Costo económico del tratamiento de las úlceras por presión : una aproximación teórica

O presente artigo consiste numa abordagem teórica sobre a problemática dos custos económicos das úlceras por pressão. Parte-se do conhecimento do problema, numa perspetiva conceptual, para, de seguida, apresentar resultados de estudos de prevalência, a partir dos quais foram delineados estudos de impacto económico. O objectivo deste artigo é o de reflectir sobre os custos económicos associados às úlceras por pressão, quer numa perspetiva global, considerando a repercussão financeira, quer numa vertente personalista, atendendo aos custos intangíveis. Relativamente ao impacto económico das úlceras por pressão, foi efectuada uma estimativa ao nível da Região Autónoma dos Açores do custo total do tratamento por ambiente de cuidados. Nos cuidados domiciliários o custo com o tratamento de todas as categorias é calculado em 7.086.415 euros; nos cuidados hospitalares, em 1.723.509 euros, e nos cuidados prestados em lares de idosos, em 1.002.562 euros. Nos Açores, a estimativa do custo total do tratamento das úlceras por pressão, considerando todas as suas categorias, ronda os 9.812.486 euros. Quanto ao impacto emocional associado, este tem elevados custos para pessoa e para os familiares, nomeadamente pelo sofrimento gerado. De facto, as úlceras por pressão acarretam elevados custos económicos associados ao tratamento, bem como custos intangíveis pelo sofrimento vivenciado por pessoas e cuidadores.RESUMEN: El presente artículo consiste en una reflexión teórica sobre el problema de los costos económicos de las úlceras por presión. Se empieza por el conocimiento del problema, desde una perspectiva conceptual, y, a continuación, se presentan los resultados de estudios de prevalencia, a partir de los cuales se diseñaron estudios de impacto económico. El objetivo del artículo es reflexionar sobre los costos económicos asociados a las úlceras por presión tanto en una perspectiva global, considerando la repercusión financiera, como en una vertiente personalista, de acuerdo a los costos intangibles. En cuanto al impacto económico de las úlceras por presión, se realizó una estimación de la Región Autónoma de Açores del costo total del tratamiento por ámbito de atención. En la atención domiciliaria el costo con el tratamiento de todas las categorías se estima en € 7.086.415, en la atención hospitalaria, se estima € 1.723.509 y en la atención en los asilos se estima en €1.002.562. En Açores, el costo total estimado del tratamiento de las úlceras por presión en todas las categorías, es de alrededor de € 9.812.486. En cuanto al impacto emocional asociado, éste tiene elevados costos para la persona y para los familiares, principalmente, por el sufrimiento causado. De hecho, las úlceras por presión implican altos costos económicos asociados con el tratamiento, así como, costos intangibles generados por el sufrimiento experimentado por los individuos y los cuidadores.ABSTRACT: The present study consisted of a theoretical approach to the problem posed by the economic costs associated with pressure ulcers (PUs). The initial aim was to assess the target problem from a conceptual perspective and then to report the results of prevalence studies that formed the basis for investigations of the disease’s economic impact. The purpose of the present article is to discuss the economic costs associated with PUs from both the global point of view (appraising their financial repercussion) and the individual point of view (addressing the intangible costs). Regarding the economic impact of the costs associated with PUs, the total cost of treatment per healthcare setting was estimated relative to the Autonomous Community of Azores. The total cost of all the PU categories was EUR 7,086,415 in the homecare setting, EUR 1,723,509 in the hospital setting, and EUR 1,002,562 in older people’s homes. Therefore, the estimated total treatment cost of all the PU categories was approximately EUR 9,812,486 in Azores. However, the emotional impact of this disease imposes high costs on patients and their relatives as a function of the resultant suffering. Indeed, PUs impose high costs not only related to the treatment but also related to the intangible costs of the suffering caused to patients and their caregivers.Project ICE 2 – Investigação Científica em Enfermagem – Estudo do “Custo Económico das Úlceras por Pressão na Macaronésia” (MAC/1/A029) de Iniciativa Comunitária – Programa de Cooperação Transnacional Madeira-Açores-Canárias 2007-2013info:eu-repo/semantics/publishedVersio

Violence in intimacy relationships in young people : research-action in the initial training of nurses

