Co-creation of services to maintain independence and optimise well-being: Learnings from Australia's Older Women Living Alone (OWLA) project

For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of individuals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.

Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations

BACKGROUND

Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems.

OBJECTIVE

To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action.

DESIGN

Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study.

SETTING AND PARTICIPANTS

Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations.

INTERVENTIONS

Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care.

MAIN OUTCOME MEASURES

Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA.

RESULTS

The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples.

DISCUSSION AND CONCLUSIONS

The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.

Correction to: Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?

Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0International License.

Economic evaluation of simulated and traditional clinical placements in occupational therapy education

INTRODUCTION

This economic evaluation complements results of the randomised controlled trial that established non-inferiority of the learning outcomes of a one-week simulated clinical placement (SCP) in occupational therapy qualifying degrees in comparison to an equivalent traditional clinical placement (TCP). This companion study presents detailed cost analyses of two placement alternatives and a cost-benefit study to assess the value for money of SCP. An economic evaluation of simulated versus traditional placements has not previously been conducted in Australia.

METHODS

Nine SCP/TCP rounds were conducted by six Australian universities. Costs were collected using study-specific instruments. Public health sector costs were sourced from available literature. Willingness-to-pay for SCP/TCP was estimated using both a Discrete Choice Experiment and a Contingent Valuation method. These methods were employed to assess a comparative 'value' of SCP/TCP from the perspective of heads of occupational therapy departments (N = 28), who were asked to put a monetary value on the broader range of benefits associated with SCP/TCP.

RESULTS

From the universities' perspective the average cost per student ranged from AUD$460 to AUD$1511 for simulated and AUD$144 to AUD$1112 for traditional placement. From the health care sector perspective, the difference in costs favoured simulated placements for four implementations and traditional placements for five. In the Discrete Choice Experiment respondents preferred traditional rather than simulated placement and would pay additional AUD$533. The estimated monetary value of simulated placements from a contingent valuation ranged from AUD$200 to AUD$1600.

CONCLUSIONS

For universities that procure TCPs predominately at public health care facilities and sustain high administrative overheads, the SCP program could be a cost-saving alternative. From a broader value-for-money perspective, respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement. Results should be interpreted with caution and further research with larger sample sizes is required.

Sharing and the Provision of "Cost-Ineffective" Life-Extending Services to Less Severely Ill Patients

BACKGROUND

Cost-utility analysis prioritizes services using cost, life-years, and the health state utility of the life-years. Nevertheless, a significant body of evidence suggests that the public would prefer more variables to be considered in decision making and at least some sharing of the budget with services for severe conditions that are not cost-effective because of their high cost.

OBJECTIVES

To examine whether this preference for sharing persists for less severe conditions when both cost effectiveness and illness severity would indicate that resources should be allocated to other services.

METHODS

Survey respondents were asked to divide a budget between two patients facing life-threatening illnesses. The severity of the illnesses differed and the price of treatment was varied.

RESULTS

Sharing occurred in all scenarios including scenarios in which the illness was less severe and services were not cost-effective. Results are consistent with behavior commonly observed in other contexts.

CONCLUSIONS

Results suggest that sharing per se is important and that the public would support some funding of cost-ineffective services for less severe health problems.

Does the use of the proportional shortfall help align the prioritisation of health services with public preferences?

It has been proposed that equity may be included in the economic evaluation of health services using the 'proportional shortfall' (PS)-the proportion of a person's QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people's preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.

Uncertainty and the Undervaluation of Services for Severe Health States in Cost-Utility Analyses

OBJECTIVES

To test the hypothesis that the "severity effect"-the preference for more than utility-maximizing expenditure on severe health states-may be the result of, or exacerbated by, the uncertainty associated with the chance of contracting the illness that causes the severe health state.

METHODS

Survey respondents were asked to imagine that they will contract one of two illnesses and asked to allocate a budget between two insurance policies, each of which provides services for the treatment of one of the illnesses. A person's final health state varied with the amount of insurance purchased for the illness that occurred and therefore with the level of treatment. The relative cost of the two policies was altered and the selected levels of insurance compared with the levels that would be provided by a health authority that sought to maximize total utility or quality-adjusted life-years from its own budget.

RESULTS

Respondents selected more than utility-maximizing insurance for protection against severe health states. A number of psychological factors that affect measurement under uncertainty do not affect utility as currently measured. This difference may explain the present results and also explain the "severity paradox" that personal preferences as presently measured imply less expenditure on severe health states than do "social preferences" for the treatment of strangers.

CONCLUSIONS

Uncertainty alters preferences. Incorporating these preferences in decision making would result in greater spending on severe health states.

Does a patient's health potential affect the social valuation of health services?

Background

Patients with a permanent impairment may be unable to reach full health. Consequently health services which cure illnesses which are unrelated to the impairment may increase health less than services for patients with no impairment. While it has been argued that this should not lead to discrimination against impaired patients there is little evidence to determine whether this equity-efficiency trade-off is consistent with social values.

Objectives

To measure the effect of permanent impairment upon the social valuation of services for unrelated illnesses.

Methods

Social valuations of services for illnesses associated with mobility, depression or pain were assessed and compared for patients with and without a permanent impairment using the Relative Social Willingness to Pay (RS-WTP) instrument. The maximum valuation of services for impaired patients was also compared with the maximum utility which could be gained when utility was measured using three multi attribute utility instruments.

Results

Curing the illness of impaired patients was valued 8–11 percent less than the cure of patients with no impairment. Discrimination decreased as the severity of the illness increased. Valuation of health states using the utility instruments implied significantly greater discrimination than the social valuations using the RS-WTP instrument.

Conclusions

Health services are valued less highly when a patient’s health potential is impaired. However discrimination is significantly less than would occur if the value of the services were limited to the value of the health state causing the impairment. The argument for disregarding a patient’s limited health potential when resources are allocated therefore receives some support from social valuations but the case for completely equal treatment depends upon additional ethical arguments.

How important is severity for the evaluation of health services: new evidence using the relative social willingness to pay instrument

The 'severity hypothesis' is that a health service which increases a patient's utility by a fixed amount will be valued more highly when the initial health state is more severe. Supporting studies have employed a limited range of analytical techniques and the objective of the present paper is to test the hypothesis using a new methodology, the Relative Social Willingness to Pay. Three subsidiary hypotheses are: (1) that the importance of the 'severity effect' varies with the type of medical problem; (2) that the relationship between value and utility varies with the severity of the initial health state; and (3) that there is a threshold beyond which severity effects are insignificant. For each of seven different health problems respondents to a web-based survey were asked to allocate a budget to five services which would, cumulatively, move a person from near death to full health. The time trade-off utilities of health states before and after the service were estimated. The social valuation of the service measured by the budget allocation was regressed upon the corresponding increase in utility and severity as measured by the pre-service health state utility. Results confirm the severity hypothesis and support the subsidiary hypotheses. However, the effects identified are quantitatively significant only for the most severe health states. This implies a relatively limited redistribution of resources from those with less severe to those with more severe health problems.

Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?

BACKGROUND

There is a debate in the health economics literature concerning the most appropriate way of applying Amartya Sen's capability approach in economic evaluation studies. Some suggest that quality-adjusted life years (QALYs) alone are adequate while others argue that this approach is too narrow and that direct measures of capability wellbeing provide a more extensive application of Sen's paradigm.

OBJECTIVE

This paper empirically explores whether QALYs provide a good proxy for individual capabilities.

METHODS

Data is taken from a multinational cross-sectional survey of individuals with seven health conditions (asthma, arthritis, cancer, depression, diabetes, hearing loss, heart disease) and a healthy population. Each individual completed the ICECAP-A measure of capability wellbeing for adults and six health utility instruments that are used to generate QALYs, including EQ-5D and SF-6D. Primary analysis examines how well health utility instruments can explain variation in the ICECAP-A using ordinary least squares regression.

RESULTS

The findings show that all seven health conditions have a negative association on overall capability as measured by the ICECAP-A index. Inclusion of health utility instruments into separate regressions improves the predictive power of capability but on average, explains less than half of the variation in capability wellbeing. Individuals with arthritis appear to be less inhibited in terms of capability losses when accounting for health utility, yet those who have depression record significant reductions in capability relative to the healthy population even after accounting for the most commonly used health utility instruments.

CONCLUSION

The study therefore casts doubt on the ability of QALYs to act as a reliable proxy measure of individuals' capability.

"Fibromyalgia and quality of life: mapping the revised fibromyalgia impact questionnaire to the preference-based instruments"

Background

The revised version of the Fibromyalgia Impact Questionnaire (FIQR) is one of the most widely used specific questionnaires in FM studies. However, this questionnaire does not allow calculation of QALYs as it is not a preference-based measure. The aim of this study was to develop mapping algorithm which enable FIQR scores to be transformed into utility scores that can be used in the cost utility analyses.

Methods

A cross-sectional survey was conducted. One hundred and 92 Spanish women with Fibromyalgia were asked to complete four general quality of life questionnaires, i.e. EQ-5D-5 L, 15D, AQoL-8D and SF-12, and one specific disease instrument, the FIQR. A direct mapping approach was adopted to derive mapping algorithms between the FIQR and each of the four multi-attribute utility (MAU) instruments. Health state utility was treated as the dependent variable in the regression analysis, whilst the FIQR score and age were predictors.

Results

The mean utility scores ranged from 0.47 (AQoL-8D) to 0.69 (15D). All correlations between the FIQR total score and MAU instruments utility scores were highly significant (p < 0.0001) with magnitudes larger than 0.5. Although very slight differences in the mean absolute error were found between ordinary least squares (OLS) estimator and generalized linear model (GLM), models based on GLM were better for EQ-5D-5 L, AQoL-8D and 15D.

Conclusion

Mapping algorithms developed in this study enable the estimation of utility values from scores in a fibromyalgia specific questionnaire.

Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey

INTRODUCTION

This paper suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective, i.e. when more health could be produced by allocating funds to other services. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost.

METHODS

Survey respondents were asked to allocate a budget between cost-effective services that had a small effect upon a large number of relatively well patients and SRDs that benefited a small number of severely ill patients but were not cost effective because of their high cost.

RESULTS

Part of the budget was always allocated to the SRDs. The budget share rose with the number sharing the cost.

DISCUSSION

Sharing per se appears to characterise preferences. This has been obscured in studies that focus upon cost per patient rather than cost per person sharing the cost.

Assessing the validity of the ICECAP-A capability measure for adults with depression

BACKGROUND

Effectiveness and cost-effectiveness are increasingly important considerations in determining which mental health services are funded. Questions have been raised concerning the validity of generic health status instruments used in economic evaluation for assessing mental health problems such as depression; measuring capability wellbeing offers a possible alternative. The aim of this study is to assess the validity of the ICECAP-A capability instrument for individuals with depression.

METHODS

Hypotheses were developed using concept mapping. Validity tests and multivariable regression analysis were applied to data from a cross-sectional dataset to assess the performance of ICECAP-A in individuals who reported having a primary condition of depression. The ICECAP-A was collected alongside instruments used to measure: 1. depression using the depression scale of the Depression, Anxiety and Stress Scale (DASS-D of DASS-21); 2. mental health using the Kessler Psychological Distress Scale (K10); 3. generic health status using a common measure collected for use in economic evaluations, the five level version of EQ-5D (EQ-5D-5L).

RESULTS

Hypothesised associations between the ICECAP-A (items and index scores) and depression constructs were fully supported in statistical tests. In the multivariable analysis, instruments designed specifically to measure depression and mental health explained a greater proportion of the variation in ICECAP-A than the EQ-5D-5L.

CONCLUSION

The ICECAP-A instrument appears to be suitable for assessing outcome in adults with depression for resource allocation purposes. Further research is required on its responsiveness and use in economic evaluation. Using a capability perspective when assessing cost-effectiveness could potentially re-orientate resource provision across physical and mental health care services.

Mapping Between the Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and Five Multi-Attribute Utility Instruments (MAUIs)

PURPOSE

Economic evaluation of health services commonly requires information regarding health-state utilities. Sometimes this information is not available but non-utility measures of quality of life may have been collected from which the required utilities can be estimated. This paper examines the possibility of mapping a non-utility-based outcome, the Sydney Asthma Quality of Life Questionnaire (AQLQ-S), onto five multi-attribute utility instruments: Assessment of Quality of Life 8 Dimensions (AQoL-8D), EuroQoL 5 Dimensions 5-Level (EQ-5D-5L), Health Utilities Index Mark 3 (HUI3), 15 Dimensions (15D), and the Short-Form 6 Dimensions (SF-6D).

METHODS

Data for 856 individuals with asthma were obtained from a large Multi-Instrument Comparison (MIC) survey. Four statistical techniques were employed to estimate utilities from the AQLQ-S. The predictive accuracy of 180 regression models was assessed using six criteria: mean absolute error (MAE), root mean squared error (RMSE), correlation, distribution of predicted utilities, distribution of residuals, and proportion of predictions with absolute errors <0.0.5. Validation of initial 'primary' models was carried out on a random sample of the MIC data.

RESULTS

Best results were obtained with non-linear models that included a quadratic term for the AQLQ-S score along with demographic variables. The four statistical techniques predicted models that performed differently when assessed by the six criteria; however, the best results, for both the estimation and validation samples, were obtained using a generalised linear model (GLM estimator).

CONCLUSIONS

It is possible to predict valid utilities from the AQLQ-S using regression methods. We recommend GLM models for this exercise.

Age Weights for Health Services Derived from the Relative Social Willingness-to-Pay Instrument

The effect of a patient's age on the social valuation of health services remains controversial, with empirical results varying in magnitude and implying a different age-value profile. This article employs a new methodology to re-examine these questions. Data were obtained from 2 independent Web-based surveys that administered the Relative Social Willingness to Pay instrument. In the first survey, the age of the patient receiving a life-saving service was varied. Patients were left with either poor mental or physical health. In the second survey, patient age was varied for a service that fully cured the patient's poor mental or physical health. In total, therefore, 4 sets of age weights were obtained: weights for life-extending services with poor physical or mental health outcomes and weights for quality-of-life improvement for patients in poor mental or physical health. Results were consistent. Increasing age was associated in each case with a monotonic decrease in the social valuation of the services. The decrease in value was quantitatively small until age 60 years. By age 80 years, the social value of services had declined by about 50%. The decline commenced at an earlier age in the context of physical health, although the magnitude of the decrement by age 80 years was unrelated to the type of service. With 1 exception, there was little difference in the valuation of services by the age of the survey respondent. Respondents aged >60 years placed a lower, not higher, value on quality-of-life improvement for elderly individuals than other respondents. There was no difference in the valuation of life-extending services.

