**Keywords**

Functional units, Primary Health Care, Patient Safety Culture, Education and Training in Patient Safety.

P91

**Online opinion leaders and weight loss: a literature review based model**

Inga Saboia¹, Ana M Almeida²

¹Universidade Federal do Ceará, 60020-181 Fortaleza, Ceará, Brasil;

²Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Inga Saboia (guiguisaboia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P91

**Background**

Online opinion leaders shape the trends of the current Web 2.0 [1] and eHealth context [2]. In 2013, in the USA, 72% of the netizens sought out others with the same health problem [3]. This illustrates a scenario of a network among users that mutually influence health behaviours and health decisions, creating a new setting of an increasing digital literacy in health [4], in which the patient becomes an agent of their treatment. One of the most researched topics is weight control (3). The subject of this study is related to public health, specifically obesity, the epidemic of the 21st century [5].

**Objective**

This study intends to build a model of analysis, based on a literature review. This model is expected to support a deeper understanding of the role of the opinion leaders on social networks, particularly the ones which sphere of influence acts on weight loss.

**Methods**

A literature review was conducted through a systematic mapping [6]. The handled databases were: Web of Science, Scopus, PubMed, and Google Scholar. The keywords were: Opinion leader OR Digital Influencer OR Powerful Patient OR Community AND Nutrition OR Obesity OR Weight AND Behaviour change, from 2012 to 2017.

**Results**

Opinion leadership relates to the degree in which an individual can influence others, according to their characteristics and practices, building interpersonal ties [7]. The opinion leaders types in the current Web 2.0 context are: professionals and non-professionals, being these last ones mainly patient opinion leaders (POLs) [8] or digital influencers [9]. POLs are patients who share content as support for others [8]. Besides these agents, we see the rise of health professionals who connect directly with their audience [9]. These have conquered the media by promoting the "right way to feed" and legitimating themselves through a scientific discourse [10]. Considering the digital influencers context, a dichotomy arises: they can be taken as a threat to public health, or as partners fostering the communication between doctors and patients [9]. Furthermore, social networks have also an important role in this scenario as they connect people with a common purpose (weight loss) [10-15].

**Conclusions**

This study identified two types of opinion leaders: health professionals, and nonprofessional ones. Both have different behaviours in social networks, but both have an important role in influencing the experience of their followers in weight loss.

**Keywords**

Online opinion leaders, Online social network, Digital influencers, Patient opinion leader, Digital literacy in health, Nutrition, Public health, Obesity, eHealth, Web 2.0.

P92

**Pharmacotherapeutic follow-up in institutionalized elderly**

Ana Grou¹, Carmen Monteiro², Jorge Balteiro¹

¹Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ²Farmácia Luciano e Matos, 3000-142 Coimbra, Portugal

**Correspondence:** Jorge Balteiro (balteiro@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P92

**Background**

The pharmacotherapy follow-up is one of the best methods to diminish health problems and medicine therapy-associated morbidity. This procedure aims at improve the results obtained at the clinical level and optimize therapeutic plans.

**Objective**

This work aimed to perform the pharmacotherapy follow-up of elderly residents in long-stay institutions, identify their prevalent pathologies and trends in medicines consumption, as well as to identify and solve negative results of medication (NOM).

**Methods**

Pharmacotherapy follow-up procedures were applied to 38 elderly Residents in a Long-Stay Institution. The population analysed referred to suffer from a total of 212 pathologies. The majority of these concerned the circulatory system (n=45) and mental and behavioural disturbs (n=38). Daily, 273 medicines are consumed by this population and most of them target the nervous and cardiovascular systems (n= 93 and n=74, respectively).

**Results**

During the pharmacotherapy follow-up interviews 88 NOM were identified. Upon pharmacist intervention, 52 of the identified NOM were solved or placed under control. During this pharmacotherapy follow-up procedure 131 interventions were performed.

**Conclusions**

The establishment of pharmacotherapy follow-up is greatly advantageous for patients, particularly for elderly ones. This procedure optimized the results of the therapeutic plan, decreased the impact and solved NOM.

**Keywords**

Pharmacotherapy Follow-up, Elderly Residents in Long-Stay Institutions, Negative Outcomes Associated with Medication Pharmacist Intervention.

P93

**The person with ostomy of intestinal elimination: social representation of nurses**

Joana Pinho, Tânia Jesus, Liliana Mota

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

**Correspondence:** Liliana Mota (saxoenfermeira@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P93

**Background**

During the surgical formation of an intestinal elimination ostomy, the person is challenged to develop a set of self-care skills to guarantee quality of life throughout the health/illness transition process, and the nurse should act as a facilitator in this process [1]. Nurses have an important role to prepare these patients to return back home. This study intends to extract the essence from the nurses' point of view, about people with ostomy of intestinal elimination.

**Objective**

To describe the social representation of nurses about the person with intestinal elimination ostomy.

**Methods**

We conducted a qualitative, descriptive-exploratory study. Data was collected with an online form. The online form had five questions focused in the aim of the study, and each participant answered each question with five words according to their perception. The sample was of convenience, non-probabilistic constituted by 64 nurses which answered to an online form. Data were collected during the month of November (2017) sending emails to all contacts of nurses in the data bases of the nursing school. Anonymity was preserved. Data analysis was computed in IRAMUTEQ. We performed a classic lexicographical analysis.

**Results**

Participants had on average 33.08 (± 8.83) years old (between 22 and 58 years). The majority (76.6%) belonged to the feminine gender and 84.4% of participants were graduated. When the nurses think in ostomy of intestinal elimination, they think in the characteristics of the stoma. The smell has an important role in this category. Focused
in person with intestinal ostomy, nurses are centred in self-care. The nurses consider support (emotional and familiar) and the teachings, the most important necessities of the person with an intestinal ostomy. When they think in the care of these persons they are focused in capacity and knowledge. The preparation to return back home is centred in the acceptance of the disease and on the relationship between nurses and patient.

## Conclusions

The social representation of nurses about the person with intestinal elimination ostomy is focused in emancipatory patterns of nursing. The person is the centre of care and the care plan is focused in helping the person to live with quality with this new condition. These results are an important contribution to enhance the practices and to demonstrate the relevance of nursing health/illness transitions of the person with intestinal elimination ostomy.

## References

1. Mota M, Gomes G, Petuco V, Heck R, Barros E. Facilitadores do processo de transição para o autocuidado da pessoa com estoma: subsídios para enfermagem. Revista da Escola de Enfermagem USP. 2015. 49(1):82-88.

## Keywords

Ostomy, Intestinal elimination, Social representation, Nursing.

## P94

### A synthesis of Portuguese studies regarding infertile patients

Joana Romeiro, Sílvia Caldeira
Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023
Lisbon, Portugal

**Correspondence:** Joana Romeiro (joana.m.romeiro@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P94

### Background

Infertility is clinically defined as the inability to conceive and to achieve successful clinical pregnancy after 12 months of regular and unprotected sexual intercourse [1]. In 2010, 48.5 million couples worldwide were reported to have fertility problems [2], affecting both genders in 40% of the cases [3]. Due to this high and broad prevalence, infertility is acknowledged as a public health issue with prioritized intervention [4]. The prevalence in Portuguese population was first known in 2009, when a study estimated that about 260-290 thousand individuals were infertile and approximately 9% to 10% of couples displayed some type of reproductive confinement [5]. These results triggered scientific interest in the study of Portuguese infertile patients and a synthesis of the published Portuguese studies regarding infertility seems important in understanding and caring for these patients.

### Objective

To review scientific health empirical research in the study of Portuguese infertile patients.

### Methods

Literature review based on search conducted in December 2017. A total of 12 scientific data bases were searched: CINAHL with full text, MEDLINE with full text, MedicLatina, Academic Search Complete, Pubmed, Web of Science, LILACS, SciELO, RCAAP, and across ESENFC; Nursing School of Lisbon and Nursing School of Porto databases. No date limit has been applied. Studies considered eligible for inclusion were primary studies in Portuguese samples of male or female individuals and/or in couples having reproductive impairment, available in a full-text format, published on peer-reviewed journals in English, Spanish or Portuguese language.

### Results

A total of 2,052 results have been identified and 101 papers were included. Empirical research regarding infertile couples started to be published in 1995. Until current date, 2013 was the year with the highest publication score (13.8%) with psychological aspects of the infertile experience being the most explored (57.4%) in comparison with other health aspects, like for instance related to nursing (2.9%), and psychiatry (0.9%). Primary studies were also published in international journals (53.4%) as original papers (62.3%), and in a thesis format (37.6%).

## Conclusions

Although the developments in health research regarding infertile couples, a significant gap in the knowledge remains, particularly concerning other health disciplines (despite psychology). This seems to be a global tendency in healthcare, and further investigation is needed to fully acknowledge this phenomenon and consequently allow the provision of an effective patient-centred care to these patients.

## References

1. Zegers-Hochschild F, Adamson G D, Mouzon J de, Ishihara O, Mansour R, Nygren K van der, Poel S. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Human Reproduction, 24(11), 2683-2687.

2. Mascarenhas M N, Flaxman S R, Boerma T, Vanderpoel S, Stevens G A. National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLOS Medicine. 2012, 9(12), 1-12.

3. NICE. Fertility, Assessment and treatment for people with fertility problems. 2013. National Institute for Health and Care Excellence.

4. Centers for Disease Control and Prevention. National Public Health Action Plan for the Detection, Prevention, and Management of Infertility. U.S. Department of Health and Human Services. 2014. Retrieved from http://www.cdc.gov/reproductivehealth/infertility/pdf/drh_nap_final_508.pdf

5. Carvalho, J. L. S., & Santos, A. Estudo Afrodite, Caracterização da Infertilidade em Portugal (p. 74). Porto: Faculdade de Medicina da Universidade do Porto, Sociedade Portuguesa de Medicina da Reprodução, KeyPoint. 2009.

## Keywords

Infertility, Health, Evidence-based, Review.

## P95

### Knowledge and consumption of vitamins and food supplements in sportspeople and physical exercise in Coimbra

Adriana Ferreira, Clara Rocha, Jorge Balteiro
Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854
Coimbra, Portugal

**Correspondence:** Jorge Balteiro (balteiro@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P95

### Background

The demand for healthy lifestyles, the concern with health and well-being, and the relentless pursuit of the trend of the “ideal body” has been increasing in recent years, as well as the prevalence of supplement use, as a compensation for an unbalanced diet and search for physical/psychic intensity.

### Methods

In order to evaluate the consumption and knowledge about vitamin and dietary supplements in Coimbra, a sample of 333 individuals practicing sports was studied.

### Results

The study lasted for nine months. The collection of information was carried out through a questionnaire. The study found that 201 (60.4%) subjects have consumed supplementation, with a prevalence of higher consumption in males (73.3%). Supplement use was higher between 33 and 40 years old individuals. The most consumed type of vitamin supplement was multivitamins with minerals (44.3%) and the food supplement was protein (69%). The most cited reason for the consumption of supplements was “physical and/or intellectual fatigue” (50.5%). The daily frequency of supplementation was high (33.7%), with the highest expenditure on consumption of supplements varying from 10 to 20€, monthly. The place of purchase and the source from which subjects obtained knowledge about supplements was the Internet. As for knowledge on the subject, it was noted that it has been classified as “insufficient” (45.8%) by respondents.
## Conclusions

In Portugal, the prevalence of supplementation consumption is still unknown, so it becomes necessary to raise awareness among the population, about potential risks associated with improper supplementation, special diets and unbalanced exercise.

## Keywords

Vitamins supplements, Food supplements, Consumption, Knowledge.

## P96

### Stability of paediatric oral diazepam suspensions

Patrícia Marinho¹, Patrícia Correia²

¹Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal

**Correspondence:** Patrícia Marinho (patriciampmarinho@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P96

### Background

Currently, hospital pharmacies prepare formulations that aim to adjust the medication to the needs of each patient when the pharmaceutical industry is not able to respond to those needs [1]. One of the formulations produced in the hospital pharmacy is the diazepam suspension 0.4 mg/ml for paediatric use, obtained from diazepam tablets. However, the use of tablets or powders in oral liquid formulations may alter the stability of the active ingredients. Therefore, these formulations should be submitted to stability studies [2]. Nevertheless, the information on the stability of manipulated oral suspensions is scarce [3], so this study is relevant.

### Objective

The main goal of this study is to validate a method of diazepam quantification in suspensions. Additionally, we aim to evaluate the stability of diazepam in suspensions during 30 days, after the suspension preparation, establishing an expiration date.

### Methods

The quantification method of diazepam in oral suspensions arose from the adaptation of the method described in Portuguese Pharmacopoeia [4], for the same active ingredient in tablets. After the method's validation, the stability of diazepam was evaluated weekly, during 30 days, and the first analysis was done immediately after the preparation of the suspension. During the study period, suspensions were stored under suitable cold conditions (4°C).

### Results

With an accuracy, evaluated by the mean recovery of 80%, and a precision, evaluated by the variation coefficient, varying between 6.1 and 11.5%, the method proved to be practicable. Two suspension's samples were prepared with a similar diazepam concentration (0.43 mg/ml). The stability study of those suspensions showed that diazepam concentration decayed linearly, and that diazepam suspensions lose about 70% of their active principle within 30 days. Moreover, given the limits indicated by the Portuguese Pharmacopoeia [4] for diazepam tablets, it was verified that these suspensions only comply with these limits after 7 days, and that within the established period of validity these limits are no longer met.

## Conclusions

Despite all limitations, the adapted method proved to be practicable and the results that followed have pointed to the possible instability of diazepam, when included in this oral suspension formulation. Given the dosage limits set for diazepam tablets [4] and knowing in advance that the validity period usually attributed to the suspension is 15 days, the results point to a new shelf-life of approximately 7 days. However, for a more consistent period of validity to be established, a more detailed stability study is required.

## References

1. Patel VP, Desai TR, Chavda BG, Katira RM. Extemporaneous dosage form for oral liquids. Pharmacophore, 2011, 2(2), 86-103.

2. Schlatter J, Bourguignon E, Majoul E, Kabiche S, Balde I B, Cisternino S, Fontan J E. Stability study of oral paediatric idebenone suspensions. Pharmaceutical Development and Technology, 2016, 22(2), 296-299

3. Ensom M H H, Kendrick J, Rudolph S, Decarie D. Stability of Propranolol in Extemporaneously Compounded Suspensions. The Canadian Journal of Hospital Pharmacy, 2013, 66(2), 118-124.

4. INFARMED. Farmacopeia Portuguesa. 8ª edição. 2008, 1925-1926; 2224-2225.

## Keywords

Diazepam suspensions, Chemical stability, Validation tests, Dosing method, Expiration date.

## P97

### First-time grandparents and transition to grandparenthood: integrative review of the literature

Sónia Coelho¹, Rogério Rodrigues², Isabel Mendes²

¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Nursing School of Coimbra, 3046-051 Coimbra, Portugal

**Correspondence:** Rogério Rodrigues (rogerio@esenfc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P97

### Background

Nowadays families become smaller but at the present time a family involves several generations (even if they do not live together). The family members' roles change and the role of the grandparents in the transition of first-time parents to grandparenthood needs to be understood.

### Objective

To systematize an integrative review of the literature related to the transition to grandparenthood in contemporary Western societies.

### Methods

We conducted an integrative review of the literature, in electronic databases (EBSCO®, b-On® and Web of Knowledge®) in order to answer the question: "How is experienced the transition to grandparenting?" The search was limited to articles published between 2006-2016 years, with the descriptors "grandparents" and "transition" in English, French, Portuguese or Spanish.

### Results

After analysing the abstracts of 179 articles, excluding repetitions, and those who did not respond to the original question, we obtained 13 articles to include in the integrative review. The level of the methodological approach was level 4. Only descriptive and qualitative studies (non-experimental) were included. The results of the literature review on the topic were grouped into five themes: grand-parenting and gender; become a grandfather/ grandmother; parenting and the transition process; role and health; parenting and intergenerational relations.

## Conclusions

It was found that the transition to Grandparenthood is studied in risk situations, and more studied in women than in men. Grandparenthood can be seen as a transition or as an adaptive process; as the search for the meaning of life; opportunity for personal growth; a normative event that has emotions and positive and negative cognitions. The process of becoming a grandparent can be considered an event of great social impact. Grandparents see their grandchildren as their extension in time and this gives them a more positive view of aging. The perception that grandparents have of themselves may be important in promoting a positive and healthy aging.

## Keywords

Grandparenthood, Grandparents, Transition.

## P98

### Intestinal microbiota - impact on host health

Nastasia Fernandes, Alice Nunes, Maria José Alves

Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal

**Correspondence:** Nastasia Fernandes (nastasia-ar1000@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P98
**Background**

At present it is known that in addition to establish and maintain a normal intestinal health, the intestinal microbiota can exacerbate a multitude of diseases, ranging from colorectal cancer to autoimmune and allergic diseases [1]. The interest in studying the human microbiome, its diversity and human-microorganism interactions has been developing in the last years, as such it has been made available immense information in this area.

**Objective**

Bibliographic review of the intestinal microbiota: constitution, what affects it, and its influence in the triggering of some pathologies.

**Methods**

A comprehensive search was performed on the PubMed search, being obtained from this review 112 articles from which 67 were used.

**Results**

The intestinal microbiota is considered a "superorganism" and is extremely complex. It is composed of a great diversity of microorganisms, which varies among individuals; however, it is essentially dominated by two phyla, the Bacteroidetes and the Firmicutes. It is dynamic and can be affected by several factors such as diet [2], breastfeeding [3], use of antibiotics [4,5] and type of delivery [6,7]. When an imbalance of the microbiota occurs, known as dysbiosis [1,8], the host is affected, being related to pathologies such as allergies, obesity and Crohn's disease. Some studies [9,10-14] have demonstrated that the microbiota participates in the maturation of the immune system and as such is predominant in the response to infectious processes. On the other hand, the intestinal microbiota seems to play a fundamental role in the prevention of allergies [15-26]. Inappropriate colonization after birth and excessive hygiene during childhood, may promote greater allergic reactions. Rats without bacteria have been shown to present more severe allergic reactions [22-26]. Regarding obesity, several authors [27-30] have demonstrated that changes in microbiota are strongly related to the establishment of obesity. It has been demonstrated that the type of microbiota influences obesity; rats with higher amounts of Firmicutes compared to the amount of Bacteroidetes, present greater capacity to promote fat deposition. On the other hand, a switch to a less caloric diet produced a change in the microbiota that led to a decrease in Firmicutes and an increase in Bacteroidetes. These results are surprising and suggest that future obesity control may originate from the type of intestinal microbiota.

**Conclusions**

Intestinal microbiota is of great relevance because it protects against external factors and the development of certain pathologies. It is therefore important to keep the population informed so that a microbiota considered "normal" can be maintained from childhood to adulthood.

**References**

1. Parnell JA, Reimer RA. Prebiotic fiber modulation of the gut microbiota improves risk factors for obesity and the metabolic syndrome. Gut Microbes. 2012;3(1):29-34.

2. David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-563.

3. Cox LM, Blaser M. J. Antibiotics in early life and obesity. Nat Rev Endocrinol. 2015;11(3):182-190.

4. Clemente JC, Ursell LK, Parfrey LW, Knight R. The impact of the gut microbiota on human health: an integrative view. Cell. 2012;148(6):1258-1270.

5. Jernberg C, Löfmark S, Edlund C. Long-term impacts of antibiotics exposure on the human intestinal microbiota. Microbiology. 2010;156(Pt11):3216-3223.

6. Adlerberth I, Strachan DP, Matricardi PM, Ahrne S, Orfei L, Aberg N, et al. Gut microbiota and development of atopic eczema in 3 European birth cohorts. J Allergy and Clin Immunol. 2007;120(2):343-50.

