Cultura organizacional na área de diagnóstico por imagem - percepção dos coordenadores de CHLC

Para fazer face a uma nova realidade, limitada pela crise financeira e organizacional em que se encontra o Serviço Nacional de Saúde, têm surgido várias tentativas de mudança dos modelos tradicionais de organização e de gestão nas Organizações de Saúde, a fim de se obterem organizações eficazes (Ferreira, 2011). Tendo como ponto de partida a premissa dos novos desafios impostos pelo sector da saúde, a gestão da Área de Diagnóstico Por Imagem (ADPI) do Centro Hospitalar Lisboa Central (CHLC) defronta-se com a crescente necessidade de traçar estratégias de mudança organizacional, com capacidade de adaptação à realidade vigente no sistema de saúde português. Como vários autores reiteram, o passo primordial para a introdução de mudanças organizacionais, passa pela identificação do tipo de cultura organizacional existente. Partindo desta lógica definiu-se a questão de investigação para o estudo, “Qual a percepção da Coordenação da ADPI do CHLC face à cultura organizacional vigente e à considerada desejada face à mudança organizacional para tornar a organização mais eficaz?”. Na mesma lógica, definiram-se como objectivos da investigação empírica, identificar as características da cultura organizacional da ADPI do CHLC de forma a criar estratégias de mudança organizacional, reconhecer as características da cultura que influenciam a eficácia organizacional nos diferentes polos da ADPI do CHLC e comparar as percepções do coordenador e subcoordenadores da ADPI do CHLC, face à cultura organizacional vigente e à considerada desejada em função da mudança organizacional. Trata-se de um estudo exploratório e descritivo, seguindo a estratégia de estudo de caso único com uma abordagem quantitativa. Para o efeito, recorreu-se ao questionário Organizational Culture Assessment Instrument (OCAI) desenvolvido por Cameron & Quinn (1999), o qual se aplicou à população em estudo constituída por 14 indivíduos da coordenação da ADPI do CHLC. Os resultados demonstram que a cultura organizacional vigente na ADPI do CHLC é do tipo Clã, e que é este tipo de cultura que o coordenador e subcoordenadores consideram ideal para o futuro. Havendo diferenças significativas entre hospitais que devem ser exploradas aquando do desenho de uma intervenção de desenvolvimento organizacional.In order to face the new reality of the financial and organizational crises in which the National Health Service is facing, there have been several attempts at changing the traditional organizational and managerial models implemented in Health Organizations, with the objective of attaining efficient organizations (Ferreira, 2011). Having the new challenges that the health sector is confronted with as a starting point, the management of the Field of Diagnostic Imaging Department (ADPI) of the Hospital Centre of Central Lisbon (CHLC) has encountered the increasing needs of outlining strategies of organizational changes with the ability of adapting them to the current reality that the Portuguese health system is in. Like many authors have stated, the first step to introduce such changes would be to identify the current type of organizational culture. With this mind, the fundamental investigation question for the study was defined, “What is the Coordination of ADPI of CHLC´s perception in regards to the current organizational culture and the one considered ideal in face of organizational changes to make the organizational more efficient?”. In the same rationale, it was determined as objectives of the empirical research to, identify the organizational culture´s characteristics adopted by ADPI of the CHLC as in to create strategies of organizational change, recognize the cultural characteristics that influence organizational efficiency in the different hubs of ADPI of the CHLC, as well as compare the perceptions of the coordinator and sub-coordinators of this institution in relation to the current organizational culture and the one considered ideal, revolving around the topic of organizational change. This is an exploratory and descriptive study, following the strategy of a unique case study with a quantitative approach. For this end, the Organizational Culture Assessment Instrument (OCAI) questionnaire by Cameron and Quinn (1999) as referred to, which was answered by the study population composed of 14 individuals of the coordination of ADPI of the CHLC. The findings show that the current type of organizational culture implemented at ADPI of the CHLC is of Clan type and that this is considered the ideal culture for the future, for both the coordinator and the sub-coordinators. Substantial differences were found between hospitals, which should be investigated during a future intervention to the organizational development

