COMPLICAÇÕES PÓS-OPERATÓRIAS EM DOENTES CIRÚRGICOS DE RISCO INTERNADOS NA UNIDADE DE CUIDADOS INTERMÉDIOS DO INSTITUTO PORTUGUÊS DE ONCOLOGIA DO PORTO: INFORMAÇÕES RELEVANTES PARA O PLANEAMENTO DOS CUIDADOS CENTRADOS NO DOENTE

Knowing the surgical burden and risk profile of surgical complications is mandatory to support the effective organization of perioperative care. The purpose of this work was to characterize the complication’s profile of patients admitted and treated in the years 2017 and 2018 in the surgical intermediate care unit (SICU) at our institution. The clinical records of surgical patients admitted to the intermediate surgery care unit (n=2017) with a high risk of complications were retrospectively studied, considering the comorbidities and surgical complexities. In this group of patients, 832 postoperative complications occurred. Most were grade I and II according to the Clavien-Dindo classification. Respiratory, sepsis and cardiac complications were the most prevalent medical major complications. Surgical site infections, anastomosis leak and peritonitis were the most prevalent surgical complications, 2.2% of patients died in this series. These data point out the need of an organized and resourceful perioperative care program that includes a prehabilitation program, proficient intraoperative care and a multidisciplinary team in the SICU to ensure quality post-operative care, for high-risk surgical patient.Conhecer o perfil do risco de complicações cirúrgicas é crucial para a organização eficiente dos cuidados perioperatórios. O objetivo deste trabalho foi caracterizar o perfil de complicações dos doentes internados e tratados em 2017 e 2018 na unidade de cuidados intermediários de cirurgia (UCI) de nossa instituição. Foram estudados retrospectivamente os processos clínicos de doentes cirúrgicos admitidos na UCI (n = 2017) com elevado risco de complicações, tendo em conta as comorbilidades e a complexidade cirúrgica. Nesse grupo de doentes, ocorreram 832 complicações pós-operatórias. A maioria foi de grau I e II de acordo com a classificação de Clavien-Dindo. As complicações respiratórias, sépticas e cardíacas foram as complicações médicas mais prevalentes. As infecções do local cirúrgico, as deiscências da anastomose e as peritonites foram as complicações cirúrgicas mais frequentes. Nesta série 2,2% dos doentes faleceram. Estes dados apontam para a necessidade de um programa de cuidados perioperatórios organizado, com recursos e que inclua um programa de pré-reabilitação, cuidados intra-operatórios proficientes e uma equipe multidisciplinar na UCI para garantir que o atendimento pós-operatório ao doente cirúrgico de alto risco seja de qualidade

Occupational health: physical activity, musculoskeletal symptoms and quality of life in computer workers: a narrative review

Computer work has assumed a very important role for many companies, but specific occupational and health symptoms associated with the use of computers can appear. According to the literature, physical activity is considered a key player in the prevention and control of work-related musculoskeletal symptoms, contributing to a better quality of life in computer workers. The principal aims of this review are to contribute to a better understanding of the relationship among sedentary behavior, physical activity and quality of life of computer workers; to outline the importance of promoting the development of an educational program for Occupational Health directed at computer workers at the level of quality of life, musculoskeletal symptoms, and physical activity; and to call for attention to the factors needed to initiate and maintain a health program that involves the active participation of workers who must be concerned about their health. This review demonstrates the important role of workplaces in health promotion and the opportunities that workplaces provide to establish and continue successful health-promotion programs for computer workers, generating important benefits for the health and quality of life of individuals and groups.info:eu-repo/semantics/publishedVersio

The effects of COVID-19 lockdown on the perception of physical activity and on the perception of musculoskeletal symptoms in computer workers: comparative longitudinal study design

Lockdown resulting from the pandemic led to a change in the health habits of the computer workers community. Sedentary work, together with less active lifestyles, aggravated by the COVID-19 pandemic leads to impacts on physical activity (PA) and can contribute to the development of musculoskeletal symptoms (MSS). Understand the effects of lockdown on the perception of physical activity levels and on the perception of frequency of musculoskeletal symptoms, over periods of 12 months and 7 days, in computer workers. Longitudinal comparative study between 2019 (M1) and 2021 (M2), over 18 months, in 40 volunteer participants. The inclusion criteria were full-time workers aged between 18 and 65 and the exclusion criteria included diagnosis of non-work-related medical conditions. In addition to a socio-demographic questionnaire, the Nordic musculoskeletal questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ), was used to analyse the perception of the level of PA. These questionnaires were used in two assessment stages (M1 and M2). McNemar test and Wilcoxon paired test were used to evaluate the effect of lockdown on the perception of PA, and on the perception of frequency of musculoskeletal symptoms. The MSS prevalence in the previous 12 months increased significantly in the neck (M1: 45.0%, M2: 62.5%, p = 0.046), in the shoulders (M1: 37.5%, M2: 55.0%, p = 0.033), and in the hands/wrists (M1: 25.0%, M2: 45.0%, p = 0.019). The mean pain score increased in the shoulders (1.43 ± 2.24, 2.35 ± 2.55, p = 0.003) and in the elbows (0.18 ± 0.59, 0.60 ± 1.34, p = 0.015). No differences were found in the PA between M1 and M2, but the weekly mean sitting time increased from 4.75 ± 2.26 to 6.26 ± 2.65 (p < 0.001). After 18 months it became clear that MSS perception increased mainly in the neck, shoulders and hands/wrists with a significant increase in pain intensity in the shoulder and elbow regions. The weekly sitting time increased significantly. Further studies are needed in order to determine the impact of teleworking in a pandemic context. But multifactor behind these results should be taken into account by health institutions and those responsible for the Prevention of Occupational Risks in Computer Workers in order to adopt educational strategies for the promotion of Physical activity (PA), in these workers.info:eu-repo/semantics/publishedVersio

NÍVEIS DE ATIVIDADE FÍSICA PRÉ-OPERATÓRIA E PROGNÓSTICO PÓS-CIRÚRGICO EM DOENTES ONCOLÓGICOS: UM ESTUDO OBSERVACIONAL PROSPETIVO

