PREVALENCE OF ANTI- Toxocara ANTIBODIES IN A RANDOM SAMPLE OF INPATIENTS AT A CHILDREN'S HOSPITAL IN VIT��RIA, ESP��RITO SANTO, BRAZIL

In the streets of Vit��ria, in the State of Esp��rito Santo, Brazil, are large number of stray dogs, many of which are infected with Toxocara canis, suggesting a high risk for human infection. In order to investigate the prevalence of Toxocara infection in children in Esp��rito Santo we studied the prevalence of anti-Toxocara antibodies in 100 random inpatients over one year of age, at the Children's Hospital N.S. da Gl��ria, the reference children's hospital for the State.All the sera were collected during the period between October 1996 and January 1997. The mean age was 6.6��4.1 yrs. (1 to 14 yrs., median 6yrs.) and there were patients from all of the different wards of the hospital. Sixty-eigth patients came from the metropolitan area of Vit��ria and the other 32 from 17 other municipalities. The anti-Toxocara antibodies were investigated by ELISA-IgG using a secretory-excretory antigen obtained from second stage larvae. All sera were adsorbed with Ascaris suum antigen before the test. Thirty-nine sera (39%) were positive, predominantly from boys, but the gender difference was not statistically significant (boys:25/56 or 44.6%; girls:14/44 or 31.8%; p=0.311). The prevalence of positive sera was higher, but not statistically significant, in children from the urban periphery of metropolitan Vit��ria (formed by the cities of Vit��ria, Cariacica, Vila Velha, Serra and Viana) than in children from 17 other municipalities (44.1% and 28.1% respectively, p=0.190). Although the samples studied do not represent all children living in the State of Esp��rito Santo, since the Children's Hospital N.S. da Gl��ria admits only patients from the state health system, it is probable that these results indicate a high frequency of Toxocara infection in children living in Esp��rito Santo. Further studies of population samples are necessary to ascertain the prevalence of Toxocara infection in our country.

Nosocomial infection in long-term care facilities. A survey in a Brazilian psychiatric hospital

Nosocomial infection among male patients in a public psychiatric hospital was studied and the definitions for use in long-term care facilities were employed for diagnosis. The overall nosocomial infection rate was 6.7 per 1,000 day inpatients; 55.6% of these infections were identified in the respiratory tract, 50% of them being respiratory viral diseases; 38.9% of the nosocomial infections involved the eyes, ears, nose, throat and mouth, and 5.6% involved the skin and soft tissues. The epidemiological characteristics and the main clinical alterations of these inpatients were also identified.

Aplica����o de um sistema de teledermatologia no Hospital do Divino Esp��rito Santo nos A��ores : an��lise custo-efectividade

RESUMO - Nos A��ores, a telemedicina representa uma mais-valia para os seus habitantes devido �� sua dispers��o geogr��fica e aos elevados custos que as institui����es de sa��de incorrem na desloca����o dos utentes e profissionais de sa��de. A teledermatologia tem sido referenciada como uma das sub-especialidades da telemedicina, apresentando resultados semelhantes aos da consulta convencional em termos de fiabilidade e precis��o no diagn��stico. No contexto a��oriano, a teledermatologia pode ajudar a colmatar a falta de resposta por parte das institui����es de sa��de nesta especialidade, assim como poupar recursos ��s mesmas. OBJECTIVOS: Pretende-se realizar uma an��lise de custo-efectividade da teleconsulta em dermatologia no Hospital do Divino Esp��rito Santo em Ponta Delgada, na perspectiva do hospital, tendo como comparador a consulta convencional. METODOLOGIA: Realizou-se uma revis��o da literatura de estudos de custo-efectividade para averiguar os recursos que deveriam ser considerados. Os recursos identificados seriam posteriormente valorizados de acordo com os custos verificados no hospital. RESULTADOS: O custo com o transporte dos doentes representa um peso bastante elevado para o Hospital, assim como a comparticipa����o de despesas de alojamento e alimenta����o dos doentes. Dado a constante desloca����o de doentes entre as ilhas dos A��ores e o Continente, a teledermatologia apresenta-se como uma solu����o vi��vel em termos de custos e diagn��stico, comparando com a pr��tica convencional. CONCLUS��ES: Na perspectiva do Hospital, a teledermatologia permite reduzir os custos relacionados com o transporte dos doentes entre as ilhas dos A��ores e Continente, assim como despesas com alojamento e alimenta����o, considerados evit��veis. ------- ABSTRACT - In Azores, telemedicine represents an added-value for its population due to its geographic dispersion and to the high costs that health institutions incur to transport patients and health providers. Teledermatology has been highlighted as a telemedicine sub-specialty, presenting similar results comparing to the traditional consult, in terms of precision and reliability. In the Azorean context, teledermatology could help to diminish the lack of response of the health institutions on this specialty, as well as spare its resources. OBJECTIVES: In this project, is intended to carry out a cost-effectiveness analysis of the dermatology teleconsult in the Hospital do Divino Esp��rito Santo, in Ponta Delgada, on the Hospital perspective, comparing to the conventional consult. METHODOLOGY: A literature revision of cost-effectiveness studies was accomplished in order to find out what resources should be considered. The identified resources would be afterward valued according to the costs verified in the Hospital. RESULTS: The cost associated to the patient transport represents an overweight for the hospital, as well as the expenses reimbursement relating to lodging and others that patients have to incur. Due to the constant transport of patients between the Azores islands and the mainland, teledermatology constitutes a viable solution in terms of cost and diagnosis, comparing to conventional practice. CONCLUSIONS: On the Hospital perspective, teledermatology allows to reduce the costs relating to patients transport between the Azores islands and the mainland, as well as expenses with lodging and others, considered avoidable.

