Mothers' perception of the care of newborn in the home environment.

OBJECTIVES: to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. METHODS: qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. RESULTS: the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. FINAL CONSIDERATIONS: the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.

"A Certainty for you Does Not Mean That it is a Certainty for Science": A Phenomenological Analysis of Experiences of Uncertainty in Clinical Reasoning of Nurses in the Postanesthesia Care Unit.

PURPOSE: To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU). DESIGN: A phenomenological descriptive design, following Colaizzi's analysis. METHODS: Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting. FINDINGS: From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress. CONCLUSIONS: The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice.

Nurses' Views on How to Best Design a Program to Prevent Adolescents' Anxiety in the Perioperative Period. A Qualitative Study.

PURPOSE: To describe the nurses' views for consideration when designing a program to prevent adolescents' anxiety in the perioperative period. DESIGN: A qualitative descriptive case study using focus group and thematic analysis was conducted. METHODS: Three face-to-face focus group interviews were conducted in October and November 2019 in the pediatric department of a university hospital. A purposive criterion method was applied to achieve a sample of 19 pediatric nurse specialists. Data were organized and systematized in the professional software for qualitative and mixed methods data analysis software (MAXQDA) and treated through the thematic analysis method. The COREQ checklist was used to report data collection, analysis, and results. FINDINGS: Four major themes and 14 subthemes regarding the perioperative period were generated. The first, adolescent evaluation, included the knowledge evaluation about procedures, signs and symptoms, and desire to be engaged in care. The second, caring adolescents and parents, means that nurses must be ready to care for both, use the opportunities to implement the nursing interventions, and manage physical teen space to accommodate adolescents in the ward. The third, nurses' challenges in the perioperative period, comprise the lack of time and trained nurses to work with adolescents, and the absence of prior adolescents' preparation and postoperative feedback. The fourth, nursing consultation, consists in promoting interdisciplinarity, developing the nursing interventions, and the main content to be included in the program's design. CONCLUSIONS: Given the challenges experienced by nurses when caring for adolescents in the perioperative period, nurses suggested a systematized assessment of the adolescent at an early stage of the perioperative caring process. Added to this is the nurse's readiness for the adolescent and parents, as well as the existence of trained nurses to evaluate adolescents and to implement non-pharmacological interventions in the perioperative period. A nursing consultation emerges as the most suitable solution to include in a program to prepare adolescents for the surgical procedure and help them to manage anxiety. This kind of intervention should begin in the preoperative period, preferably after the decision on the need for the procedure.

Adolescents' perioperative experiences in relation to inpatient and outpatient elective surgery - a qualitative study.

BACKGROUND: Perioperative experience can be very distressing in adolescence if not managed properly by healthcare professionals. In the clinical context, the emotional expression of the adolescent is less spontaneous, which makes the assessment of anxiety, pain or even the desire to be involved in the perioperative process, difficult. Listening to their perioperative experiences will permit an understanding of their difficulties and expectations, regardless of the surgical intervention undergone. AIM: To explore the adolescents' perioperative experiences in relation to inpatient and outpatient elective surgery. METHODS: Qualitative exploratory study, with thematic analysis approach. A purposive sample of 40 adolescents aged 14-18 years and in the perioperative period, from two paediatric surgery settings in a university hospital, was questioned from January to July 2020. Data were collected using a semi-structured interview and analysed inductively with qualitative thematic analysis. RESULTS: The data yielded one major theme, five themes, and 14 sub-themes. The major theme, Adolescent in perioperative period, included the five themes: (1) emotional and psychological aspects; (2) physical aspects; (3) social aspects; (4) organizational aspects; (5) previous surgical experience. Adolescents expressed fear of the unknown, anxiety, difficulty in pain control, and feelings of autonomy loss. Issues related to withdrawal from school and friends is also a focus of adolescent concern during the perioperative period. Despite showing satisfaction with the way they were cared for, they complained about the lack of pre- and post-operative preparation. CONCLUSION: There are aspects that should be considered when caring for adolescents in perioperative period. As far as possible, programmes to prevent adolescents' anxiety in perioperative period should be designed in a holistic perspective, with aim at the psychological, physical, sociocultural, and organisational aspects.

Effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period. INTRODUCTION: Adolescents undergoing surgery suffer considerable levels of anxiety and distress before surgery, which are maintained beyond the procedure. Although the benefit of non-pharmacological interventions in this area is significant, their efficacy is still under-studied. INCLUSION CRITERIA: This review will consider studies that focus on adolescents aged 10 to 19 years, who have undergone a surgical procedure. All studies that focus on non-pharmacological interventions occurring in the perioperative period designed to reduce anxiety without restrictions on comparators, geography, or culture will be included. METHODS: An initial limited search of PubMed and CINAHL has been undertaken and will be followed by a second search for published and unpublished studies, without limitations of publication date, in major health care-related electronic databases. Studies in English, Spanish, and Portuguese will be included. After full-text studies are retrieved, methodological quality assessment and data extraction will be performed independently by two reviewers. A narrative synthesis will accompany the results and, if possible, a meta-analysis will be performed and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020184386.

Nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents: a scoping review.

OBJECTIVE: The objective of this scoping review was to examine and map the range of nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents. INTRODUCTION: Undergoing surgery involves experiencing fears and uncertainties that lead to an increase in anxiety levels. The interventions used to prevent anxiety in the perioperative period in adolescents must be appropriate to their developmental stage. INCLUSION CRITERIA: Studies involving adolescents (10 to 19 years of age) undergoing any type of surgical procedure and specifying any nonpharmacological interventions administered to prevent anxiety, implemented in the perioperative period, were included in this review. METHODS: A comprehensive search strategy using multiple databases was employed to find relevant studies. The databases search included MEDLINE via PubMed; CINAHL Plus with Full Text via EBSCO; Cochrane Central Register of Controlled Trials; LILACS; Scopus; Library, Information Science and Technology Abstracts; PsycINFO; JBI Connect+; and Cochrane Database of Systematic Reviews. Sources of unpublished studies and gray literature were TDX - Tesis Doctorals en Xarxa (Spain); RCAAP - Repositório Científico de Acesso Aberto de Portugal; OpenGrey - System for Information on Grey Literature in Europe; and MedNar. Studies published in English, Spanish, or Portuguese were included. There was no date restriction, or geographical or cultural limitation applied to the search. The relevant studies and their reported outcomes were organized and analyzed. RESULTS: The database search yielded 1438 articles, and three additional records were added after hand searching. Title, abstract, and full-text review identified 11 papers that met the inclusion criteria. The final data set represented 947 participants. The data were analyzed according to the type of nonpharmacological intervention, population, concept (outcome measured and tool used), context (physical location; preoperative vs. postoperative), frequency and duration of the intervention, and which professional team member implemented the intervention. Eight nonpharmacological interventions were identified, applied either in the preoperative or postoperative context. The nurses were the main professionals administering the nonpharmacological interventions to the adolescents. CONCLUSIONS: A variety of nonpharmacological interventions were used in the perioperative period to prevent anxiety in adolescents. The most common interventions were music/musicotherapy and hypnosis/guided imagery. However, other interventions such as therapeutic play, preoperative preparation program, mothers' presence during the anesthesia induction, distraction, relaxation training, massage therapy, and reading were also identified. These interventions were used alone or in a combination of two interventions, either preoperatively or postoperatively. The adolescents in the early stage (10 to 14 years) were the most studied group and the adolescents in the late stage (17 to 19 years) were the least studied. Future research should focus on the implementation of nonpharmacological interventions in the perioperative period involving adolescents, particularly late adolescents. A systematic review on the effect of nonpharmacological interventions for anxiety management in adolescents in the perioperative period should be conducted. SCOPING REVIEW REGISTRATION: Open Science Framework: https://osf.io/jhwca/.

