Estresse dos enfermeiros atuantes em UTI nas regiões do Brasil

Introduction: This research is based on a survey regarding he level of stress and the stressors in ICU nurses in the regions of Brazil. The study received approval from the Local Research Ethics Committee.Methodology: The data were collected from May to December 2005. The Bianchi Stress Scale, constituted by a socio-demographic categorization and 51 items about activities performed by nurses, was used.Sample: The sample was comprised of 263 ICU nurses working in high - complexity hospitals of Brazilian state capitals. The sample was predominantly female (91.6%) and young (80.2% < 40 years old). Of the total sample, 87.8% were assistential nurses and 74.5% held a postgraduate degree.Results: Considering the stressors score by region, the results showed that Southeast (SE) > Central-West (CW) > North (N) > Northeast (NE) > South (S). Nurses in the Southeast region had higher levels of stress when compared with those in the Northeast in domain C, and this result is statistically significant.Conclusion: The study evidentiates the need to better prepare nurses to overcome difficulties by providing them with accessible tools in order to assess stressors based on the available coping mechanisms, thus lowering the occurrence of individual stress.Introducción: El estudio propone un informe del nivel de estrés y de los estresores presentes en los enfermeros que actúan en las UCIs de las regiones de Brasil. El estudio fue sometido y aprobado por la Comissão de Ética em Pesquisa local.Metodología: Los datos fueron colectados en el período de mayo a diciembre de 2005, utilizándose la Escala Bianchi de Stress, constituida por caracterización sociodemográfica y 51 items que versan sobre las actividades desempeñadas por los enfermeros.Resultados: La población fue de 263 enfermeros actuantes en las UCIs de hospitales de alta complejidad de las capitales de los estados brasileños. La muestra tuvo predominio femenino (91,6%), jóvenes (80,2% < 40 anos), siendo 87,8% asistenciales y 74,5% con post-graduación. Considerándose la puntuación de estresores por región, se obtuvo que Sudeste>Centro-Oeste>Norte>Nordeste>Sur. Los enfermeros de la Región Sudeste presentaron niveles de estrés más elevados comparados a los del Nordeste en el dominio C, siendo estadísticamente significante.Conclusión: En el estudio resulta evidente la necesidad de instrumentalizar cada vez más al enfermero para que la evaluación del estresor sea hecha basándose en los mecanismos de enfrentamiento disponibles, posibilitando la menor ocurrencia de estrés para el individuo.Introdução: O estudo propõe um levantamento do nível de estresse e dos estressores presentes nos enfermeiros que atuam nas UTIs das regiões do Brasil. O estudo foi submetido e aprovado pela Comissão de Ética em Pesquisa local.Metodologia: Os dados foram coletados no período de maio a dezembro de 2005, utilizando-se a Escala Bianchi de Stress, constituída por caracterização sociodemográfica e 51 itens que versam sobre as atividades desempenhadas pelos enfermeiros.Resultados: A população foi de 263 enfermeiros atuantes nas UTIs de hospitais de alta complexidade das capitais dos estados brasileiros. A amostra teve predomínio feminino (91,6%), jovens (80,2% < 40 anos), sendo 87,8% assistenciais e 74,5% com pós-graduação. Considerando-se o escore de estressores por região, obteve-se que Sudeste>Centro-Oeste>Norte>Nordeste>Sul. Os enfermeiros da Região Sudeste apresentaram níveis de estresse mais elevados comparados aos da Nordeste no domínio C, sendo estatisticamente significante.Conclusão: No estudo fica evidente a necessidade de se instrumentalizar cada vez mais o enfermeiro para que a avaliação do estressor seja feita com base nos mecanismos de enfrentamento disponíveis, possibilitando a menor ocorrência de estresse para o indivíduo

Prevalence of human papillomavirus in young Italian women with normal cytology: how should we adapt the national vaccination policy?