7. Gronlund MM, Lehtonen OP, Eerola E, Kero P. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J. Pediatr Gastroenterol Nutr. 1999;28(1):19-25.

8. Blumberg R, Powrie F. Microbiota, Disease, and Back to Health: A Metastable Journey. Sci Transl Med. 2012;4(137):137rv7.

9. Swidsinski A, Loening-Baucke V, Lochs H, Hale LP. Spatial organization of bacterial flora in normal and inflamed intestine: a fluorescence in situ hybridization study in mice. Word J Gastroenterol. 2005;11(8):1131-1140.

10. Hartstra AV, Bouter KE, Backhed F, Nieuwdorp M. Insights into the role of the microbiome in obesity and type 2 diabetes. Diabetes Care. 2015;38(1):159-65.

11. Chow J, Lee SM, Shen Y, Khosravi A, Mazmanian SK. Host-bacterial symbiosis in health and disease. Adv Immunol. 2010;107:243-274.

12. O'Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep. 2006;7:688-693.

13. Purchiaroni F, Tortora A, Gabrielli M, Bertucci F, et al. The role of intestinal microbiota and the immune system. Eur Rev Med Pharmacol Sci. 2013;17(3):323-33.

14. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol. 2009;9:313-323.

15. Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002;347:911-20.

16. Pelucchi C, Galeone C, Bach JF, La Vecchia C, Chatenoud L. Pet exposure and risk of atopic dermatitis at the pediatric age: a metaanalysis of birth cohort studies. J. Allergy Clin Immunol. 2013;132(3):616622.e7.

17. Stiemsma LT, Turvey SE. Asthma and the microbiome: defining the critical window in early life. Allergy Asthma Cli Immun. 2017;13:3.

18. Chieppa M, Rescigno M, Huang AY, Germain RN. Dynamic imaging of dendritic cell extension into the small bowel lumen in response to epithelial cell TLR engagement. J Exp Med. 2006;203(13):2841-52.

19. Ignacio A, Morales CI, Camara NO, Almeida RR. Innate sensing of the gut microbiota: modulation of inflammatory and autoimmune diseases. Front Immunol. 2016;7:54.

20. Round JL, Lee SM, Li J, Tran G, Jabri B, Chatila TA, et al. The Toll-like receptor pathway establishes commensal gut colonization. Science. 2011;332(6032):974-977.

21. Hessle C, Hanson LA, Wold AE. Lactobacilli from human gastrointestinal mucosa are strong stimulators of IL-12 production. Clinical and Experimental Immunology. 1999;116(2):276-282.

22. Herbst T, Sichelstiel A, Schar C, Yadava K, Burki K, Cahenzli J, et al. Dysregulation of allergic airway inflammation in the absence of microbial colonization. Am J Respir Crit Care Med. 2011;184(2):198-205.

23. rompette A, Gollwitzer ES, Yadava K, Sichelstiel AK, Sprenger N, NgomBru C, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nat Med. 2014;20(2):159-66.

24. Schuijs MJ, Willart MA, Vergote K, Gras D, Deswarte K, Ege MJ, et al. Farm dust and endotoxin protect against allergy through A20 induction in lung epithelial cells. Science. 2015;349(6252):1106-10.

25. Kumar H, Lund R, Laiho A, Lundelin K, Ley RE, Isolauri E, et al. Gut microbiota as an epigenetic regulator: pilot study based on wholegenome methylation analysis. MBio. 2014;5(6):e02113-4.

26. Thorburn AN, McKenzie CI, Shen S, Stanley D, Macia L, Mason LJ, et al. Evidence that asthma is a developmental origin disease influenced by maternal diet and bacterial metabolites. Nat Commun. 2015; 6:7320.

27. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(7122):1027-1031.

28. Bäckhed F, Ding H, Wang T, Hooper LV, Koh GY, Nagy A, et al. The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci U S A. 2004; 101:15718-23.

29. Schwiertz A, Taras D, Schäfer K, Beijer S, Boss NA, Donus C, Hardt PD. Microbiota and SCFA in lean and overweight healthy subjects. Obesity (SilverSpring) 2010;18:190-195.

30. Bäckhed F, Manchester JK, Semenkovich CF, Gordon JI. Mechanisms underlying the resistance to diet-induced obesity in germ-free mice. Proc Natl Acad Sci U S A. 2007; 104:979-84.

**Keywords**

Intestinal microbiota, microbioma, immune system, dysbiosis, obesity, allergies, Crohn's disease.
P99

Effects of aging on neuromuscular activity during the performance of a ballistic motor skill

António M Vencesbrito¹,²,³,⁴, Mário A Rodrigues-Ferreira¹,²,³

¹Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ²Unidade de Investigação do Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ³Centro de Investigação em Qualidade de Vida, 2040-413 Rio Maior, Portugal;

⁴International Martial Arts and Combat Sports Scientific Society, Rzeszów, Poland

**Correspondence:** António M Vencesbrito (abrito@esdrm.ipsantarem.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P99

Background

Human aging leads to a progressive decline of biological func-
tions that affects the neuro-muscular systems. Sport practice is
associated with health maintenance and a better quality of life in
older people.

Objective

The aim of this study was to investigate the effects of aging on the neuromuscular reaction time and electromechanical delay during the performance of the karate frontal kick (Mae-Geri).

Methods

Participated in this study 9 elite karate athletes (age, 21.0 ± 2.47 years; height, 175 ± 6.53 cm; weight, 72.0 ± 9.25 kg) and 9 veteran karate practitioners (age, 54.0 ± 3.87 years; height, 176 ± 4.72 cm; weight, 76.0 ± 9.17 kg). Surface electromyography was recorded from rectus femoris (RF) and vastus lateralis (VL) portions of the quadriceps femoris, long head of the biceps femoris (BF), tibialis anterior (TA) and lateralis gastrocnemius (GA). Kinematic analysis was performed with the Ariel Performance Analysis System (APAS, Ariel Dynamics-2003). The neuromuscular reaction time was defined as the time interval between the auditory stimulus and the onset of electrical activation of a muscle, while the electromechanical delay was the time interval between the onset of the electric activity of a muscle and the beginning of joint movement. Student t-test (two-tailed) was used to analyse the differences between groups, with a significance level of p < 0.05 (SPSS 17.0).

Results

It was observed a tendency to a longer neuromuscular reaction time of the TA in veteran karate practitioners than among elite karate athletes (136.00 ± 58.80 vs 122.00 ± 45.94 ms, p = 0.566), although a significantly shorter neuromuscular reaction time was found in the RF in veteran karate practitioners (137.00 ± 27.93 vs 184 ± 51.55 ms, p = 0.030). Veteran karate practitioners presented a significantly longer RF electromechanical delay than elite karate athletes (127.00 ± 59.11 vs 39.00 ± 47.68 ms, p = 0.003).

Conclusions

The results of the study showed that with the aging process there is
an increase in the electromechanical delay, although no negative im-
pact on the neuromuscular reaction time has been observed. There-
fore, continuous sport practice in veteran karate practitioners seems
to attenuate the effects of aging on neuromuscular systems.

Keywords

Neuromuscular reaction time, Electromechanical delay, Electromyography, Karate.

P100

Nutritional status in institutionalized elderly: is it influenced by polymedication and length of stay?

Maria A Marques¹,², Ana Faria³,⁴, Marisa Cebola²,⁵

¹Santa Casa da Misericórdia de Alvaliázere, 3250-115 Alvaliázere, Portugal;

²Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa,

Portugal; ³Centro Hospitalar e Universitário de Coimbra, 3000-075

Coimbra, Portugal; ⁴Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ⁵Escola Superior Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal

**Correspondence:** Maria A Marques (mariaanfm@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P100

Background

Aging is frequently associated with conditions, like malnutrition, that may affect the elderly health status and quality of living. Malnutrition has a high prevalence in institutionalized elderly [1]. Polymedication is also frequent in older individuals, impairing appetite and possibly contributing to the development of malnutrition [2].

Objective

The aim of this study was to identify nutritional risk in institutional-
ized elderly and establish a relationship between length of stay in
the institution, pharmacotherapy and presence of malnutrition.

Methods

Day of admission, number of medications and sociodemographic data were collected from the patient's medical file. Malnutrition and nutritional risk were assessed using the Mini Nutritional Assessment (Short Form) (MNA-SF).

Results

Seventy-eight individuals, mainly female (59.0%), with a mean age of 81.7 years (SD= 10.2) were evaluated. Mean length of stay was 6.4 years (SD= 7.8). MNA-SF classified 32 individuals (41.0%) at risk of malnutrition and 20 (25.6%) as malnourished. According to the elderly Body Mass Index (BMI) classification, 28 were at risk of malnutrition and 23 were malnourished (35.9% and 29.7%, respectively), showing a positive correlation with MNA-SF results (p < 0.05). The female gender presented an overall higher risk of malnutrition (p < 0.05). Those who were more dependent to feed themselves were at risk of malnutrition or malnourished (p < 0.05). Fifty-seven of the subjects (73.0%) were under polymedication, with a mean number of daily medications of 7.5 (SD= 3.4). A higher number of regular medications is correlated with higher BMI (p < 0.05). No association was found between length of stay or number of drugs taken and malnutrition.

Conclusions

In this population, a high prevalence of risk of malnutrition was iden-
tified, particularly in the female gender. Although previously de-
scribed, a correlation between polypharmacy and malnutrition was
not found. A closer look to type of medication might be necessary.
In this sample, a very long length of stay was also found. Nutritional
intervention in this population should be prompt since admission
and regularly provided, preventing the development of malnutrition
and comorbidities.

References

1. Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care. 2012;15(1):29-41.

2. Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. Janeiro de 2012;15(1):1-6.

Keywords

Malnutrition, Elderly, Polypharmacy.

P101

Food safety and public health in canteens of public and private educational establishments and in private institutions of social solidarity

Cristina Santos¹, Esmeralda Santos²

¹Department of Environmental Health, Coimbra Health School, 3046-854

Coimbra, Portugal; ²Agrupamentos de Centros de Saúde do Baixo

Mondego, 3150-195 Condeixa, Portugal

**Correspondence:** Cristina Santos (cristinasofiasantos@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P101

Background

To promote and guarantee hygiene and food safety is nowadays a
requirement in any service involving the provision of food, as a
means of ensuring the promotion of a high level of protection and
consumer confidence. These changes boosted the growth of the
catering industry. However, they also require the evolution of tech-
niques, so as to enable catering and catering companies to offer
food of quality [1-3]. Most cases of food poisoning are due to poor
hygiene habits. Structural failures and ignorance or neglection of
good hygiene and food safety practices may also lead to food contamination [4,5].

**Objective**

The sample consisted of canteens of public and private educational establishments and of public and private social solidarity institutions, totalling 26 canteens and 127 professionals. Data collection was performed using a diagnostic sheet of the structural conditions and operation of the facilities.

**Results**

Measurements of polar compounds in canteens indicated good quality, except for one of the measurements that indicated a less satisfactory quality. In the evaluation of food temperature, it was found that there are some foods that are served in the "danger zone" (< 65°C). School cafeterias (without food confectionery) had, in majority, deficient conditions of installation because they were rooms of activities where the meals were served. For this reason, there were no water baths or meal service facilities.

**Conclusions**

With this work it was concluded that there are deficiencies regarding the structural and operating conditions of canteens/refectorios, which could be filled by the construction/enlargement of spaces. Regarding the evaluation of the quality of the oils and temperature of the meals, there were flaws, with possible repercussions on the quality of the meals served. It is also important to develop skills for the elaboration of menus suited to the different age groups and the confection of healthier diets. Emphasis can be placed on the training of manipulators in order to raise awareness of the repercussions of their role and responsibilities in preventing contamination. Ensuring and promoting food safety is nowadays a requirement of any institution, where food is produced or distributed, as a means of ensuring the promotion of high levels of confidence and safeguarding of the consumer's health.

**References**

1. Baptista P, Antunes C. Higiene e Segurança Alimentar na Restauração. Vol. I. Guimarães: Forvisão – Consultoria em Formação Integrada; 2005.

2. Baptista P, Antunes C. Higiene e Segurança Alimentar na Restauração. Vol. II. Guimarães: Forvisão – Consultoria em Formação Integrada; 2005.

3. Afifi HS, Abushelaibi A. Assessment of personal hygiene knowledge, and practices in Al Ain, United Arab Emirates. Food Control. 2012;25:249-253.

4. Associação da Restauração e Similares de Portugal. Higiene e Segurança Alimentar – Código de boas práticas para a restauração pública; 2006.

5. Lima VT. Educação nutricional na escola. In: Seminário de Alimentação ESCOLAR, 3, 1999, ITAL. Resumos. Campinas, São Paulo. p.61.

**Keywords**

Public Health; Food Safety; Canteens; Promoting Food Safety.

## P102

### Evaluation of the correlation between height and health of the spine in the student population in the age group of 16 - 19 years old - evaluation with spinal mouse*

Alexandra Monteiro, Nelson Azevedo, João Silva, Liliana Rodrigues, Gilvan Pacheco
Instituto Superior de Saúde do Alto Ave, 4720-155 Amares, Portugal

**Correspondence:** Nelson Azevedo (nelsonjaze@gmail.com)
BMC Health Services Research 2018, **18**(Suppl 2):P102

**Background**

The increasing number of postural deviations observed in the student population leads to changes in the spine' normal curvature, which translates into a greater vulnerability to mechanical stress and traumatic injuries. Although the causes of these postural deviations are diverse and difficult to analyse, the present study decided to investigate whether the height of the students may be one of the factors influencing the appearance of postural alterations detected by the non-invasive evaluation method of the Spinal Mouse®.

**Objective**

Analyse differences in the incidence of postural changes in a sample of students aged 16-19 years with different heights (cm).

**Methods**

Eighty-five (85) students aged 16-19 years from Amares High school (Braga) were selected and submitted to a non-invasive postural evaluation by the Spinal Mouse® device, which showed the presence of hypomobility, normal mobility and hypermobility at the sagittal plane in three zones of the vertebral spine (sacral, thoracic and lumbar), as well as an overall tilt in three distinct positions: orthostatic, flexion and extension. Data analysis was performed using the statistical program IBM® SPSS® (Statistical Package for the Social Sciences), version 25. In the statistical tests performed, it was considered as levels of significance, the values of 0.05 (significant) and of 0.01 (extremely significant).

**Results**

The results indicate statistically significant differences (Kruskal-Wallis test, H) in the incidence of postural deviations (sagittal plane) in the sacral zone in flexion position (H = 6.629, p-value = 0.036), in general slope in flexion position (H = 6.738, p-value = 0.046), in the thoracic zone in the extension position (H = 11.390, p-value = 0.003) and in the lumbar zone in the extension position (H = 6.738, p-value= 0.034) for the different height groups considered ("<159 cm", "159 - 177 cm" and "> 177 cm").

**Conclusions**

Through the results we can conclude that there is a significant relationship between postural changes and students' height. In this way, it is fundamental to equate the ergonomic model of the school support material in order to adjust to different postures.

**Keywords**

Spine, Postural changes, Adolescent height, Ergonomics, Spinal Mouse.

## P103

### The contribution of a Portuguese innovation to prevent complication in venous catheterization

Inês Cardoso¹, Anabela Salgueiro-Oliveira¹, Arménio Cruz¹, José M Martins¹, Liliana Sousa¹, Sara Cortez², Filipa Carneiro³, Pedro Parreira¹
¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Muroplás - Indústria de Plásticos, 4745-334 Muro, Trofa, Portugal; ³Innovation in Polymer Engineering, University of Minho, 4800-058 Guimarães, Portugal

**Correspondence:** Inês Cardoso (inescardoso@esenfc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P103

**Background**

Venous catheterization is one of the most frequent procedures in nursing clinical practice. Despite the procedure's importance for healthcare quality, it has some risks and complications such infiltration, bloodstream infection and phlebitis. Healthcare associated infections are considered a worldwide problem, having a considerable impact on the patients' and community's health and economy [1,2]. According to the European Centre for Disease Prevention and Control, prevalence of this type of infections is 6.0% and 10.6%, in Europe and in Portugal, respectively. Bloodstream infections, related with venous catheters, have one of the lowest prevalence, but they may lead to serious consequences [2].

**Objective**

Explore the procedure of venous catheterization as a risk factor for infection. Explore the role of an innovation as a contribution to the implementation of a prevention measure, in the practice of flushing.

**Methods**

A literature review involved search in EBSCOhost databases, including articles up to 2017. Some terms used were "infection", "venous catheter", "catheterization", catheter-related infection", "complication", "prevention", "management", "practices", "flushing".
Articles regarding haemodialysis and urinary catheters were excluded. Guidelines of the societies regarding infusion nursing practices were also included.

## Results

Catheterization is considered a risk factor because it creates a possibility for microorganisms to access to the bloodstream. The implementation of an insertion protocol is not enough to eliminate microorganisms and avoid the formation of a biofilm. Integrated in maintenance procedures, flushing contributes to reduce the risk of complications. Studies concluded that the use of an adequate technique of flushing may reduce the biofilm and the probability of infection [3]. Infusion Nurses Society [4] and the Royal College of Nursing [5] include it as a procedure to prevent complications of the infusion therapy. Despite the recommendations, the implementation of this practice is not consistent. To explain lack of adherence, one of the reasons pointed out is the complexity of the task [6]. These results support the development of a Medical Device (MD) (double chamber syringe) that may contribute to the adherence of the flushing practice.

## Conclusions

It is important to create strategies to improve adherence to guidelines in clinical context, particularly regarding healthcare associated infections. The development of a MD that may simplify the accomplishment of a good practice, such as, flushing in venous catheter to prevent complication, is proposed in this project.

## Acknowledgements

Work funded by the FEDER fund, through the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), project POCI-01-0247-FEDER-017604.

## References

1. World Alliance for Patient Safety. The Global Patient Safety Challenge 2005-2006 "Clean Care is Safer Care". Geneva, World Health Organization; 2005.

2. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. ECDC; 2013.

3. Ferroni A, Gaudin F, Guiffant G, Fland P, Durussel JJ, Descamps P, et al. Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices. Medical Devices. 2014;7:379-383.

4. Royal College of Nursing. Standards for infusion therapy (4th ed.). London: Royal College of Nursing; 2016.

5. Infusion Nurses Society. Infusion therapy standards of practice. Journal of Infusion Nursing. 2016;39(1S):S1-160.

6. Keogh S, Shelverton C, Flynn J, Davies K, Marsh N, Rickard C. An observational study of nurses' intravenous flush and medication practice in the clinical setting. 2017;3(1):3-10.

## Keywords

Venous catheter, Infection, Prevention, Flushing.

## P104

### Patient safety culture: evaluation of multiprofessional teams

Luciane PA Cabral¹, Daniele Brasil¹, Andressa P Ferreira², Clóris RB Grden¹, Caroline Gonçalves¹, Guilherme Arcaro²

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

**Correspondence:** Luciane PA Cabral (luciane.pacabral@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P104

### Background

Patient safety is an essential constituent of the quality of care, and assumes absolute relevance for managers, health professionals, family members and patients, in an attempt to provide a safe care.

### Objective

The aim of the study was to evaluate the characteristics of the Patient Safety Culture among professionals of an Intensive Care Unit, through the

application of the Hospital Survey on Patient Safety Culture (HSOPSC) instrument.

