Smooth muscle tumours of the uterus: MR imaging malignant predictive features-a 12-year analysis in a referral hospital in Portugal.

PURPOSE: To evaluate the magnetic resonance imaging (MRI) features that may help distinguish leiomyosarcomas from atypical leiomyomas (those presenting hyperintensity on T2-W images equal or superior to 50% compared to the myometrium). MATERIALS AND METHODS: The authors conducted a retrospective single-centre study that included a total of 57 women diagnosed with smooth muscle tumour of the uterus, who were evaluated with pelvic MRI, between January 2009 and March 2020. All cases had a histologically proven diagnosis (31 Atypical Leiomyomas-ALM; 26 Leiomyosarcomas-LMS). The MRI features evaluated in this study included: age at presentation, dimension, contours, intra-tumoral haemorrhagic areas, T2-WI heterogeneity, T2-WI dark areas, flow voids, cyst areas, necrosis, restriction on diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) values, signal intensity and heterogeneity after contrast administration in T1-WI, presence and location of unenhanced areas. The association between the MRI characteristics and the histological subtype was evaluated using Chi-Square and ANOVA tests. RESULTS: The MRI parameters that showed a statistically significance correlation with malignant histology and thus most strongly associated with LMS were found to be: irregular contours (p < 0.001), intra-tumoral haemorrhagic areas (p = 0.028), T2-WI dark areas (p = 0.016), high signal intensity after contrast administration (p = 0.005), necrosis (p = 0.001), central location for unenhanced areas (p = 0.026), and ADC value lower than 0.88 × 10-3 mm2/s (p = 0.002). CONCLUSION: With our work, we demonstrate the presence of seven MRI features that are statistically significant in differentiating between LMS and ALM.

Self-management plan of chronic disease among inpatients admitted to a Portuguese Endocrinology unit: a best practice implementation project.

INTRODUCTION: Globally, there is an increasing incidence of chronic diseases, particularly, diabetes. Patient engagement in disease self-management is essential to improve outcomes and reduce consumption of health resources. Despite investment in this area, there is a need to improve nursing care practices. AIMS: To increase compliance of Endocrinology nurses with best practice in promoting self-management of diabetes by patients. METHODS: The project was conducted in an Endocrinology unit of a Portuguese central hospital. It was based on the JBI's model approach, considering three phases: baseline audit, strategy design and implementation, and follow-up audit. For the audits, 11 criteria were considered. The sample was composed of patients (15 in the baseline; 30 at the follow-up audit), and nurses (15 in both audits). RESULTS: The baseline audit showed that there was poor compliance in some criteria. Four barriers were identified and the strategies/resources to mitigate them. There was improvement in all audit criteria as the project developed (100% compliance in seven criteria; two criteria increased from 0 to 100%). CONCLUSION: The evidence-based implementation project improved nursing practices for self-management planning of the person with diabetes. The adequacy of the strategies developed should be highlighted, namely the training and reflection on practices. The creation of the standardized discharge procedure has also improved compliance (criteria 7-10). The culture of patient-centred care, the desire to provide quality care, the involvement of the nurse manager, informal leaders, and the support office for information and documentation systems in nursing were facilitators in this process.

Organizational Commitment and Intention to Leave of Nurses in Portuguese Hospitals.

Intention to leave is influenced by the commitment and individual and structural factors. It is a critical dimension in health systems due to the shortage of professionals and the potential impact on the quality of care. The present paper: (i) characterizes organizational commitment and intention to leave; (ii) analyzes the relationship between structural factors (such as, work environment and nurse staffing), individual factors (age), and nurses' organizational commitments and intention to leave; and (iii) analyzes the differences in the intention to leave and in the organizational commitment according to service specialty, nurses' specialization, and contractual relationship in Portuguese public hospitals. A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals units. The results show a high affective and continuance commitment of nurses with the hospital, and a reduced tendency of the intention to leave. A significant positive association was also found between the intent to leave and individual/structural factors. Organizational commitment and intention to leave levels are satisfactory, despite the influence of several factors, such as nurse staffing, work environment, or other opportunities for professional development. The results identify particularly sensitive areas that, through adequate health and management policies, can reduce nurses' intentions to leave and promote the sustainability of the health system.

Nursing Students' Perceptions on Healthcare-Associated Infection Control and Prevention Teaching and Learning Experience in Portugal.

