Living in an untouchable world: Barriers to recreation and tourism for Portuguese blind people during the COVID-19 pandemic.

Despite the COVID-19 pandemic having affected the lives of all citizens, some groups, as people with disabilities (PwD), have felt its effects more intensely, specifically due to social distancing measures adopted. However, PwD are a heterogeneous group and the impacts of COVID-19 are, therefore, experienced differently. Blind people (BP) face considerable challenges during the COVID-19 pandemic, since they "access the world" through touch, something strongly discouraged in order to control the spread of the virus. Nevertheless, no studies are known which analyze the constraints experienced by BP during COVID-19 on participating in recreation and tourism activities. To extend knowledge in this field, the intention of this study is to examine the constraints faced by BP during COVID-19 on participation in outdoor recreation and tourism activities and the strategies used to overcome these constraints. A qualitative methodology (in-depth interviews with BP) was used. The results reveal that during the COVID-19 pandemic, BP faced several constraints that made their participation in outdoor recreation and tourism activities difficult. The paper ends with a discussion of the strategies used by BP to overcome these constraints. Management implications: Understanding the impact of COVID-19 on the recreation and tourism practices of blind people, and the constraints that they face as a consequence of this pandemic, this study provides relevant implications managers for public and private tourism supply agents. Therefore, managers and planners can use the findings of this study to design strategies to overcome the strong constraints faced by blind people due to the COVID-19 pandemic, to minimize risk exposure and to increase their quality of life. Thus, the type of activities offered and the marketing strategy should be rethought to increase the engagement of blind people in recreation and tourism experiences in an "untouchable world."

Are Health Information Systems Ready for the Digital Transformation in Portugal? Challenges and Future Perspectives.

PURPOSE: This study aimed to reflect on the challenges of Health Information Systems in Portugal at a time when technologies enable the creation of new approaches and models for care provision, as well as to identify scenarios that may characterize this practice in the future. DESIGN/METHODOLOGY/APPROACH: A guiding research model was created based on an empirical study that was conducted using a qualitative method that integrated content analysis of strategic documents and semi-structured interviews with a sample of fourteen key actors in the health sector. FINDINGS: Results pointed to the existence of emerging technologies that may promote the development of Health Information Systems oriented to "health and well-being" in a preventive model logic and reinforce the social and management implications. ORIGINALITY/VALUE: The originality of this work resided in the empirical study carried out, which allowed us to analyze how the various actors look at the present and the future of Health Information Systems. There is also a lack of studies addressing this subject. RESEARCH LIMITATIONS/IMPLICATIONS: The main limitations resulted from a low, although representative, number of interviews and the fact that the interviews took place before the pandemic, so the digital transformation that was promoted was not reflected. Managerial implications and social implications: The study highlighted the need for greater commitment from decision makers, managers, healthcare providers, and citizens toward achieving improved digital literacy and health. Decision makers and managers must also agree on strategies to accelerate existing strategic plans and avoid their implementation at different paces.

The State of Web Accessibility for tourists with disabilities: a comparative study between different tourism supply agents.

