Implicações da Sobrecarga Horária na Prestação dos Cuidados de Enfermagem

Nos dias de hoje a sobrecarga horária tem sido um fenómeno bastante preocupante na nossa sociedade. Relativamente a enfermagem, a sobrecarga horária acarreta implicações na qualidade dos cuidados de enfermagem e na vida dos profissionais de saúde. A qualidade dos cuidados em enfermagem para além da importância que tem para a instituição de saúde e para o utente, deve ter uma importância máxima para o enfermeiro. Ele deve ambicionar a qualidade em cada gesto realizado, deve procurar que o desempenho da sua função seja mais do que uma simples execução de tarefas. É com base nisto, que a realização do presente estudo pretendeu-se conhecer as implicações da sobrecarga horária na qualidade dos cuidados em enfermagem no Hospital Baptista de Sousa, visando avaliar o impacto da sobrecarga horária na vida dos enfermeiros e na qualidade dos cuidados prestados pelos enfermeiros. Optou-se por uma metodologia quantitativa, com um estudo do tipo exploratório e descritivo, sendo esta realizada através da aplicação de um questionário a quarenta (40) enfermeiros dos cento e nove (109) que trabalham no Hospital Baptista de Sousa (HBS), mais precisamente os que trabalham nos seguintes serviços: Quarto Particular (QP), Banco de Urgência Adulto (BUA), Banco de Urgência de Pediatria (BUP), Serviço de Medicina (SMed), Serviço de Maternidade (SM), Serviço de Cirurgia (SC). Através dos resultados obtidos constatou-se que de facto existe sobrecarga horária no HBS com uma percentagem de 97.5% (39 enfermeiros) respondendo que sim. Esta trás implicações tanto a nível dos cuidados de enfermagem prestados aos utentes (87.5% respondendo sim) como para os enfermeiros (95% respondendo sim). Nos cuidados de enfermagem as implicações mais presenciadas foram baixa produção nas tarefas, trabalho mecanicista e relação interpessoal negativa e nos enfermeiros foram o desgaste físico e profissional, baixo nível de satisfação profissional e o aparecimento da síndrome de burnout o que pode-se concluir que a sobrecarga horária tem vindo a ser um grande problema para a classe de enfermagem, em que esta merece ser estudada devido as várias consequências que ela trás aos utentes, aos enfermeiros e a instituição hospitalar.

Humanização dos cuidados de enfermagem no atendimento ao doente etílico

O alcoolismo é considerado um problema a nível mundial, em Cabo Verde é a 3ª causa de morte e é responsável por uma alta taxa de mortalidade que deve ser encarada como tal, com profundidade, merecendo atenção adequada, por parte da sociedade, particularmente do Estado no que concerne à adopção de medidas visando o seu combate. O aumento do consumo e do número de usuários tem levado a agravos decorrentes da dependência desta substância, havendo maior procura pelos serviços de Banco de Urgência. Os cuidados às pessoas com problemas relacionados ao consumo do álcool, no entanto, ainda estão pautados em modelos tradicionais, punitivos e segregadores que dificultam o acesso humanizado aos serviços de saúde. Constata-se que a humanização é a característica fundamental de uma administração eficiente, pois deve estar presente em todos os cuidados de saúde prestados aos doentes, com a finalidade de garantir o bem-estar físico, psíquico, social e moral do doente. A humanização enfatiza a prestação de cuidados nos serviços de saúde, neste sentido considera importante desenvolver um estudo intitulado humanização assistência de enfermagem no atendimento ao doente etílico, tendo como objetivo geral conhecer a perceção dos enfermeiros de BUA acerca da humanização do cuidado prestado ao doente etílico. Para melhor compreender os objetivos do trabalho optou-se por uma abordagem qualitativa, com um estudo de caráter descritivo e exploratório utilizando como método de colheita de dados uma entrevista semi-estruturada com perguntas abertas, feita a 9 enfermeiros que trabalham no serviço. Relativamente aos dados obtidos, constata-se que os profissionais de enfermagem do Serviço, têm alguma noção da Humanização dos Cuidados embora não de forma técnica e científica. Os enfermeiros afirmam ainda que existem dificuldades na implementação deste conceito por ser um serviço de urgência o tempo é pouco, à falta de recursos materiais, humanos e físicos para implementação deste cuidado neste serviço. Deste modo, os resultados desta pesquisa fornecem um contributo enorme, servindo como fonte de informação para o serviço, de modo a que os profissionais de saúde possam implementar novas metas que visem a melhorar as condições de saúde do doente, e os próprios profissionais desse Serviço.

