimuli on scaffolds for tissue engineering. In this study we develop a new finite element-based (FE) multiphysics framework that allows the numerical optimization of the parameters involved when electrical stimulation is applied on bioscaffolds with different geometries and characteristics. The FE framework that has been developed allows the prediction of the electrical stimulation as a function of the scaffold geometry and its electrical characteristics, that may contribute to the acceleration of the proliferation and differentiation of the cells.

Keywords

Finite element model, Bioscaffolds, Electrical stimulation, Tissue engineering.

O164 Motor competence in preschoolers with and without hearing loss

Guida Veiga^1,2,3, Mariana Santos¹, Brenda S Silva⁴, Catarina Pereira^1,2,3

¹Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal; ²Comprehensive Health Research Center, University of Évora, 7000-671 Évora, Portugal; ³Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Developmental Psychology, Leiden University, 2311 EZ Leiden, Netherlands

Correspondence: Guida Veiga (gveiga@uevora.pt)

Background

Several studies have been demonstrating the developmental consequences of early childhood hearing loss in terms of language, communication, academic, and social-emotional functioning [1]. However, there is still no consensus on whether young children with hearing losses (HL) are comparable to hearing peers regarding their motor competence. Whereas some studies associate hearing loss with poorer motor development [2], others show that HI children are as proficient as their hearing peers [3]. Nevertheless, most of these studies has been focusing older children and to date, no study has examined Portuguese HI children’s motor competence.

Objective

This study aimed to examine motor competence of children with HL in comparison with hearing children.

Methods

A total of 35 children participated in the study; 13 (mean age 4,73 years) with HL and 22 (mean age 5,09) hearing children. Children were tested by the Movement Assessment Battery for Children–Second Edition (MABC-2).

Results

Children with HL showed worse performances on manual dexterity, ball skills and balance than hearing peers, however these differences were only significant regarding balance (p=.006).

Conclusion

Children with HL are at greater risk for balance deficits.

References

1. Joint Committee on Infant Hearing. 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898–921.

2. Hartman E, Houwen S, Visscher C. Motor skill performance and sports participation in deaf elementary school children. Adapted Physical Activity Quarterly. 2011;28(2):132-145.

3. Engel-Yeger B, Weissman D. A comparison of motor abilities and perceived selfefficacy between children with hearing impairments and normal hearing children. Disability And Rehabilitation. 2009;31(5):352-358.

Keywords

Motor skills, Emotion understanding, Empathy, Deafness, Cochlear implant.

O165 Determinants of the beginning of breastfeeding in the first half hour of life

Dolores Sardo (dolores.sardo@gmail.com)

Nursing School of Porto, 4200-072 Porto, Portugal

Background

Breastfeeding in the first hour of life is associated with longer duration of breastfeeding, reduction of infant deaths in low-resource countries and improvement of the health status of the child and of mother. This practice favours early contact between mother and baby, and in Step 4 of the Ten Measures to be considered a Baby Friendly Hospital, it is recommended to help mothers to initiate breastfeeding within the first half hour after birth (WHO & UNICEF).

Objective

To evaluate the rate of breastfeeding initiation in the first half hour and two hours of the child's life; identify the determinants of breastfeeding in the first half-hour and two hours of life and their relationship to the prevalence of exclusive breastfeeding at four months.

Methods

We performed a quantitative, descriptive and cross-sectional study in a Portuguese population. The sample was no probabilistic, intentional (n = 150) 89.3% married mothers or with partner and average age was 31.1 years old, with normal delivery (43.3%). Data collection was conducted through a self-report questionnaire to mothers, 4 months after delivery.

Results

The rate of breastfeeding initiation in the first half hour and two hours of the child's life was 48% and 88% respectively. In this sample the determinants related to obstetric history, new-born and breastfeeding were studied: only caesarean delivery revealed statistical significance in the first half hour (X²(1) = 6.141; p = 0.010); and there was a statistically significant difference associated with eutocic delivery and the initiation of breastfeeding up to two hours of life. The prevalence of exclusive breastfeeding at 4 months was predicted only by the weight of the new-born (b_{pequeno para a idade gestacional}=4.821; X²_wald(1)= 21.616; p < 0.001; OR=124.038).

