Educação alimentar na formação de adultos: contributos para a educação: promoção da saúde

A saúde deve ser entendida como um recurso para a vida, como tal, exige a adoção de comportamentos saudáveis para se atingir o bem-estar pleno. Atualmente, as alterações dos estilos de vida começam a repercutir-se em problemas graves de saúde pública. Nesta perspetiva, todos os espaços e tempos são profícuos para a promoção de atitudes saudáveis, sendo a escola um dos locais de excelência para implentar a Educação/ Promoção da Saúde (Precioso, 2004). A alimentação para além de ser uma necessidade fundamental do ser humano, é um dos fatores mais determinante no estado de saúde (Loureiro, 2004). Como tal, é de extrema importância conhecer os hábitos alimentares das populações, a fim de se poder agir e promover a educação alimentar (Baixinho 2008). O presente estudo teve como objetivos principais: conhecer os hábitos alimentares dos alunos dos cursos do 1º ciclo de Educação de Adultos do concelho de Vinhais, elaborar recursos didáticos adequados, contribuir para a promoção de uma alimentação saudável e aumento dos níveis de literacia. A análise dos resultados permitiu inferir que os referidos alunos apresentavam alguns hábitos e conceções alimentares incorretos. Face aos resultados obtidos foram elaborados recursos didáticos adequados a este nível de ensino, para orientar atividades e procedimentos no sentido de alterar os hábitos nocivos, melhorar a saúde e aumentar a literacia numa perspetiva de aprendizagem ao longo da vida e ao exercício de uma cidadania ativa e responsável

Determinants of skilled birth attendants in Nepal: a case of Surkhet district

Background: Safe delivery incentive program was introduced to increase the skilled attendants at births. The program provided childbirth by skilled birth attendants as well as incentives to skilled birth attendants ‘cash’ to women giving birth in a health facility in addition to incentives to health provider for each delivery attended, either at home or the facility. Due to its implementation and administrative delays, the program was reformed and implemented as a ‘safer mother program’ popularly known as “aama-suraksha-karyakram” since January 2009. Methods: The study was conducted in Surkhet district of Nepal. Surkhet is a hilly district and is head-quarter of mid-western development region of Nepal. There is one hospital, 5 PHCCs, 9 HPs and 38 SHPs serving 288,527 people in the district. The delivery by trained health worker (HW) in the district is 31.8% in 2005/06 which has increased about two times for two years. Surkhet is one of the districts monitoring the process indicators for safe motherhood programme in Nepal. Birth preparedness package programme has been implementing in the district from this year. The study population were the mothers within the age group of 15 to 49 years in Surkhet district. The sampling frame of the study was the mothers who had delivered the baby within 12 months preceding the survey. Results: About one third mothers, having 0-5 poverty score, utilised delivery assisted by HWs, while about three fourth of them having more than 5 score utilised HWs as delivery assistant. Higher educated mothers utilised HWs as delivery assistant more than that of higher educated husband. Among higher educated mothers, about 85% utilised delivery assisted by HWs, while it was about 75% for higher educated husband. Occupation of mother was also significantly associated with utilisation of delivery by HWs. Mother having office work utilised about 5 times higher HWs than others as their delivery assistant. The distance to health facility was significantly associated with utilisation of delivery attendant (p value <0.001). The mothers with less travelling time to reach health facility were more likely to utilise HWs as delivery attendant. About three fourth mothers who needed less than half an hour utilised delivery assisted by HWs. There was equal proportion of mothers who needed 30-59 minutes to reach the nearest health facility. In the other hand, about 73% of mothers who needed one hour or more to reach health facility utilised others as delivery assistant. Perceived quality of service to nearby health facility by mothers was also significantly associated with utilisation of HWs as delivery attendant (p value <0.05). About two third of mothers perceiving good quality of service at local health facility utilised HWs as delivery attendant while, it was only 44% among mothers perceiving poor quality of services. Conclusions: There should be adequate planning and preparation at all levels of health facilities; implementing a new program should not adversely affect another existing service delivery system. For the optional implementation, hospital organogram should be revised; and physical facilities and the low-risk birthing-centers with referral linkages should be expanded.info:eu-repo/semantics/publishedVersio