Undergraduate training in Nursing requires an analysis of teachinglearning strategies and processes in the relationship between theory and practice in clinical teaching. Violence in young people’s intimate relationships is a sensitive issue for Nursing care, and peer education can produce moments of cooperative training among students. Action research and project methodology promote intervention in Community Nursing for vulnerable groups and the acquisition of skills in Nursing students. To reflect on the teaching-learning process in Nursing training in Clinical Teaching to Vulnerable Groups, in the last three years, in a community context and using the project methodology, where attitudes related to violence in the intimate relationships of young people are measured in a certain population, and hence, targeting the decision-making process in an action research context, a typology of interventions and outcomes in peer education interventions is described. A reflection on action research, project methodology and peer education in the training of Nursing students was elaborated. The analysis of the data obtained in the different editions of clinical teaching was carried out and the clinical teaching reports were analyzed to extract the interventions carried out in the face of the phenomenon under study. There is a legitimation of violence in the intimate relationships of young people that justifies a structured and continuous intervention in the target population. Intervention strategies were diversified and adapted to the young population, making peer education tangible in the training of young people in the specific protection of violence in intimate relationships. Teaching-learning has to bring theory and practice closer. Research and intervention in Community Nursing can be supported by the use of research action strategies, peer education and by integrating intervention projects focusing on the worrying legitimation of violence in the intimate relationships of young people.info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio

A presença como cuidado de enfermagem:estudo do processo de desenvolvimento da presença em contexto psiquiátrico

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2012A presença como cuidado de enfermagem é apresentada na literatura como uma competência dos enfermeiros. Consiste num processo que se desenvolve e materializa num encontro entre enfermeiro e utente. Sendo o cerne de uma relação é no contexto de prestação de cuidados de enfermagem de saúde mental e psiquiátrica que possui maiores singularidades. É um conceito pouco delimitado e apesar do desenvolvimento da disciplina não existe investigação suficiente para responder à questão de investigação: Como se desenvolve a presença como cuidado, na relação enfermeiro/utente em contexto psiquiátrico? Tinha-mos como objectivos, compreender o processo de desenvolvimento da presença como cuidado; compreender o significado da presença como cuidado para enfermeiros e utentes e desenvolver uma teoria substantiva sobre a presença como cuidado em contexto psiquiátrico. É um estudo qualitativo utilizando a metodologia da Grounded Theory e decorreu num serviço de agudos de uma instituição de internamento na área da psiquiátrica. Os informantes foram um grupo de utentes e de enfermeiros. As técnicas de colheita de dados foram a observação participante, a entrevista e a análise documental. A análise e tratamento dos dados foram efectuados através das comparações constantes e da amostragem teórica. O trabalho indutivo permitiu-nos elaborar proposições referentes ao compromisso de presença. O compromisso de presença favorece o cuidado de enfermagem através do acolhimento hospitaleiro, promove a gestão do cuidado e permite o desenvolvimento de um cuidado singular. O compromisso de presença significa o conjunto de actividades que envolvem a gestão do internamento entre a permanência do cuidado e a consciência partilhada entre enfermeiro e utente. Propomos uma teoria substantiva onde o compromisso de presença como cuidado de enfermagem em contexto psiquiátrico é um processo vivido com momentos de tensão e contenção que promovem o cuidado de enfermagem.Nursing presence is presented in the literature as a nurses’ competence, being a process that develops and materializes in a meeting between the nurse and the patient. As the core of a relationship it is in the context of mental health and psychiatric nursing that higher singularity can be found. Nevertheless nursing presence is a concept lean defined and despite the development of the discipline there is not enough research to answer the research question: How does develop the nursing presence as a care behaviour in the relationship nurse/patient in a psychiatric context? The aim of this study were to understand the process of developing nursing presence, to understand the meaning of nursing presence for nurses and patients and develop a substantive theory about nursing presence in a psychiatric context. A qualitative study using Grounded Theory methodology has been developed in an acute service in the area of psychiatric hospitalization. The group of informants was composed by patients and nurses. Data collection has been made through participant observation, interviews and document analysis. The analysis and data processing has been performed using constant comparisons and theoretical sampling. The inductive study allowed us to develop propositions regarding the presence commitment. Presence commitment promotes the nursing presence through the hospitality, promotes the management of care and allows the development of singular caring. This presence commitment means the set of activities involving the management of hospital permanence and the care awareness shared between nurse and patient. We propose a substantive theory where the presence commitment as a nursing care in psychiatric context is a living process with moments of tension and contention that promotes nursing care.Fundação para a Ciência e a Tecnologia (FCT, bolsas de estudo da Marie Curie Actions

Competência emocional do enfermeiro e a comunicação terapêutica face à pessoa com manifestações de perturbação mental : estudo num hospital geral português

