The hospital survey on patient safety culture in Portuguese hospitals: instrument validity and reliability

Purpose – Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability. Design/methodology/approach – A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done. Findings – Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed. Originality/value – This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

Survey of trace elements (Al, As, Cd, Cr, Co, Hg, Mn, Ni, Pb, Se, and Si) in retail samples of flavoured and bottled waters

Concentrations of eleven trace elements (Al, As, Cd, Cr, Co, Hg, Mn, Ni, Pb, Se, and Si) were measured in 39 (natural and flavoured) water samples. Determinations were performed using graphite furnace electrothermetry for almost all elements (Al, As, Cd, Cr, Co, Mn, Ni, Pb, and Si). For Se determination hydride generation was used, and cold vapour generation for Hg. These techniques were coupled to atomic absorption spectrophotometry. The trace element content of still or sparkling natural waters changed from brand to brand. Significant differences between natural still and natural sparkling waters (p<0.001) were only apparent for Mn. The Mann–Whitney U-test was used to search for significant differences between flavoured and natural waters. The concentration of each element was compared with the presence of flavours, preservatives, acidifying agents, fruit juice and/or sweeteners, according to the labelled composition. It was shown that flavoured waters generally increase the trace element content. The addition of preservatives and acidifying regulators had a significant influence on Mn, Co, As and Si contents (p<0.05). Fruit juice can also be correlated to the increase of Co and As. Sweeteners did not provide any significant difference in Mn, Co, Se and Si content.

Validação da versão brasileira do Youth Risk Behavior Survey 2007

OBJETIVO: Validar as propriedades psicométricas da versão brasileira do questionário Youth Risk Behavior Survey (YRBS), versão 2007. MÉTODOS: Foram realizadas tradução para o português da versão original do YRBS2007 e retrotradução para o inglês. As versões do questionário foram analisadas por comitê de juízes. O comitê utilizou como critério de análise as equivalências semântica, idiomática, cultural e conceitual. Para identificação das propriedades psicométricas, a versão final do questionário YRBS2007 traduzida foi administrada em duas ocasiões com intervalo de duas semanas em amostra de 873 estudantes de ambos os sexos, do ensino médio, em Londrina, PR, em 2007. A confiabilidade teste-reteste foi analisada pelo cálculo do índice de concordância Kappa e da taxa de prevalência de cada comportamento de risco nas réplicas de aplicação. Teste de qui-quadrado foi empregado para identificar diferenças estatísticas entre a primeira e a segunda aplicações do questionário. RESULTADOS: Após discretas modificações apontadas nos processos de tradução, o comitê de juízes considerou que a versão para o idioma português do YRBS2007 apresentou equivalências semântica, idiomática, cultural e conceitual. Diferenças significativas entre as taxas de prevalências de ambas as aplicações foram observadas em 23,4% dos itens. A identificação de 91% dos itens com índice de concordância Kappa entre moderado a substancial e valor médio desse índice de 68,6% indicou a qualidade das propriedades psicométricas do YRBS2007 traduzido para o idioma português. CONCLUSÕES: A tradução, a adaptação transcultural e as qualidades psicométricas do questionário YRBS2007 foram satisfatórias, o que viabiliza sua aplicação em estudos epidemiológicos no Brasil.

