Behavioural and emotional problems in Malaysian children and adolescents with type 1 diabetes mellitus: A cross-sectional study in a single centre / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development.@*Objective@#To identify behavioural and emotional problems in children and adolescents with T1DM.@*Methodology@#A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia.@*Results@#Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis.@*Conclusion@#T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.

Lista de verificação para segurança cirúrgica: conhecimento e desafios para a equipe do centro cirúrgico / Lista de verificación de seguridad quirúrgica: conocimientos y desafíos para el equipo del centro quirúrgico / Surgical safety checklist: knowledge and challenges for the surgical center team

Resumo Identificar o conhecimento de profissionais da saúde sobre a Lista de Verificação para Segurança Cirúrgica, os desafios e estratégias para sua implantação em uma instituição pública hospitalar. Trata-se de uma pesquisa quantitativa, de caráter descritivo, transversal. Realizada entre abril e maio de 2017, compreendeu o preenchimento de um questionário sobre o conhecimento e percepções do Protocolo de Cirurgia Segura por profissionais que atuam no centro cirúrgico. Os dados foram analisados considerando a estatística descritiva. 72 profissionais participaram do estudo, entre técnicos de enfermagem, enfermeiros, médicos e instrumentadores, a maioria conhecia o Protocolo e objetivos. A falta de adesão da equipe foi o principal desafio encontrado por esta equipe para utilização deste protocolo. Apontaram estratégias importantes que possivelmente subsidiariam a implantação da ferramenta na instituição. A hipótese do estudo foi confirmada, pois se constatou que os profissionais possuem conhecimento sobre a Lista de Verificação e a reconhecem como uma ferramenta que assegura a qualidade da assistência durante o período perioperatório, além de elencarem os principais desafíos para sua implantação.

Abstract The aim of this study was to identify the knowledge of health professionals about the Surgical Safety Checklist, the challenges and strategies for its implementation in a public hospital. This is a quantitative, descriptive, crosssectional research. Held between April and May 2017, it comprised the completion of a questionnaire about the knowledge and perceptions of the Safe Surgery Protocol by professionals working in the operating room. Data were analyzed considering descriptive statistics. 72 professionals participated in the study, including nursing technicians, nurses, doctors and instructors, most knew the Protocol and objectives. The lack of adherence of the team was the main challenge encountered by this team to use this protocol. They pointed out important strategies that could possibly subsidize the implementation of the tool in the institution. The study hypothesis was confirmed, as it was found that professionals have knowledge about the Checklist and recognize it as a tool that ensures the quality of care during the perioperative period, and list the main challenges for its implementation.

Resumen El objetivo de este artículo fue identificar el conocimiento de los profesionales de la salud sobre la Lista de verificación de seguridad quirúrgica, los desafíos y las estrategias para su implementación en un hospital público. Esta es una investigación cuantitativa, descriptiva, transversal. Realizada entre abril y mayo de 2017, incluyó la realización de un cuestionario sobre el conocimiento y las percepciones del Protocolo de cirugía segura por parte de los profesionales que trabajan en el quirófano. Los datos fueron analizados considerando estadística descriptiva. 72 profesionales participaron en el estudio, incluidos técnicos de enfermería, enfermeras, médicos e instructores, la mayoría conocía el Protocolo y los objetivos. La falta de adherencia del equipo fue el principal desafío que encontraron para usar este protocolo. Señalaron estrategias importantes que posiblemente podrían subsidiar la implementación de la herramienta en la institución. Se confirmó la hipótesis del estudio, ya que se descubrió que los profesionales tienen conocimiento sobre la Lista de verificación y la reconocen como una herramienta que garantiza la calidad de la atención durante el período perioperatorio, y enumeran los principales desafíos para su implementación.

Mental health status of patients with coronavirus disease 2019 in Changsha / 中南大学学报(医学版)

OBJECTIVES@#The epidemic of coronavirus disease 2019 (COVID-19) brought psychological stress to the public, especially to patients. This study aims to investigate the mental health of patients with COVID-19 in Changsha.@*METHODS@#We took cross-section investigation for the mental health of 112 patients with COVID-19 via questionnaires. Mann-Whitney test, Chi-square test, and Fisher's exact test were performed to compare general and clinical data between the slight-ordinary patients and severe patients. Single sample -tests were used to compare the difference between the factor scores of the Symptom Check-List 90 (SCL-90) in COVID-19 patients with the norm of 2015 and factor scores of SCL-90 in patients with the severe acute respiratory syndrome (SARS).@*RESULTS@#The obsessive-compulsive, depression, sleep and eating disorders had the highest frequency among the positive symptoms of SCL-90 in patients with COVID-19 in Changsha. The factor scores of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 were higher than those of the norm (≤0.001 or 0.05).@*CONCLUSIONS@#The levels of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 in Changsha are higher than those of the norm. However, the mental health of slight-ordinary patients with COVID-19 is better than that of patients with SARS. It needs to provide targeting psychological interventions depending on the severity of patients.

