the program; introduction of a final moment of relaxation through abdominal breathing. The terminology used and visual presentation of the program were reformulated in order to improve user experience. The created program was considered by the elderly and healthcare professionals involved during the course of this process as pleasant and interesting, raising its structure, thematic contents and proposed activities.

**Conclusions**

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

**Acknowledgements**

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

**References**

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

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

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

**Keywords**

Cognitive dysfunction, Aged, Program development, Reminiscence therapy.

## O43

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

Francisco Sampaio<fnref n="1" />,<fnref n="2" />,³, Odete Araújo³,⁴, Carlos Sequeira<fnref n="2" />,⁴, Teresa L Canut⁵, Teresa Martins<fnref n="2" />,⁴

**Correspondence:** Francisco Sampaio (fmcsampaio@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O43

**Background**

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

**Objectives**

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

**Methods**

A single-blind randomised controlled trial was conducted at a Psychiatry Ward Outpatient Service of a Hospital in the north of Portugal. Participants were psychiatric outpatients, aged 18-64, with nursing diagnosis "anxiety", who were randomly allocated to an intervention group (n = 29) or a treatment-as-usual control group (n = 31). The

interventions consisted in psychotherapeutic interventions for the nursing diagnosis "anxiety", integrated in the Nursing Interventions Classification. One mental health nurse provided the individual-based intervention over a 5-week period (one 45-60 minutes weekly session). A treatment-as-usual control group received only pharmacotherapy (if applicable). The primary outcomes, anxiety level and anxiety self-control, were assessed with the outcomes "Anxiety level" and "Anxiety self-control", integrated in the Nursing Outcomes Classification (Portuguese version) [5] respectively. Time frames for assessment were at baseline and post-test (6 weeks after).

**Results**

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

**Conclusions**

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

**Trial Registration Number**

NCT02930473

**References**

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

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

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

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

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

**Keywords**

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

## O44

**"Art therapy" in acute psychiatry: a Portuguese case study**

Clara Campos<fnref n="1" />, Aida Bessa<fnref n="1" />, Goreti Neves<fnref n="1" />, Isabel Marques<fnref n="2" />, Carlos Laranjeira³

**Correspondence:** Clara Campos (cccalmeidacampos@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O44

**Background**

In the last few years, some researchers have focused on the valorisation of interventions that stimulate the use of art therapy in individuals with mental illness. This assessment is based on the assumption that biological programs (including psycho pharmaceuticals) should be increasingly inclusive, and therefore should include psychosocial

<footnote n="1">¹Psychiatry Department, Hospital of Braga, 4710-243 Braga, Portugal;</footnote>

<footnote n="2">²Nursing School of Porto, 4200-072 Porto, Portugal; ³Center for Health</footnote>

<footnote>Technology and Services Research, 4200-450 Porto, Portugal; ⁴School of Nursing, University of Minho, 4710-057 Braga, Portugal; ⁵Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, Barcelona University, 08907 Barcelona, Spain</footnote>

<footnote n="1">¹Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal; ³Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal</footnote>
approaches based on the recovery model. However, there is as yet
no effective consensus on techniques and interventions that reveal
greater effectiveness as well as systematization.

Objectives

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

Methods

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

Results

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

Conclusions

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

Trial registration

NCT03575442

Keywords

Recovery, Art therapy, Mental Health Nursing.

O45

Nursing care at the postpartum home visit: the couple perspective

Bárbara Pinto¹, Marília Rua², Elsa Melo²

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

**Correspondence:** Bárbara Pinto (barbarapinto_41@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O45

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

References

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

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

Keywords

Family Nurse, Family, Puerperium, Home visit.

O46

Skills of occupational therapy students required for an effective relationship

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O46

Background

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

Objective

The objective of the study was to analyse how the perception of oc-
cupational therapy students changes their personal traits and chal-
lenges throughout their careers.

Methods

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

Results

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

## Conclusions

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

## References

1. Taylor,

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

## Keywords

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

## O47

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

Ana S Tavares, Elisabete Carolino

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O47

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

This exploratory survey revealed the use of PES amongst Portuguese gym/fitness users and its increasing importance to investigate the psychosocial factors that may influence PES use in this specific

population. Exploring these factors may improve the effectiveness of practical interventions and motivational strategies to reduce PES use among gym/fitness users.

## References

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

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

## Keywords

Performance enhancing substances, Orevalence, Gym/fitness users.

## O48

### Identification of frailty condition of elderly people in the community

Inês Machado¹, Pedro Sá-Couto², João Tavares³,⁴

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

**Correspondence:** Inês Machado (inessantiago@live.ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O48

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### Acknowledgements

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

### References

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

### Keywords

Frailty, Elderly, Instrument, Prisma7.

## O49

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

Ana Sucena¹,²,³,⁴, Ana F. Silva¹,²

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O49

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

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

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

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

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

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

### Keywords

Graphohame, Reading acquisition, Reading intervention.

## O50

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

Andreia Carreira¹, Catarina Valente¹, Joana Tomé¹, Tânia Henriques¹, Fátima Roque¹,², Márcio Rodrigues¹,², Maximiano P Ribeiro¹,², Paula Coutinho¹,², Sandra Ventura¹,², Sara Flores¹,², Cecília Fonseca¹,², André RTS Araujo¹,²,³

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O50

### Background

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

### Objective

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

### Methods

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

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

## Conclusions

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

## References

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

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

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

## Keywords

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

# O51
## Allergic rhinitis characterization in community pharmacy customers of Guarda city

Hélio Guedes<fnref n="1" />, Agostinho Cruz<fnref n="2" />, Cecília Fonseca<fnref n="1" />,³, André RTS Araujo 1,3,4

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

BMC Health Services Research 2018, **18**(Suppl 2):O51

## Background

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

## Objective

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

## Methods

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

## Results

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

## Conclusions

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

## References

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

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

## Keywords

Allergic rhinitis; Community pharmacy customers; Quality of life.

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

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

## Background

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

## Objective

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

## Methods

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

## Results

Thirty-two patients (70.28 ± 10.19 years; 25.54 ± 3.26 Kg/m<fnref n="2" />) were included. Different groups were identified, according to the knee

<footnote n="1">¹School of Health Sciences, Polytechnic Institute of Guarda, 6300-749 Guarda, Portugal;</footnote>

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

<footnote n="1">¹School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal</footnote>

<footnote>BMC Health Services Research 2018, **18**(Suppl 2):O52</footnote>
pattern: (1) normal at T0 and T1 (N = 10); (2) normal pattern only at T1 (N = 7); (3) acquisition/change in the knee pattern deviation (N = 7); (4) maintenance of the knee pattern deviation (N = 8). Modifications in the normal knee pattern might be developed to reach acceptable levels of functioning performance (p > 0.05, Groups 1/3). Speed and balance recovery was restricted when an abnormal knee pattern in WT was observed (Group 3 and 4), being worst when this pattern persisted (Group 4).

### Conclusions

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

### Trial Registration

NCT02746835

### Keywords

Weight transfer, Gait, Stroke, Knee patterns.

## O53

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

Patrícia Rebelo¹,², Ana Oliveira¹,²,³, Alda Marques¹,²

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

³Faculty of Sports, University of Porto, 4200-450 Porto, Portugal

**Correspondence:** Patrícia Rebelo (patriciarebelo@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O53

### Background

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

### Objective

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

### Methods

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

### Results

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

81-90y: 29.0[9.1-67.1]rep/min vs. 22.3[16.2-28.3]rep/min). Significant interactions between age and gender were only observed in the ISWT.

### Conclusions

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

### References

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

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

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

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

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

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

### Keywords

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

## O54

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

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O54

### Background

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

### Objective

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

## Results

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

## Conclusions

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

## References

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

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

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

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

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

## Keywords

Aged, Frail Elderly, Prevalence, Geriatric Nursing.

## O55

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

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O55

### Background

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

### Objective

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

### Methods

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

## Results

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

## Conclusions

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

## Keywords

Acute Myocardial Infarction, Mortality rate, Ecological study.

## O56

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

Ana Alves¹, João Simões¹, Alexandre Rodrigues¹, Pedro Couto²

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

**Correspondence:** Ana Alves (anamargaridamartins@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O56

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

### Keywords

Mental adjustment, Nursing Family, Arterial Hypertension.

## O57

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

Júlia Alves, Joana Mirra, Rita F Soares, Margarida Santos, Isabel Barbedo, Sara Silva, Elga Freire
Equipa Intra-hospitalar de Suporte em Cuidados Paliativos, Departamento de Medicina Interna, Centro Hospitalar do Porto, 4099-001 Porto, Portugal

**Correspondence:** Júlia Alves (juliasousaalves@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O57

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

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

### Keywords

Palliative care, Family, Health.

## O58

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

Claudia Oliveira¹, Helena José²,³, Alexandre C Caldas¹

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O58

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

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

### Keywords

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

## O59

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

Paulino Sousa¹, Marisa Bailas²

¹Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450

Porto, Portugal ²Centro Hospitalar de São João, 4200-319 Porto, Portugal

**Correspondence:** Paulino Sousa (paulino@esen.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O59

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### Keywords

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

## O60

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

Maria C Rocha, José G Sousa, Madalena G Silva

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

**Correspondence:** Madalena G Silva

(madalena.gomesdasilva@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O60

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

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

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

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

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

Pain, Activity, Older adults.

O61

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

Cristina Simões¹,², Sofia Santos²,³

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O61

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Keywords

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

O62

Factors that influence the decision on how and when to use a
"health kiosk"

João Rodrigues¹,⁴, Paulino Sousa², Pedro Brandão³,⁴

¹Administração Regional de Saúde do Norte, 4000-099 Porto, Portugal;

²Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450

Porto, Portugal; ³Faculdade de Ciências, Universidade do Porto, 4169-007

Porto, Portugal; ⁴Instituto de Telecomunicações, 1049-001 Lisboa,
Portugal

**Correspondence:** João Rodrigues (joaorodrigues006@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O62

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Acknowledgements

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

Keywords

Health kiosk, Technological Acceptance Mode, Monitoring.
## O63

**Delirium care: a survey into nursing perceptions and knowledge**

Marta Bento¹, Rita Marques²

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

**Correspondence:** Marta Bento (marsofia81@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O63

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

**Keywords**

Delirium, Nursing, Knowledge, Risk factors.

## O64

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

Plácida Silva¹, Paulino Sousa², Élvio Jesus¹

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

**Correspondence:** Plácida Silva (placidasilva@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O64

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

Health Information Systems, Nurses, Satisfaction, Evaluation.

## O65

**How prevalent are psychoactive substances among health students?**

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

¹Escola Superior de Saúde, Instituto Politécnico da Guarda, 6300-749

Guarda, Portugal; ²Centro de Respostas Integradas da Guarda, Administração Regional de Saúde do Centro, 6300-725 Guarda, Portugal

**Correspondence:** Sandra Ventura (scventura@ipg.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O65

**Background**

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

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

**Methods**

A questionnaire was applied to the students and we collected 261
answers, from a total of 175 students of the Nursing Course and 88
of the Pharmacy Course.

**Results**

The results obtained indicate that the most consumed substances
were, in descending order: alcohol, tobacco, psychoactive drugs and
illicit substances. Regarding alcohol experimentation, it was found
that 76.6% of nursing students and 85.2% of pharmacy students had
already consumed alcohol. These data were higher than the national
prevalence throughout life in 2015 (71%). The consumption of alco-
hol by nursing students (74.3%) and by pharmacy students (89.8%)
was also higher than the consumption of Portuguese young people
between 13 and 18 years old (62%). Tobacco consumption by nursing and pharmacy students were of 51.6% and 56.8%, respectively,
both higher than the national data of 40%. The consumption of tobacco was of 39.3% by nursing students and 45.5% by pharmacy students, and it was also higher than the 30% reported for national
consumption. Illicit substances were the least consumed, with a
prevalence throughout life of 13.3% and 9.0%, respectively, by nursing and pharmacy students, inferior than the national data (19%).
Cannabis was the illicit substance more consumed by either nursing
and pharmacy students.

**Conclusions**

These results indicate that there is work to be done in the prevention and dissuasion of consumption of psychoactive substances by our student community.

**Keywords**

Psychoactive substances, Consumption, Prevalence, Prevention, Dissuasion.

O66

Diabetes Mellitus as a key indirect causal factor for pressure ulcer development

Pedro Sardo¹,², Jenifer Guedes², José Alvarelhão¹, Elsa Melo¹
¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro,
Portugal; ²Centro Hospitalar do Baixo Youga, 3810-501 Aveiro, Portugal

Correspondence: Pedro Sardo (pedro.sardo@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O66

**Background**

Ensuring patient safety in healthcare is a challenge [1-6]. With the
growing *Diabetes Mellitus* incidence, healthcare professionals and plan-
ners are encouraged to pay further attention to the major complica-
tions of this disorder [3]. According to EPUAP and EWMA [3], poor
circulation and infection are among the most common complications
that effect diabetic patients. A recent pressure ulcer conceptual frame-
work [7, 8] identified *Diabetes Mellitus* as a key indirect causal factor
(and poor perfusion as a direct causal factor) for pressure ulcer develop-
ment and encourages the development of clinical studies that explore
the correlation(s) between these specific risk factors and pressure ulcer
development.

**Objective**

To identify the influence of *Diabetes Mellitus* on pressure ulcer develop-
ment in adult patients admitted to medical and surgical wards in 3 Por-
tuguese hospitals.