Ansiedade perioperatória em adolescentes: manifestações e necessidades de controlo. Revisão integrativa / Perioperative anxiety in adolescents: manifestations and control needs. An integrative review

Background: In a phase of development as complex as adolescence, the surgical experience is a great challenge. While there is some knowledge about manifestations of anxiety in children, less is known about manifestations of anxiety in adolescents. Likewise, the knowledge about adolescents needs for control of anxiety in the perioperative period is missing. Aims: To synthesize the existing research on the manifestations of anxiety in adolescents in the perioperative period and to identify the adolescents needs for control of anxiety in the perioperative period. Methods: An integrative review was conducted using a literature search in five different health databases. Only original studies related to the study topic were included. A six-step method was used to develop the revision and to analyze the results. Results: Of the 251 articles initially selected, only five met the inclusion criteria. A total of 114 adolescents from five different countries were represented. The manifes-tations of anxiety were grouped in psychological, social and physical. These manifes-tations were mostly related with fear of surgery, how would they deal with pain, body image change, anxiety itself and the separation from their friends. The needs were 'to be informed' and 'to be involved in the decisions about their own care process'. Conclusions: The adolescents have manifestations of anxiety and specific needs to deal with perioperative anxiety, which need to be taken into account in the planning of perioperative care. Further research is needed to promote the development of an evidence-based program tailored to answer to the adolescent's needs and to minimize their manifestations of anxiety in the perioperative period

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Non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the range of non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents. INTRODUCTION: Evidence shows that 80% of adolescents report having experienced significant anxiety in the perioperative period. Non-pharmacological interventions implemented in the perioperative period are recommended as a resource to help to control anticipatory, separation and perioperative anxiety and fear related to surgical procedures in adolescents. INCLUSION CRITERIA: This review will consider studies that focus on adolescents aged 10 to 19 who have undergone a surgical procedure, regardless of the type of surgery, and participated in non-pharmacological interventions aimed to prevent anxiety in the perioperative period. The intervention may be provided by any healthcare professional. Studies related to non-pharmacological interventions associated with hospitalization in a non-surgical context will be excluded. METHODS: The methodology will follow the JBI recommendations for scoping reviews. Any published and unpublished sources of information will be considered. Studies published in English, Spanish and Portuguese will be included, with no geographical or cultural limitations. Duplicates will be removed and two independent reviewers will screen the abstracts and assess the full text of selected studies, based on the inclusion criteria. The results of study selection will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for scoping reviews. Data synthesis will be presented in a narrative summary to provide a description of the existing evidence.

Nursing students in the community: entrepreneurial strategy and proponent of changes.

OBJECTIVE: To report the insertion of the nursing students of the Franciscan University Center in the community through the project Adopting a Family, contributing to critical thinking within the Nursing academic production and its articulation to collective health. RESULTS: In the professors' evaluation, the activity represented an effective articulation and insertion of the university in the community; for the students, it allowed for spaces of construction, deconstruction and negotiation with the unknown and the uncertain; for the families, it enabled the feeling of being remembered and valued as human beings and citizens. Through the experiences had, the transformation of health practices goes through the emergence and valuation of new knowledge. FINAL CONSIDERATIONS: The insertion of the university in the community is constituted by an entrepreneurial strategy that is proponent of changes, due to its more effective and resolute outreach of health issues proposed by the national health system.

Nursing students in the community: entrepreneurial strategy and proponent of changes / Académicos de enfermería en la comunidad: estrategia emprendedora y proponente de cambios / Acadêmicos de enfermagem na comunidade: estratégia empreendedora e propositora de mudanças

ABSTRACT Objective: To report the insertion of the nursing students of the Franciscan University Center in the community through the project Adopting a Family, contributing to critical thinking within the Nursing academic production and its articulation to collective health. Results: In the professors' evaluation, the activity represented an effective articulation and insertion of the university in the community; for the students, it allowed for spaces of construction, deconstruction and negotiation with the unknown and the uncertain; for the families, it enabled the feeling of being remembered and valued as human beings and citizens. Through the experiences had, the transformation of health practices goes through the emergence and valuation of new knowledge. Final considerations: The insertion of the university in the community is constituted by an entrepreneurial strategy that is proponent of changes, due to its more effective and resolute outreach of health issues proposed by the national health system.