Proceedings of the 3rd IPLeiria's International Health Congress : Leiria, Portugal. 6-7 May 2016

S1 Health literacy and health education in adolescence

Catarina Cardoso Tomás

S2 The effect of a walking program on the quality of life and well-being of people with schizophrenia

Emanuel Oliveira, D. Sousa, M. Uba-Chupel, G. Furtado, C. Rocha, A. Teixeira, P. Ferreira

S3 Diagnosis and innovative treatments - the way to a better medical practice

Celeste Alves

S4 Simulation-based learning and how it is a high contribution

Stefan Gisin

S5 Formative research about acceptability, utilization and promotion of a home fortification programme with micronutrient powders (MNP) in the Autonomous Region of Príncipe, São Tomé and Príncipe

Elisabete Catarino, Nelma Carvalho, Tiago Coucelo, Luís Bonfim, Carina Silva

S6 Safety culture of the patient: a reflexion about the therapeutic approach on the patient with vocal pathology

Débora Franco

S7 About wine, fortune cookies and patient experience

Jesús Alcoba González

O1 The psychological impact on the emergency crews after the disaster event on February 20, 2010

Helena G. Jardim, Rita Silva

O2 Musculoskeletal disorders in midwives

Cristina L. Baixinho, Mª Helena Presado, Mª Fátima Marques, Mário E. Cardoso

O3 Negative childhood experiences and fears of compassion: Implications for psychological difficulties in adolescence

Marina Cunha, Joana Mendes, Ana Xavier, Ana Galhardo, Margarida Couto

O4 Optimal age to give the first dose of measles vaccine in Portugal

João G. Frade, Carla Nunes, João R. Mesquita, Maria S. Nascimento, Guilherme Gonçalves

O5 Functional assessment of elderly in primary care

Conceição Castro, Alice Mártires, Mª João Monteiro, Conceição Rainho

O6 Smoking and coronary events in a population of Spanish health-care centre: An observational study

Francisco P. Caballero, Fatima M. Monago, Jose T. Guerrero, Rocio M. Monago, Africa P. Trigo, Milagros L. Gutierrez, Gemma M. Milanés, Mercedes G. Reina, Ana G. Villanueva, Ana S. Piñero, Isabel R. Aliseda, Francisco B. Ramirez

O7 Prevalence of musculoskeletal injuries in Portuguese musicians

Andrea Ribeiro, Ana Quelhas, Conceição Manso

O8 Hip fractures, psychotropic drug consumption and comorbidity in patients of a primary care practice in Spain

Francisco P. Caballero, Jose T. Guerrero, Fatima M. Monago, Rafael B. Santos, Nuria R. Jimenez, Cristina G. Nuñez, Inmaculada R. Gomez, Mª Jose L. Fernandez, Laura A. Marquez, Ana L. Moreno, Mª Jesus Tena Huertas, Francisco B. Ramirez

O9 The role of self-criticism and shame in social anxiety in a clinical SAD sample

Daniel Seabra, Mª Céu Salvador

O10 Obstruction and infiltration: a proposal of a quality indicator

Luciene Braga, Pedro Parreira, Anabela Salgueiro-Oliveira, Cristina Arreguy-Sena, Bibiana F. Oliveira, Mª Adriana Henriques

O11 Balance and anxiety and depression symptoms in old age people

Joana Santos, Sara Lebre, Alda Marques

O12 Prevalence of postural changes and risk factors in school children and adolescents in a northern region (Porto)

Clarinda Festas, Sandra Rodrigues, Andrea Ribeiro, José Lumini

O13 Ischemic stroke vs. haemorrhagic stroke survival rate

Ana G. Figueiredo

O14 Chronobiological factors as responsible for the appearance of locomotor pathology in adolescents

Francisco J. Hernandez-Martinez, Liliana Campi, Mª Pino Quintana-Montesdeoca, Juan F. Jimenez-Diaz, Bienvenida C. Rodriguez-De-Vera

O15 Risk of malnutrition in the elderly of Bragança

Alexandra Parente, Mª Augusta Mata, Ana Mª Pereira, Adília Fernandes, Manuel Brás

O16 A Lifestyle Educational Programme for primary care diabetic patients: the design of a complex nursing intervention

Mª Rosário Pinto, Pedro Parreira, Marta L. Basto, Ana C. Rei, Lisete M. Mónico

O17 Medication adherence in elderly people

Gilberta Sousa, Clementina Morna, Otília Freitas, Gregório Freitas, Ana Jardim, Rita Vasconcelos

O18 Hospitalization for cervical cancer of residents in the metropolitan region of Porto Alegre, Southern Brazil, 2012 to 2014

Lina G. Horta, Roger S. Rosa, Luís F. Kranz, Rita C. Nugem, Mariana S. Siqueira, Ronaldo Bordin

O19 Oncologic assistance of high complexity: evaluation of regulating accesses

Rosiane Kniess, Josimari T. Lacerda

O20 Perceived barriers for using health care services by the older population as seen by the social sector: findings from the Vila Nova de Gaia Gerontological Plan

Joana Guedes, Idalina Machado, Sidalina Almeida, Adriano Zilhão, Helder Alves, Óscar Ribeiro

O21 Sleep difficulties and depressive symptoms in college students

Ana P. Amaral, Ana Santos, Joana Monteiro, Mª Clara Rocha, Rui Cruz

O22 Psychopathological symptoms and medication use in higher education

Ana P. Amaral, Marina Lourenço, Mª Clara Rocha, Rui Cruz

O23 Sexually transmitted diseases in higher education institutions

Sandra Antunes, Verónica Mendonça, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes

O24 Alcohol consumption and suicide ideation in higher education students

Lídia Cabral, Manuela Ferreira, Amadeu Gonçalves

O25 Quality of life in university students

Tatiana D. Luz, Leonardo Luz, Raul Martins

O26 Male and female adolescent antisocial behaviour: characterizing vulnerabilities in a Portuguese sample

Alice Morgado, Maria L. Vale-Dias

O27 Risk factors for mental health in higher education students of health sciences

Rui Porta-Nova

O28 International classification of functioning disability and health as reflexive reasoning in primary attention in health

Tânia C. Fleig, Éboni M. Reuter, Miriam B. Froemming, Sabrina L. Guerreiro, Lisiane L. Carvalho

O29 Risk factors and cardiovascular disease in Portalegre

Daniel Guedelha, P. Coelho, A. Pereira

O30 Health status of the elderly population living in Portalegre historic city centre: A longitudinal study

António Calha, Raul Cordeiro

O31 Student’s sleep in higher education: sleep quality among students of the IPB

Ana Gonçalves, Ana Certo, Ana Galvão, Mª Augusta Mata

O32 Trend in mortality from cervical cancer in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil, 2000 to 2013

Aline Welter, Elayne Pereira, Sandra Ribeiro, Marcia Kretzer

O33 Adherence to treatment in the elderly in an urban environment in Spain

Juan-Fernando Jiménez-Díaz, Carla Jiménez-Rodríguez, Francisco-José Hernández-Martínez, Bienvenida-Del-Carmen Rodríguez-De-Vera, Alexandre Marques-Rodrigues

O34 Beira Baixa Blood Pressure Study (Study PABB)

Patrícia Coelho, Tiago Bernardes, Alexandre Pereira

O35 Trends in cervical cancer mortality statistics in Santa Catarina State, Brazil, by age group and macro-region, from 2000 to 2013

Patrícia Sousa, João G. Filho, Nazare Nazario, Marcia Kretzer

O36 Sleep problems among Portuguese adolescents: a public health issue

Odete Amaral, António Garrido, Nélio Veiga, Carla Nunes, Ana R. Pedro, Carlos Pereira

O37 Association between body fat and health-related quality of life in patients with type 2 diabetes

António Almeia, Helder M. Fernandes, Carlos Vasconcelos, Nelson Sousa, Victor M. Reis, M. João Monteiro, Romeu Mendes

O38 Therapy adherence and polypharmacy in non-institutionalized elderly from Amares county, Portugal

Isabel C. Pinto, Tânia Pires, João Gama

O39 Prevalence of surgical site infection in adults at a hospital unit in the North of Portugal

Vera Preto, Norberto Silva, Carlos Magalhães, Matilde Martins

O40 Frailty phenotype in old age: implications to intervention

Mafalda Duarte, Constança Paúl, Ignácio Martín

O41 Portuguese women: sexual symptoms in perimenopause

Arminda A. Pinheiro

O42 Predictive ability of the Perinatal Depression Screening and Prevention Tool – preliminary results of the categorical approach

Sandra Xavier, Julieta Azevedo, Elisabete Bento, Cristiana Marques, Mariana Marques, António Macedo, Ana T. Pereira

O43 Aging and muscle strength in patients with type 2 diabetes: cross sectional analysis

José P. Almeida, António Almeida, Josiane Alves, Nelson Sousa, Francisco Saavedra, Romeu Mendes

O44 Accessibility of the elderly in the prevention of hypertension in a family health unit

Ana S. Maia, Michelle T. Oliveira, Anderson R. Sousa, Paulo P. Ferreira, Luci S. Lopes, Eujcely C. Santiago

O45 Community Health screenings and self-reported chronic diseases

Sílvia Monteiro, Ângelo Jesus, Armanda Colaço, António Carvalho, Rita P. Silva, Agostinho Cruz

O46 Evaluation of indoor air quality in Kindergartens

Ana Ferreira, Catarina Marques, João P. Figueiredo, Susana Paixão

O47 Atmospheric exposure to chemical agents under the occupational activity of pathology technicians

Ana Ferreira, Carla Lopes, Fernando Moreira, João P. Figueiredo

O48 Occupational exposure to air pollutants in night entertainment venues workers

Ana Ferreira, Diana Ribeiro, Fernando Moreira, João P. Figueiredo, Susana Paixão

O49 Beliefs and attitudes of young people towards breastfeeding

Telma Fernandes, Diogo Amado, Jéssica Leal, Marcelo Azevedo, Sónia Ramalho

O50 Profiling informal caregivers: surveying needs in the care of the elderly

Catarina Mangas, Jaime Ribeiro, Rita Gonçalves

O51 Visual health in teenagers

Amélia F Nunes, Ana R. Tuna, Carlos R. Martins, Henriqueta D. Forte

O52 Amenable mortality and the geographic accessibility to healthcare in Portugal

Cláudia Costa, José A. Tenedório, Paula Santana

O53 Bacterial contamination of door handles in a São Paulo See Metropolitan Cathedral public restrooms in Brazil

J. A. Andrade, J. L. Pinto, C. Campofiorito, S. Nunes, A. Carmo, A. Kaliniczenco, B. Alves, F. Mendes, C. Jesus, F. Fonseca, F. Gehrke

O54 Adherence of patients to rehabilitation programmes

Carlos Albuquerque, Rita Batista, Madalena Cunha, António Madureira, Olivério Ribeiro, Rosa Martins

O55 Prevalence of malnutrition among Portuguese elderly living in nursing homes: preliminary results of the PEN-3S project

Teresa Madeira, Catarina Peixoto-Plácido, Nuno Santos, Osvaldo Santos, Astrid Bergland, Asta Bye, Carla Lopes, Violeta Alarcão, Beatriz Goulão, Nuno Mendonça, Paulo Nicola, João G. Clara

O56 Relation between emotional intelligence and mental illness in health students

João Gomes, Ana Querido, Catarina Tomás, Daniel Carvalho, Marina Cordeiro

P1 Fall risk factors in people older than 50 years old – a pilot report

Marlene C. Rosa, Alda Marques

P2 What about the Portuguese oldest old? A global overview using census data

Daniela Brandão, Óscar Ribeiro, Lia Araújo, Constança Paúl

P3 Prevalence of injuries in senior amateur volleyball athletes in Alentejo and Algarve clubs, Portugal: factors associated

Beatriz Minghelli, Sylvina Richaud

P4 Shame feelings and quality of life: the role of acceptance and decentring

Ana L. Mendes, Joana Marta-Simões, Inês A. Trindade, Cláudia Ferreira

P5 Assessment of social support during deployment in portuguese colonial war veterans

Teresa Carvalho, Marina Cunha, José Pinto-Gouveia

P6 Hospitalization for acute viral bronchiolitis of residents in the metropolitan region of Porto Alegre, Southern Brazil, 2012 to 2014

Morgana C. Fernandes, Roger S. Rosa, Rita C. Nugem, Luís F. Kranz, Mariana S. Siqueira, Ronaldo Bordin

P7 Falls-risk screening – an opportunity for preventing falls in the elderly from Nordeste

Anabela C. Martins, Anabela Medeiros, Rafaela Pimentel, Andreia Fernandes, Carlos Mendonça, Isabel Andrade, Susana Andrade, Ruth L. Menezes

P8 Aging provokes chronodisruption in mature people in temperature circadian rhythm

Rafael Bravo, Marta Miranda, Lierni Ugartemendia, José Mª Tena, Francisco L. Pérez-Caballero, Lorena Fuentes-Broto, Ana B. Rodríguez, Barriga Carmen

P9 The influence of climate and pollution factors in dengue cases of great ABC region, São Paulo

M. A. Carneiro, J. N. Domingues, S. Paixão, J. Figueiredo, V. B. Nascimento, C. Jesus, F Mendes, F. Gehrke, B. Alves, L. Azzalis, F. Fonseca

P10 Visual function and impact of visual therapy in children with learning disabilities: a pilot study

Ana R. Martins, Amélia Nunes, Arminda Jorge

P11 Edentulism and the need of oral rehabilitation among institutionalized elderly

Nélio Veiga, Ana Amorim, André Silva, Liliana Martinho, Luís Monteiro, Rafael Silva, Carina Coelho, Odete Amaral, Inês Coelho, Carlos Pereira, André Correia

P12 Therapy adherence of outpatients in the pharmacy services of a hospital unit

Diana Rodrigues, Nídia Marante, Pedro Silva, Sara Carvalho, André Rts Araujo, Maximiano Ribeiro, Paula Coutinho, Sandra Ventura, Fátima Roque

P13 Universal access and comprehensive care of oral health: an availability study

Cristina Calvo, Manoela Reses

P14 Is the respiratory function of children a predictor of air quality? Coimbra as a case study

