Prevalência da doença pulmonar obstrutiva crónica em Lisboa, Portugal: estudo burden of obstructive lung disease

Introdução - A prevalência da doença pulmonar obstrutiva crónica (DPOC) apresenta valores muito heterogéneos em todo o mundo. A iniciativa Burden of Obstructive Lung Disease (BOLD) foi desenvolvida para que a prevalência da DPOC possa ser avaliada com metodologia uniformizada. O objetivo deste estudo foi estimar a prevalência da DPOC em adultos com 40 ou mais anos numa população alvo de 2 700 000 habitantes na região de Lisboa, de acordo com o protocolo BOLD. Métodos - A amostra foi estratificada de forma aleatória multifaseada selecionando-se 12 freguesias. O inquérito compreendia um questionário com informação sobre fatores de risco para a DPOC e doença respiratória autoreportada; adicionalmente, foi efetuada espirometria com prova de broncodilatação. Resultados - Foram incluídos 710 participantes com questionário e espirometria aceitáveis. A prevalência estimada da DPOC na população no estadio GOLD I+ foi de 14,2% (IC 95%: 11,1; 18,1) e de 7,3% no estadio ii+ (IC 95%: 4,7; 11,3). A prevalência não ajustada foi de 20,2% (IC 95%: 17,4; 23,3) no estadio i+ e de 9,5% (IC 95%: 7,6; 11,9) no estadio ii+. A prevalência da DPOC no estadio GOLD II+ aumentou com a idade, sendo mais elevada no sexo masculino. A prevalência estimada da DPOC no estadio GOLD I+ foi de 9,2% (IC 95%: 5,9; 14,0) nos não fumadores versus 27,4% (IC 95%: 18,5; 38,5) nos fumadores com carga tabágica de ≥ 20 Unidades Maço Ano. Detetou-se uma fraca concordância entre a referência a diagnóstico médico prévio e o diagnóstico espirométrico, com 86,8% de subdiagnósticos. Conclusões - O achado de uma prevalência estimada da DPOC de 14,2% sugere que esta é uma doença comum na região de Lisboa, contudo com uma elevada proporção de subdiagnósticos. Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de saúde sobre a DPOC, bem como a necessidade de maior utilização da espirometria nos cuidados de saúde primários.

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.

Gamma radiation effects on microbial inactivation of two medicinal plants

The consumption of natural products has become a public health problem, since these medicinal teas are prepared using natural plants without an effective hygienic and sanitary control. The aim of this study was to assess the effects of gamma radiation, on the microbial burden of two medicinal plants: Melissa officinalis and Lippia citriodora. Dried samples of the two plants were irradiated at a Co-60 experimental equipment. The applied gamma radiation doses were 1, 3, and 5 kGy at a dose rate of 1.34 kGy/h. Non-irradiated samples followed all the experiments. Bacterial and fungal counts were assessed before and after irradiation by membrane filtration method. Challenging tests with Escherichia coli were performed in order to evaluate the disinfection efficiency of gamma radiation treatment. Characterization of M. officinalis and L. citriadora microbiota indicated an average bioburden value of 102CFU/g. The inactivation studies of the bacterial mesophilic population of both dried plants pointed out to a one log reduction of microbial load after irradiation at 5 kGy. Regarding the fungal population, the initial load of 30 CFU/g was only reduced by 0.5 log by an irradiation dose of 5 kGy. The dynamics with radiation doses of plants microbial population’s phenotypes indicated the prevalence of gram-positive rods for M. officinalis before and after irradiation, and the increase of the frequency of gram-negative rods with irradiation for L. citriadora. Among fungal population of both plants, Mucor, Neoscytalidium, Aspergillus and Alternaria were the most isolated genera. The results obtained in the challenging tests with E. coli on plants pointed out to an inactivation efficiency of 99.5% and 99.9% to a dose of 2 kGy, for M.officinalis and L. citriadora, respectively. The gamma radiation treatment can be a significant tool for the microbial control in medicinal plants.