A reengenharia de processos de negócio : um estudo de casos

Mestrado em Gestão e EmpreendedorismoA eficácia e eficiência dos processos de negócio são condições fundamentais para o sucesso das empresas. Num mundo cada vez mais globalizado onde a mudança, a competição e a exigência dos clientes cada vez é mais importante, as empresas procuram soluções para se manterem competitivas face a uma concorrência galopante. Essa solução parece encontrar-se, para muitas empresas de sucesso no mundo, na reengenharia dos processos de negócio. A reengenharia compreende a alteração radical dos processos existentes como forma de alcançar a sua melhoria substancial ao nível do desempenho e da criação de valor. A sua importância para a sociedade e economia é atribuída à necessidade das empresas se orientarem para o cliente, proporcionando serviços de excelência novos ou significativamente transformados garantindo respostas adequadas às novas exigências dos mercados. A metodologia adotada para este estudo baseou-se num estudo de quatro empresas com o propósito de compreender como decorreu a sua implementação e consequente vantagem competitiva alcançada. Os resultados revelam que grandes mudanças não representam necessariamente a adoção de reengenharia de processos. Uma efetiva aplicação desta estratégia com sucesso depende da sua necessidade, da superação das barreiras que irão ser encontradas ao longo do processo e na abrangência da mudança alcançada nas dimensões tecnológica, humana e organizacional.The effectiveness and efficiency of business processes are fundamental requirements for business success. In an increasingly globalized world where change, competition and customer demand is increasingly important, organizations are looking for solutions to remain competitive in order to maintain business competition. This solution seems to lie, for many successful companies in the world, in business process reengineering. Reengineering includes the radical change of the existing processes in order to achieve its substantial improvement in performance and value creation. Its importance to society and the economy is attributed to the need for companies to be oriented to the customer, providing new service excellence or significantly ensuring appropriate responses to new market demands. The methodology adopted for this study was based on a research of four companies in order to understand how its implementation and consequent competitive advantage is achieved. The results show that major changes do not necessarily represent the adoption of a business process reengineering. Effective and successful implementation of this strategy depends on the need, overcoming the barriers that will be found throughout the process and the reach of change achieved in the technological, human and organizational dimensions

Prevalence of four urogenital sexually transmitted infections in a dedicated clinic from Lisbon

Background/Objectives: To determine the prevalence of urogenital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) among attendees of an open and freely available sexually transmitted infections (STI) dedicated clinic in Lisbon, at Centro de Saúde da Lapa, during 1-year. Methods: Molecular testing for CT, NG, MG, and TV was performed on 1,062 urogenital specimens (one specimen per person). A descriptive, cross- sectional, observational study was conducted to evaluate the characteristics of infected persons. Statistical analysis was performed. Results: Around 237 infections were detected in 214 patients. CT was the most prevalent (11.6%), with a similar infection rate between men and women. NG was the second most frequently detected (7.3%), followed by MG and TV (2.9 and 0.5%, respectively). Statistically significant associations were found: 1) between younger age and CT and NG prevalence, where being < 25 years old constituted an increased risk factor; 2) between CT and NG prevalence and sexual orientation, where heterosexuals presented an increased risk for CT infections while men who have sex with men (MSM) had a higher risk for NG infections; and 3) between “having symptoms” and gonococcal infection. Conclusions: This study highlights the rising of CT and NG in contrast to a low rate of MG and to the scarceness of TV.info:eu-repo/semantics/publishedVersio

Diagnóstico laboratorial da infeção por Chlamydia trachomatis, 1991-2014

Objetivo: O presente trabalho tem por objetivo apresentar os resultados do diagnóstico laboratorial das infeções por C. trachomatis realizado no Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA) entre 1991 e 2014

Impacto da revelação da homossexualidade na família: revisão integrativa da literatura

