Pressure ulcer risk profiles of hospitalized patients based on the Braden Scale: A cluster analysis.

AIM: The aim of this work is to identify the pressure ulcer risk profiles of hospitalized patients with reference to Braden Scale subscales. METHODS: A total of 2996 hospitalized Portuguese participants were screened using the Braden Scale. A hierarchical and nonhierarchical cluster analysis was conducted, with ethical approval. RESULTS: Five risk profiles (clusters) based on the first risk assessments were identified. Regarding the Braden Scale total score, two profiles with high risk and three profiles with low risk of pressure ulcer development were identified. All clusters were statistically significantly different in terms of sociodemographic and clinical variables. When the first and the last risk assessments were compared, all the clusters improved the Braden Scale total score on the last risk assessment, except Cluster 4 (low-risk category). Clusters 3, 4 and 5, which were classified as low risk, decreased in several Braden subscales at the last risk assessment. CONCLUSIONS: The classification of low risk may misguide the early identification of patients with individual risk factors. Increasing the awareness of health care professionals for the importance of risk assessment of each Braden subscale is necessary for pressure ulcer prevention. We recommend the implementation of strategies for early identification of patients at risk at local and national levels.

Hospital-acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders.

AIM: The aim of this study was to understand the perceptions of 11 Portuguese nurses' stakeholders regarding pressure ulcers prevention practice and reality in the hospital setting. METHODS: Convenience sampling was used to recruit nursing stakeholders for a heterogeneous focus group. A semi-structured interview was conducted with 11 nursing stakeholders involved in pressure ulcers prevention and/or patient safety. MaxQda 2020 qualitative analysis software was used in the content analysis and data processing. Informed consent was obtained, and anonymity was guaranteed. RESULTS: Four themes were approached in the interview: (1) Pressure ulcer risk assessment; (2) Nurses and doctors pressure ulcers monitoring; (3) Pressure ulcer risk profiles; and (4) Effective interventions to improve patient safety. The categorisation of the four themes was created aposteriori based on the 'Awareness/Knowledge/Competence, Opportunity, and Motivation - Behaviour Change Wheel' (adapted COM-B system). Interest, responsibility, autonomy, leadership and prioritisation for decision-making were some categories linked to motivation. Braden scale operationalisation, education given during undergraduate degree continued professional health education, missing care, reliability of the records and patients' clinical characteristics emerged as categories associated with awareness/knowledge/competence. Understaffing/nursing hours, health policies, electronic health records systems and clinical language used, access to appropriate equipment and resources, teamwork and clinical support specialist on tissue viability/wound care were some categories related to opportunity. CONCLUSIONS: Pressure ulcer prevention is complex and requires a focussed attitude, robust evidenced-based knowledge and enhanced skills in risk assessment, communication and team collaboration. The highlighted categories could be further analysed at an organisational level to develop tailored strategies that could contribute to successful evidence-based practice implementation. RELEVANCE TO CLINICAL PRACTICE: The findings provide directions for behavioural change in the hospital context related to pressure ulcers prevention through awareness/knowledge/competence, motivation and opportunity to improve care delivered.

Health risk behaviors before and during COVID-19 and gender differences.

Changes in routines and habits, fear of contamination from the coronavirus disease 2019 (COVID-19) virus, and economic crisis have resulted in significant impacts upon individuals' lives, health, and risk behaviors. The present study aims to analyze health risk behaviors and gender differences of Portuguese adults before and during the COVID-19 pandemic. A quantitative analysis using SPSS v. 26 software presents the evaluation of 5746 responses (M = 48.5 years, SD = 14.3), of which 67.7% were female. t Test was used to study differences in means before and during the pandemic and analysis of variance test to analyze gender differences. In the comparative study before and during the pandemic showed a decrease in the number of meals per day, physical activity and perception of sleep quality; an increase in tobacco use, beer consumption, and media use (TV, mobile phone, social networks, and online games). Gender differences study demonstrated that the number of meals per day suffered a decrease from pre to pandemic in women, while increasing in men, becoming prominent in the second moment under study. Both genders had an increase in consumption behaviors and substance use, but women revealed a decrease in the consumption of wine during the pandemic, while men revealed more consumption behaviors in the variables under study. The use of media also changed, with men showing a higher level in TV hours per day, social networks and online games before the pandemic and in TV hours per day and games/online during the pandemic. Women stand out in the use of mobile phone per day during the pandemic. Daily physical activity decreased during the pandemic, as did sleep quality. Males revealed a higher practice of physical activity at both periods, as well as sleep quality. Based on the results presented, it is expected that considerations and actions in the scope of public health policies and health prevention and promotion, will be rethought and adapted to the specificities of each gender.

