Relatório de Estágio

O presente Relatório é referente ao estágio de enfermagem comunitária realizado no âmbito do 2.º Curso de Mestrado em Enfermagem com a área de Especialização em Enfermagem de Saúde Comunitária. Este relatório tem como objetivo descrever as etapas realizadas no âmbito do planeamento em saúde durante o respetivo estágio. A temática abordada foi a Sexualidade na Adolescência, tendo sido desenvolvida com a intenção de capacitar a população-alvo de forma a contribuir para a promoção de comportamentos saudáveis dos adolescentes. São descritas as atividades e estratégias desenvolvidas, os objetivos definidos bem como as competências adquiridas específicas do enfermeiro especialista em enfermagem comunitária, citadas pela Ordem dos Enfermeiros. Serviram como base de fundamentação teórica das intervenções de Educação Sexual na Adolescência, as necessidades identificadas no diagnóstico de situação, efetuado previamente na Escola EB 2,3 Cristóvão Falcão, bem como as necessidades referenciadas pela Diretora da Escola Secundária Mouzinho da Silveira. Considera-se que a Intervenção da Educação sexual teve uma avaliação positiva, uma vez que foram atingidos os indicadores propostos para os objetivos definidos. A reflecção efetuada assenta na premissa de que o enfermeiro especialista de enfermagem comunitária e de saúde pública desenvolve uma prática globalizante centrada na comunidade, na capacitação de pessoas face aos processos de vida e aos problemas de saúde identificados

Relatório de estágio

Este relatório destina-se a descrever as acções desenvolvidas no estágio, do 1º Curso de Mestrado em Enfermagem Comunitária, realizado na Escola Superior de Saúde de Portalegre. A intervenção comunitária, realizou-se na comunidade escolar de Portalegre, tendo tido duas vertentes: Educação sexual na adolescência; Promoção de comportamentos saudáveis nos estilos de vida dos adolescentes. As ações realizadas abordaram a educação sexual na adolescência, com base no diagnóstico de situação e, através da elaboração de um projecto de intervenção, aplicado em metodologia de planeamento em saúde. A intervenção comunitária teve como base a promoção de comportamentos saudáveis nos estilos de vida dos adolescentes, a alunos das escolas de Portalegre do 9º e 12º anos, na área de ciências e tecnologias. Todo este trabalho foi desenvolvido na fase teórica e suportou a nossa intervenção em estágio. Assim, após a conclusão deste diagnóstico, seguiu-se a fase de estabelecimento de prioridades, fixação dos objectivos, selecção de estratégias, preparação da execução e avaliação. Na adolescência, a educação sexual deverá ser orientada para a maturação psicossexual, para os afetos, para a contraceção e planeamento familiar e para a prevenção de doenças. É da responsabilidade dos profissionais de saúde, da escola, mas sobretudo da família, proporcionar um ambiente favorável à aprendizagem e ao diálogo. O realce da educação sexual, deverá ser colocado na igualdade de papéis, na tolerância face ao pluralismo de orientação e de condutas sexuais. Por outro lado, é também na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola e a família, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infecções sexualmente transmissíveis e cidadania

Regional Disparities in Sedentary Behaviors and Meal Frequency in Iranian Adolescents: The CASPIAN-III Study

Background: The prevalence of obesity is increasing among Iranian youngsters like other developing countries. Objectives: This study was conducted to assess regional disparities in sedentary behaviors and meal frequency in Iranian adolescents. Patients and Methods: In this national survey, 5682 students aged 10 - 18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. The country was classified into four sub-national regions, based on criteria of the combination of geography and socioeconomic status (SES). Mean of meal frequency and physical activity levels as well as prevalence of omitting meals and sedentary behavior were compared across regions with different SES after stratifying with sex and age group. Results: Meal frequency in lower socio-economic regions was significantly higher than two other regions in 10 - 13 and 10 - 18 years old groups (P trend < 0.001). However, the mean of working hours with computer was linearly increased with increasing the SES in studied regions (P trend < 0.001), whereas the corresponding figure was not significant for the mean of watching TV (P trend > 0.05). Frequency of adolescents omitting their meals was higher in higher SES regions especially in West Iran (P < 0.001) in 10 - 13 years old age group. Having personal computer and working with it more than two hours per day mainly was observed in central Iran which ranked as the highest SES group. Conclusions: Efforts to ensure Iranian youth meet healthy food habits and screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time is required.