Healthcare-associated infections (HAI) are one of the major concerns worldwide, posing significant challenges to healthcare professionals' education and training. This study intended to measure nursing students' perceptions regarding their learning experiences on HAI prevention and control. In the first phase of the study, a cross-sectional and descriptive study with a convenience sample composed of undergraduate nursing students from Portugal, Spain, Poland, and Finland was conducted to develop the InovSafeCare questionnaire. In the second phase, we applied the InovSafeCare scale in a sample of nursing students from two Portuguese higher education institutions to explore which factors impact nursing students' adherence to HAI prevention and control measures in clinical settings. In phase one, the InovSafeCare questionnaire was applied to 1326 students internationally, with the instrument presenting adequate psychometric qualities with reliability results in 14 dimensions. During phase two, the findings supported that Portuguese nursing students' adherence to HAI prevention and control measures is influenced not only by the curricular offerings and resources available in academic settings, but also by the standards conveyed by nursing tutors during clinical placements. Our findings support the need for a dedicated curricular focus on HAI prevention and control learning, not only through specific classroom modules, innovative resources, and pedagogical approaches, but also through a complementary and coordinated liaison between teachers and tutors in academic and clinical settings.

Staging of Endometrial Cancer Using Fusion T2-Weighted Images with Diffusion-Weighted Images: A Way to Avoid Gadolinium?

Endometrial cancer is the eighth most common cancer worldwide, and its prognosis depends on various factors, with myometrial invasion having a major impact on prognosis. Optimizing MRI protocols is essential, and it would be useful to improve the diagnostic accuracy without the need for other sequences. We conducted a retrospective, single-center study, which included a total of 87 patients with surgically confirmed primary endometrial cancer, and who had undergone a pre-operative pelvic MRI. All exams were read by an experienced radiologist dedicated to urogenital radiology, and the depth of myometrial invasion was evaluated using T2-Weighted Images (T2WI) and fused T2WI with Diffusion-Weighted Images (DWI). Both results were compared to histopathological evaluations. When comparing both sets of imaging (T2WI and fused T2WI-DWI images) in diagnosing myometrial invasion, the fused images had better accuracy, and this difference was statistically significant (p < 0.001). T2WI analysis correctly diagnosed 82.1% (70.6-88.7) of cases, compared to 92.1% correctly diagnosed cases with fused images (79.5-97.2). The addition of fused images to a standard MRI protocol improves the diagnostic accuracy of myometrial invasion depth, encouraging its use, since it does not require more acquisition time.

Bilateral shoulder arthritis in COVID-19 patient after prolonged mechanical ventilation assist: a case report.

Prolonged immobilization and, in particular, mechanical ventilation, have been linked to muscle atrophy. Anecdotal reports in the literature describe rhabdomyolysis as a potential late complication of COVID-19 infection which, in severe cases, may coexist with fluid collections. We report a case of a 28-year-old patient that had been recently hospitalized with SARS-CoV-2 pneumonia, with need for invasive ventilation support. Days after being discharged, the patient presents with retrosternal thoracalgia irradiating to the left upper limb. On physical examination, abduction and external rotation were limited due to pain complaints and there was soft tissue swelling of the corresponding shoulder and arm. Imaging evaluation was essential to establish the underlying condition, revealing bilateral arthritis communicating with large rotator cuff collections, which was considered of septic nature.

Nurse staffing in Portuguese public hospitals.

AIM: This study aims to contribute to the knowledge of nurse staffing in hospital settings in central and northern Portugal. BACKGROUND: Nurse staffing is a critical factor for the quality and safety of health care and is still an understudied topic in Portugal. METHOD: A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals in the central and northern regions of Portugal. RESULTS: Nurse staffing in these hospital units is insufficient, especially in internal medicine units and central hospitals. Nurses' perceptions are in line with the objective data. CONCLUSIONS: The shortage of nurses is a horizontal issue that is especially serious in internal medicine units and central hospitals and a potential threat to the quality of care. IMPLICATIONS FOR NURSING MANAGEMENT: The results stress the need for an urgent leadership intervention in nurse staffing levels in the hospitals analysed in this study. Contextual knowledge about nurse staffing is essential for decision-making and supporting health and human resource management policies.

Impact of safe nurse staffing on the quality of care in Portuguese public hospitals: A cross-sectional study.