Effect of supplementation with vitamin D3 and calcium on quantitative ultrasound of bone in elderly institutionalized women: a longitudinal study.

Supplementation of elderly institutionalized women with vitamin D and calcium decreased hip fractures and increased hip bone mineral density. Quantitative ultrasound (QUS) measurements can be performed in nursing homes, and easily repeated for follow-up. However, the effect of the correction of vitamin D deficiency on QUS parameters is not known. Therefore, 248 institutionalized women aged 62-98 years were included in a 2-year open controlled study. They were randomized into a treated group (n = 124), receiving 440 IU of vitamin D3 combined with 500 mg calcium (1250 mg calcium carbonate, Novartis) twice daily, and a control group (n = 124). One hundred and three women (42%), aged 84.5 +/- 7.5 years, completed the study: 50 in the treated group, 53 in the controls. QUS of the calcaneus, which measures BUA (broadband ultrasound attenuation) and SOS (speed of sound), and biochemical analysis were performed before and after 1 and 2 years of treatment. Only the results of the women with a complete follow-up were taken into account. Both groups had low initial mean serum 25-hydroxyvitamin D levels (11.9 +/- 1.2 and 11.7 +/- 1.2 micrograms/l; normal range 6.4-40.2 micrograms/l) and normal mean serum parathyroid hormone (PTH) levels (43.1 +/- 3.2 and 44.6 +/- 3.5 ng/l; normal range 10-70 ng/l, normal mean 31.8 +/- 2.3 ng/l). The treatment led to a correction of the metabolic disturbances, with an increase in 25-hydroxyvitamin D by 123% (p < 0.01) and a decrease in PTH by 18% (p < 0.05) and of alkaline phosphatase by 15% (p < 0.01). In the controls there was a worsening of the hypovitaminosis D, with a decrease of 25-hydroxyvitamin D by 51% (p < 0.01) and an increase in PTH by 51% (p < 0.01), while the serum calcium level decreased by only 2% (p < 0.01). After 2 years of treatment BUA increased significantly by 1.6% in the treated group (p < 0.05), and decreased by 2.3% in the controls (p < 0.01). Therefore, the difference in BUA between the treated subjects and the controls (3.9%) was significant after 2 years (p < 0.01). However, SOS decreased by the same amount in both groups (approximately 0.5%). In conclusion, BUA, but not SOS, reflected the positive effect on bone of supplementation with calcium and vitamin D3 in a population of elderly institutionalized women.

Quantitative Ultrasound of the Heel and Fracture Risk Assessment: an Updated Meta-Analysis

Objectives: Quantitative ultrasound (QUS) is an attractive method for assessing fracture risk because it is portable, inexpensive, without ionizing radiation, and available in areas of the world where DXA is not readily accessible or affordable. However, the diversity of QUS scanners and variability of fracture outcomes measured in different studies is an important obstacle to widespread utilisation of QUS for fracture risk assessment. We aimed in this review to assess the predictive power of heel QUS for fractures considering different characteristics of the association (QUS parameters and fracture outcomes measured, QUS devices, study populations, and independence from DXA-measured bone density).Materials/Methods : We conducted an inverse-variance randomeffects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound &SOS;, stiffness index &SI;, and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic, and major osteoporotic fractures) were reported based on study questions.Results : 21 studies including 55,164 women and 13,742 men were included with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fractures. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43-2.00), SOS was 1.96 (95% CI 1.64-2.34), SI was 2.26 (95%CI 1.71-2.99), and QUI was 1.99 (95% CI 1.49-2.67). Validated devices from different manufacturers predicted fracture risks with a similar performance (meta-regression p-values>0.05 for difference of devices). There was no sign of publication bias among the studies. QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip DXA showed a significant and independent association with fracture risk (RR/SD for BUA =1.34 [95%CI 1.22-1.49]).Conclusions : This study confirms that QUS of the heel using validated devices predicts risk of different fracture outcomes in elderly men and women. Further research and international collaborations are needed for standardisation of QUS parameters across various manufacturers and inclusion of QUS in fracture risk assessment tools. Disclosure of Interest : None declared.

Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis.

UNLABELLED: The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time. INTRODUCTION: The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture. METHODS: In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored. RESULTS: Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20-100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40-1.51) and SOS (1.42, 95 % CI 1.36-1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56-1.82) and 1.60 (95 % CI, 1.48-1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p < 0.001). The predictive value of QUS was the same for men and women and for all ages (p > 0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p = 0.018 and p = 0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42-1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27-1.46). CONCLUSIONS: Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.