Call recognition and individual identification of fish vocalizations based on automatic speech recognition: An example with the Lusitanian toadfish

The study of acoustic communication in animals often requires not only the recognition of species specific acoustic signals but also the identification of individual subjects, all in a complex acoustic background. Moreover, when very long recordings are to be analyzed, automatic recognition and identification processes are invaluable tools to extract the relevant biological information. A pattern recognition methodology based on hidden Markov models is presented inspired by successful results obtained in the most widely known and complex acoustical communication signal: human speech. This methodology was applied here for the first time to the detection and recognition of fish acoustic signals, specifically in a stream of round-the-clock recordings of Lusitanian toadfish (Halobatrachus didactylus) in their natural estuarine habitat. The results show that this methodology is able not only to detect the mating sounds (boatwhistles) but also to identify individual male toadfish, reaching an identification rate of ca. 95%. Moreover this method also proved to be a powerful tool to assess signal durations in large data sets. However, the system failed in recognizing other sound types.

Estado nutricional y etapas de cambio comportamental frente a la actividad física niños y adolescentes de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: El propósito del estudio fue relacionar la etapa en el cambio en el comportamiento frente a la actividad física y el estado nutricional en escolares entre 9 y 17 años de Bogotá- Colombia, pertenecientes al estudio FUPRECOL. Método: Se trata de un estudio transversal, en 6.606 niños y adolescentes entre 9 y 17 años, pertenecientes a 24 instituciones educativas, de Bogotá-Colombia. Se aplicó de manera auto-diligenciada el cuestionario de cambio de comportamiento en función a la intensión de realizar actividad física (CCC-Fuprecol) y se midió el peso y la estatura para determinar el estado nutricional con el índice de masa corporal (IMC). Resultados: El porcentaje de respuesta fue 94% y se consideraron válidos 6,606 registros, siendo 58.3 % (n=3.850) niñas con un promedio de edad de 12,7±2,3 años. En la población general, el 5,3 % de los escolares se encontraban en etapa de pre-contemplación, 31,8 % en contemplación, el 26,7 % en acción y el 36,2 % en etapa de mantenimiento. Al comparar la etapa de cambio con el estado nutricional por IMC, los escolares clasificados en obesidad mostraron mayor frecuencia de respuesta en la etapa de pre-contemplación, mientras que los escolares con peso saludable acusaron mayores porcentajes en la etapa de mantenimiento. Conclusión: En escolares de Bogotá, Colombia, se encontró una relación estadísticamente significativa entre a la intensión de realizar actividad con el estado nutricional medido con el IMC. Fomentar la promoción de la actividad física y monitorear el estado nutricional, deberá ser una prioridad en las agendas y políticas públicas dentro del ámbito escolar.

Características preferidas por hombres y mujeres que buscan pareja estable de su mismo sexo

Las preferencias en elección de pareja de hombres y mujeres interesados en establecer relaciones a largo plazo con personas de su mismo sexo biológico ha sido un tema de interés para el análisis evolucionista, ya que existe debate frente a los resultados de las investigaciones y los planteamientos de las teorías de inversión parental y estrategias sexuales. Con el objetivo de identificar qué características son preferidas por hombres y mujeres interesados en establecer una relación a largo plazo con personas de su mismo sexo biológico y contribuir a esta discusión, se llevó a cabo un estudio descriptivo en el que analizamos el contenido de 732 perfiles de hombres y mujeres (H=491; M=241) que buscaban una relación estable con parejas de su mismo sexo biológico. Las categorías analizadas fueron: edad, atractivo físico (apariencia, contextura, estatura y peso), estatus socioeconómico (situación laboral, nivel educativo y zona de residencia buscada), estado civil, número de hijos y hábitos saludables (fumar y beber). Los resultados encontrados muestran que los hombres presentan rangos amplios en las características deseadas en una pareja (edad=16.87; estatura=11.37; peso=15.23) y además buscan personas menores a la edad ofrecida (M=-4.17 años). En las mujeres se encontró que los rangos son más restringidos (edad=13.85; estatura=9.83; peso=12.77) y además prefieren parejas mayores (M=2.89 años). A nivel general, se evidencia que los resultados encontrados en la mayoría de las variables podrían indicar congruencia con los planteamientos de la teoría de inversión parental y estrategias sexuales; sin embargo, en otras variables los resultados no son claros.

