## Results

Teaching professionals were mostly women (70.8%), aged between 30 and 62 years old (Mean=44.8; SD=7.86), 27.1% diagnosed with a mental disease and 41.1% referred contact with mental health patients. Teaching professionals revealed low levels of global psychological symptoms. Higher scores were found in Obsession-Compulsion (M=0.88; SD=0.73). A moderate level of stigma was found in the global sample (M=3.63; SD=0.74). Stigmatizing helping attitudes and behaviour were higher (M=6.50, SD=1.86). Although no difference was found in total stigma between groups, higher education professors rate responsibility higher than high-school teachers (M=3.06, SD=1.08 vs M=2.55, SD=0.97; p=0.02). Significant positive correlations were found between total stigma and psychological symptoms in Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety and Psychoticism (p < 0.01).

## Conclusions

Teaching professionals experience low intensity of several psychological symptoms, and reveal medium stigma towards mental illness. High-school teachers revealed higher psychological distress compared to higher education professors but no differences were found in stigma. The higher the psychological distress, the higher the stigma is expected to be towards people with mental illness. Therefore intervention towards mental health is needed, addressing psychological distress in order to minimize mental health stigma.

## References

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

2. Hamann

J, Bühner M, Rüsch N. Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services. Psychiatr Serv. 2017;68(8):783–788.

3. Basar MCZ. The beliefs of teachers toward mental illness. Procedia - Soc Behav Sci. 2012;47:1146–1152.

4. Ketchen SL, Gaddis SM, Heinze J, Beck K, Eisenberg D. Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities. J Am Coll Heal. 2015;63(6):388–396.

5. De

Sousa S, Marques A, Curral R, Queirós C. Stigmatizing attitudes in relatives of people with schizophrenia: a study using the Attribution Questionnaire AQ-27. Trends Psychiatry Psychother. 2012;34(4):186-197.

## Keywords

Mental health, Psychological symptoms, Stigma, Teaching professionals.

## O154

### Exploring quality of life in individuals with cognitive impairment and chronic mental health difficulties in the context of supported employment services

Ana R Jesus, Cristina Silva, João Canossa Dias, Karina Sobral, Mário Matos, Patrícia Sá, Rui Moreira, Sara Coutada, Sara A Oliveira, Telma Antunes Associação para a Recuperação de Cidadãos Inadaptados da Louís, 3200-901 Louís, Portugal

**Correspondence:** Sara A Oliveira (saraoliveira.atalaia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O154

### Background

The complex combination of many broad factors may have adverse effects in health with an impact on several areas. Quality of life (QoL) is a useful concept measuring the health state experienced by individuals. Perceived physical health, psychological well-being, social relationships, and environmental factors are QoL's main dimensions (WHOQOL Group, 1995). In the field of employment, evidence-based supported employment is one of the most effective approaches. Thus, A.R.C.I.L's Centre of Resources for Employment and Open Labour Market Inclusion started to include workers according to their preferences, mainly individuals with cognitive impairment and chronic mental health difficulties. In Portugal, few studies explored

QoL in individuals with cognitive impairment and chronic mental health difficulties, particularly from the individual's own perspective.

## Objective

This study aims to explore differences in QoL between individuals with cognitive impairment and chronic mental illness, attending supported employment services given by the Centre of Resources for Employment and Open Labour Market Inclusion. Moreover, from baseline to 6 months, the outcomes from individuals self-reported QOL will be analysed.

## Methods

The sample was composed by adults (N = 169; 52.1% women and 47.9% men), aged 18-64 years-old, with a mean age of 41.34 (SD = 11.33), who attended supported employment services. All participants had a previous diagnosis of cognitive impairment and/or chronic mental illness. QoL was assessed by WHOQOL-Bref (N=169 at baseline; N=51 at 6 months follow-up).

## Results

Results from independent t-test revealed significant gender and age differences between individuals QoL, with men reporting better physical and psychological QoL when compared to women. Younger participants (age ≤ 40 years-old) also presented better QoL (in all domains, except in social relations) when compared to older participants. All differences reflected small to moderate effect sizes. Overall QoL, as well as its physical and environmental dimensions were significantly and negatively associated with participants' age. Finally, after attending six-months of supported employment services 29.4% of participants increased global QoL, 35.3% increased their physical and psychological QoL, 37.3% showed an improvement in their social relationships and 55% reported feeling better in their environment.

## Conclusions

Overall, results suggest that individuals with cognitive impairment and chronic mental illness, attending supported employment services, have perceived a positive QoL at the 6-month follow-up. As the supported employment services are still on-going, future studies would have to be conducted to explore results in a larger sample and to measure impact in people's health and living conditions.

## Keywords

Quality of Life, WHOQOL-Bref, Supported employment services, Cognitive impairment, Chronic mental illness.

## O155

### Characterization of pediatric medicines use in pre-scholar and primary school children

Isabel C Pinto<sup>1,2</sup>, Luís M Nascimento<sup>2,3</sup>, Ana Pereira<sup>4</sup>, Ana Izidoro<sup>5</sup>, Cátia Patrocinio<sup>6</sup>, Daniela Martins<sup>7</sup>, Margarida Alves<sup>8</sup>

<sup>1</sup>Departamento de Tecnologias de Diagnóstico e Terapêutica, Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; <sup>2</sup>Centro de Investigação de Montanha, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; <sup>3</sup>Unidade Local de Saúde do Nordeste, 5300-253 Bragança, Portugal; <sup>4</sup>Farmácia D'Izeda, 5300-592 Izeda, Bragança, Portugal; <sup>5</sup>Farmácia Rainha, 5140-067 Carrazeda deysiães, Portugal; <sup>6</sup>Farmácia Confiança, 5300-178 Bragança, Portugal; <sup>7</sup>Farmácia Holon, 2870-225 Montijo, Portugal; <sup>8</sup>Farmácia da Ponte, 5370-390 Mirandela, Portugal

**Correspondence:** Isabel C Pinto (isabel.pinto@ipb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O155

### Background

Parents or other caregivers usually resort to the use of medication without prescription in their children, which can be considered as a facilitative process of drug intoxication. The child is not an adult in small size, which necessarily has implications for the use of drugs to ensure safety and effectiveness.

### Objective

To examine the use of paediatric medicines and of associated factors, in children of pre-school and of the 1st cycle of basic years of education in the city of Bragança, in the Northeast of Portugal.

### Methods

This cross-sectional, descriptive and correlational study was based on a questionnaire applied to 371 parents or guardians of children of
pre-school and 1st cycle of basic education in the city of Bragança, in the academic year 2014/2015. Statistical analysis was performed on the SPSS program, v. 20.0. It was used descriptive statistics; correlations were accessed using Spearman and qui-square tests, considering the significance level of 5%.

## Results

The results revealed that 86% of parents use drugs without prescription, of these 49% resort to this practice under the influence of ancient medical guidelines and 28% under the influence of information transmitted in the pharmacy. Mostly parents (53%) resort to self-medication to relieve fever or treatment of influenza symptoms (14%) of their children. No statistically significant factors related to the use of non-prescription medication in children were found.

## Conclusions

Paediatric self-medication is a common practice, especially made based on old medical guidelines. No explanatory factors have been found for this paediatric self-medication.

## Acknowledgements:

The authors thank Fundação para a Ciência e a Tecnologia (FCT, Portugal) and the infrastructure FEDER under the PT2020 program for financial support to CIMO (UID/AGR/00690/2013).

## Keywords

Children, Pediatric medicines use, Pediatric self-medication, Pre-schooler children, Primary school children.

## O156

### Sleep and perimenopause: contributions to its management

Arminda Pinheiro (aanes@ese.uminho.pt)

Higher School of Education, University of Minho, 4710-228 Braga, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):O156

### Background

There are large geographical differences in the prevalence of menopausal symptoms. Given the differences in study methodologies, it has been difficult to establish comparisons. In middle-aged women, sleep disorders are quite prevalent problems and are sometimes attributed directly to the menopausal transition. Based on the conceptual framework proposed by Meleis and Schumacher, we consider that recent changes in the sleep pattern are an indicator of the transition process, assuming that they can interfere with quality of life, and that we can try to identify the conditions/factors associated with this change.

### Objective

To evaluate sleep disorders and related factors in perimenopausal women.

### Methods

This was a cross-sectional study, correlational; with a non-probabilistic convenience sample, in which 600 Portuguese perimenopause women (45–55 years) were requested to complete: the Menopause Rating Scale (MRS), Scale of attitudes and beliefs about menopause and the Satisfaction Scale Social Support; Self-Esteem Scale. Semi-structured interviews collected: socio-demographic and socio-economic data; lifestyle data; psychological data - global health perception; stressful life events; perception of the recent change of body image; have life projects and data on health history. Physical examination included: blood collection for determination of follicle stimulating hormone (FSH) and estradiol (E2), weight, height, and abdominal measurements. Women signed informed consents after exhibition of the study objectives and after guaranteeing anonymity and confidentiality.

