Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to ß-lactams in two Portuguese hospitals

The post-surgical period is often critical for infection acquisition. The combination of patient injury and environmental exposure through breached skin add risk to pre-existing conditions such as drug or depressed immunity. Several factors such as the period of hospital staying after surgery, base disease, age, immune system condition, hygiene policies, careless prophylactic drug administration and physical conditions of the healthcare centre may contribute to the acquisition of a nosocomial infection. A purulent wound can become complicated whenever antimicrobial therapy becomes compromised. In this pilot study, we analysed Enterobacteriaceae strains, the most significant gram-negative rods that may occur in post-surgical skin and soft tissue infections (SSTI) presenting reduced β-lactam susceptibility and those presenting extended-spectrum β-lactamases (ESBL). There is little information in our country regarding the relationship between β-lactam susceptibility, ESBL and development of resistant strains of microorganisms in SSTI. Our main results indicate Escherichia coli and Klebsiella spp. are among the most frequent enterobacteria (46% and 30% respectively) with ESBL production in 72% of Enterobacteriaceae isolates from SSTI. Moreover, coinfection occurred extensively, mainly with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (18% and 13%, respectively). These results suggest future research to explore if and how these associations are involved in the development of antibiotic resistance.

Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors

OBJECTIVE: To examine the prevalence of body dissatisfaction and associated factors in 8- to 11-year-old schoolchildren. METHODS: A cross-sectional study including children aged 8- to 11-years enrolled in public and private schools in Porto Alegre, Southern Brazil, was carried out from August to December, 2001. A total of 901 subjects were selected through cluster sampling. Participants answered a questionnaire aimed at measuring body dissatisfaction and self-esteem and questions about family and social pressures on weight change. Height and weight were measured. The relationship between body dissatisfaction and the variables studied was measured by logistic regression. RESULTS: The prevalence of body dissatisfaction was 82%. Fifty-five percent of the girls wanted a thinner body size, and 28% desired a larger one; the estimates for the boys were 43% and 38%, respectively. Children with the lowest self-esteem (OR=1.80; 95% CI: 1.13-2.89) and who thought their parents (OR=6.10; 95% CI: 2.95-12.60) and friends (OR=1.81; 95% CI: 1.02-3.20) expected them to be thinner showed a higher chance of presenting body dissatisfaction. CONCLUSIONS: Body dissatisfaction was highly prevalent among the evaluated schoolchildren, especially in those with lower self-esteem and who thought their parents and friends expected them to be thinner.

Motivations and management factors of volunteer work in nonprofit organisations: a literature review

The objective of this paper is to review and discuss the literature about volunteers’ motivations to donate their time to NPOs and the management factors that can influence volunteer work. Firstly, the paper illustrates and compares the different types of motivation followed by a presentation of a typology that organises the volunteers’ motivations into four types: (i) altruism, (ii) belonging, (iii) ego and social recognition and (iv) development and learning. Secondly we discuss the key management factors in volunteering: recruitment, training and rewarding. Finally, we present four gaps in the literature that justify the scope for further research: (i) omission of differences between motivations related to volunteers’ "Attraction" versus "Retention"; (ii) focus of the research on the USA, UK and Australia context; (iii) absence of comparative analyses that relate motivations by NPO types and (iv) comprehension of how management factors (recruitment, training and rewarding) influence volunteers’ satisfaction and retention.

Volunteers and management factors in nonprofit organisations: a brief literature review

The objective of this paper is to review and discuss the literature about the management factors that can influence volunteer work. First we present the different management factors. This discussion is followed by the identification of the key management factors in volunteering: recruitment, training and rewarding. Finally, we present two main gaps in the literature that justify the scope for further research: (i) how management factors (recruitment, training and rewarding) influence volunteers’ satisfaction and retention; and (ii) predominance of the investigations in the North American context, followed by English and Australian context.

Family and non-family businesses on internal factors of entrepreneurship

Small firms are a major player in development. Thus, entrepreneurship is frequently attached to these rms and it must be present in daily management of factors such as planning and cooperation. We intend to analyze these factors, comparing familiar and non-familiar businesses. This study was conducted in a Portuguese region in the north of Portugal - Vale do Sousa . The results allow us to conclude that even with some managerial di erences it was not possible to identify distinct patterns between them. The main goal of this paper is to open research lines on important issues to distinguish familiar from non-familiar businesses.

Factors influencing innovation decision making in Portuguese firms

There is an undeniable positive effect of innovation for both firms and the economy, with particular regards to the financial performance of firms. However, there is an important role of the decision making process for the allocation of resources to finance the innovation process. The aim of this paper is to understand what factors explain the decision making process in innovation activities of Portuguese firms. This is an empirical study, based on the modern theoretical approaches, which has relied on five key aspects for innovation: barriers, sources, cooperation, funding; and the decision making process. Primary data was collected through surveys to firms that have applied for innovation programmes within the Portuguese innovation agency. Univariate and multivariate statistical techniques were used. Our results suggest that the factors that mostly influence the Portuguese firms’ innovation decision-making processes are economical and financial (namely those related to profit increase and labour costs reduction).

