A qualidade das salas de berçários nos concelhos de Setubal e de Palmela

Tendo por principal objetivo contribuir para o estudo da qualidade das creches dos Concelhos de Setúbal e de Palmela, com este trabalho pretende-se (1) avaliar e descrever a qualidade de 30 salas de berçário através da aplicação da Escala de Avaliação do Ambiente de Creche – Edição Revista (Infant/Toddler Environment Rating Scale – Revised Edition [ITERS-R], Harms, Cryer, & Clifford, 2006), (2) avaliar e descrever as práticas de socialização dos prestadores de cuidados responsáveis pelas 30 salas de berçário através da aplicação da Escala de Interação do Prestador de Cuidados (Caregiver Interaction Scale [CIS], Arnett, 1989), (3) estudar a associação entre as práticas de socialização dos profissionais e a qualidade das salas de berçário, (4) estudar associações entre a qualidade das salas de berçário e as práticas de socialização dos profissionais e algumas variáveis de estrutura (rácio adulto/criança, tamanho do grupo, educação, formação e experiência dos prestadores de cuidados). Tendo em conta que os estudos efetuados em Portugal revelam qualidade inadequada e mínima nas salas de creche, os resultados obtidos no presente estudo sugerem que as salas observadas possuem qualidade entre o mínimo e o bom. Embora o presente estudo apresente resultados superiores, verificou-se que os itens que apresentam maiores fragilidades (áreas deficitárias), assim como os itens que expressam maior qualidade (áreas fortes) parecem convergir com os resultados das investigações já efetuadas, com efeito os itens relacionados com as subescalas Atividades e Rotinas de cuidados pessoais são os que apresentam os resultados mais preocupantes. A subescala Interação foi a que apresentou resultados superiores e as práticas de socialização dos prestadores de cuidados revelaram ser excelentes. Verificou-se, igualmente, que as salas orientadas por educadores de infância, assim como, as salas em que o principal prestador de cuidados era educador de infância revelaram qualidade superior do que salas orientadas por assistentes operacionais (auxiliares de ação educativa). Este efeito chama a atenção para a importância da formação e qualificação dos profissionais de educação, assim como, para a necessidade de se alterarem as políticas educativas, nomeadamente no que diz respeito à obrigatoriedade de existirem educadores de infância nas salas de berçário. - ABSTRACT With the main objective of contributing to the study of quality of infant/toddler center-based child care in the Counties of Setúbal and Palmela, this work aims to (1) assess and describe the quality of 30 infant classrooms by applying the Infant/Toddler Environment Rating Scale-Revised Edition ([ITERS-R], Harms, Cryer, & Clifford, 2006), (2) assess and describe the socialization practices of caregivers responsible for 30 infant classrooms by applying the Caregiver Interaction Scale ([CIS], Arnett, 1989), (3) study the association between the socialization practices of professionals and the quality of infant classrooms, (4) to study associations between the quality of infant classrooms and the socialization practices of professionals and some structure variables (ratio adult/child group size, education, training, and experience of carers). Considering that the studies carried out in Portugal reveal minimum or inadequate quality in infant/toddler center-based child care, the results of this study suggest that, in accordance with ITERS-R, the quality of the infant classrooms observed varies between minimum and good. Although the present study reports higher quality scores, it was found that items which present the biggest weaknesses (deficit areas) as well as the items which express higher quality (strengths) appear to converge with the results of the investigations already carried out, since the items related with subscales Activities and Personal Care Routines are those with the most worrisome results. The Interaction subscale from ITERS-R proved to be the one with higher scores, and socialization practices of caregivers proved to be excellent. It was also found that the rooms oriented by early childhood teachers, as well as the rooms in which the primary care provider was also guided by childhood teachers showed higher quality than when guided by operational assistants (educational activities assistants). This effect draws attention to the importance of the education professionals training and qualification, as well as the need for altering the educational policies, in particular as regards the obligation to ensure the existence of early childhood teachers in infant classrooms.

Fungal contamination assessment in Portuguese elderly care centers

Individuals spend 80-90% of their day indoors and elderly subjects are likely to spend even a greater amount of time indoors. Thus, indoor air pollutants such as bioaerosols may exert a significant impact on this age group. The aim of this study was to characterize fungal contamination within Portuguese elderly care centers. Fungi were measured using conventional as well as molecular methods in bedrooms, living rooms, canteens, storage areas, and outdoors. Bioaerosols were evaluated before and after the microenvironments' occupancy in order to understand the role played by occupancy in fungal contamination. Fungal load results varied from 32 colony-forming units CFU m(-3) in bedrooms to 228 CFU m(-3) in storage areas. Penicillium sp. was the most frequently isolated (38.1%), followed by Aspergillus sp. (16.3%) and Chrysonilia sp. (4.2%). With respect to Aspergillus genus, three different fungal species in indoor air were detected, with A. candidus (62.5%) the most prevalent. On surfaces, 40 different fungal species were isolated and the most frequent was Penicillium sp. (22.2%), followed by Aspergillus sp. (17.3%). Real-time polymerase chain reaction did not detect the presence of A. fumigatus complex. Species from Penicillium and Aspergillus genera were the most abundant in air and surfaces. The species A. fumigatus was present in 12.5% of all indoor microenvironments assessed. The living room was the indoor microenvironment with lowest fungal concentration and the storage area was highest.

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 μm2/cm3. The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.

A checklist for patient safety rounds at the care pathway level

Objective - To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design - We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. Setting and Participants - A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. Main outcome measures - Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). Results - Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. Conclusion - The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 mu m(2)/cm(3). The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.