RESUMEN Objetivo: relatar la inserción comunitaria de los académicos de enfermería del Centro Universitario Franciscano, a través del proyecto Adotando uma família, y contribuir a la reflexión crítica en el ámbito de la producción académica y su articulación con la salud colectiva. Resultados: en la evaluación de los docentes, la actividad representó una efectiva articulación e inserción de la universidad en la comunidad; para los académicos, posibilitó espacios de construcción, deconstrucción y negociación con lo desconocido y lo incierto; y para las familias, el sentimiento de haber sido recordadas y valoradas como seres humanos y ciudadanos. La transformación de las prácticas de salud pasa, a partir de lo vivido, por la emergencia y valorización de nuevos saberes. Consideraciones finales: la inserción de la universidad en la comunidad se constituye, por lo tanto, en una estrategia emprendedora y proponente de cambios, por el alcance más efectivo y resolutivo de las cuestiones propuestas por el sistema de salud nacional.

RESUMO Objetivo: relatar a inserção comunitária dos acadêmicos de enfermagem do Centro Universitário Franciscano, por meio do projeto Adotando uma Família, e contribuir para a reflexão crítica no âmbito da produção acadêmica e sua articulação com a saúde coletiva. Resultados: na avaliação dos docentes, a atividade representou uma efetiva articulação e inserção da universidade na comunidade; para os acadêmicos, possibilitou espaços de construção, desconstrução e negociação com o desconhecido e o incerto; e para as famílias, o sentimento de terem sido lembradas e valorizadas como seres humanos e cidadãos. A transformação das práticas de saúde passa, a partir do vivido, pela emergência e valorização de novos saberes. Considerações finais: a inserção da universidade na comunidade se constitui, portanto, em uma estratégia empreendedora e propositora de mudanças, pelo alcance mais efetivo e resolutivo das questões propostas pelo sistema de saúde nacional.

Transporte de crianças em ambulâncias terrestres: segurança e conhecimentos dos profissionais / Transporte de niños en ambulancias terrestres: seguridad y conocimiento de los profesionales / Transportation of children on land ambulances: safety and professional knowledge

INTRODUÇÃO: O transporte de crianças em ambulâncias terrestres é uma problemática ainda insuficientemente investigada em todo o mundo. Neste contexto pretende-se conhecer as medidas de segurança usadas no transporte de crianças em ambulâncias terrestres e identificar o conhecimento dos profissionais acerca das medidas a adotar para este tipo de transporte. MATERIAIS E MÉTODOS: Estudo quantitativo, exploratório descritivo. A análise das medidas de segurança usadas no transporte de crianças tem por base as recomendações da National Highway Traffic Safety Administration. Aplicado um questionário a 135 enfermeiros e bombeiros/tripulantes de ambulâncias portuguesas baseado em 4 possíveis situações de transporte e abrangendo 5 faixas etárias pediátricas. RESULTADOS: Os profissionais adotam uma grande variedade de medidas de segurança na prática havendo uma diferença significativa entre a forma como transportam as crianças e o modo que consideram ser o ideal. Os resultados da avaliação do transporte situam-se mais próximos dos níveis de segurança aceitáveis do que dos níveis recomendados como ideais. Verifica-se que mulheres, profissionais graduados e enfermeiros de pediatria transportam as crianças em ambulâncias com mais segurança. DISCUSSÃO E CONCLUSÕES: Muitos profissionais desconhecem as possibilidades de transporte seguro para as crianças nem conhecem recomendações para este tipo de transporte. A dispersão apurada na forma como o transporte é efetuado e os resultados obtidos sugerem a necessidade de regulamentação deste transporte, de investimento na formação dos profissionais e de sensibilização das instituições de saúde para a importância do uso de sistemas de retenção para crianças durante o seu transporte