A relação dos pais com o ensino pré-escolar: representações e envolvimento no jardim-de-infância dos seus filhos

Dissertação de Mestrado, Psicologia da Educação (Contextos Educativos), 12 de Novembro de 2010, Universidade dos Açores.

Which factors could explain the low birth weight paradox?

OBJECTIVE: Low birth weight children are unusual among well-off families. However, in Brazil, low birth weight rate was higher in a more developed city than in a less developed one. The study objective was to find out the reasons to explain this paradox. METHODS: A study was carried out in two municipalities, Ribeirão Preto (Southeastern Brazil) and São Luís (Northeastern Brazil), which low birth weight rates were 10.7% and 7.6% respectively. Data from two birth cohorts were analyzed: 2,839 newborns in Ribeirão Preto in 1994 and 2,439 births in São Luís in 1997-1998. Multiple logistic regression analysis was performed, adjusted for confounders. RESULTS: Low birth weight risk factors in São Luís were primiparity, maternal smoking and maternal age less than 18 years. In Ribeirão Preto, the associated variables were family income between one and three minimum wages, maternal age less than 18 and equal to or more than 35 years, maternal smoking and cesarean section. In a combined model including both cohorts, Ribeirão Preto presented a 45% higher risk of low birth weight than São Luís. When adjusted for maternal smoking habit, the excess risk for low birth weight in Ribeirão Preto compared to São Luís was reduced by 49%, but the confidence interval was marginally significant. Differences in cesarean section rates between both cities contributed to partially explain the paradox. CONCLUSIONS: Maternal smoking was the most important risk factor for explaining the difference in low birth weight between both cities. The other factors contributed little to explain the difference in low birth weight rates.

Qualidade de vida do doente com insuficiência cardíaca do Centro Hospitalar Tâmega e Sousa

A Insuficiência Cardíaca (IC), como uma doença crónica, tem vindo a ser alvo de análise devido ao seu impacto, não só a nível económico, mas também a nível da qualidade de vida (QV). Vários estudos demonstram que os doentes com IC apresentam um comprometimento da QV, em várias dimensões. OBJETIVO: Descrever a QV dos doentes com IC do Centro Hospitalar Tâmega e Sousa (CHTS). METODOLOGIA: O estudo é quantitativo, transversal, prospetivo e descritivo. Foi aplicado, entre janeiro a junho de 2012, o Euro Quality of Life Instrument-5D (EQ-5D) para avaliar o estado de saúde (ES) e o Kansas City Cardiomyopathy Questionnaire (KCCQ) para avaliar a QV de 326 doentes com IC, dos quais 226 seguidos na Consulta Externa (77,9% masculinos, idade média 67,5 ±11,6 anos, desvio padrão) e 100 na Clínica de IC (CIC) (73,0% masculinos, idade média 59,0 anos, desvio padrão ±12,7). Foi usada a estatística descritiva, teste t, qui quadrado e a análise da variância. RESULTADOS: Os doentes do género feminino, do grupo etário 75-100 anos, solteiros, divorciados, separados ou viúvos, que não sabem ler nem escrever, sem apoio dos amigos e sem condições económicas mínimas para o tratamento da IC apresentaram pior ES e QV. Os doentes submetidos à terapia de ressincronização cardíaca e às cirurgias valvular e de revascularização tiveram melhor QV. Os doentes com IC de etiologia isquémica e em classe III-IV da New York Heart Association apresentaram pior ES. Nestas classes e com fração de ejeção ≤35% os doentes tiveram pior QV. Os doentes da CIC evidenciaram melhor ES e QV. CONCLUSÕES: A QV dos doentes com IC do CHTS é influenciada pelos fatores pessoais, clínicos e pelo local de intervenção. É fundamental mensurar a QV, na prática clínica, para evidenciar a perceção do ES dos doentes e o impacto da IC na QV.

O papel da angiogênese e da hemólise na úlcera de perna de pessoas com anemia falciforme

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Reliability of nasal auscultation and their relation to middle ear condition – a clinical interest to pediatrics respiratory physiotherapy

Background: Acute respiratory infections are usual in children under three years old occurring in upper respiratory tract, having an impact on child and caregiver’s quality of life predisposing to otitis media or bronchiolitis. There are few valid and reliable measures to determine the child’s respiratory condition and to guide the physiotherapy intervention. Aim: To assess the intra and inter rater reliability of nasal auscultation, to analyze the relation between sounds’ classification and middle ear’s pressure and compliance as well as with the Clinical Severity Score. Methods: A cross-sectional observational study was composed by 125 nursery children aged up to three years old. Tympanometry, pulmonary and nasal auscultation and application of Clinical Severity Score were performed to each child. Nasal auscultation sounds’ were recorded and sent to 3 blinded experts, that classified, as “obstructed” and “unobstructed”, with a 48 hours interval, in order to analyze inter and intra rater reliability. Results: Nasal auscultation revealed a substantial inter and intra rater reliability (=0,749 and evaluator A - K= 0,691; evaluator B - K= 0,605 and evaluator C - K= 0,724, respectively). Both ears’ pressure was significantly lower in children with an "unobstructed" nasal sound when compared with an “obstructed” nasal sound (t=-3,599, p<0,001 in left ear; t=-2,258, p=0,026 in right ear). Compliance in both ears was significantly lower in children with an "obstructed" nasal sound when compared with “unobstructed” nasal sound (t=-2,728, p=0,007 in left ear; t=-3,830, p<0,001 in right ear). There was a statistically significant association between sounds’ classification and tympanograms types in both ear’s (=11,437, p=0,003 in left ear; =13,535, p=0,001 in right ear). There was a trend to children with an "unobstructed" nasal sound that had a lower clinical severity score when compared with “obstructed” children. Conclusion: It was observed a good intra and substantial inter reliability for nasal auscultation. Nasal auscultation sounds’ classification was related to middle ears’ pressure and compliance.