**Methods**

Cross sectional design survey developed on June 16th, 2015 with 236
adult patients admitted to medical and surgical wards in 3 Portuguese
hospitals. The study was performed after Hospital Council Board and
Ethics Committee approval (Reference Number 049688). Data were
analysed using SPSS v25.0. Descriptive statistics were calculated for the

sample characterization. Pressure ulcer risk, prevalence and incidence
were calculated according to EPUAP statement [9]. Odds ratio (OR) was
calculated by univariate logistic regression.

**Results**

This study included a sample of 236 participants with the median age of 76 years (Q1 = 62 years; Q3 = 83 years). The majority of the participants was male (56.8%), admitted trough the emergency service (80.9%) and stayed in medical units (60.2%). On the day of the survey, 121 (51.3%) participants were classified as "high risk of pressure ulcer development" (Braden Scale score ≤ 16); 45 (19.1%) participants had at least one pressure ulcer documented; 7 (3.0%) participants developed a new pressure ulcer since the admission in inpatient setting; and 67 (28.4%) participants had *Diabetes Mellitus*. Using a univariate logistic regression model, the odds of developing a pressure ulcer during the length of inpatient stay were significantly higher for the participants with *Diabetes Mellitus* with OR = 6.73 (95% CI:1.27-35.61, Nagelkerke R² = 0.103) compared to the other participants.

**Conclusions**

This study supports the pressure ulcer conceptual framework pro-
posed by Coleman, Nelson [7] and Coleman, Nixon [8], showing that
*Diabetes Mellitus* is a key (indirect) causal factor for pressure ulcer de-
velopment in inpatient settings. However, further studies are needed
in order to understand the influence of *Diabetes Mellitus* on skin and
tissue (poor) perfusion and consequently on pressure ulcer
development.

**Acknowledgements**

Thanks are due to "Centro Hospitalar Baixo Youga, EPE" (Portugal),
particularly to the Nursing Council Board, head nurses and to the nurses that
recorded the data in the medical and surgical services of Águeda Hospital,
Aveiro Hospital and Estarreja Hospital.

**References**

1. EPUAP, EWMA. Patient safety across Europe: the perspective of pressure ulcers.2017.

2. EPUAP, EWMA. The time to invest in patient safety and pressure ulcer prevention is now! 2017.

3. EPUAP, EWMA. Diabetic Control & Pressure Ulcers: fighting fatal complications and improving quality of life. 2017.

4. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients. Journal of Clinical Nursing. 2015;24(21-22):3165-76.

5. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital. Journal of Tissue Viability. 2016;25(2):75-82.

6. Sardo P, Simões C, Alvarelhão J, Simões JL, Machado P, Amado F, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. Journal of Tissue Viability. 2016;25(4):209-15.

7. Coleman S, Nelson EA, Keen J, Wilson L, McGinnis E, Dealey C, et al. Developing a pressure ulcer risk factor minimum data set and risk assessment framework. J Adv Nurs. 2014;70(10):2339-52.

8. Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222-34.

**Keywords**

Diabetes Mellitus, Nursing Assessment, Portugal, Pressure Ulcer, Risk
Assessment

O67

Frailty syndrome in the elderly hospitalized in a teaching hospital

Luciane Cabral, Clóris Regina, Bruno A Condas, Péricles Reche, Danielle Bordim, Jacy Sousa

Departamento de Enfermagem e Saúde Pública, Universidade Estadual de Ponta Grossa, 4748 Ponta Grossa, Paraná, Brasil

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

BMC Health Services Research 2018, **18**(Suppl 2):O67
## Background

In Brazil and in the world, the growth of the elderly population is an indisputable reality, so it is necessary to identify the factors that favour the sickness of this age group, with emphasis on the fragility, which can be defined as a syndrome which presents innumerable causes and is characterized by a set of clinical manifestations, such as decreased in strength, endurance and physiological function, collaborating to make the individual more vulnerable to addiction and/or death [1].

## Objective

In view of the above, the present study aimed to evaluate the fragility syndrome of the elderly hospitalized in a teaching hospital.

## Methods

A cross-sectional study, carried out with a convenience sample of 107 elderly patients admitted to the emergency room, at the medical, surgical and neurology clinic of the medical, surgical and neurology of a teaching hospital in the Campos Gerais region, from October 2016 to April 2017. Data collection included the application of the Mini Mental State Examination [2] for cognitive screening and Edmonton Fragility Scale [3], culturally adapted to the Portuguese language in Brazil [4]. Data were analysed using Stata®12 software. The association was verified through simple linear regression (Fisher's F and Student's t tests), significance level of p = 0.05. The project was approved by the Ethics Committee of the State University of Ponta Grossa (CAAE nº 34905214.0.0000.0105).

## Results

The results showed a predominance of females (58.9%), married (61.0%), low schooling (71.0%), living with spouse (n = 42, 39.3%), considered their income satisfactory (50.5%). The mean age of participants was 70.3 years. Regarding clinical variables, 99.1% had a disease, 36.5% used medication and 50.5% reported hospitalization in the last 12 months. The fragility evaluation identified that 19.6% of the elderly were nonfragile, 24.3% apparently vulnerable, 26.2% had mild fragility, 15.9% moderate and 14.0% severe. It was found that any level of schooling used medication (p = 0.001), solitude (p = 0.001), loss of urine (p = 0.001) and hospitalization in the last 12 months (p = 0.001) and was associated with the fragility syndrome.

## Conclusions

The importance of early detection of the syndrome is emphasized through the use of an instrument that is valid, reliable and easy to apply by the health team, such as the Edmonton Fragility Scale. The results presented can support the planning of health care, considering the characteristics and demands of the elderly who are hospitalized, thus contributing to improve the quality of care provided.

## References

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

2. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for granding the cognitive state of patients for the clinician. J PsychiatrRes. 1975, 12(3):189-98.

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

4. Fabricio-Wehbe SCC, Cruz IR, Haas VJ, Diniz MA, Dantas RAS, Rodrigues RAP. Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community. Rev Latino-Am Enfermagem. 2013; 21(6):1330-6.

## Keywords

Aged, Frail Elderly, Geriatric Nursing.

O68

## Braden Scale accuracy tests

Pedro Sardo<sup>1,2</sup>, Jenifer Guedes<sup>2</sup>, José Alvarelhão<sup>1</sup>, Elsa Melo<sup>1</sup>
<sup>1</sup>School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; <sup>2</sup>Centro Hospitalar do Baixo Vouga, 3810-501 Aveiro, Portugal

**Correspondence:** Pedro Sardo (pedro.sardo@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O68

## Background

Pressure ulcers management is a challenge [1-6]. Portuguese guidelines [7] encourage the implementation of regular pressure ulcer risk assessments through the application of the Braden Scale and the patients' categorisation into two levels of risk (defined by cut-off point of 16). However, the development of pressure ulcer(s) is complex and multifactorial [8] and whenever the Braden Scale score falls below 18, each patient functional deficit and/or risk factor should be individually addressed [9].

## Objective

To analyse the Braden Scale accuracy tests in adult patients admitted to general wards in a Portuguese hospital during one year, using different cut-off points.

## Methods

The study was designed as a retrospective cohort analysis of electronic health record database from 6,552 adult patients admitted without any pressure ulcer in medical and surgical wards in a Portuguese hospital during 2012. All data were extracted after Hospital Council Board and Ethics Committee approval (Reference Number 049688). Braden Scale Accuracy Tests (BSAT) such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) were assessed [10].

## Results

The study included 6,552 participants with a mean age of 64 years and 6 months. The majority of participants was male (52.6%); admitted trough emergency service (69.1%); in surgical (64.5%) units. During the length of stay 153 (2.3%) participants developed (at least) one pressure ulcer. Considering the cut-off point of 15, the BSAT showed: sensitivity of 50%(95%CI:42%-58%); specificity of 82%(95%CI:81%-83%); PPV of 6%(95%CI:5%-8%); NPV 99%(95%CI:98%-99%); and AUC of 66%(95%CI:61%-71%). Considering the cut-off point of 16, the BSAT showed: sensitivity of 63%(95%CI:55%-71%); specificity of 74%(95%CI:73%-75%); PPV of 5%(95%CI:4%-7%); NPV 99%(95%CI:98%-99%); and AUC of 69%(95%CI:64%-73%). Considering the cut-off point of 17 the BSAT showed: sensitivity of 78%(95%CI:71%-84%); specificity of 63%(95%CI:61%-64%); PPV of 5%(95%CI:4%-6%); NPV 99%(95%CI:99%-99%); and AUC of 71%(95%CI:67%-74%).

## Conclusions

Although our BSATs follow the trend of the results found in a recent systematic review [11], they showed some of the limitations of the patients' categorisation into two levels of risk according to a specific cut-off value. Like Braden [9], we believe that this assessment tool should be supplied with clinical judgment in order to identify patients' specific risk factors that should be individually addressed with accurate preventive interventions. Furthermore, in order to develop evidence-based practice, we should create a minimum data set for pressure ulcer prevention, assessment and documentation [12-14] based on patients' characteristics, international guidelines [15] and conceptual frameworks [12-14].

## References

1. EPUAP, EWMA. Patient safety across Europe: the perspective of pressure ulcers. 2017.

2. EPUAP, EWMA. The time to invest in patient safety and pressure ulcer prevention is now! 2017.

3. EPUAP, EWMA. Diabetic Control & Pressure Ulcers: fighting fatal complications and improving quality of life. 2017.

4. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients. Journal of Clinical Nursing. 2015;24(21-22):3165-76.

5. Sardo P, Simões C, Alvarelhão J, Costa C, Simões CJ, Figueira J, et al. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital. Journal of Tissue Viability. 2016;25(2):75-82.

6. Sardo P, Simões C, Alvarelhão J, Simões JL, Machado P, Amado F, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. Journal of Tissue Viability. 2016;25(4):209-15.

7. DGS. Escala de Braden: Versão Adulto e Pediátrica (Braden Q). Lisboa: Direção-Geral da Saúde; 2011.
8. Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011;20(5):364-75.

9. Braden BJ. The Braden Scale for Predicting Pressure Sore Risk: reflections after 25 years. Adv Skin Wound Care. 2012;25(2):61.

10. Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Continuing Education in Anaesthesia, Critical Care & Pain. 2008;8(6):221-3.

11. Park SH, Choi YK, Kang CB. Predictive validity of the Braden Scale for pressure ulcer risk in hospitalized patients. J Tissue Viability. 2015;24(3):102-13.

12. Coleman S, Nelson EA, Keen J, Wilson L, McGinnis E, Dealey C, et al. Developing a pressure ulcer risk factor minimum data set and risk assessment framework. J Adv Nurs. 2014;70(10):2339-52.

13. Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222-34.

14. Coleman S, Nelson EA, Vowden P, Vowden K, Adderley U, Sunderland L, et al. Development of a generic wound care assessment minimum data set. J Tissue Viability. 2017;26(4):226-40.

15. NPUAP, EPUAP, PPPIA. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Perth, Australia: Cambridge Media; 2014.

## Keywords

Nursing Assessment, Portugal, Pressure Ulcer, Risk Assessment, Sensitivity and Specificity.

## O69

### Health literacy: the importance of experimental activities in the 1st cycle of basic education: report of an educational intervention on hand hygiene

Maria C Lamas¹,²,³, Carla Lago⁴

¹Escola Superior Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Escola EB1/JI Picua, Grupamento de Escolas de Águas Santas, 4425-143 Águas Santas, Maia, Portugal

**Correspondence:** Maria C Lamas (mariaculamas@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O69

## Background

Primary school students usually have very little previous knowledge about a number of educational issues. So, it is important to create moments where the students can tell whatever they know about a subject, in order to make an additional scientific explanation. The program of the 1st cycle of basic education aims to develop an attitude of permanent research and experimentation, and the part "The health of your body", to produce knowledge and the application of norms of body hygiene [1]. However, the contents expressed in the textbooks for these levels of education do not justify the need for children to adopt these hygiene habits, which must be acquired as early as possible, to be a systematic routine throughout life. On the other hand, it allows to eradicate some of the alternative conceptions that some 1st cycle students present on some issues [2], as the notion about the morphological view of microorganisms away from reality, idealizing them similar to animals [3,4,5]. There is evidence that children are able to learn about microorganisms at this age [3,4,5] and it is desirable that it occurs as early as possible, avoiding late conceptual changes that are difficult to reconstruct in their entirety [4]. For some authors [6,7], children should realize that the knowledge learned in the classroom can be applied in their daily lives.

## Objective

In this context and with the purpose of promoting scientific and critical literacy, we developed an activity about hand hygiene because handwashing should be learned and be a properly reasoned behaviour.

## Methods

The activities were developed by all 26 students in the class A, 2nd grade of the School EB1/JI Picua. The students' age ranged from 7 to 8 years, with 54% (14) boys and 46% (12) girls. It started with the question "Handwashing: Why, When, How?". According to the concepts expressed by the students the appropriate theoretical contents

were presented in a gradual and interactive way. This was followed by the experimental procedure with permanent monitoring and support based on the succeeding steps: role-playing stages for proper handwashing; applied activity; listing expected results; observation of cultures and microscopic observation of microorganisms, recording and reflection about the results achieved.

## Results

All groups showed the expected results, i.e., higher microbial growth in the quadrants corresponding to unwashed hands.

## Conclusions

Giving the results and the theoretical framework, the students learned proper concepts on the subject, which allowed them a better understanding of the world around them.

## References

1. DGE - Direção Geral de Educação (2004). Organização Curricular e Programas. 1º Ciclo do Ensino Básico. Lisboa, Ministério da Educação e Ciência, 4ª edição.

