Comparación del estrés en universitarios de enfermería de primer año y egresos de la carrera

Objective: To compare stress levels in freshman and senior nursing students. Method: A cross-sectional study was carried out in a public federal university of the state of Bahia, with students who answered questionnaires about sociodemographic variables, academic life, and a scale for assessing stress in nursing students. Chi-square and Fisher’s exact tests were applied to analyze the relationship between variables. To assess proportional trends between ordinal variables and groups, a chi-square test for linear trend was applied. The significance level was 5%. Results: One hundred and fifty-four students participated in the study. There was a tendency to higher stress levels among students in the last year compared to those in the first year, in four out of six domains: Performance of Practical Activities (p=0.00), Professional Communication (p=0.00), Environment (p=0.00) and Professional Education (p=0.00). Conclusion: High levels of stress were observed in students taking the last year. There is a need for broader research that includes other years of the course, an institutional reflection on stress factors and the adoption of an institutional policy that favors a better confrontation of stress factors.Objetivo: Comparar o nível de estresse de universitários de enfermagem ingressantes e concluintes do curso. Método: Estudo transversal, desenvolvido em uma universidade pública federal, do estado da Bahia, com estudantes que responderam a questionários sobre variáveis sociodemográficas, vida acadêmica e a escala para Avaliação de Estresse em Estudantes de Enfermagem. Para avaliar as relações entre as variáveis empregaram-se os testes do Qui-quadrado de Pearson e Exato de Fisher. Para verificar tendências proporcionais entre variáveis do tipo ordinal e os grupos utilizou-se do Teste Qui-Quadrado de Tendência Linear. O nível de significância estatística foi de 5%. Resultados: Participaram 154 estudantes. Houve tendência a maior nível de estresse em estudantes do último ano comparados aos do primeiro, em quatro dos seis domínios: Realização das atividades práticas (p=0,00), Comunicação profissional (p=0,00), Ambiente (p=0,00) e Formação profissional (p=0,00). Conclusão: Constatou-se níveis elevados de estresse no último ano. Ressalta-se a necessidade de ampliação da investigação para outros anos do curso, a reflexão institucional sobre os fatores estressores e a adoção de uma política institucional que propicie melhor enfrentamento dos estressores.Objetivo: Comparar el nivel de estrés de universitarios de enfermería de primer año y egresos de la carrera. Método: Estudio transversal, desarrollado en una universidad pública federal, del Estado de Bahía, con estudiantes que respondieron a cuestionarios acerca de variables sociodemográficas, vida académica y la escala para la Evaluación de Estrés en Estudiantes de Enfermería. Para valorar las relaciones entre las variables, se emplearon las pruebas de Chi cuadrado de Pearson y Exacta de Fisher. A fin de verificar tendencias proporcionales entre variables del tipo ordinal y los grupos, se utilizó la Prueba Chi cuadrado de Tendencia Lineal. El nivel de significación estadística fue del 5%. Resultados: Participaron 154 estudiantes. Hubo tendencia a un mayor nivel de estrés en estudiantes del último año comparados con los del primero, en cuatro de los seis dominios: Realización de las actividades prácticas (p=0,00), Comunicación profesional (p=0,00), Ambiente (p=0,00) y Formación profesional (p=0,00). Conclusión: Se constataron niveles elevados de estrés en el último año. Se subraya la necesidad de ampliación de la investigación a otros años de la carrera, la reflexión institucional acerca de los factores de estrés y la adopción de una política institucional que facilite un mejor enfrentamiento de dichos factores

Lack of association between rrl and erm(41) mutations and clarithromycin resistance in Mycobacterium abscessus complex