Jorge Conde, Ana Ferreira, João Figueiredo

P15 Meaning-in-life of college students

David Silva, Luís Seiça, Raquel Soares, Ricardo Mourão, Teresa Kraus

O57 Training needs for nurses in palliative care

Ana C. Abreu, José M. Padilha, Júlia M. Alves

O58 Impact of computerized information systems in the global nurses’ workload: nurses’ perceptions and real-time

Paulino Sousa, Manuel Oliveira, Joana Sousa

O59 The perspective of health care professionals on self-care in hereditary neurodegenerative disease: a qualitative study

Sónia Novais, Felismina Mendes

O60 Contribution for health-related physical fitness reference values in healthy adolescents

Joana Pinto, Joana Cruz, Alda Marques

School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

O61 Perception of learning, satisfaction and self-efficacy of nursing students about High-Fidelity Simulation

Hugo Duarte, Maria Dos Anjos Dixe, Pedro Sousa

O62 Analysis of statements of diagnosis about health deviation in self-care requisites customized in a Nursing Practice Support System (SAPE®): Management of therapeutic regimen

Inês Cruz, Fernanda Bastos, Filipe Pereira

O63 Hybrid management and hospital governance: doctors and nurses as managers

Francisco L. Carvalho, Teresa T. Oliveira, Vítor R. Raposo

O64 Time management in health professionals

Conceição Rainho, José C. Ribeiro, Isabel Barroso, Vítor Rodrigues

O65 Financial rewards and wellbeing in primary health care

Carmo Neves, Teresa C. Oliveira

O66 Patient safety promotion in the operating room

Bárbara Oliveira, Mª Carminda Morais, Pilar Baylina

O67 Difficulties and needs of pre-graduate nursing students in the area of Geriatrics/Gerontology

Rogério Rodrigues, Zaida Azeredo, Corália Vicente

O68 Teaching and learning sexuality in nursing education

Hélia Dias, Margarida Sim-Sim

O69 Entrepreneurial Motivations Questionnaire: AFC and CFA in academy

Pedro Parreira, Anabela Salgueiro-Oliveira, Amélia Castilho, Rosa Melo, João Graveto, José Gomes, Marina Vaquinhas, Carla Carvalho, Lisete Mónico, Nuno Brito

O70 Nursing intervention to patient with Permanent Pacemakers and Implantable Cardioverter Defibrillators: a qualitative analysis

Cassilda Sarroeira, José Amendoeira, Fátima Cunha, Anabela Cândido, Patrícia Fernandes, Helena R. Silva, Elsa Silva

O71 Alcohol consumption among nursing students: where does education fail?

Isabel Barroso, Leila Lapa, Cristina Antunes

O72 Labour stress in nursing

Ana Gonçalves, Ana Galvão, Mª José Gomes, Susana R. Escanciano

O73 The influence of safe staff nursing in patient satisfaction with nursing care

Maria Freitas, Pedro Parreira, João Marôco

O74 Intention to use eHealth strategies with nursing students

Ana R. Fernandes, Cremilde Cabral, Samuel Alves, Pedro Sousa

O75 Community Based Mental Health: contributions of an interdisciplinary international program for students in higher health education

António Ferreira, Fernanda Príncipe, Ulla-Maija Seppänen, Margarida Ferreira, Maribel Carvalhais, Marilene Silva

O76 Study of satisfaction at work of graduates in nursing: 2002-2014

Manuela Ferreira, Joana Silva, Jéssica Neves, Diana Costa, Bruno Santos, Soraia Duarte

O77 Health professionals’ attitudes towards breastfeeding

Sílvia Marques, Sónia Ramalho, Isabel Mendes

O78 Continuity of nursing care to person with type 2 diabetes

Clarisse Louro, Eva Menino, Maria Dixe, Sara S. Dias

O79 Stigma toward mental illness among future health professionals

Marina Cordeiro, Catarina Tomás, Ana Querido, Daniel Carvalho, João Gomes

O80 Working with fears and anxieties of medical students in search of a humanized care

Frederico C. Valim, Joyce O. Costa, Lúcia G. Bernardes

P16 Surgical paediatrics patients’ psycho prophylaxis at a teaching hospital

Helena Prebianchi

P17 Patient-perceived outcomes in physiotherapy – a pilot study

Marlene Cristina Rosa

P18 Building competencies for managers in nursing

Narcisa Gonçalves, Maria M. Martins, Paulina Kurcgant

P19 Theoretical basis underlying physiotherapy practice in stroke rehabilitation

André Vieira

P20 When the life-cycle ends: the nurse’s confrontation with death

Sandrina Bento, Sérgio Deodato, Isabel Rabiais

P21 Nursing students’ opinion about the supervision relationship during their first clinical experience

Laura Reis

P22 Nursing Relational Laboratory: Pedagogical, dialogic and critical project

Ana Torres, Sérgio Soares, Margarida Ferreira, Pedro Graça

P23 Job satisfaction of bioscientists at a Lisbon hospital

Céu Leitão, Renato Abreu, Fernando Bellém, Ana Almeida, Edna Ribeiro-Varandas, Ana Tavares

P24 Sociodemographic and professional profile of nurses and its relation with the importance of family in nursing practices

João G. Frade, Carolina Henriques, Eva Menino, Clarisse Louro, Célia Jordão

P25 Professional satisfaction of rehabilitation nurses

Sofia Neco, Carminda Morais, Pedro Ferreira

P26 The person living with a stoma: the formalization of knowledge in nursing

Carla R. Silva, Alice Brito, Antónia Silva

P27 Validation of the Portuguese versions of the nursing students’ perceptions of learning and learner satisfaction with simulation tool

Hugo Duarte, Maria Dos Anjos Dixe, Pedro Sousa

P28 Physiotherapists’ perceived knowledge on technologies for electronic health records for physiotherapy

Gabriela Postolache, Raul Oliveira, Isabel Moreira, Luísa Pedro, Sónia Vicente, Samuel Domingos, Octavian Postolache

P29 Quality of life and physical activity of medicine undergraduate students in the University of Southern Santa Catarina, Brazil

Darlen Silva, João G. Filho, Nazare Nazario, Marcia Kretzer, Dulcineia Schneider

P30 The curricular skills for decision making education in a Nursing Degree

Fátima M. Marques

P31 Effect of nurses’ mobilization in satisfaction at work and turnover: An empirical study in the hospital setting

Pedro Parreira, Carla Carvalho, Lisete M. Mónico, Carlos Pinto, Sara Vicente, São João Breda

P32 Entrepreneurial skills of students of polytechnic higher education in Portugal: Business influences

José H. Gomes, Rosa Melo, Pedro Parreira, Anabela Salgueiro, João Graveto, Marina Vaquinhas, Amélia Castilho

P33 Design and assessment of e-learning modules for Pharmacology

Ângelo Jesus, Nuno Duarte, José C. Lopes, Hélder Nunes, Agostinho Cruz

P34 Perspective of nurses involved in an action-research study on the changes observed in care provision: results from a focus group

Anabela Salgueiro-Oliveira, Pedro Parreira, Marta L. Basto, Luciene M. Braga

P35 Use of peer feedback by nursing students during clinical training: teacher’s perception

António Ferreira, Beatriz Araújo, José M. Alves, Margarida Ferreira, Maribel Carvalhais, Marilene Silva, Sónia Novais

P36 What’s new on endotracheal suctioning recommendations

Ana S. Sousa, Cândida Ferrito

P37 Assessment of the nurses satisfaction on the Central Region of Portugal

Pedro L. Ferreira, Alexandre Rodrigues, Margarida Ferreira, Isabel Oliveira

P38 Study of graduate’s satisfaction with the school of nursing

Manuela Ferreira, Jéssica Neves, Diana Costa, Soraia Duarte, Joana Silva, Bruno Santos

P39 Partnership between the school of nursing and the hospital: Supervisors´ perspectives

Cristina Martins, Ana P. Macedo, Odete Araújo, Cláudia Augusto, Fátima Braga, Lisa Gomes, Maria A. Silva, Rafaela Rosário

P40 Coping strategies of college students

Luís Pimenta, Diana Carreira, Patrícia Teles, Teresa Barros

P41 Emotional intelligence and mental health stigma in health students

Catarina Tomás, Ana Querido, Daniel Carvalho, João Gomes, Marina Cordeiro

P42 Stigma of mental health assessment: Comparison between health courses

Daniel Carvalho, Ana Querido, Catarina Tomás, João Gomes, Marina Cordeiro

O81 Short- and long-term effects of pulmonary rehabilitation in mild COPD

Cristina Jácome, Alda Marques

O82 Phonological awareness programme for preschool children

Sylvie Capelas, Andreia Hall, Dina Alves, Marisa Lousada

O83 REforma ATIVA: An efficient health promotion program to be implemented during retirement

Mª Helena Loureiro, Ana Camarneiro, Margarida Silva, Aida Mendes, Ana Pedreiro

O84 Intervention for men who batter women, a case report

Anne G.Silva, Elza S. Coelho

O85 Immediate effects of Bowen Therapy on muscle tone and flexibility

Flávio Melo, Fernando Ribeiro, Rui Torres, Rui Costa

O86 Predictive equation for incremental shuttle walk test in adolescents

Tânia Pinho, Cristina Jácome, Alda Marques

O87 Life satisfaction and psychopathology in institutionalized elderly people: The results of an adapted Mindfulness-Based Stress Reduction program

Bárbara Cruz, Daniel Seabra, Diogo Carreira, Maria Ventura

O88 Outcome changes in COPD rehabilitation: exploring the relationship between physical activity and health-related outcomes

Joana Cruz, Dina Brooks, Alda Marques

O89 Assessing the effectiveness of a Complex Nursing Intervention

M Rosário Pinto, Pedro Parreira, Marta Lima-Basto, Miguel Neves, Lisete M. Mónico

O90 Psychotherapeutic intervention in addiction disorders: Change in psychopathological symptoms and emotional states

Carla Bizarro, Marina Cunha, Ana Galhardo, Couto Margarida, Ana P. Amorim, Eduardo Silva

O91 Economic impact of a nursing intervention program to promote self-management in COPD

Susana Cruz, José M. Padilha, Jorge Valente

O92 Multimodal acute pain management during uterine artery embolization in treatment of uterine myomas

José T. Guerrero, Francisco P. Caballero, Rafael B. Santos, Estefania P. Gonzalez, Fátima M. Monago, Lierni U. Ugalde, Marta M. Vélez, Maria J. Tena

O93 Fluid administration strategies in major surgery: Goal-directed therapy

José T. Guerrero, Rafael Bravo, Francisco L. Pérez-Caballero, Isabel A. Becerra, Mª Elizabeth Agudelo, Guadalupe Acedo, Roberto Bajo

O94 Development and implementation of a self-management educational programme using lay-led’s in adolescents Spina Bifida: A pilot study

Isabel Malheiro, Filomena Gaspar, Luísa Barros

O95 Influence of chair-based yoga exercises on salivary anti-microbial proteins in institutionalized frail-elderly women: a preliminary study

Guilherme Furtado, Mateus Uba-Chupel, Mariana Marques, Luís Rama, Margarida Braga, José P. Ferreira, Ana Mª Teixeira

O96 High intensity interval training vs moderate intensity continuous training impact on diabetes 2

João Cruz, Tiago Barbosa, Ângela Simões, Luís Coelho

O97 Family caregiver of people with pressure ulcer: Nursing intervention plan

Alexandre Rodrigues, Juan-Fernando Jiménez-Díaz, Francisco Martinez-Hernández, Bienvenida Rodriguez-De-Vera, Pedro Ferreira, Alexandrina Rodrigues

O98 Chronic effects of exercise on motor memory consolidation in elderly people

André Ramalho, João Petrica, Pedro Mendes, João Serrano, Inês Santo, António Rosado

O99 Impression cytology of the ocular surface: Collection technique and sample processing

Paula Mendonça, Kátia Freitas

O100 Does sport practice affect the reaction time in neuromuscular activity?

Dora Ferreira, António Brito, Renato Fernandes

O101 Efficiency of the enteral administration of fibbers in the treatment of chronic obstipation

Sofia Gomes, Fernando Moreira, Cláudia Pinho, Rita Oliveira, Ana I. Oliveira

O102 Fast decalcifier in compact bone and spongy bone

Paula Mendonça, Ana P. Casimiro, Patrícia Martins, Iryna Silva

O103 Health promotion in the elderly – Intervention project in dementia

Diana Evangelista

O104 Prevention of musculoskeletal disorders through an exercise protocol held in labour context

Catarina Leitão, Fábia Velosa, Nélio Carecho, Luís Coelho

O105 Knowledge of teachers and other education agents on diabetes type 1: Effectiveness of an intervention program

Eva Menino, Anjos Dixe, Helena Catarino, Fátima Soares, Ester Gama, Clementina Gordo

O106 Treatment of diabetic peripheral neuropathic pain: a systematic review of clinical trials of phase II and III

Eliana Moreira, Cristiana Midões, Marlene Santos

O107 New drugs for osteoporosis treatment: Systematic review of clinical trials of phase II and III

Sara Machado, Vânia P. Oliveira, Marlene Santos

O108 Promoting hope at the end of life: Effectiveness of an Intervention Programme

Ana Querido, Anjos Dixe, Rita Marques, Zaida Charepe

P43 Psychomotor therapy effects on adaptive behaviour and motor proficiency of adults with intellectual disability

Ana Antunes, Sofia Santos

P44 The effect of exercise therapy in multiple sclerosis – a single study case

Marlene C. Rosa

P45 Physical condition and self-efficacy in people with fall risk – a preliminary study

Marlene C. Rosa, Silvana F. Marques

P46 Shock waves: their effectiveness in improving the symptoms of calcifying tendinitis of the shoulder

Beatriz Minghelli, Eulália Caro

P47 Pacifier – construction and pilot application of a parenting intervention for parents of babies until six months in primary health care

Mª José Luís, Teresa Brandão

P48 The influence of Motor Imagery in fine motor skills of individuals with disabilities

Pedro Mendes, Daniel Marinho, João Petrica, Diogo Monteiro, Rui Paulo, João Serrano, Inês Santo

P49 Evaluation of the effects of a walking programme on the fall risk factors in older people – a longitudinal pilot study

Lina Monteiro, Fátima Ramalho, Rita Santos-Rocha, Sónia Morgado, Teresa Bento

P50 Nursing intervention programme in lifestyles of adolescents

Gilberta Sousa, Otília Freitas, Isabel Silva, Gregório Freitas, Clementina Morna, Rita Vasconcelos