AIM: To assess the impact of safe nurse staffing on the quality of care, based on the structure-process-outcome approach, in Portuguese hospitals. BACKGROUND: Safe nurse staffing is essential for the quality of care in hospital settings, together with work environment, organisational commitment and nursing practices. However, there is little evidence of its analysis in the Portuguese context. METHOD: A cross-sectional survey study was conducted using a sample of 850 nurses from 12 public hospital units in the central and northern regions of Portugal. RESULTS: The proposed structural equation model for quality assessment has a good fit (χ2 /df = 2.37; CFI = 0.88, PCFI = 0.83; PGFI = 0.77, RMSEA = 0.04), showing the impact of safe nurse staffing, work environment, and affective and normative organisational commitment on the quality of care (mortality rate and adverse events). The mediating effect of nursing practices was also found. CONCLUSION: Safe nurse staffing, which is compromised in 90% of the units, is a predictor of the quality of care through the mediating effect of nursing practices. IMPLICATIONS FOR NURSING MANAGEMENT: The results not only highlight the need for urgent intervention but also support political decision-making with a view to improving the access to quality care.

Nurse managers' perceptions of nurse staffing and nursing care quality: A cross-sectional study.

AIM: To verify the association between the nurse staffing and the quality of nursing care, mediated by the care process, based on a hypothetical model, in Portuguese public hospitals. BACKGROUND: Nurse staffing influences health outcomes. Understaffing is associated with an increased risk for adverse events (AEs) and a reduction in the quality of care. METHOD: A cross-sectional study was conducted using a sample of 55 Portuguese nurse managers. A path model was developed to analyse potential causal mediation effects on care quality. RESULTS: Nurse staffing (number and competencies) and teamwork indirectly influence the quality of care. This process is mediated by the response capacity, the use of new techniques and work methods and patient's surveillance capacity. The AEs occurrence also has a mediating role, being negatively associated with the quality of care. CONCLUSIONS: Optimizing nursing care safety and quality requires an adequate nurse staffing level, both in terms of number and competencies, as well as teamwork. Process components seem to play a mediating role in these relations. IMPLICATIONS FOR NURSING MANAGEMENT: These results deserve the attention of nursing management for investment in the nursing staff and in the care process, to improve quality and create value in health care.

Uncracking a Case.

Nutcracker phenomenon (NCP) refers to compression of the left renal vein (LRV), most frequently between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the terminology used when the nutcracker phenomenon is accompanied by a complex of symptoms such as pain (abdominal, flank, and pelvic), hematuria and orthostatic proteinuria. Diagnosis can be made with Doppler ultrasound (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and venography. We describe a case of a young female adult who was identified with NCP by DUS, after a first CT had found no abnormalities. She presented with flank pain and severe hematuria causing a drastic decrease in hemoglobin levels. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options range from conservative to nephrectomy. Treatment decision should be based on the age of patients, severity of symptoms, and their expected reversibility. This case describes an underreported disorder that presents with non-specific symptoms, demonstrating the difficulties of the diagnostic approach of NCS, as well as the challenges in the appropriate management, given the lack of standardized treatment.

Scale of adverse events associated to nursing practices: a psychometric study in Portuguese hospital context.

OBJECTIVE: to contribute to the validation study of the Scale of Adverse Events associated with Nursing Practices in the hospital context. METHOD: cross-sectional study, in public hospital units, in the central and northern regions of Portugal. The exploratory factor analysis of the Scale of Adverse Events associated to Nursing Practices was conducted with a sample of 165 nurses and the confirmatory factorial analysis was made with a sample of 685 nurses. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples to confirm the stability of the factorial solution. RESULTS: the global sample consisted of 850 nurses aged between 22 and 59, mostly licensed professionals. The model had a good overall fit in the subscales (Nursing Practices: χ2/df = 2.88, CFI = 0.90, GFI = 0.86, RMSEA = 0.05, MECVI = 3.30; Adverse Events: χ2/df = 4.62, CFI = 0.93, GFI = 0.95, RMSEA = 0.07, MECVI = 0.39). There was a stable factor structure, indicating strong invariance in the subscale Nursing Practices and structural invariance in the subscale Adverse Events. CONCLUSION: the refined model of the Scale of Adverse Events associated with Nursing Practices revealed good fit and stability of the factorial solution. The instrument was adjusted to evaluate the perception of nurses about adverse events associated with health care, precisely nursing care, in the hospital setting.

Organizational commitment, psychometric qualities and invariance of the Meyer and Allen Questionnaire for Portuguese Nurses1.