### Methods

The study population consisted of 2% (n= 1) resident physicians; 2% (n= 1) nutritionists; 2% (n= 1) administrative assistants; 5% (n= 3) general service aiders; 7% (n= 4) social workers; 8% (n= 5) dentists; 17% (n= 10) nurses; 18% (n= 11) therapists and 40% (n= 24) nursing technicians. Of these 77% (n= 46) were females and 23% (n= 14) males. When questioned about whether their errors were recorded on their functional sheets or used against them in future opportunities, the data became alarming. When questioned about the conduct of their supervisor or boss, it was noted that a considerable number of respondents opted to abstain from comments, marking the option "I do not agree or disagree". In the issue that addresses the communication in the service, the results were partially satisfactory. Regarding the frequency of reported events, there is a lack of notifications in the sector. When questioned about how patient safety is in the industry 3% (n= 2) considered it excellent, 63% (n= 38) very good and 33% (n= 20) regular. Regarding the general information of the interviewees, which were cited in the introduction of the results, in the open question, only 5% (n= 3) of respondents answered.

### Conclusions

The study allowed the evaluation of patient safety characteristics from the perspective of the multi-professional team of an Intensive Care Unit, indicating that there are many aspects to improve in several dimensions on the patient's culture. However, there are areas with greater fragility, that need a closer look, such as the lack of notifications on the part of the team, issues on the supervisor/chief of the sector and mainly fear of punitive culture.

## Keywords

Patient, Safety, Multi-professional.

## P105

### Innovation in nursing in the creation of medical devices: a Portuguese case study

Pedro Parreira¹, Inês Cardoso¹, Liliana Sousa¹, Arménio Cruz¹, José Martins¹, Sara Cortez², Filipa Carneiro³, Luciene Braga⁴ Anabela Sousa-Salgueiro¹

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Muroplás - Indústria de Plásticos, 4745-334 Muro, Trofa, Portugal; ³Innovation in Polymer Engineering, University of Minho, 4800-058 Guimarães, Portugal; ⁴Federal University of Viçosa, 36570-900 Viçosa, Minas Gerais, Brazil

**Correspondence:** Pedro Parreira (parreira@esenfc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P105

### Background

The administration of intravenous medication is a frequent practice in health units (approximately 90% of hospitalized patients experience intravenous medication). Venous catheterization (peripheral or central) allows the administration of medication directly into the bloodstream through an inserted catheter. Although the flushing procedure is desirable between and after the administration of intravenous medication, this procedure is often not observed.

### Objective

In order to reduce this problem, a consortium with complementary experience and skills was created between: Muroplás company, Innovation Polymers Engineering Centre (PIEP) and the Coimbra Nursing School (ESEnfC). The consortium developed the "DUO SYRINGE", a new Medical Device consisting in a sequential-release double-chamber syringe. The benefits of this new device are several: a greater adherence to flushing by health professionals, a higher level of patient safety and a significant reduction of complications.

### Methods

After a literature review regarding disease control and prevention, mainly sustained by the Infusion Nurses Society and Royal College of Nursing guidelines, we established important characteristics for this new MD. A focus groups with nurse experts identified and validated the technical characteristics of the device. After developing the preliminary geometry of the syringe through three-dimensional
modelling (3D), a new expert panel of end users evaluated the us-
ability of the MD alpha version sustained in Technology Acceptance
Model. In the future, we also intend to carry out laboratory tests for
safety validation and to perform clinical studies in a hospital
environment.

Results

We identified a set of characteristics that the MD should incorporate,
namely syringe size, volume of the two chambers, cannon syringe
configuration, and plunger configuration. There was an alignment
between literature review and the experts panel opinion.

Conclusions

Clinical practice creates daily new challenges to Nursing and it is cru-
cial to create responses that promote better quality of health care.
Identifying problems, creating technological partnerships with com-
panies and technological centres allows to innovate through the de-
velopment and creation of new MDs. The clinical research with MD
allows the evaluation of safety, making clinical practice more effect-
ive and safe. This is a new challenge placed to the health profes-
sionals. It is desirable to display the intellectual capital available to
generate innovations for citizens, reverting in gains to the quality of
care.

Acknowledgements

This work is funded by the FEDER fund through the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020) within project POCI-01-0247- FEDER-017604.

Keywords

Medical Device, Nursing, Innovation, Syringe.

P106

Nursing home care: nurses' perspective

Tatiana Antunes¹, Teresa Capelo¹, Anabela Salgueiro-Oliveira¹, Luciene Braga², Pedro Parreira¹

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Federal University of Viçosa, 36570-900 Viçosa, Minas Gerais, Brazil

**Correspondence:** Anabela Salgueiro-Oliveira (anabela@esenfc.pt)
BMC Health Services Research 2018, **18**(Suppl 2):P106

Background

Nursing home care is a trend of the current society, due to the aging
of the population and shorter hospitalization times, for economic
reasons and also to prevent infections. In addition, it represents a
high potential for improving the quality of care by enabling self-care
of patients in their life contexts, involving their families and taking
advantage of existing social support networks.

Objective

Analyse the scientific production, in the last seven years, concerning domiciliary nursing care, attending to the nurse's perspective.

Methods

The search method used was the integrative literature review. The in-
vestigation question was formulated based on the PICO strategy:
*What is the nurse's perspective about nursing home care?* The search
was conducted between 22 and 26 May, 2017, in the following data-
bases: SciELO, Medline with full text, CINHAL with full text, Academic
Search Complete, Complementary Index. We only looked for primary
scientific studies, published in the last six years, in English, Portu-
guese or Spanish. The selected descriptors were: Home care nursing
OR Domiciliary Care Or Home visits) AND Self-care AND Nurse. We
accessed 1,293 scientific articles. After reading title, abstract and full
text we retained 9 studies for analysis.

Results

The mobilization of different nursing competencies is important be-
cause of patient's profile and difficulties associated with the contexts
where they perform nursing care [1]. Nurses should demonstrate avail-
ability, sensitivity, education, creativity and attend to the care needs of
the person and family [2]. The care process success depends on the re-
lationship between nurse and patient and/or family [3]. The unpredict-
ability, the lack of in house resources, distance and work overload are
some of the difficulties manifested by the nurses [2, 4].

Conclusions

Nurses who provide nursing home care, due to the limited resources
they face, will have to carry out a rigorous planning of care, mobilize
and inform patients and families about social support networks, as
well as to promote self-care.

References

1. Sherman H, Forsberg C, Törnkvist A. The 75-year-old persons' self-reported health conditions: a knowledge base in the field of preventive home visits. Journal of Clinical Nursing. 2012;21:3170-3182.

2. Consoni E, Salvaro M, Ceretta L, Soratto, M. Os desafios do enfermeiro no cuidado domiciliar. Enfermagem Brasil. 2015;14(4):229-234.

3. Gago E, Lopes M. Cuidados domiciliares – interação do enfermeiro com a pessoa idosa/familia. Acta Paulista de Enfermagem. 2012;25(1):74-80.

4. Rodrigues A, Soriano J. Fatores influenciadores dos cuidados de enfermagem domiciliares na prevenção de úlceras por pressão. Revista de Enfermagem Referência. 2011;3(5):55-63.

Keywords

Patients, Home nursing care.

P107

Knowledge on pharmacogenomics: gaps and needs of educational
resources

Andrea Pinho, Marlene Santos

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

Correspondence: Marlene Santos (mes@estsp.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P107

Background

Pharmacogenomics is a science that aims to predict the contribution of
genes in an individual's response to the administration of a drug, in
order to increase the therapeutic effect and minimize any Adverse Drug
Reaction (ADR). The professionals must have knowledge on the subject,
however the studies point to a lack of information of the future health
professionals, about concepts and applications of Pharmacogenomics.

Objective

To compare the study plans of Pharmacy, Pharmaceutical Sciences and Medicine courses at a national level and to find out the existence of topics related to Pharmacogenomics, and to verify the knowledge of the students of the Degree in Pharmacy of Escola Superior de Saúde (ESS) of Porto on the topic "Pharmacogenomics", identifying gaps and needs of educational resources among students of this course.

Methods

A questionnaire-type study was carried out, the first one being ap-
plied to the Coordinators of the three courses, at a national level,
and another applied to the ESS Pharmacy students about their know-
ledge about Pharmacogenomics.

Results

The courses have an hourly schedule for Pharmacogenomics be-
tween 2.5 hours in Pharmacy and 60 hours in Pharmaceutical Sci-
ences. The students' knowledge of this subject went from 15.91% in
the first year, to 95.92% and 97.3% in the 3rd and 4th years, respect-
ively. Between 76% and 86% of the students were not able to iden-
tify drugs or drug metabolizing enzymes whose activity is influenced
by genetic variations. Comparing the 3 courses it can be stated that
the workload in the curricular plans is reduced, being especially evi-
dent in the course of Pharmacy. There is a significant increase in
knowledge about Pharmacogenomics as the years of undergraduate
studies progress, and the difference between the 3rd and 4th year is
not significant, since this subject is taught only on the 2nd year.

Conclusions

The knowledge passed on to undergraduate students and future
health professionals is reduced, with an insufficient workload, and
does not take place uniformly at a national level. In the case of ESS
Pharmacy, there was an increase of knowledge as the degree pro-
gresses, despite the few contents taught regarding Pharmacogenom-
ics. In the future, it may be useful to create supplementary courses
and trainings for students on this subject.
Keywords

Pharmacogenomics, Knowledge, Students, Curricular plan

P108

Influence of the rs776746 CYP 3A5 gene polymorphism on
response to immunosuppressant tacrolimus in patients
undergoing liver transplantation: a systematic review

Cristiana Rocha, Marlene Santos

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

**Correspondence:** Marlene Santos (mes@estp.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P108

Background

Hepatic transplantation is a lifesaving therapy that has been increasing over the years in Portugal. Its success is due largely in part to the use of immunosuppressants, like tacrolimus, the first-line immunosuppressant drug for people undergoing liver transplantation. It is a drug with narrow therapeutic window and great inter-individual variability. This variability is explained in part by polymorphisms of the CYP3A5 gene, which encodes the CYP3A5 metabolizing enzyme. The rs776746 polymorphism affects the CYP3A5 gene and gives rise to a non-functional metabolizing enzyme. The CYP3A5 gene is expressed in both the liver and the gut, that is, the metabolism of tacrolimus is affected by the transplanted liver (donor) genotype, as well as by the gut (receptor) genotype. The identification of polymorphisms becomes important especially in the period immediately after transplantation in order to avoid acute rejection of the organ.

Objective

The objective of this work was to review the influence of rs776746 polymorphism of the CYP3A5 gene on pharmacokinetics of tacrolimus.

Methods

A systematic review was conducted through the Pubmed database search, from 2000 to 2017. Articles that meet the study query and the inclusion and exclusion criteria were included for review.

Results

We selected 23 articles that discuss the influence of the rs776746 polymorphism on the pharmacokinetics of tacrolimus. The evidence suggests that individuals with the CYP3A5*3 (non-expressing) allele have a decreased metabolism of tacrolimus and, consequently, lower blood concentrations of the drug compared to individuals carrying the CYP3A5*1 (expressing) allele. The receptor genotype plays a more important role in the first days after transplantation and the donor genotype becomes more important later when the transplanted organ begins to function properly.

Conclusions

This review concluded that regarding hepatic transplantation it is im-
portant to identify both the polymorphisms affecting the metabolism
of tacrolimus in the donor and recipient genotypes for a more effect-
ive dose adjustment, especially in the critical period immediately
after transplantation.

Keywords

Transplant, Liver, Polymorphism, rs776746, Tacrolimus, CYP3A5.

P109

The FITWORK European Project - good practices to develop
physical activity programs at work

Maria Campos, Alain Massart, Carlos Gonçalves, Luís Rama, Ana Teixeira
Faculty of Sport Sciences and Physical Education, University of Coimbra,
3040-156 Coimbra, Portugal

Correspondence: Maria Campos (mjcampos@fcdef.uc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P109

Background

Workplace physical demands have widely changed in the last cen-
tury. Nowadays, most of the jobs in the European Union (EU) have a
low overall energy demand. In this context, the FITWORK project
aims to develop good practices to support ergonomics and health
by implementing physical activity programs, addressed to reduce
specific ergonomic risks at the workplace. This 2-year project (2017-

2018) is co-funded by the Erasmus+ Programme of the European Union and coordinated by Instituto de Biomecánica of Valencia (IBV) Spain. The partners are the University of Coimbra (UC); Romtens Foundation, Romania; Eindhoven University of Technology (TU/e); the European Network for Workplace Health Promotion (ENWHP) and KOMAG, Poland (http://fitwork.eu/).

Objective

Therefore, the general objective of the project is to promote physical activity at work, awareness of workers and health and safety professionals on the significance of health-enhancing physical activity attending to job demands. To meet this objective, FITWORK will identify good practices in occupational risk prevention through physical activities, including motivational aspects, and best practices for implementing workplace health promotion programs (WHPP).

Methods

The workout programs are being implemented in two different organi-
zations, with experimental group and control group, during six months
at the Institute of Mining Technology KOMAG, Poland and INNEX S.R.L,
Italy, with the following aims: I) to identify and evaluate the worksites
and the professional risks within each organization; II) to adapt the
WHP Programme to every worksite: identify the most appropriate exer-
cises to carry out in each worksite and when the workers have to per-
form them; III) to monitor and collect data using specific instruments
and report periodically about the development of the programme; IV)
to give recommendations related to good practice and aspects for im-
proving the implementation of the program.

Results

The primary purposes of the analysis of the results are to validate the effect of the designed physical activity programs and to elaborate good practices guidelines in developing and implementing WHP Programs.

Conclusions

There is evidence that behaviour changes are ignited by a complex cocktail of perceived benefits other than health alone, but a lack of evidence still exists on the effectiveness of health promotion activities on productivity, absenteeism or wellbeing. Hence, the desired impact of this European Project is to raise awareness and to engage stakeholders and target groups, sharing solutions and know-how with professional audiences.

Keywords

FITWORK, Job demands, Workplace, Physical activity programs, Eras-
mus+ Programme.

P110

Adventitious respiratory sounds to monitor lung function in
pulmonary rehabilitation

Cristina Jácome<fnref n="1" />,<fnref n="2" />, Joana Cruz<fnref n="2" />,³,⁴, Alda Marques<fnref n="2" />,⁵

Correspondence: Cristina Jácome (cristinajacome@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P110

Background

Peak expiratory flow (PEF) has been traditionally used to monitor lung function in patients with chronic obstructive pulmonary disease (COPD) before pulmonary rehabilitation (PR) sessions. However, PEF mainly reflects changes in large airways and it is known that COPD primarily targets small airways. Adventitious respiratory sounds (ARS - crackles and/or wheezes), are related to changes within lung morphology and are significantly more frequent in patients with acute exacerbations of COPD. Thus, ARS may be also useful for the routine monitoring of lung function during PR programs.

Objective

This study explored the convergent validity of ARS and PEF in pa-
tients with COPD.

<footnote n="1">¹Center for Health Technology and Information Systems Research,
Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;</footnote>

<footnote n="2">²Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁵Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal</footnote>
**Methods**

Twenty-four (24) stable patients (66 ± 9 years; FEV1 71 ± 19% pred) participating in a PR program were included. Assessments were conducted immediately before one PR session. Presence of ARS (crackles and/or wheezes) at posterior right chest was first assessed by a physiotherapist using a digital stethoscope (ds32a, ThinkLabs, CO, USA). Resting dyspnoea was collected using the modified Borg scale (0-10) and PEF with a peak flow meter (Micro I, Carefusion, UK). Independent t-tests, Pearson and point-biserial correlations were used.

**Results**

ARS were present in 5 participants (20.8%). Patients with ARS had a lower PEF than patients without ARS (294 ± 62 l/min vs. 419 ± 128 l/min; p = 0.048). PEF was negatively correlated with presence of ARS (r = -0.41; p = 0.048). Resting dyspnoea was negatively correlated with PEF (r = -0.41; p = 0.039), but not with ARS (r = 0.21; p = 0.32).

**Conclusions**

Findings suggest that both ARS and PEF offer complementary information before a PR session, but that ARS provide additional information on the patients' respiratory status. Further research correlating ARS and PEF with patients' performance and progression during PR is needed to strengthen the usefulness of assessing these parameters in PR.

**Keywords**

Peak expiratory flow, Adventitious respiratory sounds, Crackles, Wheezes, Pulmonary rehabilitation.

P111

**Health care services and their influence on the autonomy and quality of life of the elderly**

Keila CR Pereira, Silvania Silva, Jefferson L Traebert
Universidade do Sul de Santa Catarina, 88137-272, Palhoça, Santa Catarina, Brasil

**Correspondence:** Keila CR Pereira (keilarausch@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P111

**Background**

Primary Care (PA) performance can be assessed by Ambulatory Care-Sensitive Conditions (ACSC) [1]. They are health problems whose morbidity and mortality can be reduced through resolute and comprehensive care. The performance and access to the health system can delay the hospitalizations of the elderly with all the risks arising from it [2,3].

**Objective**

Analyse the impact of actions of health care of the elderly on primary care in the ICSAB rate.

**Methods**

Ecological study of the information on the hospitalizations of people over 60 years of age was obtained by hospital admission authorizations (HAA) from the Hospital Information System (HIS), from all municipalities in the state of Santa Catarina (SC) from 2008 to 2015. For the definition of the Primary Care Sensitive Conditions (PCSC), the official report published by the Ministry of Health was used [4]. The crude PCSC rate was calculated by the ratio between the number of PCSC in the elderly and the reference population for the period multiplied by 10,000. Next, the PCSC hospitalization rates for the elderly were standardized by age using the direct method, using the world population [5] as the standard. To soften the historical series, as a function of the oscillation of the points, was calculated the moving average centred in three groups. The analysis was performed through the Joinpoint program, version 4.3.1, used to calculate the variation of the rates of hospitalization of elderly people by age-adjusted PCSC, in the period from 2008 to 2015, resulting in the behaviour of the rate in the period studied for each municipality of Santa Catarina.

**Results**

The analysis showed that for each percentage point of increase in the elderly population rate, one percentage point increases in the annual rate of hospitalization rate for PCSC in the elderly (R² = 0.025). The variables of the performance of attention to the elderly did not show association in the hospitalizations.

**Conclusions**

The individual's lifestyle may be more determinant for a healthy aging than access to services when the individual has aged. In order for services to effectively act as a reducer of hospitalizations in the elderly they must be offered before the establishing of the aging process in the individual.

**References**

1. Caminal J, Starfield B, Sanchez E, Casanova C, Morales M. The role of primary care in preventing ambulatory care sensitive conditions. Eur J Public Health. 2004 Sep;14(3):246-51

2. Santos M. Epidemiologia do envelhecimento. In: Nunes I M; Ferreri R E L; Santos M. Enfermagem em geriatria e gerontologia. Rio de Janeiro: Guanabara Koogan, 2012. pp. 4-8.

3. Silveira R E, Santos A S, Sousa M C, Monteiro T S A. Gastos relacionados a hospitalizações de idosos no Brasil: perspectivas de uma década. Gestão e Economia em Saúde, São Paulo, 2013. Dec;11(4):514-520.

4. BRASIL. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. – 2012. Brasília.

5. Doll R, Payne P, Waterhouse J. Cancer Incidence in Five Continents: A Technical Report. Berlin: Springer-Verlag (for UICC), 1966.

**Keywords**

Aged, Primary Health Care, Health Promotion, Healthy Aging, Life Style.

P112

**Morphological and functional cardiac changes in TAVI follow-up – evaluation through transthoracic echocardiography**

Virginia Fonseca, Ana Costa, Inês Antunes, João Lobato
Escola Superior de Tecnologia da Saúde de Lisboa, 1990-094 Lisboa, Portugal

**Correspondence:** Virginia Fonseca (virginia.fonseca@estesl.ipl.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P112

**Background**

Aortic Stenosis is a valvular disease with increasing prevalence. Transcatheter aortic valve implantation (TAVI) is a treatment option for patients who cannot undergo surgical valve replacement [1,2,3,4].

