Contribution of EQA to improve Preanalytical practices by systematic verification of Laboratory Services

International literature describes the preanalytical phase as the most susceptible to errors due to the numerous non automated activities it involves Most EQA organizers offer preanalytical schemes to participants. There are basically three types of surveys procedures registration, samples circulation and errors registration The Portuguese EQA Programme ( provides these type of schemes for 13 years, using as a guide the ISO 15189 2012 In order to improve the evaluation of the preanalytical phase, PNAEQ recently launched two other preanalytical EQA schemes, mystery client and presential audits in 2015 and 2016 respectively. The aim of the mystery client survey is to verify whether the information provided to the patient is constant regardless the day and time or if it is dependent on the collaborator. The aim of the presential audit survey is to give the participants a tool to verify if the procedures performed daily are in accordance with laboratorial good practices recommendations. Conclusions: Results from Mystery Client surveys demonstrate the need for written procedures and harmonization of practices for all collaborators, as more than a third of the responses differed in date/time and operator in a global view. In the Presential Audit surveys we highlight as critical points the results regarding questions 3 5 and 6 as they point to specific problems that occurred during the blood collection procedure, such as operator and patient safety, as well as the quality of the sample collected, suggesting the need to review legal and normative issues and to train collaborators. Participants who use systematically these two methodologies are monitoring some of the requirements of ISO 15189:2012, namely 4. 1.2.6, 4.3, 4.4.1, 4.14, 5.4.2 (both), 5.4.4.2 (mystery client) and 5.1.2, 5.2.2, 5.2.5, 5.3.2.5, 5.3.2.7, 5.4.4 (presential audit), contributing to release reliable results for medical decisions. For the future, we will extend the questions and items in evaluation in these two surveys to Microbiology area and continuing to offer training in Preanalytical matters.N/