PURPOSE: This study intends to examine the web accessibility of three tourism supply agents (hotels, travel agents and museums). The results obtained contribute to observing whether there are differences in levels of web accessibility among these tourism supply agents and, based on the problems identified, suggest strategies to overcome these problems. METHODS: To evaluate the level of web accessibility of tourism supply agents, two automatic online tools (AccessMonitor and TAW), which consider Web Content Accessibility Guidelines (WCAG), version 2.0, were used. To identify differences among the supply tourism agents in terms of the level of web accessibility, statistical tests (ANOVA and Kruskal-Wallis) were used. RESULTS: All the tourism supply agents analysed reveal considerable problems related to web accessibility. The perceivable and robust principles are the two principles of WGAG 2.0 with the greatest number of failures. However, differences among the supply agents analysed are observed. Museums present the highest level of web accessibility, while travel agents have the lowest. Therefore, it is necessary to implement improvements in tourism websites to overcome informational constraints that many people with disabilities (PwD) face in tourism activities. CONCLUSIONS: Due to the central role of the Internet for people with and without disabilities, this study highlights barriers that should be eliminated to facilitate the travel decision-making process, especially for PwD. Consequently, it can contribute to a greater number of people being able to participate in tourism activities, improving their well-being and rehabilitation.Implications for rehabilitationThe participation in tourism activities contributes to improve health, quality-of-life and well-being of all people.For people with disabilities (PwD) to be able to travel, without constraints, access to online information needs to be provided.The identification of the level of web accessibility of tourism supply agents provides important guidelines to improve the websites, facilitating the travel tourism planning of PwD.If informational barriers to access tourism activities are eliminated, the participation of PwD in tourism activities will tend to increase, and consequently improvements in their well-being, health and rehabilitation will happen.

Benzodiazepine Use in Opioid Maintenance Treatment Programme: Risks and Clinical Outcomes.

INTRODUCTION: The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit. MATERIAL AND METHODS: We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). We conducted a descriptive, bivariable, and multivariable analysis to determine clinical differences between benzodiazepines users and non-users. RESULTS: The prevalence of consumption of benzodiazepines was 25.4% (60). The benzodiazepines were obtained with a medical prescription (49.8%) or on the black market (42.6%). The most prescribed benzodiazepine was diazepam (29.1%), and the main reasons were to relieve insomnia (27.7%) or anxiety (26.9%) and to enhance the psychoactive effects of other drugs (19.7%). Regarding the clinical outcomes, we highlight: a very high prevalence of hepatitis C (51.7%); severe ongoing consumption of psychoactive drugs (73.7%); and a high rate of depression and anxiety (> 60%), significantly higher in the benzodiazepines-user group. In the multivariable analysis of benzodiazepine use, we found alcohol consumption (OR 0.482; IC 95% 0.247, 0.238) had a negative association and having hepatitis C (OR 2.544, IC 95% 1.273, 5.084) or anxiety symptoms (OR 5.591; IC 95% 2.345, 13.326) had positive associations. DISCUSSION: Our results suggest the BZD users had a complex drug addiction problem and underline the importance of adequately addressing BZD use, contemplating psychological and psychiatric approach in this particular population. CONCLUSION: Past or current use of benzodiazepines is associated with poor clinical and psychiatric outcomes. A multidisciplinary approach with a focus on infectious diseases and mental health is critical in order to enhance the treatment effectiveness and overall prognosis.

Introdução: A co-associação entre benzodiazepinas e opióides associa-se a risco aumentado de overdose, morte e pior prognóstico psicossocial. Pretendemos determinar a prevalência, o padrão de consumo e as principais co-morbilidades do uso de benzodiazepinas, em utentes sob tratamento de manutenção opióide. Material e Métodos: Conduzimos um estudo transversal, envolvendo 236 doentes tratados com substitutos opióides (metadona e buprenorfina). Realizou-se uma análise descritiva, bivariável e multivariável das características clínicas entre os usuários de benzodiazepinas e os não-usuários de benzodiazepinas. Resultados: A prevalência do uso de benzodiazepinas foi de 25,4% (60). A obtenção de benzodiazepinas foi através de prescrição médica (49,8%) ou mercado negro (42,6%). A substância mais prescrita foi o diazepam (29,1%), e as principais razões para a toma foi insónia (27,7%), ansiedade (26,9%), e para potenciar os efeitos psicoativos de outras drogas (19,7%). No que respeita aos resultados clínicos sublinhamos: prevalência elevada de hepatite C (51,7%); elevado consumo continuado de substâncias psicoativas (73,7%); elevada taxa de depressão e ansiedade (> 60%), significativamente mais elevada nos utilizadores de benzodiazepinas. Na análise multivariável para o uso de benzodiazepinas, verificámos que o consumo de álcool (OR 0,482; IC 95% 0,247, 0,238) tem associação negativa; a hepatite C (OR 2,544; IC 95% 1,273, 5,084) e a ansiedade (OR 5,591; IC 95% 2,345, 13,326) tiveram associações positivas. Discussão: Os resultados obtidos sugerem que os utilizadores de BZD têm um problema complexo de dependência de drogas e sublinham a importância de abordar adequadamente o uso de BZD, contemplando uma abordagem psicológica e psiquiátrica nesta população em particular. Conclusão: O uso de benzodiazepinas, no passado ou atualmente, associa-se a piores indicadores físicos e psiquiátricos. A abordagem multidisciplinar com foco nas doenças infeciosas e na saúde mental é uma necessidade crítica para a efetividade do tratamento e prognóstico global.

