Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors.

BACKGROUND: Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours. METHODS: A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. RESULTS: A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001). CONCLUSIONS: The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

Assistive technologies for children with cognitive and/or motor disabilities: interviews as a means to diagnose the training needs of informal caregivers.

PURPOSE: The present study seeks to survey information and training needs of informal caregivers related to the use of assistive technologies at home, so as to, in the near future, try to meet them. Therefore, the full aim of this study is to contribute to reducing technology abandonment and to enhancing its use in the family setting by children with cognitive and/or motor limitations. MATERIALS AND METHODS: Content analysis of a set of ten interviews with informal caregivers of children and youngsters with cognitive and/or motor disabilities. RESULTS: Assistive technologies open a wide range of opportunities, mostly to students whose learning skills diverge from standard development. They promote communication, independence as well as inclusion of children with cognitive and/or motor disabilities. Despite the human and material resources available, the implementation of assistive technologies in many family settings is still a struggling task. The results reveal a perspective on (i) the interaction between those caregivers and their children, (ii) children's skills in using assistive technology, (iii) caregivers' digital literacy and (iv) their training needs. CONCLUSIONS: The present paper highlights the fact that carrying out interviews with informal caregivers leads to obtaining significant data for a diagnosis of the use of assistive technologies in the family setting and to assess the needs of informal caregivers. From this study, the need to provide caregivers with further training on assistive technologies emerges as preponderant, and to improve caregivers' skills in the search for and access to practical information.Implication for RehabilitationCognitive and/or motor disabilities impact on communication, independence and also on the full inclusion of children, especially when efforts developed at school do not have any follow up at home.Endowing informal caregivers with the knowledge and skills to use assistive devices with their children is a step forward to their full development.Interviews conducted with informal caregivers are a means to gaining insights into understanding the reasons behind assistive technology abandonment at home.

Undiagnosed Risk of Obstructive Sleep Apnea in Obese Individuals in a Primary Health Care Context.

INTRODUCTION: Obstructive sleep apnea is a clinical entity that is associated with an increase in morbidity and mortality and it is estimated that it is significantly undiagnosed. The objective of this study was to assess the risk of undiagnosed obstructive sleep apneain obese individuals. MATERIAL AND METHODS: A descriptive and analytical cross-sectional study; the risk of obstructive sleep apnea's was assessed over a period of 11 months by applying the STOP-Bang questionnaire to all individuals who attended a family health unit who were aged ≥ 18 years and had body mass index of ≥ 30 kg/m2 and who had not yet been diagnosed with obstructive sleep apnea and agreed to participate; the risk of an undiagnosed moderate to severe obstructive sleep apnea was considered for any STOP-Bang score of ≥ 3. RESULTS: The risk of undiagnosed obstructive sleep apnea was assessed in 888 individuals (59.3% females) with an average age of 59.6 ± 14.68 years and a mean body mass index 33.6 ± 3.43 kg/m2; the mean STOP-Bang score was 3.5 ± 1.74, 70.9% scored ≥ 3; the frequency of all STOP-Bang questionnaire parameters was higher (p < 0.004) within the group with score ≥ 3. DISCUSSION: The studied population is one of the main strengths, since it is in obese people that the incidence of this disease is higher. There are some limitations related to this sample coming from a single family health unit, as well as the patients' follow-up being carried out throughout routine appointments for diseases that are closely related with obstructive sleep apnea. CONCLUSION: The level of underdiagnosis of obstructive sleep apnea's in obese individuals can be significantly high and a large proportion of them may have the disease at a moderate to severe stage; Family Physicians can have a very important role in screening and diagnosis.

