A large outbreak of Legionnaires’ Disease in an industrial town in Portugal

Background: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure tothe affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centeredon each cooling tower system. We compared the number of cases with expected numbers,calculated from the outbreak’s attack rates applied to 2011 census population. Using Stones’Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km fourdirections. Isolates of Legionella pneumophila were compared using molecular methods

A Lei da Mediação de Conflitos: estudos sobre a sua aplicação

Financiamento de MEDLaw - FCT UIDB/04112/2020.Os dez anos de vigência da Lei da Mediação em Portugal constituíram o mote para a compilação nesta obra de diversos estudos empírico-dogmáticos sobre a sua aplicação, analisando-se questões prementes como a voluntariedade ou obrigatoriedade da mediação, a executoriedade do acordo de mediação e a Convenção de Singapura, as exigências processuais e a suspensão dos prazos de prescrição e caducidade com o recurso à mediação, a organização associativa dos mediadores e a importância da sua formação, o funcionamento dos sistemas públicos de mediação, bem como novas áreas de aplicação da mediação, em especial no domínio administrativo e na recuperação extrajudicial de empresas, e ainda a relevância do desenvolvimento científico sobre este meio de resolução de conflitos. Ao regulamentar num único diploma, pela primeira vez no nosso ordenamento jurídico, a mediação pública e privada, a Lei n.º 29/2013, de 19 de abril, constituiu um marco legislativo. Dez anos volvidos, importava refletir sobre a sua aplicação prático-jurídica, norteados pelo objetivo de promover o estudo e a efetiva implementação da mediação de conflitos em Portugal. Esta obra constitui o output desenvolvido no âmbito do projeto de investigação MEDLAW, com o apoio da Fundação para a Ciência e Tecnologia, no âmbito do financiamento base atribuído ao polo de Leiria do Instituto Jurídico Portucalense, com a ref. UIDB/04112/2020.info:eu-repo/semantics/publishedVersio

Castastrophe strikes a summer festival – health response

O Festival Andanças é um festival de música e dança que reúne todos os anos no verão mais de 15000 pessoas durante uma semana em ambiente rural no centro-interior de Portugal. A edição de 2016 foi ameaçada por um incêndio no parque de estacionamento automóvel de apoio ao festival, que destruiu 458 veículos e obrigou à evacuação de todos os participantes, por precaução, sob o comando da Proteção Civil. Pelas suas características e magnitude, ímpar a nível mundial, procedeu-se à análise dos cuidados de saúde prestados durante e após este incidente. A vigilância epidemiológica do festival contou com a participação do Departamento de Epidemiologia do Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), pelo terceiro ano consecutivo, em estreita colaboração com a equipa de prestação de cuidados no festival. O processo de recolha e registo dos dados decorreu em tempo real através de uma plataforma eletrónica desenvolvida pelo Departamento de Epidemiologia do INSA para o efeito. Durante e após o acidente, a análise dos dados foi realizada e comunicada diariamente no formato de relatório e em ambiente de reunião diária com as entidades intervenientes. O registo formal (eletrónico) foi suspenso durante a evacuação e retomado após o regresso ao recinto, três horas depois. Em 2016 registaram-se no Festival Andanças no total 1267 ocorrências de saúde, correspondendo a 920 utilizadores diferentes. Estes eram na sua maioria do sexo feminino (62,9%), portugueses (77,8%) e com idade entre os 20 e os 39 anos (58,5%). Os principais diagnósticos foram as feridas (41,0%), as queixas gastrointestinais (12,5%) e osteoarticulares (11,4%). O número de queixas gastrointestinais levou a investigação mais detalhada, que motivou a intervenção da autoridade de saúde em dois estabelecimentos de restauração e bebidas. A análise dos dados recolhidos informalmente durante a evacuação não evidenciou um impacto relevante na procura de cuidados de saúde pelos participantes, destacando-se apenas o transporte de 4 participantes ao Hospital de Portalegre, com queixas respiratórias após combate direto às chamas, que receberiam alta em menos de 24h. Sem prejuízo dos avultados danos materiais, os dados recolhidos permitem concluir que não houve um aumento relevante da procura de cuidados de saúde associada ao acidente. A existência de ferramentas específicas para recolha e gestão da informação e profissionais treinados nesta área revelam-se importantes para a gestão quer de eventos de massas deste tipo, quer para a atuação em caso de acidente.The Andanças Festival is a music and dance festival taking place every year in the summer, gathering more than 15,000 people during a week in rural environment in the countryside of Portugal. The 2016 edition was threatened by a fire in the car park, which destroyed 458 vehicles and forced the evacuation of all participants, as a precaution, under the command of Civil Protection. Due to its unique characteristics and magnitude the health response during and after this incident was analyzed. The epidemiological surveillance of the festival had the participation of the Department of Epidemiology of the National Health Institute Doutor Ricardo Jorge (INSA), for the third consecutive year, in close collaboration with the healthcare team at the festival. Data collection and registration was carried out in real time through an electronic platform developed by the Department of Epidemiology of INSA for this purpose. During and after the incident, data analysis was performed daily, creating a report and presented in a daily meeting with the intervening entities. The formal (electronic) record was suspended during the evacuation and resumed after returning to the venue three hours later. In 2016 there were 1267 health episodes in the Andanças festival, corresponding to 920 different users. These were mostly female (62.9%), Portuguese (77.8%) and aged 20-39 (58.5%). The main diagnoses were wounds (41.0%), gastrointestinal complaints (12.5%) and osteoarticular complaints (11.4%). The number of gastrointestinal complaints led to more detailed investigation, which led to the intervention of the health authority in two food and beverage facilities. The analysis of the data gathered informally during the evacuation did not show a relevant impact on the health care demand of the participants, highlighting only the transport of 4 participants to the Hospital of Portalegre, with respiratory complaints after direct firefighting, who would be discharged in less than 24 hours. Notwithstanding the considerable material damages, the data collected allowed us to conclude that there has not been a relevant increase in the demand for healthcare associated with the accident. The existence of specific tools for collecting and managing the information as well as trained professionals in this field are important for the management of mass gatherings, enabling rapid response in case of an accident.info:eu-repo/semantics/publishedVersio