Conclusions

In this study, only the type of delivery had significant statistical influence for the initiation of breastfeeding in the first half hour of life. We also found that the initiation of breastfeeding in the first two hours of life did not predict its prevalence at four months.

Keywords

Breastfeeding, Prevalence, First half-hour.

O166 Body image acceptance as a protector against the effect of body image-related shame memories on emotional eating in women with Binge Eating Disorder

Cristiana Duarte¹, José Pinto-Gouveia²

¹School of Psychology, Faculty of Medicine and Health, University of Leeds, LS2 9JT, Leeds, United Kingdom; ²Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal

Correspondence: Cristiana Duarte (c.duarte@leeds.ac.uk)

Background

Understanding the factors underlying the public health problem of Binge Eating Disorder (BED) is a pressing need. Research show that body image-related shame memories are significantly associated with the severity of binge eating symptomatology in women with Binge Eating Disorder (BED) [1]. These individuals may eat as a means to temporarily avoid or reduce negative emotions related to body weight and shape [2, 3]. Evidence suggests that body image flexibility (i.e., the ability to accept and fully experience body image-related internal experiences - thoughts, emotions, memories - when doing so is consistent with valued-living [4], may deter the engagement in emotional eating [5].

Objective

The current study examined the moderator effect of body image flexibility on the association between shame memories and emotional eating in a sample of women with BED.

Methods

109 women with the diagnosis of BED participated in this study. Mean (SD) participants age was 37.39 (10.51) years and BMI was 33.69 (7.75) kg/m². Participants were assessed through the Eating Disorder Examination 17.0D, the Shame Experiences Interview (SEI) and filled self-report measures assessing the centrality of the recalled shame memories, emotional eating and body image flexibility.

Results

Descriptive statistics showed that body image-related shame memories were the most frequently recalled memories. Correlational analysis revealed that the extent to which the recalled shame memory is central to identity is significantly associated with emotional eating. Body image flexibility was negatively associated with the centrality of the recalled shame memory and emotional eating. Results of the moderation analysis showed that body image flexibility significantly moderate the association between the centrality of the recalled shame memory and emotional eating. This suggests that patients with BED with a greater trait-like ability to accept body image-related negative internal experiences, present a lower tendency to use food as a form of experiential avoidance.

Conclusions

Findings support a conceptual integrative model of binge eating symptomatology that clarifies the role that contextual and interpersonal variables play in the development and persistence of difficulties in regulating eating behaviour in BED, and how body image flexibility may have a protective role in these associations. These results also have important clinical implications supporting the relevance of contextual-behavioural interventions that address the role of shame memories, body image difficulties and that help patients to develop body image flexibility.

References

1. Duarte C, Pinto-Gouveia J. The impact of early shame memories in Binge Eating Disorder: The mediator effect of current body image and cognitive fusion. Psychiatry Reseach, 258:511- 517.

2. Duarte C, Pinto-Gouveia J, Ferreira C. Ashamed and fused with body image and eating: Binge eating as an avoidance strategy. Clin Psychol Psychother. 2015. doi: 10.1002/cpp.1996. 3. Heatherton T, Baumeister R. Binge eating as escape from self-awareness. Psychol Bull 1991;110(1):86-108.

4. Sandoz E, Wilson K, Merwin R, Kellum K. Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science. 2013;2(1-2):39-48.

5. Duarte C, Pinto-Gouveia J. Returning to emotional eating: The psychometric properties of the EES and association with body image flexibility. Eating and Weight Disorders. 2015;20 (4):497-504.

Keywords

Body image-related shame memories, Shame memories centrality, emotional eating, Body image flexibility, Binge Eating Disorder.

