Acceptability and applicability of an intervention programme with substance addicts. / Aceitabilidade e aplicabilidade de um programa de intervenção com usuários dependentes de substâncias.

The complexity of the problems related to the harmful use of substances requires regular questioning of practices. This article aims to explore the acceptability and applicability of an intervention programme for patients with problematic substance use. Qualitative study. Data collection, through a focus group with 6 nurses and 6 semi-structured interviews with patients under treatment. We have used lexicographic textual analysis. From the focus group, 151 text segments were analysed, retaining 85.8% of the total for the creation of five classes. An analysis of similarity led to the formation of two central nuclei, represented by the words "Nursing" and "Intervention". From interviews, 252 text segments were analysed, retaining 71.83% for the creation of 5 classes. An analysis of similarity led to the formation of three central nuclei, represented by the words "want", "programme" and "see". Nurses recognise the need for a more structured and flexible approach focused on people's needs. Users also affirm the need for flexible interventions, without a pre-established time frame, that promote labour integration, therapeutic support for abstinence and management of comorbidities.

A complexidade dos problemas relacionados com o uso problemático de substâncias requer questionamento regular das práticas. O objetivo deste artigo é explorar a aceitabilidade e a aplicabilidade de um programa de intervenção com pessoas dependentes de substâncias. Estudo qualitativo. Recolha de dados, realizada através de 1 grupo focal com 6 enfermeiros e 6 entrevistas semiestruturadas a usuários em tratamento. Utilizou-se à análise textual lexicográfica. No grupo focal, foram analisados 151 segmentos de texto, retendo 85,8% do total para a criação de cinco classes. A análise de similitude conduziu à formação de dois núcleos centrais, representados pelas palavras: Enfermeiro e Intervenção. Das entrevistas, foram analisados 252 segmentos de texto, retendo 71,83% para a criação de 5 classes. A análise de similitude conduziu à formação de três núcleos centrais, representados pelas palavras: querer, programa e ver. Os enfermeiros reconhecem a necessidade de uma abordagem mais estruturada, centrada nas necessidades das pessoas e flexível. Os usuários, acrescentam a necessidade de ser flexível, sem tempo definido à partida, promovendo trabalho, suporte terapêutico para abstinência e gestão das comorbilidades.

Ethics issues experienced in HBM within Portuguese health surveillance and research projects.

BACKGROUND: In keeping with the fundamental practice of transparency in the discussion and resolution of ethics conflicts raised by research, a summary of ethics issues raised during Portuguese biomonitoring in health surveillance and research is presented and, where applicable, their resolution is described. METHODS: Projects underway aim to promote the surveillance of public health related to the presence of solid waste incinerators or to study associations between human exposure to environmental factors and adverse health effects. The methodological approach involves biomonitoring of heavy metals, dioxins and/or other persistent organic pollutants in tissues including blood, human milk and both scalp and pubic hair in groups such as the general population, children, pregnant women or women attempting pregnancy. As such, the projects entail the recruitment of individuals representing different demographic and health conditions, the collection of body tissues and personal data, and the processing of the data and results. RESULTS: The issue of autonomy is raised during the recruitment of participants and during the collection of samples and data. This right is protected by the requirement for prior written, informed consent from the participant or, in the case of children, from their guardian. Recruitment has been successful, among eligible participants, in spite of incentives rarely being offered. The exception has been in obtaining guardians' consent for children's participation, particularly for blood sampling. In an attempt to mitigate the harm-benefit ratio, current research efforts include alternative less invasive biomarkers.Surveys are currently being conducted under contract as independent biomonitoring actions and as such, must be explicitly disclosed as a potential conflict of interests. Communication of results to participants is in general only practised when a health issue is present and corrective action possible. Concerning human milk a careful approach is taken, considering breast-feeding's proven benefits. CONCLUSION: No national legislation currently accounts for the surveillance component of biomonitoring as distinct from research. Ethics issues arising within the domain of research are resolved according to available regulations. For issues encountered during surveillance, the same principles are used as guidance, completed by the authors' best judgement and relevant ethics committees' findings.