### Results

In this study 43.5% of the women reported having no problems with sleep; 18.2% light intensity problems; 10.2% moderate intensity and 28.2% very intense problems. In relation to the influence of the different factors included in the final model on the probability of a woman having reported uncomfortable sleep problems, the logistic regression Forward: LR revealed that the conditions of socio-

demographic and socioeconomic factors: level of education (b<sub>basiceducation</sub>=0.933, X<sup>2</sup><sub>wald(1)</sub>=4.386, p=0.035, OR=2.222), the conditions of the psychosocial factor: attributed meaning menopause (b<sub>positivemeaning</sub>=-0.504; X<sup>2</sup><sub>wald(1)</sub>=6.262, p=0.012; OR=0.604), satisfaction with social support (b<sub>familysupport</sub>=-0.154, X<sup>2</sup><sub>wald(1)</sub>=10.849, p=0.001, OR=0.857), attitudes and beliefs regarding menopause(b<sub>changeshealthaging</sub>=0.207; X<sup>2</sup><sub>wald(1)</sub>=10.634, p=0.001, OR=0.813), attitudes(b<sub>physicalchanges</sub>=0.130, X<sup>2</sup><sub>wald(1)</sub>=5.282; p=0.022; OR=0.878); have projects (b<sub>donothaveprojects</sub>=-0.662; X<sup>2</sup><sub>wald(1)</sub>=9.907; p=0.002; OR=0.516) and the condition of the lifestyle factor: number of feed (b<sub>numberoffeed</sub>=-0.285, X<sup>2</sup><sub>wald(1)</sub>=10.658, p<0.001, OR=0.752), presented a statistically significant effect, significant difference on the Logit of the probability of a woman having referred problems, according to the adjusted Logit-model(G<sup>2</sup>(10)=173.916; p<0.001; X<sup>2</sup><sub>wald(8)</sub>=6.484; p=0.593; R<sup>2</sup><sub>CS</sub>=0.252; R<sup>2</sup><sub>N</sub>=0.342; R<sup>2</sup><sub>MF</sub>=0.218).

### Conclusions

Problems with sleep can be considered a negative indicator of processes in perimenopausal women. The model suggests some modifiable factors, specifically: eating habits, attitudes, beliefs and meaning attributed to menopause, and importance of satisfaction with family social support. These aspects should be included in the initial nursing assessment and risk evaluation of women who cross this period, in the sense of adequately managing nursing interventions.

## Keywords

Problems, Sleep, Menopause.

## O157

### Preschooler's executive and socio-emotional functioning: effects of two intervention programs- Psychomotor therapy and Creative Dance

Andreia Sarnadinha¹, Catarina Pereira¹,²,³, Ana C Ferreira¹,²,³, Jorge Fernandes¹,²,³, Guida Veiga¹,²,³

¹Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal; ²Comprehensive Health Research Center, University of Évora, 7000-671 Évora, Portugal; ³Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Andreia Sarnadinha (asarnadinha@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O157

### Background

The preschool years represent a critical time period for the development of children's executive functioning and socio-emotional competences [1] and therefore it is the ideal period for the stimulation of these competencies [2, 3]. Interventions with children in preschool age should privilege spontaneity, creativity and play as a method of learning and stimulation [4, 5]. Psychomotor therapy and Creative Dance are two therapeutic approaches based on these principles [5, 6]. However, to date, no research has been done comparing the effects of Psychomotor therapy and Creative Dance.

### Objective

The aim of this study was to examine the feasibility and the impact of two intervention programs, Psychomotor therapy versus Creative Dance, on the executive and socio-emotional functioning of preschoolers.

### Methods

Fifty preschool children (M = 4.04 years; SD = 0.67) were divided into two intervention groups and a control group. An experimental group participated in 24 Psychomotor therapy sessions, mainly involving sensorimotor activities and games with rules. The other experimental group participated in 24 Creative Dance sessions. The control group maintained daily life activities. Cold executive functions, hot executive functions, externalized and internalized behaviours and aggressiveness were evaluated.

### Results

The intervention programs were well tolerated by pre-school aged children. No significant differences were found in terms of intra- and inter-observer comparisons, except in the control group (p < 0.05). Cold executive functions were negatively correlated to reactive aggressiveness (r = -0.408, p = 0.003).
## Conclusions

The results suggest that both programs were feasible and well tolerated in this age group, but their benefits were not evident. Increased working memory was associated with decreased levels of reactive aggression. This study alerts to the need for further research focused on pre-schoolers' executive and socio-emotional functioning, particularly on the effects of interventions programs.

## References

1. Papalia DE, Olds SW, Feldman, RD. O mundo da criança. Lisboa: McGraw-Hill; 2001.

2. Diamond A, Lee K. Interventions shown to aid executive function development in children 4–12 years old. Science, 2011;333(6045):959–964.

3. León CBR, Rodrigues CC, Seabra AG, Dias NM. Funções executivas e desempenho escolar em crianças de 6 a 9 anos de idade. Revista Psicopedagogia. 2013;30(92):113-120.

4. Vygotsky LS. A formação social da mente. São Paulo: Martins Fontes; 2010.

5. Traverso L, Viterbori P, Usai MC. Improving executive function in childhood: evaluation of a training intervention for 5-year-old children. Front Psychol. 2015;6:525-536.

6. Gilbert AG. Creative dance for all ages: a conceptual approach. Australia: Shape America; 2015.

## Keywords

Executive functions, Mental health, Mind-body therapies, Psychomotor intervention.

## O158

### Impact of a 10 km race on inflammatory and cardiovascular markers: comparison between trained and untrained recreational adults

Margarida Carvalho¹, Andreia Noites², Daniel Moreira-Gonçalves³,⁴, Rita Ferreira⁵, Fernando Ribeiro⁶

¹Hospital de Santa Maria, 4049-025 Porto, Portugal; ²Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, 4200-072 Porto, Portugal; ³Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁴Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; ⁵Mass Spectrometry Group, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal; ⁶School of Health Sciences and Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Margarida Carvalho
(margarida.carvalho.ft@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O158

### Background

Previous studies have found that trained athletes had lower changes in circulating levels of inflammatory biomarkers and cardiovascular stress than untrained athletes, upon prolonged or exhausting exercise. Particularly, recreational runners with less training showed higher risk of cardiac injury and dysfunction after a marathon. Presently, we are observing a steadily growing number of young and older adults engaging in running events without having a professional orientation or training, emphasizing the need to assess biochemical markers that allow the evaluation of the acute changes imposed in these recreational athletes.

### Objective

To compare the immediate and 24-hour effects of a 10-km run on inflammatory and cardiovascular biomarkers between recreational athletes, with and without specific running training.

### Methods

18 recreational athletes (38.5 ± 14.5 years), 10 men and 8 women, were recruited and divided in a trained and untrained group. Venous blood samples were taken prior to the 10km race (48 hours before),

immediately after (within 30 minutes), and 24 hours after the race. The following biomarkers were analysed by slot blotting assay: vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), high sensitive C-reactive protein (hsCRP), ghrelin, matrix metalloproteinase-2 (MMP-2) and MMP-9.

### Results

The trained group completed the race in 50.3 ± 13.0 minutes per comparison to the 66.8 ± 5.6 minutes of the untrained group (p = 0.003). A significant increase in circulating levels of hsCRP, ghrelin, VEGF and MMP-9 was observed immediately after the race in both groups; the levels of these biomarkers returned to baseline 24h post-race. A significant increase in IL-6 was also detected after the race in both groups, which returned to baseline levels at 24 hours post-race in the untrained group. Regarding MMP-2 levels, a significant increase was detected after the race only in the untrained that returned to baseline levels at 24 hours post-race.

### Conclusions

The impact of a 10-km race in the inflammatory and cardiovascular markers assessed in this study was different between recreational athletes, with and without specific training.

### Keywords

Biomarkers, Cardiovascular system, Exercise, Inflammation, Running.

## O159

### The health of the informal caregiver of dependent person in self-care

Maria A Dixe¹,², Ana CS Cabecinhas², Maura R Domingues², Ana JCF Santos², Marina G Silva², Ana Querido¹,²

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

**Correspondence:** Maria A Dixe (ana.querido@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O159

### Background

Caring for a caregiver should be a constant concern and a responsibility of all health professionals, so that those who give care do not end up being uncared-for.

### Objective

This correlational study had the following main aims: to assess the level and prevalence of burden of the informal caregiver of a person dependent in self-care; to determine the relationship between the levels of burden and the informal caregiver's perception of their level of competence to be a caregiver.

### Methods

Participants in this study were 33 informal caregivers of self-care dependent-persons in at least one activity of daily living, to whom a structured interview was performed at the time of hospital discharge. The interview included socio-demographic and professional data, perception of the informal caregiver on their level of competence to be a caregiver, and the Portuguese version of the Zarit Burden Interview [1]. This study was approved by the National Data Protection Commission and the ethics committee of the hospital where the study was conducted (nº 24/2017).

### Results

The majority of dependent-persons were female (60.6%) with a mean age of 81.6 ± 11.3 years old, with the majority being dependent on all self-care activities. The mean age of caregivers was 61.4 ± 12.1 years old, mainly females. The family relationship was mostly a son/daughter (39.4%) or a spouse (33.3%), taking care of the patient on average at 63.9 ± .93 months. It was possible to verify that all caregivers had previous experience of caregiving to a family dependent. We also verified that the 33 caregivers presented a mean of 53.9 ± 15.8 on the emotional burden scale (maximum possible value of 110) which corresponds to little burden. We can also mention that 30.3% of the caregivers present no burden, 30.3%, present mild burden and 39.4% present intense burden. Regarding the relationship between caregiver burden, we verified that higher levels of informal caregivers
burden were related to lower levels of perception of their competence to satisfy the needs related to the hygiene of the dependent-person (rs=-0.514; p> 0.05).