P51 The person submitted to hip replacement rehabilitation, at home

Tatiana Azevedo, Salete Soares, Jacinta Pisco

P52 Effects of Melatonin use in the treatment of neurovegetative diseases

Paulo P. Ferreira, Efrain O. Olszewer, Michelle T. Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. Oliveira

P53 Review of Phytotherapy and other natural substances in alcohol abuse and alcoholism

Erica Santos, Ana I. Oliveira, Carla Maia, Fernando Moreira, Joana Santos, Maria F. Mendes, Rita F. Oliveira, Cláudia Pinho

P54 Dietary programme impact on biochemical markers in diabetics: systematic review

Eduarda Barreira, Ana Pereira, Josiana A. Vaz, André Novo

P55 Biological approaches to knee osteoarthritis: platelet-rich plasma and hyaluronic acid

Luís D. Silva, Bruno Maia, Eduardo Ferreira, Filipa Pires, Renato Andrade, Luís Camarinha

P56 Platelet-rich plasma and hyaluronic acid intra-articular injections for the treatment of ankle osteoarthritis

Luís D. Silva, Bruno Maia, Eduardo Ferreira, Filipa Pires, Renato Andrade, Luís Camarinha

P57 The impact of preventive measures in the incidence of diabetic foot ulcers: a systematic review

Ana F. César, Mariana Poço, David Ventura, Raquel Loura, Pedro Gomes, Catarina Gomes, Cláudia Silva, Elsa Melo, João Lindo

P58 Dating violence among young adolescents

Joana Domingos, Zaida Mendes, Susana Poeta, Tiago Carvalho, Catarina Tomás, Helena Catarino, Mª Anjos Dixe

P59 Physical activity and motor memory in pedal dexterity

André Ramalho, António Rosado, Pedro Mendes, Rui Paulo, Inês Garcia, João Petrica

P60 The effects of whole body vibration on the electromyographic activity of thigh muscles

Sandra Rodrigues, Rui Meneses, Carlos Afonso, Luís Faria, Adérito Seixas

P61 Mental health promotion in the workplace

Marina Cordeiro, Paulo Granjo, José C. Gomes

P62 Influence of physical exercise on the self-perception of body image in elderly women: A systematic review of qualitative studies

Nelba R. Souza, Guilherme E. Furtado, Saulo V. Rocha, Paula Silva, Joana Carvalho

O109 Psychometric properties of the Portuguese version of the Éxamen Geronto-Psychomoteur (P-EGP)

Marina Ana Morais, Sofia Santos, Paula Lebre, Ana Antunes

O110 Symptoms of depression in the elderly population of Portugal, Spain and Italy

António Calha

O111 Emotion regulation strategies and psychopathology symptoms: A comparison between adolescents with and without deliberate self-harm

Ana Xavier, Marina Cunha, José Pinto-Gouveia

O112 Prevalence of physical disability in people with leprosy

Liana Alencar, Madalena Cunha, António Madureira

O113 Quality of life and self-esteem in type 1 and type 2 diabetes mellitus patients

Ilda Cardoso, Ana Galhardo, Fernanda Daniel, Vítor Rodrigues

O114 Cross-cultural comparison of gross motor coordination in children from Brazil and Portugal

Leonardo Luz, Tatiana Luz, Maurício R. Ramos, Dayse C. Medeiros, Bruno M. Carmo, André Seabra, Cristina Padez, Manuel C. Silva

O115 Electrocardiographic differences between African and Caucasian people

António Rodrigues, Patrícia Coelho, Alexandre Coelho

O116 Factors associated with domestic, sexual and other types of violence in the city of Palhoça - Brazil

Madson Caminha, Filipe Matheus, Elenice Mendes, Jony Correia, Marcia Kretzer

O117 Tinnitus prevalence study of users of a hospital of public management - Spain

Francisco J. Hernandez-Martinez, Juan F. Jimenez-Diaz, Bienvendida C. Rodriguez-De-Vera, Carla Jimenez-Rodriguez, Yadira Armas-Gonzalez

O118 Difficulties experienced by parents of children with diabetes mellitus of preschool age in therapeutic and nutritional management

Cátia Rodrigues, Rosa Pedroso

O119 E-mental health - “nice to have” or “must have”? Exploring the attitudes towards e-mental health in the general population

Jennifer Apolinário-Hagen, Viktor Vehreschild

O120 Violence against children and adolescents and the role of health professionals: Knowing how to identify and care

Milene Veloso, Celina Magalhães, Isabel Cabral, Maira Ferraz

O121 Marital violence. A study in the Algarve population

Filipe Nave, Emília Costa, Filomena Matos, José Pacheco

O122 Clinical factors and adherence to treatment in ischemic heart disease

António Dias, Carlos Pereira, João Duarte, Madalena Cunha, Daniel Silva

O123 Can religiosity improve optimism in participants in states of illness, when controlling for life satisfaction?

Lisete M. Mónico, Valentim R. Alferes, Mª São João Brêda, Carla Carvalho, Pedro M. Parreira

O124 Empowerment, knowledge and quality of life of people with diabetes type 2 in the Alto Minho Health Local Unit

Mª Carminda Morais, Pedro Ferreira, Rui Pimenta, José Boavida

O125 Antihypertensive therapy adherence among hypertensive patients from Bragança county, Portugal

Isabel C. Pinto, Tânia Pires, Catarina Silva

O126 Subjective perception of sexual achievement - An exploratory study on people with overweight

Maria Ribeiro, Maria Viega-Branco, Filomena Pereira, Ana Mª Pereira

O127 Physical activity level and associated factors in hypertensive individuals registered in the family health strategy of a basic health unit from the city of Palhoça, Santa Catarina, Brazil

Fabrícia M. Almeida, Gustavo L. Estevez, Sandra Ribeiro, Marcia R. Kretzer

O128 Perception of functional fitness and health in non-institutionalised elderly from rural areas

Paulo V. João, Paulo Nogueira, Sandra Novais, Ana Pereira, Lara Carneiro, Maria Mota

O129 Medication adherence in patients with type 2 diabetes mellitus treated at primary health care in Coimbra

Rui Cruz, Luiz Santiago, Carlos Fontes-Ribeiro

O130 Multivariate association between body mass index and multi-comorbidities in elderly people living in low socio-economic status context

Guilherme Furtado, Saulo V. Rocha, André P. Coutinho, João S. Neto, Lélia R. Vasconcelos, Nelba R. Souza, Estélio Dantas

O131 Metacognition, rumination and experiential avoidance in Borderline Personality Disorder

Alexandra Dinis, Sérgio Carvalho, Paula Castilho, José Pinto-Gouveia

O132 Health issues in a vulnerable population: nursing consultation in a public bathhouse in Lisbon

Alexandra Sarreira-Santos, Amélia Figueiredo, Lurdes Medeiros-Garcia, Paulo Seabra

O133 The perception of quality of life in people with multiple sclerosis accompanied in External Consultation of the Local Health Unit of Alto Minho

Rosa Rodrigues, Mª Carminda Morais, Paula O. Fernandes

O134 Representation of interaction established between immigrant women and nurse during pregnancy to postpartum, from the perspective of immigrant women

Conceição Santiago, Mª Henriqueta Figueiredo, Marta L. Basto

O135 Illness perceptions and medication adherence in hypertension

Teresa Guimarães, André Coelho, Anabela Graça, Ana M. Silva, Ana R. Fonseca

O136 A Portuguese study on adults’ intimate partner violence, interpersonal trust and hope

Luz Vale-Dias, Bárbara Minas, Graciete Franco-Borges

P63 QOL’ predictors of people with intellectual disability and general population

Cristina Simões, Sofia Santos

P64 Content validation of the Communication Disability Profile (CDP) - Portuguese Version

Ana Serra, Maria Matos, Luís Jesus

P65 Study of biochemical and haematological changes in football players

Ana S. Tavares, Ana Almeida, Céu Leitão, Edna Varandas, Renato Abreu, Fernando Bellém

P66 Body image dissatisfaction in inflammatory bowel disease: exploring the role of chronic illness-related shame

Inês A. Trindade, Cláudia Ferreira, José Pinto-Gouveia, Joana Marta-Simões

P67 Obesity and sleep in the adult population - a systematic review

Odete Amaral, Cristiana Miranda, Pedro Guimarães, Rodrigo Gonçalves, Nélio Veiga, Carlos Pereira

P68 Frequency of daytime sleepiness and obstructive sleep apnea risk in COPD patients

Tânia C. Fleig, Elisabete A. San-Martin, Cássia L. Goulart, Paloma B. Schneiders, Natacha F. Miranda, Lisiane L. Carvalho, Andrea G. Silva

P69 Working with immigrant-origin clients: discourses and practices of health professionals

Joana Topa, Conceição Nogueira, Sofia Neves

P70 Systemic Lupus Erythematosus – what are audiovestibular changes?

Rita Ventura, Cristina Nazaré

P71 Mental disorders in the oldest old: findings from the Portuguese national hospitalization database

Daniela Brandão, Alberto Freitas, Óscar Ribeiro, Constança Paúl

P72 Recurrence analysis in postural control in children with cerebral palsy

Cristiana Mercê, Marco Branco, Pedro Almeida, Daniela Nascimento, Juliana Pereira, David Catela

P73 The experience of self-care in the elderly with COPD: contributions to reflect proximity care

Helga Rafael

P74 Culturally competent nurses: managing unpredictability in clinical practice with immigrants

Alcinda C. Reis

O137 Paediatric speech and language screening: An instrument for health professionals

Ana Mendes, Ana R. Valente, Marisa Lousada

O138 Anthropometric and nutritional assessment in bodybuilders

Diana Sousa, Ana L. Baltazar, Mª Helena Loureiro

O139 Computerized adventitious respiratory sounds in children with lower respiratory tract infections

Ana Oliveira, José Aparício, Alda Marques

O140 Role of computerized respiratory sounds as a marker in LRTI

Alda Marques, Ana Oliveira, Joana Neves, Rodrigo Ayoub

O141 Confirmatory factor analysis of the Personal Wellbeing Index in people with chronic kidney disease

Luís Sousa, Cristina Marques-Vieira, Sandy Severino, Helena José

O142 Phonological awareness skills in school aged children

Inês Cadorio, Marisa Lousada

O143 Assessment of early memories of warmth and safeness in interaction with peers: its relationship with psychopathology in adolescence

Marina Cunha, Diogo Andrade, Ana Galhardo, Margarida Couto

O144 The molecular effects induced by single shot irradiation on a diffuse large B cell lymphoma cell line

Fernando Mendes, Cátia Domingues, Susann Schukg, Ana M. Abrantes, Ana C. Gonçalves, Tiago Sales, Ricardo Teixo, Rita Silva, Jéssica Estrela, Mafalda Laranjo, João Casalta-Lopes, Clara Rocha, Paulo C. Simões, Ana B. Sarmento-Ribeiro, Mª Filomena Botelho, Manuel S. Rosa

O145 Morpho-functional characterization of cardiac chambers by Transthoracic Echocardiography, in young athletes of gymnastics competition

Virgínia Fonseca, Diogo Colaço, Vanessa Neves

O146 Prevalence of the antibodies of the new histo-blood system – FORS system

Carlos Jesus, Camilla Hesse, Clara Rocha, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Lola Svensson, Fernando Mendes, Wafa A. Siba, Cristina Pereira, Jorge Tomaz

O147 Assessment of the war-related perceived threat in Portuguese Colonial War Veterans

Teresa Carvalho, José Pinto-Gouveia, Marina Cunha

O148 Pulse transit time estimation for continuous blood pressure measurement: A comparative study

Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto

O149 Blood pressure assessment during standard clinical manoeuvres: A non-invasive PPT based approach

Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto

O150 Development and initial validation of the Activities and Participation Profile related to Mobility (APPM)

Anabela C. Martins

O151 MEASYCare-2010 Standard–A geriatric evaluation system in primary health care: Reliability and validity of the latest version in Portugal

Piedade Brandão, Laura Martins, Margarida Cardoso

O152 Interrater and intrarater reliability and agreement of the range of shoulder flexion in the standing upright position through photographic assessment

Nuno Morais, Joana Cruz

O153 Three-dimensional biofabrication techniques for tissue regeneration

Nuno Alves, Paula Faria, Artur Mateus, Pedro Morouço

O154 A new computer tool for biofabrication applied to tissue engineering

Nuno Alves, Nelson Ferreira, Artur Mateus, Paula Faria, Pedro Morouço

O155 Development and psychometric qualities of a scale to measure the functional independence of adolescents with motor impairment

Isabel Malheiro, Filomena Gaspar, Luísa Barros

O156 Organizational Trust in Health services: Exploratory and Confirmatory factor analysis of the Organizational Trust Inventory- Short Form (OTI-SF)

Pedro Parreira, Andreia Cardoso, Lisete Mónico, Carla Carvalho, Albino Lopes, Anabela Salgueiro-Oliveira

O157 Thermal symmetry: An indicator of occupational task asymmetries in physiotherapy

Adérito Seixas, Valter Soares, Tiago Dias, Ricardo Vardasca, Joaquim Gabriel, Sandra Rodrigues

O158 A study of ICT active monitoring adoption in stroke rehabilitation

Hugo Paredes, Arsénio Reis, Sara Marinho, Vítor Filipe, João Barroso

O159 Paranoia Checklist (Portuguese Version): Preliminary studies in a mixed sample of patients and healthy controls

Carolina Da Motta, Célia B. Carvalho, José Pinto-Gouveia, Ermelindo Peixoto

O160 Reliability and validity of the Composite Scale on Morningness: European Portuguese version, in adolescents and young adults

Ana A. Gomes, Vanessa Costa, Diana Couto, Daniel R. Marques, José A. Leitão, José Tavares, Maria H. Azevedo, Carlos F. Silva

O161 Evaluation scale of patient satisfaction with nursing care: Psychometric properties evaluation

João Freitas, Pedro Parreira, João Marôco

O162 Impact of fibromyalgia on quality of life: Comparing results from generic instruments and FIQR

Miguel A. Garcia-Gordillo, Daniel Collado-Mateo, Gang Chen, Angelo Iezzi, José A. Sala, José A. Parraça, Narcis Gusi

O163 Preliminary study of the adaptation and validation of the Rating Scale of Resilient Self: Resilience, self-harm and suicidal ideation in adolescents

Jani Sousa, Mariana Marques, Jacinto Jardim, Anabela Pereira, Sónia Simões, Marina Cunha