Determinants of Bone Strength and Predictors of Hip Fracture among Finnish Adults. Results from the Health 2000 Survey and the Mini-Finland Health Survey

The objective of this thesis was to identify the determinants of bone strength and predictors of hip fracture in representative samples of Finnish adults. A secondary objective was to construct a simple multifactorial model for hip fracture prediction over a 10-year follow-up period. The study was based on the Health 2000 Survey conducted during 2000 to 2001 (men and women aged 30 years or over, n=6 035) and the Mini-Finland Health Survey conducted during 1978 to 1980 (women aged 45 years or over, n=2 039). Study subjects participated in health interviews and comprehensive health examination. In the Health 2000 Survey, bone strength was assessed by means of calcaneal quantitative ultrasound (QUS). The follow-up information about hip fractures was drawn from the National Hospital Discharge Register. In this study, age, weight, height, serum 25-hydroxyvitamin D (S-25(OH)D), physical activity, smoking and alcohol consumption as well as menopause and eventual HRT in women were found to be associated with calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS). Parity was associated with a decreased risk of hip fracture in postmenopausal women. Age, height, weight or waist circumference, quantitative ultrasound index (QUI), S-25(OH)D and fall-related factors, such as maximal walking speed, Parkinson’s disease, and the number of prescribed CNS active medication were significant independent predictors of hip fracture. At the population level, the incremental value of QUS appeared to be minor in hip fracture prediction when the fall-related risk factors were taken into account. A simple multifactorial model for hip fracture prediction presented in this study was based on readily available factors (age, gender, height, waist circumference, and fallrelated factors). Prospective studies are needed to test this model in patient-based study populations.

Association between dietary phyto-oestrogens and bone density in men and postmenopausal women

Phyto-oestrogens have been associated with a decreased risk for osteoporosis, but results from intervention and observational studies in Western countries have been inconsistent. In the present study, we investigated the association between habitual phyto-oestrogen intake and broadband ultrasound attenuation (BUA) of the calcanaeum as a marker of bone density. We collected 7 d records of diet, medical history and demographic and anthropometric data from participants (aged 45–75 years) in the European Prospective Investigation into Cancer-Norfolk study. Phyto-oestrogen (biochanin A, daidzein, formononetin; genistein, glycitein; matairesinol; secoisolariciresinol; enterolactone; equol) intake was determined using a newly developed food composition database. Bone density was assessed using BUA of the calcanaeum. Associations between bone density and phyto-oestrogen intake were investigated in 2580 postmenopausal women who were not on hormone replacement therapy and 4973 men. Median intake of total phyto-oestrogens was 876 (interquartile range 412) μg/d in postmenopausal women and 1212 (interquartile range 604) μg/d in men. The non-soya isoflavones formononetin and biochanin A were marginally significant or significantly associated with BUA in postmenopausal women (β = 1·2; P < 0·1) and men (β = 1·2; P < 0·05), respectively; enterolignans and equol were positively associated with bone density in postmenopausal women, but this association became non-significant when dietary Ca was added to the model. In the lowest quintile of Ca intake, soya isoflavones were positively associated with bone density in postmenopausal women (β = 1·4; P < 0·1). The present results therefore suggest that non-soya isoflavones are associated with bone density independent of Ca, whereas the association with soya or soya isoflavones is affected by dietary Ca.

Congenital Chagas disease: time to screen pregnant women?

The congenital transmission of Trypanosoma cruzi has gained epidemiological importance because it is partially responsible for the spread of Chagas disease worldwide. The feasibility of a cure when infected children are treated early makes the detection of congenital infection a valuable goal toward the control of the disease. Here, the authors review and discuss the findings of Bua et al., who quantified the parasitemia of infected women and their newborns by quantitative PCR. The authors demonstrate that the maternal parasite burden is directly related to the risk of neonatal infection. This study points out the importance of a quantitative screen for T. cruzi in pregnant women who live in, or have traveled to, endemic areas for improving the diagnosis of infected newborns and providing prompt treatment.

Neue Methoden zur Darstellung von Blockcopolymeren unter Beteiligung radikalischer Polymerisationsmechanismen