Give some to get some - Analysing the relationship between worker satisfaction with human resources management and perceived individual performance in a Portuguese hospital

The purpose of this study is to investigate the association between the satisfaction with HRM practices in an organization and the workers' perceived performance. We are interested in learning if indeed workers that are more satisfied with the organization���s practices will also perceive themselves as more hardworking than others, thus confirming the happy-productive worker hypothesis, from an individual perception standpoint. Data originates from a large Portuguese hospital, with a sample of 952 clinical and nonclinical hospital workers. Data was originally explored using SPSS software and later tested in AMOS software where a multiple regression model was constructed and tested. Results indicate that overall satisfaction with HRM practices are related with the workers��� perceived performance; most of the HRM satisfaction subscales also relate, except for pay and performance appraisal, that do not seem to be good predictors of the workers perceived performance. The present study is based on a single large public hospital, and thus, these findings need to be further tested in other settings. This study offers some clues regarding the areas of HRM that seem to be more related with the workers��� perceived performance, and hence provide an interesting framework for managers dealing with healthcare teams. This study contributes to the happy-productive worker hypothesis research, by including seldom used variables in the equation and taking a different perspective. Results provide new clues for investigation and practice regarding the areas of action in HRM that seem to be more prone to elicit perceived effort from the workers.

Epidemiological analysis of bacterial strains involved in hospital infection in a University Hospital from Brazil

Hospital infections cause an increase in morbidity and mortality of hospitalized patients with significant rise in hospital costs. The aim of this work was an epidemiological analysis of hospital infection cases occurred in a public University Hospital in Rio de Janeiro. Hence, 238 strains were isolated from 14 different clinical materials of 166 patients hospitalized in the period between August 1995 and July 1997. The average age of the patients was 33.4 years, 72.9% used antimicrobials before having a positive culture. The most common risk conditions were surgery (19.3%), positive HIV or AIDS (18.1%) and lung disease (16.9%). 24 different bacterial species were identified, S. aureus (21%) and P. aeruginosa (18.5%) were predominant. Among 50 S. aureus isolated strains 36% were classified as MRSA (Methicillin Resistant S. aureus). The Gram negative bacteria presented high resistance to aminoglycosides and cephalosporins. A diarrhea outbreak, detected in high-risk neonatology ward, was caused by Salmonella serovar Infantis strain, with high antimicrobial resistance and a plasmid of high molecular weight (98Mda) containing virulence genes and positive for R factor.

Biotyping, serotyping and ribotyping as epidemiological tools in the evaluation of Acinetobacter baumannii dissemination in hospital units, Sorocaba, S��o Paulo, Brazil

Dissemination of Acinetobacter baumannii strains in different units of a hospital in Sorocaba, S��o Paulo, Brazil was evaluated over a period of two years. By using biotyping, serotyping and ribotyping, 27 distinct clones were differentiated among 76 strains isolated between 1993-94, from clinical specimens of hospitalized patients. Two clones, 2:O4:A (biotype:serotype:ribotype) and 2:O29:A accounted for the majority of strains widely disseminated in the units during 1993. The introduction in the hospital setting, of a new clone, 6:O13:B, at the end of 1993 and its predominance through 1994 is discussed. Among 15 strains isolated from neonates, 6 (40%) belonged to the same clone, 2:O4:A. Interestingly, this clone was almost all recovered in neonatal intensive care unit, nursery and in pediatric unit. All strains were susceptible to imipenem and polymyxcin B. Multiresistant strains (up to 12 antimicrobial agents) accounted for 66.7% and 84.8% of the strains isolated in 1993 and in 1994, respectively.