### Conclusions

Caring of a dependent-person may lead to health risks to the caregiver. Even though the sample size is small, it was possible to verify that a considerable number of caregivers presented intense emotional burden. Therefore, it is necessary that health professionals develop interventions to prevent caregiver burden.

### Acknowledgments

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

### References

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

### Keywords

Emotional burden, Informal caregiver, Self-care, Dependent-person, help2care.

## O160

### Growth and puberty in adolescent artistic gymnasts: is energy intake a question of concern?

Rita Giro¹, Mónica Sousa², Inês T Marques³, Carla Rêgo³

¹Universidade do Porto, 4099-002 Porto, Portugal; ²Escola Superior de Saúde, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal; ³Centro da Criança e do Adolescente, Hospital CUF Porto, 4100-180 Porto, Portugal

**Correspondence:** Rita Giro (aritagiro@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O160

### Background

Whether high-intensity training during childhood and adolescence compromises the growth and pubertal development of artistic gymnasts, remains a question for debate. However, when coupled with low energy availability, this hypothesis strengthens [1].

### Objective

To characterize growth, sexual maturation, total energy intake and training aspects of competing artistic gymnasts and check for associations.

### Methods

Convenience sample of 22 competing artistic gymnasts (13.8 ± 1.9 years) of both sexes. Anthropometric evaluation and body composition assessment were performed (InBody230™). Tanner stage was determined in all athletes and age of menarche and regularity of menses were assessed in females. Total energy intake was quantified (3-day food record) and its inadequacy verified according to the recommendations [2]. Athletes' training habits were also characterized.

### Results

Females showed significantly higher body fat (15.9 ± 3.2 vs 7.2 ± 3.6) and lower skeletal muscle mass (45.7 ± 2.1 vs 51.1 ± 3.0) percentages than males (p < 0.05). No differences were found between genders for any of the additional variables in the study (p ≥ 0.05). Mean age of menarche was 12.6 (± 1.3) years. Short stature was detected in 12.6% of the female gymnasts (z score < -2), but no cases of low weight-for-height (z score <-2) were observed. All athletes presented total energy intakes below the recommendations. A high training frequency and intensity (median: 6 days/week, in a total of 20.8 hours) were reported, as well as an association of both training frequency (p=+0.765; p=0,016) and training intensity (p=+0.727; p=0,026) with a later onset of menarche.

### Conclusions

Our data suggests metabolic adaptation to chronically insufficient energy intakes in these athletes which, in accordance with growing evidence, might play a role in growth and pubertal delay.

### Acknowledgements

Authors would like to thank and recognise the contribution of Cristina Córte-Real and Manuel Campos to the development of the investigation.

### References

1. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-497.

2. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Scientific Opinion on Dietary Reference Values for energy. EFSA Journal. 2013;11(1):3005.

### Keywords

Athletes, Energy availability, Health, Nutrition assessment, Paediatrics.

## O161

### Communication effectiveness in nursing teams

António Calha¹, Liliana Grade³, Olívia Engenheiro⁴, Sandra Sapatinha⁵, Eva Neto²

¹Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal;

²Centro Hospitalar do Algarve, 8000-386 Faro, Portugal; ³Unidade Local de Saúde Baixo Alentejo, 7801-849 Beja, Portugal; ⁴Hospital Espírito Santo, 7000-811 Évora, Portugal; ⁵Unidade Local de Saúde Norte Alentejano, 7300-074 Portalegre, Portugal

**Correspondence:** António Calha (antoniocalha@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O161

### Background

The communication processes established among nurses are influential factors of the quality and effectiveness of care.

### Objective

This research had as main objective to identify how nurses evaluate the different dimensions of the communicative process of the service in which they carry out their professional activity and what are the main obstacles to the proper functioning of the communication process.

### Methods

This is eminently a quantitative study of correlational nature. For the collection of data, a questionnaire was used with closed-ended questions. 75 nurses from four health services (Neonatology, Medicine II, Emergency and Basic Emergency) were surveyed.

### Results

Five indices were elaborated to measure the different facets of the communicative process: Communication efficiency (α = 0.82); Information sufficiency (α = 0.84); Information timing (α = 0.85); Explicitness of the message (α = 0.90) and practical applicability (α = 0.087). Similarly, five indices were computed in order to measure the nature of the information: Information of a clinical nature (α = 0.88); Organizational information (α = 0.89); Service information (α = 0.91); Team information (α = 0.92) and Personal information (α = 0.93). All indices had a variation range between 1, corresponding to the worst possible appraisal and 5, corresponding to the best possible appraisal. The results show that it is organizational information that nurses (M = 2.96) do worse in the communicative process, especially in the timely manner in which information arrives to them (M = 2.76). The results obtained through a Kruskal-Wallis test allowed to identify differences regarding the consideration of conflict as an obstacle to the communication process (χ²KW(3)= 30.01, p= 0.000) and overvaluation of personal and professional relations (χ²KW(3)= 12.60, p= 0.006).

### Conclusions

The research identifies some communication weaknesses in the clinical context related mainly to the way information of organizational nature is disseminated in the services.
Keywords

Communication, Efficiency, Nursing, Teams.

O162

Factors affecting interpersonal conflict in nursing teams

António Calha¹, Marília Ferreira², Sílvia Alminhas², Telmo Pequito²

¹Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal;

²Hospital Espírito Santo, 7000-811 Évora, Portugal

**Correspondence:** António Calha (antoniocalha@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O162

Background

Teamwork is one of the foundations of nursing, exposing the profes-
sion to the vulnerabilities of the dynamics of group functioning. In
this context, skills of conflict management in working teams are par-
ticularly relevant.

Objective

This research aimed to: I) identify how often nurses deal with conflict situations; II) identify the main causes of conflict mentioned by nurses and, III) assess the strategies adopted to deal with conflicting situations.

Methods

This is an exploratory, quantitative and correlational research. For the
collection of data, a questionnaire was used with closed-ended ques-
tions. The sample consisted of a total of 35 nurses from the emer-
gency department of a Hospital of the Portuguese NHS.

Results

Five indexes were computed in order to evaluate the different strat-
egies to deal with conflict situations: I) commitment strategy (α =
0.745); II) avoidance strategy (α = 0.699); III) accommodation strategy
(α = 0.745); IV) confrontation strategy (α = 0.618) and collaboration
strategy (α= 0.698). All indices had a variation that ranged between
1, corresponding to the less frequent possible appraisal and 5, corre-
sponding to most frequent possible appraisal. Most of the nurses re-
ported that they were rarely involved in situations of conflict,
however, 57.1% stated that they sometimes observed those situa-
tions. Results show that nurses mostly indicated the use of two strat-
egies to deal with conflict: accommodation (M= 3.11) and
confrontation (M= 3.07). Data analysis revealed that the strategy of
accommodation had a statistically significant positive correlation co-
efficient in relation with the incompatibility of personalities (rs=
0.400, p < 0.05) and a negative correlation coefficient in relation with
the scarcity of material (rs= -0.358, p < 0.05) as cause of conflict.

Conclusions

The results obtained allow us to conclude that the nature of the con-
flict determines the way it is managed by nurses. The data reveal, in
particular, that the scarcity of material resources strengthens the con-
frontation in the nursing team, contributing to the degradation of
the organizational environment. Thus, conflict management is an es-
sential skill and tool that nurses can, and should, use as a basis of
sustainability and development of nursing practice.

Keywords

Interpersonal conflict, Team work, Nursing, Emergency service.

O163

Numerical modelling of electrical stimulation on scaffolds for tissue engineering

Paula Pascoal-Faria¹,², Pedro C Ferreira¹, Abhishek Datta³,⁴, Nuno Alves¹

¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2411-091 Leiria, Portugal; ²School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal;

³Soterix Medical Inc., 10001 New York, New York, United States of America; ⁴City City College of New York, 10031 New York, New York, United States of America

**Correspondence:** Paula Pascoal-Faria (paula.faria@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O163

Preliminary experimental in vitro studies on tissue engineering appli-
cations have shown the advantage of using different type of stimuli,

namely, mechanical, electrical, magnetic or its combination to en-
hance cell behaviour. In these studies cells proliferation and differen-
tiation change significantly when electrical stimulation is applied on
cells placed inside scaffolds systems within a bioreactor. We estab-
lished an ambitious research program on numerical modelling of
stimuli on scaffolds for tissue engineering. In this study we develop a
new finite element-based (FE) multiphysics framework that allows
the numerical optimization of the parameters involved when elec-
trical stimulation is applied on bioscaffolds with different geometries
and characteristics. The FE framework that has been developed al-
lows the prediction of the electrical stimulation as a function of the
scaffold geometry and its electrical characteristics, that may contrib-
ute to the acceleration of the proliferation and differentiation of the
cells.

Keywords

Finite element model, Bioscaffolds, Electrical stimulation, Tissue engineering.

