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.

Corporate social responsibility reporting: The case of Portuguese hospitals

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

Pro poor tourism for community development on Atauro Island, Timor-Leste

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

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.

A CSR communication strategy for Continente: Improving brand image and reinforcing local community bonds

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The impact of online brand community on electronic word-of-mouth communications

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Da assistência aos pobres aos cuidados de saúde primários em Portugal : o papel da enfermagem : 1926-2002

RESUMO - Este estudo analisa a forma como os cuidados de saúde não hospitalares e a enfermagem comunitária, se desenvolveram e se influenciaram mutuamente, no período 1926-2002. Trata-se de um estudo histórico que recorre a fontes escritas, imagéticas e orais, e utiliza conceções do novo institucionalismo e os conceitos de poder e biopoder de Foucault, para investigar este processo. Apresenta e analisa as origens destes cuidados e da enfermagem comunitária, o modo como se institucionalizaram e como evoluíram. A criação e desenvolvimento dos cuidados de saúde não hospitalares foram acompanhados pela individualização da enfermagem comunitária. As políticas e práticas dos cuidados de saúde primários e da enfermagem comunitária apresentam uma clara dependência do percurso já realizado. A sua génese está ligada a práticas de caridade cristã de assistência aos mais pobres liderada pelas Misericórdias e ordens religiosas. O novo entendimento sobre o papel do Estado relativamente à saúde conduziu à criação de instituições não hospitalares e à diferenciação da enfermagem comunitária. Assinale-se como momentos positivos para enfermeiros e instituições a formação das visitadoras sanitárias, apoio à formação em saúde pública pela Fundação Rockefeller, a criação de instituições corporativas, privadas e públicas de cuidados não hospitalares, a reforma de 1971 e o movimento dos CSP. As políticas institucionais condicionaram o próprio desenvolvimento e o da enfermagem comunitária, devido aos estereótipos associados ao papel da mulher, à multiplicidade e disparidade de formações e às visões divergentes sobre o que era a enfermagem comunitária. Este processo de desenvolvimento entretecido entre enfermagem comunitária e CSP apresenta influências e contributos mútuos. Os cuidados de saúde não hospitalares proporcionaram aos enfermeiros formação, desenvolvimento profissional, oportunidade de uma intervenção diversificada e com elevado grau de autonomia. Já estes trouxeram aproximação à comunidade, atenção especial aos mais vulneráveis, criatividade, capacidade de adaptação perante condições adversas, contribuindo para a visibilidade e relevância afetiva dos CSP.

The impact of Ireland’s current Mental Health Policy on the profile of community mental Health Services

RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------ABSTRACT: In 2006, a new Government policy for mental health “A Vision for Change” was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning “Vision for Change” into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between „staff views‟ and „advocate views‟ on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Preliminary study of community-acquired Staphylococcus aureus infection in Manaus Hospital, Amazonia Region, Brazil

Methicillin resistant Staphylococcus aureus is considered a public health problem with a strong potential for dissemination and high rates of morbidity and mortality. In this study we describe bacteriological and epidemiological characteristics of Staphylococcus aureus in Manaus (Amazon region). During the one-year study period (2000-2001), sixteen cases of acute pyogenic multiple abscess were evaluated. Community-acquired S. aureus was identified as causative agent in 10 (62.5%) patients. The strains tested with antimicrobials by discs diffusion method, exhibited a high rate of sensitivity to cephalexin (100%), erythromycin (90%). Oxacillin-susceptible Staphylococcus aureus was 90%. No isolate was resistant to Vancomycin. To our knowledge, no series of community-acquired Staphylococcus aureus in Manaus hospital has been published. Our partial results showed a high rate of antimicrobial sensitivity among community-acquired Staphylococcus aureus in the hospital of Tropical Medicine Institute of Manaus, Amazon Region.

Nosocomial Mycobacterium tuberculosis transmission among healthcare students in a high incidence region, in Vitória, State of Espírito Santo

This open comparative study for evaluating hypersensitivity to tuberculin among medical students (n=441), nursing students (n=178) and economics students (n=230) in Vitória, State of Espírito Santo, had the aim of assessing whether the prevalence of positive tuberculin tests among healthcare students could be used as a sentinel event for nosocomial transmission in localities with high endemicity. There was a significant change in the frequency of purified protein derivative reactivity in the nursing students (20. 3%) and medical students (18. 4%), in comparison with the economics students (6%) (p <0. 001). As expected, the medical and nursing students had more knowledge about tuberculosis than did the economics students (p <0. 001). Our data suggest that the incidence of Mycobacterium tuberculosis infection among nursing and medical students in our region, which has high endemicity of tuberculosis, does not differ from what is found in low-incidence countries. These data reinforce the need for implementing biosafety programs for this target population.

Problems and perspectives for Chagas disease control: in search of a realistic analysis

Chagas disease was an important medical and social problem in almost all of Latin America throughout the twentieth century. It has been combated over a broad swath of this continent over recent decades, with very satisfactory results in terms of vector and transfusional transmission. Today, a surveillance stage still remains to be consolidated, in parallel with appropriate care required for some millions of infected individuals who are today living in endemic and non-endemic areas. Contradictorily, the good results attained have generated excessive optimism and even disregard among health authorities, in relation to this disease and its control. The loss of visibility and priority may be a logical consequence, particularly in Latin American healthcare systems that are still disorganized and overburdened due to insufficiencies of financial and human resources. Consolidation of the victories against Chagas disease is attainable but depends on political will and continual attention from the most consequential protagonists in this struggle, especially the Latin American scientific community.

