Risk factors associated with the professional performance of civil servants with impairment

Apresentação realizada na "8th Conference of European Academy of Occupational Health Psychology", que decorreu em Valência, Espanha, de 12 a 14 novembro de 2008

Constructing and validating a scale of employee satisfaction with HRM practices in the healthcare context

The concept of HRM perceptions is a growing interest in the literature, as one of the antecedents of HRM outcomes. Regardless, not only the cognitive aspect of perception is interesting in this field (what you think) but also the affective perspective is of interest (how you feel about it). In this study we propose a scale for assessing satisfaction with the perceptions of the HRM practices. A 24 item Likert-type scale was developed considering literature review, to assess subjects’ satisfaction with Human Resources Practices in a healthcare setting. Talked reflections were held and a survey encompassing all workers from a Hospital was conducted later, with a sample of 922 subjects. Exploratory and Confirmatory Factor Analysis were performed; reliability was tested using Cronbach’s alpha. The scale presents good psychometric properties with alpha values that range from .71 to .91. Exploratory and Confirmatory Factor Analysis demonstrated that the scale presents a very good fit with CFI= 0.94, AGFI= 0.88, and RMSEA= 0.07. The present study represents a first approach in the usage of this scale and despite having a large sample, respondents originate from a single institution. This study presents a pertinent scale towards measuring a seldom explored construct of the worker-organization relationship. The scale is parsimonious and results are promising. There seems to be very little research on how subjects feel about the HRM practices. This construct, very much in line with more recent studies concerning worker perceptions can be especially interesting in the context of the worker-organization relationship.

Defining health law or the edgewood syndrome

ABSTRACT - The authors’ main purpose is to present ideas on defining Health Law by highlighting the particularities of the field of Health Law as well as of the teaching of this legal branch, hoping to contribute to the maturity and academic recognition of Health Law, not only as a very rich legal field but also as a powerful social instrument in the fulfillment of fundamental human rights. The authors defend that Health Law has several characteristics that distinguish it from traditional branches of law such as its complexity and multidisciplinary nature. The study of Health Law normally covers issues such as access to care, health systems organization, patients’ rights, health professionals’ rights and duties, strict liability, healthcare contracts between institutions and professionals, medical data protection and confidentiality, informed consent and professional secrecy, crossing different legal fields including administrative, antitrust, constitutional, contract, corporate, criminal, environmental, food and drug, intellectual property, insurance, international and supranational, labor/employment, property, taxation, and tort law. This is one of the reasons why teaching Health Law presents a challenge to the teacher, which will have to find the programs, content and methods appropriate to the profile of recipients which are normally non jurists and the needs of a multidisciplinary curricula. By describing academic definitions of Health Law as analogous to Edgewood, a fiction house which has a different architectural style in each of its walls, the authors try to describe which elements should compose a more comprehensive definition. In this article Biolaw, Bioethics and Human Rights are defined as complements to a definition of Health Law: Biolaw because it is the legal field that treats the social consequences that arise from technological advances in health and life sciences; Bioethics which evolutions normally influence the shape of the legal framework of Health; and, finally Human Rights theory and declarations are outlined as having always been historically linked to medicine and health, being the umbrella that must cover all the