Aceitabilidade e aplicabilidade de um programa de intervenção com usuários dependentes de substâncias / Acceptability and applicability of an intervention programme with substance addicts

Resumo A complexidade dos problemas relacionados com o uso problemático de substâncias requer questionamento regular das práticas. O objetivo deste artigo é explorar a aceitabilidade e a aplicabilidade de um programa de intervenção com pessoas dependentes de substâncias. Estudo qualitativo. Recolha de dados, realizada através de 1 grupo focal com 6 enfermeiros e 6 entrevistas semiestruturadas a usuários em tratamento. Utilizou-se à análise textual lexicográfica. No grupo focal, foram analisados 151 segmentos de texto, retendo 85,8% do total para a criação de cinco classes. A análise de similitude conduziu à formação de dois núcleos centrais, representados pelas palavras: Enfermeiro e Intervenção. Das entrevistas, foram analisados 252 segmentos de texto, retendo 71,83% para a criação de 5 classes. A análise de similitude conduziu à formação de três núcleos centrais, representados pelas palavras: querer, programa e ver. Os enfermeiros reconhecem a necessidade de uma abordagem mais estruturada, centrada nas necessidades das pessoas e flexível. Os usuários, acrescentam a necessidade de ser flexível, sem tempo definido à partida, promovendo trabalho, suporte terapêutico para abstinência e gestão das comorbilidades.

Abstract The complexity of the problems related to the harmful use of substances requires regular questioning of practices. This article aims to explore the acceptability and applicability of an intervention programme for patients with problematic substance use. Qualitative study. Data collection, through a focus group with 6 nurses and 6 semi-structured interviews with patients under treatment. We have used lexicographic textual analysis. From the focus group, 151 text segments were analysed, retaining 85.8% of the total for the creation of five classes. An analysis of similarity led to the formation of two central nuclei, represented by the words "Nursing" and "Intervention". From interviews, 252 text segments were analysed, retaining 71.83% for the creation of 5 classes. An analysis of similarity led to the formation of three central nuclei, represented by the words "want", "programme" and "see". Nurses recognise the need for a more structured and flexible approach focused on people's needs. Users also affirm the need for flexible interventions, without a pre-established time frame, that promote labour integration, therapeutic support for abstinence and management of comorbidities.

Human exposure to heavy metals in the vicinity of Portuguese solid waste incinerators--Part 3: biomonitoring of Pb in blood of children under the age of 6 years.

As a part of environmental health surveillance programs related to Portuguese solid waste incinerators (SWI), two biomonitoring projects have been established to investigate additional exposure to lead in children under the age of 6 years living in the vicinity of those facilities. The above-mentioned programs, being the only ones in the country that integrate systematic observations on human exposure to heavy metals, have to provide systematic data from Portuguese regions on the extent and pattern of human exposure to heavy metals, namely to lead. The present paper is the third of a series of papers prepared to accomplish that objective in regards to lead exposure as evaluated by measuring lead levels in children under the age of 6 years. Altogether, 250 children from Lisbon and 247 from Madeira Island have already been involved in the investigation. The present study evaluates spatial and temporal trends of lead exposure, based on comparisons of children's blood lead levels, either stratified by living area (exposed and control groups), or by time of exposure (T0, the baseline time, and T1, after approximately 2 years of regular operation of the facilities). The results obtained correspond to a relatively reduced number of individuals. Possibly for this reason, they are not fully conclusive in relation to whether living in the vicinity of SWI represents an additional risk of higher exposure to lead. Time trends of lead exposure as evaluated by blood lead levels in children also do not show any clear pattern. These conclusions and the fact that altogether around 3% of children from the whole group have blood lead levels >or=10 microg/dl warrant further investigation in order to clarify the contribution of incinerator emissions to the levels of lead in children and to identify alternative sources for preventive purposes, taking into consideration the relevance of even low lead exposure from a public health perspective, mainly in relation to children.