**Objective**

The aim of this study was to describe and compare morphological and functional cardiac changes, through transthoracic echocardiography, in the follow-up after TAVI.

**Methods**

Patients, with ages between 63 and 85 years old, submitted to TAVI were evaluated by transthoracic echocardiography between 24h to 72h and 1 to 4 months after the procedure. The study variables selected were perivalvular regurgitation, maximum velocity and gradient, left ventricular (LV) function and dimensions, and left atrium (LA) diameter. Statistical analysis of the study variables was made using descriptive statistics, Shapiro-Wilk test, Wilcoxon's test and McNemar test. The results were considered statistically significant when p value < 0.05.

**Results**

It was registered a significant increase in maximum velocity and gradient (p=0.004 and p=0.010, respectively) from the first to the second echocardiogram. There weren't significant differences in LV ejection fraction, LV telediastolic and telesistolic volumes and in LA diameter. LV índice mass decreased comparing to the first echocardiogram (from 157.92 to 142.28 g/m2), however, this difference wasn't statistically relevant. The prevalence of regurgitation (80%) was unchanged between evaluations.

**Conclusions**

Transcatheter valve aortic implantation is a relatively new procedure for aortic stenosis treatment, with morphological and functional changes in the heart [3] The studied variables didn't demonstrate any significant changes, with the exception of maximum velocity and gradient. LV mass decreased in average 15.71
g/m2, and from a clinical perspective, can have an impact in the patient's prognostic.

## References

1. Pereira E, Silva G, Caeiro D, Fonseca M, Sampaio F, Fonseca C, et al. Cirurgia cardiaca na estenose áótica severa: o que mudou com o advento do tratamento percutáneo? Revista Portuguesa de Cardiologia. 2013 Oct;32(10):749-56.

2. Gavina C, Gonçalves A, Almeria C, Hernandez R, Leite-Moreira A, Rocha-Gonçalves F, et al. Determinants of clinical improvement after surgical replacement or transcatheter aortic valve implantation for isolated aortic stenosis. Cardiovascular ultrasound. 2014;12:41.

3. Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, et al. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology. Elsevier Inc.; 2012;59(13):1200-54.

4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who 10 Cannot Undergo Surgery. New England Journal of Medicine. 2010 Oct 21;363(17):1597-607.

## Keywords

TAVI, Transcatheter aortic valve implantation, Aortic stenosis, Trans-thoracic echocardiography.

## P113

### Literacy of family caregivers of people with Alzheimer's disease

Rui Moreira<fnref n="1" />, Lia Sousa², Carlos Sequeira<fnref n="3" />

**Correspondence:** Rui Moreira (ruijorgelm@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P113

### Background

Increasing population ageing is bringing with it a higher incidence and prevalence of Alzheimer's disease. In addition to incapacitating the sick person this disease has destabilising effects on the family, particularly because they are the caregivers. Therefore, it is important to know how informed family caregivers are about Alzheimer's disease.

### Objective

To characterise family caregivers of people with Alzheimer's disease and identify their level of knowledge about the disease.

### Methods

A quantitative, transversal and descriptive study was carried out. For this, 52 caregivers who are relatives of people with Alzheimer's disease were identified through a convenience sample from both private homes and day-care centres in the North region of Portugal. A questionnaire was administered that contained the sociodemographic characterisation of the caregivers as well as questions that dealt with different facets of the disease, ranging from pathophysiology to intervention strategies. The questionnaire was designed for this study, underpinned by consistent theoretical bases, and was sent to five experts for evaluation. These experts were nurses with experience in gerontology/Alzheimer's disease. The questions are essentially closed, with the only open question coming at the end, relating to the difficulties experienced by the family members in caring for the patient.

### Results

Focusing on aspects related to literacy, the main results indicate that although 87% of these caregivers know how to define Alzheimer's disease, only about 30% understand what underlies it, while about 50% show some difficulties in identifying risk factors. Most of them (75%) are able to list symptoms of the disease but only half know how to keep the sick person active. It should be noted that only 38% can identify ways to preserve memory and that about 30% of family caregivers are unaware of the purpose of the medication.

### Conclusions

It was found that there is considerable uncertainty among family caregivers about several facets of Alzheimer's disease. There was also some lack of knowledge about existing resources and support. The study also highlights the fact that the family members questioned do not often ask nurses for information relevant to the care process.

### Keywords

Health literacy, Family caregivers, Alzheimer's disease.

## P114

### Positive effects of a health promotion program in sedentary elderly with type 2 diabetes

Luís Coelho<fnref n="1" />,², Nuno Amaro<fnref n="1" />,², João Cruz<fnref n="1" />,², Rogério Salvador<fnref n="1" />,², Paulino Rosa<fnref n="1" />,², Ricardo Gonçalves<fnref n="1" />,², Rui Matos<fnref n="1" />,²

Santarém, Portugal

**Correspondence:** Luís Coelho (coelho@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P114

### Background

Diabetes is projected to be the 7th leading cause of death by 2030 by WHO (2017) [1]. Physical Activity along with a healthy diet and medication is one of the crucial options to prevent and control diabetes. About 40% of the Portuguese population aged 25 to 79 years-old presents a condition of diabetes or intermediate hyperglycaemia (Observatório Nacional da Diabetes, 2016) [2].

### Objective

To examine the impact of a health promotion program in sedentary elderly with type 2 diabetes.

### Methods

The program consisted on a 30-minute daily walking routine and a weekly educational session regarding healthy behaviours for 8 weeks. All participants were medicated with insulin and anti-diabetics. Twenty-six elderly diabetics (16 male and 10 female) aged 70.1 ± 8.0 years old, were assessed for Body Mass (BM), Body Mass Index (BMI), Systolic and Diastolic Blood Pressure (SBP, DBP respectively), Waist Circumference (WC), and Capillary Glycaemia (CG). Wilcoxon test was used on inferential analysis for repeated measures (pre-post). Significance level was kept at 5%. The effect size for this test was calculated by dividing the z value by the square root of N, being N the number of observations over the two times points [3].

### Results

All parameters measured values decreased significantly from initial to final moments: BM from 80.8 ± 8.9 kg to 78.2 ± 9.0 kg (p=0.000; r=-0.512), BMI 30.2 ± 3.8 kg/m² to 29.1 ± 3.1 kg/m² (p=0.000; r=-0.543), SBP from 143.4 ± 10.9 mmHg to 134.3 ± 10.4 mmHg (p=0.002; r=-0.426), DBP from 79.5 ± 8.6 mmHg to 75.3 ± 8.7 mmHg (p=0.035; r=-0.292), WC from 100.9 ± 7.8 cm to 96.7 ± 6.7cm (p=0.000; r=-0.584), CG from 182.5 ± 56.3 mg/dl to 124.1 ± 17.7 mg/dl (p=0.000; r=-0.588).

### Conclusions

The inclusion of physical activity and the awareness of engaging in healthy behaviours seem to complement the medication-based therapeutic in sedentary elderly with type 2 diabetes. Although the physical activity assessment was self-reported, sport sciences can play an important role in the prescription and monitoring of exercise in clinical patients. Multidisciplinary interventions in community health programs are recommended in order to achieve stronger and consistent results. These should include medical practitioners, physiologists and nutritionists.

### References

1. World Health Organization. Diabetes Fact Sheet. Updated November 2017. http://www.who.int/mediacentre/factsheets/fs312/en/.

2. Diabetes: Factos e Números – O Ano de 2015 – Relatório Anual do Observatório Nacional da Diabetes. Sociedade Portuguesa de Diabetologia. Depósito Legal n.o: 340224/12 ISBN: 978-989-96663-2-0.

<footnote n="1">¹Centro Hospitalar de São João, Pólo Valongo, 4440-563 Valongo, Portugal; ²Centro Hospitalar de São João, 4200-319 Porto, Portugal;</footnote>

<footnote n="3">³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal</footnote>

<footnote n="1">¹School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-091 Leiria, Portugal; ²Life Quality Research Centre, 2001-904</footnote>
3. Pallant J. SPSS Survival Manual: A Step by Step Guide to Data Analysis using SPSS for Windows (3rd ed.). Milton Keynes, UK: Open University Press: 2007.

Keywords

Health promotion, Type 2 diabetes, Active life styles, Elderly.

P115

Prevalence of childhood obesity

Fátima Frade¹, Joana M Marques¹, Luis Sousa¹, Maria J Santos¹, Fátima Pereira¹, Dora Carteiro¹, João MG Frade²,³,⁴

¹Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal;

²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal;

³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal;

⁴Multidisciplinary Unit for Biomedical Research, Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal

**Correspondence:** Fátima Frade (ffrade@uatlantica.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P115

Background

The prevalence of obesity in children and adolescents has been increasing worldwide [1, 2], having impact on children's physical, psychological and social well-being [3, 4].

Objective

To identify the prevalence of childhood obesity worldwide.

Methods

A systematic review of the literature began with the question: "What is the prevalence of childhood obesity worldwide?" The research was carried out on the EBSCO host, Google Scholar and B-On, on the scientific databases Medline/Pubmed, LILACS, CINAHL, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina and SciELO. The inclusion criteria were: full-text articles, in English, Portuguese or Spanish, published from 2013 to 2017. The Boolean equation used was: (Pediatric Obesity) OR (Overweight) AND (Children) AND (Prevalence). One hundred twenty-two (122) articles were found, of these, 24 were selected after comprehensive reading.

Results

Globally, in 2016, there were 41 million children under 5 years of age who were overweight or obese and 340 million children and adolescents aged 5 to 19 years were overweight/obese [5]. In 2013, in the European region the prevalence of overweight/obese people was 31.6%, with 17.7% corresponding to pre-obesity and 13.9% to childhood obesity [6, 7]. In China, the prevalence of overweight people doubled from 13% in 1986, to 27.7% in 2009. In the United States, 31.8% of children were overweight or obese [8]; in New Zealand, 31.7% were overweight and obese, and 2.5% were severely obese [9]. In Mexico City, 30.8% of adolescents, 24.2% of school-age children, 14.5% of latent and 11.5% of children in preschool age were overweight and obese [2]. In Brazil, 30.59% of the children/adolescents studied were overweight, obese or severely obese [8].

Conclusions

Childhood obesity is one of the Public Health problems worldwide, it becomes urgent to monitor the problem properly and implement preventive measures to reduce this risk.

References

1. Viveiro C, Brito S, Moleiro P. Sobrepeso e obesidade pediátrica: a realidade portuguesa. Rev Port Saúde Pública. 2016;34(1):30-37.

2. Wollenstein-Seligson D, Iglesias-Leboreiro J, Bernárdez-Zapata I, Bravenman-Bronstein A. Prevalencia de sobrepeso y obesidad infantil en uno hospital privado de la ciudad de México. Rev Mex Pediatr. 2016;83(4):108-114.

3. Vásquez-Guzmán M, González-Castillo J, González-Rojas M. Prevalencia de período de sobrepeso y obesidade en escolares. Rev Sanid Milit Mex. 2014;68(2):64-67.

4. Salinas-Martínez A, Mathiew-Quirós, Hernández-Herrera R, González-Guajardo E, Garza-Sagástegui M. Estimación de sobrepeso y obesidad en pre-escolares - Noramtividad nacional e internacional. Rev Med Inst Mex Seguro Soc. 2014;52(Supl 1):S23-S33.

5. World Health Organization - WHO. Obesity and Overweight. [online] 2013. [cited 2013 May 15]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.

6. Wijnhoven T, van Raaij J, Breda J. WHO European Childhood Obesity Surveillance Initiative: Implementation of Round 1 (2007/2008) and Round 2 (2009/2010). Copenhagen: WHO Regional Office for Europe,2014. Disponível em: www.euro.who.int/_data/assets/pdf_file/0004/258781/C OSI-report-round1-and-2_final-for-web.pdf

7. Kulaga Z, Gurzkowska B, Grajda A, Wojtylo M, Gózdz M, Litwin M. The prevalence of overweight and obesity among Polish pre-school-aged children. Dev Period Med. 2016;XX:2:143-149.

8. Cabrera T, Correia I, Oliveira dos Santos D, Pacagnelli F, Prado M, Dias da Silva T, Monteiro C, Fernani D. Analisis of the prevalence of overweight and obesity and the level of physical activity in chifren and adolescents of a soudwestern city of São Paulo. JHGD. 2014;24(1):67-66.

9. Farrant B, Utter J, Ameratunga S, Clark T, Fleming T, Simon D. Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-Being. J Pediatr. 2013;25:1-7.

Keywords

Prevalence, Pediatric Obesity, Overweight, Children.

P116

The urgency for a nursing intervention towards sexual education at Cape Verde: university students' perception

Sónia Ramalho¹,², Carolina Henriques¹,³, Elisa Caceiro¹, Maria L Santos¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal;

²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Sónia Ramalho (sonia.ramalho@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P116

Background

We know today that knowledge about sexuality is essential for young people to live in a society that allows to develop healthy attitudes and behaviours. To that end, health professionals, namely nurses, should be able to Educate for Sexuality in order to contribute for the improvement of affective-sexual relationships among the young; contribute to the reduction of possible negative occurrences resulting from sexual behaviours, such as early pregnancy and sexually transmitted infections (STIs), and contribute to conscious decision-making in the area of health education/sex education [1-4].

Objective

To evaluate young people's knowledge about sexuality.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data, and a questionnaire consisting of twenty questions related to the anatomy of the reproductive system, contraceptive methods and sexually transmitted infections was applied. One hundred and eight (108) young people from the Republic of Cape Verde participated in the study. All formal and ethical procedures were taken into account.

Results

The results show that in a sample of 108 university students, 81.5% female, with a mean age of 21.26 years; 1.9% reported having already been forced by a stranger, family member or older person to have sex, and 10.2% reported having had sex after a party, under the influence of alcohol or drugs. As far as knowledge is concerned, it can be said that the level of knowledge of young people regarding the sexual health aspects is satisfactory, safeguarding that the most erroneous questions were those related to: male anatomy (40.7%) and hormonal physiology of women (25.9%). It was found that 32.4% of the university students did not know/did not answer the questions related to female hormonal processes and their functioning when associated with an oral contraceptive.

Conclusions

It is essential to know what young people know about sexuality, so that specific nursing interventions can be designed to meet their sexual education needs.
## References

1. Barbosa A, Gomes-Pedro J. Sexualidade. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2000.

2. López F, Fuertes A. Para compreender a sexualidade. Lisboa: Associação para o Planeamento da Familia; 1999.

3. Epstein D, O'Flynn S, Telford D. Innocence and Experience: Paradoxes in sexuality and education. In: Richardson D, Seidman S, editors. Handbook of Lesbian and Gay Studies. Thousand Oaks, CA: Sage; 2002. p 271-311.

4. Louro GL. Um corpo estranho: Ensaios sobre sexualidade e Teoria Queer. Belo Horizonte: Autêntica Editores; 2004.

## Keywords

Young people, Knowledge, Sexuality.

## P117

### Cape Verde young university students: determinants of whether or not to have sex

Carolina Henriques<fnref n="1" />,², Sónia Ramalho<fnref n="1" />,², Elisa Caceiro<fnref n="1" />, Maria L Santos<fnref n="1" />

**Correspondence:** Carolina Henriques (carolina.henriques@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P117

### Background

In Cape Verde there is still no national study regarding the sexual behaviour of its youth, however, data provided by the Cape Verde Association for Family Protection (VERDEFAM) [1], tells us that more than half of Cape Verde adolescents and youngsters start their sexual lives before the age of 16 and the determinants of having or not having sex are not known. In this study, we tried to make some efforts to know some determinants of whether or not to have sex in young Cape Verde university students.

### Objective

To know the determinants of whether or not to have sex in young Cape Verde university students.

### Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data and the motivation scale for having or not having sex by Gouveia, Leal, Maroco and Cardoso (2010) [2]. Ninety-eight (98) university students from the Republic of Cape Verde participated in the study. All formal and ethical procedures have been taken into account.

### Results

Youngsters had a mean age of 21.25 years (SD = 2.76), 62.2% started sexual activity with their boyfriend, and 64.3% used the condom as contraceptive method. Considering the determinants of having sex, the young people that participated in the study considered not important to have sex: "because my partner wanted" (51.9%), "to please my partner" (56.6%), "to seduce" (64.8%), "for curiosity" (53.7%) and "for fun or to play" (72.2%). In turn, they consider very important not to have sex: for fear of venereal diseases (24.1%); fear of AIDS (37%); fear of pregnancy (28.7%); lack of opportunity or inability to find a partner (25%) and because they did not know their partner long enough (46.3%).

### Conclusions

The Cape Verde youth that participated in the study emphasizes the importance of health-related and safe relationships, not emphasizing both the desire of the other and pleasure for pleasure, factors that are strongly associated with the determinants of whether or not to have sex.

## References

1. Cape Verdean Association for the Protection of the Family (VERDEFAM). Recovered from http://www.verdefam.cv/

2. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de Motivação para fazer e para não fazer Sexo. In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 84-99.

## Keywords

Young; Sex; Determinants; Cape Verde.

## P118

### Attitude of Cape Verdean young university students towards sexuality

Carolina Henriques<fnref n="1" />,², Sónia Ramalho<fnref n="1" />,², Maria L Santos<fnref n="1" />, Elisa Caceiro<fnref n="1" />

**Correspondence:** Carolina Henriques (carolina.henriques@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P118

### Background

Cape Verde, a country with about 500,000 inhabitants, has a markedly young population, a fact that places special responsibility on the role of local health professionals, in the contexts of sexual and reproductive health, where sexuality issues are included.

### Objective

To evaluate the attitudes of Cape Verdean university students towards sexuality.

### Methods

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data and the sexual attitudes scale of Gouveia, Leal, Maroco and Cardoso (2010) [1]. One hundred and eight (108) university students from the Republic of Cape Verde participated in the study. All formal and ethical procedures have been taken into account.

### Results

The results show that participants of this cross-border research had a mean age of 21.26 years (SD = 2.93), were mostly female (81.5%) and started their sexual activity with a mean age of 17.37 years (SD = 1.31). As far as sexual attitudes are concerned, 11.1% agrees that "one does not have to be committed to the person to have sex with her/him"; 18.5% agree that "casual intercourse is acceptable"; 76.9% totally disagree with "I would like to have sex with many partners"; 74.1% disagree completely that "it is right to have sex with more than one person during the same time period" and 36.1% agree that "sex is primarily a physical activity". 10.2% of young people agree that "sex, by sex alone, is perfectly acceptable", 33.3% agree that "sex is primarily a bodily function, just like eating". Regarding the permissiveness of university students in relation to occasional/non-engaging sex, they present a significant level of agreement (M = 14.44, Sd = 3.66, Xmax = 24.00) which relates to instrumentality (M = 11.93, SD = 2.62, Xmax = 19.00).

### Conclusions

Data shows that young Cape Verdean university students seek to have sexual relations with respect for their partner, although they agree with sex without commitment, closely associated with the vision of the sexual act as a corporal function response.

## References

1. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de Atitudes Sexuais-Versão adolescentes (EAS-A). In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 58-72.

## Keywords

Youth, Sexuality, Attitudes, Cape Verde.