INTRODUCCIÓN: El transporte de niños en ambulancia terrestre es un problema poco investigado en todo el mundo. En este contexto se pretende conocer las medidas de seguridad usadas en el transporte de niños en ambulancias terrestres e identificar el conocimiento de los profesionales acerca de las medidas que se deben adoptar para este tipo de transporte. MATERIALES Y MÉTODOS: Estudio cuantitativo exploratorio y descriptivo. El análisis de las medidas de seguridad usadas en el transporte de niños es basado en las recomendaciones de la National Highway Traffic Administration. Se aplicó un cuestionario a 135 enfermeros y bomberos/tripulación de ambulancias portuguesas basado en 4 posibles situaciones de transporte y abarcando 5 rangos de edad pediátricas. RESULTADOS: Los profesionales adoptan una amplia variedad de medidas de seguridad en la práctica existiendo una diferencia significativa entre la forma como transportan los niños y la forma que consideran ideal. Los resultados de la evaluación del transporte están situados más cerca de los niveles de seguridad aceptables que de los niveles recomendados como ideales. Se verificó que mujeres, profesionales graduados y enfermeros de pediatría transportan los niños en ambulancias con más seguridad. DISCUSIÓN Y CONCLUSIONES: Muchos profesionales desconocen las posibilidades de transporte seguro para los niños y ni conocen las recomendaciones para este tipo de transporte. La difusión exacta en la forma como el transporte es realizado y los resultados obtenidos sugieren la necesidad de normas para este transporte, invertir en la formación de los profesionales y sensibilización de las instituciones de salud para la importancia del uso de sistemas de retención para niños durante el transporte

INTRODUCTION: Transportation of children on land ambulances is still a problem not sufficiently researched throughout the world. Within this context, we aim to know the safety measures used in the transport of children in terrestrial ambulances and identify the knowledge of professionals on the measures to be adopted for this type of transportation. MATERIALS AND METHODS: This was a quantitative, exploratory descriptive study. The analysis of the safety measures used when transporting children is based on the recommendations of the U.S. National Highway Traffic Safety Administration. A questionnaire was applied to 135 nurses and Portuguese ambulance firefighters / crew based on four possible transport situations and covering five pediatric age groups. RESULTS: Professionals adopt a wide variety of safety measures in practice, with a significant difference between the way they transport children and the way they consider it as ideal. The results of the transport assessment are closer to acceptable levels of safety than levels recommended as ideal. It is verified that women, professional graduates, and pediatric nurses transport children in ambulances more safely. DISCUSSION AND CONCLUSIONS: Many professionals are unaware of the possibilities of safe transportation for children and do not know of any recommendations for this type of transport. The accurate dispersion on how the transport is carried out and the results obtained suggest the need to regulate this transport, invest on the formation of the professionals, and raise awareness of health institutions on the importance of using restraint systems for children during their transport

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to examine and map the use of motivational interviews (MI) by nurses in their clinical practice with adolescents to promote health behaviors.More specifically, the review will focus on the following questions:What is the current nature and extent of use of nurse-led MI in the promotion of health behaviors in adolescents?Which adolescent populations (in terms of health status and adoption or not of health risk behaviors have been included in nurse-led MI with the aim of promoting health behaviors?What are the contexts in which nurses have used MI to promote health behaviors in adolescents?Which specific MI techniques and/or strategies have been used by nurses to promote health behaviors in adolescents?What outcomes on the promotion of health behaviors have been reported from nurse-led MI with adolescents? CENTER CONDUCTING THE REVIEW: The Portugal Centre for Evidence-based Practice: a Collaborating Centre of the Joanna Briggs Institute.