Human exposure to heavy metals in the vicinity of Portuguese solid waste incinerators--Part 2: biomonitoring of lead in maternal and umbilical cord blood.

As part of environmental health surveillance programs related to solid waste incinerators located near Lisbon and on Madeira Island, human biomonitoring projects have been implemented in Portugal, some of them focused on cross-sectional surveys of heavy metals in blood. One of the general aims of these programs is to provide Portuguese data on the extent and pattern of human exposure to the pollutants potentially released in the stack gases from the incinerators, namely heavy metals. The present investigation reports information specifically on blood lead levels of newborn-mother pairs living in the vicinity of the incinerators under study, as well as of statistically similar participants living outside the exposed area. For Lisbon, lead levels determined at the baseline period (T0), as well as three subsequent evaluations of potential specific impacts of the incinerator (T1, T2 and T3) are described in order to investigate spatial and temporal trends of human exposure to lead. Available data for Madeira, namely lead levels in blood from the study population before the incinerator started operation, is also described. For Lisbon, analyses showed a statistically significant decrease of lead concentrations in maternal (p<0.001) and umbilical cord blood (p<0.001) during the whole monitoring period. Practically "overt" transplacental exposure to lead was observed only in the Lisbon biomonitoring project and for some cross-sectional surveys. Baseline levels for Madeira were the lowest found in all observations already performed in both programs (maternal and umbilical cord mean lead levels of 0.4 microg/dl and 0.3 microg/dl, respectively). No statistical associations have been found between lead levels in blood and age neither for global populations from Lisbon and Madeira nor for specific groups included in the different observational periods.

Human exposure to heavy metals in the vicinity of Portuguese solid waste incinerators--Part 1: biomonitoring of Pb, Cd and Hg in blood of the general population.

Human exposure to heavy metals makes it necessary to monitor these elements in the human body if the objective is to relate heavy metal exposure to adverse health effects. In Portugal, biomonitoring projects on heavy metals are being carried out on people living in the vicinity of solid waste incinerators. The projects are being developed in the ambit of two environmental health surveillance programs related to solid waste incineration facilities, one near Lisbon and the other on Madeira Island, that have the main objective of guaranteeing the safeguard of public health in relation to the potential negative impact of incineration processes on human health. These programs are the only ones in the country that integrate a systematic observation of human exposure to heavy metals as determined by the respective body burden in several population groups. Therefore, they are the only ones that are currently able to provide systematic data from Portuguese regions on the extent and pattern of human exposure to this type of pollutants. The present paper is the first of a series of three prepared papers with the objective of presenting and discussing available data. It addresses exposure to lead, cadmium and mercury as determined by their levels in blood of general population adults. Results suggest the effectiveness of source control measures in relation to both incinerators under study, similarly to what has been concluded from previous studies addressing exposure to dioxins. They also show, in relation to the baseline situation, a general significant trend for reduction of exposure to all studied heavy metals. Individuals from Lisbon seem to have a significantly higher body burden of the studied metals than those living in Madeira and, in general, metal exposure in men is significantly higher than in women, with the most relevant exception being the case of higher mercury levels in women, at the baseline and for both communities. Compared with published reference values for similar conditions, blood levels of cadmium, lead, and mercury of the present investigation seem to be relatively higher, in median terms and for extreme values, mainly in the case of cadmium and mercury. In the case of lead the differences are not so marked.

Nurses' perceptions about the feeding of preterm newborns / Percepción de enfermeros sobre la alimentación del recién nacido prematuro / Percepção dos enfermeiros sobre a alimentação do recém-nascido pré-termo

ABSTRACT Objective: to analyze nurses' perceptions about the feeding of preterm newborns and their motivations in using feeding methods during hospitalization in the neonatology unit. Method: descriptive study with a qualitative approach. Data collection was carried out between July 2019 and January 2020, using semi-structured interviews with 30 nurses from a neonatology unit. The analysis of interview data was carried out using lexicographical textual analysis, the descending hierarchical classification, and similarity analysis through IRaMuTeQ - R Interface software. Results: 876 text segments were analyzed in the descending hierarchical classification, retaining 86.3% of the total for the creation of five classes that resulted from content participation. The similarity analysis of the words representing the nurses' perception about oral feeding and the choice of feeding method led to three central cores, represented by the words: think, give, bottle. Conclusion: Nurses recognize the importance of continuing education and training in the assessment of oral skills. The reason for choosing the feeding method is often based on criteria such as preference, speed, and ease.