O164

Motor competence in preschoolers with and without hearing loss

Guida Veiga¹,²,³, Mariana Santos¹, Brenda S Silva⁴, Catarina Pereira¹,²,³

¹Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal; ²Comprehensive Health Research Center, University of Évora, 7000-671 Évora, Portugal; ³Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Developmental Psychology, Leiden University, 2311 EZ Leiden, Netherlands

Correspondence: Guida Veiga (gveiga@uevora.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O164

Background

Several studies have been demonstrating the developmental consequences of early childhood hearing loss in terms of language, communication, academic, and social-emotional functioning [1]. However, there is still no consensus on whether young children with hearing losses (HL) are comparable to hearing peers regarding their motor competence. Whereas some studies associate hearing loss with poorer motor development [2], others show that HL children are as proficient as their hearing peers [3]. Nevertheless, most of these studies has been focusing older children and to date, no study has examined Portuguese HL children's motor competence.

Objective

This study aimed to examine motor competence of children with HL
in comparison with hearing children.

Methods

A total of 35 children participated in the study; 13 (mean age 4,73 years) with HL and 22 (mean age 5,09) hearing children. Children were tested by the Movement Assessment Battery for Children–Second Edition (MABC-2).

Results

Children with HL showed worse performances on manual dexterity, ball skills and balance than hearing peers, however these differences were only significant regarding balance (p=.006).

Conclusion

Children with HL are at greater risk for balance deficits.

References

1. Joint Committee on Infant Hearing. 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898-921.

2. Hartman E, Houwen S, Visscher C. Motor skill performance and sports participation in deaf elementary school children. Adapted Physical Activity Quarterly. 2011;28(2):132-145.

3. Engel-Yeger B, Weissman D. A comparison of motor abilities and perceived selfefficacy between children with hearing impairments and normal hearing children. Disability And Rehabilitation. 2009;31(5):352-358.

Keywords

Motor skills, Emotion understanding, Empathy, Deafness, Cochlear implant.
O165

Determinants of the beginning of breastfeeding in the first half hour of life

Dolores Sardo (dolores.sardo@gmail.com)
Nursing School of Porto, 4200-072 Porto, Portugal
BMC Health Services Research 2018, **18**(Suppl 2):O165

Background

Breastfeeding in the first hour of life is associated with longer dur-
ation of breastfeeding, reduction of infant deaths in low-resource
countries and improvement of the health status of the child and of
mother. This practice favours early contact between mother and
baby, and in Step 4 of the Ten Measures to be considered a Baby
Friendly Hospital, it is recommended to help mothers to initiate
breastfeeding within the first half hour after birth (WHO & UNICEF).

Objective

To evaluate the rate of breastfeeding initiation in the first half hour and two hours of the child's life; identify the determinants of breast-feeding in the first half-hour and two hours of life and their relation-ship to the prevalence of exclusive breastfeeding at four months.

Methods

We performed a quantitative, descriptive and cross-sectional study in a Portuguese population. The sample was no probabilistic, intentional (n = 150) 89.3% married mothers or with partner and average age was 31.1 years old, with normal delivery (43.3%). Data collection was conducted through a self-report questionnaire to mothers, 4 months after delivery.

Results

The rate of breastfeeding initiation in the first half hour and two
hours of the child's life was 48% and 88% respectively. In this sample
the determinants related to obstetric history, new-born and breast-
feeding were studied: only caesarean delivery revealed statistical sig-
nificance in the first half hour (X²(1) = 6.141; p = 0.010); and there
was a statistically significant difference associated with eutocic deliv-
ery and the initiation of breastfeeding up to two hours of life. The
prevalence of exclusive breastfeeding at 4 months was predicted
only by the weight of the new-born (b<sub>pequeno para a idade gestac-
nal</sub>=4.821; X<sup>2</sup><sub>wald(1)</sub>= 21.616; p < 0.001; OR=124.038).

Conclusions

In this study, only the type of delivery had significant statistical influ-
ence for the initiation of breastfeeding in the first half hour of life.
We also found that the initiation of breastfeeding in the first two
hours of life did not predict its prevalence at four months.

Keywords

Breastfeeding, Prevalence, First half-hour.

O166

Body image acceptance as a protector against the effect of body
image-related shame memories on emotional eating in women
with Binge Eating Disorder

Cristiana Duarte¹, José Pinto-Gouveia²

¹School of Psychology, Faculty of Medicine and Health, University of Leeds, LS2 9JT, Leeds, United Kingdom; ²Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal

Correspondence: Cristiana Duarte (c.duarte@leeds.ac.uk)

BMC Health Services Research 2018, **18**(Suppl 2):O166

Background

Understanding the factors underlying the public health problem of Binge Eating Disorder (BED) is a pressing need. Research show that body image-related shame memories are significantly associated with the severity of binge eating symptomatology in women with Binge Eating Disorder (BED) [1]. These individuals may eat as a means to temporarily avoid or reduce negative emotions related to body weight and shape [2, 3]. Evidence suggests that body image flexibility (i.e., the ability to accept and fully experience body image-related internal experiences - thoughts, emotions, memories - when doing so is consistent with valued-living [4], may deter the engagement in emotional eating [5].

Objective

The current study examined the moderator effect of body image flexibility on the association between shame memories and emotional eating in a sample of women with BED.

Methods

109 women with the diagnosis of BED participated in this study. Mean (SD) participants age was 37.39 (10.51) years and BMI was 33.69 (7.75) kg/m². Participants were assessed through the Eating Disorder Examination 17.0D, the Shame Experiences Interview (SEI) and filled self-report measures assessing the centrality of the recalled shame memories, emotional eating and body image flexibility.

Results

Descriptive statistics showed that body image-related shame memories were the most frequently recalled memories. Correlational analysis revealed that the extent to which the recalled shame memory is central to identity is significantly associated with emotional eating. Body image flexibility was negatively associated with the centrality of the recalled shame memory and emotional eating. Results of the moderation analysis showed that body image flexibility significantly moderate the association between the centrality of the recalled shame memory and emotional eating. This suggests that patients with BED with a greater trait-like ability to accept body image-related negative internal experiences, present a lower tendency to use food as a form of experiential avoidance.

Conclusions

Findings support a conceptual integrative model of binge eating symptomatology that clarifies the role that contextual and interpersonal variables play in the development and persistence of difficulties in regulating eating behaviour in BED, and how body image flexibility may have a protective role in these associations. These results also have important clinical implications supporting the relevance of contextual-behavioural interventions that address the role of shame memories, body image difficulties and that help patients to develop body image flexibility.

References

1. Duarte C, Pinto-Gouveia J. The impact of early shame memories in Binge Eating Disorder: The mediator effect of current body image and cognitive fusion. Psychiatry Research, 258:511-517.

2. Duarte C, Pinto-Gouveia J, Ferreira C. Ashamed and fused with body image and eating: Binge eating as an avoidance strategy. Clin Psychol Psychother. 2015. doi: 10.1002/cpp.1996. 3. Heatherton T, Baumeister R. Binge eating as escape from self-awareness. Psychol Bull 1991;110(1):86-108.

4. Sandoz E, Wilson K, Merwin R, Kellum K. Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science. 2013;2(1-2):39-48.

5. Duarte C, Pinto-Gouveia J. Returning to emotional eating: The psycho-metric properties of the EES and association with body image flexibility. Eating and Weight Disorders. 2015;20 (4):497-504.

Keywords

Body image-related shame memories, Shame memories centrality, emotional eating, Body image flexibility, Binge Eating Disorder.

O167

Psychometric properties of the Psychological Welfare Scale

Rosa M Freire, Filipe Pereira, Teresa Martins, Maria R Grilo
Nursing School of Porto, 4200-072 Porto, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O167

Background

Pleasure and happiness have been associated with well-being, and obtaining maximum enjoyment is seen as a life goal. Nowadays, well-being is perceived to be either subjective wellbeing (SWB) or psychological well-being (PWB). SWB involves global evaluations that affect life quality, whereas PWB examines perceived existential challenges of life [1].
**Objective**

To measure Psychological Welfare and validate the constructs of 42 items of the Psychological Welfare Scale.

**Methods**

Quantitative, exploratory and cross study was used as methodology. A convenience sample was performed with 252 participants. The measuring instrument was developed using the Qualtrics program. The study had favourable appreciation and consent from the College Nursing of Porto (ESEP) that provided a computer platform that allowed the participants to access to the measurement instrument. The construct in analysis in this study was developed by Ryff [2] and intended to measure Psychological Welfare on six scales: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Originally, each subscale was composed of 20 items, but the author suggested smaller versions, preferably the version of seven items per subscale. Respondents rated statements on a scale of 1 to 6, with 1 indicating strong disagreement and 6 indicating strong agreement. Participants are, on average, 31.38 years old (SD=12.88) and 81% are female. The analysis of the items of the scale was performed through item descriptive analysis, confirmatory factorial analysis, internal consistency analysis of each subscale and factorial validity using AMOS (version 22, IBM SPSS).

**Results**

The descriptive analysis of the items showed that the response tendency is above the midpoint. In the analysis of the adaptation of the theoretical model to the empirical model, we verified that the model constituted by a factor with six manifested variables resulting from the sum of the seven items of each subscale showed good indexes of adjustment. The internal consistency values of each subscale ranged from 0.69 to 0.82 suggesting a reasonable to good internal consistency. All correlations showed significant values at the 0.01 level.

**Conclusions**

The values found suggest that the concepts of the subscales of the measuring instrument are related but without any redundancy of measurements. The Psychological Welfare Scale is a theoretically grounded instrument which specifically focuses on measuring multiple facets of psychological welfare. We consider this Scale of Psychological Welfare to be a valid and reliable tool to measure psychological welfare in a Portuguese context.

