**Objective**

To evaluate the prevalence of chronic pain, and intradialytic pain in patient undergoing haemodialysis, as well as the effectiveness of analgesic therapy.

**Methods**

Cross-sectional, descriptive and observational study. A random sample consisting of 172 patients undergoing haemodialysis in two clinics in the region of Lisbon, Portugal. The Brief Pain Inventory, which analyses the influence of pain in a patient's life, was only applied to evaluate chronic pain [5]. The Visual Analogue Scale was used to assess the intradialytic pain. Tests were administered during dialysis sessions from May to June 2015. Categorical variables were expressed as percentages and continuous variables were expressed as mean standard deviations or medians. This study was approved by the Ethics Committee of Diaverum (N 1/2015).

**Results**

The sample consisted mostly of men (61.6%) of Portuguese nationality (80.7%), the mean age was 60 years (± 14.4), and patients were under haemodialysis treatment for 72.6 months (± 54.4). Chronic pain occurs in 54.1% of patients and intradialytic pain in 75%. The causes of pain were musculoskeletal (69.3%), associated to vascular access (19.3%) and other causes (11.4%). Chronic pain was most commonly located in the legs (43.2%), followed by back (21.6%) and vascular access (19.3), head (8%), arms (4.5%), abdomen (2.3%) and, lastly, chest (1.1%). The percentage of patients that took analgesics for chronic pain was much higher (62.0%), of these 87.8% are non-opiates, 10.2% weak opiates and 2% strong opiates. The other therapeutic interventions referred were: rest (24.1%), massage and relaxation (6.3%), cryotherapy (1.3%), exercise (1.3%), while 5.1% reported doing nothing. The effectiveness of the treatment was successful for chronic pain, in 62.6% of the patients, there was a relief felt of over 50%.

**Conclusions**

Pain of musculoskeletal origin is a frequent symptom in our sample. The pharmacological management of chronic pain is the most applied intervention.

**References**

1. Pelayo Alonso R, Martínez Álvarez P, Cobo Sánchez JL, Gándara Revuelta M, Ibarguren Rodríguez E. Evaluación del dolor y adecuación de la analgesia en pacientes en tratamiento con hemodiálisis. Enferm Nefrol. 2015;18(4):253-259.

2. Calls J, Rodríguez CM, Hernández SD, Gutiérrez NM, Juan AF, Tura D, Torrijos J. An evaluation of pain in haemodialysis patients using different validated measurement scales. Nefrologia. 2009;29(3):236-243.

3. Ahís Tomás P, Peris Ambou I, Pérez Baylach CM, Castelló Benavent J. Evaluación del dolor en la punción de una fístula arteriovenosa para hemodiálisis comparando pomada anestésica frente a frío local. Enferm Nefrol. 2014;17(1):11-15.

4. Upadhyay C, Cameron K, Murphy L, Battistella M. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools. Clin Kidney J. 2014;7(4):367-372.

5. Sousa LM, Marques-Vieira CM, Severino SS, Pozo-Rosado JL, José HM. Vali- dación del Brief Pain Inventory en personas con enfermedad renal cróni- ca. Aquichan. 2016;17(1):42-52.

**Keywords**

Renal Insufficiency, Chronic, Renal Dialysis, Quality of life, Pain.

O98

**Prevalence of musculoskeletal symptoms in nursing students**

Cristiana Firmino<sup>1,2</sup>, Luis Sousa<sup>2,3</sup>, Joana M Marques<sup>2,5</sup>, Fátima Frade<sup>2</sup>, Ana V Antunes<sup>2</sup>, Fátima M Marques<sup>4</sup>, Celeste Simões<sup>6</sup>
<sup>1</sup>Hospital Cuf Infante Santo, 1350-070 Lisboa, Portugal; <sup>2</sup>Escola Superior de Saúde Atlántica, 2730-036 Barcarena, Portugal; <sup>3</sup>Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, Portugal; <sup>4</sup>Escola de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; <sup>5</sup>Centro de Medicina de Reabilitação de Alcoitão, 2645-109 Alcabideche, Portugal; <sup>6</sup>Faculdade de Motricidade Humana / Instituto de Saúde Ambiental, 1495-687 Cruz Quebrada, Portugal

**Correspondence:** Cristiana Firmino (furtado.cristy@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O98

**Background**

Musculoskeletal symptoms are the most common conditions in society, being indicated as one of the main factors of disability during the life cycle of an individual [1-2]. Students are exposed to the factors that can trigger these musculoskeletal symptoms [3], both during class periods and clinical teaching. Prevalence of musculoskeletal pain is higher in the cervical region among nursing students of 1st year and 2nd year, and lower back in nursing students of the 3rd and 4th years [4].

**Objective**

To determine the prevalence of musculoskeletal symptoms in nursing students.

**Methods**

Cross-sectional and descriptive study. One hundred and fifty-five (155) nursing students from two nursing schools in Lisbon participated in this study. The data collection instrument consisted on sociodemographic and health behaviour variables and the Nordic musculoskeletal questionnaire (NMQ). The NMQ consists of 27 binary choice questions (yes or no) [5]. The variables were expressed as percentages. This study was approved by the Ethics Committee of two nursing's schools.

**Results**

83.23% of the sample are females, single (88.38%) and 32.26% are working students. 81.94% are non-smoking; 87.1% do not usually ingest alcoholic drinks; 65.81% use a backpack and 23.23% carry objects on their way to school. 49.03% spend between 2 and 4 hours on the computer and electronic devices and 42.58% spend more than 4 hours. 71% spend more than 4 hours seated during classes. 85.8% had no training prevention of musculoskeletal injuries. The prevalence of musculoskeletal symptoms by location of the aches, pain, discomfort and numbness were as following: 66.23% in the neck; 52.29% shoulders; 7.24% elbows; 39.47% wrists/hands; 20.53% upper back; 69.33% lower back; 15.33% hips/thighs, 32% knees and 22.82% ankles/feet.

**Conclusions**

The most frequent aches, pain, discomfort, numbness location are located on the neck, shoulders and lower back. The main causes related to musculoskeletal injuries are the transportation of weights, use of computer and electronic devices and to be seated for long periods of time. It is recommended the implementation of prevention strategies in order to reduce the occurrence of musculoskeletal injuries.

**References**

1. Abledu JK, Offei EB. Musculoskeletal disorders among first-year Ghanaian students in a nursing college. Afr Health Sci. 2015;15(2):444-449.

2. Alhariri S, Ahmed AS, Kalas A, Chaudhry H, Tukur KM, Sendhil V, Muttappallymyalil J. Self-reported musculoskeletal disorders and their associated factors among university students in Ajman, UAE. Southern Med J. 2016;5(S2):S61-70.

3. Martins AC, Felli VE. Sintomas músculo-esqueléticos em graduandos de enfermagem. Enferm Foco. 2013;4(1):58-62.

4. Nunes H, Cruz A, Queirós P. Dor músculo esquelética a nível da coluna vertebral em estudantes de enfermagem: Prevalência e fatores de risco. Rev Inv Enferm. 2016;11(14):28-37.

5. Mesquita CC, Ribeiro JC, Moreira P. Portuguese version of the standardized Nordic musculoskeletal questionnaire: cross cultural and reliability. J Public Health. 2010;18(5):461-466.

**Keywords**

Nursing Students, Musculoskeletal Pain, Prevalence, Cross-Sectional Studies.

O99

**Eating habits: determinants of Portuguese adolescents' choices**

Susana Cardoso¹, Carla Nunes¹, Osvaldo Santos², Isabel Loureiro¹

¹Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal; ²Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal

**Correspondence:** Susana Cardoso (suscardoso@yahoo.com.br)

BMC Health Services Research 2018, **18**(Suppl 2):O99
**Background**

Proper eating habits are crucial to a healthy life. It is important to understand the determinants of eating choices made at adolescence because this stage of life is paramount for the formation of lifelong enduring habits.

**Objective**

To identify determinants of eating choices based on adolescents' perception and characterizing them, in particular, to the level of relevance attributed by adolescents.

**Methods**

A cross-sectional study was carried out, based on a sample of 358 adolescents (14-18 years old) from two schools of Coimbra. First, a quantitative study was carried out using the scales: EHA (eating habits scale), TAA-25 (eating attitudes test) and GSQ (general self-efficacy scale). In a second step, a qualitative study was carried out with subgroups that were selected from the results of the first phase of the study. These subgroups presented opposite patterns of habits (group A: better eating habits - EHA≥160 and group B: worst habits - EHA≤125) and we moved into a grounded theory approach with semi-structured individual interviews.

**Results**

Gender emerges as a determinant of eating choices pattern, with girls assuming more adequate eating habits (t = 3.84; p < .0001; r²adjusted= .037, p < .0001). The perception of general self-efficacy assumes greater relevance for boys, functioning as a protective factor that reduces unhealthy options. Through multinomial regression models, we could see that gender and general self-efficacy have a big influence on eating habits. The ideals of beauty have influence on this effect. Resisting adversity has an important influence in the choices, being associated to self-regulation. The situations of risk to develop an eating behaviour disturbance appear mainly in the cases of adolescents presenting better habits (r<sub>sp</sub>= .203; p < .001) and are more frequent in girls (t = 3.54; p < .0001; OR = 4.04). Through content analysis it was possible to identify determinant factors that were perceived by adolescents in both groups. The ones that were more often mentioned (in a decreasing order) were family influence, taste preferences, knowledge of healthy eating rules and availability. This was followed by determinants such as self-control capacity, feeling well or bad, peer influence, feeling hungry or full, developing a task or not, impulsiveness, time available and humour/stress.

**Conclusions**

The differences found between sexes can justify differentiated interventions. Our results also suggest the relevance to work on self-image. Family must be considered as an integrating part of the interventions in health education. Political measures taken by schools and government agents can also have a very important role in making healthy choices easier.

**Keywords**

Adolescents, Eating habits, Determinants.

## O100

**The influence of regular sports practice on motor skills and student's physical fitness**

Júlio Martins¹,², João Cardoso¹, José Reis¹, Samuel Honório³

¹University of Beira Interior, 6201-001 Covilhã, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal; ³School of Education, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal

**Correspondence:** Samuel Honório (samuelhonorio@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O100

**Background**

Sports practice develops several motor skills that help practitioners not only in game, but also brings benefits to their physical fitness. Practitioners develop an effective motor response and quick solutions to daily situations.

**Objective**

Determine if the regular practice of sports influences or not motor skills, physical fitness and body composition of students. We wish also to

identify the correlation between the performance of students in specific motor skills tests of football, physical fitness and body composition.

**Methods**

The sample consisted in 160 (divided in two groups of 80) male students, 12-year-old, living in Madeira and that practice football regularly. One group of students had an extracurricular physical activity beyond curricular physical activity (Federated Sports), and the other group entails students who only practice physical activities as a curricular activity (School Sport). Body composition (BMI and %BF) were also evaluated by Fitnessgram. To evaluate motor abilities the software Predictive Analytics Software - PASW was applied.

**Results**

After analysing the results, we became aware that students with extracurricular physical activities had better results in motor skills than students with curricular physical activities. This result is perhaps the less surprising in the set of all assessments due to the longer physical commitment of these students in relation to the students that only exercise in the context of curricular activities. Regarding physical fitness, students with extracurricular physical activity can have more students in HFZ (healthy fitness zone) than students with curricular physical activity. Regarding the arms extension and flexion, 26% of the students with curricular physical activity are above HFZ, achieving better performance than the students that have extracurricular physical activity. According to the skills measured, the students with extracurricular physical activities achieve a relatively higher average than students with curricular physical activities. Regarding body composition and after determining the BMI and %BF of each group, it appears that students with extracurricular physical activities achieve better results than those achieved by the students of curricular physical activities.

**Conclusions**

The regular practice of sports with curricular and extracurricular physical activities, seems to contribute to an improvement of physical fitness, motor skills and body composition of students, keeping them in a healthy fitness zone, thus preventing premature cardiovascular diseases, among others.

**Keywords**

Motor Skills, Physical Fitness, Body Composition, Federated Sports, School Sports.

## O101

**Promotion of language skills in children aged 5-6 years, without language disorders**

Tiago Rodrigues, Catarina Mangas

School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Tiago Rodrigues (tiagoac.rodrigues@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O101

**Background**

Language is a human faculty that enables communication with various interlocutors. This appears early and develops, exponentially, in the early years of life. For such, it is important that the surrounding environment is stimulating and allows the exchange of experiences with other speakers. The pre-school age is a milestone in the development, not only for stimulation, but also to identify deviant behaviours. In order to avoid future complications, professionals who deal with these children should prevent any language disorders. The speech and language therapist, being a health professional trained to deal with the areas of communication and language, has a prominent role in this preventive action. In Portugal, there aren't many references concerning prevention in language disorders. As such, it is necessary to promote a definite change in the present scenario, namely with innovative and stimulating materials to develop language.

**Objective**

Therefore, this is an exploratory-descriptive study, with a qualitative-quantitative paradigm and the general objective of this study was "to create and implement a Language Skills Promotion Program for 5-6
year-old children without any language disorders, in order to analyse
their potential influence on their language skills".

Methods

To this end, a 10-session program was built, evaluated and validated by a panel of experts. Before the beginning of the program, all the sample children were evaluated with a language test for preschool age. A sample of 12 children, divided equally in two groups, was selected and the program was applied by a Speech and Language Therapist only to one of these groups. At the same time, the Childhood Educator's opinion was collected in order to understand the influence of the respective program on the children's language skills.

Results

The final results of the study show that children who participated in the program improved their language skills, which was not the case of the children who did not take part in that same study. These results prove that the investment in prevention actions, through the promotion of language skills, enhances the oral and written language skills of children, especially in terms of literacy, something that is indispensable for their educational success.

Conclusions

Finally, the study also emphasizes the importance of primary prevention actions, such as the application and development of programs to stimulate or organize information actions, with a view to promoting the health and the well-being of society in general.

Keywords

Child language, Child-rearing, Early intervention, Prevention, Speech therapy.

O102

The impact of a training program on the performance of nurses working at a chemotherapy ward

Joana M Silva, Isabel M Moreira, Anabela Salgueiro-Oliveira
Nursing School of Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Joana M Silva (joanamota19@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O102

Background

Oral mucositis (OM) is the major complication reported by patients
undergoing chemotherapy and/or radiotherapy, with a strong impact
on their quality of life by compromising physical and psychological
functions [1]. OM affects 40-76% of patients undergoing chemother-
apy and up to 90% of patients undergoing radiotherapy [3,4]. Inad-
equate oral hygiene is a patient-related risk factor in which health
professionals can intervene [5,7], namely nurses [6]. Oral examination
allows diagnosing the different stages of OM and establishing an in-
dividualized care plan.

Objective

To assess the impact of a training program on the performance of nurses working at a chemotherapy ward regarding OM risk assessment and prevention in cancer patients.

Methods

This action-research study aimed to identify nurses' interventions in pa-
tients with or at risk for OM. Data were collected from the nursing re-
cords of 110 patients between October and November 2016 in order to
analyse the nursing documentation pattern based on an evidence-based
grid. Data were analysed using descriptive statistics. The discussion with
the team nurses about the results obtained in the document analysis
was used to design a three-session training program. The next step was
to reanalyse the nursing documentation pattern with the purpose of
identifying positive changes in the aspects under study. The study was
approved by the Ethics Committee.

Results

The analysis of the documentation pattern showed that 31.8% of the pa-
tients were not asked about oral hygiene practices, although 25.7% of the
sampled patients were in the 1st cycle of chemotherapy. A total of 21.9%
of patients were not observed during oral hygiene care. Only 14.5% of pa-
tients were given instructions about the treatment of side effects, and
only 12.5% of them were given instructions about oral hygiene care. Only
2.7% of the patients had their oral cavity/mucous membranes examined,

and all of them were diagnosed with OM. The implementation of the
training program led to the introduction of standardized records for oral
cavity surveillance. Nurses showed high adherence levels to this practice
and considered it very relevant in clinical practice.

Conclusions

The research results show that nurses do not perform a systematic diagnostic evaluation of patients' oral cavity and that few patients receive instruction on oral hygiene care, which does not contribute to patient empowerment in this area. The implementation of the training program showed that nurses recognize the need for and are committed to changing practices in this area.

References

1. Yarbro CH, WujciK D, Gobel B H. Cancer Nursing: Principles and Practice. 8th edition. Destin, Florida: Jones & Bartlett Publishers; 2016.

2. Eilers J, Harris D, Henry K, Johnson L. Evidence-based interventions for cancer treatment – Related mucositis: Putting evidence into practice. Clin J Oncol Nurs. 2016;18:80-96.

3. Peterson D, Boers-Doets C, Bensadoun R, Herrstedt J. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Annals of Oncology. 2015;26(Suppl 5):139-151.

4. Araújo S, Luz M, Silva G, Andrade E, Nunes L, Moura R. O paciente oncológico com mucosite oral: desafios para o cuidado de enfermagem. Rev. Latino-Am. Enfermagem. 2015;23(2):267-274.

5. Gondin F, Gomes I, Firmino F. Prevenção e tratamento da mucosite oral. Rev. enferm. UERJ. 2010;18(1):67-74.

6. Eilers J, Million R. Clinical update: Prevention and management of oral mucositis in patientes with cancer. Semin Oncol Nurs. 2011;27(4):e1-16.

7. Teixeira S. Mucosite oral em cuidados paliativos (Dissertação de mestrado em oncologia – Especialização em enfermagem oncológica). Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. 2010.

8. Kuhne GW, Quigley BA. Understanding and Using Action Research in Practice Settings. In Quigley BA, Kuhne GW, editors. Creating Practical Knowledge Through Action Research: Posing Problems, Solving Problems, and Improving Daily Practice. San Francisco: Jossey-Bass Publishers. 1997. p. 23-40.

Keywords

Oral mucositis, Nursing care, Oncology.

O103

Styles of conflict management and patient safety

Anabela Almeida¹, Sara Cabanas², Miguel C Branco¹
¹Universidade da Beira Interior, 6200-001 Covilhã, Portugal; ²Centro
Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal

Correspondence: Anabela Almeida (aalmeida@ubi.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O103

Background

Health is a demanding scenario of changes and successive adaptations that, very easily, allows the emergence of differences between the involved and conflicts between professionals. Ineffectively managed conflicts in health organizations reduce quality, compromise safety, and increase the costs of health care delivery, secondarily to the goals of being effective and efficient.

Objective

Thus, the general objective of the study is to investigate the relation-
ship between the conflict management styles used and the level of
patient safety climate among the clinical services professionals at
Hospital Pêro da Covilhã of CHCB.

Methods

The research is of a quantitative nature, of a descriptive and correl-
ational character and of a transverse nature. The sample is non-
probabilistic, consisting of 137 health professionals who work at
CHCB. The use of ROCI-II and SAQ allowed the evaluation of the
styles of conflict management and the perceptions of attitudes of
health professionals related to patient safety.
## Results

The results show that professionals, in all relations with the opponent, opt preferentially for collaboration, with competition being the least common style of conflict management. There were no differences in the styles of conflict management used in relation to the opponent. The participants presented positive attitudes towards the patient's safety, and it was verified that the professionals perceived a lower security relative to the dimension of management's perception and greater in relation to the dimensions of job satisfaction and recognition of stress, which show the highest values. The relationship between conflict management styles and the security climate level was verified. There is an association between literacy and conflict management styles, and years of service and conflict management styles. Regarding the ordinal independent variables, all are associated with the perceptions of the security climate.

## Conclusions

Gender, marital status, integration period, function and years of service, influence the conflict management styles used; and age, gender, choice of service, integration period, function, area of service and years of service, influence the perceptions of professionals' attitudes related to patient safety.

## Keywords

Conflict, Conflict management, Patient safety, Safety climate.

## O104

### Influence of a rehabilitation nursing care program on quality of life of the patients undergoing cardiac surgery

José Moreira, Jorge Bravo

Department of Sports and Health, School of Science and Technology, University of Évora, 7000 Évora, Portugal

**Correspondence:** José Moreira (jafonsomoreira@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O104

### Background

Cardiac rehabilitation (CR) is fundamental in the treatment of patients undergoing cardiac surgery (CS) regarding the educational, physical exercise and quality of life dimensions. Considering the competences of Specialist Nurses in Rehabilitation Nursing (SNRN) and the current prevalence of risk factors associated with cardiovascular disease, it is essential to implement programs in this area.

