Segurança do doente em cuidados de saúde primários : aplicação do Diagrama de Ishikawa à análise de incidentes

RESUMO - A segurança do doente constitui um dos grandes desafios dos cuidados de saúde do séc. XXI e é um componente essencial da qualidade em saúde. Os Cuidados de Saúde Primários representam o primeiro nível de contacto dos indivíduos, da família e da comunidade com o sistema de saúde. O objectivo deste trabalho foi aplicar o Diagrama de Ishikawa no estudo dos incidentes ocorridos numa unidade de Cuidados de Saúde Primários – Unidade de Saúde Familiar Marginal. A análise das causas dos incidentes relatados (n=379) mostrou que os factores associados à „tarefa‟ foram os mais frequentes (n=196) e os factores associados ao doente foram os menos frequentes (n=22). A análise de correlações mostrou uma associação positiva entre os factores da tarefa e os factores da equipa e entre os factores da tarefa e os factores da comunicação (p<0.05). Esta análise mostrou ainda, uma associação negativa entre os factores das condições de trabalho e os factores da organização (p<0.05). As medidas de discriminação aplicadas aos resultados da análise de correlação múltipla, mostraram que os factores da comunicação, os factores individuais, as condições de trabalho e o contexto institucional foram as principais associações encontradas. A análise qualitativa de oito incidentes, permitiu reflectir sobre medidas de melhoria. Este estudo aponta para a utilidade da aplicação do Diagrama de Ishikawa no apuramento das causas sistémicas mais prováveis de um incidente, e na identificação de necessidades de atuação na gestão de risco dentro das organizações. Será, no entanto, necessário testar este instrumento em outras unidades de cuidados de Saúde Primários.

Canada, a child's play

Science4you, a Portuguese developer, producer and seller of scientific and educational toys, leveraged the worldwide growth of this category to successfully expand its operations abroad. Following a recent entry into the United States market, the purpose of this report is to help the company define the next step in its international expansion. A customized scoring model, based on a set of relevant macro and micro-criteria was developed for Anglo-Saxon and Asian countries, yielding Canada as the market with the highest potential. The recommended entry mode is direct exporting via an independent distributor, being complemented with a financial and risk analysis.

Cadmium hyperaccumulation and genetic differentiation of Thlaspi caerulescens populations

Although the knowledge on heavy metal hyperaccumulation mechanisms is increasing, the genetic basis of cadmium (Cd) hyperaccurnulation remains to be elucidated. Thlaspi caerulescens is an attractive model since Cd accumulation polymorphism observed in this species suggests genetic differences between populations with low versus high Cd hyperaccumulation capacities. In our study, a methodology is proposed to analyse at a regional scale the genetic differentiation of T. caerulescens natural populations in relation to Cd hyperaccumulation capacity while controlling for different environmental, soil, plant parameters and geographic origins of populations. Twenty-two populations were characterised with AFLP markers and cpDNA polymorphism. Over all loci, a partial Mantel test showed no significant genetic structure with regard to the Cd hyperaccumulation capacity. Nevertheless, when comparing the marker variation to a neutral model, seven AFLP fragments (9% of markers) were identified as presenting particularly high genetic differentiation between populations with low and high Cd hyperaccurnulation capacity. Using simulations, the number of outlier loci was showed to be significantly higher than expected at random. These loci presented a genetic structure linked to Cd hyperaccumulation capacity independently of the geography, environment, soil parameters and Zn, Pb, Fe and Cu concentrations in plants. Using a canonical correspondence analysis, we identified three of them as particularly related to the Cd hyperaccumutation capacity. This study demonstrates that populations with low and high hyperaccurnulation capacities can be significantly distinguished based on molecular data. Further investigations with candidate genes and mapped markers may allow identification and characterization of genomic regions linked to factors involved in Cd hyperaccumulation.

How CSR and stakeholder engagement encourage the development of Industrial symbiosis from the management viewpoint?