2. Mafra, P., Lima, N., Carvalho, G. (2015). Microbiologia no 1º Ciclo do Ensino Básico: Uma proposta de atividade experimental sobre a higiene das mãos. Livro de atas do XI Seminário Internacional de Educação Física, Lazer e Saúde.

3. Byrne J, Sharp J. Children's ideas about micro-organisms. School science review. 2006;88(322):71-79.

4. Byrne J. Models of Micro-Organisms: Children's knowledge and understanding of micro-organisms from 7 to 14 years old. International Journal of Science Education. 2011;33(14):1927-1961.

5. Mafra, P. (2012). Os Microrganismos no 1.º e 2.º Ciclos do Ensino Básico: Abordagem Curricular, Conceções Alternativas e Propostas de Atividades Experimentais. Tese de Doutoramento. Braga: Universidade do Minho, Portugal.

6. Pro, A. (2012). Los cuidadosan necessitan conocimientos de ciencias para dar respuestas a los problemas de su contexto. In Pedrinaci, E. (coord.), Caamaño, A. Cañal, P.; Pro, A. 11 ideas clave. El desarrollo de la competencia científica. Barcelona: Editorial Graó.

7. Lupión, T. e Prieto, T. (2014). La contaminación atmosférica: un contexto para el desarrollo de competencias en el aula de secundária. Enseñanza de las Ciencias, 32 (1), 1-18.

## Keywords

Hygiene, Handwashing, 1st cycle, Monitored support, Microrganisms.

## O70

### Stand by me! Assessing the risk of falls in community -dwelling older adults

Luís PT Lemos¹, João Pinheiro², Edite Teixeira-Lemos³,⁴, Jorge Oliveira³,⁴, Ana P Melo⁵, Anabela C Martins⁶

¹Centro Hospitalar Tondela-Viseu, 3509-504 Viseu, Portugal; ²Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ³Escola Superior Agrária de Viseu, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; ⁴Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu Portugal; ⁵Laboratory Medicine Unit and Department of Quality and Risk Management, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁶Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra Portugal

**Correspondence:** Edite Teixeira-Lemos (etlemos2@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O70

## Background

About a third of community-dwelling adults age 65 and older fall each year. Accidental falls are a cause of fractures, traumatic brain injury, and even death. They can also lead to restrictions in participation, eventually resulting in loss of independence in normal activities of self-care. Falls in older adults are multifactorial and can be caused by medical conditions, cognitive impairment, medications, and home hazards. Therefore, a single identifiable factor may account for only a small portion of the fall risk in the community-dwelling elderly population, stressing the need for a multifactorial evaluation in this population.
**Objective**

Identify the risk of accidental falls in an independent elderly population by using functional tests that can be routinely applied in clinical practice and evaluate the influence of medication in the risk of falling.

**Methods**

The sample consisted of 108 individuals who attended a health care facility between October 2016-January 2017. Inclusion criteria: age 65-85, Functional Independence Measure (FIM) ≥ 120 and Timed Up and Go (TUG) ≤ 12s. Individuals with serious cognitive or motor impairment were excluded. A form was filled with sociodemographic data, daily medication and history of falls. Handgrip strength was measured. Fear of falling was assessed using the Activities-specific Balance Confidence (ABC) scale. Participation was evaluated using the Activities and Participation Profile related to Mobility (APPM). Informed written consent was obtained for all participants.

**Results**

The average age was 72.28±6.02. The majority of subjects were female (54.6%). Fallers were older, had lower ABC and handgrip strength. ABC showed strong negative associations with APPM. All of the functional parameters were affected by age, with older individuals performing worse than younger participants. Polypharmacy was identified in 41.7% and increased the risk of falls (OR = 3.597; CI 95% 1.174-11.024; p = 0.025). Individuals taking antidepressants showed an increased risk of falls (OR = 9.467; CI 95% 2.337-38.495; p = 0.002). Anti-arrhythmic drugs (p = 0.002), benzodiazepines (p = 0.015) and other CNS-acting medication (p = 0.039) negatively influenced ABC scores. APPM scores were higher in subjects who reported taking CNS-acting medication (p = 0.012) and anti-arrhythmic medication (p = 0.035).

**Conclusions**

Individuals with low balance confidence showed higher restrictions in participation related to mobility. All of the functional parameters evaluated in this study were affected by age. These results stress that a comprehensive and multifactorial evaluation of risk factors for falls in older people and the adoption of interventions tailored to this age group, which could include a reassessment of their usual medication, are necessary in order to reduce fall risk and fall-related injury.

**Keywords**

Accidental falls, Risk factors, Elderly, Community-dwelling, Polypharmacy.

O71

**Trust requirements for the uptake of ambient assisted living digital advisory services**

Soraia Teles¹,², Ana Ferreira², Pedro Vieira-Marques², Diotima Bertel³, Constança Paül¹,², Andrea C Kofler⁴

¹Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto, 4050-313 Porto, Portugal; ²Center for Health Technology and Services Research, 4200-450 Porto, Portugal;

³SYNYO GmbH, 1060 Vienna, Austria; ⁴Zurich University of Applied Sciences, Reidbach 8820 Wädenswil, Zurich, Switzerland

**Correspondence:** Soraia Teles (teles.s.soraia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O71

**Background**

For the last 10 years, Ambient Assisted Living (AAL) solutions have been conquering an important place in policies addressing economic and social challenges resulting from population ageing [1]. The AAL concept corresponds to a new paradigm building on ubiquitous computing devices and new interaction forms to improve older adults' health, autonomy and security [2]. In spite of promising contributions of AAL solutions for ageing in place, low adoption by end users was reported [3-5]. This is thought to result from the intersection of technology features, user characteristics and attitudes [6]. Research has suggested that among attitudinal factors preventing adoption of these solutions there is a lack of trust, substantiated, among other factors, by user's concerns about data security and privacy [5,7-10]. Digital advisory services for AAL solutions have to foster not only user's trust on the advisory service *per se*, but also on AAL products and services and the web communication within a community.

**Objective**

To analyse stakeholders' attitudes and requirements towards AAL digital advisory services, applying the findings to develop a pan-European advisory and decision-support platform for AAL solutions (ActiveAdvice).

**Methods**

A qualitative approach was used. Thirty-eight semi-structured interviews with AAL stakeholders— older adults and informal caregivers, businesses and government representatives— were conducted in six European countries (Austria, Switzerland, Belgium, Netherlands, Portugal and UK). The data was analysed using the matrix method [11].

**Results**

For the uptake of AAL digital advisory services, the level of user's trust in the system seems to be critical. Features emerging as crucial to foment trust in digital advisory services were threefold: presence of security and privacy cues; personalization-related cues; and community features, including availability of client-to-client interactions and feedback given by reliable peers or experts. Older adults expressed their interest in becoming active in a digital community if provided an environment perceived as secure and, simultaneously, easy to use.

**Conclusions**

Building trust in AAL digital advisory services depends on multiple and complex user requirements. Security issues have shown to be of utmost relevance due to the nature of information exchanged, i.e. personal, health-related and sensitive data, and generational preferences, with privacy and security cues having primacy for 'Baby Boomers', as supported by previous research [12]. These findings stress the need for a paradigm shift towards user-centred and user empowering models and mechanisms for securing the interaction with systems (e.g. authentication mechanisms, access control models and visualization techniques; e.g. SoTRAACE model) [13].

**Acknowledgements**

The authors would like to acknowledge the co-financing by the European Commission AAL Joint Programme and the related national agencies in Austria, Belgium, the Netherlands, Portugal, Switzerland and the United Kingdom.

**References**

1. AAL Programme. Strategy 2014-2020 for the Active and Assisted Living Programme. 2014; Retrieved from: http://www.aal-europe.eu/wp-content/uploads/2015/11/20151001-AAL Strategy_Final.pdf.

2. Betchold U, Sotoudeh M. Assistive technologies: Their development from a technology assessment perspective. Gerontechnology. 2013;11(4):521-533.

3. Doyle J, Bailey C, Scanaill CN, van den Berg F. Lessons learned in deploying independent living technologies to older adults' homes. Univ Access Inf Soc. 2013;13:191.

4. Michel JP, Franco A. Geriatricians and Technology. J Am Med Dir Assoc. 2014;15(12):860-2.

5. Peek ST, Wouters EJ, van Hoof J, Luijkk KG, Boeije HR, Vrijhoef HJ. Factors influencing acceptance of technology for aging in place: A systematic review. Int J Med Inform. 2014;83(4):235-248.

6. Nedopil C, Schauber C, Glende I. AAL stakeholders and their requirement. 2013; Report by the Ambient and Assisted Living Association.

7. Damodaran L, Olphert W. User Responses to Assisted Living Technologies (ALTs) — A Review of the Literature. Journal of Integrated Care. 2010;18(2):25-32.

8. Nordgren A. Personal health monitoring: ethical considerations for stakeholders. Journal of Information, Communication and Ethics in Society. 2013;11(3):156-173.

9. Olphert W, Damodaran L, Balatsoukas P, Parkinson C. Process requirements for building sustainable digital assistive technology for older people. Journal of Assistive Technologies. 2009;3(3):4-13.

10. Wright D. Structuring stakeholder e-inclusion needs. Journal of Information, Communication and Ethics in Society. 2010;8(2):178-205.

11. Nadin S, Cassell C. Using Data Matrices. In: Cassel C, Symon G, editors. Essential Guide to Qualitative Methods in Organizational Research. London: SAGE Publications Ltd; 2011. p. 271-287.
12. Obal M, Kunz W. Trust development in e-services: a cohort analysis of Millennials and Baby Boomers. J. Serv. Manag. 2013;24(1):45–63.

13. Moura P, Fazendeiro P, Marques P, Ferreira A. SoTRAACE — Socio-technical risk-adaptable access control model. 2017 International Carman Conference on Security Technology (ICCST) [Internet]. IEEE; 2017 Oct; Available from: https://doi.org/10.1109/ccst.2017.8167835

## Keywords

Ambient Assisted Living (AAL), Digital Advisory Services, Trust in Online Services, Data Security.

## O72

### Self-confidence for emergency intervention and nurses’ perceptions of importance of the Intra-Hospital Emergency Team

Marisa J Cardo¹, Pedro Sousa²,³

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

**Correspondence:** Marisa J Cardo (marisacardo@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O72

### Background

The Intra-Hospital Emergency Team (IHET) has emerged to respond to situations of clinical deterioration of hospitalized patients, being nurses the fundamental links in the activation. During a situation of clinical deterioration with the need for IHET intervention, the actions of nurses in inpatient services depend on many factors. To facilitate the activation and effectiveness of this team, nurses must have self-confidence to carry out the activation of IHET. Nurses believe that IHET's intervention is important in the pursuit for safe care and that the most important ingredient for the effective use of this team is the nurse.

### Objective

This study aims to evaluate the level of self-confidence for emergency intervention of nurses and to identify the nurses’ perceptions of the importance of the IHET.

### Methods

This correlational study included 129 nurses from the Centro Hospitalar de Leiria who answered a questionnaire about the perception of IHET importance and the self-confidence scale for emergency situations validated for the Portuguese population by Martins et al. (2014), which consists of 12 items with Likert type responses. Pearson correlation and t-student were used for data analysis.

### Results

In this study, 84% were female nurses with a mean age of 39.70 ± 9.02 years, with an average professional experience of 16.97 ± 8.95 years, and the majority with training in the emergency area (94%). The mean self-confidence level of the nurses was 3.263 ± 0.571, for a maximum of 5 points. Regarding the nurses’ perception of importance of the IHET, a positive tendency was observed (results ranged from 3.426 ± 0.570 to 4.775 ± 0.419). A partial relation between the professional experience (r = 0.25; p = 0.004), the training (t = 6.143; p ≤ 0.0001) and the level of self-confidence (r = -0.205; p = 0.020) with the level of perception is highlighted.

### Conclusions

In this study, regarding the self-confidence for emergency intervention, the nurses demonstrated confidence, albeit modestly. Likewise, they presented a tendency towards positive agreement regarding the importance of IHET. Of note, the higher the experience of the nurses, the greater the importance attributed to the IHET. Finally, it was verified that the higher the nurse's self-confidence index, the lower the feeling of insecurity in an emergency situation.

### Keywords

Hospital Rapid Response Team, Nursing, Emergency situation, Perception of importance, Self-confidence in emergency

## O73

### Relationship between cognitive impairment and nutritional assessment on functional status in institutionalized Portuguese older adults

Catarina Caçador¹, Edite Teixeira-Lemos²,³, Jorge Oliveira²,³, Fernando Ramos¹, Manuel T Veríssimo⁴,⁵, Maria C Castilho⁶

¹Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal; ²Agrarian School, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; ³Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; ⁴Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁵Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁶Laboratory of Bromatology, Pharmacognosy and Analytical Science, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal

**Correspondence:** Catarina Caçador (cacasabel@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O73

### Background

Elderly are particularly vulnerable to nutritional change deficits. Malnutrition in elderly patients is frequently underdiagnosed [1] and it has a large number of negative consequences on health and quality of life [2]. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. Few studies have focused on the relationship between patient's nutritional assessment and a severity of cognitive impairments, comorbidity and functional status in institutionalized older adults.

### Objective

In the present study we evaluated the relationship between functional disability, cognitive impairment and nutritional status.