### Objective

To assess the impact of SNRN interventions on a CR program during hospitalization (phase I) and 1 month after CS (phase II).

### Methods

Participants (n = 11) submitted to CS, of both sexes, between 25 and 64 years of age (61.09 ± 7.09 years), that according to the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation, met the criteria for low or moderate risk, class B for participation and exercise supervision, absence of signs/symptoms after CS, with a left ventricular ejection fraction greater than 40%. Supervised interventions were performed during hospitalization, pre- and post-cardiac surgery, and 1 month after hospital discharge. In phase II, a physical exercise program was fulfilled according to the norms of the American College of Sports Medicine, comprising 3 sessions of physical exercise per week lasting between 30 to 60 minutes, including heating, aerobic exercise and recovery/stretching. Hemodynamic data (blood pressure, heart rate, peripheral oxygen saturation, pain) and the Borg scale were recorded in the initial, intermediate and final periods of each session. The aerobic capacity was evaluated through the 6-minute Walk Test and the health-related quality of life using the Short Form Health Survey 36 (SF-36V2) questionnaire.

### Results

Significant statistical improvements were observed in the time/walk relationship, such as the increase in the respective functional capacity (p = 0.05) and quality of life (in various domains). During the hospitalization, the subjective perception of the effort of session to session decreased in 81.82% of the participants. T-test for

independent samples revealed that differences in resting heart rate (phase I) were not significant, however, the difference in distances was significant at a 95% confidence level.

## Conclusions

Nursing rehabilitation care is essential to improve the quality of life of patients undergoing CS in a phase I and II rehabilitation program. The benefits of CR programs are evident when initiated early after CC, reinforcing the need to increase their implementation in the rehabilitation of cardiovascular disease. Although the reduced sample size, the results represent a basis for future studies with a larger number of participants and a longer intervention period after CC.

## Trial Registration

NCT03517605

## Keywords

Cardiac Rehabilitation, Quality of Life, Rehabilitation Nursing.

## O105

### Study of knee arthroplasty in the elderly population with agricultural activity

Carla Costa¹, Jorge Nunes²,³, Ana P Martins⁴

¹Faculdade de Ciências da Saúde, Universidade da Beira Interior, 6200, 506 Covilhã, Portugal; ²Universidade da Beira Interior, 6200-001 Covilhã, Portugal; ³Centro Hospitalar Cova da Beira, 6200-251 Covilhã, Portugal; ⁴Centro de Matemática e Aplicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal

**Correspondence:** Carla Costa (csofia_29@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O105

### Background

Arthrosis is a major cause of pain, disability and loss of quality of life [1]. It affects the knee of elderly, overweight people and women frequently, and is influenced by articular overload, that occurs in Agriculture [2-9]. The majority of the individuals submitted to Total Knee Arthroplasty (TKA) refer significant decrease of knee pain and increase of knee functionality [1]. In this context, there are no studies on the recovery of elderly if they return to Agriculture after TKA.

### Objective

Realize if elderly people between 65 and 80 years old, patients of Pêro da Covilhã Hospital, with Agricultural activity before surgery and submitted to TKA, with medial approach and posterior cruciate ligament sacrifice for the first time, can return to Agriculture and how long does it take; otherwise, identify the reasons for the interruption. Secondarily, analyse if Body Mass Index (BMI), gender, job, among others, influence this return.

### Methods

This is an observational retrospective study with 38 patients between 65 and 80 years old submitted to TKA. Data was collected through clinical processes and patients self-report Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and analysed on SPSS and R software (statically significant p < 0.05).

### Results

Of the 38 patients, 76.3% were female. Average age was 72.21 ± 4.50 and 75.13 ± 5.01 years old at the time of TKA and at the time of the questionnaire, respectively. On both moments the majority of the individuals had overweight or obesity. 84.2% returned to Agriculture (81.2% partially and 18.8 % fully), on average 6.34 ± 4.90 months after TKA. The median age at the surgery of the seniors who didn't return to Agriculture is superior to the one of the seniors who returned (p = 0.025). The higher score in Stiffness and the lowest total score on WOMAC was seen in the individuals who returned four or more months after TKA (p = 0.0125 and p = 0.026, respectively).

## Conclusions

The majority of the individuals between 65 and 80 years old, with Agricultural activity before surgery and submitted to TKA with medial approach and posterior cruciate ligament sacrifice, can return to Agriculture, in 6 months. Most of them don't return fully. The most cited reason was surgery consequences. The median age at the time of TKA of
the seniors who didn't return is superior to the one of the seniors who returned. A worst score in Stiffness and a better Total score was seen in the seniors who took longer to return to Agriculture.

## References

1. Surgeons TAA of O. Arthroplastia total de joelho (Total Knee Replacement). OrthoInfo. 2017. p. 1-10.

2. Saúde DDA. Programa Nacional Contra as Doenças Reumáticas. Lisboa; 2005.

3. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(4):507-515.

4. Alfieri FM, Silva NCOVE, Battistella LR. Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis. Einstein (São Paulo. 2017;15(3):307-12.

5. Toivanen AT, Heliövaara M, Impivaara O, Arokoski JPA, Knekt P, Lauren H, et al. Obesity, physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis-a population-based study with a follow-up of 22 years. Rheumatology. 2010;49(2):308-14.

6. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil. 2005;13(9):769-81.

7. Pua YH, Seah FJ, Seet FJ, Tan JW, Liaw JS, Chong HC. Sex Differences and Impact of Body Mass Index on the Time Course of Knee Range of Motion, Knee Strength, and Gait Speed After Total Knee Arthroplasty. Arthritis Care Res. 2015;67(10):1397-405.

8. Liljensøe A, Lauersen JO, Søballe K, Mechlenburg I. Overweight preoperatively impairs clinical outcome after knee arthroplasty: a cohort study of 197 patients 3-5 years after surgery. Acta Orthop. 2013;84(4):392-397.

9. Kennedy JW, Johnston L, Cochrane L, Boscainos PJ. Total knee arthroplasty in the elderly: Does age affect pain, function or complications? Clin Orthop Relat Res. 2013;471(6):1964-1969.

## Keywords

Knee, Arthrosis, Elderly, Agriculture, Arthroplasty.

## O106

### Teachers Acceptance and Action Questionnaire Portuguese version (TAAQ-PT): factor structure and psychometric characteristics

Ana Galhardo<sup>1,2</sup>, Bruna Carvalho<sup>1</sup>, Ilda Massano-Cardoso<sup>1</sup>, Marina Cunha<sup>1,2</sup>

<sup>1</sup>Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; <sup>2</sup>Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal; <sup>3</sup>Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

**Correspondence:** Ana Galhardo (anagalhardo@ismt.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O106

### Background

Teaching has the potential to provide high satisfaction levels but it is described as a demanding profession with multiple sources of stress. Teachers' psychological well-being is essential not only for themselves but also for students. Experiential avoidance of private events (e.g., thoughts, feelings, body sensations) has been pointed as a key construct linked to psychopathological symptoms. The Teachers Acceptance and Action Questionnaire (TAAQ) is a teacher-specific measure developed to target experiential avoidance related to the teaching activity.

### Objective

The current study sought out to develop the Portuguese version of Teachers Acceptance and Action Questionnaire (TAAQ-PT), explore its factor structure and psychometric properties in a sample of Portuguese teachers teaching in the 1st, 2nd and 3rd basic cycles and secondary education.

### Methods

A sample of 304 teachers, 256 women (84.2%) and 48 men (15.8%) was recruited through teachers' professional associations. Participants

completed online a sociodemographic and professional questionnaire and a set of self-report instruments: the TAAQ-PT, the Depression Anxiety and Stress Scale 21 (DASS - 21), the Utrecht Work Engagement Scale (UWES), and the Five Facet Mindfulness Questionnaire (FFMQ). TAAQ-PT confirmatory factor analysis was conducted and reliability and validity were estimated.

### Results

The TAAQ-PT revealed a single factor structure. Correlated measurement errors were specified for items 5 and 7, 3 and 10, and 8 and 9 due to similar phrasing. The one factor model, which specified method effects between those items, fits the data well: $χ^2/gl = 1.55, CFI = .99, GFI = .97, RMSEA = .043, MECVI = .321$. The TAAQ-PT presented a Cronbach alpha of .91. Additionally, composite reliability (CR) was calculated, and a value of .95 was found. The TAAQ-PT presented significant negative correlations with mindfulness facets ($r = -.60; p < .01$), and work engagement ($r = -.62, p < .01$), and positive correlations with negative emotional symptoms of depression ($r = .69; p < .01$), anxiety ($r = .63; p < .01$) and stress ($r = .70; p < .01$).

### Conclusions

Similar to the original version, confirmatory factor analysis revealed that the single-component model fits the data well. It showed good internal consistency, and correlations with other mental health measures suggested good convergent and discriminant validity. The TAAQ-PT was found to be a valid and reliable measure of experiential avoidance in teachers to be used in clinical and research contexts.

### Keywords

Experimental avoidance, Teachers, Confirmatory factor analysis, Psychometric properties.

## O107

### Youth sports injuries according to health-related quality of life and parental instruction

Lara C Silva<sup>1,2</sup>, Júlia Teles<sup>2,3</sup>, Isabel Fragoso<sup>1,2</sup>

<sup>1</sup>Laboratory of Physiology and Biochemistry of Exercise, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal;

<sup>2</sup>Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal;

<sup>3</sup>Mathematics Unit, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal

**Correspondence:** Lara C Silva (laras@uatlantica.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O107

### Background

Participation in physical activity involves a risk of injury that has a considerable public health impact [1]. Sports injuries are the major cause of morbidity among children and adolescents in developed countries [2]. They account for half of all injuries in school age children. The relationship between sports injuries, health-related quality of life (HRQoL) and parental instruction is still not clear.

### Objective

Determine sports injuries biosocial predictors in Portuguese youth.

### Methods

Information about HRQoL, parental instruction and sports injuries was assessed via three questionnaires; KIDSCREEN-52 [3,4], RAPIL II [5,6] and LESADO [1,7,8] respectively. They were filled by 651 subjects aged 10 to 18 years, attending four Portuguese community schools. Univariate analyses were used to verify significant differences between groups. Logistic, linear and multinomial regression analyses were used to determine significant biosocial predictors of injury, injury rate, injury type and body area injury location.

### Results

Injury rate was higher in boys with lower scores in the school environment dimension of KIDSCREEN-52 ($p = .022$) and in girls was higher in those with lower scores in the moods and emotions dimension ($p < .001$) and higher scores in the self-perception dimension ($p < .001$). Also in girls, upper limbs injuries were associated with higher scores in the moods and emotions dimension, and the spine and torso with lower scores ($p = .037$). Lower limbs injuries were associated with lower parents'
education and upper limbs (p = .046) and spine and torso (p = .034) in-
juries with higher parents' education.

Conclusions

Surprisingly given the large number of injuries resulting from par-
ticipation in sports and the associated high costs of health care,
very few investigations have been conducted into biosocial vari-
ables and their relation to sports injuries. Injuries in the Portu-
guese youth were linked to three dimensions of KIDSCREEN-52
(moods and emotions, self-perception and school environment)
and parents education level. Sports injuries usually result from
the combination of several risk factors interacting at a given time
[9]. Understanding the role of social and environmental factors
related to sports injuries is needed, as they can be a part of this
complex equation.

Acknowledgements

We would like to express our immeasurable gratitude to Ana Lúcia Silva and João Albuquerque for helping in data collection, and Carlos Barrigas for evaluating all x rays. We also thank to Escola Básica 2,3 Professor Delfim Santos, Agrupamento de escolas de Portela e Moscavide and Escola Secundária Quinta do Marquês, for making both their infrastructures and students available for the study and to all participants for their time and effort. Lara Costa e Silva, Ana Lúcia Silva e João Albuquerque were supported by a scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/77408/2011), (SFRH/BD/91029/2012), and PTDC/DES/ 113156/2009, respectively) and by the Interdisciplinary Center for the Study of Human Performance (CIPER).

References

1. Costa e Silva L, Fragoso I, Teles J. Prevalence and injury profile in Portuguese children and adolescents according to their level of sports participation. J Sports Med Phys Fitness. 2018 Mar;58(3):271-279.

2. Williams JM, Currie CE, Wright P, Elton RA, Beattie TF. Socioeconomic status and adolescent injuries. Soc Sci Med. 1997;44(12):1881-1891.

3. The Kidscreen Group. Description of the KIDSCREEN instruments. KIDSCREEN-52, KIDSCREEN-27 & KIDSCREEN-10 index. Health Related Quality of Life Questionnaires for Children and Adolescents. 2004. Report No.: EC Grant Number: QLG-CT-2000-00751.

4. Janssens L, Gorter JW, Ketelaar M, Kramer WLM, Holtslag HR. Health-related quality-of-life measures for long-term follow-up in children after major trauma. Qual Life Res. 2008;17(5):701-13.

5. Varela-Silva M, Fragoso I, Vieira F. Growth and nutritional status of Portugue children from Lisbon, and their parents. Notes on time trends between 1971 and 2001. Ann Hum Biol. 2010;37:702-716.

6. Fragoso I, Vieira F, Barrigas C, Baptista F, Teixeira P, Santa-Clara H, et al. Influence of Maturation on Morphology, Food Ingestion and Motor Performance Variability of Lisbon Children Aged Between 7 to 8 Years. In: Olds T, Marfell-Jones M, editors. Kinanthropometry X Proceedings of the 10th Conference of the International Society for the Advancement of Kinanthropometry (ISAK). London: Routledge; 2007. p. 9-24.

7. Costa e Silva L, Fragoso MI, Teles J. Physical Activity-Related Injury Profile in Children and Adolescents According to Their Age, Maturation, and Level of Sports Participation. Sports Health. 2017;9(2):118-125.

8. Pires D, Oliveira R. Lesões no sistema musculo-esquelético em tenistas portugueses. Rev Port Fisioter no Desporto. 2010;4(2):15-22.

9. Powell J, Barber-Foss K. Injury patterns in selected high school sports: A review of the 1995-97 seasons. J Athl Train. 1999;34(3):277-84.

Keywords

Sports Injuries, Children and Adolescents, Health Related Quality of Life, Parental Instruction.

O108

The influence of moderate- to vigorous-intensity activity on the
physical fitness of non-institutionalised elderly people

Fernanda Silva¹, João Petrica¹,², João Serrano¹,², Rui Paulo¹,³, André Ramalho¹,⁵, José P Ferreira⁴, Pedro Duarte-Mendes¹,³

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O108

Background

As a result of the ageing process, there is evidence of a decline in phys-
ical aptitude (strength, endurance, agility and flexibility) associated with a
lower performance in the activities of daily living [1]. Physical activity
plays therefore a key role in maintaining the health and physical fitness
of the elderly [2]. The recommendations on physical activity for health
suggest that the elderly should perform at least 30 minutes of moderate-
to vigorous-intensity activity per day [3, 4].

Objective

The aim of this paper is to accurately quantify physical activity time in the elderly and to verify the existence of differences regarding physical fitness levels between two groups of people: those who complied and those who did not comply with the Global Recommendations on Physical Activity for Health [4].

Results

This cross-sectional study sample includes 36 elderly individuals (72.28 ± 6.58 years old), both male and female, divided into two groups: the group which has fulfilled the recommendations (N = 16; 53.76 ± 24.39 minutes) and the group that has not fulfilled the recommendations (N = 20; 15.95 ± 7.79 minutes). Physical activity was assessed for 3 consecutive days and 600 minutes of daily recording, at least. The ActiGraph® GT1M Accelerometer was hence used. The "Functional Fitness Test" battery (Rikli and Jones) was used to assess the physical and functional autonomy of the elderly [5]. In order to analyse data, descriptive and inferential statistics were used. The Shapiro-Wilk test was applied to assess normality, whereas the Mann-Whitney test and the t-Test were used for independent samples.

Results

On average, participants spent more time in sedentary activities than
in physical activity. The group which has fulfilled the recommenda-
tions on physical activity has achieved better results on almost all
physical fitness tests: 30 s chair stand (repetitions), arm curl (repeti-
tions), 6-minute walk test (m), 8-foot up-and-go (s). However, no sig-
nificant difference was found between the groups.

Conclusions

The results therefore suggest that only 44.4% of the evaluated partic-
ipants complied with the Global Recommendations on Physical Activ-
ity for Health. Evidence also suggests that the adherence to these
guidelines might have a positive influence on the physical fitness of
the elderly, particularly muscular strength, endurance and agility, but
not flexibility.

Acknowledgements

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

1. Tuna HD, Edeer AO, Malkoc M, Aksakoglu G. Effect of age and physical activity level on functional fitness in older adults. Eur Rev Aging Phys Act. 2009;6:99-106.

2. Nawrocka A, Mynarski W, Cholew J. Adherence to physical activity guidelines and functional fitness of elderly women, using objective measurement. Ann Agr Env Med. 2017;24:632-635.

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

4. Department of Health. Start Active, Stay Active: A report on physical activity for health from the four home countries' Chief Medical Officers. London: Department of Health; 2011. Available from: https://www.sportengland.org/media/2928/dh_128210.pdf.

5. Rikli R, Jones C. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Activ. 1999;7:129-161.

## Keywords

Physical fitness, Elder, Physical activity, Recommendation.

## O109

### Effects of strength and conditioning programs in strength and dynamic balance in older adults

Rogério Salvador¹,², Luís Coelho¹,², Rui Matos¹,², João Cruz¹,², Ricardo Gonçalves¹,², Nuno Amaro¹,²

¹School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Life Quality Research Centre, 2001-904 Santarém, Portugal

**Correspondence:** Rogério Salvador (rogerio.salvador@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O109

### Background

To independently accomplish their daily routines with no need of assistance, older adults require an optimal physical fitness. In fact, this lack of physical fitness may reduce older individuals' quality of life, leading to dependence on personal daily assistance or even to becoming significantly more prone to fatal falls [1]. Prevention through physical activity programs, are used to slow down and delay these aging effects, by improving individuals' agility, flexibility and body improved functionality. Most of these programs take place in in-water environment due to age limiting factors such as high-risk osteoporosis, reduced mobility, higher risk of fracture from falls, arthrosis and spinal disorders among other.

### Objective

To assess the effects of two strength and conditioning programs in strength and dynamic balance in older adults.

### Methods

One hundred elderlies (36 males and 64 females) aged 67.3 ± 5.2 years old enrolled the 5-year long intervention program and were assessed for lower body strength (LBS) and dynamic balance (DB). Two intervention programs were set up and subjects were included in each group according to their own will. Program A (n = 52; 24 males and 28 females; age 67.2 ± 5.2 y-o) consisted of 1 in-water session and 2 in dry-land sessions per week. Program B (n = 48; 12 males and 36 females; age 67 ± 5.2 y-o) consisted of 2 in-water sessions and 1 in dry-land session per week. Wilcoxon test was used on inferential analysis for repeated measures (pre-post). Significance level was kept at 5%. The effect size for this test was calculated by dividing the z value by the square root of N [2].

### Results

Combined data from both programs showed that LBS and DB improved significantly at the end of the intervention programs: LBS from 18.3±3.2 reps to 18.8±3.1 reps (p=0.003; r=-0.295), DB 4.2±0.7 secs to 4.0±0.7 secs (p=0.017; r=-0.245). Program A significantly improved LBS from 19.1±2.8 reps to 19.9±2.7 reps (p=0.001; r=-0.465) but not DB 4.1±0.7 secs to 4.0±0.7 secs (p=0.083; r=-0.240). No differences were found neither in Program B LBS - 17.5±3.4 reps to 17.6

±3.1 reps (p=0.462; r=-0.106) - nor DB - 4.2±0.6 secs to 4.1±0.6 secs (p=0.083; r=-0.250).

