Importância da caracterização das estruturas e processos de avaliação e gestão do risco em hospitais portugueses

RESUMO - As organizações de saúde do Séc. XXI deverão ter como objetivo estratégico assumir a responsabilidade pela melhoria contínua da qualidade e da segurança dos cuidados prestados ao cidadão e ao doente, promovendo uma cuidadosa conceção do sistema de cuidados. Para ter sucesso nesta missão são necessárias mudanças ao nível individual do profissional, das equipas, das organizações e do sistema de saúde na sua totalidade. Em Portugal as questões da melhoria da qualidade têm sido amplamente debatidas. Melhorar a qualidade na saúde implica o conhecimento e reflexão sobre a natureza do sistema complexo que a enquadra e também sobre as suas imperfeições e riscos, de modo a identificá-los e desenvolver ações com vista à sua prevenção, redução, e minimização do seu impacto - Gestão do Risco - criando e reforçando uma cultura de segurança robusta. Nalgumas unidades de saúde estes processos têm vindo a ser desenvolvidos e dinamizados, noutras encontram-se ainda em fase de planeamento. Neste sentido, tornou-se pertinente a construção de um questionário que permita a caracterização das estruturas e práticas de avaliação e gestão do risco nos hospitais em Portugal. A construção do instrumento foi realizada em três fases: (i) pesquisa, recolha e análise bibliográfica para fundamentação das questões e estrutura do questionário, (ii) realização de pré teste ou teste informal para validação de conteúdo quanto à clareza e pertinência e (iii) realização de teste piloto para validação da confiabilidade/especificidade. O teste piloto foi aplicado com sucesso e os resultados obtidos parecem-nos promissores, na medida em que os resultados demostraram que é possível obter conhecimento sobre alguns dos aspetos que permitem caraterizar as estruturas e politicas de gestão do risco em hospitais. Sugere-se a sua aplicação, em estudos futuros, a todos os hospitais e centros hospitalares do serviço nacional de saúde em Portugal, para que dessa forma seja possível uma descrição da realidade das estruturas, políticas e práticas da avaliação e gestão do risco.ABSTRACT - The 21st century health organizations should have the strategic objective of taking responsibility for the continuous improvement of the quality and safety of care provided to the citizen and the patient by promoting a careful design of the care system. Success in this mission requires changes at the individual level of the professional, teams, organizations and the health system as a whole. In Portugal the issues of quality improvement have been widely debated. Improving quality in health implies knowledge and reflection on the nature of the complex system that surrounds it, as well as its imperfections and risks, in order to identify them and develop actions to prevent, reduce and minimize their impact - Risk Management - creating and reinforcing a robust security culture. In some health units these processes have been developed and streamlined, in others they are still in the planning phase. In this sense, it became pertinent to develop a questionnaire that would allow the characterization of risk assessment and risk management structures and practices in Portuguese hospitals. The development of the instrument was carried out in three phases: (i) research, collection and bibliographic analysis to substantiate the questions and structure of the questionnaire, (ii) pre-test or informal test to validate content for clarity and relevance and (iii) pilot test to validate reliability / specificity. The pilot test has been successfully applied and the results seem promising, as they show that it is possible to learn/assess some of the aspects that allow characterizing risk management structures and policies in hospitals. We suggest the instrument application in future studies to all hospitals and hospital centers of the National Health Service in Portugal, in order to be enable to describe the reality of risk assessment and management structures, policies and practices

A survey on gram-negative bacteria in saffron finches (Sicalis flaveola) from illegal wildlife trade in Brazil

