Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Validity and reliability of the Questionnaire for Compliance with Standard Precaution

ABSTRACT OBJECTIVE : To evaluate the validity and reliability of the Questionnaire for Compliance with Standard Precaution for nurses. METHODS : This methodological study was conducted with 121 nurses from health care facilities in Sao Paulo's countryside, who were represented by two high-complexity and by three average-complexity health care facilities. Internal consistency was calculated using Cronbach's alpha and stability was calculated by the intraclass correlation coefficient, through test-retest. Convergent, discriminant, and known-groups construct validity techniques were conducted. RESULTS : The questionnaire was found to be reliable (Cronbach's alpha: 0.80; intraclass correlation coefficient: (0.97) In regards to the convergent and discriminant construct validity, strong correlation was found between compliance to standard precautions, the perception of a safe environment, and the smaller perception of obstacles to follow such precautions (r = 0.614 and r = 0.537, respectively). The nurses who were trained on the standard precautions and worked on the health care facilities of higher complexity were shown to comply more (p = 0.028 and p = 0.006, respectively). CONCLUSIONS : The Brazilian version of the Questionnaire for Compliance with Standard Precaution was shown to be valid and reliable. Further investigation must be conducted with nurse samples that are more representative of the Brazilian reality. The use of the questionnaire may support the creation of educational measures considering the possible gaps that can be identified, focusing on the workers' health and on the patients' safety.

Characteristics of HIV patients who missed their scheduled appointments

ABSTRACT OBJECTIVE: To analyze whether sociodemographic characteristics, consultations and care in special services are associated with scheduled infectious diseases appointments missed by people living with HIV. METHODS: This cross-sectional and analytical study included 3,075 people living with HIV who had at least one scheduled appointment with an infectologist at a specialized health unit in 2007. A secondary data base from the Hospital Management & Information System was used. The outcome variable was missing a scheduled medical appointment. The independent variables were sex, age, appointments in specialized and available disciplines, hospitalizations at the Central Institute of the Clinical Hospital at the Faculdade de Medicina of the Universidade de S&#227;o Paulo, antiretroviral treatment and change of infectologist. Crude and multiple association analysis were performed among the variables, with a statistical significance of p &#8804; 0.05. RESULTS: More than a third (38.9%) of the patients missed at least one of their scheduled infectious diseases appointments; 70.0% of the patients were male. The rate of missed appointments was 13.9%, albeit with no observed association between sex and absences. Age was inversely associated to missed appointment. Not undertaking anti-retroviral treatment, having unscheduled infectious diseases consultations or social services care and being hospitalized at the Central Institute were directly associated to missed appointments. CONCLUSIONS: The Hospital Management & Information System proved to be a useful tool for developing indicators related to the quality of health care of people living with HIV. Other informational systems, which are often developed for administrative purposes, can also be useful for local and regional management and for evaluating the quality of care provided for patients living with HIV.

Satisfa����o profissional dos enfermeiros em unidades de cuidados continuados integrados

A Satisfa����o no trabalho, definida como rea����es individuais, cognitivas, afetivas e avaliativas perante o trabalho (Locke, 1983), tem sido amplamente estudada no ��mbito das organiza����es. A sua medi����o na ��rea da sa��de contribui para incrementar um bom ambiente na pr��tica e bem-estar dos profissionais e para aumentar a qualidade dos cuidados. Em 2006 surge um novo contexto de trabalho atrav��s da cria����o da RNCCI, que pretende fazer face ao crescente aumento de popula����o em situa����o de depend��ncia ou incapacidade, mas tamb��m aliviar a sobrecarga e custos associados aos cuidados hospitalares. A reorganiza����o do trabalho nas unidades de cuidados continuados acenta nos princ��pios da interdisciplinariedade e coopera����o entre a equipa, requerendo mudan��a e adapta����o �� pr��tica. Sendo os enfermeiros a classe profissional com maior tempo de contacto nos cuidados, importa verificar se est��o satisfeitos com a mudan��a induzida. Assim, este estudo de natureza quantitativa pretende medir e analisar a satisfa����o profissional ddos enfermeiros que trabalham no servi��o de longa dura����o e manuten����o nas unidades de cuidados continuados do distrito de Braga, e verificar se esta vari��vel �� influenciada por fatores sociodemogr��ficos e laborais. Para a recolha de dados utiliza-se a Escala de Avalia����o da Satisfa����o no Trabalho para Enfermeiros - EASPE�� (��=0,814) e um question��rio sociodemogr��fico e profissional. A an��lise dos dados �� efetuada com recurso �� estat��stica descritiva e inferencial com utiliza����o dos testes de Mann-Whitney e de Kruskal-Wallis. Os resultados obtidos evidenciam que os enfermeiros apresentam um n��vel de satisfa����o global no trabalho positivo, mas negativo nas dimens��es satisfa����o com benef��cios e recompensas e satisfa����o com promo����o. Conclui-se, ainda, que a satisfa����o com promo����o �� influenciada pelas habilita����es liter��rias, que a satisfa����o com a comunica����o �� influenciada pela remunera����o, que a satisfa����o com benef��cios e recompensas �� influenciada pelo hor��rio semanal e que a unidade de cuidados �� determinante na satisfa����o global no trabalho.