## Conclusions

Strength and conditioning programs over a 5-year time span seem to substantially delay the negative effects of aging on LBS/DB in the elderly. No visible decline in the assessed parameters was observed. Our results may suggest different effects of in-water and dry-land programs. However, participants generally responded positively to both intervention programs.

## References

1. World Health Organization. Falls Fact Sheet. Updated August 2017. http://www.who.int/mediacentre/factsheets/fs344/en/

2. Rosenthal R. Parametric measures of effect size. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p. 231-244.

## Keywords

Elderly, Physical activity, Quality of life, Strength, Balance.

## O110

### Compassion attributes and actions in adolescents: are they related to affect and peer attachment quality?

Marina Cunha¹,², Cátia Figueiredo¹, Margarida Couto¹, Ana Galhardo¹,²

¹Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; ²Cognitive and Behavioural Center for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal

**Correspondence:** Marina Cunha (marina_cunha@ismt.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O110

### Background

Research has been showing potential benefits of compassion practice in various populations, nonetheless it is relevant to extend the assessment of compassion attributes and actions for adolescents and explore its relationship with other psychosocial adjustment constructs.

### Objective

To explore association patterns between the various directions of compassion (self- directed, directed to others and receiving compassionate from others) and variables related to affect, social comparison and peers' attachment to quality.

### Methods

A total of 338 adolescents, aged between 12 and 18 years old, completed a set of self-report instruments to assess their compassionate attitudes and actions towards themselves and others (EAAC), peers attachment to quality (AQ-C), positive and negative affect (PANAS), and peers social comparison (SCS-A).

### Results

Significant correlations were found in the expected direction between self-compassion, compassion for others and received from others and the study variables (positive and negative affect, social comparison and attachment style). Specifically, positive affect, positive peer comparison, and secure attachment style were positively associated with compassionate attributes and actions. Negative affect, in turn, showed a negative correlation with compassionate actions in the three analysed directions, and with compassionate attributes when considering receiving compassion from others. The avoidant unsecure attachment style revealed a negative association with compassionate attributes and actions in the different directions. Finally, the ambivalent insecure attachment style revealed a significant negative correlation with self-directed compassionate actions and with receiving compassion from others, regarding actions and attributes.

## Conclusions

These findings suggest the importance of stimulating a compassionate mind in adolescents. In fact, the positive association between
compassion and psychological and emotional adjustment variables point to the relevance of developing compassion skills during this developmental stage.

### Keywords

Compassion attributes, Compassion actions, Adolescents, Positive and negative affect, Peer attachment

## O111

### Association palmar grip strength with self-reported symptoms in the arm

Alice Carvalhais¹, Tatiana Babo, Raquel Carvalho¹, Paula Rocha, Gabriela Brochado¹, Sofia Lopes¹,²

¹Department of Technology Physiotherapy, Cooperativa de Ensino Superior Politécnico e Universitário, Polytechnic Institute of Health, 4585-116 Paredes, Portugal; ²Department of Physical Therapy, School of Health Technology, Polytechnic Institute of Porto, 4200-465 Porto, Portugal

**Correspondence:** Gabriela Brochado (gabriela.brochado@ipsn.cespu.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O111

### Background

World Health Organization (WHO) defined work-related musculoskeletal injuries as multifactorial diseases. These injuries are the main concern of public health and individual health, and are becoming increasingly frequent, in both developed and developing countries. Workers during working hours are often exposed to repetitive movements, the lifting and carrying heavy loads, verifying an increase in demand in terms of muscle strength in the upper limbs. The palmar grip strength provides an objective index of the functional integrity for the evaluation of upper limbs.

### Objective

Verify that the palmar grip strength is associated with self-reported symptoms in the arm in industry worker's electrical components.

### Methods

An observational, analytical study was performed on a sample of 167 workers. The Nordic Musculoskeletal Questionnaire was applied and the palmar grip strength was measured using the hydraulic dynamometer. Descriptive statistics were used to analyse the prevalence of self-reported symptoms and the U test of Mann-Whitney, Kruskal-Wallis H test, Chi-square test and Fisher's exact test was used to analyse relationships between variables, with a 95% confidence level.

### Results

The palmar grip strength was related to self-reported symptomatology in the dominant upper limb, shoulder regions (p = 0.018) and wrist (p = 0.005) in females. It was also found that the risk factors are not associated with palmar grip strength in individuals of both genders.

### Conclusions

Palmar grip strength is associated with self-reported symptomatology in the shoulder and wrist of the dominant upper limb in female workers.

### Keywords

Dynamometer, Palmar grip strength, Upper limb, Symptomatology auto referred.

## O112

### Social-skills as facilitators of a healthy lifestyle

Luisa Aires¹,², Sara Lima³, Susana Pedras³, Raquel Esteves³, Fátima Ribeiro³, Assunção Nogueira³, Gustavo Silva¹,⁴, Teresa Herdeiro³, Clarisse Magalhães³

¹Instituto Universitário da Maia, 4475-690 Maia, Portugal; ²Centro de Investigação em Atividade Física Saúde e Lazer, Universidade do Porto, 4099-002 Porto, Portugal; ³Cooperativa de Ensino Superior Politécnico e Universitário, Polytechnic Institute of Health, 4585-116 Paredes, Portugal; ⁴Research Center in Sports Sciences, Health Sciences and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal

**Correspondence:** Luisa Aires (luisa.aires@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O112

### Background

The Knowledge of behaviours and social-skills of adolescents can contribute to the construction of an effective school-based intervention to promote healthy lifestyles.

### Objective

Identify homogeneous groups (clusters) according to lifestyle and social skills.

### Methods

This cross-sectional study included 1,008 students from 5 elementary schools of Tâmega and Sousa region, mean age of 13.43 (SD = 1.1) and 50% of girls. A sociodemographic questionnaire "My Lifestyle" was used with 28 items composing 4 subscales: Physical Exercise (PE), Nutrition, Self-Care, Monitored Safety, Use of Drugs and Similar (UDS) (0.41< α <0.85). A "Social Skills Inventory for Teenagers" questionnaire (Social-Skills) was applied, including subscales: Empathy, Civility, Assertiveness, Self-Control, Affective Approach and Social-Development (0.64< α <0.90). Both questionnaires had 5 categories of answers from "almost always" to "almost never" or "rarely". In order to identify homogeneous groups of students, according to lifestyle and social skills, it was performed a k-means cluster analysis

### Results

For Lifestyle, mean scores were: UDS = 4.09, Self-Care = 4.07, PE = 3.86, Monitored Safety = 3.63 and Nutrition = 3.40. For Social-Skills, 50.7% had a highly elaborate repertoire of Social Skills, 11% had elaborate repertoire, 20.1% had good repertoire and 2.7% had lower average of social skills repertoire. It was decided to follow a three-cluster solution. Cluster 1 included students with a poor elaborated repertoire of social skills, but with good lifestyle indicators in all subscales. In cluster 2, students had a good repertoire of social skills, with good lifestyle indicators in all subscales, except for subscales of nutrition with poor indicators (38.7) and Monitored Safety (46.95). Cluster 3 included students with highly developed repertoire of social skills and the best lifestyle indicators.

### Conclusions

Results revealed healthy practices in general, however students had the lowest scores in Nutrition, especially in sugar intake and absence of dietary plan. Students included in cluster 2 presented also the lowest results in Monitored Safety, especially about driving with alcohol. These students at risk of develop unhealthy lifestyle need special attention. The high profile of social skills in particular Affective Approach and Assertiveness, should be taking into account as a mechanism for intervention programs. In addition, relevance given to PE, should also be used as a good strategy to reinforce the accomplishment of healthy eating habits in all students. In another point of view, good indicators of lifestyles (cluster 1) can act as matrix to reinforce improvements in social-skills.

### Keywords

Adolescents, Lifestyle, Social Skills.

## O113

### Palliative care: nursing student's conceptions and motivations

Suzana Duarte, Vitor Parola, Adriana Coelho
Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra,
Portugal

**Correspondence:** Suzana Duarte (susanafcduarte@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O113

### Background

Palliative care (PC) is an inevitability in view of the demographic and epidemiological transition curves of Western society. The inclusion of a PC Curricular Unit (CU) in the Nursing Undergraduate Program (NUP) translates into the acquisition of competencies that allow caring for people and families in need of those carefulness. Although considering professional, institutional and family barriers, there is evidence that students apply, in clinical practice, the principles inherent of PC [1]. During clinical education, students are confronted with persons in need of PC, however without benefiting from such care. These experiences can form the basis, from which, it is possible to build the teaching-learning process of future nurses, regarding this theme.
**Objective**

To identify the conceptions and motivations for the frequency of the CU option of PC, by nursing undergraduate students¹.

**Methods**

In the first class, nurses' students were asked to anonymously write what they understood as PC and the motivation for attending this CU. The 210 responses collected over 5 years were subjected to content analysis [2].

**Results**

The PC conceptions reported were grouped into the categories: "Care for people in the final stages of life", "Care to alleviate suffering" and "Comfort care". The reasons for choosing the PC option were grouped in "Difficult and not tackled area", "Area that arouses more interest" and "Previous Experiences". It is verified that the concept of PC remains as care for people in terminal phase of life and in suffering. Some students report experiencing situations that would lead to PC, conditions of therapeutic obstinacy and end of life in circumstances of intense suffering. Students also mention the nurses' attempts to provide those carefulness, which is not well favoured for, in the hospital wards. Students indicate interventions that are intrinsic to palliative care, such as, communication, psychological support, coping with death and mourning, without any reference to the need for knowledge in other areas, namely pathology, pharmacology, or maintenance and healthcare technologies. The orientation of care for quality of life, family integration and management of symptoms is not considered.

**Conclusions**

There is a need to include in each NUP a PC CU, preferably after a period of clinical education in hospital wards. In this way it is possible to consider the previous experiences of the students, capitalizing them to the understanding of the fundamental principles of Palliative Care.

**References**

1. Bassah N, Cox K, Seymour J. A qualitative evaluation of the impact of a palliative care course on preregistration nursing students' practice in Cameroon. BMC Palliat Care. 2016;15(1):37.

2. Bardin L. Análise de Conteúdo. 6th edition. Edições 70; 2013.

**Keywords**

Palliative Care, Nursing student's, Motivations and conceptions.

O114

**"As eat" effects of a physical exercise program and nutrition in obese and binge eating adults**

Ana Barroco¹, José A Parraça¹, Nuno Pascoa¹, Daniel Collado-Mateo², José Adsuar³, Jorge Bravo¹

¹Department of Sports and Health, School of Science and Technology, University of Evora, 7000 Évora, Portugal; ²Instituto de Actividad Física y Salud, Universid Autonoma de Chile, Providencia, Chile; ³Universidad de Extremadura, 06006 Badajoz, Spain

**Correspondence:** José A Parraça (jparraca@uevora.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O114

**Background**

Overweight and Obesity are defined as an abnormal or excessive fat accumulation and present a health risk. Binge eating is a food disorder characterized by episodes of abusive food intake in the absence of regular compensatory behaviours such as vomiting or abuse of laxatives. Those who suffer from this disorder often increase their weight and fat mass by excessive intake of calories, thus becoming overweight or obese.

**Objective**

To determine the relation between the effects of an exercise and nutrition program, in overweight or obese adults (30-60 years) and binge eating, regarding body composition and physical fitness. The program also aimed to promote learning and self-control in the practice of physical activity and in the food choices of this population.

**Methods**

41 patients from USF Planície de Évora. Groups were randomly assigned: the experimental group (N = 23) and the control group (N = 18). The study lasted eight months and consisted of 47 practical sessions of one-hour group exercise, twice a week, one weekly self-help session, and three sessions of nutritional monitoring throughout the program. Practical sessions were structured with specific exercises aimed at improving the different components evaluated; namely in physical fitness (strength, cardiovascular endurance and flexibility) and body composition (fat loss). There were significant improvements in body composition, namely in the percentage of fat mass (40.75 (±6.46) to 37.44 (±7.06) p = .000), fat free mass (59.98 (±6.44) to 62.26 (±7.56) p = .001), of fat mass in the trunk (35.95 (±4.90) to 32.06 (±4.93) p = .000), in the Visceral index (12.00 (±3.42) to 10.88 (±2.97) p = .000) and in metabolic age (59.88 (±9.35) to 55.94 (±7.92) p = .024). There were improvements in physical fitness, mainly in trunk flexibility (-0.18 (±9.72) to 8.93 (±10.06) p = .002) and in leg strength (0.10 (±0.03) to 0.13 (±0.02) p = .034) and arms (25.48 (±8.91) to 30.81 (±7.68) p = .000). Regarding weight, there is a tendency to significance, since there was a significant improvement (92.25 (±12.73) to 88.93 (±13.77) p = .056).

**Conclusions**

We conclude that the physical exercise and nutrition program allows improvements in physical fitness and body composition in the obese population suffering from binge eating.

**Keywords**

Exercise, Nutrition, Obesity, Body composition, Food addiction.

O115

**Exploratory analysis of the association between motives for the practice of physical exercise and body composition**

Roberta Frontini¹, Maria Monteiro², António Brandão², Filipe M Clemente²,³

¹Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²School of Sports and Leisure, Polytechnic Institute of Viana do Castelo, 4900-347 Viana do Castelo, Portugal; ³Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

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

BMC Health Services Research 2018, **18**(Suppl 2):O115

**Background**

Understanding what reasons lead individuals to start and maintain physical activity is extremely important to help individuals to engage and adhere to physical exercise. It allows exercise professionals to define the most appropriate actions to implement more suitable strategies and remove possible barriers to exercise. The decrease in body fat mass may be indirectly related to the motivation that the individual has for the practice of the physical exercise. Higher levels of motivation to lose weight may be related with higher adherence to, for example, the training plan and, consequently, be related to higher levels of body mass fat reduction.

**Objective**

This study aimed to analyse the association between body fat and motives to practice physical exercise.

**Methods**

The sample comprised 85 adults (38 males and 47 females) attending the gym, who completed a sociodemographic form and the Exercise Motivations Inventory - 2 (EMI-2). A multiple regression analysis was used to predict the value of a %body fat (%BF) based on the value of survey categories. The significance was set at p < 0.05. The statistical procedures were made in SPSS software (version 23.0, IBM, USA).

**Results**

A multiple regression analysis was run to predict %BF of the participants from social recognition, positive health, weight management, stress management, revitalization, enjoyment, challenge, affiliation, competition, health pressures, health avoidance, appearance,
strength and endurance and nimbleness categories. These variables statistically significantly predicted %BF, F(14.70) = 2.249, p < 0.014, R² = 0.310. Only three variables (social recognition, positive health and weight management) added statistically significance to the prediction, p < 0.05. The unstandardized coefficient, B1, for social recognition is equal to 2.178, for positive health is equal to 4.860 and for weight management is equal to 2.490.

## Conclusions

Social variables (specifically social recognition), positive health and weight management are important for body mass fat reduction, more than variables related, for example, with health concerns. It is important, in future studies, to understand what processes influence those relations. The results of our study reinforce the importance of these three variables for the reduction of body fat mass emphasizing that it may be important to take these issues into account not only to maintain the adherence of individuals, but also to promote the practice of physical exercise.

## Keywords

Motivation, Physical exercise, Body fat, Social recognition, Positive health.

## O116

### Simulation as a pedagogical strategy in nursing teaching

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

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

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

**Correspondence:** Luís Ramos (luis_filipe-ramos@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O116

### Background

Nowadays, the use of laboratories with specific equipment and classes with resource to simulated practice, are increasingly advocated, especially in graduation courses, whose practice is a crucial tool for students to apply in real life situations.

### Objective

Therefore, we intended to know the perception of students and teachers of a nursing degree, on the use of simulated practice as a pedagogical strategy.

### Methods

To achieve this, we developed a research study using a qualitative approach and a semi-structured interview applied to six students of the nursing graduation course and to seven teachers who teach classes, with the resource of simulated practice, at Escola Superior de Saúde de Leiria.

### Results

From the results we verified that for teachers, simulation is a pedagogical strategy in the development of the students' competences, in a way that will translate in a provision of care based on the scientific knowledge, safety and humanism that is expected from a health professional. However, from the students' perspective, we verified that the results indicate that the simulation is undoubtedly an added value, since the interviewees were able to approach the concept of simulated practice at several levels, also enabling to highlight the partnership between the pertinence and the contributions of the simulation and, finally, to mention several constraints and respective solutions.

### Conclusions

As Goostone et al., (2013) [1] states, simulation is a pedagogical strategy that allows the student to acquire skills necessary for clinical practice, in a risk-free real environment, that is, students are faced with a clinical situation like what they would find in a real clinical environment, receiving feedback on their performance. Thus, it's fundamental that there are teachers with the necessary training to implement this type of pedagogical strategy, as well as the necessary resources, associated to the will and commitment of the students. This triad is essential for the development of the students' competencies as future professionals. In summary, the groups interviewed highlighted the importance of simulation, being able to answer to

our research questions, complementing each other, once they recognized the importance of simulation in the health field.

### References

1. Goodstone L, Goodstone M, Cino K, Glaser C, Kupferman K, Dember-Neal T. Effect of Simulation on the Development of Critical Thinking in Associate Degree Nursing Students. Nurs Educ Perspect. 2013;34(3):159-62.

## Keywords

Simulation, Nursing, Education.

## O117

### Optimising protocol using dual in-situ hybridization to breast cancer in HER2 status

Paulo Teixeira¹,²,³, Maria F Silva¹,², Paula C Borges¹, José M Ruivo², Diana Martins⁴, Fernando Mendes¹,³,⁵,⁶

¹Department Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal

²Pathologic Anatomical Service, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ³Biophysics Institute, CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal

⁴Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; ⁵Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal; ⁶Coimbra Institute for Clinical and Biomedical Research, University of Coimbra, 3004-504 Coimbra, Portugal

**Correspondence:** Paulo Teixeira (paulo.teixeira@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O117

### Background

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 20 to 30 % of breast cancer, as well as in others human cancers [1,2]. The Dual in-situ hybridization (DISH) assay is widely used to study HER2 status, and gives predictive and therapeutic information in invasive breast cancer, although it is dependent on pre-analytical variables, as ischemic time and fixation, among others [1,3].

### Objective

The aim is to implement a HER2 DISH assay, contributing to its optimization and decrease of variability, clarifying the pre-analytical and analytical variables, with impact in tissue staining and morphology.

### Methods

Forty-four (44) cases of invasive breast cancer cases previously scored with HER2 2+, were included in this study. Thin 4 µm paraffin sections were submitted to DISH. Unsuccessful cases were submitted to subsequent DISH protocols to attempt a valid result. Slides were evaluated according to staining and morphology integrity, by three independent observers proficient in this methodology, in a blind way, with a light microscope.

### Results

From the 44 cases, 30 (68.2%) were readily validated, since 14 (31.8%) showed nuclear vacuolization and morphologic disruption leading to further tests with optimized protocols. Unsuccessful cases showed severe morphology damage and were reprocessed with further optimized protocols.

### Conclusions

According to the obtained results, we can conclude that the pre-analytical variables with major impact on the standardization of the results were time of cold ischemic; unsliced operatory specimens and length of fixation. Analytical variables as time and temperature of cellular permeabilization can be changed to improve inadequate tissue preservation.

### References

1. Meric-Bernstam F, Hung M-C. Advances in Targeting Human Epidermal Growth Factor Receptor-2 Signaling for Cancer Therapy. Clin Cancer Res. 2006;12(21):6326-30.

2. Brenton JD, Carey LA, Ahmed AA, Caldas C. Molecular Classification and Molecular Forecasting of Breast Cancer: Ready for Clinical Application? J Clin Oncol. 2005;23(29):7350-60.
3. Khoury T, Sait S, Hwang H, Chandrasekhar R, Wilding G, Tan D, et al. Delay to formalin fixation effect on breast biomarkers. Mod Pathol. 2009;22(11):1457-67.

Keywords

Dual in situ hybridization, Pre-analytical variables, Breast cancer, Optimization protocols.