**References**

1. Sweta SM. Cross-cultural Validity of Ryff's Well-being Scale in India. Asia-Pacific Journal of Management Research and Innovation. 2013;9(4):379-387.

2. Ryff C. Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. American Psychological Association, Inc. Journal of Personality and Social Psychology. 1989;57(6):1069-1081.

**Keywords**

Assessment, Psychological Welfare, Scale, Psychometrics properties, Validation Studies.

**O168**

**The influence of statins in the skeletal muscle of individuals with hypercholesterolemia - ultrasound study**

Alexandra André¹, João P Figueiredo¹, Carlos AF Ribeiro², Gustavo F Ribeiro³, Paula Tavares³

¹Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal; ²Instituto Biomédico de Investigação da Luz e da Imagem, 3000-548 Coimbra, Portugal; ³Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, 3040-248 Coimbra, Portugal

**Correspondence:** Alexandra André (alexandra.andre@estescoimbra.pt)
BMC Health Services Research 2018, **18**(Suppl 2):O168

**Background**

The skeletal muscle (SM) is a kind of tissue that has the capacity to adjust with different stimulus. Intake drugs can cause alterations and

incapacity to do exercise. To evaluate the muscle macroscopically measurements is important to do. Pennate angle and fascicle length are determinants of muscle strength. Thickness is important to evaluate state of atrophy or hypertrophy. The ecogenicity evaluates the fat infiltration in atrophy.

Statins interfere with the SM functions and are the prescribed medications for prevention and treatment of high cholesterol more used in the world. A side effect of these drugs is myotoxicity. Creatine Kinase (CK) is a biomarker to evaluate the severity of muscle damage that can change with gender, age, and physical activity. Factors that influence the increase of CK are exercise intensity, if it exceeds the metabolic capacity alterations that origin CK release to the blood circulation and sarcomere degradation.

**Objective**

The aim of this study was to evaluate and analyse macroscopically muscle structures in patients with hypercholesterolemia, in order to interpret the pathophysiological mechanisms produced by statins inducing myotoxicity. The sensitivity and acuity to the ultrasound were used to evaluate the muscle.

**Methods**

The study was performed in 47 individuals, age between [50-65] years old. Ultrasound tests were performed to the 47 individuals in three different groups – control group, individuals that intake statins and individuals that intake statins and do exercise. Gastrocnemius muscle was performed bilaterally using a 13Mhz probe to determine the dimensions of the pennate angle, fascicle length and thickness. A questionnaire and the informed consent term were signed by all individuals. The study was approved by the Ethics Committee for Health of the Regional Health Administration (Study nº45-2015)

**Results**

Differences in dimensions were observed. Significant differences were obtained for the pennate angle and the fascicle. The main differences were observed between the control group and experimental groups that intake statins.

**Conclusions**

Ultrasound has sensitivity and specificity to analyse the muscle tissue macroscopically. Individuals who intake statins have lower values of the evaluated structures. Differences were observed in the pennate angle in both sides, in the group that intake statins. The literature is unanimous in stating that individuals who take statins develop muscle changes called myalgia. The side effects of statins may increase with exercise. Ultrasonography is an imaging modality not yet widely used in this type of approach.

**Keywords**

Muscle, Ultrasound, Statins, Hypercholesterolemia.

**O169**

**Maximum expiratory pressure (MEP) Increase through a program with a sportive blowgun in institutionalized women with intellectual disability**

Marisa Barroso¹,², Rui Forte², Rui Matos¹,², Luís Coelho¹,², David Catela¹
¹Life Quality Research Center, 2001-904 Santarém, Portugal; ²School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Marisa Barroso (marisa.barroso@ipleiria.pt)
BMC Health Services Research 2018, **18**(Suppl 2):O169

**Background**

Blowgun is a long tube through which projectiles are shot [1]. The propulsive power is limited by the user's strength of respiratory muscles and the vital capacity of the lungs [2]. People with intellectual disability have limited levels of maximum oxygen consumption and ventilatory capacity [3].

**Objective**

The aim of this study is to investigate the effect of a Sportive Blowgun program on the respiratory capacity of institutionalized women with intellectual disability.

**Methods**

The sample was divided into two groups, the control group (n = 9; age 49.80 ± 8.50), and an experimental group (n = 9; age 44.80 ±
13.30). The experimental group underwent a 12-week Sportive Blowgun program, with 2 weekly sessions where each subject threw 40 darts at a distance that progressed from 4m to 10m away from the target. Maximum expiratory pressure (MEP) values (L/min) were collected through a Micro Medical - Micro RPM portable spirometer. Five measurements were taken for both groups. One before the beginning of the program, 3 during the program 1 at the end of the program. Informed permission from the institution and the participants assent was obtained.

## Results

In the experimental group, a significant difference (p = 0.008) was observed in the mean values of initial maximum expiratory pressure (MEP1 = 48.11 L/min) and final (MEP5 = 73.56 L/min). There is a significant difference between the values of the initial measurement with all other measurements, suggesting a positive evolution between them. There is only no significant difference between the intermediate measurements, which suggests a stagnation of the values between the second, third and fourth measurements. In the control group, except for the second measurement, there was no significant difference between the initial maximal expiratory pressure and the other measurements, which suggests that there was an initial adaptation to the test but that did not last. Comparing groups, except for the first measurement, all the others present a significant difference. A very significant difference was observed in the third (p = 0.005) and final measurement (p = 0.005), where the experimental group presented values always higher than the control group.

## Conclusions

The results suggest that the Sportive Blowgun program increases maximum expiratory pressure (MEP) by providing a respiratory capacity gain in institutionalized women with mental disability. Is suggested a more extensive study to verify the possibility of considering the sportive blowgun program as a complementary non-clinical therapy for respiratory insufficiencies.

## References

1. Mariñas AP, Higuchi H. Blowgun Techniques: The Definitive Guide to Modern and Traditional Blowgun Techniques. Vermont: Tutle Publishing; 2010.

2. Nagasaki T, Okada H, Kai S, Takahashi S. Influence of Blowgun Training on Respiratory Function. Rigakuryoho Kagaku 2010; 25(6): 867-871.

3. McGrother CW, Marshall B. Recent trends in incidence, morbidity and survival in Down's syndrome. Journal of Mental Deficiency Research. 1990;34:49-57.

## Keywords

Blowgun, Intellectual disability, Respiratory therapy.

O170

### Respiratory control technique and attention deficit hyperactivity disorder in children

David Catela¹, Isabel Piscalho², Rita Ferreira², Ana Victorino², Bárbara Cerejeira², Nicole Marques², Sara Dias²

¹Life Quality Research Center, 2001-904 Santarém, Portugal; ²Education School, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal

**Correspondence:** David Catela (catela@esdrm.ipsantarem.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O170

### Background

Attention deficit hyperactivity disorder (ADHD) comprises a persistent pattern of symptoms hyperactivity, impulsiveness and/or lack of attention [1] and can cause a significant impairment in academic activities [2]. ADHD has a prevalence rate ranging from 3% to 7% among school age children [3]. Respiratory sinus arrhythmia (RSA) is higher among children with typical development than in children with ADHD [4], and ADHD in childhood is associated with abnormal sympathetic mechanisms [5], with significantly higher mean heart rates, mean R-R interval significantly shorter (lower heart rate variability) and ratio LF/HF significantly higher than children with typical development [6-10].

## Objective

The purpose of this study is to verify if through breath control ADHD children can increase heart rate variability (HRV).

## Methods

Vital signs of ten potential ADHD children (11.22 ± .42 years old, 3 girls), were collected for 6 minutes, in supine position, under two conditions: I) normal breathing (NB); and, II) slow abdominal breathing (AB), e.g., [11]. HRV data acquisition was carried out through Polar V800 [12]. HRV analysis was made through gHRV software [13-15].

## Results

During AB children significantly reduced breathing frequency (BF) (8.9±4.2, Md=8) compared to NB frequency (18.3±5.9, Md=19) (Z= 6.439, p<.001, r=.81); and diastolic pressure (DP) (AB = 61.3±8.7, Md=61; NB = 63.6±6.4, Md=63; Z= 2.146, p<.05, r=.29); significantly augmented standard deviation of HR (AB = 7.4±1.4; NB = 5.9±1.5; Z= 2.310, p<.05, r=.89); standard deviation of mean interval RR (AB 80.5±22.9ms; NB = 64.3±27.7ms; Z= 2.192, p<.05, r=.73), and SD2 (AB = 106.9±29.7; NB = 82.5±35.6; Z= 2.192, p<.05, r=.73). Also, during AB children reduced systolic pressure (101.3±16.4, Md=97; NB = 104.9 ±17.1, Md=103; ns), heart rate frequency (79.8±11.7bpm, Md=81.8; NB = 81.7±11.8bpm, Md=83.9; ns); and, mean interval RR was greater (766.9±117.8ms Md=734.8; NB = 749.1±115.2ms, Md=715.8; ns); like rMSSD (112.9±53.3ms, Md=108.1; NB = 97.5±64.1ms, Md=79.9; ns), and HRV index (18.3±4.7ms, Md=18.9; NB = 15.6±6.1ms, Md=14.1; ns); and, ApEn became positive (greater) (.0001±.001ms, Md=.0001; NB - (-).001±.002ms, Md=(-) .0001; ns).