Analysis of Scores of SCL-90 of Patients with Traumatic Subdural Effusion / 法医学杂志

Objective To investigate the factors affecting changes of Symptom Check List-90 （SCL-90） of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007-2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance （P<0.05）. The differences in depression and hostility factor scores between males and females had statistical significance （P<0.05）. The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance （P<0.05）. The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance （P<0.05）. The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance （P<0.05）. The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance （P<0.05）. Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.

Treehoppers (Hemiptera: Aetalionidae and Membracidae) from Madre de Dios region, Peru / Membrácidos (Hemiptera: Aetalionidae y Membracidae) de la región de Madre de Dios, Perú

A list of treehoppers (Aetalionidae and Membracidae) is presented from Madre de Dios region at the southeastern Amazon basin in Peru. The treehopper specimens were collected as by-catch in a survey of the beetles in the Villa Carmen Biological Station and Los Amigos Biological Station. The list comprises 44 species, 31 genera, 16 tribes and 9 subfamilies. Ten genera are new records to Peru. The images of representative specimens of each identified species and genera are provided to facilitate the identification of the local treehopper fauna.

Se presenta una lista de los membrácidos (Aetalionidae y Membracidae) de la región Madre de Dios, en el sureste de la cuenca Amazónica, en Perú. La lista está basada en especímenes recolectados como captura fortuita en un inventario de escarabajos en las estaciones biológicas Villa Carmen y Los Amigos. La lista incluye 44 especies, 31 géneros, 16 tribus y 9 subfamilias. Diez géneros son nuevos registros para Perú. Se presentan las imágenes de especímenes representativos de cada especie y género para facilitar la identifición de la fauna local de los membrácidos.

A cross-sectional study of behavioural disorders in children with human immunodeficiency virus / acquired immuno deficiency syndrome attending an anti-retroviral therapy centre

Background: HIV is a chronic disease which also significantly affects the behavior. This study aims at evaluating behavioral disorders in children with HIV/AIDS.Methods: This Cross-sectional study utilized the Child Behaviour Check List.Results: The overall prevalence of borderline and clinically significant behavioral problems were 69.3% (n=104). The prevalence of behavioral disorders were observed in the eight categories - anxious/depressed (borderline-7.7%, clinically significant-18.3%), withdrawn/depressed (6.7%, 18.3%), somatic problems (7.7%, 6.7%), rule-breaking behavior (7.7%, 18.3%), aggressive behavior (10.6%, 21.1%), attention problems (15.4%, 2.9%) and thought problems (9.6%, 2.9%). No social problems were observed. Internalizing problems were common in girls and externalizing problems were common in boys. As age advanced a simple linear progression in prevalence of Behavior Problems was found. There were 47.1% of Orphans in study and behavioral problems were more common in them.Conclusions: High prevalence of behavioural abnormalities warrants comprehensive management including Behavioural counselling and therapy and not just drugs for these children.

Método OCRA en diferentes sectores productivos. Una revisión de la literatura, 2007-2018 / OCRA method in different productive sectors. A review of the literature, 2007-2018

Resumen Los desórdenes musculo esqueléticos (DME) son la nueva epidemia de enfermedades crónicas, son multifactoriales y afectan los diferentes sectores productivos. Aunque se encuentran múltiples instrumentos para la evaluación de la carga estática y dinámica, el OCRA (Occupational Repetitive Action) parece ser una opción atractiva. Objetivo. Realizar una búsqueda de literatura sobre el uso del método OCRA y DME en trabajadores de diversos sectores productivos (20072018). Materiales y métodos. Una revisión de literatura (siguiendo la declaración PRISMA) de estudios que evaluaran el nivel de riesgo biomecánico (OCRA) y DME en las bases de datos Scielo, Science Direct, Scopus, ProQuest, Gale, PubMed, Lilacs y Ebsco fue realizada, 7 estudios cumplieron con los criterios de selección; la mayoría son cuantitativos (corte transversal). Resultados. El 79% de las condiciones relacionadas con la tarea requieren exigencia física e implican movimientos repetitivos (jardinería y floricultores); la aparición de DME en espalda alta-baja, extremidades superiores e inferiores, los cuales se generan por la frecuencia de las actividades realizadas (producción de calzado); además, "riesgos muy alto" de desarrollar DME (industria del salmón) y un índice medio (OCRA) por movimientos repetitivos que requiere cuidado especial (línea de Ensamblaje en U) fueron encontrados. Conclusiones. La revisión arrojo el uso limitado del método OCRA para la detección de DME en trabajadores de diferentes sectores; y este método puede ser usado para la detección del riesgo biomecánico.

