Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: Identification of ecologically relevant pharmaceuticals

The impact of effluent wastewaters from four different hospitals: a university (1456 beds), a general (350 beds), a pediatric (110 beds) and a maternity hospital (96 beds), which are conveyed to the same wastewater treatment plant (WWTP), was evaluated in the receiving urban wastewaters. The occurrence of 78 pharmaceuticals belonging to several therapeutic classes was assessed in hospital effluents and WWTP wastewaters (influent and effluent) as well as the contribution of each hospital in WWTP influent in terms of pharmaceutical load. Results indicate that pharmaceuticals are widespread pollutants in both hospital and urban wastewaters. The contribution of hospitals to the input of pharmaceuticals in urban wastewaters widely varies, according to their dimension. The estimated total mass loadings were 306 g d− 1 for the university hospital, 155 g d− 1 for the general one, 14 g d− 1 for the pediatric hospital and 1.5 g d− 1 for the maternity hospital, showing that the biggest hospitals have a greater contribution to the total mass load of pharmaceuticals. Furthermore, analysis of individual contributions of each therapeutic group showed that NSAIDs, analgesics and antibiotics are among the groups with the highest inputs. Removal efficiency can go from over 90% for pharmaceuticals like acetaminophen and ibuprofen to not removal for β-blockers and salbutamol. Total mass load of pharmaceuticals into receiving surface waters was estimated between 5 and 14 g/d/1000 inhabitants. Finally, the environmental risk posed by pharmaceuticals detected in hospital and WWTP effluents was assessed by means of hazard quotients toward different trophic levels (algae, daphnids and fish). Several pharmaceuticals present in the different matrices were identified as potentially hazardous to aquatic organisms, showing that especial attention should be paid to antibiotics such as ciprofloxacin, ofloxacin, sulfamethoxazole, azithromycin and clarithromycin, since their hazard quotients in WWTP effluent revealed that they could pose an ecotoxicological risk to algae.

Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital

OBJETIVO: Comparar os resultados maternos e neonatais em mulheres de baixo risco atendidas em centro de parto normal peri-hospitalar e hospital. MÉTODOS: Estudo transversal com amostra representativa de mulheres de baixo risco atendidas em São Paulo, SP, de 2003 a 2006. Foram incluídas 991 mulheres que tiveram o parto no centro de parto normal e 325 que deram à luz no hospital. Os dados foram obtidos dos prontuários. A análise comparativa foi realizada para o total de mulheres e estratificada segundo a paridade. Foram aplicados os testes qui-quadrado e exato de Fisher. RESULTADOS: Houve distribuição homogênea das mulheres segundo a paridade (45,4% nulíparas e 54,6% mulheres com um ou mais partos anteriores). Foram encontradas diferenças estatisticamente significantes em relação às seguintes intervenções: amniotomia (mais freqüente entre nulíparas do hospital); utilização de ocitocina no trabalho de parto e utilização de analgésico no pós-parto (mais freqüentes no hospital entre as mulheres de todas as paridades). A taxa de episiotomia foi maior entre as nulíparas, tanto no centro de parto como no hospital. Houve maior freqüência de intervenções com o neonato no hospital: aspiração das vias aéreas superiores, aspiração gástrica, lavagem gástrica, oxigênio por máscara aberta. Também ocorreram com mais freqüência no hospital bossa serossanguínea, desconforto respiratório e internação na unidade neonatal. Não houve diferença nos valores de Apgar no quinto minuto nem casos de morte materna ou perinatal. CONCLUSÕES: A assistência no centro de parto normal foi realizada com menos intervenções e com resultados maternos e neonatais semelhantes aos do hospital.