Tomografia por emiss��o de positr��es: constru����o de uma guideline de atendimento

Mestrado em Medicina Nuclear - ��rea de especializa����o: Tomografia por emiss��o de positr��es

Relat��rio de est��gio em ensino do 1.�� ciclo do ensino b��sico

Relat��rio EPE - Relat��rio de est��gio em Educa����o Pr��-Escolar: O trabalho realizado no relat��rio de est��gio tem como prop��sito a reflex��o e an��lise cr��tica de todo o processo desenvolvido no contexto de educa����o pr��-escolar, no ��mbito da Unidade Curricular (UC) de Pr��tica Pedag��gica Supervisionada, Ao longo do presente relat��rio ser�� mobilizado o quadro te��rico e conceptual da formanda que sustentou e orientou as pr��ticas desenvolvidas no decorrer do per��odo de est��gio, evocando autores conceituados como Piaget, Vygotsky, Oliveira-Formosinho, Zabalza, Rold��o, entre muitos outros. Deste modo, ser�� mencionado o papel da crian��a bem como a natureza do seu processo de desenvolvimento e de constru����o, evidenciando o seu papel ativo, participativo e construtivo. Tamb��m, ser�� referida a import��ncia do papel do Educador de inf��ncia, bem como os princ��pios deontol��gicos que o orientam na sua constru����o profissional e pessoal. Torna-se, tamb��m, fundamental referir os referenciais legais que norteiam a Educa����o Pr��-Escolar referindo a sua import��ncia no desenvolvimento das crian��as, assim como os modelos curriculares e pedag��gicos que orientam a pr��xis pedag��gica, permitindo a constru����o de pr��ticas fundamentadas e conscientes. Para isso ��, tamb��m, imprescind��vel adotar uma atitude indagadora de car��ter investigativo, cr��tico e reflexivo, permitindo responder de forma adequada ��s necessidades individuais de cada crian��a, numa perspetiva diferenciada e individualizada, mas tamb��m global. Neste sentido, ao longo de todo o per��odo de est��gio, foi adotada, a metodologia de investiga����o-a����o, denotando a import��ncia dos momentos de observa����o, planifica����o, a����o e reflex��o. S�� desta forma foi poss��vel compreender a realidade, de modo a transform��-la com o intuito de melhorar a qualidade da Educa����o