Last-mile-as-a-service (LMaaS): An innovative concept for the disruption of the supply chain.

Recent events such as Covid-19 vaccine distribution issues and the blockage of the Ever Given ship in the Suez Canal raised concerns about how fragile the traditional supply chain is. Last-mile personalized fulfillment can have a catalyst role in the proliferation of the Industry 4.0. This growing trend will reduce standard production, bringing manufacturing closer to the client and, ultimately, boiling down the supply chain to the last mile. However, the literature is not clear about the breakdown of the supply chain to enhance cities' sustainability and reducing the number of transports and circulating vehicles. Stemming from an empirical study to simulate the existing gap in the market and the development of a case study through structured interviews with privileged interlocutors complemented by the document analysis, this paper highlights how the integration of local stakeholders can efficiently enhance a personalized service based on dynamic collaborations to set up the supply chain, by introducing the Last-Mile-as-a-Service (LMaaS) concept. This concept relies on a revenue-sharing framework based on an open marketplace composed by last-mile manufacturing, transport, and storage assets and stakeholders to disrupt the supply chain, enabling any company to provide personalized products in almost real-time to any location.

Desenvolvimento de competências de prática baseada em evidência dos enfermeiros: contributos da supervisão clínica / Development of nurses' evidence-based practice skills: contributions of clinical supervision

RESUMO Objetivo avaliar o impacto da implementação do Modelo SafeCare nas competências de prática baseada em evidência dos enfermeiros. Métodos método misto caracterizado pela triangulação concomitante. Os dados quantitativos foram coletados antes e após a implementação do Modelo, por meio do Questionário de Eficácia Clínica e Prática Baseada em Evidências, com análise estatística descritiva. Os valores de prova foram obtidos com recurso ao teste de Wilcoxon. Participaram 13 enfermeiros. Os dados qualitativos foram obtidos de entrevistas com 11 enfermeiros de um hospital público e analisados pela técnica de Análise de Conteúdo. Resultados não houve diferenças estatisticamente significativas com a implementação do modelo. Contudo, os enfermeiros identificaram o aumento de competências em prática baseada em evidência com o reconhecimento de vantagens no seu desenvolvimento profissional, na organização e na assistência ao paciente. Conclusão a implementação do modelo mostrou ter contribuído para o desenvolvimento das competências em prática baseada em evidência.

ABSTRACT Objective to evaluate the impact of the implementation of the SafeCare Model on the evidence-based practice competencies of nurses. Methods mixed method characterized by concomitant triangulation. Quantitative data were collected before and after the implementation of the Model, by means of the Clinical Effectiveness and Evidence-Based Practice Questionnaire, with descriptive statistical analysis. Evidence values were obtained using the Wilcoxon test. Thirteen nurses participated. Qualitative data were obtained from interviews with 11 nurses from a public hospital and analyzed using the Content Analysis technique. Results there were no statistically significant differences with the implementation of the model. However, nurses identified increased competencies in evidence-based practice with the recognition of advantages in their professional development, organization, and patient care. Conclusion the implementation of the model has been shown to have contributed to the development of competencies in evidence-based practice.