BACKGROUND Mycobacterium abscessus complex (MABC) includes species with high resistance rates among mycobacterial pathogens. In fact, MABC infections may not respond to clarithromycin treatment, which has historically been very effective against MABC infection. Molecular markers have been proposed to detect both acquired (rrl polymorphisms) and inducible (erm(41) polymorphisms) clarithromycin resistance in MABC isolates. OBJECTIVES This study aimed to evaluate the susceptibility profile and molecular markers of clarithromycin resistance in MABC. METHODS The clarithromycin susceptibility profile was determined by broth microdilution with reads on days 3, 5, 7 and 14. Mutations in the rrl and erm(41) genes were evaluated by polymerase chain reaction (PCR) using specific primers, followed by sequencing. FINDINGS A total of 14 M. abscessus subsp. abscessus isolates and 28 M. abscessus subsp. massiliense isolates were evaluated, and clarithromycin resistance was observed in all isolates for up to three days of incubation. None of the 42 isolates exhibited a point mutation in the rrl gene, while all the isolates had a T28 polymorphism in the erm(41) gene. Moreover, all 28 M. abscessus subsp. massiliense isolates had a deletion in the erm(41) gene. MAIN CONCLUSIONS While all the MABC isolates exhibited acquired clarithromycin resistance, no isolates exhibited a point mutation in the rrl gene in this study. The M. abscessus subsp. massiliense isolates demonstrated clarithromycin resistance, which is an uncommon phenotype. The molecular data for the rrl and erm(41) genes were not consistent with the phenotypic test results of clarithromycin susceptibility, indicating a lack of correlation between molecular clarithromycin resistance markers for both acquired and inducible resistance

Tools for communicating agricultural drought over the Brazilian Semiarid using the soil moisture index

Soil moisture over the Brazilian semiarid region is presented in different visualizations that highlight spatial, temporal and short-term agricultural risk. The analysis used the Soil Moisture Index (SMI), which is based on a normalization of soil moisture by field capacity and wilting point. The index was used to characterize the actual soil moisture conditions into categories from severe drought to very wet. In addition, the temporal evolution of SMI was implemented to visualize recent trends in short-term drought and response to rainfall events at daily time steps, as new data are available. Finally, a visualization of drought risk was developed by considering a critical value of SMI (assumed as 0.4), below which water stress is expected to be triggered in plants. A novel index based on continuous exposure to critical SMI was developed to help bring awareness of real time risk of water stress over the region: the Index of Stress in Agriculture (ISA). The index was tested during a drought over the region and successfully identified locations under water stress for periods of three days or more. The monitoring tools presented here help to describe the real time conditions of drought over the region using daily observations. The information from those tools support decisions on agricultural management such as planting dates, triggering of irrigation, or harvesting.Peer ReviewedPostprint (published version

Incidência de nefropatia diabética tipo 1 e tipo 2 em pacientes internados em clínica médico-cirúrgica: subsídios para elaboração de um protocolo de assistência de enfermagem / Incidence of type 1 and type 2 diabetic nephropathy in patients admitted to a medical-surgical clinic: subsidies for the elaboration of a nursing care protocol

Objetivo: Avaliar a incidência de nefropatia diabética em pacientes portadores de diabetes mellitus tipo 1 e tipo 2 em unidades de internação clínica e cirúrgica. Elaborar um protocolo de assistência de enfermagem para pacientes com nefropatia diabética tipo 1 e 2. Método: Trata-se de um estudo exploratório, descritivo, de corte transversal e com abordagem quantitativa. A pesquisa foi realizada nas unidades de Internação clínica e cirúrgica de um hospital de ensino na zona central do município de São Paulo. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa (CEP) da ISCMSP, atendendo a resolução 466/2012, registrado sob nº CAAE 20709219.9.0000.5479. Resultados: A amostra foi composta por 27 pacientes, com idade média foi de 62,2 anos, predomínio de mulheres (74,0 %), negras (40,7 %), solteiras (40,7 %), do lar (55,6%), católicas (51,8 %), procedente da região sudeste, da cidade de São Paulo (44,4%), com predomínio do DM tipo 2 (88,9 %), com tempo médio de diagnóstico da doença de 144 meses, HAS e outras cardiopatias como IAM e IC, 85,2%, com antecedentes familiares de DM 44,4%, em uso de insulina como tratamento do DM (85,1%), com tempo médio de uso de insulina de 52 meses. Já para os hipoglicemiantes orais a média foi de 81,6 meses, que não internaram por descompensação diabética (74%), sem complicações decorrentes do DM (66,7%), que reconhecem os sinais e sintomas da doença quando descompensada (70,4%) e que tem conhecimento sobre as complicações da doença (51,9%). Observa-se um perfil de pacientes que não usam insulina (37%), os que usam fazem rodízio nos locais de aplicação (48,1%) e tem uma média de UI aplicadas de 4,4, com DP ±8,4. Em relação à avaliação renal na admissão do paciente, os pacientes tinham uma média de 1,27 mg/dL para creatinina, 49,2 para ureia mg/dL e 321,5 mL de volume urinário 24 horas. No dia da coleta de dados, média de 1,21 mg/dL de creatinina, 55,7 de uréia mg/dL e 215,5 mL de volume urinário. O desfecho de alteração da função renal mostra que 85,2% (n=23) dos pacientes não apresentaram disfunção renal e 14,8% (n=4) apresentaram alterações (LRA, DRC e ttansplantes). Conclusão: o DM é um problema de saúde relevante, o qual está associado a fatores demográficos, como idade avançada e outras condições de saúde, como a HAS, somando-se a isso, as complicações renais irreversíveis que o DM pode desencadear. Tais condições levam a uma condição de controle de saúde e da qualidade de vida dos pacientes comprometidas pelo DM descontrolado, desconhecimento da forma de controle e eficácia do tratamento além dos desfechos diante das complicações, do impacto emocional que podem ser observados. A proposta de intervenção pode ser de acesso a todos os pacientes de forma a prevenir o agravo do DM e enfrentamento da doença