Catástrofe num festival de verão: resposta na área da saúde

O Festival Andanças é um festival de música e dança que reúne todos os anos no verão, mais de 15.000 pessoas durante uma semana em ambiente rural no centro-interior de Portugal. A edição de 2016 foi ameaçada por um incêndio no parque de estacionamento automóvel de apoio ao festival, que destruiu 458 veículos e obrigou à evacuação de todos os participantes, por precaução, sob o comando da Proteção Civil. Pelas suas características e magnitude, ímpar a nível mundial, procedeu-se à análise dos cuidados de saúde prestados durante e após este incidente. A vigilância epidemiológica do festival foi coordenada pelo Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), pelo terceiro ano consecutivo, em estreita colaboração com a equipa de prestação de cuidados no festival. O processo de recolha e registo dos dados decorreu em tempo real através de uma plataforma eletrónica desenvolvida pelo Departamento de Epidemiologia do INSA para o efeito. Durante e após o acidente, a análise dos dados foi realizada e comunicada diariamente no formato de relatório e em ambiente de reunião diária com as entidades intervenientes. O registo formal (eletrónico) foi suspenso durante a evacuação e retomado após o regresso ao recinto, três horas depois. Em 2016 registaram-se no festival Andanças no total, 1267 ocorrências de saúde, correspondendo a 920 utilizadores diferentes. Estes eram na sua maioria do sexo feminino (62,9%), portugueses (77,8%) e com idade entre os 20 e os 39 anos (58,5%). Os principais diagnósticos foram as feridas (41,0%), as queixas gastrointestinais (12,5%) e osteoarticulares (11,4%). O número de queixas gastrointestinais levou a investigação mais detalhada, que motivou a intervenção da autoridade de saúde em dois estabelecimentos de restauração e bebidas. A análise dos dados recolhidos informalmente durante a evacuação não evidenciou um impacto relevante na procura de cuidados de saúde pelos participantes, destacando-se apenas o transporte de 4 participantes ao Hospital de Portalegre, com queixas respiratórias após combate direto às chamas, que receberiam alta em menos de 24h. Sem prejuízo dos avultados danos materiais, os dados recolhidos permitem concluir que não houve um aumento relevante da procura de cuidados de saúde associada ao acidente. A existência de ferramentas específicas para recolha e gestão da informação e profissionais treinados nesta área revelam-se importantes para a gestão quer deste eventos de massas deste tipo, quer para a atuação em caso de acidente.N/

Clinicopathological significance of ERCC1 expression in breast cancer

The excision repair cross-complementation 1 (ERCC1) enzyme plays an essential role in the nucleotide excision repair pathway and is associated with resistance to platinum-based chemotherapy in different types of cancer. The aim of the present study was to evaluate the clinicopathological significance of ERCC1 expression in breast cancer patients. We analyzed the immunohistochemical expression of ERCC1 in a tissue microarray from 135 primary breast carcinomas and correlated the immunohistochemical findings with clinicopathological factors and outcome data. ERCC1 expression analysis was available for 109 cases. In this group, 58 (53.2%) were positive for ERCC1. ERCC1-positive expression was correlated with smaller tumor size (P=0.007) and with positivity for estrogen receptor (P=0.040), but no correlation was found with other clinicopathological features. Although not statistically significant, triple negative breast cancers were more frequently negative for ERCC1 (61.5% of the cases) compared to the non-triple negative breast cancer cases (41.5%). In conclusion, ERCC1 expression correlated significantly with favorable prognostic factors, such as smaller tumor size and ER-positivity, suggesting a possible role for ERCC1 as a predictive and/or prognostic marker in breast cancer. © 2013 Elsevier GmbH

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

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society