**Keywords**

Accelerometry, Chronic obstructive pulmonary disease, Psychometric properties, Physical activity, Self-report measure.

P150

Concurrent validity of the Portuguese version of the brief physical activity assessment tool

Joana Cruz¹,²,³, Cristina Jácome³,⁴, Nuno Morais¹,²,⁵, Ana Oliveira³,⁶, Alda Marques³,⁶

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; ⁵Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Joana Cruz (joana.cruz@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P150

**Background**

Physical activity (PA) is recognised as an important health enhancing behaviour and should be routinely assessed in clinical practice to identify insufficiently active people. Activity monitors, such as accelerometers, provide objective assessment of free-living PA being the preferred assessment method in research settings. However, they are too expensive to be used in resource-constrained clinical settings. Several PA questionnaires have already been validated to the European Portuguese but some of them take too long to complete, hence unfeasible for use in clinical practice. Shorter PA assessment tools are, therefore, needed.

**Objective**

To explore the relationship between the Portuguese version of a short PA questionnaire, the Brief physical activity assessment tool (Brief-PA tool), and the International Physical Activity Questionnaire short form (IPAQ-sf), which is a valid and reliable PA assessment tool already tested in the Portuguese population. A secondary aim was to explore the test-retest reliability of the Brief-PA tool.

**Methods**

The Brief-PA tool [1] consists of 2 questions which assess the frequency and duration of moderate and vigorous PA undertaken in a 'usual' week. The total score is obtained by summing the results of the two questions (range 0-8). People with a score ≥ 4 are considered 'sufficiently active'. Since the tool is not available in Portuguese, a linguistic adaptation was conducted using the forward- and back-translation method. Then, 86 healthy volunteers (49.5±18.1 years, age range 20-69; 53 female) completed the Brief-PA tool and the IPAQ-sf. A sub-sample (n=56, 43.1±18.1 years, 37 female) completed the Brief-PA tool one week later. Spearman's rank correlation coefficient (ρ) was used to assess correlations between the Brief-PA total score with IPAQ-sf results (MET-min/week). Percentage of agreement (%agreement) and Cohen's kappa were used to assess the agreement between categorical scores obtained from the two measures (i.e., 'sufficiently' and 'insufficiently' active) and test-retest reliability of the Brief-PA tool.

**Results**

Significant correlations were found between the Brief-PA tool and the IPAQ-sf (ρ = 0.721, p < 0.001). The Brief-PA tool identified 34.8% sufficiently active participants while the IPAQ-sf identified 59.3%. Agreement between measures was moderate (%agreement=70.9%, kappa=0.450). Test-retest reliability of the Brief-PA tool was substantial (%agreement=89.3%, kappa=0.755).

**Conclusions**

The Brief-PA tool seems to be valid and reliable for assessing PA in the Portuguese adult population, although the agreement with the

IPAQ-sf was only moderate. Further research assessing the validity of the Brief-PA tool with objective measures is needed.

**References**

1. Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39(5):294-297.

**Keywords**

Concurrent validity, Daily living, Physical activity, Self-report measure.

P151

Effect of an exercise program on risk of fall in a community dwelling older adults

Sara Martins, Anabela Martins, Carla Guapo, Sílvia Vaz
Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

**Correspondence:** Sara Martins (ftsaramartins@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P151

**Background**

Falls are a problem among the elderly population. It is known that currently about 30% of people over 65 years fall every year. The European Union estimates a cost of € 281 per inhabitant per year and a cost of € 25 billion per year in health care [1] which translates into a significant economic impact. The World Health Organization (WHO) [2] argues that it is possible to reduce these costs through prevention and health promotion strategies. For this, it is important to raise awareness, evaluate risk factors and identify and implement intervention programs.

**Objective**

To test the effect of an exercise program on the prevention of risk of fall.

**Methods**

This study, which lasted 4 months, was experimental, prospective. The experimental group (EG) performed an exercise program and the control group (CG) maintained their usual routine. For the measurement and evaluation of the variables under study, were used: a sociodemographic data questionnaire, the self-efficacy for exercise scale, the Portuguese version of the falls efficacy scale (FES), the 10m walking speed (WS), the Timed Up & Go test (TUG), step test and the Hercules® Force Platform (static balance). A significance level of 5% (p ≤ 0.05) was considered for all comparisons.

**Results**

After intervention, there were differences in walking speed (p < 0.001), FES (p < 0.001), static balance (p < 0.001), and self-efficacy for exercise (p = 0.004), with EG scoring higher than CG.

**Conclusions**

This exercise program integrated activities of daily living (ADL), muscle strengthening, balance and flexibility exercises, complemented by walking, showed improvements in static balance and walking speed. There was also a change in the behaviour regarding confidence in the performance of the ADL and perception of ability to learn and integrate exercise in daily life, thus contributing to decrease the risk of fall.

**Acknowledgements**

To the Penacova Health Center - ARS CENTRO for opening their facility to the program implementation and for the collaboration provided by all professionals.

**References**

1. Active ageing through preventing falls: "Falls prevention is everyone's business". European Stakeholders Alliance for Active Ageing through Falls Prevention. Prevention of Falls Network for Dissemination (ProFouND); 2015.
2. Global recommendations on physical activity for health. Switzerland: World Health Organization (WHO); 2010.

Keywords

Prevention, Active Ageing, Fall, Fall Risk, Exercise Programs.

P152

Nutritional impact of food waste in a school cafeteria

Ana Braga¹, Ana Pedrosa¹, Fabiana Estrada¹, Matilde Silva¹, Ana Sousa¹,
Cidália Pereira¹,², João Lima¹,³, Vânia Ribeiro¹,²

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

**Correspondence:** Ana Braga (anabraga423@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P152

Background

In Portugal, it is estimated that about 31% of food waste occurs in the last stage of the food production chain and that about 13% of the food served is not consumed [1]. Food waste contributes to an inadequate nutritional intake, since part of the served food is being discarded, therefore its evaluation is important [2].

Objective

To evaluate the nutritional impact of food waste in relation to nutri-
tional requirements in a food unit of the Social Services of the Poly-
technic of Leiria.

Methods

Food waste was determined by the aggregate component weighing method, being evaluated at lunch and dinner periods of a randomly chosen day. The data were collected in the cafeteria and snack bar that served the largest number of meals. Only non-fractioned dishes were considered in this analysis. The nutritional impact of food waste was evaluated considering the nutritional requirements of a typical costumer of the food services - an average energy value of 2000 kcal and the percentages corresponding to the two evaluation moments of the day, corresponding to 55% of the Total Energy Value (TEV), 30% to lunch and 25% to dinner [3, 4].

Results

It was produced 288.9 kg of food, being 40.3 kg of plate waste. The average amount of food served per meal was 329 g and an average of 50 g per meal was plate waste. It can be concluded that about 14% of the total food produced was discarded as plate waste, which represents around 123 meals. When evaluating the nutritional impact of food waste, it was observed that the average waste per person was 84 kcal, which represents about 15.3% of the energy value of meals. It was also observed that 2.4 g of lipids, 5.6 g of protein and 9.6 g of carbohydrates were wasted, per meal, which is the equivalent to about 13.1%, 20.4% and 14.0%, respectively, of the needs of the typical costumer of the food services.

Conclusions

Based on these results, we can observe a food waste impact of about 10% of the nutritional requirements of an individual, being imperative the reinforcement of periodic evaluation of consumption and plate waste in school meals, attending that food waste is a decisive factor in terms of energy and nutritional adequacy [5]. On the other hand, it is still necessary to develop actions to raise the awareness among the student community about the nutritional impact of food waste on the health of the population.

References

1. Baptista P, Campos I, Pires I, Vaz S. Do Campo ao Garfo. 2012.

2. Figueira J. Influência da satisfação com as refeições escolares no desperdício alimentar, em crianças do 4º ano de escolaridade. 2012.

3. Afonso C, Santos MCT, Morais C, Franchini B, Chilro R, Rocha A. Sistema de planeamento e avaliação de refeições escolares - SPARE. Rev Aliment Humana. 2011;17(1-3):37-46.

4. Jorge IN de SDR. Tabela da Composição de Alimentos. 2007.

5. Bergman EA, Buergel NS, Englund TF, Femrite A. The Relationship of Meal and Recess Schedules to Plate Waste in Elementary Schools. J Child Nutr Manag. 2004;28(2).

Keywords

College, Dining, Lunch, School Meals, Rests.

P153

Food insecurity and obesity paradox: nutritional intervention strategies

Carla C Correia¹, Ana L Baltazar², José Camolas¹, Manuel Bicho¹

¹Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;

²Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Carla C Correia (carlacamposcorreia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P153

Background

The economic crisis in the recent years has triggered social dispar-
ities in Europe, which are shown in people's food insecurity levels
and public health. Food insecurity occurs when the consumer's phys-
ical, social and economic access to adequate and nutritional food are
scarce or non-existent. Food insecurity is associated to chronic dis-
eases, such as obesity, type 2 diabetes, dyslipidaemia, hypertension,
and a poor health status, due to unbalanced food habits and seden-
tary lifestyles. In this low socioeconomic position, people need social
and nutritional intervention to improve their habits and their health,
in general.

Objective

Analyse and discuss the existing strategies to further intervene at the paradox "food insecurity versus obesity".

Methods

A scientific narrative of the state of art was performed according to PRISMA standards and in snowball, inserting scientific articles, official documents and books applied to the European population, from 2007-2017.

Results

The access of each person to a health and nutritive diet should be a right guaranteed by any country. The strategies to deal with the impact of food insecurity in health status should be multidisciplinary, addressing economic, psychologic, social and physiological issues, together with the health, social, education, agriculture and economic sectors. The prices are an important determinant for people's choices. Food marketing control and agriculture and local markets supports are strategies to facilitate the access to healthy food. It's important to alert the professionals to food insecurity issues and the relation with obesity, and to intervene timely in pregnancy and family planning appointments, as means to prevent diseases related to food insecurity.

Conclusions

Chronic diseases bring us high costs to health systems and some
questions about their sustainability. An adequate and timely inter-
vention should consider food education and health lifestyles
promotion, so that the integration of nutritionists into food assist-
ance programs is emergent.

Keywords

Food insecurity, Chronic diseases, Social disparities, Nutritional intervention.

P154

Numerical methodology to support a medical device development

Filipa Carneiro¹, Lourenço Bastos¹, Ângelo Marques¹, Rita Marques¹,
Jordana Gonçalves¹, Andreia Vilela¹, André Maia², Sara Cortez², Anabela
Salgueiro-Oliveira³, Pedro Parreira³, Bruno Silva¹

¹Innovation in Polymer Engineering, Universidty of Minho, 4800-058
Guimarães, Portugal; ²Muroplás - Indústria de Plásticos, S.A., 4745-334
Trofa, Portugal; ³Health Sciences Research Unit: Nursing, Nursing School
of Coimbra, 3046-851 Coimbra, Portugal

**Correspondence:** Filipa Carneiro (f.carneiro@piep.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P154

Background

The use of numerical simulations as part of product development
process allows the existence of virtual prototypes that can be tested
quickly and cheaply. These computational tools facilitate and im-
prove the design optimization and the materials selection, to match
the pre-defined product requirements, during the development
process, for use in health contexts [1].

Objective

Development and validation of a numerical methodology to support an innovative syringe, predicting its mechanical and flow behaviour, during the syringe loading and patient administration; as also the injection molding process of its constituent components. This methodology aims to optimize the geometries of the syringe's components, creating in this way an iterative process for product development based on numerical simulations.

Methods

This numerical methodology was implemented using software for fluid
dynamics, mechanical behaviour and injection process, respectively. To
study the fluid-structure interaction (FSI), during syringe loading and
patient administration of medicines and washing solutions, the fluid dy-
namics output served as structural simulations input. Material proper-
ties were experimentally determined. The FSI numerical models were
validated by comparison with experimental tests on a single chamber
syringe. Afterwards, the same numerical models were implemented in
new innovative syringe concepts. The injection molding processes of
these concepts were also numerically evaluated.

Results

Validation of the numerical simulations using a simple case of a sin-
gle chamber syringe, where the numerical solution is compared with
an experimental case. Development and application of an iterative
process for product development, based on numerical simulations.
Optimization of an innovative product design that fulfils all the speci-
fications and requirements predefined.

Conclusions

This iterative process based on numerical simulations is a powerful
tool for product development that allows obtaining fast and accurate
results, without the strict need of prototypes. An iterative process
can be implemented, consisting on consecutive constructions and
evaluations of new concepts, to obtain an optimized solution, which
fulfils all the predefined specifications and requirements. The prior
validation of the numerical methodology with a reference model, is
an extremely important step to guarantee the reliability of the nu-
merical model applicability in the development of medical devices.

Acknowledgments

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

References

1. Oliveira RF, Teixeira SFCF, Silva LF; Teixeira JCF, Antunes H. Development of new spacer device geometry: a CFD study (Part I), Computer Methods in Biomechanics and Biomedical Engineering. 2012;15(8):825-833.

Keywords

Numerical simulation, Fluid-structure interaction, Injection process, Syringe.

P155

The impact in burden of care provided by informal caregivers of patients with mental illness

Catarina Tomás¹,², Ana Querido¹,², Marina Cordeiro¹,², Daniel Carvalho³,
João Gomes³

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901
Leiria, Portugal; ²Center for Innovative Care and Health Technology,
Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Santo André
Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal

**Correspondence:** Catarina Tomás (catarina.tomas@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P155

Background

Psychiatric disease is one of the most incapacitating conditions, cre-
ating the need for continuous care, generating burden in family
members [1, 2]. Recent research has revealed some tasks developed
by family caregivers like preparing meals, help in daily living activities
and in-house maintenance which contributes to enhance burden.

Objective

To understand the correlation between provided care and burden in
informal caregivers of patients with mental illness and to analyse the
impact of the care provided in caregivers’ burden.

Methods

This is a cross-sectional correlational study. Data was collected in a
sample of 113 caregivers, in 2015, using a face-to-face interview
which comprised sociodemographic questions, the type of care pro-
vided and the Zarit Burden Interview (Portuguese version by
Sequeira [3]). Ethical procedures were taken into account during re-
search according to the Helsinki Declaration.