Capacity sharing and stealing in serverbased real-time systems

A dynamic scheduler that supports the coexistence of guaranteed and non-guaranteed bandwidth servers is proposed. Overloads are handled by an efficient reclaiming of residual capacities originated by early completions as well as by allowing reserved capacity stealing of non-guaranteed bandwidth servers. The proposed dynamic budget accounting mechanism ensures that at a particular time the currently executing server is using a residual capacity, its own capacity or is stealing some reserved capacity, eliminating the need of additional server states or unbounded queues. The server to which the budget accounting is going to be performed is dynamically determined at the time instant when a capacity is needed. This paper describes and evaluates the proposed scheduling algorithm, showing that it can efficiently reduce the mean tardiness of periodic jobs. The achieved results become even more significant when tasks’ computation times have a large variance.

Qualidade percebida e satisfação dos pacientes nos meios complementares de diagnóstico e terapêutica do serviço de oftalmologia do Hospital CUF Descobertas/Centro Hospitalar de Lisboa Central, EPE: um contributo para a validação de um questionário

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Impact of urban atmospheric environment on hospital admissions in the elderly

OBJECTIVE: To analyze the impact of intra-urban atmospheric conditions on circulatory and respiratory diseases in elder adults. METHODS: Cross-sectional study based on data from 33,212 hospital admissions in adults over 60 years in the city of São Paulo, southeastern Brazil, from 2003 to 2007. The association between atmospheric variables from Congonhas airport and bioclimatic index, Physiological Equivalent Temperature, was analyzed according to the district's socioenvironmental profile. Descriptive statistical analysis and regression models were used. RESULTS: There was an increase in hospital admissions due to circulatory diseases as average and lowest temperatures decreased. The likelihood of being admitted to the hospital increased by 12% with 1ºC decrease in the bioclimatic index and with 1ºC increase in the highest temperatures in the group with lower socioenvironmental conditions. The risk of admission due to respiratory diseases increased with inadequate air quality in districts with higher socioenvironmental conditions. CONCLUSIONS: The associations between morbidity and climate variables and the comfort index varied in different groups and diseases. Lower and higher temperatures increased the risk of hospital admission in the elderly. Districts with lower socioenvironmental conditions showed greater adverse health impacts.

A decisão técnica num serviço de radiologia de urgência hospitalar: o caso dos técnicos de radiologia do Hospital de São José (Centro Hospitalar de Lisboa — Zona Central)

Mestrado em Intervenção Sócio-Organizacional na Saúde - Ramo de especialização: Políticas de Administração e Gestão de Serviços de Saúde

Interação medicamentosa associada à reinternação hospitalar: estudo retrospectivo em um hospital geral

OBJETIVO: Analisar a relação entre interação medicamentosa potencial e reinternação hospitalar. MÉTODOS: Estudo retrospectivo com 1.487 pacientes maiores de 18 anos admitidos em um hospital geral em Vitória da Conquista, BA, de janeiro a dezembro de 2007. Os dados foram extraídos da Autorização de Internação Hospitalar do Sistema de Informação Hospitalar do Sistema Único de Saúde. O relacionamento probabilístico foi empregado para combinar múltiplas autorizações de uma mesma internação em um único registro e para identificar readmissões. Informações sobre prescrições foram agregadas manualmente aos registros do Sistema de Informação Hospitalar. Regressão logística foi utilizada para quantificar a influência de interação medicamentosa potencial e reinternação. Regressão de Cox foi empregada para testar a influência dessa variável no tempo até a primeira reinternação. RESULTADOS: Foram identificadas 99 readmissões (7% dos pacientes). Interação medicamentosa potencial foi encontrada em 35% das prescrições analisadas. Pacientes com potencial de interação medicamentosa na admissão prévia foram mais propensos à reinternação. A razão de chance ajustada indicou que esses pacientes tinham chance 2,4 vezes maior de readmissão; a taxa de risco ajustada mostrou que em pacientes com interação medicamentosa esse risco foi 79% maior (p < 0,01). CONCLUSÕES: Os resultados encontrados neste trabalho sugerem associação entre exposição à interação em internação prévia e risco aumentado de reinternação. Os profissionais de saúde devem atentar para os riscos potenciais de certas combinações medicamentosas e monitorar cuidadosamente pacientes em maior risco, como aqueles com insuficiência renal ou idosos.