issues raised in the area of Health Law. To complete this brief incursion on the definition on Health Law the authors end by giving note of the complex relations between this field of Law and Public Health. Dealing more specifically on laws adopted by governments to provide important health services and regulate industries and individual conduct that affect the health of the populations, this aspect of Health Law requires special attention to avoid an imbalance between public powers and individual freedoms. The authors conclude that public trust in any health system is essentially sustained by developing health structures which are consistent with essential fundamental rights, such as the universal right to access health care, and that the study of Health Law can contribute with important insights into both health structures and fundamental rights in order to foster a health system that respects the Rule of Law.-------------------------- RESUMO – O objectivo principal dos autores é apresentar ideias sobre a definição de Direito da Saúde, destacando as particularidades desta área do direito, bem como do ensino deste ramo jurídico, na esperança de contribuir para a maturidade e para o reconhecimento académico do mesmo, não só como um campo juridicamente muito rico, mas, também, como um poderoso instrumento social no cumprimento dos direitos humanos fundamentais. Os autores defendem que o Direito da Saúde tem diversas características que o distinguem dos ramos tradicionais do direito, como a sua complexidade e natureza multidisciplinar. O estudo do Direito da Saúde abrangendo normalmente questões como o acesso aos cuidados, a organização dos sistemas de saúde, os direitos e deveres dos doentes e dos profissionais de saúde, a responsabilidade civil, os contratos entre instituições de saúde e profissionais, a protecção e a confidencialidade de dados clínicos, o consentimento informado e o sigilo profissional, implica uma abordagem transversal de diferentes áreas legais, incluindo os Direitos contratual, administrativo, antitrust, constitucional, empresarial, penal, ambiental, alimentar, farmacêutico, da propriedade intelectual, dos seguros, internacional e supranacional, trabalho, fiscal e penal. Esta é uma das razões pelas quais o ensino do Direito da Saúde representa um desafio para o professor, que terá de encontrar os programas, conteúdos e métodos adequados ao perfil dos destinatários, que são normalmente não juristas e às necessidades de um currículo multidisciplinar. Ao descrever as várias definições académicas de Direito da Saúde como análogas a Edgewood, uma casa de ficção que apresenta um estilo arquitectónico diferente em cada uma de suas paredes, os autores tentam encontrar os elementos que deveriam compor uma definição mais abrangente. No artigo, Biodireito, Bioética e Direitos Humanos são descritos como complementos de uma definição de Direito da Saúde: o Biodireito, dado que é o campo jurídico que trata as consequências sociais que surgem dos avanços tecnológicos na área da saúde e das ciências da vida; a Bioética cujas evoluções influenciam normalmente o quadro jurídico da Saúde; e, por fim, a teoria dos Direitos Humanos e as suas declarações as quais têm estado sempre historicamente ligadas à medicina e à saúde, devendo funcionar como pano de fundo de todas as questões levantadas na área do Direito da Saúde. Para finalizar a sua breve incursão sobre a definição de Direito da Saúde, os autores dão ainda nota das complexas relações entre este último e a Saúde Pública, onde se tratam mais especificamente as leis aprovadas pelos governos para regular os serviços de saúde, as indústrias e as condutas individuais que afectam a saúde das populações, aspecto do Direito da Saúde que requer uma atenção especial para evitar um desequilíbrio entre os poderes públicos e as liberdades individuais. Os autores concluem afirmando que a confiança do público em qualquer sistema de saúde é, essencialmente, sustentada pelo desenvolvimento de estruturas de saúde que sejam consistentes com o direito constitucional da saúde, tais como o direito universal ao acesso a cuidados de saúde, e que o estudo do Direito da Saúde pode contribuir com elementos