RESUMEN Objetivo: analizar la percepción del enfermero sobre la alimentación del recién nacido prematuro y sus motivaciones para aplicación de los métodos de alimentación durante la internación en la unidad de neonatología. Método: estudio descriptivo con abordaje cualitativo. Datos recolectados entre julio de 2019 y enero de 2020, aplicándose entrevista semiestructurada a 30 enfermeros de una unidad de neonatología. El análisis de datos resultante del contenido de las entrevistas se efectuó mediante análisis textual lexicográfico, recurriéndose a la Clasificación Jerárquica Descendente y al análisis de similitud, utilizándose software IRaMuTeQ - Interfaz de R. Resultados: en la Clasificación Jerárquica Descendente fueron analizados 876 segmentos textuales, reteniéndose el 86,3% del total para creación de cinco clases, resultantes de la participación del contenido. El análisis de similitud de palabras representativas de la percepción de los enfermeros sobre alimentación oral y elección del método de alimentación determinó la conformación de tres núcleos centrales, representados por las palabras creer, dar, biberón. Conclusión: los enfermeros reconocen la importancia de la educación continua y de la capacitación en evaluación de las competencias orales. La razón de elección del método de alimentación se fundamenta, frecuentemente, en criterios como preferencia, rapidez y facilidad.

RESUMO Objetivo: analisar a perceção do enfermeiro sobre a alimentação do recém-nascido pré-termo e as suas motivações na aplicação dos métodos de alimentação, durante o internamento na unidade de neonatologia. Método: estudo descritivo, com abordagem qualitativa. Recolha de dados, feita entre julho de 2019 e janeiro de 2020, com recurso à entrevista semiestruturada, a 30 enfermeiros de uma unidade de neonatologia. A análise dos dados que resultaram do conteúdo das entrevistas, fez-se com recurso à análise textual lexicográfica, recorrendo à Classificação Hierárquica Descendente e análise de similitude, através do software IRaMuTeQ - Interface de R. Resultados: na Classificação Hierárquica Descendente, foram analisados 876 segmentos de texto, retendo 86,3% do total para a criação de cinco classes, resultantes da participação do conteúdo. A análise de similitude das palavras representativas da perceção dos enfermeiros, sobre a alimentação oral e a escolha do método de alimentação, conduziu à formação de três núcleos centrais, representados pelas palavras: achar, dar, biberão. Conclusão: os enfermeiros reconhecem a importância da formação contínua e do treino na avaliação das competências orais. O motivo de escolha do método de alimentação baseia-se, frequentemente, em critérios como a preferência, rapidez e facilidade.

Técnicas de alimentación en la promoción de las habilidades oromotoras del recién nacido prematuro: a scoping review / Técnicas de alimentação na promoção das competências oro-motoras do Recém-nascido Pré-termo: a Scoping Review / Feeding methods in promoting the oral motor skills of the Preterm Newborn: a Scoping Review