Localização e medidas preventivas de úlceras de pressão em idade pediátrica: revisão integrativa da literatura / Localización y medidas preventivas de las úlceras por presión en edad pediátrica: revisión integrativa de la literatura / Location and preventive measures for pressure ulcers in paediatric age: integrative literature review

Introdução: As úlceras de pressão (UP) são um problema de saúde pública e indicador da má qualidade dos cuidados. A sua problematização é consensual em adultos mas não é reconhecida em pediatria. Apesar de consideradas raras, estudos existentes revelam o contrário.Materiais e Métodos: Realizou-se uma revisão integrativa da literatura on-line nas bases de dados CINAHL, Academic Search Complete e Elsevier ScienceDirect seleccionando estudos que identificassem as localizações anatómicas mais frequente das úlceras de pressão em pediatria e medidas preventivas mais eficazes. Foi adicionada uma pesquisa a partir das referências bibliográficas dos estudos selecionados. A avaliação dos resultados permitiu selecionar 5 estudos: 3 abordam as localizações anatómicas mais frequentes e 2 as medidas preventivas mais eficazes. Resultados: As localizações anatómicas mais referidas são a região occipital e sacrococcígea havendo alguma discrepância entre autores. Apesar da escassez de estudos de eficácia de materiais e de a maioria das medidas se basearem na eficácia em adultos, as medidas preventivas apontadas como mais eficazes são as consultas de nutrição, a alternância de decúbitos, almofadas no alívio de pressão, superfícies adequadas e placas de gel. Discussão e Conclusões: Os estudos evidenciam algumas discordâncias acerca das localizações mais frequentes das úlceras de pressão, sendo as variações justificadas pelas diferenças anatómicas entre crianças e mudança nos locais de pressão consoante o crescimento em pediatria. Verifica-se ainda uma escassez de evidência empírica sobre a eficácia de medidas preventivas. Sendo vital o reconhecimento desta problemática em pediatria, sugerem-se investigações futuras.

Introducción: Las úlceras por presión (UP) son un problema de salud pública y un indicador de la mala calidad de los cuidados. Su cuestionamiento es consensual en adultos pero no es reconocida en pediatría. Aunque considerado raro, los estudios existentes revelan lo contrario. Materiales y Métodos: Se realizó una revisión integrativa de la literatura en las bases de datos on-line CINAHL, Academic Search Complete y Elsevier ScienceDirect seleccionando los estudios que identifican las localizaciones anatómicas más frecuentes de UP en pediatría y las medidas preventivas más eficaces. La evaluación de los resultados permitió seleccionar 5 estudios: 3 cubren las localizaciones más frecuentes y 2 las medidas preventivas más eficaces. Resultados: Las localizaciones anatómicas mencionadas son la región occipital y sacro coccígea habiendo alguna discrepancia entre autores. A pesar de la escasez de estudios de eficacia de los materiales y que la mayoría de las medidas se basan en efectividad en adultos, las medidas preventivas que se destacan cómo más eficaces son consultas de nutrición, alternando posiciones decúbitos, almohadas en alivio de la presión, superficies apropiadas y placas de gel. Discusión y Conclusiones: Los estudios demuestran algunos desacuerdos acerca de las localizaciones más frecuentes de las UP, siendo justificadas por las diferencias anatómicas de las variaciones entre los niños y el cambio en los locales de presión dependiendo del crecimiento en pediatría. Todavía hay una escasez de evidencia empírica sobre la eficacia de las medidas preventivas. Siendo fundamental el reconocimiento de esta problemática en pediatría, se sugieren investigaciones futuras.

Introduction: The pressure ulcers (UP) are a public health problem and an indicator of the poor quality of care. This issue is consensual in adults but not recognized in pediatrics. Although it is considered rare, existing studies prove otherwise. Materials and Methods: An integrative review of literature was conducted online using CINAHL, Academic Search Complete and Elsevier ScienceDirect database and selecting the studies that identified the most frequent anatomical locations of pressure ulcers in pediatrics and the more effective preventive measures. A research from the references of the selected studies was added. From the evaluation of the results, 5 studies were selected: 3 address the most common anatomical locations and 2 focus on effective preventive measures. Results: The most mentioned anatomical sites are the occipital and the sacrococcygeal, existing some discrepancy between authors. Despite the lack of studies about the efficacy of the materials and the measures focusing mainly in adults, the most effective preventive measures selected are the nutritional appointments, alternance of decubitus, and use of cushions to relieve the pressure, having suitable surfaces and applying gel plates. Discussion and Conclusions:Studies reveal a disagreement about the most frequent sites of pressure ulcers, which is justified by the anatomical differences among children and the changes in the pressure locations according to their growth. There is also a dearth of empirical evidence about the effectiveness of the preventive measures. Being vital the recognition of this issue in pediatrics, further investigation is suggested.