O118

Psychometric properties update of AGITE – a medication self-management and adherence in the elderly questionnaire

Maria Almeida¹, Suzana Duarte¹, Hugo Neves²,³

¹Coimbra Nursing School, 3046-851 Coimbra, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Maria Almeida (mlurdes@esenfc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O118

Background

As the human body ages, its function also tends to decline resulting
in a higher risk of development of diseases. This leads to the pres-
ence of multiple and complex medications in the life of many older
adults (OA). As the self-management and adherence behaviours of
these medications require the development of competences, it is im-
portant to develop a quick and easy instrument to provide systema-
tized data for the health professional that will allow a better
decision-making process and a higher probability of developing in-
terventions with impact in the medication-taking ability of the OA.
With this purpose, AGITE was developed following a process of sys-
tematic literature review, content analysis and psychometric testing,
resulting in a total of nineteen questions with a Likert scale ap-
proach. Previous studies demonstrated the need for further testing
of its psychometric properties.

Methods

After application of the AGITE to 146 elders in day centres in Central Portugal, exploratory factorial analysis (EFA) using the eigenvalue criteria, and internal consistency (IC) through Cronbach's Alpha were performed.

Results

From the EFA, using varimax rotation and screen plot analysis, an ac-
ceptable KMO of 0.653 was obtained, with no items being eliminated
through analysis of anti-image matrix. A total of five dimensions
emerged explaining 53.6% of the variance: "Engagement", "Neglect
and External Influences", "Perceived Benefits", "Healthcare Professionals
Support", and "Value assigned to Written Information". Through analysis
of the items of each dimension, higher scores of "Engagement" indicate
a responsible attitude towards self-management and adherence, while
higher scores of "Neglect and External Influences" demonstrate a ten-
dency to cease medication, according to individual and non-
professional external beliefs. Regarding the dimension "Perceived Bene-
fits", higher scores evidence how the elder positively perceives the ef-
fects of the medication, while higher scores of "Healthcare
Professionals Support" are related with perceived importance of the
healthcare professionals in the medication-taking ability. Higher scores
of "Value assigned to Written Information" demonstrate a tendency to
attribute significance to written data regarding medication. Overall the
questionnaire dimensions demonstrate questionable to acceptable IC
(0.6 < α < 0.8).

Conclusions

New analysis of the psychometric properties evidences the emer-
gence of new dimensions, allowing for a wider understanding of the
profile of the medication-taking ability of the elder population in
Portugal. These new dimensions will provide a better analysis of this
skill to the healthcare professional, allowing a more personalized
intervention, with higher chance of success.

Keywords

Polypharmacy, Medication management, Elders.

O119

Emotional intelligence and fear of death in Spanish elders

Pedro García-Ramiro¹, Juan FJ Díaz², Maria González-Melero¹, Maria DCP Jiménez¹, Antonio MP Jiménez¹, Francisco JR Peregrina¹

¹Universidad de Jaén, 23071 Jaén, Spain; ²Universidad Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain

**Correspondence:** Pedro García-Ramiro (pgramiro@ujaen.es)

BMC Health Services Research 2018, **18**(Suppl 2):O119

Background

Researchers, stakeholders and policy makers agree about the im-
portance of the population ageing in modern societies. Emotional
Intelligence (EI) has generated a broad interest in the scientific
community in Spain [1]. Prestigious social scientists from different
lines of research contribute to assess important theoretical and
empirical topics on this construct [2]. Aging is a process during
which important changes occur in different areas of development
and emotional intelligence plays an essential role. Throughout
the years, the subject of death has been conceived in different
ways. People abstain from talking about it, and a conduct of
avoidance can be observed manifesting itself in fear and anxiety
[3].

Objective

The objective of this study was to examine the relationship be-
tween emotional intelligence and fear of death in an older
population.

Methods

A Spanish sample of 384 older people aged 65 years and older (51.82% women; 71.23 ± 8.34 years of age), without cognitive impairment, were included in this descriptive and correlational study. Data on emotional intelligence and fear of death were obtained through the TMMS-24 and Collett-Lester scales, respectively.

Results

Structural equation modelling indicated that emotional intelligence exerted an influence on fear of death. The emotional perception component was positively correlated with the fear of death (r = 0.14; p < 0.05), while understanding and emotional regulation were negatively correlated with fear of death (r = -012; p < 0.001). The higher scores for fear of death were associated with the female gender, and singles. These aspects underscore the importance of the results of this study.

Conclusions

These findings show that high levels of emotional intelligence were associated with less fear of death. After controlling sociodemographic variables, the EI dimensions, emotional perception and emotional regulation, accounted for part of the variance in several fears of dead facets. These dimensions can have an important role in the fear of dead of older people.

References

1. Wilson CA, Saklofske DH. The relationship between trait emotional intelligence, resiliency, and mental health in older adults: the mediating role of savouring. Aging Ment Health. 2018;22(5):646-654.

2. Lloyd SJ, Malek-Ahmadi M, Barclay K, Fernandez MR, Chartrand MS. Emotional intelligence (EI) as a predictor of depression status in older adults. Arch Gerontol Geriatr. 2012;55(3):570-573.

3. Arca MG. Enfermería en el proceso de humanización de la muerte en los sistemas sanitarios. Enfermería Clínica. 2014;24(5):296-301.

Keywords

Emotional intelligence, Fear of death, Ageing, Older adults.
## O120

**Vitamin D in food supplements: are we taking too much?**

Isabel M Costa, Alexandra Figueiredo, Deolinda Auxtero
Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal

**Correspondence:** Alexandra Figueiredo (alexandra.f@netcabo.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O120

**Background**

Over the last years, an increase in vitamin D (VitD) supplements intake has been observed. Evidence has suggested multiple effects of VitD beyond bone homeostasis. Low VitD levels are associated with numerous disorders including diabetes, cancer, cardiovascular disease, Parkinson's disease, among others. Consumers have the general misperception that "vitamin" denotes something harmless and vital, disregarding its potentially harmful effects. Although vitD toxicity is uncommon, case reports attributed to vitD supplementation have raised. Being a fat-soluble vitamin, excessive supplementation may result in body accumulation and toxicity. It increases intestinal calcium absorption and plays a central role in its homeostasis. Thus, most symptoms of toxicity result from hypercalcemia. Adverse effects include gastrointestinal disorders (anorexia, diarrhoea, nausea, vomiting), muscle and joint pain, cardiac complaints, hypertension, central nervous system effects and renal disorders (polyuria, polydipsia).

**Objective**

The aim of this study was to evaluate whether VitD3 (cholecalciferol) daily dose indicated on food supplements (FS) labels coincided with the recommended daily allowance (RDA) for this vitamin defined by the European Union Directive.

**Methods**

Labels of 110 FS sold in Portuguese pharmacies, supermarkets or health shops were examined. Selection criteria included: oral solid pharmaceutical forms for adults, containing vitD in its composition, as stated in the label, regardless of the purpose of the FS.

**Results**

66.4% of FS presented vitD label doses above RDA and four of them indicated a daily dose ≥ the tolerable upper intake level defined by EFSA (UL=100 µg/day). In the majority of the FS evaluated, vitD label dose far exceeded RDA value and some exceeded UL defined by EFSA.

**Conclusions**

At present, the safety of FS and the authenticity of label information is exclusively ensured by the economic operators who place FS on the market. Since FS are usually taken without any medical supervision or counselling and attending the potential adverse effects of vitD excess, it is imperative that the daily doses of vitD present in FS are reviewed attending to RDA values. Authors also suggest that FS should be under the same quality control of pharmaceuticals, regarding FS consumers health.

**Keywords**

Vitamin D, Food Supplements, Recommended Daily Allowances, Tolerable Upper Intake Level.

## O121

**Functional ability and risk of falling - a base for exercise prescription**

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

**Correspondence:** Silvia Vaz (leontina_vaz@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O121

**Background**

Falls are currently considered one of the most common and serious public health problems [1, 2]. Faced with this problem, it becomes necessary to explore which factors can better predict the risk of falls in individuals living in the community [3], so that, preventive measures can be considered.

**Objective**

To identify fall risk indicators and to relate them to exercise prescription levels; to relate the history of falls, the functional capacity (measured through the Timed Up & Go, 10-meter walking speed test, Step test) and

the fall risk factors and propose a guide based on those relations to address exercise prescription.

**Methods**

Descriptive and exploratory study. Two hundred community dwelling adults aged 55 or older were assessed, integrating two sub-samples, a Portuguese and a Polish. Study participants were assessed for socio-demographic data, history of falls, fear of falling, exercise, sedentary lifestyle, hearing problems and/or dizziness, visual problems, alcohol consumption, exercise self-efficacy and confidence in activities of the daily life (FES-Portuguese version). Functional capacity was assessed by three golden measures for the risk of fall: the Timed Up and Go (TUG), the 10-meter walking speed test and the Step Test (15s). The statistical design included descriptive analyses, inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson's correlation coefficient).

**Results**

Fall incidence was 39.5% and 45.3% in the total and Portuguese samples, respectively. TUG, 10-meter walking speed test and step test can distinguish those with history of falls from those without, with statistically significant differences (p ≤ 0.05). Taking more than 4 different medications per day, fear of falling, hearing problems and/or dizziness and the need for help getting up from a chair were correlated to the history of falls, the TUG, the walking speed and the step test (p ≤ 0.05). The sedentary lifestyle and the use of assistive devices were associated with worst performance in the functional tests (p < 0.05) in the Portuguese sample. TUG, 10-meter walking speed test and step test were correlated with exercise self-efficacy.

**Conclusions**

The incidence of falls is higher than literature has reported and it is inversely associated with the functional capacity of community-dwelling adults aged over 55 years old. Data from this study is a valuable basis for exercise prescription, taking into account the levels of risk and the components of exercise prescription.

**References**

1. Gschwind Y, Kressig R, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatrics. 2013;13(1):105.

2. NICE.

Falls in older people overview. NICE Pathways. 2016;1-13.

3. Avin K, Hanke T, Kirk-Sanchez N, McDonough C, Shubert T, Hardage J, Hartley G. Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association.Physical Therapy. 2015;95(6):815-834.

**Keywords**

Risk of fall, Functional capacity, Prevention of falls, Exercise prescription, Self-efficacy.

## O122

**The impact of the FIFA 11+ on physical performance of amateur futsal players: short and long term effects**

Mário Lopes¹, Daniela Simões², João M Rodrigues³,⁴, Rui Costa¹,⁵, José Oliveira⁶, Fernando Ribeiro¹,⁷
¹School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ²Santa Maria Health School, 4049-024 Porto, Portugal; ³Institute of Electronics and Informatics Engineering of Aveiro, 3829-193 Aveiro, Portugal; ⁴Department of Electronics, Telecommunications and Informatics, University of Aveiro, 3810-193 Aveiro, Portugal; ⁵Center for Health Technology and Services Research, University of Aveiro, 3810-193 Aveiro, Portugal; ⁶Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal; ⁷Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Mário Lopes (mariolopes77@ua.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O122

**Background**

The effects of the FIFA 11+ on physical performance parameters has demonstrated controversial results.
### Objective

The aim of this study was to observe the short and long-term effects of the FIFA 11+ on performance in male amateur futsal players.

### Methods

Seventy-one (71) male futsal players from six amateur clubs were randomized to an intervention (N = 37, age: 27.0 ± 5.1 years) or a control group (N = 34, age: 26.0 ± 5.1 years). The intervention group was submitted to 10 weeks of FIFA 11+ injury prevention program, 2 sessions/week, followed by a 10-week follow-up period, while the control group performed regular futsal warm-ups during the training sessions. During the follow-up period both groups performed only regular warm-ups during their training sessions. Physical performance was assessed by measuring agility (T-test), sprint (30-meter sprint), flexibility (sit and reach) and vertical jump performance (squat jump).

### Results

Differences between groups were found at baseline for training exposure, body mass index, body weight, flexibility and sprint. The results of the effect of the FIFA 11+ on the sit and reach, speed, jump performance and agility did not show differences pre-post intervention after adjustment for the baseline differences, as well as for the 10-week follow-up.

### Conclusions

The current study has shown no short and long-term performance enhancement in sprint, flexibility, agility and jump performance after the FIFA 11+ in male amateur futsal players.

### Keywords

Prevention program, Warm-up, Injury, Neuromuscular training, Amateur male players.

O123

### Effects of aquatic fitness in older women conditioning: an 8-week program

Pedro Morouço¹, Sandra Amado¹,²,³, Susana Franco⁴, Fátima Ramalho⁴
¹Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal

**Correspondence:** Pedro Morouço (pedro.morouco@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O123

### Background

There are several evidences in the literature demonstrating a high positive association between increased levels of exercise and improved health, specifically in older adults [1]. As such, in recent years there has been a large number of studies examining the benefits imposed by different types of exercise (e.g. resistance training [2], and aquatic fitness [3]). However, in addition to the benefits imposed, it is crucial that the exercise is motivating and challenging.

### Objective

It was aimed to examine the possible effects on conditioning induced by 8-weeks of aquatic fitness, in female older adults.

### Methods

Fourteen women (64.3 ± 7.3 years old) enrolled in bi-weekly aquatic fitness of 45' sessions for 8 weeks. Before and after the 8 weeks, participants performed the Senior Fitness Test [2], hand-grip strength and body measures. All participants were volunteer, informed consent was obtained and all procedures were in accordance to Helsinki Declaration. Sessions were instructed by a CSCS®.

### Results

Significant and meaningful improvements were observed in lower body strength (p < 0.001; d = 1.22), lower body flexibility (p < 0.001; d = 3.54), aerobic endurance (p < 0.001; d = 1.35), dynamic balance (p < 0.001; d = 1.53) and hand grip strength (p < 0.001; d = 2.02). Significant, but moderate improvements were observed in body mass (p = 0.021; d = 0.72) and hip circumference (p = 0.048; d = 0.59).

### Conclusions

Eight weeks of aquatic fitness induced extensive benefits in older women conditioning, suggesting that this activity is able to promote an increase in life quality. The present results corroborate previous studies, demonstrating that aquatic exercise is a reliable approach for improved health in the elderly.

### Acknowledgements

This research was supported by the European Regional Development Fund (FEDER), through COMPETE2020 under the PT2020 program (POCI-01-0145-FEDER-023423), and by the Portuguese Foundation for Science and Technology (UID/Multi/04044/2013).

### References

1. Taylor D. Physical activity is medicine for older adults. Postgrad Med J. 2014;90:26-32.

2. Martins WR, Safons MP, Bottaro M, Blasczyk JC, Diniz LR, Fonseca RMC, et al. Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial. BMC Geriatr. 2015;15(1):99.

3. Bartolomeu RF, Barbosa TM, Morais JE, Lopes VP, Bragada JA, Costa MJ. The aging influence on cardiorespiratory, metabolic, and energy expenditure adaptations in head-out aquatic exercises: Differences between young and elderly women. Women Health. 2017;57(3):377-391.

4. Rikli RE, Jones CJ. Senior fitness test manual. 2nd edition. Human Kinetics; 2013.

### Keywords

Exercise, Health, Aging, Physical Fitness.

O124

### Predicting social participation in the community-dwelling older adults

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

**Correspondence:** Silvia Vaz (leontina_vaz@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O124

### Background

Nowadays, active ageing is both a complex scientific term and a goal for most people, but also an undeniable political objective [1]. Participating socially helps to develop the feeling of belonging to a community and allows everyone to see each individual contribution in upholding the community [2-4].

### Objective

Characterize the profile of community-dwelling adults aged 55 or older, regarding social participation, functional capacity (walking speed, grip strength, lower limb strength, static and dynamic balance) and personal factors (age, gender, BMI, confidence/fear of falling and perception of general health); verify the relationship between social participation and functional capacity as well as participation and personal factors; and find, among all the variables, which can be the best predictors of social participation.

### Methods

Descriptive, exploratory and cross-sectional study. The sample is composed of 150 Portuguese community-dwelling older adults. The statistical design included descriptive analyses (measures of central tendency and dispersion); inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson's correlation coefficient; multivariate: linear multiple regression, moderated linear multiple regression and hierarchical linear multiple regression). The level of significance was α =0.05, with a 95% confidence interval.

### Results

The results have shown that this sample was composed mostly by women, mean age approximately 69 years old. Statistically significant associations between social participation and all study variables: Age (r = 0.301, p = 0.00), BMI (r = 0.169, p = 0.039), Grip strength (r =
-0.318, p = 0.00), Pressure platform Hercules® (r = -0.337, p = 0.00), perception of general health (r = 0.468, p = 0.00), Timed Up & Go (r = 0.668, p = 0.00), T10M (r = -0.576, p = 0.00), Test Step (r = -0.456, p=0.00) and Fall Efficacy Scale (r = 0.768, p = 0.00). Regression analysis shows that the confidence in performing activities of the daily living without fear of falling, health perception and dynamic balance, measured by Timed Up & Go test, as a whole, are responsible for 65.5% of the variance of social participation (R² = 0.655; p < 0.001). Using a second model we have seen that a sizeable part of the variance percentage related to the participants' social participation, 55%, is due once again to dynamic balance and health perception, followed by age (R² = 0.549; p < 0.001).

## Conclusions

The Timed Up & Go test and the unique question on health perception: "In general, would you say that your health is excellent, very good, good, satisfactory or poor?" account for a significant percentage of the variance in social participation in elderly individuals. Incorporating these two factors into the physical therapist's clinical practice takes very little time and greatly benefits the decision-making process and planning of interventions.

## References

1. Fernandez-Ballesteros R, Zamarron MD, Diez-Nicolas J, Lopez-Bravo MD, Molina MA, Schettini R, Productivity in Old Age. Research on Aging. 2011;33(2):205-226.

2. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta- analytic review. PLoS Medicine. 2010;7(7):e1000316.

3. Korpershoek C, van der Bijl J, Hafsteinsdottir TB. Self-efficacy and its influence on recovery of patients with stroke: A systematic review. Journal of Advanced Nursing. 2011;67(9):1876-1894.

4. Nayak N, Mahajan P. Walking Capacity and Falls-Efficacy Correlates with Participation Restriction in Individuals with Chronic Stroke: A Cross Sectional Study. International Journal of Physiotherapy. 2015;2(1):311.

## Keywords

Active ageing, Elderly, Social participation, Functional capacity, Functioning.

O125

## Motor development in children from 11 to 44 months old: influence of the variable "presence of siblings"

Miguel Rebelo<fnref n="1" />, João Serrano<fnref n="1" />, Daniel Marinho<fnref n="3" />,⁴, Rui Paulo<fnref n="1" />,², Vivian Corte<fnref n="1" />, Pedro Duarte-Mendes<fnref n="1" />,²

## Background

Motor development presupposes a set of life-long processes of change. These processes occur mostly during the first years of the child's life, having each child different developmental rhythms [1]. Motor skills are fundamental to our day-to-day life, representing the key to the child's development [2]. As such, it is important to know the different factors that influence the development of motor skills during childhood. According to bibliography, the presence of siblings may be an important factor, because this relationship provides a basis for learning and socialization opportunities in various contexts [3].

## Objective

The main goal of this study was to verify if there were differences in the development of motor skills (global and fine) through the scales of the PDMS-2, comparing children that have or do not have siblings.

## Methods

In this study 91 children of both sexes participated (30.20 ± 10.56 months). Two groups were created: the sibling group, consisting of

48 children (31.06 ± 10.76 months) and the non-sibling group, consisting of 43 children (29.23 ± 10.37 months). Motor skills were assessed using the PDMS-2 test battery scales. The evaluation was performed during 4 months, 3 times a week and individually (approximately 30 minutes for each child). For the data analysis, we used descriptive and inferential statistics. The Kolmogorov-Smirnov test was applied to test normality, and the Mann-Whitney test was applied to independent samples.

## Results

The sibling group achieved, on average, better results in all motor skills (global and fine). However, there were only statistically significant differences in fine motor skills (p = 0.016), where the sibling group had the best results (average = 52.29) compared to the non-sibling group (average = 38.98).

## Conclusions

These results show that the presence of siblings in the family context positively influences motor development, providing cooperative activities through play and challenges that improve cognitive, social, emotional and physical development.