Passerines such as canaries or finches are the most unlawfully captured species that are sent to wildlife centers in São Paulo, Brazil. Captured birds may have infection by opportunistic bacteria in stressful situations. This fact becomes relevant when seized passerine are reintroduced. The aim of this study was to evaluate the health state of finches from illegal wildlife trade using microbiological approaches. Microbiological samples were collected by cloacal and tracheal swabs of 100 birds, captured during 2012 and 2013. The results indicate high frequency of gram-negative bacteria in feces and oropharynx, especially from the Enterobacteriaceae family (97.5%). The most frequent genera were Escherichia coli (46.5%) and Klebsiella pneumoniae (10.4%). Enterobacter cloacae, Serratia liquefaciens, Serratia spp. Klebsiella oxytoca and Citrobacter freundii were isolated with lower frequency from asymptomatic birds. The presence of enteropathogenic Escherichia coli (EPEC) and Shiga toxin-producing strain (STEC) confirm the zoonotic risks and public health concern.No Estado de São Paulo, Brasil, os pássaros como os canários-da-terra têm sido uma das espécies mais frequentemente resgatadas do tráfico illegal e enviadas aos centros de vida selvagem. Em situações de estresse estas aves podem ser acometidas por infecções causadas por bactérias oportunistas. Este fato é de grande importância quando é planejada da reintrodução das aves na natureza. O presente trabalho foi delineado para avaliar o estado de saúde de canários-da-terra resgatados do tráfico ilegal. Foram colhidas soabes da traqueia e da cloaca de 100 aves resgatadas durante os anos de 2012 e 2013. Os resultados obtidos revelaram alta frequência de bactérias gram-negativas nas fezes e no orofaringe dos animais, com maior frequência para os membros da família Enterobacteriaceae (97,5%). Os gêneros mais frequentes foram Escherichia coli (46,55) e Klebsiella pneumoniae (10,4%). Outros microorganismos incluindo Enterobacter cloacae, Serratia liquefaciens, Serratia spp, Klebsiella oxytoca e Citrobacter freundii também foram isolados em menor frequencia de aves assintomáticas. A presença de estirpes de Escherichia coli enteropagênicas (EPEC) e as produtoras da toxina de Shiga confirmam o risco de zoonose e a importância para saúde pública deste tipo de ave.

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

O facility management aplicado à gestão de edifícios

Trabalho de dissertação para obtenção do grau de mestre em Engenharia Civil na área de Especialização de EdificaçõesO presente Trabalho Final de Mestrado, aborda, de uma forma geral, a importância do Facility Management na Gestão e Manutenção de Edifícios. Este tema é atual por três razões principais: necessidade de sobrevivência à crise financeira que se vivencia; urgência da adoção de medidas mais sustentáveis na conceção e gestão de edifícios, em resposta às exigências preponderantes no bem-estar e vivência das pessoas, numa sociedade que é cada vez mais competitiva; exigências regulamentares. O Facility Management, com a sua normativa de suporte (EN 15221 – partes 1 a 7), “regula” a gestão eficiente e otimizada dos edifícios, em linha com as preocupações da Comissão Europeia sobre a necessidade de incrementar substancialmente a eficiência energética dos edifícios a construir, ou a reabilitar (adaptado de: diretivas europeias 2010/31/EU, 2012/27/EU, Decreto-Lei 118/2013; EN 15221). Consequentemente, o presente trabalho final de mestrado pretende: enquadrar o FM na gestão global de edifícios; abordar a gestão de edifícios do ponto de vista estratégico e com foco em ferramentas de gestão via web; estudar de que modo os edifícios podem ser dotados de sistemas que tenham como função a automação, isto é, sensorização dos seus equipamentos e sistemas, análise de dados, seriação desses dados e seu encaminhamento através de software adequado, para se conseguir uma melhoria do desempenho das instalações. Objetivamente pretende-se que as caraterísticas dos edifícios sejam tais, que lhes permitam receber, ao longo do seu ciclo de vida, as tecnologias presentes e as que se avizinham, necessárias para que os consumos de recursos que utilizam sejam cada vez mais reduzidos, tornando-os, portanto, mais sustentáveis. Apresenta-se as mais recentes tendências na gestão avançada de edifícios: ➢ A contribuição da internet das coisas (IoT) na gestão dos edifícios, apresentando-se o conceito de edifício energeticamente eficiente. ➢ A contribuição das redes neuronais artificiais (Artificial Neural Networks - ANN) e dos algoritmos genéticos (Genetic Algorithms – GA)The present Final Master's Work deals with, in a general way, the importance of Facility Management in the Management and Maintenance of Buildings. This theme is current for three main reasons: need to survive the financial crisis experienced; The urgency of adopting more sustainable measures in the design and management of buildings, in response to the prevailing demands on people's well-being and living in a society that is increasingly competitive; Regulatory requirements. Complementing the current reason for the theme "regulatory requirements", it should be mentioned that the European directives 2010/31 / EU, 2012/27 / EU and Decree-Law 118/2013 of 20 August have imposed a lot of measures that require buildings to be more energy efficient. Facility Management, with its supporting regulations (EN 15221 - Parts 1 to 7), "regulates" the efficient and optimized management of buildings, in line with the European Commission's concerns about the need to substantially increase energy efficiency of buildings to be built or rehabilitated (adapted from: European directives 2010/31 / EU, 2012/27 / EU, Decree-Law 118/2013, EN 15221). Consequently, the present master's thesis aims to: frame the FM in the global management of buildings; Approach building management from a strategic point of view and focusing on web management tools; To study how buildings can be equipped with systems that have the function of automation, that is, the sensing of their equipment and systems, data analysis, serialization of these data and their routing through appropriate software, to achieve a performance improvement of the installations. Objectively, it is intended that the characteristics of buildings be such as to enable them to receive, throughout their life cycle, the technologies present and those that are close, necessary for the consumption of resources that they use to be increasingly reduced, making them, therefore, more sustainable. The latest trends in advanced building management are presented: ➢ The contribution of the Internet of Things (IoT) in the management of buildings, presenting the concept of energy efficient building. ➢ The contribution of Artificial Neural Networks (ANN) and Genetic Algorithms (GA) to the latest and most advanced building management.N/