## P119

### Central auditory processing and sleep deprivation

Diogo Garcia, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

**Correspondence:** Diogo Garcia (diogojorge04@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P119

<footnote n="1">¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901</footnote>

<footnote>Leiria, Portugal; ²Center for Innovative Care and Health Technology,</footnote>

<footnote>Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal</footnote>

<footnote n="1">¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901</footnote>

<footnote>Leiria, Portugal; ²Center for Innovative Care and Health Technology,</footnote>

<footnote>Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal</footnote>
**Background**

Auditory Processing is a natural process of taking in sound through the ear and having it travel to the language area of the brain to be interpreted. Sleep deprivation may influence this process.

**Objective**

To evaluate the impact of sleep deprivation, for a 24-hour period, on central auditory processing in healthy young adults.

**Methods**

Fourteen (14) healthy young adults were selected, 9 of which (64.3%) were female and 5 (35.7%) were male, aged 18-29 years. The subjects were submitted to audiological evaluation using tonal audiometry and the threshold of 1 in 1 dB was obtained in the frequencies of 250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz, alternating disyllabic dichotic listening test Staggered Spondaic Words Test (SSW). The evaluation of central auditory processing, as well as the determination of the auditory threshold was performed in two situations: without sleep deprivation and after 24 hours of sleep deprivation.

**Results**

At the level of the Audiogram, the reduction of the auditory thresholds after sleep deprivation in the frequencies of 500Hz and 1000Hz, around 3dB, increased in the frequency of 250Hz and 4000Hz, between 1 and 9dB, and remained in the right ear in frequencies of 2000Hz and 8000Hz. In the right ear, none of the differences found were statistically significant. In the left ear the auditory threshold increased at the frequency of 2000Hz about 5dB, and decreased in the frequencies of 250Hz, 500Hz, 1000Hz, 4000Hz and 8000Hz between 1 and 8dB, without statistically significant differences. In the SSW, there was a slight decrease in the percentage of correct answers in both ears, as well as in the percentage of total hits, after sleep deprivation. In none of the ears there were statistically significant differences in SSW results before and after 24 hours of sleep deprivation.

**Conclusions**

The results demonstrate that there are no statistically significant changes before and after 24h of sleep deprivation, both at the level of the Auditory Threshold and in the SSW.

**Keywords**

Central Auditory Processing (PAC), Sleep Deprivation, Staggered Spondaic Words Test (SSW), Audiological Evaluation.

P120

Missed nursing care: incidence and predictive factors - integrative literature review

Ivo CS Paiva¹,², Isabel M Moreira¹, António FS Amaral¹

¹Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Department of Internal Medicine and Palliative Care, Portuguese Oncology Institute of Coimbra Francisco Gentil, 3000-075 Coimbra, Portugal

**Correspondence:** Ivo CS Paiva (ivocsoarespaiva@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P120

**Background**

The increasing complexity and demand in health care, together with patients' changing needs, put into evidence the need for nurses to focus their interventions on people's real needs, thus rethinking their role. In this context, unfinished, delayed, or missed nursing care (MNC), which is a strong indicator of health care quality, can compromise quality care and patient safety.

**Objective**

To identify the most common MNC, as well as its predictors and strategies to prevent its occurrence.

**Methods**

A systematic literature review was conducted on studies available in the EBSCOhost and B-on databases. Twenty-four articles were selected based on predefined criteria. All articles were published between 2012 and 2017.

**Results**

The studies showed that nurses and patients have different perceptions about MNC. Autonomous interventions related to early mobility

and walking, repositioning every 2 hours, or oral and body hygiene are more often missed than interdependent interventions. [1-5]. Medication administration within 30 minutes of prescription, planning and update of care plans, vital signs monitoring, and treatment effectiveness assessment also emerged as MNC [5-7]. Predictive factors are associated with the patient (health status/workload) [2, 5]; the nurse (interruptions by other professionals or patients' relatives) [4, 8]; the materials or equipment (late deliveries) [9], or the hospital's health care policies (management/leadership and staffing) [10]. The nurse-patient/family communication emerged as MNC, whereas the nurse-other health professional communication emerged as a predictive factor because teamwork and its effectiveness are compromised [2, 11]. Nurses' personal interests and moral sense can influence the occurrence of MNC. Therefore, the strategies used to reduce the incidence of MNC should be adjusted to the needs of each setting [2, 5].

**Conclusions**

Although MNCs are being explored internationally, it is an understudied topic in Portugal, which may be explained by the punitive error reporting culture. The findings cannot be generalized due to the diversity of studies. Thus, the phenomenon of MNC and its impact on patient/family prognosis should be explored in different settings, with the purpose of achieving excellence in health care and ensuring that people recognize the importance of health care.

**References**

1. Bruyneel K, Li B, Ausserhofer D, Lesaffre E, Dumitrescu I, Smith H, et al. Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences with Care in Europe. Med Care Res Rev. 2015;72(6):643-664.

2. Chapman R, Rahman A, Courtney M, Chalmers C. Impact of teamwork on missed care in four Australian hospitals. J Clin Nurs. 2017;26(1-2):170-181.

3. Cho S, Kim Y, Yeon K, You S, Lee I. Effects of increasing nurse staffing on missed nursing care. Int Nurs Rev. 2015;62(2):267-274.

4. Kalisch B, Xie B, Dabney B. Patient Reported Missed Nursing Care Correlated With Adverse Events. Am J Med Qual. 2014;29(5):415-422.

5. Papastavrou E, Charalambous A, Vryonides S, Eleftheriou C, Merkouris A. To what extent are patients' needs met on oncology units? The phenomenon of care rationing. Eur J Oncol Nurs. 2016;21:48-56.

6. Ball J, Murrels T, Rafferty A, Morrow E, Griffiths P. 'Care left undone' during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014, 23:116-125.

7. Schubert M, Ausserhofer D, Desmedt M, Schwendimann R, Lessafre E, Li B, Geest S. Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals - A cross sectional study. Int J Nurs Stud. 2013;50(2):230-239.

8. Cho S, Mark B, Knafl G, Chang H. Yoon H. Relationships Between Nurse Staffing and Patients' Experiences, and the Mediating Effects of Missed Nursing Care. J Nurs Scholarsh. 2017;49(3):347-355.

9. Moreno-Monsiváis M, Moreno-Rodríguez C, Interial-Guzmán M. Missed Nursing Care in Hospitalized Patients. Aquichán. 2015;15:318-328.

10. Dehghan-Nayeri N, Ghaffari F, Shali M. Exploring Iranian nurses' experiences of missed nursing care: a qualitative study: a threat to patient and nurses' health. Med J Islam Repub Iran. 2015;29:276.

11. Bragadóttir H, Kalisch B, Tryggvadóttir G. Correlates and predictors of missed nursing care. J Clin Nurs. 2017;26(11-12):1524-1534.

**Keywords**

Missed Nursing Care, Delayed Nursing Care, Unfinished Nursing Care.

P121

The meaning of the family for future family nurses

João MG Frade¹,², Carolina Henriques¹,², Célia Jordão¹, Clarisse Louro¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Carolina Henriques (carolina.henriques@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P121
**Background**

The family must be understood as a natural context of growth, involving the notion of complexity, of blood and/or affective bonds, generating love, but also suffering. The systemic view of the family considers the family as a whole, in which its members interact with one another, being that the imbalance of the system can cause imbalance in the individual and vice versa. The Family Nurse can be the reference professional, ensuring for the specialized accompaniment of the family, as a care unit, throughout the life cycle.

**Objective**

To know the perception about "family" and "family health nursing" by future family nurses.

**Methods**

A descriptive, cross-sectional study using a questionnaire consisting of questions related to sociodemographic data, and open questions regarding conceptual understanding of family and family health nursing. A total of 13 nurses participated in the study to develop skills in the field of family health nursing. All formal and ethical procedures have been taken into account.

**Results**

Nurses report that they (100%) never attended before any training course in the field of family health nursing, recognizing the importance of knowing who the family members are (92.3%). 38.5% disagrees that the presence of family members alleviates their workload and 23.1% state that the presence of family members makes them feel that they are being evaluated. Mostly, the family is defined as a group of people with a common link (n= 10). Family health nursing is seen as: caring for the family; personalizing and integrating the nursing care provided to the person and to the family; the existence of a family nurse who knows all its members; the one that equates the care to the individuals according to the characteristics of the family; a health support of the group; a nurse that focuses mainly on the patient and on the family, in partnership with the respective family doctor.

**Conclusions**

Given the data obtained, it is understood that the conceptualization of family and family health nursing should be clarified so that nurses can focus on the internal dynamics of the families and their relationships, family structure and functioning. This can be as such, that the relationship of the different subsystems, of the family as a whole and with the surrounding environment, generates changes in the intrafamilial processes and in the interaction of the family with the environment.

**Keywords**

Family, Nurses, Family nursing.

**Methods**

Scientific articles were searched according to the search engines B-on, PubMed, Scielo and ScienceDirect, obtaining a total of 48 articles. After applying the inclusion criteria, 12 articles were analysed in more detail, 4 of which were selected to integrate this systematic review of the literature.

**Results**

After a systematic review of all articles, we found data reporting a decrease in the amplitude of the response wave vestibular evoked myogenic potential (cVEMP), an increase in average scores in the Dizziness Handicap Inventory (DHI), and an alteration of the classification of the caloric response (normal → hyporeflexia and/or hyporeflexia → arreflexia), in the postoperative period. However, it is not possible, to conclude that these vestibular changes are directly related to the placement of the CI. The use of a protocol evaluating vestibular function at the pre- and post-surgical periods was not verified, nor was the anatomical relationship between the cochlea and the vestibule and semi-circular canals (SSC).

**Conclusions**

We conclude that the studies directed to the vestibular evaluation during the protocol of placement of CI are reduced and without conclusions on the long term, since this follow up was done within a short time after its placement. There is a lack of a basic protocol, which helps the health professionals involved in the process to evaluate the vestibular system, as well as the sensitization of these to the possible influence of the CI insertion surgery in this system.

**Keywords**

Audiology, Vestibular Disorders, Dizziness, Cochlear Implant, cVEMP.

P122

The dizziness in patients with cochlear implants

Ana Rosado, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of
Coimbra, 3046-854 Coimbra, Portugal

**Correspondence:** Ana Rosado (anarnamoradorosado@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P122

**Background**

The cochlear implant (CI) is a surgical method widely used today for the (re)habilitation of individuals with bilateral, severe to profound sensorineural hearing loss. Due to the proximity between the cochlea and the surrounding structures without vestibular system, and a delivery endolymphatic fluid, there may be a relationship between this form of (re)hearing activation and vestibular dysfunctions presented after a cochlear implant placement surgery.

**Objective**

Through a systematic review of the literature, we intend to determine the post-surgical vestibular changes existing in individuals submitted to CI placement, as well as to understand the procedures involved in this evaluation.

P123

Practice of episiotomy during labour

Manuela Ferreira¹, Onélia Santos², João Duarte¹

¹Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ²Centro

Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal

**Correspondence:** Manuela Ferreira (mmcferreira@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P123

**Background**

The World Health Organization (WHO, 1996) recommends the use of limited episiotomy since no credible evidence that its widespread use or routine practice has a beneficial effect.

**Objective**

To demonstrate scientific evidence of the determinants of the practice of selective episiotomy in women with normal/eutocic delivery; to identify the prevalence of episiotomy; and analyse the factors (sociodemographic variables, variables related to the new-born, contextual variables of pregnancy and contextual delivery) that influence the practice of episiotomy.

**Methods**

The empirical study I (part I) followed the systematic methodology of literature review. A search of studies published between January 2008 and December 23, 2014, was made in the databases: EBSCO, PubMed, Scielo, RCAAP. The studies found were evaluated taking into account the inclusion criteria previously established. Two reviewers assessed the quality of the studies to include using a prospective, randomized and controlled grid for critical evaluation. After critical evaluation of the quality of the study, 4 research articles that obtained a score between 87.5% and 95% were included.

The empirical study II (part II) is part of a quantitative, cross-sectional, descriptive, retrospective study, developed in the Obstetrics Service of Hospital Cova da Beira, according to a non-probability sampling process for convenience (n = 382). Data collection was executed by consulting medical records of women aged ≥ 18 years who had a vaginal delivery with a live foetus after 37 weeks of gestation.

**Results**

Evidences that episiotomy should not be performed routinely and that should be limited to specific clinical situations were found. While performing selective episiotomy, when compared to routine episiotomy, a lower risk of trauma of the posterior perineum was
associated with less need for suturing and fewer healing compli-
cations. Studies carried out on a sample of 382 women, aged be-
tween 18-46 years, which did not carry episiotomy in 41.7% of
the cases, pointed to the relevance of selective episiotomy.
Among the sample, a significant number of women with eutocic
delivery (80.5%), with suture (95.0%), grade I lacerations (64.9%),
perineal pain (89.1%) were subjected to episiotomy (58.3%).
Among the group of women undergoing episiotomy (91.4%),
most of the babies born presented a normal weight (92.3%).

Conclusions

In view of these results and based on the available scientific evidence recommendations given for several years, that a more a selective use of episiotomy should be made; it is suggested that health professionals should be more awake to this reality, so we can override the resistance and barriers against the selective use of episiotomy.

Keywords

Eutocic Childbirth, Selective Episiotomy, Routine episiotomy.

P124

RNAO's Best Practice Guidelines in the nursing curriculum –
implementation update

Ana V Antunes<fnref n="1" />, Olga Valentim<fnref n="1" />, Fátima Pereira<fnref n="1" />, Fátima Frade<fnref n="1" />, Cristiana Firmino<fnref n="1" />, Joana Marques<fnref n="1" />, Maria Nogueira<fnref n="1" />, Luís Sousa 1,2

**Correspondence:** Ana V Antunes (vantunes@atlantica.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P124

Background

In the last 30 years Nursing Education in Portugal went through
several changes which directly impacted on the professional devel-
opment model and on the recognition of nurse's scope of practice.
Since the Declaration of Bolonha, nursing students are provided with
a more practical and profession oriented nursing training [1, 2]. As
our professionals' skills become more recognized in the global health
market, also our need to improve education and professional devel-
opment rises. The best way to enhance the quality of practice educa-
tion provided to undergraduate nursing students and to improve
clinical outcomes is by enriching the academic *curriculum* with
evidence-based nursing practices (EBNP) [3]. The Best Practice Guide-
lines Program (BPGP) was developed by the Registered Nurses Asso-
ciation of Ontario (RNAO) to support EBNP [4].

Objective

Provide an update on the process of implementation of RNAO's Best
Practice Guidelines (BPGs) in the nursing curriculum.

Methods

The implementation process was supported by the RNAO's Toolkit for Implementing Best Practice Guidelines (BPGs) [5]. It is a comprehensive resource manual, grounded in theory, research and experience, that provides practical processes, strategies and tools to both Providers, Educational Institutions, Governments, and others committed to implement and evaluate BPGs.

Results

The BPGs selection and implementation brought together some
of the suggested activities from the six steps of the manual. It re-
sulted in the selection of three clinical guidelines (Engaging Cli-
ents Who Use Substances [6]; Prevention of Falls and Fall Injuries
in the Older Adult [7]; Primary Prevention of Childhood Obesity
[8] and a Healthy Work Environments Guideline (Practice Educa-
tion in Nursing, [9]). We considered two main areas to intervene,
in order to address the challenge of generating scientific evi-
dence for nursing practice: the academic and the clinical setting
(partner institutions, where students undertake their clinical prac-
tice). The implementation process included three fundamental
players from both settings: professors, nursing students and clin-
ical nursing instructors. To evaluate our performance and meas-
ure the improvements, we created structure, process and

outcome indicators for each guideline. Data collection tools were
first used in the curricular units that precede clinical teaching,
and results will be processed and analysed.

Conclusions

Professors, students and partner institutions were successfully en-
gaged in the initiative. We are investing in an action plan to embed
the evidence-based practice culture, through an orientation program
for clinical nursing instructors. The strategy is to strengthen the rela-
tionship with providers in order to standardize evidence-based pro-
cedures and improve both nurses' education and quality of care.

References

1. Hvalič-Touery S, Hopia H, Sihvonen S, Diwan S, Sen S, Skela-Savič B. Perspectives on enhancing international practical training of students in health and social care study programs-A qualitative descriptive case study. Nurse Educ Today. 2017;48:40-47.

2. Arrigoni C, Grugnetti AM, Caruso R, Gallotti ML, Borrelli P, Puci M. Nursing students' clinical competencies: a survey on clinical education objectives. Ann Ig. 2017;29(3):179-188.

3. Drayton-Brooks SM, Gray PA, Turner NP, Newland JA. Building clinical education training capacity in nurse practitioner programs. J Prof Nurs. 2017;33(6):422-428.

4. Athwal L, Marchuk B, Laforét, Fliesser Y, Castanza J, Davis L, LaSalle M. Adaptation of a Best Practice Guideline to Strengthen Client- Centered Care in Public Health. Public Health Nursing. 2014 Mar 1;31(2):134-43.

5. Registered Nurses' Association of Ontario (RNAO). Toolkit: Implementation of best practice guidelines (2nd ed.). Toronto, ON: Registered Nurses' Association of Ontario. 2012.

6. Registered Nurses' Association of Ontario (RNAO). Engaging Clients Who Use Substances. Toronto, ON: Registered Nurses' Association of Ontario. 2015.

7. Registered Nurses' Association of Ontario (RNAO). Prevención de caídas y lesiones derivadas de las caídas en personas mayores. (Revisado). Toronto, ON: Asociación Profesional de Enfermeras de Ontario. 2015.

8. Registered Nurses' Association of Ontario (RNAO). Primary Prevention of Childhood Obesity (Second Edition). Toronto, ON: Registered Nurses' Association of Ontario. 2014.

9. Registered Nurses' Association of Ontario (RNAO). Practice Education in Nursing. Toronto, ON: Registered Nurses' Association of Ontario. 2016.

Keywords

Evidence-Based Nursing, Nursing Education, Substance-Related Disor-
ders, Accidental Falls, Pediatric Obesity.

P125

Swimming practice and hearing disorders

Mara Rebelo, Carla Silva

Audiology Department, Coimbra Health School, Polytechnic Institute of
Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Mara Rebelo (mararebelo@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P125

Background

Health assessment, promotion and prevention are a crucial pillar in the face of emerging trends and threats. In fact, disease prevention is surely the way to go. This is not to say that we should neglect the treatment of disease, but rather that we must make a clear bet on its prevention according to our daily behaviour and the circumstances in which we live. The practice of swimming is recommended, especially for children, since it presents benefits, namely in the treatment of respiratory diseases, allergic problems and in the improvement of motor coordination and/or postural problems. However, during swimming lessons, children are exposed to numerous harmful risk factors to the middle ear and the outer ear. Therefore, preventive measures are essentially the eviction of some factors that increase the associated risks.

Objective

To analyse possible audiological changes in swimming children, aged
between 3 and 10 years. It is also intended to sensitize educators

<footnote n="1">¹Escola Superior de Saúde Atlântica, 2730-036 Barcarena, Portugal;</footnote>

<footnote n="2">²Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal</footnote>
about the risk factors associated with possible hearing loss, even if
temporary.

Methods

The sample consisted of 56 students from the School Group of Bene-
dita - Municipality of Alcobaça. All children underwent: otoscopy,
tympanogram and tonal audiogram of screening, after the prior
authorization of their legal representatives for their participation in
the study.

Results

Among the 112 otoscopies performed were: 85.7% without alter-
ations in the right ear and 83.9% in the left ear. Of the 56 individuals
participating in the sample, it was verified that 17.9% had audio-
logical alterations, of which 20.7% were swimming practitioners and
14.8% did not practice swimming. Of the 29 swimming practitioners,
6.9% had a type B tympanogram, of which 7.1% in the 3 to 5 age
group, and 6.7% in the 6 to 10 age group.