## Acknowledgements

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

## References

1. Barreiros J, Neto C. O Desenvolvimento Motor e o Género. Lisboa: Faculdade de Motricidade Humana; 2005.

2. Leonard HC, Hill EL. The impact of motor development on typical and atypical social cognition and language: a systematic review. Child and Adolescent Mental Health. 2014;19(3):163-170.

3. Brody GH. Siblings' direct and indirect contributions to child development. Current Directions, Psychological Science. 2004;13(3):124-126.

4. Folio R, Fewell R. Peabody Developmental Motor Scales-2. Austin: TX: Pro-Ed; 2000.

## Keywords

Motor Development, Family Context, PDMS-2.

O126

## Childhood obesity in the urban parishes of Coimbra municipality

Margarida Pereira, Cristina Padez, Helena Nogueira
Research Centre for Anthropology and Health, University of Coimbra,
3000-456 Coimbra, Portugal

**Correspondence:** Margarida Pereira (mmiguel06@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O126

## Background

Childhood obesity is a major public health concern worldwide and Portugal has one of the highest rates of childhood obesity among the European countries. It is known that childhood obesity is particularly high in urban settings. Thus, a deeper understanding of the impact of such areas in children weight is needed. Evidence suggests that parents' perception of the neighbourhood safety might determine children weight once unsafety perceptions of the neighbourhood prevent children from playing outside.

## Objective

This work main goal was to examine the impact of parents' safety perception of the neighbourhood in children's weight status regarding the localization of the neighbourhood (urban centre or urban periphery).

## Methods

Weight (kg) and height (cm) of 1,493 children from Coimbra municipality were measured and BMI (weight/height²) was calculated to use IOTF cut-off points to classify children in "normal" or "obese". Parents provided their parish of residence as well as their weight, height and number of schooling years. They also responded to a questionnaire regarding their neighbourhood perceptions and physical activity engagement of their children. The sample was analysed separately, i.e., chi-square tests were computed to children living in

<footnote n="1">¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Vila Nova de Gaia, Portugal;</footnote>

<footnote n="3">³Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; ⁴Research Centre in Sports, Health and Human Development, University of Beira Interior, 6201-001 Covilhã, Portugal</footnote>

<footnote>**Correspondence:** Miguel Rebelo (miguelrebelo7@hotmail.com)</footnote>

<footnote>BMC Health Services Research 2018, **18**(Suppl 2):O125</footnote>
parishes from the urban centre and posteriorly to children living in
parishes from the urban periphery.

## Results

This study results showed proportionality between overweight or obese children residing in the urban centre, mainly girls, with low socioeconomic status and obese parents that strongly agree that their neighbourhood is unsafe to walk during the day. Except for mother weight status, none of the variables analysed differentiated normal from overweight or obese children living in the urban periphery, regarding the chi-square tests.

## Conclusions

Overall, parents' perceptions of the environment might impact children's weight status. However, even within the same urban area, perceptions of neighbourhood safety change. The aspects that influence children weight status differ according to the parishes they live in - urban centre or peripheric parishes. For example, parents from a significant proportion of overweight or obese children living in the urban centre parishes perceives their neighbourhood environment as unsafe to walk during the day, however, no differences were found between normal and overweight or obese children from the peripheric parishes. This should be held in consideration when developing healthy urban planning strategies.

## Acknowledgements

Work funded by the Foundation for the Science and Technology (PTDC/DTP-SAP/1520/2014 and grant SFRH/BD/133140/2017).

## Keywords

Childhood Obesity, Urban Settings, Neighbourhood, Safety Perceptions.

O127

## Cardiovascular causes of disqualification from competitive sports: young vs. veteran athletes

Ana P Silva, Virgínia Fonseca, Carolina Diniz, Daniel Pereira, Rodrigo Sousa, João Lobato
Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-094 Lisboa, Portugal

Correspondence: Ana P Silva (ana.silva@estesl.ipl.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O127

## Background

Cardiovascular disease is the most common cause of disqualification from competitive sports. The pre-participation screening is fundamental in order to detect these diseases and is based on clinical history and physical examination in addition to a 12-lead electrocardiogram. Additional tests are requested only for those with any abnormality in the initial evaluation [1-2]. According to previous studies, the most common cardiovascular diseases that disqualify young athletes are different from those associated to veteran athletes: congenital arrhythmias vs. subclinical coronary disease, respectively [3-5].

## Objective

To analyse and compare, amongst young and veteran athletes, the cardiovascular causes of disqualification from competitive sports, consecutively screened at a sports medicine unit in a decade (2007-2017).

## Methods

Descriptive-comparative retrospective study. The study population consisted of all case files from athletes disqualified from competitive sports due to cardiovascular disease during the 2007-2017 period. A sample of 58 case files was divided into group A (young athletes, < 35 years, n<sub>A</sub>= 36) and group B (veteran athletes, ≥ 35 years, n<sub>B</sub>=22). It was evaluated the clinical history, sport disciplines, symptoms and cardiovascular diseases. Descriptive statistics and statistical inference (Chi-squared distribution) were applied for the characterization and comparison of the study variables.

## Results

Both sample groups consisted mainly in male athletes (group A 94.4%, group B 100%). The most referred symptom in group A was

palpitations (16.7%), whereas in group B was chest pain (36.4%). There was a significant association between relevant cardiovascular history and veteran athletes. The most frequent cardiovascular diseases in group A were hypertrophic cardiomyopathy (19.4%), arterial hypertension (11.1%), left ventricle noncompaction (8.3%) and great vessel transposition (8.3%). Arterial hypertension (50%) and coronary disease (45.4% were the most frequent diseases that disqualified the practice of competition sports in veteran athletes. It's important to emphasize that some veteran athletes presented simultaneously more than one cardiovascular cause of disqualification.

## Conclusions

The most frequent cardiovascular diseases in groups A and B matched those found in literature [3-5]. The prevalence of hypertrophic cardiomyopathy and coronary disease in the respective groups may be associated with a higher awareness towards the dangers of these particular diseases in the practice of competition sports. The data in this study confirms the key role of pre-participation screening for the identification of cardiovascular diseases that can cause sudden cardiac death during sport.

## References

1. Corrado D, Pelliccia A, Bjørnstad H, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. European Heart Journal. 2005;26:516-524.

2. Despacho no 25 357/2006. D.R. no 238 de 13.12.2006 - 2a Série, (2006).

3. Abbatemarco J, Bennett C, Bell A, Dunne L, Matsumura M. Application of Pre-participation Cardiovascular Screening Guidelines to Novice Older Runners and Endurance Athletes. SAGE Open Medicine. 2016;4:1-8.

4. Pescatore V, Basso C, Brugin E, Bigon L, Compagno S, Reimers B et al. Cardiovascular causes of disqualification from competitive sports in young athletes and long term follow-up. European Heart Journal. 2013;34(sup 1):1783.

5. Corrado D, Basso C, Schiavon M, Thiene G. Screening for Hypertrophic Cardiomyopathy in Young Athletes. The New England Journal Of Medicine. 1998;339:364-69.

## Keywords

Cardiovascular diseases, Competitive sports, Pre-participation screening.

O128

## Bioethics, health promotion and sustainability: interfaces in higher education

Ivani N Carlotto, Maria AP Dinis
Energy, Environment and Health Research Unit, Energy, Environment and Environmental & Public Health Research Laboratories, Fernando Pessoa University, 4249-004 Porto, Portugal

Correspondence: Ivani N Carlotto (ivani.carlotto@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O128

## Background

Universities are essential institutions for health promotion (HP) [1]. As they have their own ethos and distinct cultures, they may act as potential enhancers of the conceptual frameworks of HP and interdisciplinary values such as equity, social justice and sustainable growth [2]. Bioethics, as a transversal discipline, seeks to ethically analyse and systematize such values, strengthening the synergy between health and sustainability [3]. Bioethics is a reflexive, mutually shared and interdisciplinary tool whose goal is to promote health and sustainability in an integrated and coherent way, adapting life actions in their equitable and inclusive characters.

## Objective

1) Identify how bioethics takes place in daily life and how it is possible to establish links between scientific and ethical knowledge, in order to avoid negative impacts on people's lives; 2) Describe the appropriate bioethical tools (principles) for intervention in the context of higher education (HE), HP and sustainability.

## Methods

Exploratory-descriptive methodology using a quanti-qualitative approach [4]. Sample: University teachers from Rio Grande do Sul/Brazil, random
sample, probabilistic sampling by convenience, CI = 95%, n = 1400 persons. The research was approved by the Research Ethics Committee of the Hospital de Clínicas of Porto Alegre (HCPA)/Brazil, Ethics Committee of the Universidade Fernando Pessoa (UFP)/Porto-Portugal, receiving the approval number CAAE 55066616.8.0000.5327/Plataforma Brasil/Brazil. The interviews were carried out after receiving the informed consent from the participants, taking into account the assumptions of the National Health Council Brazil (NHC) 466-2012.

## Results

Beyond the principalistic formulation - charity, non-maleficence, justice and respect for autonomy [5], certain subjacent referentials, such as, solidarity, shared commitment, and health environment/sustainability were evoked, causing a positive impact on HP, individual and collective well-being, quality of life, inclusion and social justice in the University environment.

## Conclusions

HE upholds a fundamental role in HP for their faculty teachers. Universities act as places for investigation and learning in a way that it invigorates HP activities [6]. Bioethics, as a transdisciplinary activity, seeks to help building qualified actions in health, which uphold and promote well-being, cohesion, inclusion, sustainability and social justice, with the respective conceptual clarity that resides therein [2, 7].

## References

1. Dooris M, Doherty S, Cawood J, Powell S. The Healthy Universities approach: Adding value to the higher education sector. In: Health promotion settings: Principles and practice. London: Sage; 2012. p. 153-169.

2. Dooris M, Doherty S, Orme J. The application of salutogenesis in universities. In: The Handbook of Salutogenesis. England: Springer; 2017.

3. Garrafa V. Da bioética de princípios a uma bioética interventiva. Bioética. 2005;13:125-134.

4. Prodanov CC. Metodologia do trabalho científico: métodos e técnicas da pesquisa e do trabalho acadêmico. Novo Hamburgo: Feevale; 2013.

5. Beauchamp TL, Childress JF. The principles of biomedical ethics. New York: Oxford;1979.

6. Organização PanAmericana de Saúde [http://www.paho.org/]. Regional program on bioethics. [Accessed in 02 may 2017]. Available in http://www.paho.org/hq/index.php?option=com_content&view=article&id=5582%3A2011-regional-program-onbioethics&cid=3347%3Abioethics&Itemid=4124&lang=es

7. Carlotto IN, Dinis MAP. Bioética e promoção da saúde docente na educação superior: uma interface necessária. Revista Saber & Educar. 2017;23:168-179.

## Keywords

Bioethics, Health Promotion, Higher Education, Sustainability.

## O129

### Pilot program to develop clinical skills in counseling-based motivational interview (CBMI) to prevent obesity in Chile

Ricardo Cerda¹, Daniela Nicoletti¹, Macarena P Lillo³, Margarita Andrade, Patricia Galvez¹, Lorena Iglesias¹, Denisse Parra², Magdalena C Coke, Natalia Gomez¹

¹Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile; ²Department of Nursing, Faculty of Medicine, University of Chile, Santiago, Chile; ³School of Journalism, Faculty of Communication and Letters, University Diego Portales, Santiago, Chile

**Correspondence:** Ricardo Cerda (rcerdarioseco@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O129

### Background

To influence mediator variables of behavioural change in health and the adherence to treatment in an individual context, health professionals and users must develop a help-based relation mediated by effective communication. At the same time, health professionals must trigger processes in the users that allow them to recognize and develop intrinsic motivation towards change. In this sense, a pilot program is proposed for training CBMI for primary health care (PHC) nutritionists that develops knowledge and tools to foster behavioural

change in users. The pilot project was developed as part of the Chilean health program "Vida Sana".

### Objective

Describe a training pilot program to develop clinical skills in CBMI, for PHC nutritionists, to prevent obesity in Chile.

### Methods

A training program was built comprised by 34 face-to-face hours and 8 hours of accompaniment at the workplace for 13 Nutritionists. The program was based on a constructivist approach centred on the development of skills in the following sequence: critical analysis for regular practice, adherence comprehension and behavioural change, communication skills, motivational interviewing skills, skill integration in a simulated and real situation. The program employed psychometric scales for motivation, beliefs and self-efficacy for CBMI, video analysis, observations performed at the Centre for Clinical Skills at the Facultad de Medicina de la Universidad de Chile and accompaniment at PHC centres.

### Results

Participant knowledge increased on average 5.25 to 20.85 (p = 0.008). The average of total points did not vary at the beginning or at the end (74 pts). Effective beliefs increased from 61.3 to 68.7 (p < 0.05) and self-efficacy from 1617 to 1851 (p < 0.05). Observation and video analysis showed that Nutritionists went from delivering information to open and strategic inquiring during the course. Accompaniment showed that skills were deepened and the level of satisfaction improved with practice.

### Conclusions

This is an innovative program that incorporates CBMI and defines a methodology centred on reflection, practice and accompaniment in real and simulated situations. It is necessary to evaluate the effects in indicators that measure user behaviour and the effect and impact on adult obesity. This training program represents a tool to promote behavioural change and adherence in PHC to prevent obesity.

### Acknowledgements

The project was financed by CONICYT: FONIS SA16I0122.

### Keywords

Behavior Change, Motivational Interview, Professional Education, Obesity, Nutritionists Skills.

## O130

### Childhood body fat and motor competence in elementary school (5 to 9 years old)

Francisco Campos¹, Ricardo Santos¹, Mariana Temudo¹, Kátia Semedo¹, Diogo Costa¹, Ricardo Melo¹, Fernando Martins¹,²

¹Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329

Coimbra, Portugal; ²Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

**Correspondence:** Francisco Campos (francicampos@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O130

### Background

Obesity rates have increased globally in the last decades, justifying the denomination "public health epidemic". According some studies [1], in Portugal, childhood overweight and obesity affects about 31.5% of elementary school children, with higher values for girls, except between 7.5 and 9.0 years old. Overweight and obesity are strictly related with childhood motor competence [2]. To access overweight and obesity, among others, is recommended the body fat percentage (BFP), classified by age and gender by McCarthy centiles of BFP [3].

### Objective

The main objectives of this investigation are: 1) to characterize childhood elementary school overweight/obesity and compare it by gender and age; 2) to correlate childhood elementary school overweight/obesity with motor competence.

### Methods

Data was collected from 604 children's between 5 to 9 years old (7.40 ± 1.16 years old; 295 female) of the 10 elementary schools from
the "Agrupamento de Escolas de Montemor-o-Velho" (Coimbra-Portugal), using: a) the electrical bio-impedance (model BC-533*) method, to access BFP; and b) a battery of physical tests [shifting platforms and lateral jumps (stability); shuttle run and standing long jump (locomotion); throwing velocity and kicking velocity (manipulation); and handgrip strength] to access motor competence [3]. Data analysis was conducted using IBM SPSS software (version 24.0) for a statistical significance of 10%.

## Results

In this study case, only 58.8% (n = 355) of the elementary school children had normal weight, and 41.2% showed overweight/obesity [overweight: 17.0% (n = 103); obesity: 24.2% (n = 146)]. There were no significant statistical differences (p = 0.519) between genders (Mann-Whitney). By age (Kruskal-Wallis), there were significant statistical differences (p = 0.001), specially between the 5 years old (Md=2) [p=0.016 (7 years old; Md=1); p=0.003 (8 years old; Md=1); p=0.021 (9 years old; Md=1)] and the 6 years old (Md=2) [p=0.005 (7 years old; Md=1); p=0.001 (8 years old; Md=1); p=0.013 (9 years old; Md=1)]. For Md interpretation, normal weight is classified by 1, overweight by 2 and obesity by 3. The Spearman test (r) allowed to verify significant statistical correlations, two positive [shuttle run (p=0.001; r=0.136); handgrip (p=0.002; r=0.123)] and three negative [lateral jump (p=0.001; r=-0.174); standing long jump (p=0.001; r=-0.249); throwing velocity (p=0.072; r=-0.073)].

## Conclusions

It is important to take into account the current recommendations and concerns of the WHO [4] (healthy eating habits, physical activity regular practice), improving body composition and motor competence in childhood from an early age, resulting probably in healthier adults and minimizing possible social problems concerning public health.

## Acknowledgements

This work is funded by FCT/MEC through national funds and when applicable cofunded by FEDER - PT2020 partnership agreement under the project UID/EEA/50008/2013 and by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07-CT62-FEDER-005012; ID: 64765).

## References

1. Venâncio P, Aguilar S, Pinto G. Obesidade infantil... um problema cada vez mais atual. Revista Portuguesa de Medicina Geral e Familiar 2012;28:410-416.

2. Luz C, Cordovil R, Almeida G, Rodrigues L. Link between motor competence and Health related fitness in children and adolescents. Sports 2017;5(41):1-8.

3. McCarthy H, Cole T, Fry T, Jebb S, Prentice A. Body fat reference curves for children. International Journal of Obesity 2006;30:598-602.

4. Inchley J, Currie D, Jewell J, Breda J, Barnekow V. Adolescent obesity and related behaviours: trends and inequalities in the WHO. Copenhagen: WHO; 2017.

## Keywords

Body Fat Percentage, Elementary School, Motor Competence, Obesity, Overweight.

## O131

### Working pregnant woman affectivity assessment regarding psychological requirements of the work

Mária S Medina, Valeriana G Blanco
Universidad de Burgos, 09001 Burgos, Spain

**Correspondence:** Valeriana G Blanco (vguijo@ubu.es)
BMC Health Services Research 2018, **18**(Suppl 2):O131

### Background

The labour situation of the pregnant woman has special connotations, both physical and psychological and this may influence work performance and perceived welfare, therefore also interfering in the development of different emotions.

### Objective

Aware of this, the present work has as an objective to evaluate the relationship between the psychological requirements of the work of pregnant women and affectivity.

### Methods

It had a convenience sample of 165 pregnant working women living in Burgos (Spain). The study has a cross-cutting nature and the data collection was carried out with the PANAS questionnaire for affectivity rating, ISTAS for psychological demand and an *ad hoc* questionnaire to collect identification data. The criterion variables were: work psychological requirements (EP), positive affectivity (AP) and negative affectivity (AN).

### Results

The results show that pregnant women have high unfavourable exposition levels for health regarding variables of psychological requirements.

### Conclusions

The relation between variables showed significant relation between the EP and AN variables, concluding that pregnant women with a friendly exposition level of psychological requirements (EP) have a lot of positive affectivity (AP) and less negative. Pregnant women that had an unfavourable psychological exposition level (EP) had more negative affectivity (AN).

### Keywords

Working pregnant woman, Affectivity assessment, Psychological requirements of the work.

## O132

### The perception of social support and adherence to medication, on the person with COPD

Silvia Vieira¹, Celeste Bastos¹,², Ligia Lima¹,²

¹Nursing School of Porto, 4200-072 Porto, Portugal; ²Center for Health Technology and Services Research, University of Porto, 4200-450 Porto, Portugal

**Correspondence:** Silvia Vieira (silvia_vieira3@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O132

### Background

COPD (Chronic Obstructive Pulmonary Disease) is a chronic and incapacitating disease, characterized by the presence of persistent respiratory symptoms and a gradual decrease in energy [1-3]. The person with COPD has to cope with a complex therapeutic regimen and with the progressive worsening of the clinical condition [3], which may compromise their capacity for self-care. Therefore, people with COPD need support to manage the disease and the therapeutic regimen [4-6].

### Objective

The study aims were to study people with COPD perception about their social support, as well as their level of adherence to medications and to analyse the association between perceived social support and adherence to medication.

### Methods

This is a quantitative, descriptive and cross-sectional study, with a sample of 45 adults diagnosed with COPD, admitted to medical service at a hospital in the northern part of Portugal, between February and May 2017. Participants mean age was 71 years (SD = 11.9), they were mostly male (86.7%), married (72.7%) and had a low level of education. The measures used were: a sociodemographic and clinical questionnaire, the Social Support Scale (SSS) and Reported Adherence to Medication Scale (RAMS).