Differences of absorptive capacity between firms within a cluster

Firms located within a cluster have access to tacit, complex and specific local knowledge which allow them to develop competitive advantage. However, firms have no equal ability to access and to apply that knowledge, meaning that not all have a similar knowledge absorptive capacity. Using a sample of the largest Portuguese firms within a footwear cluster, this paper examine whether there are significant differences in firm’s absorptive capacity and whether such differences within a cluster are related to firms’ specific characteristics. The results suggest that absorptive capacity is significantly associated with the firms’ characteristics, namely size, export intensity and position within the cluster.

Eventos adversos a medicamentos em hospital terciário: estudo piloto com rastreadores

OBJETIVO : Estimar a frequência e caracterizar os eventos adversos a medicamentos em hospital de cuidados terciários. MÉTODOS : Revisão retrospectiva de 128 prontuários de hospital do Rio de Janeiro, em 2007, representando 2.092 pacientes. A ferramenta utilizada foi uma lista de rastreadores, como antídotos, análises laboratoriais com resultados anormais, suspensão brusca de medicação e outros. Foi extraída amostra aleatória simples daqueles pacientes com 15 anos ou mais de idade. Foram excluídos pacientes oncológicos e da obstetrícia, e os internados por menos de 48 horas ou na emergência. Os pacientes com e sem eventos adversos a medicamentos foram comparados quanto a características sociais, demográficas e de doenças, para testar as diferenças entre os grupos. RESULTADOS : Cerca de 70,0% dos prontuários apresentaram no mínimo um rastreador. A capacidade dos rastreadores de identificar eventos adversos a medicamentos foi 14,4%. A incidência de eventos adversos a medicamentos foi 26,6/100 pacientes. Foram identificados um ou mais eventos em 15,6% dos pacientes. O tempo mediano de permanência hospitalar foi 35,2 dias para os pacientes com eventos adversos a medicamentos e 10,7 dias para os demais (p < 0,01). As classes de medicamentos mais envolvidos foram as que atuam sobre o aparelho cardiovascular e sobre o sistema nervoso, e os do trato digestivo e metabolismo. Os fármacos mais imputados foram: tramadol, dipirona, glibenclamida e furosemida. Do total de eventos, 82,0% contribuíram ou provocaram danos temporários ao paciente e demandaram intervenção, e 6,0% podem ter contribuído para o óbito do paciente. Estima-se que o hospital apresente, anualmente, 131 eventos de sonolência e lipotimia, 33 quedas e 33 hemorragias potencialmente associados aos medicamentos. CONCLUSÕES : Quase 1/6 dos pacientes internados apresentou um evento adverso a medicamentos (16,0%). A ferramenta estudada pode ser útil como técnica de monitoramento e avaliação do resultado dos cuidados aos pacientes internados. A revisão da terapia com psicotrópicos merece ser feita, dada a frequência de eventos associados, como sedação excessiva, letargia, queda e hipotensão.

A capacity sharing and stealing strategy for open real-time systems

This paper focuses on the scheduling of tasks with hard and soft real-time constraints in open and dynamic real-time systems. It starts by presenting a capacity sharing and stealing (CSS) strategy that supports the coexistence of guaranteed and non-guaranteed bandwidth servers to efficiently handle soft-tasks’ overloads by making additional capacity available from two sources: (i) reclaiming unused reserved capacity when jobs complete in less than their budgeted execution time and (ii) stealing reserved capacity from inactive non-isolated servers used to schedule best-effort jobs. CSS is then combined with the concept of bandwidth inheritance to efficiently exchange reserved bandwidth among sets of inter-dependent tasks which share resources and exhibit precedence constraints, assuming no previous information on critical sections and computation times is available. The proposed Capacity Exchange Protocol (CXP) has a better performance and a lower overhead when compared against other available solutions and introduces a novel approach to integrate precedence constraints among tasks of open real-time systems.