Bullying: desafíos para a convivencia ética no combate ao assedio

Este artigo registra parte dos resultados de uma atividade de extensão universitária realizada junto a trabalhadores na educação e saúde do município de Humaitá, sul do Estado do Amazonas, onde foram realizadas atividades de reflexão-ação acerca da convivência ética e democrática. Está organizado em duas partes: a primeira destaca aspectos conceituais e filosóficos acerca do tema; a segunda parte apresenta os resultados da intervenção em contextos da educação e da saúde

Survey on Non-Human Primates and Mosquitoes Does not Provide Evidences of Spillover/Spillback between the Urban and Sylvatic Cycles of Yellow Fever and Zika Viruses Following Severe Outbreaks in Southeast Brazil

International audienceIn the last decade, Flaviviruses such as yellow fever (YFV) and Zika (ZIKV) have expanded their transmission areas. These viruses originated in Africa, where they exhibit both sylvatic and interhuman transmission cycles. In Brazil, the risk of YFV urbanization has grown, with the sylvatic transmission approaching the most densely populated metropolis, while concern about ZIKV spillback to a sylvatic cycle has risen. To investigate these health threats, we carried out extensive collections and arbovirus screening of 144 free-living, non-human primates (NHPs) and 5219 mosquitoes before, during, and after ZIKV and YFV outbreaks (2015–2018) in southeast Brazil. ZIKV infection was not detected in any NHP collected at any time. In contrast, current and previous YFV infections were detected in NHPs sampled between 2017 and 2018, but not before the onset of the YFV outbreak. Mosquito pools screened by high-throughput PCR were positive for YFV when captured in the wild and during the YFV outbreak, but were negative for 94 other arboviruses, including ZIKV, regardless of the time of collection. In conclusion, there was no evidence of YFV transmission in coastal southeast Brazil before the current outbreak, nor the spread or establishment of an independent sylvatic cycle of ZIKV or urban Aedes aegypti transmission of YFV in the region. In view of the region’s receptivity and vulnerability to arbovirus transmission, surveillance of NHPs and mosquitoes should be strengthened and continuous