Lighting conditions at an operating room in a Portuguese maternity

Lighting is one of the most important factors in human interaction with the environment. Poor lighting may increase the risk of accidents and could also cause a variety of symptoms including: rapid fatigue, headaches, eyestrain, tired eyes, dry eyes, ocular surface symptoms (watery and irritated eyes), decreased concentration and stress. Specific disorders: degeneration of the sharpness of vision (blurred and double vision) and slowness in changing focus. Apart from the advantages in the health and welfare for the workers, good lighting also leads to better job performance (faster), less errors, better safety, fewer accidents and less absenteeism. The overall effect is: better productivity. Good lighting includes quantity and quality requirements, and should necessarily be appropriate to the activity/task being carried out, bearing in mind the comfort and visual efficiency of the worker.

Risk analysis in a Portuguese archive what has changed in five years?

The Cultural Property Risk Analysis Model was applied in 2006 to a Portuguese archive located in Lisbon. Its results highlighted the need for the institution to take care of risks related to fire, physical forces and relative humidity problems. Five years after this first analysis the results are revisited and a few changes are introduced due to recent events: fire and high humidity remain an important hazard but are now accompanied by a pressing contaminants problem. Improvements in storage systems were responsible for a large decrease in terms of calculated risk magnitude and proved to be very cost-effective.

Mould and yeast identification in archival settings: preliminary results on the use of traditional methods and molecular biology options in Portuguese archives

This project was developed to fully assess the indoor air quality in archives and libraries from a fungal flora point of view. It uses classical methodologies such as traditional culture media – for the viable fungi – and modern molecular biology protocols, especially relevant to assess the non-viable fraction of the biological contaminants. Denaturing high-performance liquid chromatography (DHPLC) has emerged as an alternative to denaturing gradient gel electrophoresis (DGGE) and has already been applied to the study of a few bacterial communities. We propose the application of DHPLC to the study of fungal colonization on paper-based archive materials. This technology allows for the identification of each component of a mixture of fungi based on their genetic variation. In a highly complex mixture of microbial DNA this method can be used simply to study the population dynamics, and it also allows for sample fraction collection, which can, in many cases, be immediately sequenced, circumventing the need for cloning. Some examples of the methodological application are shown. Also applied is fragment length analysis for the study of mixed Candida samples. Both of these methods can later be applied in various fields, such as clinical and sand sample analysis. So far, the environmental analyses have been extremely useful to determine potentially pathogenic/toxinogenic fungi such as Stachybotrys sp., Aspergillus niger, Aspergillus fumigatus, and Fusarium sp. This work will hopefully lead to more accurate evaluation of environmental conditions for both human health and the preservation of documents.

Routine screening of harmful microorganisms in beach sands: implications to public health

Beaches worldwide provide recreational opportunities to hundreds of millions of people and serve as important components of coastal economies. Beach water is often monitored for microbiological quality to detect the presence of indicators of human sewage contamination so as to prevent public health outbreaks associated with water contact. However, growing evidence suggests that beach sand can harbor microbes harmful to human health, often in concentrations greater than the beach water. Currently, there are no standards for monitoring, sampling, analyzing, or managing beach sand quality. In addition to indicator microbes, growing evidence has identified pathogenic bacteria, viruses, and fungi in a variety of beach sands worldwide. The public health threat associated with these populations through direct and indirect contact is unknown because so little research has been conducted relating to health outcomes associated with sand quality. In this manuscript, we present the consensus findings of a workshop of experts convened in Lisbon, Portugal to discuss the current state of knowledge on beach sand microbiological quality and to develop suggestions for standardizing the evaluation of sand at coastal beaches. The expert group at the "Microareias 2012" workshop recommends that 1) beach sand should be screened for a variety of pathogens harmful to human health, and sand monitoring should then be initiated alongside regular water monitoring; 2) sampling and analysis protocols should be standardized to allow proper comparisons among beach locations; and 3) further studies are needed to estimate human health risk with exposure to contaminated beach sand. Much of the manuscript is focused on research specific to Portugal, but similar results have been found elsewhere, and the findings have worldwide implications.