#COVID#BACKTOSCHOOL: Qualitative study based on the voice of Portuguese adolescents.

Due to the COVID-19 pandemic and the exponential increase in cases, educational institutions worldwide were forced to close, making way for digital learning. After a period of confinement and an online teaching methodology, a new school year has begun. However, this new school year included the application of a wide range of measures that transformed the educative setting. The present study aimed to understand the health consequences for adolescents and young adults (AYA) during the back to school period after the COVID-19 lockdown. This mixed-method study included 304 participants between 16 and 24 years old (M = 18.4, SD = 2.12), female (71.1%), Portuguese (90.8%) and students (85.2%). In general, it was with a pessimistic perspective that young people in general, particularly girls and university students, understood the new school reality postconfinement, the effects on friendship relations, leisure activities and physical activity. By demonstrating AYA's ability and competence to identify and expose their problems, this study intends to raise awareness of the need for their involvement in the issues that affect them.

Foreign adolescents living in Portugal: Quality of life and school experiences.

The present study intends to (1) analyze the differences regarding the quality of life between young foreigners and young Portuguese adolescents; (2) understand the relationship between variables related to the school context and the quality of life of foreign adolescents living in Portugal. In all, 8215 adolescents participated in this study, and only the sub-sample of 578 foreigners was considered. 50.3% are boys, aged between 10 and 22 years old. Foreign students in Portugal have a lower well-being index than Portuguese students and a worse relationship with peers and teachers. Foreign girls like school more than boys, have less difficulties in school and have a higher perception of security at this context. On the other hand, they have a lower perceived academic competence and a worse relationship with peers. The importance of developing programs to promote socioemotional skills, empowering teachers and educators, and promoting the adoption of an inclusive model in schools is highlighted.

Making the best out of youth-The Improve the Youth project.

Adolescents' mental health determines their general health and their mental health as adults. Improve the Youth project (ITY) was created and implemented among Polish and Portuguese adolescents. The aim of the project was to investigate the well-being of Portuguese and Polish adolescents, and to evaluate differences between them in self-rated health, life satisfaction and perceived psychosomatic health. A mixed-method approach was applied. The quantitative part was based on Health Behaviour in School-aged Children (HBSC) 2014 data, including adolescents aged 11-15 years (6026 in Portugal; 4545 in Poland). This study meets the issues raised by the HBSC results, regarding mental health in adolescence, and it is aimed to improve adolescents' social participation and active citizenship. In most study areas, findings in Poland were less favourable than in Portugal. The qualitative part was developed to recognize the main threats for adolescent's well-being. In this, they emphasised that every opportunity to talk about their feelings and needs resulted in improvement of their mental health. Elevated levels of stress were connected to environmental pressure and high expectations that they were often unable to cope with. Nervousness, perceiving that it was impossible to meet expectations, the desire to keep up with their peers, fatigue, and uncertainty of the future increased the feelings of frustration. The differences found between countries may be due to cultural roots, surfacing the relevance of assessing adolescents' mental health needs in the social context of family, school and peers. This study also aims to raise awareness among educators and stakeholders to the importance of youth engagement.

Pressure ulcers: The challenge of monitoring in hospital context.

AIM: To describe and analyse the PUs problem based on data from hospital electronic health records. METHODS: A retrospective cohort descriptive study was performed based on electronic health records (medical and nursing) from adult patients (≥18 years) admitted to medical, surgical and orthopaedics wards during 2016 after implementation of National Strategy of Patient Safety 2015-2020. Ethical approval was obtained. RESULTS: A sample of 3904 patients was obtained, 66% (n = 2575) were older than 65 years, 24.6% (n = 962) at admission and 21.2% (n = 829) at discharge stay at high risk of develop PUs and 88.6% (n = 3458) has no visual skin assessment. PUs identification, categorization and localization are inconsistent between nurses and doctors. CONCLUSION: The creation of a unified minimum dataset for PUs monitoring to standardize data on the occurrence of PUs and assessed the effectiveness of preventive strategies in patient at risk of PUs development at national level is need. Current Portuguese guideline of PUs needs a review and an innovating upgrade with zero tolerance for PUs.

Community-based Youth Participatory Action Research studies with a focus on youth health and well-being: A systematic review.

On the basis of the systematic literature review, we investigate the characteristics of community-based Youth Participatory Action Research (YPAR) programs with a focus on health and well-being and their recommendations for future programs. The study was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Most included a case study design, mixed or qualitative methodology, interview as data collection, and YPAR youth in data reporting. The sample differs between studies, and most of the work took place in the United States. The stages (raise awareness, capacitation, design, motivation, implementation, evaluation, dissemination, and replication) are evident as a fundamental strategy in these programs.

