Trends in influenza vaccination coverage in Portugal from 1998 to 2010: effect of major pandemic threats.

BACKGROUND: Vaccination is the key measure available for prevention of the public health burden of annual influenza epidemics. This article describes national trends in seasonal influenza vaccine (IV) coverage in Portugal from 1998/99 to 2010/11, analyzes progress towards meeting WHO 2010 coverage goals, and addresses the effect of major public health threats of the last 12 years (SARS in 2003/04, influenza A (H5N1) in 2005/06, and the influenza A (H1N1)2009 pandemic) on vaccination trends. METHODS: The National Institute of Health surveyed (12 times) a random sample of Portuguese families. IV coverage was estimated and was adjusted for age distribution and country region. Independence of age and sex coverage distribution was tested using a modified F-statistic with a 5% significance level. The effect of SARS, A (H5N1), and the A (H1N1)2009 pandemic was tested using a meta-regression model. The model was adjusted for IV coverage in the general population and in the age groups. RESULTS: Between 1998/99 and 2010/11 IV, coverage in the general population varied between 14.2% (CI(95%): 11.6%-16.8%) and 17.5% (CI(95%): 17.6%-21.6%). There was no trend in coverage (p = 0.097). In the younger age group (<15 years) a declining trend was identified until 2008/09 (p = 0.005). This trend reversed in 2009/10. There was also a gradual and significant increase in seasonal IV coverage in the elderly (p for trend < 0.001). After 2006/07, IV coverage remained near 50%. Adjusting for baseline trends, there was significantly higher coverage in the general population in 2003/04 (p = 0.032) and 2005/06 (p = 0.018). The high coverage observed in the <15-year age group in season 2009/10 was also significant (p = 0.015). CONCLUSIONS: IV coverage in the elderly population displayed an increasing trend, but the 75% WHO 2010 target was not met. This result indicates that influenza vaccination strategy should be improved to meet the ambitious WHO coverage goals. The major pandemic threats of the past decade had a modest but significant effect on seasonal influenza vaccination. There was an increase in vaccine uptake proportion in the general population in 2003/04 and in 2005/06, and in individuals <15 years old in 2009/10.

Recommendations for capturing signatures digitally to optimize their suitability for forensic handwriting examination.

The use of digitally captured signatures in everyday course of business increases annually and, compared to pen and paper signatures, provides various advantages concerning the administration of documents. These signatures may also become subjects of a forensic handwriting examination and, therefore, in order to optimize their suitability for this purpose, they should satisfy several requirements. This paper presents recommendations drawn up by forensic handwriting examiners associated with ENFHEX (ENFSI) in a project aimed at defining best practices in forensic examination of digitally captured signatures. The paper is dedicated mainly to hardware and software developers, providers, and user institutions of digitally captured signature technologies to improve their practice to a level optimized for forensic handwriting examination. The most important requirements outlined in this paper concern digitally captured signature data, hardware, and software used to acquire these data, as well as optimized signing conditions. Following these requirements ensures the suitability of signature data for forensic handwriting examination and, consequently, increases the reliability of the associated electronic documents. In spite of rapidly evolving technology, they can serve as a solid basis for understanding and consideration of the optimal use of digitally captured signatures for signing electronic documents.

The role of the nurse in caring for the critical patient with sepsis.

OBJECTIVES: to know the nursing interventions in the identification, prevention and control of sepsis in critical patients. METHODS: integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample. RESULTS: nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis. FINAL CONSIDERATIONS: the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.

The role of the nurse in caring for the critical patient with sepsis / El papel del enfermero ante el paciente crítico con sepsis / O papel do enfermeiro perante o paciente crítico com sepse

ABSTRACT Objectives: to know the nursing interventions in the identification, prevention and control of sepsis in critical patients. Methods: integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample. Results: nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis. Final Considerations: the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.

RESUMEN Objetivos: conocer las intervenciones de enfermería en la identificación, prevención y control de la sepsis en el paciente crítico. Métodos: se trata de una revisión integradora de literatura, llevada a cabo mediante dos investigaciones paralelas con diferentes descriptores Me SH, recurriendo a la base de datos EBSCO y motor de búsqueda Google Académico. Se obtuvieron 9 estudios que forman parte de la muestra. Resultados: las intervenciones de enfermería están enfocadas en la creación/implantación de protocolos para el reconocimiento precoz de la sepsis, para la formación de equipos que garanticen un abordaje seguro y eficiente y para la adopción de medidas preventivas y de control de la infección para impedir la sepsis. Consideraciones Finales: las evidencias demostraron que el enfermero es fundamental en la identificación temprana, en el control y prevención de la sepsis, para evitar la progresión de la enfermedad y contribuir en la disminución de la morbilidad y de la mortalidad.

RESUMO Objetivos: conhecer as intervenções de enfermagem na identificação, prevenção e controle da sepse no paciente crítico. Métodos: revisão integrativa da literatura, realizadas duas pesquisas paralelas com diferentes descritores MesH, recorrendo à base de dados EBSCO e ao motor de busca Google Acadêmico. Obtiveram-se 9 estudos que integram a amostra. Resultados: as intervenções de enfermagem centram-se na criação/implementação de protocolos que auxiliem o reconhecimento precoce da sepse, na formação das equipes para garantir uma abordagem segura e eficaz e na adoção de medidas que promovam a prevenção e o controle de infeção como forma de prevenir a sepse. Considerações Finais: as evidências demonstraram que o enfermeiro é fundamental na identificação precoce, controle e prevenção da sepse, evitando a progressão da doença e contribuindo para a diminuição da morbilidade e mortalidade.