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Portugal é um dos países europeus mais envelhecidos. A solidão e o isolamento nos idosos podem desencadear enorme sofrimento, com grande impacto na sua vida e na sua saúde. Este trabalho, pretende descrever e analisar a solidão e o isolamento em idosos em Portugal, identificando os determinantes e as estratégias adotadas no combate à solidão. É uma revisão sistemática da literatura. Os termos de pesquisa utilizados foram “solidão”, “isolamento” e “idoso”, nas bases de dados científicos RCAAP e Scielo, com intervalo temporal 2010-2018. Após aplicação dos critérios de inclusão e exclusão e avaliação da qualidade dos artigos, resultaram 8 artigos. Maioritariamente utilizaram metodologias quantitativas, com amostragem não probabilística. Foram identificados em todos os estudos baixos níveis de solidão e isolamento. Os determinantes de solidão e isolamento identificados nesta revisão são a morte do conjugue (50%), seguido da perda ou enfraquecimento da relação com os filhos (37,5%), o ser mulher (37,5%), o viver só (37,5%), a incapacidade de desempenho das AVD (37,5%), o aumento da idade (25%) e a presença de doenças (25%) e as carências económicas (12,50%). Estão presentes a adoção de adoção de mecanismos ou estratégias de combate à solidão e isolamento, que evidenciam a procura de atividades de relação, de inclusão e por outro lado, uma certa acomodação ao viver só. Concluímos que os idosos portugueses estudados apresentam em geral níveis baixos de isolamento e solidão. Sendo os principais determinantes o sexo, a idade, a presença do conjugue, o viver só, as relações com os filhos, a autonomia no desempenho das AVD, as comorbilidades e as carências económicas. Como estratégias de combate ou controlo da solidão surge a procura de atividades de relação, de inclusão e a adaptação ou acomodação ao viver só. O conhecimento desta realidade é de crucial importância ao nível da tomada de decisão. info:eu-repo/semantics/publishedVersion

Em dezembro de 2019 a Organização Mundial de Saúde (OMS) foi informada de casos de pneumonia de etiologia desconhecida na cidade de Wuhan, China. Posteriormente foi isolado e identificado um novo Coronavírus – SARS-CoV-2. A 11 de março de 2020 a OMS declarou a pandemia, que implicou, mundialmente, a adoção de um conjunto de medidas urgentes que restringiram direitos e liberdades, potenciando situações de crise, nomeadamente na área da saúde. Objetivos: Este estudo pretende avaliar o impacto da Pandemia no acesso aos serviços de saúde, pelos utentes. Metodologia: Realizou-se uma revisão integrativa da literatura, de acordo com a metodologia PICO, cuja colheita de dados foi realizada em abril de 2021, nas bases de dados SciELO, RCAAP, Cochrane Library, LILACS, PubMed, com as seguintes palavras-chave: Pandemia; Acesso aos Serviços de Saúde. Definiram-se como critérios de inclusão artigos publicados e indexados nas bases de dados científicas, entre março de 2020 e abril de 2021,acesso integral ao documento, artigos referentes a estudos quantitativos/qualitativos que retratassem a temática pertinente ao objetivo do trabalho e que respondesse à questão orientadora e artigos em português, inglês e espanhol. E como critérios de exclusão artigos quantitativos/qualitativos que não abordassem a temática, artigos que não respondessem à questão orientadora e se distanciassem do tema e artigos de RIL, dissertações de mestrado ou teses de doutoramento. Foram encontrados 284 artigos, tendo sido selecionados, após verificação dos critérios de inclusão e de exclusão 3 artigos. Resultados: A análise dos artigos incluídos no estudo permitiu abordar o impacto das medidas restritivas, suscitadas pela Pandemia, no acesso aos cuidados de saúde. Conclusão: A Pandemia por Sars-Cov-2 trouxe implicações no acesso aos cuidados de saúde, verificando-se a suspensão de tratamentos, consultas e cirurgias, com priorização de situações de urgência e emergência, potenciando situações de morbimortalidade por doenças evitáveis e tratáveis. info:eu-repo/semantics/publishedVersion

O processo de envelhecimento inicia-se à nascença e sabemos que a saúde não é uma questão aleatória, relaciona-se com escolhas, com o meio no qual se vive e com o acesso à saúde que se dispõe. O envelhecimento é diversificado, mas os profissionais tendem a generalizar os cuidados. Verificam-se políticas inadequadas, serviços desajustados, acessibilidade aos cuidados condicionada e consultas de Enfermagem desadequadas. É primordial que se analisem os documentos emanados pelas estruturas da saúde e se reflita numa prática de consulta direcionada para o idoso. O objetivo deste estudo é abordar a pertinência e aplicabilidade do Programa Nacional para a Saúde das Pessoas Idosas, do Relatório Mundial de Envelhecimento e Saúde, da Estratégia Nacional para o Envelhecimento Ativo e Saudável e da proposta para o Plano Nacional de Saúde para as Demências, apresentando uma reflexão crítica sobre a implicação destas na prática de cuidados ao idoso. Da análise efetuada, concluímos que a tomada de decisão Portuguesa não reflete a implementação de medidas ao mesmo ritmo de outros países da UE. É urgente e pertinente a criação de um programa em exclusivo para as pessoas idosas, que valorize a realização periódica de avaliações dos utentes, permitindo a identificação precoce de alterações e, por outro lado, desenvolva um plano individual de cuidados personalizados a cada um deles. O paradigma Biomédico deve ser quebrado sendo essencial que se realize uma Consulta de Enfermagem ao Idoso estruturada, com recurso à avaliação de cinco vertentes: avaliação clínica cuidada; avaliação física; avaliação mental; avaliação funcional e; avaliação social. Na tomada de decisão, deve ser primordial a implementação de programas aos vários níveis de prevenção, no sentido de promover o estado de saúde e melhoria da qualidade de vida dos idosos. info:eu-repo/semantics/publishedVersion