Fatores individuais de risco de infe����o hospitalar : conhecer para prevenir

RESUMO - Medidas efetivas de preven����o e controlo de infe����o, assim como a sua aplica����o di��ria e consistente, devem fazer parte da cultura de seguran��a dos profissionais de sa��de para promover a excel��ncia da presta����o de cuidados. Tamb��m a identifica����o dos fatores de riscos individuais de infe����o �� crucial e indispens��vel para a ado����o de medidas para a gest��o desses mesmos riscos. A avalia����o do risco pretende determinar a probabilidade que um doente tem de adquirir ou disseminar uma infe����o hospitalar (IH) (WIRRAL, 2008) nas unidades de sa��de. A avalia����o deve ser efetuada na admiss��o do doente e, de forma peri��dica durante o internamento, usando uma grelha de avalia����o, integrada no processo global de cuidados do doente. Efetuada a avalia����o de risco individual, que pressup��e a identifica����o dos fatores de risco do doente (fatores de risco intr��nsecos e extr��nsecos) pode ser implementado um plano de cuidados individualizado para os gerir. Pretendeu-se com este estudo identificar os fatores de risco de infe����o hospitalar do doente que est��o presentes na admiss��o e/ou que podem surgir durante o seu internamento, para que posteriormente seja poss��vel determinar as medidas de preven����o (gest��o do risco) a aplicar individualmente. Foi realizado um estudo de caso-controlo com os doentes internados no Hospital dos Lus��adas em 2011 com o objetivo de, por um lado, determinar os fatores de risco individuais que contribuem para a aquisi����o da IH e, por outro, caraterizar os fatores de risco para uma futura identifica����o de poss��veis medidas de preven����o e controlo da aquisi����o e transmiss��o cruzada da infe����o hospitalar. A popula����o em estudo foi constitu��da pelos doentes que foram internados, entre 1 de Janeiro e 31 de Dezembro de 2011 sendo os casos os doentes em que foi identificada a presen��a de infe����o hospitalar atrav��s do programa institucional de vigil��ncia epidemiol��gica das infe����es, tendo os controlos sido selecionados numa raz��o de 3:1 caso. Foi utilizado um suporte estruturado para a colheita de dados, com a listagem de fatores de risco identificados na revis��o bibliogr��fica e de todos os fatores de risco apresentados pelos doentes em estudo. Os fatores de risco identificados que apresentaram um maior significado estat��stico foram: a idade acima dos 50 anos, o g��nero masculino, a administra����o de antimicrobianos nas tr��s semanas anteriores ao internamento, a coloca����o de cateter venoso central, a algalia����o e, no caso dos doentes cir��rgicos, a cirurgia de urg��ncia e a classifica����o ASA 3. Ap��s a identifica����o dos fatores de risco da popula����o estudada neste hospital, �� agora poss��vel utilizar a informa����o obtida e delinear investiga����es adicionais, objetivando a constru����o de instrumentos para a identifica����o de doentes com risco aumentado de infe����o.

Sa��de Mental em meio prisional : avalia����o de necessidades de cuidados em reclusos com perturba����o mental