Breastfeeding and infant/young child feeding in Nepal

Background: Under nutrition being a major problem in Nepal, it is necessary to meet the minimum dietary standard which is essential for growth and development of young children, so promotion of infant and young child feeding practices among children is important intervention. Methods: A descriptive, cross sectional study was conducted among mothers of children of Bardia and Kailali districts of under 2 years and data was collected using the pre-tested questionnaire. Results: The study shows 30.3 percent of the mothers initiated breastfeeding within an hour of birth, 47.9 percent gave colostrums, 25.5 percent were practicing exclusive breastfeeding at 6 or more months,60 percent mothers fed anything else as prelacteal feed before breast feeding, 60 percent of mothers started complementary feeding between 3-6 months, 47.9 percent of mothers used anything from a bottle with a nipple yesterday or last night, 74.8 percent of mothers were currently breast feeding their children, 58 percent used iodized salt and 70.05 percent revealed that their child received Vit A within last six months. Conclusions: The present study showed that late initiation of breast feeding and practice of prelacteal feeds among home delivered mothers being high. The frequency of complementary feeding ranged was less and early/late weaning are still widely prevalent, use of bottle feeding is high, use of iodized salt is still low. There is a need to educate the mothers regarding proper infant/child feeding practices.info:eu-repo/semantics/publishedVersio

Key Factors to Consider in Team Meetings when Dealing with Multimorbidity in Primary Care: Results from a Delphi Panel

Background: Multimorbidity brings several difficulties and challenges to the daily work of primary care teams. Team meetings are opportunities to discuss approaches and solutions on how to best manage multimorbid patients. Objective: This qualitative study aimed to collect a consensus, from general practitioners that deal with multimorbid patients, about their perspectives regarding multimorbidity team meetings in primary care. Methods: The study followed a modified Delphi method with 15 Portuguese general practitioners. After every round of responses, results were analyzed, and justifications for non-consensual items were aggregated by the investigators, and then a new Delphi round with the revised questionnaire was again initiated. This process was repeated until consensus has been reached. Results: Overall, a list of 10 key themes associated with the ideal meeting was agreed: (a) definition; (b) setting; (c) duration; (d) frequency; (e) number of participants; (f) attendance; (g) requirement of patient’s presence; (h) number of patients/clinical cases; (i) structure of the meeting; and (j) sharing meeting results. The consensus was achieved after two Delphi rounds with a mean score between 7.9 and 8.7 (maximum score of 9.0 per key theme). Conclusion: The complexity of multimorbidity affects meetings’ periodicity, duration, and participants. Ideally, it should be an interprofessional primary care team meeting. Further research exploring meeting outcomes (organizational effectiveness and healthcare quality) of the proposed factors is needed before they can be recommended for general use.info:eu-repo/semantics/publishedVersio

COVID-19 or threat of a nuclear war in Europe? A cross-sectional study of anxiety levels in adults living in Portugal