Análisis político del Programa de Control del dengue en Morelos, México

OBJETIVO: Analizar medidas municipales implementadas para el control de la epidemia del dengue, sobretodo las de coordinación sectorial, gobernanza y participación de grupos sociales. MÉTODOS: Estudio de observación, realizado en Morelos, México, 2007. Los datos colectados en entrevistas y observaciones directas fueron sometidos a análisis de contenido y mapeo político. El software Policy Marker fue utilizado para evaluar los pesos atribuidos a los datos de desempeño (e.g. criterios alto, medio y bajo) y el papel de actores (acciones realizadas sean ellas de vigilancia, control o administrativas). Se realizó análisis estratégico de las oportunidades y desafíos en el cumplimiento de las políticas públicas y control del dengue. RESULTADOS: Las bases jurídicas indican que la respuesta a la epidemia es una tarea multisectorial. Sin embargo, la respuesta está centrada en actividades de los servicios de la salud, que están forzados a dar mayor apoyo financiero y derivar los recursos humanos necesarios, en contraste con la contribución de otros sectores (e.g. agua y saneamiento básico), que desconocen sus responsabilidades. El sector de la salud presenta alto nivel de factibilidad para la vinculación intra?institucional, en términos de optimización de recursos y cumplimiento de objetivos, particularmente entre autoridades de salud en los niveles estatal, jurisdiccional, municipal y local. CONCLUSIONES: El abordaje multidisciplinario y el fortalecimiento de las responsabilidades políticas permitirán la respuesta eficaz ante la epidemia del dengue, sustentada en la coordinación sectorial e involucramiento activo de la población afectada.

Monitoring of ochratoxin a exposure of the Portuguese population through a nationwide urine survey — winter 2007

Ochratoxin A (OTA) is a mycotoxin produced by a variety of fungi, such as Penicillium verrucosum and Aspergillium spp., which has been found to have a wide number of potentially deadly toxic effects, and can enter the human organism through a variety of means. It then finds its way into the bloodstream and, after a lengthy process, is eventually excreted through the urine. It can thus be detected in its original form not only in blood samples but also in this biological medium. As such, and in an attempt to evaluate the exposure of the Portuguese population to this mycotoxin, morning urine samples were collected during the Winter of 2007, from each of five geographically distinct Portuguese locations — Bragança, Porto, Coimbra, Alentejo, and Algarve — and subjected to extraction by immunoaffinity columns and to OTA quantification through liquid chromatography coupled with fluorescence detection. Prevalent incidence was higher than 95% with Coimbra being the exception (incidence of 73.3%). In nearly all locations, the OTA content of most samples was found to be above the limit of quantification (LOQ) of 0.008 ng/ml. Indeed, excluding Coimbra, with an OTA content level of 0.014 ng/ml, all regions featured content values over 0.021 ng/ml.

Jornalismo político e censura na I Guerra – uma visão comparativa entre os jornais O Mundo e A Lucta

“Se os governantes soubessem a curiosidade que desperta a censura, se pudessem ler as perguntas feitas aos jornais censurados, se avaliassem bem os efeitos da criação deste novo fruto proibido, mandariam para as profundezas do inferno a lei da censura preventiva”, escrevia João Barbosa, a 1 de Maio de 1917, no diário A Lucta. A materialização da censura nas páginas dos jornais diários, por via de intrusivos espaços em branco, de configuração variável, não deixou de constituir uma nova forma de enunciar o “problema” político. Na nossa análise sobre a censura aos jornais A Lucta e o O Mundo, durante a I Guerra Mundial, procuraremos ultrapassar a visão excessivamente redutora dos jornais como sendo meros transmissores de mensagens de um emissor para um recetor, aceitando a proposta de M. Schudson:“ que o poder dos média está não apenas (e nem sequer primariamente) no seu poder de declarar as coisas como sendo verdadeiras mas no poder de fornecer as formas nas quais as declarações aparecem”. A prática de censura constitui elemento determinante na reconfiguração do campo político republicano.

O projecto Político dos Capitães

“A partir de Janeiro de 1974 o Movimento dos Capitães “adquire novo fôlego e dimensão. Multiplicam-se os encontros e reuniões, de diferente âmbito, tendo em vista a definição da estratégia a seguir. Á medida que a opção pelo golpe de estado ganha adeptos e posições, intensifica-se o debate ideológico e equaciona-se a necessidade de um plano político. Desenvolvem-se contactos com elementos da Armada, Força Aérea e procuram-se novos apoios. A maior surpresa acabará por residir na atitude dos que o Movimento escolhera como ‘chefes’: enquanto Costa Gomes recusa qualquer envolvimento, António de Spínola assume a posição inversa. Esta estratégia em breve dará os seus frutos contribuindo, em última análise, para que seja catapultado para um lugar cimeiro na nova ordem dos pós 25 de Abril” (do texto).