Background: the diversity of human sexuality has caused changes in society. However, homosexuality continues to contain a social taboo within itself, generating different responses in families. Objectives: to analyze the impact caused by the disclosure of an individual's homosexuality on their heterosexual family of origin. Methodology: this is an integrative literature review, according to the PICO methodology, whose data collection was carried out in May 2020, in the SciELO, RCAAP, Cochrane Library, LILACS, PubMed, IBECS and NCBI databases. Results: the analysis of the 5 articles included in the study allowed us to approach the impact of the disclosure of sexual orientation in different contexts: family and work/social, allowing the identification of issues associated with the coming out process. Conclusions: the young people's decision to reveal their sexual orientation to the family is linked to issues of family functionality. Her answers range from acceptance to expulsion/leaving the house, including situations of verbal and physical violence. Given the possibility of a negative reaction from parents, it is essential that health professionals are trained to promote environments capable of reducing negative behaviours/responses. It is also important to normalize different sexual orientations, particularly in schools, to prevent discrimination.Marco contextual: la diversidad de la sexualidad humana ha provocado cambios en la sociedad. Sin embargo, la homosexualidad sigue siendo un tabú social, generando diferentes respuestas en las familias. Objetivos: analizar el impacto que tiene la revelación de la homosexualidad de un individuo en su familia heterosexual de origen. Metodología: revisión integrativa de la literatura, según la metodología PICO, recolección de datos realizada en mayo de 2020, en las bases de datos SciELO, RCAAP, Cochrane Library, LILACS, PubMed, IBECS y NCBI. Resultados: el análisis de los 5 artículos permitió abordar el impacto de la revelación de la orientación sexual en el contexto familiar y laboral/social, lo que nos permitió identificar problemas asociados con el proceso de revelación. Conclusión: la decisión de los jóvenes de revelar su orientación sexual a la familia está ligada a cuestiones de funcionalidad familiar. Sus respuestas van desde la aceptación hasta la expulsión/salida de casa, pasando por situaciones de violencia verbal y física. Ante la posibilidad de una reacción negativa de los padres, es fundamental que los profesionales de la salud estén capacitados para promover entornos capaces de reducir las conductas/respuestas negativas. También es importante normalizar las diferentes orientaciones sexuales, especialmente en las escuelas, para prevenir situaciones de discriminación.Enquadramento: a diversidade da sexualidade humana tem suscitado alterações na sociedade. Contudo, a homossexualidade continua a encerrar em si um tabu social, gerando diferentes respostas nas famílias. Objetivos: Analisar o impacto causado pela revelação da homossexualidade do indivíduo na sua família heterossexual de origem. Metodologia: trata-se de uma revisão integrativa da literatura, de acordo com a metodologia PICO, cuja colheita de dados foi realizada em maio de 2020, nas bases de dados SciELO, RCAAP, Cochrane Library, LILACS, PubMed, IBECS e NCBI.  Resultados: a análise dos 5 artigos incluídos no estudo permitiu abordar o impacto da revelação da orientação sexual em diferentes contextos: familiar e laboral/social, permitindo identificar questões associadas ao processo de coming out. Conclusão: a decisão, dos jovens, em revelar a orientação sexual à família prende-se a questões de funcionalidade familiar. As respostas da mesma variam desde a aceitação até à expulsão/saída de casa, com passagem por situações de violência verbal e física. Face à possibilidade de reação negativa, por parte dos pais, é essencial que se formem os profissionais de saúde para promoverem ambientes capazes de reduzir comportamentos/respostas negativas. É também importante normalizar as diferentes orientações sexuais, nomeadamente nas escolas, para prevenir situações de discriminação

Infections by Chlamydia trachomatis and Neisseria gonorrhoeae: results of laboratory diagnosis at INSA, 2017-2022