### Methods

This was an observational study with data collected from residents living in institutions in the district of Viseu (centre of Portugal). Inclusion criteria were: subjects aged 65 or older, living in institutions, that voluntarily accepted to participate in the study. All of the 216 subjects studied underwent multidimensional geriatric assessment. A form was filled with sociodemographic data and the nutritional state was assessed with the Mini Nutritional Assessment (MNA), whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). The functional state was assessed by Barthel Index (BI). Statistical evaluations (p < 0.05) were based on Qui-square tests between Barthel Index (BI), Mini Mental State Evaluation (MMSE), Body Mass Index (BMI) and Mini Nutritional Assessment (MNA) scores. Statistical evaluations (p < 0.05) were based on Qui-square tests between BI, MMSE, BMI and MNA scores.

### Results

A cognitive impairment in MMSE performance was displayed in 39.4% patients. Slight disability occurred in 69.4% of the residents, 24.1% were independent in activities of daily living and only 6.5% of the seniors had moderate dependence. There was a proportional increase of the cognitive impairment of the elderly (p ≤ 0.001) with increasing dependence. According to MNA, 27.8% of the elderly were at risk of malnutrition and 71.3% showed no nutritional problems. Statistical analysis showed that dependence increased the risk of malnutrition.

### Conclusions

A close relationship between malnutrition and functional dependence has been obtained. Both tests, MNA and BI, are positively associated. The scores of BI can help to determine who may be at risk of poor nutrition.

### References

1. Gariballa SE. Nutritional support in elderly patients. J Nutr Health Aging. 2000; 4: 25-7.

2. Pérez-Llamas F. Risk of desnutrition in the Spanish population. Evaluation of the current situation and need for a nutritional intervention. Med Clin (Barc) 2012; 139:163-4
**Keywords**

Elderly, Cognitive impairment, Functional status, Nutritional assessment, Malnutrition.

O74

**The evaluation of nursing care provided by Integrated Continuing Care Teams**

Carlos Vilela¹,², Paulino Sousa², Filipe Pereira²

¹Institute of Health Sciences, Portuguese Catholic University, 1649-023

Lisboa, Portugal; ²Nursing School of Porto, 4200-072 Porto, Portugal

**Correspondence:** Carlos Vilela (carlosvilela@esenf.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O74

**Background**

The evaluation of nursing care is an imperative for the continuous development of quality improvement and for the cyclical redefinition of action plans that correspond to the real needs of the population. In the specific case of the Integrated Continuing Care Teams (ICCT), inserted in the National Network of Continued Integrated Care of Portugal, it is justified the use of a panel of indicators of health gains "Sensitive to Nursing Care", given the nature of the services provided in these units, which helps to measure the clinical results obtained.

**Objective**

1) To identify the main nursing care needs of ICCT clients; and 2) Identify health gains sensitive to nursing care related to those needs.

**Methods**

Based on the definition model of indicators "sensitive to nursing care", we developed a quantitative study-exploratory, descriptive and correlational, using the analysis of the nursing documentation available in Information Systems in use, in a convenience sample of 217 cases, attended in four ICCT of the northern region of Portugal, from October 2012 to May 2013.

**Results**

From the analysis of 9,258 documented nursing diagnoses, it was possible to generate eight "types" of health gains indicators. Five related to the dependent person and three referring to the family caregiver (FC). Here the great incidence of the care provided in these ICCT was revealed, where the Gains in autonomy/independence in the universal requirements of self-care and Gains in knowledge of the FC were the most representative areas of the care provided. Then, came the domains of Gains in the evolution of nursing diagnoses of the dependent person ("others") and Gains in knowledge of the dependent person. Approximately 10% of the results computed were in areas that focused on Gains in FC performance (11.20%), Gains in performance of dependent persons (10.43%) and Gains in the prevention of Ulcers of Pressure (9.32%). With an order of magnitude in the order of 3.30% emerged the field of indicators related to Gains in the evolution of nursing diagnoses centred on the Role of Care Provider.

**Conclusions**

Reflecting on these results allows a more effective approach to the representation of nursing care in the evaluation of quality and, certainly, a better redefinition of the panel of indicators at the national level, with "sensitivity" to the nursing work developed by ICCT.

**Keywords**

Healthcare Quality Indicators, Quality of Health Care, Home Care Services, Nursing Care, Nursing Care Management.

O75

**Psychosocial impact of the powered wheelchair on the social participation of its users**

Inês Domingues¹, João Pinheiro¹, Anabela Martins², Patrícia Francisco²

¹Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;

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

**Correspondence:** Inês Domingues (inesfsdomingues@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O75

**Background**

There is a growing prevalence of disability worldwide, which indicates an increasing number of persons who might benefit from assistive technologies. Several studies showed positive effects of the use of assistive technologies on activity and participation of adults with mobility impairments [1, 2], as well as on psychosocial factors [3, 4].

**Objective**

The purpose of this study is to assess the psychosocial impact of the powered wheelchair, evaluating its repercussions on the social participation of its users.

**Methods**

Design - Observational, descriptive, cross-sectional study; Setting - All data was collected from May to October 2017; Participants - 30 powered wheelchair users with mean age of 40.63 years old (60% male) with diverse medical conditions (SCI, TBI, CP, among others); Main outcome measures - Interviews were conducted by an independent researcher using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Activities and Participation Profile Related to Mobility (PAPM), in addition to demographic, clinical and wheelchair-related questions.

**Results**

Participants were quite satisfied with both the assistive technologies and the related services, with the lowest QUEST scores belonging to those who had been using their wheelchairs for a longer period of time. PAPM scores revealed significant restrictions in participation (6.7% of participants with mild restrictions, 56.7% with moderate restrictions and 36.7% with severe restrictions), with a worst participation profile also among the users who had the wheelchairs for a longer period. The most satisfied users were the ones with better performance in terms of social participation. PIADS scores showed a positive impact of the powered wheelchairs in all subscales, with the following average scores: total 1.37, competence 1.39, adaptability 1.32 and self-esteem 1.38. The psychosocial impact, in terms of adaptability, was higher among users who transitioned from a manual wheelchair to a powered wheelchair compared to those who already had a powered wheelchair previously (1.85 vs 1.10; p = 0.02).

**Conclusions**

There was an overall positive psychosocial impact of powered wheelchairs, and, therefore, an increase in the quality of life of the users. Adaptability to the device seems to be the most contributing factor to social participation.

**References**

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

2. Lofqvist C, Pettersson C, Iwarsson S, Brandt A. Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use. Disabil Rehabil Assist Technol. 2012;7(3):211-8.

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

4. Buning ME, Angelo JA, Schmeler MR. Occupational performance and the transition to powered mobility: a pilot study. Am J Occup Ther. 2001;55(3):339-44.

**Keywords**

Assistive technologies, Powered wheelchair, Psychosocial impact, Social participation.

O76

**Work and breastfeeding: mom's double duty**

Rita MF Leal¹, Amâncio AS Carvalho², Marilia S Rua¹

¹School of Health, University of Aveiro, 3810-193 Aveiro, Portugal;

²School of Health, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal

**Correspondence:** Rita MF Leal (ritamariaferreiraleal@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O76
**Background**

Work is known to be an obstacle to breastfeeding (BF) continuation [1-5].

**Objective**

To analyse if there is a relationship between the employment status of the mother, the age of the child when she returns to work, the level of difficulty in reconciling work with BF and BF duration.

**Methods**

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect from November 2015 to September 2016. Data was analysed using SPSS software.

**Results**

Most women had difficulties in reconciling work with BF (72.5%). Of these, 26.6% said that conciliating work and BF was "very difficult" or "difficult", while 73.4% said they had "some difficulty" or "very little difficulty". Job status (employed versus unemployed) did not present a statistically significant relationship with BF duration. As to the age of the child when the mother returned to work, we verified a statistically significant relationship (p = 0.001) with BF duration. The level of difficulty the mother experienced in reconciling her job with BF also presented a statistically significant relationship (p = 0.002) with BF duration.

**Conclusions**

The majority of mothers reported difficulties in reconciling work with BF. Women who returned to work before their child was 6 months old had shorter BF duration. This reinforces the need to explore family's timely expectations, and plan strategies to promote an effective management of work and BF. In this context, we believe there is a need to establish in our culture jurisdiction policies that favour BF and work. Health professionals should act as mediators in the definition of family-oriented health policies. In this case, the extension of a parental leave for mothers up to 6 months postpartum, the existence of a place at work where breastfeeding mothers can extract and conserve their breastmilk or the existence of day-care centres in the workplace, in accordance to the Global Strategy for Infant and Young Child Feeding [6,7], may prolong BF duration and ease mothers difficulty in managing BF when returning to work.

**References**

1. Lynch S. Breastfeeding and the workplace. Community Pract. 2016;89(6):29-31.

2. Smith JP, McIntyre E, Craig L, Javanparast S, Strazdins L, Mortensen K. Workplace support, breastfeeding and health. Fam Matters. 2013;93:58-73.

3. Sriraman NK, Kellams A. Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals. J Women's Heal. 2016;0:1-9.

4. UNICEF. From the First Hour of Life: Making the case for improved infant and young child feeding everywhere Part1: Focus on Breastfeeding [Internet]. New York; 2016. Available from: http://www.unicef.pt/docs/pdf_publicacoes/FromTheFirstHourOfLife-Part1.pdf

5. Rivera-Pasquel M, Escobar-Zaragoza L, González de Cosío T. Breastfeeding and Maternal Employment: Results from Three National Nutritional Surveys in Mexico. Matern Child Health J. 2015;19(5):1162-72.

6. World Health Organization, United Nations Children's Fund. Global Strategy for Infant and Young Child Feeding. World Health Organ [Internet]. 2003 [cited 2016 Dec 21];1-30. Available from: http://www.paho.org/english/ad/fch/ca/GSIYCF_infantfeeding_eng.pdf

7. IBFAN Portugal Rede Internacional Pró-Alimentação Infantil. Relatório de Portugal da Iniciativa Mundial Sobre Tendências do Aleitamento Materno (WBTi) Situação da Estratégia Global para a Alimentação de Lactentes e Criança [Internet]. 2015 [cited 2016 Aug 29]. Available from: http://www.worldbreastfeedingtrends.org/GenerateReports/report/WBTi-Portugal-2015.pdf

**Keywords**

Breastfeeding, Employment, Job, Parental leave.

O77

**Health information shared in blogs by breast cancer survivors living in Portugal**

Francisca MMC Pinto¹, Paulino AF Sousa²,³, Maria RSP Esteves⁴,⁵

¹Universidade Católica Portuguesa, 4169-005 Porto, Portugal; ²Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Cooperativa de Ensino Superior Politécnico e Universitário, 4560-462 Penafiel, Portugal; ⁵Instituto de Investigação e Formação Avançada em Ciências e Tecnologias Saúde, 4560-462 Penafiel, Portugal

**Correspondence:** Francisca MMC Pinto (franciscampinto@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O77

**Background**

Breast cancer survivors (BCS), and other cancer patients, are digital social networks users; have their personal blogs where share their life/dis ease experiences after being diagnosed for cancer [1, 2]. Research on blogging activity among BCS is scarce and suggests that is a multifaceted activity with several purposes: self-management of emotions, problem-solving, and sharing information [3]. But the question remains: what health information is share by BCS in blogosphere?

**Objective**

The present work reports the results of a study that explored personal blogs of BCS who lives in Portugal, with focus on written health information that was posted and/or commented.

**Methods**

A qualitative study design and thematic content analysis. Blog selection by snowball strategy that included 3 phases: I) phase 1: first 20 search results on Google, with Portuguese keywords "blogues cancro da mama"; II) phase 2 and 3: links to other blogs that are present on each blog selected on phase 1 and 2, respectively. Blogs included for analysis met all criteria for inclusion: I) personal blog of women self-identified with a breast cancer diagnosis; II) blogger profile allows to confirm residence in Portugal; III) blog is public domain; IV) blog must present data related to post-primary treatment phase. Data collection was done between March-November, 2017. The scope analysis started on first post after finish primary treatment for breast cancer and ended in blog's last post at time we finished to read it.

**Results**

38 blogs were included for analysis. Results refer to health information shared by BCS in posts and commentaries between 2007-2017. Most of the information shared were uncertainties regarding: I) nutrition & physical exercise recommendations; II) management of long-term side effects of cancer treatment and comorbidities; III) management recurrence risk and psychological wellbeing; IV) treatment plans & health surveillance during survivorship; V) management of body image changes; VI) non-conventional therapies benefits & risks; vii) news about research on cancer. Less shared information regards to: I) return to work & social protection; II) general healthcare recommendations; III) community support to cancer patients; IV) genetics & heredity; V) sexuality; VI) infertility/fertility after breast cancer.

**Conclusions**

BCS use personal blogs to share difficulties, uncertainties and to search for information support to manage their health condition. Having access to useful information and education may help BCS manage uncertainty in illness, improve health literacy and self-efficacy to manage health condition. This study alerts health professionals to pay attention to BCS information and emotional needs.

**References**

1. Kim S, Chung D. Characteristics of cancer blog users. J Med Libr Assoc. 2007;95(4):445-50.

2. Damásio C, Nunes LM, Sobral JM. A Análise de Redes Sociais no estudo do processo da construção da ajuda mútua da pessoa com doença oncológica com blogue. REDES- Revista hispana para el análisis de redes sociales. 2014;25(1):153-89.

3. Koskan A, Klasko L, Davis SN, Gwede CK, Wells KJ, Kumar A, et al. Use and Taxonomy of Social Media in Cancer-Related Research: A Systematic Review. American Journal of Public Health. 2014;104(7):e20-e37.
**Keywords**

Breast cancer survivors, Blogs, Health information needs, Content analysis.