Abstract Musculoskeletal disorders (MSD) are the new epidemic of chronic diseases, are multifactorial and affect to different productive sectors. Although there are multiple tools for the evaluation of static and dynamic load, OCRA (Occupational Repetitive Action) seems to be an attractive option. Objective. To conduct a literature search on the use of the OCRA and DME method in workers of various productive sectors (2007-2018). Materials and methods. A literature review (following the PRISMA statement) of studies assessing the level of biomechanical risk (OCRA) and the prevalence of DME in the Scielo, Science Direct, Scopus, ProQuest, Gale, PubMed, Lilacs and Ebsco databases was performed, 7 studies met the selection criteria; Most are quantitative. Results. 79% of the conditions related to the task require physical demands and involve repetitive movements (gardening and flower growers); the production of DME in upper-lower back, upper and lower extremities, wich are generated by the frequency of the activities in the footwear production; In addition, "very high risks" of developing DME (salmon industry) and a medium index (OCRA) for repetitive movements that require special care (U-Assembly line) were found. Conclusions. The review showed the limited use of the OCRA method for the detection of SMD in workers from different sectors; and this method can be used for the detection of biomechanical risk.

Perfil higiênico-sanitário dos estabelecimentos de frutas comercializadas na “Feira da Cidade” do município de Ananindeua / PA / Hygienic-sanitary profile of the establishments of fruits marketed in the “City Fair” of the municipality of Ananindeua / PA

As feiras livres desenvolvem um ambiente favorável para a proliferação de microrganismos, acarretando problemas de risco à saúde pública. A pesquisa objetivou descrever o perfil higiênico-sanitário de estabelecimentos que comercializam frutas em uma feira no Município de Ananindeua/PA. O estudo realizou visita ao local e utilizou um check-list adaptado da legislação vigente. Avaliou-se três itens, subdividindo-os em tópicos de avaliação. Os estabelecimentos classificaram-se com porcentagem inferior a 50% dos itens atendidos. A partir dos elevados índices de inadequações, observou-se a necessidade de uma reestruturação através da implementação das Boas Práticas com a realização de cursos e palestras periódicos para garantir a segurança na comercialização das frutas nessa feira.

Avaliação da adequação ao sistema de Boas Práticas de Fabricação de alimentos em uma Unidade de Alimentação e Nutrição no município de São Raimundo das Mangabeiras - MA / Evaluation of the adequacy to the system os good manufacturing pratices in a food and nutrition unit in town of São Raimundo das Mangabeiras, Maranhão

As unidades de alimentação e nutrição são responsáveis pelo fornecimento derefeições balanceadas e dentro de condições higiênico-sanitárias satisfatórias. O presenteestudo teve como objetivo avaliar as condições de higiene no preparo e manipulação dealimentos na Unidade de Alimentação e Nutrição do IFMA campus São Raimundo dasMangabeiras, através da aplicação de um check-list, baseado na resolução RDC 275/2002.O estudo exploratório foi realizado por meio de um guia de verificação. A avaliação por itensmostrou que o maior percentual de adequação foi verificado na matéria-prima, ingredientese embalagens e o maior percentual de inadequação foi para o item do controle de qualidadedo produto final. A referida UAN encontra-se deficiente em relação ao nível de adequaçãocom legislação. Assim, constatou-se a necessidade de se implantar as Boas Práticas defabricação (BPF).

Avaliação da capacitação de manipuladores sobre temas de Boas Práticas de Manipulação utilizando uma ferramenta de qualidade em uma Unidade de Alimentação e Nutrição hospitalar em Rio das Ostras - RJ / Evaluation of manipulator training on good handling practices using a quality tool in a hospital supply and nutrition unit in Rio das Ostras - RJ

Demanda-se dentro de uma unidade de alimentação e nutrição (UAN) condições higiênicossanitárias apropriadas e que estejam de acordo com a legislação, a fim de manter o alimento inócuo e em perfeitas condições de higiene, para que não sejam prejudiciais à saúde do indivíduo. Assim, a adoção de boas práticas é uma das formas de redução de riscos à saúde do consumidor. Tendo em vista o manipulador como principal via de contaminação, o presente artigo objetivou avaliar a capacitação de manipuladores abordando temas como boas práticas de manipulação, doenças transmitidas por alimentos, contaminantes alimentares, manipulação higiênica dos alimentos e controle da temperatura de exposição dos alimentos (binômio tempo/temperatura). A capacitação foi elaborada de acordo com a RDC 216, a CVS 05/2013 e o manual de boas práticas da ANVISA.

