Madalena Cunha

Adolescent coping with everyday stressors: A seven-nation study of youth from central, eastern, southern, and northern Europe

The present study compares problem-specific coping strategies and coping styles of European adolescents from seven nations. The sample consisted of 3031 adolescent participants, aged 11 to 20, from Croatia, the Czech Republic, Germany, Italy, Norway, Portugal, and Switzerland. The adolescents completed the Coping Across Situations Questionnaire (CASQ) by indicating which coping strategies (from 20 alternatives) they usually employed in dealing with age-specific problems (covering 8 different domains). The strategies can be collapsed to three coping styles: active coping, internal coping, and withdrawal. Results show that adolescents from all seven nations predominantly employed functional forms of coping, i.e., active coping and internal coping. In addition, the pattern of frequently and rarely applied coping strategies was similar across cultures. Differences in coping style were revealed for some, but not all problem domains, suggesting that cross-cultural similarity in coping exists for specific stressors. Problem-specific analyses helped to clarify where cultural influence is most distinct. Whereas cultural diversity was highest for coping with job-related problems, coping with self- and future-related problems was highly similar among adolescents from all the nations. Despite the considerable traditional, educational, and economic differences among the cultures investigated, the similarities in coping behaviour were impressive. Explanations for cultural universals and differences in adolescent coping are discussed.

Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization: a systematic review

Las infecciones del tracto urinario asociadas con cateterismo son muy comunes en el contexto comunitario y hospitalario. Actualmente existen varias recomendaciones para su prevencion. Sin embargo, las dudas persisten en la eleccion del soluto utilizado en el meato urinario antes del cateterismo. Por lo tanto, este estudio trata de determinar la eficacia de la limpieza del meato urinario con agua/solucion salina comparativamente con su asepsia, mediante la realizacion de una revision sistematica con meta-analisis. Para lo cual, se siguieron los principios propuestos por el Manual Cochrane, el analisis critico realizado por dos investigadores y el analisis estadistico utilizando el programa STATA 11.1. Podemos concluir que la limpieza o desinfeccion del meato urinario antes del cateterismo no es estadisticamente significativo (OR=1,07, 95%CI=0,68-1,68, p=0,779) existiendo algunas evidencias de que el uso de agua/solucion salina reduce las tasas de ITU.The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection).

The effects of emergency department overcrowding on admitted patient outcomes: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the effects of emergency department (ED) overcrowding on admitted patient outcomes.More specifically, the questions are: does ED overcrowding increase the admitted patients mortality? Does ED overcrowding increase the admitted patients hospital length-of-stay? Does ED overcrowding increase the delay in door-to-needle time to treatment (time to antibiotic, time to thrombolysis and time to analgesic)?

Eficacia da limpeza ou desinfecao do meato urinario antes da cateterizacao urinaria: revisao sistematica

Las infecciones del tracto urinario asociadas con cateterismo son muy comunes en el contexto comunitario y hospitalario. Actualmente existen varias recomendaciones para su prevencion. Sin embargo, las dudas persisten en la eleccion del soluto utilizado en el meato urinario antes del cateterismo. Por lo tanto, este estudio trata de determinar la eficacia de la limpieza del meato urinario con agua/solucion salina comparativamente con su asepsia, mediante la realizacion de una revision sistematica con meta-analisis. Para lo cual, se siguieron los principios propuestos por el Manual Cochrane, el analisis critico realizado por dos investigadores y el analisis estadistico utilizando el programa STATA 11.1. Podemos concluir que la limpieza o desinfeccion del meato urinario antes del cateterismo no es estadisticamente significativo (OR=1,07, 95%CI=0,68-1,68, p=0,779) existiendo algunas evidencias de que el uso de agua/solucion salina reduce las tasas de ITU.The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection).