**O78**

**Visual images spectrum android classification for diabetic foot ulcers**

Ricardo Vardasca¹, Rita Frade2,3, Rui Carvalho4, Joaquim Mendes2,3
¹Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal; ²Porto Biomechanics Laboratory, Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal; ³Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial - Laboratório Associado de Energia, Transportes e Aeronáutica, 4200-465 Porto, Portugal; ⁴Clinica Multidisciplinar do Pé Diabético, Centro Hospitalar do Porto, 4099-001 Porto, Portugal

**Correspondence:** Ricardo Vardasca (ricardo.vardasca@fe.up.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O78

**Background**

According to the Portuguese Society of Diabetology, about 415 million (8.8%) of the worldwide population was diagnosed with Diabetes Mellitus in 2015. Being the Portuguese population incidence of 1 million people (13.3% of the total population), with a national annual total estimated cost of 1.7 billion euros with this condition. One in each four patients of DM develop Diabetic Foot Ulcer (DFU) in their lifetime, ending some in amputations and consequently in death [1]. Furthermore, the Directorate-General of Health estimated that in 2016, the prevalence of DFU was of 11.5% in the Portuguese population [2]. Throughout the years, DFU assessment tools have been created, such as: I) scales, which depend on visual examination being highly subjective; II) invasive methods that use manual procedures for depicting the shape, area, depth and volume of wounds, that are time consuming, susceptible to human errors and can lead to wound contamination [3]; or III) non-invasive methods such as optical based techniques which provide three-dimensional information about the lesion, which are expensive, time consuming and require user training [4]. Therefore, more objective measures are required.

**Objective**

This research study aims to create an objective and simple methodology based in a mobile application which incorporates an algorithm that characterises DFU ulcers providing information about its area and tissue colour composition.

**Methods**

An Android mobile application was developed, tested and evaluated in 200 diabetic foot ulcers, after signing the informed consent and the procedure being explained to patients. The study was approved by the ethical committee of Centro Hospitalar do Porto.

**Results & Conclusions**

The use of this new android mobile app showed a high correlation with the traditional clinical assessment (r² = 0.97), reducing subjectivity, avoiding wound contamination probability and smaller costs when compared to conventional solutions.

**Acknowledgements**

The authors gratefully acknowledge the funding of project NORTE-01-0145-FEDER-000022 - SciTech - Science and Technology for Competitive and Sustainable Industries, cofinanced by Programa Operacional Regional do Norte (NORTE2020), through Fundo Europeu de Desenvolvimento Regional (FEDER) and of project LAETA - UID/EMS/50022/2013.

**References**

1. Sociedade Portuguesa de Diabetologia. Relatório Anual do Observatório Nacional da Diabetes. Diabetes: Factos e Números; 2016.

2. Direcção Geral de Saúde. Relatório do Programa Nacional para a Diabetes; 2017.

3. Plassmann P. Measuring wounds. Journal of Wound Care 4(6); 1995. 269-272.

4. Wang L, Pedersen PC, Strong DM, Tulu B, Agu E, Ignotz R, He Q. An Automatic Assessment System of Diabetic Foot Ulcers Based on Wound Area Determination, Color Segmentation, and Healing Score Evaluation. Journal of diabetes science and technology 10(2); 2016. 421-428.

**Keywords**

Android, Classification, Diabetic foot ulcers, Imaging, Wound assessment.

**O79**

**Sleep disorders in elderly: is it a problem?**

Vitor Moreira¹, Ângela Mota¹, Bárbara Santos¹, Olívia R Pereira¹,², Xavier Costa¹,³

¹Departamento de Tecnologias de Diagnóstico Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 Bragança, Portugal; ²Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; ³Centro Hospitalar de Trás-os-Montes e Alto Douro, Unidade Hospitalar de Chaves, 5400-279 Chaves, Portugal

**Correspondence:** Olívia R Pereira (oliviapereira@ipb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O79

**Background**

Sleep disorders are one of the most relevant clinical symptoms in adults, with increasing prevalence throughout life, reaching in large scale the elderly population.

**Objective**

The present study aimed to characterize sleep disorders in the elderly and its pharmacological therapy.

**Methods**

A cross-sectional study was performed through application of a questionnaire to 381 elderly in pharmacies of Braga, Bragança and Porto cities. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

**Results**

Elders were most from female gender (60.1%), aged between 65 and 74 years (49.6%) and lived in rural areas (73.4%). Just 36.5% of the elderly practice physical exercise and an important amount of elderly drink coffee and tea (68.8% and 73.2%, respectively). Concerning sleep characteristics, the elders go to bed between 6 p.m. and 2 a.m. and about half of participants (52.8%) go between 10 p.m. and 12 a.m. Approximately one third had difficulty in falling asleep (38.1%), especially the elderly from the region of Bragança. During sleep, a large proportion of the elderly reported having sleep stops (78.2%) usually for 15-30 minutes and 26.5% reported waking up twice during the night. Taking into account that the time of delay to sleep is an important factor, in the present study, this was statistically related with the gender (p = 0.003) and with taking medication to sleep (p < 0.001). The same two factors are statistically related with "wake up during the night" (p = 0.046, p = 0.003, respectively). 40.7% of the surveyed elderly have been diagnosed with sleep disorders, mainly insomnia (19.7%) following by restless legs syndrome (3.4%), excessive drowsiness (2.9%) and sleep apnoea, sleep-walking and narcolepsy (about 1%). It is important to refer that among the elderly, that assume to suffer from sleep disorders, just 40.7% have been consulted by a physician. Of those who consulted a doctor, 21.3% of the elderly were advised to change their lifestyle habits, such as, to avoid heavy meals before bedtime, to establish a sleep routine, to lie down only when he/she is sleepy and to practice physical activity. Concerning the pharmacological therapy, 41.7% take medication for sleep disorders, 9% take medication without consulting a doctor, while 32.5% elderly people take medication after consulting a doctor. From
these, the most used are benzodiazepines such as alprazolam (12.5%), diazepam (8.6%), lorazepam (4.5%) and brotizolam (3.7%).

**Conclusions**

Sleep disorders are frequent in the elderly population. It is necessary to raise awareness in this population group, which associates sleep problems to age.

**Keywords**

Sleep Disorders, Elderly, Pharmacological Therapy, Sleep and aging.

**O80**

**Physical and mental health in community-dwelling elderly: functional assessment and implications to multidisciplinary clinical practice**

Rogério Rodrigues¹, Zaida Azeredo², Sandrina Crespo¹, Cristiana Ribeiro¹, Isabel Mendes¹

¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ²Research in Education and Community Intervention, Piaget Institute, 1950-157 Lisbon, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O80

**Background**

Disability in old age may pose barriers to the achievement of goals and the ability to carry on roles that are important to a person. Knowledge about the functional disability in physical and mental areas in old people is crucial for the planning of interventions by the health technicians.

**Objective**

To evaluate functional physical and mental abilities of community-dwelling elderly for planning health care and the implementation of services.

**Methods**

Quantitative descriptive-correlational study of the project "*The oldest old: Coimbra's ageing study*" PTDC/CS-SOC/114895/2009 [1]. Sample constituted by 202 elderlies from a population of 808 (three age groups: 65-74; 75-84 and ≥ 85 years old), obtained in a randomized and probabilistic trial, from the files of users of a Health Centre, after ethic commission approval. As instrument and method of data collection was used the QAFMI (Portuguese version of the Older Americans Resources and Services), to evaluate the functional status, in terms of physical and mental health. Data analysis: a) descriptive analyses on the most common pathologies, their limitation and medication consumption; b) functional evaluation using the score given by the computer software based on the model of QAFMI.

**Results**

As main results we point out, the pathologies with major interference in physical activities, which are chronic bronchitis, skin disease, arthritis or rheumatism, effects of stroke and circulation troubles. Related to the consumption of medication, it was observed that for the most cited pathologies (hypertension and cardiac problems) there is a great percentage of consumption. Others (arthritis or rheumatism) have a lower prescription. There was no statistically significant difference for physical health, in the comparative study between genders. There are differences between the age groups, with lower scores for the oldest. Related to mental functional abilities, there is a statistically significant difference for the diverse age groups, with an increase of impaired capacity for the oldest. For the whole of the sample gender differences exist, being worst scored the women.

**Conclusions**

Women and the oldest, in general, appear as the ones that present lower functional physical abilities. The classification by

the QAFMI model, regarding the area of mental health, reports the approach of cognitive decline and perception of memory loss. Like in other studies, differences were found between genders, resulting in worse scores for women.

**References**

1. Rodrigues R. Os muito idosos: estudo do envelhecimento em Coimbra – Perfis funcionais e intervenção [eBook]. Coimbra: Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Enfermagem de Coimbra; 2014.

**Keywords**

Elderly, Community-dwelling, Functional assessment, Physical health, Mental health.

**O81**

**Adherence to therapy in elderly**

Ana Rodrigues, Clara Rocha, Jorge Balteiro
Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854
Coimbra, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O81

**Background**

In recent decades, the elderly population has grown significantly, leading to an increase in the number of chronic diseases and, consequently, to an increased need for polymedication for disease control. Polymedication means the use of multiple medications, which can cause adverse reactions/drug interactions that increase depending on the number of medications administered. In elderly with high number of pathologies associated or not with age, complex therapies are instituted which may lead to non-adherence to therapy. This situation can impair the aim of treatment, worsen the disease, add errors to diagnosis and treatment itself, or even lead to therapy failure.

**Objective**

The objective of the present study is to assess the adherence to therapy in elderly institutionalized during the day and investigate the main factors that influence it.

**Methods**

The study was conducted with the collection and processing of questionnaires, consisting of 3 parts: demographic characterization (e.g., age, gender, marital status); therapeutic characterization (amount of daily medications and treatment regimen) and evaluation of adherence to therapy by adapting the scale of measurement of adherence to treatment (MAT). The study sample was made up of 51 elderlies institutionalized during the day.

**Results**

It was observed that 98% of seniors join the instituted therapy: 37.3% showed a level of 5 therapeutic membership, approximately 49% showed a level of accession of 6 and only 14.9% expressed below. Of the factors studied as susceptible of influencing therapeutic membership, it was only found that oblivion is the conditioning factor associated with the recommended therapy (p = 0.047), affecting the levels of membership.

**Conclusions**

The results obtained allowed to conclude that the high levels of membership can be associated to the fact that the elderly were institutionalized during the day, having support available. Another possible explanation is the fact that the same live with family, being also accompanied during the night.

**Keywords**

Adherence to therapy, Elderly, Polymedication, MAT.
## O82

### Ionizing radiation effects in a bladder and an esophageal cancer cell lines

Neuza Oliveira¹, Mafalda Vitorino¹, Ricardo Santo², Paulo Teixeira¹,³,⁴
Salomé Pires³,⁵, Ana M Abrantes³,⁵, Ana C Gonçalves⁵,⁶, Clara Rocha⁷,⁸
Paulo C Simões⁹, Fernando Mendes¹,³,⁵, Maria F Botelho³,⁵

¹Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal; ³Biophysics Institute-CNC.IBIL, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; ⁴SERVICE de Anatomia Patológica, Centro Hospitalar Universitário de Coimbra, 3000-075 Coimbra, Portugal; ⁵Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal; ⁶Laboratory of Oncobiology and Hematology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal;

⁷Department Complementary Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ⁸Institute for Systems Engineering and Computers at Coimbra, 3030-290 Coimbra, Portugal; ⁹Radiation Oncology Department, Hospital and University Center of Coimbra, 3000-075 Coimbra, Portugal

**Correspondence:** Fernando Mendes (fjmendes@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O82

### Background

Oesophageal cancer (EC) and bladder cancer (BC) share the same embryonic origin (endoderm) and according to the latest numbers, EC is the eighth and BC is the ninth most frequently diagnosed cancers worldwide. Radiotherapy (RT) is currently used in the treatment of both types of cancer [1-4].

### Objective

Assessment of the effects of ionizing radiation (IR) on cell lines of EC (OE19) and of BC (HT1376), namely viability and cell proliferation, characterisation of cellular death type and cell cycle, as well to establish survival factor and determination of the aggression model, after different radiation dose exposure to calculate half lethal dose (DL50).

### Methods

Cell lines were cultured and exposed to single-shot doses of X-rays from 0.5 Gy to 12.0 Gy, except control cells (0.0 Gy). Cell viability and proliferation were assessed by trypan blue assay. The proliferation index determination was performed by immunocytochemistry trough Ki-67 expression. Flow cytometry was used to assess cell death type and cell cycle and the main morphological features of cell death were evaluated by May-Grünwald Giemsa stain. Clonogenic assays enabled assessment to differences in reproductive viability (capacity of cells to produce progeny) [5-11].

### Results

Our results showed that IR induces cytotoxic and antiproliferative effects in OE19 and HT1376 cells in a dose-dependent manner and dose and time-dependent manner, respectively. Main types of cell death observed were apoptosis or necrosis. We also observed cell cycle arrest on G2/M phase and a decrease of the Ki-67 expression in both cell lines studied. The cell survival curves were established according to the quadratic linear model for both cell lines. For OE19 cell line the DL50 was 2.47 Gy and for HT1376 cell line was 3.10 Gy, accompanied by a decrease in the survival factor for both lines.

### Conclusions

The direct effects of the DNA molecule that are unrepairable, activate multiple intracellular mechanisms on radio-sensitivity, such as cell death, namely by apoptosis and necrosis and cell cycle arresting G2/M phase. The increase radiation dose induces alterations in cell death, from apoptosis to necrosis. According to our results, OE19 is more radio-sensible than HT1376 cell line. This study demonstrates that molecular mechanisms underlying RT are important in oesophageal adenocarcinoma and bladder cancer therapeutic approaches.