Results

Sample was mostly composed by females (70.8%), aged between 20
and 81 years old (Mean=49.85; SD=14.25), married (74.3%), wives
(15.9%) and mothers (17.7%) of the patients. Depressive disorders
(36.3%) were the most common mental problems of their sick rela-
tives. Most caregivers categorized themselves has primary (39.8%)
and secondary caregivers (42.5%) providing total care most fre-
quently (Mean=26.58; SD=31.20). The majority of these caregivers
presents no burden (62.8%), scoring the mean 38.31 (SD=22.54).
Total burden is correlated with the provision of total care (R=0.340;
p=0.000) and support (R=0.216; p=0.022). This kind of care provision
is also correlated with impact of giving care (R=0.355; p=0.000), inter-
personal relations (R=0.360; p=0.000) and perceptions of self-efficacy
(R=0.275; p=0.003). Burden is 11.5% explained by the total care pro-
vided (F=14.330; p=0.000) and 6% by support provided (F=11,542;
p=0,000). Additionally, 25.3% of burden is explained by care in dressing
and shoeing (F=37.288; p=0.000), 5% by preparing the meals
(F=23.724; p=0.000) and 4.8% by support to accomplish patient professional demands. All factors of burden were influenced by total care provided (p<0.005).

Conclusions

A medium range of burden was found in this sample of caregivers of patients with mental illness inquired. By considering themselves has secondary caregivers they provide regularly or occasionally care depending on their relative's needs. Nevertheless, they provide total care frequently. There was a positive and significant correlation found between burden and care provided, with an impact of this care in the caregiver's burden. Intervention in caregivers of patients
with mental illness should address this relation, providing support and developing their skills to improve the care provided and preventing caregivers' burnout.

## References

1. Albuquerque E, Cintra A, Bandeira M. Sobrecarga de familiares de pacientes psiquiátricos: comparação entre diferentes tipos de cuidadores. J Bras Psiquiatr. 2010;59(4):308-316.

2. Eloia S, Oliveira E, Eloia S, Lomeo R, Parente J. Sobrecarga do cuidador familiar de pessoas com transtorno mental: uma revisão integrativa. Saúde Debate. 2014;38(103):996-1007.

3. Sequeira C. Adaptação e validação da Escala de Sobrecarga do Cuidador de Zarit. Revista Referência. 2010;2(12):9-16.

## Keywords

Family caregivers, Care provided, Mental disorders, Burden.

## P156

### Levels of physical activity and sedentary behavior in school-time of elementary school children

Mariana Lima¹, Ana Soares¹, Andreia Santos¹, Fernando Martins¹,², Rui Mendes¹,³

¹Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal; ²Telecommunications institute, University Beira Interior, 6200-161 Covilhã, Portugal; ³Center for Research on Sport and Physical Activity, University of Coimbra, 3040-248 Coimbra, Portugal

**Correspondence:** Mariana Lima (asms.mecl@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P156

### Background

Zimmo et al. (2017) [1], concluded that in what concerns the physical activity (PA) of children in elementary schools (ES), only 39% of the children reached the recommended values of moderate (M) and vigorous (V) PA (30 or more daily minutes), and showed that children spend most of their school time involved in sedentary activities (SB).

### Objective

The aims of this study were I) the description of PA (light, moderate and vigorous levels) and sedentary behaviours (SB) of ES boys and girls in relation with the time spent in each level of PA; II) to determine the average time children spend on each level of PA during 4 weekdays (9:00 a.m. to 5:30 p.m., Monday to Thursday) and, III) to compare the MVPA developed by children during formal physical education sessions, with other weekdays.

### Methods

Forty (40) voluntarily children with 7.9 ± 0.6 years (30 girls and 10 boys) were authorized by their parents to participate in the study. PA was assessed using a three-axial accelerometer (ActiGraph® wGT3X-BT) during to 7.5 daily hours of school period. For classifying moderate-to-vigorous physical activity (MVPA) a cut-off point of 818 counts per 5s was used.

### Results

The average duration of MVPA was 36.51 ± 13.50 min per day. Only 35% of the participating children reached the recommended school-based MVPA of 30 min or more, per day. Children spent on average 71.74 ± 6.37% of their school time on SB. MVPA of girls were lower (31.9 ± 8.9 min/day) than boys (51.3 ± 16.1 min/day, ES = 1.76, p=0.004). Our results showed that the percentage of MVPA on the day of the physical education lesson (11.4 ± 3.8%) was higher, when compared to other weekdays (7.5 ± 2.6%).

### Conclusions

We objectively assessed PA during school hours among elementary school-children. This study found that children spend the majority of their school time in SB and many of them do not perform sufficient time of being physically active at school. The low participation of girls in MVPA and the lesser time spend in MVPA on weekdays without physical education lessons are relevant data to reflect and implement strategies to increase the time of physical activity during school-time, which corresponds to one third of the daily life of children.

## Acknowledgements

Research partially supported by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07- CT62-FEDER- 005012; ID: 64765).

## References

1. Zimmo L, Farooq A, Almudahka F, Ibrahim I, Al-Kuwari M. School-time physical activity among Arab elementary school children in Qatar. BMC Pediatrics. 2017;17(1):76.

## Keywords

Physical activity, Motor development, School-time, Accelerometer, Physical education.

## P157

### Labor pain relief: sterile water injection vs finger ischemic compression technique on the lumbosacral region

Ana Moulaz (anamoulaz@gmail.com)

Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):P157

### Background

Nowadays there is an overvaluation about the pain of giving birth. Therefore, Brazil presented 56% of caesareans and Portugal 33.1% in 2016. In order to assist women when giving birth, analgesia has been a strong ally to enable delivery without pain. There are non-pharmacological techniques for pain control in obstetrics. There is, the Sterile Water Injection on the Michaelis Triangle which causes immediate pain relief in the lumbosacral region. Physiologically, sterile water doesn't act as a local anaesthetic and doesn't inhibit the fibres that report visceral pain; however, causes a release of the C fibres and A-delta fibres associated with somatic pain. Distilled water stimulates A-delta fibres and subjugates the visceral pain reported by the C fibres, which fails to notify visceral pain, modulating afferent patterns of pain. In this way, it silences the C fibres and releases endorphins. Based on this mechanism, an experimental study has been done applying the finger ischemic compression technique to the same region, in Brazil in 2014, to characterize the technique as a tool to pain control.

### Objective

To compare the technique of sterile water injection with the experiment of finger ischemic compression in the lumbosacral.

### Methods

A Comparative study between those techniques through a systematic review of literature based on the Clinical Practice Guide on Normal Childbirth Care, by the Basque Government, about sterile water injection and the finger ischemic compression technique (Nursing Residency Program in Obstetrics, in Brazil in 2015). This study compares the effect versus time duration of analgesia between them.

### Results

The analysis of 292 studies showed that the sterile water injection into the Michaelis triangle decreased lumbar pain during delivery by approximately 60%, and the effect remained for up to 2 hours. In the finger ischemic compression experiment, there was a pain level reduction by 66%, remaining for 4 hours. However, in both cases, patients referred an intense burning during application.

### Conclusions

This study contributes to pain control in obstetrics, as the two methods lead to a significant reduction of the pain level. However, finger ischemic compression had a longer duration of analgesia, when compared to sterile water injection. The injection in obstetrics is already recommended as an effective method for pain control and there is a need for further research on the finger ischemic compression experiment, to also consolidate the technique as a method of pain management.

### Keywords

Labor pain relief, Obstetrics, Giving birth, Non-pharmacological techniques, Analgesia.
P158

Microencapsulation of phytosterols and/or other bioactive ingredients for minimizing cardiovascular risk

Pedro Vieira¹, Isabel Andrade², Rui Cruz¹

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

**Correspondence:** Pedro Vieira (pedromdvieira96@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P158

Background

Several bioactive ingredients such as phytosterols, resveratrol, curcumin and catechin have shown efficacy in the prevention of chronic diseases, namely in cardiovascular diseases, one of the leading causes of death in the world. Besides all the potentialities, many of these bioactive ingredients present the disadvantage of instability and sensitivity to environmental factors (e.g. light and oxygen) and are also characterized by low water solubility due to its lipophilicity. Microencapsulation of bioactive compounds emerges as a strategy to improve their stability, avoiding adverse conditions and promoting their bioavailability. It includes a set of several techniques that allows the coating of these ingredients through a protective film, to guarantee its protection and to modulate its release at the target cells. Many techniques of microencapsulation and different materials can be used, the choice depends on the intended application, particle size, the release mechanism and on the physicochemical properties of both active material to be encapsulated and encapsulating agent.

Objective

To review the available research in this field of expertise.

Methods

A research was conducted using Google Scholar, PubMed and Elsevier databases, in Portuguese, English or Spanish languages over the last 10 years, and using as keywords Microencapsulation; bioactive compounds; phytosterols; cardiovascular risk.

Results

The search retrieved 10 studies. The findings demonstrated not only the potential of the compounds in the reduction of cardiovascular risk, through the action on risk factors, but also the increase of their activity due to the increase of their bioavailability, achieved through microencapsulation. The research also revealed a wide range of materials that can be used, while the choice of method must take into account several factors such as its cost and necessary equipment, as well as the quality of the microcapsules formed. The microencapsulation process has a wide range of advantages, namely the ability to increase gastrointestinal absorption of the bioactive compounds encapsulated, and in addition, while the conversion of those compounds into the powder form is enhanced, their stability increases and their handling is facilitated.

Conclusions

The use of microencapsulation avoids some undesirable characteristics, proving to be an alternative to increase the bioavailability of the bioactive compounds. Future studies should address the exploration of newer encapsulating methods and materials.

Keywords

Microencapsulation, Bioactive compounds, Phytosterols, cardiovascular risk.

P159

A weighted decision making approach for a new medical device concept selection

Marta Gomes¹, Ângelo Marques¹, Ricardo Freitas¹, Anabela Salgueiro-Oliveira², Pedro Parreira², Alberta Coelho³, Sara Cortez², Bruno Silva¹, Filipa Carneiro¹

¹Innovation in Polymer Engineering, Universidty of Minho, 4800-058 Guimarães, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ³Muroplás – Indústria de Plásticos, S.A., 4745-334 Trofa, Portugal

**Correspondence:** Filipa Carneiro (f.carneiro@piep.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P159

Background

The development of an innovative syringe results, at an early stage, in several preliminary concepts that should be compared and analysed to select the most promising one. Making the selection decision is a very important task that should be structured and well-founded. Decision making methods can be applied to help in the selection process, leading to more informed and better decisions.

Objective

To apply a weighted decision matrix, in order to select the most promising concept for an innovative syringe.

Methods

To select the most suitable concept for the device to be developed, it is mandatory to define the specifications that it must obey, considering the functional requirements of the product and the requirements for the production process. Not all the specifications have the same importance in concept selection, and so this was analysed trough a weighted decision matrix. Based on the identified specifications, it was defined the corresponding criteria, which must be evaluated and weighted regarding their relative importance to each of the other criteria. These weights were summed for each criterion. As experts from different areas were involved, it was decided that each expert group should weigh, considering their experience. As expected, different matrixes were obtained and results were managed to achieve only one weight matrix which included the opinion of all the groups. A final weighted matrix with all the criteria and its weight for concept selection was obtained. Each concept of the syringe was evaluated according to these defined criteria and calculated it weighted sum. It was selected the concept with the highest weighted sum of all the defined criteria.

Results

By analysing the proposed weighting table of the specifications, and considering the defined relative weight, it was verified that the most relevant specifications are the cost, the number of operations to be performed and the possibility of error. Based on this, the concept with better weighted performance was selected for further detailed development.

Conclusions

A weighted decision matrix has showed to be a very effective tool to assist the development of new products for use in health, particularly in cases where there are many concepts and many criteria of varying importance to be considered.

Acknowledgments

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

Keywords

Weighted decision matrix, Medical device, Product design.

P160

Vestibular symptoms in sensorineural hearing loss

Maria Araújo¹, Luis Rama²

¹Audiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-256 Coimbra, Portugal

**Correspondence:** Maria Araújo (ines@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P160

Background

The type of aetiology of hearing loss is directly related with the embryonic and physiological interactions of the anatomical structures of the auditive and vestibular systems. The proximity between both system structures can evolve simultaneously audition and balance, mainly in individuals with peripheral pathologies.

Objective

To characterize and evaluate the vestibular symptoms in individuals with bilateral severe and profound hearing loss.
## Methods

The information was gathered with resource to two questionnaires: one for anamnesis and the Dizziness Handicap Inventory (DHI). The sample was constituted by 28 adults with severe and profound sensorineural hearing loss, between 19 and 64 years old (15 females and 13 males). 42.9 % of the sample had idiopathic aetiology, 10.7 % had meningitis and the same percentage with the aetiology of measles.

### Results

Seventy-five percent 75% had tinnitus, being 33% bilateral. Regarding vertigo symptoms, 53.6% reported at least one episode, describing it as a rotatory vertigo (66.7%), with the length of minutes (33.3%) to days (26.7%). Regarding DHI, the functional sub scale is the one that perceives more difficulties when performing daily tasks, as a consequence of vertigo and/or unbalance (5.7 ± 8.5), followed by the physical sub scale (4.8 ± 6.8).

## Conclusions

The study has shown that the major part of the sample had already faced symptoms as tinnitus, vertigo and/or unbalance.

## Keywords

Hearing Loss, Vestibular symptoms, Tinnitus, Vertigo.

## P161

### Men's prenatal experience in the transition to fatherhood

Catarina Silva<fnref n="1" />, Cristina Martins², Cândida Pinto<fnref n="3" />

**Correspondence:** Catarina Silva (catsilva@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P161

### Background

Pregnancy is a demanding period in terms of psychological reorganization in the transition to fatherhood [1,2]. The involvement of men in this period is associated with their own psychological well-being as well as the whole household [3]. This is a transition with implications for the couple, for the father/child relationship, and child development [4]. Contemporary fatherhood emphasizes the involvement of men and greater affective contact with their children, in addition to their traditional role as a financial provider [5].

### Objective

This study sought to understand the experiences of men as they transition to fatherhood during the prenatal period, aiming to contribute to a complete assistance to the family and improving the health gains of the family.