Drowning deaths in Australian rivers, creeks and streams: a 10 year analysis

735 people drowned in Australian rivers, creeks and streams between 2002 and 2012. Rivers claimed more lives than any other aquatic location across the same period. • Executive Summary This report details the number of drowning deaths in Australian rivers, creeks and streams across the last 10 financial years and the circumstances around those deaths. Rivers have consistently been the aquatic location with the highest number of drowning deaths in annual Royal Life Saving National Drowning Reports and subsequent Australian Water Safety Strategies have highlighted the importance of reducing drowning deaths in rivers in order to achieve a 50% reduction in all drowning deaths experienced in Australia by the year 2020. A review of drowning deaths allows for patterns to be identified and evidence-based strategies for drowning reduction can be developed. Data on all known drowning deaths in rivers across the last 10 financial years (1 July 2002 to 30 June 2012) has been sourced from the National Coronial Information System (NCIS), State and Territory Coronial Offices and the media. It has been collated and analysed by the Royal Life Saving Society – Australia. Between 1 July 2002 and 30 June 2012, a total of 2,965 people died as a result of drowning in Australian waterways. Of these 735 people drowned in rivers, creeks and streams, accounting for 25% of all drowning deaths experienced in Australian waterways across this ten year period. Males accounted for 80% of all river drowning deaths across the period of this study. The male burden in river drowning deaths was most prominent in the 25-34 years age group where males accounted for 92% of all drowning deaths experienced in people in that age group. New South Wales, as the most populous State, experienced the highest number of river drowning deaths across the 10 year period of this report, with 246 deaths or 34% of all river drowning deaths. When examining rates per 100,000 population, the Northern Territory experienced the highest average annual rate of river drowning deaths per 100,000 population, with a rate of 1.81 compared to a national annual average of 0.35 drowning deaths per 100,000 population. The Northern Territory’s drowning rate is also over 2.5 times greater than the next closest State, Tasmania, with a rate of 0.66 per 100,000 population. The male rate of drowning in the Northern Territory was the highest of any State or Territory with a rate of 3.19 males drowning per 100,000 population. The average rates per 100,000 population for female drowning deaths in rivers across the States and Territories of Australia were highest in the Northern Territory (0.30), followed by Queensland (0.26) followed by Tasmania (0.24). Almost three quarters (74%) of people who drowned in rivers, did so within 100kms of their home postcode. This provides strength to the argument that public awareness and drowning prevention strategies should be targeted at the local community level to ensure greatest efficacy. The largest proportion of drowning deaths in rivers took place in areas deemed Inner Regional (29.7%). A concerning, 10% took place in areas considered to be Very Remote. By their very definition, areas deemed Very Remote are isolated from basic services such as medical services. Therefore first responder skills in CPR and first aid are vital, as is education among those living in Remote and Very Remote areas about how to minimise the risk of drowning in rivers. When river drowning deaths are segmented and analysed by drainage division, the North East Coast division of Queensland had the highest number of drowning deaths, with 27% of all river drowning deaths during the 10 year period of this study. This was followed by the Murray-Darling Basin (21%) and the South East Coast region of New South Wales (19%). By river system, the Murray River experienced the highest number of drowning deaths across the 10 years, followed by the Brisbane River and the Yarra River. Falls into water were the most common activity being undertaken immediately prior to drowning in rivers (20%), followed by accidents involving non- aquatic transport (18%) and swimming and recreating (15%). Males were more likely to drown as a result of intentionally interacting with water or intentionally entering the water as a result of fishing, jumping in, undertaking a rescue and using watercraft. Females were more likely to drown in rivers as a result of unintentionally entering the water, either as a result of being swept away by floodwaters or a non-aquatic transport accident. Summer experienced the highest proportion of river drowning deaths with 39% of the total number of deaths, followed by Spring (23%). Interestingly, Winter experienced one-fifth of all river drowning deaths (146 drowning deaths) and saw a greater number of drowning deaths than occurred in Autumn (131 drowning deaths). Analysis of the data showed that 17% of all river drowning deaths were known to be related to flooding. The State of Queensland experienced 56% of all known flood related drowning deaths in rivers. Over half (56%) of all drowning deaths that took place in flooded rivers were as a result of either being swept in or deliberately entering floodwaters in non-aquatic transport. Further work must be conducted within the community to highlight the dangers of flooded rivers. Indigenous people drowned at a rate of 1.58 per 100,000 population in rivers, a rate that is 4.4 times that of the general population. Almost half (46%) of drowning deaths in Indigenous Australians occurred in the 25-44 years age range. Over half of all Indigenous people that drowned in rivers (54%) were known to have a positive reading for alcohol in their bloodstream when they drowned. Alcohol was also known to be a contributing factor in 64% of all cases where Indigenous people intentionally entered floodwaters. Culturally appropriate strategies to prevent drowning in Indigenous Australians should be developed that highlight the dangers of floodwaters and alcohol consumption whilst recreating in, on or near rivers. 6Alcohol was known to be involved in 37% of all river drowning deaths. There were a further 252 cases (representing 35% of all river drowning deaths) where information on the involvement of alcohol was not available. This suggests the involvement of alcohol in river drowning deaths could be larger than currently known. Drowning deaths known to involve alcohol accounted for almost half (49%) of all drowning deaths in the 45-54 years age group. A key issue identified during analysis of the data was the extremely large amounts of alcohol being consumed prior to drowning deaths in rivers. Half of all drowning victims whose blood alcohol concentrations were deemed to be contributory (i.e. a Blood Alcohol Content equal to or greater than 0.05g/L) had a Blood Alcohol Content of 0.2 or higher. This level of alcohol in the bloodstream is four times that of the legal driving limit. Twenty seven percent of all river drowning victims recorded some form of drug in their bloodstream when they drowned. In just over a third of these cases, the drugs were known to be illegal, the most common of which were cannabis and methamphetamine. Of the legal drugs detected, commonly occurring types were anti-depressants, anti-convulsants and cardiovascular agents such as anti-arrythmic drugs. The analysis of river drowning data, clearly indicates a significant issue related to alcohol consumption, in rivers across Australia. Although better reporting is required, drowning prevention strategies for rivers must include information on the risks of interacting with rivers when under the influence of alcohol, alcohol and medications and/or alcohol and illicit drugs. Linked to the issue of medication use is the finding that 37% of all river drowning victims were known to have an underlying medical condition. Logically underlying medical conditions were more common in middle aged and elderly people with people aged 45-54 and 75+ accounting for 38% of all drowning victims in rivers known to have underlying medical conditions. Further research is required around the true contribution of underlying medical conditions to river drowning risk. This report makes a number of recommendations aimed at expanding our knowledge of river recreational patterns and to reduce drowning deaths in Australian rivers. These include enhanced understanding of the risks of floodwaters, increased awareness and enforcement of legislative requirements regarding use of watercraft whilst under the influence of alcohol in rivers and improving CPR and first aid skills in Remote and Very Remote areas. Further research is also required around the recreational patterns and risk profiles of river drowning black spots and improving our understanding of river user’s attitudes towards the risks and hazards present in rivers

