Psychological Functioning and Disease-Related Quality of Life in Pediatric Patients With an Implantable Cardioverter Defibrillator

The objective of this multicenter study was to evaluate psychological functioning and disease-related quality of life (DRQoL) in pediatric patients with an implantable cardioverter defibrillator (ICD) in The Netherlands. Thirty patients were investigated; the mean age was 16.3 years, and the mean duration of implantation was 3.6 years. To assess psychological problems, three domains of the Symptom Checklist (SCL-90-R) were administered to the 25 patients >13 years old. DRQoL was assessed with a disease-specific pediatric questionnaire, the short-form 11-item Worries About (WA)ICDs Scale. Patients ≥13 years old scored significantly higher than the reference group on the domains of anxiety, depression, and sleeping problems of the SCL-90-R (T = 7.5, p < 0.001; T = 5.4, p < 0.001; and T = 7.8, p < 0.001, respectively). Patients who had received an (in)appropriate shock reported more depressive symptoms (T = 2.1, p < 0.03). Patients with >2 years implant duration (N = 19) or who had received an (in)appropriate shock (N = 13) showed lower DRQoL scores on the modified WAICD (T = 2.1, p < 0.04; T = 2.1, p < 0.5, respectively). Age at implantation or underlying disease did not influence psychological problems or DRQoL. Young ICD patients showed more anxiety, depression, and sleeping disorders. Worries were increased among patients with ICD shocks and in those who had their ICD implanted for >2 years. To determine psychological problems and help children to learn to cope with shocks, proper guidance and monitoring of young ICD patients are recommended

Restriction and Sequence Alterations Affect DNA Uptake Sequence-Dependent Transformation in Neisseria meningitidis

Transformation is a complex process that involves several interactions from the binding and uptake of naked DNA to homologous recombination. Some actions affect transformation favourably whereas others act to limit it. Here, meticulous manipulation of a single type of transforming DNA allowed for quantifying the impact of three different mediators of meningococcal transformation: NlaIV restriction, homologous recombination and the DNA Uptake Sequence (DUS). In the wildtype, an inverse relationship between the transformation frequency and the number of NlaIV restriction sites in DNA was observed when the transforming DNA harboured a heterologous region for selection (ermC) but not when the transforming DNA was homologous with only a single nucleotide heterology. The influence of homologous sequence in transforming DNA was further studied using plasmids with a small interruption or larger deletions in the recombinogenic region and these alterations were found to impair transformation frequency. In contrast, a particularly potent positive driver of DNA uptake in Neisseria sp. are short DUS in the transforming DNA. However, the molecular mechanism(s) responsible for DUS specificity remains unknown. Increasing the number of DUS in the transforming DNA was here shown to exert a positive effect on transformation. Furthermore, an influence of variable placement of DUS relative to the homologous region in the donor DNA was documented for the first time. No effect of altering the orientation of DUS was observed. These observations suggest that DUS is important at an early stage in the recognition of DNA, but does not exclude the existence of more than one level of DUS specificity in the sequence of events that constitute transformation. New knowledge on the positive and negative drivers of transformation may in a larger perspective illuminate both the mechanisms and the evolutionary role(s) of one of the most conserved mechanisms in nature: homologous recombination

Grau de satisfação de usuários de um hospital privado Grado de satisfacción de usuarios de un hospital privado Degree of satisfaction of users of a private hospital

OBJETIVOS: Conhecer o grau de satisfação dos usuários de um hospital privado e os fatores intervenientes nessa satisfação, baseado no modelo de Parasuraman, Zeithaml e Berry. MÉTODOS: Estudo exploratório descritivo de abordagem quantitativa realizado em um hospital privado com amostra constituída de 288 usuários. A coleta dos dados ocorreu de abril a julho de 2009, por meio de um questionário e a análise estatística descritiva e inferencial. RESULTADOS: Identificaram os níveis de satisfação dos usuários, bem como as dimensões com maior escore: garantia e confiabilidade e com menor escore: responsividade e empatia. As equipes de enfermagem e médica obtiveram as maiores pontuações. CONCLUSÕES: Observou-se a necessidade de intervenção nas áreas de nutrição e atendimento inicial. Assim, este estudo propiciou um diagnóstico multissetorial, subsidiando os gestores da instituição na revisão de processos assistenciais e gerenciais.<br>OBJETIVOS: Conocer el grado de satisfacción de usuarios de un hospital privado y los factores intervenientes en esa satisfacción, basado en el modelo de Parasuraman, Zeithaml y Berry. MÉTODOS: Estudio exploratorio descriptivo de abordaje cuantitativo realizado en un hospital privado con una muestra constituida por 288 usuarios. La recolección de los datos ocurrió de abril a julio de 2009, por medio de un cuestionario y el análisis estadístico descriptivo e inferencial. RESULTADOS: se identificaron los niveles de satisfacción de los usuarios, así como las dimensiones con mayor score: garantia y confiabilidad y con menor score: receptividad y empatía. Los equipos de enfermería y médica obtuvieron las mayores puntuaciones. CONCLUSIONES: Se observó la necesidad de intervención en las áreas de nutrición y atención inicial. Así, este estudio propició un diagnóstico multisectorial, subsidiando a los gestores de la institución en la revisión de procesos asistenciales y gerenciales.<br>OBJECTIVES: To know the degree of satisfaction of users of a private hospital and the factors involved in this satisfaction, based on the model of Parasuraman, Zeithaml and Berry. METHODS: A descriptive, exploratory, quantitative study conducted in a private hospital with a sample consisting of 288 users. Data collection occurred between April to July 2009, by means of a questionnaire and analysis using descriptive and inferential statistics. RESULTS: We identified levels of user satisfaction, and the dimensions with the highest scores: security and reliability, and with lower scores, responsiveness and empathy. The nursing and medical teams had the highest scores. CONCLUSIONS: There is a need for intervention in the areas of nutrition and initial care. Thus, this study provided a multisectoral diagnosis, assisting managers in reviewing the institution's clinical and managerial processes