Update on the population structure of MRSA causing infection in a central hospital and in healthcare centers in Portugal

RESUMO:Staphylococcus aureus é um dos principais agentes patogénicos humanos, sendo frequentemente associado a infecções nosocomiais e infecções na comunidade. A prevalência de S. aureus resistentes à meticilina (MRSA) em hospitais portugueses é uma das mais elevadas da Europa e tem sido caracterizada extensivamente; contrariamente, a prevalência e epidemiologia de MRSA na comunidade em Portugal não tem sido devidamente seguida. Com o objectivo de compreender as causas possíveis do aumento na frequência de MRSA num dos maiores hospitais centrais portugueses (HSM) ao longo de 17 anos, isolados de MRSA recolhidos em 1993 (n=54) e 2010 (n=180) de pus, sangue e urina foram analisados por PFGE, MLST, tipagem do spa e tipagem de SCCmec. Os resultados mostraram que ocorreu uma mudança global nos tipos clonais predominantes, onde o clone ST22-IVh substituiu os clones, ST239-IIIvar e ST247-I, representando mais de 70% da população actual. Além disso, entre 1993 e 2010 verificou-se um aumento na diversidade genética dos tipos clonais de MRSA. Para determinar a frequência e a natureza clonal de MRSA e S. aureus sensíveis à meticilina (MSSA) isolados de infecções de pele e tecidos moles (SSTI) em pessoas que frequentam centros de saúde em Portugal, 73 amostras foram recolhidas em nove centros de saúde (Rede Médicos Sentinela). Isolou-se um total de 40 S. aureus (55%), dos quais 17,5% eram MRSA. Os isolados de MRSA pertenciam aos clones ST22-IVh (n=4), ST5-IVc (n=2) e ST105-II (n=1), que foram descritos neste estudo como sendo clones de origem hospitalar. Os nossos resultados sugerem que o aumento da frequência de MRSA no HSM pode estar associado à emergência de um clone de MRSA com maior capacidade epidémica. Além disso, verificámos que a principal causa de SSTI em pessoas que frequentam centros de saúde em Portugal são MRSA de origem hospitalar e não MRSA associados à comunidade.------ABSTRACT: Staphylococcus aureus is one of the most important human pathogens, being a major cause of infections worldwide both in the hospital and in the community. In Portugal, the prevalence of methicillin resistant S. aureus (MRSA) in hospitals is one of the highest in Europe and has been characterized extensively; contrarily the prevalence and epidemiology of MRSA in the community has not been followed in a meaningful way. To understand the epidemiological events that could explain a steep increase in MRSA frequency in a major Portuguese central hospital (HSM) within a 17 year period, two MRSA collections recovered in 1993 (n=54) and 2010 (n=180) from pus, blood and urine were analyzed by PFGE, MLST, spa and SCCmec typing. The results showed that a major clonal shift occurred, wherein ST22-IVh clone has replaced the previous ST239-IIIvar and ST247-I clones and accounts for more than 70% of the present population. Moreover, an increase in genetic diversity of MRSA clonal types was observed between the two study periods. With the aim of determining the frequency and clonal nature of MRSA and methicillin-susceptible S. aureus (MSSA) causing skin and soft tissue infections (SSTI) in patients attending healthcare centers in Portugal, 73 samples were collected from nine healthcare centers (Medicos Sentinela Network). A total of 40 S. aureus were isolated, accounting for 55% of the SSTI, of which 17.5% were MRSA. MRSA isolates belonged to ST22-IVh (n=4), ST5-IVc (n=2) and ST105-II (n=1) that have also been described in the hospital in an equivalent period. Our results suggest that the increase in MRSA frequency in HSM may be associated to the emergence of a MRSA clone with higher epidemic potential. Moreover, we propose that the spillover of MRSA from the hospital rather than community-associated-MRSA was the main cause of SSTI in persons attending healthcare centers in Portugal.

Impact of sensor nodes scaling and velocity on handover mechanisms for healthcare wireless sensor networks with mobility support

Health promotion in hospital environments can be improved using the most recent information and communication technologies. The Internet connectivity to small sensor nodes carried by patients allows remote access to their bio-signals. To promote these features the healthcare wireless sensor networks (HWSN) are used. In these networks mobility support is a key issue in order to keep patients under realtime monitoring even when they move around. To keep sensors connected to the network, they should change their access points of attachment when patients move to a new coverage area along an infirmary. This process, called handover, is responsible for continuous network connectivity to the sensors. This paper presents a detailed performance evaluation study considering three handover mechanisms for healthcare scenarios (Hand4MAC, RSSI-based, and Backbone-based). The study was performed by simulation using several scenarios with different number of sensors and different moving velocities of sensor nodes. The results show that Hand4MAC is the best solution to guarantee almost continuous connectivity to sensor nodes with less energy consumption.

Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: a randomized controlled trial

Background Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. Objective To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS). Design, setting, participants and interventions We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n = 39) and the control (n = 30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. Main outcome measures Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. Results In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. Conclusion The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

Immediate effects of Tuina techniques on working-related musculoskeletal disorder of professional orchestra musicians

BACKGROUND: Musicians are a prone group to suffer from working-related musculoskeletal disorder (WRMD). Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their efficiency is sometimes disappointing. OBJECTIVE: The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: We performed a prospective, controlled, single-blinded, randomized study. Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group (n=39) and the control group (n=30). During an individual interview, Chinese diagnosis took place and treatment points were chosen. Real acupoints were treated by Tuina techniques into the experimental group and non-specific skin points were treated into the control group. Pain was measured by verbal numerical scale before and immediately after intervention. RESULTS: After one treatment session, pain was reduced in 91.8% of the cases for the experimental group and 7.9% for the control group. CONCLUSION: Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal, further investigations with stronger measurements, double-blinding designs and bigger simple sizes are needed.