Evaluation of the Sigma Quality level for Serum Iron determination by two colorimetric methods, Ferrozine and Ferene S

Iron plays important functions in the body such as the formation and functioning of hemoglobin and it’s disorders are among the most common diseases of human1. It is essential to ensure that its levels determination through laboratory tests are accurate and precise. The participation of laboratories in the External Quality Assessment (EQA) allows the increases of the quality level of the laboratory results and improvement of its performance.2This study was developed in the Portuguese Nacional EQA Program (PNAEQ) concerning the laboratories results from the Clinical Chemistry Scheme. The main objective of this study was to evaluate and improve the sigma quality level regarding the Iron parameter and reduce the variability of the laboratories results participating in the EQA program of Clinical Chemistry of the Nacional External Quality Assessment Program (PNAEQ). The mean Sigma quality level indicated that the Ferrozine method had a better performance compared with Ferene S method. Half of the control samples had a sigma quality level higher than 3.0, which is set as the minimum acceptable quality.3 Despite of the improved of the Sigma quality level in the Pilot Test, the results demonstrated a need to improved the analytical process performance and to identified more potential causes and implement new improvement actions. It becomes necessary to raise awareness with the laboratories, improving the Pilot Test participation frequency, resulting in a recurrent and current assessment of the laboratory activity performance. Developing Six Sigma projects on a periodic basis is important for continuously and progressively increasing the level of Sigma quality in laboratory examinations. The main advantage of quality assessment on the sigma scale is providing evidence of overall laboratory performance, taking into account random and systematic errors.N/

Atividade física, ansiedade e gravidez

Introdução: A gravidez e a prática da atividade física (AF) são temas ainda pouco abordados na nossa sociedade. Muitas mulheres sofrem de ansiedade no período pré-natal e não conhecem os benefícios que a prática da AF tem sobre a mesma. Estudos demonstram que a AF está associada à diminuição da ansiedade, contudo poucos avaliam este efeito na gravidez. Objetivo(s): Os objetivos deste estudo foram classificar o nível de AF das grávidas; avaliar os sintomas de ansiedade e analisar a associação entre os níveis de ansiedade e a AF das gestantes. Métodos: Trata-se de um estudo longitudinal prospetivo, realizado numa amostra de 56 grávidas com idades entre os 18 e os 37 anos (29,14 ±4,641 anos). As participantes foram avaliadas em dois momentos, T1 (10-12 semanas gestacionais) e T2 (20-22 semanas gestacionais), tendo sido mensurada a AF com acelerómetros GTX3 e a ansiedade com a escala de Zung. Resultados: A média da AF leve e moderada não apresentou diferenças entre os dois momentos de avaliação; contudo, verificou-se uma tendência para a AF leve diminuir do primeiro para o segundo trimestre (1283,88 ± 530,37 vs 1098,16 ± 489,72 counts/min total semana; p=0,459) e a AF moderada aumentar (2470,62 ± 404,50 vs 2528,55 ± 493,05 counts/min total semana; p=0,459). A maioria das grávidas não cumpriu as recomendações da ACSM nos dois momentos de avaliação (T1: 72,1% e T2: 73,2%) (p=0,06). Não se verificaram diferenças no estado de ansiedade das grávidas de T1 para T2. 10,7% das grávidas apresentaram ansiedade em T1 e 7,1% em T2 (p=0,063). Cumprir ou não as recomendações da ACSM não esteve associado ao estado de ansiedade. Conclusão: Neste estudo verificámos que a maioria das gravidas não cumpre as recomendações da AF segundo ACSM, os níveis de ansiedade não diferiram ao longo da gravidez, verificámos ainda que o cumprimento das recomendações da AF não está associado aos níveis de ansiedade.Background: The pregnancy and the practice of physical activity (PA) are themes which are not approached in our society. Many women suffer from anxiety in the prenatal period and not know the benefits of the practice of PA have about the same. Studies show that physical activity is associated with decreased anxiety, however few assess this effect on pregnancy. Aim(s): The purpose of this study was to classify the level of PA pregnant, evaluate symptoms of anxiety and analyze the association between levels of anxiety and PA of pregnant women. Methods: This is a prospective longitudinal study with a sample of 56 pregnant women aged between 18 and 37 years 29,14 ±4,641 years). Participants were assessed at two time points T1 (10-12 gestational weeks ) and T2 (20-22 gestational weeks) and were measured PA with accelerometers GTX3 and anxiety with the Zung scale. Results: The mean of light and moderate PA showed no differences between the two time points however there was a trend to decrease light PA from the first to the second quarter (1283,88 ± 530,37 vs 1098,16 ± 489,72 counts/min total week; p=0,459) and moderate PA increase (2470.62 ± 404.50 vs 2528.55 ± 493.05 counts/min total week, p = 0.459). Most pregnant women do not fulfill the recommendations of the ACSM in the two time points (T1: 72,1% e T2: 73,2%) (p = 0.06). 10.7% of pregnant women reported anxiety in T1 and 7.1 % in T2 (p = 0.063). Comply or not the recommendations of the ACSM were not associated with state anxiety. Conclusion: This study found that the majority of pregnant does not meet the recommendations of the PA second ACSM , anxiety levels did not differ throughout pregnancy, found yet that compliance with the recommendations of PA is not associated with levels of anxiety