Social capital and adolescent health risk behavior in El Salvador

An emerging body of research suggests that the social capital available in one's social environment, as defined by supportive and caring interpersonal relationships, may provide a protective effect against a number of youth risk behaviors. In exploring the potential protective effect of social capital at school and at home on adolescent health and social risk behavior, a comprehensive youth risk behavior study was carried out in El Salvador during the summer of 1999 with a sample of 984 secondary school students attending 16 public rural and urban schools. The following dissertation, entitled Social Capital and Adolescent Health Risk Behavior in El Salvador, presents three papers centered on the topics of social capital and risk behavior. ^ Paper #1. Dangers in the Adolescent River of Life: A Descriptive Study of Youth Risk Behavior among Urban and Rural presents prevalence estimates of four principal youth risk behavior domains—aggression, depression, substance use, and sexual behaviors among students primarily between the ages of 13 and 17 who attend public schools in El Salvador. The prevalence and distribution of risk behaviors is examined by gender, geographic school location, age, and subjective economic status. ^ Paper #2. Social Capital and Adolescent Health Risk Behavior among Secondary School Students in El Salvador explores the relationship between social resources (social capital) within the school context and several youth risk behaviors. Results indicated that students who perceived higher social cohesion at school and higher parental social support were significantly less likely to report fighting, having been threatened or hurt with a weapon, suicidal ideation, and sexual intercourse than students with lower perceived social cohesion at school and parental social support after adjusting for several socio-demographic variables. ^ Lastly, paper #3. School Health Environment and Social Capital : Moving beyond the individual to the broader social developmental context provides a theoretical and empirical basis for moving beyond the predominant individual-focus and physical health concerns of school health promotion to the larger social context of schools and social health of students. This paper explores the concept of social capital and relevant adolescent development theories in relation to the influence of social context on adolescent health and behavior. ^

Maltreatment, Psychiatric Symptoms and Human Immunodeficiency Virus/Sexual Transmitted Infection Risk Behavior Among Youth with Alcohol and Other Drug Use Problems: A Person-Centered Analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth.

Body dissatisfaction on top of depressive mood among adolescent with severe dysmenorrhea

Purpose: Dysmenorrhea is the leading cause of recurrent short-term school absenteeism among adolescent girls. Yet, studies of menstrual symptoms in the light of adolescent psychological background seldom appear in the recent literature. This study aims to determine whether adolescent girls with severe dysmenorrhea (SD) have different body perception on top of poorer psychological health. Methods: We analyzed data from the Swiss Multicentre Adolescent Survey on Health (SMASH 2002) among a nationally representative sample of adolescents (n = 7548; 3340 females) aged 16 to 20 years attending post-mandatory education. Dysmenorrhea was defined as presence of abdominal or back pain during menstruation on the last 12 months. The severity of dysmenorrhea was defined according to the impact on daily activity and was assessed by 3 questions on the way menstruations interfere with daily life: 1) "You feel well and have normal activities", 2)"you must stay at home" and 3) "you feel restricted in your school or professional activities". Studied variables were: depressive symptoms, suicidal attempt, sexual abuse, health perception in general, body satisfaction, desire to modify body shape, and disordered eating behavior (DEB) with restrictive or bulimic tendency. Controlling variables included socio-economic status (SES) as measured by both parent's level of education, gynecological age (age-age at menarche), academic track (student/apprentice) and age. Results: 12.4% (95% CI: 11.0-14) declared severe dysmenorrhea, 74.2% (95% CI: 71.8-76.5) mild to moderate dysmenorrhea and 13,4% (95% CI: 11.5-15.5) had no dysmenorrhea. Compared to their peers, controlling for confounding variables, subjects with SD were more numerous to report depressive symptoms (AOR: 1.73; 95% CI: 1.39-2.15), to feel in poor health (AOR: 1.44; 95% CI: 1.14-1.81). Moreover, the proportion of those reporting dissatisfaction with their body appearance was higher (AOR: 1.48; 95% CI: 1.00-2.18). Conclusion: Patients with SD not only show a different profile than their peers in terms of their mental health and health perception, but also a distinct relation to their body. Therefore clinicians should pay particular attention to patients with SD and offer them a global evaluation keeping in mind what can be associated with SD.

Adolescent(e)s migrant(e)s et sexualité [Migrant adolescents and sexuality].

Besides its emotional, hormonal and physical components, sexuality has also an important social function. Analyzing these interactions in immigrant adolescents who are challenged at the same time by developmental changes and modified cultural and social rules--especially if they differ from the rules assimilated during childhood--might help professionals to access better comprehension. Personal experience, individual and external resources, whether they are family oriented or professional, are prone to influence on behavior, perception and outcome related to sexual health. The subject is discussed on the base of scientific literature and medical practice.