Impacto de um modelo de supervisão clínica nas capacidades da inteligência emocional em enfermeiros / Impact of a model of clinical supervision over the emotional intelligence capacities of nurses

RESUMO Objetivo analisar o impacto da implementação de um modelo de supervisão clínica em enfermagem nas capacidades da inteligência emocional dos enfermeiros. Métodos estudo de métodos mistos. Colheu-se os dados quantitativos antes e após a implementação do Modelo, pela escala Capacidades da Inteligência Emocional em Enfermeiros; analisou-se por estatística descritiva e pelo teste-t para amostras emparelhadas. Participaram 47 enfermeiros de um hospital. Obteve-se os dados qualitativos pela análise dos discursos dos enfermeiros numa apresentação pública, através de técnicas de análise de conteúdo tipo temática/categorial. Os achados foram integrados no final para gerar os resultados. Resultados não se verificou diferenças estatisticamente significativas com a implementação do Modelo. Contudo, os enfermeiros envolvidos reconheceram o impacto positivo do Modelo SafeCare no desenvolvimento das competências emocionais. Conclusão o estudo apresentou contributos para a supervisão clínica e para o desenvolvimento das competências emocionais.

ABSTRACT Objective to analyze the impact of the implementation of a model of clinical supervision over the emotional intelligence capacities of nurses. Methods mixed methods study. Quantitative data were collected before and after the implementation of the Model, using the scale of Emotional Intelligence Capacities of Nurses; analyses were carried out using descriptive statistics and paired samples were analyzed using the t-test. 47 nurses from one hospital participated. Qualitative data were obtained from the analysis of the discourses of the nurses in a public presentation, using thematic/categorizing content analysis. The findings were integrated at the end to generate the results. Results no statistically significant differences were found with the implementation of the Model. However, the nurses involved recognized the positive impact of the SafeCare Model in the development of emotional competences. Conclusion the study contributed for clinical supervision and for the development of emotional competences.

Implementação de um modelo de supervisão clínica em enfermagem - modelo safecare / Implementation of a nursing clinical supervision model - SAFECARE model

The actual context, marked by the high cost of health care associated with technological advances, the increase in the workload of health professionals and the aging of the population with multiple chronic diseases. There are concerns raised by health organizations regarding the quality of care, with emphasis on actions aimed to the continuous quality improvement. The effects of clinical supervision on quality of care defined as a target area by the World Health Organization are a key aspect in improving quality. The literature shows that there is no model of nursing clinical supervision capable to respond to the actual context needs. The objective of this exploratory, descriptive and longitudinal study was to implement a contextualized nursing clinical supervision model, SafeCare model, in order to identify the contributions of its implementation in the indicators sensitive to nursing clinical supervision. The study was conducted in the surgery department of a health care institution and the nurses of the surgery department composed the sample. With this article we intend to disseminate the results of the implementation of the SafeCare model and to prove that the implementation of a contextualized Nursing clinical supervision model based on nurses' needs, SafeCare Model, has contributed to obtaining higher quality and safer care for clients

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Evidence based practice as an indicator of clinical supervision in nursing in context of ambulatory surgery / A prática baseada na evidência como indicador da supervisão clínica em enfermagem no contexto de cirurgia de ambulatório

Clinical supervision and evidence-based practice in nursing should be understood as complementary and indissociable as they go hand in hand towards the same objectives. Therefore, the supervising process, should boost the evidence-based practice in order to promote better nursing care. The purpose of this study is to evaluate nurse's predisposition to incorporate evidence-based practice into their care and to identify barriers to its application with the purpose of propose contributions for the implementation of a nursing clinical supervision model that encourages the use of the best evidence available into the daily practice. The study is integrated into the research project "SAFECARE - Supervisão Clínica para a segurança e qualidade dos cuidados". It was developed an exploratory-descriptive study in an ambulatory surgery unit of a University Hospital in Porto, Portugal. It had a target population of 59 nurses, and it was used the "Evidence-Based Practice Questionnaire" as a method of collecting data. From the 49 questionnaires collected, we find that the subscale "Practices" has an average score of 4.89, the subscale "Attitudes" 5.36 and the subscale "knowledge/skills and competences" 5.08. These results showed that nurses have a low use of evidence-based practice when compared with the level of knowledge, skills and competences shown, although they seem to have a positive attitude towards this subject. These results can be partially explained by the overburden felt by the nurses, which identified the lack of time and motivation, but also inappropriate training and scarcity of team meetings and proper tools in the workplace as barriers