### Methods

Qualitative research paradigm. Exploratory, descriptive, cross-sectional and retrospective study, with the participation of 10 men experiencing, for the first time, the pregnancy of their partners, in the last trimester, in a common-law marriage and with gestation without maternal-foetal pathology. Data collection was performed using the semi-structured interview. The data was analysed with the content analysis technique, with semantic categorization and an inductive approach.

### Results

Through content analysis three themes emerged, "experiencing transition", "development of father identity" and "(de)construct bridges to transition." The results revealed a male experience of pregnancy characterized by an enormous psychic and emotional depth. Men accept and try to actively engage in the pregnancy process and experience a panoply of positive and negative feelings and emotions, sometimes ambivalent. The prenatal period triggers the development of paternal identity. During this process, expectant fathers revaluate their personal values, reflect on their own fathering experiences and reshape their view of the world and themselves. Despite their proactive role in the fatherhood journey, they find obstacles and not bridges to their transition. The fact that they feel peripheral in prenatal care services makes it more difficult to embrace fatherhood and may compromise overcoming the transition process.

## Conclusions

This study provided insight on the complex nature of this developmental transition and showed fragile environments in the approach of the expectant fathers to the prenatal care services. This reality encourages healthcare professionals to think critically about how fatherhood transition can be facilitated by practices which promote smoother transitions and benefit the family as a whole.

## References

1. Condon J, Boyce P, Corkindale C. The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Aust N Z J Psychiatry. 2004;38(1-2):56-64.

2. Genesoni L, Tallandini M. Men's Psychological Transition to Fatherhood: An Analysis of the Literature, 1989-2008. Birth. 2009;36(4):305-318.

3. Plantin L, Olukoya A, Ny P. Positive Health Outcomes of Fathers' Involvement in Pregnancy and Childbirth Paternal Support: A Scope Study Literature Review. Fathering: A Journal of Theory, Research, and Practice about Men as Fathers. 2011;9(1):87-102.

4. Bawadi H, Qandil A, Al-Hamdan Z, Mahallawi H. The role of fathers during pregnancy: A qualitative exploration of Arabic fathers' beliefs. Midwifery. 2016;32:75-80.

5. McGill B. Navigating New Norms of Involved Fatherhood. J Fam Issues. 2014;35(8):1089-1106.

## Keywords

Fathers, Parenting, Pregnancy, Qualitative research.

## P162

### Diffuse large b-cell lymphoma, which treatment options are available?

Mariana Carvalho<fnref n="1" />, Fernando Mendes²,<fnref n="3" />,⁴, Salomé Pires²,⁴, Ricardo

Santo²,⁷, Nicole Eicher<fnref n="8" />, Ricardo Teixo²,⁴, Rui Cruz<fnref n="1" />

BMC Health Services Research 2018, **18**(Suppl 2):P162

### Background

Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive subtypes of non-Hodgkin's lymphoma (NHL). The current therapy for DLBCL is the combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). R-CHOP-14 and R-CHOP-21 are two subtypes of R-CHOP, which differ in their treatment, like CHOP-14 that has better results within high dosage in advanced stages, while CHOP-21 has better efficiency and better overall survival in elderly patients. These treatments have increased the survival of patients, though about 40% of patients there is still a failure rate of treatment. New approaches for relapsed DLBCL are outlined here, for example the understanding of the new drugs role, individualized treatments and dosage regimes.

### Objective

To review the treatments available for DLBCL and all the developments of novel treatments, particularly in DLBCL recurrence variants of treatment with R-CHOP and in patients over 80 years.

### Methods

A research was conducted using Google Scholar and PubMed databases, in English languages over the last 5 years, and using as

<footnote n="1">¹Agrupamento de Centros de Saúde do Alto Ave, 4810-503 Guimarães, Portugal; ²Nursing School, University of Minho, 4700-057 Braga, Portugal; ³Nursing School of Porto, 4200-072 Porto, Portugal</footnote>

<footnote n="1">¹Pharmacy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Biophysics Unit, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal;</footnote>

<footnote n="3">³Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra Health School, 3046-854 Coimbra, Portugal; ⁴Center of Investigation in Environment- Genetics and Oncobiology, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal; ⁵Immunology Institute, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁶Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, 3004-504 Coimbra, Portugal; ⁷Faculty of Sciences and Technologies, University of Coimbra, 3004-504 Coimbra, Portugal;</footnote>

<footnote n="8">⁸Biomedical Laboratory Sciences Department, University of Applied Sciences, 6711 Gratz, Austria

**Correspondence:** Fernando Mendes (fjmendes@estescoimbra.pt)</footnote>
keywords: Diffuse large B-cell lymphoma (DLCLB) treatment; rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulphate, prednisone (R-CHOP); cyclophosphamide, doxorubicin hydrochloride, vincristine sulphate, prednisone (CHOP).

**Results**

The treatment of this pathology has advanced over time starting with CHOP and later incorporating rituximab with lower relapse and upturn survival rates. Currently, about 80% to 90% of patients in early stage of DLBCL remain free of the disease after treatment with R-CHOP and radiotherapy consolidation. Concerning elderly patients (> 80 years), the addition of rituximab, namely, a reduced dose R-CHOP provides a good compromise between toxicity and the efficiency of overall survival. The survival of patients with DLBCL with more than 66 years has improved substantially since the introduction of rituximab. However, finding the optimal dose for older patients without associated toxicity is an important focus for further research.

**Conclusions**

The DLBCL is a heterogeneous disease, both clinically and biologically. Although, DLBCL therapy results have improved significantly over the past decades with the introduction of new specific therapeutic antitumor strategies.

**Keywords**

Diffuse large B-cell lymphoma, Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Novel treatments.

P163

Mistreatment to elderly in family context

Maria FP Ribeiro (fatima.ribeiro@ipsn.cespu.pt)

School of Health of Vale do Sousa, North Polytechnic Institute of Health,
4760-409 Vila Nova de Famalicão, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):P163

**Background**

The evidence about the increasing number of elderly people who, in their everyday lives, are abused and the implications that these events have on the practice of health professionals, plus the need for new «powers» bear alone the importance of the subject of this study. This issue of great sensitivity imposes a multifactorial attention to the social, educational, clinical and ethical domains. This involves the concerted action by all health professionals whose mission passes through contacting with seniors.

**Objective**

To identify signs of elder abuse and typology of abuse in a family context.

**Methods**

Exploratory study and empirical work, constituted by a sample of four hundred (400) elderly, enrolled in a ACES in the north of the country, in order to identify signs of abuse. In this study, a questionnaire was used to collect information about indicators of abuse in the elderly [1]. For processing and analysis, we've recurred to tech- nics of descriptive and inferential statistics using factor analysis.

**Results**

The analysis made allowed us to sort indicators of abuse, by type of abuse, in the following order: neglection (64.8%), emotional/psychological (26.6%), economic (21.6%) and physical abuse (7.1%).

**Conclusions**

The results of this study suggest the emergence and necessity of early screening for signs and/or symptoms indicative of risk factors that may lead to the installation of maltreatment. The role of health professionals proves to be of prime importance and helps fighting this phenomenon.

**References**

1. Carney MT, Kahan FS, Paris Barbara EC. Questions to Elicit Elder Abuse (QEEA), 2003. Translated and adapted into Portuguese by Alves, JF; Sousa M. 2005.

**Keywords**

Abuse, Elderly, Mistreatment, Prevention.

P164

Guidelines and training a role to play for learning health organizations? The HAIs example

Sandra Oliveira¹,², Sofia Ferreirinha³, Carla Cordiro³, António Lopes⁴

¹Polytechnic Institute of Santarém, 2001-902 Santarém, Portugal; ²Center for Health Studies and Research, University of Coimbra, 3004-504

Coimbra, Portugal; ³District Hospital of Santarém, 2005-177 Santarém, Portugal; ⁴Hospital Center of the Medio Tejo, 2304-909 Tomar, Portugal

Correspondence: Sandra Oliveira (sandra.oliveira@esg.ipsantarem.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P164

**Background**

International projections estimate that, in 2050, 390,000 people will die annually in Europe, as a direct consequence of Healthcare Associated Infections (HAIs) [1]. In Portugal, we estimate that 5 in 100 patients could have acquired HAIs during hospitalization [2]. Research based on practice guidelines was published, and despite evidence that good practice strategies are sufficient to reduce the rate of HAIs, hospitals struggle to comply [3]. Investigation of organizational solutions that may contribute to reduce the rate of HAIs is much needed.

**Objective**

This exploratory study has the following objectives: (1) to identify if the legal standards are known by health professionals of acute services of Portuguese hospitals, detect training actions or courses as well as the most common subjects taught in formal training actions; (2) to recognize the strategies implemented in the hospitals; (3) to analyse whether there are differences between knowledge and implementation of practices in hospitals; (4) to study the suggestions made by the health professionals.

**Methods**

Through a quantitative and qualitative approach, using quantitative data analysis and content analysis procedures, this study explores the different perspectives given by the health professional groups. The design of the study involved a literature review, study of the legal standards and conduction of informal interviews to field experts, with the aim of producing a list of topics to assess the level of implementation of the legal norms. A focus group method was used to encourage participants to exchange experiences and perspectives. These interactions allowed the collection of more detailed information and an in-depth exploration of the opinions of the participants [4][5]. The focus group also served as a pre-test to the questionnaire. A convenience sample of four acute services of Portuguese Hospitals was selected. The questionnaire was distributed in the hospitals after receiving the accordance of the Administration Board and Ethical Commission of the institutions involved. Participation in the study was voluntary and ranged all the health professionals of the medical and surgery services.

**Results**

The results suggest that, although aware of the legal norms, when we control for differences between groups, we find differences between health professional groups. Health professionals recognize and value the existence of training, mainly under the responsibility of the Health Institutions, but do not consider it effective.

**Conclusions**

This research highlights the importance of spreading knowledge and training in healthcare organizations, notably through the identification of the need for new approaches of training as well as for new training areas.

**References**

1. Direção Geral de Saúde 2016.

2. OPSS Acesso aos cuidados de saúde. Um direito em risco?. Relatório de Primavera Observatório Português dos Sistemas de Saúde (OPSS). Lisboa; 2015.
3. Zingg W, Holmes A, Dettenkofer M, Goetting T, Sicca F, Clack L, et al. Hospital organization, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis. 2015;15(2):212-224.

4. Kitzinger J. Introduction focus groups in qualitative research. In: Mays N, Pope C., editors. Health care. London: Blackwell; 1996. p. 36–45.

5. Morgan DL. Focus groups as qualitative research. 2nd Edition. Outstand Oaks, CA: Sage; 1994.

Keywords

Guide lines, HAls, Training and Health Organizations.

P165

Barriers, obstacle, difficulties or challenges in development of
health partnerships in community intervention projects: a
systematic review

Odete Alves¹, Paula C Santos²,³, Lídia Fernandes⁴, Paulo Moreira⁵,⁶

¹Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal; ²Physical Therapy Department, Health School, Polytechnic Institute of Porto, 4200-465 Porto, Portugal;

³Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁴School of Health, Polytechnic Institute of Viana do Castelo, 4900-314 Viana do Castelo, Portugal; ⁵Center of Administration and Public Policies of the University of Lisbon, 1300-663 Lisbon, Portugal; ⁶University Atlântica, 2730-036 Oeiras, Portugal

Correspondence: Odete Alves (odetemaalves@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P165

Background

Engaging communities in authentic partnerships is increasingly ac-
cepted as best practice in community intervention projects, despite
the many barriers or challenges to doing so.

Objective

The purpose of this study is to identify barriers, obstacles, difficulties or challenges in development of health partnerships in community intervention projects of some countries.

Methods

We conducted a systematic review using the following data sources: PubMed, B-on, Medline and EBSCOhost. We searched articles from September 2006 through January 2016. A standard form was used to extract data using the key words in the search: Health Partnerships AND Community Health AND Primary Health Care. The articles were selected according to inclusion and exclusion criteria. In the end, we grouped these results based on the six categories used by the Wilder Research Centre: Environment; Membership; Process and structure; Purpose; Communication; Resources, which includes leadership and power.

Results

From the research conducted, 844 articles emerged, which were
submitted to the filter, which implied references to at least one
of the keywords: Barriers OR Obstacle OR Difficulties OR Chal-
lenges. According to the inclusion criteria, a total of fifty-six arti-
cles was found. Of these articles, forty-four dealt with factors
relating to Environment, which included factors related to com-
munity, geography, culture, religious faith and homophily, and
politics. Regarding the characteristics of the members that influ-
ence the development of the partnership, the relationship be-
tween the partners is key and this was commented in fifty-three
articles. Factors relating to the process of collaboration were
found in a total of forty-six articles, while factors related to struc-
tural elements were mentioned in forty articles. Thirty-one articles
identified the factors relating to objectives, vision and mission.
Another factor that was highly discussed was communication,
appearing in a total of thirty-four articles. Factors relating to re-
sources were given great importance in the literature, appearing
in forty-eight articles. In twenty-three articles, the subject of lead-
ership and factors relating to power were mentioned. The litera-
ture reviewed highlighted that factors such as relationships,

commitment, communication, funding and structure, are key in
the long-term sustainability of the partnership. This topic ap-
peared in fifteen articles.

Conclusions

The systematic literature review identified a set of barriers, obstacles, difficulties or challenges for the development of health partnerships in community intervention projects. In each of the categories we present the factors that are related to them and that can positively or negatively influence the development of those collaborations.

Acknowledgements

We are very grateful to Dr. Alcino Maciel Barbosa for his insightful comments on an earlier draft of this project and to Caroline Esteves for her contributions in this paper.

Keywords

Barriers, Obstacle, Difficulties, Challenges, Partnerships.

P166

Parental perception of child body image: retrospective analysis of
two studies

Graça Aparício¹,², Patrícia Nascimento³, Madalena Cunha¹,², João Duarte¹,²

¹Escola Superior de Saúde de Viseu, Instituto Politécnico de Viseu, 3500-843 Viseu, Portugal; ²Centro de Estudos em Educação, Tecnologias e Saúde, 3504-510 Viseu, Portugal; ³Centro de Saúde de Seia, 6270-468 Seia, Portugal

Correspondence: Graça Aparício (gaparicio5@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P166

Background

Childhood obesity is a major problem in Portugal and studies show
that parents are concerned about their children's overweight, but
their perception of children's nutritional status is not always ad-
equate or is even distorted.