Attitudes towards mentally ill in professionals working in Ndera neuropsychiatric hospital in Rwanda

ABSTRACT: This quantitative study investigated the attitudes toward the mentally ill in professionals working in Ndera neuropsychiatric hospital. The research questions explored were centered on the attitudes of directly involved and supportive professionals toward mentally ill clients and also on the difference between the attitudes of directly involved and supportive professionals toward mentally ill clients and demographic variables. The purpose of this study was to determine whether there are differences in attitude between direct care providers and supportive professionals toward the mentally ill clients. The Community Attitudes towards Mentally Ill (CAMI) scale (Dear & Taylor, 1982; Taylor, Dear & Hall, 1979; Taylor & Dear, 1981) was used. A total of 72 members of the staff, including 55 directly involved staff and 17 supportive staff members, participated in the survey. A summary interpretation of the main findings in this thesis reinforces the assumption that negative attitudes towards people with mental illness received in Ndera neuropsychiatric hospital are in existence, even though the majority have favorable attitudes towards the mentally ill. This suggests that persons with mental illness may encounter stigmatizing attitudes from mental health professionals. This study represents one of the first to explore professionals’ attitudes towards the mentally ill. It is hoped that this work will highlight the need to explore the influence of attitudes in the delivery of high quality healthcare. The provider–patient relationship is at the heart of effective treatment and the detrimental impact of prejudicial judgments on this relationship should not be ignored. This study also demonstrates that professionals with different roles report different attitudes and this suggest that they would behave differently towards patients with mental illness. The directly involved professionals have been found to have more positive attitudes than the supportive professional and this seems to show that as individuals improve their ability to interact with persons with mental illness, they become more tolerant. The present study demonstrates that the sociodemographic variables tested have no impact on the attitudes of the professionals working in Ndera neuropsychiatric hospital. The extent of mental health training (as part of general health training) and duration of experience of working in mental health settings did not influence attitudes. Finally, this study demonstrates that there is no correlation between the attitudes towards mentally ill patients and their inclusion in the process of decision-making.

Lack of methicillin-resistant Staphylococcus aureus nasal carriage among patients at a primary-healthcare unit in Porto Alegre, Brazil

INTRODUCTION: Community-associated methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a pathogen in individuals without traditional risk factors. MATERIAL AND METHODS: MRSA nasal carriage was assessed in individuals consulting at a Primary Health Unit in Brazil. RESULTS: A total of 336 individuals were included: 136 were tested only for MRSA and 200 for any S. aureus. No MRSA was found among the 336 individuals and 23 (11.5%) of 200 were colonized by S. aureus. DISCUSSION: Low prevalence rates have been found in non-hospitalized individuals, but MRSA surveillance should be encouraged to monitor clinical and molecular epidemiology of CA- MRSA.

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

Qualidade no Serviço Nacional de Saúde : evolução recente e perspectivas futuras

RESUMO - A qualidade é um pilar fundamental de qualquer sector de actividade. No sector da saúde, a qualidade deixou de ser um factor opcional e tornou-se uma prioridade, uma exigência e um requisito de enorme importância na gestão das organizações de saúde, representando a sua responsabilidade, ética e respeito pelos cidadãos que a elas recorrem. O crescente interesse pelas questões da qualidade segue, ao longo das últimas décadas, uma tendência mundial nos sistemas de saúde, sendo um dos temas mais presentes no debate político e nas estratégias de saúde um pouco por todo o mundo. Porém, as abordagens à qualidade são díspares, reflectindo a sua dinâmica e o pouco consenso nesta área, o que justifica a necessidade de reflectir sobre o tema e de estudar as estratégias actualmente implementadas. Objectivos Este trabalho pretendeu apresentar uma perspectiva integrada e completa da qualidade em saúde em Portugal, contribuindo para o seu entendimento global e reflexão. Teve como finalidade estudar a sua evolução, nomeadamente a nível das políticas, das práticas e dos seus resultados, e conhecer a situação actual da qualidade nas organizações públicas de saúde nacionais, podendo assim contribuir para novas medidas nesta área. Metodologia Foram realizadas entrevistas semi-estruturadas a oito peritos portugueses na área da qualidade em saúde, seleccionados diante critérios de diversidade profissional, formação de base, tipo de instituição e localização geográfica onde exercem a sua actividade. Para as entrevistas foi elaborado um guião com perguntas sobre vários temas relacionados com a área da qualidade em saúde. As entrevistas foram gravadas e a informação foi transcrita e organizada em categorias através de uma análise de conteúdo. Para o segundo objectivo do estudo, foi construído e proposto um questionário, como projecto para investigações futuras. Resultados e Conclusões Os resultados mostraram que a qualidade é um tema muito valorizado e presente nos quadros da administração de saúde portuguesa. A sua evolução sofreu diversas mudanças, com fases de grande progresso e outras de grande indefinição. No entanto, ficou evidente que a grande divergência de opiniões justifica a necessidade de uma maior discussão e consenso a nível nacional e internacional nesta área. O futuro da qualidade em saúde em Portugal irá depender da capacidade do Departamento da Qualidade na Saúde e das organizações gerirem esta complexa área.