OBJECTIVE: to evaluate the psychometric qualities of the Portuguese version of the Organizational Commitment Questionnaire for the nursing context, through confirmatory analysis and invariance, aiming to evaluate the reliability, internal consistency, construct validity and external validity of the instrument. METHOD: confirmatory factor analysis of the Portuguese version of the questionnaire was carried out with a sample of 850 nurses, in hospital context. The analysis was complemented using specification search. Goodness of fit was evaluated through different indices. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples of the same sample, in order to confirm the external validity of the factorial solution. RESULTS: the refined model demonstrated good overall fit (χ2/df=6.37; CFI=0.91; GFI=0.92; RMSEA=0.08; MECVI=0.62). The factorial structure was stable (λ:Δχ2(14)=18.31; p=0;193; Intercepts: Δχ2(14)=22.29; p=0.073; Covariance: Δχ2(3)=6.01; p=0.111; Residuals: Δχ2(15)=22.44; p=0.097). CONCLUSION: the simplified model of the questionnaire demonstrated adequate goodness of fit, representing a stable factorial solution. The instrument was fit to monitor and evaluate the organizational commitment of Portuguese nurses.

Practice environment scale of the nursing work index: Portuguese version and psychometric properties.

AIM: To assess the psychometric properties regarding the Portuguese version of the Practice Environment Scale of the Nursing Work Index. BACKGROUND: The Practice Environment Scale of the Nursing Work Index is the most widely used measure for assessing the practice environment. A model with a higher number of factors appears to be more adequate to Portuguese settings. METHOD: A confirmatory factor analysis was performed to the Practice Environment Scale of the Nursing Work Index using a sample of 850 Portuguese nurses. Three models were tested: the original model, a seven-factor model and a higher-order model. An analysis of invariance was performed in two subsets to confirm the stability of the solution. RESULTS: The seven-factor model fit better to the data than the original model. After refinement, this solution showed suitability and a stable factor structure. Reliability, convergent validity and discriminant validity were confirmed. A second-order factor solution also showed suitability. CONCLUSION: The seven-factor structure of the Practice Environment Scale of the Nursing Work Index showed a better goodness-of-fit to Portuguese settings than the original structure. The second-order factor solution allows an overall assessment of practice environments. IMPLICATIONS FOR NURSING MANAGEMENT: The Portuguese version of the Practice Environment Scale of the Nursing Work Index is a valuable tool for assessing Portuguese nursing practice environments. The seven-factor solution of the Practice Environment Scale of the Nursing Work Index showed high specificity.

Organizational commitment, psychometric qualities and invariance of the Meyer and Allen Questionnaire for Portuguese Nurses / Commitment organizacional, qualidades psicométricas e invariância do questionário de Meyer e Allen em enfermeiros portugueses / Compromiso organizacional, cualidades psicométricas e invarianza del cuestionario de Meyer y Allen para enfermeros portugueses

ABSTRACT Objective: to evaluate the psychometric qualities of the Portuguese version of the Organizational Commitment Questionnaire for the nursing context, through confirmatory analysis and invariance, aiming to evaluate the reliability, internal consistency, construct validity and external validity of the instrument. Method: confirmatory factor analysis of the Portuguese version of the questionnaire was carried out with a sample of 850 nurses, in hospital context. The analysis was complemented using specification search. Goodness of fit was evaluated through different indices. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples of the same sample, in order to confirm the external validity of the factorial solution. Results: the refined model demonstrated good overall fit (χ2/df=6.37; CFI=0.91; GFI=0.92; RMSEA=0.08; MECVI=0.62). The factorial structure was stable (λ:Δχ2(14)=18.31; p=0;193; Intercepts: Δχ2(14)=22.29; p=0.073; Covariance: Δχ2(3)=6.01; p=0.111; Residuals: Δχ2(15)=22.44; p=0.097). Conclusion: the simplified model of the questionnaire demonstrated adequate goodness of fit, representing a stable factorial solution. The instrument was fit to monitor and evaluate the organizational commitment of Portuguese nurses.

RESUMO Objetivo: avaliar as qualidades psicométricas da versão portuguesa do Questionário de Comprometimento Organizacional, para o contexto da enfermagem, através de análise confirmatória e de invariância, visando a confiabilidade, consistência interna, validade de construto e a validade externa do instrumento. Método: procedeu-se à análise fatorial confirmatória da versão portuguesa do questionário, numa amostra de 850 enfermeiros, em contexto hospitalar. Complementou-se a análise com recurso à pesquisa de especificação. A qualidade de ajustamento foi avaliada através de diferentes índices. Estimou-se a confiabilidade, consistência interna e validade de construto. A invariância do modelo foi avaliada em duas subamostras, da amostra global, por forma a confirmar a validade externa da solução fatorial. Resultados: O modelo obtido após refinamento demonstrou bom ajustamento global (χ2/df=6,37; CFI=0,91; GFI=0,92; RMSEA=0,08; MECVI=0,62). A estrutura fatorial revelou-se estável (λ:Δχ2(14)=18,31; p=0,193; Interceptos: Δχ2(14)=22,29; p=0,073; Covariância: Δχ2(3)=6,01; p=0,111; Resíduos: Δχ2(15)=22,44; p=0,097). Conclusão: o modelo simplificado do questionário revelou boa qualidade de ajustamento, apresentando uma solução fatorial estável. O instrumento revelou-se ajustado para monitorizar e avaliar o comprometimento organizacional dos enfermeiros portugueses.