Introdução: A apneia obstrutiva do sono é uma entidade clínica que condiciona aumento da morbimortalidade e estima-se que exista um elevado subdiagnóstico. Foi objetivo deste estudo avaliar o risco de apneia obstrutiva do sono não diagnosticada em indivíduos obesos. Material e Métodos: Estudo transversal descritivo e analítico; durante um período de 11 meses foi avaliado o risco de apneia obstrutiva do sono aplicando o questionário STOP-Bang a todos os indivíduos com idade ≥ 18 anos e índice de massa corporal ≥ 30 kg/m2 que frequentaram uma unidade de saúde familiar, sem o diagnóstico de apneia obstrutiva do sono e que aceitaram participar; considerou-se risco de apneia obstrutiva do sono não diagnosticada para score STOP-Bang ≥ 3. Resultados: Foi avaliado o risco de apneia obstrutiva do sono não diagnosticada em 888 indivíduos (59,3% do género feminino), com idade média de 59,6 ± 14,68 anos e índice de massa corporal médio de 33,6 ± 3,43 kg/m2; o score STOP-Bang médio foi de 3,5 ± 1,74, 70,9% apresentaram score ≥ 3; a frequência de todos os parâmetros do questionário STOP-Bang foi superior (p < 0,004) no grupo com score ≥ 3. Discussão: A população estudada é uma das principais forças, pois é nas pessoas obesas que a incidência dessa doença é maior. Existem algumas limitações relacionadas com a amostra ser de uma única unidade de saúde, bem como o seguimento dos pacientes ser por doenças relacionadas com a apneia obstrutiva do sono. Conclusão: O subdiagnóstico da apneia obstrutiva do sono nos indivíduos obesos pode ser muito elevado e uma grande parte destes pode apresentar doença moderada a grave; os médicos de Medicina Geral e Familiar podem ter um papel muito importante no rastreio e diagnóstico.

Effectiveness of a Combined Intervention on Psychological and Physical Capacities of Frail Older Adults: A Cluster Randomized Controlled Trial.

BACKGROUND: Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Methods: Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. Results: At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ r < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. Conclusion: The CI is effective on managing older adults' psychological and physical capacities.

The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal. / Intervenção da Terapia Ocupacional na toxicodependência: estudo de caso na Comunidade Terapêutica Clínica do Outeiro ­ Portugal.

Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.

As 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 .

Intervenção da Terapia Ocupacional na toxicodependência: estudo de caso na Comunidade Terapêutica Clínica do Outeiro - Portugal / The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal

Resumo As 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 .

Abstract Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.

Dificuldades intraescolares na efetividade do projeto de cultura de paz / Las dificultades intra-escolares en la eficacia del projecto de cultura de paz (proyecto cultura de la paz) / Intra-school difficulties in the effectiveness of the projeto cultura de paz (project culture of peace)

RESUMO Objetivo: Investigar as dificuldades intraescolares para efetividade da cultura de paz na escola. Método: configura-se como um estudo exploratório e descritivo, com abordagem qualitativa, concretizado num estudo de caso em uma escola pública da Rede Municipal de Fortaleza-Ceará, com o grupo gestor e professores da referida escola. A coleta de dados foi de fevereiro a junho de 2015. A produção dos dados foi realizada por intermédio de entrevista semiestruturada. A análise e organização dos dados foram realizadas mediante Análise de Conteúdo. Resultado: verificou-se falha de comunicação, desgaste e desmotivação dos docentes, despreparo para realizarem atividades que contemplem a paz, assim como a ausência de parcerias municipais e governamentais. Conclusão: necessidade de capacitação dos professores e gestores para que ocorra de forma efetiva a promoção da Cultura de Paz nas escolas.

RESUMEN El presente estudio tuvo como objetivo investigar las dificultades intraescolares para la efectividad de la cultura de paz en la escuela. El curso metodológico basado en el objeto de estudio fue exploratorio y descriptivo con un enfoque cualitativo. Se desarrolló un estudio de caso en la Escuela Municipal de Fortaleza-Ceará, establecida en la Región V. El público objetivo del estudio fue el grupo de gestión y los maestros de esta escuela pública. La recopilación de datos se realizó de febrero a junio de 2015. La producción de los datos se realizó mediante entrevistas semiestructuradas. El análisis y la organización de los datos se realizaron a través de Análisis de Contenido. Hubo fallas en la comunicación, desgaste y desmotivación de los docentes, falta de preparación para las actividades que contemplan la paz, así como ausencia de asociaciones municipales y gubernamentales.