Background: Human Papillomavirus (HPV) is the most common sexually transmitted infection. In Italy, HPV vaccination is now offered free of charge to 12-year-old females. However, some regional health authorities have extended free vaccination to other age-groups, especially to girls under 18 years of age. We conducted a multicentre epidemiological study to ascertain the prevalence of different genotypes of HPV in young Italian women with normal cytology, with the aim of evaluating the possibility of extending vaccination to older females.Methods: The study was performed in 2010. Women aged 16-26 years with normal cytology were studied. Cervical samples were analyzed to identify the presence of HPV by PCR amplification of a segment of ORF L1 (450 bp). All positive HPV-DNA samples underwent viral genotype analysis by means of a restriction fragment length polymorphism assay.Results: Positivity for at least one HPV genotype was found in 18.2% of the 566 women recruited: 48.1% in the 16-17 age-class, 15.4 in the 18-20 age-class, 21.9% in the 21-23 age-class, and 15.5% in the 24-26 age-class; 10.1% of women were infected by at least one high-risk HPV genotype. HPV-16 was the most prevalent genotype. Only 4 (0.7%), 4 (0.7%) and 3 (0.5%) women were infected by HPV-18, HPV-6 and HPV-11, respectively. Of the HPV-DNA-positive women, 64.1% presented only one viral genotype, while 24.3% had multiple infections. The HPV genotypes most often involved in multiple infections were high-risk. A high prevalence was noted in the first years of sexual activity (48.1% of HPV-DNA-positive women aged 16-17 years); HPV prevalence subsequently declined and stabilized.The estimate of cumulative proportions of young women free from any HPV infection at each age was evaluated; 93.3% and 97.1% of 26 year-old women proved free from HPV-16 and/or HPV-18 and from HPV-6 and/or HPV-11, respectively.Conclusions: Our findings confirm the crucial importance of conducting studies on women without cytological damage, in order to optimise and up-date preventive interventions against HPV infection, and suggest that vaccinating 26-year-old females at the time of their first pap-test is to be recommend, though this issue should be further explored

Molecular characterization and phylogenetic analysis of human influenza A viruses in three consecutive seasons with different epidemiological profiles

Introduction. Influenza activity and influenza virus circulation were observed in Lombardy (northern Italy) during three con- secutive seasons and the molecular characteristics of circulating viruses analysed to control for introduction of new variants. Methods. The molecular characterization of 38 isolates, namely 20 A/H3N2 and 18 A/H1N1 influenza strains from the 2005/06, 2006/07 and 2007/08 seasons, was performed by sequence analy- sis of the globular head region of the HA protein (HA1 subunit), specific for influenza virus A/H3 and A/H1. Results and discussion. The last three influenza seasons in the study region were characterized by medium-low activity. A typical co-circulation of several variants was shown for A/H3 viruses for approximately two years and were subsequently almost entirely substituted by new emerging variants. Vice versa, A/H1 viruses had a more homogeneous circulation with a single lineage clearly dominating each season. The HA sequences of the A/H3 and the A/H1 viruses isolated in the last three seasons fell into 4 and 3 principal phylogenetic groups, respectively. No evidence of positive or negative selection in the sequence align- ments was observed. Conclusions. Molecular characterization of the influenza viruses in three consecutive seasons highlighted considerable heteroge- neity in their HA sequences. A careful surveillance of genetic changes in the HA1 domain during seasonal influenza epidemics may reveal immune escape and provide early information on newly emerging strains with epidemiologic inference

Loop Quantum Gravity a la Aharonov-Bohm

The state space of Loop Quantum Gravity admits a decomposition into orthogonal subspaces associated to diffeomorphism equivalence classes of spin-network graphs. In this paper I investigate the possibility of obtaining this state space from the quantization of a topological field theory with many degrees of freedom. The starting point is a 3-manifold with a network of defect-lines. A locally-flat connection on this manifold can have non-trivial holonomy around non-contractible loops. This is in fact the mathematical origin of the Aharonov-Bohm effect. I quantize this theory using standard field theoretical methods. The functional integral defining the scalar product is shown to reduce to a finite dimensional integral over moduli space. A non-trivial measure given by the Faddeev-Popov determinant is derived. I argue that the scalar product obtained coincides with the one used in Loop Quantum Gravity. I provide an explicit derivation in the case of a single defect-line, corresponding to a single loop in Loop Quantum Gravity. Moreover, I discuss the relation with spin-networks as used in the context of spin foam models.Comment: 19 pages, 1 figure; v2: corrected typos, section 4 expanded

Heterogeneous Host Susceptibility Enhances Prevalence of Mixed-Genotype Micro-Parasite Infections