Introduction: There is a growing interest to understand the impact of preoperative physical activity (PA) levels in postoperative morbidity and mortality. The aim of this study is to assess the levels of PA in patients with head/neck or gastric cancer through accelerometry and compare postoperative burden among those “complying” or “not complying” with PA recommendations. Methods: We conducted an observational, longitudinal and prospective study in newly diagnosed patients with gastric or head/ neck cancer, recruited at IPO-Porto. The levels of PA were evaluated through accelerometry. Data about postoperative burden (complications, length of hospital stay and mortality) were collected from clinical records. Results: A total of 81 patients were recruited, mostly men (76.5%), with an average age 61.8±11.55 years, 69.08±15.55 kg of weight and a BMI of 25.82±5.29 kg/m2. Fifty-four patients had a diagnosis of gastric cancer (66.7%) and 27 had head/neck cancer (33.3%). Patients spent 54% of their wearing time in sedentary behavior, 42% in light PA, and 4% in moderate to vigorous PA. Their median weekly MVPA was 132 (3-1860) min, and only 46.9% of patients accomplished the minimum amount of MVPA/week recommendations. No differences were noted among gastric and head/neck cancer patients. Regarding postoperative burden, 23.4% of patients had minor complications and 12.5% had major complications. The length of hospital stay was 13.86 ± 15.58 days and 9.9% deaths occurred after surgery. Postoperative mortality was superior among those patients “not complying” with international recommendations of PA (7 vs. 1 death). Conclusion: Our data suggests that high preoperative PA levels may decrease the risk of postoperative mortality. Assessing preoperative levels of PA could bring value to identify those patients at greater risk of surgical burden and guide them to intervention designed to mitigate that risk by increasing their physical activity, such as prehabilitation.Introdução: Há um interesse crescente em entender o impacto dos níveis de atividade física (AF) pré-operatória na morbimortalidade pós-operatória. O presente trabalho teve como objetivo avaliar os níveis de AF em doentes com cancro da cabeça/pescoço ou estômago e comparar o desfecho pós-operatório entre aqueles que “aderem” ou “não aderem” às recomendações de AF.&nbsp; Métodos: Foi realizado um estudo observacional, longitudinal e prospetivo em doentes recém-diagnosticados com cancro da cabeça/pescoço ou estômago, recrutados no IPO-Porto. Os níveis de AF foram avaliados por acelerometria. Os dados sobre o desfecho pós-operatório (complicações, tempo de internamento e mortalidade) foram consultados nos registos clínicos. Resultados: Foram recrutados 81 doentes, a maioria homens (76,5%), com idade média de 61,8 ± 11,55 anos, peso de 69,08 ± 15,55 kg e IMC de 25,82 ± 5,29 kg / m2. Cinquenta e quatro doentes tinham diagnóstico de cancro do estômago (66,7%) e 27 tinham cancro da cabeça/pescoço (33,3%). Os doentes passaram 54% do tempo de uso em comportamento sedentário, 42% em AF leve e 4% em AF moderada a vigorosa (AFMV). A mediana semanal de AFMV foi de 132 (3-1860) min, e apenas 46,9% dos doentes cumpriram as recomendações mínimas de AFMV / semana. Não foram observadas diferenças entre os doentes cancro da cabeça/pescoço ou estômago. Em relação ao desfecho pós-operatório, 23,4% dos doentes apresentaram complicações minor e 12,5%, complicações major. O tempo de internamento hospitalar foi de 13,86 ± 15,58 dias e ocorreram 9,9% mortes no período pós-operatório. A mortalidade pós-operatória foi superior entre os doentes que ou “não aderem” as recomendações internacionais de AF (7 vs. 1 óbito). Conclusão: Os nossos dados sugerem que níveis elevados de AF no pré-operatório reduzem o risco de mortalidade pós-operatória. A avaliação dos níveis de AF pré-operatória poderá auxiliar na identificação dos doentes com maior risco cirúrgico e orientá-los para intervenções de otimização pré-operatória, como a pré-habilitação

Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery

DSAIPA/DS/0042/2018 UID/DTP/00617/2019Background: Gastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the accuracy of specific perioperative risk assessment tools to predict postoperative complications, identifying the most informative variables and combining them to test their prediction ability as a new score. Methods: A prospective cohort study of digestive cancer surgical patients admitted to the surgical intermediate care unit of the Portuguese Oncology Institute of Porto, Portugal was conducted during the period January 2016 to April 2018. Demographic and medical information including sex, age, date from hospital admission, diagnosis, emergency or elective admission, and type of surgery, were collected. We analyzed and compared a set of measurements of surgical risk using the risk assessment instruments P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score according to the outcomes classified by the Clavien-Dindo score. According to each risk score system, we studied the expected and observed post-operative complications. We performed a multivariable regression model retaining only the significant variables of these tools (age, gender, physiological P-Possum, and ACS NSQIP serious complication rate) and created a new score (MyIPOrisk-score). The predictive ability of each continuous score and the final panel obtained was evaluated using ROC curves and estimating the area under the curve (AUC). Results: We studied 341 patients. Our results showed that the predictive accuracy and agreement of P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score were limited. The MyIPOrisk-score, shows to have greater discrimination ability than the one obtained with the other risk tools when evaluated individually (AUC = 0.808; 95% CI: 0.755-0.862). The expected and observed complication rates were similar to the new risk tool as opposed to the other risk calculators. Conclusions: The feasibility and usefulness of the MyIPOrisk-score have been demonstrated for the evaluation of patients undergoing digestive oncologic surgery. However, it requires further testing through a multicenter prospective study to validate the predictive accuracy of the proposed risk score.publishersversionpublishe

