Cultura de Seguridad del Paciente en el Servicio de Emergencias Médicas: estudio transversal

Introduction: Problems related to patient safety in the pre-hospital context are little explored, but essential, given the vulnerability to incidents. Objective: to analyze the patient safety climate from the perspective of the multidisciplinary team that works in Mobile Pre-Hospital Care (PHC). Materials and Methods: cross-sectional study, conducted in a Mobile Pre-Hospital Care. Data collection was performed through Safety attitudes Questionnaire (SAQ), with convenience sampling and participation rate of 94.3% of eligible professionals. Descriptive statistics and the Mann-Whitney test were used for data analysis. Results: Among the 151 participating professionals, males predominated (54.6%), nursing assistants and technicians (42.0%), working for 10 or more years (61.0%), in adult and pediatric care (93.4%). The SAQ Total had a median of 70, indicating a negative perception of the participants about patient safety in the APH. The domains with a negative perception were: Safety Climate, Stress Recognition, Management Perception and Working Conditions; while the Teamwork Climate and Job Satisfaction domains showed a positive perception. In the comparative analysis among professionals, differences were observed between some categories for the domains of Job Satisfaction, Stress Recognition and Working Conditions. Conclusions: This study presents the peculiarities of emergency medical services and the need to sensitize professionals and managers about patient safety, with a view to better understanding the current scenario and possibilities of reducing adverse events to improve the care offered. How to cite this article: João, Virgilio Malundo; Dias, Bruna Moreno; Oliveira, Marília Pilotto de; Laus, Ana Maria; Bernardes, Andrea; Gabriel, Carmen Silvia.  Cultura de Segurança do Paciente no Serviço Médico de Urgência: estudo transversal. Revista Cuidarte. 2023;14(1):e2531. http://dx.doi.org/10.15649/cuidarte.2531Highlights: A atitude de segurança positiva foi observada no Clima de Trabalho em Equipe e na Satisfação no Trabalho A atitude de segurança negativa foi observada no Clima de Segurança, no Reconhecimento de Estresse, na Percepção da Gestão e nas Condições de Trabalho Para todas as categorias profissionais, houve melhor percepção da Satisfação no Trabalho e pior percepção da Gestão Enfermeiros apresentaram pontuações inferiores na atitude de segurança, quando comparados a outras categorias profissionais Introdução: Os problemas relacionados à segurança do paciente no contexto pré-hospitalar são pouco explorados, porém essenciais, dada a vulnerabilidade para a ocorrência de incidentes. Objetivo: analisar o clima de segurança do paciente na perspectiva da equipe multiprofissional que atua no Atendimento Pré-Hospitalar Móvel (APH). Materiais e Métodos: estudo transversal, conduzido em um Atendimento Pré-Hospitalar Móvel. A coleta de dados foi realizada por meio do Safety Attitudes Questionnaire (SAQ), com amostragem por conveniência e taxa de participação de 94,3% dos profissionais elegíveis. Empregou-se estatística descritiva e o teste Mann-Whitney para análise de dados. Resultados: Dentre os 151 profissionais participantes, predominaram aqueles do sexo masculino (54,6%), auxiliares e técnicos de enfermagem (42,0%), atuantes há 10 ou mais anos (61,0%), em atendimentos