Avaliação do índice de conformidades em escolas estaduais do município de Pombal-PB / Evaluation of the conformity index in state schools of the municipality of Pombal-PB

A segurança alimentar é um fator primordial em todos os setores do ramo alimentício, por tratar de qualquer alimento que quando consumido não causará danos à saúde do consumidor. O trabalho teve como objetivo avaliar as condições higiênico-sanitárias de escolas estaduais situadas no município de Pombal- PB, através da aplicação de um checklist de boas práticas de fabricação. No decorrer das visitas pôde-se observar que os refeitórios das escolas não apresentam índices de conformidades tão satisfatório o quanto era esperado em todos os aspectos avaliados, com destaque para edificações e instalações da escola B, que apresentou 75,7% de conformidade. A escola B foi classificada como Bom, enquanto as escolas A, C, D e E foram classificadas como Regular.

Avaliação das condições higiênico-sanitárias da comercialização de carnes em feira livre de Garanhuns-PE / Evaluation of the hygienic-sanitary conditions of the commercialization of meats in free fair of Garanhuns-PE

O problema grave e recorrente encontrado nas feiras livres é o descumprimento às normas higiênico-sanitárias de manipulação e comercialização de alimentos. Devido à alta perecibilidade dos alimentos de origem animal é importante verificar a comercialização destes nas feiras livres. O objetivo deste trabalho foi aplicar um check-list para avaliar as condições higiênico-sanitárias da venda de carnes em feira livre do município de Garanhuns-PE. Foram analisadas 6 barracas, sendo 4 de carne vermelha (bovina, ovina e caprina) e 2 de carne branca (aves e pescado). As barracas 3 (aves) e 4 (pescado), obtiveram percentuais de não conformidade de 48,39 e 64,52%, respectivamente e as barracas de carne vermelha obtiveram percentuais de não conformidades de 83,87%, 80,65%, 54,84% e 61,30% para as barracas 1, 2, 5 e 6, respectivamente.

Condições higiênico-sanitárias e Boas Práticas de Manipulação em quiosques na cidade de Pombal-PB / Hygienic-sanitary conditions and good handling practices in kiosks in the city of Pombal-PB

O constante aumento no número de estabelecimentos alimentícios como forma de obtenção de renda, associado à inexperiência dos produtores iniciantes, vem colocando em risco a segurança alimentar do consumidor. Neste contexto, objetivou-se com este estudo avaliar e discutir as condições higiênico-sanitárias e a aplicação das Boas Práticas de Manipulação em quiosques localizados na cidade de Pombal-PB. Para isso, foi aplicado Check List adequado para análise das Boas Práticas de Manipulação, conforme a RDC n° 275 e RDC nº 216. Verificou-se que os quiosques avaliados mostraram-se em condições inadequadas para o funcionamento devido inconformidades com a maioria dos parâmetros aplicados, tornando-se necessária uma maior fiscalização por parte dos órgãos competentes.

Análisis y aplicación de una lista de verificación en anestesia en trauma y cirugía de urgencia / Analysis and application of a checklist in trauma anesthesia and emergency surgery

Resumen: El manejo anestésico afecta directamente en la evolución del paciente durante la resucitación dentro del quirófano, influenciando directamente en la mortalidad y morbilidad. Se ha demostrado que recibir atención en centros hospitalarios de trauma nivel I disminuye el riesgo de muerte en pacientes lesionados en un 25% comparado con un centro no traumatológico. El presente trabajo presenta una lista de verificación para el paciente con trauma y cirugía de urgencia, en un intento de ayudar al anestesiólogo y al equipo quirúrgico a no olvidar pasos esenciales en momentos de estrés, adaptándose a cada centro hospitalario de acuerdo con protocolos y recursos propios de cada institución, ya que son, evidentemente, recomendaciones basadas en prevenir la conocida y temida tríada de la muerte, así como las múltiples complicaciones tardías, que se pudieran presentar.

Abstract: Anesthetic management directly affects the evolution of the patient during resuscitation within the operating room, directly influencing mortality and morbidity. It has been shown that receiving hospital care in trauma level I reduces the risk of death in injured patients by 25% compared to a non-traumatological center. The present work presents a checklist for the patient with trauma and emergency surgery, in an attempt to help the anesthesiologist and the surgical team not to forget essential steps in times of stress, adapting to each hospital according to protocols and resources own of each institution, since they are, evidently, recommendations based on preventing the well-known and feared triad of death, as well as the multiple late complications, that could arise.