Edentulism and shortened dental arch in Brazilian elderly from the National Survey of Oral Health 2003

OBJECTIVE: To describe the distribution of edentulism and estimate the prevalence of functional dentition and shortened dental arch among elderly population. METHODS: A population-based epidemiological study was carried out with a sample of 5,349 respondents aged 65 to 74 years obtained from the 2002 and 2003 Brazilian Ministry of Health/Division of Oral Health survey database. The following variables were studied: gender; macroregion of residence; missing teeth; percentage that met the World Health Organization goal for oral health in the age group 65 to 74 years (50% having at least 20 natural teeth); presence of shortened dental arch; number of posterior occluding pairs of teeth. The Chi-square test assessed the association between categorical variables. The Kruskal-Wallis and Mann-Whitney tests were used to assess differences of mean between number of posterior occluding pairs teeth, macro-region and gender. RESULTS: The elderly population had an average of 5.49 teeth (SD: 7.93) with a median of 0. The proportion of completely edentulous respondents was 54.7%. Complete edentulism was 18.2% in the upper arch and 1.9% in the lower arch. The World Health Organization goal was achieved in 10% of all respondents studied. However, only 2.7% had acceptable masticatory function and aesthetics (having at least shortened dental arch) and a mean number of posterior occluding pairs of 6.94 (SD=2.97). There were significant differences of the percentage of respondents that met the World Health Organization goal and presence of shortened dental arch between men and women. There were differences in shortened dental arch between macroregions. CONCLUSIONS: The Brazilian epidemiological oral health survey showed high rate of edentulism and low rate of shortened dental arch in the elderly population studied, thus suggesting significant functional and aesthetic impairment in all Brazilian macroregions especially among women.

Agressão no trabalho em processos de mudança organizacional: O papel mediador do cinismo organizacional e do comportamento político

Workplace aggression is a factor that shapes the interaction between individuals and their work environment and produces many undesirable outcomes, sometimes introducing heavy costs for organizations. Only through a comprehensive understanding o f the genesis of workplace aggression is possible to develop strategies and interventions to minimize its nefarious effects. The existent body of knowledge has already identified several individual, situational and contextual antecedents of workplace aggr ession, although this is a research area where significant gaps occur and many issues were still not addressed (Dupré & Barling, 2006). According to Neuman and Baron (1998) one of these predictors is organizational change, since certain changes in the work environment (e.g., changes in management) can lead to increased aggression. This paper intends to contribute to workplace aggression research by studying its relationship with organizational change, considering the mediation role of political behaviors an d organizational cynicism (Ammeter, Douglas, Gardner, Hochwarter, & Ferris, 2002). The literature review suggests that mediators and moderators that intervene in the relationships between workplace aggression and its antecedents are understudied topics. Ja mes (2005) sustains that organizational politics is related to cynicism and the empirical research of Miranda (2008) has identified leadership political behavior as an antecedent of cynicism but these two variables were not yet investigated regarding their relationship with workplace aggression. This investigation was operationalized using several scales including the Organizational Change Questionnaire - climate of change, processes, and readiness (Bouckenooghe, Devos, & Broeck, 2009), a Workplace Aggressio n Scale (Vicente, 2008, 2009), an Organizational Cynicism Scale (Wanous, Reichers, & Austin, 1994) and a Political Behavior Questionnaire (Yukl & Falbe, 1990). Participants representing a wide variety of jobs across many organizations were surveyed. The r esults of the study and its implications will be presented and discussed. This study contribution is also discussed in what concerns organizational change practices in organizations.