Enrichment of a PHA producing microbial community in a continuous bioreactor setup

Polyhydroxyalkanoates (PHAs) are biosynthetic polyesters, biodegradable and biocompatible making them of great interest for industrial purposes. The use of low value substrates with mixed microbial communities (MMC) is a strategy currently used to decrease the elevated PHA production costs. PHA production process requires an important step for selection and enrichment of PHA-storing microorganisms which is usually carried out in a Sequencing Batch Reactor (SBR). The aim of this study was to optimize the PHA accumulating culture selection stage using a 2-stage Continuous Stirrer Tank Reactor (CSTR) system. The system was composed by two separate feast and famine bioreactors operated continuously, mimicking the feast and famine phases in a SBR system. Acetate was used as carbon source and biomass seed was highly enriched in Plasticicumulans acidivorans obtained from activated sludge. The system was operated under two different sets of conditions (setup 1 and 2), maintaining a system total retention time of 12 hours and an OLR of 2.25 Cmmol/L.h-1. An average PHB-content of 3.3 % wt was obtained in setup 1 and 4.8% wt in setup 2. Several other experiments were performed in order to better understand the continuous system behaviour, using biomass from the continuous system. With the fed-batch experiment a maximum of 8.1% PHB was stored and the maximum substrate uptake and specific growth rates obtained in the growth experiment (1.15 Cmol Cmol-1.h-1 and 0.53 Cmol Cmol-1.h-1) were close to the ones from continuous system (1.12 Cmol Cmol-1.h-1 and 0.59 Cmol Cmol-1.h-1). The microbial community was characterized trough microscopic visualization, Denaturing Gradient Gel Electrophoresis (DGGE) analysis and Fluorescent in situ hybridization (FISH). The last studied performed mimicked the continuous system by building up a SBR system with all the same operational conditions while adding an extra acetate dosage during the 12 h cycle, simulating the substrate passing from the feast to the famine reactors under continuous operation. It was shown that possibly the continuous system was not able to efficiently select for PHB storing organisms under the operational conditions imposed, although the selected culture was capable of consuming the substrate and grow fast. This main conclusion might have resulted from two major factors affecting the system performance: the ammonium concentration in the Feast reactor and the amount of substrate leaching from the Feast to the Famine reactor.

O contributo da farmácia comunitária no envelhecimento ativo

RESUMO: A população mundial está a envelhecer de forma sustentada. O setor das farmácias em Portugal está a passar por um conjunto de alterações que conduzirá a uma ação mais interventiva ao nível da prestação de cuidados de saúde. Deste modo delineou-se um estudo descritivo, transversal e exploratório sem intervenção, de carácter qualitativo e quantitativo que compara diferentes grupos etários com o objectivo de compreender melhor o papel do farmacêutico no âmbito do envelhecimento das populações. Pretendemos assim optimizar práticas e serviços que podem ser realizados nas farmácias e alertar os utentes, para gerir melhor a sua condição de saúde, sensibilizando-os para o próprio processo de envelhecimento. Como principais resultados destacamos o papel de intervenção crucial da farmácia, quer pela sua acessibilidade quer pela contribuição que pode ter para a condição de saúde das populações. Pela amostra estudada em 100% das farmácias são feitos despistes e controlo da hipertensão arterial e hipercolesterolemia, factores fundamentais no controlo da aterosclerose e das doenças cardiovasculares. Podemos ainda concluir que a farmácia pode ser o elemento de otimização, revisão e reconciliação das terapêuticas dos resistentes em lares e ao domicílio, junto da população 65+. Em termos das pessoas idosas, o nosso estudo indicia que, apesar da crise sócio económica dos últimos anos, continuam a tomar os medicamentos mais essenciais, o que se relaciona com a política do medicamento implementada. Este trabalho pretende também, contribuir para o desenvolvimento de uma rede de competências da farmácia ao nível do envelhecimento ativo, podendo ser uma oportunidade futura.--------------ABSTRACT: World population is getting older in a sustained way. Portuguese community pharmacies are going through a change process, leading to a higher intervention in healthcare delivery. The study designed is descriptive, transversal and exploratory, with no intervention, with a qualitative and quantitative component that compares different age groups. The purpose is to better understand pharmacists’ role in population aging. One of our main goals is to optimize practices and services with potential to be performed in pharmacies and aware patients to better manage their health, becoming more conscious of their aging process. As main results we highlight the intervention of pharmacies, not only by its accessibility but also sustained on the unique contribution pharmacies deliver in the best benefit of populations’ health condition. In the sample studied, 100% of pharmacies perform screening and vigilance of hypertension and hypercholesterolemia, essential for the control of atherosclerosis and cardiovascular diseases. We may also determine the importance of pharmacies intervention over therapeutics optimization, revision and reconciliation in nursing homes and in domicile, mostly focusing patients over 65. In what concerns to elderly population our study indicates that, despite social and economic crises of recent years, the elderly keeps taking its essential medicines, which is related with medicines politics implemented at the present moment. This project intends to pay a relevant contribution to the development of a group of core competencies in pharmacies, related to the promotion of an active and healthy aging process, which represents an important future opportunity for Portuguese Pharmacies.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal:

Methicillin-resistant Staphylococcus aureus (MRSA), a human pathogen confined to hospitals (HAMRSA) for over 30 years have been emerging worldwide in the last two decades as a leading cause of severe infections in healthy individuals in the community (CA-MRSA). Despite its clinical significance, in the beginning of our studies no information existed on the prevalence, and population structure of CA-MRSA in Portugal. Moreover, it remained to be clarified how CA-MRSA emerged in our country. In particular, it was not known if CA-MRSA emerged locally by acquisition of the staphylococcal cassette chromosome mec (SCCmec) by established methicillin-susceptible S. aureus (MSSA) in the community, if they were imported from abroad or have escaped from the hospital.(...)