Assessment of nursing students and nurses' orientation towards patient-centeredness

Background - Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery. Objectives - The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years. Settings - Public School of Nursing and a Central Hospital, in Lisbon (Portugal). Participants - Students in the first, second and fourth year of nursing school and nurses participated in the study. Methods - For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience. Results - A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales. Conclusions - These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Environmental mycology in public health: fungi and mycotoxins risk assessment and management

Fungi are essential to the survival of our global ecology, but they might pose a significant threat to the health of occupants when they grow in our buildings. The exposure to fungi in homes is a significant risk factor for a number of respiratory symptoms. Well-known illnesses caused by fungi include allergy and hypersensitivity pneumonitis. Environmental monitoring for fungi and their disease agents are important aspects of exposure assessment, but few guidelines exist for interpreting their health impacts. This book answers the questions: How does one detect and measure the presence of indoor fungi? What is an acceptable level of indoor fungi? How do we relate this information to human health problems?

Avaliação da Usabilidade de um Projeto de eHealth, enquadrado na visão europeia de Health Technology Assessment (HTA)

Trabalho de projeto apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Audiovisual e Multimédia.

Microbiota assessment in optical shops: an ignored concern to public health

The presence of microorganisms in ophthalmic instruments and surfaces can lead to the exposure of patients to several infections. However, there is no information regarding fungal and bacteria contamination in optical shops. This study aims to characterize fungi and bacteria contamination in air and surfaces from 10 optical shops covering also ophthalmic instruments. Air samples were collected through an impaction method onto malt extract agar (MEA) supplemented with chloramphenicol (0.05%) used for fungi and Tryptic Soy Agar (TSA) supplemented with nystatin (0.2%) used for bacteria. Outdoor samples were also performed to be used as reference. Surface and equipment’s swab samples were also collected side-by-side. All the collected samples were incubated at 27ºC for 5 to 7 days (fungi) or at 30º for 7 days (bacteria). Regarding fungal distribution, thirteen different species/genera were found in the air, being the most common Alternaria sp. (62.0%). Eight different species/genera were identified in the surfaces, ranging from 2 to 5x104 CFU/m2, being the most common A. versicolor complex and Penicillium sp. (40.0%). The trial frames were the most contaminated equipment, since 50.0% of the collected samples were with countless colonies. The airborne bacterial population indicated higher concentrations in the contactology office (average: 133 CFU/m3) than in the client’s waiting rooms (average: 126 CFU/m3). The surface samples indicated bacterial concentrations ranging from 2x104 to 1x106 CFU/m2, pointing out the automatic refractometer as the surface with higher bacterial load.

Fungi spores dimension matters in health effects: a methodology for more detail fungi exposure assessment

Health effects resulting from dust inhalation in occupational environments may be more strongly associated with specific microbial components, such as fungi, than to the particles. The aim of the present study is to characterize the occupational exposure to the fungal burden in four different occupational settings (two feed industries, one poultry and one waste sorting industry), presenting results from two air sampling methods – the impinger collector and the use of filters. In addition, the equipment used for the filter sampling method allowed a more accurate characterization regarding the dimension of the collected fungal particles (less than 2.5 μm size). Air samples of 300L were collected using the impinger Coriolis μ air sampler. Simultaneously, the aerosol monitor (DustTrak II model 8532, TSI®) allowed assessing viable microbiological material below the 2.5 μm size. After sampling, filters were immersed in 300 mL of sterilized distilled water and agitated for 30 min at 100 rpm. 150 μl from the sterilized distilled water were subsequently spread onto malt extract agar (2%) with chloramphenicol (0.05 g/L). All plates were incubated at 27.5 ºC during 5–7 days. With the impinger method, the fungal load ranged from 0 to 413 CFU.m-3 and with the filter method, ranged from 0 to 64 CFU.m-3. In one feed industry, Penicillium genus was the most frequently found genus (66.7%) using the impinger method and three more fungi species/genera/complex were found. The filter assay allowed the detection of only two species/genera/complex in the same industry. In the other feed industry, Cladosporium sp. was the most found (33.3%) with impinger method and three more species/genera/complex were also found. Through the filter assay four fungi species/genera/complex were found. In the assessed poultry, Rhyzopus sp. was the most frequently detected (61.2%) and more three species/genera/complex were isolated. Through the filter assay, only two fungal species/genera/complex were found. In the waste sorting industry Penicillium sp. was the most prevalent (73.6%) with the impinger method, being isolated two more different fungi species/genera/complex. Through the filter assay only Penicillium sp. was found. A more precise determination of occupational fungal exposure was ensured, since it was possible to obtain information regarding not only the characterization of fungal contamination (impinger method), but also the size of dust particles, and viable fungal particles, that can reach the worker ́s respiratory tract (filters method). Both methods should be used in parallel to enrich discussion regarding potential health effects of occupational exposure to fungi.