Lower protocol layers for wireless sensor networks: a survey

Wireless Sensor Networks (WSNs) have been attracting increasing interests in the development of a new generation of embedded systems with great potential for many applications such as surveillance, environment monitoring, emergency medical response and home automation. However, the communication paradigms in Wireless Sensor Networks differ from the ones attributed to traditional wireless networks, triggering the need for new communication protocols and mechanisms. In this Technical Report, we present a survey on communication protocols for WSNs with a particular emphasis on the lower protocol layers. We give a particular focus to the MAC (Medium Access Control) sub-layer, since it has a prominent influence on some relevant requirements that must be satisfied by WSN protocols, such as energy consumption, time performance and scalability. We overview some relevant MAC protocol solutions and discuss how they tackle the trade-off between the referred requirements.

A survey of techniques and technologies for web-based real-time interactive rendering

When exploring a virtual environment, realism depends mainly on two factors: realistic images and real-time feedback (motions, behaviour etc.). In this context, photo realism and physical validity of computer generated images required by emerging applications, such as advanced e-commerce, still impose major challenges in the area of rendering research whereas the complexity of lighting phenomena further requires powerful and predictable computing if time constraints must be attained. In this technical report we address the state-of-the-art on rendering, trying to put the focus on approaches, techniques and technologies that might enable real-time interactive web-based clientserver rendering systems. The focus is on the end-systems and not the networking technologies used to interconnect client(s) and server(s).

Ethernet goes real-time: a survey on research and technological developments

Ethernet is the most popular LAN technology. Its low price and robustness, resulting from its wide acceptance and deployment, has created an eagerness to expand its responsibilities to the factory-floor, where real-time requirements are to be fulfilled. However, it is difficult to build a real-time control network using Ethernet, because its MAC protocol, the 1-persistent CSMA/CD protocol with the BEB collision resolution algorithm, has unpredictable delay characteristics. Many anticipate that the recent technological advances in Ethernet such as the emerging Fast/Gigabit Ethernet, micro-segmentation and full-duplex operation using switches will also enable it to support time-critical applications. This technical report provides a comprehensive look at the unpredictability inherent to Ethernet and at recent technological advances towards real-time operation.

A survey in Portuguese X-ray fluoroscopy equipment: dose rates and image quality

X-ray fluoroscopy is essential in both diagnosis and medical intervention, although it may contribute to significant radiation doses to patients that have to be optimised and justified. Therefore, it is crucial to the patient to be exposed to the lowest achievable dose without compromising the image quality. The purpose of this study was to perform an analysis of the quality control measurements, particularly dose rates, contrast and spatial resolution of Portuguese fluoroscopy equipment and also to provide a contribution to the establishment of reference levels for the equipment performance parameters. Measurements carried out between 2007 and 2013 on 143 fluoroscopy equipment distributed by 34 nationwide health units were analysed. The measurements suggest that image quality and dose rates of Portuguese equipment are congruent with other studies, and in general, they are as per the Portuguese law. However, there is still a possibility of improvements intending optimisation at a national level.

Jornalismo político na revolução: a imprensa Trotskista em 1974-75.

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Jornalismo.

Survey of hearing disorders in an urban population in Rondonia, Northern Brazil

OBJECTIVE: To identify the prevalence of hearing loss for the population in the urban area. METHODS: A cross-sectional household survey based on the World Health Organization Ear and Hearing Disorders Survey Protocol was conducted in 298 households in the urban area of Monte Negro, Rondonia, Northern Brazil, from 2005 to 2007. Ear examinations, behavioral audiometry and pure tone audiometry were conducted on 577 individuals. RESULTS: The results showed that 3.8% (95%CI 2.17;5.45) of population were classified in the disabling hearing impairment category. The prevalence of moderate hearing impairment was 3.4%; severe impairment was 0.4%; and profound hearing impairment was not found. CONCLUSIONS: The impairing hearing loss prevalence found in this study is within of the international prevalence for this level of hearing loss and smaller than observed in a previous study in the South region of Brazil.