Analysis of mental state of allergic rhinitis patients in Chengdu city by symptom check list 90 (SCL-90) scale / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyse the mental state of patients with allergic rhinitis (AR) in Chengdu.@*Methods@#One thousand five hundred and thirty-six AR patients from Sichuan Provincial Integrated Traditional Chinese and Western Medicine Hospital, West China Hospital of Sichuan University, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan People′s Hospital, Sichuan Second Hospital of Traditional Chinese Medicine were selected from July 2013 to January 2018. Eight hundred and twenty-seven patients were screened into study group by inclusion and exclusion standards. The symptom check list 90 (SCL-90) was used to group and score the mental state of these patients according to nine classification criteria: gender, BMI, age, marital status, monthly salary, disease duration, living environment, education level and working environment. Then, the scores were compared within groups. Inter-group comparison was made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, i.e. nasal itching, sneezing, clear discharge and nasal congestion, were scored on the visual analogue scale (VAS). SPSS 19.0 software was used to carry out statistical analysis. Partial correlation analysis was performed between the positive factors and the symptom scores by multiple regression statistical method.@*Results@#The total score of SCL-90 in the study group was 2.64±0.25, which was accorded with mild to moderate mental health impairment. There were 124 (15.0%) without mental health damage, 176 (21.3%) with mild damage, 474 (57.3%) with mild to moderate damage, 41 (5.0%) with moderate to severe damage and 12 (1.4%) with severe damage. The in-group comparison showed that the top three categories of different items were the living environment, gender and working environment. The scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, psychosis, other (sleep, diet) and total average score of urban residents were higher than that of country residents (3.29±0.61 vs 2.65±0.50, 2.81±0.77 vs 2.05±0.38, 3.10±0.19 vs 2.49±0.67, 3.40±0.84 vs 2.49±0.70, 3.04±0.64 vs 2.33±0.51, 3.02±0.55 vs 2.40±0.77, 3.40±0.41 vs 2.52±0.77, 2.91±0.11 vs 2.29±0.40, Z value was 4.88, 5.25, 4.57, 5.91, 5.09, 4.63, 5.55, -4.55, respectively, all P<0.05). Women scored higher than man for somatization, interpersonal sensitivity, depression and others (2.66±0.51 vs 2.00±0.45, 3.37±0.47 vs 2.63±0.51, 3.44±0.57 vs 2.85±0.52, 3.47±0.36 vs 2.76±0.45, Z value was -5.10, -5.51, -4.86, -5.28, respectively, all P<0.05). The scores of somatization, interpersonal sensitivity, psychosis and other (sleep, diet) were higher in the indoor group than those in the outdoor group (3.49±0.64 vs 2.78±0.46, 3.33±0.30 vs 2.56±0.68, 3.28±0.60 vs 2.67±0.31, 3.50±0.85 vs 2.85±0.37, Z value was 5.31, 5.79, 4.89, 5.00, respectively, all P<0.05). The outdoor group scored higher on obsessive-compulsive symptoms, anxiety and hostility (3.44±0.40 vs 2.83±0.35, 3.40±0.50 vs 2.57±0.93, 3.34±0.88 vs 2.69±0.56, Z value was 4.96, 6.22, 5.08, respectively, all P<0.05). The inter-group comparison found that depression, anxiety, psychosis and other (sleep, diet) could be partially correlated with VAS scores as 4 positive factors. The results of partial correlation analysis showed that depression was positively correlated with sneezing and nasal runny discharge, anxiety was positively correlated with nasal itching and nasal obstruction, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with nasal runny discharge and nasal obstruction.@*Conclusion@#AR patients have mild to moderate mental health impairments, which are correlated with AR symptoms.

Programa Cirurgias Seguras Salvam Vidas como Desafio Global da Organização Mundial de Saúde: panorama das medidas de prevenção de infecção do sítio cirúrgico adotadas em hospitais de grande porte de Minas Gerais / Safe Surgery Saves Lives program as a Global Challenge of the World Health Organization: overview of surgical site infection prevention measures adopted in large hospitals in Minas Gerais

A Infecção do Sítio Cirúrgico (ISC) é considerada um dos eventos adversos (EA) mais frequentes no cenário mundial. Uma das estratégias para melhorar o cuidado com o paciente cirúrgico foi proposta pela Organização Mundial da Saúde (OMS), em 2008, pelo Programa Cirurgias Seguras Salvam Vidas com finalidade de reduzir em 25% a taxa da ISC até 2020. No entanto, a adesão às medidas de prevenção de ISC para redução das taxas de tal complicação ainda não está consolidada na prática clínica. Objetivou-se avaliar as ações de prevenção e controle da ISC adotadas na prática clínica de hospitais de grande porte do estado de Minas Gerais e propor um escore de risco para essa adesão, a fim de se obter um panorama de como as instituições de grande porte têm adotado as medidas para prevenção da ISC. Tratou-se de um estudo epidemiológico, com delineamento transversal, realizado em 30 hospitais de grande porte de Minas Gerais. Procedeu-se à coleta de dados por meio de cinco instrumentos estruturados: entrevista com o gestor do hospital, o coordenador do Serviço de Controle de Infecção Hospitalar (SCIH) e o coordenador do Centro Cirúrgico (CC), um diagnóstico situacional e uma observação de um procedimento cirúrgico no momento da visita. Os dados foram analisados no programa Statistical Package for the Social Sciences (SPSS). As variáveis foram descritas utilizando frequências, porcentagens e medidas de tendência central. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (COEP) da Universidade Federal de Minas Gerais (UFMG) (CAAE: 30782614.3.00005149). Identificou-se predomínio dos hospitais na região central do estado 43,3% (13), de alta/média complexidade 60% (18), financiados por entidades filantrópicas 43,3% (13) e sem acreditação hospitalar 63,3% (19). A média de salas cirúrgicas foi de 9 (4-19), com média mensal de 721 (250-1.300) cirurgias. Observou-se que 93,3% (28) das instituições possuem um protocolo para orientar a prescrição do antibiótico profilático. A tricotomia pré-operatória foi realizada dentro da sala cirúrgica em 60% (18) das instituições, com uso de lâmina cortante em 36,7% (11) dos casos. A conferência da esterilidade dos materiais por meio de indicadores de processos na sala cirúrgica, antes da cirurgia, foi realizada em todos os hospitais. No tocante à vigilância da ISC, evidenciou-se o acompanhamento de 100% dos pacientes para a ocorrência de ISC. A divulgação das taxas de ISC para os cirurgiões ocorreu em 63,3% (19) dos hospitais. Para a composição do escore, consideraram-se variáveis reconhecidas como padrão-ouro pelos guidelines no tocante à prevenção da ISC, bem como sua adesão entre as instituições: auditoria de antibiótico profilático 86,6% (26), momento correto da administração do antibiótico no transoperatório 63,3% (19), método correto adotado para tricotomia 36,6% (11), local adequado para realização da tricotomia 23,3% (7), conferência dos materiais esterilizados 93,3% (28), ter SCIH 100% (30), realizar vigilância dos pacientes para a ISC 100% (30) e divulgação das taxas de ISC 63,3% (19). De acordo com o nível de adoção dessas medidas, foi proposto um escore de adesão dos hospitais que apontou que 3,3% (1) das instituições visitadas adotavam as medidas de prevenção e controle da ISC de forma suficiente, 83,3% (25) parcialmente e 13,3% (4) de modo deficiente, evidenciando que ainda é preciso maiores esforços para se alcançar a melhoria das práticas para o cuidado ao paciente cirúrgico conforme proposto pelo Segundo Desafio Global da OMS ­ Cirurgias Seguras Salvam Vidas.(AU)

Surgical Site Infection (SSI) is considered one of the most common adverse events (AEs) worldwide. One of the strategies to improve surgical patient care was proposed by the World Health Organization (WHO) in 2008 by the Safe Surgery Saves Lives program to reduce the rate of SSI by 25% by 2020. However, adherence to the SSI prevention measures to reduce the rates of such complication is not yet consolidated in clinical practice. Our objective was to evaluate the SSI prevention and control actions adopted in the clinical practice of large hospitals in the state of Minas Gerais and to propose a risk score for their adherence, in order to obtain an overview of how large institutions have been adopting measures to prevent SSI. This was a cross-sectional epidemiological study conducted in 30 large hospitals in Minas Gerais. Data were collected through five structured instruments: interview with the hospital manager, the coordinator of the Hospital Infection Control Service (SCIH) and the coordinator of the Surgical Center (CC), a situational diagnosis and observation of a surgical procedure at the time of the visit. Data were analyzed using the Statistical Package for Social Sciences (SPSS) program. The variables were described using frequencies, percentages and measures of central tendency. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (COEP/UFMG) (CAAE: 30782614.3.00005149). There was a predominance of hospitals in the central region of the state 43.3% (13), high/medium complexity 60% (18), funded by philanthropic entities 43.3% (13) and without hospital accreditation 63.3% (19). The average of operating rooms was 9 (4-19), with a monthly average of 721 (250-1,300) surgeries. It was observed that 93.3% (28) of the institutions have a protocol to guide the prescription of prophylactic antibiotics. Preoperative trichotomy was performed in the operating room in 60% (18) of the institutions, using a blade/safety razor in 36.7% (11) of the cases. Sterility testing of materials by means of process indicators in the operating room prior to surgery was held in all hospitals. Concerning SSI surveillance, the follow-up of 100% of patients for the occurrence of SSI was evidenced. The disclosure of SSI rates to surgeons occurred in 63.3% (19) of hospitals. For score formulation, variables recognized as the gold standard by the guidelines regarding SSI prevention were considered, as well as adherence to them among the institutions: prophylactic antibiotic audit 86.6% (26), correct timing of antibiotic administration the trans-operative period 63.3% (19), correct method adopted for trichotomy 36.6% (11), trichotomy adequate site 23.3% (7), inspection of sterilized materials 93.3% (28), having SCIH 100% (30), performing patient surveillance for SSI events 100% (30) and disclosure of SSI rates 63.3% (19). According to the level of adoption of these measures, a hospital adherence score was proposed, which indicated that 3.3% (1) of the institutions visited adopted the SSI prevention and control measures sufficiently, 83.3% (25) adopted them partially and 13.3% (4) poorly, showing that further efforts are still needed to achieve better practices in surgical patient care as proposed by the WHO Second Global Challenge - Safe Surgery Saves Lives.(AU)

Value of TCC and qSOFA score on the early diagnosis of severe trauma with sepsis / 中华急诊医学杂志

Objective To explore the value of trauma-care check list (TCC) and quick sequential organ failure assessment (qSOFA) on the early diagnosis of severe trauma with sepsis,and analyze the treatment time lines.Methods Totally 120 patients with severe trauma treated in Taizhou People's Hospital from February 2017 to January 2018 were reviewed.Sixty cases adopted TCC and qSOFA trauma care integration process (integration group),and the rest 60 cases adopted systemic inflammatory response syndrome (SIRS) score and emergency surgery multi-section support process (traditional group).According to the 2016 International Sepsis Guide Criteria,the diagnostic sensitivity and specific degrees of the two groups were calculated.The treatment time node,blood loss,complication rate,postoperative survival rate,and the total length of hospital stay of the two groups were analyzed.Results Of the 60 cases in the integration group,32 cases were confirmed severe trauma with sepsis,and 27 cases were confirmed in 41 primary diagnosed patients,with a diagnostic sensitivity of 84.38％ and a specific degree of 50.00％.In the traditional group,30 cases were confirmed severe trauma with sepsis,and 25 cases were confirmed in 38 primary diagnosed patients with a diagnostic sensitivity of 83.33％ and a specific degree of 56.67％.The significant shorter MDT consultation time,primary diagnosis time of sepsis,the duration from injury to surgery time and total hospitalization time were statistically significant different between the two groups (P＜0.05).Patients in the integration group had significantly lower incidence of postoperative complications and 28-day fatality rate,but there was no significant difference between them (P＞0.05).Conclusions TCC and qSOFA score in the treatment of severe trauma can optimize salvage process,significantly shorten the treatment time,and reduce postoperative complications.Moreover,qSOFA score and SIRS score have the same effect on the early diagnosis of sepsis in patients with severe trauma.

Avaliação das condições higienicossanitárias de padarias no município de Cabo de Santo Agostinho, PE

Para garanti as condições higienicossanitárias de um local é de suma importância implantar processos preventivos que evitem as doenças transmitidas por alimentos para assim não afetar a saúde do consumidor. O Objetivo desse estudo foi avaliar as condições higienicossanitárias de padarias no município de Cabo de Santo Agostinho-PE, no período entre março e abril de 2018. Foi aplicado uma lista de verificação (checklist), baseado nas legislações RDC n° 216/04 e RDC n° 275/02 da Anvisa, em três padarias na forma de avaliação observacional do local. Para classificar o grau de conformidades dos estabelecimentos foram considerados os seguintes critérios conforme a RDC nº 275/02: Grupo 1 (satisfatório), com 76% a 100% das conformidades, Grupo 2 (regular), com 51% a 75 % das conformidades atendidas e Grupo 3 (insatisfatório), com 0% a 50% das conformidades. Todos os estabelecimentos avaliados obtiveram a classificação no grupo 3, que atende (0% a 50%) das conformidades, apresentando resultados de (19,7%), (14,4%) e (3,9%), respectivamente. Conclui-se que a ausência de um profissional habitado nos locais avaliados dificulta a implementação do processo de boas práticas haja vista o despreparo e desconhecimento por parte dos proprietários em relação à segurança dos alimentos. Nos estabelecimentos avaliados os pontos críticos encontrados foram os problemas estruturais, documentações inexistentes e ausência de curso de boas práticas de manipulação dos funcionários.

ln order to guarantee the hygienic and sanitary conditions of a place, it is of the utmost importance to implement preventive processes that prevent foodborne diseases so as not to affect the health of the consumer. The objective of this study was to evaluate the sanitary and sanitary conditions of bakeries in the municipality of Cabo de Santo Agostinho, PE, from March to April 2018. A check list was applied, based on RDC regulations 216/04 and RDC n°275/02 of Anvisa, in 3 bakeries in the form of observational evaluation of the place. To classify the degree of conformity of the establishments, the following criteria were considered according to RDC n° 275/02: Group 1 (satisfactory), with 76% to 100% of conformities, Group 2 (regular), with 51% to 75% of conformities and Group 3 (unsatisfactory), with 0% to 50% of compliances. All the evaluated establishments obtained the classification in group 3, which meets (0% to 50%) of the corformities, presenting results of (19.7%), (14.4%) and (3.9%), respectively. lt is concluded that the absence of a professional inhabited in the evaluated places, aggravates the implementation of the process of good practices since there is a lack of preparation and lack of knowledge on the part of the owners in relation to food security. Considering that, in the evaluated establishments the critical points were the structural problems, non existent documentation and absence of good practices of manipulation of the employees.