Capacity sharing and stealing in dynamic server-based real-time systems

This paper proposes a dynamic scheduler that supports the coexistence of guaranteed and non-guaranteed bandwidth servers to efficiently handle soft-tasks’ overloads by making additional capacity available from two sources: (i) residual capacity allocated but unused when jobs complete in less than their budgeted execution time; (ii) stealing capacity from inactive non-isolated servers used to schedule best-effort jobs. The effectiveness of the proposed approach in reducing the mean tardiness of periodic jobs is demonstrated through extensive simulations. The achieved results become even more significant when tasks’ computation times have a large variance.

The capacity exchange protocol

This paper proposes a new strategy to integrate shared resources and precedence constraints among real-time tasks, assuming no precise information on critical sections and computation times is available. The concept of bandwidth inheritance is combined with a capacity sharing and stealing mechanism to efficiently exchange bandwidth among tasks to minimise the degree of deviation from the ideal system’s behaviour caused by inter-application blocking. The proposed Capacity Exchange Protocol (CXP) is simpler than other proposed solutions for sharing resources in open real-time systems since it does not attempt to return the inherited capacity in the same exact amount to blocked servers. This loss of optimality is worth the reduced complexity as the protocol’s behaviour nevertheless tends to be fair and outperforms the previous solutions in highly dynamic scenarios as demonstrated by extensive simulations. A formal analysis of CXP is presented and the conditions under which it is possible to guarantee hard real-time tasks are discussed.

The quest for a balanced manpower capacity: different flexibility strategies examined

To cope with permanent fluctuations in demand, organizations are challenged to organize their manpower capacity in a flexible way. Different strategies of manpower planning are being used for this purpose. Using data from the 2002 Panel Survey of Organisations Flanders, we first verify to what extent temporal, contractual and functional flexibility strategies are applied in Flemish organizations. Subsequently, logistic regression is used to analyse the link between these flexible work strategies and a ‘fitting manpower capacity’. While the results show a negative association between the use of temporal or contractual flexibility measures and a balanced manpower capacity, functional flexibility seems to be positively related. The different logics in which numerical and functional flexibility proceed can be labeled as ‘curative’ versus ‘preventive’ strategies of flexibility. Further analyses discern between various interpretations of functional flexibility and assess whether different team types make a contribution to a fitting manpower capacity.

Shared resources and precedence constraints with capacity sharing and stealing

This paper proposes a new strategy to integrate shared resources and precedence constraints among real-time tasks, assuming no precise information on critical sections and computation times is available. The concept of bandwidth inheritance is combined with a greedy capacity sharing and stealing policy to efficiently exchange bandwidth among tasks, minimising the degree of deviation from the ideal system's behaviour caused by inter-application blocking. The proposed capacity exchange protocol (CXP) focus on exchanging extra capacities as early, and not necessarily as fairly, as possible. This loss of optimality is worth the reduced complexity as the protocol's behaviour nevertheless tends to be fair in the long run and outperforms other solutions in highly dynamic scenarios, as demonstrated by extensive simulations.

Does 6-minutes walk test predict functional capacity in elderly people?

Portugal has an accentuated aging tendency, presenting an elderly population (individuals with more than 65 years old) of 19.2%. The average life expectancy is 79.2 years. Thus, it’s important to maintain autonomy and independency as long as possible. Functional ability concept rises from the need to evaluate the capacity to conduct daily activities in an independent way. It can be estimated with the 6-minute walk test (6MWT) and other validated test. This test is simple, reliable, valid and consists in a daily activity (walk). The goals of this study was to verify associations between functional capacity measured with two different instruments (6MWT and Composite Physical Function (CPF) scale) and between those results and characterization variables.