Proposta de Implementação de um Sistema de Avaliação de Desempenho na IPSS Os Melros - Associação, Cultural, Social, Recreativa e Desportiva

A Avaliação de Desempenho assume-se como um importante instrumento estratégico entre as ferramentas de gestão de recursos humanos, atendendo à sua analogia com a apreciação do desempenho dos mesmos, enquanto promotor da sustentabilidade organizacional. Mediante o acentuar considerável da competitividade no contexto atual das organizações sociais, impera que estas desenvolvam competências e estratégias que lhes permitam a devida adaptação às alterações decorrentes de uma sociedade em permanente mutação e o aumento do seu potencial competitivo. O fator diferenciador passa, então, pela reorganização das práticas de gestão adotadas pelas organizações, com especial destaque para uma gestão eficiente dos seus recursos humanos, assente na sua valorização, considerados por muitos estudiosos como o fator chave de competitividade. A presente investigação constituiu como fim o desenvolvimento de uma proposta de implementação de um Sistema de Avaliação de Desempenho direcionado para a organização objeto de estudo. Para tal, procedeu-se, a uma sistematização dos fundamentos teóricos da Avaliação de Desempenho e uma análise sobre a sua importância para as organizações. Procuraram identificar-se os principais fatores que caracterizam o contexto organizacional atendendo a uma eficiente implementação do Sistema de Avaliação de Desempenho, nomeadamente caracterizar a instituição e aferir a perceção que a comunidade organizacional tem acerca da importância da Avaliação de Desempenho. No que concerne a metodologia, o presente estudo foi sustentado numa investigação-ação, a fim de obter uma caracterização da organização em estudo e aferir a perceção que gestão de topo e colaboradores têm sobre a Avaliação de Desempenho, recorrendo a técnicas de recolha de dados como a entrevista e o inquérito por questionário. Dos resultados obtidos, foi possível aferir que a gestão de topo da instituição perceciona a Avaliação de Desempenho como uma forma de melhorar o desempenho individual dos colaboradores e de melhorar os resultados organizacionais, reconhecendo pertinência à sua implementação.No que concerne aos colaboradores, foi possível aferir que o seu conhecimento relativo à Avaliação de Desempenho é rudimentar, não se evidenciando qualquer relação direta entre este e as funções, habilitações literárias e faixa etária.Performance Assessment is an important strategic tool among human resources management tools, taking into account their analogy with the evaluation of their performance, as a promoter of organizational sustainability. By emphasizing considerable competitiveness in the current context of social organizations, it is imperative that they develop skills and strategies that allow them to adapt to changes arising from a constantly changing society and increase their competitive potential. The differentiating factor is then the reorganization of the management practices adopted by the organizations, with special emphasis on the efficient management of their human resources, based on their valuation, considered by many scholars as the key factor of competitiveness. The present investigation aims the development of a proposal for the implementation of a Performance Assessment System directed to the organization under study. To this end, we made a systematization of theoretical foundations of Performance Assessment and an analysis of its importance to the organizations. Next, we sought to identify the main factors that characterize the organizational context, attending to an efficient implementation of the Performance Evaluation System, namely to characterize the institution and to gauge the perception that the organizational community has about the importance of the Performance Assessment. As far as the methodology is concerned, the present study was supported by an action research, in order to obtain a characterization of the organization in study and to verify the perception that top management and collaborators have on the Performance Assessment, using techniques of collection of such as the interview and the questionnaire survey. From the results obtained, it was possible to verify that the top management of the institution perceives the Performance Assessment as a way to improve the individual performance of the employees and to improve the organizational results, recognizing its pertinence to its implementation. With regard to the employees, it was possible to verify that their knowledge regarding the Performance Assessment is rudimentary, not showing any direct relationship between this and the functions, literacy and age group

Nutritional status in preschool children: current trends of mother’s body perception and concerns