"Hey, we also have something to say": A qualitative study of Portuguese adolescents' and young people's experiences under COVID-19.

OBJECTIVE: (1) To give adolescents and youth a voice and listen to the impact of coronavirus disease 2019 (COVID-19) in their lives; (2) to identify their coping strategies; (3) present lessons learned to be better prepared for future pandemics. METHODS: Six hundred and seventeen participants from 16 to 24 years old (M = 19.2 years; F = 19.1 years) answered the online questionnaire during the pandemic lockdown. Sociodemographic data were analyzed with SPSS version 26 and qualitative data with MAXQDA 2020. Engel's Biopsychosocial model supported the analysis and data presentation. RESULTS: in terms of impacts, stands out: biological-headaches and muscle pain; psychological-more time to perform pleasant and personal development activities, but more symptoms of depression, anxiety, and loneliness, longer screen time, and more substance use; social-increase of family conflicts and disagreements, loss of important life moments, contacts, and social skills, but it allows a greater selection of friendships. Regarding coping strategies, the importance of facing these times with a positive perspective, carrying out pleasurable activities, keeping in touch with family and friends, and establishing routines are emphasized. As lessons for future pandemics, the importance of respecting the norms of the Directorate-General for Health, the need for the National Health System to be prepared, as well as teachers and students for online learning, and studying the possibility of establishing routines with the support of television. CONCLUSIONS: This study illustrates adolescents and young people's perception of the impacts of the pandemic upon them, as well as their competence to participate in the issues that directly affect them. Priorities to mitigate the impact of future pandemics are presented.

Positive youth development, thriving and social engagement: An analysis of gender differences in Spanish youth.

The framework of Positive Youth Development (PYD) arose from a strength-based conception of the transition to adulthood. Although previous literature has provided evidence for some PYD correlates, little is known about gender differences in PYD and its outcomes in thriving and social engagement, which could improve interventions" effectiveness. Thus, this study aimed to examine gender differences in PYD dimensions (i.e., competence, confidence, connection, caring, and character), individual thriving (i.e., psychological adjustment, academic adjustment, and healthy lifestyles) and social engagement, and to examine the associations between them. Data from the 'PYD in a Cross-National Perspective Project" in Spain were collected by administering a paper-based self-report to students from high school and university. Results showed greater scores in connection, caring, and character in women, as well as greater social engagement and academic adjustment. Men presented higher competence and confidence, more frequent physical activity and better psychological adjustment. In addition, more PYD was related to greater social engagement, better psychological and academic adjustment, and healthier lifestyles. Some practical implications for program design may be derived, which underscore the need to promote the five PYD dimensions equally in female and male youths in order to improve their individual thriving and social engagement.

Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review.

The effective approach on pressure ulcer (PU) prevention regarding patient safety in the hospital context was evaluated. Studies were identified from searches in EBSCO host, PubMed, and WebofScience databases from 2009 up to December 2018. Studies were selected if they were published in English, French, Portuguese, or Spanish; incidence of PUs was the primary outcome; participants were adults (≥18 years) admitted in hospital wards and/or units. The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on-screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs. Repositioning only was effective when supported by technological pressure-mapping feedback or by a patient positioning system. Risk-assessment tools are not effective in preventing PUs. PUs in the hospital context are still a worldwide issue related to patient safety. Multiple intervention programmes were more effective in decreasing PU occurrence than single interventions in isolation. Single interventions (prophylactic dressings, support surfaces, repositioning, preventive skin care, system reminders, and education for health care professionals) were effective in decreasing PUs, which was always in compliance with other preventive measures. These results provide an overview of effective approaches that should be considered when establishing evidence-based guidelines to hospital health care professionals and administrators for clinical practice effective in preventing PUs.

Dream Teens: Adolescents-Led Participatory Project in Portugal in the Context of the Economic Recession.

This article describes the implementation process of a nationwide project to enhance young people's participation and active citizenship in the context of Portugal's economic recession. This project used an innovative Positive Youth Development approach that engaged Portuguese youth (aged 11-18 years) through social media tools to facilitate their civic engagement and development. Participants from all over the country were empowered (1) to design and conduct research activities on topics of their choice and about their life contexts and (2) to create ways to improve youth civic participation in their communities, while developing supportive interactions with adults and peers. Overall, youth were engaged in their activities, felt their voices were heard, and felt that they were viewed as experts of their own well-being and living contexts. Youth research actions and preliminary findings were then compiled in a set of recommendations that was formally received by a high commissioner of the Ministry of Health. The article concludes with a discussion of the next steps for the project and its limitations so far.