RESUMEN Objetivo: evaluar las propiedades psicométricas de la versión portuguesa del Cuestionario de Compromiso Organizacional para el contexto de enfermería a través del análisis de confirmación e invarianza, para evaluar la fiabilidad, la consistencia interna, la validez de constructo y la validez externa del instrumento. Método: se procedió a un análisis factorial confirmatorio de la versión en portugués del cuestionario, con una muestra de 850 enfermeros en el ámbito hospitalario y se complementó el análisis con un recurso a la investigación de especificación. La calidad del ajuste se evaluó a través de diferentes índices. Se estimó la confiabilidad, la consistencia interna y la validez de constructo. La invarianza del modelo fue evaluada en dos sub-muestras de la muestra global, para confirmar la validez externa de la solución factorial. Resultados: el modelo obtenido tras el refinamiento demostró un buen ajuste global (χ2/df=6,37; CFI=0,91; GFI=0,92; RMSEA=0,08; MECVI=0,62). La estructura factorial reveló estable (λ:Δχ2(14)=18,31; p=0,193; Interceptos: Δχ2(14)=22,29; p=0,073; Covariancia: Δχ2(3)=6,01; p=0,111, Residuos: Δχ2(15)=22,44; p=0,097). Conclusión: el modelo simplificado del cuestionario demostró una buena calidad de ajuste, presentando una solución factorial estable. El instrumento resultó estar ajustado para monitorear y evaluar el compromiso de la organización de los enfermeros portugueses.

Scale of adverse events associated to nursing practices: a psychometric study in Portuguese hospital context / Escala de eventos adversos associados às práticas de enfermagem: estudo psicométrico em contexto hospitalar português / Escala de eventos adversos asociados a las prácticas de enfermería: estudio psicométrico en contexto hospitalaria portugués

Objective to contribute to the validation study of the Scale of Adverse Events associated with Nursing Practices in the hospital context. Method cross-sectional study, in public hospital units, in the central and northern regions of Portugal. The exploratory factor analysis of the Scale of Adverse Events associated to Nursing Practices was conducted with a sample of 165 nurses and the confirmatory factorial analysis was made with a sample of 685 nurses. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples to confirm the stability of the factorial solution. Results the global sample consisted of 850 nurses aged between 22 and 59, mostly licensed professionals. The model had a good overall fit in the subscales (Nursing Practices: χ2/df = 2.88, CFI = 0.90, GFI = 0.86, RMSEA = 0.05, MECVI = 3.30; Adverse Events: χ2/df = 4.62, CFI = 0.93, GFI = 0.95, RMSEA = 0.07, MECVI = 0.39). There was a stable factor structure, indicating strong invariance in the subscale Nursing Practices and structural invariance in the subscale Adverse Events. Conclusion the refined model of the Scale of Adverse Events associated with Nursing Practices revealed good fit and stability of the factorial solution. The instrument was adjusted to evaluate the perception of nurses about adverse events associated with health care, precisely nursing care, in the hospital setting.

Objetivo contribuir para o estudo de validação da Escala de Eventos Adversos associados às Práticas de Enfermagem, em contexto hospitalar. Método estudo transversal, em unidades hospitalares públicas, das regiões centro e norte de Portugal. A análise fatorial exploratória da Escala de Eventos Adversos associados às Práticas de Enfermagem foi desenvolvida em uma amostra de 165 enfermeiros e a análise fatorial confirmatória em uma amostra de 685 enfermeiros. Estimou-se a confiabilidade, consistência interna e validade de construto. A invariância do modelo foi avaliada em duas subamostras para confirmar a estabilidade da solução fatorial. Resultados amostra global de 850 enfermeiros, com idades entre 22 e 59 anos, maioritariamente licenciados. Modelo com bom ajustamento global nas subescalas (Práticas de Enfermagem: χ2/df=2,88; CFI=0,90; GFI=0,86; RMSEA=0,05; MECVI=3,30; Eventos Adversos: χ2/df=4,62; CFI=0,93; GFI=0,95; RMSEA=0,07; MECVI=0,39). Estrutura fatorial estável, identificandose invariância de medida forte na subescala Práticas de Enfermagem e, na subescala Eventos Adversos, invariância estrutural. Conclusão o modelo refinado da Escala de Eventos Adversos associados às Práticas de Enfermagem revelou boa qualidade de ajustamento e estabilidade da solução fatorial. O instrumento revelou-se ajustado para avaliar a percepção dos enfermeiros acerca dos eventos adversos associados aos cuidados de saúde, nomeadamente aos cuidados de enfermagem, em contexto hospitalar.