A sustentabilidade das finanças públicas das regiões autónomas portuguesas

Dissertação de Mestrado em Ciências Económicas e Empresariais

Sustentabilidade das finanças locais

Dissertação de Mestrado em Ciências Económicas e Empresariais

Assessment of nursing students and nurses' orientation towards patient-centeredness

Background - Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery. Objectives - The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years. Settings - Public School of Nursing and a Central Hospital, in Lisbon (Portugal). Participants - Students in the first, second and fourth year of nursing school and nurses participated in the study. Methods - For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience. Results - A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales. Conclusions - These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Risk of colorectal cancer associated with the C677T polymorphism in 5,10-methylenetetrahydrofolate reductase in Portuguese patients depends on the intake of methyl-donor nutrients

Background: Polymorphisms located in genes involved in the metabolism of folate and some methyl-related nutrients are implicated in colorectal cancer (CRC). Objective: We evaluated the association of 3 genetic polymorphisms [C677T MTHFR (methylene tetrahydrofolate reductase), A2756G MTR (methionine synthase), and C1420T SHMT (serine hydroxymethyltransferase)] with the intake of methyl-donor nutrients in CRC risk. Design: Patients withCRC(n 196) and healthy controls (n 200) matched for age and sex were evaluated for intake of methyl-donor nutrients and the 3 polymorphisms. Results: Except for folate intake, which was significantly lower in patients (P 0.02), no differences were observed in the dietary intake of other methyl-donor nutrients between groups. High intake of folate ( 406.7 g/d) was associated with a significantly lower risk of CRC (odds ratio: 0.67; 95% CI: 0.45, 0.99). The A2756G MTR polymorphism was not associated with the risk of developing CRC. In contrast, homozygosity for the C677TMTHFRvariant (TT) presented a 3.0-fold increased risk of CRC (95% CI: 1.3, 6.7). Similarly, homozygosity for the C1420T SHMT polymorphism also had a 2.6-fold increased risk (95% CI: 1.1, 5.9) of developing CRC. When interactions between variables were studied, low intake of all methyl-donor nutrients was associated with an increased risk ofCRC in homozygous participants for the C677T MTHFR polymorphism, but a statistically significant interaction was only observed for folate (odds ratio: 14.0; 95% CI: 1.8, 108.5). No significant associations were seen for MTR or SHMT polymorphisms. Conclusion: These results show an association between the C677T MTHFR variant and different folate intakes on risk of CRC.

Prefácio

Prefácio/Foreword do Livro de Atas do Simpósio Internacional sobre Direitos Humanos e Qualidade de Vida nas Comunidades Falantes do Português nos EUA e Canadá, realizado nos dias 9 e 10 de novembro de 2011.

The D1822V APC polymorphism interacts with fat, calcium, and fiber intakes in modulating the risk of colorectal cancer in Portuguese persons

Background - Both genetic and environmental factors affect the risk of colorectal cancer (CRC). Objective - We aimed to examine the interaction between the D1822V polymorphism of the APC gene and dietary intake in persons with CRC. Design - Persons with CRC (n = 196) and 200 healthy volunteers, matched for age and sex in a case-control study, were evaluated with respect to nutritional status and lifestyle factors and for the D1822V polymorphism. Results - No significant differences were observed in energy and macronutrient intakes. Cases had significantly (P < 0.05) lower intakes of carotenes, vitamins C and E, folate, and calcium than did controls. Fiber intake was significantly (P = 0.004) lower in cases than in controls, whereas alcohol consumption was associated with a 2-fold risk of CRC. In addition, cases were significantly (P = 0.001) more likely than were controls to be sedentary. The homozygous variant for the APC gene (VV) was found in 4.6% of cases and in 3.5% of controls. Examination of the potential interactions between diet and genotype found that a high cholesterol intake was associated with a greater risk of colorectal cancer only in noncarriers (DD) of the D1822V APC allele (odds ratio: 1.66; 95% CI: 1.00, 2.76). In contrast, high fiber and calcium intakes were more markedly associated with a lower risk of CRC in patients carrying the polymorphic allele (DV/VV) (odds ratio: 0.50; 95% CI: 0.27, 0.94 for fiber; odds ratio: 0.51; 95% CI: 0.28, 0.93 for calcium) than in those without that allele. Conclusion - These results suggest a significant interaction between the D1822V polymorphism and the dietary intakes of cholesterol, calcium, and fiber for CRC risk.