Comparing adult-youth and adult-adult online sexual solicitation: Manipulative behaviors, situational factors, and outcomes

Online sexual solicitation (solicitation) of youth has received widespread media and research attention during the last decade. The prevalence rates of youth who have experienced solicitation or solicitation attempts vary between studies depending on the methodology used (e.g., whether youth or adults are the target study group). In studies focusing on youth victims, the prevalence of solicitation attempts made by adults during the past year is typically reported to be between 5 and 9%. Adults who solicit youth online have been found to use deception and other manipulative behaviors to gain access to sexual activities with youth. However, previous studies have lacked a control group of adults who solicit other adults online. Without this comparison, one could argue that deceiving others online about one’s identity, and engaging in manipulative behaviors, is an inherent part of most online sexual interactions with strangers. Additionally, little is known about the associations between manipulative behaviors and the solicitation outcomes. In research concerning offline sexual behaviors, it has been noted that situational factors, such as sexual arousal, may alter both sexual interest and behavior. The effects of situational factors on online sexual behaviors have been less extensively studied (especially so with a quantitative approach); no studies have to date focused on adults’ solicitation of youth. Investigating the role of a lowered sexual age preference and the role of situational factors in the soliciting adults could be an important step in order to receive deeper knowledge of the role of traits and states in the context of solicitation. Additionally, there is a lack of knowledge of the effect of the age of the youth. Although previous studies on solicitation has found that older youth, compared with younger youth and children, are more often solicited, the possible reasons for this have not been investigated. Are adults who solicit youth affected by legal deterrence (through the legal age of consent), is it because older youth are more available online, or are the adults’ age preferences merely a product of a normally distributed age preference in the population? The purpose of the present thesis was fivefold: 1) to obtain an estimate of the frequency of adults’ solicitation of youth as self-reported and observed in actual behavior; 2) to explore whether the legal age of consent (LAC) affects solicitation frequency, or whether a normally distributed sexual age preference more accurately describe the proportion of solicited youth of different ages; 3) to investigate the associations of both traits (e.g., lower sexual age preference) and states (immediate situational factors, such as alcohol intoxication), and the solicitation target; 4) to explore whether adults who solicit youth and adults who solicit adults are equally deceitful and manipulative online, and whether the different solicitation outcomes are as common in both groups; and 5) to investigate whether the deceitful and manipulative behaviors engaged in had different associations with the solicitation outcomes depending on the age of the solicited. In the survey study, a convenience sample of 1393 adult participants (aged 18 years or older) self-reported any online communication with strangers during the past year. Of these, 56% (776 respondents) reported that they had solicited or attempted to solicit at least one stranger. Of the respondents, 453 (58.4%) were men, and 323 (41.6%) were women. Participants with only adult contacts (18 years or older) constituted the majority (640 respondents). In contrast, 136 individuals reported a youth contact (a 13 year old or younger, or a 14 to 17-year old). Approximately half of the participants were men in the adult contact group, while 75% of the participants were men in the youth contact group. Approximately 60% of the participants with youth contacts were recruited from two websites associated with a pedophilic sexual interest. In an online quasi-experimental study, with researchers impersonating youth of different ages (10–18 year olds) in chat rooms, 251 online conversations with chat room visitors made up the entire sample. All chat room visitors alleged to be men. The self-reported frequency of having solicited youth (0–17-year olds) during the past year was approximately 10% in our sample of adults who reported communicating with any strangers online. When we observed this behavior in chat rooms, we found that approximately 30% of the chat room visitors who believed they interacted with a 10 to 14 year old attempted to solicit the youth. We found that solicitation attempts increased equally much when increasing the age of the impersonated youth from 14 to 16, as from 16 to 18. Thus, we concluded that a normally distributed age preference in the population was a more plausible explanation to the effect of the age of the solicited, rather than the LAC (here; 15 and 16). If the chat room visitors would have been deterred only by the LAC, we would have expected that the change in amount of solicitation attempts from an illegal age group to a legal age group would have been significantly stronger than changes between age groups within illegal-illegal and legal-legal groups. Our subsample of survey participants from the pedophilia-related websites expectedly reported that they had solicited youth more often in comparison to the sample gathered through general (i.e., not associated with any particular sexual preference) websites. We also found that participants with a youth contact reported higher levels of sexual arousal and shame before the sexual interaction with their online contact, compared with participants with an adult contact. Additionally, the participants with youth contacts who reported consumption of child- and adolescent pornography also reported being more sexually aroused before the interaction, compared to the participants with youth contacts who did not report consumption of these kinds of pornography. We also found clear indications that the online sexual interaction had an alleviatory effect on reported levels of sadness, boredom and stress, independent of the age of the contact. Generally, the participants with youth and adult contacts reported deceiving their contacts as often and suggesting keeping the communication a secret from someone as often. Participants with a youth contact, however, reported using more persuasion techniques for online sexual purposes or for the purpose of an offline meeting, compared to those with an adult contact. In the chat rooms, we found that more indirect ways of future sexual communication (e.g., continuing chatting) was suggested by the chat room visitors that were under the assumption of interacting with youth aged 10 to 14, compared with more direct means (e.g., meeting offline). Survey participants with youth contacts who had used deception, suggested keeping the interactions a secret, and/or persuaded their contact by appealing to the contacts feelings of love and attachment for the participant had also more often engaged in cybersex with the contact. No other manipulative behaviors were associated with the other investigated solicitation outcomes (receiving a sexual picture, meeting offline, and engaging in sexual contact offline) within this group of participants. However, using deception, suggesting secrecy and using persuasion was also positively associated with certain solicitation outcomes within participants with an adult contact. In summary, adults’ solicitation of youth is much more frequent when observed in chat rooms than self-reported. Additionally, an underlying lowered sexual age preference seems to be a motivating factor on a group level in adults who solicit youth. We concluded that directed prevention efforts should be made on pedophiliarelated websites. Additionally, the role of situational factors, especially sexual arousal in persons with a pedo- or hebephilic sexual interest should be investigated further in the context of online sexual solicitation.