Os efeitos de um programa de exercício supervisionado em indivíduos com factores de risco cardiovascular no Hospital da Santa Casa da Misericórdia de Arouca

Introdução: Estudar os factores de risco cardiovasculares (FRCV), permitem tomar medidas preventivas em relação ao estado de saúde, contribuindo para a melhoria da qualidade de vida dos indivíduos e ajudando a prevenir a ocorrência de um evento cardiovascular. Objectivo: O principal objectivo deste estudo é comprovar se o programa de exercício físico supervisionado melhora a condição física e a capacidade funcional. Como objectivo secundário, foi analisada a correlação existente entre as diferentes variáveis, após realização do programa. Métodos: Vinte sujeitos de Arouca, constituíram a amostra do estudo, dividindo-se em grupo de controlo (n=10) e grupo experimental (n=10). Todos os indivíduos receberam informação para controlo e prevenção dos FRCV, através de palestras educacionais. Apenas o grupo experimental participou no programa de exercício, com a duração de 12 semanas / 36 sessões. Foi feito o levantamento e registo dos valores das provas de esforço (Frequência Cardíaca (FC) máxima, equivalente metabólicos (MET´s) máximos e duplo produto (DP) máximo), avaliação antropométrica (índice de massa corporal (IMC), perímetro abdominal, peso, gordura visceral, massa muscular, gordura total), FRCV (Tensão Arterial, colesterol total, colesterol HDL, triglicerídeos, proteína C reactiva) e os níveis de ansiedade e depressão antes e após o programa. Por fim, verificou-se a correlação entre as variáveis. Foi utilizada a estatística inferencial e um nível de significância de 5% (α=0,05). Resultados: Na análise comparativa intergrupo da variável diferença (MII-MI), registaram-se diminuições estatisticamente significativas da variável perímetro abdominal (p=0,02) e aumento estatisticamente significativo da variável MET´s máximo (p=0,01). As principais correlações foram encontradas entre as variáveis antropométricas: peso – gordura visceral (r2=0,824; p<0,001), peso – perímetro abdominal (r2=0,560; p=0,013), peso – IMC (r2=0,527; p=0,017), IMC – peímetro abdominal (r2=0,770; p=0,001). Conclusões: Conclui-se que o programa de exercício parece aumentar a tolerância ao esforço máximo e diminui o perímetro abdominal dos indivíduos em estudo.

Prevalence of alcohol abuse and associated factors in a population-based study

OBJECTIVE: To estimate the prevalence of alcohol abuse/dependence and identify associated factors among demographic, family, socioeconomic and mental health variables. METHODS: A household survey was carried out in the urban area of Campinas, southeastern Brazil, in 2003. A total of 515 subjects, aged 14 years or more were randomly selected using a stratified cluster sample. The Self-Report Questionnaire and the Alcohol Use Disorder Identification Test were used in the interview. Prevalences were calculated, and univariate and multivariate logistic analyses performed by estimating odds ratios and 95% confidence intervals. RESULTS: The estimated prevalence of alcohol abuse/dependence was 13.1% (95% CI: 8.4;19.9) in men and 4.1% (95% CI: 1.9;8.6) in women. In the final multiple logistic regression model, alcohol abuse/dependence was significantly associated with age, income, schooling, religion and illicit drug use. The adjusted odds ratios were significantly higher in following variables: income between 2,501 and 10,000 dollars (OR=10.29); income above 10,000 dollars (OR=10.20); less than 12 years of schooling (OR=13.42); no religion (OR=9.16) or religion other than Evangelical (OR=4.77); and illicit drug use during lifetime (OR=4.47). Alcohol abuse and dependence patterns were different according to age group. CONCLUSIONS: There is a significantly high prevalence of alcohol abuse/dependence in this population. The knowledge of factors associated with alcohol abuse, and differences in consumption patterns should be taken into account in the development of harm reduction strategies.

Avaliação de fatores determinantes e da taxa de incidência da condição DFD (Dark, Firm, Dry) na carne de bovinos abatidos no matadouro da ilha Terceira

Dissertação de Mestrado, Engenharia Zootécnica, 13 de Junho de 2014, Universidade dos Açores.

Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.