Objetivo contribuir para el estudio de validez de la Escala de Eventos Adversos asociados a las Prácticas de Enfermería, en contexto hospitalario. Método estudio transversal, en unidades hospitalares públicas, de las regiones centro y norte de Portugal. El análisis factorial exploratorio de la Escala de Eventos Adversos asociados a las Prácticas de Enfermería fue desarrollada en una muestra de 165 enfermeros y el análisis factorial confirmatorio en una muestra de 685 enfermeros. Se estimó la confiabilidad, consistencia interna y validez de constructo. La invariancia del modelo fue evaluada en dos sub-muestras, para confirmar la estabilidad de la solución factorial. Resultados muestra global de 850 enfermeros, con edades entre 22 y 59 años, mayoritariamente licenciados. Modelo con buen ajuste global en las sub-escalas (Prácticas de Enfermería: χ2/df=2,88; CFI=0,90; GFI=0,86; RMSEA=0,05; MECVI=3,30; Eventos Adversos: χ2/df=4,62; CFI=0,93; GFI=0,95; RMSEA=0,07; MECVI=0,39). Estructura factorial estable, identificándose invariancia de medida fuerte en la sub-escala Prácticas de Enfermería y en la sub-escala Eventos Adversos, invariancia estructural. Conclusión o modelo refinado da Escala de Eventos Adversos asociados a las Prácticas de Enfermería reveló buena calidad de ajuste y estabilidad de la solución factorial. El instrumento se reveló ajustado para evaluar la percepción de los enfermeros acerca de los eventos adversos asociados a los cuidados de salud, nombradamente a los cuidados de enfermería en el contexto hospitalario.

Interdisciplinaridade e formação na área de saúde coletiva / Interdisciplinarity and training in the collective health area / Interdisciplinaridad y formación en el área de salud colectiva

Resumo O artigo apresenta os resultados da pesquisa que objetivou discutir a potencialidade da práxis e conceitos de saúde pública/coletiva envolvendo profissionais e saberes na construção do conhecimento em saúde no ambiente escolar. O estudo foi desenvolvido durante o ano letivo de 2012 em uma escola pública, na cidade do Rio de Janeiro, com a participação de professores, alunos de ensino médio e estagiários de licenciatura. A metodologia utilizada de pesquisa-ação supõe uma ação coletiva orientada em função da re-solução de problemas, identificados a partir de um diagnóstico da situação elaborado pelos participantes. O diagnóstico foi realizado por meio de perguntas dirigidas aos professores e estagiários, e de uma redação direcionada aos alunos. Os resultados obtidos dos professores revelam que a saúde pública é compreendida como dever do Estado na prestação de serviços de prevenção e assistência à saúde. Já a saúde coletiva é associada ao bem-estar físico, mental e social da população. Tanto os professores como os estagiários, que já participaram de projetos interdisciplinares, reconhecem a experiência como positiva. Os alunos reconheceram que a educação é priorizada em relação às condições físicas e sanitárias da escola, mas identificaram em tais condições fatores de risco ao aprendizado e, consequentemente, à saúde e à qualidade de vida.

Abstract This article presents and discusses the results of research that discusses the potentiality of the praxis and public/collective health involving professionals and knowledge in the construction of knowledge in health in the school environment. The study was conducted during the 2012 school year in a public school in the city of Rio de Janeiro, Brazil with the participation of teachers, high school students, and undergraduate interns. The research action methodology involves collective action guided based on the resolution of problems identified from a diagnosis of the situation prepared by the participants. The diagnosis was made through questions made to the teachers and trainees, and an essay directed to students. The results obtained from teachers reveal that public health is understood as a duty of the State in the provision of prevention and health care services. Collective health, meanwhile, is associated with the population's physical, mental, and social well-being. Both professors and trainees, who have participated in interdisciplinary projects, recognize the experience as positive. Students recognized that education is prioritized in relation to the school's physical and sanitary conditions, but identified in such conditions risk factors for learning and, consequently, health and quality of life.

