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1.
Pharmaceuticals (Basel) ; 14(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34451851

RESUMO

Cytostatics are drugs used in cancer treatment, which pose serious risks to healthcare workers. Dermal absorption via surface contamination is the key exposure route; thus, rapid, reliable, and validated analytical methods for multicomponent detection are crucial to identify the exposure risk. A surface-wipe-sampling technique compatible with hospitals' safety requirements (gauze, 1 mL isopropanol) and a fast and simple extraction method (1 mL acetonitrile, 20 min ultrasonic bath, evaporation, reconstitution in 200 µL acetonitrile), coupled with liquid chromatography-tandem mass spectrometry analysis, were developed. It allowed identification and quantification of 13 cytostatics on surfaces: cyclophosphamide, doxorubicin, etoposide, ifosfamide, paclitaxel, bicalutamide, capecitabine, cyproterone, flutamide, imatinib, megestrol, mycophenolate mofetil, prednisone. Good linearity, sensitivity, and precision were achieved (R2 > 0.997, IDLs < 4.0 pg/cm2, average CV 16%, respectively). Accuracy for four model surfaces (melamine-coated wood, phenolic compact, steel 304, steel 316) was acceptable (80 ± 12%), except for capecitabine and doxorubicin. Global uncertainty is below 35% for concentrations above 100 pg/cm2 (except for capecitabine and doxorubicin)-a guidance value for relevant contamination. Method application in a Portuguese university hospital (28 samples) identified the presence of seven cytostatics, at concentrations below 100 pg/cm2, except for three samples. The widespread presence of cyclophosphamide evinces the necessity to review implemented procedures.

2.
Artigo em Inglês | MEDLINE | ID: mdl-34462811

RESUMO

BACKGROUND: The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM). METHODS: This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era. RESULTS: We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation). CONCLUSION: This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.

3.
Occup Environ Med ; 78(9): 648-653, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34193594

RESUMO

OBJECTIVES: To assess the prevalence of SARS-CoV-2-specific IgM and IgG antibodies among workers of the three public higher education institutions of Porto, Portugal, up to July 2020. METHODS: A rapid point-of-care test for specific IgM and IgG antibodies of SARS-CoV-2 was offered to all workers (SD Biosensor STANDARD Q COVID-19 IgM/IgG Duo and STANDARD Q COVID-19 IgM/IgG Combo). Testing was performed and a questionnaire was completed by 4592 workers on a voluntary basis from 21 May to 31 July 2020. We computed the apparent IgM, IgG, and combined IgM or IgG prevalence, along with the true prevalence and 95% credible intervals (95% CrI) using Bayesian inference. RESULTS: We found an apparent prevalence of 3.1% for IgM, 1.0% for IgG and 3.9% for either. The estimated true prevalence was 2.0% (95% CrI 0.1% to 4.3%) for IgM, 0.6% (95% CrI 0.0% to 1.3%) for IgG, and 2.5% (95% CrI 0.1% to 5.3%) for IgM or IgG. A SARS-CoV-2 molecular diagnosis was reported by 21 (0.5%) workers; and of these, 90.5% had a reactive IgG result. Seroprevalence was higher among those reporting contacts with confirmed cases, having been quarantined, having a previous molecular negative test or having had symptoms. CONCLUSIONS: The seroprevalence among workers from the three public higher education institutions of Porto after the first wave of the SARS-CoV-2 infection was similar to national estimates for the same age working population. However, the estimated true seroprevalence was approximately five times higher than the reported SARS-CoV-2 infection based on a molecular test.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2/imunologia , Instituições Acadêmicas/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Idoso , Anticorpos Antivirais/sangue , COVID-19/sangue , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Prevalência , Estudos Soroepidemiológicos
4.
J Virol Methods ; 296: 114223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34224753

RESUMO

The delays in the production and delivery of COVID-19 vaccines and the growing number of fatal infections across the globe raised the question whether it would be more advantageous to vaccinate a larger group of individuals with one dose instead of a smaller one with two doses. Through a group of vaccinated healthcare workers, we describe the qualitative and quantitative serological response to a single dose of the BNT162b2 vaccine. We found that, before the second dose inoculation, 95.3 % (182/191) already had anti-SARS-CoV-2 IgG and, half of them, antibodies concentrations against RBD (the key target of neutralizing antibodies) that reached maximum values for the used evaluation immunoassay. In order to improve the execution of vaccination programs, further studies are needed to assess whether there are individuals for whom a single dose of mRNA vaccine or a delay in the inoculation of the second dose, produce a sufficient immune response. Additionally, follow-up studies will help in understanding post-vaccination immunity, how long it lasts and how it relates to infection and reinfection.