O164 Development of the first pressure ulcer in inpatient setting: Focus on length of stay

Pedro Sardo, Jenifer Guedes, João Lindo, Paulo Machado, Elsa Melo

O165 Forms of Self-Criticizing and Self-Reassuring Scale: Adaptation and early findings in a sample of Portuguese children

Célia B. Carvalho, Joana Benevides, Marina Sousa, Joana Cabral, Carolina Da Motta

O166 Predictive ability of the Perinatal Depression Screening and Prevention Tool – Preliminary results of the dimensional approach

Ana T. Pereira, Sandra Xavier, Julieta Azevedo, Elisabete Bento, Cristiana Marques, Rosa Carvalho, Mariana Marques, António Macedo

O167 Psychometric properties of the BaSIQS-Basic Scale on insomnia symptoms and quality of sleep, in adults and in the elderly

Ana M. Silva, Juliana Alves, Ana A. Gomes, Daniel R. Marques, Mª Helena Azevedo, Carlos Silva

O168 Enlightening the human decision in health: The skin melanocytic classification challenge

Ana Mendes, Huei D. Lee, Newton Spolaôr, Jefferson T. Oliva, Wu F. Chung, Rui Fonseca-Pinto

O169 Test-retest reliability household life study and health questionnaire Pomerode (SHIP-BRAZIL)

Keila Bairros, Cláudia D. Silva, Clóvis A. Souza, Silvana S. Schroeder

O170 Characterization of sun exposure behaviours among medical students from Nova Medical School

Elsa Araújo, Helena Monteiro, Ricardo Costa, Sara S. Dias, Jorge Torgal

O171 Spirituality in pregnant women

Carolina G. Henriques, Luísa Santos, Elisa F. Caceiro, Sónia A. Ramalho

O172 Polypharmacy in older patients with cancer

Rita Oliveira, Vera Afreixo, João Santos, Priscilla Mota, Agostinho Cruz, Francisco Pimentel

O173 Quality of life of caregivers of people with advanced chronic disease: Translation and validation of the quality of life in life threatening illness - family carer version (QOLLTI-C-PT)

Rita Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa

O174 The psychometric properties of the brief Other as Shamer Scale for Children (OAS-C): preliminary validation studies in a sample of Portuguese children

Joana Benevides, Carolina Da Motta, Marina Sousa, Suzana N. Caldeira, Célia B. Carvalho

O175 Measuring emotional intelligence in health care students – Revalidation of WLEIS-P

Ana Querido, Catarina Tomás, Daniel Carvalho, João Gomes, Marina Cordeiro

O176 Health indicators in prenatal assistance: The impact of computerization and of under-production in basic health centres

Joyce O. Costa, Frederico C. Valim, Lígia C. Ribeiro

O177 Hope genogram: Assessment of resources and interaction patterns in the family of the child with cerebral palsy

Zaida Charepe, Ana Querido, Mª Henriqueta Figueiredo

O178 The influence of childbirth type in postpartum quality of life

Priscila S. Aquino, Samila G. Ribeiro, Ana B. Pinheiro, Paula A. Lessa, Mirna F. Oliveira, Luísa S. Brito, Ítalo N. Pinto, Alessandra S. Furtado, Régia B. Castro, Caroline Q. Aquino, Eveliny S. Martins

O179 Women’s beliefs about pap smear test and cervical cancer: influence of social determinants

Ana B Pinheiro, Priscila S. Aquino, Lara L. Oliveira, Patrícia C. Pinheiro, Caroline R. Sousa, Vívien A. Freitas, Tatiane M. Silva, Adman S. Lima, Caroline Q. Aquino, Karizia V. Andrade, Camila A. Oliveira, Eglidia F. Vidal

O180 Validity of the Portuguese version of the ASI-3: Is anxiety sensitivity a unidimensional or multidimensional construct?

Ana Ganho-Ávila, Mariana Moura-Ramos, Óscar Gonçalves, Jorge Almeida

O181 Lifestyles of higher education students: the influence of self-esteem and psychological well-being

Armando Silva, Irma Brito, João Amado

P75 Assessing the quality of life of persons with significant intellectual disability: Portuguese version of Escala de San Martín

António Rodrigo, Sofia Santos, Fernando Gomes

P76 Childhood obesity and breastfeeding - A systematic review

Marlene C. Rosa, Silvana F. Marques

P77 Cross-cultural adaptation of the Foot and Ankle Ability Measure (FAAM) for the Portuguese population

Sara Luís, Luís Cavalheiro, Pedro Ferreira, Rui Gonçalves

P78 Cross-cultural adaptation of the Patient-Rated Wrist Evaluation score (PRWE) for the Portuguese population

Rui S. Lopes, Luís Cavalheiro, Pedro Ferreira, Rui Gonçalves

P79 Cross-cultural adaptation of the Myocardial Infraction Dimensional Assessment Scale (MIDAS) for Brazilian Portuguese language

Bruno H. Fiorin, Marina S. Santos, Edmar S. Oliveira, Rita L. Moreira, Elizabete A. Oliveira, Braulio L. Filho

P80 The revised Portuguese version of the Three-Factor Eating Questionnaire: A confirmatory factor analysis

Lara Palmeira, Teresa Garcia, José Pinto-Gouveia, Marina Cunha

P81 Assessing weight-related psychological inflexibility: An exploratory factor analysis of the AAQW’s Portuguese version

Sara Cardoso, Lara Palmeira, Marina Cunha; José Pinto-Gouveia

P82 Validation of the Body Appreciation Scale-2 for Portuguese women

Joana Marta-Simões, Ana L. Mendes, Inês A. Trindade, Sara Oliveira, Cláudia Ferreira

P83 The Portuguese validation of the Dietary Intent Scale

Ana L. Mendes, Joana Marta-Simões, Inês A. Trindade, Cláudia Ferreira

P84 Construction and validation of the Inventory of Marital Violence (IVC)

Filipe Nave

P85 Portable continuous blood pressure monitor system

Mariana Campos, Iris Gaudêncio, Fernando Martins, Lino Ferreira, Nuno Lopes, Rui Fonseca-Pinto

P86 Construction and validation of the Scale of Perception of the Difficulties in Caring for the Elderly (SPDCE)

Rogério Rodrigues, Zaida Azeredo, Corália Vicente

P87 Development and validation of a comfort rating scale for the elderly hospitalized with chronic illness

Joana Silva, Patrícia Sousa, Rita Marques

P88 Construction and validation of the Postpartum Paternal Quality of Life Questionnaire (PP-QOL)

Isabel Mendes, Rogério Rodrigues, Zaida Azeredo, Corália Vicente

P89 Infrared thermal imaging: A tool for assessing diabetic foot ulcers

Ricardo Vardasca, Ana R. Marques, Adérito Seixas, Rui Carvalho, Joaquim Gabriel

P90 Pressure ulcers in an intensive care unit: An experience report

Paulo P. Ferreira, Michelle T. Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. Oliveira, Pablo O. Costa, Maiza M. Silva

P91 Validation of figures used in evocations: instrument to capture representations

Cristina Arreguy-Sena, Nathália Alvarenga-Martins, Paulo F. Pinto, Denize C. Oliveira, Pedro D. Parreira, Antônio T. Gomes, Luciene M. Braga

P92 Telephone assistance to decrease burden in informal caregivers of stroke older people: Monitoring and diagnostic evaluation

Odete Araújo, Isabel Lage, José Cabrita, Laetitia Teixeira

P93 Hope of informal caregivers of people with chronic and advanced disease

Rita Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa

P94 Functionality and quality information from the Portuguese National Epidemiological Surveillance System

Sara Silva, Eugénio Cordeiro, João Pimentel

P95 Resting metabolic rate objectively measured vs. Harris and Benedict formula

Vera Ferro-Lebres, Juliana A. Souza, Mariline Tavares

O182 Characteristics of non-urgent patients: Cross-sectional study of an emergency department

Mª Anjos Dixe, Pedro Sousa, Rui Passadouro, Teresa Peralta, Carlos Ferreira, Georgina Lourenço

O183 Physical fitness and health in children of the 1st Cycle of Education

João Serrano, João Petrica, Rui Paulo, Samuel Honório, Pedro Mendes

O184 The impact of physical activity on sleep quality, in children

Alexandra Simões, Lucinda Carvalho, Alexandre Pereira

O185 What is the potential for using Information and Communication Technologies in Arterial Hypertension self-management?

Sara Silva, Paulino Sousa, José M. Padilha

O186 Exploring psychosocial factors associated with risk of falling in older patients undergoing haemodialysis

Daniela Figueiredo, Carolina Valente, Alda Marques

O187 Development of pressure ulcers on the face in patients undergoing non-invasive ventilation

Patrícia Ribas, Joana Sousa, Frederico Brandão, Cesar Sousa, Matilde Martins

O188 The elder hospitalized: Limiting factors of comfort

Patrícia Sousa, Rita Marques

O189 Physical activity and health state self-perception by Portuguese adults

Francisco Mendes, Rosina Fernandes, Emília Martins, Cátia Magalhães, Patrícia Araújo

O190 Satisfaction with social support in the elderly of the district of Bragança

Carla Grande, Mª Augusta Mata, Juan G. Vieitez

O191 Prevalence of death by traumatic brain injury and associated factors in intensive care unit of a general hospital, Brazil

Bruna Bianchini, Nazare Nazario, João G. Filho, Marcia Kretzer

O192 Relation between family caregivers burden and health status of elderly dependents

Tânia Costa, Armando Almeida, Gabriel Baffour

O193 Phenomena sensitive to nursing care in day centre

Armando Almeida, Tânia Costa, Gabriel Baffour

O194 Frailty: what do the elderly think?

Zaida Azeredo, Carlos Laranjeira, Magda Guerra, Ana P. Barbeiro

O195 The therapeutic self-care as a nursing-sensitive outcome: A correlational study

Regina Ferreira

O196 Phonetic-phonological acquisition for the European Portuguese from 18 months to 6 years and 12 months

Sara Lopes, Liliana Nunes, Ana Mendes

O197 Quality of life of patients undergoing liver transplant surgery

Julian Martins, Dulcineia Schneider, Marcia Kretzer, Flávio Magajewski

O198 Professional competences in health: views of older people from different European Countries

Célia Soares, António Marques

O199 Life satisfaction of working adults due to the number of hours of weekly exercise

Marco Batista, Ruth J. Castuera, Helena Mesquita, António Faustino, Jorge Santos, Samuel Honório

O200 Therapeutic itinerary of women with breast cancer in Santa Maria City/RS

Betina P. Vizzotto, Leticia Frigo, Hedioneia F. Pivetta

O201 The breastfeeding prevalence at 4 months: Maternal experience as a determining factor

Dolores Sardo

O202 The impact of the transition to parenthood in health and well-being

Cristina Martins, Wilson Abreu, Mª Céu Figueiredo

P96 Self-determined motivation and well-being in Portuguese active adults of both genders

Marco Batista, Ruth Jimenez-Castuera, João Petrica, João Serrano, Samuel Honório, Rui Paulo, Pedro Mendes

P97 The geriatric care: ways and means of comforting

Patrícia Sousa, Rita Marques

P98 The influence of relative age, subcutaneous adiposity and physical growth on Castelo Branco under-15 soccer players 2015

António Faustino, Paulo Silveira, João Serrano, Rui Paulo, Pedro Mendes, Samuel Honório

P99 Data for the diagnostic process focused on self-care – managing medication regime: An integrative literature review

Catarina Oliveira, Fernanda Bastos, Inês Cruz

P100 Art therapy as mental health promotion for children

Cláudia K. Rodriguez, Márcia R. Kretzer, Nazaré O. Nazário

P101 Chemical characterization of fungal chitosan for industrial applications

Pedro Cruz, Daniela C. Vaz, Rui B. Ruben, Francisco Avelelas, Susana Silva, Mª Jorge Campos

P102 The impact of caring older people at home

Maria Almeida, Liliana Gonçalves, Lígia Antunes

P103 Development of the first pressure ulcer in an inpatient setting: Focus on patients’ characteristics

Pedro Sardo, Jenifer Guedes, João Simões, Paulo Machado, Elsa Melo

P104 Association between General Self-efficacy and Physical Activity among Adolescents

Susana Cardoso, Osvaldo Santos, Carla Nunes, Isabel Loureiro

O203 Characterization of the habits of online acquisition of medicinal products in Portugal

Flávia Santos, Gilberto Alves

O204 Waiting room – A space for health education

Cláudia Soar, Teresa O. Marsi

O205 Safey culture evaluation in hospitalized children

Ernestina Silva, Dora Pedrosa, Andrea Leça, Daniel Silva

O206 Sexual Self-awareness and Body Image

Ana Galvão, Maria Gomes, Paula Fernandes, Ana Noné

O207 Perception of a Portuguese population regarding the acquisition and consumption of functional foods

Jaime Combadão, Cátia Ramalhete, Paulo Figueiredo, Patrícia Caeiro

O208 The work process in primary health care: evaluation in municipalities of southern Brazil

Karine C. Fontana, Josimari T. Lacerda, Patrícia O. Machado

O209 Exploration and evaluation of potential probiotic lactic acid bacteria isolated from Amazon buffalo milk

Raphaelle Borges, Flávio Barbosa, Dayse Sá

O210 Road safety for children: Using children’s observation, as a passenger

Germana Brunhoso, Graça Aparício, Amâncio Carvalho

O211 Perception and application of quality-by-design by the Pharmaceutical industry in Portugal

Ana P. Garcia, Paula O. Fernandes, Adriana Santos

O212 Oral health among Portuguese children and adolescents: a public health issue

Nélio Veiga, Carina Brás, Inês Carvalho, Joana Batalha, Margarida Glória, Filipa Bexiga, Inês Coelho, Odete Amaral, Carlos Pereira

O213 Plant species as a medicinal resource in Igatu-Chapada Diamantina (Bahia, Brazil)

Cláudia Pinho, Nilson Paraíso, Ana I. Oliveira, Cristóvão F. Lima, Alberto P. Dias

O214 Characterization of cognitive and functional performance in everyday tasks: Implications for health in institutionalised older adults

Pedro Silva, Mário Espada, Mário Marques, Ana Pereira

O215 BMI and the perception of the importance given to sexuality in obese and overweight people

Ana Mª Pereira, Mª Veiga-Branco, Filomena Pereira, Maria Ribeiro

O216 Analysis and comparison of microbiological contaminations of two different composition pacifiers

Vera Lima, Ana I. Oliveira, Cláudia Pinho, Graça Cruz, Rita F. Oliveira, Luísa Barreiros, Fernando Moreira

O217 Experiences of couple relationships in the transition to retirement

Ana Camarneiro, Mª Helena Loureiro, Margarida Silva

O218 Preventive and corrective treatment of drug-induced calcium deficiency: an analysis in a community pharmacy setting

Catarina Duarte, Ângelo Jesus, Agostinho Cruz

O219 Profile of mood states in physically active elderly subjects: Is there a relation with health perception?