Distribution and Etiology of Chronic Respiratory Diseases in Primary Healthcare Departments in Cape Verde

Data on chronic respiratory diseases (CRD) are scarce or unavailable in most African countries. We aimed to determine the prevalence of CRD and associated risk factors in Cape Verde, at the primary healthcare level.

Obama's law : analysis of a breakthrough law on healthcare access and lessons for the Portuguese health system management

ABSTRACT - The Patient Protection and Affordable Care Act shook the foundations of the US health system, offering all Americans access to health care by changing the way the health insurance industry works. As President Obama signed the Act on 23 March 2010, he said that it stood for “the core principle that everybody should have some basic security when it comes to their health care”. Unlike the U.S., the Article 64 of the Portuguese Constitution provides, since 1976, the right to universal access to health care. However, facing a severe economic crisis, Portugal has, under the supervision of the Troika, a tight schedule to implement measures to improve the efficiency of the National Health Service. Both countries are therefore despite their different situation, in a conjuncture of reform and the use of new health management measures. The present work, using a qualitative research methodology examines the Affordable Care Act in order to describe its principles and enforcement mechanisms. In order to describe the reality in Portugal, the Portuguese health system and the measures imposed by Troika are also analyzed. The intention of this entire analysis is not only to disclose the innovative U.S. law, but to find some innovative measures that could serve health management in Portugal. Essentially we identified the Exchanges and Wellness Programs, described throughout this work, leaving also the idea of the possibility of using them in the Portuguese national health system.

Adesão terapêutica em doentes submetidos a transplante hepático e renal

RESUMO - Introdução - A não adesão à terapêutica nos doentes transplantados foi identificada em diversos estudos e constitui um fator preditivo de morbilidade e mortalidade. Como em Portugal não existe um conhecimento aprofundado sobre os comportamentos de não adesão nos doentes transplantados, este estudo tem como objetivo a avaliação da adesão terapêutica nos doentes submetidos a transplante hepático e renal e a identificação de fatores associados à não adesão. Metodologia - Foi elaborado e aplicado um questionário a uma amostra de doentes com mais de 18 anos submetidos a transplante renal ou hepático há mais de seis meses. Foi analisada a associação entre o comportamento de não adesão e fatores relacionados com o doente, condição, terapêutica e acesso aos serviços de saúde. Resultados - Dos 75 inquiridos, 60% eram doentes transplantados de fígado e 40% transplantados renais, com uma média de 48 anos e maioritariamente do sexo masculino (65,3%). Entre os inquiridos, verificou-se que 44% admitiu ter tido um comportamento de não adesão aos medicamentos prescritos. Os doentes que reportaram comportamento de não adesão tinham uma média de idades de 44 anos, possuíam como escolaridade o ensino secundário ou curso profissional, trabalhavam ou estudavam, tomavam menos de oito comprimidos por dia e tinham sido transplantados há mais de 5 anos. Adicionalmente, verificou-se que a dieta (28,8%), o exercício físico (33,3%) e o deixar de fumar (10,7%) são as indicações dadas pelos profissionais de saúde que os doentes referiram ter mais dificuldade em cumprir. Conclusão - Com este estudo esperamos ter contribuído para aumentar o conhecimento sobre a adesão à terapêutica nos doentes transplantados, o qual deve ser aprofundado para permitir o desenvolvimento de estratégias efetivas de melhoria da adesão aos planos terapêuticos.