Assuntos
Teste Sorológico para COVID-19/métodos , Vacinas contra COVID-19/imunologia , COVID-19/imunologia , SARS-CoV-2/imunologia , Anticorpos Neutralizantes/sangue , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , COVID-19/sangue , Vacinas contra COVID-19/administração & dosagem , Pessoal de Saúde , Humanos , Imunidade , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/imunologia
5.
Porto Biomed J ; 5(6): e093, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33283063

RESUMO

To analyze the use of compression stockings to avoid the formation of occupational edema of the lower limbs in jobs with prolonged orthostatism. We carried out a review of the articles published in PubMed, from the 1st of January 2008 to 31st of December 2018 using the term "Occupational Leg Swelling". Only articles that met the following criteria were selected: prospective, observational and experimental retrospectives articles written in Portuguese or English. The research resulted in 23 articles. After reading the titles and abstracts and applying the inclusion and exclusion criteria, 5 were selected. Prolonged orthostatism is considered a risk factor for the development of chronic venous disease. The use of compression stockings reduces the occupational edema of the lower limbs. Professionals exposed to prolonged orthostatism during their work activity have a higher risk of developing lower limb edema; Despite few studies demonstrated the effectiveness of wearing compression stockings to prevent occupational edema of the lower limbs, they have showed benefit in reducing edema as well as associated symptoms. The use of compression stockings should therefore be recommended to all professionals at increased risk for occupational edema of the lower limbs.

6.
Porto Biomed J ; 5(4): e064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32734009

RESUMO

Introduction: Little is known about iron deficiency anemia (IDA)'s treatment in Portugal. We aim to estimate the proportion of anemia, IDA, and iron deficiency without anemia; characterize the diagnostic procedures and prescription patterns; assess anemia's impact over work absenteeism, in a Local Health Unit. Material and methods: Cross-sectional study that evaluated complete blood counts, iron-containing prescriptions, comorbidities, economic failure, and disability certificates issued in 2015 at the Local Health Unit. Results: We evaluated 62,794 complete blood count. The proportion of anemia was 16.5%, higher in patients with economic failure, pregnant women, and patients with congestive heart failure. Of the patients with anemia 87.8% had not serum iron and/or ferritin dosing, and of those with serum iron/ferritin levels tested 50.6% had IDA. IDA was higher in pregnant women, women aged ≥15 years and in patients with congestive heart failure. Approximately 56.2% of patients with IDA did not receive iron-containing medication, and in 38% of the cases the prescribed dose was subtherapeutic. Of the total iron prescriptions 44.1% were association therapies. Anemia accounted for 5.2% of the disability certificates issued in 2015 (1749 workdays lost). Discussion: Most patients with anemia are not being adequately evaluated and a major proportion does not undergo treatment or has subtherapeutic doses of iron. These results may explain the anemia's impact on work capacity. Conclusion: This is one of the largest studies on anemia in Portugal. An effort to adapt to the established recommendations is urged, to minimize the consequences of this disease.

7.
Porto Biomed J ; 5(4): e076, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32734015

RESUMO

Introduction: Adverse health effects related with chronic exposure to waste anesthetic gases remain controversial. Strict threshold values are recommended to minimize possible health risks. The objective of our study was to measure the concentration of waste anesthetic gases in different hospital settings in an 11-year period. Materials and methods: Six-monthly assessment of nitrous oxide, sevoflurane, and desflurane was made between 2005 and 2016 in different hospital departments. Trace gas analysis was performed by infrared spectroscopy. Results: An anesthetic gas concentration above the upper limit of the threshold value was found in computed tomography/magnetic resonance imaging (CT/MRI) (45.5%), ambulatory operating room (34.5%), and in the burn unit (31.6%). Desflurane assessment was more frequently above the upper limit of threshold value (12.37%). Discussion: In the CT/MRI department, the small number of air cycling per hour and the frequent use of a face mask with the associated risk of leakage may explain the results. In burn unit patients inhalatory route is also frequent. Desflurane is widely used for its rapid elimination and rapid recovery, which is compatible with the results. Being odorless, it may be connected to undetected escape. Conclusion: The places with more anesthetic agents exposure were the CT/MRI, the ambulatory operating room, and the burn unit. Desflurane was the anesthetic agent more frequently above the upper limit of threshold value. To complement environmental surveillance, it is essential to establish a health surveillance system for professionals exposed to anesthetic agents.