ABSTRACT The present study aimed to research the intra-school difficulties for effectiveness of the culture of peace in the school. The methodological course based on the object of study was exploratory and descriptive with a qualitative approach. A case study was developed at the Municipal School of Fortaleza-Ceará, established in Regional V. The target public of the study was the management group and teachers of this public school. The data collection occurred from February to June 2015.The production of the data was carried out through semi-structured interviews. The analysis and organization of the data were performed through Content Analysis. There was communication failure, attrition and demotivation of teachers, lack of preparation for activities that contemplate peace, as well as the absence of municipal and governmental partnerships.

Alterações do perfil ocupacional da população em situação de sem-abrigo na cidade de Leiria / Changes in the occupational profile of the homeless population at the city of Leiria

Introdução:O conceito de pessoa em situação de rua, também designado por pessoa em situação de sem-abrigo, representa qualquer indivíduo que esteja destituído de uma habitação e privado dos bens essenciais. Isto acarreta problemas a nível físico, psicossocial e emocional, podendo alterar os hábitos, rotinas e papéis destes indivíduos. Objetivo: Conhecer e descrever as alterações do perfil de saúde, em concreto do perfil ocupacional, da população em situação de sem-abrigo na cidade de Leiria, antes e na atual situação. Métodos: Estudo de caso descritivo, de abordagem qualitativa, com recurso à recolha de dados por entrevista semiestruturada. A análise de conteúdo foi efetuada por meio do software webQDA de apoio à análise de dados qualitativos num ambiente colaborativo e distribuído. Amostra: Quatro indivíduos na situação de sem-abrigo residentes na cidade de Leiria, agregados ao Centro de Acolhimento de Leiria. Resultados/Conclusão: São identificadas alterações de Papéis e Contextos e Ambientes nos indivíduos em situação de sem-abrigo, onde se destacam a perda de papéis sociais e de relações familiares, as condições habitacionais precárias e o recurso continuado a apoios sociais. Sobrepõe-se a destruturação das rotinas o que conduz ao desequilíbrio ocupacional

Introduction: The homeless person concept represents any individual who is deprived of a habitation and essential needs. These facts increase physical, psychosocial and emotional problems and may modify the habits, the routines and the roles of these individuals. Objective: To know and describe the changes in the occupational profile of the homeless population in the city of Leiria, before and in the current situation. Methods: Descriptive case study, with a qualitative approach, using data collection by semi-structured interview. Content analysis was performed using webQDA software to support qualitative data analysis in a collaborative and distributed environment.Sample: Four homeless people, residents in the city of Leiria, added to the Centro de Acolhimento de Leiria. Results/Conclusion: Changes in Roles and Contexts/Environments are identified in homeless individuals, in which the loss of social roles and family relationships, poor housing conditions and continued use of social support are highlighted. It overlaps the

[Efficacy of the Vaccines Against Human Papillomavirus in Women Older than 24 Years in the Cervix Cancer Prevention]. / Eficácia das Vacinas Contra o Vírus do Papiloma Humano nas Mulheres com mais de 24 Anos na Prevenção do Cancro do Colo do Útero.

INTRODUCTION: Cervix cancer is the fourth most common female cancer and the second most frequent in women aged 15 to 44 years. The infection by the human papillomavirus is a necessary condition in almost all of cervix cancer cases; it is a sexually transmitted disease and all women sexually active are at risk of being infected. There are currently three vaccines against human papillomavirus, and despite of the efficacy being well proven in woman aged up to 25 years, it is not well established in older ages. MATERIAL AND METHODS: It was performed a literature review of the current evidence about the efficacy of the vaccines against human papillomavirus in women older than 24 years in the cervix cancer prevention, and was assessed the evidence quality by the GRADE system. RESULTS: Two randomized controlled trials were identified with a total of 9,571 participants - 4,792 vaccinated and 4,779 at the control group and reported data of 48 months period follow-up. The relative risk reduction was 41% (95% CI: 29 a 50%) - for the vaccinated group. There were no differences in safety and tolerability between the two groups - vaccine and control. CONCLUSION: The actual evidence shows that the vaccines against human papillomavirus 16 and/or 18 in women older than 24 until 45 years have an important efficacy at reducing the risk of having persistent infection and/or to acquire cervix cancer precursor lesions.

