Episiotomia: resultados maternos e neonatais

Overview and aims: Episiotomy is one of the most common procedures in Obstetrics, despite actual scientific evidence does not support its routine practice. The aim of this study was to determine the impact of selective and routine practice of episiotomy in early maternal and neonatal outcomes. Study design: An observational, transversal, descriptive and analytic study was conducted in two public Hospitals in no r - thern Portugal, with different policies for the practice of episiotomy: selective practice (Hospital A) and routine practice (Hospital B). Population: A non-random sampling of convenience of the whole puerperal women whose deliveries was performed in these hospitals during months of July and August 2011 was utilized. A total of 397 women was analyzed, 200 in selective group and 197 in routine group. Methods: Data was collected by consultation of medical records of the puerperal women. Comparison between hospitals was performed with the chi-square test. Results: The groups were similar for the obstetric history, demographic, biometric, pregnancy and labor characteristics. However, gestational age, weight and head circumference of newborns as well as instrumentation rate were significantly higher in selective group. Episiotomy was performed in 72.5% cases of selective group and in 88.8% of routine group (p=0.001). There was less perineal suturing (p=0.001) and a greater number of intact perineum in selective group (p=0.001), without differences in lacerations type or degree. The routine group presented more frequent early perineal complications and higher pain levels in the first postpartum day (p=0.001). No differences were found between groups in Apgar scores, neonatal trauma and Neonatal Intensive Care Unit admissions number. Conclusions: The selective use of episiotomy was associated with better early maternal outcomes, with no differences in neonatal morbidity. Thus, the routine practice of episiotomy showed no benefits

Effective and Low-Maintenance IMTA System as Effluent Treatment Unit for Promoting Sustainability in Coastal Aquaculture

This research was supported by MAR2020, PORTUGAL2020 Partnership Agreement, through IFAP and ERDF (reference MAR-04.03.01-FEAMP-0007).This article is a result of the project ALGADEPUR—Aquacultura Multitrófica Integrada como veículo para a sustentabilidade (reference MAR-04.03.01-FEAMP-0007), supported by MAR2020, PORTUGAL2020 Partnership Agreement, through FEAMPA. The authors would like to acknowledge Nasharyba—Produção e Comérico de Peixe, Lda. for all the support given during this work and the space provided for the IMTA-pilot system. The authors would also like to acknowledge Ana Margarida Bóia and José Almeida for assisting in part of the work performed.Integrated multitrophic aquaculture (IMTA) is a versatile technology emerging as an ecological and sustainable solution for traditional monoculture aquacultures in terms of effluent treatment. Nevertheless, IMTA is still poorly applied in aquaculture industry due to, among other reasons, the lack of effective, low-investment and low-maintenance solutions. In this study, one has developed a practical and low maintenance IMTA-pilot system, settled in a semi-intensive coastal aquaculture. The optimisation and performance of the system was validated using Ulva spp., a macroalgae that naturally grows in the fishponds of the local aquaculture. Several cultivation experiments were performed at lab-scale and in the IMTA-pilot system, in static mode. The specific growth rate (SGR), yield, nutrient removal, N and C enrichment, protein and pigment content were monitored. Ulva spp. successfully thrived in effluent from the fish species sea bream (Sparus aurata) and sea bass (Dicentrarchus labrax) production tanks and significantly reduced inorganic nutrient load in the effluent, particularly, NH4 + , PO4 3− and NO3 −. The enrichment of nitrogen in Ulva spp.’s tissues indicated nitrogen assimilation by the algae, though, the cultivated Ulva spp. showed lower amounts of protein and pigments in comparison to the wild type. This study indicates that the designed IMTA-pilot system is an efficient solution for fish effluent treatment and Ulva spp., a suitable effluent remediator.Ana Margarida BóiaComérico de PeixeIFAPMAR2020European Regional Development Fund MAR-04.03.01-FEAMP-000

Photochemical degradation of triclosan: a comparison between different light sources