Face aos novos desafios sociais, torna-se imprescindível uma aprendizagem emocional, que possa facilitar as relações interpessoais dos enfermeiros, designadamente face à pessoa com manifestações de perturbação mental. Este estudo teve como objetivo central conhecer a influência da competência emocional do enfermeiro na comunicação terapêutica face à pessoa com manifestações de perturbação mental. Foi desenvolvido um estudo quantitativo, descritivo-correlacional. A amostra foi de 171 enfermeiros de um hospital geral dos Açores. O instrumento de colheita de dados incluiu um questionário sociodemográfico e profissional, a Escala Veiga de Competência Emocional – Reduzida [EVCE-Reduzida], e o questionário “Comunicação terapêutica: utilização pelos enfermeiros”. Os enfermeiros, maioritariamente do sexo feminino, com idades entre 20 e 40 anos, revelam níveis moderados de competência emocional. Os enfermeiros especialistas com mais tempo de exercício profissional demonstram ser mais literatos emocionalmente. A EVCE-Reduzida demonstra uma boa fiabilidade interna. A Automotivação foi a capacidade mais preditiva da competência emocional, e a Autoconsciência a capacidade com maior média. Delinearam-se 3 perfis comunicacionais, sendo o Perfil 1 (Enfermeiro centrado na pessoa e em si) o mais representativo. Apesar de não se verificar correlação entre a competência emocional e a comunicação terapêutica, evidenciou-se que quanto mais empáticos os enfermeiros se percecionam, mais utilizam as técnicas de comunicação terapêutica; e quanto melhor gerem as emoções, mais mobilizam as técnicas de comunicação terapêutica e atitudes face à pessoa com manifestações de perturbação mental. Face aos resultados obtidos importa aprofundar o modo como a comunicação terapêutica e a competência emocional se manifestam na prática profissional, o que facilita ou inibe a sua expressão, e como se pode potenciar o seu desenvolvimento. Neste sentido, as instituições de saúde devem investir na formação dos enfermeiros, através do contributo da prática especializada em Enfermagem de Saúde Mental, permitindo aprimorar a literacia emocional e performance nos contextos de trabalho.ABSTRACT: Faced with the new social challenges, emotional learning becomes essential, which can facilitate the nurses' interpersonal relationships, namely with the person with manifestations of mental disorder. The main objective of this study was to know the influence of the nurse's emotional competence in the therapeutic communication towards the person with manifestations of mental disorder. A quantitative, descriptive-correlational study was developed. The sample consisted of 171 nurses from a general hospital in the Azores. The data collection instrument included a sociodemographic and professional questionnaire, the Veiga Scale of Emotional Competence – Reduced [EVCE-Reduced], and the questionnaire “Therapeutic communication: use by nurses”. Nurses, mostly female, aged between 20 and 40 years, show moderate levels of emotional competence. Specialist nurses with more time in professional practice demonstrate to be more emotionally literate. The EVCE-Reduced demonstrates good internal reliability. Self-Motivation was the most predictive ability of emotional competence, and Self-Awareness the ability with the highest average. 3 communication profiles were outlined, with Profile 1 (Nurse centered on the person and on the self) being the most representative. Although there was no correlation between emotional competence and therapeutic communication, it was evident that the more empathetic nurses perceive themselves, the more they use therapeutic communication techniques; and the better they manage emotions, the more they mobilize therapeutic communication techniques and attitudes towards the person with manifestations of mental disorder. In view of the results obtained, it is important to deepen the way in which therapeutic communication and emotional competence are manifested in professional practice, what facilitates or inhibits their expression, and how their development can be enhanced. In this sense, health institutions should invest in the training of nurses, through the contribution of specialized practice in Mental Health Nursing, allowing for the improvement of emotional literacy and performance in work contexts.info:eu-repo/semantics/publishedVersio

Costo económico del tratamiento de las úlceras por presión : una aproximación teórica