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Clinical supervision: analysis of postoperative pain evaluation in the ambulatory surgery setting / Supervisão clínica: análise da avaliação da dor pós-operatória em cirurgia de ambulatório

Clinical supervision, as a formal process of monitoring professional practice, aims to improve decision-making to contribute to safety and quality of care through reflection processes and analysis of clinical practice. This study aimed to compare the postoperative pain evaluation and clinical recording procedures performed by nursing staff and clinical supervisors in ambulatory surgery patients.The study was integrated into the research project "SAFECARE". It was developed a descriptive cross-sectional quantitative study in an ambulatory surgery unit of a University Hospital in Oporto, Portugal. The study population was the nursing staff with an intentional non-probabilistic sampling method. A questionnaire was constructed and evaluation of postoperative pain, patient clinical and demographic variables was included. This instrument was applied in 116 patients matched by 12 surgical specialties. Results were compared between nursing staff, clinical supervisors and electronic nursing records. Patients had an average age of 48.6 years, being mostly female. Regarding pain evaluation, the scale most used by nurses (62.1%) and clinical supervisors (67.2%) was the "Numerical Scale". Postoperative pain evaluation scores ranged from 0 to 7, with score 0 (no pain) presenting more frequently by nurses, electronic nursing records and clinical supervisors. 34.5% of results were not documented in electronic nursing records. These findings support the importance of an intervention of clinical supervision in the indicator "pain" for the outpatient surgery setting. Local protocols of clinical supervision practice would contribute to improve postoperative pain evaluation, as well as standardization and optimization of nursing records, thus ensuring quality care

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Non-pharmacologicalinterventions in the control of urinary incontinence and the instruments that allow the diagnosis: integrative review / Intervenções não farmacológicas no controle da incontinência urinária e os instrumentos que permitam o seu diagnóstico: revisão integrativa

Introduction: Urinary incontinence is a major health problem resulting in physical, psychological and social changes with economic repercussions on the health system. Is a multifactorial condition associated with age-related changes and disorders of the genitourinary system, which corroborates the fact that it is the most often recurring geriatric syndrome. Aims: To identify non-pharmacological interventions for adults with urinary incontinence and to identify tools for urinary incontinence diagnosis in adults. Method: An integrative review study design was completed. Two electronic databases was search (MEDLINE and Web of Science). Three independent reviewers searched databases according to a predetermine inclusion and exclusion criteria. Results: Twelve articles were included in the review. Eleven articles mentioned non-pharmacological interventions, such as physical therapies, lifestyle strategies, behavioural therapies and alternative conservative management options. These interventions should be targeted and individualized to the type of incontinence to result in health gains for the population. One article mentioned an assessment tool for urinary incontinence - The Gaudenz-Fragebogen tool. The evaluation tools can help to systematize the diagnostic activity and consequently improve the clinical practice in the field of urinary incontinence. Conclusion: In care conception, nurses should target their interventions to personal data to address individual symptoms and use assessment tools that can help in the differential diagnosis of UI. Then, to advancing the quality and rigor of nursing care, we advocate that providing nurses with skills in attaining a differential diagnosis of UI presents an added value to the improvement of quality of care in a multidisciplinary context

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Portuguese Haemophilia Registry.