The Co-occurrence of Depressive Symptoms and Alcohol Use for Adolescent Boys and Girls: An Investigation of the Role of Self-Regulation and Approach Behavior

While many studies have been conducted on adolescent depressive symptoms and alcohol use, much of the research has examined these behaviors separately rather than examining their co-occurrence within individuals. In the present study, adolescents (N = 4412; 49% female) were surveyed at four time points (grade 9, 10, 11, and 12) and growth mixture modeling was used to identify groups of individuals reporting various patterns of depressive symptoms and alcohol use across the high school years. Four groups were identified, including co-occurrence (higher depressive symptoms and higher alcohol use relative to peers, comprising 6.1 % of boys and 7.1 % of the girls in the sample), pure depressive symptoms (higher depressive symptoms and lower alcohol use; 12.7% of boys and 12.5% of girls), pure alcohol use (higher alcohol use and lower depressive symptoms; 20.9% of boys and 19.9% of girls), and low co-occurrence (lower depressive symptoms and alcohol use, 60.3% of boys and 60.5% of girls). Groups were compared on self-regulatory (i.e., delay of gratification) and approach behaviors. For both boys and girls, delay of gratification was the strongest predictor of group membership, with the co-occurrence group scoring the lowest and the low co-occurrence group the highest. This finding emphasizes the importance of assessing delay of gratification in the identification of high risk youth.

Predicting adolescent perpetration in cyberbullying : An aplication of the theory of planned behavior

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Teleconsultation in sexual and reproductive health for young adults through mobile devices: Experience in Colombia

Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To measure the perception of changes in sexual and reproductive risk behavior after the use of a teleconsultation service via mobile devices in a sample of young adults. Methods: A before and after observational study was designed, where a mobile application to inquire about sexual and reproductive health was developed. The perception of changes in sexual and reproductive health risk behaviors in a sample of young adults after the use of the application was measured using the validated survey “Family Health International (FHI) – Behavioral Surveillance Survey (BSS) – Survey for Adults between 15 to 40 Years”. Non-probabilistic convenience recruitment was undertaken through the study´s web page. Participants answered the survey online before and after the use of the mobile application for a six month period (intervention). For the inferential analysis, data was divided into three groups (dichotomous data, discrete quantitative data, and ordinal data), to compare the results of the questions between the first and the second survey. For all tests, a confidence interval of 95% was established. For dichotomous data, the Chi-squared test was used. For quantitative data, we used the Student’s t-test, and for ordinal data, the Mann-Whitney-Wilcoxon test. Results: A total of 257 subjects were registered in the study and met the selection criteria. The pre-intervention survey was answered by 232 subjects, and 127 completely answered the post-intervention survey, of which 54.3% did not use the application, leaving an effective population of 58 subjects for analysis. 53% (n=31) were female, and 47% (n=27) were male. The mean age was 21 years, ranging between 18 and 40 years. The differences between the answers on the first and the second survey were not statistically significant. The main risk behaviors identified in the population were homosexual relations, non-use of condoms, sexual relations with non-regular and commercial partners, the use of psychoactive substances, and ignorance about the symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and post-intervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting educational strategies on this matter and the importance of providing patients with easily accessible tools with reliable health information.