### Results

The results showed that the study participants perceived a positive social support (M = 3.5, SD = 0.8). The higher scores were found for the dimension of family and affective support (M = 3.9, SD = 1.0), and the lowest scores were found in the financial support dimension (M = 2.7, SD = 1.0). In relation to the treatment of COPD, most participants reported high adherence levels (M = 12.5, SD = 4.4). A positive association was found between perceived social support and medication adherence (r = 0.46, p = 0.001).
## Conclusions

Our results support the importance of social support in adherence to medication, on the person with COPD. The study also suggests the existence of a group of patients more at risk, in terms of lack of social support and non-adherence to medication, pointing out the need to develop nursing interventions focused on the promotion of self-management of COPD.

## References

1. Global Initiative for Chronic Obstructive Lung Diseases. Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for Health Care Professionals (2017 Report). Global Initiative for Chronic Lung Disease, Inc., 2017.

2. Criner G, Bourbeau J, Diekemper R, Ouellette D, Goodridge D, Stickland M, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest 2015;147(4):894-942.

3. Wedzicha J, Miravitlles M, Hurst J, Calverley P, Albert R, Krishnan J, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3). pii: 1600791.

4. Korpershoek Y, Bos-Touwen I, de Man-van Ginkel J, Lammers J, Schuurmans M, Trappenburg J. Determinants of activation for self-management in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:1757-66.

5. Halding A, Grov E. Self-rated health aspects among persons living with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2017 Apr 12;12:1163-1172.

6. Fotokian Z, Mohammadi Shahboulaghi F, Fallahi-Khoshknab M, Pourhabib A. The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease. Plos One 2017;12(4):e0174028.

## Keywords

COPD, Chronic obstructive pulmonary disease, Medication adherence, Social support.

O133

## The organizational commitment of health professionals (doctors, nurses and auxiliaries) in two public hospitals in Cape Verde

Jacqueline Delgado<fnref n="1" />, António Nunes<fnref n="1" />,<fnref n="2" />, Amélia Nunes<fnref n="1" />

¹Universidade da Beira Interior, 6201-001 Covilhã, Portugal; ²Núcleo de

Estudos em Ciências Empresariais, 6200-209 Covilhã, Portugal

Correspondence: António Nunes (anunes@ubi.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O133

## Background

The organizational commitment (OC) has its origin in the "Side bets" theory, representing the result of the accumulation of bets, which can be lost in a situation where the interruption of an activity occurs [1] The terms are understood as the maintenance of the belonging to the organization, being something of value in which the individual invested [2]. That is, while the individual works, creates bonds, commits himself and goes investing in the organization. The three-dimensional model [3] identifies the three dimensions of OC: the affective commitment, which consists in the feeling or desire to participate in the organization; the continuance commitment, which consists in the obligation to remain in the organization; and finally, the normative commitment, which consists in the worker's need to remain in the organization.

## Objective

The objective of this study is to measure the OC levels, in its several dimensions, on the health professionals (physicians, nurses and auxiliaries) in two public hospitals in Cape Verde, considering the importance of sociodemographic variables (age, gender, marital status and academic qualifications) and Working context (work income, seniority in the company, type of contract and Hierarchical position) for the CO levels revealed.

## Methods

The study used a quantitative methodology to evaluate the impact of sociodemographic and professional context variables on OC levels. In order to measure OC, we used the scale of three components: affective, normative and calculative [3], adapted for the Portuguese language in 2008 [4]. The sample consisted of 224 health professionals.

## Results

The scale presented good levels of internal consistency (Cronbach's alpha of 0.85), with median OC values correlating positively with age; simultaneously, low OC levels were identified in higher education levels and High values of OC were identified in lower education levels. Finally, OC levels were also significantly higher for the less qualified professionals, auxiliaries showed the highest levels while the doctors showed the lowest levels of OC.

## Conclusions

It is emphasized the positive and statistically significant relationship between age and OC, implying higher OC levels in the higher age groups, as identified in previous studies [5-8]. The inverse relation between OC levels and levels of academic qualifications, as identified by other authors [2-3, 5,8-9], is also a subject of interest. As well as the fact that the lower levels of OC appear in the most qualified professions: doctors and nurses, a not treated aspect in the literature and that characterizes the health professionals of Cape Verde.

## References

1. Becker HS. Notes on the concept of commitment. Am J Sociol 1960;66(1):32-40.

2. Meyer JP, Allen NJ. Testing "side-bet theory" of organizational commitment: some methodological considerations. J Appl Psychol 1984;69(3):372-378.

3. Meyer JP, Allen NJ. A three-component conceptualization of organizational commitment. Hum R manage R 1991;1(1):61-89.

4. Nascimento JL, Lopes A, Salgueiro MDF. Estudo sobre a validação do "Modelo de Comportamento Organizacional" de Meyer e Allen para o contexto português. Comp.Org Gestão; 2008.

5. Mathieu JE, Zajac DM. A review and meta-analysis of the antecedents, correlates, and consequences of organizational commitment. Psychol Bull 1990;108(2):171.

6. Addae HM, Praveen KP, Velinor N. Role stressors and organizational commitment: public sector employment in St Lucia. Int J Manpow 2008;29(6):567-582.

7. Allen NJ, Meyer JP. The measurement and antecedents of affective, continuance and normative commitment to the organization. J Occup Organ Psychol 1990;63(1):1-18.

8. Angle HL, Perry JL. An empirical assessment of organizational commitment and organizational effectiveness. Adm Sci 1981;Q:1-14.

9. Mowday RT, Steers RM, Porter LW. The measurement of organizational commitment. J Vocat Behav 1979; 14 (2):224-247.

## Keywords

Organizational commitment, Health professionals, Physicians nurses and auxiliaries, Cape verde (Africa).

O134

## Sleep quality and food intake of high school students

Ana SC Carvalho<fnref n="1" />, Adilia P Fernandes<fnref n="2" />, Josiana A Vaz<fnref n="2" />, Ana B Gallego<fnref n="3" />, Matilde S Veja<fnref n="3" />

Correspondence: Ana SC Carvalho (ana.s.coelho@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O134

## Background

Poor sleep quality is associated with increased food intake and poor diet quality [1]. People with lack of sleep show a positive correlation

<footnote n="1">¹Unidade Local de Saúde do Nordeste, 5301-852 Bragança, Portugal;</footnote>

<footnote n="2">²Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-146 Bragança, Portugal;</footnote>

<footnote n="3">³Universidade de León, 24071 León, Spain</footnote>
between free time and food intake and also experience hormonal
and brain changes that drive the intake of food with high calorific
value [1-3]. In addition, scientific research has shown a healthy and
balanced diet to positively influence the quality of sleep [1].

**Objective**

The present study was set out to assess the sleep quality of high school students in Bragança county, and its association with food intake.

**Methods**

The study used non-experimental, analytical and transversal methodology, of epidemiological character and with a quantitative approach. It was intended to carry out the study in a population of 862 high school students. However, due to consent being required from both legal guardians and students, a smaller sample of 345 students was obtained. The data was collected in May 2017 through a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), validated for the Portuguese population.

**Results**

Throughout the study and following PSQI analysis, it was concluded that 39.71% (n = 137) of participants showed poor quality of sleep (PSQI > 5 points). The correlation between sleep quality and food intake was assessed and a statistically significant association was found between the quality of sleep and the intake of snacks (X² = 17.144; p = 0.000), sugary products (X² = 18.603; p = 0.000), fast-food (X² = 12.353; p = 0.002) and ready meals (X² = 14.852; p = 0.000). The risk of suffering from poor sleep quality is higher in young populations who frequently eat snacks ([OR]: 2.811; 99%), sugary products ([OR]: 1.901; 95%), fast-food ([OR]: 4.000; 99%) and ready meals ([OR]: 5.621; 95%) in comparison with young populations who rarely eat this sort of food. The sleep quality is also significantly related with the number of meals young people have in a day (X² = 7.580; p = 0.023). The risk of having poor quality sleep is 2.240 times higher in young people who rarely eat 4-6 meals a day.

**Conclusions**

A correlation between sleep quality and food intake in the sampled students was seen. The risk of having poor quality of sleep is higher in students who frequently eat a high calorie diet and also in students who rarely have 4-6 meals a day. There are several connections between sleep quality and eating habits. Sleep promotion and its connection with standard diets should be included as an essential part of community empowerment for health-promoting lifestyles [1,4,5].

**References**

1. McNeil J, Doucet E, Chaput JP. Inadequate Sleep as a Contributor to Obesity and Type 2 Diabetes. Canadian Journal of Diabetes. 2013;37:103-108.

2. Dewald JF, Meijer AM, Oort J, Kerkhof GA, Bogels SM. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 2010;14:179-189.

3. Paiva T. Bom Sono, Boa Vida. Cruz Quebrada: Oficina do Livro; 2008.

4. Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation 2012;126(14):1770-1779.

5. Direção Geral da Saúde Programa Nacional de Saúde Escolar. Lisboa: Ministério da Saúde de Portugal; 2015.

**Keywords**

Sleep Quality, Food intake, Balanced diet.

0135

Education matters!!! The link between childhood obesity and parents' level of education

Ricardo Melo¹, Ana Inácio¹, Mariana Pereira¹, Miguel Santos¹, Simão Sousa¹, Francisco Campos¹, Fernando Martins¹,²

¹Applied Sport Sciences Research Unit, Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal; ²Instituto de Telecomunicações, University of Beira Interior, 6201-001 Covilhã, Portugal

Correspondence: Ricardo Melo (ricardo.es.melo@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O135

**Background**

Obesity is a public health problem in most developed countries [1,2]. In Portugal this scenario is very serious because it stands as one of the European countries with more obese children [3,4], which is associated to poor eating habits, low level of physical activity, and sedentary lifestyles [2].

**Objective**

The objectives of this investigation are: I) to determine the prevalence of overweight/obesity in elementary school children; II) to compare children's levels of body mass by age and gender; III) to verify correlations between children's levels of body mass and family socio-demographic characteristics.

**Methods**

The sample was composed by 294 children between 5-9 years old (M ± SD = 7.35 ± 1.18 years old; 147 female) of the 10 elementary schools from the "Agrupamento de Escolas de Montemor-o-Velho (AEMMV)" (Coimbra-Portugal). Data was collected from September to December 2017. Family socio-demographic characteristics data were collected using a survey questionnaire applied to parents of participating children. Weight was evaluated using a Tanita Body Composition Monitor (model BC-420 SMA). Height was calculated using a stadiometer. Body Mass Index (BMI) was calculated using the formula weight/height². The definition of underweight (level 1), normal weight (level 2), overweight (level 3) and obesity (level 4) was based on the tables in use by the Portuguese Directorate-General for Health [5], which correlates BMI with percentile tables. Data analysis was conducted using IBM SPSS (version 24.0, Chicago, USA) and a statistical significance of 10.0% was defined.

**Results**

Results of this study show that 17.7% of the evaluated children are overweight and 16.3% are obese (34.0% are overweight/obese). No significant statistical differences were observed by gender (Mann-Whitney = 10416; p = 0.529) or by age (Kruskal-Wallis test = 4.01; p = 0.405). Results of Spearman correlation test (r) also evidence not existing significant statistical relations between levels of body mass and parents' age (mother: r = -0.031; p = 0.608; father: r = 0.015; p = 0.797) or with household composition (r = -0.040; p = 0.499). However, a negative correlation exists between body mass levels and parents' education (mother: r = -0.136, p = 0.019; father: r = -0.158, p = 0.006) evidencing that the higher the level of education of the parents the lower the prevalence of high levels of body mass (overweight/obesity).

**Conclusions**

Despite policies to tackle obesity are being implemented, results of this study show a high prevalence of overweight/obesity children's in the AEMMV. Results also confirm that parents' education is a strong social health determinant [1]. This study suggests that public authorities need to implement more efficient programs (e.g. nutrition and physical activity) at schools and community to promote active and healthier lifestyles.

**Acknowledgements**

This work is funded by FCT/MEC through national funds and when applicable cofounded by FEDER - PT2020 partnership agreement under the project UID/EEA/50008/2013 and by QREN, Mais Centro - Programa Operacional Regional do Centro, FEDER (CENTRO-07-CT62-FEDER-005012; ID: 64765). The authors also would like to thank to: Agrupamento de Escolas de Montemor-o-Velho, Câmara Municipal de Montemor-o-Velho, and Unidade de Cuidados na Comunidade de Montemor-o-Velho.

**References**

1. OECD [internet]. Obesity Update 2017. Retrieved from https://www.oecd.org/els/healthsystems/Obesity-Update-2017.pdf

2. WHO [internet]. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002–2014 2017. Retrieved from http://www.euro.who.int/_data/assets/pdf_file/0019/339211/WHO_ObesityReport_2017_v3.pdf

3. Padez C, Fernandes T, Mourão I, Moreira P, Rosado V. Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 19702002.Am J Human Biology. 2004;16 (6):670-678.
**Objective**

The aim of this study was to evaluate musculoskeletal pain due to schoolbag carriage in terms of prevalence, intensity and predisposing risks factors in students of 5th grade in schools of the range of community health centres of Aveiro region, during the school year of 2016-2017.

**Methods**

A cross-sectional study was designed. The presence, intensity and duration of pain was assessed using a body chart and numeric rating scale for pain. Predisposing risk factors was assessed by means of an *ad hoc* questionnaire.

**Results**

A total of 960 children (male 51.1%: female 48.6%) with a mean age of 10.4 years (± 7.6) were included. The majority had backpacks (96.6%) and 82.4% (n = 775) carried the backpack over 2 shoulders. The mean schoolbag weight (4.9 ± 1.3 kg) represented a mean % body weight (%BW) of 13.0% (± 4.8). Only 29.3% carried schoolbags that were ≤ 10 %BW. The majority (79.9%) carried schoolbags to school for ≤ 15 min. The prevalence of musculoskeletal pain was reasonable (37.8%), and in the region of spine was low (16.0%). Multiple linear regression model indicated that pain is only explained by the number of hours of physical activity (negative correlation: r = -0.367) in 12.4% (R² = 0.124; p = 0.001, SEE = 0.143).

**Conclusions**

This study highlights the need to consider the multifactorial nature of musculoskeletal pain in children, and also the need to reinforce protective factor of physical exercise in future prevention programs dedicated to children.

**References**

1. Swain MS, Henschke N, Kamper SJ, Gobina I, Ottova-Jordan V, Maher CG. An international survey of pain in adolescents. BMC public health. 2014;14:447.

2. Paananen MV, Taimela SP, Auvinen JP, Tammelin TH, Kantomaa MT, Ebeling HE, et al. Risk factors for persistence of multiple musculoskeletal pains in adolescence: a 2-year follow-up study. European Journal of Pain. 2010;14(10):1026-32.

3. Stinson J, Connelly M, Kamper SJ, Herlin T, Toupin April K. Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best practice & research Clinical rheumatology. 2016;30(3):468-82.

4. Iyer SR. An ergonomic study of chronic musculoskeletal pain in schoolchildren. Indian journal of pediatrics. 2001;68(10):937-41.

5. Noll M, Candotti CT, da Rosa BN, Loss JF. Back pain prevalence and associated factors in children and adolescents: an epidemiological population study. Revista de Saúde Pública. 2016;50:31.

6. Aprile I, Di Stasio E, Vincenzi MT, Arezzo MF, De Santis F, Mosca R, et al. The relationship between back pain and schoolbag use: a cross-sectional study of 5,318 Italian students. The spine journal : official journal of the North American Spine Society. 2016;16(6):748-55.

7. Dianat I, Sorkhi N, Pourhossein A, Alipour A, Asghari-Jafarabadi M. Neck, shoulder and low back pain in secondary schoolchildren in relation to schoolbag carriage: should the recommended weight limits be gender-specific? Appl Ergon. 2014;45(3):437-42.

8. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine (Phila Pa 1976). 2006;31(4):468-72.

9. Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinanen-Kiukaanniemi S. Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine (Phila Pa 1976). 2004;29(15):1662-9.

10. Hakala P, Rimpela A, Salminen JJ, Virtanen SM, Rimpela M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Bmj. 2002;325(7367):743.

11. Goodburn EA, Ross DA. A Picture of health?: a review and annotated bibliography of the health of young people in developing countries / undertaken World Health Organization; 1995.

**Keywords**

Physiotherapy, Schoolbags, Musculoskeletal pain, Children.

**O139**

**Looking over Portuguese school-aged children lifestyles: results from a pilot study**

Goreti Marques, Ana R Pinheiro, Fátima Ferreira, Daniela Simões, Sara Pinto

Escola Superior de Saúde de Santa Maria, 4049-024 Porto, Portugal

**Correspondence:** Goreti Marques (goreti.marques@santamariasaude.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O139

**Background**

Childhood obesity is considered one of the new epidemics of the 21st century. This study is part of a largest project regarding the improvement of healthy lifestyles in school-aged children, through a transdisciplinary team.

**Objective**

To describe food consumption and sport activities of Portuguese school-aged children.

**Methods**

An exploratory/descriptive pilot-study was conducted with third grade school-aged students from two Portuguese primary schools. Data were collected during through a self-filling form focusing on socio-demographic variables, sport activities and anthropometric measures (sex, age, house hold composition, practice of at least 60 minutes/week of sport activities outside school, weight, height). A booklet was used during five consecutive days to register food consumption. The study was previously approved by an Ethics Committee, and by the National Data Protection Commission (NDPC no.1704/2015). The informed consent of the child's legal representative was signed. Data were analysed using the SPSS®-version 24.0.

**Results**

Preliminary results included 109 school-aged children (mean age = 7.5 years old; mean weight = 28.50 kg; mean height = 131.60 cm). Regarding the Body Mass Index (BMI), 65.1% of the children were considered to have normal weight, 11.9% overweight, and 8.3% obesity; underweight emerged in 14.7% of children. The consumption of fruit/vegetables was significantly greater (p < 0.05) in underweight children when compared with normal weight and overweight/obese children. The average consumption of fat/oil, and sugary/salty products seemed smaller in underweight children and greater in overweight/obese children, while the consumption of dairies/meat/fish/eggs, cereals and their derivatives, tubers and water seemed similar; however, statistically significant differences were not found (p > 0.05). Most children (77.1%) performed at least 60 minutes/week of sport activities outside school (66.7% practice only one type, 25.0% practice two, and 8.3% practice three different sports per week). Food consumption was not significantly different between children that practiced at least 60 min/week of sports outside school comparing to the children who didn't.

**Conclusions**

Though most children have normal weight, data show important abnormalities in BMI. The consumption of fruit/vegetables appears to be increased in underweight children and decreased in overweight/obese children, which highlights the need for more detailed research. Food consumption does not seem to differ depending on the practice of outside-school sports. Further stages must bring the development of a transdisciplinary healthcare program to improve healthy lifestyles among school-aged children.

**Acknowledgements**

This work was funded by project NORTE-01-0145-FEDER-024116.
**Keywords**

Childhood obesity, Food consumption, Sport activities, Health promotion.

O140

## Dating violence in university context: practices, beliefs and impacts on the health of victims

Sofia Neves¹,², Ana Sousa,¹ Joana Topa¹,², Janete Borges¹

¹Instituto Universitário da Maia, 4475-690 Maia, Portugal; ²Centro Interdisciplinar de Estudos de Género, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, 1300-663 Lisboa, Portugal

**Correspondence:** Sofia Neves (asneves@ismai.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O140

## Background

Dating violence is an obvious and worrying social and health problem with serious consequences for its victims. It is characterized as a pattern of coercive and abusive tactics employed by one partner in a relationship to gain power and control over the other partner. It can take many forms, including physical violence, coercion, threats, intimidation, isolation, and emotional, sexual or economic abuse and occurs in the context of intimate heterosexual or homosexual/lesbian relationships. This kind of violence seems to be supported on conservative and traditional gender norms and stereotypes.

## Objective

The main objective of this study is to characterize university students' beliefs and practices regarding dating violence, identifying the impacts of this type of violence on the psychological, physical, sexual and social health of their victims.

## Methods

Were used self-administered questionnaires and a socio-demographic survey for data collection: Gender Belief Inventory (Maia University Institute and Interdisciplinary Centre for Gender Studies, version for research, 2017) and the Inventory on Violent Youth Relations (University Institute of Maia and Interdisciplinary Centre for Gender Studies, version for research, 2017). These were applied to 200 university students (142 females and 55 males), aged 18-44 (M = 20.54; SD = 4.435) who were attending the Maia University Institute. Data analysis was performed using the statistical program IBM- Statistics Package for the Social Sciences (version 24).

## Results

The results showed that 12.8% of students reported having been victims of some act of violence by someone with whom they maintain or maintained a relationship of intimacy. Men were identified as the main perpetrators, with women having the highest rates of victimization. With regard to the type of violence perpetuated, psychological and social violence appear as the most experienced by students. With regard to gender social beliefs, this study reveals that these students maintain conservative and traditional gender beliefs that continue to perpetuate violence. Regarding the impact of dating violence, there was awareness among respondents of the implications of this violence on the health of the victims.

## Conclusions

This study shows that despite the efforts that have been made in the implementation of policies and projects to prevent gender violence, this has not been enough to finish its practice. The commitment to the implementation of gender equality programs in school education seems fundamental in order to prevent this public health problem.

**Keywords**

Dating Violence, University Students, Beliefs, Practices, Implications to health.

O141

## Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)

Ana Sargento¹,², Ana Querido³,⁴, Henrique Carvalho², Isa Santos², Catarina Reis²,⁵, Marisa Maximiano²,⁵, Manuela Frederico⁶, Sandra Oliveira⁷,⁸, Susana Leal⁷,⁹

¹Center for Applied Research in Management and Economics, School of Technology and Management, 2411-901 Leiria, Portugal; ²School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁵Center for Research in Informatics and Communications, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ⁷School of Management and Technology, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal; ⁸Center for Health Studies and Research, University of Coimbra, 3004-504 Coimbra, Portugal; ⁹Life Quality Research Centre, 2001-904 Santarém, Portugal

**Correspondence:** Ana Sargento (ana.sargento@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O141

## Background

Increasing healthcare costs is a concern of all developed countries. In Long-Term Healthcare (LTH) this is reinforced by population ageing and corresponding prevalence of chronic diseases. Thus, it is fundamental to accurately measure costs and outcomes in healthcare, improving value created for patients, i.e., patient-centred health outcomes per monetary unit of cost [1, 2]. TDABC methodology applied to healthcare allows identifying the cost for each clinical condition in the full cycle of care, mapping processes, activities, resources and allocated time [3–5]. It has been mostly applied in acute-care settings, partly due to complexity of defining chronic condition [6].

## Objective

This paper focuses on the cost component of a larger on-going research project (CARE4VALUE), aiming to enhance value creation in LTH providers and applied to a partner LTH unit. Specifically, the main objective is to define clinical conditions in the context of LTH, as a first step in the implementation of TDBAC.

## Methods

Mixed qualitative and quantitative methods were applied, including: 1) three focus groups conducted with the health team of the LTH unit (physician, nurses, physiotherapist, psychologist, social assistant) to select, discuss and validate the criteria to define clinical conditions; 2) construction of a composite indicator and testing it over a sample of anonymized clinical data from 21 patients; 3) structured observation of processes taken throughout the full cycle of care of patients in different conditions. Qualitative data was submitted to content analysis and validated among participants. Quantitative data used in the composite indicator, based on validated scales, was subject to normalization, aggregation and sensitivity analysis.

## Results

One consensual outcome of the focus groups was that, in LTH, the disease or cause of entrance is less relevant to costs than the overall complexity of the patient, entailing psychical, social, spiritual and psychic-mental dimensions. Accordingly, a multidimensional classification model of patients in four complexity levels was delivered, after being validated and receiving consensus from the LTH team. Additionally, it will include a logging tool and dashboard to integrate separate patient-centred information and aid patient classification in complexity conditions.
## Conclusions

The completion of this step allowed progressing in the design and implementation of the cost model, which, in turn, will support value measurement, and enhancing of the focus LTH unit. Besides, all involved professionals stated that their engagement in this phase of the project generated exceptional opportunities for interdisciplinary meetings and debate, contributing to closer ties between different areas of LTH.

## References

1. Porter ME, Kaplan RS. How to pay for health care. Harv Bus Rev. 2016 Jul-Aug;94(7-8):88-98, 100, 134.

2. Schupbach J, Chandra A, Huckman RS. A Simple Way to Measure Health Care Outcomes. Havard Bus Rev [Internet]. 2016; Disponível em: https://hbr.org/2016/12/a-simple-way-to-measure-health-careoutcomes

3. Crott R, Lawson G, Nollevaux MC, Castiaux A, Krug B. Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach. Eur Arch Oto-Rhino-Laryngology. 2016;273(9):2621-2628.

4. Alaoui S El, Lindefors N. Combining time-driven activity-based costing with clinical outcome in cost-effectiveness analysis to measure value in treatment of depression. PLoS One. 2016;11(10): e0165389.

5. Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: A systematic review of the literature. Health Policy (New York). 2017;121(7):755-763.

6. Nolte EE, McKee M. Caring for people with chronic conditions: a health system perspective. Eur Obs Heal Syst Policies Ser. 2008;XXI:259.

## Keywords

Long-term healthcare, Time-Driven Activity Based Costing (TDABC), Clinical conditions, Patient-centered data, patient complexity.

## O142

### Effects of aerobic land-based and water-based exercise training programs on clinical and functional parameters in older women

Rafael Oliveira¹,², Carlos T Santamarinha³, João Brito¹,²

¹Research Unit in Quality of Life, Sport Sciences School of Rio Maior, Polytechnic of Santarém, 2040-413 Rio Maior, Portugal; ²Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal; ³City Hall of Esposende, 4740-223 Esposende, Portugal

**Correspondence:** Rafael Oliveira (rafaeloliveira@esdrms.ipsantarem.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O142

## Background

In Portugal, most exercise training programs are offered by municipalities, seasonally, by 8 to 10 months.

### Objective

The aim of the study was to access the clinical and functional effects of the application of different fitness exercise training programs, which included aerobic fitness group classes, with calisthenics exercises and water-based exercise, for nine months, to older women.

### Methods

In the study, 96 active older women participated. They were divided in four exercise groups: 2xland-based group (GA, n=21; age 71.46 ±9.75 years; body weight 72.44±11.85 kg; height 153.82±5.83cm); 2xwater-based group (GB, n=9; age 70.10±9.98 years; body weight 70.48±10.92 kg; height 153.68±5.64cm); group of 1xland plus 2xwater-based (GC, n=7, age 71.35±8.32 years; body weight 73.42 ±11.20 kg; height 154.39±5.01cm), group of 2xland plus 2xwater-based exercise (GD, n=39, age 71.46±7.38 years; body weight 71.70 ±11.66 kg; height 154.23±6.82 cm). Clinical parameters were also accessed, such as, fast glucose, triglycerides, rest blood pressure, rest heart rate frequency (FCR) and functional parameters [1]; resistance of upper and lower limbs, agility and aerobic capacity. The training intensity of the programs was moderate, 10-14 on the "Rate of Perceived Exertion" scale [2], run accordingly [3]. It was use inferential statistic through T-test to compare baseline vs post-training.

### Results

After nine months of intervention, the main results were at fast: glycemia (GA=116.0±12.11 vs 101.50±13.36 mg/dL; GC= 120.43±15.34 vs

100.47±11.65 mg/dL; GD = 127.29±36.60 vs 111.23±29.18 mg/dL); triglycerides (GA= 288.13±136.78 vs 158.13±47.24 mg/dL; GC= 295.94 ±112.92 vs 153.63±101.96 mg/dL; GD= 244.79±122.41 vs 144.98±69.27 mg/dL), FCR (GD=71.34±11.26 vs 66.31±8.68 bpm); aerobic capacity (GB= 541.88±51.03 vs 605.0±31.12 m ; GD=127.29±174.06 vs 111.23 ±131.65 m), in resistance of lower limbs (GA=16.57±5.19 vs 18.90±5.07 repetitions; GB=14.89±5.21 vs 19.11±4.83 repetitions ; GD=20.54±5.38 vs 22.87±6.39 repetitions) and agility (GA= 7.94±3.52 vs 8.82±2.91 seconds; GB=8.86±4.09 vs 6.53±2.40 seconds; GC=7.90±4.56 vs 6.81±3.78 seconds; GD 6.13±1.66 vs 5.48±1.87 seconds), p < 0.05 for all. Also, it was observed that there were correlations between aerobic capacity and triglycerides; fast glucose and triglycerides.

## Conclusions

The results showed a positive effect in all exercise training programs offered by municipality of Esposende, for clinical and functional parameters in older women. Groups of land-based exercise, at least twice a week, seam to lead to better results. The study supports the role of physical exercise to improve hemodynamic, lipid profile and functional parameters as reported previously by another similar study [4]. In addition, this study also revealed efficiency to improve clinical parameters that were not studied yet.

## References

1. Rikli R, Jones C. The development and validation of a functional fitness test for community-residing older adults. J Aging Phys Activ. 1999;7:129-161.

2. Borg G. Phytophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377-381.

3. American College of Sports Medicine, ACSM. ACSM's Guidelines for exercise testing and prescription (9th ed). Philadelphia: Lippincott Williams and Wilkins; 2013.

4. Oliveira R, Santa-Marinha C, Leão R, Monteiro D, Bento T, Rocha RS, Brito JP. Exercise training programs and detraining in older women. J Hum Sport Exerc. 2017;12(1):142-155.

## Keywords

Older women, Water-based exercise, Land-based exercise, Functional capacities, Clinical parameters.

## O143

### The influence of emotional intelligence in stigmatizing attitudes toward mental illness of undergraduate nursing students

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O143

## Background

Health care professionals share the general public's attitude towards people with mental illness, being generalized the harmful beliefs and the subsequent negative attitudes to these patients [1]. A significant correlation between emotional intelligence and mental illness stigma has been found.

### Objective

To analyse the correlation between emotional intelligence and stigmatizing attitudes towards mental illness and to access the influence of this intelligence in those stigmatizing attitudes, among undergraduate nursing students.

### Methods

It was performed a cross-sectional correlational study. Data was collected from a non-probabilistic sample of nursing students from a health school of the centre region of Portugal, using a questionnaire with sociodemographic questions, the Wong and Low Emotional Intelligence Scale (1-5) [2] and the Community Attitudes Toward the Mentally Ill Scale (40-200) [3]. Ethical procedures were taken into account during research according the Helsinki Declaration.
## Results

Most of the nursing students inquired (N=335) were female (N=263). The sample had an average age of 21.69 years (SD=4.64), distributed by all levels of nursing graduation. Some (n=25) had already suffered from mental illness, mainly (N=17) humour disorders, and 41.2% referred to have regular contact with mental health patients in their lives. These nursing students showed a good emotional intelligence (Mean=3.62; SD=0.41), being higher in self-emotional appraisal (Mean=3.73; SD=0.58) and others' emotional appraisal (Mean=3.85; SD=0.49). Stigmatizing attitudes towards mental illness are medium-low (Mean=122.15; SD=5.02), being more intense in authoritarianism (Mean=23.92; SD=4.44) and social restrictiveness (Mean=20.87; SD=4.94). Emotional intelligence is positively correlated with attitudes in community mental health ideology (R=0.133; p=0.015). Other's emotional appraisal ability of emotional intelligence is correlated with attitudes regarding benevolence (R=0.276; p=0.000), community mental health ideology (R=0.221; p=0.000), authoritarianism (R=-0.156; p=0.005) and social restrictiveness (R=-0.254; p=0.000). Other's emotional appraisal ability can explain some of the attitudes regarding authoritarianism (R²=0.024; F=8.138; p=0.005), benevolence (R²=0.076; F=27.136; p=0.000), social restrictiveness (R²=0.065; F=22.560; p=0.000) and community mental health ideology (R²=0.049; F=16.862; p=0.000). Regulation of emotions also influences benevolence attitudes (R²=0.016; F=16.578; p=0.000).

## Conclusions

Postgraduate nursing students have good emotional intelligence and low stigmatizing attitudes towards mental illness. A significant correlation was found between emotional intelligence and stigmatizing attitudes, mostly positive, and an influence of this type of intelligence in the four areas of this kind of attitudes. These results enhance the importance of developing emotional intelligence, specially the ability of other's emotional appraisal, in a way to improve attitudes toward mental illness.

## References

1. Poreddi V, Thimmaiah R, Pashupu D, Ramachandra, Badamath S. Undergraduate Nursing students' attitudes towards mental illness: Implications for specific academic education. Indian J Psychol Med. 2014;36(4):368-372.

2. Querido A, Tomás C, Carvalho D, Gomes J, Cordeiro M. Measuring emotional intelligence in health care students - revalidation of WLEIS-P. In: Proceedings of the 3rd IPLEiria's International health Congress; 2016 maio 6-7; Leiria, Portugal. London: BMC Health Services Research; 2016. p. 87.

3. Taylor S, Dear M. Scaling community Attitudes Toward the Mentally Ill. Schizophrenia Bulletin. 1981, 7(2): 225-240.

## Keywords

Mental health, Stigma, Nurse students, Emotional intelligence.

## O144

### Functional decline in older acute medical in-patients

Cecília Rodrigues¹, Denisa Mendonça², Maria M Martins³
¹Centro Hospitalar do Porto, 4099-001 Porto, Portugal; ²Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

**Correspondence:** Cecília Rodrigues (ceciliarodrigue@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O144

### Background

Older patients hospitalised for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes.

### Objective

The aim of this study was to compare basic self-care needs in older acute medical in-patients between 2 weeks before hospitalization and discharge.

### Methods

Single-centred, observational, and prospective cohort study. Data were collected between May and September 2017 and included 91 patients,

aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Performance in basic activities of daily living (BADL) at home (self-reported), at hospital admission (observed) and at discharge (observed) was collected. Functional status of the elderly patients at 2 weeks before hospitalization (baseline), at hospital admission, and at discharge was measured by the Katz Index. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline.

### Results

Pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the patients, respectively. Patients were independent on average in 3.63, 1.41 and 1.90 BADL 2 weeks before admission, at hospital admission and at discharge, respectively. In-hospital functional improvement occurred in 36.3% of the patients.

### Conclusions

Due to their attitude to observe, support and guide patients and their 24 hours patient supervision, nurses play a key role in strategies to prevent functional decline in older patients. An adequate planning of nursing care that includes interventions to promote and maintain mobility, in the logic of self-care, can be a valuable contribution in the prevention of functional decline and in the reconstruction of independence in self-care, after a generative event of dependence.

## Keywords

Functional decline, Elderly, Hospital outcomes.

## O145

### Validation of the Weight Focused Feelings Scale in a sample of overweight and obese women participating in a community-based weight management programme

Cristiana Duarte¹, Marcela Matos,² James Stubbs¹, Corinne Gale³, Liam Morris⁴, Paul Gilbert³,⁵

¹School of Psychology, Faculty of Medicine and Health, University of Leeds, LS2 9JT, Leeds, United Kingdom; ²Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal; ³College of Life and Natural Sciences, University of Derby, Kedleston Road, DE22 1GB, Derby, United Kingdom; ⁴Nutrition and Research Department, Slimming World, Clover Nook Road, DE55 4RF, Derbyshire, United Kingdom; ⁵Mental Health Research Unit, Kingsway Hospital, DE22 3LZ, Derby, United Kingdom

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

BMC Health Services Research 2018, **18**(Suppl 2):O145

### Background

A significant body of literature suggests that negative emotions may undermine self-regulation of eating behaviour during/subsequent to weight loss attempts by influencing loss of control of eating behaviour [1]. Negative feelings related to body weight and shape seem to play a role in eating problems, with some studies suggesting that binge eating may occur as a means of momentarily avoiding/reducing negative affects related to body weight and shape [2, 3]. Recent evidence suggests that positive emotions may also relate to overeating in healthy and obese adults [4-6]. Nonetheless, research on emotions and eating focuses primarily on negative emotions and there is a lack of measuring relating positive emotions to eating.

### Objective

The current study aimed to test the factorial structure and psychometric properties of the Weight Focused Feelings Scale (WFFS), an 11-item measure that assesses negative and positive feelings linked to body weight and shape.

### Methods

2,236 women attending a community-based weight management programme participated in this study. Mean (SD) participants age was 41.71 (12.34) years and BMI was 31.62 (6.10) kg/m². Data was randomly split in two independent data sets to conduct an Exploratory Factor Analysis (EFA) in 1,088 participants, and a Confirmatory Factor Analysis (CFA), in 1,148 participants.

### Results

Results of the EFA indicated a two-factor structure: negative feelings (7 items) and positive feelings (3 items). Items presented factorial
loading above .49 on the first factor, and above .64 on the second factor. The CFA confirmed the plausibility of this 2-factor model ($X^2_{(41)} = 283.771: p < .001$; CFI = .96; TLI = .95; PCFI = .72; RMSEA = .07 [.06 to .08]). Standardized Regression Weights ranged from .55 to .68 in the Negative affect subscale; and .75 to .90 in the Positive affect subscale. Items' Squared Multiple Correlations ranged from .30 to .81. The subscales presented Composite Reliability values of .93 and .88, respectively. The two subscales were associated, in the expected direction, with measures of depressive, anxiety and stress symptoms, psychological wellbeing, shame, dietary disinhibition, restraint and susceptibility to hunger, and body mass index (BMI).

## Conclusions

The WFFS is a valid measure to assess body weight and shape-related negative and positive emotions. This measure may be useful for future model testing examining the differential role of negative and positive emotions in eating behaviour and weight management.

## References

1. Singh M. Mood, food and obesity. Frontiers Psychol. 2014;5:925.

2. Duarte C, Pinto-Gouveia J, Ferreira C. Ashamed and fused with body image and eating: Binge eating as an avoidance strategy. Clin Psychol Psychother. 2017;24(1):195-202.

3. Heatherton T, Baumeister R. Binge eating as escape from self-awareness. Psychol Bull 1991;110(1):86-108.

4. Bongers P, Jansen A, Havermans R, Roefs A, Nederkoorn C. Happy eating. The underestimated role of overeating in a positive mood. Appetite 2013;67:74-80.

5. Cardi V, Leppanen J, Treasure J. The effects of negative and positive mood induction on eating behaviour: A meta-analysis of laboratory studies in the healthy population and eating and weight disorders. Neuroscience & Biobehavioral Reviews in Cardiovascular Medicine 2015;57:299-309.

6. Evers C, Adriaanse M, Ridder DTD, Witt Huberts JC. Good mood food. Positive emotion as a neglected trigger for food intake. Appetite 2013;68:1-7.

## Keywords

Negative and Positive emotions, Body weight and shape, Eating behavior, Factorial Analysis, Psychometric analysis.

O146

## Nurses' perceptions of barriers for implementing EBP in a central hospital in the north of Portugal

Ana IC Teixeira¹,²,³,⁴, António L Carvalho³,⁴, Cristina Barroso⁴

¹Centro Hospitalar São João, 4200-319 Porto, Portugal; ²Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ³Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal; ⁴Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

**Correspondence:** Ana IC Teixeira (enf.anat@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O146

## Background

Evidence based practice (EBP) is defined as an integration of best research evidence with clinical expertise and patient values in clinical decision making [1, 2]. Research confirms positive outcomes when implementing EBP: patient safety; improved clinical outcomes; reduced healthcare costs and decreased variation in patient outcomes [3]. Considered as a standard of care, EBP has benefits for nurses, patients, general population, health care systems, as well as for research and education. Authors describe several types of obstacles to the use of research in practice: characteristics of the adopter, organization, innovation and communication [1]. Individual barriers include lack of knowledge and how to critique research studies; lack of awareness; colleagues not supportive of practice change and nurses feeling a lack of authority to change practice. Organizational barriers include insufficient time to implement new ideas; lack of access to research; and lack of awareness of available educational tools related to research [3]. The most important factor related to nurses' EBP is support from their employing organizations to use and conduct

research. Programme implementation is most likely to be successful when it matches the values, needs and concerns of practitioners. Concerning the development and implementation of competence for EBP, firstly, is important to identify the barriers.