Objective

The general objective was to explore the parental perception of their
children's body image in two studies, study A [1] and study B [2].

Methods

Cross-sectional and retrospective study using two samples, from
study A (792) and study B (1424) totalizing 2,216 pre-school children,
with mean age = 4.51 years old (SD= 0.97), living in the region of
Viseu and Dão (study A) and Viseu, Lamego, Vila Real, Évora and
Leiria (study B). The original authors performed the children's an-
thropometric evaluation and the nutritional classification based on
NCHS reference (CDC, 2000). A Sociodemographic Characterization
Questionnaire for Children and Parents was used and the Parental
Perception of Children's Body Image Assessment [3].

Results

In Study A, overweight was 31.3% (including 12.4% obesity) and 2.7% underweight. In study B was 34.3% overweight (17.4% obesity) and 5.5% underweight, with significant differences (Chi-square= 21.355; p= 0.000). In study B, parents were significantly more concerned about their children nutritional status (UMW = 498564.000, p = 0.000) and a higher percentage of parents pointed the representative pre-obesity images (27.5%) and obesity (0.6%), compared to study A, where more children in the normal and low-weight group (56.3% and 20.4% respectively) were selected. A significant difference of means from the parental perception of the child's body image was found between studies (UMW = 528960.500; p = 0.037), showing a closer perception to the higher values of BMI, i.e., parents presented a less distorted perception of their children's body image, when they have higher BMI values.

Conclusions

The results indicate more accuracy of the parental perception of the
children body image and an oncoming to their real nutritional status
in the latest study. This may be the first step towards their recogni-
tion of their children's overweight that is critical to prompting family
action, and consequently preventing and treating childhood obesity.
## References

1. Aparício G, Cunha M, Duarte J, Pereira A. Olhar dos pais sobre o estado nutricional das crianças pré-escolares. Millenium 2011;(40):99-115.

2. Aparício G, Cunha M, Duarte J, Pereira A, Bonito J, Albuquerque C. Nutritional status in preschool children: Current trends and concerns. Atención Primaria 2013;(45)(Espec cong 1):94-200.

## Keywords

Parents, Weight perception, Body image, Pediatric obesity.

## P167

### Informal caregivers of mental health patients: burden and care provided

Daniel Carvalho¹, Catarina Tomás²,³, Ana Querido²,³, Marina Cordeiro²,³, João Gomes¹

¹Santo André Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Daniel Carvalho (drscarvalho@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P167

## Background

Families and informal caregivers play an important role in providing care for mental health patients [1]. Family caregivers of these patients usually are overloaded with caring activities [2], being more vulnerable to psychological disturbance and burden due to the care provided [3].

## Objective

To characterize the care provided; access the burden experienced by informal caregivers of mental health patients and identify its determinants.

## Methods

Cross-sectional correlational study, with a non-probabilistic sample of 113 Portuguese relatives and caregivers of mental health patients. Data were collect in the first semester of 2015. Caregivers were interviewed about sociodemographics, type of care (wholly compensatory, partially compensatory, supervision), time spent in self-care daily activities and its intensity (0-7) and with the Portuguese version of the Zarit Burden Interview [4]. Ethical procedures, according to Helsinki Declaration, were taken into account.

## Results

Caregivers were mainly females (n=80), with a median age of 51 years, married (n=84), with 12 years of education (n=33) and patients-mothers (n=20). These patients had majorly depressive disorders (36.3%). Caregivers cared for their relatives from 0 up to 54 years (Median=3.25; Mean=7.86; SD=10.78). Most of them (42.5%) corresponded to someone who provided care occasionally. Nevertheless, they provided a wholly compensatory care in most areas of patient self-care daily activities (Mean=26.58; SD=31.20). Preparing and providing meals (Mean=3.54; SD=3.29), Organizing medication (Mean=3.57; SD=3.16) and its administration (Mean=3.30; SD=3.29) was the most frequent self-care provided. Intensity of wholly compensatory care provided was higher in female (t=-2.950; p=0.004) older (r=0.215; p=0.022) relatives, who took full responsibility for caring (p<0.001), living with the patient (t=-2.762; p=0.007). Most caregivers revealed no burden (62.8%; Mean=38.31; SD=22.54). Burden was higher in females (t=-2.869; p=0.005), older (r=0.259; p=0.006) and among primary or secondary caregivers (p<0.001). Impact of giving care, interpersonal relations and perceptions of self-efficacy were also higher in older females with lower education relatives, primary caregivers and caregivers that perspective gravity of their relative illness higher.

## Conclusions

The caregivers inquired were mainly secondary and provided total care in all areas. The burden presented by those was low, and they provided care especially in preparing meals and organizing and administering medicines. In this sample, care provided and burden were higher in older female caregivers, low educated

and with a high perspective of gravity of their relative illness. Intervention among these caregivers is needed, promoting knowledge, improving skills and providing support, which can allow to reduce the psychological consequences of the needed assistance by the relatives.

## References

1. Pakenham K. Caregiving tasks in caring for an adult with mental illness and associations with adjustment outcomes. Int J Behav Med. 2012;19(2):186-198.

2. Martins S, Bandeira M, Nascimento E. Sobrecarga de familiares de pacientes psiquiátricos atendidos na rede pública. Rev Psiq Clín. 2007;34(6):270-277.

3. Cabral L, Duarte J, Ferreira M, Santos C. Anxiety, stress and depression in family caregivers of the mentally ill. Atenção Primaria. 2014;46(5):176-179.

4. Sequeira C. Adaptação e validação da Escala de Sobrecarga do Cuidador de Zarit. Revista Referência. 2010;2(12):9-16.

## Keywords

Informal caregivers, Mental health, Burden, Family care.

## P168

### Your PEL - promote and empower for literacy in health in young people: from investigation to action

Hélia Dias¹, José Amendoeira¹, Ana Spínola¹, Maria C Figueiredo¹, Celeste Godinho¹, Clara André¹, Filipe Madeira¹, Manuela Ferreira², José C Quaresma³, Mónica Ferreira⁴, Teresa Simões², Rosário Martins⁶, António Duarte¹, Madalena Ferreira¹, Marta Pintor¹

¹Escola Superior de Saúde de Santarém, Instituto Politécnico de Santarém, 2005-075 Santarém, Portugal; ²Escola Superior de Saúde de Viseu, Instituto Politécnico de Viseu, 3500-843 Viseu, Portugal; ³Escola Superior de Saúde de Leiria, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal; ⁴Agrupamento de Escolas da Chamusca, 2140-052 Chamusca, Portugal; ⁵Agrupamento de Escolas da Golegã, Azinhaga e Pombalinho, 2154-909 Golegã, Portugal; ⁶Unidade Cuidados na Comunidade Chamusca Golegã, Agrupamento de Centros de Saúde Lezíria, 2140-078 Chamusca, Portugal

**Correspondence:** Hélia Dias (helia.dias@essaude.ipsantarem.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P168

## Background

The "Your PEL - Promote and empower for literacy in health in young people" project focus on a health approach, supported by the new technologies, including three different areas: feeding, harmful consumption and sexuality. It is based on scientific evidences of health promotion, on which the need to refocus the action on the results implies the development of appropriate interventions [1, 2]. It is a multi-regional project outlined in the national strategy of smart specialization, in a partnership between IPSantarém - ESSS and ESGT, IPLeiria - ESSL e IPViseu - ESSV, the Agupamento de Escolas da Chamusca, the Agrupamento de Escolas da Golegã and ACES Lezíria - UCC Chamusca/ Golegã. The students' participation reveals itself in the project construction, framed in the curricular program and valued by the knowledge mobilization and by the skill gaining on real context.

## Objective

Develop a tool for impact evaluation of health education programs for school in the feeding, harmful consumption and sexuality areas, at ages between 12 to 15 years old and monitoring the health determinants and the effectiveness of the developed strategies.

## Methods

A research-action study divided in three phases: I) construction of the data collection tool and web communication platform; II) evaluation of the intervention needs of the students, development and implementation of the intervention program using the web platform; and III) evaluation of the impact of the program developed. The valuation of the knowledge generated by the project is based on a plan of actions different from the diffusion and dissemination of results, involving the institutions plots and adapted to the very essence.
## Results

The project strategic impact is situated at two levels. One, evaluated after execution, corresponding to the expected results: tool development for impact measurement of the program and intervention program creation, supported by the web platform. The other, longer in time, that will be evaluated by health gains of the populations in the future.

## Conclusions

The project's relevance and originality support themselves on scientific evidence, reviling the monetarization as an essential component of the promotional health program [3, 4], valorising the innovation and sustentation of the action on the results, including more suitable interventions for the young population on a school environment. The scientific and technological knowledge impact generated and disseminated by the project will contribute for regional and national valorisation, on a logic translation of knowledge.

## References

1. Amendoeira J, Carreira T, Cruz O, Dias H, Santiago MC. Programas de educação sexual em meio escolar: Revisão sistemática da literatura*, Revista da UIPS. 2013;1(4):198-211.

2. André C, Amendoeira J. Intervention programs for the prevention of smoking in children and adolescents: A systematic literature review. Atenção Primária. 2013;45(Especial C):23.

3. Matos M, Simões C, Camacho I, Reis M. A Saúde dos Adolescentes Portugueses em tempos de recessão. HBSC; 2015. Acedido em:www.aventurasocial.com

4. Ministério da Saúde. Plano Nacional de Saúde - Orientações estratégicas para 2012-2016. Lisboa, Portugal: DGS; 2012.

## Keywords

Health promotion, Empowerment, Health literacy, Young population.

## P169

### Effects of education on functional health: mobility and musculoskeletal back pain in the elderly

Gustavo Desouzart<fnref n="1" />,²,<fnref n="3" />, Cristina Farias<fnref n="3" />, Sandra Gagulic<fnref n="1" />,²,<fnref n="3" />

**Correspondence:** Gustavo Desouzart (gustavodesouzart@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P169

### Background

The bio-psycho-social changes that seniors undergo determine the importance of promoting a better quality of life, simultaneously with the extension of life expectancy. In what concerns this theme, a new concept of aging emerges, "the active aging" [1,2].

### Objective

The aim of the study is to evaluate the effects of a functional health education program on the functional capacity of a group of elderly.

### Methods

This is an experimental study, with a sample of 20 elderly people aged 67-91 years (mean of 80.70 ± 5.99), who attended day centres and were enrolled in the "Atividade Sénior" Program. This Program was developed by the social responsibility of the Viseu city council and is very important among the community, to promote physical activity in the population. Elders were randomly assigned to Experimental (n=10) and Control (n=10) groups. During this study all individuals maintained the physical activity training of the "Atividade Sénior" Program, where the experimental group had a training with aerobic, flexibility and strength components, associated with stimulation. The exercise program lasted 12 weeks with a frequency of 3 times a week, with each session lasting 30 minutes. The study was pre and post-tested, with the following scales: Timed Up and Go (TUG), to check the functional capacity [3] and the Visual Analogue Scale (VAS) to check pain level [4], with the use of body chart for identifying the site of pain. The study was submitted to the

International Ethics Committee in accordance with the guidelines of the World Health Organization (WHO).

## Results

In the study population, 80% of the elderly indicated some type of back pain. Of these, 50% indicated that the pain is chronic and 81.2% indicated that the main location is low back pain. At the beginning of the study participants had a mean pain according to the VAS of 5.70; the experimental group with a mean pain score of 7.10 and the control group with an average of 4.30. After 12 weeks, the participants presented a reduction in pain level (3.78), the experimental group with a significant reduction to 3.38 (p= 0.034), and the control group also with a reduction to 3.70 (p= 0.529). Regarding the functionality, according to the TUG, the experimental group obtained the mean initial time of 21.10 +10.06 and the final time of 16.32 ± 7.80 (p= 0.043), compared to the control group (p= 0.436).

## Conclusions

The implemented program demonstrated that physical exercise in general allows global improvements in the elderly population of day centres, and the specific implementation of a functional mobility physiotherapy program has allowed significant results. Then there is the awakening to this theme.

## Acknowledgements

Authors would like to thank those responsible for the senior activity program of the Municipal Council of Viseu, as well as to thank participants, local promoters and day centres.

## Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) registration number: ACTRN12617001170314.

## References

1. Desouzart G, Matos R, Melo F, Filgueiras E. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work. 2016;53(2).

2. WHO AA. A policy Framework. Geneva, Switz World Health Organ. 2002.

3. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. Oxford University Press; 2002;82(2):128-137.

4. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. PAIN*. Elsevier; 2011;152(10):2399-2404.

## Keywords

Functional health, Senior activity, Back pain.

## P170

### The Practice Environment Scale of the Nursing Work Index (PES-NWI): validation to primary health care

Eva Menino<fnref n="1" />, Maria A Dixe²,<fnref n="3" />, Clarisse Louro², Francisco Stefanie<fnref n="4" />

**Correspondence:** Eva Menino (eva.guilherme@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P170

### Background

The environment of nurses' professional practice and the adequacy of resources are structural factors that are related to the results and quality of care. The validated PES scale for the Portuguese population is adequate to evaluate the conditions for nursing practice, and it was validated in Portugal in hospital settings but not in primary health care. This study proposes to make content validation for primary health care and its psychometric validation, having obtained previous authorization of the author for this validation.

### Objective

Validation of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for Primary Health Care.

<footnote n="1">¹Research in Education and Community Intervention, Piaget Institute, 1950-157 Lisbon, Portugal; ²Piaget Institute, 1950-157 Lisbon, Portugal;</footnote>

<footnote n="3">³Health School of Viseu, Piaget Institute, 3515-776 Viseu, Portugal</footnote>

<footnote n="1">¹Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906</footnote>

<footnote>Lisbon, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal;</footnote>

<footnote n="4">⁴Posto Saúde da Junta de Freguesia de Penha de França, 1170-070 Lisboa, Portugal</footnote>
## Methods

The original scale was submitted to a panel of 5 experts. We decided to keep items with levels of agreement greater than 75%, after analysing and after making the changes suggested, we submitted the scale to a second round by the same panel of experts. The new version was used to determine its psychometric characteristics and its revalidation.

