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- Association between living setting and malnutrition among older adults: The PEN-3S studyPublication . Madeira, Teresa; Peixoto-Plácido, Catarina; Sousa-Santos, Nuno; Santos, Osvaldo; Costa, Joana; Alarcão, Violeta; Nicola, Paulo Jorge; Severo, Milton; Lopes, Carla; Clara, João GorjãoObjectives: Malnutrition is frequent among older adults, especially those living in nursing homes, but the association between residential setting and nutritional status is controversial. The aim of this study was to examine the association between living setting (nursing home versus community) and malnutrition while adjusting for demographic, socioeconomic, health-related, and psychosocial factors. Methods: This cross-sectional study included a randomly selected representative sample of Portuguese adults ≥65 y of age. Interviewers collected data regarding demographic and socioeconomic characteristics, nutritional status, physical activity, energy intake, cognitive function, self-reported general health, functional status, symptoms of depression, and loneliness. Logistic regression models were used to estimate the association between residential setting and malnutrition. Results: Participants were 1186 nursing home residents (72.8% women, 49.2% ≥85 y of age) and 1120 community dwellers (49% women, 21.3% ≥85 y of age). Following Mini Nutritional Assessment (MNA®) criteria, 29.6% of nursing home residents and 14.1% of community dwellers were at risk of malnutrition, whereas 2.3% and 0.3%, respectively, were malnourished. The living setting was not significantly associated with malnutrition after adjusting for functional status, symptoms of depression, and feelings of loneliness (odds ratio, 1.03; 95% confidence interval, 0.67–1.58). Conclusions: Risk of malnutrition and malnutrition are more prevalent among nursing home residents than community dwellers. Physical (functional status) and mental health (symptoms of depression and loneliness) seems more relevant to nutritional status than residential setting by itself. These findings should be taken into account when designing public health policies to tackle malnutrition among older adults.
- Avaliação familiar e processo de enfermagem: programa de desenvolvimento de competênciasPublication . Henriques, Carolina Miguel Graça; Santos, Eva João De Jesus; Barroso, TerezaBackground: In the family approach, it is essential for nurses to have tools to intervene. The Calgary Family Assessment Model (MCAF) is an important instrument in family nursing practice. Objectives: To know the importance attributed to the family by nurses who are part of a family health unit (FHU) in the Central Region of Portugal; Identify nurses’ knowledge of family assessment by applying the MCAF; To evaluate the impact of the application of an intervention program involving knowledge and skills on family assessment by the MCAF in nursing professionals. Methodology: Longitudinal, quasi-experimental study, performed in two moments of data collection, pre and post test design, without control group, with 8 nurses, selected by the non-probabilistic/accidental /convenience method. Results: Nurses have family supportive attitudes. There are significant statistical differences in knowledge and skills in family assessment by the MCAF before and after intervention. Conclusion: The implementation of intervention programs in family assessment by the MCAF, allows knowledge transfer and skills development. © 2019, Escola Superior de Enfermagem de Coimbra. All rights reserved.