O papel dos media no quadro do terrorismo como acção estratégica

Dissertação de Mestrado em EstratégiaA cobertura mediática de actos terroristas tem registado duras críticas e levantado questões quanto ao papel dos media na expansão do fenómeno terrorista. Através da aplicação de conceitos teóricos do domínio da Estratégia, e validando a hipótese de o terrorismo constituir um fenómeno de cariz estratégico, percebemos que, apesar de a cobertura mediática ser, muitas vezes, favorável ao cumprimento dos objectivos parcelares dos terroristas – atenção, reconhecimento, respeito e legitimidade -, não é determinante para a obtenção do seu objectivo final. Isto é, não tem um contributo decisivo no desenvolvimento do terrorismo. A relação entre media e terrorismo é, de facto, complexa. No entanto, os media apenas se apresentam como um meio empregue pelos grupos terroristas. Na verdade, os media são um meio explorado pela sua capacidade de difundir mensagens de forma célere, abolindo a condicionante da distância. Um meio que é simultaneamente uma força material e moral, aumentando substancialmente o potencial estratégico dos intervenientes no conflito, em especial pela possibilidade de mobilizar o factor psicológico tão caro às modalidades de acção indirectas que marcam os conflitos da actualidade. Porém, não se consideram os media decisivos na concretização da estratégia terrorista. Por um lado, pelo facto de o seu emprego enquanto meio ser muito condicionado por factores diversos do ambiente estratégico, podendo até ter impactos inesperados, nem sempre favoráveis ao actor que o empregou. Por outro, porque a mensagem transmitida, ainda que impregnada de uma interpretação feita pelo meio que a divulga, está sempre sujeita a uma camada de interpretação feita pela audiência. E esta interpretação é condicionada por factores de ordem política, social e cultural que envolvem essa mesma audiência. Deste modo, consideramos que os media são apenas um meio ao serviço da estratégia terrorista. Tal conclusão não invalida, contudo, que sejam debatidas questões relativamente à ética subjacente à cobertura mediática e à forma como os media podem guiar a sua conduta, no sentido de melhor cumprirem os seus objectivos informativos primordiais.The media coverage of terrorist acts has experienced harsh criticism and raised questions about the role of media in the expansion of terrorism. Through the application of theoretical concepts of the strategic domain, and the validation of the hypothesis of terrorism constituting a strategic nature phenomenon, we realized that, despite being the media coverage often favorable to the fulfillment of partial terrorist objectives - attention, recognition, respect and legitimacy -, it is not decisive for achieving their ultimate goal. That is, it does not have a decisive contribution to the terrorism development. The relationship between media and terrorism is, in fact, complex. However, media present themselves only as a mean employed by terrorist groups. In fact, the media are a mean exploited for its ability to rapidly spread messages by abolishing the distance factor. A mean that is both a physical and moral strength, which substantially increases the strategic potential of the actors in conflict, especially regarding the possibility of mobilizing the psychological factor, so relevant when developing the indirect actions that characterize conflicts today. However, we do not consider the media as a decisive factor in the achievement of the terrorist strategy. On the one hand, because of the fact that media employment is conditioned by several factors of the strategic environment and may even have unexpected impacts, not always favorable to the actor who employed them. On the other, because the message conveyed, although impregnated with an interpretation provided by the media itself, it is always subject to a layer of interpretation made by the audience. And this interpretation is conditioned by political, social and cultural aspects involving that same audience. Thus, we consider that the media are only a mean which serves the terrorist strategy. Such a conclusion does not invalidate, however, a discussion on the underlying ethical media coverage and on how the media can guide their conduct, in order to better fulfill their primary information purposes.N/

Animal models in pharmacology: a brief history awarding the Nobel Prizes for Physiology or Medicine

Background: The Nobel Prize of Physiology or Medicine (NPPM) has recognized the work of 222 scientists from different nationalities, from 1901 until 2020. From the total, 186 award researchers used animal models in their projects, and 21 were attributed to scientists and projects directly related to Pharmacology. In the most recent years, genetics is a dominant scientific area, while at the beginning of the 20th century, most of the studies were more related to anatomy, cytology, and physiology. Summary: Mammalian models were used in 144 NPPM projects, being rodents the most used group of species. Moreover, 92 researchers included domestic species in their work. The criteria used to choose the species, the number of animals used and the experimental protocol is always debatable and dependent on the scientific area of the study; however, the 3R’s principle can be applied to most scientific fields. Independently of the species, the animal model can be classified in different types and criteria, depending on their ecology, genetics, and mode of action. Key-Messages: The use of animal models in NPPM awarded projects, namely in Pharmacology, illustrates their importance, need and benefit to improve scientific knowledge and create solutions. In the future, with the contribute of technology, it might be possible to refine the use of animal models in pharmacology studies