New emerging contaminants could represent a danger to the environment and Humanity with repercussions not yet known. One of the major worldwide pharmaceutical and personal care productions are antimicrobials products, triclosan, is an antimicrobial agent present in most products. Despite the high removal rate of triclosan present in wastewater treatments, triclosan levels are on the rise in the environment through disposal of wastewater effluent and use of sewage sludge in land application. Regulated in the EC/1272/2008 (annex VI, table 3.1), this compound is considered very toxic to aquatic life and it has been reported that photochemical transformation of triclosan produces dioxins. In the current work it was defined three objectives; determination of the most efficient process in triclosan degradation, recurring to photochemical degradation methods comparing different sources of light; identification of the main by-products formed during the degradation and the study of the influence of the Fenton and photo-Fenton reaction. Photochemical degradation methods such as: photocatalysis under florescent light (UV), photocatalysis under visible light (sunlight), photocatalysis under LEDs, photo-Fenton and Fenton reaction have been compared in this work. The degradation of triclosan was visualized through gas chromatography/mass spectrometry (GC/MS). In this study photo-Fenton reaction has successfully oxidized triclosan to H2O and CO2 without any by-products within 2 hours. Photocatalysis by titanium dioxide (TiO2) under LEDs was possible, having a degradation rate of 53% in an 8 hours essay. The degradation rate of the Fenton reaction, UV light and sunlight showed degradation between 90% and 95%. The results are reported to the data observed without statistic support, since this was not possible during the work period. Hydroquinone specie and 2,4-dichlorophenol by-products were identified in the first hour of photocatalysis by UV. A common compound, possibly identified has C7O4H , was present at the degradation by UV, sunlight and LEDs and was concluded to be a contaminant. In the future more studies in the use of LEDs should be undertaken given the advantages of long durability and low consumption of energy of these lamps and that due to their negative impact on the environment fluorescent lamps are being progressively made unavailable by governments, requiring new solutions to be found. Fenton and photo-Fenton reactions can also be costly processes given the expensive reagents used

Impacto de la supervisión clínica en la satisfacción laboral y en la competencia emocional de los enfermeros

Objective: To evaluate the impact of implementing the SafeCare clinical supervision model on nurses’ job satisfaction and emotional competence profile. Methods: This is a quasi-experimental study, with a sample of 28 nurses from a hospital in northern Portugal. A self-administered questionnaire was applied, used as pre and post-test, which included: sociodemographic and professional characterization; “Job Satisfaction Scale”; and “Veiga Emotional Competence Scale”. We conducted descriptive statistical analysis and the Wilcoxon Test. Results: A significant decrease in the nurses’ satisfaction with hierarchical superior was observed in the post-test. No significant differences were found in the nurses’ job satisfaction and emotional competence after the implementation of the SafeCare Model. Conclusion: The SafeCare Model needs improvement, suggesting increasing the amount of training time administered to nurses and strengthening the healthcare institution’s link to the Model.Objetivo: Avaliar o impacto da implementação do Modelo de supervisão clínica SafeCare na satisfação profissional e no perfil de competência emocional dos enfermeiros. Métodos: Estudo quase-experimental, com uma amostra de 28 enfermeiros de um hospital do norte de Portugal. Aplicou-se um questionário de autopreenchimento, utilizado como pré e pósteste, que engloba caracterização sociodemográfica e profissional, “Escala da Satisfação Profissional” e “Escala Veiga de Competência Emocional”. Realizaram-se análise estatística descritiva e Teste de Wilcoxon. Resultados: Observou-se uma diminuição significativa na satisfação dos enfermeiros com o superior hierárquico no pós-teste. Não se verificaram diferenças significativas na satisfação profissional e na competência emocional dos enfermeiros após a implementação do Modelo SafeCare. Conclusão: É necessário aperfeiçoar o Modelo SafeCare, sugerindo que se aumente o tempo de formação administrada aos enfermeiros e fortaleça o vínculo da instituição de saúde ao Modelo.Objetivo: Evaluar el impacto de la aplicación del Modelo de supervisión clínica SafeCare en la satisfacción laboral y en el perfil de competencia emocional de los enfermeros. Métodos: Se trata de un estudio cuasi experimental, realizado con una muestra de 28 enfermeros de un hospital del norte de Portugal. Se aplicó un cuestionario autocompletado como pre y pos test, que incluía la caracterización sociodemográfica y profesional, la “Escala de Satisfacción Laboral” y la “Escala Veiga de Competencia Emocional”. Se llevaron a cabo análisis estadísticos descriptivos y la prueba de Wilcoxon. Resultados: Fue posible observar una disminución significativa de la satisfacción de los enfermeros con su superior jerárquico en la prueba posterior al test. No se encontraron diferencias significativas en la satisfacción laboral y en la competencia emocional de los enfermeros tras la aplicación del modelo SafeCare. Conclusión: Es necesario perfeccionar el Modelo SafeCare, aumentando la cantidad de formación impartida a los enfermeros y reforzando el vínculo de la institución sanitaria con el Modelo.info:eu-repo/semantics/publishedVersio