A influência da idade nos parâmetros metabólicos durante a marcha com andarilho

Introdução: Estruturalmente, a marcha é modificada de acordo com as características de cada individuo, sua natureza morfológica, tipo de atividade, idade e a presença de determinadas doenças, entre outros fatores. Devidas as alterações fisiológicas de envelhecimento, o custo energético da marcha normal por si só é superior nos idosos comparativamente com os jovens. Objetivo: Analisar a influência do uso de andarilho com rodas e fixo nos parâmetros metabólicos de indivíduos com mais de 60 anos e em jovens. Metodologia: realizou-se um estudo analítico transversal numa amostra de 21 voluntários, sendo 11adultos jovens (idade compreendida entre 18 e 25 anos) e 10 são adultos com idade superior a 60 anos. Utilizou-se o sistema K4b2 COSMED de forma a recolher os dados relativos ao consumo energético, quociente respiratório e volume de CO2 produzido. Os participantes realizaram os diferentes tipos de marcha (marcha normal, a três pontos com andarilho fixo, a três pontos modificada com andarilho fixo, a três pontos com andarilho com rodas e a três pontos modificada com andarilho com rodas) durante 10 minutos num percurso rectilíneo de 20 metros. Para a análise estatística recorreu-se ao software IBM SPSS Statistics v20 com um nível de significância de 0,05. Resultados: observou-se que á exceção da marcha normal em todos os outros tipos de marcha com andarilho, os participantes com mais de 60 anos, apresentam valores significativamente superiores aos dos jovens, nomeadamente nas marchas com andarilho fixo, a 3 pontos e a 3 pontos modificada e com andarilho de rodas, na marcha a 3ponto modificada. Verificaram-se diferenças apenas no grupo dos jovens, pois a marcha normal apresentou valores significativamente maiores que as restantes. Conclusão: A idade influenciou os parâmetros metabólicos da marcha normal e com andarilhos fixo e móvel apresentando os idosos um maior gasto energético, bem como os METS utilizados.Background: Structurally, the gait is modified according characteristics of each individual, their morphological nature, type of activity, age and presence of certain diseases, among other factors .Due to aging physiological changes, the energetic cost of gait of elderly is higher than of young. Objective: To analyze the influence of using stroller with wheels and fixed, in the metabolic parameters of subjects over 60 years and young. Methodology: An analytic cross-sectional study was performed in a sample of 21 volunteers, 11 young adults (aged between 18 and 25 years) and 10 adults aged over 60 years . We used the system K4b2 COSMED in order to collect data on energy consumption, respiratory quotient and volume of CO2 produced. Participants performed different types of gait ( normal gait , a three points with fixed stroller , a three points modified fixed walking , three points with wheels stroller and three points modified stroller with wheels ) for 10 minutes in a straight path of 20 meters. For statistical analysis we used the IBM SPSS statistics software v20 with a significance level 0.05. Results: It was observed that with exception of normal walking, in all the other types of gait with stroller, participants with more than 60 years, showed values significantly higher than those of young people, particularly in fixed walking with 3 points and 3 points modified and with stroller wheel in the 3 points modified gait . Differences were observed only in the young people group, because normal gait presented values significantly higher than the others. Conclusion: The age influenced the metabolic parameters of normal gait and with stroller fixed or with wheels, since the elderly presenting a greater energy expenditure, as well as the METS used

Bursaphelenchus antoniae sp. n. (Nematoda: Parasitaphelenchidae) associated with Hylobius sp. from Pinus pinaster in Portugal

