Infeção por Mycobacterium Tuberculosis em profissionais de saúde : metodologia de avaliação do risco e sua aplicação num hospital central

RESUMO - A Tuberculose surge, de acordo com o último relatório da Organização Mundial da Saúde, como a segunda principal causa de morte em todo o mundo, de entre as doenças infeciosas. Em 2012, 1.3 milhões de pessoas morreram devido a esta patologia e surgiram 8.6 milhões de novos casos. De entre os grupos de risco de infeção, surgem os profissionais de saúde. A dificuldade no diagnóstico da Tuberculose, o contacto próximo com os pacientes, as medidas de controlo de infeção por vezes inadequadas são algumas das razões que explicam o risco mais elevado de contrair Tuberculose no local de trabalho. Esta Dissertação de Mestrado pretende estabelecer uma nova classificação de risco de infeção por M. tuberculosis em estabelecimentos de saúde, com vista a promover a saúde destes profissionais, inovadora nos critérios de avaliação das medidas de controlo de infeção e de análise dos casos de exposição não protegida a Tuberculose ativa. Esta metodologia de avaliação foi o resultado de uma revisão bibliográfica sobre a temática, tendo sido aplicada num hospital para verificar a sua adequabilidade e mais-valia.ABSTRACT - Tuberculosis arises, according to the latest report from the World Health Organization as the second leading cause of death worldwide, among infectious diseases. In 2012, 1.3 million people died due to this disease and 8.6 million new cases emerged. Among those at risk of infection, there are health professionals. The difficulty in the diagnosis of tuberculosis, close contact with patients and inadequate infection control measures are some of the reasons for the higher risk of contracting TB in the workplace. This dissertation aims to establish a new classification of risk of infection by M. tuberculosis in health facilities, in order to promote the health of the professionals, with innovative criteria for the evaluation of infection control measures and analysis of cases of exposure to active TB. This methodology was the result of a literature review on the subject, having been applied in a hospital to verify the suitability and added value

Nurses' promotion of Mental Health First Aid Training Programmes for upper secondary students: a modified Delphi approach

Background: Mental Health First Aid Training Programmes can be carried out by nurses in schools. Adolescents have reported the importance of these interventions, the contents to be addressed, and intervention strategies that should be used. Mental health nurses have also discussed the characteristics of these training programmes. This study sought to create a consensus on the features of Mental Health First Aid Training Programmes promoted by nurses aimed at upper secondary students. Methods: A descriptive mixed method study was developed using the modified e-Delphi technique. Original statements on the topic were drawn from the results section of previous studies with nurses and adolescents. The statements were included in a structured online questionnaire. An expert panel of 78 mental health nurses participated in the two-rounds online survey from October to December 2021. Absolute and relative frequencies of responses were analysed. The experts' comments were also considered. Results: In the first round, experts suggested 4 new ideas about training programmes. Experts took a position on a total of 59 declarations. At least 75% of participants agreed with 58 statements about training programmes, namely about facilitators, intervention foci, evaluation methodology, participants, the implementation context, period and regularity, intervention strategies and content. The experts' opinions differed only in one statement that expressed the impaired sexual behaviour as a mental health problem to be addressed in the training programmes. Conclusions: Mental health nurses can lead the delivery of training programmes in upper secondary schools, improving adolescent competencies in mental health. Several educational approaches can be used to teach about mental health, related problems and actions underlying these conditions. Valid and appropriate assessment methods must be used. Our findings guide the planning, implementation and evaluation of these interventions in upper secondary schools and encourage nurses to explore these programmes and include them in their educational curricula

A qualitative study exploring adolescents' perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools

ABSTRACT:Mental Health First Aid Training Programmes are educational interventions thataim to disseminate basic first aid skills in the community. Adolescents in the context of theirsecondary school education are a particularly appropriate population for literacy promotioninterventions. This study explores adolescents’ perspectives on Mental Health First Aid TrainingProgrammes promoted by nurses in Portuguese upper secondary schools. A qualitative andexploratory study was conducted. Data were collected through semi-structured interviews with 12adolescents who participated voluntarily and with the consent of their parents. Data wereanalysed using content analysis. Fourteen themes were identified around three main areas: (i)Relevance of training programmes, (ii) Content of training programmes and (iii) Interventionmethods of training programmes. The results obtained indicate that adolescents consider MentalHealth First Aid Training Programmes in school relevant and necessary. Adolescents identified thecontent they deemed most appropriate and how it could be taught. These results can guide thedevelopment of training programmes. Nurses should take the lead in implementing these interventions in schools. Adolescents can take a more active role in mental health issues byimproving their literacyinfo:eu-repo/semantics/publishedVersio

A qualitative study exploring adolescents' perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools

Mental Health First Aid Training Programmes are educational interventions that aim to disseminate basic first aid skills in the community. Adolescents in the context of their secondary school education are a particularly appropriate population for literacy promotion interventions. This study explores adolescents’ perspectives on Mental Health First Aid Training Programmes promoted by nurses in Portuguese upper secondary schools. A qualitative and exploratory study was conducted. Data were collected through semi-structured interviews with 12 adolescents who participated voluntarily and with the consent of their parents. Data were analysed using content analysis. Fourteen themes were identified around three main areas: (i) Relevance of training programmes, (ii) Content of training programmes and (iii) Intervention methods of training programmes. The results obtained indicate that adolescents consider Mental Health First Aid Training Programmes in school relevant and necessary. Adolescents identified the content they deemed most appropriate and how it could be taught. These results can guide the development of training programmes. Nurses should take the lead in implementing theseinfo:eu-repo/semantics/publishedVersio

Nurses’ perspective about the Mental Health First Aid Training Programmes for adolescents in upper secondary schools: A focus group study

Introduction: Mental Health First Aid Training Programmes performed by nurses can empower adolescents to aid people with mental health problems. There do not appear to be any studies that describe these healthier interventions aimed at adolescents in upper secondary schools. The development of these educational interventions benefits from the input of their participants and facilitators. Aim: To explore the perspective of nurses about Mental Health First Aid Training Programmes for adolescents in upper secondary schools. Method: A qualitative, descriptive and exploratory study was conducted. Data were collected from seven mental health nurses during two focus group sessions. Data were analysed using content analysis. Results: Twelve themes were identified around nine main areas: facilitators, intervention foci, outcomes assessment methods, process assessment methods, participants, implementation context, duration and frequency, intervention methods and strategies, and contents. Discussion: Mental health nurses can regularly perform these classroom interventions to improve the mental health competencies of adolescents. Various educational methods can facilitate learning related to mental health literacy components, mental health nursing problems and the first aid plan. Valid and appropriate assessment methods enhance a good representation of these interventions. Implications for Practice: This evidence can guide the creation and modelling of these first aid training programmesinfo:eu-repo/semantics/publishedVersio

Phenotypic architecture of sociality and its associated genetic polymorphisms in zebrafish

Sociality relies on motivational and cognitive components that may have evolved independently, or may have been linked by phenotypic correlations driven by a shared selective pressure for increased social competence. Furthermore, these components may be domain-specific or of general-domain across social and non-social contexts. Here, we used zebrafish to test if the motivational and cognitive components of social behavior are phenotypically linked and if they are domain specific or of general domain. The behavioral phenotyping of zebrafish in social and equivalent non-social tests shows that the motivational (preference) and cognitive (memory) components of sociality: (1) are independent from each other, hence not supporting the occurrence of a sociality syndrome; and (2) are phenotypically linked to non-social traits, forming two general behavioral modules, suggesting that sociality traits have been co-opted from general-domain motivational and cognitive traits. Moreover, the study of the association between single nucleotide polymorphisms (SNPs) and each behavioral module further supports this view, since several SNPs from a list of candidate “social” genes, are statistically associated with the motivational, but not with the cognitive, behavioral module. Together, these results support the occurrence of general-domain motivational and cognitive behavioral modules in zebrafish, which have been co-opted for the social domain. © 2022 The Authors. Genes, Brain and Behavior published by International Behavioural and Neural Genetics Society and John Wiley & Sons Ltd.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio

Motor uncoordination and neuropathology in a transgenic mouse model of Machado-Joseph disease lacking intranuclear inclusions and ataxin-3 cleavage products

Machado-Joseph disease (MJD) is a late-onset neurodegenerative disorder caused by a polyglutamine (polyQ) expansion in the ataxin-3 protein. We generated two transgenic mouse lineages expressing the expanded human ataxin-3 under the control of the CMV promoter: CMVMJD83 and CMVMJD94, carrying Q83 and Q94 stretches, respectively. Behavioral analysis revealed that the CMVMJD94 transgenic mice developed motor uncoordination, intergenerational instability of the CAG repeat and a tissue-specific increase in the somatic mosaicism of the repeat with aging. Histopathological analysis of MJD mice at early and late stages of the disease revealed neuronal atrophy and astrogliosis in several brain regions; however, we found no signs of microglial activation or neuroinflammatory response prior to the appearance of an overt phenotype. In our model, the appearance of MJD-like symptoms was also not associated with the presence of ataxin-3 cleavage products or intranuclear aggregates. We propose the transgenic CMVMJD94 mice as a useful model to study the early stages in the pathogenesis of MJD and to explore the molecular mechanisms involved in CAG repeat instability.We would like to thank to Dr. Henry Paulson for providing the anti-ataxin-3 serum, Dr. Monica Sousa for the pCMV vector and to Eng. Lucilia Goreti Pinto for technical assistance. AS-F., M.C.C., S.S. and C.B. received FCT fellowships (SFRH/BD/15910/2005; SFRH/BPD/28560/2006; PTDC/SAU-GMG/64076/2006; SFRH/BPD/20987/2004). This research was funded by Fundacao para a Ciencia e Tecnologia through projects FEDER/FCT, POCI/SAU-MMO/60412/2004, PTDC/SAU-GMG/64076/2006; and Ataxia MJD Research Project

Hemodialysis vascular access coordinator: Three‐level model for access management

Management of vascular access is a challenge for the dialysis team, particularly tokeep the arteriovenous access working. The vascular access coordinator can posi-tively contribute to increase the number of arteriovenous fistulas and reduce centralvenous catheters. In this article, we introduce a new approach to vascular accessmanagement centered on (the results of setting up) the role of vascular access coor-dinator. We described the three-level model (3Level_M) for vascular access manage-ment organized in three levels: vascular access nurse manager, vascular accesscoordinator, and vascular access consultant. We defined the instrumental skills andtraining required to be developed by each element and clarify the articulationbetween the model and all members of the dialysis team related to vascular access.1|INTRODUCTIONThe implementation and effectiveness of renal replacement therapy(RRT) depend directly on appropriate vascular access, such as arterio-venous fistula (AVF) (best choice), or alternatively a graft or a centralvenous catheter (CVC).1Nowadays, chronic kidney disease (CKD) patients are older, sufferfrom a larger number of comorbidities, and have more complex vascu-lar accesses. Therefore, the dialysis team and patients face new chal-lenges. The complications of the arteriovenous accesses are alreadydocumented and require supervision (monitoring and surveillance) inorder to decide the appropriate time to intervene.1,2Literature shows that the vascular access coordinator canhave an important contribution in the identification ofthese situations and in the implementation of a new approachleading to the best results in clinical care.3–8The vascularaccess coordinator's role can be crucial to improve the planning oftimely interventions free of thrombosis,7,6improve vascular accessoutcomes,3,7decrease the number of grafts and CVCs,5and applya quality policy with the vascular access.6The purpose of thisarticle is to analyze the vascular access coordinator's contribution(to) in the vascular access outcomes and introduce a newapproach on vascular access management, the three-level model(3Level_M).Received: 12 February 2023 Revised: 22 March 2023 Accepted: 26 March 2023DOI: 10.1111/sdi.13153Semin Dial.2023;1–6.wileyonlinelibrary.com/journal/sdi© 2023 Wiley Periodicals LLC.1info:eu-repo/semantics/publishedVersio