adultos e pediátricos (93,4%). O SAQ Total apresentou mediana de 70, indicando percepção negativa dos participantes acerca da segurança do paciente no APH. Os domínios com percepção negativa foram: Clima de Segurança, Reconhecimento de Estresse, Percepção da Gestão e Condições de Trabalho; enquanto os domínios Clima de Trabalho em Equipe e Satisfação no Trabalho apresentaram percepção positiva. Na análise comparativa entre os profissionais, foram observadas diferenças entre algumas categorias para os domínios Satisfação no Trabalho, Reconhecimento de Estresse e Condições de Trabalho. Conclusões: Este estudo apresenta as peculiaridades dos serviços de médicos de emergência e a necessidade de sensibilizar profissionais e gestores acerca da temática segurança do paciente, com vistas a melhor compreensão do atual cenário e possibilidades de redução de eventos adversos para a melhoria da assistência ofertada. Como citar este artigo: João, Virgilio Malundo; Dias, Bruna Moreno; Oliveira, Marília Pilotto de; Laus, Ana Maria; Bernardes, Andrea; Gabriel, Carmen Silvia.  Cultura de Segurança do Paciente no Serviço Médico de Urgência: estudo transversal. Revista Cuidarte. 2023;14(1):e2531. http://dx.doi.org/10.15649/cuidarte.2531Introducción: Los problemas relacionados con la seguridad del paciente en el contexto prehospitalario son poco explorados, pero esenciales, dada la vulnerabilidad a incidentes. Objetivo: analizar el clima de seguridad del paciente desde la perspectiva del equipo multidisciplinario que actúa en la Atención Prehospitalaria Móvil (APS). Materiales y Métodos: estudio transversal, realizado en una Atención Prehospitalaria Móvil. La recolección de datos se realizó a través de Seguridad actitudes Cuestionario (SAQ), con muestreo por conveniencia y tasa de participación del 94,3% de los profesionales elegibles. Para el análisis de los datos se utilizó estadística descriptiva y la prueba de Mann-Whitney. Resultados: Entre los 151 profesionales participantes, predominaron los del sexo masculino (54,6%), auxiliares y técnicos de enfermería (42,0%), con 10 o más años de actuación (61,0%), en la atención de adultos y pediátrica (93,4%). El SAQ Total tuvo una mediana de 70, indicando una percepción negativa de los participantes sobre la seguridad del paciente en la APH. Los dominios con percepción negativa fueron: Clima de Seguridad, Reconocimiento del Estrés, Percepción de la Gestión y Condiciones de Trabajo; mientras que los dominios Clima de Trabajo en Equipo y Satisfacción Laboral mostraron una percepción positiva. En el análisis comparativo entre profesionales, se observaron diferencias entre algunas categorías para los dominios de Satisfacción en el Trabajo, Reconocimiento del Estrés y Condiciones de Trabajo. Conclusiones: Este estudio presenta las peculiaridades de los servicios médicos de emergencia y la necesidad de sensibilizar a los profesionales y gestores sobre la seguridad del paciente, con el fin de comprender mejor el escenario actual y las posibilidades de reducción de eventos adversos para mejorar la atención ofrecida. Como citar este artículo: João, Virgilio Malundo; Dias, Bruna Moreno; Oliveira, Marília Pilotto de; Laus, Ana Maria; Bernardes, Andrea; Gabriel, Carmen Silvia.  Cultura de Segurança do Paciente no Serviço Médico de Urgência: estudo transversal. Revista Cuidarte. 2023;14(1):e2531. http://dx.doi.org/10.15649/cuidarte.253

New evidence of pectenotoxins in farmed bivalve molluscs from Sardinia (Italy)

Several planktonic dinoflagellates can produce lipophilic phycotoxins that represent a significant threat to public health as well as to shellfish and fish farming. Poisoning related to some of these toxins is categorised as diarrhetic shellfish poisoning. We analysed 975 shellfish samples from Tortolì in the central-eastern region of Sardinia (Italy) from January 2016 to March 2020, to investigate the prevalence of different lipophilic marine biotoxins in mollusc bivalves. The results highlighted the predominant presence of toxins belonging to the okadaic acid group in all samples with toxin concentrations exceeding legal limits, and revealed the new occurrence of pectenotoxins in oysters and clams with a winter seasonality in recent years. The origin of shellfish toxicity was associated with the same Dinophysis species, mainly D. acuminata. Based on both these results and other precedents, monitoring and recording systems are strongly recommended

Identification and quantification of potential microplastics in shellfish harvested in Sardinia (Italy) by using transillumination stereomicroscopy

Plastics are non-biodegradable polymers made up of different groups of petrochemical materials. Several biotic and abiotic factors can change the density of plastic fragmenting it and originating microplastics (MPs). MPs have been defined as small pieces of plastic less than 5 mm in size. Due to their small size, they are an emerging concern in the marine environment since they can be ingested by aquatic organisms, especially filter-feeding organisms, such as bivalve mollusks. Impacts of MPs exposure have been shown at various levels of biological organization, from cellular to tissue to individual and population levels. For example, oxidative stress and inflammation have been observed in copepods and mussels, obstruction and physical damage of the digestive tract were found in fish and swimming behavior alterations, disruption of foraging and feeding behavior and overall reduced fitness and survival were observed in fish and oysters. In addition, MPs can act as a vector for the transfer of chemicals to marine biota. The aim of the present study was the identification and quantification of potential MPs in shellfish harvested in Sardinia (Italy) by using transillumination stereomicroscopy. Bivalves were collected from 4 of the main production areas located along the Sardinian coast and selected according to the principles of the risk assessment. The results of the present study demonstrated the presence of potential MPs in 70% of the analyzed samples: the presence of MPs in bivalve mollusks may pose a threat to food safety, and there is an urgent need to evaluate the potential risks of MPs to human health

Odontogenic cysts and tumors : a retrospective study of the cases diagnosed in a period of 10 years in a southern Brazilian hospital

Introdução: as lesões odontogênicas (LOs) compreendem um grupo heterogêneo de patologias orais e maxilofaciais que apresentam características distintas. O objetivo do presente estudo foi identificar as características clínico- -patológicas das LOs diagnosticadas em um hospital da região sul do Brasil. Materiais e métodos: foi realizado um estudo retrospectivo para levantamento dos casos com diagnóstico histopatológico de LOs no período entre 2007 e 2017. Os laudos dos pacientes foram avaliados para extração das características clínico-patológicas e dos diagnósticos histopatológicos de cada caso. Resultados: um total de 255 casos de LOs foram identificados. Destes casos, 197 (77%) cistos odontogênicos e 58 (23%) tumores odontogênicos foram coletados, sendo que somente um caso (0,39%) possuiu o diagnóstico de neoplasia odontogênica maligna. Os diagnósticos mais prevalentes foram cisto radicular (32,5%) e cisto dentígero (31,76%), seguidos de ceratocisto odontogênico (10,98%), odontoma (10%) e ameloblastoma (10%). A maioria dos casos acometeu mandíbula (53,7%), com uma discreta predileção pelo sexo feminino (51%). A média de idade foi de 34±20,53 anos. Discussão: os dados apresentados corroboram com a literatura no que se refere à raridade do diagnóstico de tumores odontogênicos. Conclusão: o presente estudo demonstrou as principais características clínico-patológicas de LOs diagnosticadas em um hospital no sul do Brasil, contribuindo para um maior conhecimento do perfil destas lesões.Introduction: odontogenic lesions (OLs) represent a heterogeneous group of oral and maxillofacial pathologies presenting distinct characteristics. The present study aimed to identify the clinical and pathological characteristics of OLs diagnosed in a southern Brazilian hospital. Materials and methods: a retrospective study was performed to evaluate cases with histopathological diagnosis of OLs identified in the period between 2007 and 2017. The patient’s medical records were evaluated in order to obtain the clinical and pathological characteristics and the histopathological diagnosis from each case. Results: a total of 255 cases of OLs were identified. From these, 197 (77%) odontogenic cysts and 58 (23%) odontogenic tumors were surveyed, with only one case (0,39%) of a malignant odontogenic neoplasm. The most prevalent diagnosis were radicular cyst (32.5%) and dentigerous cyst (31.76%), followed by odontogenic keratocyst (10.98%), odontoma (10%) and ameloblastoma (10%). The majority of the cases affected the mandible (53.7%) with a slight preference by female individuals (51%). The mean age was 34±20.53 years old. Discussion: the presented data are in accordance with the literature regarding the rarity of the diagnosis of odontogenic tumors. Conclusion: the present study demonstrated the main clinical and pathological characteristics of OLs diagnosed in a southern Brazilian hospital, contributing to a better understanding of these injuries profiles

methods and tools for the development of adaptive applications

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Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings