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This paper answered some authors' requests to analyze the Helping Relationships Skills Inventory psychometric properties, a four dimensions measure. At this level, the study contributed to accessing the first reliable and valid instrument headed to Portuguese nurses and doctors. Methods: An online survey with Portuguese nurses and doctors (n = 262) was managed to assess the psychometrics properties analysis of the Helping Relationships Skills Inventory. Data were analyzed using descriptive statistics, confirmatory factor analysis, the average variance extracted (AVE), the heterotrait-monotrait ratio of correlations (HTMT), Cronbach's Alpha, and McDonald's Omega were computed. Results: The four-factor of the original Helping Relationships Skills Inventory was only supported by Exploratory Factor Analysis, with good internal consistency. Our study accepted this correlational structure hypothesis, which demonstrated acceptable to good sensitivity, convergent validity (AVE: 0.84-0.67), and reliability (Cronbach's Alpha: 0.92-0.88; McDonald'Omega: 0.93-0.79). Also stays verified discriminant validity for the majority of the factors with some reserves between Generics and Emphatics dimensions (HTMT: 0.90), revealing high commonality among them (r = 0.84; p < .001) Conclusions: The findings support the sensitivity, construct validity, and reliability of the Helping Relationships Skills Inventory among Portuguese nurses and doctors. However, will be useful to associate qualitative methodologies to explore the phenomenon better.
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OBJECTIVES: The aim of this study, as the first review directed at Primary Health Care, is to identify the screening practices and health outcomes related to the care provided by Family Health Teams to the malnourished elderly people/population. METHODS: Following PRISMA and PICO strategies, searches were conducted in four electronic databases (PubMed, Web of Science, Scopus & EMBASE) on observational, qualitative, quantitative, or mixed studies, written in Portuguese, Spanish and English language, with participants of 65 years old or older at a community setting. The literature selected for this study ranges from the period 2011 to 2021; additional articles were included through reference lists. RESULTS: From the 483 studies identified, 16 were considered eligible to use in this work. The Mini Nutritional Assessment (MNA) score appears as the main criteria of choice, however, a standardized practice in the health systems regarding the use of screening methods has not been demonstrated. Studies are more oriented towards the analysis of the relationship of mortality/morbidity and malnutrition than towards the relationship of the cost and quality of life and malnutrition of the elderly. DISCUSSION: Malnutrition is one of the modifiable risk factors which contributes to the vulnerable condition of the elderly, with serious effects, especially when related to other comorbidities. Yet, several authors argue that the Primary Health Care intervention can minimize the negative impacts and improve the health outcomes.
Subject(s)
Malnutrition , Quality of Life , Aged , Humans , Malnutrition/diagnosis , Mass Screening , Primary Health Care , Risk FactorsABSTRACT
BACKGROUND: Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. METHODS: A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. RESULTS: The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. CONCLUSIONS: Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group.
Subject(s)
Checklist , Language , Aged , Aged, 80 and over , Ethnicity , Humans , Portugal/epidemiology , Quality Indicators, Health CareABSTRACT
O presente estudo assume como relevância o cenário demográfico português nas últimas décadas, condição que exerce um forte impacto económico-social, particularmente, na sustentabilidade do SNS. Se considerar a senescência como uma etapa de vulnerabilidade, frequentemente são rastreáveis situações clínicas suscetíveis de prevenção/intervenção. Neste ponto, evidencia-se a atenção para o conjunto de indicadores CSP, com listagem de 365 métricas de desempenho, destas, apenas 4 se remetem para processos de qualidade na gestão saúde no idoso. Reconhece-se a importância de, na prática clínica e na relação direta com o idoso, se incrementar e reforçar, pelo recurso a indicadores de desempenho, a cultura de qualidade nas equipas de saúde. A este nível, distintos artigos de investigação realçam o ACOVE (conjunto amplo de indicadores) como um instrumento que promove o acesso da pessoa idosa a processos assistenciais com qualidade. Como principais objetivos do estudo destacam-se: i) adaptar transculturalmente o ACOVE-3, do inglês americano para o contexto português, ajustado ao nível de intervenção dos CSP; ii) apresentar a construção e validação de indicadores de processo que respondam, face ao hiato concetual identificado no ACOVE-3, à avaliação da dimensão de equidade no acesso do idoso aos cuidados de saúde; e iii) analisar a perceção de valor reconhecida pelos profissionais de saúde do ACES Cávado III, perante o recurso do ACOVE-3. Na sua estrutura metodológica, opta-se por um desenho exploratório/qualitativo/aplicado, com a participação de dois painéis de peritos (essencial ao processo de equivalência semântica do instrumento) e de profissionais de saúde (no processo de validação qualitativa análise do potencial de adesão). Para efeitos conclusivos, salienta-se a ampla aceitabilidade do instrumento pelos distintos painéis, vigorando um perfil fundamental científico, o de confiabilidade do mesmo. Na análise dos profissionais de saúde, demonstra-se: a dificuldade expressa na objetivação/enunciação clara das condições clínicas que traduzem vulnerabilidade no idoso (aumenta o risco de iatrogenia); a tomada de consciência, de preocupação perante o facto dos atuais IQ não permitirem orientar as equipas de saúde para a necessidade de uma avaliação integral da pessoa; a necessidade de se incluírem mais métricas, que associadas ao IQ existentes, contribuam para a avaliação do desempenho das equipas na Gestão da Saúde do Idoso; o reconhecimento do ACOVE-3 como um instrumento/fator estratégico de valor, capaz incrementar qualidade ao processo de cuidados.
