Purpose: To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care. Data sources: Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish. Study selection: Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included. Data extraction: Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement. Results: The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'. Conclusion: The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.

A segurança do paciente como dimensão da qualidade do cuidado de saúde -um olhar sobre a literatura Patient safety as a dimension of the quality of health care -a look at the literature

The evaluation of the culture of patient safety in hospitals is nowadays considered as a management too, since it helps to identify problem areas and provide valuable information for planning improvements. This study explored the reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture, an instrument that evaluates characteristics of patient safety culture among hospital staff. The reliability of the instrument was evaluated by analyzing the internal consistency of each dimension. The validity of the tool was carried out by means of exploratory and confirmatory factor analysis. The sample was made up of 322 questionnaires that were collected in two Brazilian hospitals in 2012. Cronbach's alpha ranged from 0.52 to 0.91 for the different dimensions, with the exception of two, for which it was much lower. After excluding four items, the exploratory factor analysis presented adjusted indices that were appropriate for a 10 factor model.

A cultura de segurança, aspecto específico da cultura organizacional geral, é definida como o produto de valores, atitudes, competências e padrões de comportamento individuais e de grupo, os quais determinam o compromisso, o estilo e a proficiência da administração de uma organização saudável e segura 2 . Organizações com uma cultura de segurança positiva são caracterizadas pela comunicação fundada na confiança mútua, pelas percepções partilhadas da importância da segurança e pela confiança na efetividade de ações preventivas 3 .Avaliar cultura de segurança permite identificar e gerir prospectivamente questões relevantes de segurança nas rotinas e condições de trabalho. Esta abordagem permite acessar informações dos funcionários sobre suas percepções e comportamentos relacionados à segurança, identificando pontos fracos e fortes de sua cultura de segurança e as áreas mais problemáticas para que se possa planejar e implementar inter-NOTA RESEARCH NOTE

Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift to

Resumo: Eventos adversos constituem grave problema relacionado à qualidade do cuidado de saúde. A prática odontológica, por ser eminentemente invasiva e implicar contato íntimo e rotineiro com secreções, é potencialmente propícia à ocorrência desses eventos. Diversos estudos em segurança do paciente foram desenvolvidos nas duas últimas décadas, entretanto, em maior número no ambiente hospitalar, em função de sua complexidade organizacional, gravidade de casos, diversidade e especificidade de procedimentos. O objetivo foi identificar e explorar os estudos voltados à segurança do paciente odontológico. Foi realizada revisão integrativa da literatura com consulta ao MEDLINE via PubMed, Scopus via Portal Capes e ao Portal Regional da Biblioteca Virtual de Saúde, utilizando-se os termos segurança do paciente e odontologia nos idiomas inglês, espanhol e português a partir de 2000. Utilizou-se o ciclo de pesquisa em segurança do paciente, proposto pela Organização Mundial da Saúde para classificar os estudos incluídos. Foram analisados 91 artigos. Os eventos adversos mais comuns foram relacionados às alergias, às infecções, ao atraso ou falha de diagnóstico e ao erro da técnica. Medidas para mitigar o problema apontaram para a necessidade de melhoria da comunicação, incentivo à notificação e procura por instrumentos para auxiliar a gestão do cuidado. Constatou-se carência de estudos de implementação e avaliação de impacto das propostas de melhoria. A Odontologia evoluiu no campo da segurança do paciente, mas ainda está aquém de transpor resultados para a prática, sendo importante envidar esforços para prevenir os eventos adversos nesta área.

This study aimed to reassess the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) adapted to Portuguese for use in the Brazilian context. An observational, cross-sectional study was performed in a large, private, non-profit, acute care hospital, reference in patient safety, in a major Brazilian metropolis. Participants were selected from a non-probability sample of all eligible personnel in the various hospital departments invited to participate in the study. Reliability of the HSOPSC was assessed by estimating Cronbach's alpha for each dimension. confirmatory factor analysis (CFA), a matrix of correlations between the dimensions, and exploratory structural equation modelling (ESEM) were used in exploratory and confirmatory analyses of the structural validity of the construct. The overall response rate was 18.7% (n = 1,439). Four dimensions ("overall perceptions of patient safety"; "staffing"; "teamwork across units"; and "non-punitive response to error") returned problems of internal consistency. CFA returned acceptable fit with the original 12-dimension model. Correlations between the dimensions of the original 12-dimension model indicated discriminant validity problems, while residual variance was greater than 0.70 in 13 items. The ESEM of the original 12-dimension model returned good fit, with the following indices: CFI = 0.985; TLI = 0.968,). Although better than those of the first evaluation, the results obtained in this validity and reliability reassessment of the Brazilian version of the HSOPSC require further research. Patient Safety; Organizational Culture; Health Care Surveys; Reproducibility of Results Correspondence J. Laguardia BackgroundSafety culture comprises values, beliefs, and standards regarding what is important in an organization and what safety-related attitudes and behavior are valued, supported, and expected 1 . It is a multidimensional concept, defined in the health service context as the product of individual and group values, attitudes, perceptions, competences, and behavior patterns that determine the commitment to, and the style and proficiency of, an organization's patient safety management 2 .In health care organizations, safety culture assessment is a key strategy in the world movement to improve health care quality and patient safety. There is evidence of the association between high safety culture scores and positive clinical outcomes, especially in hospitals, as a result of interventions to improve the quality of patient care 3,4,5 .Among the instruments developed to assess safety culture in hospitals, the Hospital Survey on Patient Safety Culture (HSOPSC) is one of the most widely used 1,6 . Developed in American English by the Agency for Healthcare Research and Quality (AHRQ), this instrument contains 42 items and 12 dimensions and was conceived as a questionnaire to be self-administered, to ensure respondents' anonymity. The theoretical model underpinning its development is fully documented by the AHRQ 1 . Since its introduction in 2004, the...