Psychosocial factors as predictors of quality of life in chronic portuguese patients

Background - Chronic illnesses are diseases of long duration and generally of slow progression. They cause significant quality of life impairment. The aim of this study was to analyse psychosocial predictors of quality of life and of subjective well-being in chronic Portuguese patients. Methods - Chronic disease patients (n = 774) were recruited from central Portuguese Hospitals. Participants completed self-reported questionnaires assessing socio-demographic, clinical, psychosocial and outcome variables: quality of life (HRQL) and subjective well-being (SWB). MANCOVA analyses were used to test psychosocial factors as determinants of HRQL and SWB. Results - After controlling for socio-demographic and clinical variables, results showed that dispositional optimism, positive affect, spirituality, social support and treatment adherence are significant predictors of HRQL and SWB. Similar predictors of quality of life, such as positive affect, treatment adherence and spirituality, were found for subgroups of disease classified by medical condition. Conclusions - The work identifies psychosocial factors associated with quality of life. The predictors for the entire group of different chronic diseases are similar to the ones found in different chronic disease subgroups: positive affect, social support, treatment adherence and spirituality. Patients with more positive affect, additional social support, an adequate treatment adherence and a feel-good spirituality, felt better with the disease conditions and consequently had a better quality of life. This study contributes to understanding and improving the processes associated with quality of life, which is relevant for health care providers and chronic diseases support.

O conselho geral: um desafio estratégico à autonomia

Nos últimos vinte e cinco anos o tema da autonomia e da administração e gestão escolar tem ocupado um lugar relevante na agenda política dos sucessivos Governos da República e na preocupação dos diferentes parceiros educativos. Rara tem sido a maioria política que resiste a dar o seu contributo sobre esta matéria, com o objetivo sempre confesso de outorgar maior autonomia às escolas. No enquadramento teórico da nossa investigação começamos por abordar a emergência do conceito de autonomia, nas suas diferentes dimensões e nos seus distintos significados. Não esquecemos também a analise das questões relacionadas com a problemática, cada vez mais atual da regulação múltipla. Analisamos de seguida a evolução da legislação portuguesa, operada a partir da publicação da Lei de Bases do Sistema Educativo com especial destaque às propostas de configuração dos órgãos de Direção e de Gestão das escolas e das competências atribuídas a cada um deles produzido pela CRSE e pelos decretos-leis 43/89, 172/91, 115-A/98 e 75/2008. A investigação empírica teve como objeto de análise dois agrupamentos localizados em concelhos distintos da Área Metropolitana de Lisboa, e procurou determinar se o conselho geral de cada uma dessas unidades orgânicas, assume na totalidade as competências que lhe são conferidas pelo quadro legislativo em vigor, e nessa medida como se articula com os outros órgãos da direção no processo de tomada de decisão. Simultaneamente fizemos o contraponto com a imagem que os intervenientes na gestão intermédia de cada um dos agrupamentos construíram sobre o seu conselho geral e das relações de poder que se estabelecem no interior de cada uma das organizações. Para corresponder aos pressupostos da nossa investigação entrevistaram-se os diretores e os presidentes dos conselhos gerais e facultámos questionários aos docentes que desempenhavam cargos nos dois agrupamentos. Concluímos, em função do que pudemos analisar, que embora o conselho geral veja o seu papel na organização da escola formalmente reconhecido não consegue desempenhar na totalidade as funções que lhe são incumbidas, já que defronta o poder real do diretor e o poder oculto do conselho pedagógico, encontrando dificuldades em libertar-se do reino das sombras.

Knowledge, attitude and practice of mammography among women users of public health services

OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.

Surfaces contamination with 5-Fluorouracil in two Portuguese hospitals

During the last years there has been an increasing concern about occupational exposure to cytostatic drugs in hospitals. The first findings on occupational exposures among hospital personnel administering chemotherapy were reported only in 1979. Since then, a great number of studies have been publishing describing possible exposure-related health effects. Consequently, rigorous guidelines for the safe handling of cancer chemotherapeutic agents were devised and the handling facilities in hospitals were extensively improved. However, recent studies developed in European countries revealed detectable amounts of several drugs in surface wipe samples. Dermal absorption after contact with contaminated surfaces can play an important role in exposure to antineoplastic drugs. Therefore, the existence of contamination in workplace surfaces implies an increased risk of exposure for health care workers. Since there is no recent report in Portugal, regarding the occupational exposure to antineoplastic drugs, a study was developed aiming to determine the 5-fluorouracil (5-FU) contamination on work surfaces of two Portuguese hospitals.