Conclusions

It seems unlikely that swimming practice is directly related to the in-
crease of middle ear secretions, and possible auditory alterations,
given the minimal differences observed between swimmers and
non-swimmers. Swimming practice beyond the malefic factors can to
some extent be associated with beneficial factors, both in promotion
and in the prevention of middle ear health.

Keywords

Hearing Loss, Swimming, Children, Middle ear infections, Audiological
changes.

P126

The impact of physical activity on spirometric parameters in non-
institutionalised elderly people

Fernanda Silva¹, João Petrica¹,³, João Serrano¹,³, Rui Paulo¹,², André Ramalho¹,², José P Ferreira⁴, Pedro Duarte-Mendes¹,²

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Centro de Estudos em Educação, Tecnologias e Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ³Research on Education and Community Intervention, 4411-801 Arcozelo - Vila Nova de Gaia, Portugal; ⁴Research Unit for Sport and Physical Activity, University of Coimbra, 3040-248 Coimbra, Portugal

Correspondence: Fernanda Silva (f.m.a.s_298@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P126

Background

Physical activity decreases as a result of the ageing process. Therefore,
the elderly tend to spend more time adopting sedentary behaviours
[1]. The respiratory system also undergoes progressive involution with
age, resulting in anatomical and functional alterations [2]. The positive
relationship between physical activity and spirometric parameters has
been thus confirmed [3]. It is recommended that the elderly should ac-
cumulate at least 30 minutes of moderate- to vigorous-intensity phys-
ical activity per day [4].

Objective

The aim of this paper is to verify the existence of differences regarding spirometric values between two groups of people: those who complied and those who did not comply with the Global Recommendations on Physical Activity for Health [4].

Methods

The current study included 36 participants of an average age of
72.28, both male and female (SD= 6.58). The group which has ful-
filled the recommendations included 16 elderly individuals (53.76 ±
24.39 minutes); the group which has not fulfilled the recommenda-
tions included 20 elderly individuals (15.95 ± 7.79 minutes). Physical
activity was assessed using accelerometer (ActiGraph®, GT1M model,
Fort Walton Beach, Florida, EUA). Data were recorded for three con-
secutive days and 600 minutes of daily recording, at least. Spirometry
tests were performed using the Cosmed® Microquark spirometer. The

following parameters were analysed: Forced Vital Capacity (FVC),
Forced Expiratory Volume in one second (FEV1), Peak Expiratory Flow
(PEF) and Expiratory Volume in one second and Forced Vital Capacity
rate (FEV1/FVC). In order to analyse data, descriptive and inferential
statistics were used. The Shapiro-Wilk test was applied to assess nor-
mality, whereas the Mann-Whitney test and the t-Test were used for
independent samples.

Results

The group which has fulfilled the recommendations on physical ac-
tivity has achieved better percentage spirometric values in VEF1, PEF
e VEF1/FVC. However, significant differences were only found in
VEF1/FVC% (p= 0.023).

Conclusions

The results therefore suggest that compliance with the Global Rec-
ommendations on Physical Activity for Health is associated with bet-
ter VEF1/FVC% values in non-institutionalised elderly people.

Acknowledgements

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

References

1. Matthews CE, Moore SC, Sampson J, Blair A, Xiao Q, Keadle SK, Hollenbeck A, Park Y. Mortality Benefits for Replacing Sitting Time with Different Physical Activities. Med Sci Sports Exerc. 2015;47:1833-1840.

2. Lalley PM. The aging respiratory system-Pulmonary structure, function and neural control. Respir Physiol Neurobiol. 2013;187:199-210.

3. Nawrocka A, Mynarski W. Objective Assessment of Adherence to Global Recommendations on Physical Activity for Health in Relation to Spirometric Values in Nonsmoker Women Aged 60-75 Years. J Aging and Phys Act. 2016;25:123-127.

4. WHO. Global Recommendations on Physical Activity for Health. Switzerland: World Health Organization; 2011. Available from: http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf

Keywords

Accelerometry, Recommendations on physical activity, Elder,
Spirometry.

P127

Predictors of abandonment of exclusive breastfeeding before 6 months

Cristiana Afonso, Cristiana Lopes, Fernanda Pais, Suzi Marques, João Lima School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Cristiana Afonso (cristiana_oa@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P127

Background

The World Health Organization (WHO) recommends exclusive breast-
feeding up to 6 months of age, considering its nutritional, immuno-
logical, psychological and economic benefits. However, according to
the *Inquérito Alimentar Nacional e de Atividade Física*, only about 46%
of the children were exclusively breastfed for less than 4 months and
only 21.6% for 6 months or more.

Objective

This study aimed to identify the predictors that most influence
mothers in the decision to not to exclusively breastfeed until 6
months.

Methods

A review of the literature on the main determinants of exclusive
breastfeeding was carried out, and an inquiry was then compiled
with the identified predictors. In this context, mothers who had not
breastfed or had not exclusively breastfed until 6 months of age
were asked to choose the determinant that best suited their situ-
ation. The inquiry was made available through several online
platforms, some of which aimed at childcare. It was considered inclusion criteria to be a mother.

## Results

A total of 1,685 mothers were questioned, 1,644 (97.57%) of whom breastfed and 866 (51.39%) exclusively breastfed up to 6 months. The predictors most frequently identified by mothers who had not breastfed or had not breastfed exclusively until 6 months (819 mothers) were "work-constrains related to work schedule to breastfeeding" (33.1%), "milk drying" (27.1%), "few daily periods of breastfeeding" (12.9%), "personal condition" (11.5%), "missing or few conditions for breastfeeding at work" (11.2%).

## Conclusions

This work allowed the identification of the predictors of non-breastfeeding or of its non-exclusivity until 6 months, observing a strong contribution of the working conditions to this problem. Knowledge of this reality may be important to develop policy measures to act against this trend.

## Keywords

Exclusive breastfeeding, Predictors, Inquiry.

## P128

### Auditory training in children and youngsters with learning disabilities

Mariana Araújo, Cristina Nazaré

Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854

Coimbra, Portugal

**Correspondence:** Mariana Araújo (mariana_msda@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P128

### Background

Hearing has a fundamental role in the learning process, and studies had showed that some children and youngsters, with normal hearing, could present auditory processing disorders with possible implications in the learning process. It is also known that not all learning problems are due to auditory processing disorders and all cases of auditory processing disorders do not lead to learning problems. Studies also point out that an adequate and personalized auditory training may be a viable option in the rehabilitation of auditory information processing in the central nervous system (brain neuroplasticity training), being the early assessment and intervention important to minimize the associated consequences, such as the possible difficulties on the learning process.

### Objective

To analyse the influence that auditory training has on the improvement of auditory processing disorders of children and youngsters, with learning disabilities.

### Methods

For this purpose was conducted a systematic literature review with search of scientific papers on electronic databases B-on, PubMed, ScienceDirect and SciELO with keywords such as auditory training, auditory processing, auditory processing disorders, learning disabilities, learning difficulties, children and youngsters (in Portuguese, English or Spanish). For this review were established inclusion criteria such as: publication type and date (original articles available since 2007); sample (in accordance with our purpose) and tests used (to evaluate and training the auditory processing).

### Results

After the search strategies five articles in accordance with the pre-established inclusion criteria were selected from out of the 127 found.

### Conclusions

The auditory training is effective in the rehabilitation of auditory processing disorders in children and youngsters with learning disabilities, and studies showed that a specific diagnosis of the abilities affected is fundamental, in order to achieve the perfect and most efficient training plan for each individual, as well as, a continuous re-evaluation to adjust the training. Since it is a complex interaction between those disorders it is still necessary to carry out further studies in this area that should try to establish some guidelines and try to clarify the plan of the auditory training program.

### Keywords

Auditory training, Auditory processing disorders, Learning disabilities, Children, Youngsters.

## P129

### Inadequate environmental sanitation diseases (IESDs) in Porto Alegre - RS/ Brasil

Rita C Nugem¹, Roger S Rosa², Ronaldo Bordin³, Caroline N Teixeira⁴

¹Health Services and Performance Research, Claude Bernard Lyon University, 69100 Lyon, France; ²Department of Social Medicine, Medical School, Rio Grande do Sul Federal University, 90040-060 Porto Alegre, Brazil; ³Administration School, Rio Grande do Sul Federal University, 96201-900 Rio Grande do Sul, Brazil; ⁴Fundação Hospitalar Getúlio Vargas, 93210-020 Sapucaia do Sul, Rio Grande do Sul, Brazil

**Correspondence:** Rita C Nugem (rcnugem@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P129

### Background

Countries in Europe and North America managed to control and eradicate most of the infectious-parasitic diseases that occurred in the first half of the twentieth century [1]. Nevertheless, infectious and parasitic diseases are still present in certain metropolitan areas of Brazil, despite the increased prevalence of chronic diseases. This work aims to present the general aspects of the situation of diseases related to inadequate environmental sanitation (IESDs) and of the sanitation policy of Porto Alegre.

### Objective

The general objective was to examine the public policy for environmental sanitation in Porto Alegre, and, the specific objectives were: I) to analyse the relationship between indicators of poverty and inadequate environmental sanitation and the occurrence of diseases related to inadequate environmental sanitation; and, II) to present the situation of IESDs and the sanitation policy of Porto Alegre.

### Methods

The method was qualitative and quantitative, with data collection and analysis of public policies. The period analysed was from 2008 to 2012. Data were obtained from Health Information Systems, DATASUS website of the Ministry of Health, along with a set of basic indicators from the Porto Alegre's Observatory. The indicators were classified according to the specific objectives: poverty(P); environmental sanitation(S); diseases(D). Pearson's linear correlation coefficient was used for statistical analysis to test the associations between poverty and basic sanitation indicators with IESDs indicators.

### Results

The results showed that the biggest problems related to IESDs occur in the poorest regions, which are: Restinga, Parthenon, Nordeste, Lomba do Pinheiro, Glória, Ilhas and Extremo Sul. The higher concentration of Dengue was found in the Parthenon region; Leptospirosis in the regions of Restinga, Extremo Sul, Lomba do Pinheiro, Norte and Eixo Baltazar; Hepatitis A in the regions of Ilhas, Nordeste, Humaitá /Navegantes, Centro, Lomba do Pinheiro, Norte, Leste and Parthenon. Regarding the public policy for Environmental Sanitation in Porto Alegre, we concluded that there are some urban policies, but the subject needs greater systemic view directed to the most specific problems of the city. About the Sanitation Plans, we concluded that the regions that need the sanitation, at most - a sewage collection network - have a lower footage for infrastructure installation, such as, the region of Ilhas. The sanitation basic plan (Water) gives various information about areas that need the implementation of infrastructures of universal supply, however there is still no date of when that will be possible.

### Conclusions

Finally, infectious and parasitic diseases are a reality in Porto Alegre. Still at the XXI century, there are about 1,200 annual hospitalizations in health services (SUS) and are responsible for about 750 deaths per year in the capital city.

### References

1. Carvalho EMF, Lessa F, Gonçalves FR, Silva JAM, Lima MEF, Melo Jr, SW. O processo de transição epidemiológica e iniquidade social: o caso de Pernambuco. RASPP Rev. Assoc. Saúde Pública de Piauí. 1998;1(2):107-119.

### Keywords

Environmental sanitation, Health, Hydric disease, Sanitation, Public policy.
P130

Lateralization of the visual word form area in patients with alexia after stroke

Inês Rodrigues¹,², Nádia Canário, Alexandre Castro-Caldas³

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal

**Correspondence:** Inês Rodrigues (ines.rodrigues@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P130

Background

Knowledge of the process by which visual information is integrated
into the brain reading system promotes a better understanding of
writing and reading models.

Objective

This study aimed to use functional Magnetic Resonance Imaging (fMRI) to explore whether the Blood-oxygen-level dependent (BOLD) contrast imaging patterns, of putative cortical region of the Visual Word Form Area (VWFA), are distinct in aphasia patients with moderate and severe alexia.

Methods

Twelve chronic stroke patients (5 patients with severe alexia and 7 pa-
tients with moderate alexia) were included. A word categorization task
was used to examine responses in the VWFA and its right homolog re-
gion. Patients performed a semantic decision task in which words were
contrasted with non-verbal fonts to assess the lateralization of reading
ability in the ventral occipitotemporal region.

Results

A fixed effects (FFX) general linear model (GLM) multi-study from the contrast of patients with moderate alexia and those with severe alexia (FDR, p = 0.05, corrected for multiples comparisons using a Threshold Estimator plugin (1000 Monte Carlo simulations), was performed. Activation of the left VWFA was robust in patients with moderate alexia. Aphasia patients with severe reading deficits also activated the right homolog VWFA.

Conclusions

This bilateral activation pattern only in patients with severe alexia could
be interpreted as a result of reduced recruitment of the left VWFA for
reading tasks due to the severe reading deficit. This study provides
some new insights about reading pathways and possible neuroplasti-
city mechanisms in aphasia patients with alexia. Additional reports
could explore the predictive value of right VWFA activation for reading
recovery and aid language therapy in patients with aphasia.

Keywords

Stroke, Aphasia, Alexia.

P131

Sexuality in women with oncological pathology

Filomena Paulo¹, Manuela Ferreira²

¹Centro Hospitalar Tondela-Viseu, 3509-504 Viseu, Portugal; ²Instituto

Politécnico de Viseu, 3504-510 Viseu, Portugal

**Correspondence:** Filomena Paulo (filopaulo@live.com.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P131

Background

It is a challenge for current nursing to care for women with onco-
logical pathology, in what a nursing philosophy of care is concerned,
and whose main focus of care are women in their multidimensional-
ity and not the disease itself.

Objective

To identify some determinant factors of physical well-being, quality
of life and sexuality in women with oncological disease.

Methods

The methodology that guided the research was an integrative review (IR) of literature. A survey was carried out in the databases: LILACS, SCIELO, Google Academic, BDENF and B-ON, between 2012 and 2016, starting from the previously defined inclusion criteria. The selected studies were subsequently evaluated. 71 articles emerged from this research study strategy. After reading all the abstracts of the articles, 27 were selected, including integrative review articles, systematic reviews of cross-sectional studies and descriptive and exploratory studies, whose contents were of interest to this review.

Results

After analysing the articles, it was concluded that sexual health and treatments are important aspects for the quality of life of women with oncological disease and that radical mastectomy has repercussions on body image and sexual function, since it affects self-esteem and the feeling of femininity and sexuality. Factors such as hair loss, gain or loss of weight, chronic fatigue, nausea, pain, stress, feeling of not being a complete woman, decreased arousal, lack of interest or dissatisfaction are determinants for a woman's sexual activity.

Conclusions

Integrative care for women with oncological pathology is a challenge for health professionals. The strategies to be adopted involve the inclusion of women's sexuality in the nursing care plan, without taboos or prejudices, because the evidence identifies the need for intervention in this field to improve, effectively, the quality of life of these women.

Keywords

Sexuality, Woman, Oncology, Integrative care, Quality of life.

P132

Patient compliance to arterial hypertension treatment: integrative review

Diana Tavares¹, Célia Freitas², Alexandre Rodrigues³

¹USF Salinas – Agrupamento de Centros de Saúde do Baixo Vouga,

Portugal; ²Center for Research in Health Technologies and Services,
Aveiro University, Higher School of Health, 3810-193 Aveiro, Portugal;

³Center for Health Studies and Research of the University of Coimbra,

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

**Correspondence:** Diana Tavares (diana.marsilia@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P132

Background

Cardiovascular diseases are the main cause of worldwide mortality, and hypertension is an important public health problem [1]. Nonadherence to treatment influences the health of the patient and can generate several complications. In this way, health care providers are confronted with the best strategies to promote effective management of the disease, together with patients and families. The nursing consultation seems to be a privileged setting for assisting patients for healthy behaviour changes with a personalized intervention adjusted to the needs of each one [2, 3].

Objective

To analyse the factors that promote or inhibit adherence to treat-
ment and to identify the nursing interventions that determine treat-
ment adherence.

Methods

We conducted an integrative literature review with qualitative and quantitative studies through electronic databases Scielo, Scopus, Medline, LILACS and B-on, using the following selected research discriminators, “adherence”, “patient”, “hypertension” and “nursing care” from the DeCs and MeSH for articles published between 2011 and 2016. The PICOD [4, 5] method and the QualSyst [6] tool were used
to evaluate the research question and the quality of the articles, respectively.

## Results

In this research 372 articles were found, and 10 were selected, corresponding to 2,565 hypertensive patients over 18 years old, of whom 64% were female. Despite the differences found in the methodologies of these studies, the results indicated a poor adherence to the treatment [7]. The analysis resulted in two major categories that explain patients' adherence to the treatment of hypertension, namely the factors that influence adherence and nursing interventions. The most significant factors that inhibit adherence are complex drug regimens, lack of knowledge, and poor physical activity. The nursing interventions that enhance adherence were the adoption of continued educational strategies.

## Conclusions

Patient adherence is a complex issue with a huge burden for the health system because it not only implies the change of patient behaviours, but also other factors like the involvement of caregivers and families. Considering the factors described in this review, the nursing consultation, through the definition of educational strategies, seems to increase patient adherence to treatment. In future research, guidelines will be suggested that aim to increase adherence to treatment.

## References

1. Direção-Geral da Saúde. Doenças Cérebro-Cardiovasculares em Números 2015 [Internet]. 2016 [cited 2016 Mar 18]. Available from: https://www.dgs.pt/em-destaque/portugal-doencascerebro-cardiovasculares-numeros-201511.aspx

2. Organização Mundial da Saúde [OMS]. Adherencia a los tratamientos a largo plazo [Internet]. Genebra; 2004 [cited 2016 Feb 20]. p. 127-32.
Available from: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=18722&Itemid=1

3. Organização Mundial da Saúde [OMS]. A global brief on HYPERTENSION [Internet]. World Health Day 2013. Geneva; 2013 [cited 2016 Feb 22].
Available from: http://www.who.int/iris/handle/10665/79059

4. The Joanna Briggs Institute. Reviewers' Manual [Internet]. 2011th ed. Vol. 53, Adelaide: The Joanna Briggs Institute; 2011 [cited 2016 Oct 5].
Available from: http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2011.pdf

5. Ramalho A. Manual para redacção de Estudos e Projectos de Revisão Sistemática com e sem metanálise – Estrutura, funções e utilização na investigação em enfermagem. Coimbra: Formasau - Formação e Saúde, Lda; 2005.

6. Kmet LM, Lee RC, Cook LS. Standard quality assessment criteria for evaluating primary research from a variety of fields. HTA Initiat [Internet]. 2004;13(February). Available from: http://gateway.nlm.nih.gov/MeetingAbstracts/103140675.html%5Cnpapers3://publication/uuid/C9499D35-AE13-428E-960B-68727C1B1833

7. Organização Mundial da Saúde. Adherence to long-term therapies: evidence for action. 2003.

## Keywords

Patient compliance, Nursing care, Hypertension.

## P133

### Didactic material as an intervention strategy in homecare for families of patients with mental disorders

Luísa FT Ferreira¹, Ednéia AN Cerchiani¹, Simara S Elias¹, João B Almeida²
¹Mato Grosso do Sul State University, 79804-970 Mato Grosso do Sul, Brazil; ²Centro Universitário Salesiano de São Paulo, 13467-600 Americana, São Paulo, Brazil

**Correspondence:** Luísa FT Ferreira (luisaftf@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P133

### Background

On a daily basis, we have discussed and reflected about health education on public care as a way of interaction between health care professional and patients, with the purpose of, not only to inform, but also to exchange knowledge and experiences.

### Objective

To elaborate and validate a Practical Guide of Care for family members of patients with mental disorders: guidelines and highlights.