Doença pulmonar por micobactérias não tuberculosas em uma região de alta incidência de tuberculose no Brasil

Objective: The incidence of lung disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. In Brazil, there are few studies about nontuberculous mycobacterial lung disease (NTMLD), and its prevalence is yet to be known. Our objective was to determine the specific etiology of the disease in the state of Rio Grande do Sul, Brazil, as well as the frequency and diversity of NTM species in our sample of patients. Methods: This is a retrospective analysis of the medical records of patients diagnosed with NTMLD treated in a referral center located in the city of Porto Alegre, Brazil, between 2003 and 2013. Results: Our sample comprised 100 patients. The most prevalent NTM species were Mycobacterium avium complex (MAC), in 35% of the cases; M. kansasii, in 17%; and M. abscessus, in 12%. A total of 85 patients had received previous treatment for tuberculosis. Associated conditions included structural abnormalities in the lungs, such as bronchiectasis, in 23% of the cases; COPD, in 17%; and immunosuppressive conditions, such as AIDS, in 24%. Conclusions: MAC and M. kansasii were the most prevalent species involved in NTMLD in the state, similarly to what occurs in other regions of Brazil. Data on regional epidemiology of NTMLD, its specific etiology, and associated conditions are essential to establish appropriate treatment, since each species requires specific regimens. Most patients with NTMLD had received previous tuberculosis treatment, which might lead to development of resistance and late diagnosis.Objetivo: A incidência de doença pulmonar causada por micobactérias não tuberculosas (MNT) tem aumentado em todo o mundo. No Brasil, há poucos estudos sobre doença pulmonar por MNT, e sua prevalência ainda não é conhecida. Nosso objetivo foi determinar a etiologia específica da doença no estado do Rio Grande do Sul, bem como a frequência e a diversidade das espécies de MNT em nossa amostra de pacientes. Métodos: Análise retrospectiva dos prontuários de pacientes diagnosticados com doença pulmonar por MNT atendidos em um centro de referência localizado na cidade de Porto Alegre, RS, entre 2003 e 2013. Resultados: Nossa amostra foi composta por 100 pacientes. As espécies de MNT mais prevalentes foram Mycobacterium avium complex (MAC, complexo M. avium), em 35% dos casos; M. kansasii, em 17%; e M. abscessus, em 12%. Um total de 85 pacientes havia feito tratamento anterior para tuberculose. Condições associadas incluíram anormalidades estruturais nos pulmões, como bronquiectasias, em 23% dos casos; DPOC, em 17%; e condições imunossupressoras, como AIDS, em 24%. Conclusões: MAC e M. kansasii foram as espécies mais prevalentes envolvidas na doença pulmonar por MNT no estado, à semelhança do que ocorre em outras regiões do Brasil. Dados sobre a epidemiologia regional da doença pulmonar por MNT, sua etiologia específica e condições associadas são fundamentais para se estabelecer um tratamento adequado, já que cada espécie requer um esquema específico. A maioria dos pacientes com doença pulmonar por MNT havia feito tratamento anterior para tuberculose, o que pode levar a desenvolvimento de resistência e diagnóstico tardio

Outer membrane vesicles (OMV) production of Neisseria meningitidis serogroup B in batch process