RESUMO: A popula����o prisional �� constitu��da por indiv��duos geralmente sujeitos a alguma forma de exclus��o social e que apresentam problemas de sa��de f��sica e mental mais frequentes do que na popula����o em geral. A preval��ncia mais elevada de perturba����es mentais e de suic��dio nos reclusos, em rela����o �� popula����o civil, �� consensual e est�� demonstrada em numerosos estudos internacionais. O abuso/depend��ncia de subst��ncias, a depress��o, as psicoses e a perturba����o anti-social de personalidade s��o as perturba����es mais comuns na popula����o prisional. As perturba����es mentais s��o importantes factores de risco de suic��dio, de vitimiza����o, de reincid��ncia e de reentrada no sistema prisional. Assim sendo, o grupo de reclusos com perturba����o mental constitui um grupo de risco relevante. A avalia����o de necessidades de cuidados foi iniciada no Reino Unido como um m��todo para o planeamento, medi����o dos resultados e financiamento dos cuidados de sa��de. Para esta avalia����o foram desenvolvidos instrumentos que avaliam as necessidades em diversos dom��nios (cl��nicos e sociais) para aplica����o aos utentes, cuidadores e profissionais. At�� aos anos noventa, a avalia����o de necessidades no contexto prisional incidia especialmente nas necessidades de seguran��a dos servi��os, segundo a perspectiva dos profissionais. Contudo, a partir do relat��rio Reed (1992), sobre a situa����o dos reclusos com perturba����o mental, verificou-se uma abordagem mais abrangente, que inclu��a a avalia����o das necessidades de cuidados dos reclusos. Embora as necessidades dos reclusos com perturba����o mental pare��am ser similares ��s dos doentes psiqui��tricos em geral, existem diferen��as em determinados dom��nios como a comorbilidade do eixo II, o abuso de subst��ncias e o risco de viol��ncia. Por este motivo, as necessidades de cuidados de sa��de mental dos reclusos s��o elevadas e frequentemente n��o se encontram satisfeitas. De forma a incluir estas especificidades foi desenvolvida a vers��o forense do Camberwell Assessment of Need (CAN), designada por CAN - Forensic Version (CANFOR). Actualmente existe um consenso generalizado entre as institui����es internacionais do dever de proporcionar aos reclusos cuidados de sa��de, de preven����o e de tratamento, equivalentes aos cuidados dispon��veis para a popula����o civil - o princ��pio da equival��ncia de cuidados. A presente investiga����o pretendeu caracterizar e avaliar as necessidades de cuidados dos reclusos acompanhados nos servi��os de psiquiatria prisionais na ��rea da Grande Lisboa (internamento no Servi��o de Psiquiatria do Hospital Prisional de S. Jo��o de Deus (HPSJD) e consultas nos Estabelecimentos Prisionais (EP) de Caxias e de Tires). De modo a estabelecer uma compara����o com sujeitos civis foi seleccionada uma amostra de conveni��ncia de pacientes acompanhados num departamento de psiquiatria da mesma regi��o, segundo um emparelhamento por sexo, escal��o et��rio, e por diagn��stico, num per��odo de 3 meses. Realizou-se um estudo de tipo observacional, transversal e comparativo. Aplicaram-se os seguintes instrumentos de avalia����o: question��rio espec��fico, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning, CAN-R e CANFOR-R. No per��odo do estudo (12 meses) foram assistidos 149 reclusos, dos quais, 35 (23,5%) n��o cumpriram os crit��rios de inclus��o. A amostra final de reclusos (PRs) (n=114) foi constitu��da por 79 homens (69,3%) e 35 mulheres (30,7%), dos quais 77 eram condenados (67,5%) e 37 (32,5%) encontravam-se detidos preventivamente. A amostra final de participantes civis (PCs) foi constitu��da por 121 indiv��duos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%).A amostra final de participantes civis (PCs) foi constitu��da por 121 indiv��duos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%). Relativamente aos PRs, o diagn��stico mais frequente foi a Perturba����o Anti-social da Personalidade (57,9%), seguida pela Depress��o Major (56,1%). A maioria (53,5%) apresentava tr��s ou mais categorias diagn��sticas. Aproximadamente um ter��o dos PRs (30%) pontuou o n��vel elevado de risco de suic��dio. A probabilidade deste risco aumentava, significativamente, nos portadores de Depress��o Major, de um maior n��vel de psicopatologia e de uma condena����o actual. Perto de metade dos PRs (47,4%) possu��a duas ou mais condena����es pr��vias e mais de metade estavam envolvidos em crimes contra pessoas (53,5%). A probabilidade de condena����es m��ltiplas foi significativamente superior nos portadores de Perturba����o Antisocial da Personalidade e nos reclusos com maior n��mero de necessidades totais. Entre os PRs dos dois sexos, as principais diferen��as significativas residiram na maior frequ��ncia de consumo de subst��ncias e no maior n��mero de necessidades de cuidados n��osatisfeitas nos homens versus mulheres. A compara����o entre os PRs, antes da deten����o, e os PCs mostrou que os primeiros possu��am menor escolaridade, menos medica����o psiqui��trica, mas mais emprego e mais consumos de subst��ncias il��citas. A Perturba����o Anti-social da Personalidade (OR=26,4; IC95%: 10,7-64,9), a Perturba����o P��s-stress Traum��tico (OR=15,0; IC95%: 3,5-65,4), a Depend��ncia/Abuso de Subst��ncias (OR=8,5; IC95%: 4,2-17,6) a Depress��o Major (OR=2,6; IC95%: 1,5-4,4) e o Risco de Suic��dio Elevado (OR=2,6; IC95%: 1,4-5,0) foram significativamente mais frequentes nos PRs versus PCs. Relativamente �� avalia����o de necessidades de cuidados, os PRs mostraram maior n��mero de necessidades n��o-satisfeitas e maior necessidade de ajuda profissional, em rela����o aos PCs. Embora diversas necessidades n��o-satisfeitas possam resultar da condi����o de recluso, outras, em dom��nios da sa��de f��sica, da seguran��a do pr��prio e dos consumos t��xicos, poder��o indicar que os PRs recebem um n��vel de cuidados inferior ao necess��rio, em compara����o com os PCs. Os PRs apresentaram patologia mental, predominantemente n��o-psic��tica e elevado risco de suic��dio/auto-agress��o, associado a depress��o, necessidades de cuidados e uma pena de pris��o. Possu��am, numa frequ��ncia elevada, caracter��sticas, consistentemente, associadas �� reincid��ncia criminal (personalidade anti-social, consumos t��xicos, condena����es anteriores), pelo que se justifica um especial acompanhamento deste grupo, no per��odo pr�� e p��s-liberta����o. A compara����o de necessidades de cuidados no contexto civil e prisional indica um maior n��vel de necessidades e um menor n��vel de cuidados recebidos pelos PRs, em rela����o aos PCs. O princ��pio da equival��ncia de cuidados poder�� estar comprometido nos indiv��duos reclusos com perturba����o mental. A utiliza����o do CANFOR foi f��cil e poder�� contribuir para um melhor planeamento, oferta e avalia����o de resultados ao n��vel individual. Os PRs e PCs revelaram caracter��sticas cl��nicas e de necessidades muito diferentes entre si, pelo que, os reclusos com perturba����o mental dever��o ser assistidos em servi��os de sa��de mental preparados para abordar as suas especificidades.