Avaliação das condições higienicossanitárias de padarias no município de Cabo de Santo Agostinho, PE

Para garanti as condições higienicossanitárias de um local é de suma importância implantar processos preventivos que evitem as doenças transmitidas por alimentos para assim não afetar a saúde do consumidor. O Objetivo desse estudo foi avaliar as condições higienicossanitárias de padarias no município de Cabo de Santo Agostinho-PE, no período entre março e abril de 2018. Foi aplicado uma lista de verificação (checklist), baseado nas legislações RDC nº 216/04 e RDC nº 275/02 da Anvisa, em três padarias na forma de avaliação observacional do local. Para classificar o grau de conformidades dos estabelecimentos foram considerados os seguintes critérios conforme a RDC nº 275/02: Grupo 1 (satisfatório), com 76% a 100% das conformidades, Grupo 2 (regular), com 51% a 75 % das conformidades atendidas e Grupo 3 (insatisfatório), com 0 % a 50% das conformidades. Todos os estabelecimentos avaliados obtiveram a classificação no grupo 3, que atende (0% a 50%) das conformidades, apresentando resultados de (19,7%), (14,4%) e (3,9%), respectivamente. Conclui-se que a ausência de um profissional habitado nos locais avaliados dificulta a implementação do processo de boas práticas haja vista o despreparo e desconhecimento por parte dos proprietários em relação à segurança dos alimentos. Nos estabelecimentos avaliados os pontos críticos encontrados foram os problemas estruturais, documentações inexistentes e ausência de curso de boas práticas de manipulação dos funcionários

In order to guarantee the hygienic and sanitary conditions of a place, it is of the utmost importance to implement preventive processes that prevent foodborne diseases so as not to affect the health of the consumer. The objective of this study was to evaluate the sanitary and sanitary conditions of bakeries in the municipality of Cabo de Santo Agostinho, PE, from March to April 2018. A check list was applied, based on RDC regulations 216/04 and RDC nº 275/02 of Anvisa, in 3 bakeries in the form of observational evaluation of the place. To classify the degree of conformity of the establishments, the following criteria were considered according to RDC nº 275/02: Group 1 (satisfactory), with 76% to 100% of conformities, Group 2 (regular), with 51% to 75% of conformities and Group 3 (unsatisfactory), with 0% to 50% of compliances. All the evaluated establishments obtained the classification in group 3, which meets (0% to 50%) of the conformities, presenting results of (19.7%), (14.4%) and (3.9%), respectively. It is concluded that the absence of a professional inhabited in the evaluated places, aggravates the implementation of the process of good practices since there is a lack of preparation and lack of knowledge on the part of the owners in relation to food security. Considering that, in the evaluated establishments the critical points were the structural problems, non existent documentation and absence of good practices of manipulation of the employees

Analyzing the mental health status and its impact factors among female nurses in China / 中华劳动卫生职业病杂志

Objective@#To analyze the mental health status and its impact factors among nurses, finding ways to improve the mental health of nurses.@*Methods@#A total of 13 425 female healthcare workers aged from 18 to 65 were selected as study objects. The survey was conducted with unified design questionnaire. The survey included the basic situation of the individuals and SCL-90 questionnaire. Comparing the female doctors, the mental health status and its impact factors of nurses were analyzed.@*Results@#The income, age, education and occupation, which include shift work, heavy work load and overtime work are different between nurses and doctors. The main mental health problems of nurses were obsessive-compulsive symptoms, depressive symptoms and somatization. The results of univariate analysis indicated that shift work, overtime work, and heavy work load affected the positive rate of each factor. The results of multivariate analysis showed that occupation, shift work, overtime work, and heavy work load have significant adverse effects on the positive rate of the total score in female healthcare workers (P<0.01) . The positive rate of each dimension of SCL-90 in nurses is significantly higher than that of doctors.@*Conclusion@#The mental health problems of nurses are significantly higher than doctors. The main reasons are low occupational level and adverse workstyles which include shift work, heavy workload and so on. Health administration and hospital management departments should pay much more attention to the mental health of nurses, improving their mental health through a variety of ways.