O presente artigo consiste numa abordagem teórica sobre a problemática dos custos económicos das úlceras por pressão. Parte-se do conhecimento do problema, numa perspetiva conceptual, para, de seguida, apresentar resultados de estudos de prevalência, a partir dos quais foram delineados estudos de impacto económico. O objectivo deste artigo é o de reflectir sobre os custos económicos associados às úlceras por pressão, quer numa perspetiva global, considerando a repercussão financeira, quer numa vertente personalista, atendendo aos custos intangíveis. Relativamente ao impacto económico das úlceras por pressão, foi efectuada uma estimativa ao nível da Região Autónoma dos Açores do custo total do tratamento por ambiente de cuidados. Nos cuidados domiciliários o custo com o tratamento de todas as categorias é calculado em 7.086.415 euros; nos cuidados hospitalares, em 1.723.509 euros, e nos cuidados prestados em lares de idosos, em 1.002.562 euros. Nos Açores, a estimativa do custo total do tratamento das úlceras por pressão, considerando todas as suas categorias, ronda os 9.812.486 euros. Quanto ao impacto emocional associado, este tem elevados custos para pessoa e para os familiares, nomeadamente pelo sofrimento gerado. De facto, as úlceras por pressão acarretam elevados custos económicos associados ao tratamento, bem como custos intangíveis pelo sofrimento vivenciado por pessoas e cuidadores.RESUMEN: El presente artículo consiste en una reflexión teórica sobre el problema de los costos económicos de las úlceras por presión. Se empieza por el conocimiento del problema, desde una perspectiva conceptual, y, a continuación, se presentan los resultados de estudios de prevalencia, a partir de los cuales se diseñaron estudios de impacto económico. El objetivo del artículo es reflexionar sobre los costos económicos asociados a las úlceras por presión tanto en una perspectiva global, considerando la repercusión financiera, como en una vertiente personalista, de acuerdo a los costos intangibles. En cuanto al impacto económico de las úlceras por presión, se realizó una estimación de la Región Autónoma de Açores del costo total del tratamiento por ámbito de atención. En la atención domiciliaria el costo con el tratamiento de todas las categorías se estima en € 7.086.415, en la atención hospitalaria, se estima € 1.723.509 y en la atención en los asilos se estima en €1.002.562. En Açores, el costo total estimado del tratamiento de las úlceras por presión en todas las categorías, es de alrededor de € 9.812.486. En cuanto al impacto emocional asociado, éste tiene elevados costos para la persona y para los familiares, principalmente, por el sufrimiento causado. De hecho, las úlceras por presión implican altos costos económicos asociados con el tratamiento, así como, costos intangibles generados por el sufrimiento experimentado por los individuos y los cuidadores.ABSTRACT: The present study consisted of a theoretical approach to the problem posed by the economic costs associated with pressure ulcers (PUs). The initial aim was to assess the target problem from a conceptual perspective and then to report the results of prevalence studies that formed the basis for investigations of the disease’s economic impact. The purpose of the present article is to discuss the economic costs associated with PUs from both the global point of view (appraising their financial repercussion) and the individual point of view (addressing the intangible costs). Regarding the economic impact of the costs associated with PUs, the total cost of treatment per healthcare setting was estimated relative to the Autonomous Community of Azores. The total cost of all the PU categories was EUR 7,086,415 in the homecare setting, EUR 1,723,509 in the hospital setting, and EUR 1,002,562 in older people’s homes. Therefore, the estimated total treatment cost of all the PU categories was approximately EUR 9,812,486 in Azores. However, the emotional impact of this disease imposes high costs on patients and their relatives as a function of the resultant suffering. Indeed, PUs impose high costs not only related to the treatment but also related to the intangible costs of the suffering caused to patients and their caregivers.Project ICE 2 – Investigação Científica em Enfermagem – Estudo do “Custo Económico das Úlceras por Pressão na Macaronésia” (MAC/1/A029) de Iniciativa Comunitária – Programa de Cooperação Transnacional Madeira-Açores-Canárias 2007-2013info:eu-repo/semantics/publishedVersio

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).publishersversionpublishe

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Acknowledgements: We gratefully acknowledge the engagement and willingness of all participants to share information critical to the investigation. We are grateful to the authors and laboratories that originated and submitted the genetic sequences released in GenBank. The acquisition of equipment associated with whole-genome sequencing used in this study (including the Illumina NextSeq 2000) was funded by the HERA (Human and Environmental Risk Assessment) project (Grant/2021/PHF/23776), supported by the European Commission through the European Centre for Disease Prevention and Control (ECDC), and partially funded by the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 (Operational Programme for Competitiveness and Internationalisation (POCI)), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020) under the PORTUGAL 2020 Partnership Agreement through the European Regional Development Fund (ERDF), and by the Portuguese Science and Technology Foundation (FCT). This study was also supported by the ERINHA-Advance project (funded by the European Union’s Horizon 2020 Research & Innovation program, grant agreement no. 824061) and benefited from co-funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement no. 773830 (One Health European Joint Programme), in particular by the co-funding of the post-doctoral fellowships of J.S.D. and V.M. and the development of INSaFLU. We also thank M. Pinheiro (iBiMED at the Universidade de Aveiro) for his continuous support in updating the INSaFLU platform and the Infraestrutura Nacional de Computação Distribuída (INCD) for providing computational resources for testing it. INCD was funded by the FCT and FEDER under the project 22153-01/SAICT/2016. M.P.D. is funded by the Gates Cambridge Scholarship (no. OPP1144). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The GAT-Intendente team also thanks A. Vasques, L. Fortuna, J. Moreira, I. Correia and Á. Baginha.Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population

Portuguese guide lines for the use of biological agents in rheumatoid arthritis - october 2011 update

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 des pite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regi -mens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2,without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opi -nion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituxi mab or tocilizumab).publishersversionpublishe

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved