A Violência no Local de Trabalho em Instituições de Saúde: Um Estudo Monocêntrico sobre Causas, Consequências e Estratégias de Prevenção

Introduction: Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational health prevention and surveillance strategies. Material and Methods: Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test and the Fisher’s exact test were used to calculate p values. Results: The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28 [78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it is possible to minimize workplace violence. Discussion: Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our study reflects the negative effects of threatening occupational stressors on mental health. Conclusion: Our results show that workplace violence is a relevant risk factor that significantly impacts workers’ health in a noxious manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir estratégias de prevenção e vigilância em saúde ocupacional. Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p. Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o incidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema. Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado reflete o efeito prejudicial da exposição a fontes de stress e ameaça. Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo. Palavras-chave: Fatores de Risco Profissionais; Prevenção; Saúde Ocupacional; Trabalhadores da Saúde; Violência no Local de trabalho.info:eu-repo/semantics/publishedVersio

Working conditions and high emotional exhaustion among hospital nurses

Background: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. Objective: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. Methods: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). Results: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). Conclusion: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.info:eu-repo/semantics/publishedVersio

Expansion of activated cxcr5+icos+ tfh cells and plasmablasts induced by seasonal influenza vaccine is impaired in anti-il-6r treated rheumatoid arthritis patients

Objectives: To investigate the importance of IL-6 for the in vivo differentiation of human Tfh cells, taking advantage of influenza vaccination in patients under anti-IL-6R therapy.info:eu-repo/semantics/publishedVersio

Volatile organic compounds mixtures in hospital environment: the common exposure scenario

EXPOsE—Establishing protocols to assess occupational exposure to microbiota in clinical settings (02/SAICT/2016 - Project nº 23222).Chemical contamination is a reality in the hospital environment but unfortunately is rarely studied. However, if we consider that healthcare workers use a high diversity of products such as disinfectants, sterilizers, anesthetic gases, and much other is easy to recognize that workers and patients can be exposed to a complex mixture of chemicals. The aim of this study was to determine, through a review, the presence of volatile organic compounds (VOCs) mixtures in a hospital environment. Results showed that a complex mixture of VOCs is normally present and this aspect should be reflected in the risk assessment process. Future research work must be developed related to the possible health effects caused by exposure to complex mixtures of chemicals.info:eu-repo/semantics/publishedVersio

Supplementary Material for: Translation, cultural adaptation, and content validation of a pleural mesothelioma questionnaire to Portuguese context: a key tool for epidemiological surveillance

OBJECTIVE To describe the translation, cultural adaptation, and content validation process of the French National Surveillance Programme for Pleural Mesothelioma (FNSPPM) questionnaire for the Portuguese context. METHODS A search was conducted in the PubMed database and Web of Science, in the period from 1 January 1960 to 31 December 2022, to select the questionnaire. Forward and reverse translations, calculation of the content validity index (CVI) by a panel of experts (n=9), and cognitive interviewing with individuals with at least one exposure to asbestos (n=10) were performed. Experts rated items on a Likert scale (1-4) based on their relevance. The item-level content validity index (I-CVI), scale-level content validity index based on the average method (S-CVI/Ave), scale-level content validity index based on the universal agreement method (S-CVI/UA) were calculated. RESULTS The final version of the FNSPPM questionnaire for the Portuguese context resulted from a translation and content validation process. The panel of experts considered the questionnaire relevant, with an I-CVI of up to 0.78 in 68 of 69 of the questions, an S-CVI/Ave of 0.98, and an S-CVI/UA of 0.90. The participants in the cognitive interviews reported an understanding of the questionnaire. CONCLUSION A validated FNSPPM questionnaire for the Portuguese context is now available to study individuals with Pleura Mesothelioma (PM) and asbestos exposure

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

Health care professionals deal on a daily basis with several job demands - emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demands have a negative impact on the quality of care delivered by health professionals. Backup behaviors had a mediating effect between job demands and quality of care. Also, the positivity ratio of professionals (ratio of positive and negative emotions experienced) was also found as a significant mediator between most job demands and quality of care dimensions. Finally, we found a double mediation between most job demands and quality of care, where backup behaviors influenced the positivity ratio. Quality of care in hospitals is closely related to job demands. Hospital managers should consider the importance of cooperation within health care professionals' teams and ought to find ways to develop teamwork in order to promote patients' safety. © 2014 Colegio Oficial de Psicólogos de Madrid. Production by Elsevier España, S.L. All rights reserved