Background: Since 2019, Europe has experienced ongoing stressors with the emergence of the COVID-19 pandemic and the Russian–Ukrainian War, which have had social, financial, physical, and psychological impacts. Studies suggest that anxiety, fear, post-traumatic stress disorder, depression, and other psychological disorders are common in such situations, and there is a need for more research on the impact of the war on mental health in Portugal. The main goal of the present study was to assess the impact of the fear of COVID-19 and anxiety related to nuclear war on the general anxiety levels of adult individuals living in Portugal. Methods: A cross-sectional study was conducted from May to July 2022 using an online questionnaire built on the Google Forms platform. Portuguese-speaking male and female individuals aged 18 years or older, who provided informed consent and agreed to participate, were included. The outcome variable was defined using the Portuguese version of the GAD-7 scale, while the main predictors were the FCV-19S and the NWA Scale in Portuguese. Linear and logistic regression models were used to test associations between predictors and outcome variable. Results: The study included 1,182 participants, with a mean age of 46.5 (±11.7) years, mostly women (80.6%). The global mean GAD-7 score was 5.8 (±4.5) points, and 17.9% of the participants scored above the 10-point cutoff. Higher scores were found in both the FCV-19S and the NWA scale among participants with anxiety, as measured by both a 10-point cutoff (p < 0.001), and GAD-7 scale mean scores (p < 0.001). The study showed that fear of COVID-19 [OR of 1.133 (95%CI: 1.097–1.170)] and, at a lesser extent, nuclear war anxiety [OR of 1.020 (95%CI, 1.009–1.031)] contribute to anxiety in the general population. This is also true for those with a personal history of anxiety, revealed by multiple regression. Discussion: This study contributes to the research on COVID-19’s impact on anxiety and provides the first comprehensive assessment of nuclear war anxiety in Portugal. Results highlight the need for long-term care for anxiety, as prevalence is expected to increase due to the pandemic and war, even in non-conflict areas like Portugal.info:eu-repo/semantics/publishedVersio

Carta ao Editor a Propósito do Artigo: “Prescrição Inapropriada em Idosos numa Enfermaria de Medicina Interna”

Dear Editor, We read with interest an article about inappropriate prescribing to elderly patients in an internal medicine ward and a letter to the editor regarding the same paper. We developed a similar study in the Portuguese primary care setting with a nation-wide representative sample of 757 elderly patients in accordance to its distribution in Portuguese health regions and we found that 77% of them were on ≥ 5 medications (with a mean of 8.2) and that 68% had at least one potentially inappropriate medication according the to 2015 Beers Criteria (with a mean of 1.72). The most common potentially inappropriate pharmacological classes were proton pump inhibitors (45.6%), non-steroid anti-inflammatory agents (34.5%) and benzodiazepines (27.3%). As such, we were also surprised with the low proportion of inappropriate prescribing at admission and at discharge reported in the study. One of the explanations, that was already reported, is the restricted number of pharmacologica classes used. This does raise many questions. Are we managing the various problems of our population in the best way? Is it necessary to rethink the polypharmacy cut-off since with the aging of the population there is an increase in the number of chronic diseases and consequently an increase in the number of drugs necessary to control them? Do we have to practice according to the guidelines or according to our clinical judgement of pathophysiology? Does this defnition of fve drugs for polypharmacy put people at a higher risk of undermedication, instead of overmedication?5 Shouldn’t we think of a new defnition for polypharmacy that isn’t the same for all people, but which takes into account the burden of disease that it is subject to? E.g. does it make sense to use the same polypharmacy cut-off for a healthy individual and a post-myocardial infarction patient? We consider this issue as fundamental, since as already mentioned the management of multimorbidity and polypharmacy (more specifcally of potentially inappropriate medication) are essential pillars in the provision of health care nowadays, both in primary and secondary care. So this raises the question of time since, in medical education, when should this topic be addressed and by whom? It is also important to analyze if there are differences between the work at the different health care levels regarding the management of multimorbidity, polymedication and potentially inappropriate medication. Are we all working towards the same goal?info:eu-repo/semantics/publishedVersio

Prevalence of polypharmacy in the older adult population within primary care in Portugal: a nationwide cross-sectional study

Introduction Polypharmacy is commonly defined as the simultaneous use of five or more medications; however, there is a lack of consensus regarding the most appropriate definition. It is a significant predictor of morbidity and mortality. The aim of this study was to determine the prevalence of polypharmacy in the population of older adults attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Material and methods We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older adult patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred in March 2018. The variables utilised were sociodemographic characteristics, clinical profile and medication. For each patient, polypharmacy was measured either by the concurrent use of ≥ 5 drugs or by the median number of drugs at the time of data collection. Logistic regression analyses were performed to determine associations between polypharmacy and other variables. Results Polypharmacy (≥ 5 drugs) was present in 77% of the sample. A cut-off of over the median number of drugs was present in 55%. The likelihood of having polypharmacy increased significantly with age (OR = 1.05 (1.02–1.08)), number of chronic health problems (OR = 1.24 (1.07–1.45)) and number of prescribers (OR = 4.71 (3.42–6.48)). Cardiovascular, metabolic and musculoskeletal medications were the most commonly involved in polypharmacy. Conclusions Polypharmacy was a very common occurrence in Portugal. Future primary healthcare policies should address polypharmacy.info:eu-repo/semantics/acceptedVersio

Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature

Background Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.info:eu-repo/semantics/publishedVersio

COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in Portugal

The COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs’ levels of distress should be identified and reduced, so their work is not impaired.info:eu-repo/semantics/publishedVersio

A prática pedagógica do gestor democrático no ambiente escolar e a construção do projeto pedagógico de apoio: estudo de caso na escola estadual de ensino fundamental "Mário Carneiro de Miranda"

O objetivo geral foi relatar e analisar em que a experiência do Projeto Pedagógico de Apoio (PPA) da Escola Estadual de Ensino Fundamental “Mário Carneiro de Miranda” nos anos de 2007-2008 contribuiu na organização do processo ensino aprendizagem e na formação de leitores e escritores competentes. Os objetivos específicos foram analisar como a organização do trabalho pedagógico escolar possibilitou nos educandos a intervenção por meio de experiências significativas de aprendizagem; verificar como o Projeto Pedagógico de Apoio contribui para obtenção de dados concretos do caminho percorrido pelo aluno no processo da aprendizagem no foco da leitura e escrita; avaliar como foram detectadas as causas e consequências do fracasso escolar no foco da leitura e escrita e como o Projeto Pedagógico de Apoio passou a intervir como estratégia de avaliação diagnóstica do processo leitura e escrita; descrever como prática pedagógica, adquirida pelo papel do professor integrador levou-o a uma indagação sistemática e autocrítica sobre o que ocorre na sala de aula; conhecer como as estratégias de intervenção pedagógicas propostas no Projeto Pedagógico de Apoio pôde aprimorar o ato de aprender a aprender por meio de todo o processo interventivo com foco na leitura e escrita e apresentar uma análise crítica sobre o processo interventivo realizado pelo Projeto Pedagógico de Apoio dentro da realidade de uma escola pública que busca a prática de uma ação pedagógica significativa. A metodologia utilizada foi quali-quantitativa a partir da aplicação de questionários aos participantes da escola. Observou-se que este instrumento melhorou consideravelmente o entendimento do professor quanto ao aprendizado do aluno, pois a partir de uma avaliação prévia o professor vê e entende o que o aluno está compreendendo e assim passa a desenvolver um trabalho mais próximo quanto ao entendimento da escrita e leitura; ABSTRACT:The overall objective was to report and analyze the experience of the Educational Project Support (PPA) of the State School of Basic Education "Mário Carneiro de Miranda" in the years 2007 to 2008 helped organize the learning process and training of readers and competent writers. The specific objectives were to analyze how the organization of educational work in school allowed students to intervention by means of significant learning experience, see how the project contributes Educational Support to obtain the actual data path followed by the student in learning the focus of reading and writing, as they were detected to evaluate the causes and consequences of school failure in the focus of reading and writing and how the Educational Project Support has to intervene as a strategy for diagnostic assessment of reading and writing process, describe how teaching practice, acquired by the role integrating the teacher took him to a systematic and self-questioning about what happens in the classroom, to know how the educational intervention strategies proposed in Education Programme Support could enhance the act of learning to learn through the process of intervening withfocus on reading and writing and presenting a critical analysis of the intervention process conducted by the Educational Support Project within the reality of a public school that seeks to practice a significant pedagogical action. The methodology was qualitative and quantitative from the questionnaires to the participants of the school. It was observed that this instrument has considerably improved the understanding of teacher and student learning, because from a preliminary assessment the teacher sees and understands what the student is understanding and so will develop a closer working on the understanding of written and reading