Os indicadores de gestão na prestação de contas dos municípios portugueses

Dissertação de mestrado em Estudos de GestãoPassados quinze anos da implementação do POCAL e em vésperas da apresentação de um novo modelo contabilístico para o sector público, verifica-se pertinente a análise da divulgação dos indicadores de gestão nos documentos de prestação de contas dos municípios portugueses, concretamente no relatório de gestão, conforme estabelece o POCAL. A presente dissertação tem como objetivo, no âmbito da Nova Gestão Pública e da temática da accountability, analisar e caracterizar os tipos e padrão de indicadores de gestão divulgados pelos municípios portugueses nos seus documentos de prestação de contas, bem como o perfil dos municípios que os divulgam. O estudo desenvolvido é de natureza exploratória, tendo sido adotada uma abordagem quantitativa, após a análise efetuada ao conteúdo do relatório de gestão dos municípios. Como indicadores de gestão atendeu-se essencialmente aos rácios. A análise compreendeu o levantamento de todos os indicadores divulgados nesse documento elaborado pelos 301 municípios para os quais se obteve os documentos de prestação de contas do exercício de 2013. Constatou-se a existência de uma grande variedade de indicadores divulgados, tendo sido encontrados 665 indicadores de gestão diferentes, dos quais 415 são indicadores orçamentais, 231 são indicadores patrimoniais e 19 são outros indicadores de gestão – não rácios. Este facto pode dever-se à relevância que a contabilidade orçamental assume ainda para os gestores públicos. O subgrupo de indicadores referentes à estrutura e de cobertura é o que se destaca, quer no grupo dos indicadores orçamentais, quer no grupo dos indicadores patrimoniais. No entanto, 49 municípios, 29 de pequena dimensão e 20 de média dimensão, não apresentam qualquer indicador. Tal indicia que os municípios de maior dimensão apresentam uma maior preocupação com a divulgação de indicadores de gestão nos seus relatórios, mas esta não é uma prática partilhada por todos os municípios portugueses. Quanto à divulgação de indicadores de gestão no relatório de gestão dos municípios, conclui-se também pela inexistência de um padrão, decorrente da ausência de sistematização na produção de indicadores de gestão. Os resultados obtidos não permitem ainda caraterizar um perfil dos municípios que divulgam os indicadores de gestão, apesar da obtenção de evidência empírica quanto à existência de alguma diferenciação na publicação de alguns indicadores, atendendo à dimensão e localização dos municípios. Face ao apresentado, o estudo realça a necessidade da definição de um conjunto de indicadores de gestão, de forma a construir um referencial capaz de fornecer informação útil e comparável para a avaliação e acompanhamento do desempenho dos municípios.After fifteen years of the implementation of POCAL and on the eve of the presentation of a new accounting model for the public sector, the analysis of the management indicators' disclosure by Portuguese municipalities in the management report, as established in POCAL, is still relevant. The aim of this dissertation, in the context the New Public Management and the accountability issue, is to analyse and characterize the different types and standard of management indicators disclosed by the Portuguese municipalities in its financial report, as well as the profile of these municipalities. This is an exploratory study, with a quantitative approach, supported by the content analysis of the municipalities’ management report. All indicators, with a particularly focus on ratios, disclosed in this statement enclosed in the annual report of 2013 of 301 municipalities, were analysed. The results show the existence of a wider multiplicity of management indicators disclosed: 665 different management indicators. These were classified into three categories: 415 are budgetary indicators, 231 are financial indicators and 19 are considered ‘other management indicators - non ratios’. The high number of budgetary indicators reveals the relevance of the budgetary accounting for public managers. The subgroup of indicators regarding the structure and coverage stands out, within both budgetary and financial indicators. However, 49 municipalities, 29 small and 20 medium-sized, do not present any indicator. This suggests that larger municipalities have a greater awareness about the importance of management indicators disclosure, but this is not a current practice by all Portuguese municipalities. This study also concludes that there is not a standard to the disclosure of management indicators in the management report by municipalities. The results do not allow characterizing a profile of municipalities that disclose management indicators, despite of empirical evidence show the existence of some differentiation in the disclosure of some indicators within size and location dimensions of the municipalities. The study highlights the need to define a set of management indicators to build a framework able to provide useful and comparable information to evaluate the performance of municipalities