## Results

Consequently, with one short training session, these children had the capacity to implement a significantly slower BF to values near 8 bpm, cf. [11], which resulted in a reduction in HR, SP, and DP; and, in an augmentation of various parameters of HRV. All these changes point to an increase of vagal activity during AB. If vagal activity was reinforced during AB [16-17], it means that, maybe, a process of bottom-up adjustment of attention and emotional responses can be promoted, cf. [18-20].

## References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

2. Cantwell DP, Baker L. Association between attention deficit-hyperactivity disorder and learning disorders. J Learn Disabil. 1991;24(2):88-95.

3. Rash JA, Aguirre-Camacho A. Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review. ADHD Attention Deficit and Hyperactivity Disorders. 2012;4(4):167-77.

4. Buchhorn R, Conzelmann A, Willaschek C, Störk D, Taurines R, Renner TJ. Heart rate variability and methylphenidate in children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders. 2012;4(2):85-91.

5. Musser ED, Backs RW, Schmitt CF, Ablow JC, Measelle JR, Nigg JT. Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). J Abnorm Child Psychol. 2011; 39(6):841-852.

6. Tonhajzerova I, Ondrejka I, Adamik P, Hruby R, Javorka M, Trunkvalterova Z, et al. Changes in the cardiac autonomic regulation in children with attention deficit hyperactivity disorder (ADHD). Indian Journal of Medical Research. 2009;130:44-50.

7. Griffiths KR, Quintana DS, Hermens DF, Spooner C, Tsang TW, Clarke S, et al. Sustained attention and heart rate variability in children and adolescents with ADHD. Biological psychology. 2017;124:11-20.

8. Imeraj L, Antrop I, Roeyers H, Deschepper E, Bal S, Deboutte D. Diurnal variations in arousal: a naturalistic heart rate study in children with ADHD. European child & adolescent psychiatry. 2011;20(8):381-392.

9. Rukmani MR, Seshadri SP, Thennarasu K, Raju TR, Sathyaprabha TN. Heart rate variability in children with attention-deficit/hyperactivity disorder: a pilot study. Annals of neurosciences. 2016;23(2):81-88.

10. de Carvalho TD, Wajnsztejn R, de Abreu LC, Vanderlei LCM, Godoy MF, Adami F, et al. Analysis of cardiac autonomic modulation of children with attention deficit hyperactivity disorder. Neuropsychiatric disease and treatment. 2014;10:613.

11. Lehrer PM, Vaschillo E, Vaschillo B. Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied psychophysiology and biofeedback. 2000;25(3):177-191.
12. Giles D, Draper N, Neil W. Validity of the Polar V800 heart rate monitor to measure RR intervals at rest. European Journal of Applied Physiology. 2016, 116(3):563-571.

13. Rodríguez-Liñares L, Lado MJ, Vila XA, Méndez AJ, Cuesta, P. gHRV: Heart rate variability analysis made easy. Computer Methods and Programs in Biomedicine. 2014;116(1):26-38.

14. Rodríguez-Liñares L, Méndez AJ, Vila XA, Lado MJ. gHRV: A user friendly application for HRV analysis. In: Information Systems and Technologies (CISTI); 2012. p. 1-5.

15. Vila J, Palacios F, Presedo J, Fernández-Delgado M, Felix P, Barro S. Time-frequency analysis of heartrate variability. IEEE Engineering in Medicine and Biology Magazine. 1997;16(5):119-126.

16. Levy MN. Autonomic interactions in cardiac control. Annals of the New York Academy of Sciences. 1990;601(1):209-221.

17. Uijtdehaage SH, Thayer JF. Accentuated antagonism in the control of human heart rate. Clinical Autonomic Research. 2000;10(3):107-110.

18. Ruiz-Padial E, Sollers JJ, Vila J, Thayer, JF. The rhythm of the heart in the blink of an eye: Emotion modulated startle magnitude covaries with heart rate variability. Psychophysiology. 2003;40(2):306-313.

19. Thayer JF, Brosschot JF. Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology. 2005;30(10):1050-1058.

20. Thayer JF, Lane RD. Claude Bernard and the heart-brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews. 2009;33(2):81-88.

## Keywords

ADHD, Children, HRV, Breathing Technique.

## O171

### Can older adults accurately perceive affordances for a stepping forward task? Differences between faller and non-faller community-dwelling older adults

Gabriela Almeida, Jorge Bravo, Hugo Rosado, Catarina Pereira Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal

**Correspondence:** Gabriela Almeida (gsna@uevora.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O171

### Background

Different studies framing an ecological approach to perception [1] have tried to understand how people, mostly children [2] and adults [3], perceive their action limits, in other words, what an environment affords related on individual characteristics. However, studies about older adults seem to be scarcer [4-7], particularly studies focused on whether or not faller and non-faller older adults can accurately perceive affordances for a stepping forward task.

### Objective

The purpose of this study was to determine if older people could accurately perceive affordances for the task of stepping forward. The relationship between real and estimated maximum distance was explored in community-dwelling older adults, comparing fallers with non-fallers.

### Methods

A sample of 347 community-dwelling older adults (age 73.02 ± 6.40 yr; non-fallers: 57.9%, fallers: 42.1%) with the absence of cognitive impairment participated in the study. Participants were asked to predict their maximum distance for a stepping forward prior to performing the task. Absolute Percent Error (APE), Absolute Error (AE) and Error Tendency (ET) were calculated accordingly (2.8). APE measured deviation percentage from accurate perceptions, AE indicated the discrepancy (in cm) between estimation and real performance. ET indicated the direction of the error (under- or overestimation bias).

### Results

On average, non-faller estimated (63.7 ± 15.5 cm) and performed (70.7 ± 14.9 cm) greater distances than faller (estimation: 57.1 ± 14.5 cm; real: 61.7 ± 14.6 cm) older adults. No statistically significant differences were observed in APE (fallers: 7.2 ± 12.4%; non-fallers: 9.6 ± 12.5%). However, differences in AE were significant between faller (6.7 ± 5.9 cm) and non-faller (9.6 ± 12.5 cm) older adults (p = .001).

Old people had a huge tendency to underestimate (77.2%) the maximum distance achieved in a stepping forward. The results show a significant association between ET and being faller (χ²(1) =6.407, p=.01). Despite general participants exhibit an underestimation tendency, this tendency is greater in non-fallers (61.6% vs 38.4%). Further, there were fewer non-fallers than fallers overestimating their ability to step forward (45.6% vs 54.4%).

## Conclusions

Older adults displayed a tendency to underestimate the maximum distance they can stepping-forward. The bias of overestimation is more frequent in fallers, whereas persons who underestimated tend to do not fall, suggesting that they have a protective behaviour which avoids falls. Data evidence that older adults can perceive what the environment affords, which is in agreement with an ecological perspective to perception and action.

## Acknowledgements

This study was funded by ESACA Project (Grant ALT20-03-0145-FEDER-000007).

## References

1. Gibson J. The ecological approach to visual perception. New Jersey: Lawrence Erlbaum; 1979.

2. Almeida G, Luz C, Martins R, Cordovil R. Differences between Estimation and Real Performance in School-Age Children: Fundamental Movement Skills. 2016;2016:3795956.

3. Cole WG, Chan GLY, Vereijken B, Adolph KE. Perceiving affordances for different motor skills. Exp brain Res. 2013;225(3):309-319.

4. Konczak J, Meeuwsen HJ, Cress ME. Changing affordances in stair climbing: the perception of maximum climability in young and older adults. J Exp Psychol Hum Percept Perform. 1992;18(3):691-697.

5. Cesari P, Formenti F, Olivato P. A common perceptual parameter for stair climbing for children, young and old adults. Hum Mov Sci. 2003;22(1):111-24.

6. Luyat M, Domino D, Noel M. Surestimer ses capacités peut-il conduire à la chute? Une étude sur la perception des affordances posturales chez la personne âgée. Psychol NeuroPsychiat Vieil. 2008;6(4):286-297.

7. Noel M, Bernard A, Luyat M. La surestimation de ses performances : Un biais spécifique du vieillissement? Geriatr Psychol Neuropsychiatr Vieil. 2011;9(3):287-294.

8. Almeida G, Luz C, Martins R, Cordovil R. Do Children Accurately Estimate Their Performance of Fundamental Movement Skills. J Mot Learn Dev. 2017;5(2):193-206.

## Keywords

Aging, Falling, Perception of affordances, Gait.

## O172

### A new affordance perception test to explain falls occurrence: preliminary results of stepping-forward task

Catarina LN Pereira, Jorge Bravo, Hugo Rosado, Gabriela Almeida Department of Sports and Health, School of Science and Technology, University of Évora, 7000-671 Évora, Portugal

**Correspondence:** Catarina LN Pereira (clnp@uevora.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O172

### Background

Falls cause injury, dependence, and death. Identify the subjects that are potential fallers is essential for a successful prevention. Researchers developed several models and tests in order to diagnose individual's risk of falling [1, 2]. Risk factors such as environmental hazards, strength, balance or dual tasks are commonly tested. However, their discriminative power is limited, indicating a gap which these tests do not address. The assessment on the perception of affordances for individual's ability to perceive the critical boundary action [3, 4], may fill this gap.