---------------ABSTRACT: The prison population is generally made up of individuals who are usually subject to some sort of social exclusion and who show physical and mental problems more frequently than the general population. Various international studies have found higher rates of mental disturbances and suicide within the prison population. The most common mental disturbances found are substance abuse or dependency, depression, psychosis, and anti-social personality disturbance. Such mental disturbances are important factors in suicide, victimization, delinquency recurrence, and the risk of reentry into prison. As a result, prison inmates with mental disturbances are a relevant at risk group. Assessment of needs of care first started in the United Kingdom as a method of care planning, results measuring and finance health care. The method involved the development of certain measuring instruments to be used by patients, caregivers and professionals in order to evaluate needs in various domains (clinical and social). Until the nineties, the assessment of needs of care in a prison context focused mainly on the service���s security needs. However, after the Reed (1992) report on mentally disturbed inmates, a much wider approach was considered, which included evaluation of the inmate���s needs of care. However similar mentally disturbed prison inmates��� needs may appear to those of other psychiatric patients, there are some differences in particular domains, namely, co-morbidity of Axis II, substance abuse and the risk of violence. For this reason, inmates��� mental health care needs are high and very often not met. In order to include these specificities, a forensic version of the Camberwell assessment of need (CAN,) designated CAN ��� Forensic version (CANFOR) was developed. There is now generalized consensus among international institutions of the duty under the equivalent health care principle to provide inmates with preventative health care and treatment, that are equivalent to the care available to the civil population. This investigation aims to characterize and assess the health care provision of prison inmates admitted to Lisbon���s Psychiatric Prison ward - the Psychiatric Ward of S��o Jo��o de Deus Hospital (HPSJD) - and inmates in the Caxias and Tires Prison Establishments (EP) undertaking outpatient treatment. In order to establish a comparison between prison and civilian patients, a convenience sample was selected from civilian patients being treated in a psychiatric ward in the same geographical area. This sample was paired by gender, age group and diagnosis during a three month period. The study was observational, transversal and comparative. The following measuring instruments were used: a purpose-built questionnaire, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning Scale, CAN-R and CANFOR-R. During the research period (12 months), 149 inmates received care, of whom 35 (23.5%) did not comply with the prerequisite criteria of this study. The final sample of inmates (PRs) (n=114) comprised 79 men (69.3%) and 35 (30.7%) women, of whom 77 (67.5%) were convicted prisoners and 37 (32.5%) were in preventive custody. The final sample for Civilian Participants (PCs) was made up of 121 individuals, of whom 76 (62.8%) were men and 45 (37.2%) were women. The most common diagnosis among the PRs was Anti-Social Personality Disorder (57.9%), followed by Major Depression (56.1%). More than half of the subjects in the sample (53.5%) showed three or more diagnostic categories. Approximately one third (30%) of the PRs showed a high level of suicide risk. The probability of this risk was significantly higher among Major Depression patients, those showing a higher level of psychopathology and those with a current conviction. Almost half of the PRs (47.4%) had been given two or more prior convictions and more than half (53.5%) were involved in crimes against people. The probability of multiple convictions was significantly higher among inmates with Anti-Social Personality Disorder and in those with more total needs. With regard to gender, the main significant difference among the PRs was that men were found to have a higher frequency of substance use and a greater number of unsatisfied caring needs than women. Comparison between the PRs prior to detention and PCs revealed that the former held lower educational qualifications and received less psychiatric medication, but had higher levels of employment and showed greater consumption of illicit substances. In addition Anti-Social Personality Disorder (OR=26.4; IC 95%: 10.7-64.9), Post-Stress Traumatic Disturbance (OR=15.0; IC 95%: 3.5-65.4), Substance Dependency/Abuse (OR=8.5; IC 95%: 4.2-17.6), Major Depression (OR=2.6; IC 95%: 1.5-4.4), and High Suicide Risk (OR=2.6; IC 95%: 1.4-5.0) were significantly more frequent amongst PRs than PCs. The results for needs assessment revealed that the PRs showed higher levels of unmet needs and a greater need for professional help in comparison with the PCs. Although various unmet needs may result from the inmate���s condition, other needs - in particular those regarding physical health, personal security and toxic substance use - suggest that the care given to PRs may be inadequate in comparison with that given to PCs. This implies that the principle of equivalent health care for PRs with mental illnesses may not be upheld. Furthermore, the mental morbidity results of the PRs indicated that they suffer predominantly from non-psychotic and high suicide/self inflicted aggression risk associated with depression, caring needs and a prison sentence. They also often showed characteristics that are consistently associated with criminal recidivism (Anti-social Personality, use of toxic substances, prior convictions). This result justifies that there should be special follow-up for this group in the pre- and after release period. The use of CANFOR proved to be simple and the application delay was acceptable. No difficulties were encountered in the understanding of its categories by its users. As a result, itcould contribute towards better planning, supply and assessment of results at an individual level. Given that the PRs and PCs revealed different clinical and needs characteristics, it is recommended that inmates with mental disturbances should be assisted in mental health services that are adequately prepared to address their specificities.