Emergência em saúde pública em contexto de saúde ocupacional: catástrofes naturais (revisão sistemática da literatura)

Mestrado em Segurança e Higiene no TrabalhoIntrodução - Nos últimos tempos, as catástrofes naturais têm sido uma das principais causas de problemas de Saúde Pública, com repercussões a nível social, económico e ambiental. De acordo com a Organização das Nações Unidas, nas últimas décadas, houve 7.348 catástrofes naturais em todo o mundo, sendo que 4 bilhões de pessoas foram afetadas, em que 1,23 milhão de pessoas morreram, o que equivale a cerca de 60 mil por ano. Para a realização do estudo foram selecionadas as catástrofes naturais mais concretamente as epidemias, tendo sido escolhido o Novo Coronavírus SARS-CoV-2, responsável pela atual Pandemia. Para o combate ao novo Coronavírus, foram destacadas equipas multidisciplinares, que trabalham de forma articulada e colaborativa, colocando-se muitas vezes em risco de exposição ao vírus. Destas equipas multidisciplinares, foi selecionado o Corpo dos Bombeiros para fazer parte do estudo. Objetivo - O objetivo do estudo é a análise dos protocolos de atuação dos bombeiros durante a fase de emergência. A questão orientadora do estudo foi: será que existem protocolos de atuação que minimizem os riscos de exposição dos bombeiros durante a fase de emergência em situação de catástrofe natural em contexto de Covid 19? Metodologia - Foi realizada uma Revisão Sistemática utilizando a metodologia PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) para a seleção de artigos a considerar para o estudo. Para o estudo, foram consultados artigos científicos disponibilizados nas bases de dados: Web of Science, PubMed e LitCovid. Resultados - A análise dos estudos permitiu a identificação de 3 pontos significativos nos protocolos de atuação dos bombeiros durante a fase de emergência: planos de resposta a doenças infeciosas, medidas de controlo do local de trabalho, utilização e formação/treino no uso de equipamento de proteção individual (EPI). Os três pontos foram categorizados na hierarquia de controlo do risco em três medidas: engenharia/ambientais; administrativos/organizacionais e EPI.ABSTRACT - Introduction - Natural disasters have been one of the main causes of public health problems lately, with, social, economic, and environmental repercussions. According to the United Nations, there have been 7,348 natural disasters worldwide, with 4 billion people affected in recent decades, in which 1.23 million people have died, which is the equivalent of about 60 thousand per year. To carry out the study, natural catastrophes, specifically epidemics, were selected and the new virus responsible for the current Pandemic, Coronavirus Sars-Cov-2, was chosen. Multidisciplinary teams were deployed to fight the new Coronavirus, working in an articulated and collaborative manner, often putting themselves at risk of exposure to the virus. From these multidisciplinary teams, the Fire Department was the one selected to take part in the study. Purpose - The aim of the study is to analyze the protocols of action of firefighters during the emergency phase. The guiding question to the study was: Are there any action protocols that minimize the firefighters’ risks of exposure during the emergency phase in a natural disaster situation? Methodology - A Systematic Review was carried out using the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) for the selection of articles to be considered for the study. For that, scientific articles available in the following databases were consulted: Web of Science, PubMed, and LitCovid. Results - The study’s analysis allowed the identification of three significant points in the firefighters’ performance protocols during the emergency phase: infectious diseases response plans; workplace control measures; use and training in the use of Personal Protective Equipment (PPE). The three points were categorized in the risk control hierarchy: engineering/environmental, administrative/organizational control measures; and PPE.N/