9.
BMJ Open ; 10(5): e035898, 2020 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-32423935

RESUMO

INTRODUCTION: Excessive salt intake is a public health concern due to its deleterious impact on health. Most of the salt consumed come from those that are added when cooking. This study will improve knowledge on the effectiveness of interventions to reduce salt consumption among consumers. METHODS AND ANALYSIS: In this randomised clinical trial, we will be evaluating the efficacy of an intervention-the Salt Control H, an innovative prototype equipment to monitor and control use of salt when cooking-among workers from a public university, with the aim of reducing their dietary salt intake. We will randomly select 260 workers who meet the eligibility criteria and who are enrolled to an occupational health appointment and randomise them into one of the two arms of the study (either control or intervention), with matched baseline characteristics (sex and hypertension). The intervention will last for 8 weeks, during which the participants will use the equipment at home to monitor and control their use of salt when cooking. The main outcome will be 24-hour urinary sodium excretion at baseline, at fourth and eighth weeks of intervention, and at 6 months after intervention. ETHICS AND DISSEMINATION: Ethical approval for the study has been obtained from the Ethics Committee of the Centro Hospitalar Universitário São João. The results of the investigation will be published in peer-reviewed scientific papers and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT03974477 EQUIPMENT PROVISIONAL PATENT NUMBER: Registered at INPI: 20191000033265.


Assuntos
Culinária , Hipertensão , Cloreto de Sódio , Adulto , Criança , Comportamento Alimentar , Humanos , Saúde do Trabalhador , Ensaios Clínicos Controlados Aleatórios como Assunto , Sódio
10.
Acta Med Port ; 33(12): 803-810, 2020 Dec 02.
Artigo em Português | MEDLINE | ID: mdl-33496250

RESUMO

INTRODUCTION: Scabies outbreaks in healthcare institutions are an emerging problem. To determine the best management strategy is a topical matter. We analyzed two hospital scabies outbreaks and reviewed the management strategy of institutional scabies outbreaks. MATERIAL AND METHODS: We performed an observational retrospective study of two independent scabies outbreaks that occurred in a Portuguese tertiary hospital in 2018. Following the identification of the index cases, scabies cases and exposed individuals, we calculated the attack rate in patients and professionals. We also evaluated the treatment and infection control measures, as well as the global cost of each outbreak. RESULTS: The hospital outbreaks of scabies occurred in two wards of Internal Medicine. Both had as index cases institutionalized patients with dermatosis at the time of admission. In the Ward 1, there have been identified 409 exposed individuals, 14 cases of scabies and the attack rate was 3.4%. In the Ward 2, there have been identified 254 exposed individuals, 17 cases and the attack rate was 6.7%. Topical treatment was prescribed to the cases and environmental measures were implemented. DISCUSSION: In our analysis, both outbreaks had as index cases institutionalized patients and had a significant impact, with hundreds of exposed individuals and considerable costs. The analysis of hospital scabies outbreaks is mostly retrospective and represents an opportunity to review its best management strategy. CONCLUSION: Implementation of guidelines on tackling scabies outbreaks in institutional settings is urgent.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Escabiose/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Infecção Hospitalar/terapia , Feminino , Humanos , Masculino , Portugal/epidemiologia , Estudos Retrospectivos , Escabiose/terapia , Centros de Atenção Terciária
11.
PLoS One ; 13(12): e0207837, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30550599

