The Family and Safety of the Hospitalized Patient: An Integrative Literature Review

Framework: Considering that the current data on health care safety remain alarming, there is an overwhelming urge for the ongoing study of this topic and for recommendations and differentiated strategies which aim to promote health and which prove effective. Some recommendations have been taken into consideration, such as patient-centered care, and consequently the need for greater involvement of patient and family in this process. However, we have identified arguments for and against the involvement of family in the care process, and consequently a greater or lesser openness towards hospital visits. Objective: What are the implications of the presence of family for the safety of hospitalized patients? What does the science say about these implications? Methods: We conducted an integrative literature review by referring to the Web of Science, CINAHL, Medline, and Scopus databases, according to the recommendations of the Joanna Briggs Institute for scoping review. Results: We found 115 articles. After selection, 13 articles were included in this review. There were 6 qualitative studies, 5 quantitative studies, and 2 literature reviews. Data were grouped according to: the perspective of patients and their families, the health professionals’ perspective, and statistical evidence. Conclusion: Families take efforts to protect the safety of hospitalized patients but feel unprepared; a lack of follow-up was reported. Some health professionals claim that the presence of the family can increase the risks for patient safety and the fear of an increased workload. The evidence of the presence of the family and its link to the safety of the hospitalized patient demonstrated that this relationship is not yet well understood. There were limited findings about this in the current literature. Relevance to Clinical Practice: Structured interventions about family integration in ensuring the safety of hospitalized patients may have the potential to contribute to the safety of health care.Enquadramento: Considerando que os dados atuais sobre segurança em saúde ainda são alarmantes, há uma urgência avassaladora pelo estudo contínuo desse tema e por recomendações e estratégias diferenciadas que visem a promoção da saúde. Existem algumas recomendações que têm sido levadas em consideração a esse respeito, como o cuidado centrado no paciente e, consequentemente, a necessidade de maior envolvimento do paciente e de sua família nesse processo. Porém, no contexto de trabalho, identificamos argumentos a favor e contra o envolvimento da família no processo de cuidado e, consequentemente, uma maior ou menor abertura para visitas no contexto hospitalar. Objetivo: Quais as implicações da presença da família na segurança do doente internado com o intuito de responder á questão de investigação: Qual a produção científica sobre as implicações da presença da família na segurança do doente hospitalizado? Métodos: Revisão integrativa da literatura através de pesquisa nas bases de dados Web of Science, CINAHL, Medline e Scopus, de acordo com as recomendações do Joanna Briggs Institute para scoping review. Resultados: Da pesquisa foram encontrados 115 artigos. Após a seleção foram incluidos neste estudo 13 artigos. Destes, 7 estudos qualitativos, 5 quantitativos e 2 revisões de literatura, cujos dados foram agrupados de acorco com: perspetiva da família e doente, a perspetiva dos profissionais de saúde e a evidência estatistica. Conclusão: A familia desenvolve esforços no sentido de proteger a segurança do doente internado mas sente-se despreparada e desacompanhada. Alguns profissionais de saúde alegam que a presença da familia pode aumentar os riscos para a segurança do doente e receiam aumento da carga de trabalho. A evidência encontrada sobre presença da família e a sua relação com a segurança do doente internado demonstra que esta relação ainda não é bem compreendida, com achados disponíveis limitados na literatura atual. Relevância para a Prática Clínica: Intervenções estruturadas de integração da família na salvaguarda da segurança do doente internado podem ter o potencial de contribuir para a segurança dos cuidados de saúde.info:eu-repo/semantics/publishedVersio

The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: a prospective cohort study

Objectives: To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses’ depression, anxiety and stress symptoms. Methods: Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales – short version (DASS-21)). Results: The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). Conclusions: Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses’ stress, anxiety and depression symptoms during the COVID-19 outbreak.info:eu-repo/semantics/publishedVersio

Patient-centered care for people with depression and anxiety: an integrative review protocol