Background: Studies in several countries indicate that parents show little concern and aren’t much aware of the nutritional status of their children, and have the tendency to underestimate the overweight which may present a difficulty when promoting healthier life styles. The aim of this study was to identify maternal body image perceptions in preschool children and analyze its relationship with nutritional status and family social demographic variables. Methods: A transversal and descriptive study was developed in a sample of 1424 preschool children and their mothers living in several parts of Portugal. The children were weighted and measured by trained personnel, the BMI was calculated and the nutritional status was classified according to the NCHS referential (CDC, 2000).1 Mother’s real and ideal body image perception from their children was evaluated according to Collins’ body image silhouettes (1991).2 Results: The ideal and real perception was translated in a negative index on both children’s genders, however 67.2% of the mothers revealed accuracy of perception, while 22.3% had a negative and 12.8% a positive discrepancy, being this significant concerning gender and age of the children. Children’s actual weight status (ie, 60.2% normal weight, 16.9% overweight, 17.4% obese and 5.5% underweight) was significantly different from their parents’ perceptions (ie, 52.3% normal weight, 27.5% overweight 0.6% obesity and 19.6% underweight) explaining in 25.9% the variability of this perception. Globally 42.3% has no discrepancy but 44.3% thinks that children were thin and 13.4% heavier. This difference is significant concerning the age and scholarship of the mothers but has no relation with the income and residence. Conclusion: Despite signs of a positive trend, mothers continue to show difficulty in recognizing the children’s nutritional status, so effective public health strategies to increase parents’ awareness could be the first step in an effort to prevent childhood obesity

Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland: Case report and review

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99mTc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window

Reliability and Validity of the PHQ-9 in Portuguese Women with Breast Cancer

Depression is often overlooked in oncology practice. Depressive module PHQ-9 was not studied in Portuguese cancer patients, despite its brevity and comparable psychometric proprieties to other depression scales. Which are the psychometric properties of the Portuguese version of the PHQ-9 for use with women with breast cancer? Reliability, sensitivity to change and the construct validity will be studied. The purpose of this study is to assess the psychometric properties of the Portuguese version of the PHQ-9 for use with women with breast cancer. This study intends to evaluate the reliability, the sensitivity to change and the construct validity of the PHQ-9 in a Portuguese Breast Cancer women sample. It was reproduced a principal component analysis and explored the reliability and validity of the questionnaire. The validation used a sample of 63 Portuguese women with breast cancer. A test-retest was conducted in 45 women, after 8 weeks. Construct validity was analyzed. PHQ-9 scores ranged from 0-27, with a mean score of 4,92 (SD= 4,63). The scale presented adequate internal consistency (α = .86) and test retest reliability (ICC= .87). It also presented good construct validity, as overall scores and severity levels were strongly associated with functional and symptoms subscales. The principal component analysis explains 48.42% of the variance. The validation process of the Portuguese PHQ-9 version shows metric properties similar to those in international studies, suggesting that it measures the same constructs, in the same way, as the original version. Data provided evidence for the validity of the PHQ-9 as a brief measure of depression severity in Portuguese women with breast cancer

KRAS as a modulator of the inflammatory tumor microenvironment: therapeutic implications

KRAS mutations are one of the most frequent oncogenic mutations of all human cancers, being more prevalent in pancreatic, colorectal, and lung cancers. Intensive efforts have been encouraged in order to understand the effect of KRAS mutations, not only on tumor cells but also on the dynamic network composed by the tumor microenvironment (TME). The relevance of the TME in cancer biology has been increasing due to its impact on the modulation of cancer cell activities, which can dictate the success of tumor progression. Here, we aimed to clarify the pro- and anti-inflammatory role of KRAS mutations over the TME, detailing the context and the signaling pathways involved. In this review, we expect to open new avenues for investigating the potential of KRAS mutations on inflammatory TME modulation, opening a different vision of therapeutic combined approaches to overcome KRAS-associated therapy inefficacy and resistance in cancer.This work was financed by the Portuguese Foundation for Science and Technology (Fundacao para a Ciencia e a Tecnologia, FCT) within the scope of two PhD grants, SFRH/BD/140137/2018 attributed to FP and SFRH/BD/142486/2018 attributed to AF. A.P. acknownledges FCT within the scope of the project PTDC/QUIQIN/28662/2017. A.P. and M.J.S. also acknowledge the support of the CBMA strategic programme "Contrato-Programa" UIDB/04050/2020 funded by national funds through the FCT I.P. C.A.R. acknowledges the project Norte-01-0145-FEDER-000051-"Cancer Research on Therapy Resistance: From Basic Mechanisms to Novel Targets", supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). M.J.O. acknowledges FEDER funds through COMPETE 2020-Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, Portuguese funds through FCT/Ministerio da Ciencia, Tecnologia e do Ensino Superior in the framework of the project POCI-01-0145-FEDER-31859/2017

Nutritional status in preschool children: current trends of mother's body perception and concerns