RESUMO

INTRODUCTION: Healthcare workers account for 10% of the EU's total workforce, with a significant proportion of those employed in hospitals. Musculoskeletal injuries are the predominant group of injuries in healthcare professionals due to the physical demands of their work, such as the mobilization and positioning of the dependent patients. The management of this type of problem should take into account direct and indirect costs, such as periods of incapacity for work due to illness, hiring and training of new employees during periods of absence, reduced levels of productivity and the effects on production and quality of work. OBJECTIVES: 1-Characterization of injuries resulting from occupational accidents in hospital workers according to the International Classification of Diseases ICD-10; 2-Identification of the predictive factors of absenteeism duration due to temporary work incapacity in workplace accidents. METHODS: A retrospective observational study was conducted based on the analysis of 1621 cases of work-related accidents of employees of Centro Hospitalar São João from January 2011 to December 2014. An ICD-10 classification code was associated with each of the accident cases, based on pre-established criteria for classification of the specific diagnoses of musculoskeletal injuries. The duration of temporary work incapacity was compared between the categories of sociodemographic variables, among six categories of ICD-10 primary diagnosis (reclassification), and between the two major chapters of ICD-10 classification-chapter XIX (direct trauma) and chapter XIII (indirect trauma-strain injuries). The sociodemographic predictors of the occurrence of strain injuries were determined by logistic regression. A multinomial logistic regression analysis was conducted with selection of duration of work incapacity as the dependent variable. RESULTS: A total of 824 cases of musculoskeletal injuries occurred on hospital premises during the study period, which corresponded to a total of 22159 lost workdays in the context of temporary work incapacity due to work injury. According to the ICD-10 reclassification, the three most frequent diagnostic groups were direct lower limb trauma (n = 230, 27.9%), spinal strain injuries (n = 194, 23.5%) and direct upper limb trauma (n = 174, 21.1%). Significant differences were observed in temporary work incapacity duration among the ICD-10 diagnostic categories: spinal strain injuries were the diagnostic group associated with longer duration of temporary work incapacity, with a median = 14.0 (25-75th percentile: 6.0-35.0). The only variable that demonstrated to be significantly predictive of temporary work incapacity less than or greater than 20 days was the ICD-10 diagnostic group. The regression results revealed a 5-fold increase in risk in the case of spinal strain injuries for temporary work incapacity durations of less than or greater than 20 days (OR = 5.58 and OR = 5.89 respectively). CONCLUSIONS: The study findings support the benefits of the characterization of workplace injuries by medical diagnostic groups, namely in the interpretation of the sequelae of the accidents and the medical contextualization of the accidents. Association of ICD-10characterization can improve the analysis of workplace accidents at an institutional level, and promote the implementation of preventive measures and control of absenteeism.


Assuntos
Absenteísmo , Pessoal de Saúde , Sistema Musculoesquelético/lesões , Traumatismos Ocupacionais/classificação , Traumatismos Ocupacionais/epidemiologia , Adulto , Feminino , Humanos , Classificação Internacional de Doenças , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Estudos Retrospectivos , Fatores de Risco
12.
Work ; 61(4): 551-560, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30475783

RESUMO

BACKGROUND: Understanding which factors influence occupational safety and health risks is crucial to promote psychosocial risk management. OBJECTIVE: To assess the main work-related determinants of high exposure to psychosocial risk factors among Portuguese employees in the hospital setting. METHODS: Between May and July 2014, 399 employees of a public hospital completed a structured questionnaire. Psychosocial factors were assessed by the Portuguese medium length version of the Copenhagen Psychosocial Questionnaire. Age and gender adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were computed by logistic regression models. RESULTS: The highest psychosocial risks emerged in the p ersonality (53.8%), workplace demands (28.1%), and social relationships and leadership (24.4%) categories. Professionals with non-health care roles presented a higher risk in the worker-work interface (OR = 2.60;95% CI:1.02-6.62), that evaluated work insecurity, satisfaction and the work-family interface. Shift workers were exposed to a higher psychosocial risk in workplace demands (OR = 1.79;95% CI:1.10-2.91), personality (OR = 2.45;95% CI:1.36-4.41), and health and well-being (OR = 3.18; 95% CI:1.72-5.66). Non-government employees had a higher risk exposure in personality (OR = 2.20;95% CI:1.15-4.21), and those who were absent from work in personality (OR = 2.62;95% CI:1.41-4.86), and health and wellbeing (OR = 2.34;95% CI:1.27-4.31). CONCLUSIONS: Employees working in the hospital setting are vulnerable to psychosocial risk factors. Identifying those risks contributes to optimize workers' psychosocial health, increasing the effectiveness of the organization.


Assuntos
Saúde do Trabalhador , Recursos Humanos em Hospital/psicologia , Local de Trabalho/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Personalidade , Portugal , Fatores de Risco , Meio Social , Inquéritos e Questionários , Carga de Trabalho
13.
Int Arch Occup Environ Health ; 91(6): 657-674, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29845564

RESUMO

PURPOSE: The aim of this systematic review was to describe the prevalence of Helicobacter pylori infection in specific occupational groups and to compare them with the general population. METHODS: We searched PubMed® to identify original studies reporting the prevalence of H. pylori infection in occupational groups. The differences between occupational groups and the general population were analyzed taking into account the direction and statistical significance of the differences observed when comparing each occupational group with a reference group (either recruited in the same study or using an external comparator). RESULTS: A total of 98 studies addressing the prevalence of H. pylori infection in occupational groups were included in the systematic review. Overall, health professionals showed a significantly higher prevalence of H. pylori infection than the general population, especially among those working at gastrointestinal units. Similar results were found in subjects involved in agricultural, forestry and fishery, as well as in sewage workers, miners, and workers at institutions for the intellectually disabled, although differences were less pronounced. CONCLUSIONS: Our results show an occupational risk of H. pylori infection supporting the role of oral-oral, fecal-oral, and zoonotic transmission. Studies comparing specific occupational groups with adequate comparators may contribute to better identify groups at higher risk of infection. The recognition of this infection as an occupational disease would result in early detection and treatment, as well as prevention and control of its transmission in workplaces.


Assuntos
Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/transmissão , Doenças Profissionais/epidemiologia , Doenças Profissionais/microbiologia , Exposição Ocupacional/efeitos adversos , Ocupações/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Endoscópios/microbiologia , Endoscopia , Helicobacter pylori , Humanos , Prevalência
14.
Prostate Cancer Prostatic Dis ; 21(3): 337-344, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29700389

RESUMO

BACKGROUND: Recent studies suggested that the relation between night-shift work and prostate cancer may differ between rotating and fixed schedules. OBJECTIVES: We aimed to quantify the independent association between night-shift work and prostate cancer, for rotating and fixed schedules. METHODS: We searched MEDLINE for studies assessing the association of night-shift work, by rotating or fixed schedules, with prostate cancer. We computed summary relative risk (RR) estimates with 95% confidence intervals (95% CI) using the inverse variance method and quantified heterogeneity using the I2 statistic. Meta-regression analysis was used to compare the summary RR estimates for rotating and fixed schedules, while reducing heterogeneity. RESULTS: A total of nine studies assessed the effect of rotating and, in addition, four of them provided the effect of fixed night-shift work, in relation to daytime workers. Rotating night-shift work was associated with a significantly increased risk of prostate cancer (RR = 1.06, 95% CI of 1.01 to 1.12; I2 = 50%), but not fixed night-shift work (RR of 1.01, 95% CI of 0.81 to 1.26; I2 = 33%). In meta-regression model including study design, type of population, and control of confounding, the summary RR was 20% higher for rotating vs. fixed schedule, with heterogeneity fully explained by these variables. CONCLUSIONS: This is the first meta-analysis suggesting that an increased risk of prostate cancer may be restricted to workers with rotating night shifts. However, the association was weak and additional studies are needed to further clarify this relation before it can be translated into measures for risk reduction in occupational settings.


Assuntos
Ritmo Circadiano/fisiologia , Neoplasias da Próstata/epidemiologia , Jornada de Trabalho em Turnos/efeitos adversos , Tolerância ao Trabalho Programado/fisiologia , Humanos , Masculino , Neoplasias da Próstata/etiologia , Medição de Risco
15.
Workplace Health Saf ; 65(5): 188-196, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28061740

RESUMO

Bullying is defined as systematic exposure to humiliation as well as hostile and violent behaviors against one or more individuals. These behaviors are a serious, growing problem, which affects a significant proportion of health care professionals. To support the hospital's risk management policy, a cross-sectional study was undertaken to determine the prevalence of bullying in this institution and identify the determinants of bullying. Bullying was measured using the Negative Acts Questionnaire-Revised, Portuguese version (NAQ-R), a self-administered tool. The questionnaire was made available in digital format on the hospital's internal network (Intranet) and in hard copy; questionnaires were returned via nonidentified internal mail addressed to the occupational health unit or deposited in suggestion boxes located throughout the hospital. Multiple questionnaire delivery methods guaranteed data anonymity and confidentiality. The prevalence of bullying in this hospital was 8% (95% confidence interval [CI] = [6.2, 10.2]). Reported bullying was predominantly vertical and more frequently occurring among nurses, clerical staff, and health care assistants (12.5%, 7.6%, 6.4%, respectively; p = .005). After adjusting for gender, age, occupation, type of contract, and work schedule, only type of contract was significantly associated with bullying in the workplace; the risk of bullying was twice as high among government employees compared to workers with indefinite duration employment contracts ( p = .038). This study identified a high prevalence of bullying among health professionals; hence a program to prevent and control this phenomenon was implemented in this institution.