Bursaphelenchus antoniae sp. n. is described and illustrated. Dauer juveniles were isolated from the body of the large pine weevil, Hylobius sp., collected from maritime pine (Pinus pinaster) stumps, in Portugal. Bursaphelenchus antoniae sp. n. was reared and maintained in P. pinaster wood segments and on Petri dish cultures of the fungi Botrytis cinerea and Monilinia fructicola. The new species is characterised by a relatively small body length of ca 583 μm (females) and 578 μm (males), a lateral field with two incisures, presence of a small vulval flap and a conoid female tail with a rounded or pointed terminus. Males have stout spicules with a disc-like cucullus and seven caudal papillae arranged as a single midventral precloacal papilla, one precloacal pair and two postcloacal pairs. In the character of the lateral field, B. antoniae sp. n. comes close to B. abietinus, B. rainulfi and B. hylobianum, whilst spicule characters place it within the piniperdae-group sensu Ryss et al. Morphologically, B. antoniae sp. n. is closest to B. hylobianum; the spicules of these two species having flattened, wing-like, alae on the distal third of the lamina. Bursaphelenchus antoniae sp. n. is distinguished from B. hylobianum on the arrangement of the caudal papillae (two vs three pairs). ITS-RFLP profiles and the failure to hybridise support the separation of the two species. Phylogenetic analysis of the new species, based on the 18S rDNA sequence, supports the inclusion of this new species in the B. hylobianum-group sensu Braasch. Sequence analysis of the 28S rDNA D2/D3 domain did not place the new species in a definite group

Matosinhos hearing screening requirements for school-aged children between October 2012 and May 2014

This research is focused on deafness and impaired hearing in children who attend special education, and its main objective is to understand whether the presence of an audiologist is an advantage and if it works as a complement to the linguistic, social, and cognitive development of children attending the 1st year of primary school.info:eu-repo/semantics/publishedVersio

ARP Case Report nº 13: What is your diagnosis?

Presentation of the CaseA 73-year-old woman who has been consulting the gynaecologist regarding persistent pelvic pain since last month. No other complaints including systemic symptoms or metrorrhagia.The ultrasound study showed a large pelvic tumour mass and it was not possible to determine the organ of origin. Values of Ca-125 are normal.Pelvic MRI was requested for additional characterization of the pelvic mass and to determine the organ of origin

Caso Clínico ARP Nº13: Torção com Enfarte de Mioma Pediculado

A 73-year-old woman consulted the gynecologist for persistent pelvic pain for the past month. No other complaints including systemic symptoms or metrorrhagia. The ultrasound study showed a large pelvic tumour mass. It was not possible to determine the organ of origin. Values of Ca- 125 were normal.Pelvic MRI was requested for additional characterization of the pelvic mass and to determine the organ of origin.Magnetic resonance imaging revealed a well-defined solid tumour lesion located in the midline independent of the ovaries and bladder but contacting the uterine fundus by a small pedicle. The mass reveals blood inside and there was no enhancement after IV contrast. The findings suggest the diagnosis of torsion on pedunculated subserous uterine myoma with infarction.Mulher de 73 anos que recorre à médica ginecologista por dor pélvica persistente desde o último mês. Sem outras queixas nomeadamente sintomas sistémicos ou metrorragias. O estudo ecográfico realizado mostra volumosa massa tumoral pélvica não sendo possível determinar o órgão de origem. Os valores de Ca-125 são normais. Foi pedida RM pélvica para caracterização adicional da massa pélvica e determinar órgão de origem. A RM magnética revelou lesão tumoral sólida, bem delimitada, localizada na linha média independente dos ovários e da bexiga mas que contacta com o fundus uterino por um pequeno pedículo. A massa revela sangue no seu interior e aquando do contraste não exibe qualquer captação de contraste. O diagnóstico avançado e confirmado na cirurgia foi de mioma fundico pediculado complicado com torção e enfarte

Community pharmacy: Going beyond dispensing pharmaceuticals

The aim of this study is to understand if it is possible to predict health crisis based on biochemical and physiological measurements made at the pharmacy, and, if needed, refer patients to the doctor. This would avoid emergency services and increase pharmacies’ income. Three pharmaceutical consultations were made, where these parameters were measured and the therapeutics registered. The short duration of the study (three months) and the small sample (57 patients) did not allow to reach clear conclusions, as patients had little variation in their health. It was also addressed the issue of how important these consultations are for patients and results were positive: they considered consultations important and helpful and the majority of patients were willing to pay €5 or less for them