Introduction: Depression and anxiety are mental diseases found worldwide, with the tendency to worsen in the current pandemic period. These illnesses contribute the most to the world’s rate of years lived with disability. We aim to identify and synthesize indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment, care planning, and intervention. Methods and analysis: An integrative literature review will be conducted, and the research carried out on the following databases: MEDLINE, PsycINFO, Scopus, and Psychology and Behavioral Sciences Collection, CINAHL, Web of Science, TrialRegistry, and MedicLatina. The research strategy contains the following terms MesH or similar: “patient-centered care”, “depression”, and “anxiety”. Two independent revisers will perform the inclusion and exclusion criteria analysis, the quality analysis of the data, and its extraction for synthesis. Disagreements will be resolved by a third revisor. All studies related to diagnostic assessment, care planning, or intervention strategies will be included as long as they focus on care focused on people with depression and anxiety, regardless of the context. Given the plurality of the eligible studies, we used the narrative synthesis method for the analysis of the diagnostic assessment, the care and intervention planning, and the facilitators and barriers.info:eu-repo/semantics/publishedVersio

Morphological and Postural changes in the foot during pregnancy and puerperium : a longitudinal study

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium

Hábitos Alimentares das Pessoas com Diabetes Mellitus Tipo 2 em Portugal: Um Estudo Transversal

Introdução: A nutrição é uma área de intervenção na prevenção e gestão da diabetes mellitus; por isso, é fulcral promover a capacitação da população para a adoção de hábitos alimentares saudáveis. Ainda que existam alguns estudos nesta área, não se conhecem os principais erros nos hábitos alimentares das pessoas com diabetes em Portugal. Os objetivos deste estudo foram identificar os principais erros nos hábitos alimentares das pessoas com diabetes mellitus tipo 2 em Portugal e avaliar a sua relação com variáveis sociodemográficas. Métodos: Estudo transversal multicêntrico, em amostra de conveniência de pessoas com diabetes mellitus tipo 2 seguidas em Unidades de Cuidados de Saúde Primários. Aplicação do UK Diabetes and Diet Questionnaire (UKDDQ) – traduzido e adaptado, de julho a outubro de 2022. Análise estatística descritiva e inferencial. Resultados: Amostra de 550 participantes, 52,2% do sexo feminino, 68,3% com 65 anos ou mais, 55,8% com nível de escolaridade igual ou inferior ao 1.º ciclo do ensino básico, 24,7% com insuficiência económica e tempo desde o diagnóstico médio de 10,60 ± 8,13 anos. Apenas 36,2% da amostra obteve um score UKDDQ considerado saudável. Menos de 50% obteve scores saudáveis para os itens “arroz ou massa ricos em fibras”, “pão integral”, “manteiga, margarina e óleos vegetais” e “vegetais e leguminosas”. Somente 8,9% da amostra obteve score saudável para o consumo de fibras. Cerca de 70,4% obteve score saudável para o consumo de açúcares livres e 54,7% para o consumo de ácidos gordos saturados. Verificou-se a existência de uma correlação com significado estatístico positiva fraca entre o score UKDDQ e a idade (ρ = 0,201, p < 0,001), com escolha mais frequente de alimentos saudáveis com o aumentar da idade. As pessoas do sexo feminino reportaram hábitos alimentares mais saudáveis, particularmente no consumo de fibras e ácidos gordos saturados. Conclusão: A maior parte da nossa amostra não usufruiu do potencial efeito positivo de uma alimentação saudável. Individualizam-se grupos de alimentos cujos consumos devem ser enfatizados ou desencorajados, particularmente, a necessidade de incentivar o consumo de alimentos ricos em fibra. Ações educacionais dirigidas devem ter especial foco em pessoas mais jovens e/ou do sexo masculino

Influenza severe cases in hospitals, between 2014 and 2016 in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.info:eu-repo/semantics/publishedVersio

Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe: inverno 2013/2014

A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe (RPLDG) integra, atualmente, 15 laboratórios maioritariamente hospitalares e é coordenada pelo Laboratório Nacional de Referência para o Vírus da Gripe (LNRVG) do Departamento de Doenças Infecciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P. A RPLDG realiza o diagnóstico laboratorial do vírus da gripe assim como de outros vírus respiratórios, permitindo um conhecimento mais preciso da etiologia das infeções respiratórias, particularmente em casos hospitalizados de infeção respiratória aguda grave, constituindo um complemento valioso para o PNVG. Os casos de SG provenientes de emergências hospitalares e casos de Infecção Respiratória Aguda Grave, incluindo casos com internamento em unidade de cuidados intensivos, foram notificados pelos laboratórios da Rede ao LNRVG. Dos 15 laboratórios da Rede, 13 notificaram casos de doença respiratória durante a época de 2013/2014. Os dados recolhidos foram inseridos em suporte informático tendo as bases de dados sido agregadas numa base de dados comum submetida a um processo de validação de congruência de dados. Os dados analisados correspondem ao período que decorreu entre a semana 38 de 2013 e a semana 21 de 2014. Foram notificados pelos Laboratórios da Rede um total de 3790 casos de infeção respiratória. O maior número de notificações foi observado no mês de janeiro e fevereiro (semanas 2/2014 a 8/2014), com um pico de ocorrência na semana 4/2014 com a notificação de 454 casos de infeção respiratória. O vírus da gripe foi detetado em 822 casos de infeção respiratória. O vírus influenza A foi identificado em 807 (98,2%) dos casos positivos, destes 403 (49,0%) pertencem ao subtipo A(H1)pdm09, 98 (12,0%) ao subtipo A(H3) e 306 (37,0%) vírus influenza A não foram subtipados. O vírus influenza B foi detetado em 14 (2,0%) casos. Foi identificada 1 infecção mista por vírus influenza A(H1)pdm09 e A(H3) (0,1%). A maior percentagem de casos de gripe foi observada em indivíduos entre os 15 e os 64 anos sendo o vírus influenza A(H1)pdm09 o predominantemente detetado. Nas crianças com menos de 4 anos o vírus influenza foi detetado numa proporção reduzida, apenas em 8,8% dos casos analisados laboratorialmente, sendo o agente mais detetado neste grupo etário, o vírus sincicial respiratório (dados não mostrados). A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe permitiu a deteção dos vírus da gripe em meio hospitalar, incluindo doentes em internamento e UCI. Os vírus influenza A foram predominantes e detetados em maior percentagem nos jovens e adultos

Dichloroacetate, the Pyruvate Dehydrogenase Complex and the Modulation of mESC Pluripotency.

The pyruvate dehydrogenase (PDH) complex is localized in the mitochondrial matrix catalyzing the irreversible decarboxylation of pyruvate to acetyl-CoA and NADH. For proper complex regulation the E1-α subunit functions as an on/off switch regulated by phosphorylation/dephosphorylation. In different cell types one of the four-pyruvate dehydrogenase kinase isoforms (PDHK1-4) can phosphorylate this subunit leading to PDH inactivation. Our previous results with human Embryonic Stem Cells (hESC), suggested that PDHK could be a key regulator in the metabolic profile of pluripotent cells, as it is upregulated in pluripotent stem cells. Therefore, we wondered if metabolic modulation, via inexpensive pharmacological inhibition of PDHK, could impact metabolism and pluripotency.In order to assess the importance of the PDH cycle in mouse Embryonic Stem Cells (mESC), we incubated cells with the PDHK inhibitor dichloroacetate (DCA) and observed that in its presence ESC started to differentiate. Changes in mitochondrial function and proliferation potential were also found and protein levels for PDH (both phosphorylated and non-phosphorylated) and PDHK1 were monitored. Interestingly, we were also able to describe a possible pathway that involves Hif-1α and p53 during DCA-induced loss of pluripotency. Results with ESCs treated with DCA were comparable to those obtained for cells grown without Leukemia Inhibitor Factor (LIF), used in this case as a positive control for differentiation.DCA negatively affects ESC pluripotency by changing cell metabolism and elements related to the PDH cycle, suggesting that PDHK could function as a possible metabolic gatekeeper in ESC, and may be a good target to modulate metabolism and differentiation. Although further molecular biology-based experiments are required, our data suggests that inactive PDH favors pluripotency and that ESC have similar strategies as cancer cells to maintain a glycolytic profile, by using some of the signaling pathways found in the latter cells

Affectivity in schizophrenia: Its relations with functioning, quality of life, and social support satisfaction

Objective: To evaluate the relationship between affectivity and sociodemographic and clinical characteristics, quality of life, functioning, and social support satisfaction in schizophrenia. Method: Cross‐sectional study of a sample of 282 schizophrenic patients. An interview was performed using a sociodemographic and clinical questionnaire and scales to evaluate positive and negative affect, quality of life, social support satisfaction, and functioning. Results: Participants' employment status, gender, whether they smoked, hospitalization in the last year, antidepressant medication and benzodiazepines, quality of life, functioning, and satisfaction with social support had relationships with positive or negative affect. Conclusion: This study provides further understanding of the factors related to affectivity in schizophrenia. More studies are needed to prove these relations and their effects on rehabilitation in people with schizophrenia.info:eu-repo/semantics/publishedVersio