Assuntos
Bullying/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ocupações/classificação , Recursos Humanos em Hospital/estatística & dados numéricos , Portugal/epidemiologia , Prevalência , Inquéritos e Questionários , Local de Trabalho/estatística & dados numéricos
16.
J Forensic Leg Med ; 36: 54-60, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26397767

RESUMO

INTRODUCTION: People over 65 years old are expected to be an increasing group exposed to abuse. Despite the well-studied intra-familial abuse, institutional abuse still lacks a proper understanding about its determinants and characteristics. AIM: The general objective of this study is to provide a better knowledge about physical abuse against elderly people in institutional settings, in order to contribute to a timely detection, correct forensic diagnosis and prevention of these cases. METHODS: A retrospective study was conducted through the analysis of forensic medical exams performed in the North Forensic Medical Services of Portugal, between 2004 and 2013, to elderly persons allegedly victims of physical abuse in an institutional setting by a caregiver (n = 59). RESULTS: All the alleged cases occurred in nursing homes and in most of them (93.2%) the charges were against the institution and not focussing on a particular individual. The alleged victims were mainly female (79.7%), 75 years or older (75.9%), presenting a severe disability (55.9%) and 47.2% being unable to communicate. No injuries or post-traumatic pain were found in 55.9% of the cases to support the charge of physical abuse. Only in 6.8% of the cases were the forensic medical findings suggestive of physical abuse and, although this was not the object of the examination, 69.1% were considered suggestive or highly suggestive of neglect. A statistically significant association was found between the alleged victim's degree of disability and the occurrence of neglect (p = 0.003). CONCLUSION: The sample's size seems to be underestimated, probably due to lack of detection and/or reporting. The condition of these persons, mainly related with their inability to perceive abusive behaviours and/or to disclose them (mostly by physical and/or mental disability), as well as their reluctance to press charges due to fear of reprisal, affects significantly the detection and diagnosis of physical abuse, particularly in whom injuries are not obvious. In anticipation to the rapid ageing of the population, it is urgent to analyse and understand this emerging issue so that social policies and regulation may be developed, in an effort to protect the elderly, as well as to make improvements in the professionals' skills.


Assuntos
Abuso de Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Vítimas de Crime/estatística & dados numéricos , Pessoas com Deficiência , Feminino , Idoso Fragilizado , Humanos , Masculino , Portugal , Estudos Retrospectivos , Distribuição por Sexo
17.
J Forensic Leg Med ; 28: 19-24, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25440142

RESUMO

Abuse against elders with disabilities is a growing problem as the world population ages. Though they require mandatory reporting, these cases are most frequently not detected or not reported by health professionals for a variety of reasons, including the difficulty of making an accurate diagnosis. By performing a retrospective analysis of alleged domestic violence cases against elders with moderate or severe disability, presented to medical forensic examination at the North Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, in Porto, between 2005 and 2013 (n = 70), we aimed to improve our knowledge of some demographic and forensic characteristics of these cases as well as improve their detection and prevention. The most frequently reported type of abuse was physical (86%), allegedly perpetrated by male abusers (63%) living with their victims (90%), who were most commonly their children (47%) or partners (49%; when victims are married). The victims were most frequently female (63%) who had motor disabilities (49%) and presented a history of previous episodes of abuse in 74% of cases; however, only 28% were previously reported. The physical consequences were most frequently minor injuries (95%) with permanent consequences (scars) in only 6.8% of the cases. The injuries were multiple in the majority of the cases (64%), and the preferred locations were the head and neck (75%). Elderly females with motor disabilities appear to have a greatest risk of domestic violence, which translates, most frequently, into multiple injuries that are mainly in the head and neck.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Abuso de Idosos/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Autopsia , Feminino , Medicina Legal , Humanos , Masculino , Portugal/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Fatores Socioeconômicos , Cônjuges/estatística & dados numéricos , Fatores de Tempo
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