Positive effects of an online workplace exercise intervention during the COVID-19 pandemic on quality of life perception in computer workers: A quasi-experimental study design

Computer workers’ sedentary work, together with less active lifestyles, aggravated by the COVID-19 pandemic, represents a high risk for many chronic diseases, leading to a decrease in health-related quality of life (QoL). Workplace exercises consist of a set of physical exercises, implemented during work breaks, that have multiple benefits for workers’ health. To assess the impact of online workplace exercises on computer workers’ perception of quality of life. Methods: Quasi-experimental study with two groups: a control group (n = 26) and an intervention group (n = 13). The inclusion criteria were that participants must be aged between 18 and 65 years old and the exclusion criteria included diagnosis of non-work-related medical conditions. The interventions consisted of workplace exercises, which were applied for 17 consecutive weeks, each session lasting 15 min, three times a week. The exercise programme, performed online and guided by a physiotherapist, consisted of mobility exercises, flexibility and strength exercises, with the help of a TheraBand® for elastic resistance. The control group were not subjected to any intervention. A socio-demographic questionnaire and the Health Survey Questionnaire (SF-36v2) were used in two assessment stages (M0—baseline and M1—final of intervention). A mixed ANOVA with interaction time*group was used to evaluate the effect of the exercise programme. A good perception of the QoL was obtained in both stages. The exercise programme had a positive effect in the domains of Pain (ptime*group = 0.012, η2p = 0.158), Physical Function (ptime*group = 0.078, η2p = 0.082), Physical Performance (ptime*group = 0.052, η2p = 0.098), and Emotional Performance (ptime*group = 0.128, η2p = 0.061). After 17 weeks of workplace exercises, it became clear that the intervention group positively increased their QoL perception, with this improvement being significant in the Pain domain, which resulted in an improvement in their health condition. Therefore, further studies are needed to determine the optimal exercise for CWs, with detailed exercise types, different intensities and focused on various health conditions. info:eu-repo/semantics/publishedVersio

A literatura infantil na construção do imaginário social da inclusão contribuições do dialogismo bakhtiniano

Com este artigo, objetivamos considerar, com base na concepção bakhtiniana de linguagem, literatura e dialogismo, o livro Romeu e Julieta, de Ruth Rocha (1999), para discutir as relações entre o aspecto dialógico presente no texto literário e a construção do imaginário social da inclusão. De abordagem qualitativa, primeiramente, buscamos construtos teóricos em autores, como: Abramovich (1997), Silveira (2012), Faraco (2006), Bakhtin (2006; 2008; 2018), Barros (2003), entre outros; depois, aplicamos os conceitos mobilizados anteriormente ao texto literário de Ruth Rocha. Os resultados apontam que a obra de literatura infantil analisada pode assumir uma importante função na construção do imaginário social da inclusão, sendo este o conjunto das representações e figuras que reverberam a valorização das diferenças, desde que ocorra com um trabalho mediado por uma relação dialógica

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: A retrospective observational cohort study

FCT project IPOscore (DSAIPA/DS/0042/2018).Background: Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods: From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results: Sixty patients (75% male) with a median age of 64.5 [47-81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion: PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.publishersversionpublishe

TECNOLOGIA MÓVEL E DISLEXIA: POSSIBILIDADES PEDAGÓGICAS INCLUSIVAS PELA INTERFACE DO APPMOBILE “SILABANDO”

Este artigo objetiva compreender a dislexia, suas características e intervenções no contexto da inclusão e das novas tecnologias. Para tanto, foi realizado uma pesquisa qualitativa em duas etapas. Na primeira, buscou-se construtos teóricos para fundamentar as concepções e intersecções da tríade: inclusão, dislexia e tecnologia móvel; na segunda, foi feito um estudo exploratório, a fim de analisar o aplicativo móvel “Silabando”. Os resultados apontam que o uso pedagógico do aplicativo analisado, pode otimizar a aprendizagem das crianças disléxicas e, consequentemente, favorecer sua inclusão