Efici��ncia Energ��tica no Hospital Pedro Hispano

Os crescentes custos ligados ao consumo el��trico, n��o apenas de cariz financeiro mas tamb��m ambiental, despertam cada vez mais para a import��ncia da defini����o de estrat��gias de melhor utiliza����o de recursos e efici��ncia energ��tica. Esta import��ncia tem sido refor��ada pela defini����o de decretos-lei que v��m colocar metas e limites relativamente ��s despesas energ��ticas. Estes diplomas s��o tamb��m acompanhados por programas de incentivo para um setor ligado �� efici��ncia energ��tica. Em Portugal as medidas ligadas ao setor tem vindo a ser redirecionadas para o consumo final de energia, com a defini����o de metas para as instala����es de maior consumo. As instala����es hospitalares s��o grandes centros de consumo energ��tico devido n��o s�� ao elevado n��mero de utentes que recebem mas tamb��m pelos diversos tipos de equipamentos el��tricos usados para a presta����o dos servi��os m��dicos. Como consequ��ncia disso, os investimentos e os custos operacionais s��o elevados, o que refor��a a necessidade de gerir os gastos e consumos energ��ticos com a procura constante de melhoria na recolha de informa����o sobre todo o sistema e na adequa����o de interven����es com vista a uma maior efici��ncia energ��tica. O Hospital Pedro Hispano vem desde algum tempo a investir no sentido de conhecer mais e melhor toda a instala����o bem como os consumos energ��ticos a ela associados. Algumas medidas foram tomadas nesse sentido nomeadamente a instala����o de analisadores de energia, de modo a obter um retrato mais fiel e fidedigno dos principais vetores de consumo. Neste momento a gest��o t��cnica do hospital tem em an��lise uma grande parte da instala����o recolhendo dados do consumo el��trico real do hospital. Nesta disserta����o procurou-se fazer uma an��lise e enquadramento dos programas e metas ligados ao setor energ��tico com ��nfase nos diplomas que vis��o e abrangem as instala����es hospitalares. Dos v��rios programas de incentivo �� ado����o de pol��ticas de maior efici��ncia energ��tica �� dado especial destaque ao programa ECO.AP que visa a celebra����o de contratos para implementa����o de medidas de poupan��a energ��tica ao setor p��blico. Em colabora����o com o HPH, iniciaram-se os trabalhos pelo estudo e identifica����o das principais fases e ferramentas utilizadas na gest��o energ��tica do edif��cio tendo como objetivo a reavalia����o dos vetores energ��ticos j�� identificados no HPH e a cria����o e contabiliza����o de novos grupos de consumo. Atrav��s de v��rias medi����es do consumo el��trico, num total superior a 650 horas de funcionamento, foi poss��vel a cria����o do mapa de desagrega����o de consumos para o ano de 2013. A desagrega����o realizada conta com 3 novos vetores energ��ticos e com a reavalia����o do peso relativo de mais 5 grupos de consumo. Das medi����es efetuadas destaca-se a reavalia����o do consumo da central de bombagem onde a parcela considerada at�� �� data estava 3 vezes acima do valor real medido. Com base na desagrega����o feita foram apontadas e estudadas medidas de implementa����o com o objetivo de reduzir os consumos energ��tico em todo o hospital, destacando-se a solu����o apresentada para a central de bombagem. Esta medida traria um grande impacto em toda a fatura energ��tica, n��o s�� pela sua viabilidade, mas tamb��m porque atuaria num grande centro de consumo onde at�� ao momento nenhuma a����o do g��nero foi implementada.

The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men

Severe leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK), 3.5-5 mEq/L (normoK) and above 5 mEq/L (hyperK) were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1% in the hypoK, 14.7% in the normoK and 47.1% in the hyperK group (p = 0.002). In a logistic regression model (normoK as referent), including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR) = 0.80; p > 0.1). On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021). In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death.

Evaluation of surrogate markers for human immunodeficiency virus infection among blood donors at the blood bank of "Hospital Universit��rio Regional Norte do Paran��", Londrina, PR, Brazil

This study evaluated the usefulness of the anti-HBc, hepatitis C virus antibodies (anti-HCV), human T cell lymphotropic virus I and II antibodies (anti-HTLV I/II), serologic tests for syphilis, and surface antigen of hepatitis B virus (HBsAg) as surrogate markers for the risk for HIV infection in 80,284 serum samples from blood donors from the Blood Bank of "Hospital Universit��rio Regional Norte do Paran��", Londrina, Paran�� State, Brazil, analyzed from July 1994 to April 2001. Among 39 blood donors with positive serology for HIV, 12 (30.8%) were anti-HBc positive, 10 (25.6%) for anti-HCV, 1 (2.6%) for anti-HTLV I/I, 1 (2.6%) was positive for syphilis, and 1 (2.6%) for HBsAg. Among the donors with negative serology for HIV, these markers were detected in 8,407 (10.5%), 441 (0.5%), 189 (0.2%), 464 (0.6%), and 473 (0.6%) samples, respectively. The difference was statistically significant (p < 0.001) for anti-HBc and anti-HCV. Although the predictive positive value for these surrogate markers were low for HIV infection, the results confirmed the anti-HBc and anti-HCV as useful surrogate markers for HIV infection thus reinforcing the maintenance of them in the screening for blood donors contributing to the prevention of the small number of cases in which HIV is still transmitted by transfusion.