### Objective

To analyse the appropriateness of a new stepping-forward test to explain fall occurrence in community-dwelling adults, that assess perception and action boundary.
## Methods

Participants were 266 women and 81 men aged 73.0 ± 6.4 years. They were assessed for fall occurrence (yes vs. no), and for stepping-forward and perception boundaries. Participants judged their maximum stepping-forward distance prior to the performance of the estimated task. Absolute Error (AE) [[estimated – real]] (cm) and Absolute Percent Error (APE) (%) were computed, and the Error Tendency (ET) was classified (underestimation vs. overestimation) [5, 6].

## Results

Univariate binary regression analysis showed that all the described variables explain significantly fall occurrence (p < 0.05). Data showed that, for each additional cm estimated in the stepping-forward test, the likelihood of falling decreased on 2.9%, OR: 0.971 (95%CI: 0.957-0.986), and for each additional cm performed in the test, this likelihood decreased on 4.0%, OR: 0.960 (95%CI: 0.945-0.975). Furthermore, data showed that for each additional cm computed as AE, the likelihood of falling decreased on 3.6%, OR: 0.964 (95%CI: 0.933-0.996), and for each additional 1% computed as APE this likelihood decreased on 0.9%, OR: 0.991 (95%CI: 0.969-1.013). Finally, data showed that subjects reporting an ET of underestimation were less 47.7% likely for falling, OR: 0.523 (95%CI: 0.315-0.867), than subjects showing an ET of overestimation.

## Conclusions

The new stepping-forward affordance perception test evidenced to be useful to determine the risk of fall occurrence. A higher estimation of maximum distance achieved or a higher real performance on the test were associated with a lower risk of falling. Further, a higher AE and an underestimation tendency showed to be associated with a decreased risk of falling. This suggests that is the marge of security provided by the higher performance ability, in contrast with a lower perception of affordance, which is protective and avoids falls.

## Acknowledgements

This study was funded by ESACA Project (Grant ALT20-03-0145-FEDER-000007).

## References

1. Pereira CLN, Baptista F, Infante P. Role of physical activity in the occurrence of falls and fallrelated injuries in community-dwelling adults over 50 years old. Disabil Rehabil. 2014;36(2):117-124.

2. Lohman M, Crow R, DiMilia P, Nicklett E, Bruce M, Batsis J. Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. J Epidemiol Community Health. 2017;71(12):1191-1197.

3. Luyat M, Domino D, Noel M. Surestimer ses capacités peut-il conduire à la chute? Une étude sur la perception des affordances posturales chez la personne âgée. Psychol NeuroPsychiatr Vieil. 2008;6(4):286-297.

4. Noel M, Bernard A, Luyat M. La surestimation de ses performances : Un biais spécifique du vieillissement? Geriatr Psychol Neuropsychiatr Vieil. 2011;9(3):287-294.

5. Almeida G, Luz C, Martins R, Cordovil R. Differences between Estimation and Real Performance in School-Age Children : Fundamental Movement Skills. 2016;2016:3795956.

6. Almeida G, Luz C, Martins R, Cordovil R. Do Children Accurately Estimate Their Performance of Fundamental Movement Skills. J Mot Learn Dev. 2017;5(2):193-206.

## Keywords

Aging, Falling risk, Boundary action, Perception.

# Poster Communications

## P1

### Prevalence of low back pain in surfers: associated factors

Beatriz Minghelli¹,², Inês Sousa¹, Sara Graça¹, Sofia Queiroz¹, Inês Guerreiro¹

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P1

## Background

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

## Objective

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

## Methods

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

## Results

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

## Conclusions

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

## Keywords

Low back pain, Prevalence, Surf.

## P2

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

Paula C Santos¹,², Sofia Lopes¹,³,⁴, Vanessa Silva¹, Pedro Norton⁵, João Amaro⁵, Cristina Mesquita¹,⁴

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P2

## Background

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

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

Musculoskeletal disorders, RULA, Occupational Health.

P3

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

Alice Morgado (alice.morgado@northampton.ac.uk)
University of Northampton, Northampton, NN2 6JU, United Kingdom
BMC Health Services Research 2018, **18**(Suppl 2):P3

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

psychopathology, researchers should have in mind the promotion of positive development throughout the life-span.

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

**References**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**Keywords**

Disaster, Psychological impact, Trauma, Resilience, Development.

P4

**Evaluation of Portuguese athletes knowledge regarding doping in sports**

Marco Jardim¹, André Ruivo², Catarina Jesus³, David Cristovão
¹School of Health, Polytechnic Institute of Setúbal, 2915-503 Setúbal, Portugal; ²Portuguese Sports Physiotherapy Interest Group, Portuguese Association of Physiotherapists, 2785-679 São Domingos de Rana, Portugal; ³Hospital de Loulé, 8100-503 Loulé, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P4
**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P5

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

Ana P Soares¹, Andreia Nunes¹, Paulo J Martins², Marisa Lousada³
¹Psychology Research Center, School of Psychology, University of Minho, 4710-057 Braga, Portugal; ²Center for Humanistic Studies of the University of Minho, University of Minho, 4710-057 Braga, Portugal; ³Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P5

**Background**

Specific Language Impairment (SLI) is a neurodevelopmental disorder involving language deficits in the absence of other associated condition [1]. The aetiology of SLI is hotly debated, ranging from representational deficits in grammar to impairments in the cognitive processes that underlie language acquisition. Recent research suggests that SLI difficulties may arise from implicit learning (IL) deficits, i.e. impairments in the cognitive mechanisms that allow children to extract the structural regularities present in the input and to generalize it to new contexts [2]. IL studies have

been conducted mainly with adults and unimpaired children using the Serial Reaction Time Task (SRTT). The few studies conducted with language impaired children produced inconsistent results [3]. Since performance of this task involves a motor component that seems to be also impaired in SLI, it is critical to conduct studies using other tasks and paradigms.

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

**Keywords**

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

P6

Fatal road accidents: behavior and the use of safety equipment

Christine B Godoy¹, Maria HPM Jorge², Jackeline G Brito¹
¹Faculty of Nursing, Universidade Federal de Mato Grosso. 78060-900 Cuiabá, Mato Grasso, Brazil; ²School of Public Health, Universidade de São Paulo, 01246-904 São Paulo, Brazil

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

BMC Health Services Research 2018, **18**(Suppl 2):P6

**Background**

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

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

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

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

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

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

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

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

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

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

### Keywords

Road accidents, External cause, Mortality, Risk factor.

## P7

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

Marta Assunção¹, Susana Pinto¹, Lurdes Lopes², Claudia Oliveira¹, Helena José³,⁴

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

**Correspondence:** Marta Assunção (martaassuncao@icloud.com)

BMC Health Services Research 2018, **18**(Suppl 2):P7

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

### References

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

2. Teixeira CRS, Kusumota L, Braga FTMM, Gaioso VP, Santos CB, Silva VLS, et al. O Uso de Simulador no Ensino e Avaliação Clínica em Enfermagem. Texto Contexto Enferm (Florianópolis) [serial on the Internet]. 2011 [cited 2017 October 11]; 20: 187-93. Available from: http://dx.doi.org/10.1590/S0104-07072011000500024.
3. Ferreira C, Carvalho JM, Carvalho FLQ. Impacto da Metodologia de Simulação Realística, Enquanto Tecnologia Aplicada a Educação nos Cursos de Saúde. STAES [serial on the Internet]. 2015 [cited 2017 October 11]; 32-40. Available from: www.revistas.uneb.br/index.php/staes/article/view/1617/1099.

**Keywords**

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

P8

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

Paula Diogo (pmdiogo@esel.pt)
Unidade de Investigação & Desenvolvimento em Enfermagem, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal
BMC Health Services Research 2018, **18**(Suppl 2):P8

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

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

**References**

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

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

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

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

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

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

**Keywords**

Emotions, Emotional Labour, Conceptual Model, Paediatric Nursing.

P9

Cardiovascular risk factors in patients with ischemic and hemorrhagic stroke

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

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

**Correspondence:** Leonel Preto (leonelpreto@ipb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P9

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

**Keywords**

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

P10

Topical oxygen therapy in wound healing: a systematic review

João L Simões, Dilsa A Bastos, Raquel V Grilo, Marta L Soares, Sílvia S Abreu, Juliana R Almeida, Elsa P Melo
School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P10
**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P11

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

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P11

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

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

**Keywords**

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

P12

**Microbiological characterization of food handlers in school canteens**

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P12
**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

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

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

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

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

**Keywords**

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

P13

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

Karin Panitz, Jennifer Apolinário-Hagen

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

Karin Panitz (mail@hp-panitz.de)

BMC Health Services Research 2018, **18**(Suppl 2):P13

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

P14

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

Maria FMS Nunes¹, João L Simões², Marília S Rua²

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P14

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P15

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

Rafael Bernardes, Cristina L Baixinho
Lisbon Nursing School, 1700-063, Lisbon, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P15

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

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

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

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

**Keywords**

Motor activity, Nursing, Sarcopenia, Frail elderly, Dependence.
P16

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

Liliana Abreu¹, Pedro S Couto², Susana Mestre³

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

²Center for Research and Development in Mathematics and
Applications, Department of Mathematics, University of Aveiro, 3810-193
Aveiro, Portugal³

Aveiro, Portugal. ³University Hospital Center of Algarve, 8000-386 Faro,
Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P16

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Acknowledgements

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

References

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

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

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

Keywords

Swallowing, Dysphagia, AVC, Evaluation, PSAND.