O167 Psychometric properties of the Psychological Welfare Scale

Rosa M Freire, Filipe Pereira, Teresa Martins, Maria R Grilo

Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Rosa M Freire (rosafreire@esenf.pt)

Background

Pleasure and happiness have been associated with well-being, and obtaining maximum enjoyment is seen as a life goal. Nowadays, well-being is perceived to be either subjective wellbeing (SWB) or psychological well-being (PWB). SWB involves global evaluations that affect life quality, whereas PWB examines perceived existential challenges of life [1].

Objective

To measure Psychological Welfare and validate the constructs of 42 items of the Psychological Welfare Scale.

Methods

Quantitative, exploratory and cross study was used as methodology. A convenience sample was performed with 252 participants. The measuring instrument was developed using the Qualtrics program. The study had favourable appreciation and consent from the College Nursing of Porto (ESEP) that provided a computer platform that allowed the participants to access to the measurement instrument. The construct in analysis in this study was developed by Ryff [2] and intended to measure Psychological Welfare on six scales: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Originally, each subscale was composed of 20 items, but the author suggested smaller versions, preferably the version of seven items per subscale. Respondents rated statements on a scale of 1 to 6, with 1 indicating strong disagreement and 6 indicating strong agreement. Participants are, on average, 31.38 years old (SD=12.88) and 81% are female. The analysis of the items of the scale was performed through item descriptive analysis, confirmatory factorial analysis, internal consistency analysis of each subscale and factorial validity using AMOS (version 22, IBM SPSS).

Results

The descriptive analysis of the items showed that the response tendency is above the midpoint. In the analysis of the adaptation of the theoretical model to the empirical model, we verified that the model constituted by a factor with six manifested variables resulting from the sum of the seven items of each subscale showed good indexes of adjustment. The internal consistency values of each subscale ranged from 0.69 to 0.82 suggesting a reasonable to good internal consistency. All correlations showed significant values at the 0.01 level.

Conclusions

The values found suggest that the concepts of the subscales of the measuring instrument are related but without any redundancy of measurements. The Psychological Welfare Scale is a theoretically grounded instrument which specifically focuses on measuring multiple facets of psychological welfare. We consider this Scale of Psychological Welfare to be a valid and reliable tool to measure psychological welfare in a Portuguese context.

References

1. Sweta SM. Cross-cultural Validity of Ryff’s Well-being Scale in India. Asia-Pacific Journal of Management Research and Innovation. 2013;9(4):379–387.

2. Ryff C. Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. American Psychological Association, Inc. Journal of Personality and Social Psychology. 1989;57(6):1069–1081.

Keywords

Assessment, Psychological Welfare, Scale, Psychometrics properties, Validation Studies.

O168 The influence of statins in the skeletal muscle of Individuals with hypercholesterolemia - ultrasound study

Alexandra André¹, João P Figueiredo¹, Carlos AF Ribeiro², Gustavo F Ribeiro³, Paula Tavares³

¹Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ²Instituto Biomédico de Investigação da Luz e da Imagem, 3000-548 Coimbra, Portugal; ³Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, 3040-248 Coimbra, Portugal

Correspondence: Alexandra André (alexandra.andre@estescoimbra.pt)

Background

The skeletal muscle (SM) is a kind of tissue that has the capacity to adjust with different stimulus. Intake drugs can cause alterations and incapacity to do exercise. To evaluate the muscle macroscopically measurements is important to do. Pennate angle and fascicle length are determinants of muscle strength. Thickness is important to evaluate state of atrophy or hypertrophy. The ecogenicithy evaluates the fat infiltration in atrophy.

Statins interfere with the SM functions and are the prescribed medications for prevention and treatment of high cholesterol more used in the world. A side effect of these drugs is myotoxicity. Creatine Kinase (CK) is a biomarker to evaluate the severity of muscle damage that can change with gender, age, and physical activity. Factors that influence the increase of CK are exercise intensity, if it exceeds the metabolic capacity alterations that origin CK release to the blood circulation and sarcomere degradation.