M��todos de avalia����o do impacto econ��mico dos eventos adversos em meio hospitalar

RESUMO - O sistema de sa��de �� constantemente sujeito a press��es sendo as mais relevantes a press��o para o aumento da qualidade e a necessidade de conten����o de custos. Os Eventos Adversos (EAs) ocorridos em meio hospitalar constituem um s��rio problema de qualidade na presta����o de cuidados de sa��de, com consequ��ncias clinicas, sociais, econ��micas e de imagem, que afectam pacientes, profissionais, organiza����es e o pr��prio sistema de sa��de. Os custos associados �� ocorr��ncia de EAs em meio hospitalar, incrementam significativamente os custos hospitalares, representando cerca de um em cada sete d��lares gastos no atendimento dos doentes. S�� na ��ltima d��cada surgiram estudos com o objectivo principal de avaliar esse impacto em meio hospitalar, subsistindo ainda uma grande indefini����o quanto ��s vari��veis e m��todos a utilizar. O objectivo principal deste trabalho de projecto foi conhecer e caracterizar as diferentes metodologias utilizadas para avalia����o dos custos econ��micos, nomeadamente dos custos directos, relacionados com a ocorr��ncia de eventos adversos em meio hospitalar. Tendo em aten����o as dificuldades referidas, utilizou-se como metodologia a revis��o narrativa da literatura, complementada com a realiza����o de uma t��cnica de grupo nominal. Os resultados obtidos foram os seguintes: i) a metodologia utilizada na maioria dos estudos para determinar a frequ��ncia, natureza e consequ��ncias dos EAs ocorridos em meio hospitalar, utiliza matrizes de base observacional, anal��tica, com base em estudos de coorte retrospectivo recorrendo aos crit��rios definidos pelo Harvard Medical Practice Study; ii) a generalidade dos estudos realizados avaliam os custos directos dos EAs em meio hospitalar, iii) verificou-se a exist��ncia de uma grande diversidade de m��todos para a determina����o dos custos associados aos EAs. A generalidade dos estudos determina esse valor com base na contabiliza����o do n��mero de dias adicionais de internamento, resultantes do EA, valorizados com base em custos m��dios; iv) o grupo de peritos, prop��s como metodologia para a determina����o do custo associado a cada EA, a utiliza����o de sistemas de custeio por doente; v) prop��e-se o desenvolvimento de uma plataforma inform��tica, que permita o cruzamento da informa����o dispon��vel no registo clinico electr��nico do doente com um sistema autom��tico de identifica����o de EAs, a desenvolver, e com sistemas de custeio por doente, de modo a valorizar os custos por doente e por tipo de EA. A avalia����o dos custos directos associados �� ocorr��ncia de EAs em contexto hospitalar, pelo impacto econ��mico e social que tem nos doentes e organiza����es, ser�� seguramente uma das ��reas de estudo e investiga����o futuras, no sentido de melhorar a efici��ncia do sistema de sa��de e a qualidade e seguran��a dos cuidados prestados aos doentes.