Maria Mota, Sandra Novais, Paulo Nogueira, Ana Pereira, Lara Carneiro, Paulo V. João

O220 (Un)Safety behaviour at work: the role of education towards a health and safety culture

Teresa Maneca Lima

O221 Analysis of the entrepreneurial profile of students attending higher education in Portugal: the Carland Entrepreneurship Index application

Anabela Salgueiro-Oliveira, Marina Vaquinhas, Pedro Parreira, Rosa Melo, João Graveto, Amélia Castilho, José H. Gomes

O222 Evaluation of welfare and quality of life of pregnant working women regarding the age of the pregnant

María S. Medina, Valeriana G. Blanco

O223 Psychological wellbeing protection among unemployed and temporary workers: Uncovering effective community-based interventions with a Delphi panel

Osvaldo Santos, Elisa Lopes, Ana Virgolino, Alexandra Dinis, Sara Ambrósio, Inês Almeida, Tatiana Marques, Mª João Heitor

O224 Chilean population norms derived from the Health-related quality of life SF-6D

Miguel A. Garcia-Gordillo, Daniel Collado-Mateo, Pedro R. Olivares, José A. Parraça, José A. Sala

O225 Motivation of college students toward Entrepreneurship: The influence of social and economic instability

Amélia Castilho, João Graveto, Pedro Parreira, Anabela Oliveira, José H. Gomes, Rosa Melo, Marina Vaquinhas

O226 Use of aromatic and medicinal plants, drugs and herbal products in Bragança city

Mónia Cheio, Agostinho Cruz, Olívia R. Pereira

O227 Edible flowers as new novel foods concept for health promotion

Sara Pinto, Adriana Oliveira, M. Conceição Manso, Carla Sousa, Ana F. Vinha

O228 The influence of leisure activities on the health and welfare of older people living in nursing homes

Mª Manuela Machado, Margarida Vieira

O229 Risk of falling, fear of falling and functionality in community-dwelling older adults

Beatriz Fernandes, Teresa Tomás, Diogo Quirino

O230 Musculoskeletal pain and postural habits in children and teenage students

Gustavo Desouzart, Rui Matos, Magali Bordini, Pedro Mouroço

O231 What's different in Southern Europe? The question of citizens’ participation in health systems

Ana R. Matos, Mauro Serapioni

O232 Occupational stress in Portuguese police officers

Teresa Guimarães, Virgínia Fonseca, André Costa, João Ribeiro, João Lobato

O233 Is occupational therapy culturally relevant to promote mental health in Burkina Faso?

Inmaculada Z. Martin, Anita Björklund

P105 Pay-for-performance satisfaction and quality in primary care

Aida I. Tavares, Pedro Ferreira, Rui Passadouro

P106 Economic development through life expectancy lenses

Sónia Morgado

P107 What is the effectiveness of exercise on smoking cessation to prevent clinical complications of smoking?

Nuno Tavares, João Valente, Anabela C. Martins

P108 A systematic review of the effects of yoga on mental health

Patrícia Araújo, Rosina Fernandes, Francisco Mendes, Cátia Magalhães, Emília Martins

P109 Healthy lifestyle: comparison between higher education students that lived until adult age in rural and urban environment

Pedro Mendes, Rui Paulo, António Faustino, Helena Mesquita, Samuel Honório, Marco Batista

P110 Evaluation of the Mobile Emergency Care Service (SAMU) in Brazil

Josimari T. Lacerda, Angela B. Ortiga, Mª Cristina Calvo, Sônia Natal

P111 Bioactive compounds - antioxidant activity of tropical fruits

Marta Pereira

P112 Use of non-pharmacological methods to relieve pain in labour

Manuela Ferreira, Ana R. Prata, Paula Nelas, João Duarte

P113 Mechanical safety of pacifiers sold in Portuguese pharmacies and childcare stores

Juliana Carneiro, Ana I. Oliveira, Cláudia Pinho, Cristina Couto, Rita F. Oliveira, Fernando Moreira

P114 The importance of prenatal consultation: Information to pregnant women given on a unit of primary care

Ana S. Maia, Michelle T. Oliveira, Anderson R. Sousa, Paulo P. Ferreira, Géssica M. Souza, Lívia F. Almada, Milena A. Conceição, Eujcely C. Santiago

P115 Influence of different backpack loading conditions on neck and lumbar muscles activity of elementary school children

Sandra Rodrigues, Gabriela Domingues, Irina Ferreira, Luís Faria, Adérito Seixas

P116 Efficacy and safety of dry extract Hedera helix in the treatment of productive cough

Ana R. Costa, Ângelo Jesus, Américo Cardoso, Alexandra Meireles, Armanda Colaço, Agostinho Cruz

P117 A portrait of the evaluation processes of education groups in primary health care

Viviane L. Vieira, Kellem R. Vincha, Ana Mª Cervato-Mancuso

P118 Benefits of vitamins C and E in sensorineural hearing loss: a review

Melissa Faria, Cláudia Reis

P119 BODY SNAPSHOT – a web-integrated anthropometric evaluation system

Marco P. Cova, Rita T. Ascenso, Henrique A. Almeida, Eunice G. Oliveira

P120 Anthropometric evaluation and variation during pregnancy

Miguel Santana, Rafael Pereira, Eunice G. Oliveira, Henrique A. Almeida, Rita T. Ascenso

P121 Knowledge of college students on the amendments of their eating habits and physical activity index in the transition to higher education

Rita Jesus, Rodrigo Tapadas, Carolina Tim-Tim, Catarina Cezanne, Matilde Lagoa, Sara S. Dias, Jorge Torgal

P122 Muscular activity of a rally race car driver

João Lopes, Henrique Almeida, Sandra Amado, Luís Carrão

O234 Literacy and results in health

Madalena Cunha, Luís Saboga-Nunes, Carlos Albuquerque, Olivério Ribeiro

O235 Literacy promotion and empowerment of type 2 diabetics elderly in four family health units of the group of health centers of Dão Lafões

Suzete Oliveira, Mª Carminda Morais

O236 Mediterranean diet, health and life quality among Portuguese children

Emília Martins, Francisco Mendes, Rosina Fernandes, Cátia Magalhães, Patrícia Araújo

O237 Health literacy, from data to action - translation, validation and application of the European Health Literacy Survey in Portugal (HLS-EU-PT)

Ana R. Pedro, Odete Amaral, Ana Escoval

O238 Oral health literacy evaluation in a Portuguese military population

Victor Assunção, Henrique Luís, Luís Luís

O239 Preferences to Internet-based cognitive behavioural therapy – do attachment orientations matter?

Jennifer Apolinário-Hagen, Viktor Vehreschild

O240 A comparative transnational study in health literacy between Austria and Portugal

Ulrike Fotschl, Gerald Lirk, Anabela C. Martins, Isabel Andrade, Fernando Mendes

O241 Health literacy and social behaviours: relationship with sexually transmitted diseases?

Verónica Mendonça, Sandra Antunes, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes

O242 Parenting styles and attachment to parents: what relationships?

Paula A. Silva, Lisete M. Mónico, Pedro M. Parreira, Carla Carvalho

O243 Work-life balance in health professionals and professors: comparative study of workers with shift work and fixed schedule

Carla Carvalho, Pedro M. Parreira, Lisete M. Mónico, Joana Ruivo

O244 Technology literacy in self-management of diabetes

Vânia Silva, Paulino Sousa, José M. Padilha

O245 Satisfaction with therapeutic education and its relationship with clinical variables in children with type 1 diabetes

Vera Ferraz, Graça Aparício, João Duarte

O246 Nutrition-related knowledge in middle-age and older patients with type 2 diabetes

Carlos Vasconcelos, António Almeida, Joel Neves, Telma Correia, Helena Amorim, Romeu Mendes

O247 Validating the HLS-EU-(PT) questionnaire to measure health literacy in adolescents (CrAdLiSa project: HLS-EU-PT)

Luís Saboga-Nunes, Madalena Cunha, Carlos Albuquerque

O248 Health education in people with coronary heart disease: Experience of the cardiology department of a hospital on the outskirts of Lisbon

Elsa S. Pereira, Leonino S. Santos, Ana S. Reis, Helena R. Silva, João Rombo, Jorge C. Fernandes, Patrícia Fernandes

O249 Information and training needs of informal caregivers of individuals with stroke sequelae: a qualitative survey

Jaime Ribeiro, Catarina Mangas, Ana Freire

O250 Prevention of psychoactive substances consumption in students from 6th grade of Albergaria-a-Velha´s School Group

Sara Silva, Irene Francisco, Ana Oliveira

O251 Promoting healthy sexuality: shared responsibility for family, youth and educators

Helena Catarino, Mª Anjos Dixe, Mª Clarisse Louro

O252 Sexual risk behaviour in adolescents and young people

Saudade Lopes, Anjos Dixe

O253 Knowledge of school staff on type 1 diabetes

Mª Anjos Dixe, Eva Menino, Helena Catarino, Fátima Soares, Ana P. Oliveira, Sara Gordo, Teresa Kraus

O254 Sexual health in adolescents: the impact of information search in literacy

Catarina Tomás, Paulo Queirós, Teresa Rodrigues

P123 Improving basic life support skills in adolescents through a training programme

Pedro Sousa, João G. Frade, Catarina Lobão

P124 Difficulties in sexual education reported by basic education teachers in the city of Foz do Iguaçu - Brazil

Cynthia B. Moura, Laysa C. Dreyer, Vanize Meneghetti, Priscila P. Cabral

P125 Breast cancer survivors: subjects and resources for information. A qualitative systematic review

Francisca Pinto, Paulino Sousa, Mª Raquel Esteves

P126 Relationship between health literacy and prevalence of STI in Biomedical Laboratory Science students

Sofia Galvão, Ite Tytgat, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes

P127 Health literacy, risk behaviours and sexually transmitted diseases among blood donors

Mónica Casas-Novas, Helena Bernardo, Isabel Andrade, Gracinda Sousa, Ana P. Sousa, Clara Rocha, Pedro Belo, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes

P128 Promoting literacy in pregnancy health-care

Fátima Martins, Montserrat Pulido-Fuentes

P129 The lifestyles of the operating assistants of education

Isabel Barroso, Gil Cabral, M. João Monteiro, Conceição Rainho

P130 Experiences of service-learning health and the literary art: reflections about the health education

Alessandro Prado, Yara M. Carvalho

P131 Life long swimming – a European Erasmus + project

Maria Campos, Liliana Moreira, José Ferreira, Ana Teixeira, Luís Rama

Relationship between Reduced BCL-2 Expression in Circulating Mononuclear Cells and Early Nephropathy in Type 1 Diabetes

Microalbuminuria is the earliest clinical evidence of diabetic nephropathy, but the mechanisms linking hyperglycemia and kidney complications are not clear. The aim of this study was to evaluate whether enhanced oxidative stress in patients with microalbuminuria can contribute to diabetic nephropathy development through downregulation of the antiapoptotic gene Bcl-2 that promotes in turn a pro-inflammatory status. We studied 30 patients with type 1 diabetes (15 with and 15 without microalbuminuria) compared to 15 matched healthy controls. Plasma oxidant status, and expression of Bcl-2, activated NF-kB, inducible Nitric Oxide synthase (iNOS), and monocyte chemoattractant protein (MCP)-1 in circulating monocytes were evaluated at baseline and after 8-week oral vitamin E treatment (600 mg b.i.d.). Bcl-2 expression was significantly reduced in microalbuminuric diabetic patients as a consequence of increased oxidant burden secondary to persistent hyperglycemia. Bcl-2 down-regulation was associated with enhanced expression of NF-kB, iNOS and MCP-1, and showed a strong correlation with the albumin excretion rate. Low Bcl-2 expression and high inflammatory status were normalized by vitamin E both in vivo and in vitro. Our study showed that Bcl-2 down-regulation in diabetic patients with poor glycemic control results in the activation of the NF-kB pathway leading to the development of nephropathy. Vitamin E might provide a novel form of therapy for prevention of nephropathy in diabetic patients in which an acceptable glycemic control is difficult to achieve despite insulin therapy.

The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study

Background

Evaluations of the impact of interventions for resource allocation purposes commonly focus on health status. There is, however, also concern about broader impacts on wellbeing and, increasingly, on a person's capability. This study aims to compare the impact on health status and capability of seven major health conditions, and highlight differences in treatment priorities when outcomes are measured by capability as opposed to health status.

Methods

The study was a cross-sectional four country survey (n = 6650) of eight population groups: seven disease groups with: arthritis, asthma, cancer, depression, diabetes, hearing loss, and heart disease and one health population ‘comparator’ group. Two simple self-complete questionnaires were used to measure health status (EQ-5D-5L) and capability (ICECAP-A). Individuals were classified by illness severity using condition-specific questionnaires. Effect sizes were used to estimate: (i) the difference in health status and capability for those with conditions, relative to a healthy population; and (ii) the impact of the severity of the condition on health status and capability within each disease group.

Findings

5248 individuals were included in the analysis. Individuals with depression have the greatest mean reduction in both health (effect size, 1.26) and capability (1.22) compared to the healthy population. The effect sizes for capability for depression are much greater than for all other conditions, which is not the case for health. For example, the arthritis group effect size for health (1.24) is also high and similar to that of depression, whereas for the same arthritis group, the effect size for capability is much lower than that for depression (0.55). In terms of severity within disease groups, individuals categorised as 'mild' have similar capability levels to the healthy population (effect sizes <0.2, excluding depression) but lower health status than the healthy population (≥0.4).

Conclusion

Significant differences exist in the relative effect sizes across diseases when measured by health status and capability. In terms of treating morbidity, a shift in focus from health gain to capability gain would increase funding priorities for patients with depression specifically and severe illnesses more generally.