### Acknowledgements

The authors would like to thank to Institute for Biomedical Imaging and Life Sciences is a research Institution of the Faculty of Medicine, University of Coimbra and to Radiotherapy Service of the Centro Hospitalar e Universitário de Coimbra.

### References

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-tieulent J, Jemal A. Global Cancer Statistics, 2012. CA a cancer J Clin. 2015;65(2):87-108.

2. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol. 2016;1-13.

3. Nassim R, Mansure JJ, Chevalier S, Cury F, Kassouf W. Combining mTOR Inhibition with Radiation Improves Antitumor Activity in Bladder Cancer Cells In Vitro and In Vivo: A Novel Strategy for Treatment. PLoS One. 2013;8(6).

4. Rubenstein JH, Shaheen NJ. Epidemiology, diagnosis, and management of esophageal adenocarcinoma. Gastroenterology. 2015;149(2):302-317.e1.

5. Mendes F, Sales T, Domingues C, Schugk S, Abrantes AM argarida, Gon??alves AC ristina, et al. Effects of X-radiation on lung cancer cells: the interplay between oxidative stress and P53 levels. Med Oncol. 2015;32(12):266.

6. Mendes F, Domingues C, Schugk S, Abrantes AM, Gonçalves AC, Casalta-Lopes J, et al. Single Shot Irradiation and Molecular Effects on a Diffuse Large B Cell Lymphoma Cell Line. J Cancer Res Treat. 2016;4(1):9-16.

7. Santo RP. Resposta Celular à Radioterapia – Estudo in vitro em linhas celulares do carcinoma da próstata Resposta Celular à Radiação Ionizante. Faculdade de Medicina da Universidade de Coimbra; 2017.

8. Tran WT, Iradji S, Sofroni E, Giles A, Eddy D, Czarnota GJ. Microbubble and ultrasound radioenhancement of bladder cancer. Br J Cancer. 2012;107(3):469-76.

9. Barbosa T V., Rosas MP, Costa AC, Rapoport A. Valor prognóstico do Ki-67 no carcinoma indiferenciado de grandes células de glândula salivar maior: estudo de 11 casos. Rev Bras Otorrinolaringol [Internet]. 2003;69(5):629-34. Available from: http://www.scielo.br/scielo.php?script=sci Artículo&pid=S0034-72992003000500007&lng=en&nrm=iso&tlng=pt

10. Ding Z, Yang H-W, Xia T-S, Wang B, Ding Q. Integrative genomic analyses of the RNA-binding protein, RNPC1, and its potential role in cancer prediction. Int J Mol Med. 2015;36(2):473-84.

11. Franken NAP, Rodermond HM, Stap J, Haveman J, Bree C Van. Clonogenic assay of cells in vitro. 2006;(October 2016).

### Keywords

Esophageal cancer, Urinary Bladder Neoplasms, Radiotherapy, Ki-67 antigen.

## O83

### Sociodemographic characteristics and breastfeeding duration

Rita MF Leal¹, Amâncio AS Carvalho², Marília S Rua¹

¹School of Health, University of Aveiro, 3810-193 Aveiro, Portugal;

²School of Health, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal

**Correspondence:** Rita MF Leal (ritamariaferreiraleal@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O83

### Background

Sociodemographic characteristics have been related to breastfeeding (BF) duration. Research has shown interest in these factors which may even be predictive [1].

### Objective

To analyse a correlation between sociodemographic characteristics (maternal age, level of education, marital status, number of older children, child gender, child's year of birth) and breastfeeding (BF) duration.

### Methods

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect. Data was analysed using SPSS software.

### Results

Maternal age, marital status, child's gender and child's year of birth did not present a statistically significant relationship with BF duration. On
the other hand, mothers educational level (p = 0.001) and the number of older children (p = 0.018) presented a statistically significant relationship with BF duration.

## Conclusions

Our study did not establish a correlation between maternal age and BF duration which contradicts other findings [1-3] and can be explained by pregnancy and childbirth postponement nationwide [4]. In relation to mothers' educational level, we verified a statistically significant relationship with BF duration, being that the mothers who detained a higher level of education, breastfed longer [1,5-7]. As for marital status, we did not verify a statistically significant relationship with BF duration, which is in line with a recent Portuguese study [5] but differs from other international studies [2,3] that refer that married mothers breastfeed longer. This difference can be explained by cultural differences and by the paradigmatic change of the women's role, concept of marriage, and a diversity of forms of family life (great increase in unmarried couples). We also verified an increasing tendency in BF duration with the increase of the number of older children [6,7], but it was not lowest in primiparous women which contradicts other findings [6,7]. This may be clarified, once again, by the sociodemographic changes in the last decade in Portugal that include population ageing, an increasing tendency for families with an only child [4] and the great investment in parenthood and child well-being. Health care professionals should consider that sociodemographic characteristics are in constant change and so is its relation to health. These findings help health professionals to identify who may be most vulnerable to early weaning and allows them to explore expectations and develop a care plan accordingly.

## References

1. Scott J A, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev. 1999;7(1):5-16.

2. Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth. 2004;31(4):285-92.

3. Ogbuanu C, Glover S, Probst J, Hussey J, Liu J. Balancing Work and Family: Effect of Employment Characteristics on Breastfeeding. J Hum Lact. 2011;27(3):225-38.

4. Delgado A, Wall K. Familias nos Censos 2011: Diversidade e Mudança [Internet]. 1a edição. Instituto Nacional de Estatística, editor. Lisboa: Imprensa de Ciências Sociais; 2014 [cited 2016 Dec 13]. 239 p. Available from: http://repositorio.ul.pt/bitstream/10451/23625/1/ICS_SAatalaia_VCunha_KWall_SMarinho_VRamos_Como_ASITEN.pdf

5. Dias A, Monteiro T, Oliveira D, Guedes A, Godinho C, Alexandrino AM. Aleitamento materno no primeiro ano de vida: prevalência, fatores protetores e de abandono. Acta Pediátrica Port. 2013;44(6):6-11.

6. Caldeira T, Moreira P, Pinto E. Aleitamento materno: estudo dos factores relacionados com o seu abandono. Rev Port Clínica Geral Clin Geral. 2007;23:685-99.

7. Lopes B, Marques P. Prevalência do aleitamento materno no distrito de Viana do Castelo nos primeiros seis meses de vida. Rev Port Clínica Geral. 2004;20:539-44.

## Keywords

Age, Breastfeeding, Education, Population characteristics, Population dynamics.

## O84

### Population analysis of cleft lip and/or palate patients treated in the Postgraduate Orthodontic Department of the Faculty of Medicine of the University of Coimbra

Ana Roseiro, Inês Francisco, Luisa Malo, Francisco Vale Universidade de Coimbra, 3004-531 Coimbra, Portugal
**Correspondence:** Ana Roseiro (a-roseiro@hotmail.com)
BMC Health Services Research 2018, **18**(Suppl 2):O84

### Background

Cleft lip and palate is one of the most common dentofacial congenital anomalies, affecting on average 1:700 new-borns. Although the aetiology of this condition is not fully understood, it seems to be

related with both genetic and environmental factors. This type of malformation may occur isolated or it could be associated with a syndrome. When compared with the general population, cleft lip and palate patients present in a larger number, a series of dental anomalies in number, size and tooth shape.

## Objective

Analyse in a population of cleft lip and/or palate patients a number of anatomical and sociodemographic characteristics.

## Methods

The study included 60 patients referred to the Postgraduate Orthodontic Department of the Faculty of Medicine of Coimbra by the Children's Hospital during the year of 2015. All data related to patients was obtained through a meticulous and thorough orthodontic exam (medical history, cast models, intra and extra oral pictures and radiographic exams).

## Results

Of the 60 patients included in the study, 65% were of male gender. Patients with 11 years of age were the most prevalent ones (5-22 years of range). The most common anomaly was unilateral lip and palate cleft (63%). Maxillary endognathy was present in 75% of the cases. 74% of the patients presented at least one dental agenesis being the upper lateral incisor the more common one.

## Conclusions

Cleft lip and palate is more frequent in male individuals and seems to be associated with conditions like maxillary endognathy and dental agenesis, with orthodontic treatment being required in these patients.

## Keywords

Cleft lip and palate, Dental agenesis, Maxillary endognathy.

## O85

### Drug use in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança

Ana Branco¹, Ana Coutinho¹, Ana Machado¹, Bárbara Alves¹, Miguel Nascimento¹,², Olívia R Pereira¹,³

¹Departamento de Tecnologias de Diagnóstico Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 Bragança, Portugal; ²Serviços Farmacêuticos, Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal; ³Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal

**Correspondence:** Olívia R Pereira (oliviapereira@ipb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O85

### Background

The use of drugs during the gestational period is a subject of great concern, once the exposure of medicines may result in toxicities with possible irreversible lesions for the foetus. In fact, drugs in pregnancy have been restricted since the accident of thalidomide. In 1979 the U.S. Food and Drug Administration (FDA) adopted the classification of drugs as the risk associated with their use during pregnancy, these being classified into 5 classes (A, B, C, D and X).

### Objective

The aim of the present study was to characterize the use of drug therapy in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança regions.

### Methods

A cross-sectional study was performed through application of a questionnaire to 134 pregnant women in the Northeast (Mirandela, Macedo de Cavaleiros and Bragança regions) during consultation in a health centre. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

### Results

The sample comprised a total of 134 pregnant women from the Northeast area, mostly with ages between 21 and 30 years or between 31 and 40 years (56.7% and 35.8%, respectively), holding secondary or higher education (48.5% and 42.5%, respectively) and employment (67.2%). About half of the pregnant (47.8%) were in the 3rd quarter of pregnancy. 78.4% (105 women) of the pregnant had used drugs during the pregnancy, 64.4% after medical prescription, and 71.6% have acquired the medication at the pharmacy. In detail,
the medication most used was folic acid (64.2%, 86 of the pregnant women) which belongs to class A; paracetamol from class B (35.1%, n = 47), iodine (17.2%, n = 23) and iron (14.9%, n=20), both belonging to the class A. Less reported drugs have included metoclopramide (6.0%) and Vitamin D₃ (6.0%), from Class C and Class D, respectively. It is important to refer that 12.7% of the women had a chronic disease and 2.2% had an acute disease during pregnancy. Diseases more reported were asthma and diabetes.

### Conclusions

In the present study, the use of drugs in pregnancy was independent of the education level, chronic or acute disease, locality, marital status, employment status, gestational period and health centre. The drugs most used by pregnant women belong to class A (18.5%), class B (25.9%) and class C (33.3%) and the less used belong to class D and X. Supplements such as folic acid, iodine and iron and the analgesic paracetamol were the most reported.

### Keywords

Pregnancy, Drug therapy, Risk, Disease.

O86

## Knowledge representation about self-management of medication regime in Portuguese Nursing Information Systems

Inês Cruz, Fernanda Bastos, Filipe Pereira
Nursing School of Porto, 4200-072 Porto, Portugal

**Correspondence:** Inês Cruz (inescruz@esenf.pt)
BMC Health Services Research 2018, **18**(Suppl 2):O86

### Background

The use of a standardized language in nursing supports the nursing science and contributes to the management of the discipline's own knowledge [1, 2]. Nurses can control, practice, and teach only what they can name. The documentation of care in Nursing Information Systems in Portugal is based on the international classification for nursing practice (ICNP®) [3].

### Objective

The purpose of this study is to describe and specify nursing diagnoses centred on the clients' knowledge for self-managing the medication regime in chronic diseases.

### Methods

Exploratory study. All nursing documentation, concerning all health centres and public hospitals, customized in the Portuguese nursing information System-SAPE® (2012) and in SClinico® (2016) was subject to content analysis. Content analysis of nursing documentation was based on ICNP® terminology. After conducting content analysis, the material was validated by a group of 14 nursing experts.

### Results

A set of nursing diagnoses related to the person's knowledge on the medication regime management were specified. Knowledge refers to the development of the client's informational content about how to manage his medication regime. These diagnoses focus on the potential to improve knowledge about: self-management of the medication regime; medication regime; response to medication and side effects of medication; health services; complications and preventing complications of compromised self-management; and the use of devices to facilitate drug intake.

### Conclusions

The specified diagnoses reflect nursing care needs that nurses document in the Portuguese nursing information systems, related to medication self-management. These results are contributes to the formalization of nursing science's knowledge in the field of self-care of people living with chronic diseases.

### References

1. Peace J, Brennan P. Formalizing Nursing Knowledge: from theories and models to ontologies. Connecting Health and Humans. 2009; 347-351.

2. Pereira F, Silva A. Information technologies and nursing practice: the Portuguese case. In Nursing and informatics for the 21st century: an international look at practice, education and HER trends. Weaver C, Delaney P, Weber, et al. AMIA. 2010; 435-441.

3. Cruz I, Bastos F, Pereira F, Silva A, Sousa P. Analysis of the nursing documentation in use in Portugal - building a clinical data model of nursing centered on the management of treatment regimen. Nursing Informatics. 2016. 225; 407-411.

### Keywords

Self-management, Knowledge, Nursing Diagnoses, Nursing Information Systems.