Abstract Background: Studies in several countries indicate that parents show little concern and aren't much aware of the nutritional status of their children, and have the tendency to underestimate the overweight which may present a difficulty when promoting healthier life styles. The aim of this study was to identify maternal body image perceptions in preschool children and analyze its relationship with nutritional status and family social demographic variables. Methods: A transversal and descriptive study was developed in a sample of 1424 preschool children and their mothers living in several parts of Portugal. The children were weighted and measured by trained personnel, the BMI was calculated and the nutritional status was classified according to the NCHS referential 1 Mother's real and ideal body image perception from their children was evaluated according to Collins' body image silhouettes (1991). 2 Results: The ideal and real perception was translated in a negative index on both children's genders, however 67.2% of the mothers revealed accuracy of perception, while 22.3% had a negative and 12.8% a positive discrepancy, being this significant concerning gender and age of the children. Children's actual weight status (ie, 60.2% normal weight, 16.9% overweight, 17.4% obese and 5.5% underweight) was significantly different from their parents' perceptions (ie, 52.3% normal weight, 27.5% overweight 0.6% obesity and 19.6% underweight) explaining in 25.9% the variability of this perception. Globally 42.3% has no discrepancy but 44.3% thinks that children were thin and 13.4% heavier. This difference is significant concerning the age and scholarship of the mothers but has no relation with the income and residence. Conclusion: Despite signs of a positive trend, mothers continue to show difficulty in recognizing the children's nutritional status, so effective public health strategies to increase parents' awareness could be the first step in an effort to prevent childhood obesity

Competências profissionais no âmbito da prevenção e do tratamento do tabagismo no final da formação pré-graduada dos profissionais de saúde: Estudo de avaliação com os cursos de formação em ciências farmacêuticas, enfermagem, medicina e medicina dentária – Sumário Executivo.

Este documento é o resultado de um estudo de avaliação das competências profissionais no âmbito da prevenção e do tratamento do tabagismo no final da formação pré-graduada dos cursos de Ciências Farmacêuticas, Enfermagem, Medicina e Medicina Dentária. Principais conclusões? 1 - Elevadas prevalências de tabagismo; 2 - Atitudes positivas relativamente ao controlo do tabaco; 3 - Um nível razoável de conscientização sobre as políticas de não fumador nos espaços das práticas letivas e clínicas; 4 - Um alinhamento com o quadro teórico e concetual sobre as temáticas da prevenção e do tratamento do tabagismo, assim como acerca do papel dos profissionais de saúde neste domínio; 5 - Limitadas competências de intervenção ao nível da prevenção e do tratamento do tabagismo; 6 - Necessária introdução de um conjunto de temas teóricos e práticos na formação académica destes profissionais, percecionados como omissos, que suportem o seu pensamento e as suas decisões na atual no domínio do tabagismo

Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland -Case report and review Hiperparatiroidismo primário persistente: glândula ectópica em localização rara -Caso clínico e revisão

SUMMARY Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middleaged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Ima ging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, Tc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99m Tc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroi dectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99m Tc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window. Arq Bras Endocrinol Metab. 2012;56(6):393-403 SUMÁRIO O hiperparatiroidismo primário (HPP) é uma endocrinopatia frequente que afeta maioritariamente mulheres de meia-idade e é geralmente assintomática. A doença pode ser atribuível a hiperplasia, carcinoma, adenomas únicos ou múltiplos. O HPP inclui formas esporádicas e familiares. As formas familiares englobam neoplasia endócrina múltipla tipo 1 ou 2A, hipercalcemia hipocalciúrica familiar e síndrome hiperparatiroidismo/tumor mandibular-maxilar. As causas mais frequentes de HPP persistente são a presença de doença multiglandular ou de paratiroide anômala ectópica ou ortotópica não identificada previamente. É recomendável que a localização imagiológica preceda a reintervenção cirúrgica. A janela aortopulmonar é uma localização ectópica rara, sendo o 99m Tcsestamibi SPECT/TC um exame de confirmação vantajoso ou, alternativamente o 99m Tc-sestamibi seguido de TC ou RM torácica. A paratiroidectomia pode ser efetuada por meio de esternotomia mediana, toracotomia ou toracoscopia videoassistida. Descrevemos um caso de HPP persistente atribuível à presença de uma glândula paratiroide ectópica localizada à janela aortopulmonar. O diagnóstico de HPP foi estabelecido na sequência da investigação requisitada para esclarecimento etiológico da nefrolitíase recidivante constatada nessa doente. Foi submetida à paratiroidectomia subtotal; não obstante, o HPP persistiu. Excluíram-se síndromes genéticas que pudessem justificar esse quadro clínico. Os exames imagiológicos disponíveis (à época) revelaram-se infrutíferos na detecção de paratiroides anômalas; adicionalmente, a doente recusou exploração cirúrgica. Posteriormente, a doente foi submetida a 99m Tc-sestamibi SPECT/TC, que revelou a presença de uma paratiroide na janela aortopulmonar. Arq Bras Endocrinol Metab. 2012;56(6):393-40