## Results

The PES version adapted for primary health care presents a Cronbach value of 0.905, meaning a very good internal consistency, with reasonable correlation values for each item with the total of the scale (0.315-0.685). In the analysis through the matrix of main components, only factorial loads above 0.30 were considered, so it was necessary to regroup the items by factors, other than the original scale. Considering the KMO value of 0.797, which indicates that there is a good correlation between the variables, and with a Bartlett test (1407.494, $p < 0.001$), we could infer that the variables are significantly correlated and consequently we can confirm the validity of the adapted scale. Between the original scale and the one obtained, we identified factors that focus on the same areas, but there was a change in the items that make up these factors. These changes are expected and show greater adequacy regarding the differences between primary and hospital health care. There are differences regarding the items that portray the nurse's functions, which is in line with the evidence that shows that the community context is generally more favourable for nurses to perform autonomous functions.

## Conclusions

It is considered essential to use valid instruments to evaluate the characteristics of the nursing practice environment in Primary Health Care, since it is the first "door" to access to health services, with nurses having a central role in this context.

## Keywords

Public Health Nursing, Continuous quality management, Validation studies.

P171

# Elaboration of an IAP prevention clinical practice guideline using the ADAPTE methodology

Ana Sousa¹,²,³, Cândita Ferrito⁴, José A Paiva²

¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Centro Hospitalar S. João, 4200-319 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ⁴Escola Superior de Saúde, Instituto Politécnico de Setúbal, 2914-503 Setúbal, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P171

## Background

Intubation associated pneumonia (IAP) is the most frequent health care associated infection in Intensive Care Units (ICU), causing increased length of stay, multiple health and economic costs and antibiotic resistance [1-4]. The impact of this infection motivated this study.

## Objective

Elaborate a Clinical Practice Guideline (CPG).

## Methods

Using the ADAPTE methodology, we performed the following sequence of steps: Configuration (definition of the study area, objectives and research questions), Adaptation (search for guidelines and other relevant documents, quality selection and assessment of currency, acceptability and applicability and elaboration of recommendations); Finalization (production of the final document, implementation and statistical data

collection in terms of feedback by users about its contributions and final result). We evaluated the document regarding its quality through the application of the AGREE II instrument and its clarity, content and applicability through the presentation of the CPG draft and the application of a questionnaire to all its users in three ICUs. These results were processed using the Statistical Package for the Social Sciences system.

## Results

After assessment of evidence grade, applicability and acceptability, we included in the CPG eight recommendations: avoid endotracheal intubation; daily sedation assessment and reduction; daily ventilator weaning; change ventilator circuit only when visibly soiled; head of bed elevation of 30-45°; early exercise and patient mobilization; maintenance of endotracheal tube cuff pressure between 20-30 cm H₂O; oral hygiene care with chlorhexidine 0.12% or 0.20% [5-9]. Regarding the application of the AGREE II, the CPG obtained a rating of 7 in all domains, which corresponds to a high quality. The questionnaire obtained a total of 82 responses, which corresponds to a rate of 45.6% of the respondents. All of the health care professionals stated that CPG's objective is clear, relevant and agree with the content and the adequacy of the recommendations. Regarding applicability, 89% of the respondents stated that is applicable.

## Conclusions

There is a lack of systematization and adequacy concerning CPG's elaboration. This methodology allowed us to find the most recent recommendations regarding IAP prevention and adapt to a specific scenario successfully according to quality and user's evaluation. We can find a limitation of the study in the fact that the evidence supporting some of the recommendations included in the CPG is moderate, and there is a shortage of experimental studies that assess the impact of implementing each individual recommendation. In the next phase

## References

1. Agbaht K, Díaz E, Muñoz E, Lisboa T, Gómez F, Depuydt PO, et al. Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: a study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia. Crit Care Med. 2007;35:2064-2070.

2. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.

3. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care-associated pneumonia., 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.

4. Tejерina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care. 2006;21:56-65.

5. Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35 Suppl 2:S133-54.

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

7. Bo, Lulong & Li, Jinbao & Tao, Tianzhu & Bai, Yu & Ye, Xiaofei & S. Hotchkiss, Richard & H. Kollef, Marin & Crooks, Neil & Deng, Xiaoming. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014; 10.

8. Paiva et al. "Feixe de Intervenções" de Prevenção de Pneumonia Associada à Intubação. Departamento da Qualidade na Saúde da Direção-Geral da Saúde. Direção-Geral da Saúde. 2015; 021/2015.
9. National Guideline C. Prevention of ventilator-associated pneumonia. Health care protocol. 2011.

Keywords

ADAPTE, Clinical Practice Guideline, Health Care Associated Infection, Intubation-associated pneumonia, ICU.

P172

The factorial analysis of a quality of life scale for people addicted to drugs in methadone programs

Paulo Seabra¹, José Amendoeira², Luís Sá¹, Olga Valentim³, Manuel Capelas¹

¹Interdisciplinary Research Health Center, Portuguese Catholic University, Health Sciences Institute, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Health Center, Polytechnic Institute of Santarém, Health School, 2005-075 Santarém, Portugal; ³Portuguese Catholic University, Health Sciences Institute, 1649-023 Lisbon, Portugal

**Correspondence:** Paulo Seabra (pauloseabra@ics.lisboa.ucp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P172

Background

The evaluation scale of drug users Quality of life (QoL) in a substitu-
tion program with methadone, was developed with 21 items, two
subscales, “family and economic situation” (11 items) and “personal
satisfaction” (10 items) [1]. Concerning their reliability, in the valid-
ation study for the Portuguese population in 2005 (n=236) was ob-
tained an Alfa of Cronbach of 0.88 and in a recent study in
2011(n=308) of 0.93 [1].

Objective

To determine a scale factorial structure and its psychometric
properties.

Methods

Methodological study. Participants – 180 drug users participated, aging an average of 41 years (SD=7.58 [24-69]), mostly men (73.3%), single (55.6%) and with children (52.8%), from 3 outpatients drug units. Data analyses - The correlation matrix of the items was evaluated through exploratory and confirmatory factorial analysis. The factorial load as well as the internal consistency estimated the dimensionality.

Results

In the reliability analysis with 21 items was found an Alfa of Cron-
bach of 0.89, all communalities >0.40, KMO=0.88 (p<0.001) and
58.42% of explained variance by 5 factors. When extracted item 18
(item-total correlation 0.16), all items assumed an item-total correl-
ation > 0.20; alpha increased (α=0.90) and KMO increased to 0.88
maintaining the stability of the Bartlett test; communalities main-
tained above 0.40; total variance explained by the 5 factors increased
to 60.4%, but 5 factors diverged from theoretical matrix and 10 items
weighed in more than one factor. Through confirmatory analysis (ex-
cluding item 18) forcing for the 2 original scale factors, we verified
that 4 items had commonalities <0.30. The total variance explained
after the spin fell to 43.11% and 4 items weighed in more than one
factor. We explored with 3 factors, KMO maintained in 0.88, Bartlett
test remained within criteria, total variance explained after de rota-
tion stayed 49.6%. Although this structure presents 3 items weigh in
more than one factor, justifies its maintenance by underlying the the-
oretical model. Alpha is higher to initial (α=0.90). The extraction of
any item will weaken scale consistency. The most stable structure
was with 3 renamed factors: 1- Personal satisfaction and self-care (8
items) (38.5% explained variance); Social Family situation (8 items)
(7.4%); 3- Socio professional and economic situation (4 items) (6.5%).
The fidelity of the scale is reinforced by the internal consistency of
its subscales, factor 1 α=0.85; factor 2 α=0.79; factor 3 α=0.72 and by
the correlation between them (0.51-0.67; p<0.01).

Conclusions

Good internal consistency. Factorial analysis supported by the theor-
etical matrix. Good discriminant capacity by differences pointed out
in some variables.

References

1. Murcho N, Pereira P. A qualidade de vida dos doentes toxicodependentes em programas de substituição com metadona no Algarve: Um estudo comparativo da sua situação em 2003 e 2008. Rev Investig em Enferm. 2011;(23):57-64.

Keywords

Quality of Life, Substance related disorders, Assessment, Nursing, Methadone.

P173

Occupational sedentary lifestyle and overweight among workers of
a higher education institution – Coimbra

Sónia Fialho¹, Anabela Martins², João Almeida³

¹Dietetics and Nutrition Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Physiotherapy Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ³Environmental Health Department, Coimbra Health School, 3046-854 Coimbra, Portugal

**Correspondence:** Sónia Fialho (sonia.fialho@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P173

Background

In the last decades, with the introduction of changes in the work
processes and with the innovation inherent to new technologies,
there has been an increase of the sedentary labour lifestyle,
where the worker remains sitting for long periods of time in a
working day. Sedentary behaviour is associated with an increased
risk of developing chronic diseases such as obesity, type II dia-
betes, cardiovascular diseases, and these diseases are the main
cause of mortality and morbidity in Portugal.

Objective

This study aims to evaluate the relationship between sedentary work and overweight in teaching and non-teaching workers.

Methods

The Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was applied and then calculated the percentage of the activity for each domain (sitting, standing, walking) by the number of hours worked per day. Data on age, gender and body mass index, between December 2017 and January 2018, were collected from a sample of 58 adult men and women in full-time employment at the time of the study. To study the correlation between the percentage of the occupational sitting by the number of working hours per day and overweight, authors analysed the information with SPSS Statistics.

Results

In the present study, 39 of the individuals were females and 19
males, aged between 31 and 62 years. In the analysis done to the
OSPAQ, 44 (75.8%) individuals spend more than 50% of their working
day in the sitting position. In relation to the BMI, considering the pur-
pose of the study and according to the classification of the World
Health Organization, 32 (55.2%) of the individuals presented a BMI ≥
25. Pearson correlation revealed that there is no association between
the sitting time and the BMI ≥ 25 (p> 0.05).

Conclusions

With this study it was possible to verify that there are individuals
with a sedentary lifestyle associated to their work day. Although in
this study there is no association between occupational sitting and
BMI ≥ 25, despite there are studies that demonstrate a significant as-
sociation between these two parameters. A further study, including
other criteria, is in progress, involving the anthropometric level, such
as body fat, waist circumference and physical activity assessments.

References

1.Yang

L, Hipp JA, Lee JA., Tabak RG, Dodson EA, Marx CM, Brownson RC. Work-related correlates of occupational sitting in a diverse sample of employees in Midwest metropolitan cities. Preventive Medicine Reports. 2017;6:197-202.
2. Chau J, Van der Ploeg H, Dunn S, Kurko J, Bauman A. Validity of the occupational sitting and physical activity questionnaire. Medicine & Science in Sports & Exercise. 2012;44(1):118-125.

3. Lin T, Courtney TK, Lombardi DA, Verma SK. Association between sedentary work and BMI in a U.S. national longitudinal survey. American Journal of Preventive Medicine. 2015;49(6):117-123.

4. Mummery WK, Schofield GM, Steele R, Eakin EG, Brown WJ. Occupational sitting time and overweight and obesity in Australian workers. American Journal of Preventive Medicine. 2005;29:91-97.

## Keywords

Health promotion, Sedentary behaviour, Body mass index, Workplace.

## P174

### Oral health assessment among elderly stroke patients

Nélio Veiga¹,², Ricardo Figueiredo¹, António Coelho¹, André Almeida¹, Gonçalo Lopes¹, Salvatore Bellantone¹

¹Health Sciences Institute, Portuguese Catholic University, 3504-505

Viseu, Portugal; ²Center for Interdisciplinary Health Research, Portuguese Catholic University, 3504-505 Viseu, Portugal

**Correspondence:** Nélio Veiga (nelioveiga@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P174

### Background

Oral hygiene can become a very difficult task for patients who have suffered a stroke, due to motor and cognitive complications and lack of coordination, which usually accompany the post-stroke period. Many of these patients require support from caregivers to properly hygiene the oral cavity as well as, their prostheses.

### Objective

Characterization of oral health among elderly who have suffered a stroke.

### Methods

A cross-sectional observational study was carried out in institutionalized elderly individuals aged between 60 and 98 years old. Data collection was carried out in two households in the city of Viseu, Portugal: Fundação Dona Mariana Seixas and Viscondessa House of São Caetano. Due to health limitations of the study participants, in terms of speech and cognitive problems, the final sample consisted of 30 participants. Data collection was achieved through the application of a questionnaire.

### Results

Of the final sample, 20 elderlies had at least one stroke episode, representing 67% of the sample. Of these 20 elderlies, 5 reported having had cognitive or speech sequelae, while the remaining 15 reported that the main sequel was motor dysfunction. Of a total of 30 institutionalized elderly, 19 had total absence of dental pieces, corresponding to 63% of the sample. However, the remaining 37% reported multiple dental losses due mainly to dental caries and periodontal problems. These problems may be associated with deficient oral hygiene of the participants, where 18 affirm that they perform dental or denture brushing only once a day, while 40% said they did not take care of their own oral hygiene.

### Conclusions

Within the limitations of this study, it is possible to conclude that stroke is a constant among the Portuguese population and that patients who have suffered from stroke have a lower oral hygiene.

## Keywords

Stroke, Oral hygiene, Elderly, Oral health, Dysfunction.

## P175

### The daily life of people with human immunodeficiency virus in an island space: what trends?

Gilberta Sousa¹, Maria A Lopes², Vitória Mourão³

¹Universidade da Madeira, 9000-034 Funchal, Madeira, Portugal; ²Escola Superior de Enfermagem Lisboa, 1600-190 Lisboa, Portugal;

³Universidade de Lisboa, 1649-004 Lisboa, Portugal

**Correspondence:** Gilberta Sousa (gfranca@uma.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P175

### Background

Human immunodeficiency virus/acquired immunodeficiency virus (HIV/AIDS) infection continues to haunt the lives of millions of people and, despite the progress made in the treatment of HIV/AIDS, it is estimated that 36.7 million people in the world living with HIV in 2017 [1]. In the year 2016 and until June 30, 2017, 1,030 new cases of HIV infection were reported, corresponding mostly (99.7%) to individuals aged ≥ 15 years. Portugal has had the highest rates of new cases of HIV and AIDS infection in the European Union [2]. We found that it is not possible to stop the HIV epidemic only with medical interventions. It is vital to address in everyday life the underlying social issues that prevent people from accessing interventions for prevention, diagnosis and treatment of infection, including unequal human rights, stigma and discrimination. When a person is stigmatized or unable to access services as a result of discrimination, the health of the entire community is threatened and epidemic HIV transmission continues to expand rather than to contract [3].