Measuring the Sensitivity and Construct Validity of 6 Utility Instruments in 7 Disease Areas

Background. Health services that affect quality of life (QoL) are increasingly evaluated using cost utility analyses (CUA). These commonly employ one of a small number of multiattribute utility instruments (MAUI) to assess the effects of the health service on utility. However, the MAUI differ significantly, and the choice of instrument may alter the outcome of an evaluation. Aims. The present article has 2 objectives: 1) to compare the results of 3 measures of the sensitivity of 6 MAUI and the results of 6 tests of construct validity in 7 disease areas and 2) to rank the MAUI by each of the test results in each disease area and by an overall composite index constructed from the tests. Methods. Patients and the general public were administered a battery of instruments, which included the 6 MAUI, disease-specific QoL instruments (DSI), and 6 other comparator instruments. In each disease area, instrument sensitivity was measured 3 ways: by the unadjusted mean difference in utility between public and patient groups, by the value of the effect size, and by the correlation between MAUI and DSI scores. Content and convergent validity were tested by comparison of MAUI utilities and scores from the 6 comparator instruments. These included 2 measures of health state preferences, measures of subjective well-being and capabilities, and generic measures of physical and mental QoL derived from the SF-36. Results. The apparent sensitivity of instruments varied significantly with the measurement method and by disease area. Validation test results varied with the comparator instruments. Notwithstanding this variability, the 15D, AQoL-8D, and the SF-6D generally achieved better test results than the QWB and EQ-5D-5L.

Diabetes and quality of life: Comparing results from utility instruments and Diabetes-39

OBJECTIVE

To compare the Diabetes-39 (D-39) with six multi-attribute utility (MAU) instruments (15D, AQoL-8D, EQ-5D, HUI3, QWB, and SF-6D), and to develop mapping algorithms which could be used to transform the D-39 scores into the MAU scores.

RESEARCH DESIGN AND METHODS

Self-reported diabetes sufferers (N=924) and members of the healthy public (N=1760), aged 18 years and over, were recruited from 6 countries (Australia 18%, USA 18%, UK 17%, Canada 16%, Norway 16%, and Germany 15%). Apart from the QWB which was distributed normally, non-parametric rank tests were used to compare subgroup utilities and D-39 scores. Mapping algorithms were estimated using ordinary least squares (OLS) and generalised linear models (GLM).

RESULTS

MAU instruments discriminated between diabetes patients and the healthy public; however, utilities varied between instruments. The 15D, SF-6D, AQoL-8D had the strongest correlations with the D-39. Except for the HUI3, there were significant differences by gender. Mapping algorithms based on the OLS estimator consistently gave better goodness-of-fit results. The mean absolute error (MAE) values ranged from 0.061 to 0.147, the root mean square error (RMSE) values 0.083 to 0.198, and the R-square statistics 0.428 and 0.610. Based on MAE and RMSE values the preferred mapping is D-39 into 15D. R-square statistics and the range of predicted utilities indicate the preferred mapping is D-39 into AQoL-8D.

CONCLUSIONS

Utilities estimated from different MAU instruments differ significantly and the outcome of a study could depend upon the instrument used. The algorithms reported in this paper enable D-39 data to be mapped into utilities predicted from any of six instruments. This provides choice for those conducting cost-utility analyses.

Mapping between 6 Multiattribute Utility Instruments

Background: Cost-utility analyses commonly employ a multiattribute utility (MAU) instrument to estimate the health state utilities, which are needed to calculate quality-adjusted life years. Different MAU instruments predict significantly different utilities, which makes comparison of results from different evaluation studies problematical. Aim: This article presents mapping functions (“crosswalks”) from 6 MAU instruments (EQ-5D-5L, SF-6D, Health Utilities Index 3 [HUI 3], 15D, Quality of Well-Being [QWB], and Assessment of Quality of Life 8D [AQoL-8D]) to each of the other 5 instruments in the study: a total of 30 mapping functions. Methods: Data were obtained from a multi-instrument comparison survey of the public and patients in 7 disease areas conducted in 6 countries (Australia, Canada, Germany, Norway, United Kingdom, and United States). The 8022 respondents were administered each of the 6 study instruments. Mapping equations between each instrument pair were estimated using 4 econometric techniques: ordinary least squares, generalized linear model, censored least absolute deviations, and, for the first time, a robust MM-estimator. Results: Goodness-of-fit indicators for each of the results are within the range of published studies. Transformations reduced discrepancies between predicted utilities. Incremental utilities, which determine the value of quality-related health benefits, are almost perfectly aligned at the sample means. Conclusion: Transformations presented here align the measurement scales of MAU instruments. Their use will increase confidence in the comparability of evaluation studies, which have employed different MAU instruments.

Can Multi-attribute Utility Instruments Adequately Account for Subjective Well-being?

Introduction: The quality of life is included in cost utility analyses by weighting the relevant years of life by health state utilities. However, the utilities predicted by multi-attribute utility instruments (MAUIs) for this purpose do not correlate highly with the subjective well-being (SWB) of people experiencing the health states. This suggests that MAUIs may not take account of the SWB experienced by patients. This article explores an alternative hypothesis: that a failure of an MAUI to account for variation in SWB is primarily a result of the failure of its descriptive system to include the elements of health that determine SWB and that cannot therefore be included in assessment of the health state utility. Methods: Survey data are used to determine the extent to which 6 MAUIs with significantly different descriptive systems explain differences between the SWB of the healthy public and patients in 7 disease areas. Results: The EQ-5D-5L takes least account and AQoL-8D most account of SWB. AQoL-8D overpredicts the loss of SWB in 2 cases where hedonic adaptation is known to occur. Discussion: Results suggest that, to a large extent, utility can account for variation in SWB. The case for replacing utility with SWB in economic evaluation studies has arisen, in part, because elements of importance for SWB have been omitted from the descriptive systems of commonly used MAUIs.

Assessing outcomes for cost-utility analysis in depression: comparison of five multi-attribute utility instruments with two depression-specific outcome measures

BACKGROUND

Many mental health surveys and clinical studies do not include a multi-attribute utility instrument (MAUI) that produces quality-adjusted life-years (QALYs). There is also some question about the sensitivity of the existing utility instruments to mental health.

AIMS

To compare the sensitivity of five commonly used MAUIs (Assessment of Quality of Life - Eight Dimension Scale (AQoL-8D), EuroQoL-five dimension (EQ-5D-5L), Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), 15D) with that of disease-specific depression outcome measures (Depression Anxiety Stress Scales (DASS-21) and the Kessler Psychological Distress Scale (K10)) and develop 'crosswalk' transformation algorithms between the measures.

METHOD

Individual data from 917 people with self-report depression collected as part of the International Multi-Instrument Comparison Survey.

RESULTS

All the MAUIs discriminated between the levels of severity measured by the K10 and the DASS-21. The AQoL-8D had the highest correlation with the disease-specific measures and the best goodness-of-fit transformation properties.

CONCLUSIONS

The algorithms developed in this study can be used to determine cost-effectiveness of services or interventions where utility measures are not collected.

Mapping of incontinence quality of life (I-QOL) scores to assessment of quality of life 8D (AQoL-8D) utilities in patients with idiopathic overactive bladder

Background

The Incontinence Quality of Life (I-QOL) questionnaire is a commonly used and validated incontinence specific QOL instrument. The objective of this study is to develop an algorithm to map I-QOL to the Assessment of Quality of Life (AQoL) 8D utility instrument in patients with idiopathic overactive bladder (iOAB).

Methods

I-QOL and AQoL-8D scores were collected in a survey of 177 Australian adults with urinary incontinence due to iOAB. Three statistical methods were used for estimation, namely ordinary least squares (OLS) regression, the robust MM-estimator, and the generalised linear models (GLM). Each included a range of explanatory variables. Model performance was assessed using key goodness-of-fit measures in the validation dataset.

Results

The I-QOL total score and AQoL-8D utility scores were positively correlated (r = 0.50, p < 0.0001). Similarly, the three sub-scales of the I-QOL were correlated with the eight dimensions and two super-dimensions of the AQoL-8D. The GLM estimator, with I-QOL total score as the explanatory variable exhibited the best precision (MAE = 0.15 and RMSE = 0.18) with a mapping function given by AQoL-8D = exp(−1.28666 + 1.011072*I-QOL/100).

Conclusions

The mapping algorithm developed in this study allows the derivation of AQoL-8D utilities from I-QOL scores. The algorithm allows the calculation of preference-based QOL scores for use in cost-utility analyses to assess the impact of interventions in urinary incontinence.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-014-0133-0) contains supplementary material, which is available to authorized users.

Comparing and Explaining Differences in the Magnitude, Content, and Sensitivity of Utilities Predicted by the EQ-5D, SF-6D, HUI 3, 15D, QWB, and AQoL-8D Multiattribute Utility Instruments

Background. Cost utility analysis permits the comparison of disparate health services by measuring outcomes in comparable units, namely, quality-adjusted life-years, which equal life-years times the utility of the health state. However, comparability is compromised when different utility instruments predict different utilities for the same health state. The present paper measures the extent of, and reason for, differences between the utilities predicted by the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D. Methods. Data were obtained from patients in seven disease areas and members of the healthy public in six countries. Differences between public and patient utilities were estimated using each of the instruments. To explain discrepancies between the estimates, the measurement scales and content of the instruments were compared. The sensitivity of instruments to independently measured health dimensions was measured in pairwise comparisons of all combinations of the instruments. Results. The difference between public and patient utilities varied with the choice of instrument by more than 50% for every disease group and in four of the seven groups by more than 100%. Discrepancies were associated with differences in both the instrument content and their measurement scales. Pairwise comparisons of instruments found that variation in the sensitivity to physical and psychosocial dimensions of health closely reflected the items in the instrument's descriptive systems. Discussion. Results indicate that instruments measure related but different constructs. They imply that commonly used instruments systematically discriminate against some classes of services, most notably mental health services. Differences in the instrument scales imply the need for transformations between the instruments to increase the comparability of measurement.

Validity and reliability of the Assessment of Quality of Life (AQoL)-8D multi-attribute utility instrument

Objective

The purpose of this paper was to report tests of the validity and reliability of a new instrument, the Assessment of Quality of Life (AQoL)-8D, which was constructed to improve the evaluation of health services that have an impact upon the psychosocial aspects of the quality of life.

Methods

Australian and US data from a large multi-instrument comparison survey were used to conduct tests of convergent, predictive and content validity using as comparators five other multi-attribute utility (MAU) instruments—the EQ-5D, SF-6D, Health Utilities Index (HUI) 3, 15D and the Quality of Well-Being (QWB)—as well as four non-utility instruments—the SF-36 and three measures of subjective well-being (SWB). A separate three part Australian survey was used to assess test–retest reliability.

Results

Results indicate that AQoL-8D correlates more highly with both the SWB instruments and the psychosocial dimensions of the SF-36, and that it is similar to the other MAU instruments in terms of its convergent and predictive validity. The second Australian survey demonstrated high test–retest reliability.

Conclusions

The results indicate that the AQoL-8D is a reliable and valid instrument which offers an alternative to the MAU instruments presently used in economic evaluation studies, and one which is particularly suitable when psychosocial elements of health are of importance.

An instrument for measuring the social willingness to pay for health state improvement

This paper describes an instrument for measuring the social value of changes in health status, the Relative Social Willingness to Pay. It is a unique combination of measurement attributes designed to minimise cognitive complexity and provide an additional option for measuring 'social value'. Similar to the person trade-off (PTO), it adopts a social perspective and asks respondents to evaluate programmes on behalf of society. Unlike the PTO, trade-offs between the options use dollars, not numbers of patients. Respondents are not, however, asked for their personal willingness to pay. Rather, the opportunity cost of funds spent on one service is as an offsetting reduction in funds for a second service. The amount spent on each service therefore indicates relative, not absolute, value. However, the two services combine to produce one Quality adjusted life year which allows the calculation of a Quality adjusted life year-like unit of social value on a 0-1 scale. A three-stage survey was used to test the instrument's reliability, validity and sensitivity to the framing of the main question. Results indicate that the Relative Social Willingness to Pay produces values similar to but less than the PTO and time trade-off techniques.

Utility weights for the vision-related Assessment of Quality of Life (AQoL)-7D instrument

PURPOSE

To obtain utility weights consistent with the needs of economic evaluation for the Assessment of Quality of Life (AQoL)-7D, a generic instrument created to increase the sensitivity of the measurement of quality of life amongst people with impaired vision.

METHODS

Two extant instruments were combined, the Vision-related Quality of Life Index (VisQoL) and the AQoL-6D. Utilities were obtained from patients with visual impairment and from the general population using time trade-off (TTO) methodology. Dimensions were combined and an econometric adjustment used to eliminate the effects of instrument redundancy. Bias was tested by comparison of holistic TTO values with utility scores predicted from the AQoL-7D scoring formula.

RESULTS

The AQoL-7D instrument consists of 26 items and 7 dimensions each with good psychometric properties. Their combination into a single instrument resulted in significant redundancy which was successfully eliminated. Utility formulae for both the public and patients produced bias-free estimates of the utility of holistic health states describing visual impairment. Results imply differing valuations of health states by the public and by people with impaired vision.

CONCLUSIONS

The AQoL-7D can detect changes in health states affecting people with impaired vision which are likely to be overlooked by other generic instruments due to content insensitivity. The utilities it produces are generated using a "mainstream" methodology, the TTO. Quality-adjusted life year values based on the AQoL-7D may therefore be used for economic evaluation of programs.

Maximising health versus sharing: measuring preferences for the allocation of the health budget

Empirical evidence indicates that people consider sharing health resources to be important even in the absence of the attributes usually associated with equity (age, social class, ethnicity, disease severity or geographic location). If government is to take account of these preferences then survey methods are needed which allow their measurement. The present paper presents a new technique for measuring these preferences and reports the results of a representative survey of 626 Australians which employed the technique. The online and postal survey did not include any of the attributes usually associated with equity but was designed to quantify the respective importance of sharing life years (outcome egalitarianism), resource sharing per se and the changing importance of total health as other attributes varied. Results indicate respondents were primarily concerned with outcome egalitarianism, and that cost per life year had a relatively small effect upon their allocative decisions.

Construction of the descriptive system for the Assessment of Quality of Life AQoL-6D utility instrument

BACKGROUND

Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.

METHODS

The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.

RESULTS AND DISCUSSION

The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.