an ecological study in Portugal

Funding Information: The present publication was funded by Fundação Ciênciae Tecnologia, IP national support through CHRC (UIDP/04923/2020) and NOVA National School of Public Health. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Background: Hospitalisations for Ambulatory Care Sensitive Conditions (ACSC) cause harm to users and to health systems, as these events are potentially avoidable. In 2009, Portugal was hit by an economic and financial crisis and in 2011 it resorted to foreign assistance (“Memorandum of Understanding” (2011–2014)). The aim of this study was to analyse the association between the Troika intervention and hospitalisations for ACSC. Methods: We analysed inpatient data of all public NHS hospitals of mainland Portugal from 2007 to 2016, and identified hospitalisations for ACSC (pneumonia, chronic obstructive pulmonary disease, hearth failure, hypertensive heart disease, urinary tract infections, diabetes), according to the AHRQ methodology. Rates of hospitalisations for ACSC, the rate of enrollment in the employment center and average monthly earnings were compared among the pre-crisis, crisis and post-crisis periods to see if there were differences. A Spearman’s correlation between socioeconomic variables and hospitalisations was performed. Results: Among 8,160,762 admissions, 892,759 (10.94%) were classified as ACSC hospitalizations, for which 40% corresponded to pneumonia. The rates of total hospitalisations and hospitalisations for ACSC increased between 2007 and 2016, with the central and northern regions of the country presenting the highest rates. No correlations between socioeconomic variables and hospitalisation rates were found. Conclusions: During the period of economic and financial crisis based on Troika’s intervention, there was an increase in potentially preventable hospitalisations in Portugal, with disparities between the municipalities. The high use of resources from ACSC hospitalisations and the consequences of the measures taken during the crisis are factors that health management must take into account.publishersversionpublishe

Adenocarcinoma de células claras do colo do útero em idade jovem: um desafio diagnóstico

Clear cell adenocarcinoma of the cervix is a rare tumor, classically related with in utero diethylstilbestrol (DES) exposure. The authors report a rare case of clear cell adenocarcinoma of the cervix in a 21-yearold woman who had no history of in utero DES exposure, presenting with intermittent vaginal bleeding. It stresses the relevance to always clarify the etiology of abnormal genital bleeding and consider the possibility of cervicovaginal tumors

O impacto de um curso de ensino a distância (EAD) de prevenção em LER/DORT na qualidade de vida de um grupo de enfermagem