Characterization of a cohort of Angolan children with sickle cell anemia treated with hydroxyurea

Background: Sickle Cell Anemia (SCA) is a monogenic disease, although its severity and response to treatment are very heterogeneous. Objectives: This study aims to characterize a cohort of Angolan children with SCA and evaluate their response to hydroxyurea (HU) treatment and the potential side effects and toxicity. Methods: The study enrolled 215 patients between 3 and 12 years old before and after the administration of HU, at a fix dose of 20 mg/kg/day for 12 months. Results: A total of 157 patients started HU medication and 141 of them completed the 12-month treatment. After initiating HU treatment, the frequency of clinical events decreased (transfusions 53.4 %, hospitalizations 47.1 %). The response to HU medication varied among patients, with some experiencing an increase in fetal hemoglobin (HbF) of <5 %. The mean increase in HbF was 11.9 %, ranging from 1.8 % to 31 %. Responders to HU treatment were 57 %, inadequate responders 38.7 % and non-adherent 4.2 %. No clinical side effects related to HU were reported. Hematological toxicities were transient and reversible. Children naïve to HU and with lower HbF reported higher number of hospitalizations caused by malaria infection. During HU treatment, the frequency of malaria episodes did not appear to be affected by HbF levels. Conclusions: the present study provided a valuable contribution to the understanding of the clinical and laboratory profiles of Angolan children with SCA. These findings support the evidence that the implementation of prophylactic measures and treatment with HU is associated with increased survival in children with SCA.This research was funded by Fundação para a Ciência e Tecnologia Ministério da Ciência, Tecnologia e Ensino Superior (FCT-MCTES) and Aga Khan Foundation (FCT/MCTES/Aga Khan, project n◦ 330842553), by FCT/MCTES funding to H&TRC (UIDB/05608/2020, UIDP/05608/2020) and to GHTM IHMT NOVA (UIBD/04413/2020) and LA-REAL –LA/P/0117/2020.info:eu-repo/semantics/publishedVersio

Genetic modulation of anemia severity, hemolysis level, and hospitalization rate in Angolan children with Sickle Cell Anemia

Background Sickle Cell Anemia (SCA) is a genetic disease caused by the c.20 A > T mutation in HBB gene, generally characterized by sickle erythrocytes, chronic hemolytic anemia, and vaso-occlusive events. This study aimed to investigate genetic modulators of anemia severity, chronic hemolytic rate, and clinical manifestations in pediatric SCA patients from Angola, where the disease is a severe public health problem. Methods and Results The study was conducted on 200 SCA children living in Luanda or Caxito province. Their clinical phenotype was collected from patients’ hospital records. Hematological and biochemical phenotypes were characterized in steady state condition. Twelve polymorphic regions in VCAM1, CD36 and NOS3 genes were genotyped using PCR, RFLP, and Sanger sequencing. CD36 gene promoter variants showed a significant impact on anemia severity. Particularly, the rs1413661_C allele was associated with lower hemoglobin levels, and increased number of hospitalizations and transfusions. This is the first report associating this SNP with SCA phenotypic heterogeneity. Moreover, the rs1041163_C allele in VCAM1 was associated with lower LDH levels; inversely the rs2070744_C allele in NOS3 was related with higher LDH levels and number of hospitalizations, being a risk factor for increased hemolytic rate. Conclusion This study highlights, for the first time in the Angolan population, the importance of the genetic modifiers of vascular cell adhesion and nitric oxide metabolism in SCA pediatric phenotypic variability.publishersversionpublishe

Conductive electrospun Polyaniline/Polyvinylpyrrolidone nanofibers: Electrical and morphological characterization of new yarns for electronic textiles

UID/CTM/50025/2019Advanced functionalities textiles embedding electronic fibers, yarns and fabrics are a demand for innovative smart cloths. Conductive electrospun membranes and yarns based on polyaniline/polyvinylpyrrolidone (PANI/PVP) were investigated using the chemical modification of PANI instead of using conventional coating processes as in-situ polymerization. PANI was synthesized from the aniline monomer and the influence of the oxidant-to-monomer ratio on electrical conductivity was studied. The optimized conductivity of pellets made with pressed PANI powders was 21 S·cm-1. Yarns were then prepared from the t-Boc-PANI/PVP electrospun membranes followed by PANI protonation to enhance their electrical properties. Using this methodology, electrospun membranes and yarns were produced with electrical conductivities of 1.7 x 10-2 and 4.1 x 10-4 S·cm-1.publishersversionpublishe