## Objective

Our objective is to explore and describe nurse's perceptions of these barriers in our context.

## Methods

This study is part of a larger one, namely: "Clinical Supervision for Safety and Care Quality" (C-S2AFECARE-Q). To answer our research question a convenience sampling strategy was employed to distribute 500 questionnaires to nurses working in a central hospital in the north of Portugal. Data was collected between April and July 2017. They returned 260 questionnaires, 98 of these with the answer to the following question: "In your opinion, which are the barriers for the implementation of EBP in your context?". Data analyses were based on content analysis proposed by Bardin (1977).

## Results

Barriers were allocated into categories: Organization; Leaders and Management; Professionals and evidence [4]. Nurses reported perceived barriers in all these levels. In the organization' barrier, they identified lack of organizational culture; lack of support from management and outdated and unquestioned routines. They also reported insufficient support from the leaders. In individual terms, they identified negative attitudes, such as lack of motivation, resistance to change, lack of time and inadequate knowledge and skills.

## Conclusions

Our results are consistent with other authors' findings [5]. Nurses are clearly aware of the barriers in their context.

## References

1. Munten G, van den Bogaard J, Cox K, Garretsen H, Bongers I. Implementation of Evidence-Based Practice in Nursing Using Action Research: A Review. Worldviews Evid Based Nurs. 2010;7(3):135-157.

2. Ubbink D, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open Journal. 2013;3:e001881.

3. Black AT, Balneaves LG, Garossino C, Puyat JH, Qian H. Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians. J Nurs Adm. 2015;45(1):14-20.

4. Jylhä V, Oikarainen A, Perälä M, Holopainen A. Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. World Health Organization; 2017 [cited 2018 Jan 18]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/publications/2017/facilitating-evidence-based-practice-in-nursing-and-midwifery-in-the-who-european-region-2017.

5. Pereira RPG, Cardoso MJ, Martins MA. Atitudes e barreiras à prática de enfermagem baseada na evidência em contexto comunitário. Revista de Enfermagem Referência. 2012;3(7):55-62.

6. Solomons N, Spross JA. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Journal of Nursing Management. 2011;19(1):109-120.

## Keywords

Nursing, Evidence-Based Practice, Barriers, Hospital health care.

O147

## Patient identification, patient safety and clinical audit

Cecilia Rodrigues, Manuel Valente
Centro Hospitalar do Porto, 4099-001 Porto, Portugal

**Correspondence:** Cecilia Rodrigues (ceciliarodrigue@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O147

## Background

The correct identification of the person under health care in an institution is a basic principle of a patient safety culture and quality of care provided. Failures associated with patient identification processes are the cause of medication errors, transfusions, complementary diagnostic and therapeutic screenings, invasive procedures performed on wrong persons, and other incidents of high severity.
**Objective**

Identify if all hospitalized patients have identification wristbands and check if the name is correct and readable.

**Methods**

In a 580-bed adult teaching hospital, between January and December 2017, on random days of each month, patients were audited for identification by wristband by a team of nurses with experience in clinical audit.

**Results**

In the 12 months studied, 161 audits were performed, resulting in 3,539 patients audited. From the total patients audited, 3,406 (96.2%) were correctly identified with wristbands. There were 133 failures: 113 patients had no identification wristband, 19 patients had an identification wristband, but the name was unreadable and 1 patient had a wristband with the wrong name. The rate of correctly identified patients increased progressively over the months: in the first month (January 2017) 89.3% of patients were correctly identified with a wristband; in December 2017, the rate of correctly identified patients was 95.0%. The partial results of this audit were disclosed in general risk management meetings with clinical services in March, June and September 2017.

**Conclusions**

Given the potential negative implications of the absence of identification of the person undergoing health care, these results indicate that there is a clear opportunity for improvement in patient identification. Clinical audit has proved to be an instrument for improving quality and safety, particularly in improving the identification of patients.

**Keywords**

Patient safety, Patient identification, Clinical audit.

## O148

### Demographic differences in quality of life in elderly population of Tâmega e Sousa

Sara S Lima¹,², Raquel Esteves¹,², Clarisse Magalhães¹,², Fátima Ribeiro¹,², Lurdes Teixeira¹,², Ana Teixeira¹,², Fernanda Pereira¹,²

¹Cooperativa De Ensino Superior Politécnico Universitário, 4585-116 Gandra, Paredes, Portugal; ²Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, 4585-116 Gandra, Paredes, Portugal

**Correspondence:** Sara S Lima (ssofialima@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O148

**Background**

Aging population is associated with an increase in pathologies of prolonged evolution, making necessary to redirect and reorganize social and health structures, in order to meet the specific needs of the elderly population.

**Objective**

To characterize the demographic profile of the elderly population of the region of Tâmega e Sousa regarding quality of life as well as functionality level and social support; and to find differences in quality of life according to gender and age.

**Methods**

This cross-sectional study included 200 participants, 67% women with a mean age of 72 years old (SD=5.3). A sociodemographic questionnaire, SF-36 to assess quality of life (physical and mental dimension), Barthel Index to assess functionality level and Satisfaction with Social Support Scale to assess satisfaction with social support were used.

**Results**

For mental quality of life the mean score was 59.69 (SD=12.78) and 49.80 (SD=16.38) for physical quality of life. Satisfaction with social support was positively associated to both mental (r=.476, p<.001) and physical quality of life (r=.457, p<.001) as well as with functionality level (r=.386, p<.001; r=.458, p<.001, respectively). There were differences in mental (t(195)=-2.998, p=.003) and physical quality of life (t(195)=-3.358, p=.001) according to gender and according to age, i.e., the youngest participants (< 71 years old) showed high mental

(t(197)=-33.552, p<.001) and physical (t(197)=2.466, p=.015) quality of life.

**Conclusions**

The results highlight the role of social support and level of functionality in the quality of life of this population, emphasizing the need to foster the integration of this population into social programs and leisure time as well as to promote physical activity in order to improve the level of functionality. Physical activity improves independent living, reduces disability, and improves the quality of life of the elderly. Contrary to the literature, programs should be constructed taking into account that men presented worse quality of life and should be directed to the older ones, as expected. Therefore, results show the importance to implement multidisciplinary programs, tailored, with older people profiles, allowing the development of an integrated social and health response to the elderly population of this region.

**Keywords**

Aging, Elderly people, Quality of Life, Social Support, Functionality, Social and health structures.

## O149

### Healthy lifestyles & literacy for health in work context- what trend?

Otilia Freitas¹,², Gregório Freitas¹,², Clementina Morna¹,², Isabel Silva¹,², Gilberta Sousa¹,², Rita Vasconcelos³, Luís Saboga-Nunes⁴,⁵, Estudantes Enfermagem¹

¹Center for Health Technology and Services Research, University of Madeira, 9020-105 Funchal, Madeira, Portugal; ²Higher School of Health, 9020-105 Funchal, Madeira, Portugal; ³Faculty of Exact Sciences and Technology, University of Madeira, 9020-105 Funchal, Madeira, Portugal;

⁴Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisboa, Portugal; ⁵Institute of Sociology, University of Freiburg, 79098 Freiburg, Germany

**Correspondence:** Otilia Freitas (omsfreitas@uma.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O149

**Background**

In the National Plan for Occupational Health (PNSO) - 2nd Cycle 2013/2017, goals are established to increase health gains and guarantee the value of the workers' health in groups of employers by those responsible for governance and society in general. One of the specific objectives is to promote health and work practices and healthy lifestyles at the workplace, concerning private sector companies and Public Administration [1].

**Objective**

To describe health lifestyles and health literacy of workers of a company of the tertiary sector of Região Autónoma da Madeira, Portugal.

**Methods**

Descriptive exploratory study, with a non-probabilistic convenience sample of 118 workers, with mean age of 45 years, predominantly male (88.1%). We used a sociodemographic data collection instrument, the FANTASTIC Lifestyle Questionnaire [2] (αC 0.725) and the European Questionnaire on Literacy for Health, Portuguese version [3], (αC of 0.97). A favourable opinion was obtained from an ethics committee and the ethical procedures inherent to this type of study were respected.

**Results**

It was found that 11.9% of the respondents presented a general level of Good (73 to 86), 55.9% of Very Good (85 to 102) and 32.2% of Excellent (103 to 120) lifestyle. Regarding general health literacy, 56.70% of the respondents had limited literacy levels, being 7.20% inadequate and 49.50% problematic. The trend towards limited literacy, observed in general literacy, remained in all three domains. Thus, in the area of Health Care, 48.3% of the respondents had limited levels of literacy, being 8.47% inadequate and 39.83% problematic. Concerning disease prevention, 44.06% of the respondents showed limited levels of literacy, being 11.86% inadequate and 32.20% problematic. In terms of health promotion, 47.46% of the respondents showed limited levels of literacy, being 11.02% inadequate and 36.44% problematic. There is a positive (p = 0.277) and statistically
significant correlation between the general lifestyle score and the overall health literacy score (p value = 0.002).

## Conclusions

The results suggest the importance of an intervention with integrated activities and promoters of healthy lifestyles and of health literacy, focusing strategically on health education in the work context, aiming to raise awareness among the target population.

## References

1. DGS. Plano Nacional de Saúde Ocupacional 2013/2017. https://www.dgs.pt/saudeocupacional/programa-nacional4.aspx.

2. Saboga-Nunes L, Sorensen K, Pelikan J, Cunha M, Rodrigues E, Paixão E. Cross-cultural adaptation and validation to Portuguese of the European Health Literacy Survey (HLS-EU-PT). Atenção Primária. 2014;46(1):13.

3. Silva AMM, Brito IS, Amado J. Adaptação e validação do questionário "Estilo de Vida Fantástico": resultados psicométricos preliminares. Referência. 2011;3:650.

## Keywords

Healthy lifestyles, Health literacy, Work context, Nursing.

## O150

### 3rd pressure ulcer prevalence study in community setting - CSAH-USIT

Manuela Dias, Ana Rocha

Unidade de Saúde da Ilha Terceira, Centro de Saúde de Angra do Heroísmo, 9700-121, Açores, Portugal

**Correspondence:** Manuela Dias (maria.mm.dias@azores.gov.pt)

BMC Health Services Research 2018, **18**(Suppl 2):O150

### Background

Pressure ulcers are a problem to health care institutions and professionals. In Azores Islands, there are few prevalence studies in community settings and the results point to prevalence rates of 18.5%, according to the Nursing Scientific Investigation Group (ICE) [1] in 2006, and of 26.49% according to Rodrigues and Soriano [2], in 2010. The National Security Patient Plan 2015-2020 [3] recommends that all health institutions should supervise this problem every six month, so "Gabinete de Saúde Comunitária" is already conducting the 3rd Pressure Ulcer Prevention Study.

### Objective

This study aims to examine the prevalence rate of pressure ulcers in patients living at home, to characterize those patients as well as the most severe ulcers.

### Methods

This was a descriptive cross-sectional study using a quantitative approach with a questionnaire, which took place during November's first week, in 2017. The population was the one attending Angra Health Centre, assisted by nurses, in a community setting. Data was analysed using Excel 2007. The study was performed after the Health Centre's approval. A sample of 26 patients, with pressure ulcers, 54% female, with a medium age of 79.09 years participated in the study. Most of the patients (46.15%) belonged to the age group between 80-89 years.

### Results

The study reported a prevalence rate of 7.58%. There was a ratio of pressure ulcers *per* participant with pressure ulcer of 1.5, where the sacrum/coccyx was the main critical area. Most of the pressure ulcers recorded was category II (42.31%), with an evolution situated on 4.42 months. 77% had high risk of pressure ulcer development according to the Braden Scale; 92.31% of the patients had prevention devices on bed and only 31.25% had them on sitting chairs. Upon analysis of the three studies, we noticed that the prevalence rate had increased, the medium age decreased, with the largest group belonging to the group between 80-89 years old. There was also an increased number of the sacrum/coccyx localization in this group.

### Conclusions

This study allowed us to analyse, briefly, the pressure ulcer context, in which nurses spend a large amount of time caring and showing some strategies for recovery. Targeting those findings should be

implemented in some of these community settings, in order to improve the health quality of the patient.

## References

1. Gomes LM. Prefácio In Grupo ICE. Investigação Científica em Enfermagem, Enfermagem e úlceras de pressão: Da reflexão sobre a disciplina às evidências nos cuidados. Angra do Heroísmo: Grupo ICE. 2008; p. 8-13.

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

3. Diário da República. Plano Nacional para a Segurança dos Doentes 2015-2020, 2.ª série — N.º 28 — 10 de fevereiro de 2015.

## Keywords

Pressure Ulcer, Prevalence, Community settings, Nursing.

## O151

### Relationship between health literacy, electronic health literacy and knowledge of sexually transmitted diseases in workers of a Portuguese hospital

Alice Gonçalves¹, Anabela Martins², Clara Rocha³, Diana Martins¹,⁴, Isabel Andrade³, Margarida Martins⁵, Paula Vidas⁶, Paulo Polónio⁷, Fernando Mendes¹,⁸,⁹,¹⁰

¹Biomedical Laboratory Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Department of Physiotherapy, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ³Department of Complementary Sciences, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ⁴Institute for Research and innovation in Health Sciences, University of Porto, 4200-135 Porto, Portugal; ⁵Emergency Service, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁶Cardiology Service, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁷Laboratory Medicine Hospital, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal; ⁸Biophysics Institute, Center for Neuroscience and Cell Biology-Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ⁹Center of Investigation in Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; ¹⁰Coimbra Institute for Clinical and Biomedical Research, University of Coimbra, 3094-001 Coimbra, Portugal

**Correspondence:** Alice Gonçalves (alicevbv@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O151

### Background

Health literacy (HL) can be defined as the individual capacity of obtaining and understanding information, making appropriate decisions about health. An adequate level of HL is fundamental for risk awareness and behaviour change, as well as for disease prevention. Electronic health literacy (eHL) can be useful in promoting health, but it demands the capacity of judgment towards the obtained information and the ability to work with new technologies. Due to the high prevalence of sexually transmitted diseases (STDs) in the general population, it's important to evaluate and relate these health concepts.

### Objective

To evaluate and relate levels of HL and eHL with STD knowledge of professionals of a Portuguese Hospital.

### Methods

149 individuals from different professional categories, working at a medium size Portuguese Hospital, answered an anonymous questionnaire, composed of four parts: socio-demographic data, STDs knowledge, and the Portuguese version of both Newest Vital Sign (to assess the functional HL) and eHEALS (to assess the eHL).

### Results

Altogether 66.0% of the sample had the possibility of an adequate HL; 59.2% of those individuals were health professionals and 76.3% had a high knowledge on STDs. 72.4% were female and 27.5% male, showing similar possibility of an adequate HL (66.7% and 61.0%,
respectively). Concerning the individuals with the possibility of an ad-
equate level of HL, 27.5% were 31-40 years old and 90.6% held a
higher education degree, while 7.3% had only completed high
school. In general, "I know what health resources are available on the
Internet" and "I have the skills I need to evaluate the health resources I
find on the Internet" had the highest mean (3.99) and "I feel confident
in using information from the Internet to make health decisions" had
the lowest with 3.08.

Conclusions

Individuals with higher education, especially in health sciences, have higher probability of an adequate HL. Age may also be an interfering factor, since the youth nowadays, has more access to information early in life. Our results also show that 50% of the studied population had the possibility of an adequate level of HL and a high knowledge in STDs, which is an average percentage for people who work at this hospital. This can be changed, using specific education procedures, such as lectures or seminars, to increase HL and knowledge on STDs.

References

1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health;12(1):80.

2. Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2):e9.

3. Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. J Med Internet Res. 2006;8(4):e27.

Keywords

Health literacy, eHealth literacy, Risk behaviour, Health professionals.

O152

Stigmatizing attitudes toward mental illness in future health professionals

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

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

Correspondence: Daniel Carvalho (drscarvalho@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):O152

Background

Health professionals, like nurses, still have concerns and negative at-
titudes towards people with mental illness, despite development of
mental health services [1]. Final year students were found to be less
stigmatizing [2], being important to pay special attention to the edu-
cation of these professionals and on-the-job training [1].

Objective

To access the levels of stigmatizing attitudes towards mental illness, and to characterize the determinants of these attitudes, developed by health students.

Methods

A quantitative, cross-sectional correlational study was performed. A non-probabilistic sample of health students from a school in the centre region of Portugal was considered, and data was collected with a questionnaire with sociodemographic questions, a question about perception on their knowledge about mental health (scoring 0 to 5) and the Community Attitudes Toward the Mentally Ill Scale (scoring 40 to 200) [3]. Ethical procedures were taken into account during research, according to the Helsinki Declaration.

Results

The students inquired (N=636) were representative of five health de-
grees, namely, Dietetics, Nursing, Physiotherapy, Speech Therapy and
Occupational Therapy, mostly female (82.1%), with an average age of
21.35 (SD=4,29; Median=20). A low percentage (6.6%) had already suf-
fered from a psychiatric disease, mainly humour disorders (4.1%) and
37.6% had regular contact with a patient with mental illness in their
lives. The sample had medium-low levels of stigmatizing attitudes to-
wards mental illness (Mean=122.72; SD=5.19), being these negative

attitudes more relevant in authoritarianism (Mean=24.17; SD=4.34) and
social restriction (Mean=20.53; SD=4.93) areas. Male students showed
more positive attitudes towards authoritarianism (p=0.004) and social
restriction (p=0.007) and females towards Benevolence (p=0.016) and
Community Mental Health Ideology (0.004). Nursing students had more
frequent stigmatizing attitudes and physiotherapy students showed
better attitudes (p=0.021). Students who have had mental illness had
more stigmatizing attitudes in general (p=0.039), regarding all areas
(p<0.005) except for Community Mental Health Ideology. Students who
had regular contact with a mental health patient, had more stigmatiz-
ing attitudes in general (0.031) and in authoritarianism (p=0.039).

Conclusions

It was found medium-low levels of stigmatizing attitudes towards
mental illness among the health students inquired. There was also
evidence that having a mental disorder or having regular contact
with mental health patients can increase stigmatizing attitudes of
health students. This highlights the importance of intervention in
these students, not also to improve attitudes towards mental health
patients, but also to decrease the self-stigma that was also identified
by these results.

References

1. Ihalainen-Tamlander N, Vähäniemi A, Löyttyniemi E, Suominen T, Välimäki M. Stigmatizing attitudes in nurses towards people with mental illness: a cross-sectional study in primary settings in Finland. Journal of Psychiatric and mental Health Nursing. 2016;23(6-7):427-437.

2. Mas A, Hatim A. stigma in mental illness: attitudes of medical students towards mental illness. Med J Malaysia. 2002;57(4):433-444.

3. Taylor S, Dear M. Scaling community Attitudes Toward the Mentally Ill. Schizophrenia Bulletin. 1981;7(2):225-240.

Keywords

Mental health, Stigma, Health students, Attitudes.

O153

Psychological symptoms and mental health stigma in teaching professionals

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

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

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

BMC Health Services Research 2018, **18**(Suppl 2):O153

Background

Teaching professionals are recognised to be submitted to a daily stress, partly due to dynamic interactions associated with the teaching role, which leads to experiences of psychological and psychosomatic symptoms [1]. Facing mental health problems influences stigma towards mental illness. In this situation they are predisposed to accept preconceptions leading to internalized stigma [2]. Research has referred teachers as having negative attitudes towards mental illness [3]. Considering that there is little known about teacher professionals in secondary and higher education [4], this study addresses mental health stigma and psychological symptoms in these settings.

Objective

To characterise psychological symptoms and mental health stigma in teaching professionals; identify the differences between high-school and higher education teachers stigma; correlate psychological symptoms and mental health stigma.

Methods

Cross-sectional correlational study, with a non-probabilistic sample of 96 Portuguese teaching professionals. Data were collected using an on-line questionnaire composed by socio-demographic information, the Portuguese version of Brief Symptom Inventory (BSI) and the Attribution Questionnaire to Measure Mental Illness Stigma (AQ27) [5]. Ethical procedures were taken into account during research, according to the Helsinki Declaration.