Objective

The aim of this study was to evaluate and analyse macroscopically muscle structures in patients with hypercholesterolemia, in order to interpret the pathophysiological mechanisms produced by statins inducing myotoxicity. The sensitivity and acuity to the ultrasound were used to evaluate the muscle.

Methods

The study was performed in 47 individuals, age between [50-65] years old. Ultrasound tests were performed to the 47 individuals in three different groups – control group, individuals that intake statins and individuals that intake statins and do exercise. Gastrocnemius muscle was performed bilaterally using a 13Mhz probe to determinate the dimensions of the pennate angle, fascicle length and thickness. A questionnaire and the informed consent term were signed by all individuals. The study was approved by the Ethics Committee for Health of the Regional Health Administration (Study nº45-2015)

Results

Differences in dimensions were observed. Significant differences were obtained for the pennate angle and the fascicle. The main differences were observed between the control group and experimental groups that intake statins.

Conclusions

Ultrasound has sensitivity and specificity to analyse the muscle tissue macroscopically. Individuals who intake statins have lower values of the evaluated structures. Differences were observed in the pennate angle in both sides, in the group that intake statins. The literature is unanimous in stating that individuals who take statins develop muscle changes called myalgia. The side effects of statins may increase with exercise. Ultrasonography is an imaging modality not yet widely used in this type of approach.

Keywords

Muscle, Ultrasound, Statins, Hypercholesterolemia.

O169 Maximum expiratory pressure (MEP) Increase through a program with a sportive blowgun in institutionalized women with intellectual disability

Marisa Barroso^1,2, Rui Forte², Rui Matos^1,2, Luís Coelho^1,2, David Catela¹

¹Life Quality Research Center, 2001-904 Santarém, Portugal; ²School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Marisa Barroso (marisa.barroso@ipleiria.pt)

Background

Blowgun is a long tube through which projectiles are shot [1]. The propulsive power is limited by the user's strength of respiratory muscles and the vital capacity of the lungs [2]. People with intellectual disability have limited levels of maximum oxygen consumption and ventilatory capacity [3].

Objective

The aim of this study is to investigate the effect of a Sportive Blowgun program on the respiratory capacity of institutionalized women with intellectual disability.

Methods

The sample was divided into two groups, the control group (n = 9; age 49.80 ± 8.50), and an experimental group (n = 9; age 44.80 ± 13.30). The experimental group underwent a 12-week Sportive Blowgun program, with 2 weekly sessions where each subject threw 40 darts at a distance that progressed from 4m to 10m away from the target. Maximum expiratory pressure (MEP) values (L/min) were collected through a Micro Medical - Micro RPM portable spirometer. Five measurements were taken for both groups. One before the beginning of the program, 3 during the program 1 at the end of the program. Informed permission from the institution and the participants assent was obtained.

Results

In the experimental group, a significant difference (p = 0.008) was observed in the mean values of initial maximum expiratory pressure (MEP1 = 48.11 L/min) and final (MEP5 = 73.56 L/min). There is a significant difference between the values of the initial measurement with all other measurements, suggesting a positive evolution between them. There is only no significant difference between the intermediate measurements, which suggests a stagnation of the values between the second, third and fourth measurements. In the control group, except for the second measurement, there was no significant difference between the initial maximal expiratory pressure and the other measurements, which suggests that there was an initial adaptation to the test but that did not last. Comparing groups, except for the first measurement, all the others present a significant difference. A very significant difference was observed in the third (p = 0.005) and final measurement (p = 0.005), where the experimental group presented values always higher than the control group.

Conclusions

The results suggest that the Sportive Blowgun program increases maximum expiratory pressure (MEP) by providing a respiratory capacity gain in institutionalized women with mental disability. Is suggested a more extensive study to verify the possibility of considering the sportive blowgun program as a complementary non-clinical therapy for respiratory insufficiencies.

References

1. Mariñas AP, Higuchi H. Blowgun Techniques: The Definitive Guide to Modern and Traditional Blowgun Techniques. Vermont: Tutle Publishing; 2010.