INTRODUCCIÓN: La alimentación oral es una actividad sensoriomotora muy compleja y exigente en relación con la coordinación oromotora del recién nacido prematuro requiriendo de los enfermeros la implementación de cuidados neuroprotectores. En el cuidado de enfermería para recién nacidos prematuros, no hay consenso sobre la elección de la técnica de alimentación oral más adecuada para el desarrollo de habilidades oromotoras, lo que ciertamente influirá en la autonomía de alimentación. OBJETIVO: Identificar y mapear la literatura científica, las técnicas de la alimentación oral promotores de las competencias oromotoras del recién nacido prematuro. MÉTODO: Se realizó una scoping review c que permitió el mapeo de artículos publicados en cuatro bases de datos: Medline; CINAHL; Cochrane Central Register of Controlled Trials y Scielo y no publicados (Google scholar, tesis de maestría y doctorado), entre 2000 y 2018. RESULTADOS: Se incluyeron 28 estudios, de los cuales 21 son primarios, seis son secundarios y una tesis de doctorado. De estos surgieron tres técnicas de alimentación (biberón, taza y finger-feeding). Biberón aparece como un promotor de patrones de succión más maduros; la taza aparece como el más abierto, pero poco consensuado con respecto a los beneficios para el desarrollo oromotor y finger-feeding aparece como un facilitador del entrenamiento de succión y complementario a la lactancia materna. CONCLUSIÓN: Las publicaciones analizadas se centran principalmente en aspectos de estabilidad hemodinámica, aumento de peso y autonomía alimentaria, con el consiguiente alta hospitalaria temprana. Por lo tanto, es esencial comprender cómo cada técnica promueve el desarrollo de habilidades oromotoras, y también es esencial contemplar los deseos y expectativas de los padres con respecto a la alimentación, como la lactancia materna exclusiva

INTRODUÇÃO: A alimentação oral é uma atividade sensoriomotora altamente complexa e exigente relativamente à coordenação oro-motora do recém-nascido pré-termo, requerendo dos enfermeiros a implementação de cuidados neuroprotetores. Nos cuidados de enfermagem ao recém-nascido pré-termo, não existe consenso na escolha da técnica de alimentação oral mais adequada ao desenvolvimento das competências oro-motoras, o que decerto vai influenciar a autonomia alimentar. OBJETIVO: identificar e mapear na literatura científica, as técnicas de alimentação oral promotoras das competências oro-motoras do recém-nascido pré-termo. MÉTODO: Foi realizada uma scoping review com uma pesquisa que permitiu o mapeamento de artigos publicados em bases de dados (Medline, CINAHL, Cochrane Central Register of Controlled Trials e Scielo) e não publicados (Google Académico, teses de mestrado e doutoramento), entre o ano 2000 e 2018. RESULTADOS: Selecionaram-se 28 estudos, 21 primários, 6 secundários e uma tese de doutoramento. Destes emergiram três técnicas de alimentação (biberão, copo e finger-feeding). O biberão surge como promotor de padrões de sucção mais maturos; o copo surge como o mais descortinado, mas pouco consensual relativamente aos benefícios para o desenvolvimento oro-motor e o finger-feeding surge como facilitadora do treino da sucção e complementar da amamentação. CONCLUSÃO: As publicações analisadas focam-se sobretudo em aspetos de estabilidade hemodinâmica, de ganho ponderal e da autonomia alimentar, com consequente alta hospitalar precoce. É por isso essencial compreender de que forma cada técnica promove o desenvolvimento das competências oro-motoras, sendo também essencial contemplar os desejos e expectativas dos pais quanto à alimentação, como por exemplo a realização da amamentação exclusiva

BACKGROUND: Oral feeding is a highly complex and coordinated sensorimotor activity for the preterm infants, requiring nurses to implement neuroprotective care. In nursing care, there is no consensus on the choice of the most appropriate oral feeding method for the development of oro-motor skills and the consequent feeding autonomy of the preterm infant. OBJECTIVE: identify and map, in the scientific literature, the oral feeding method that promotes the development of oro-motor skills in preterm in preterm infants. METHOD: A scoping review was carried out with a research that allowed the mapping of articles published in databases (Medline, CINAHL, Cochrane Central Register of Controlled Trials and Scielo) and unpublished (Google scholar, master's and doctoral theses), between 2000 and 2018. RESULTS: This scoping review included 28 studies: 21 are primary studies, 6 secondary studies and a doctoral thesis. Three feeding methods emerged (bottle, cup and finger-feeding). The bottle appears as a promoter of more mature suction patterns; the cup is the must studied method but little consensual regarding the benefits for oro-motor development and finger-feeding appears as a facilitator of suction training and breastfeeding. CONCLUSION: The publications focus mainly on aspects of hemodynamic stability, weight gain and feeding autonomy, with consequent early hospital discharge. It is therefore essential to understand how each method promotes the development of oro-motor skills, and it is also essential to contemplate the wishes and expectations of parents regarding food, such as exclusive breastfeeding