CONCLUSIONS

The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Severity as an independent determinant of the social value of a health service

This paper has two objectives, first to review the relevant literature concerning the social importance of severity of pre-treatment condition, and second to present the results of a new analysis of the relationship between social value, individual assessment of health improvement and the severity of illness. The present study differs methodologically from others reported in the literature. The underlying hypothesis is that members of the public have an aversion to patients being in a severe health state irrespective of the reason for their being there, and that this aversion will affect the social valuation of a health program after taking account of the magnitude of the health improvement. This effect will be observable in a program which (compared to another) takes a person out of a severe health state--the usual case discussed in the literature--or in a program which (compared to another) leaves a person in a severe health state. The present study tests this second implication of the hypothesis. We present data consistent with the view that after taking account of health improvement, health programs are preferred which do not leave people in severe health states. Alternative explanations are considered and particularly the possibility that data reflect a social preference for individuals achieving their health potential. Both explanations imply the need to reconsider the rules for prioritizing programs. In this analysis, Person Trade-Off (PTO) scores are used to measure social preferences ('value' or 'social utility') and Time Trade-Off (TTO) scores are used to measure individual assessments of health improvement and initial severity. Econometric results suggest that severity is highly significant and may more than double the index of social value of a health service.

The relevance of personal characteristics in health care rationing: what the Australian public thinks and why

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.

Predicting time trade-off health state valuations of adolescents in four Pacific countries using the Assessment of Quality-of-Life (AQoL-6D) instrument

OBJECTIVES

Pacific Obesity Prevention in Communities (OPIC) is a community-based intervention project targeting adolescent obesity in Australia, New Zealand, Fiji, and Tonga. The Assessment of Quality of Life Mark 2 (AQoL-6D) instrument was completed by 15,481 adolescents to obtain a description of the quality of life associated with adolescent overweight and obesity, and a corresponding utility score for use in a cost-utility analysis of the interventions. This article describes the recalibration of this utility instrument for adolescents in each country.

METHODS

The recalibration was based on country-specific time trade-off (TTO) data for 30 multiattribute health states constructed from the AQoL-6D descriptive system. Senior secondary students, in a classroom setting, responded to 10 health state scenarios each. These TTO interviews were conducted for 24 groups, comprising 279 students in the four countries resulting in 2790 completed TTO scores. The TTO scores were econometrically transformed by regressing the TTO scores upon predicted scores from the AQoL-6D to produce country-specific algorithms. The latter incorporated country-specific "corrections" to the Australian adult utility weights in the original AQoL.

RESULTS

This article reports two methodological elements not previously reported. The first is the econometric modification of an extant multi-attribute utility instrument to accommodate cultural and other group-specific differences in preferences. The second is the use of the TTO technique with adolescents in a classroom group setting. Significant differences in utility scores were found between the four countries.

CONCLUSION

Statistical results indicate that the AQoL-6D can be validly used in the economic evaluation of both the OPIC interventions and other adolescent programs.

Do quality-adjusted life years take account of lost income? Evidence from an Australian survey

The procedures used in cost utility analysis for eliciting quality of life weights have generally omitted any instruction concerning the level of consumption in a health state, despite the fact that some health states preclude the possibility of normal employment. This introduces ambiguity into the interpretation of quality of life (QoL) scores, and project ranking is sensitive to the subsequent treatment of consumption in the analysis. This article reports the results of a study that questioned 131 respondents to a time trade-off (TTO) interview about their assumptions concerning consumption and the amount of thought given to consumption. Results indicate that, without prompting, most assumed unchanged consumption, implying little bias in existing studies.

Vision and quality of life: development of methods for the VisQoL vision-related utility instrument

Purpose

To describe the methods and innovations used in constructing the VisQoL, a vision-related utility instrument for the health economic evaluation of eye care and rehabilitation programs.

Methods

The VisQoL disaggregates vision into six items. Utilities were estimated for item worst responses (the worst level for each item, with all other items at their best level) and VisQoL all-worst responses (all items at their worst level) using the time trade-off procedure. Time trade-off questions require people to imagine living a fixed number of years with a particular health condition and then indicate how many of those years of life they would be willing to trade to have perfect health. Where respondents indicated a health state was “worse than death” negative utilities were estimated. Time trade-off questions minimized the “focusing effect,” which occurs if respondents discount the fact that all other aspects of health are at their best when answering questions, by using pictorial and verbal aids.

Results

Item utilities were combined using a multiplicative model, and VisQoL model utilities placed on a scale where 0.00 and 1.00 represent full health and death, respectively. The VisQoL allows utilities to be calculated for a wide range of vision-related conditions.

Conclusion

The 6-item VisQoL has excellent psychometric properties and is specifically designed to be sensitive to vision-related quality of life. It is the first instrument to permit the rapid estimation of utility values for use in economic evaluations of vision-related programs.

Vision and Quality of Life: The Development of a Utility Measure

PURPOSE

To identify the content for a vision and quality of life-related utility measure (Vision Quality of Life Index [VisQoL]) for the economic evaluation of eye care and rehabilitation programs.

METHODS

Focus groups of the visually impaired elicited key concepts. Based on these and previous research, 33 items were generated. These were administered to visually impaired adults (n = 70) and a representative sample of unimpaired adults (n = 86). The item bank was reduced through examination of item properties, exploratory factor (EFA), item response theory (IRT), and structural equation modeling (SEM) analyses. The resultant model was confirmed through administration to a second sample of participants.

RESULTS

Focus group themes included physical well-being, social well-being, independence, self-actualization, emotional well-being, and planning and organization. Poorly performing items were eliminated on basic psychometric properties, including failure to discriminate. Next, EFA loadings were used to select items. Twelve items survived. To minimize redundancy, IRT analysis and SEM reduced the VisQoL item pool to six items (Cronbach alpha = 0.88). To confirm this model, these items were then administered to an additional 218 participants; 35% with a vision impairment. A pooled SEM analysis showed the model to have very good fit properties (root mean square error of approximation [RMSEA] = 0.000). A preliminary test of the model against visual acuity showed a significant monotonic relationship.

CONCLUSIONS

The short 6-item VisQoL has excellent psychometric properties as a simple summative instrument. It can be used in its present state as a condition-specific outcome measure for the evaluation of healthcare interventions for the visually impaired. The descriptive model is also suitable for generating utility values for the economic evaluation of vision-related programs and services.

Enhanced soluble CD40 ligand contributes to endothelial cell dysfunction in vitro and monocyte activation in patients with diabetes mellitus: effect of improved metabolic control

AIMS/HYPOTHESIS

Inflammation plays a pathogenic role in the development of accelerated atherosclerosis in diabetes. Soluble CD40 ligand (sCD40L) is enhanced in diabetes; however, the molecular mechanisms linking sCD40L to accelerated atherosclerosis in diabetes are still unclear. We tested the hypothesis that sCD40L may be involved in the vascular complications in diabetes and exerts its effect by triggering inflammatory reactions on mononuclear and endothelial cells (ECs).

METHODS

We studied 70 patients, 40 with type 2 and 30 with type 1 diabetes, with a history or physical examination negative for cardiovascular disease, and 40 non-diabetic and 30 healthy subjects, matched with the type 2 and type 1 diabetic patients, respectively. Plasma and serum sCD40L, and plasma soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, E-selectin and monocyte chemo-attractant protein-1 (MCP-1) were measured. Adhesion molecules and MCP-1 release, the ability to repair an injury in ECs, and O2- generation in monocytes were analysed in vitro after stimulation with serum from patients or controls.

RESULTS

Type 2 and type 1 diabetic patients had significantly higher sCD40L levels than controls. Furthermore, high sCD40L was associated with in vitro adhesion molecules and MCP-1 release, impaired migration in ECs and enhanced O2- generation in monocytes. Improved metabolic control was associated with a reduction of plasma sCD40L by 37.5% in 12 type 1 diabetic patients. Furthermore, elevated sCD40L in diabetic patients was significantly correlated with HbA1c levels.

CONCLUSIONS/INTERPRETATION

Upregulation of sCD40L as a consequence of persistent hyperglycaemia in diabetic patients results in EC activation and monocyte recruitment to the arterial wall, possibly contributing to accelerated atherosclerosis development in diabetes.

High preprocedural non-HDL cholesterol is associated with enhanced oxidative stress and monocyte activation after coronary angioplasty: possible implications in restenosis

OBJECTIVE

To investigate whether enhanced oxidant stress in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) is associated with a higher concentration of non-high density lipoprotein (HDL) cholesterol at baseline, and whether this contributes to the inflammatory reaction and luminal renarrowing after PTCA.

DESIGN

An ex vivo and in vitro study of 46 patients who underwent PTCA and who had repeat angiograms after six months. Blood samples were collected immediately before PTCA, and at 24 hours, 48 hours, and 15 days after.

SETTING

Tertiary referral centre.

SUBJECTS

46 patients (30 male, 16 female; mean (SD) age, 62 (5) years) with stable or unstable angina who underwent elective PTCA.

MAIN OUTCOME MEASURES

Continuous variable luminal loss as defined by change in minimum lumen diameter during follow up, normalised for vessel size; lag phase of low density lipoprotein to in vitro oxidation; plasma fluorescent products of lipid peroxidation (FPLP); plasma vitamin C and E; interleukin (IL) 1beta secretion from unstimulated monocytes; plasma C reactive protein (CRP).

RESULTS

Restenosis occurred in 12 patients (26%). Oxidant stress after PTCA was greater (p < 0.0001 at 15 days) in the patients with restenosis and showed a significant correlation with the preprocedural concentration of non-HDL cholesterol (p < 0.001). Inflammatory reaction (as reflected by IL-1beta production and CRP) and late lumen loss were linearly correlated (p < 0.001) with lag phase and FPLP throughout the study, and inversely (p < 0.05) with vitamin C and E measured at two and 15 days after PTCA.

CONCLUSIONS

This study provides evidence for the critical role of cholesterol dependent oxidant stress in the pathophysiology of restenosis after PTCA. The findings raise the possibility that drugs capable of modulating oxidant status might provide a novel form of adjuvant treatment in patients with hypercholesterolaemia undergoing PTCA.

Overexpression of functionally coupled cyclooxygenase-2 and prostaglandin E synthase in symptomatic atherosclerotic plaques as a basis of prostaglandin E(2)-dependent plaque instability

BACKGROUND

Studies have implicated a role for prostaglandin (PG) E(2)-dependent matrix metalloproteinase (MMP) biosynthesis in the rupture of atherosclerotic plaque. Cyclooxygenase-2 (COX-2) and PGE synthase (PGES) are coregulated in nucleated cells by inflammatory stimuli. The aim of this study was to characterize the expression of COX-2 and PGES in carotid plaques and to correlate it with the extent of inflammatory infiltration and MMP activity and with clinical features of patients' presentation.

METHODS AND RESULTS

Plaques were obtained from 50 patients undergoing carotid endarterectomy and divided into 2 groups (symptomatic and asymptomatic) according to clinical evidence of recent transient ischemic attack or stroke. Plaques were analyzed for COX-2, PGES, MMP-2, and MMP-9 by immunocytochemistry and Western blot, whereas zymography was used to detect MMP activity. Immunocytochemistry was used to identify CD68+ macrophages, CD3+ T lymphocytes, and HLA-DR+ cells. The percentage of macrophage-rich areas was larger (P<0.0001) in symptomatic plaques. COX-2, PGES, and MMPs were detected in all specimens; enzyme concentration, however, was significantly higher in symptomatic plaques. COX-2, PGES, and MMPs were especially noted in shoulders of symptomatic plaques, colocalizing with HLA-DR+ macrophages. All symptomatic plaques contained activated forms of MMPs. Finally, inhibition of COX-2 by NS-398 was accompanied by decreased production of MMPs that was reversed by PGE(2).

CONCLUSIONS

This study demonstrates the colocalization of COX-2 and PGES in symptomatic lesions and provides evidence that synthesis of COX-2 and PGES by activated macrophages is associated with acute ischemic syndromes, possibly through metalloproteinase-induced plaque rupture.

Elevated circulating levels of monocyte chemoattractant protein-1 in patients with restenosis after coronary angioplasty

Inflammation plays a pathogenic role in the development of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Monocyte chemoattractant protein-1 (MCP-1) is a potent chemoattractant of monocytes; however, its role in the pathophysiology of restenosis is still unclear. We set out to investigate the role of MCP-1 in restenosis after PTCA. In addition, we tested the hypothesis that MCP-1 exerts its effect, at least in part, by inducing O(2)(-) generation in circulating monocytes. Plasma levels of MCP-1 were measured before and 1, 5, 15, and 180 days after PTCA in 50 patients (30 males and 20 females, aged 62+/-5 years) who underwent PTCA and who had repeated angiograms at 6-month follow-up. Restenosis occurred in 14 (28%) patients. The MCP-1 level was no different at baseline between patients with or without restenosis. However, after the procedure, restenotic patients, compared with nonrestenotic patients, had statistically significant (P<0.0001) elevated levels of MCP-1. In contrast, plasma levels of other chemokines, such as RANTES and interleukin-8, did not differ between the 2 groups after PTCA. Higher MCP-1 throughout the study was correlated with restenosis. Moreover, increased MCP-1 was significantly correlated with increased monocyte activity, as reflected by enhanced O(2)(-) generation. Finally, multivariate regression analysis showed that the MCP-1 plasma level measured 15 days after PTCA was the only statistically significant independent predictor of restenosis (beta=0.688, P<0.0001). This study suggests that MCP-1 production and macrophage accumulation in the balloon-injured vessel may play a pivotal role in restenosis after PTCA. MCP-1 may induce luminal renarrowing, at least in part, by inducing O(2)(-) release in monocytes. Further understanding of the mechanism(s) by which MCP-1 is produced and acts after arterial injury may provide insight into therapies to limit the progression of atherosclerosis and restenosis after balloon angioplasty.

Relations of employment status to emotional distress among chronic pain patients: a path analysis

OBJECTIVE

This cross-sectional study evaluated the extent to which relations between employment status and emotional distress are mediated by pain-related and psychosocial measures among employed and unemployed persons with chronic pain.

DESIGN

A total of 40 unemployed and 43 employed persons reporting chronic pain were recruited from pain services at a tertiary-care hospital and community-based organizations. Volunteers completed self-report measures of pain severity, subjective financial stress, time structure, emotional distress, and background data.

RESULTS

A path analysis indicated that pain severity had direct associations with both emotional distress and employment status. In addition, employment status was only indirectly related to emotional distress; this relation was mediated by levels of reported financial strain and structured purposeful time use.

CONCLUSIONS

Findings suggest that pain severity and the quality of specific experiences related to being employed or unemployed as opposed to employment status per se correspond directly to levels of emotional distress reported by some persons with chronic pain.