Dose response in micro-parasite infections is usually shallower than predicted by the independent action model, which assumes that each infectious unit has a probability of infection that is independent of the presence of other infectious units. Moreover, the prevalence of mixed-genotype infections was greater than predicted by this model. No probabilistic infection model has been proposed to account for the higher prevalence of mixed-genotype infections. We use model selection within a set of four alternative models to explain high prevalence of mixed-genotype infections in combination with a shallow dose response. These models contrast dependent versus independent action of micro-parasite infectious units, and homogeneous versus heterogeneous host susceptibility. We specifically consider a situation in which genome differences between genotypes are minimal, and highly unlikely to result in genotype-genotype interactions. Data on dose response and mixed-genotype infection prevalence were collected by challenging fifth instar Spodoptera exigua larvae with two genotypes of Autographa californica multicapsid nucleopolyhedrovirus (AcMNPV), differing only in a 100 bp PCR marker sequence. We show that an independent action model that includes heterogeneity in host susceptibility can explain both the shallow dose response and the high prevalence of mixed-genotype infections. Theoretical results indicate that variation in host susceptibility is inextricably linked to increased prevalence of mixed-genotype infections. We have shown, to our knowledge for the first time, how heterogeneity in host susceptibility affects mixed-genotype infection prevalence. No evidence was found that virions operate dependently. While it has been recognized that heterogeneity in host susceptibility must be included in models of micro-parasite transmission and epidemiology to account for dose response, here we show that heterogeneity in susceptibility is also a fundamental principle explaining patterns of pathogen genetic diversity among hosts in a population. This principle has potentially wide implications for the monitoring, modeling and management of infectious diseases

The Spin Foam Approach to Quantum Gravity

This article reviews the present status of the spin foam approach to the quantization of gravity. Special attention is payed to the pedagogical presentation of the recently introduced new models for four dimensional quantum gravity. The models are motivated by a suitable implementation of the path integral quantization of the Plebanski formulation of gravity on a simplicial regularization. The article also includes a self-contained treatment of the 2+1 gravity. The simple nature of the latter provides the basis and a perspective for the analysis of both conceptual and technical issues that remain open in four dimensions.Comment: To appear in Living Reviews in Relativit

S100A7 (psoriasin) expression is associated with aggressive features and alteration of Jab1 in ductal carcinoma in situ of the breast

INTRODUCTION: The S100A7 (psoriasin) gene is highly expressed in ductal carcinoma in situ (DCIS) of the breast and can be downregulated in invasive carcinoma. Persistent S100A7 expression in invasive carcinoma is associated with a worse prognosis, and this effect may be mediated in part through interaction with the multifunctional cell signaling protein Jab1. METHODS: In order to investigate the relationship between S100A7 and progression from DCIS to invasive carcinoma, we studied S100A7 expression in 136 patients with DCIS (including 46 patients with associated invasive carcinoma) by immunohistochemistry. RESULTS: S100A7 expression was present in 63 out of 136 (46%) of DCIS lesions and was associated with estrogen receptor negative status (P = 0.0002), higher nuclear grade (P < 0.0001), necrosis (P < 0.0001) and inflammation (P < 0.0001). S100A7 status was no different between DCIS with and DCIS without an invasive component, but higher levels of S100A7 were present in DCIS associated with invasive carcinoma (P < 0.004). Analysis of a subset of cases showed that S100A7 expression was also associated with an increase in nuclear Jab1 (n = 43; P = 0.0019) and reduced p27(kip1 )(n = 47; P = 0.0168). In cases of DCIS associated with invasive carcinoma, there was also a significant reduction in S100A7 between in situ and invasive components (n = 46; P < 0.0001). In pure DCIS cases treated by local excision, there was no difference in frequency of S100A7 expression between patients with recurrence of DCIS (n = 9) and those without (n = 36). CONCLUSION: The findings reported here suggest that, although S100A7 may not be a marker for recurrence of DCIS, it is associated with poor prognostic markers in DCIS and may influence progression of breast carcinoma through its interaction with and influence on Jab1

The changing carbon cycle of the coastal ocean

The carbon cycle of the coastal ocean is a dynamic component of the global carbon budget. But the diverse sources and sinks of carbon and their complex interactions in these waters remain poorly understood. Here we discuss the sources, exchanges and fates of carbon in the coastal ocean and how anthropogenic activities have altered the carbon cycle. Recent evidence suggests that the coastal ocean may have become a net sink for atmospheric carbon dioxide during post-industrial times. Continued human pressures in coastal zones will probably have an important impact on the future evolution of the coastal ocean's carbon budget