### Methods

This is a qualitative, descriptive, ongoing study with relatives of intern patients with mental disorder of a university hospital in Brazil, starting in August 2014 and finishing by October 2018.

### Results

Five families, a total of 9 people, were interviewed through a semi-structured questionnaire. In order to create the Practical Guide, the methodological steps of the Popular Education process of Paulo Freire were used to analyse the data, as following: Theoretical investigation; Thematic and Problematization. The Practical Guide of Care for Families of Patients with Mental Disorders: Guidelines and Highlights, was created in 2015 and published in 2017, containing 32 pages printed on coloured on couché paper with watercolour pictures and information arranged in short and direct texts, related to the home care of patients with mental disorders. The guide validation process began in January 2018 and is going along with professional judges that were chosen by their expertise, with one of each area: physician, psychiatrist, psychologist, nurse, social worker, pharmacist and occupational therapist. For collecting data, an instrument adapted from the Oliveira's (2006) [1] study was used, allowing apparent and content evaluation. The instrument has affirmations about the evaluated material and was developed based on a Likert scale. The data collected will be analysed through simple statistics and organized through tables, respecting the ethical aspects proposed by Resolution 466/2012 of the National Health Council, regarding research with humans. An apparent and content evaluation with the relatives of the patients will also take place.

### Conclusions

We expect that the final product of this study, the Validated Practical Guide, will provide support for adoption of increasingly effective strategies for the home treatment of patients with mental disorders.

### References

1. Oliveira VLB, Landim FLP, Collares PM, Santos ZMSA. Modelo explicativo popular e profissional das mensagens de cartazes utilizados nas campanhas de saúde. Texto Contexto Enferm. 2007;16(2):287-293.

### Keywords

Teaching materials, Public health education, Mental Disorder.

## P134

### Family health in Leiria council: study of some determinants

Marta Serrano, Rodrigo Correia, André Branco, Luís Mousinho, Teresa Kraus¹,²

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Teresa Kraus (teresa.kraus@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P134

### Background

Family is the main responsible unit for personal development, and any change on a member causes alterations to the entire family [1]. The binomial family-determinants has an impact in education, socialization, in healthcare, on believes and values of the family, as well as in the well-being and health of its members.

### Objective

To characterize the families according to its composition, family cohesion and adaptability, protective factors, health state and its determinants. Identify points of intervention on the community and family.

### Methods

This is a quantitative, correlational and transversal study, whose data was collected in February and March 2017, in the council of Leiria, by the application of a questionnaire which evaluated sociodemo-
graphic data, family functioning, family protective factors, and the
participants' mental health, resorting to MHI5 [2], FACES IV and to
the inventory of protective factors [3].

Results

The sample (N=224) had an average age of 40.7 years, the partici-
pants were mainly females (58.9%) residing in the countryside
(69.9%). The family composition went from the nuclear type (the
most common), as well as a couple, single parent, celibate, extended
family and even a reconstituted family. Most of the participants con-
sider their family function as reasonable, are satisfied with the quality
of their communication and perceive family protection. However,
these consider having few gratifying experiences. The majority of the
sample claimed to have a good family health state, furthermore
25.0% showed signs and symptoms of severe depression and 13.4%
was going through some chronical disease. As for the determinant
factors, most of the respondents seemed to have a good access to
health care, unlikely to transportation and social services. Around
80.0% denied daily tobacco or alcohol consumption and the religious
activities were the most popular among the participants.

Conclusions

The results of this study allow to identify two major focus of commu-
nity attention in the council of Leiria: the accessibility and regular
function of social services; the early diagnosis and treatment of the
family/person with depressive symptoms, with prevention of new
cases; and the knowledge and integration of care related to the per-
son living with chronic disease. Associated with the Calgary Model
and with the Dynamic Model, the philosophy of care expressed in
the Competency for Proactive Unconditional Care guides the discov-
ery of meaning and promotes rewarding relationships, even during
apparently negative experiences [4].

References

1. Hanson S. Enfermagem de Cuidados de Saúde à Família: Teoria, Prática e Investigação. 2nd edition. Loures : Lusociência; 2005.

2. Ribeiro JLP. Mental Health Inventory: Um estudo de adaptação à população portuguesa. Psicologia, Saúde & Doenças. 2001;2(1):77-99.

3. Augusto C, Ferreira O, Araújo B, Rodrigues V, Figueiredo M. Adaptation and validation of the Inventory of Family Protective Factors for the Portuguese culture. Revista latino-americana de enfermagem. 2014;22(6):1001-1008.

4. Kraus T, Dixe M, Rodrigues M. Dor, Sofrimento e Sentido de Vida: Desafio Para a Ciência, a Teologia e a Filosofia. In Lehmann O, Kroeff P, editors. Finitude e Sentido da Vida: Logoterapia no embate com a triade trágica. São Paulo: Evangraf; 2014. p. 193-237.

Keywords

Family, Family health, Health determinants.

P135

Simulation as a pedagogical strategy in nursing teaching: teachers'
perspective

Cláudia Chambel<fnref n="1" />, Catarina Carreira<fnref n="1" />, Catarina Pinheiro<fnref n="1" />, Luís Ramos<fnref n="1" />,
Catarina Lobão<fnref n="1" />,²

Correspondence: Catarina Carreira (cataricacarreira01@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P135

Background

Currently, classes with the resource of simulated practice have
become fundamental to the nursing degree. In this way, teachers
who teach classes with the resource of simulated practice feel
obliged to prepare their students for clinical situations and there
is a need to increase their training on new teaching strategies,
such as simulation. Consequently, it becomes important for the
development of students' competences, being therefore essential
to deepen knowledge in this area.

Objective

We intend to know the perception of teachers of the nursing gradu-
ation course on the use of simulated practice as a pedagogical
strategy.

Methods

To achieve our objective, we developed a research study using a qualitative approach and a semi-structured interview applied to seven teachers who teach classes with the resource of simulated practice in Escola Superior de Saúde de Leiria.

Results

From the results of our study, we verified that for the teachers,
the simulation is a pedagogical strategy important in the creation
of scenarios, a facilitator of the learning process that contributes
to the increase of the security, confidence, satisfaction, motiv-
ation and development of technical and non-technical compe-
tences, for the formation of professional identity, management of
autonomy, development of critical thinking and standardization
of nursing care. Throughout the interviews they identified con-
straints in the use of simulation, such as: economic and material
resources, realism, time available for training resourcing to simu-
lators and the constitution of classes, since the number of stu-
dents is considered excessive, and the personality of the students
is also called into question. To overcome the constraints men-
tioned above, teachers appeal for the acquisition of material, in
sufficient numbers to respond to the constitution of the classes
and the desired realism. They affirm that the practical classes
should have a superior workload, with unfolding of the classes,
thus increasing the time given to debriefing.

Conclusions

Our results agree with the opinion of Gomes & Germano (2007)
[1], Guhde (2011) [2] and Amendoeira, et al., (2013) [3], when
they affirm throughout their studies that simulated practice al-
lows a better articulation of the theoretical content with the
practice, facilitating the learning of the contents taught in theory,
via a consequent reflection of previous learning in the context of
clinical practice, with the development of students' competences.
In summary, the teachers interviewed highlight the importance of
simulation, to answer to our research question, once they
recognize the importance of simulation in the health field.

References

1. Amendoeira J, Godinho C, Reis A, Pinto R, Silva M, Santos J. Simulação na Educação em Enfermagem. Conceitos em Transição. Revista da UIPS. 2013;2:212-228.

2. Gomes C, Germano R. Processo Ensino/Aprendizagem no Laboratório de Enfermagem: visão dos estudantes. Revista Gaúcha de Enfermagem. 2007;28(3):401-408.

3. Guhde JA. Nursing Students' Perceptions of the Effect on Critical Thinking, Assessment, and Learner Satisfaction in Simple. J Nurs Educ. 2011;50(2):73-78.

<footnote n="1">¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901</footnote>

<footnote>Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal</footnote>
**Keywords**

Simulation, Nursing, Trainning.

P136

Simulation as a pedagogical strategy in nursing teaching:
students' perspective

Cláudia Chambel¹, Catarina Carreira¹, Catarina Pinheiro¹, Luís Ramos¹, Catarina Lobão¹,²

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Cláudia Chambel
(simulacaoenfermagem@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P136

Background

Nowadays, students increasingly recognize the importance of using simulated practice as an excellent pedagogical strategy, since it leads to experience situations very similar to reality, in an environment free of risks and penalties, which allows reflection and eventually to be repeated within useful time, thus leaving them readier to practice, in clinical situations.

Objective

We intend to know the perception of students of the nursing degree, on the use of simulated practice as a pedagogical strategy.

Methods

To achieve this, we developed a research study using a qualitative approach and a semi-structured interview applied to six students of the nursing degree of Escola Superior de Saúde de Leiria.

Results

From the results achieved we verify that the students indicate that the simulation is a pedagogical strategy, that facilitates the learning process and contributes to safety, confidence, satisfaction, motivation and development of technical and non-technical skills, with the recreation of scenarios closer to reality. However, they identify some constraints in the use of simulation, such as; economic resources for the acquisition of more recent and sophisticated material; realism, because the available material doesn't allow feedback; time available for simulated practice and the constitution of classes (since they consider that the number of students is excessive and also the different personality of the students, because some students can't take advantage of this strategy).

To overcome the constraints mentioned above, nursing students appeal for the acquisition of new and recent material, in sufficient number to overcome the heterogenic constitution of the classes and the desired realism. They affirm that practical classes should contribute more to the workload of the degree and should receive more attention from the teacher (either reducing the number of students or allowing the practical classes to be taught by two teachers simultaneously).

Conclusions

Our findings are in line with studies which states that high fidelity simulation facilitates the students' learning and acquisition of competencies, and results in increased motivation, satisfaction, critical thinking, and clinical decision-making. Also, Batista, Pereira and Martins (2014) [1] point out that in order for the simulated practice to reach its maximum exponent of realism, it is necessary equipment, environmental conditions similar to clinical practice and a high-fidelity simulator. In summary, the students interviewed highlight the importance of simulation in the health field.

**References**

1. Batista R, Pereira M, Martins J. Simulação no Ensino de Graduação em Enfermagem: Evidências Científicas. Série Monográfica Educação e Investigação em Saúde: A simulação no ensino de Enfermagem. 2014; pp. 65-81.

Keywords

Simulation, Nursing, Trainning.

P137

Partnership between nurses and security forces to reinforce
literacy in the use of child safety seats

Rosa Moreira¹, Anabela Almeida²

¹Hospital Center Cova da Beira, 6200-251 Covilhã, Portugal; ²Research Unit in Business, University of Beira Interior, 6201-001 Covilhã, Portugal

**Correspondence:** Anabela Almeida (aalmeida@ubi.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P137

Background

In Portugal the low literacy in health is recognized. Literacy in health is not only related to education, it arises from a convergence of factors involving education, cultural and social factors and health services. According to data provided by the World Health Organization and World Bank, if awareness is not raised and if global behavior does not change, road traffic injuries will increase dramatically by 2020, becoming the third leading cause of death around the world [1]. Nurses assume that they can be real agents of change and have a role to play in helping to shape the behavior of parents/other educators and to train them in the correct use of child safety seats (CSS).

Objective

The aim of this study was to evaluate whether the partnership between nurses from the Cova da Beira Hospital Center and the regional security forces generated better results in the effective use of CSS of parents or other carers during car transport and whether there is a gap between them and parents who have never been targeted by the team of nurses and security forces.

Methods

A cross-sectional descriptive-correlational study with a quantitative approach, whose participants are the children and their educators from 1st cycle schools in the counties of Fundão, Covilhã and Belmonte. Sample collected by accidental or convenience method, not random. The interview and the observation occur at the same moment with the driver of the vehicle that carries the child and is the subject of stop operation.

Results

The stop operations had a strong pedagogical and informative component, where the drivers were clarified about the data found during the observation, thus offering a good training opportunity in an informal context. In this study, 83% of the sample was for the first time benefiting from a stop operation promoted by the PROVIDAS and it was possible to conclude that drivers who have already been subject to the supervision of PROVIDAS make fewer errors in the use of CSS in relation to drivers who had never been audited by this team.

Conclusions

The results suggest to the positive influence of the training and pedagogical activity of nurses and the importance of the
partnership with security forces in the effective use of CSS. Drivers were found to have made more mistakes without connection to the PROVIDAS in relation to drivers had contact with PROVIDAS and security forces.

### References

1. Fundación Gonzalo Rodríguez. Manual de Buenas Prácticas: Cómo Abordar la Seguridad de los Niños como Pasajeros de Vehículos. Uruguay: Fundación Gonzalo Rodríguez; 2010.

### Keywords

Child safety seats, Health literacy, Partnership.

## P138

### Physical activity and body image in physiotherapy students

Paula C Santos¹, Rafael B Pereira¹, Sofia MR Lopes³, Cristina C Mesquita²
¹School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal; ²Center for Research and Rehabilitation, School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P138

### Background

There is a decrease in the physical activity of future physiotherapists, due to readjustments after admission to college. The high levels of sedentarism, cause diverse physical consequences, especially in terms of corporal image perception. This fact is due to a multidimensional construction of several psychosocial factors, which include motivational factors and behavioural changes.

### Objective

To characterize the level of physical activity and satisfaction with body image among students of the first year of graduation in physiotherapy. Analyse the influence of initiating a graduation degree, in terms of physical activity and perception of corporal image and to also identify the main barriers to regular practice of physical activity.

### Methods

An analytical cross-sectional study was carried out on a sample of 60 students (13 males and 47 females) from the first year of the physiotherapy degree at Escola Superior de Saúde do Porto (ESS-P), excluding those who had already attended a graduation degree. A sample characterization questionnaire and the International Questionnaire on Physical Activity (IPAQ) - Short Version were administered through the Qualtrics platform. For the anthropometric measurements and body composition, the Tanita BC-545NTM scale and a Seca stadiometer were used. Satisfaction with body image was assessed through the Body Shape Questionnaire. The questionnaire score and the Body Mass Index (BMI) were calculated. Data and its treatment was performed in the SPSS software, with a level of significance α = 0.05.

### Results

About 20% individuals of the total sample were physically inactive and 56.7% were moderately active, there were differences in the level of activity between male and female; males were more in a "very active level" than females (61.5 vs 14.9%; p = 0.008). To start a graduation degree leads to a decrease in the regular practice of physical activity (78.3 vs 40.0%; p = 0.001 before and after, respectively). The main barriers identified for the regular practice of physical exercise were: 71.7% inadequate schedules; 30.0% laziness and 20.0% fatigue. About satisfaction with body image, only females were dissatisfied (30% vs 0%; p < 0.001). Starting a graduation degree made the perception of body image worse in 46.7% of the sample, without differences in gender.

### Conclusions

There is a high percentage of students physically inactive and dissatisfied with body image, being this process more notorious among the female gender. Being admitted to a graduation degree has shown to influence negatively the level of physical

activity and body satisfaction. Inadequate schedules are the main barrier to the practice of a physical activity.

### Acknowledgements

We thank all the students of the first year of the degree in Physiotherapy of ESS-Porto of the 2016/2017 school year for the readiness and willingness to collaborate in the present study.

### Keywords

Physical Activity, Students, Higher Education, Physiotherapy, Body Image.

## P139

### Physical activity and stress vulnerability in physiotherapy students

Cristina C Mesquita¹, Elsa S Rodrigues², Sofia MR Lopes³, Paula CR Santos²

¹Center for Research and Rehabilitation, School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal; ²School of Health, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

**Correspondence:** Paula CR Santos (pcs@ess.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P139

### Background

International and national recommendations in Health, consider adopting an active lifestyle as fundamental. Due to the decrease in physical activity observed in students of higher education, it became fundamental to raise awareness and promote healthy behaviours. Physiotherapy students are future healthcare professionals who are experts in movement, with a primary role in health promotion. Physical activity has benefits in physical well-being, stress reduction, and academic performance.

### Objective

Characterize the physical activity level of first year physiotherapy students and its influence on stress vulnerability, as well as to analyse the evolution of physical exercise practice in the transition to higher education.

### Methods

Cross-sectional analytical study of 60 first year physiotherapy students from Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-PP). The level of physical activity was evaluated through the International Physical Activity Questionnaires (IPAQ) and the vulnerability to stress with the Stress Vulnerability Assessment Scale (23QVS). The 23QVS is a self-assessment tool, consisting of 23 questions and allows assessing the vulnerability of an individual to stress. The higher the final score, the more vulnerable the individual is to stress, considering that the value 43 is the value above which an individual is considered vulnerable to stress. The Qualtrics software was used to fill in the questionnaires and the SPSS program for data analysis, with significance of α=0.05.

### Results

Forty percent (40%) of the students practiced physical exercise, 18.3% were considered insufficiently active, with significant differences between genders, with males being more active (61.5 vs. 14.9, p = 0.003). (78.3% vs. 40.0%, p <0,001). It was verified that 40% of the individuals obtained a value of > 43 in the 23 QVS, showing more vulnerability to stress, being the greater proportion among the feminine gender. Nevertheless, statistically significant differences were not identified between genders (p = 0.074). Physical activity did not present a statistically significant relationship with stress vulnerability (p = 0.134; r<sub>s</sub> = -0.195).

### Conclusions

More than half of the students did not practice physical exercise and about a fifth were considered insufficiently active. The male gender had a higher level of physical activity. A large percentage of students showed excessive stress vulnerability. Starting higher education led to a decrease in the practice of physical exercise. There was no relationship between the level of physical activity and vulnerability to stress.
### Acknowledgements

We thank all the students of the first year of the degree in Physiotherapy of ESS-Porto of the 2016/2017 school year for the readiness and willingness to collaborate in the present study.

### Keywords

Physical Activity, Health Promotion, Stress, Academic Success.

## P140

### Representations of dementia experienced in the first person: a hermeneutic analysis

Carlos Laranjeira<fnref n="1" />, Helena Quaresma<fnref n="2" />

**Correspondence:** Carlos Laranjeira (calaranjeira@sapo.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P140

### Background

The global incidence of dementia has been growing exponentially in recent decades. As a chronic disease, it poses as a threat to physical and social existence, amputating or redefining the roles we assume as socially integrated individuals, leading to a heavy deconstruction on the everyday world.

### Objectives

a) Describe the representations of the person with dementia on the disease, after the diagnosis; b) understand the process of adjustment of the person with dementia, from the lived experience.

### Methods

The methodological option was an empirical research study of the qualitative type, of phenomenological-interpretative nature and inspired by the hermeneutic philosophy of Paul Ricoeur. Seven people with mild dementia were interviewed, most diagnosed with Alzheimer's disease, with a mean of 71 years old. For each participant, two interviews were conducted in a natural setting [residence], with data collection occurring between July and October 2017.

### Results

The main focus of the present analysis focused on the identity of the person with dementia. Two main themes were created, taking into account the factors that may influence their (de)construction. The first theme "life in suspense" aims to describe knowledge and representations about dementia. Regarding the analysis of the lived experience, it was represented by the second theme "map the transition process - living on the edge of the cliff".

Findings from this study indicate that disease representations are useful frameworks for developing an understanding of how people with dementia try to manage the threats posed by disease as they negotiate the day-to-day process. The development of disease representations reflects an understanding that the progressive decline imposed by dementia is linked to a set of consequences that are circumscribed in the personal, relational, and transcendental dimensions.

### Conclusions

In summary, the person with dementia faces several challenges, the first one stems from the need to manage the treatment; the second arises from the need to create and assign meaning to their social roles and finally the need to deal with the emotional consequences that arise from the process of disease by providing the person with adaptive strategies that promote their adjustment. In fact, this study, in addition to revealing the lived experience of the person with dementia, has the potential to contribute to the improvement of nursing care in mental health.