### Objective

To understand how people live with HIV/AIDS, everyday life in an island space.

### Methods

Qualitative study, grounded theory [4], in-depth interviews were carried out, in a convenience sample, to seropositive adults of any sexual orientation who wished to talk about their experience. Data analysis included initial coding, grouping of codes, identification of categories/subcategories and memos. Fulfilled ethical requirements and assent of an ethics committee were obtained.

### Results

Participants were between the ages of 25 and 67 and had primary education as well as secondary education. The analysis of the data gave rise to three categories: "living with fear", "surviving" and "facing fear". The data are discussed in the light of the theory of transitions [5] of how to live everyday life in an island space.

### Conclusions

We hope that the findings help in understanding the daily lives of people with HIV/AIDS, because in order to overcome this transition they have to reconfigure their way of living, especially when living on an Island. Realize how they face and fight in the daily life against stigma; what are the most demanding situations they face and what strategies they use. The strategies used and suggested will give subsidies to the health system and nursing professionals towards the design of new programs that will enable each patient to respond to their individual needs with the resources that each one has.

## References

1. UNAIDS, Right to Heath - My health, My right. 2017. Available in: http://www.unaids.org/sites/default/files/media_asset/RighttoHealthReport_Full_web%202020%20Nov.pdf

2. PORTUGAL. Ministério da Saúde. Instituto Nacional de Saúde Doutor Ricardo Jorge, IP, Infeção VIH/SIDA: a situação em Portugal a 31 de dezembro de 2016/Departamento de Doenças Infeciosas do INSA. Unidade de Referência e Vigilância Epidemiológica; Programa Nacional para a Infeção VIH/SIDA. Direção-Geral da Saúde. - Lisboa: Instituto
Nacional de Saúde Doutor Ricardo Jorge, IP, - (Documento VIH/SIDA; 148). 2017.

3. PEPFAR. President's Emergency Plan for AIDS Relief. U.S. Department of State Office of the U.S. Global AIDS Coordinator and Health Diplomacy 2017. https://www.pepfar.gov/documents/organization/267809.pdf

4. Charmaz K. Constructing Grounded Theory. 2nd edition. London: Sage Publications Limited; 2014.

5. Meleis AI, Sawyer LM, Im EO, Hilfinger Messias DK, Schumacher K. Experiencing Transitions: An Emerging Middle-Rang Theory. ANS Adv Nurs Sci. 2000;23(1):12-28.

### Keywords

People with HIV/AIDS, Theory of transitions, Everyday life, Stigma, Nursing.

## P176

### Validation of the nursing diagnosis of impaired walking in elderly

Cristina Marques-Vieria¹,², Luís Sousa³,⁴, Débora Costa⁵, Cláudia Mendes⁵, Lisete Sousa⁵,⁶, Sílvia Caldeira¹,²

¹Lisbon School of Nursing, Institute of Health Sciences, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Center for Health, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ³Curry Cabral Hospital, Central Lisbon Center Hospital, 1069-166 Lisbon, Portugal; ⁴Atlântica School of Health, 2730-036 Barcarena, Portugal; ⁵Faculty of Science, Lisbon University, 1749-016 Lisbon, Portugal; ⁶Statistics and Applications Center, Lisbon University, 1749-016 Lisbon, Portugal

**Correspondence:** Cristina Marques-Vieria
(cristina.marques@ics.lisboa.ucp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P176

### Background

The increase in longevity causes restriction of activity in the elderly, causing changes on the execution of daily activities and consequently on the quality of life [1]. Walk is an activity that requires using a variety of skills and can be highly complex particularly for the elderly people [2]. The nursing diagnosis impaired walking is part of NANDA International since 1998 and requires further validation to improve the clinical evidence [3].

### Objective

To validate the nursing diagnosis impaired walking in a sample composed of elderly.

### Methods

Observational, cross-sectional and quantitative study. After the first research phase of systematic literature review several defining characteristics and related factors of the diagnosis impaired walking have been listed.2 Then, the translation, linguistic and cultural adaptation of the nursing diagnosis was conducted, and finally, the clinical validation of the diagnosis using the clinical validation model of Richard Fehring [4], in a sample of elderly and counting on the collaboration of registered nurses and rehabilitation nurses to collect the data and fill the questionnaires, which comprised demographic data, the defining characteristics, related factors and falls efficacy scale international [5]. The study was approved by the ethical committee of SESARAM. E.P.E (Madeira Island Healthcare System).

### Results

In the systematic literature review 17 defining characteristics and 34 etiological factors of impaired walking have been identified. A European Portuguese version was obtained to validate in a sample of 126 elderly, whose average age was 73.86 years, mostly female, with the primary school, in a situation of retirement, widowed and with history of falls. The prevalence of "impaired walk" was 64.3% according to the expert's opinion and 67.5% according to the elderly. All defining characteristics and related factors have been validated. The most sensitive defining characteristic was nine (e.g. impaired ability of gait speed) and also four related factors (fear of falling, physical deconditioning, medication and feminine gender).

### Conclusions

This study justifies the need to review the defining characteristics and related factors of impaired walking. The identification of the

most sensitive defining characteristics facilitates nurses' clinical reasoning and interventions towards effective nursing outcomes.

### References

1. Marques-Vieira CM, Sousa LM, Carías JF, Caldeira SM. Nursing diagnosis "impaired walking" in elderly patients: integrative literature review. Rev Gaucha Enferm. 2015;36(1):104-111.

2. Marques-Vieira CM, Sousa LM, Sousa LM, Berenger SM. The nursing diagnosis impaired walking in elderly: systematic literature review. Texto & Contexto Enferm. 2016;25(3):e3350015.

3. Herdman HT, Kamitsuru S, editors. Nursing Diagnoses: Definitions & Classification 2018-2020. Oxford: Wiley-Blackwell; 2017.

4. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung. 1987;16(6):625-629.

5. Marques-Vieira CM, Sousa LM, Severino S, Sousa L, Caldeira S. Cross-cultural validation of the falls efficacy scale international in elderly: systematic literature review. J Clin Gerontol Geriatr. 2016;7(3):72-76.

### Keywords

Nursing, Nursing Diagnosis, Walking, Gait, Validation studies.

## P177

### Validation of the nursing diagnosis risk for falls in elderly

Cristina Marques-Vieria¹,², Luís Sousa³,⁴, Débora Costa⁵, Cláudia Mendes⁵, Lisete Sousa⁵,⁶, Sílvia Caldeira¹,²

¹Lisbon School of Nursing, Institute of Health Sciences, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ²Interdisciplinary Research Center for Health, Portuguese Catholic University, 1649-023 Lisbon, Portugal; ³Curry Cabral Hospital, Central Lisbon Center Hospital, 1069-166 Lisbon, Portugal; ⁴Atlântica School of Health, 2730-036 Barcarena, Portugal; ⁵Faculty of Science, Lisbon University, 1749-016 Lisbon, Portugal; ⁶Statistics and Applications Center, Lisbon University, 1749-016 Lisbon, Portugal

**Correspondence:** Cristina Marques-Vieria
(cristina.marques@ics.lisboa.ucp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P177

### Background

Falls and their consequences are critical for for elderly well-being quality of life, for caregivers, and for health care providers [1]. The nursing diagnosis risk for falls is listed in NANDA International since 2000 [2]. This diagnosis seems particularly important in planning effective nursing care for the community-dwelling elderly.

### Objective

To validate the nursing diagnosis risk for falls in a sample of elderly.

### Methods

Observational, cross-sectional and quantitative study conducted in three phases. The first phase, corresponded to a systematic literature review to identify the risk factors of risk for falls [3]. The second phase consisted of the translation, linguistic and cultural adaptation of the nursing diagnosis for European Portuguese language. The third, was the clinical validation of the diagnosis using the clinical validation model of Richard Fehring [4], in a sample of elderly and counting on the collaboration of registered nurses and rehabilitation nurses to collect the data and fill the questionnaires, which comprised demographic data, the risk factors and falls efficacy scale international [5]. The study was approved by the ethical committee of SESARAM. E.P.E (Madeira Island Healthcare System).

### Results

A total of 50 risk factors of risk for falls have been identified in the systematic literature review. A European Portuguese version was obtained and submitted to the clinical validation in a sample of 126 elderly, whose average age was 73.86 years, mostly female, with the primary school, in a situation of retirement, widowed and with history of falls. The prevalence of risk for falls was 68.3% in the expert's opinion and 63.5% in the opinion of the elderly. All risk factors have been validated. The most sensitive risk factor was history of falls, comorbidities, feminine gender, polymedication, difficulty with gait, and drugs.
## Conclusions

This study found the main risk factors for falls in a sample of community-dwelling elderly. The identification of the most sensitive risk factors may support nurses' clinical reasoning and interventions for effective fall prevention.

## References

1. Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Systematic Reviews. J Geriatr Phys Ther. 2017;40:1-36.

2. Herdman HT, Kamitsuru S, editors. Nursing Diagnoses: Definitions & Classification 2018-2020. Oxford: Wiley-Blackwell; 2017.

3. Sousa LM, Marques-Vieira CM, Caldevilla MN, Henriques CM, Severino SS, Caldeira SM. Risk for falls among community-dwelling older people: systematic literature review. Rev Gaucha Enferm. 2017;37(4):e55030.

4. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung. 1987;16(6 Pt 1):625-629.

5. Marques-Vieira CM, Sousa LM, Severino S, Sousa L, Caldeira S. Cross-cultural validation of the falls efficacy scale international in elderly: systematic literature review. J Clin Gerontol Geriatr. 2016;7(3):72-76.

## Keywords

Nursing, Nursing Diagnosis, Risk for falls, Fear of falling, Validation studies.

## P178

### Teachers and professors' mental health: prevalence of self-reported psychological symptoms

Ana Querido¹,², Catarina Tomás¹,², Daniel Carvalho³, Marina Cordeiro¹,², João Gomes³

¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Santo André Hospital, Hospital Center of Leiria, 2410-197 Leiria, Portugal

**Correspondence:** Ana Querido (ana.querido@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P178

### Background

The work of teaching professionals is recognized to be demanding, involving dynamic interactions with students, parents, colleagues and school authorities [1]. Teaching has been ranked as one of the most stressful profession and its nature is applicable to all professional teaching roles. Several research reports have consistently documented physical and psychological symptoms experienced by teaching professionals. Several physical complaints and psychosomatic symptoms such as lower back pain, headache, voice disorders and anxiety are frequently faced by teaching professionals, both in secondary and higher education, especially in women [1-5]. Presence of psychopathology symptoms in teachers are related to their rating of children mental health behaviors [6], as well as determinants to professional burnout. Therefore, identification of psychological symptoms among teachers is relevant in secondary and higher education.

### Objective

To identify the prevalence of self-reported psychological symptoms; Characterize the symptoms by its dimension and determine the differences in psychological symptoms between high school teachers and higher education professors.

### Methods

Cross-sectional correlational study, with a non-probabilistic sample of 96 Portuguese teaching professionals. Data were collected using an on-line questionnaire composed by sociodemographic questions and the Portuguese version of Brief Symptom Inventory (BSI) - 53 items covering nine symptom dimensions: Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation and Psychoticism; and three indices of distress: Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST). Ethical procedures were taken into account.

## Results

Teaching professionals were mostly women (70.8%), aged between 30 and 62 years old (Mean=44.8; SD=7.86), 43.8% with a bachelor degree, 27.1% diagnosed with a mental disease, and 41.1% acquainted with mental health patients. Professors (37.5%) were from different fields, including health, engineering, arts, communication, social sciences, marketing and sports. High school teachers (62.5%) were mainly from sociology, philosophy and mathematics. The most scored dimension was Obsession-Compulsion in high school teachers (Mean=1.03; SD=0.75). Globally high school teachers revealed more symptoms of distress than higher education professors. Significant differences between groups were found in Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety, Phobic Anxiety, Psychoticism, GSI and PST (p < 0.05). In the 53 BSI items, the PST was low (Mean=19.09; SD=12.70).

### Conclusions

Prevalence of symptoms were high in the samples of teaching professionals, although they experienced psychological distress in low intensity. Differences between high school teachers and higher education professors were highlighted in this study. Therefore, there is a need for intervention among high school teachers to minimize the impact of detecting mental disorders in students, as well as preventing professional absents and burn-out.

## References

1. Au DWH, Tsang HWH, Lee JLC, Leung CHT, Lo JYT, Ngai SPC, et al. Psychosomatic and physical responses to a multi-component stress management program among teaching professionals: A randomized study of cognitive behavioral intervention (CB) with complementary and alternative medicine (CAM) approach. Behav Res Ther. 2016;80:10-16.

2. Chan AHS, Chong EYL. Subjective Health Complaints of Teachers From Primary and Secondary Schools in Hong Kong. Int J Occup Saf Ergon. 2010;16(1):23-39.

3. Ferreira RC, Silveira AP da, Sá MAB de, Feres S de BL, Souza JGS, Martins AME de BL. Transtorno mental e estressores no trabalho entre professores universitários da área da saúde. Trab Educ e Saúde. 2015;13(suppl 1):135-155.

4. Seibt R, Spitzer S, Druschke D, Scheuch K, Hinz A. Predictors of mental health in female teachers. Int J Occup Med Environ Health. 2013;26(6):856-869.

5. Zamri EN, Moy FM, Hoe VCW. Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia. PLoS One. 2017;12(2):e0172195.

6. Kokkinos CM, Kargiotidis A. Rating students' problem behaviour: the role of teachers' individual characteristics. Educ Psychol. 2016;36(8):1516-32.

## Keywords

Mental health, Psychological symptoms, Teachers, Teaching professionals.