Resumen El artículo presenta y discute los resultados de la investigación que buscó discutir la potencialidad de la praxis y conceptos de salud pública/colectiva involucrando profesionales y saberes en la construcción del conocimiento en salud, en el ambiente escolar. El estudio se desarrolló durante el período lectivo de 2012 en una escuela pública, en la ciudad de Río de Janeiro, Brasil, con la participación de profesores, alumnos de la enseñanza media y pasantes del curso de licenciatura. La metodología utilizada de investigación-acción supone una acción colectiva en función de la resolución de problemas, identificados a partir de un diagnóstico de la situación elaborado por los participantes. El diagnóstico se realizó mediante preguntas dirigidas a los profesores y pasantes, y de una redacción dirigida a los alumnos. Los resultados obtenidos de los profesores revelan que la salud pública se comprende como deber del Estado en la prestación de servicios de prevención y asistencia a la salud. Ya la salud colectiva se asocia al bienestar físico, mental y social de la población. Tanto los profesores como los pasantes, que ya participaron en proyectos interdisciplinarios, reconocen la experiencia como positiva. Los alumnos reconocieron que la educación es priorizada con relación a las condiciones físicas y sanitarias de la escuela, pero identificaron en tales condiciones factores de riesgo para el aprendizaje y, en consecuencia, para la salud y la calidad de vida.

Inquietante scientia: pensar o campo epistemológico da psicanálise / Inquietante scientia: thinking the epistemological field of psychoanalysis

Assinala-se o debate que, no interior da comunidade psicanalítica internacional, opõe partidários da inscrição científica da psicanálise àqueles que liminarmente a rejeitam. Sublinha-se a emergência de uma terceira via que defende a necessidade de se refletir sobre a especificidade da investigação psicanalítica. Apresenta-se uma reflexão epistemológica que procura clarificar a natureza da atividade científica, explorando a forma como se produz e se justifica o conhecimento designado como científico, defendendo-se que é a própria elaboração epistemológica que determina a possibilidade de se constituir uma disciplina como científica. Clarificase o sentido da Junktim1 freudiana, reconhecendo-se uma base metodológica comum à cura e à investigação científica, sem que se confundam os fins e tempos específicos de cada atividade. Analisam-se os procedimentos metodológicos psicanalíticos que permitem constituir um objeto, observá-lo e produzir conhecimento sobre ele, bem como os critérios de justificação que possibilitam avaliar essa produção de saber. Esclarece-se a racionalidade epistêmica dos binômios associação livre/atenção flutuante, transferência/contratransferência, manifesto/latente da multideterminação e multissignificação dos dados, do caráter aproximativo da interpretação, da revisibilidade dos modelos teóricos e dos procedimentos de supervisão e intervisão. Afirma-se a cientificidade da psicanálise a partir, precisamente, da especificidade das dimensões clássicas da disciplina(AU)

There is an ongoing debate within the international psychoanalytic community that opposes those who defend the adoption of the traditional scientific standards in psychoanalysis to those who outright reject this approach. The emergence of a third position that supports the need to reflect on the specificity of psychoanalytic research is here emphasized. An epistemological reflection that seeks clarification on the nature of scientific activity is presented, exploring the way the so-called scientific knowledge is produced and justified. The idea that it is the epistemological development itself that determines the possibility of seeing a discipline as scientific is advocated. The meaning of the Freudian Junktim is clarified, stressing a common methodological ground for the cure and scientific research, without confusing the specific aims and timeframes of each activity. Psychoanalytic methodological procedures ­ which allow the constitution of an object, its observation and the construction of knowledge on it, as well as the justification criteria that make possible the production of such knowledge ­ are analyzed. The epistemic rationality of the following binomials are clarified: free association/free floating attention, transference/countertransference, manifest/ latent content; and also the overdetermination and multiple signification of data, of the approximated character of interpretation, of the revisability of theoretical models, and of supervision and intervision procedures. The scientific status of psychoanalysis derives precisely from the specificity of the classic characteristics of the discipline(AU)