Health related quality of life in patients with refractory chronic heart failure undergoing cardiac resynchronization: type of therapeutic response

The benefits of cardiac resynchronization therapy (CRT) in the health-related quality of life (HRQL) are largely demonstrated in selected patients with severe congestive heart failure (CHF). However, the differences between responders and non-responders, with regard to the effect of CRT in the various dimensions that constitute HRQL are still a matter of discussion. Objective: To evaluate the impact of CRT on the HRQL of patients with CHF refractory to optimal pharmacological therapy, within 6 months after CRT. Methods: 43 patients, submitted to successful implantation of CRT, were evaluated in hospital just before intervention and in the outpatient clinic within 6 months after CRT. HRQL was analyzed based on the Kansas City Cardiomyopathy Questionnaire (KCCQ). Patients were classified as super-responders (ejection fraction of left ventricle - LVEF - ≥45% post-CRT), n=15, responders (sustained improvement in functional class and LVEF increased by 15%), n=19, and non-responders (no clinical or LVEF improvement), n=9. Results: In the group of super-responders, CRT was associated with an improvement in HRQL for the various fields and sums assessed (ρ<0.05); in responders, CRT has been associated with an improvement of HRQL in the various fields and sums, except in the self-efficacy dimension (ρ<0.05); in non-responders, CRT was not associated with improvement of HRQL. Conclusion: In a population with severe CHF undergoing CRT, the patients with clinical and echocardiographic positive response, obtained a favorable impact in all dimensions of HRQL, while the group without response to CRT showed no improvement. These data reinforces the importance of HRQL as a multidimensional tool for assessment of benefits in clinical practice.

Assessment of fungal contamination in a group of Lisbon's gymnasiums with a swimming pool

The study’s main purpose was the assessment of the environmental fungal contamination, the exploration of possible associations between related environmental variables and the study of the relationship between fungal contamination of air and surfaces. A descriptive study was developed based upon air and surfaces monitoring for fungal contamination in ten indoor gymnasiums with a swimming pool located in Lisbon’s urban area. Fifty 200 litres air samples and 120 surface swabs were collected. Surfaces samples were collected before and after cleaning and disinfection and temperature and relative humidity values were registered during the collection period. Twenty five different species of fungi were identified in the air samples, being the three most commonly isolated genera the following: Cladosporium (36.6%), Penicillium (19.0%) and Aspergillus (10.2%). Thirty-seven different species of fungi were identified in the surface samples. Fusarium sp. was the most frequent genera before (19.1%) and after (17.2%) cleaning and disinfection. There was a significant association between the numbers of visitors and the fungal contamination determined in the surface samples (p<0.05). There was no significant association (p>0.05) between the contamination encountered in the air samples and the one registered in the surface samples and between the fungal contamination and the temperature or relative humidity measured on location. The data obtained enabled the assessment of the establishment’s fungal contamination and led the authors to conclude, consequently, that physical activity, which generally promotes health, can in fact be challenged by this factor.