National Patient Registries (NPR) have an important role in the management of haemophilia and other inherited bleeding disorders, representing powerful instruments to support healthcare and research. Computer software to assist the NPR is crucial, as it facilitates the introduction of the data from a national universe that will be centralized and merged into a unique location, thus ensuring a greater reliability and accuracy of the collected data, avoiding duplication of patients. In Portugal, despite the efforts and recognition of the need of a NPR, just recently the protocol for the establishment of the computer software to support the Portuguese National Registry of Haemophilia and other Congenital Coagulopathies (PorR H&CC) was approved. This paper aims to present this newly developed computerized solution, as well as to report the main variables and information that will be available. The development of this application, which includes a set of sociodemographic, clinical and treatment data, was based on the principles of WFH, and the database that supports the NPR, with anonymized data, is operated and maintained in accordance with the Data Protection Law. Currently, the first data are available on the application. Our focus now is to ensure more registries and continuous data entry in order to have complete information on the characterization of the haemophilia patient population in Portugal.

Portuguese Haemophilia Registry. Set of variables for a computerized solution.

National Patient Registries (NPR) have an important role in the management of haemophilia and other inherited bleeding disorders, representing powerful instruments to support healthcare and research. Computer software to assist the NPR is crucial, as it facilitates the introduction of the data from a national universe that will be centralized and merged into a unique location, thus ensuring a greater reliability and accuracy of the collected data, avoiding duplication of patients. In Portugal, despite the efforts and recognition of the need of a NPR, just recently the protocol for the establishment of the computer software to support the Portuguese National Registry of Haemophilia and other Congenital Coagulopathies (PorR H&CC) was approved. This paper aims to present this newly developed computerized solution, as well as to report the main variables and information that will be available. The development of this application, which includes a set of socio-demographic, clinical and treatment data, was based on the principles of WFH, and the database that supports the NPR, with anonymized data, is operated and maintained in accordance with the Data Protection Law. Currently, the first data are available on the application. Our focus now is to ensure more registries and continuous data entry in order to have complete information on the characterization of the haemophilia patient population in Portugal.

User-centered requirements engineering in health information systems: a study in the hemophilia field.

The use of sophisticated information and communication technologies (ICTs) in the health care domain is a way to improve the quality of services. However, there are also hazards associated with the introduction of ICTs in this domain and a great number of projects have failed due to the lack of systematic consideration of human and other non-technology issues throughout the design or implementation process, particularly in the requirements engineering process. This paper presents the methodological approach followed in the design process of a web-based information system (WbIS) for managing the clinical information in hemophilia care, which integrates the values and practices of user-centered design (UCD) activities into the principles of software engineering, particularly in the phase of requirements engineering (RE). This process followed a paradigm that combines a grounded theory for data collection with an evolutionary design based on constant development and refinement of the generic domain model using three well-known methodological approaches: (a) object-oriented system analysis; (b) task analysis; and, (c) prototyping, in a triangulation work. This approach seems to be a good solution for the requirements engineering process in this particular case of the health care domain, since the inherent weaknesses of individual methods are reduced, and emergent requirements are easier to elicit. Moreover, the requirements triangulation matrix gives the opportunity to look across the results of all used methods and decide what requirements are critical for the system success.

Improvement of surveillance of hemophilia treatment through ICTs.

Hemophilia, in addition of being a chronic disease, is also a rare disease, and as such, quite expensive for the National Health Service (NHS) due to the cost associated with the drugs used in treatments (Clotting Factor Concentrate - CFC). On the other hand, due to the specific characteristics of this type of disorder, it is necessary to ensure that data generated during the treatments are quickly communicated to the clinicians responsible for monitoring those patients. As such, an effective management of this disease, with maximum safety for patients, involves not only an efficient information management process, but also the coordination and management of all the associated resources. This article aims to present one specific component of a technological solution that can help in coordinate actions of patients, physicians and nurses, as well as improve the surveillance of hemophilia treatment, within a specific Comprehensive Hemophilia Diagnostic and Treatment Center (HTC).