Family Health Nursing focuses its action on the user and family and, due to its centrality and proximity, it is the main responsible for monitoring chronic diseases, where leg ulcers stand out. Given the complications that they represent in the user and family, it is essential that the Family Nurse masters their characteristics, to distinguish their etiology, as well as the different treatments available, adapting them to the particularities and background of the user. Compressive therapy is a good alternative to apply to venous ulcers, if the essential criteria for its application are met. It is up to the Nurse to evaluate them and, when properly instructed, their application, to enhance health gains and cost adequacy info:eu-repo/semantics/publishedVersion

Introduction: Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs. Methods: In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail. Results: A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported. Conclusion: Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice. Resumo: Introdução: A zona de monitorização (ZM) de cardioversor desfibrilhador implantável (CDI) permite uma funcionalidade passiva que não interfere com o funcionamento das zonas de tratamento ativo. Contudo, não é perfeitamente conhecido se a programação de ZM afeta a deteção de arritmias pelo CDI. O objetivo do presente estudo é avaliar a relevância clínica de ZM numa população submetida a implantação de CDI. Métodos: Análise retrospetiva de doentes submetidos a implantação de CDI, com ou sem terapia de ressincronização cardíaca, em prevenção primária, sob monitorização remota. ZM foi analisada e as arritmias documentadas avaliadas em detalhe. Resultados: Foram estudados 221 doentes (77% homens; 64±12 anos). Fração de ejeção média foi 30±12%. O período de seguimento médio foi 63±35 meses. Foram documentados 174 eventos na ZM, em 139 doentes (62.9%): taquicardia ventricular não sustentada (TVNS) – 74, taquicardia supraventricular – 42, fibrilhação/flutter auricular – 44, ruído – 5. Dos 137 doentes que apresentaram arritmia na ZM (excluindo dois casos de deteção de ruído), 22 (16,1%) receberam choques apropriados ou pacing antitaquicardia (PAT), enquanto que dos restantes 84 doentes, 15,5% receberam terapias apropriadas do CDI (p=NS). Dos doentes que apresentaram TVNS na ZM, 15 (20,5%) receberam choques apropriados e/ou pacing anti-taquicardia (PAT). De acordo com os achados em ZM, o médico decidiu alterar a terapia oral de ambulatório em 41,7% de todos os doentes com eventos arrítmicos reportados. Conclusão: Arritmas ventriculares e supraventriculares são achados comuns na ZM de CDI. A programação de ZM é importante no diagnóstico de arritmias e poderá ser um elemento útil na prática clínica. Keywords: Implantable cardioverter-defibrillator, Monitoring zone, Supraventricular arrhythmias, Ventricular arrhythmias, Clinical practice, Palavras-chave: Cardioversor desfibrilhador implantável, Zona de monitorização, Arritmias supraventriculares, Arritmias ventriculares, Prática clínica

Adolescence is the period of life between 10 and 19 years of conflict. Phase of intense physical, psychological and social changes that lead adolescents to promote breakdowns in their relationship with their parents and reinforce their proximity to the group of friends. Here are the first experiences of love and sex, which can lead to sexually transmitted infections and unwanted pregnancies. The objective of this study was to identify the attitudes of Portuguese primary care nurses to the 15-year-old girl about the beginning of sexual intercourse. Quantitative methodology, descriptive-correlational and cross-sectional study. The data collection instrument was the questionnaire. Sample comprised of 1735 nurses from 226 health centers in mainland Portugal, Madeira and the Azores. Most nurses would explain to the 15-year-old that he asked for “help” to start their sex life, the girl (54.2%) or boy (45.9%) the pros and cons of the decision and would report the need to use contraceptive methods, either boys or girls (32.7%) and boys (40.1%). Nurses 38 years of age or older with adolescent children who started their sexual activity after marriage advised the 15-year-old on the need to use contraceptive methods, or deviated from the subject, nurses with less than 38 years advised to postpone for later or to support the decision with some suggestions. As p greater than 0.05, we concluded nurses would advise the 15-year-old girl and boy to initiate sexual activity due to the existence of adolescent children, and specific training on sexuality and the context of their sexual initiation. It was concluded that the nurses without children supported the decision although with some suggestions, nurses with adolescent children explained the pros and cons and reported the need to use contraceptive methods.