Im Rahmen dieser Dissertation wurden die Synthese und die Charakterisierung verschiedener, zum Teil neuartiger Blockcopolymere beschrieben, wobei die Einbeziehung radikalischer Polymeri-sationsmechanismen den konzeptionellen Kern ausmachte. Mit einer auf die jeweilige Kombination von Monomeren zugeschnittenen Syntheseroute gelang die Verknüpfung von Segmenten, die allein mittels der herkömmlich zur Synthese von Blockcopolymeren genutzten, ionischen Mechanismen nur mit hohem Aufwand oder gar nicht zu verbinden sind. Auf materieller Seite stand die Herstellung amphiphiler Strukturen im Vordergrund. Diese wurden entweder direkt beim Aufbau der Blockcopo-lymere oder nach anschließender polymeranaloger Umsetzung eines ihrer Segmente erhalten. Solche amphiphilen Substanzen besitzen aufgrund ihrer Grenzflächenaktivität Anwendungspotential z. B. als Stabilisatoren in der Dispersionspolymerisation oder als Flokkulantien. Es wurden drei Verfahren zum Aufbau von Blockcopolymeren untersucht:1. Die Transformation von anionischer zu freier radikalischer Polymerisation für die Synthese von Polystyrol-b-poly(N-vinylformamid) (PS-b-P(VFA)).2. Die Transformation von anionischer zu kontrollierter radikalischer Polymerisation (ATRP) für den Aufbau von Blockcopolymeren aus Poly(dimethylsiloxan) PDMS und Segmenten von t-Butylacrylat (t-BuA) bzw. (2-(Trimethylsiloxy)ethyl)methacrylat (TMS-HEMA).3. Die kontrollierte radikalische Polymerisation unter Einsatz von Triazolinyl als Gegenradikal zur Synthese von Poly[(2-(trimethylsiloxy)ethyl)methacrylat]-b-polystyrol (P(TMS-HEMA)-b-PS) als alternative Route zur anionischen Polymerisation.

La qualità in interpretazione

Il presente lavoro di tesi passa in rassegna gli articoli scritti nell’arco dell’ultimo decennio, ovvero dal 2004 al 2014, sulla questione della Qualità in Interpretazione, con lo scopo di tracciare una panoramica relativa agli ultimi progressi compiuti nel suddetto campo d’indagine.

Quality in emergency departments: a study on 3,285,440 admissions

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

Desigualdades de género en mercado de trabajo argentino (1955-2003)

El presente artículo analiza, desde una perspectiva económica, diferentes formas en que se manifiestan las desigualdades de género en el mercado de trabajo argentino entre 1995 y 2003. Este período, signado por dos modelos macroeconómicos diferentes (el de la Convertibilidad y el posterior a la devaluación del peso); sin embargo, se caracteriza por un desempleo elevado y persistente. En síntesis, este artículo resaltará las relaciones entre género y mercado de trabajo Con este objetivo se examina información cuantitativa proveniente de la Base de Usuarios Ampliada (BUA) de la Encuesta Permanente de Hogares (EPH) correspondiente al total de aglomerados urbanos.

Desigualdades de género en mercado de trabajo argentino (1955-2003)

El presente artículo analiza, desde una perspectiva económica, diferentes formas en que se manifiestan las desigualdades de género en el mercado de trabajo argentino entre 1995 y 2003. Este período, signado por dos modelos macroeconómicos diferentes (el de la Convertibilidad y el posterior a la devaluación del peso); sin embargo, se caracteriza por un desempleo elevado y persistente. En síntesis, este artículo resaltará las relaciones entre género y mercado de trabajo Con este objetivo se examina información cuantitativa proveniente de la Base de Usuarios Ampliada (BUA) de la Encuesta Permanente de Hogares (EPH) correspondiente al total de aglomerados urbanos.

Desigualdades de género en mercado de trabajo argentino (1955-2003)

El presente artículo analiza, desde una perspectiva económica, diferentes formas en que se manifiestan las desigualdades de género en el mercado de trabajo argentino entre 1995 y 2003. Este período, signado por dos modelos macroeconómicos diferentes (el de la Convertibilidad y el posterior a la devaluación del peso); sin embargo, se caracteriza por un desempleo elevado y persistente. En síntesis, este artículo resaltará las relaciones entre género y mercado de trabajo Con este objetivo se examina información cuantitativa proveniente de la Base de Usuarios Ampliada (BUA) de la Encuesta Permanente de Hogares (EPH) correspondiente al total de aglomerados urbanos.

Analysis of ferromanganiferous sedimentary rocks from Timor

Seven manganese nodules, eight ferromanganiferous shales from the Cretaceous Wai Bua Formation of Timor, and a pelagic limestone with four ferromanganese enriched layers from the Middle Eocene of Timor have been analysed. The nodules are compared with modern deep-sea nodules, and the ferromanganiferous shales are contrasted with relatively shallow marine manganiferous shales. The conclusion is reached that these rocks from Timor were probably deposited in a bathypelagic environment. There is a total absence of any indication that volcanic material has contributed to these deposits. The chemical composition of the ferromanganiferous rocks are discussed and some indications of biogenic influences are noted. The Middle Eocene pelagic limestone is compared with a similar modern sediment described from the Easter Island Rise in the Pacific.