Using Participatory Design in a Health Information System.

This article describes the experience of developing an interactive Health Information System (iHIS) currently under test in a hospital, which benefited from the practices of the User-Centred Design (UCD), in a Participatory Design (PD) approach. Techniques from the Human-Computer Interaction (HCI) and/or Usability Engineering (UE), combined with traditional Software Engineering (SE), allowed an effective and usable solution from the user's point of view. The good results usually achieved with this approach were confirmed. Despite these good results, we deem that if there is not some control of the procedure by the project manager, it may be difficult to end the requirement analysis, since requirement reformulation is fostered.

Improving the management of chronic diseases using web-based technologies: an application in hemophilia care.

Modern methods of information and communication that use web technologies provide an opportunity to facilitate closer communication between patients and healthcare providers, allowing a joint management of chronic diseases. This paper describes a web-based technological solution to support the management of inherited bleeding disorders integrating, diffusing and archiving large sets of data relating to the clinical practice of hemophilia care, more specifically the clinical practice at the Hematology Service of Coimbra Hospital Center (a Hemophilia Treatment Center located in Portugal).

Using task analysis to improve the requirements elicitation in health information system.

This paper describes the application of task analysis within the design process of a Web-based information system for managing clinical information in hemophilia care, in order to improve the requirements elicitation and, consequently, to validate the domain model obtained in a previous phase of the design process (system analysis). The use of task analysis in this case proved to be a practical and efficient way to improve the requirements engineering process by involving users in the design process.

Risk factors for developing nosocomial infections among pediatric patients.

BACKGROUND: Nosocomial infections (NIs) are important causes of morbidity and mortality in pediatric hospitals. Multiple factors contribute towards exposing children to the risk of infection when hospitalized, and some of them differ from those in adults. METHODS: This was a prospective study in a tertiary-level teaching pediatric hospital in Salvador, Bahia, Brazil, conducted from January to July, 2003, to describe the epidemiologic characteristics of NIs. Centers for Disease Control's standard definitions were used and the data recorded included intrinsic and extrinsic risk factors. RESULTS: We evaluated 808 patients. There were 143 episodes of NI in 124 patients (15.4%). The overall incidence of NI cases was 9.2 per 1,000 patient-days, with higher rates among children aged less than 1 year (P < 0.001) and those with nonsurgical clinical diseases (P < 0.001). Gastrointestinal infections (39.2%) and eye, ear, nose, throat or mouth infections (29.4%) were most common. The factors most closely associated with higher incidence of NI were respiratory disease on admission (incidence density ratio [IDR], 4.0; 95% confidence interval [CI], 2.83-5.72), another disease associated with admission diagnosis (IDR, 3.5; 95% CI, 2.41-5.02), nonsurgical clinical disease (IDR, 5.9; 95% CI, 3.92-8.85) and pediatric intensive care unit residence (IDR, 3.5; 95% CI, 1.91-6.28). The lengths of hospital stay for patients with and without nosocomial infection were, respectively, 14.1 days (SD, 20.5 days) and 5.1 days (SD, 6.6 days) (t = 121.76; P < 0.001). CONCLUSIONS: Nosocomial infections are a frequent complication in pediatrics. They are not necessarily related to invasive procedures but certainly are related to a group of factors that have particular characteristics in the pediatric age group.

Modeling a Web-based Information System for managing clinical information in hemophilia care.

Nowadays, information systems combined with the Internet, have a significant role in data storage, as in the efficiency and promptness of data transfer and can offer a large contribute in managing and manipulating the information resulting from treatment and attendance of chronic patients, as hemophiliacs. On the other hand, the Internet also created the opportunity of patients to insert data concerning home treatments. This paper briefly describes the modeling process of a Web-based information system to help the management of inherited bleeding disorders integrating, diffusing and archiving large sets of information from heterogeneous sources in scope of the hemophilia care at the Hematology Service of Coimbra Hospital Center, in Portugal.