O87

## Illness perceptions, beliefs about medicines and medication adherence in hypertension

Teresa Guimarães, André Coelho, Anabela Graça, Ana R Fonseca, Ana M Silva

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

**Correspondence:** Teresa Guimarães (tguimaraes@estesl.ipl.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O87

### Background

Hypertension constitutes the most prevalent modifiable cardiovascular risk factor and a major risk factor for cognitive decline and dementia. Antihypertensive medication is essential to minimize the consequences of the disease, stressing the need for a high adherence to treatment to achieve hypertension control. Illness perceptions and beliefs about medication have been identified as important determinants of treatment adherence.

### Objective

To identify patients' perceptions on hypertension and beliefs about antihypertensive medication and assess associations between these beliefs and medication adherence.

### Methods

63 hypertensive patients, 69.8% females, 54-95 years (M = 69.02; SD=10.07), 96.8% diagnosed for more than one year and with antihypertensive medication prescribed completed the Revised Illness Perception Questionnaire (IPQ-R), the Beliefs about Medicines Questionnaire (BMQ-Specific) and a medication adherence measure (Medida de Adesão aos Tratamentos - MAT).

### Results

Most of the patients perceived hypertension as a chronic (100%), cyclical (96.8%) condition, which can be controlled by medication (96.8%) and behaviour (90.5%), presented strong beliefs in the necessity of medication (96.8%), but also strong concerns about the consequences of taking it (87.3%). Patients reported a high level of adherence to medication (M = 5.41; SD = 0.55 on MAT, 7 as highest possible score) and low frequency of non-adherent behaviours. Significant positive correlations were found between necessity scale (BMQ) and hypertension timeline (acute/chronic) (rs(63)= 0.34; p < 0.01), treatment control (rs(63)= 0.43; p < 0.01), emotional representations (rs(63)= 0.50; p < 0.01) and between concerns scale (BMQ) and hypertension consequences (rs(63)= 0.26; p < 0.05); timeline (cyclical) (rs(63)= 0.46; p < 0.01), emotional representations (rs(63) = 0.32; p < 0.05). Significant negative correlations were found between concerns scale and personal (rs(63)= - 0.35; p < 0.01) and treatment (rs(63)= - 0.28; p < 0.05) control. We also found significant negative correlations between adherence (MAT) and hypertension timeline (cyclical) (rs(63)= -0.27; p < 0.05), consequences (rs(63)= -0.50; p < 0.01) and emotional representations (rs(62)= -0.37; p < 0.01).

### Conclusions

Our findings suggest that illness perceptions play a key role in the way patients cope with their illness, through the development of patient's beliefs concerning the necessity of medication and concerns about taking it, and also by directly influencing adherence to treatment. In our study, non-adherence is essentially unintentional (patients forget or are careless about treatment), what explains the lack of association between adherence and beliefs about medication, although we have found that, for the majority of subjects, concerns about taking medicines are outweighed by a belief in the necessity of the prescribed medication.
**Keywords**

Hypertension, Illness perceptions, Beliefs about medicines, Medication adherence.

O88

**Self-determined motivation and life satisfaction of elderly for the supervised physical activity practice**

Marco Batista¹, João Martinho¹, Jorge Santos¹, Helena Mesquita¹, Pedro Duarte-Mendes¹, Rui Paulo²

¹Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal

**Correspondence:** Marco Batista (marco.batista@ipcb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O88

**Background**

The self-determination theory suggests that humans have several basic psychological needs that are innate, universal and essential to health and well-being, namely, autonomy, competence and relation perception. The wellness construct, measured by satisfaction with life is understood as a judgment process in which individuals generally estimate the quality of their lives based on their own criteria.

**Objective**

This study has as main objective to identify the motivations, basic psychological needs and satisfaction with the life of the Portuguese elderly for the practice of supervised Physical Activity; and to analyse the relations and comparisons between levels of practice, sex and institutional context.

**Methods**

A cross-sectional study was carried out with 62 elderly volunteers of both sexes (15 males and 47 females), institutionalized and non-institutionalized, belonging to the Municipality of Castelo Branco, with a mean age of 79.61 ± 9.34 years. The instruments used were the Behavioural Regulation in Exercise Questionnaire, the Basic Psychological Needs Scale Exercise and the Satisfaction with Life Scale.

**Results**

The results show that, apparently, the motivation that maintains the constant practice of physical activity supervised by the elderly focuses on the autonomous motivation. It can also be observed that, except for the amotivation, where women have higher levels of amotivation for the practice of supervised physical activity than men, that is, they may be more exposed to an absence of motivational orientation, there are no differences at the level of the remaining motivational variables, as well as the basic psychological needs and life satisfaction between the male and the female. The results showed that, in the supervised elderly, the satisfaction of the basic psychological needs leads to autonomously motivated behaviours, promoting high levels of satisfaction with life.

**Conclusions**

We can conclude that autonomous motivation and the satisfaction perception of basic psychological needs are externalized as factors of great importance, because they appear to be a catalyst for this population to remain active and, in a way, to "compromise" with This lifestyle.

**Keywords**

Self-determination theory, Satisfaction with life, Exercise, Well- being, Elderly.

O89

**Application of the transcontextual model of motivation in the prediction of healthy lifestyles of active adults**

Marco Batista¹, Marta Leytón², Susana Lobato³, Maria Aspano³, Ruth Jimenez-Castuera³

¹Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Universidad Pablo de Olavide, 41013 Sevilla, Spain;

³Universidad de Extremadura, 06071 Badajoz, Spain

**Correspondence:** Marco Batista (marco.batista@ipcb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O89

**Background**

The Transcontextual Model suggests an original contribution to knowledge, and can illustrate human behaviour, interpreting the theory of self-determination, contrasting with the hierarchical model of motivation, as well as with the theory of planned behaviour, seeking to predict behaviours. The strength of this model lies in the integration of different motivational theories, such that an explanation is a predicted complement to the motivational processes that are inexplicable in theory by each component.

**Objective**

The present study was designed with the objective of testing an extension of the Transcontextual Model of motivation in predicting healthy lifestyles of active adults.

**Methods**

The study sample consisted in 560 Portuguese active adults of both genders, aged between 30 and 64 years (M = 44.86; DP = 7.14). The instruments used were the Behavioural Regulation in Exercise Questionnaire, the Basic Psychological Needs Scale Exercise, Questionnaire for Planned Behaviour and the Healthy Lifestyle Questionnaire. A structural equation model was elaborated with which the predictive relations between the analysed variables were examined. The indices obtained in the measurement model were: $χ^2 = 527.193, p < .001; χ^2/gl = 3.46; CFI = .94; IFI = .94; TLI = .93; GFI = .93; RMSEA = .60; SRMR = .43$. The model goodness test showed the following adjustment indices: $χ^2 = 728.052, p < .001, χ^2/gl = 4.79, CFI = .91; IFI = .91; TLI = .90; GFI = .91; RMSEA = .075; SRMR = .070$.

**Results**

The structural equations model showed that the perception of social relation positively and significantly predicts autonomous motivation. In turn, this positively and significantly predicts control perception, predicting this, positively and significantly, the intentions. Eating habits and rest habits were positively and significantly predicted by intentions, and tobacco consumption was predicted negatively and significantly by intentions.

**Conclusions**

From the conclusions reached in this study, it is important to emphasize the importance of fostering social relations, since this will favour autonomous motivation, promoting a greater behavioural control over the intentions of the practitioners, thus generating more healthy eating habits, rest habits and lower consumption of tobacco.

**Keywords**

Theory of planned behavior, Self-determination theory, Structural equations models, Exercise, Lifestyles.

O90

**Symptoms management and adherence to antiretroviral medication - a nursing intervention**

Eunice Henriques, Maria FM Gaspar

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

**Correspondence:** Eunice Henriques (eunice.henriques@esel.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O90

**Background**

The increase of new diagnoses of HIV infection in young males, especially those who have sex with men, and the high percentage of late diagnoses, particularly in middle-aged heterosexuals continues to be our major concerns. As AIDS is now considered a chronic disease, its effective and sustainable treatment relies naturally on self-management of symptoms as well as promoting adherence to therapy. This will reduce costs and promote well-being in the person's life.

**Objective**

To develop a nursing intervention program to enhance effectiveness in managing symptoms and consequently adherence to antiretroviral therapy in the person with HIV/AIDS. Specific Objectives: Validate and adapt the following instruments: "Revised Sign and Symptom checklist for Persons with HIV disease"; "Self-care symptom management for people living with HIV/AIDS; AACTG (Adult Aids Trial Group) Instruments; "HIV/AIDS Stigma Instrument - PLWA (HASI-P) ©"; I) to
assess the frequency and intensity of the most common signs and symptoms associated with HIV infection among participants, as well as the strategies used; II) to evaluate the adherence to antiretroviral therapy (ART); and III) evaluate self-perception of stigma.

**Methods**

This is a quasi-experimental, study with pre and post intervention evaluation. Participants were selected at the HCC Day Hospital; HIV-infected, multi-stage, more than 18-year-old, to have ART for at least 6 months. We carried out the sociodemographic characterization and validation of the instruments. The intervention consisted in the application of a strategy manual for self-management of the most frequent symptoms.

**Results**

The 1st Study sample consisted of 374 individuals, 74.1% were males. The age varied from 20 years to 78. The average with 47.34 years. Of the 64 presented symptoms, the number of symptoms ranged from 0 to 53 by the same participant. The mean was 18.96 symptoms per person. The most frequent symptoms were: anxiety, fatigue, fear and worries and depression. Most do not use strategies, or they are not effective in managing these symptoms. Of the total number of respondents, 30% never stopped taking the medication and the same number failed to take the therapy in the last 3 months, the main reason is simple forgetting.

**Conclusions**

Most participants do not adequately manage the symptoms due to lack of knowledge of the appropriate strategies, indicating devaluation based on the belief of inevitability (pain). Most say they adhere to ART (70%), making more than 95% of the shots, which is not always consistent with viral load.

**Keywords**

Nursing intervention, Symptoms management, Adherence to antiretroviral medication.

## O91

### Aortic valve prosthesis: cardiovascular complications due to surgical implantation

Virginia Fonseca¹, Ana Rita Bento¹, Joana Esteves¹, Adelaide Almeida¹,²,
João Lobato¹

¹Escola Superior de Tecnologia da Saúde de Lisboa, 1990-094 Lisboa,
Portugal; ²Hospital da Luz, 1500-650 Lisboa, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O91

**Background**

Aortic stenosis represents the third most common cause of cardiovascular disease, with indication for surgical valve replacement with a biological or mechanical prosthesis in most symptomatic patients. Biological prostheses present a higher risk of reoperation due to valvular degeneration; however, do not require prolonged therapy. In spite of the long durability, mechanics prosthesis need chronic anti-coagulant therapy. The surgical intervention for valvular replacement is not free of complications and can be grouped into three main categories: prosthesis complications, non-prosthesis related cardiac complications and non-cardiac complications.

**Objective**

To characterize the cardiovascular complications resulting from the implantation of biological or mechanical aortic valve prosthesis, by surgical procedure.

**Methods**

32 patients were evaluated in four follow-up moments. Cardiovascular complications resulting from the implantation of a valve prosthesis (biological or mechanical) were analysed, and also the value of the pre and post-surgical mean gradient, symptoms and cardiovascular risk factors. All the variables under study were characterized by descriptive statistics, except the mean gradient variable, for which the Friedman test was used.

**Results**

The most frequent complication detected in individuals who implanted biological aortic prosthesis in the first (18.75%), second (21.88%), third (21.88%) and fourth (9.38%) follow-up moments were

arrhythmias and electrical conduction disturbances. There is a higher prevalence of Atrioventricular Block and Left Bundle Branch Block, in the first and second follow up moments that reverts in the last two. The complication with higher prevalence in the sample of individuals with mechanical prosthesis at the first (9.38%) and second (3.13%) follow-up moments were arrhythmias. At the third and fourth follow-up moments, the main complication was paravalvular leaks (9.38%). Statistically significant differences were detected in the mean gradient throughout the follow-up ($\chi^2(4) = 12.122, p = 0.016$).

**Conclusions**

The most frequent complications in individuals with aortic prosthesis were arrhythmias and paravalvular leaks. The structural deterioration of the biological valve prosthesis is the most commonly described complication, which may result in insufficiency of the valvular prosthesis and paravalvular leaks. However, electrical conduction disturbances after aortic valve replacement may occur through tissue manipulation of the conduction system. These disorders may be transient; however, certain patients require pacemaker implantation in the post-surgical period.

**Keywords**

Prosthetic valves, Aortic prosthesis complications, Biological prosthesis, Mechanical prosthesis.

## O92

### A Safe staff nursing model: relationship between structure, process and result variables

Maria J Freitas¹, Pedro Parreira²

¹Escola Superior de Enfermagem São Francisco das Misericórdias, 1169-023 Lisboa, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal

**Correspondence:** Maria J Freitas (mjbsfreitas@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O92

**Background**

The need to adequate nursing resources to the real needs of patients, while maintaining a balance between the quantity and the skills, without neglecting the quality and safety, has been a concern for managers. The absence of a consensual methodology to support the operationalization of a safe staff nursing, was the starting point of this investigation.

**Objective**

Develop an explanation Model Safe Staff Nursing (SSN) and analyse the relationships between the Structure, Process and Results.