Emotional Symptoms and Risk Behaviors in Adolescents: Relationships With Cyberbullying and Implications on Well-Being.

Context: Cyberbullying is considered a public health problem with serious consequences on adolescents' health and well-being. Objective: To analyze the relationships between emotional symptoms and risk behaviors with cyberbullying and understand the role of these factors as predictors of well-being. Design: This is a cross-sectional study based on the 2014 Health Behaviour in School-Aged Children of the World Health Organization (HBSC/WHO) study. Results: More girls reported being involved in cyberbullying as cybervictims, whereas more boys reported being involved in cyberbullying as cyberbullies and cyberbully victims. Girls reported more emotional symptoms, especially fear and sadness; boys reported more risk behaviors, specifically drug use and involvement in fights, but a higher well-being when compared to girls. Cyberbullies and cyberbully victims reported higher alcohol consumption than cybervictims; cyberbullies also reported higher drugs consumption compared to cybervictims and cyberbully victims. Well-being was predicted by emotional symptoms and age, independently of gender; for girls, involvement in fights also predicted well-being. Conclusions: If boys and girls, as well as cybervictims, cyberbullies, and cyberbully victims, present different levels of well-being, emotional symptoms, and risk behaviors vary in function of cyberbullying, it is crucial to develop individual interventions focused on the specific needs of each group.

Trends in self-rated health in European and North-American adolescents from 2002 to 2010 in 32 countries.

BACKGROUND: Self-rated health (SRH) in adolescence is known to be associated with health outcomes in later life. We carried out a trend analysis on data coming from three waves of data collected in 32 countries (mostly European) from 2002 to 2010 coming from the Health Behaviour in School-Aged Children surveys. METHODS: SRH in adolescents was assessed using a Likert scale (excellent, good, fair and poor). Responses were dichotomized into 'excellent' vs. 'rest'. Country, age and gender groups were compared based on the odds ratio of declaring excellent SRH in 2010 with respect to 2002 and 2006. RESULTS: The trend for European adolescents indicates an improvement over the last decade, although, in the majority of countries, a higher proportion of adolescents rate their health as excellent during the period 2002-06 with respect to the second half of the decade (2006-10).Girls were found to constantly rate their health as poorer, compared to their male peers, in all countries. Age has also a very stable trend towards a decreasing rating of health with increasing age. CONCLUSION: Decreased rating of health in the period 2006-10 may be a signal of the socio-economic difficulties of Europe in the last part of this decade.

Trends in life satisfaction in European and North-American adolescents from 2002 to 2010 in over 30 countries.

BACKGROUND: Life satisfaction (LS) is an indicator which is widely used for assessing the perception of a child's feeling about his life. METHODS: LS is assessed in Health Behaviour in School-aged Children via the Cantril ladder with 10 steps indicating the worst and best possible life. This range of values (0-10) was dichotomized into 'low' (0-5) vs. 'high' (6-10). Countries, age groups and genders were compared based on the odds ratio (OR) of declaring a higher LS in 2010 with respect to 2002. RESULTS: Analyzing the difference between 2002 and 2010, six countries from Western Europe show decreasing LS: Austria, Canada, Switzerland, Denmark, Finland and Greenland. In contrast, a group of Eastern European Countries, that is, Estonia, Croatia, Lithuania, Latvia, Russia and Ukraine, show a significant increase in LS. Data on gender and age differences confirm the lower rating of LS in girls and a decreasing rating with age. CONCLUSION: The LS scale appears to be a tool capable of discriminating the level of wellbeing of adolescent population among countries.

Trends and correlates of overweight and obesity among adolescents from 2002 to 2010: a three-cohort study based on a representative sample of Portuguese adolescents.

OBJECTIVE: To report the prevalence and factors associated with overweight/obesity in a representative sample of Portuguese adolescents, from three different cohorts. METHODS: Data on 8,610 adolescents aged 11-17, who participated in the 2002, 2006, and 2010 Health Behaviour in School-aged Children survey (HBSC/WHO) were analyzed. Body mass index (BMI) was calculated based on self-reported weight/height. Factors investigated as potential correlates of overweight/obesity were as follows: physical activity, screen time, life satisfaction, and perception of health. RESULTS: The prevalence of overweight/obesity was around 20% for boys and 17% for girls between 2002 and 2010. Among boys, the prevalence of overweight/obesity was negatively associated with age in 2002 (odds ratio, OR = 0.89, P < 0.01), 2006 (OR = 0.92, P < 0.05), and 2010 (OR = 0.91, P < 0.05). Those who engaged in physical activity were less likely to be classified as overweight/obese in 2006 (OR = 0.89, P < 0.01) and 2010 (OR = 0.92, P < 0.05). Among girls, as age increased, the likelihood of being overweight/obese significantly decreased in all years. Results from 2002 (OR = 0.69, P < 0.001) and 2010 (OR = 0.88, P < 0.01) varied by almost 20%. CONCLUSION: The prevalence of overweight/obesity is still high, but seems to have stabilized. Physical activity, for boys, and perception of health, for girls, are factors associated with a lower likelihood of being overweight or obese.