### Keywords

Mild dementia, Lived-experience, Hermeneutic, Illness representation.

## P141

### The institutionalized elderly person: representations of happiness and well-being

Magda Guerra, Carlos Laranjeira, Zaida Azeredo

School of Health, Jean Piaget Institute, Research in Education and Community Intervention, 3515-776 Viseu, Portugal

**Correspondence:** Magda Guerra (magdasantosguerra@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P141

### Background

Population aging in developed and developing countries is an un-equivocal reality and poses multiple challenges to their communities and political entities. The societies aim at prolonging the lives of their citizens but also at an improvement of their quality of life; however, the constraints of the elderly population are diverse and it is sometimes necessary to institutionalize them. The elderly persons will have to become familiar with a set of new situations such as a new space, routines and unknown people with which they will share their life. The often-negative connotations associated with these institutions may not be appropriate to reality, because of the changes that have taken place in social policy in recent times.

### Objective

We sought to know which representations the institutionalized elders have about their happiness and well-being.

### Methods

The sample consisted of 13 elderly people institutionalized in a Nursing Home of Viseu, aged between 77 and 94, with 4 to 12 years of institutionalization, an option for some, due to their own volition; while for others, due to decision of another (children/nephews). It is a qualitative study, using the semi-structured interview. The results were analysed according to content analysis, with a priori categorization.

### Results

Happiness for most of the elderly depends on a number of factors, such as being healthy, being well with oneself, being cherished at home, living with others, escaping from loneliness, not starving oneself, being loved and loving, possessing money for oneself and for others and fun. Most elderly people have confirmed that they feel good about themselves, yet two elderly people do not feel well because of sadness and illness. Their memories of the past relate to marriage, family constitution, strength to work and conviviality with friends; whereas, in the present, relate to happiness, a sense of general well-being, not being alone and living with other institutionalized elders.

### Keywords

Elderly, Institutionalization, Happiness, Well-being.

## P142

### Prevention of ventilator associated pneumonia- evidence in oral care

Ana Sousa<fnref n="1" />,<fnref n="2" />,³, Cândida Ferrito⁴

**Correspondence:** Ana Sousa (sabrinasousa72@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P142

### Background

Ventilator-associated pneumonia (VAP) is the most important nosocomial infection in intensive care units (ICUs), with an estimated incidence rate of 50% and the major cause of mortality and morbidity in ICUs [1,2]. Inadequate oral care develops an important role in this setting allowing various organisms to flourish in oral cavity and cause

<footnote n="1">¹Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal;</footnote>

<footnote n="2">²Escola Superior de Enfermagem de Coimbra, 3046-051 Coimbra, Portugal</footnote>

<footnote n="1">¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Centro</footnote>

<footnote>Hospitalar S. João, 4200-319 Porto, Portugal; ³Escola Superior de</footnote>

<footnote>Enfermagem do Porto, 4200-072 Porto, Portugal; ⁴Escola Superior de
Saúde, Instituto Politécnico de Setúbal, 2914-503 Setúbal, Portugal</footnote>
infections [1]. Many VAP prevention guidelines include oral care, but they don't specify its demandings.

**Objective**

The aim of this study is to describe evidence-based VAP prevention oral care in ICU, in terms of products, frequency and technique.

**Methods**

Integrative review. Research was conducted on B-on, PUBMED, and RCAAP between 24 and 28 December 2015, including guidelines and original articles from the last 5 years. We found 256 documents and after analysing their abstract and methodological quality, nine documents were selected. Data were compiled in a chart in terms of grade of evidence, acceptance and applicability.

**Results**

We found inconsistent results regarding the use of an antiseptic solution in oral care, though there were meta-analysis which indicated the benefit of chlorhexidine mostly in cardio-thoracic surgical patients [2-4]. We also found evidence that tooth brushing reduces oral bacterial colonization and may reduce VAP when used with chlorhexidine [5,6]. There is no consensus regarding the adequate concentration of chlorhexidine. Some studies, thought, find an association with the use of chlorhexidine 2% and the incidence of Acute Respiratory Distress Syndrome [7]. Because of this potential risk, we do not recommend the use of this type of concentration, as more randomized controlled trials are needed. We found evidence in VAP prevention oral care comprising suctioning, tooth and gums wash and rising with 15 mL chlorhexidine 0.12%. This procedure should be performed at least 2 times a day. Secretions removal and moisturization should occur between 2 to 4 times a day [1-9].

**Conclusions**

This review allowed us to describe the adequate oral care in ICUs in order to potentially reduce VAP. As limitation of this study, we can find the lack of high grade of evidence concerning most recommendations. More randomized controlled trials are needed to support the impact of each intervention separately.

**References**

1. Munro CL, Grap MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004;13(1):25-33.

2. Eom JS, Lee MS, Chun HK, Choi HJ, Jung SY, Kim YS, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control. 2014;42(1):34-37.

3. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11(11):845-854.

4. Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8:Cd008367.

5. Munro, C. L., Grap, M. J., Jones, D. J., McClish, D. K., & Sessler, C. N. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses. 2009; 18(5), 428-438.

6. Roberts N, Moule P. Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. Nursing in Critical Care. 2011;16(6):295-302.

7. Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014;174(5):751-761.

8. Kornusky J, Schub E. Oral Hygiene: Performing for an Intubated Patient. CINAHL 2015; Nursing Guide.

9. Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Critical Care. 2011;15(3):R155.

**Keywords**

ICU, Oral care, Chlorhexidine, Tooth brushing, Ventilator-associated pneumonia.

P143

Assessing preferences and features for a mobile app to promote healthy behaviors in adolescence: an exploratory study

Pedro Sousa¹,², Roberta Frontini¹, Maria A Dixte¹,², Regina Ferreira³,⁴,
Maria C Figueiredo³,⁴

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³School of Health Sciences, Polytechnic Institute of Santarém, 2005-075 Santarém, Portugal; ⁴Indicators Monitoring Unit in Health, Polytechnic Institute of Santarém, 2005-075 Santarém, Portugal

**Correspondence:** Pedro Sousa (pedro.sousa@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P143

**Background**

A mobile application (TeenPower) to promote healthy behaviours in adolescents is being created. To better tailor the features and digital content of the mobile app, it was important to understand some of the characteristics of the devices more frequently used by the adolescents. Moreover, it was important to understand which contents are essential for health-professionals who frequently work with these adolescents. This data is extremely important during the conception and planning phase of the creation of the mobile app.

**Objective**

This study has two main aims. Firstly, to characterize and assess the devices frequently used by adolescents, as well as the preferences of adolescents for the mobile app. Secondly, to understand what features are more important for health-professionals who work closely with adolescents to promote healthy behaviours.

**Methods**

Two samples were recruited. A sample of 15 adolescents (M = 15.20; SD = 0.68) with the characteristics of the future users of the mobile app was recruited. A sample of 11 health-professionals who work closely with adolescents was also recruited. Both samples answered 2 questionnaires specifically created for the purpose. Five-point Likert scales and open questions were used. The instruments comprised questions regarding the type of devices frequently used by adolescents, the content that both, adolescents and health-professionals, consider more important regarding the promotion of healthy behaviours, and the reasons adolescents consider to use mobile apps.

**Results**

All adolescents use smartphones, but only 20% of the sample frequently use lifestyle and health apps, with the majority (93.3%) using social networks. The majority of the sample referred that food suggestions (93.3%) and physical activity suggestions (93.3%) should be included in the app. Adolescents also referred what reasons and features would influence them to use a health mobile app. Health-professionals (90.9% nurses and 9.1% psychologists) referred that the app should have food suggestions (90.9%) and physical activity suggestions (90.9%). They all referred that they would advise an adolescent to use a health-related app, with 81.8% referring that they would feel comfortable giving advices through a mobile app.

**Conclusions**

The results of our study help us tailor and choose the most important features present in the TeenPower app. Understanding what content may be more appealing for adolescents may also help the creation of future content for prevention programs.

**Acknowledgements**

The current abstract is being presented on behalf of the research group of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by the FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (City Hall), and also other members, institutions and students involved in the project.

**Keywords**

Adolescents, e-Health, Preferences, Prevention, TeenPower.
P144

Epidemiological and clinical characterization of men who age with
HIV/AIDS in Teresina-Piauí, Brasil

Keila MGS Fortes¹, Maria LS Fortes², João GO Freitas², Lucas S Terto³
¹Municipal Health Foundation, 64002-595 Piauí, Brazil; ²Federal University of Piauí, 64049-550 Piauí, Brazil; ³University Center UniNovaFAPI, 64073-505 Piauí, Brazil

Correspondence: Lucas S Terto (terto_7@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P144

Background

AIDS is not a “young-only disease” as many older people still evaluate [1]. People with a more advanced age range are starting to appear in the settings of those living with HIV/AIDS [2]. Many causes are attributed: sociocultural changes, especially in sexual- ity; resistance in using condoms; healthcare innovations; access to antiretroviral therapy and other innovations in clinical areas [3]. Among men aged 60 years and over, in the last decade, there has been an increase in the rate of detection [4], which raises the need for public policies aimed at this reality.

Objective

To investigate epidemiological and clinical characteristics of men
housed in a shelter for people living with HIV/AIDS.

Methods

Descriptive study of epidemiological and clinical information on people living with HIV/AIDS, housed in a shelter in Teresina-Piauí, Brazil. Data were collected from 28 selected records, with the following criteria: male, aged 50 years or older. The following variables were considered: age group, educational level, place of residence, time of antiretroviral therapy and clinical manifestations. The data were typed in an Excel 2007 spreadsheet, analysed through percentage differences and discussed, with reference to documents and also articles in which there was content about the proposed theme.

Results

Regarding the age of the group, ages were between 50 and 64 years old, with predominance of individuals aged from 50 to 60 years old. The majority of the elderly presented a low educational level (79.75%), coming from cities with less than 50,000 inhabitants of other states of Brazil (53.57%), who seek Teresina for treatment and follow-up of their health, shelter to receive food, nursing, social and spiritual assistance and, in some cases, family reintegration. Most used antiretroviral drugs since 10 to 20 years ago, with 7.15% using it for more than 30 years. The clinical manifestations detected were: Lung Cancer, Hepatitis B and C, depression, dermatitis, tuberculosis, neuropathy and leishmaniasis.

Conclusions

This study draws attention to the increase in the detection of HIV in men aged 50 years and over, especially those aged 60 years or older, inhabitants of cities of low demographic density in Brazil, with several clinical manifestations, low educational level, which makes difficult the access to preventive information on sexual health, and under the use of antiretrovirals, from more than ten years ago. The study points towards the need for more research on HIV infection among the elderly, to help to implement more effective public policies for this group.

References

1 Gorinchteyn J. Sexo e AIDS Depois dos 50.1st edition. São Paulo: Ícone; 2010.

2 Okuno MFP, Gomes AC, Meazzini L, Júnior GS, Junior DB, Belasco AGS. Qualidade de Vida de Pacientes Idosos Vivendo Com HIV/AIDS. Cad. Saúde Pública, Rio de Janeiro. 2014;30(7):1551-1559.

3 Serra A, Sardinha, AHL, Pereira ANS, Lima SCVS. Percepção de Vida dos Idosos Portadores do HIV/AIDS atendidos em Centro de Referência Estadual. Saúde em Debate, Rio de Janeiro. 2013;37(97):294-304.

4 Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico - AIDS e DST. Ano V, Nº 1. 2015-2016.

Keywords

Old men, AIDS, Health care.

P145

Assessing digital contents for health promotion and obesity
prevention in adolescence

Rita Luz¹, Pedro Sousa¹,², Roberta Frontini², Andreia Silva¹, Briana
Manual¹, Cláudia Ramos¹, Mónica Ruivo¹, Rúben Abreu¹, Tiago Pozo¹,
Ana E Sardo¹, Francisco Rodrigues¹, Luís Fernandes¹

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Rita Luz (ritafluz@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P145

Background

The TeenPower project is an e-Health multidisciplinary program to promote healthy behaviours and prevent obesity in adolescents. In this study we focus in two of the components present in the platform: stress management and interpersonal relationships. It is important to focus on stress while designing prevention programs for adolescents, given that literature has associated higher levels of stress with obesity in youth. Moreover, interpersonal relationships were also found to influence obesity-related behaviours. Online sessions were specifically created to address those issues on the mobile app. This digital content (videos and posters) should not only be appealing for the adolescent but also scientifically valid and correct.

Objective

The main aim of this study was to assess the scientific quality and adequacy of posters and videos created for the TeenPower mobile app, regarding stress management and interpersonal relationships.

Methods

Digital resources in video and poster format were created. Contents regarded stress management and interpersonal relationships. Videos were 2 minutes long and posters included infographics and written content with adequate language for adolescents. These resources were developed by students of health, sports and design, in collaboration with health-professionals and researchers. The sample included adolescents with the sociodemographic characteristics of the future users of the mobile app, and health-professionals working in this field. A questionnaire was developed and validated for the purpose, based on the questionnaire create by Junior and colleagues.

Results

Results regarding the concept idea, information, construction of scenes and characters, dialogues, visual and audio style, and quality and relevancy of the information were obtained. Moreover, adolescents answered regarding the attractiveness and adequacy of the content, and health-professionals answered regarding the scientific accuracy of the content information. Both samples suggested content improvements.

Conclusions

The digital content of the mobile app regarding stress manage-
ment and interpersonal relationships is adequate and appealing
for both adolescents and health-professionals. The assessment of
digital content is crucial to understand the acceptability of the
contents for future users. Digital contents and online sessions are
extremely important, given that adolescents use new technolo-
gies on a daily basis. Furthermore, it is important to note that
digital contents may have the potential to enhance the adher-
ence to programs, promoting healthy behaviours and preventing
obesity.

Acknowledgements

The current abstract is being presented on behalf of the research group of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by the FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (City Hall), and also other members, institutions and students involved in the project.

Keywords

Adolescents, e-Health, Obesity, Health promotion, Digital contents.
P146

Assessing digital content in the TeenPower project: development and validation of a questionnaire

Roberta Frontini¹, Pedro Sousa ¹,², Rita Luz², Ana Duarte², Beatriz Sismeiro², Maria Moreira², Romeu Machado²

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Roberta Frontini (roberta_frontini@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P146

Background

The TeenPower project aims to develop a program to promote healthy behaviours and prevent obesity in adolescents. It is a multidisciplinary project with an important e-Health component. Therefore, including valid digital content may help to maximize and optimize the impact of the program. Given that over the years digital resources had a great evolution, there is a growing concern regarding the acceptance of the digital content by the target public. Thus, to assess the digital resources of the Teen-Power project, there was the need to develop and validate a questionnaire that could accurately assess the quality and ad-equacy of the digital content of the TeenPower mobile app.

Objective

Develop and validate a questionnaire to assess the quality and ad-
equacy of the videos and posters of the TeenPower.

Methods

Two scales were developed based on the questionnaire created by Junior and colleagues [1]: one for adolescents (12-16 years old) and one for health-professionals. The questionnaire for adolescents comprised 18 items answered on a 5-point Likert scale and 2 open questions (to assess the video content); as well as 11 items answered on a 5-point Likert scale and 2 open questions (to assess the poster content). The questionnaire for health-professionals comprised 17 items answered on a 5-point Likert and 2 open questions (to assess the video content); as well as 11 items answered on a 5-point Likert scale and 2 open questions (to assess the poster content). The sample included adolescents with the sociodemographic characteristics of the future users of the mobile app, and specialized health-professionals. Exploratory factor analyses and analysis of internal consistency through Cronbach's alpha were performed.

Results

Data regarding the concept idea, the construction of scenes and characters, the dialogues, visual and audio style and the quality and relevance of the information was obtained. Data regarding the acceptance and comprehension of the content and digital form of the app was obtained from adolescents. The quality and rigorousness of the scientific information was validated by health-professionals.

Conclusions

The questionnaire presented good psychometric qualities with ad-
equate values for internal consistency and factorial analysis. Given
that nowadays there is a vast offer of digital content related to
health, there is a concern to use not only appealing content for fu-
ture users, but also valid and scientifically correct information. This
questionnaire may be an important tool to understand the accept-
ability and quality of the scientific content of the videos and posters.

Acknowledgements

The current abstract is being presented on behalf of the research group of
the project TeenPower: e-Empowering teenagers to prevent obesity, co-
funded by the FEDER (European Regional Development Fund), under the
Portugal 2020 Program, through COMPETE 2020 (Competitiveness and
Internationalization Operational Program). We acknowledge the Polytechnic
Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria

(City Hall), and also other members, institutions and students involved in the
project.

Keywords

Adolescents, e-Health, Validation, Questionnaire, Digital content.

P147

Implementation process of “Engaging Clients Who Use Substances” guideline in a nursing school curriculum

Olga Valentim¹, Maria José Nogueira¹, Luís Sousa ¹,², Vanessa Antunes¹,
Sandy Severino ¹,³, António Ferreira⁴, Luís Gens⁴, Luís Godinho⁵

¹School of Health Sciences, Atlântica University, 2730-036 Barcarena, Portugal; ²Hospital Center Lisbon Central, Curry Cabral Hospital, 1050-099 Lisbon, Portugal; ³Health Center Groupings Loures-Odivelas, Regional Health Administration Lisboa e Vale do Tejo, 2685-101 Sacavém, Portugal; ⁴Hospitalier Order of São João de Deus, Telhal Health House, 1600-871 Lisboa, Portugal; ⁵Psychiatry Department, Garcia da Orta Hospital, 2805-267 Almada, Portugal

**Correspondence:** Olga Valentim (ommvalentim@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P147

Background

Nursing research has led to knowledge which has contributed to improving health care and to reduce costs. The implantation of guidelines ensures the transfer of the best evidence for clinical practice [1]. Substance-related problems can occur at any age, but usually begin in adolescence [2]. The Guideline Engaging Clients Who Use Substances developed by the Registered Nurses' Association of Ontario (RNAO), provides evidence-based recommendations related to the assessment and interventions for people over 11 years of age, who use substances, may be at risk of, or have a substance use disorder [3].

Objective

To present the experience of the guideline implementation process of the RNAO's Engaging Clients Who Use Substances, in the *curricu-lum* of the nursing degree (CLE) of the Atlantic Health School (ESSATLA).

Methods

Implementation procedures indorsed by the RNAO were followed, in-
volving teachers, students and nurses from several clinical practice
contexts. First, an analysis and reflection were made considering
ESSATLA's CLE *curriculum*, Unit Sheets and the Engaging Clients Who
Use Substances guideline recommendations. Afterwards, a guideline
implementation plan was designed to fit the CLE, based on structure,
process and outcome indicators. Teachers and clinical tutor train was
performed and some guideline topics were included in several units:
establishing therapeutic relationships [4] and person- and family-
centred care [5].

Results

To date, guideline implementation process results include several
outcomes: seminar meetings held with all stakeholders involved in
the guideline's implementation process; a partnership training project
- Partnership training seminars; a workshop scheduling plan; Portu-
guese translation of the "Engaging Clients Who Use Substances" in
process (teacher and nursing expert stakeholder collaboration); di-
dactic materials to support content implementation in the nursing
*curriculum*; student evaluation tools and instruments; three students
included the topic of substance use in their end-of-course mono-
graph project; some students in the clinical practice of the elderly
did a in-service training session on this subject.

Conclusions

The implementation of this guideline in the CLE curriculum has empowered students to become more confident and competent to care for substance abusers, namely regarding screening, the assessment process and intervention in substance use disorders. It also