Over 300,000 infants are born annually with sickle cell anemia (SCA) in sub-Saharan Africa, and >50% die young from infection or anemia, usually without diagnosis of SCA. Early identification by newborn screening (NBS), followed by simple interventions dramatically reduced the mortality of SCA in the United States, but this strategy is not yet established in Africa. We designed and implemented a proof-of-principle NBS and treatment program for SCA in Angola, with focus on capacity building and local ownership. Dried bloodspots from newborns were collected from five birthing centers. Hemoglobin identification was performed using isoelectric focusing; samples with abnormal hemoglobin patterns were analyzed by capillary electrophoresis. Infants with abnormal FS or FSC patterns were enrolled in a newborn clinic to initiate penicillin prophylaxis and receive education, pneumococcal immunization, and insecticide-treated bed nets. A total of 36,453 infants were screened with 77.31% FA, 21.03% FAS, 1.51% FS, and 0.019% FSC. A majority (54.3%) of affected infants were successfully contacted and brought to clinical care. Compliance in the newborn clinic was excellent (96.6%). Calculated first-year mortality rate for babies with SCA compares favorably to the national infant mortality rate (6.8 vs. 9.8%). The SCA burden is extremely high in Angola, but NBS is feasible. Capacity building and training provide local healthcare workers with skills needed for a functional screening program and clinic. Contact and retrieval of all affected SCA infants remains a challenge, but families are compliant with clinic appointments and treatment. Early mortality data suggest screening and early preventive care saves lives.

Objective To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. Study design In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included. Results Based upon the costs of screening 36 453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola. Conclusions These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.

Abstract 480 Background: Sickle cell anemia (SCA) is a significant global health problem with >300,000 affected infants born each year in sub-Saharan Africa. Up to 80–90% of all children with SCA in Africa die before five years of age, due to infection or anemia, and usually without the proper diagnosis of SCA. Early identification by newborn screening (NBS), followed by interventions such as pneumococcal immunization and prophylactic penicillin, have dramatically reduced the mortality of children with SCA in the US, but this strategy not yet been established in Africa. A novel public-private partnership involving the Republic of Angola, Chevron Corporation, and Baylor College of Medicine/Texas Children's Hospital was created to develop a pilot NBS and treatment program for SCA, focusing on capacity building and local ownership. Methods: Two large maternity hospitals in the capital city of Luanda, Angola were initially selected for dried blood spot (DBS) collection and analysis, and a third local health center was soon added. Maternity nurses were taught DBS collection and laboratory technicians learned isoelectric focusing (IEF) and capillary electrophoresis (CE) techniques. Identifiers including cell phone numbers are collected onto the Whatman NBS card to facilitate retrieval of affected babies. After collection, DBS were transported to the central NBS laboratory at Hospital Pediátrico David Bernardino (HPDB) for hemoglobin identification by IEF and CE. Demographic data and test results were entered into a unique internet-based electronic data capture system designed with secure password-protection and servers located in Houston, Texas. Results: Since initiation of NBS in July 2011, 17,055 babies have DBS collection and laboratory results: 3,588 (21%) with FAS pattern (sickle cell trait), and 264 (1.55%) with FS (consistent with SCA). Twenty-one samples produced a result other than FA, FAS, or FS, including 10 FAC and 1 FSC. Families of infants with an FS screening result are notified by phone to initiate care and treatment, ideally by age 8 weeks. In the new infant SCA clinic at HPDB, infants receive penicillin prophylaxis and PCV-13 pneumococcal immunization, while parents receive sickle cell education and insecticide-treated bed nets for malaria protection. In the first 6 months, 67.8% of DBS cards had phone numbers documented, but with education and reinforcement, 81.4% of cards had phone numbers in the past 6 months. To date, 220 FS babies are age-eligible for contact and 110 (50%) families have been reached: 104 (47%) have come to the infant SCA clinic, 6 (2.7%) had already died within the first month of life, and 0 refused care. A total of 201 doses of PCV-13 have been provided as per routine vaccination scheduling. After initial visit, the return rate for second immunization is 94% with only 3 babies lost to follow-up including 2 deaths. The calculated first-year mortality rate for all contacted FS babies (6.9%) compares favorably to the national infant mortality rate (9.8%). Conclusions: This prospective pilot study documents that newborn screening for SCA is feasible in a developing country such as Angola. Capacity building and teaching provide local healthcare workers with skills necessary to have a functional NBS program and infant SCA clinic. The sickle cell burden is extremely high in Angola, and contact and retrieval of all affected FS infants remains an ongoing challenge, but families are compliant with clinic appointments and treatment. Early mortality data suggest comprehensive SCA care can save lives, suggesting that expansion of the pilot program is warranted with an eventual national strategy for the diagnosis, care, and treatment of children with SCA in Angola. Disclosures: No relevant conflicts of interest to declare.