Drugs and alcohol consumption and sexual behaviours in night recreational settings in Portugal.

BACKGROUND: Night recreational settings have become a key location for the socialisation of young people. For customers attending these places, the consumption of alcohol and drugs is related to changes in sexual decision making and associated with increased likelihood of engagement in more risky sexual behaviours. AIM: To identify the characteristics of Portuguese young people who attend nightclubs, pubs and bars; to explore relationships between attendance at these settings and the consumption of alcohol and drugs; to study associations between substance use and sexual behaviour. METHODS: Respondent-driven sampling methodology was used in nine Portuguese cities to survey 1142 young people who attend nightlife leisure locations. RESULTS: Respondents regularly go out at night, especially at weekends. The most used substances are alcohol, cannabis, cocaine and ecstasy. Alcohol and drugs users have more regular and deeply-rooted night recreation habits than nonusers and drugs consumption increases with increased recreational activities. In the last 12 months, 83.3% of the respondents have already had sexual intercourse (X= 2.0 partner; SD = 2.3), 51.0% had sex under the influence of alcohol, 22.9% under the influence of drugs and 46.7% agreed that this influence made them have unsafe sex. Early alcohol and drug use was proportionately related to an early sexual experience. Alcohol and drugs use s were more likely to adopt more sexual risk behaviours than non-users. CONCLUSIONS: The enjoyment of recreational nightlife settings exposes Portuguese clubbers to environmental factors which, in combination with substance use, may influence the nature of relationships between alcohol and drug use and sexual behaviour.

Consumo de drogas, alcohol y conductas sexuales en los ambientes recreativos nocturnos de Portugal / Drugs and alcohol consumption and sexual behaviours in night recreational settings in Portugal

Antecedentes: Los ambientes recreativos nocturnos son lugares claves de la socialización de los jóvenes. Entre quienes frecuentan estos lugares, el consumo de alcohol y drogas provoca cambios en la toma de decisiones sobre relaciones sexuales y se asocia a una mayor probabilidad de practicar conductas sexuales de riesgo. Objetivo: Describir a los jóvenes que salen los fines de semana; analizarlas relaciones entre el hecho de ir a dichos lugares y el consumo de alcohol y drogas; estudiar asociaciones entre consumo de sustancias y conductas sexuales. Métodos: Se utilizó la metodología del respondent-driven sampling (o muestreo dirigido por los entrevistados) en nueve ciudades portuguesas para interrogar a 1.142 jóvenes que asistieron a locales de ocio nocturno. Resultados: Los participantes salen habitualmente de noche, sobre todo los fines de semana. Las sustancias más consumidas fueron alcohol, cannabis, cocaína y éxtasis. Los consumidores de alcohol y drogas presentan hábitos recreativos nocturnos mucho más arraigados que los no consumidores, y el consumo de drogas aumenta en proporción a las actividades recreativas. En los últimos 12 meses el 83,3% de los entrevistados habían mantenido relaciones sexuales ( X = 2,0 parejas; SD = 2,3), el 51,0% habían practicado sexo bajo la influencia del alcohol, el 22,9% bajo la influencia de las drogas, y el 46,7% reconocieron que dicha influencia los había llevado a practicar sexo no seguro. El consumo precoz de alcohol y drogas se asoció, proporcionalmente, a experiencias sexuales precoces. Los consumidores de alcohol y drogas fueron mucho más propensos a adoptar conductas sexuales de riesgo que los no consumidores. Conclusiones: Disfrutar de los ambientes recreativos nocturnos expone a los jóvenes portugueses a factores ambientales, que combinados con el consumo de sustancias, influyen en el tipo de relaciones entre consumo de alcohol y drogas y conducta sexual (AU)

Background: Night recreational settings have become a key location for the socialisation of young people. For customers attending these places, the consumption of alcohol and drugs is related to changes in sexual decision making and associated with increased likelihood of engagement in more risky sexual behaviours. Aim: To identify the characteristics of Portuguese young people who attend nightclubs, pubs and bars; to explore relationships between attendance at these settings and the consumption of alcohol and drugs; to study associations between substance use and sexual behaviour. Methods: Respondent-driven sampling methodology was used in nine Portuguese cities to survey 1142 young people who attend nightlife leisure locations. Results: Respondents regularly go out at night, especially at weekends. The most used substances are alcohol, cannabis, cocaine and ecstasy. Alcohol and drugs users have more regular and deeply-rooted night recreation habits than non users and drugs consumption increases with increased recreational activities. In the last 12 months, 83.3% of the respondents have already had sexual intercourse(X= 2.0 partner; SD = 2.3), 51.0% had sex under the influence of alcohol, 22.9%under the influence of drugs and 46.7% agreed that this influence made them have unsafe sex. Early alcohol and drug use was proportionately related to an early sexual experience. Alcohol and drugs users were more likely to adopt more sexual risk behaviours than non-users. Conclusions: The enjoyment of recreational nightlife settings exposes Portuguese clubbers to environmental factors which, in combination with substance use, may influence the nature of relationships between alcohol and drug use and sexual behaviour (AU)

[Positive and negative social representation of ecstasy among consumers in Coimbra (Portugal)]. / Representaciones "positivas" y "negativas" sobre el éxtasis en un grupo de consumidores en Coimbra (Portugal).

The positive and negative representations of ecstasy were studied in a sample of 223 young people who consumed ecstasy in the city of Coimbra, recruited using the snowball technique. With regard to negative representations they highlight the harmful effects on the brain, with regard to positive effects they highlight the pleasure associated with dancing. The consumers acknowledge the negative representations but consider the positive representations much more important. Rating of the positive representations does not vary according to frequency of consumption, number of pills consumed or whether or not they are polyconsumers. However, those with more negative representations show less abusive consumption patterns. Implications for prevention are discussed.

Representaciones “positivas” y “negativas” sobre el éxtasis en un grupo de consumidores en Coimbra (Portugal) / Positive and negative social representation of ecstasy among consumers in Coimbra (Portugal)

Se estudian las representaciones ‘positivas’ y negativas’ que tenían sobre el éxtasis una muestra de 223 jóvenes consumidores de éxtasis en la ciudad de Coimbra, reclutados utilizando la técnica de bola de nieve. En el ámbito de las representaciones negativas reseñadas destacan los efectos nocivos sobre el cerebro y entre los positivos destaca el placer asociado al baile. Los consumidores valoran las representaciones negativas sobre esta sustancia pero dan mucha más importancia a las representaciones positivas. La valoración de las representaciones positivas no varía en función de que los consumos sea más o menos frecuentes, se tomen un mayor o menor número de pastillas o si se hace policonsumo. Sin embargo aquellos jóvenes con representaciones sobre el éxtasis más negativas tienen un patrón de consumo menos abusivo. Se discuten las implicaciones preventivas

The positive and negative representations of ecstasy were studied in a sample of 223 young people who consumed ecstasy in the city of Coimbra, recruited using the snowball technique. With regard to negative representations they highlight the harmful effects on the brain, with regard to positive effects they highlight the pleasure associated with dancing. The consumers acknowledge the negative representations but consider the positive representations much more important. Rating of the positive representations does not vary according to frequency of consumption, number of pills consumed or whether or not they are polyconsumers. However, those with more negative representations show less abusive consumption patterns. Implications for prevention are discussed