Perceived Quality of Life and Life Satisfaction: Does the Role of Gender, Age, Skills, and Psychological Factors Remain Relevant after the COVID-19 Pandemic?

BACKGROUND: After two years of psychological, physical, social, economic, environmental, and societal challenges, this paper examines the psychological health and well-being of Portuguese students based on their socioemotional skills (SSES), positive youth development (PYD), depression, anxiety, and stress (DASS), as well as the relationship between these variables and their influence on perceived quality of life and life satisfaction. METHODS: This study examined 3235 students from lower to upper secondary, half of whom were female (M = 14.46 ± 1.883 years old). Using SPSS software, descriptive statistics were determined for all variables; mean differences between age and gender were found using ANOVA and the post hoc Scheffe test. Linear regressions with the Enter method were used to study how to predict perceived quality of life and satisfaction with life. RESULTS: Males had scores indicating more SSES|optimism, emotional control, resilience, confidence, sociability, creativity, energy, a sense of belonging to school, and PYD. Girls had better skills for cooperating and relating to teachers but more test anxiety and DASS. Younger adolescents had better psychological health, greater skills, and a better perception of quality of life and life satisfaction when compared to older adolescents. Age, gender, SSES, PYD, and the DASS variables can explain 69% of the variance in life satisfaction, while these variables can explain 60.5% of the variance in perceived quality of life. CONCLUSIONS: These results point to the relevance of SSES for psychological health and well-being, suggesting that interventions should focus on promoting these variables, paying special attention to female gender and age-related challenges.

Civic engagement and mental health trajectories in Norwegian youth.

Introduction: Applying variable-centered analytical approaches, several studies have found an association between civic engagement and youth mental health. In the present study, we used a person-centered approach to explore whether civic engagement was related to optimal trajectories of mental health compared to other trajectories. We also examined how sociodemographic factors, such as socioeconomic status (SES), gender and age were related to youth mental health trajectories. Methods: Our sample comprised 675 students (aged 16-22) who had participated in three waves of data collection (Mage = 18.85, SD = 0.55; 43% males) in the COMPLETE project, a cluster-randomized controlled trial that involved Norwegian upper secondary schools. Results: The results revealed three trajectories of mental health (reflecting a combination of mental distress and mental well-being): optimal, intermediate, and sub-optimal. Contrary to our expectations, higher levels of civic engagement were not related to the optimal trajectory of mental health vs. other trajectories. However, we found that students who reported higher levels of SES and males were more likely to follow the optimal trajectory compared to other trajectories. Discussion: While the findings on civic engagement could be due to our measurement's inability to capture the concept of "dugnad," a well-established civic activity in the Norwegian society, the findings regarding the influence of SES and gender suggest that there is still more work to be done concerning the assessment and advancement of factors that can address mental health inequalities across SES and gender.

Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory.

RATIONALE: The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information. OBJECTIVE: Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs). METHOD: The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection). RESULTS: Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators. CONCLUSIONS: We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

Correlates of Active Commuting to School among Portuguese Adolescents: An Ecological Model Approach.

Active commuting to and from school can be an important contribution to improving health in adolescents. This study aimed to analyze the influence of multilevel variables of the ecological model in the active commuting of a representative sample of Portuguese adolescents. The 2018 Health Behaviour in School-Aged Children questionnaire was applied to 5695 adolescents with an average age of 15.5 years old (SD ± 1.8), 53.9% of whom were girls. The associations were studied by applying chi-square tests and multivariate logistic regression models. In this study, 36.5% of the participants reported walking or cycling to school. Active commuting to school was directly associated with age (OR = 1.2; p < 0.05), strong family support (OR = 1.2; p < 0.05), a moderate to low financial level of the family (OR = 1.3; p < 0.05) and living near the school (OR = 2.4; p < 0.05). The results revealed that an adolescent's choice to travel to and from school using an active mode of transportation increased with strong family support. As a result, promotion campaigns should consider the adolescent's family context.