Introdução: As Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) são afecções músculo esqueléticas. A enfermagem é uma das categorias da área da saúde mais atingidas por estas, devido aos fatores de risco da profissão. Apresentar desconforto e dor em regiões específicas do corpo, faz parte do cotidiano de muitos destes trabalhadores, que acabam apresentando alterações em sua qualidade de vida. Estes fatores levam ao aparecimento do presenteísmo observado quando o trabalhador está presente no trabalho apesar de doente ou com algum problema físico ou psicológico e ao absenteísmo que ocorre quando este trabalhador falta ao trabalho. Objetivo: Avaliar o impacto de um Curso de Ensino à Distância (EAD) de Prevenção em LER/DORT na qualidade de vida destes trabalhadores e avaliar também desconforto e dor, presenteísmo e absenteísmo. Métodos: Sessenta funcionários da enfermagem de um hospital geral universitário participaram do ensaio clínico, randomizados aleatoriamente em dois grupos.Os critérios de inclusão foram: ser contratado do hospital nas categorias profissionais enfermeiros, técnicos e auxiliares de enfermagem e atuarem em unidades de internação. Foram excluídos trabalhadores com diagnóstico de LER/DORT auto-referido.O grupo intervenção participou de um curso em EAD com duração de 8 horas, composto por estratégias e dicas laborais para a prevenção de LER/DORT, literaturas disponíveis e provas teóricas, o grupo controle foi submetido a uma palestra educativa com duração de 30 minutos, com os mesmos conteúdos do curso em EAD. Foram avaliados antes da intervenção, duas e oito semanas após. Resultados: Quando comparada a qualidade de vida entre os grupos não observamos melhores resultados na percepção do grupo intervenção. O domínio de dor apresentou pior percepção. Presenteísmo foi observado em ambos os grupos, observamos redução do presenteísmo nos grupos sendo no grupo controle uma diferença significativa.Em relação ao desconforto e dor, ambos os grupos apresentaram alta prevalência, houve mudança significativa no grupo controle, com redução na escala do basal para a 8ª semana depois na região das costas inferior. No grupo intervenção não há uma diferença estatisticamente significativa, apesar de haver uma importante redução. Já o absenteísmo apresentou diferença entre os grupos, sendo que no vii grupo intervenção teve redução do número de horas de afastamento por doença. Conclusão: Não há evidência do impacto de um curso de ensino a distância (EAD) de prevenção em LER/DORT na melhora da percepção de qualidade de vida de um grupo de enfermagem.Introduction: Repetitive Strain Injuries (RSI) or Work-Related Musculoskeletal Disorders (WMSDs) are musculoskeletal disorders. Nursing is one of the health categories that area most affected by these, due to the profession risk factors. Many of these workers show discomfort and pain in specific regions of the body as part of the daily life that end up presenting changes in their quality of life. These factors lead to the appearance of presenteeism observed when the worker is present at work despite being ill or with some physical or psychological problem and to absenteeism that occurs when this worker is absent from work. Objective: To evaluate the effects of a distance learning (DL) course on prevention of RSI and WMSDs in the quality of life of these workers and also to assess discomfort and pain, presenteeism and absenteeism. Methods: Sixty nursing staff from a general university hospital participated in the randomized trial, randomly divided into two groups. The inclusion criteria were: to be a hospital employee in the categories professional nurses, technicians, nurse assistants and to work in hospitalization units. Workers with self-reported diagnosis of RSI/WMSDs were excluded. The intervention group participated in an 8h DL course, consisting of strategies and work tips for the prevention of RSI/ WMSDs, available literature and theoretical evidence, the control group was submitted to a 30 minute educational lecture, with the same content of the DL course. They were evaluated before the intervention, two and eight weeks after. Results: When comparing the quality of life between the groups, the we did not observe better results in the perception of the intervention group. The pain domain presented worse perception. Presenteeism was observed in both groups, we observed reduction of presenteeism in the groups being a significant difference in the control group. Regarding to discomfort and pain, both groups presented a high prevalence, there was a significant change in the control group, with a reduction in the baseline scale to the 8th week later in the lower back region. In the intervention group there is no significant difference statistically, although there is a significant reduction. On the other hand, absenteeism presented a difference between the groups and in the intervention group there was a reduction in the number of hours of sick leave. Conclusion: There is no evidence of the impact of a distance learning prevention course on RSI/WMSDs on the improvement of the perception of the quality of life of a nursing grou