- Desenvolvimento de Competências em Enfermagem à Pessoa em Situação Crítica – Melhoria da Qualidade dos Cuidados à Pessoa internada – necessidades formativas em situações de emergência e reanimaçãoPublication . Todo Bom, Luís Filipe Pereira; Mendonça, Susana Maria SobralO presente relatório emerge no âmbito do Ciclo de Mestrado em Enfermagem Médico- Cirúrgica – área de especialização em Enfermagem à Pessoa em Situação Crítica (PSC), cujo objetivo visa a obtenção do grau de Mestre, encontrando-se dividido em 2 partes distintas. Na Parte I, evidencia-se o desenvolvimento de competências através de uma metodologia descritiva, analítica e crítico-reflexiva sobre as atividades desenvolvidas, as experiências vivenciadas, e as dificuldades vividas no percurso do desenvolvimento das competências como Mestre, das competências comuns do Enfermeiro Especialista (EE) e das especificas do Enfermeiro Especialista em Enfermagem Médico-cirúrgica na área de Enfermagem à PSC (EEEMCPSC). Destacamos a promoção do desenvolvimento substancial do raciocínio crítico, o aumento dos conhecimentos e o fortalecimento de um suporte efetivo para as futuras tomadas de decisão. A intervenção de enfermagem baseada em evidencia científica é estruturante à diferenciação do Mestre e do EE, bem como a construção de conhecimentos científicos colaboram para fundamentar a tomada de decisão, tanto no domínio da prestação de cuidados à pessoa, como nos restantes domínios de intervenção do enfermeiro. Nos EC sentimos que o EE deve mobilizar todos os conhecimentos e competências adquiridas para a pratica diária de cuidados, e ainda promover a prática baseada na evidência, contribuindo para uma prática de excelência. Naturalmente, na área especializada dos cuidados à PSC, também as competências comuns assumem um valor crucial para obter ganhos em saúde para a pessoa e família, equipa e instituição. A Parte II teve por base um projeto de investigação-ação num serviço de internamento do Serviço Nacional de Saúde (SNS), que pretendia responder à questão: “Quais as necessidades formativas em situações de emergência e reanimação?”. Partindo da hipótese: As dificuldades que os profissionais de saúde sentem na assistência à Paragem Cardiorrespiratória (PCR) Intra-Hospitalar variam em função de variáveis sociodemográficas e fatores como a experiência profissional, o contexto profissional e a formação académica. Assim, foi implementada a Escala de Perceção de Dificuldades na Assistência à PCR Intra-Hospitalar (EPDAPI) (Catalão, 2017) a 21 enfermeiros em dois momentos distintos. Os resultados mostraram que é possível melhorar os cuidados e os conhecimentos dos profissionais através da formação. A aquisição de habilidades profissionais específicas deve dar resposta às necessidades de cuidados de saúde das populações. É necessário que o enfermeiro fundamente a sua intervenção em evidência científica.
- HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009–2014Publication . Augusto, Gonçalo; Abrantes, Alexandre V.; Martins, Maria R.; Dias, SaraThe global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals
- Intervenção da Terapia Ocupacional na toxicodependência: estudo de caso na Comunidade Terapêutica Clínica do Outeiro – PortugalPublication . Ribeiro, Jaime; Mira, Eva; Cid, Inês; Santos, Mariana; Braúna, Mônica Alencar Leão da CostaAs comunidades terapêuticas surgiram para dar resposta a indivíduos com perturbações por uso de substâncias. O artigo tem por objetivo entender a intervenção da Terapia Ocupacional na Comunidade Terapêutica “Clínica do Outeiro - Portugal”, descrevendo a perceção dos indivíduos com perturbações por uso de substâncias, dos Terapeutas Ocupacionais e dos restantes elementos da equipe. Estudo descritivo-exploratório de abordagem qualitativa, por meio de estudo de caso. Foram utilizadas entrevistas junto dos clientes e Terapeutas Ocupacionais e grupo focal com a equipe multidisciplinar para a recolha de dados. A Terapia Ocupacional destaca-se pela maior proximidade que estabelece com os utentes, bem como pelo dinamismo, criatividade e pela motivação que incute, desempenhando um papel preponderante ao nível da (re)estruturação de rotinas, desempenho das Atividades de Vida Diária (AVD) e Atividades de Vida Diária Instrumentais (AVDI), lazer e participação social dos indivíduos com perturbações por uso de substâncias. O TO surge como essencial nesta comunidade, como profissional vocacionado para um trabalho de adaptação e inclusão do indivíduo na comunidade terapêutica através da aquisição das necessárias competências de desempenho ocupacional necessárias para a vida quotidiana em sociedade .
- Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese PopulationPublication . Lages, Adriana De Sousa; Oliveira, Diana; Paiva , Isabel; Oliveira, Patrícia; Rebelo-Marques, Alexandre; Carrilho, Francisco; Frade, João Gonçalo Leal de Oliveira e SilvaIntroduction: Diagnosis of Cushing’s syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined.Material and Methods: Three groups of subjects were studied: normal subjects, suspected and proven Cushing’s syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 μg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden’s J index.Results: We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing’s syndrome. 2.5th- 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 μg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 μg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between late-night salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing’s syndrome group.Discussion: The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing’s syndrome (0.6798 ± 0.52 μg/dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 μg/dL with high sensitivity and specificity.Conclusion: Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolism
- Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paperPublication . Silva-Cardoso, José; Fonseca, Cândida; Franco Fátima; Morais, João; Ferreira, Jorge; Brito, DulceHeart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
- Proposal of an integrated decision support system for Tuberculosis based on Semantic WebPublication . Lima, Vinícius; Pellison, Felipe; Bernardi, Filipe; Carvalho, Isabelle; Alves, Domingos; Rijo, Rui, Rui Pedro Charters LopesEpidemiological surveillance of Tuberculosis (TB) requires a strong integration of different health services, programs and levels of care. The deepening and broadening of data management techniques must be constantly carried out to increase the integrality of healthcare. Otherwise, knowledge extraction and clinical and administrative decision-making processes are significantly hampered, directly affecting the management and quality of health services. Thus, this work aims to establish a computerized decision support system capable of collecting, integrating and sharing TB health data in Brazilian Unified Public Health System. Also, it will allow the monitoring of infected patients and the visualization of consolidated information of regular TB and its resistant variants for health professionals and managers. The data will be made available from heterogeneous, disconnected and unstructured sources by combining traditional web services, Semantic Web resources and security algorithms. A solid knowledge base applied to epidemiological surveillance, health information governance and clinical support will be enabled to integrate the multiple areas of TB patients care, as well as to support the creation of more accurate operational and diagnostics models
- Psoriatic arthritis and ankylosing spondylitis impact on health-related quality of life and working life: a comparative population-based study.Publication . Rodrigues, Joana; Rodrigues, Ana Maria; Sousa, Rute Dinis; Branco, Jaime Cunha; Canhão, Helena; Dias, SaraPsoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients' quality of life (QoL), health care systems and society. There is very limited data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheuma - tic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. Methods: We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects, over 18 years old, were screened for RMD. Spondyloarthritis (SpA) was defined by a posi tive expert opinion combined with the fulfillment of the Assessment of Spondyloarthritis International Socie ty (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic di - seases. Results: Prevalence rate of SpA was of 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (b=- 0.08; p=0.031). AS and PsA also had worse QoL when compared with participants with other RMD (b=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. Conclusions: AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheuma tic conditions in Portugal.
- RELATÓRIO FINAL DE ENSINO CLÍNICO Desenvolvimento de Competências Especializadas em Enfermagem à Pessoa em Situação CríticaPublication . Silva, Rui Pedro Filipe da; Sousa, Joana Sofia Dias Pereira deO relatório final surge no âmbito do 1.º Curso de Mestrado em Enfermagem Médico-Cirúrgica na Área de Especialização em Enfermagem à Pessoa em Situação Crítica, da Escola Superior de Saúde do Instituto Politécnico de Leiria. Este tem como objetivos descrever e refletir sobre o desenvolvimento das competências comuns do enfermeiro especialista e das competências específicas do enfermeiro especialista em enfermagem médico-cirúrgica na área de especialização à pessoa em situação crítica. Além do mais, pretende, ainda, descrever o desenvolvimento de um trabalho de investigação, em formato de artigo, em processo de submissão. Este trabalho encontra-se dividido em duas partes. A parte I aborda, através do método descritivo e reflexivo, as atividades e estratégias adotadas no desenvolvimento das competências do enfermeiro especialista, nos três ensinos clínicos que decorreram em contexto de serviço de urgência, de serviço de medicina intensiva e de contexto de emergência extra-hospitalar, como escolha opcional. A parte II descreve um trabalho de investigação, de metodologia quantitativa, exploratória e correlacional, desenvolvido no local laboral, denominado de “O Conhecimento dos Enfermeiros sobre a Aplicação de Contenção Mecânica no Utente em Serviço de Urgência”. O desenvolvimento do trabalho de investigação realizado é divulgado em formato de artigo.