The thesis aims to understand how CSR and stakeholder engagement can contribute to the development of industrial symbiosis. Theory suggests that corporate social responsibility and stakeholder engagement theories have many similar aspects that correlate with the development of industrial symbiosis. This study is qualitative and empirical suggestions are derived from integrative analysis of literature, secondary data and case study analysis. The empirical findings from the interviews support the framework that is created from the findings of the literature review. The results discovered throughout the thesis research suggest that CSR functions as a theoretical background for industrial symbiosis and stakeholder engagement helps develop more thorough understandings of it from the management viewpoint. Empirical findings and literature review also suggest that in the developing of industrial symbiosis the key aspect are the social characteristics such as a robust management structure, trust between partners and long-term commitment to the common goals that support the development of these symbioses. Also, communication and transparency supports the development of industrial symbiosis. For managerial contribution, this thesis presents organizational practices that can help managers to understand how they can engage in effective engagement with stakeholders in the development of industrial symbiosis.

The effects of moisture, cation concentration, temperature, density and composition of soils on their electrical resistivity

The effects. of moisture, cation concentration, dens ity , temper~ t ure and grai n si ze on the electrical resistivity of so il s are examined using laboratory prepared soils. An i nexpen si ve method for preparing soils of different compositions was developed by mixing various size fractions i n the laboratory. Moisture and cation c oncentration are related to soil resistivity by powe r functions, whereas soil resistiv ity and temperature, density, Yo gravel, sand , sil t, and clay are related by exponential functions . A total of 1066 cases (8528 data) from all the experiments were used in a step-wise multiple linear r egression to determine the effect of each variable on soil resistivity. Six variables out of the eight variables studied account for 92.57/. of the total variance in so il resistivity with a correlation coefficient of 0.96. The other two variables (silt and gravel) did not increase the · variance. Moisture content was found to be - the most important Yo clay. variable- affecting s oil res istivi ty followed by These two variables account for 90.81Yo of the total variance in soil resistivity with a correlation ~oefficient ·.of 0 . 95. Based on these results an equation to ' ~~ed{ ct soil r esist ivi ty using moisture and Yo clay is developed . To t est the predicted equation, resistivity measurements were made on natural soils both in s i tu a nd i n the laboratory. The data show that field and laboratory measurements are comparable. The predicted regression line c losely coinciqes with resistivity data from area A and area B soils ~clayey and silty~clayey sands). Resistivity data and the predicted regression line in the case of c layey soils (clays> 40%) do not coincide, especially a t l ess than 15% moisture. The regression equation overestimates the resistivity of so i l s from area C and underestimates for area D soils. Laboratory prepared high clay soils give similar trends. The deviations are probably caused by heterogeneous distribution of mo i sture and difference in the type o f cl ays present in these soils.

Exploring Chinese-Canadians' perspectives on health : a quantitative study

Chinese have unique perspectives on health and illness, which is mostly umecognized by western medicine. Immigration may contribute to problems with health consultations, inconvenience, and dissatisfaction. As the largest visible minority in Canada, Chinese- Canadians' perspectives on health should be studied in order to help Chinese immigrants adapt to a new health-care and health-promotion system, and keep them healthy. A quantitative questionnaire was designed based on the findings from a pilot study and previous literature. A hundred participants were recruited from Toronto, Vancouver, Halifax, and St. Catharines. Descriptive analysis and correlation analysis were used to investigate the structure of the variables. Findings indicated that most oftheir attitudes and corresponding practices to the different health aspects were positive. The relation between dietary practices and attitude was only found in small cities. Their attitudes were impacted by their length of stay in Canada. Their attitudes to regularly timed meals and psychological consultation were related to their acculturation level, as was the regularity of their practice of dental flossing. Their self-evaluated general health levels were also found to be affected by their medical history, education level, feeling to talk about • sexual health, and smoking, particularly in the male subjects of the study. In conclusion, they realized that each health aspect w~s important to their health. However, their practices did not bear a strong relation to their beliefs. Traditional thoughts about health reseeded with time. Acculturation level did not affect most of their attitudes or practices. Under pressure, the priority of the daily health practices decreased. Older persons, those with low incomes, lower education levels or families under stress need to pay more attention to their health level. In-depth future research was recommended.