P17

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

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

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

Correspondence: Adriane Carvalho (adrianedasc@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P17

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

References

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

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

3. Mártires MAR, Costa MAM, Santos CSV. Texto Contexto Enferm, Florianópolis. 2013 Jul-Set;22(3):797-803.
4. Malta DC, Bernal RI, Nunes ML, Oliveira MM, Iser BM, Andrade SC, et al. Prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis em adultos: estudo transversal, Brasil 2012. Epidemiol Serv Saúde, Brasília. 2014 Dez;23(4):609-22.

5. Instituto Brasileiro de Geografia e Estatística [homepage na internet]. Projeção da População do Brasil por sexo e idade: 2000-2060 [acesso em 10 dez 2017]. Disponível em: https://www2.ibge.gov.br/home/estatistica/populacao/projecao_da_populacao/2013/default_tab.shtm.

**Keywords**

Obesity, Aging, Tendencies, Population projection, Demography.

P18

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

Marta Bento, Rita Marques

Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal

**Correspondence:** Marta Bento (marsofaia81@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P18

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P19

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

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

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

**Correspondence:** Patrícia Silva (paticiairan@ig.com.br)

BMC Health Services Research 2018, **18**(Suppl 2):P19

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P20

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

Raquel MV Ramos, Ana CR Monteiro, Sílvia P Coelho

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

Raquel MV Ramos (raquel_mvr@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P20

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

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

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

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

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

**Keywords**

Needs assessment, Family, Critical illness.

P21

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

Carla Jimenez-Rodriguez<fnref n="1" />, Francisco J Hernández-Martínez<fnref n="2" />, María C Jiménez-Díaz<fnref n="1" />, Juan F Jiménez-Díaz³, Bienvenida C Rodríguez-De-Vera³

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

³Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España

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

BMC Health Services Research 2018, **18**(Suppl 2):P21

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P22

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

Carla Jiménez-Rodríguez<fnref n="1" />, Carmelo Monzón-Moreno<fnref n="2" />, Juan F Jiménez-Díaz<fnref n="2" />, María-del-Carmen Jiménez-Díaz<fnref n="1" />, Bienvenida-del-Carmen Rodríguez-de-Vera<fnref n="2" />

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

BMC Health Services Research 2018, **18**(Suppl 2):P22

**Background**

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

**Objective**

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

**Methods**

Experimental study with a control group (with physiological saline to maintain hydration conditions and group with extra virgin olive oil (EVOO) to avoid bias with the oleic excipient), to check the mesophilic microbial colonization after the use of the applied CBD topically

<footnote n="1">¹Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España;</footnote>

<footnote n="2">²Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España</footnote>
on experimental total skin ulcerative lesions in the adult male white rat, Sprague Dawley strain. Ten animals were used for each group under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. Subsequently, they are distributed in individual cages to prevent them from licking each other and with sufficient height to prevent the friction of the cutaneous ulcer with the passenger compartment. 0.15 ml of the respective product was applied daily to the ulcers. The microbiological analysis was carried out by studying the variation of the bacterial microbiota. The colony-forming units of each wound were determined by counting on a plate, after obtaining a total skin sample and a superficial sweep. The organic samples obtained were placed in sterile tubes containing 1 ml of physiological serum to which vortex was applied for 30 seconds, serial dilutions being made to the tenth of the samples subject to titration. Six plates of Tryptic Soy Agar (TSA) were then labelled, one for each dilution obtained, and 0.1 ml of each of these dilutions was added, spreading it on the surface of the plate by means of the sowing handle. Plates were incubated in an oven at 37° for twenty-four hours and then the colony forming units were counted.

## Results

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

## Conclusions

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

## Keywords

Colonization, Microbial cannabidiol, Skin, Ulcer, Rat.

## P23

### The impact of dermatologic and cosmetic counseling - case study

Stefany Moreira¹, Ana Oliveira², Rita Oliveira²,³, Cláudia Pinho², Agostinho Cruz²

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

**Correspondence:** Stefany Moreira (fany_hill@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P23

### Background

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

### Objective

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

### Methods

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

## Results

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

## Conclusions

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

## References

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

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

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

## Keywords

Community pharmacy professionals, Counselling, Dermatologic products, Cosmetics.

## P24

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

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

**Correspondence:** Inês Cruz (inescruz@esenf.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P24

### Background

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

### Objective

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

### Methods

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

### Results

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

### Conclusions

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

References

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

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

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

Keywords

Self-management, Medication regime, Nursing diagnosis, Nursing in-
formation systems.

P25

Antioxidant activity of Artemisia annua L

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P25

Background

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

Objective

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

Methods

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

Results

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

Conclusions

This study confirms the differences in antioxidant activities using dif-
ferent solvents, suggesting that the solvent effect should be taken
into account in the evaluation of the antioxidant potential of any

sample. However, the origin of the plants including the pre- and
post-harvesting practices can be also important for their chemical
composition, resulting in different values for the same antioxidant as-
says and solvents.

References

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

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

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

Keywords

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

P26

Swimming pool users and behaviors: practices and motivations

Daniel A Marinho¹,², Luís Faíl¹, Mário C Marques¹,², António Sousa¹,²,
Henrique P Neiva¹,²

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P26

Background

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

Objective

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

Methods

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

Results

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

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

## Acknowledgements

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

## References

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

## Keywords

In-water activities, Questionnaire, Physical activity.

P27

## Critical patient's comfort: Strategies to reduce environmental noise levels

Telma Ramos, Filipa Veludo
School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

**Correspondence:** Telma Ramos (telmaramos_24@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P27

## Background

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

## Objective

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

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

## Results

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

## Conclusions

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

## References

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

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

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

## Keywords

Noise, Comfort, Integrative literature review, Content analysis.

P28

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

Anabela Mendes (anabelapmendes@esel.pt)
Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal
BMC Health Services Research 2018, **18**(Suppl 2):P28

## Background

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

## Objective

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

## Methods

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

## Results

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

## Conclusions

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

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

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

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

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

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

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

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

## Keywords

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

## P29

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

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P29

### Background

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

### Objective

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

### Methods

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

## Results

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

## Conclusions

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

## Acknowledgements

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

## References

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

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

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

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

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

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

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

## Keywords

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

## P30

### Falls Efficacy Scale-International: how does it "behave" with users of adult day care centres?

Daniela Figueiredo¹,², Martina Neves¹

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P30

### Background

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Acknowledgements**

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

**Keywords**

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

P31

**Function-Focused Care: validation of self-efficacy, outcomes expectations and knowledge scales**

Lénia Costa¹, 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:** Lénia Costa (leniacosta@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P31

**Background**

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

**Objective**

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

**Methods**

Quantitative approach of a descriptive/correlational cross-sectional type. A self-report questionnaire consisting of sociodemographic and professional variables and the scales of self-efficacy, expectations

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

**Results**

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

**Conclusions**

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

**Acknowledgements**

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

**References**

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

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

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

**Keywords**

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

P32

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

Marilia Rua¹, Isabel Alarcão², Wilson Abreu³

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

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

**Correspondence:** Marilia Rua (mrua@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P32

**Background**

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

To understand the factors that influence the development of stu-
dent's skills in the clinical training.

**Methods**

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

Results

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

Conclusions

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

References

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

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

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

Keywords

Bioecological model, Student, Competencies, Clinical training.

P33

Phytochemical screening from Rosmarinus officinalis and Ginkgo biloba leaf extracts

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

¹Farmácia Holon, Baguim do Monte, 4435-668 Gondomar, Portugal;

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

Correspondence: Ana França (anap981@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P33

Background

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

Objective

The aim of this study is to determine the prevalence of adverse
events associated with use of oral antidiabetics and assessing their

impact on Health-related Quality of Life (HRQoL) of diabetic patients
tracked in primary health care.

Methods

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

Results

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

Conclusions

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

References

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

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

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

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

Keywords

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

P34

Systematic review - how comfort and comfort in nursing are characterized

Ana R Sousa¹, Eliette Castela², Patrícia Pontífice-Sousa², Teresa Silveira
¹Centro Hospitalar de Setúbal, 2910-446 Setúbal, Portugal; ²Universidade Católica Portuguesa, 1640-023, Lisboa, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):P34

Background

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

Objective

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

Methods

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

Results

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

**Conclusions**

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

**Keywords**

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

P35

Rotines of life and health of institutionalized young people

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

¹School of Education, Polytechnic Institute of Castelo Branco, 6000-266

Castelo Branco, Portugal; ²Faculty of Sports Science, University of Extramadura, 10003 Cáceres, Spain

**Correspondence:** Tiago Machado (tiagomachadix@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P35

**Background**

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

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

**Methods**

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

**Results**

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

**Conclusions**

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

**Keywords**

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

P36

Evaluation of pain in patients intubated orotracheally: BPS and CPOT

Ana RPQ Pinheiro¹, Rita Marques²

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

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

BMC Health Services Research 2018, **18**(Suppl 2):P36

**Background**

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

**Objective**

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

**Methods**

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

**Results**

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

**Conclusions**

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

**References**

1. Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Straaten HMO. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. Journal of Critical Care.
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30: p. 167-172.

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

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

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

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