Customized tracheal design using 3D printing of a polymer hydrogel: influence of UV laser cross-linking on mechanical properties

H2020-ICT-2014-1,TransFlexTeg645241 ERC-CoG-2014, CapTherPV, 647596 Pest-UID/FIS/00068/2013The use of 3D printing of hydrogels as a cell support in bio-printing of cartilage, organs and tissue has attracted much research interest. For cartilage applications, hydrogels as soft materials must show some degree of rigidity, which can be achieved by photo- or chemical polymerization. In this work, we combined chemical and UV laser polymeric cross-linkage to control the mechanical properties of 3D printed hydrogel blends. Since there are few studies on UV laser cross-linking combined with 3D printing of hydrogels, the work here reported offered many challenges.publishe

Avaliação clínica da resposta ao tratamento com Hidroxiureia em crianças com Anemia de Células Falciformes em Angola

Resumo publicado em: XII Jornadas Científicas do IHMT: livro de resumos, p. 13. http://ihmtweb.ihmt.unl.pt/Download/JornadasCientificas/XII/Livro-de-resumos_v4.pdfIntrodução: A Anemia de Células Falciformes (ACF) é uma doença genética causada por uma mutação na cadeia beta globina da hemoglobina, dando origem à hemoglobina S. É caracterizada por fenómenos vaso-oclusivos e hemólise crónica. A hemoglobina fetal (HbF) é o modificador central da doença e é passível de manipulação terapêutica. A Hidroxiureia (HU) é o único fármaco aprovado para indução de HbF em pacientes com ACF. Contudo, alguns estudos mostraram que as respostas individuais ao tratamento com HU são muito variáveis. O objectivo deste estudo é a avaliação da eficácia do tratamento com HU em crianças angolanas com ACF. Será feita a apresentação preliminar de dadosde 6 meses de tratamento com HU.Métodos: O estudo incluiu143 crianças dos 3 aos 12 anos de idade, com o diagnóstico de ACF medicadas com HU na dose de 20mg/kg/dia. O seguimento clínico foi feito mensalmente e incluiu o registo de intercorrências, exame físico, avaliação hematológica e dos parâmetros bioquímicos para estudo da hemólise e da toxicidade atribuída à HU. A HbF foi quantificada em estado basal e ao 6⁰ mês de tratamento. Resultados: Comparativamente à fase antes do tratamento e a avaliação feita ao 6⁰ mês de tratamento houve redução de: (1) frequência de episódios de crises dolorosas (59 vs 25), (2) número de transfusões (16 vs 4), (3) número de internamentos (12 vs 3). Uma criança teve recorrência de AVC no 2⁰mês e outra teve necrose asséptica da cabeça do fémur ao 5⁰mês de tratamento. O valor médio da hemoglobina (g/dl) variou de 7,5 para 8,1 (valor mínimo 5,2 e máximo 10,1 vs valor mínimo 5,8 e máximo 10,7). Em 56,1% dos pacientes houve aumento da HbF com valores médios de 5,7% emestado basal e 12,4% ao 6⁰mês de tratamento. Contudo em 12,9% dos pacientes não houve variação da % da HbF e em 30,9% das crianças o aumento da HbF foi inferior a 3% do valor da HbF basal.Na análise dos parâmetros de hemólise o valor percentual médiodos reticulócitosdecresceu de 10,1 para 6,57%, a bilirrubina indirecta (mg/dl) variou de 1,19 para 0,52. A desidrogenase láctea (U/L) não teve variação nos valores médios embora o valor máximo tenha decrescidode 1230 para 1067 e o valor mínimo de 115,1 para 106,3U/L. Não foram registados efeitos secundários importantes relacionados à HU.Conclusão: A HU teve eficácia clínica na maioria dos pacientes evidenciada pelos parâmetros clínicos e laboratoriais. Para além disso, foi demonstrada variabilidade na resposta à terapêutica pelo que está em curso a identificação de polimorfismos associados a essa variabilidade.Parcialmente financiado por FCT/Aga Khan Dev. Network, #330842553info:eu-repo/semantics/publishedVersio