2. Nagasaki T, Okada H, Kai S, Takahashi S. Influence of Blowgun Training on Respiratory Function. Rigakuryoho Kagaku 2010; 25(6): 867–871.

3. McGrother CW, Marshall B. Recent trends in incidence, morbidity and survival in Down’s syndrome. Journal of Mental Deficiency Research. 1990;34:49–57.

Keywords

Blowgun, Intellectual disability, Respiratory therapy.

O170 Respiratory control technique and attention deficit hyperactivity disorder in children

David Catela¹, Isabel Piscalho², Rita Ferreira², Ana Victorino², Bárbara Cerejeira², Nicole Marques², Sara Dias²

¹Life Quality Research Center, 2001-904 Santarém, Portugal; ²Education School, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal

Correspondence: David Catela (catela@esdrm.ipsantarem.pt)

Background

Attention deficit hyperactivity disorder (ADHD) comprises a persistent pattern of symptoms hyperactivity, impulsiveness and/or lack of attention [1] and can cause a significant impairment in academic activities [2]. ADHD has a prevalence rate ranging from 3% to 7% among school age children [3]. Respiratory sinus arrhythmia (RSA) is higher among children with typical development than in children with ADHD [4], and ADHD in childhood is associated with abnormal parasympathetic mechanisms [5], with significantly higher mean heart rates, mean R-R interval significantly shorter (lower heart rate variability) and ratio LF/HF significantly higher than children with typical development [6-10].

Objective

The purpose of this study is to verify if through breath control ADHD children can increase heart rate variability (HRV).

Methods

Vital signs of ten potential ADHD children (11.22 ± .42 years old, 3 girls), were collected for 6 minutes, in supine position, under two conditions: I) normal breathing (NB); and, II) slow abdominal breathing (AB), e.g., [11]. HRV data acquisition was carried out through Polar V800 [12]. HRV analysis was made through gHRV software [13-15].

Results

During AB children significantly reduced breathing frequency (BF) (8.9±4.2, Md=8) compared to NB frequency (18.3±5.9, Md=19) (Z= 6.439, p<.001, r=.81); and diastolic pressure (DP) (AB – 61.3±8.7, Md=61; NB – 63.6±6.4, Md=63; Z= 2.146, p<.05, r=.29); significantly augmented standard deviation of HR (AB – 7.4±1.4; NB – 5.9±1.5; Z= 2.310, p<.05, r=.89); standard deviation of mean interval RR (AB – 80.5±22.9ms; NB – 64.3±27.7ms; Z= 2.192, p<.05, r=.73), and SD2 (AB – 106.9±29.7; NB – 82.5±35.6; Z= 2.192, p<.05, r=.73). Also, during AB children reduced systolic pressure (101.3±16.4, Md=97; NB – 104.9±17.1, Md=103; ns), heart rate frequency (79.8±11.7bpm, Md=81.8; NB – 81.7±11.8bpm, Md=83.9; ns); and, mean interval RR was greater (766.9±117.8ms Md=734.8; NB – 749.1±115.2ms, Md=715.8; ns); like rMSSD (112.9±53.3ms, Md=108.1; NB – 97.5±64.1ms, Md=79.9; ns), and HRV index (18.3±4.7ms, Md=18.9; NB – 15.6±6.1ms, Md=14.1; ns); and, ApEn became positive (greater) (.0001±.001ms, Md=.0001; NB - (-).001±.002ms, Md=(-) .0001; ns).

Results

Consequently, with one short training session, these children had the capacity to implement a significantly slower BF to values near 8 bpm, cf. [11], which resulted in a reduction in HR, SP, and DP; and, in an augmentation of various parameters of HRV. All these changes point to an increase of vagal activity during AB. If vagal activity was reinforced during AB [16-17], it means that, maybe, a process of bottom-up adjustment of attention and emotional responses can be promoted, cf. [18-20].

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

2. Cantwell DP, Baker L. Association between attention deficit-hyperactivity disorder and learning disorders. J Learn Disabil. 1991;24(2):88-95.