Transferência alvéolo-capilar na monitorização dos doentes com sarcoidose: TLCOSB ou TLCOSB/VA

RESUMO: Na sarcoidose a evolução das provas de função respiratória (volumes, débitos, stCpl e TLCO) condiciona a decisio terapêutica. Uma diminuiçãoâ¥a10% em pelo menos dois parâmetros é aceite por muitos autores como suficiente para iniciar cortico-terapia. Habitualmente considera-se a TLCO/VA mais fidedigna que a TLCO não corrigida, embora não haja unanimidade no que refere às doenças do interstício pulmonar, e particularmente a sarcoidose.Propusemo-nos a avaliar comparativamente estes dois testes nos doentes com sarcoidose e, posterior-mente, o melhor deles com outros parâmetros funcionais habitualmente utilizados na avaliação destes doentes.Admitimos como parâmetro indicador de doença a TAC de alta resolução e com ela comparámos a sensibilidade e a especificidade da TLCOSB e TLC0SB/VA. Os critérios de inclusão foram: 1. presença de sarcoidose confirm ada por biópsia, 2. TAC de alta resolução e provas de função respiratória com determinação de TLCOSB e TLCOSB /VA na altura da apresentação da doença. Estudaram-se 81 doentes, com idade media de 43.5 anos, desvio padrão 12.8, sendo 79% (64) mulheres e 89% (71) não fumadores. 43 doentes não tin bam doença parenquimatosa na TAC (TAC em estadio 0 ou I) e 38 doentes tin ham doença parenquímatosa na TAC (TAC em estadio II, III ou IV).Através da analise de Mc Nemar comparámos a sensibilidade e a especificidade da TLC0SB e da TLCOSB/VA (normalâ¥a 80%) em detectar e excluir doença. A especificidade da TLCOSB é significativamente superior à da TLCOSB/VA (p=0.0016), não havendo diferença significativa para a sensibilidade.Quando comparámos com a TLCOSB a especificidade e a sensibilidade da capacidade vital (CV), da capacidade pulmonar total (CPT) e da compliance estática (stCpl) verifiámos que a TLCOSB é significativamente mais sensível que os outros parâmetros (p=0.001; 0.0001; 0.005) mas igualmente específica. A área sob a curva ROC(%) respectivamente para a TLCOSB, TLCOSB/VA, CV, CPT e stCpl é 79.7%, 66.8%, 75.7%, 74.5% e 64.9%.Em conclusão, a especificidade da TLCOSB é significativamente superior à da TLCOSB/VA na exclusão de alterações intersticiais polmonares oeste grupo de doentes com sarcoidose, devendo serem as suas alterações preferencialmente valorizadas. à também mais sensfvel que os outros parâmetros avaliadosREV PORT PNEUMOL 1998; IV (6): 591-597 ABSTRACT: The evolution of lung function tests (LFT) can be useful in the decision of initiating (or reinstituting) treatment of sarcoidosis. Usually TLCO/VA is more reliable than TLCO, but this is not clear for interstitial lung diseases including sarcoidosis.The aim of our study is to compare these two tests in patients with sarcoidosis. The best of them will be inturn compared with other lung function tests usually used in sarcoidosis' evaluation. High resolution computed tomography (HRCT) enabled us to determine the presence or absence of long disease. Afterwards, we determined the sensibility and specificity of TLCOSB and TLCOSB/VA.Patient-choosing criteria were:1. patients with biopsy proven sarcoidosis2. HRCT and LFT with TLCOSB and TLCOSB/VA at presentation time.We studied 81 patients (average age 43.5±12.8, 64/81 females and 71/81 non smokers). 43 patients (53.1%) had no pulmonary disease in HRCT and 38 patients (46.9%) had lung disease.We compared the sensibility and specificity of TLCOSB and TLCOSB/VA (normalâ¥80%). The specificity of TLCOSB is significantly greater than the specificity of TLCOSB/VA and the sensibility of TLCOSB is significantly greater than the sensibility of vital capacity (VC), total lung capacity (TLC) and static compliance (stCpl).The ROC area (%) was: TLCOSB (79.7%), TLCOSB/VA (66.8%), VC (75.7%), TLC (74.5%) and stCpl (64.9%).In patients with sarcoidosis, the TLCOSB seems to be the most precocious lung function test in assessing lung disease. The patient evolution, determined by the TLCOSB, must be taken into account.REV PORT PNEUMOL 1998; IV (6): 591-597 Key-words: Sarcoidosis, Lung function tests, TLCOSB, TLCOSB/VA, Palavras-chave: Sarcoidose, Provas funcionais respiratórias, TLCOSB, TLCOSB/V