AbstractSerogroup B outer membrane vesicles (OMV) with iron regulated proteins (IRP) from Neisseria meningitidis constitute the antigen for the vaccine against the disease caused by this bacterium. Aiming to enhance final OMV concentration, seven batch experiments were carried out under four different conditions: (i) with original Catlin medium; (ii) with original Catlin medium and lactate and amino acids pulse at the 6th cultivation hour; (iii) with Catlin medium with double initial concentrations of lactate and amino acids and (iv) Catlin medium without glycerol and with double initial concentrations of lactate and amino acids. The cultivation experiments were carried out in a 7-L bioreactor under the following conditions: 36°C, 0.5atm, overlay air 1L/min, agitation: 250–850rpm, and O2 control at 10%, 20h. After lactate and amino acids exhaustion, cell growth reached stationary phase and a significant release increase of OMV was observed. According to the Luedeking & Piret model, OMV liberation is non-growth associated. Glycerol was not consumed during cultivation. The maximum OMV concentration value attained was 162mg/L with correspondent productivity of 8.1mg/(Lh) employing Catlin medium with double initial concentrations of lactate and amino acids. The obtained OMV satisfied constitution and protein pattern criteria and were suitable for vaccine production

Plotting the Profile of a Sample of Crack Users in Treatment

Via analysis of the demographics in a sample of crack users, this study aimed to contribute to the knowledge of risk factors and drivers of health vulnerability of the population studied. The study included 45 women with a mean age of 29.11 years (SD = 7.99) in rehabilitation clinical (34) and therapeutic communities (11) in the Brazilian states of Paraiba (PB) and Pernambuco (PE). As an instrument, a demographic questionnaire was used and analyzed via descriptive statistics with software SPSS / PASW version 21.0. The results showed a profile of users mostly young people of reproductive age and maternal experiences, with low levels of education and out of the formal labor market. These data demonstrate the need for greater investment in health and education in this age of the study population and the importance of improving public policies in this area in order to reduce vulnerability and the biopsychosocial impact

Incidence of diarrhea: poor parental recall ability

Several methodological issues may have an impact on the incidence rates of childhood acute diarrhea reported by community-based studies. This study was performed to assess the impact of parental recall ability and definition of diarrhea on the estimate of incidence of acute diarrhea. Eighty-four children younger than 40 months were randomly selected and visited every other day for four weeks and the occurrence of diarrhea was registered. On the last day of the study, another visit was performed and the informants were inquired about the occurrence of diarrhea during the previous four weeks. Data gathered during the four weeks were compared to those obtained on the last visit. Additionally, the informants' definition of diarrhea was investigated and compared to the one adopted by this study. During the observation period, 33 children suffered diarrhea, but only 10 (30.3%) informants reported the occurrence of diarrhea. Although 42.4% of those informants reported that their children had been ill over that period, they did not report diarrhea. Further, 60.6% children who had diarrhea suffered at least one episode in the two weeks prior to the visitation. The same definition of diarrhea used in this study was adopted by 52.1% of the informants inquired. Parental recall is an unreliable method to estimate the incidence of diarrhea and studies with a short interval between the visits should be necessary to correctly evaluate this important health problem. Moreover, assessing the informants' own definition of diarrhea is a significant contribution to the interpretation of the results.Federal University of Bahia School of Medicine Professor Hosannah Oliveira Pediatric CenterFederal University of São Paulo Department of Pediatric Nutrition DivisionUNIFESP, Department of Pediatric Nutrition DivisionSciEL

Development and Validation of a PCR-ELISA for the Diagnosis of Symptomatic and Asymptomatic Infection by Leishmania (Leishmania) infantum

A kDNA PCR enzyme-linked immunosorbent assay (kDNA PCR-ELISA) for the diagnosis of human visceral leishmaniasis (HVL) was developed. The detection limit of the reaction, precision measurements, and cut-off of the kDNA PCR-ELISA were defined in a proof-of-concept phase. A reference strain of Leishmania (Leishmania) infantum and a bank of 14 peripheral blood samples from immunocompetent patients with VL were characterized using techniques considered gold standards, and 11 blood samples obtained from healthy individuals of an endemic area were also assessed. Phase II evaluation determined the performance of the assay in peripheral blood samples from 105 patients with VL (adults and children), 25 patients with Leishmania/HIV coinfection, 40 healthy individuals, and 33 asymptomatic individuals living in endemic areas. The kDNA PCR-ELISA exhibited satisfactory precision, with a detection limit of 0.07 fg of DNA from L. (L.) infantum and 1 parasite/mL blood. The overall sensitivity of the assay for all groups studied was 100% (95% confidence interval [CI]: 97.1–100%), and the specificity was 95% (95% CI: 83.5–98.6%). The kDNA PCR-ELISA was shown to be a useful tool for VL symptomatic and asymptomatic individuals diagnosis and its use in endemic countries may help monitor control interventions