Prevalência de úlceras de pressão em dois hospitais portugueses: Impacto da Escala de Braden associada a um protocolo de prevenção

As úlceras de pressão constituem um importante problema de saúde pública comum a diversos cenários de cuidados, em todo o mundo, e também em Portugal, nomeadamente para a população mais idosa. O presente estudo teve como objectivos determinar o impacto da escala de Braden associada a um protocolo de prevenção de úlceras de pressão na prevalência destas lesões, assim como, monitorizar o problema das úlceras de pressão em dois hospitais portugueses, em que o Hospital A utiliza estes instrumento e o Hospital 8 não usa esses instrumentos. Foi utilizado o Instrumento de Prevalência de Úlceras de Pressão validado para Portugal na recolha dos dados. Os dados foram obtidos através da observação directa dos doentes. Foram realizadas duas avaliações com um intervalo de três meses em cada hospital. Os resultados encontrados revelaram que as úlceras de pressão constituem um problema de saúde para os dois hospitais observados. No entanto, o Hospital A apresenta menor taxa de prevalência de úlceras de pressão, menor número de úlceras de pressão mais graves, menor possibilidade de um doente adquirir uma úlcera de pressão e maior utilização de medidas preventivas. Os valores encontrados foram estatisticamente significativos para p <0,05. Confirma-se que a utilização da escala de Braden associada a um protocolo de prevenção de úlceras de pressão é uma medida eficaz na redução do número de úlceras de pressão. Para uma maior eficácia deste instrumento será importante a sua utilização como ferramenta de controlo da adequação das medidas preventivas. ABSTRACT; Pressure ulcers are an important public health problem common to several scenarios of care in the world, and also in Portugal, particularly for the elderly. This study aims to determine the impact of the Braden scale associated with a protocol for prevention of pressure ulcers in prevalence of these lesions, as well as monitor the problem of pressure ulcers in two Portuguesa hospitais, the Hospital A uses these instrument and Hospital B doesn’t. It was used the instrument of Prevalence of pressure ulcers validated for Portugal in the data collection. Data were collected through direct observation of patients. There were two assessments with an interval of three months in each hospital. The results showed that the pressure ulcers are a health problem for both hospitals observed. However, the Hospital A provides a lower prevalence rate of pressure ulcers, lower number of pressure ulcers more serious, less possibility of a patient acquiring a pressure ulcer and increased use of preventive measures. The values were statistically significant for p<0.05. lt is confirmed that the use of the Braden scale associated with a protocol for prevention of pressure ulcers is an effective measure in reducing the number of pressure ulcers. For greater efficiency will be important to use it as a tool for monitoring the adequacy of preventive measures.

Life Design Counseling: A study on client's operations for meaning construction

This study evaluates the adequacy of the micro-theory of client operations to explain meaning construction in Life Design Counseling. Four adolescents were interviewed on their second counseling session. Their recollections were stimulated through the replay of counseling videotapes and the resulting transcribed interviews were qualitatively analyzed. Results confirmed a sequence of client operations evolving from the symbolic representation of experience and reflexive self-examination towards making new realizations and revisioning self. Moreover, clients reported negative and positive session moments evidencing that clients’ attention and activity during the session was not restricted to meaning construction operations. Practical implications for life design counseling are derived from the results and discussed.

Movements of Diplodus sargus (Sparidae) within a Portuguese coastal Marine Protected Area: Are they really protected?

Mark-recapture tagging and acoustic telemetry were used to study the movements of Diplodus sargus within the Pessegueiro Island no-take Marine Protected Area (MPA), (Portugal) and assess its size adequacy for this species' protection against fishing activities. Therefore, 894 Diplodus sargus were captured and marked with conventional plastic t-bar tags. At the same time, 19 D. sargus were tagged with acoustic transmitters and monitored by 20 automatic acoustic receivers inside the no-take MPA for 60 days. Recapture rate of conventionally tagged specimens was 3.47%, most occurring during subsequent marking campaigns. One individual however was recaptured by recreational fishermen near Faro (ca. 250 km from the tagging location) 6 months after release. Furthermore, three specimens were recaptured in October 2013 near releasing site, one year after being tagged. Regarding acoustic telemetry, 18 specimens were detected by the receivers during most of the study period. To analyse no-take MPA use, the study site was divided into five areas reflecting habitat characteristics, three of which were frequently used by the tagged fish: Exterior, Interior Protected and Interior Exposed areas. Information on no-take protected area use was also analysed according to diel and tidal patterns. Preferred passageways and permanence areas were identified and high site fidelity was confirmed. The interaction between tide and time of day influenced space use patterns, with higher and more variable movements during daytime and neap tides. This no-take MPA proved to be an important refuge and feeding area for this species, encompassing most of the home ranges of tagged specimens. Therefore, it is likely that this no-take MPA is of adequate size to protect D. sargus against fishing activities, thus contributing to its sustainable management in the region.