Chlamydia trachomatis e Neisseria gonorrhoeae são responsáveis pelas duas infeções sexualmente transmissíveis (IST) curáveis mais comuns em todo o mundo. Sendo frequentemente assintomáticas, o rastreio laboratorial destas IST é fundamental, para que possa ser efetuado o tratamento adequado que evite o desenvolvimento de sequelas clínicas graves e para quebrar cadeias de transmissão. O presente estudo teve por objetivo determinar a frequência das infeções por C. trachomatis e N. gonorrhoeae no âmbito da prestação de serviços do Laboratório Nacional de Referência das IST no INSA, no período 2017-2022. A pesquisa laboratorial de C. trachomatis e N. gonorrhoeae foi efetuada por uma técnica de PCR em tempo real, tendo sido obtidos resultados válidos para 47 136 amostras biológicas (genitais, anorretais e/ou orofaríngeas) de 21 188 pessoas que, em 22,6% (n=4799) dos casos, revelaram ser positivas para qualquer uma destas IST. Nas mulheres, a infeção por C. trachomatis foi a mais frequente (10,5%; 494/4692), enquanto nos homens a infeção por N. gonorrhoeae foi a mais comum (16,2%; 2669/16 455). C. trachomatis foi mais detetada nas amostras anorretais (10,1%; 1222/12 057), nas quais 19,3% (236/1222) revelaram pertencer ao grupo do linfogranuloma venéreo, e N. gonorrhoeae na orofaringe (11,5%; 1621/14 123). Ambas as infeções foram mais frequentemente detetadas nos homens (28,4%; 4680/16455) e nas pessoas (independentemente do sexo) com menos de 25 anos (36,8%; 1389/3777). Em conclusão, este estudo revelou infeção por C. trachomatis e N. gonorrhoeae em amostras colhidas de diferentes locais anatómicos, tendo sido observadas elevadas frequências de infeção por N. gonorrhoeae a nível orofaríngeo e anorretal, assim como de C. trachomatis neste último local anatómico, sugerindo que o rastreio destas IST não se deverá restringir à região genital. O aumento (8,6 pontos percentuais entre 2017 e 2022) das infeções por N. gonorrhoeae configura motivo de preocupação dada a potencial emergência de estirpes resistentes aos antibióticos.Chlamydia trachomatis and Neisseria gonorrhoeae constitute the two most common curable sexually transmitted infections (STI) worldwide. As they are of ten asymptomatic, laboratory screening of these STI is essential for establishing adequate treatment that should prevent the development of serious clinical sequelae, and to break transmission chains. The present study aimed to determine the frequency of C. trachomatis and N. gonorrhoeae infections within the scope of the routine laboratory diagnosis at the National STI Reference Laboratory at INSA, in the period 2017-2022. Laboratory research for C. trachomatis and N. gonorrhoeae was carried out using real-time PCR on 47,136 biological samples (genital, anorectal and/or oropharyngeal) from 21,188 people. Infection by any of these STI was detected in 22.6% (n=4799) of the individuals. In women, infection by C. trachomatis was the most common (10.5%; 494/4692), while infection by N. gonorrhoeae was the most common in men (16.2%; 2669/16,455). C. trachomatis was the most frequent in anorectal samples (10.1%; 1222/12057), of which 19.3% (236/1222) revealed to belong to the lymphogranuloma venereum group, and N. gonorrhoeae was the most common in the oropharynx (11.5%; 1621/14,123). Both infections were more frequently detected in men (28.4%; 4680/16,455) and in people (regardless of gender) under 25 years of age (36.8%; 1389/3777). In conclusion, laboratory screening for C. trachomatis and N. gonorrhoeae in samples collected from dif ferent anatomical sites revealed high percentages of N. gonorrhoeae infections at the oropharynx and anorectum and of C. trachomatis at the anorectum, suggesting that screening for these STIs should not be restricted to the genital region. The rise (8.6 percentage points between 2017 and 2022) of N. gonorrhoeae infections represents a serious concern, given the potential emergence of strains resistant to antibiotics.info:eu-repo/semantics/publishedVersio

Oral hygiene to a hospitalized dependent patient: perceptions of a nursing team

Objective: To discuss the perception of the nursing team about the oral hygiene of hospitalized dependent patients. Method: A descriptive, qualitative study performed in the medical and surgical clinics of a hospital in the interior of Bahia, from March to July 2006, data obtained through a semistructured interview applied to seventeen participants, complemented by structured observation. Outcome: After analyzing the thematic content emerged three categories that reveal: oral hygiene as important care for the patient; oral hygiene avoids the discomfort of the team in providing other care; and oral hygiene can be delegated to the family. Conclusion: In the context studied there is no protocol for this care, odors from the patient's mouth define their periodicity, oral hygiene is performed by family members and nurses do not participate directly in this care

Chlamydia trachomatis: when the virulence-associated genome backbone imports a prevalence-associated major antigen signature

Chlamydia trachomatis is the most prevalent sexually transmitted bacterium worldwide and the causative agent of trachoma. Its strains are classified according to their ompA genotypes, which are strongly linked to differential tissue tropism and disease outcomes [ocular disease, urogenital disease and lymphogranuloma venereum (LGV)]. While the genome-based species phylogenetic tree presents four main clades correlating with tropism/prevalence, namely ocular, LGV, urogenital T1 (more prevalent genotypes) and urogenital T2 (less prevalent genotypes), inter-clade exchange of ompA is considered a rare phenomenon probably mediating marked tropism alterations. An LGV epidemic, associated with the clonal expansion of the L2b genotype, has emerged in the last few decades, raising concerns particularly due to its atypical clinical presentation (ulcerative proctitis) and circulation among men who have sex with men (MSM). Here, we report an LGV outbreak, mostly affecting human immunodeficiency virus-positive MSM engaging in high-risk sexual practices, caused by an L2b strain with a rather unique non-LGV ompA signature that precluded the laboratory notification of this outbreak as LGV. C. trachomatis whole-genome capture and sequencing directly from clinical samples was applied to deeply characterize the genomic backbone of this novel LGV outbreak-causing clone. It revealed a chimeric genome structure due to the genetic transfer of ompA and four neighbouring genes from a serovar D/Da strain, likely possessing the genomic backbone associated with the more prevalent urogenital genotypes (T1 clade), to an LGV (L2b) strain. The hybrid L2b/D-Da strain presents the adhesin and immunodominant antigen MOMP (major outer membrane protein) (encoded by ompA) with an epitope repertoire typical of non-invasive genital strains, while keeping the genome-dispersed virulence fingerprint of a classical LGV strain. As previously reported for inter-clade ompA exchange among non-LGV clades, this novel C. trachomatis genomic mosaic involving a contemporary epidemiologically and clinically relevant LGV strain may have implications on its transmission, tissue tropism and pathogenic capabilities. The emergence of variants with epidemic and pathogenic potential highlights the need for more focused surveillance strategies to capture C. trachomatis evolution in action.info:eu-repo/semantics/publishedVersio

ATENDIMENTO ÀS NECESSIDADES DA PESSOA DEPENDENTE PARA ALIMENTAÇÃO NO AMBIENTE HOSPITALAR

A pessoa dependente para alimentação no ambiente hospitalar exige da enfermagem cuidados especiais. Estudo descritivo, qualitativo com o objetivo de descrever as ações de enfermagem no atendimento à necessidade de alimentação da pessoa dependente hospitalizada num hospital público do interior da Bahia. Os dados obtidos mediante entrevista semiestruturada e observação estruturada, entre abril e junho de 2006, foram submetidos à análise de conteúdo. Os resultados evidenciaram que, embora as técnicas de enfermagem informassem que as pessoas eram alimentadas por via oral e/ou enteral, esse cuidado era prestado pelo acompanhante. Já as enfermeiras participavam quando eram necessárias medidas mais complexas, como instalar a sonda enteral e a solução de nutrição parenteral. Concluiu-se que, no contexto estudado, há limitações para atender à necessidade de alimentação da pessoa dependente hospitalizada, o que requer adequação do quantitativo de recursos humanos, além de qualificação para o reconhecimento dessa necessidade

Curcumin and quercetin-loaded lipid nanocarriers : development of omega-3 mucoadhesive nanoemulsions for intranasal administration

Curcumin (CUR) and quercetin (QU) are potential compounds for treatment of brain diseases such as neurodegenerative diseases (ND) because of their anti-inflammatory and antioxidant properties. However, low water solubility and poor bioavailability hinder their clinical use. In this context, nanotechnology arises as a strategy to overcome biopharmaceutical issues. In this work, we develop, characterize, compare, and optimize three different omega-3 (!-3) fatty acids nanoemulsions (NEs) loaded with CUR and QU (negative, cationic, gelling) prepared by two different methods for administration by intranasal route (IN). The results showed that formulations prepared with the two proposed methods exhibited good stability and were able to incorporate a similar amount of CUR and QU. On the other side, differences in size, zeta potential, in vitro release kinetics, and permeation/retention test were observed. Considering the two preparation methods tested, high-pressure homogenization (HPH) shows advantages, and the CQ NE- obtained demonstrated potential for sustained release. Toxicity studies demonstrated that the formulations were not toxic for Caenorhabditis elegans. The developed !-3 fatty acid NEs have shown a range of interesting properties for the treatment of brain diseases, since they have the potential to increase the nose-tobrain permeation of CUR and QU, enabling enhanced treatments efficiency

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