Portuguese recommendations for the use of ultrasound in rheumatology

© 2001-2021 Sociedade Portuguesa de Reumatologia.Introduction: Ultrasound (US) is a relatively cheap, easily available and reliable method to improve the care of rheumatic patients. However, its use in rheumatology practice is very heterogeneous and needs to be standardized. Objectives: To develop recommendations for the use of US in rheumatic diseases endorsed by the Portuguese Society of Rheumatology. Methods: A systematic literature review of the available recommendations on the use of ultrasound in rheumatic diseases was performed and presented in a Portuguese Society of Rheumatology meeting to a subgroup of rheumatologists and rheumatology trainees with special interest in the subject. The most important topics to be addressed were selected and assigned to subgroups for literature review and draft recommendations. Following an iterative process of consensus, the final recommendations were developed, and their level of agreement voted anonymously online. A recommendation was approved when the average level of agreement was ≥ 7.5 in a 10-point Likert scale. Results: Fourteen recommendations were produced regarding nine rheumatology topics: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, polymyalgia rheumatica, vasculitis, crystal-deposition diseases, soft tissue rheumatism, osteoarthritis and ultrasound-guided procedures. Conclusion: We developed an up-to-date guidance in the form of recommendations for the use of US in nine different areas of rheumatology. As ultrasound is an important imaging modality with increasing use in the rheumatology setting, and there are frequent technological advances in the ultrasound machines and probes, in parallel with continuous associated research, these recommendations should be regularly updated.info:eu-repo/semantics/publishedVersio

OTIMIZAÇÃO GEOMÉTRICA DE ESCOAMENTOS COM CONVECÇÃO FORÇADA SOBRE UM ARRANJO TRIANGULAR DE CORPOS ROMBUDOS QUADRADOS

O presente estudo consiste na avaliação numérica de um arranjo triangular de corpos rombudos submetidos a um escoamento transiente, bidimensional, incompressível, laminar e com convecção forçada. A avaliação geométrica é realizada através do método Design Construtal. O problema possui uma restrição dada pela soma da área dos corpos rombudos e dois graus de liberdade: ST/D (razão da distância entre o centro dos corposrombudos posteriores e a dimensão de suas arestas), SL/D (razão da distância longitudinal entre os centros dos corpos rombudos, frontal e posteriores, e a dimensão de suas arestas). Para todas as simulações são considerados números de Reynolds e Prandtl constantes, ReD=100 e Pr = 0.71. As equações de conservação de massa, quantidade de movimento e energia são resolvidas através do Método dos Volumes Finitos (FVM). O principal objetivo é avaliaro efeito dos graus de liberdade sobre o coeficiente de arrasto (CD) e o número de Nusselt (NuD) entre os corpos rombudos e o escoamento circundante, assim como, os valores ótimos de ST/D para seis razões de ST/D = 1.5, 2.0, 2.5, 3.0, 3.5 e 4.0 e seis passos longitudinais SL/D= 1.5, 2.0, 2.5, 3.0, 3.5 e 4.0. Os resultados mostraram que a alteração da razão ST/D possuem influência sobre os coeficientes de arrasto e número de Nusselt do arranjo triangular de corpos rombudos, bem como, sobre as geometrias que conduzem aos melhoresdesempenhos fluido dinâmico e térmico do escoamento.Palavras-chave: Design Construtal, convecção forçada, arranjo triangular, escoamento externo, corpos rombudos