Introdução: O cancro do colo do útero é o quarto tipo de cancro feminino mais comum e o segundo mais frequente nas mulheres entre os 15 e os 44 anos. A infeção pelo vírus do papiloma humano é condição necessária na quase totalidade dos casos de cancro do colo do útero; trata-se de uma doença sexualmente transmissível e todas as mulheres sexualmente ativas estão em risco de contrair infeção. Atualmente existem três vacinas contra o vírus do papiloma humano, e apesar da sua eficácia estar bem comprovada nas mulheres até aos 25 anos, não está totalmente estabelecida em idades superiores.Material e Métodos: Realizou-se uma revisão da literatura sobre a evidência atual relativa à eficácia das vacinas contra o vírus do papiloma humano nas mulheres com mais de 24 anos na prevenção do cancro do colo do útero e foi avaliada a qualidade da evidência segundo o sistema GRADE.Resultados: Foram identificados dois estudos controlados randomizados relevantes para a análise que envolveram um total de 9 571 participantes ­ 4 792 no grupo vacinado e 4 779 no grupo controlo ­ e reportaram dados relativos a 48 meses de follow-up. A redução do risco relativo foi de 41% (95% CI: 29 a 50%), ­ favorável para o grupo vacinado. Não existiram diferenças entre a segurança e tolerabilidade das vacinas nos grupos vacina e controlo.Conclusão: A evidência atual demonstra que as vacinas contra o vírus do papiloma humano 16 e/ou 18 nas mulheres com mais de 24 e até aos 45 anos apresentam uma eficácia importante na redução do risco de desenvolver infeção persistente e/ou adquirir lesões precursoras de cancro do colo do útero.

Atas: investigação qualitativa em educação / Atas: investigación cualitativa en educación / Atas: qualitative research in education

O sucesso do 5º Congresso Ibero-Americano em Investigação Qualitativa (CIAIQ2016) é um importante indicador da existência de uma comunidade multidisciplinar, empenhada e de qualidade nesta área da investigação. O CIAIQ2016 decorreu nos dias 12, 13 e 14 de julho de 2016, na Universidade Lusófona do Porto, Portugal. Nesta edição da conferência foi realizada, em paralelo, a primeira edição do International Symposium on Qualitative Research (ISQR2016), que se mostrou um evento também muito bem-recebido pela comunidade científica internacional em investigação qualitativa. Assumem-se como eventos de prestígio, incontornáveis e de presença obrigatória nas agendas dos investigadores que desenvolvem pesquisas de abordagem qualitativa.

Randomized prospective study of the validity of the great auricular nerve preservation in parotidectomy.

OBJECTIVE: To evaluate the feasibility and validity of great auricular nerve preservation during parotidectomy. METHODS: Thirty patients with parotid tumors were randomized to 2 groups. Sixteen patients (group A) underwent classic parotidectomy with sacrifice of the great auricular nerve. The surgeon tried to spare the nerve in the 14 patients (group B). Tactile sensitivity, pain sensitivity, and tactile discrimination were evaluated preoperatively and at 7 days, 30 days, 6 months, and 12 months after surgery. The regions examined were the superior helix, lobule, and infra-auricular and posterior auricular regions. RESULTS: After surgery, both groups showed lower levels of sensitivity, mainly in the lobule and in the infra-auricular region. These alterations were less pronounced in group B. Both groups showed improvement over time. In group B the tactile sensitivity reached preoperative levels by 6 months after surgery. The recuperation in group A was partial and stabilized at 6 months after surgery. CONCLUSION: Great auricular nerve preservation is technically feasible during parotidectomy, with a decrease of the sensitivity alterations in the early postoperative period and avoidance of the permanent sequelae that occur when the nerve is sacrificed.