3. Rash JA, Aguirre-Camacho A. Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic

review. ADHD Attention Deficit and Hyperactivity Disorders. 2012;4(4):167-77.

4. Buchhorn R, Conzelmann A, Willaschek C, Störk D, Taurines R, Renner TJ. Heart rate variability and methylphenidate in children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders. 2012;4(2):85-91.

5. Musser ED, Backs RW, Schmitt CF, Ablow JC, Measelle JR, Nigg JT. Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). J Abnorm Child Psychol. 2011; 39(6):841-852.

6. Tonhajzerova I, Ondrejka I, Adamik P, Hruby R, Javorka M, Trunkvalterova Z, et al. Changes in the cardiac autonomic regulation in children with attention deficit hyperactivity disorder (ADHD). Indian Journal of Medical Research. 2009;130:44-150.

7. Griffiths KR, Quintana DS, Hermens DF, Spooner C, Tsang TW, Clarke S, et al. Sustained attention and heart rate variability in children and adolescents with ADHD. Biological psychology. 2017;124:11-20.

8. Imeraj L, Antrop I, Roeyers H, Deschepper E, Bal S, Deboutte D. Diurnal variations in arousal: a naturalistic heart rate study in children with ADHD. European child & adolescent psychiatry. 2011;20(8):381-392.

9. Rukmani MR, Seshadri SP, Thennarasu K, Raju TR, Sathyaprabha TN. Heart rate variability in children with attention-deficit/hyperactivity disorder: a pilot study. Annals of neurosciences. 2016;23(2):81-88.

10. de Carvalho TD, Wajnsztejn R, de Abreu LC, Vanderlei LCM, Godoy MF, Adami F, et al. Analysis of cardiac autonomic modulation of children with attention deficit hyperactivity disorder. Neuropsychiatric disease and treatment. 2014;10:613.

11. Lehrer PM, Vaschillo E, Vaschillo B. Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied psychophysiology and biofeedback. 2000;25(3):177-191.

12. Giles D, Draper N, Neil W. Validity of the Polar V800 heart rate monitor to measure RR intervals at rest. European Journal of Applied Physiology. 2016, 116(3):563–571.

13. Rodríguez-Liñares L, Lado MJ, Vila XA, Méndez AJ, Cuesta, P. gHRV: Heart rate variability analysis made easy. Computer Methods and Programs in Biomedicine. 2014;116(1):26–38.

14. Rodríguez-Liñares L, Méndez AJ, Vila XA, Lado MJ. gHRV: A user friendly application for HRV analysis. In: Information Systems and Technologies (CISTI); 2012. p. 1–5.

15. Vila J, Palacios F, Presedo J, Fernández-Delgado M, Felix P, Barro S. Time-frequency analysis of heartrate variability. IEEE Engineering in Medicine and Biology Magazine. 1997;16(5):119–126.

16. Levy MN. Autonomic interactions in cardiac control. Annals of the New York Academy of Sciences. 1990;601(1):209-221.

17. Uijtdehaage SH, Thayer JF. Accentuated antagonism in the control of human heart rate. Clinical Autonomic Research. 2000;10(3):107-110.

18. Ruiz‐Padial E, Sollers JJ, Vila J., Thayer, JF. The rhythm of the heart in the blink of an eye: Emotion modulated startle magnitude covaries with heart rate variability. Psychophysiology. 2003;40(2):306-313.

19. Thayer JF, Brosschot JF. Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology. 2005;30(10):1050-1058.

20. Thayer JF, Lane RD. Claude Bernard and the heart–brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews. 2009;33(2):81-88.

Keywords

ADHD, Children, HRV, Breathing Technique.

O171 Can older adults accurately perceive affordances for a stepping forward task? Differences between faller and non-faller community-dwelling older adults

Gabriela Almeida, Jorge Bravo, Hugo Rosado, Catarina Pereira

Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal

Correspondence: Gabriela Almeida (gsna@uevora.pt)

Background

Different studies framing an ecological approach to perception [1] have tried to understand how people, mostly children [2] and adults [3], perceive their action limits, in other words, what an environment affords related on individual characteristics. However, studies about older adults seem to be scarcer [4–7], particularly studies focused on whether or not faller and non-faller older adults can accurately perceive affordances for a stepping forward task.