**Methods**

Cross-sectional and correlational study. Data collection was achieved through a three-sample questionnaire: nurses (629), chief-nurses (43) and patients (1,290), from 43 units of 8 Portuguese hospitals. A patient's form was applied to assess the satisfaction with nursing care. The data collection instrument for nurses and chief-nurses consisted of three parts: the first characterizing the personal and professional variables, the second featuring the healthcare organization and the service on which the respondent work, and the third part was to obtain information about: overall satisfaction at work (Evaluation Scale of Overall Satisfaction at Work [1]), intended to abandon the Work (Intent Abandonment of Employment Scale [2]), quality nursing care and risk/occurrence of adverse events (Adverse Events Associated with Nursing Practices Scale [3]). The psychometric assessment study of the measuring instruments, performed by Factorial Exploratory Analysis and Confirmatory demonstrated adequate validity and reliability. For model validation, we used the technique Structural Equation Modelling.

**Results**

The relational structure of the model is statistically significant ($\chi^2(421) = 2209.095; p = 0.000; \chi^2/gl = 5.247; GFI = 0.833; CFI =0.815; RMSEA = 0.082$), being adequate to explain the impact of Structure variables over Results of SSN, and the Process variables over Results. The "Availability of nurses with the right mix of skills", "Availability of nurses in adequate amount" and "Safe environment" (Structure-variables) explain 2% of the variable variance of "Provision of quality nursing care" (Process-variables), 15% of the variance "Patient satisfaction", 94% of the variance
"Risk and occurrence of adverse events on patients" (Results-Patients), 25% of the variance "Results-Nurses" and 100% of variance "Results-Organization".

## Conclusions

The Safe Staff Nursing Model clearly identifies the influence of SSN on the results obtained for patients, nurses and organizations. Warns are given for the need to give more attention to issues of SSN, in particular to the constitution of balanced teams, based on a mix that includes number and competencies of nurses, versus workload/patients nursing care needs, as a strategy for maximizing resources and promoting the sustainability of organizations.

## References

1. Silva CF, Azevedo MH, Dias MR. Estudo Padronizado do Trabalho por Turnos: Versão Experimental. Bateria de escalas. Serviço de Psicologia Médica, Faculdade de Medicina da Universidade de Coimbra. Coimbra; 1994.

2. Meyer JP, Allen NJ, Smith CA. Commitment to organizations and occupations: Extension and test of a three-component conceptualization. J Appl Psychol 1993;78(4):538-51.

3. Castilho A, Parreira PM [InterSnet]. Design and assessment of the psychometric properties of an adverse event perception scale regarding nursing practices. Revista Investigação Em Enfermagem 2012;1(2):61-75.

## Keywords

Health care allocation resources, Nursing human resources, Safe nursing supplies, Safe Staff Nursing.

## O93

### Engineered healthy food with nutritional and therapeutic advantages

Geoffrey Mitchell¹, Artur Mateus¹, Maria Gil², Susana Mendes²
¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Leiria, Portugal; ²Marine and Environmental Sciences Centre, Polytechnic Institute of Leiria, 2520-641 Peniche, Portugal

**Correspondence:** Geoffrey Mitchell (geoffrey.mitchell@ipleiria.pt)
BMC Health Services Research 2018, **18**(Suppl 2):O93

Direct Digital Manufacturing is an emerging set of technologies, which are able to produce complex objects without the need for molds or specific tooling. The preparation of food for human consumption is a centuries old craft, which results in food with high sugar and salt levels leading to a poor health for many people and not contributing to the recovery of seriously ill-hospitalized patients. One of the key challenges is to tailor food to the individual to match their dietary requirement and metabolic characteristics. We believe that direct digital manufacturing is able to address these issues. To date the use of 3D printing for food has been restricted to the production of aesthetic shapes for chocolate and pasta products. We see the potential in a different way in which we can tailor the food to the individual incorporating where required drug-based therapies whilst retaining the requirements to be visually pleasing. In addition, it will be possible to guarantee all the organoleptic characteristics to which the consumer in general is familiar (such as smell, sound and texture). The mouth is the gateway for food and its acceptance requires specific taste triggers. We consider that by exploiting Direct Digital Manufacturing it will possible to optimize such taste triggers whilst retaining the nutritional balance and potential. Every consumer (in general) has challenges in chewing and swallowing and engineered food has the capability to achieve this, especially when coupled with a model of the processes of the mouth and the oesophagus, parameterized to the individual. Once the food reaches the digestive system, all of the foregoing topics are largely irrelevant, other than to consider where the nutritional or therapeutic agents are extracted. The challenge of the oral intake of insulin is the best-known situation, but the delivery of chemotherapeutics is another area of challenges. It is necessary to shield the toxic therapeutic from the taste sensors and the digestive system so that it reaches the critical area of the digestive system intact. We are developing a comprehensive food design and manufacturing system that will allow each of these challenges to be met. We expect the first use of such

system will be to expedite the recovery of seriously ill patients in hospitals. As enhanced testing procedures become more widely available through technological developments a wider use in the home is expected.

## Keywords

Engineered Food, Nutritional, Therapeutic.

## O94

### The influence of an eight month multicomponent training program in edlerlies gait and bone mineral mass

António M Monteiro¹,², Filipe Rodrigues²,³, Pedro Forte²,³, Joana Carvalho⁴

¹Department of Sports Sciences, Polytechnic Institute of Bragança, 5300-253 Bragança, Portugal; ²Research Center in Sports Sciences, Health and Human Development, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal; ³Department of Sports Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Research Centre in Physical Activity Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal

**Correspondence:** Filipe Rodrigues (ptfiliperodrigues@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O94

### Background

Aging induces neuromuscular changes and mass, strength, muscular resistance and power, motor coordination, so, reaction and movement speed reduction may be compromised [1]. These changes result in slower movements and functional limitations in gait and weight transfer activities [1]. Even more, the functional fitness decreasing due to aging, increases the risk of falls and bone fractures [2], reducing the elderly's quality of life.

### Objective

Thus, the aim of this study was to assess the influence of an eight months multicomponent training program in elderly's gait and bone mineral mass (BMM).

### Methods

Forty-nine elderly were recruited for this research with 64.39 (± 6.33) years old, 11 males with 67.45 (± 4.93) and 38 females with 63.50 (± 7.47) years old. The subjects were community living persons of Bragança. All procedures carried out in this research were in accordance to the Declaration of Helsinki. The multicomponent training program followed the Carvalho et al. [1], recommendations. Each session time volume was between 50 to 60 minutes. The sessions were divided in five parts: 1) general warm-up; 2) walking with aerobic exercises; 3) 1 to 3 sets of exercises of muscular resistance with 12 to 15 repetitions; 4) Static and dynamic balance training; 5) An active recovery period with stretching and bread- ing exercises. The elderly gait was evaluated with Berg Balance Scale (BBS) and BMM with bioimpedance (Tanita, BC-545). The Wilcoxon-Mann-Whitney test allowed to assess the differences between pre and post 8 months of the training program in BBS and BMM. The tests were performed with a significant level of 5%.

### Results

The BBS values pre and post the multicomponent training program for BBS were 47.33 and 50.33 respectively. In BMM, the pre and post values were 2.36kg and 2.39 kg. Despite the differences in BMM means, they were not significant between the two moments (F = 1.253; p = 0.706). However, the same did not occur in terms of BMS values (F = 1.967; p < 0.001), where gait values increased significantly in the second moment.

### Conclusions

Although the multicomponent training program did not increase the BMM in the elderly subjects, gait values increased significantly. Thus, it is possible to conclude that, the training program significantly improved the elderly's gait and quality of life.

### References

1. Carvalho J, Marques E, Soares JM, Mota J. Isokinetic strength benefits after 24 weeks of multicomponent exercise training and a combined exercise training in older adults. Aging Clin Exp Res. 2010;22(1):63-69.

2. Miyamoto ST, Lombardi Júnior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological research. 2004;37(9):1411-1421.
**Keywords**

Elderly, Bone, Gait, Multicomponent, Training.

**O95**

**Perception of virginity among Portuguese and Cape Verdeans university students – crossborder study**

Sónia Ramalho¹,², Carolina Henriques¹,², Caceiro Elisa¹, Maria L Santos¹
¹School of Health Sciences, Polytechnic Institute of Leiria, 2411-901
Leiria, Portugal; ²Center for Innovative Care and Health Technology,
Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O95

**Background**

Virginity can be defined as the attribute of a person who has never been subjected to any type of sexual intercourse. To be aware of the sexual behaviour and virginity of young people is fundamental that nurses construct health education intervention programs in this specific area.

**Objective**

To know the perception of Portuguese and Cape Verdean university students about virginity.

**Methods**

A descriptive, cross-sectional study using a questionnaire consisting of sociodemographic data and the perception scale on the loss of the virginity by Gouveia, Leal, Maroco and Cardoso (2010) [1]. A sample composed by 108 young people from the Republic of Cape Verde and 141 young Portuguese participated in the study. All formal and ethical procedures were taken into account.

**Results**

Young Portuguese university students presented a mean age of 20 years and 73% of the young people reported having started their sexual life at 17.00 years old, on average. The majority of the young people (66.7%) started their sexual activity with their boyfriends, using protection/contraception (70.9%). Young college students from Cape Verde had a mean age of 21.26 years, 69.4% reported having started their sexual life, on average, at 17.37 years. The majority (63.0%) started their sexual activity with their boyfriend, using protection/contraception (62.0%). Portuguese young people showed high levels of agreement with the ideal associated with the genital vision of loss of virginity (Md = 18.95, Xmax = 25.00, Xmin = 11.00), while Cape Verdean students had lower levels of agreement (Md = 12.34, Xmax = 24.00, Xmin = 5.00), showing in 41.7% of the cases, disagreement that 'a lesbian woman, who has never had sex with a man, is virgin and a 38.0% disagreement with the statement that "men who only practice oral sex, or anal sex or other forms of sex, do not lose their virginity".

**Conclusions**

The study shows that there is still considerable lack of knowledge in young people about the conceptualization of virginity and a very genitalized view of it in the Portuguese young people, in lower agreement with the perception of young Cape Verdeans.

**Reference**

1. Gouveia P, Leal I, Maroco J, Cardoso J. Escala de percepção sobre a perda da virgindade. In: Leal I, Maroco J, editors. Avaliação em sexualidade e parentalidade. Porto: LivPsic; 2010. p. 73-82.

**Keywords**

Young, Sexuality, Virginity, Portugal, Cape Verde

**O96**

**Influence of a specific exercise program in the institutionalized elderly balance**

Cátia Guimarães¹, Margarida Ferreira¹, Paula C Santos³, Mariana Saavedra²

¹Institute of Research and Advanced Training in Health, Sciences and Technologies, Cooperativa de Ensino Superior Politécnico e Universitário, 4585-116 Gandra, Portugal; ²Hospital da Senhora da Oliveira, 4835-044

Guimarães, Portugal; ³Department of Physical Therapy, School of Health, Polytechnic Institute of Porto, 4400-330 Vila Nova de Gaia, Portugal

**Correspondence:** Margarida Ferreira (margasufer@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O96

**Objective**

To determinate the effectiveness of a specific exercise program on balance and functional capacity of the daily activities of institutionalized elderly.

**Methods**

A randomized controlled trial. A total of 21 elderly were selected from the Santa Casa da Misericórdia de Santo Tirso and randomly distributed into experimental (n = 11) and control groups (n=10). The experimental group performed a specific program of exercises (resistance training, balance, coordination and flexibility) during 4 weeks, while the control group wasn't subjected to any intervention. The primary outcome was balance, as measured with a Performance Oriented Mobility Assessment scale (POMA), and the secondary outcome measure included functional capacity by the Timed Up & Go test. Evaluations were carried out at the beginning and end of the exercise program, for both groups. The data were analysed with Statistical Package for Social Sciences, version 22.0, for all test procedures, a probability of p< 0.05 was considered to be statistically significant. Statistical analyses of POMA and TUG were performed with use of independent and paired t-test. POMA and TUG score association were analysed via the Pearson correlation, after the intervention.

**Results**

In the pre-intervention, groups were homogeneous (p < 0.05). After intervention, there were no statistically significant differences between groups in terms of the total balance and dynamic balance subscale, except static balance subscale (p < 0.048). In the functional capacity test, the experimental group reduced significantly the functional activity time into intragroup (p < 0.001), however there were no significant differences between groups (p < 0.633). After intervention, the experimental group had a significantly strong negative association (p = 0.001).

**Conclusions**

The results of this study demonstrated that this specific exercise program was not effective in terms of the total balance and functional ability of institutionalized elderly.

**Trial Registration**

NCT03521752

**Keywords**

Balance, Institutionalized elderly people, Therapeutic exercise, Functional capacity.

**O97**

**Assessment of pain and effectiveness of analgesia in patient undergoing haemodialysis**

Luís Sousa¹,², Cristina Marques-Vieira³, Sandy Severino²,⁴, Cristiana Firmino², Ana V Antunes², Helena José⁵

¹Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal; ²Escola Superior de Saúde Atlántica, 2730-036 Barcarena, Portugal; ³Escola de Enfermagem de Lisboa, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;

⁴Agrupamento de Centros de Saúde Loures-Odivelas, Administração Regional de Saúde de Lisboa e Vale do Tejo, 2685-101 Sacavém, Portugal; ⁵Instituto Superior de Saúde Multiperfil, Clínica Multiperfil, Luanda, Angola

**Correspondence:** Luís Sousa (luismmsousa@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O97

**Background**

Pain is the most common symptom in patient's undergoing haemodialysis, due to comorbidity, although it is frequently underdiagnosed [1-2]. Pain in these patients is not valued in its entirety and does not consider the limitations resulting in their quality of life [3]. The Brief Pain Inventory short form (SF-BPI) is the most widely used instrument and has the most number of foreign language translations [4].