Envolvimento dos pais nos cuidados de saúde de crianças hospitalizadas

A hospitalização de uma criança constitui uma experiência stressante, conduzindo, muitas vezes a vivências de sofrimento por parte da criança e da família. A compreensão das necessidades dos pais e do seu nível de empoderamento familiar são fundamentais para desenvolver estratégias promotoras do envolvimento dos pais nos cuidados de saúde, capacitando-os para a continuidade de cuidados. Desenvolvemos um estudo exploratório descritivo, de cariz essencialmente quantitativo, incluindo também análise qualitativa, com uma amostra de 660 pais de crianças hospitalizadas e de 95 profissionais de saúde em três hospitais portugueses. A colheita de dados foi efectuada pela aplicação de questionários, dirigidos aos pais e aos profissionais de saúde, e que incluíam na versão dos pais o Questionário das Necessidades dos Pais e a Escala de Empoderamento Familiar, e na dos profissionais de saúde, um Questionário das Necessidades dos Pais adaptado, ambos incluíram perguntas abertas. O processo de adaptação cultural e validação destas duas escalas faz parte integrante deste trabalho. Os resultados mostram opiniões diferentes entre pais e profissionais de saúde acerca das necessidades dos pais, particularmente no que respeita às necessidades de informação e de suporte e orientação. Os pais atribuem mais importância, sentem-se menos satisfeitos e consideram que o hospital os deveria ajudar mais na concretização das suas necessidades, comparativamente com o que os enfermeiros e médicos pensam. Constatamos também a influência de algumas variáveis relativas aos pais e aos profissionais de saúde, na percepção das necessidades. Os pais demonstram menor empoderamento, no que diz respeito ao envolvimento com a comunidade, nomeadamente em relação à participação com os decisores políticos, realçando a dificuldade no exercício da cidadania. E evidenciam maior empoderamento na dimensão da família e dos cuidados prestados ao filho. Os resultados qualitativos indicam que o envolvimento dos pais nos cuidados de saúde tem múltiplos significados, destacando-se as dimensões: o quotidiano da criança no hospital, a continuidade dos cuidados de saúde após a hospitalização e as perspectivas do envolvimento nos cuidados de saúde. Esta última dimensão inclui os domínios: presença, participação, informação, necessidades e benefícios para a criança, responsabilização e direito à saúde, realização de cuidados, necessidades da família e ajuda aos profissionais de saúde.

Ecological quality assessment in transitional systems

Estuaries are poles of attraction for human settlement which is a source of pressures to surface water bodies. The implementation of the European Water Framework Directive (WDF, 2000/60/EC) has increased the investigation in order to develop methodologies to assess the Ecological Quality Status (EQS) of aquatic ecosystems. Transitional systems are naturally stressed and characterized by highly dynamic physical, chemical and hydro-morphologic conditions and by species with a higher level of tolerance to change, being more difficult to develop suitable quality indicators for these systems. The general purpose of this study is to test the ability of synthesis descriptors, including primary (S, taxa richness) and derived biological variable (H’, Shannon-Wiener diversity), biotic indices (AMBI and M-AMBI), body size properties (abundance distribution by body size classes, length, weight and length-weight relationships) and non-taxonomic indices (ISS), as well as functional indicators related to the decomposition rates of various experimental substrates, a macrophyte (Phragmites australis) and an alga (Fucus vesiculosus), to evaluate the environmental quality in transitional systems. This study was carried out in one of the most pristine channels of the Ria the Aveiro, Mira Channel, along a full salinity gradient and in a metals and metalloid sediment contamination area, the Estarreja Channel, and two reference channels (Canelas and Salreu). In this study were used different sampling techniques, the leaf-bag technique and a hand-held corer. In Mira Channel, the alga and the macrophyte presented an opposite trend in the decomposition rate along the salinity gradient, with the decomposition rates of the alga always higher than those of the macrophyte. The decomposition rates of the macrophyte and the alga were higher in the mid estuary and in higher salinity areas, respectively, corresponding to the preferencial distribution areas of each species. The macrobenthic fauna associated with the decaying and an artificial substrate (control) showed equally well the benthic succession from the marine to the freshwater areas and, despite the strong differences in the decay rates, no significant differences were found between the benthic communities associated with the alga and the macrophyte. The body size properties of the macrobenthic fauna associated with the P. australis leaf-bag (1mm and 5mm) and corer samples were studied along the full salinity gradient. The dominant species of the sub-set of measured specimens were not the same of the original macrobenthic fauna sampled but, despite that, the sub-set of measured specimens was also able to show the benthic succession from the marine to the freshwater areas. The body size abundance distribution of the benthic macroinvertebrates according to the ISS size classes did not show a particular trend in any sampler along the salinity gradient. Significant differences were found in the length, weight and length-weight relationships of Annelids, , Molluscs and even some species along the salinity gradient. No significant differences were found in the AMBI, M-AMBI and ISS values along the salinity gradient for all the samplers. The EQS of the corer samples obtained using the M-AMBI was lower than that of the leaf-bags. The EQS obtained with the ISS was higher than that obtained with the M-AMBI in the leaf-bags but not in the corer samples. The ecological effects of contaminated sediments associated with the industrial chemical effluents discharged in the Estarreja Channel were studied a decade after ceasing the emissions, using the Sediment Quality Triad approach and two reference channels. The results showed that despite the emissions ceased in 2004, the sediment remains polluted with high levels of metals and metalloid, available to bioaccumulation and with severe consequences at the community level. The sediment contamination problem was also studied using the leaf-bag technique with a macrophyte, an alga and a control substrate. The results showed that the decay rates, the associated macrofauna and the application of the AMBI, M-AMBI and ISS indices to the mesh-bag samples were not able to identify the sediment contamination. Contrarily to the AMBI, the M-AMBI and the ISS showed significant differences between the contaminated and the reference channels for the corer samples. Although such statistical significance, the interest of using these complex biotic indices could be questioned, when much simple ones, like the S and H’ allow to reach the same conclusions.