## P179

### Generating high vegetable liking among young children to promote healthy eating: results from an intervention at a kindergarten school

Cátia Braga-Pontes¹,², Ana Pinto Moura³, Luís Cunha⁴

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Sciences and Technology Department, Open University of Portugal, 4200-055 Porto, Portugal; ⁴Department of Geosciences, Environment and Spatial Planning Faculty of Sciences, University of Porto, 4485-661 Vila do Conde, Portugal

**Correspondence:** Luís Cunha (lmcunha@fc.up.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P179

### Background

Fruit and vegetables have always played a prominent role in dietary recommendations because of their high concentration of vitamins, minerals, phytochemicals and because they are a great source of fibre [1,2]. Recent data show that in general, the population should
at least double consumption of fruit and vegetables in order to reach the 400g/day recommended by World Health Organization (WHO) [3]. In Portugal, the data presented by the National Food Survey in 2017 showed that 68.9% of children do not consume more than 400g/day of fruit and vegetables, highlighting a lower consumption of vegetables compared to fruit [4].

### Objective

The purpose of this study was to evaluate the impact of a food intervention, with exposure combined with a tangible reward, on food neophobia, liking and intake of different vegetables, at the kindergarten school environment, in the South of Portugal.

### Methods

Children (n=82) aged 2 to 5 years old, from different classes, were randomly assigned by class to intervention (n=68) or control group (n=16) and the intervention lasted nine weeks. Children food neophobia [5] and eating behaviour [6,7] were evaluated by parents at the beginning of the intervention. Mother's food neophobia [8] was also measured. In each week, children attended an educative session about the vegetable they would eat at lunch (carrot, bell pepper, broccoli, tomato, cucumber, purple cabbage, spinach, arugula and beet), being rewarded with a sticker when eating the vegetable. Assessments of intake and liking were recorded at baseline sessions and after each exposure, using ASTM's pictorial scales for children [9]. Children at control group were exposed at the same experiment after the intervention group during the subsequent nine weeks.

### Results

Children from both groups presented high levels of liking for the different vegetables, with this being modulated by the children's traces of personality and eating behaviour.

### Conclusions

Exposure to the different vegetables with a playful approach yields high liking scores for a range of vegetables, indicating that such an approach has good potential to overcome vegetables avoidance by young children.

### Trial Registration

NCT03513081

### References

1. Rodriguez-Casado A. The Health Potential of Fruits and Vegetables Phytochemicals: Notable Examples. Critical reviews in food science and nutrition. 2016;56(7):1097-107.

2. Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Advances in Nutrition. 2012;3(4):506-16.

3. Pem D, Jeewon R. Fruit and Vegetable Intake: Benefits and Progress of Nutrition Education Interventions- Narrative Review Article. Iranian Journal of Public Health. 2015;44(10):1309-21.

4. Lopes C, Oliveira A, Severo M, Alarcão V, Guiomar S, Mota J, et al. Inquérito Alimentar Nacional e de Atividade Física. Porto: Universidade do Porto; 2017.

5. Pliner P. "Development of measures of food neophobia in children". Appetite 1994;23(2):147-163.

6. Wardle J, Guthrie C A, Sanderson S, Rapoport L. Development of the Children's Eating Behaviour Questionnaire. J Child Psychol Psychiatry 2001;42(7):963-970.

7. Viana V, Sinde S. O Comportamento Alimentar em Crianças: estudo de validação de um questionario numa amostra portuguesa (CEBQ). Análise Psicológica 2008;1(XXVI):111-120.

8. Pliner P, Hobden K. Development of a scale to measure the trait of food neophobia in humans. Appetite 1992;19(2):105-120.

9. ASTM. E 2299-03. Standard Guide for Sensory Evaluation of Products by Children. United States, ASTM International; 2008.

### Keywords

Children, Food Neophobia, Playful intervention, Vegetables.

## P180

### The limitations of medicinal package leaflets

Ana P Izidoro¹, Patrícia Correia²

¹Farmácia Rainha, 5140-067 Carrazeda deansiães, Bragança, Portugal;

²Escola Superior de Saúde do Porto, 4200-072 Porto, Portugal

Correspondence: Ana P Izidoro (anaizi_20@outlook.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P180

### Background

It is known that, in order to solve most of the existing health problems, it is often fundamental that a pharmacological approach exists. For this reason, patients must be adequately informed about their health status and about the medicines they are using. One of the most important resources of medicines information, available for patients, is the information leaflet. It provides a set of understandable information and should contribute to the appropriate and safe use of information, complementing the information given by health professionals. However, the content appears to be quite complex or too technical and the text is very dense and with a reduced font size, making it intimidating and difficult to read.

### Objectives

The main objectives of this study are: to identify if users read the information leaflet and whether reading frequency is associated with the importance they attribute to it; and to identify the limitations attributed by the respondents to information leaflets and possible relationships with the socio-demographic characteristics of the population.

### Methods

This was a transversal and inferential descriptive observational study, which took place between March and November, 2017, based on the application of a questionnaire in the form of an interview to 320 Bragança residents. Various data were collected, particularly with regard to the frequency of reading the information leaflets, the importance attributed to the same or each section, and existing limitations.

### Results

Regarding the possible relationships between the data obtained, it was verified that there is sufficient statistical evidence to affirm that there is an association between the reading frequency of the information leaflet and the importance attributed to it, but the same cannot be trusted as to the association between the limitations attributed to the information leaflets and the socio-demographic characteristics of the respondents.

### Conclusions

In sum, these associations and the fact that most respondents have indicated, as the main limitation in reading information leaflets, the use of very technical language, may mean that the information leaflet is not being developed in order to promote reading by part of the youngest or the oldest, which are the groups presenting the major reading difficulties.

### Keywords

Information leaflet, Illiteracy, Information, Limitations, Adherence to therapy.

## P181

### Eating habits and perception of body image in higher education students

Helena Catarino¹,², Clementina Gordo¹

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

Correspondence: Helena Catarino (helena.catarino@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P181
**Background**

The transition to higher education is one of the risk factors in the adoption and maintenance of healthy lifestyles [1] and, at this stage, many students develop concerns related to eating habits, their body [2] and body image.

**Objective**

This correlational study had two main objectives, namely, to characterize eating habits and the perception of body image among higher education students; and to relate eating habits to the students' perception of body image.

**Methods**

We used a questionnaire to collect socio-demographic and anthropometric data, an eating habits scale [3] and the body shape questionnaire [4]. The non-probabilistic convenience sample consisted of 386 students, with mean age of 21.94 years (SD = 5.30), of which 82.9% were females.

**Results**

According to WHO Body Mass Index classification, 72.3% of the students presented normal weight, 14% pre-obesity and 6.2% moderate thinness. From the point of view of the concerns related with body image, the majority, 54.7% presented no distortion of body image. However, the remaining 45.3% presented distortion of body image and among these, 16.6% presented severe distortion. From the point of view of eating habits, the results show that the sample had adequate eating habits. The majority of respondents ate 5 (36.3%) or 4 (32.6%) meals per day and for the four dimensions of the eating habits scale (quality, quantity, variety and food adequacy), the scores varied between a minimum of 2 and a maximum of 5, where the highest mean value was found at the level of food variety (M = 3.62, SD = 0.53) at the lowest mean value observed was found at the level of food quality (M = 3.40, SD = 0.56). The correlations between the dimensions of the eating habits scale (quality, quantity, variety and food adequacy) and students' perceptions of body image are statistically non-significant (respectively, r = 0.099; r = 0.011; r = -0.046; r = -0.038 and p > 0.05).

**Conclusions**

Although the results show that these students have adequate eating habits, it is important to continue to study the food culture of the populations, to identify individuals at risk, to intervene from the point of view of promoting the acquisition of healthy eating habits, and to study the factors underlying the distortion of body image and its influence on students' physical and mental well-being.

**References**

1. Soares A, Pereira M, Canavarro J. Saúde e qualidade de vida na transição para o ensino superior. Revista Psicologia, Saúde & Doenças. 2014;15(2):356-379.

2. Tekin C, Bozkir C, Nese Karakas N, Gunes G. The relation between the body perceptions and eating habits of the students in Inonu University. Analys of Medical Research. 2017;24(1):1-9.

3. Marques A, Luzio F, Martins J, Vaquinhas M. Hábitos alimentares: validação de uma escala para a população portuguesa. Escola Anna Nery Revista de Enfermagem. 2011;15(2):402-409.

4. Pimenta F, Leal I, Maroco J, Rosa B. Validação do Body Shape Questionnaire (BSQ) numa amostra de mulheres de meia-idade. Atlas do 9º Congresso Nacional de Psicologia da Saúde. Lisboa: Placebo Editora; 2011.

**Keywords**

Eating habits, Body image, Students.

P182

**Psychosocial impact of the assistive technologies for mobility on the participation of wheelchair's users**

Anabela Martins¹, João Pinheiro², Patrícia Francisco¹, Inês Domingues²
¹Physiotherapy Department, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

**Correspondence:** Anabela Martins (anabelacmartins@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P182

**Background**

Recognizing that assistive technology (AT) for mobility play an important role in their users' participation, it will be useful to rehabilitation professionals and services to assess if the perceived psychosocial impact of such devices and associated services, systems and policies contributes to enhance lifelong capacity and performance [1-3]. To build comprehensive rehabilitation services, information on a person's experience in every aspect of his/her life is essential, as well as the role of AT on functioning and, particularly, in participation.

**Objective**

To study the psychosocial impact of manual and powered wheelchairs on the participation of their users.

**Methods**

From May to December 2017, sixty AT users (30 powered and 30 manual wheelchairs), aged 28-66 (mean 46.63 ± 10.66) years old, 53.3% female, with mix diagnosis, were interviewed using the Psychosocial Impact of Assistive Devices Scale (P-PIADS), the Activities and Participation Profile related to Mobility (PAPM) and demographics, clinical and questions about AT use and training.

**Results**

The participation profiles revealed that 6.7% of the participants present no restrictions, 20.0% mild, 35.0% moderate and 38.3% severe restrictions in social participation. All subscales (competence 1.50, adaptability 1.45, self-esteem 1.15) and P-PIADS total (1.38) were positive and moderately correlated to the activities and participation profile. Age and type of wheelchair and training of AT as an intervention do not influence statistically the participation, however, number of years on a wheelchair does. In general, training experiences were described as occurring in a clinical setting base, in terms of to enhance the capacity for handing the new device, with less attention to users' performance in the community and at home, reducing the barriers and promoting a facilitator environment.

**Conclusions**

These results encourage the authors to keep studying the impact of AT for mobility on participation, namely the manual and powered wheelchairs, to develop robust evidence for rehabilitation, giving a contribution to the efforts of the Global Cooperation on Assistive Technology Initiative, and create support for Rehabilitation 2030 A Call for Action4.

**References**

1. Salminen AL, Brandt A, Samuelsson K, Toytari O, Malmivaara A. Mobility devices to promote activity and participation: a systematic review. J Rehabil Med. 2009;41(9):697-706.

2. Lofqvist C, Pettersson C, Iwarsson S, Brandt A. Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use. Disabil Rehabil Assist Technol. 2012;7(3):211-218.

3. Martins A, Pinheiro J, Farias B, Jutai J. Psychosocial Impact of Assistive Technologies for Mobility and Their Implications for Active Ageing. Technologies. 2016;4(3):28.

4. Gimiigliano F, Negrini S. The World Health Organization "Rehabilitation 2030: a call for action". Eur J Phys Rehabil Med 2017;53:155-68.

**Keywords**

Assistive Technologies, Wheelchair, Psychosocial impact, Social participation.

P183

**Unconventional therapies in nursing - innovating the practice**

Maria I Santos (marirene_mps@hotmail.com)
Higher School of Health, Polytechnic Institute of Santarém, 2005-075-Santarém, Portugal
BMC Health Services Research 2018, **18**(Suppl 2):P183

**Background**

The use of unconventional therapies by Nurses was transmitted to us as nursing students, in various clinical teaching contexts.
The disciplinary and professional coherence of these therapies, as well as the therapeutic efficacy they present, legitimizes, from the perspective of nurses, the innovation they constitute in the practice of care.

**Objective**

To understand the process of integrating nonconventional therapies into nursing practice, in the dimensions: identification of therapies in use; meanings assigned and used strategies evaluated by nurses and patients.

**Methods**

Grounded Theory was used, in the constructivist perspective of Kathy Charmaz. The main data collection techniques were the intensive interview and participant observation. Participants were 15 nurses from 9 public hospitals, from the district and central levels, from the north, central and south of the country, and a team of 10 nurses and 17 users of a pain service from an oncology hospital.

**Results**

From the results we point out: nurses innovate their practice of care through the use of nonconventional therapies of environmental, manipulative, mental-cognitive, energetic and relationship nature. The physical, social and normative environments condition the practice of these therapies; the modes of action evidence the importance they confer to the ethical aspects and the (re)combination of several techniques, result in innovative and individualized care. Nurses evaluate these therapies as very effective in various health/illness situations, emphasizing their contribution to well-being.

**Conclusions**

Conclusions and implications of the study: nurses identify a sense of high conceptual and professional coherence of nonconventional therapies with nursing, considering that they innovate and considerably increase the repertoire of practice. The innovation of Nursing practices, through the integration of these therapies, contributes to the well-being of the people cared for and enables them to better manage their health, which is relevant in an aging society.

**Keywords**

Unconventional therapies, Nursing, Innovation practices, Well-being.

P184

Translation and cultural adaptation of English Modified DABS (EMDABS) Scale for Portuguese language

Pedro JC Luz<fnref n="1" />,<fnref n="2" /> (pedrojcluz@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P184

**Background**

The occurrence of aggressive episodes by clients in the contexts of mental health settings are recurrent, being imperative to adapt staff interventions to stabilize the psychopathological state of the client, consequently reducing the risk of injury. The de-escalation technique prevents the escalation of aggressiveness, allows a relationship of trust to be established by demonstrating understanding of the client's problems and concerns [1]. The same authors performed the psychometric validation of the English modified De-Escalating Aggressive Behaviour Scale (EMDABS). This scale aims to evaluate the education/training and de-escalation skills of health professionals, based on seven items: "valuing the client; reducing fear; inquiring about client's queries and anxiety; providing guidance to the client; working out possible agreements; remaining calm; risky". The scale revealed a high level of consistency between the seven items of the de-escalation α=0.901.

**Objective**

This study aims to translate and effect the cultural adaptation of the EMDABS scale to the Portuguese language in order to improve nursing de-escalation techniques.

**Methods**

The translation and cultural adaptation of this instrument followed a methodological sequence: translation of the scale into Portuguese; focus group discussion; retroversion to English and pre-testing [2].