Competências oro-motoras para a alimentação do recém-nascido pré-termo: influência no neurodesenvolvimento / Oral-motor skills for feeding preterm newborns: influence on neurodevelopment

A elaboração do presente relatório, pretende retratar o percurso de aprendizagens pessoais, profissionais e académicas que contribuíram para o desenvolvimento das competências comuns do enfermeiro especialista e específicas do enfermeiro especialista em enfermagem de saúde infantil e pediatria. As oportunidades de aprendizagem experienciadas nos diferentes contextos, promoveram momentos de análise e de reflexão contribuindo para elevados níveis de julgamento clínico, essenciais para prática refletida e fundamentada, baseada na evidência científica e no regulamento dos Padrões de Qualidade dos Cuidados de Enfermagem Especializados em Enfermagem de Saúde da Criança e do Jovem. O ponto de partida para este trabalho foi a necessidade de resposta a uma inquietação pessoal e profissional quanto à intervenção do enfermeiro na promoção das competências oro-motoras para a alimentação do recém-nascido pré-termo. Sabe-se que os recém-nascidos pré-termo são especialmente vulneráveis às dificuldades alimentares, pelo que o suporte alimentar deverá corresponder a uma das intervenções prioritárias nos cuidados. Por este motivo, é fundamental compreender de que modo as intervenções de enfermagem promovem o desenvolvimento das competências oro-motoras e de que forma auxiliam o recém-nascido a reter, atingir ou manter a sua estabilidade ao nível da alimentação oral e gestão nutricional. Com o trabalho desenvolvido espera-se contribuir para uma mudança positiva para melhorar a qualidade dos cuidados prestados e consequentemente para a excelência do exercício profissional. Pretende-se igualmente potenciar o desenvolvimento do conhecimento científico de enfermagem no âmbito da alimentação oral do recém-nascido pré-termo. Estruturalmente o relatório será constituído pela justificação da problemática; pelo o referencial teórico; pelo enquadramento conceptual; pela apresentação do percurso formativo que levou à aquisição das competências comuns do enfermeiro especialista e específicas do enfermeiro especialista em enfermagem de saúde infantil e pediatria; pela explicitação da importância de dar continuidade ao percurso iniciado através de projetos futuros e no seu termino as considerações finais.

The present report aims to demonstrate my personal, professional and academic learning path towards the development of general and specific competencies as a specialist nurse in pediatrics. All the learning opportunities in the different training contexts, promoted moments of analysis and reflexion, which contributed to the acquisition of high standards of clinical judgement, key factor of the reflective practice, as well as evidence based and respecting the quality standards of practice of the specialized pediatric nurse. At the starting point of this report, was a personal necessity towards improving and giving recognition to the nursing role in promoting the oro-motor competencies of the preterm baby. It's known that the preterm baby is specially vulnerable to experiencing feeding difficulties, which justifies the fact that this should be one of the nursing care priorities. For this reason, it's fundamental to understand how the nursing interventions promote the development of the oro-motor competencies and in what way they help the baby retain, achieve and maintain the oral feeding stability and adequate nutritional management. With the developed work it's expected a contribution towards a positive change in improving the quality of care and consequently towards the nursing care excellency. It's also expected to develop the scientific knowledge regarding oral feeding of the preterm baby. Structurally, the present report will include the problem justification; theoretical references; the conceptual framework; the presentation of the educational path that led to the acquisition of the general and specific competencies as a specialist nurse in pediatrics; the demonstration of the importance of giving continuity to the developed work through future projects; and, finally, the final considerations.