IMPACT OF TYPE-II ENDOLEAK ON ANEURYSM SAC IN A SINGLE CENTER

Objective: Type 2 endoleak occurs in up to 30% of endovascular aneurysm repair (EVAR), but its long-term significance continues to be one of the most controversial topics. We reviewed our experience to evaluate late outcomes associated with type 2 endoleak. Methods: Between January 2008 to December 2014, 57 patients undergoing EVAR were enrolled in the presenting study. Computed tomography (angioCT) scan assessment was performed to evaluate aneurysm sac evolution. Primary end points included type 2 endoleak incidence, aneurysm sac growth, abdominal aortic aneurysm (AAA) related rupture and death. Secondary endpoints included conversion to open repair, reintervention rate, type 2 endoleak persistence and failure to shrinkage > 5mm and abdominal aortic aneurysm (AAA) rupture. Results: We identified 10 (17.5%) patients with type 2 endoleaks (6 early at the first follow-up CT scan). Median followup was 39.0 ± 31,6 months. Endoleaks persisted in 7 patients (12,2% of total patients; 70,0% of type 2 endoleaks) for >6 months. Overall survival rate was 100%, 98% and 80% at 1, 2 and 5 years. Spontaneous sealing occurred in 6/10 (60%): 3/3 (100.0%) transient type 2 endoleaks and 3/7 (43%) persistent type 2 endoleak. Transient type 2 endoleak (those that resolved <6 months of EVAR) weren´t associated with adverse late outcomes. In contrast, persistent endoleak was associated with several adverse outcomes. When evaluating patients with transitory endoleak vs persistent endoleak, freedom from sac expansion at 1, 3, and 5 years was 100% (transitory) vs 85%, 65%, e 40% (persistent) (P < .001). Patients with persistent endoleak were at increased risk for aneurysm sac growth vs patients without endoleak (odds ratio [OR], 36.0; 95% confidence interval [CI] 2,15 - 79; P < .02). The only reintervention occurred in a persistent endoleak). There was no aneurysm rupture or AAA-related death. Conclusion: Small sample size have limited this study ability to evaluate the impact on endoleak on adverse outcomes. Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rate

An analysis of survival and disability milestones

Funding Information: This work was supported by Fundação para a Ciência e Tecnologia (FCT) through a Ph.D. Scholarship ( SFRH/BD/143797/2019 ) and Prémio João Lobo Antunes by Santa Casa da Misericórdia de Lisboa. Funding Information: This work was supported by Fundação para a Ciência e Tecnologia (FCT) through a Ph.D. Scholarship (SFRH/BD/143797/2019) and Prémio João Lobo Antunes by Santa Casa da Misericórdia de Lisboa. Publisher Copyright: © 2023Background: Data on the long-term survival and incidence of disability milestones after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) is limited. Objectives: To estimate mortality and assess the frequency/time-to-development of disability milestones (falls, freezing, hallucinations, dementia, and institutionalization) among PD patients post STN-DBS. Methods: A longitudinal retrospective study of patients undergoing STN-DBS. For mortality, Cox proportional hazards regression analysis was performed. For disease milestones, competing risk analyses were performed and cumulative incidence functions reported. The strength of association between baselines features and event occurrence was calculated based on adjusted hazard ratios. Results: The overall mortality for the 109 patients was 16 % (62.1 ± 21.3 months after surgery). Falls (73 %) and freezing (47 %) were both the earliest (40.4 ± 25.4 and 39.6 ± 28.4 months, respectively) and most frequent milestones. Dementia (34 %) and hallucinations (32 %) soon followed (56.2 ± 21.2 and mean 60.0 ± 20.7 months after surgery, respectively). Higher ADL scores in the OFF state and higher age at surgery were associated with falls, freezing, dementia and institutionalization. Conclusions: Long-term mortality rate is low after STN-DBS. Disease milestones occur later during the disease course, with motor milestones appearing first and at a higher frequency than cognitive ones.publishersversionpublishe