Terapêutica da sarcoidose: importância da avaliação da PEP

RESUMO: A clearance do DTPA marcado com 99mTc pode ser um método não invasivo para determinar a Permeabilidade Epitelial Pulmonar (PEP). Os objectivos do nosso estudo consistiram em avaliar a PEP de doentes com sarcoidose por aquele método e: 1) Correlacionar o seu valor com os testes funcionais respiratórios â capacidade vital (CV), volume expiratório máximo no primeiro segundo (VEMS), compliance pulmonar estática (St Cpl), difusão de monóxido de carbono (DLCO) e pressão arterial de oxigénio (PaO2) com a TAC, com a fixação pulmonar de Gallium 67 e com o valor de enzima conversora de angiotensina (ECA); 2) Avaliar sea PEP poderá preverá evolução da doença pulmonar, podendo ser, nessa perspectiva, um indicador útil a ter em conta na decisão de tratar a sarcoidose pulmonar.Estudámos 34 doentes com sarcoidose confirmada por biópsia (idade média 43.3±10.9, 27/34 do sexo feminino, 20% estadio 0, 23% estadio 1, 26% estadio n e 31% estadio III ou IV, tempo de evolução da doença 3. 7±5.4 anos). Os doentes foram divididos em dois grupos: a) com PEP normal â grupo 0 (n=14), b) com PEP aumentada â grupo 1 (n=20). O teste Anova e o teste de Fisher foram utilizados para testar 1. A analise da covariância e teste de Mc Nemar foram utilizados para testar 2.Encontrámos uma correlação estatisticamente significativa entre os valores da PEP e a CV (G0=102.6±18.3vsG1=86.4±19.7, p=0.01), FEV1, (G0=105.4±20.5 vs G1=85.8±21.5, p=0.0 19), DLCO (G0=100.4 19.4 vs G1=83.2±22.2, p=0.02) e cintigrafia pulmonar com Gallium 67 positiva (p=0.05). Os nossos resultados sugeriram ainda que a PEP poderá prever a evolução da compliance pulmonar estática (p=0.069).Parece assim que a determinação da PEP através da clearance de99mTc â DTPA possivelmente será útil na decisão clínica de iniciar (ou reiniciar) tratamento, em doentes com sarcoidose pulmonar. ABSTRACT: SARCOIDOSIS THERAPY: IMPORTANCE OF PEP DETERMINATION: Clearance of 99mTc â DTPA may be a non invasive way to determinate Pulmonary Epithelial Permeability (PEP). The aim of our study was to assess PEP of patients with sarcoidosis and: 1) To correlate its value with the initial lung function tests values - VC, FEV1, St Cpt, DLCO, PaO2, TC, 67 Gallium pulmonary fixation and SACE determinations; 2) To evaluate if PEP can predict patients evolution after one year of follow up, being a valid indicator to decide about pulmonar sarcoidosis treatment.We studied 34 patients with biopsy proven sarcoidosis (mean age 43.3±10.9, 27/34 females, 20% stage 0, 23% stage 1, 26% stage II, 3 1% stage III, mean time of disease evolution 3. 7±5.4 years).Patients were divided in two groups a) normal PEP â Group 0 (n=14) b) increased PEP â Group 1 (n=20). Anova and Fisher testes were used to test 1) and study of change was made by Me Nemar test and analysis of covariance to test 2). We found a significant correlation of PEP values and VC (G0=102.6±18.3 vs G1=86.4±19.7, p=0.01), FEV, (G0=105.4±20.5 vs G1=85.8±21.5, p=0.019), DLCO (G0=100.4±19.4 vs G1=83.2±22.2, p=0.02) and lung 67 Gallium positivity (p=0.05). Regarding predictability of evolution there was a sugestion that initial PEP value would predict evolution of St Cpl (p=0.069).Our results suggest that PFP evaluation are probably useful in the decision of initiating (or reinstituting) treatment in pulmonary sarcoidosis. Key Words: Sarcoidosis treatment, Pulmonary Epithelial Permeability, Palavras chave: Terapêutica na sarcoidose, Permeabilidade Epitelial Pulmona