Objective

The purpose of this study was to determine if older people could accurately perceive affordances for the task of stepping forward. The relationship between real and estimated maximum distance was explored in community-dwelling older adults, comparing fallers with non-fallers.

Methods

A sample of 347 community-dwelling older adults (age 73.02 ± 6.40 yr; non-fallers: 57.9%, fallers: 42.1%) with the absence of cognitive impairment participated in the study. Participants were asked to predict their maximum distance for a stepping forward prior to performing the task. Absolute Percent Error (APE), Absolute Error (AE) and Error Tendency (ET) were calculated accordingly (2.8). APE measured deviation percentage from accurate perceptions, AE indicated the discrepancy (in cm) between estimation and real performance. ET indicated the direction of the error (under- or overestimation bias).

Results

On average, non-faller estimated (63.7 ± 15.5 cm) and performed (70.7 ± 14.9 cm) greater distances than faller (estimation: 57.1 ± 14.5 cm; real: 61.7 ± 14.6 cm) older adults. No statistically significant differences were observed in APE (fallers: 7.2 ± 12.4 %; non-fallers: 9.6 ± 12.5 %). However, differences in AE were significant between faller (6.7 ± 5.9 cm) and non-faller (9.6 ± 12.5 cm) older adults (p = .001). Old people had a huge tendency to underestimate (77.2%) the maximum distance achieved in a stepping forward. The results show a significant association between ET and being faller (χ²(1) =6.407, p=.01). Despite general participants exhibit an underestimation tendency, this tendency is greater in non-fallers (61.6% vs 38.4%). Further, there were fewer non-fallers than fallers overestimating their ability to step forward (45.6% vs 54.4%).

Conclusions

Older adults displayed a tendency to underestimate the maximum distance they can stepping-forward. The bias of overestimation is more frequent in fallers, whereas persons who underestimated tend to do not fall, suggesting that they have a protective behaviour which avoids falls. Data evidence that older adults can perceive what the environment affords, which is in agreement with an ecological perspective to perception and action.

Acknowledgements

This study was funded by ESACA Project (Grant ALT20-03-0145-FEDER-000007).

References

1. Gibson J. The ecological approach to visual perception. New Jersey: Lawrence Erlbaum; 1979.

2. Almeida G, Luz C, Martins R, Cordovil R. Differences between Estimation and Real Performance in School-Age Children: Fundamental Movement Skills. 2016;2016:3795956.

3. Cole WG, Chan GLY, Vereijken B, Adolph KE. Perceiving affordances for different motor skills. Exp brain Res. 2013;225(3):309–319.

4. Konczak J, Meeuwsen HJ, Cress ME. Changing affordances in stair climbing: the perception of maximum climability in young and older adults. J Exp Psychol Hum Percept Perform. 1992;18(3):691–697.

5. Cesari P, Formenti F, Olivato P. A common perceptual parameter for stair climbing for children, young and old adults. Hum Mov Sci. 2003;22(1):111–24.

6. Luyat M, Domino D, Noel M. Surestimer ses capacités peut-il conduire à la chute? Une étude sur la perception des affordances posturales chez la personne âgée. Psychol NeuroPsychiatr Vieil. 2008;6(4):286–297.

7. Noel M, Bernard A, Luyat M. La surestimation de ses performances : Un biais spécifique du vieillissement? Geriatr Psychol Neuropsychiatr Vieil. 2011;9(3):287–294.

8. Almeida G, Luz C, Martins R, Cordovil R. Do Children Accurately Estimate Their Performance of Fundamental Movement Skills. J Mot Learn Dev. 2017;5(2):193-206.

Keywords

Aging, Falling, Perception of affordances, Gait.

O172 A new affordance perception test to explain falls occurrence: preliminary results of stepping-forward task

Catarina LN Pereira, Jorge Bravo, Hugo Rosado, Gabriela Almeida

Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal

Correspondence: Catarina LN Pereira (clnp@uevora.pt)

Background

Falls cause injury, dependence, and death. Identify the subjects that are potential fallers is essential for a successful prevention. Researchers developed several models and tests in order to diagnose individual’s risk of falling [1, 2]. Risk factors such as environmental hazards, strength, balance or dual tasks are commonly tested. However, their discriminative power is limited, indicating a gap which these tests do not address. The assessment on the perception of affordances for individual’s ability to perceive the critical boundary action [3, 4], may fill this gap.

Objective

To analyse the appropriateness of a new stepping-forward test to explain fall occurrence in community-dwelling adults, that assess perception and action boundary.

Methods

Participants were 266 women and 81 men aged 73.0 ± 6.4 years. They were assessed for fall occurrence (yes vs. no), and for stepping-forward and perception boundaries. Participants judged their maximum stepping-forward distance prior to the performance of the estimated task. Absolute Error (AE) [|estimated – real|] (cm) and Absolute Percent Error (APE) (%) were computed, and the Error Tendency (ET) was classified (underestimation vs. overestimation) [5, 6].

Results

Univariate binary regression analysis showed that all the described variables explain significantly fall occurrence (p < 0.05). Data showed that, for each additional cm estimated in the stepping-forward test, the likelihood of falling decreased on 2.9%, OR: 0.971 (95%CI: 0.957-0.986), and for each additional cm performed in the test, this likelihood decreased on 4.0%, OR: 0.960 (95%CI: 0.945-0.975). Furthermore, data showed that for each additional cm computed as AE, the likelihood of falling decreased on 3.6%, OR: 0.964 (95%CI: 0.933-0.996), and for each additional 1% computed as APE this likelihood decreased on 0.9%, OR: 0.991 (95%CI: 0.969-1.013). Finally, data showed that subjects reporting an ET of underestimation were less 47.7% likely for falling, OR: 0.523 (95%CI: 0.315-0.867), than subjects showing an ET of overestimation.

Conclusions

The new stepping-forward affordance perception test evidenced to be useful to determine the risk of fall occurrence. A higher estimation of maximum distance achieved or a higher real performance on the test were associated with a lower risk of falling. Further, a higher AE and an underestimation tendency showed to be associated with a decreased risk of falling. This suggests that is the marge of security provided by the higher performance ability, in contrast with a lower perception of affordance, which is protective and avoids falls.

Acknowledgements

This study was funded by ESACA Project (Grant ALT20-03-0145-FEDER-000007).

References

1. Pereira CLN, Baptista F, Infante P. Role of physical activity in the occurrence of falls and fallrelated injuries in community-dwelling adults over 50 years old. Disabil Rehabil. 2014;36(2):117–124.

2. Lohman M, Crow R, DiMilia P, Nicklett E, Bruce M, Batsis J. Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. J Epidemiol Community Heal. 2017;71(12):1191–1197.

3. Luyat M, Domino D, Noel M. Surestimer ses capacités peut-il conduire à la chute? Une étude sur la perception des affordances posturales chez la personne âgée. Psychol NeuroPsychiatr Vieil. 2008;6(4):286–297.

4. Noel M, Bernard A, Luyat M. La surestimation de ses performances : Un biais spécifique du vieillissement? Geriatr Psychol Neuropsychiatr Vieil. 2011;9(3):287–294.

5. Almeida G, Luz C, Martins R, Cordovil R. Differences between Estimation and Real Performance in School-Age Children : Fundamental Movement Skills. 2016;2016:3795956.

6. Almeida G, Luz C, Martins R, Cordovil R. Do Children Accurately Estimate Their Performance of Fundamental Movement Skills. J Mot Learn Dev. 2017;5(2):193-206.

Keywords

Aging, Falling risk, Boundary action, Perception.

Poster Communications

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, Sakashitaa 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 Acad