The study was authorized by the hospital ethics committee. The participants of the focus-group agreed to participate freely and clarified.

**Results**

The first translation was carried out by two teachers, born in Portugal and fluent in English, with a Degree in Modern Languages and Literatures. Conceptual translation was privileged instead of literal translation, promoting the conservation of simple and accessible language characterized by the original instrument. The translation was evaluated by a focus group (6 professionals) with experience in the field, all participants speak Portuguese and are fluent in English, having evaluated the translation obtained and suggested necessary changes. The translation was then back-translated into the English language, by a Clinical Psychologist, from South Africa, with English native language, fluent in Portuguese, with experience in the field, as well as in the translation of evaluation instruments. This professional had no previous contact with antecedent versions of this instrument. The Pre-testing was applied to a group of ten nurses to evaluate the adequacy of the structure and items of this scale, as well as to validate eventual difficulties in filling it.

**Conclusions**

In the pre-test, the instrument showed a good internal consistency and the participants did not present filling difficulties. The next step is to determine the psychometric properties of the scale.

**References**

1. Mavandadi V, Bieling P, Madsen V. Effective ingredients of verbal de-escalation: validating an English modified version of the De-Escalating Aggressive Behaviour Scale. J Psychiatr Ment Health Nurs. 2016;23(6-7):357-68.

2. Waltz C, Strickland O, Lenz E. Measurement in Nursing and Health Research (4th. Ed.). New York: Springer Publishing Company; 2010.

**Keywords**

Aggressive behavior, Cultural adaptation, De-escalation, Mental illness, Nursing interventions.

P185

Supporting informal caregivers of people dependent in self-care

Maria A Dixe<fnref n="1" />,<fnref n="2" />, Ana CS Cabecinhas<fnref n="2" />, Ana JCF Santos<fnref n="2" />, Marina G Silva<fnref n="2" />, Maura R Domingues<fnref n="2" />, Ana Querido<fnref n="1" />,<fnref n="2" />

Correspondence: Maria A Dixe (maria.dixe@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P185

**Background**

Informal caregivers (IC) are crucial in care provision to dependent patients, frequently aged and suffering from chronic diseases. Therefore, besides helping the dependent people carrying out daily activities, they should also provide them support and assistance in dealing with self-care difficulties.

**Objective**

This quantitative exploratory descriptive study aims to: identify self-care needs in which the person is dependent, and the dependency degree; identify socio-demographic characteristics and ICs support to care for a dependent-person; identify the type, quality of information provided to the IC and the health-professional who delivered the information; assess the perception of ICs regarding their abilities to care for dependent-patients.

**Methods**

An intentional sample of thirty-three dyads of dependent-patients (at least in one self-care daily activity) and their caregivers participated in this study. Participants were referred by the hospital health-care team of a hospital service, at the time of discharge. Dependent-people clinical and sociodemographic data were collected from clinical files. ICs answered a structured interview composed by sociodemographic and professional data, type of support in caring for dependent-people, ability of ICs to care for the dependent-person

<footnote n="1">¹Hospital Professor Doctor Fernando Fonseca, 2720-276 Lisbon, Portugal;</footnote>

<footnote n="2">²Lisbon Nursing School, 1600-190 Lisbon, Portugal</footnote>

<footnote n="1">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</footnote>
and to promote self-care. This study was approved by the ethic committee of the hospital where the study was conducted (nº 24/2017).

## Results

The majority of dependent-persons were female (60.6%) with a mean age of 81.6 (±11.3) years. Regarding self-care activities, the majority of persons were dependent and did not take part in preparing medication (66.7%), preparing food for ingestion (51.5%), nor in obtaining objects for the bath (51.5%). Caregivers were mostly women, mean age of 61.4 (±12.1) years old. Regarding family ties, is mostly a son/ daughter (39.4%) or a spouse (33.3%) who takes care of their family member on average for 63.9 (±93) months. Nurses were the main providers of information, nonetheless most of the caregivers were not provided with information about auxiliary equipment (79.3%) nor economic support available (71.0%). ICs feel less competent in caring for a dependent-person regarding ability to transfer. Ability to dress was the area in which the dependent-person presented the highest degree of dependence. Regarding "feeding", ICs refer the identification of signs of malnutrition and dehydration as the main difficulty.

## Conclusions

Supporting families in acquiring practical problem-solving skills in every day's life, in the management of resources and of emotional needs of the dependent-person should be promoted by health-professionals at the beginning of hospitalization, in order to take good care of the family member and of oneself.

## Acknowledgments

The current abstract is being presented on the behalf of the Help2Care research project. This study was funded by COMPETE 2020 under the Scientific and Technological Research Support System, in co-promotion. We acknowledge CiTechCare, Polytechnic Institute of Leiria, Polytechnic Institute of Santarém, Centro Hospitalar de Leiria, Polytechnic Institute of Castelo Branco and also all other members, institutions and students involved in the project.

## Keywords

Capacity, Informal caregiver, Self-care, Dependent-person, help2care project.

P186

## Absenteeism on nurses in primary health care

Rosa M Freire¹, Rosário Vieira², Elisabete Borges¹

¹Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal;

²Agrupamento de Centros de Saúde Tâmega II Vale do Sousa Sul, 4560-682 Porto, Portugal

**Correspondence:** Rosa M Freire (rosafreire@esenf.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P186

## Background

The Primary Health Care reform and the introduction of Health Centre Groupings brought changes in the management standards in force until then. The new model care reorganized and changed work contexts and human resources. The new organizational paradigm requires adaptation of the professionals to this new reality. In any situation of change people reacts with resistance in greater or lesser intensity. Also changes in organizations can create resistances that can manifest themselves with absenteeism. In health organizations the absenteeism of nurses constitutes a complex problem and needs to be valued and monitored by nursing managers [1].

## Objective

To identify the presence and causes of absenteeism and analyse the relationship between absenteeism and demographic and professional variables.

## Methods

Quantitative, exploratory and cross study was used as methodology. A sociodemographic/professional questionnaire and questions related to absenteeism were used for the collection of data. The sample was composed by 109 nurses working at primary health care units of northern Portugal. The sample was composed by 77.1% of females, 54.1% aged more than 36 years, 72.5%

married, 82.6% working on fixed schedules, 51.4% with nearly 14 years of job experience (varied between 7 and 33 years), and 81.7% considered their job as stressful.

## Results

Of all nurses, 66% admitted to having been absent from service in the last year: 28.4% due to their own illness and 16.5% due to their relatives' illness. Statistically, there were found significant differences in the association between the variables of to have children (p = 0.007), place of work (p = 0.045) and absenteeism. We also found that nurses with children and those who work in Health Family Units are the ones that are absent from work most frequently.

## Conclusions

We believe that the results can induce the development, implementation and evaluation of preventive measures, aiming at the promotion and protection of nurses' health. In this regard, they can be crucial for the management of human resources and for strategic planning of the ACeS, in particular, in grounded decision-making.

## References

1. Sancinetti TR, Soares AVN, Lima AFC, Santos NC, Melleiro MM, Fugulin FMT, et al. Nursing staff absenteeism rates as a personnel management indicator. Rev. esc. enferm. USP. 2011;45(4):1007-1012.

## Keywords

Nurse, Absenteeism, Primary health care, Management in nursing.

P187

## Assessment and intervention in a family with a care dependent person and mental illness: a case study

Inês Esteves, Isabel Bica

Health School, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

**Correspondence:** Isabel Bica (isabelbica@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P187

## Background

Mental illness can have profound repercussions in family dynamics, since it is a serious illness and generates great stress. The assessment and intervention of a family with psychosocial problems requires the nursing team to use models that allow the design of care oriented both for data collection and for the planning of interventions in domiciliary context.

## Objective

To analyse the care needs in a family with mental illness using the Dynamic Model of Family Assessment and Intervention (MDAIF).

## Methods

The case study focused on the process of family intervention developed with a family in a domiciliary context in Primary Health Care, according to MDAIF. The following data collection instruments were applied: genogram, ecomap, FACES II, Graffar and Family Apgar Scales.

## Results

The family consists of a middle-aged couple, childless, lower middle class (grade IV, Graffar, 1956). The woman is the main care provider of her husband, with mental illness. They have an extensive network of community support, namely in Social Solidarity Institutions, Recreational Associations, the extended family and the Community Care Unit (health team). As a couple, they show good cohesion and adaptability facing everyday problems (Faces II Scale) and perceive their family as highly functional (score 10 - Apgar Scale), despite the perception of communicational difficulties and emotional expression. After the interventions of the nursing team, in the different dimensions of the MDAIF, gains were obtained in the knowledge and capacity of income management, heating system of the residential building, management and knowledge about the mental illness, communication and marital satisfaction and the role of caregiver. In this way, the caregiver has been trained in knowledge and skills in the field of care for
the dependent person and with mental pathology, in order to
maximize their health, as well as in the care and importance of
the satisfaction of her own needs.

Conclusions

The valuation of caregiver perspectives is essential for the adjust-
ment of the formal responses of the nursing team. Empowerment of
family caregivers - as well as being able to express themselves and
be an active element in the healthcare process, as well as the articu-
lation of formal and informal responses constitute challenges for
health professionals. The support provided by the health team to the
caregiver and dependent patient has proved to be effective not only
in improving family functioning but also in reducing stress, burnout
and isolation of the caregiver.

Keywords

Caregiver, Family, Nursing, Primary health care.

P188

Elderly people, physical therapy services and human resources: current and future challenges

Carla Leão¹,² (caraleao@sapo.pt)

¹Escola Superior de Saúde, Universidade Atlântica, 2730-036 Barcarena, Portugal; ²Instituto Português de Relações Internacionais, 1000-155

Lisboa, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):P188

Background

The aging process implementation in Portugal, and the consequent
increase in the number of elderly people is evident and constitutes
an increasing process. Undeniably, the elderly people are the main
users of health services and specifically physiotherapy services. The
economic and financial crisis that affected Portugal, has imposed re-
strictions on the health system and specifically on the National
Health Service (NHS) [1]. Considering this scenario, we have put as a
guiding question: *Are, in Portugal, physiotherapy health services and
human resources included in the health system at NUTS III regional
level, and essentially in the NHS, proportional to the number of elderly
people and respond to their current and future needs?* [NUTS III - No-
menclature of territorial units for statistics (NUTS) with level III corre-
sponding to the territorial division constituted by 30 regions,
according to the division of 2013].

Objective

We aim to understand the current and future numbers of the elderly people at the regional level (NUTS III); to know the current number of physiotherapy services and human resources at the same regional level; to prospective the future physical therapy services and human resources, considering the health political trends related to services and human resources; and to assess if these services and human resources respond to the needs of the current and future elderly people.

Methods

For this purpose, we performed a statistical analysis at the re-
gional level NUTS III, considering the indicators - number of eld-
erly people and physical therapy services and human resources.
We used the data from the Statistics National Institute, the Health
Regulatory Body, the Portuguese Physiotherapists Union and the
Portuguese Association of Physiotherapists.

Results

The results showed that at the regional level (NUTS III), physiotherapy
services and human resources are scarce and there is no proportion-
ality between the number of elderly people and the physiotherapy
services and human resources. With the increasing number of elderly
people and the restrictive political trend, we assume that, if the polit-
ical trends continue, proportionality will remain non-existent.

Conclusions

In this way, we conclude that current and future physiotherapy ser-
vices and human resources do not respond to the needs of the
current and future elderly population, and there is a need to adapt
physiotherapy services and human resources to the current and fu-
ture demographic reality, in order to achieve better levels of healthy
life expectancy.

References

1. Rodrigues T F, Martins M R O (Coordenadores). Envelhecimento e saúde. Prioridades políticas num Portugal em mudança. Lisboa. CEPSE/Instituto Hidrográfico. 2014.

Keywords

Portugal, Elderly people, Physical therapy services, Physical therapy human resources.

P189

Ultrasound evaluation of subcutaneous tissue and relation with the evaluation of fat mass in women with cellulitis

Alexandra André, João P Figueiredo, Óscar Tavares, Catarina Bulamarqui, Catarina Frade

Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal

Correspondence: Alexandra André (alexandra.andre@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P189

Background

Ultrasound (US) is an easily accessible imaging modality that al-
lows the evaluation of various structures. Despite the potential of
this technique there are a few studies referring to subcutaneous
tissue analysis with US. This allows the evaluation of altered tis-
sues such as gynoid lipodystrophy, a very common alteration in
female. the better the characterization, location, definition of the
affected areas and the degree of severity of LDG, the greater the
success of treatment. In this study US and densitometry was per-
formed to evaluate the thickness of the subcutaneous tissue and
the body mass composition, such as lean mass and fat mass.

Objective

The aim was, by using two different images modality, to evaluate
the subcutaneous tissue in normal weight and overweight, as
well as the possible relation with the percentage of fat in women
with cellulite.

Methods

The study was performed in 25 individuals aged between [18-60] years old. Some inclusion and exclusion criteria were done. The images were performed in the midpoint between the great trochanter and the medial aspect of the gluteal region and the thighs in the proximal third, particularly in the proximal and lateral portion of the thigh, between the great trochanter and the knee joint.

Results

Spearman's correlation tests for a correlation between bone mineral
density and fat mass with subcutaneous cell tissue thickness at a rho
= 1 p-value must be less than or equal to 0.005%. Thus, with the re-
sults obtained, we verified that there is no possible correlation be-
tween measurements of bone mineral density, fat mass and
subcutaneous cellular tissue of the gluteal and thigh regions. There
were no significant differences in the variances between groups.

Conclusions

Ultrasonography has sensitivity to evaluate subcutaneous cellular tissue as well as deformations that may exist in it. We concluded that the percentage of fat measured by bone densitometry does not correlate with the thickness of subcutaneous tissue, with the percentage of fat being higher in overweight women but the thickness of subcutaneous tissue varies from woman to woman. The only possible relationship is between the bone mineral density and the thickness of the subcutaneous tissue of the right gluteus that leads to force that the greater the thickness the subcutaneous cellular tissue, the greater the bone mineral density, because although they are structurally different both respond to the stimuli of atrophy and hypertrophy.

Keywords

Subcutaneous tissue, Ultrasound, Dexa.

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