This study takes as its relevance the portuguese demographic scenario in the last decades, a condition that has a strong economic and social impact, particularly on the sustainability of the NHS. If we consider senescence as a stage of vulnerability, clinical situations susceptible to prevention/intervention are often traceable. At this point, attention is drawn to the set of PHC indicators, with a list of 365 performance metrics, of which only 4 refer to quality processes in health management in the elderly. It is recognized the importance of, in clinical practice and in the direct relationship with the elderly, to increase and strengthen, through the use of performance indicators, the culture of quality in health teams. At this level, different research articles highlight ACOVE (broad set of indicators) as an instrument that promotes the access of the elderly to quality care processes. The main objectives of the study are: i) to transculturally adapt ACOVE-3, from the American English to the Portuguese context, adjusted to the intervention level of the CSP; ii) to present the construction and validation of process indicators that respond, given the concetual gap identified in ACOVE-3, to the evaluation of the equity dimension in the access of the elderly to health care; and iii) to analyse the perception of value recognised by the health professionals of ACES Cávado III, given the appeal of ACOVE-3. In its methodological structure, an exploratory/qualitative/applied design is chosen, with the participation of two panels of experts (essential to the semantic equivalence process of the instrument) and health professionals (in the process of qualitative validation - analysis of the adhesion potential). For conclusive purposes, the broad acceptability of the instrument by the different panels is emphasized, with a fundamental scientific profile, that of its reliability. In the analysis of health professionals, it is demonstrated: the difficulty expressed in the objectification/ clear announcement of the clinical conditions that translate vulnerability in the elderly (increases the risk of iatrogenicity); the awareness, concern with the fact that the current QIs do not allow orienting the health teams to the need for a comprehensive assessment of the person; the need to include more metrics, which associated with the existing QI, contribute to the evaluation of the performance of the teams in the Health Management of the Elderly; the recognition of ACOVE-3 as a strategic instrument/factor of value, capable of increasing the quality of the care process.
Subject(s)
Betrayal , Old Age Assistance , Nursing , Delivery of Health CareABSTRACT
OBJECTIVE: To analyse aspects of mineral metabolism, bone mineral density (BMD), bone remodelling activity and serum IGF-1 levels in children with chronic cholestatic disease (CCLD). PATIENTS AND MEASUREMENTS: A total of 13 children with chronic cholestatic liver disease (CCLD; mean age 7.2 +/- 4.8 years) and 22 control subjects (mean age 7.6 +/- 4.5 years) were studied. Serum osteocalcin, bone alkaline phosphatase (BAP), 25-hydroxyvitamin D, PTH and IGF-1 levels and urinary deoxypyridinoline were determined. BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine, total hip and whole body. Lumbar spine areal BMD was converted mathematically to apparent volumetric BMD (aBMD) and corrected for the bone age of the patient. RESULTS: Z-score of lumbar spine BMD was lower in CCLD patients than in controls and the difference was maintained when BMD was expressed as aBMD (control = 0.107 +/- 0.02 vs. CCLD = 0.092 +/- 0.02 g/cm(3), P < 0.05) and after conversion for bone age. All participants showed normal 25-hydroxyvitamin D levels, with no significant differences in serum levels of 25-hydroxyvitamin D and PTH between groups. IGF-1 levels were significantly lower in the CCLD group (control = 19.6 +/- 16.8 vs. CCLD = 6.4 +/- 7.6 nmol/l, P < 0.05) and a positive correlation was observed between whole body BMD and IGF-1 in this group. CONCLUSIONS: These results indicate that CCLD limits bone mass gain in children. A reduction in hepatic IGF-1 production might be responsible, at least in part, for the low bone mass of these patients.
Subject(s)
Bone Development/physiology , Cholestasis, Intrahepatic/physiopathology , Absorptiometry, Photon , Adolescent , Alkaline Phosphatase/blood , Amino Acids/urine , Biomarkers/blood , Biomarkers/urine , Body Height , Bone Density/physiology , Bone Remodeling , Case-Control Studies , Child , Child, Preschool , Cholestasis, Intrahepatic/blood , Cholestasis, Intrahepatic/urine , Female , Humans , Infant , Insulin-Like Growth Factor I/analysis , Linear Models , Lumbar Vertebrae , Male , Osteocalcin/blood , Parathyroid Hormone/blood , Vitamin D/analogs & derivatives , Vitamin D/bloodABSTRACT
Hipertensão Arterial em Pediatria - Parte I: Conceitos e Definições
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Child Health , HypertensionABSTRACT
Hipertensão Arterial em Pediatria - Parte II: Técnicas de Aferição de Pressão Arterial na Criança
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Child Health , HypertensionABSTRACT
Hipertensão Arterial em Pediatria - Parte III: Investigação e Tratamento da Hipertensão Arterial na Criança
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Child Health , HypertensionABSTRACT
O recurso áudio-visual trata da clínica médica de Diabetes Mellitus Infantil com manifestações de sinais e sintomas
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Diabetes MellitusABSTRACT
O recurso áudio-visual sobre o tratamento de Diabetes Mellitus Infantil com suas principais indicações e orientações
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Diabetes MellitusABSTRACT
O recurso áudio-visual sobre Fisiopatologia e Epidemiologia da Diabetes Mellitus Infantil.