Se observa el debate que tiene lugar dentro de la comunidad psicoanalítica internacional entre partidarios de la inscripción científica del psicoanálisis y los que la niegan. Se destaca la aparición de una tercera vía que apoya la necesidad de reflexionar sobre la especificidad de la investigación psicoanalítica. Se hace una reflexión epistemológica que trata de aclarar la naturaleza de la actividad científica mediante el análisis de la forma cómo se produce y se justifica el conocimiento designado como científico, argumentando que es el propio desarrollo epistemológico que determina la posibilidad de crear una disciplina como ciencia. Se aclara el significado de la Junktim freudiana, reconociendo una base metodológica común para la cura y la investigación científica, sin la confusión entre los fines y los tiempos específicos de cada actividad. Se examinan los procedimientos metodológicos psicoanalíticos que permiten crear un objeto, observarlo y producir conocimiento sobre ése, así como los criterios que evalúan esa producción de conocimiento. Se aclara la racionalidad epistémica de los binomios asociación libre/atención flotante, transferencia/contratransferencia, manifiesto/latente, de la multideterminación y multisignificación de los datos, de la naturaleza aproximada de la interpretación, de la revisibilidad de los modelos teóricos y de los procedimientos de supervisión y intervisión. Se afirma la cientificidad del psicoanálisis a partir, precisamente, de la especificidad de las dimensiones clásicas de la disciplina(AU)

Produção e registro de informações em saúde no Brasil: panorama descritivo através do PMAQ-AB / Production and record of information in health in Brazil: a descriptive landscape through PMAQ-AB

Este estudo tem o objetivo de descrever condições de produção e registro das informações geradas nas Unidades Básicas de Saúde, por regiões agregadas e por porte populacional no Brasil. Fez-se uma análise de indicadores do banco de dados gerado pelo ciclo I do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), enfatizando as seguintes dimensões: condições de infraestrutura e informática, educação permanente e processo de trabalho. Encontraram-se diferenças nas variáveis analisadas. Aponta-se um sistema carente de recursos tecnológicos para elaboração de políticas de saúde mais equânimes.

The aim of this study is to describe conditions for production and record information engendered on basic unit health in Brazil, by aggregated region and by population size. An analysis of indicators of the database generated by cycle I of the Program for Access and Quality Improvement in Primary Care (PMAQ-AB) has been made, stressing the following dimensions: infrastructure and informatics conditions, permanent education, and labor process. Differences on the analyzed variables were found. The analysis suggests that the system that needs technological resources for the development of more equitable health policies.

What is driving increasing child welfare caseloads in Ontario? Analysis of the 1993 and 1998 Ontario incidence studies.

Rates of substantiated maltreatment documented by the 1993 and 1998 Ontario Incidence Studies of Reported Child Abuse and Neglect doubled between 1993 and 1998. Although increasing public awareness and changes in investigation procedures appear to account for part of this change, the increase also reflects a significant shift in the types of maltreatment agencies are investigating and substantiating. Exposure to spousal violence has increased eightfold, and the proportion of neglect cases has more than doubled, whereas cases of sexual abuse are decreasing. The field requires a differentiated response to address the maltreatment-specific challenges underlying child welfare caseload increases in Canada.

Indicators of functional status for primary malignant brain tumour patients.

BACKGROUND: We compared the functional status and survival time of patients with malignant gliomas. METHODS: This retrospective review included 143 patients diagnosed with malignant gliomas. Patients were grouped according to histopathological diagnosis. To measure functional status, patients were assigned a Karnofksy performance status (KPS) score at the time of presentation and at one, three, six, nine, 12 months and yearly intervals thereafter. Data were analyzed using descriptive methods as well as Kruskal-Wallis tests, Chi-square tests, Log-Rank tests and Cox's proportional hazards modeling. RESULTS: Eighty-four patients were male. The median age of patients was 63 years. One hundred and seven patients had a histopathological diagnosis of glioblastoma multiforme, 23 of anaplastic astrocytoma and 13 of anaplastic oligodendroglioma. Twenty-nine patients received aggressive multimodal treatment, 83 received intermediate treatment and the remaining 31 patients received conservative therapy. Significant treatment complications occurred in 33% of patients including four post-operative deaths. The anaplastic oligodendroglioma group had lower mortality and maintained better KPS scores over time, as did patients receiving full treatment. The most significant prognostic factors for functional status included age, pretreatment KPS, and type of treatment received. The most significant factors associated with time until death included age, severity of comorbidities, pretreatment KPS, presence of confusion, histopathological diagnosis and type of treatment received. CONCLUSION: In patients with malignant gliomas, younger age, better functional status at presentation and aggressive multimodal treatment were associated with improved longer-term functional status and survival. Confirmation of the effect of multimodal treatment on patient functional status would require a randomised controlled clinical trial.