Evaluation of outpatient child-adolescent mental health services (CAMHS) in Attica-Greece

ABSTRACT: Background: Childhood is a critical time for social and emotional development, educational progress and mental health prevention. Mental health for children and adolescents is defined by the achievement of expected developmental, cognitive, social and emotional skills. The development of child-adolescent mental health services (CAMHS) is a necessity for each country, not only as a prevention measure for the wellbeing of people, but also as an investment to the future of countries. Qualitative evaluation of services is the only way to ensure whether services function under quality standards and increase the possibility of better outcomes for their patients. This study examines the greek outpatient CAMHS against the British Standards of National Institute of Excellence for community CAMHS. The Standards assessed refer to the areas of Assessment, Care and Intervention. Objectives: The main objectives of the study are 1) to evaluate Greek outpatient CAMHS in the Attica region 2) to promote the evaluation process for mental health services in Greece. Methods: Due to the fact that Greek services are based on the British model, the tool used was the British self-review questionnaire of Quality Network for Community CAMHS(QNCC).The tool was translated, adapted and posted to services. Twelve out of twenty outpatient CAMHS of Attica (including Athens) responded. Data was collected and performed by the Statistical Package for Social Sciences SPSS. Results: The study resulted that the CAMHS examined, meet moderately the British Standards of 1) Referral and Access, 2) Assessment & Care planning, 3) Care & Intervention. Two out of twelve services examined, meet the standards of "Assessment and Care" in a higher percentage between 75% and 100%. Conclusions: The paper describes a satisfactory function of CAMHS in Attica prefecture taking into consideration the extremely difficult political situation of Greece at the time of the research. Strong and weak domains are identified. Also the translation and adaptation of British tools promote the evaluation process and quality assurance of Greek CAMHS.

Estudo comparativo entre indicadores de desempenho da JCI e do Contrato Programa Cirurgia Segura

Disserta����o de mestrado em Engenharia e Gest��o da Qualidade

Stage at presentation of breast cancer in Luanda, Angola - a retrospective study

Background: It is expected that, by 2020, 15 million new cases of cancer will occur every year in the world, one million of them in Africa. Knowledge of cancer trends in African countries is far from adequate, and improvements in cancer prevention efforts are urgently needed. The aim of this study was to characterize breast cancer clinically and pathologically at presentation in Luanda, Angola; we additionally provide quality information that will be useful for breast cancer care planning in the country. Methods: Data on breast cancer cases were retrieved from the Angolan Institute of Cancer Control, from 2006 to 2014. For women diagnosed in 2009 (5-years of follow-up), demographic, clinical and pathological information, at presentation, was collected, namely age at diagnosis, parity, methods used for pathological diagnoses, tumor pathological characteristics, stage of disease and treatment. Descriptive statistics were performed. Results: The median age of women diagnosed with breast cancer in 2009 was 47 years old (range 25���89). The most frequent clinical presentation was breast swelling with axillary lymph nodes metastasis (44.9 %), followed by a mass larger than 5 cm (14.2 %) and lump (12.9 %). Invasive ductal carcinoma was the main histologic type (81.8 %). Only 10.1 % of cancer cases had a well differentiated histological grade. Cancers were diagnosed mostly at advanced stages (66.7 % in stage III and 11.1 % in stage IV). Discussion: In this study, breast cancer was diagnosed at a very advanced stage. Although it reports data from a single cancer center in Luanda, Angola it reinforces the need for early diagnosis and increasing awareness. According to the main challenges related to breast cancer diagnosis and treatment herein presented, we propose a realistic framework that would allow for the implementation of a breast cancer care program, built under a strong network based on cooperation, teaching, audit, good practices and the organization of health services. Conclusion: Angola needs urgently a program for early diagnosis of breast cancer.

Pre-clinical trials for Machado-Joseph Disease: Hypothesis-based and hypothesis-free therapeutic approaches

Tese de Doutoramento em Ci��ncias da Sa��de

Malaria and Vascular Endothelium

Involvement of the cardiovascular system in patients with infectious and parasitic diseases can result from both intrinsic mechanisms of the disease and drug intervention. Malaria is an example, considering that the endothelial injury by Plasmodium-infected erythrocytes can cause circulatory disorders. This is a literature review aimed at discussing the relationship between malaria and endothelial impairment, especially its effects on the cardiovascular system. We discuss the implications of endothelial aggression and the interdisciplinarity that should guide the malaria patient care, whose acute infection can contribute to precipitate or aggravate a preexisting heart disease.