Genetic heritage as a risk factor enabling chilhood obesity

INTRODUCTION Nowadays, it is an evidence that maternal obesity is an important predictor of obesity in the descendants, not being consensual if that influence comes from the interaction between genes and facilitators family contexts or both. OBJECTIVES 1) To determinate the prevalence of the child overweight; 2) to classify the nutritional status and metabolic risk of the progenitors; 3) to analyze the effect of the markers of the family metabolic risk in the expression of the illness in the child. MATERIAL AND METHODS Descriptive study composed by 1424 children, average age 4.58 years old and their mothers, average age 34.47 years old, living in several parts of Portugal. The childrens anthropometric measures were evaluated and classified according to the NCHS referential (CDC, 2000)(1) and of the progenitors by the orientations of the WHO (2000)(2) and Portugal, DGS (2005).(3) Social demographic data was obtained by filling in the Food Frequency Questionnaire adapted from Rito (2007).(4) RESULTS The overweight affected 34.3% of the children, (including 17.4% obesity), being the higher values on boys (36.8%) and in 5 year old children (39.5). In 41.9% of the progenitors overweight was noted (12.1% obesity), being higher in mothers with low scholarship, low income, older and living in a rural area. The probability of the child to be overweighted was 1.4 times higher when mothers were overweight, and close to 2 times in the relationship mother/daughter. Others enabling factors were revealed, like weight gain above recommended during pregnancy and a higher weight at birth. CONCLUSIONS Due to the obtained interferences, it is accepted the existence of enabling factors of maternal and child markers in the development of overweight in the child, so that the prevention of child obesity should consider not only the environmental dimension but also the genetic heritage.

Implications of literacy for health for body mass index

INTRODUCTION Literacy for health (LH) may be considered a set of skills that people appropriate, understand, evaluate and use information and knowledge of health to make informed choices, reduce risks to their health, maintain a healthy nutritional status and enhance quality of life. OBJECTIVES To assess the level of literacy for health; analyse the relationship of socio-demographic variables with LH; to classify the Body Mass Index (BMI) and to determine the effect of LH on BMI. DESIGN a quantitative study with a descriptive and cross-sectional approach conducted in the centre and north of Portugal. Particnipants: a non-probabilistic sample of 508 Portuguese participants with a mean age 44.48 years (SD = 21 years). MEASURING INSTRUMENTS LH was assessed by the European Questionnaire on Literacy for Health (LHS-EU-PT) validated in Portuguese by Saboga-Nunes and Sorensen (2013) and BMI classification followed the WHO reference accepted by Portugal, DGS (2013). RESULTS It was found that overall, 73.62% of the participants have an inappropriate and problematic level of literacy for health; this was significantly lower in women (P=.000). Participants with inadequate LH, are those with higher BMI (χ(2)=78.09; P=.000), so are at risk of a sub-optimal state of health. CONCLUSIONS The results suggest a significant relationship between the LH and BMI. It is found that, the better the LH, the more appropriate is the BMI. This evidence reinforces the importance of promoting literacy for health to the Portuguese population.

Food consumption, body mass index and risk for oral health in adolescents.

OBJECTIVE The food intake has great influence on the oral health of adolescents, being relevant to analyze the type of food consumed by adolescents and their relationship with the DMFT index (decayed, missing and filled), the plaque index (PI) and the body mass index (BMI). DESIGN Epidemiological study conducted in public schools of the 3rd cycle of basic education, central Portugal. INSTRUMENTS The sociodemographic and dietary habits and frequency characterization was obtained through a self-administered questionnaire completed by adolescents and validated for the population under study. The DMFT index was evaluated according to WHO criteria, oral hygiene was evaluated based on the plaque index and BMI through weight and height in adolescents. PARTICIPANTS Random sample by clusters (schools) with 661 adolescents, 84.1% female and 15.9% male. RESULTS Adolescents with mean age 13.22 years (± 1.139). The mean DMFT was 2.23 (± 2.484), the prevalence of PI was 96.4%, and ≥ 5 BMI <85. Adolescents with a higher DMFT index consume more cariogenic foods (r=0.160; P=.000). Adolescents with a higher BMI consume less cariogenic foods (r=-0.1343; P=.001). The value of t reveals that the consumption of cariogenic foods explains 1.8% of the variance of the BMI and 2.6% DMFT. CONCLUSION The cariogenic foods are presented as a risk factor for dental caries. The results suggest that it is important to develop up actions for health education.

Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review

Background Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium. Objectives To identify the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium. Inclusion criteria Types of participants Patients with a predicted high risk of delirium, aged 18 years or over, and in intensive care units. Patients with a history of concurrent antipsychotic medication use were excluded. Types of intervention(s)/phenomena of interest Haloperidol prophylaxis for preventing delirium. Types of studies Experimental and epidemiological study designs. Outcomes Primary outcome is the incidence of delirium. Secondary outcomes are duration of mechanical ventilation, incidence of re-intubation, incidence of unplanned/accidental removal of tubes/lines and catheters, intensive care unit and hospital length of stay, and re-admissions to both settings. Search strategy An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1967 to September 2015 in major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included. Methodological quality Two independent reviewers assessed the methodological quality of five studies using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. There was general agreement among the reviewers to exclude one relevant study due to methodological quality. Data extraction Data were extracted using the JBI data extraction form for experimental studies and included details about the interventions, populations, study methods and outcomes of significance to the review questions. Data synthesis Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity) and designs (methodological heterogeneity). For these reasons, we were unable to perform a meta-analysis. Therefore, the results have been described in a narrative format. Results Five studies met the inclusion criteria. One of these studies was excluded due to poor methodological quality. The remaining four original studies (total of 1142 patients) were included in this review. Three studies were randomized controlled trials and one was a cohort study. Two studies confirmed the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium. These studies showed that short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of delirium in elderly patients admitted to intensive care units after non-cardiac surgery and in general intensive care unit patients with a high risk of delirium. However, the two remaining studies showed contradictory results in mechanically ventilated critically ill adults, revealing that the administration of haloperidol reduced delirium prevalence, delayed its occurrence, and/or shorten its duration. Conclusions The evidence related to the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium is contradictory. However, balancing the benefits and low side effects associated with haloperidol prophylaxis, this preventive intervention may be useful to reduce the incidence of delirium in critically ill adults in intensive care units.

the effectiveness of cleansing solutions for wound treatment: a systematic review

Background The management of chronic and acute wounds has changed significantly over the last decade. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. Although there is a consensus that wound cleansing reduces infection rates, there is, however, some debate in clinical circles about the potential advantages and disadvantages of cleansing wounds. This practice may not always be necessary as the exudate itself may contain growth factors and chemokines which contribute to wound healing. Objectives The objective of this review is to identify and synthesize the best available evidence on the effectiveness of cleansing solutions for wound treatment in clinical practice and compare the effectiveness of different cleansing solutions in infection and wound healing rates. Inclusion criteria Types of participants This review considered studies that included patients with chronic and acute wounds (of any etiology), with the exception of obstetric wounds. Patients aged 18 years or more in any setting (hospital, community and general practice) were included, with the exception of malnourished patients. Types of intervention(s) This review considered studies that used any cleansing solution or chemicals as cleansing solutions other than antiseptic solutions in wound treatment. Types of studies This review considered experimental study designs including randomized controlled trials (RCTs), non‐randomized controlled trials, or other quasi‐experimental studies, including before and after studies. Types of outcomes This review focused on two types of outcomes: primary outcome (infection rate) and secondary outcome (healing rate). Search strategy An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1990 to January 2013 in major healthcare‐related electronic databases. Studies in English, Spanish and Portuguese were included. Methodological quality Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed seven studies. There was general consensus among the reviewers to include the three final studies in this review. Data collection Data were extracted using the JBI data extraction form for experimental studies and included participant characteristics, intervention characteristics and study methods. Data synthesis The impact of interventions on infection and healing rates was described in a narrative format within each intervention. Data from two studies were pooled in a meta‐analysis. Results Eight studies met the inclusion criteria. From those, five studies were excluded after assessment of methodological quality. The remaining three original articles, which consisted of 718 patients, were included in this review. The three studies were randomized clinical trials. The interventions included in this systematic review were: Tap water versus Sterile saline and Povidone‐iodine‐soaked gauze versus Saline‐soaked gauze. Data from two studies reporting the effectiveness of Tap Water versus Sterile Saline and respective wound infection rates were pooled in a meta‐analysis. The meta‐analysis showed a low heterogeneity (Heterogeneity Chi squared=1.45, p=0.23; I2 =31.1%). No statistically significant differences were found (z=0.59; p=0.55). Nevertheless, a positive effect in the prevention of infection rates was observed in the tap water group (OR=0.79; 95% Cl: 0.36, 1.72). For acute wounds, the odds ratio of developing an infection when cleansing with tap water compared with saline was 0.98 (95% CI: 0.43, 2.25). Conclusions There is no evidence that using tap water to cleanse acute and chronic wounds in adults increases infection or healing rates. There is some evidence that it reduces infection when compared to saline. There may be a trend towards a lower wound infection rate when povidone‐iodine is used in surgical wounds, but this was not significant for varicose vein surgery. However, due to the small number of studies by interventions (few cleansing solutions), the evidence is not strong enough to produce a best practice.

A eficácia das soluções de limpeza para o tratamento de feridas: uma revisão sistemática

Background: There is a consensus that wound cleansing reduces infection rates. There is, however, some debate in clinical circles about the potential advanta...