António de Sousa Uva

LER/DORT: que métodos de avaliação do risco?

O processo de selecao dos metodos observacionais de avaliacao do risco de LER/DORT e complexo, mas fundamental para a gestao do risco. Em Setubal, no periodo de 2004 a 2005, numa empresa portuguesa da industria automobilistica, onde a avaliacao do risco foi previamente efetuada, reaplicou-se o metodo OCRA checklist (avaliacao do risco de LER/DORT ao nivel dos membros superiores) em postos de trabalho (n=152) - montagem final e pintura - classificados de risco moderado/elevado (OCRA >16,5). Nas situacoes em que se reconfirmou a presenca de risco (n=71), aplicaram-se tres outros metodos: RULA, SI e HAL. Registraram-se sequencias em video da atividade de trabalho para avaliar a validade preditiva dos metodos. Revelam-se divergencias entre os metodos na classificacao dos postos de trabalho de risco elevado: OCRA - 34 postos; HAL - 35 postos; SI - 31 postos; RULA - 7 postos. A analise do efeito de cada variavel independente (fator de risco) nos scores finais dos metodos (regressao linear multivariada) revela distintos contributos e processos de ponderacao/avaliacao do risco de LER/DORT. A analise dos registros em video evidencia diversas validades preditivas relativamente aos fatores de risco integrantes dos metodos aplicados. Os resultados indicam a necessidade de uma selecao do metodo de avaliacao do risco de LER/DORT adequada a cada situacao (real) de trabalho, baseada no maior conhecimento dos metodos.

Risk-adjustment model in health outcomes evaluation: a contribution to strengthen assessment towards quality improvement in interventional cardiology

OBJECTIVE The aim of this study was to develop a risk adjustment model for major adverse cardiac and cerebrovascular events following percutaneous coronary intervention (PCI), using data from a national registry, and to highlight the use of the risk adjustment when we evaluate the quality of care in interventional cardiology. DESIGN The STUDY DESIGN was based on a Coorte study. Bivariate and multivariate logistic regression models were used to identify independent risk factors for these major adverse events. SETTING A total of 19 hospitals from the Portuguese National Registry of Interventional Cardiology. PARTICIPANTS Data from 10.641 consecutives procedures collected between June 30, 2003 and June 30, 2006. INTERVENTION Build a risk adjustment model for these major adverse events, following percutaneous coronary intervention. MAIN OUTCOME MEASURE Factors that were associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention. RESULTS The rate of in-hospital major adverse cardiac and cerebrovascular events was 1.9%. Factors associated with major adverse cardiac and cerebrovascular events included, among others: age >80 years (adjusted odds ratio = 3.91); female gender (1.72); and cardiogenic shock (6.05). Overall, a good discrimination was achieved with receiver operating characteristics curve = 0.84 and Hosmer-Lemeshow goodness of fit statistic across groups of risk was not significant (P = 0.18) indicating little departure from a perfect fit. CONCLUSIONS These findings will represent an important contribution to quality and safety improvement and should help driving new research and innovative approaches to different subgroups of patients who have higher chances of having an adverse event or poorer outcomes following this intervention.

Estratégia de avaliação do risco de lesões músculo-esqueléticas de membros superiores ligadas ao trabalho aplicada na indústria de abate e desmancha de carne em Portugal

BACKGROUND: Work-related Musculoskeletal Disorders (WRMSD) are common occupational diseases. The present study aims at examining an integrated perspective of risk assessment and health surveillance at a meatpacking plant. METHODS: The strategy adopted was of obtaining information about WRMSDs awareness at all workstations and from all their workers. This was based on: (i) questionnaire application - an adaptation of the Nordic musculoskeletal questionnaire, including a biomechanical item, (ii) WRMSDs clinical protocol (iii) RSI risk filter and Strain Index application, (iv) instrumentation with electrogoniometry and force sensors at previously classified as high risk workstations. RESULTS: WRMSDs signs and symptoms mainly in wrist/hands (n=27) and in lumbar region (n=32) were identified. Results revealed an important prevalence of WRULMSDs associated to meatpacking industry activities (30%) and high risk scores based on Strain Index (n=26 Right UL; n=7 Left UL). Instrumentation showed details of recurrency, of postures and of force, which can be used for intervention. CONCLUSIONS: Its necessary to develop ergonomic strategies and approaches on WRMSDs prevention (risk assessment and management) that will lead to changes on workstations and working processes.

Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retrospective cohort study

Abstract Objective To analyse the variation in the rate of adverse events (AEs) between acute hospitals and explore the extent to which some patients and hospital characteristics influence the differences in the rates of AEs. Design Retrospective cohort study. Chi-square test for independence and binary logistic regression models were used to identify the potential association of some patients and hospital characteristics with AEs. Setting Nine acute Portuguese public hospital centres. Participants A random sample of 4250 charts, representative of around 180 000 hospital admissions in 2013, was analysed. Intervention To measure adverse events based on chart review. Main Outcome Measure Rate of AEs. Results Main results: (i) AE incidence was 12.5%; (ii) 66.4% of all AEs were related to Hospital-Acquired Infection and surgical procedures; (iii) patient characteristics such as sex (female 11%; male 14.4%), age (≥65 y 16.4%; <65 y 8.5%), admission coded as elective vs. urgent (8.6% vs. 14.6%) and medical vs. surgical Diagnosis Related Group code (13.4% vs. 11.7%), all with p < 0.001, were associated with a greater occurrence of AEs. (iv) hospital characteristics such as use of reporting system (13.2% vs. 7.1%), being accredited (13.7% vs. non-accredited 11.2%), university status (15.9% vs. non-university 10.9%) and hospital size (small 12.9%; medium 9.3%; large 14.3%), all with p < 0.001, seem to be associated with a higher rate of AEs. Conclusions We identified some patient and hospital characteristics that might influence the rate of AEs. Based on these results, more adequate solutions to improve patient safety can be defined.

Exigências visuais e fadiga visual em médicos oftalmologistas

Background Visual demands, especially for near vision, are becoming increasingly more frequent at the workplace, and might cause visual fatigue or asthenopia. The tasks performed by ophthalmologists involve visual effort, raising interest in their study within the context of occupational health. Objectives To estimate the prevalence of visual complaints and its relationship to work demands among ophthalmologists at a university hospital in Lisbon. Methods Occurrence of visual fatigue symptoms was assessed by means of a symptom questionnaire - College of Optometrists in Vision Development Quality of Life (COVD-QoL) - and through the identification of near points of accommodation and convergence. Schirmers test was used to assess tear production. The results were analyzed by means of descriptive statistics, Spearmans coefficient and the Wilcoxon test for p<0.05. Results Most among the 27 analyzed physicians reported visual fatigue (n=25), dry eyes and frequent blinking (n=27). Schirmers test evidenced differences at the end of the working day and the near points of accommodation and convergence indicated occurrence of visual fatigue. Conclusions The results showed significant differences between the beginning and the end of the working day among ophthalmologists, with occurrence of visual fatigue at the end of the working day. These findings point to the need to implement a health surveillance program to prevent occupational visual disorders.Background Visual demands, especially for near vision, are becoming increasingly more frequent at the workplace, and might cause visual fatigue or asthenopia. The tasks performed by ophthalmologists involve visual effort, raising interest in their study within the context of occupational health. Objectives To estimate the prevalence of visual complaints and its relationship to work demands among ophthalmologists at a university hospital in Lisbon. Methods Occurrence of visual fatigue symptoms was assessed by means of a symptom questionnaire - College of Optometrists in Vision Development Quality of Life (COVD-QoL) - and through the identification of near points of accommodation and convergence. Schirmers test was used to assess tear production. The results were analyzed by means of descriptive statistics, Spearmans coefficient and the Wilcoxon test for p<0.05. Results Most among the 27 analyzed physicians reported visual fatigue (n=25), dry eyes and frequent blinking (n=27). Schirmers test evidenced differences at the end of the working day and the near points of accommodation and convergence indicated occurrence of visual fatigue. Conclusions The results showed significant differences between the beginning and the end of the working day among ophthalmologists, with occurrence of visual fatigue at the end of the working day. These findings point to the need to implement a health surveillance program to prevent occupational visual disorders.

Salud y Seguridad del Trabajo en Portugal: apuntes diversos

In the present work, the author analyzes several aspects of Occupational Health and Safety (OHS) in Portugal. He provides evidence sustaining the assumption of an important progress, since the mid-nineties, in the improvement of the working conditions from an OHS perspective. Nevertheless, several problems still remain in the practical application of legal regulations. In addition, despite of these improvements, the frequency rates of working accidents and occupational diseases remain very high. Hence, more “aggressive” strategies are required to increase the awareness of the Portuguese society relative to the OHS public policies, whose effectiveness has been demonstrated either in terms of occupational risks prevention and workers health promotion. The protection of workers’ health and safety at the workplace must then be assumed as an activity of indisputable utility by all stakeholders. The political agenda must thus promote even more the promotion of