Risk assessment of exposure to multiple mycotoxins in food

Moulds may produce a diversity of toxins such as aflatoxins, ochratoxins, trichothecenes, zearalenone, fumonisins and others. Although toxicological, environmental and epidemiological studies have addressed the problem of these toxins one by one, more than one mycotoxin are found usually in the same contaminated food. Risk assessment for humans potentially exposed to multimycotoxins suffers very much from the lack of adequate food consumption data. Furthermore, for a given mycotoxin, synergism and antagonism with other mycotoxins, found in the same food commodities, are not taken into account. Aflatoxin B1 and ochratoxin A belong to the most frequently occurring mycotoxins. This has repeatedly been demonstrated, however, normally, the risk resulting from their simultaneous occurrence is not considered. A descriptive study was developed to monitor air fungal contamination in one hospital food unit.

Exposure assessment: the influence of environmental monitoring methodology

Exposure assessment is an important step of risk assessment process and has evolved more quickly than perhaps any aspect of the four-step risk paradigm (hazard identification, exposure assessment, dose-response analysis, and risk characterization). Nevertheless, some epidemiological studies have associated adverse health effects to a chemical exposure with an inadequate or absent exposure quantification. In addition to the metric used, the truly representation of exposure by measurements depends on: the strategy of sampling, random collection of measurements, and similarity between the measured and unmeasured exposure groups. Two environmental monitoring methodologies for formaldehyde occupational exposure were used to assess the influence of metric selection in exposure assessment and, consequently, in risk assessment process.

Assessment of exposure to airborne ultrafine particles in the urban environment of Lisbon, Portugal

The aim of this study was the assessment of exposure to ultrafine in the urban environment of Lisbon, Portugal, due to automobile traffic, and consisted of the determination of deposited alveolar surface area in an avenue leading to the town center during late spring. This study revealed differentiated patterns for weekdays and weekends, which could be related with the fluxes of automobile traffic. During a typical week, ultrafine particles alveolar deposited surface area varied between 35.0 and 89.2 μm2/cm3, which is comparable with levels reported for other towns such in Germany and the United States. These measurements were also complemented by measuring the electrical mobility diameter (varying from 18.3 to 128.3 nm) and number of particles that showed higher values than those previously reported for Madrid and Brisbane. Also, electron microscopy showed that the collected particles were composed of carbonaceous agglomerates, typical of particles emitted by the exhaustion of diesel vehicles. Implications: The approach of this study considers the measurement of surface deposited alveolar area of particles in the outdoor urban environment of Lisbon, Portugal. This type of measurements has not been done so far. Only particulate matter with aerodynamic diameters <2.5 (PM2.5) and >10 (PM10) μm have been measured in outdoor environments and the levels found cannot be found responsible for all the observed health effects. Therefore, the exposure to nano- and ultrafine particles has not been assessed systematically, and several authors consider this as a real knowledge gap and claim for data such as these that will allow for deriving better and more comprehensive epidemiologic studies. Nanoparticle surface area monitor (NSAM) equipments are recent ones and their use has been limited to indoor atmospheres. However, as this study shows, NSAM is a very powerful tool for outdoor environments also. As most lung diseases are, in fact, related to deposition of the alveolar region of the lung, the metric used in this study is the ideal one.

On the assessment of exposure to airborne ultrafine particles in urban environments

The aim of this study was to contribute to the assessment of exposure levels of ultrafine particles in the urban environment of Lisbon, Portugal, due to automobile traffic, by monitoring lung deposited alveolar surface area (resulting from exposure to ultrafine particles) in a major avenue leading to the town center during late spring, as well as in indoor buildings facing it. Data revealed differentiated patterns for week days and weekends, consistent with PM2.5 and PM10 patterns currently monitored by air quality stations in Lisbon. The observed ultrafine particulate levels may be directly correlated with fluxes in automobile traffic. During a typical week, amounts of ultrafine particles per alveolar deposited surface area varied between 35 and 89.2 μm2/cm3, which are comparable with levels reported for other towns in Germany and the United States. The measured values allowed for determination of the number of ultrafine particles per cubic centimeter, which are comparable to levels reported for Madrid and Brisbane. In what concerns outdoor/indoor levels, we observed higher levels (32 to 63%) outdoors, which is somewhat lower than levels observed in houses in Ontario.

Fungal and microbial volatile organic compounds exposure assessment in a waste sorting plant

In the management of solid waste, pollutants over a wide range are released with different routes of exposure for workers. The potential for synergism among the pollutants raises concerns about potential adverse health effects, and there are still many uncertainties involved in exposure assessment. In this study, conventional (culture-based) and molecular real-time polymerase chain reaction (RTPCR) methodologies were used to assess fungal air contamination in a waste-sorting plant which focused on the presence of three potential pathogenic/toxigenic fungal species: Aspergillus flavus, A. fumigatus, and Stachybotrys chartarum. In addition, microbial volatile organic compounds (MVOC) were measured by photoionization detection. For all analysis, samplings were performed at five different workstations inside the facilities and also outdoors as a reference. Penicillium sp. were the most common species found at all plant locations. Pathogenic/toxigenic species (A. fumigatus and S. chartarum) were detected at two different workstations by RTPCR but not by culture-based techniques. MVOC concentration indoors ranged between 0 and 8.9 ppm (average 5.3 ± 3.16 ppm). Our results illustrated the advantage of combining both conventional and molecular methodologies in fungal exposure assessment. Together with MVOC analyses in indoor air, data obtained allow for a more precise evaluation of potential health risks associated with bioaerosol exposure. Consequently, with this knowledge, strategies may be developed for effective protection of the workers.

Exposure to dust in poultry: the importance of task differences for detailed exposure assessment

Dust is a complex mixture of particles of organic and inorganic origin and different gases absorbed in aerosol droplets. In a poultry unit include dried faecal matter and urine, skin flakes, ammonia, carbon dioxide, pollens, feed and litter particles, feathers, grain mites, fungi spores, bacteria, viruses and their constituents. Dust particles vary in size and differentiation between particle size fractions is important in health studies in order to quantify penetration within the respiratory system. A descriptive study was developed in order to assess exposure to particles in a poultry unit during different operations, namely routine examination and floor turn over. Direct-reading equipment was used (Lighthouse, model 3016 IAQ). Particle measurement was performed in 5 different sizes (PM0.5; PM1.0; PM2.5; PM5.0; PM10). The chemical composition of poultry litter was also determined by neutron activation analysis. Normally, the litter of poultry pavilions is turned over weekly and it was during this operation that the higher exposure of particles was observed. In all the tasks considered PM5.0 and PM10.0 were the sizes with higher concentrations values. PM10 is what turns out to have higher values and PM0.5 the lowest values. The chemical element with the highest concentration was Mg (5.7E6 mg.kg-1), followed by K (1.5E4 mg.kg-1), Ca (4.8E3 mg.kg-1), Na (1.7E3 mg.kg-1), Fe (2.1E2 mg.kg-1) and Zn (4.2E1 mg.kg-1). This high presence of particles in the respirable range (<5–7μm) means that poultry dust particles can penetrate into the gas exchange region of the lung. Larger particles (PM10) present a range of concentrations from 5.3E5 and 3.0E6 mg/m3.

Fungi, MVOCs and dust exposure assessment in poultry production

Agricultural workers especially poultry farmers, are at increased risk of occupational respiratory diseases. In poultry production besides fungi microbial volatile organic compounds (MVOCs) are also present due to compounds released during fungal metabolism. Dust is also one of the risk factors present in animal housing and is comprised by poultry residues, fungi and feathers. A study was developed aiming to assess occupational exposure to fungi, MVOCs and dust in seven poultry units located in Portugal.

Complementarity of conventional and molecular methods in the assessment of fungal contamination caused by Aspergillus fumigatus complex in one Portuguese composting plant

The handling of waste and compost that occurs frequently in composting plants (compost turning, shredding, and screening) has been shown to be responsible for the release of dust and air borne microorganisms and their compounds in the air. Thermophilic fungi, such as A. fumigatus, have been reported and this kind of contamination in composting facilities has been associated with increased respiratory symptoms among compost workers. This study intended to characterize fungal contamination in a totally indoor composting plant located in Portugal. Besides conventional methods, molecular biology was also applied to overcome eventual limitations.