Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico

Objetivos: Descrever as características do ambiente de trabalho, as atitudes de segurança, a qualidade do cuidado mensuradas pela equipe de enfermagem das unidades pediátricas e analisar a evolução dos indicadores assistenciais e de desempenho hospitalar.Método: Estudo descritivo com 136 profissionais de enfermagem de um hospital pediátrico, com aplicação da ficha de caracterização pessoal e profissional, Nursing Work Index – Revised, Safety Attitudes Questionnaire – Short form 2006 e dos indicadores de qualidade.Resultados: Os profissionais percebem o ambiente como favorável à prática profissional, avaliaram como boa a qualidade do cuidado e a redução de eventos adversos e da permanência hospitalar. O domínio satisfação no trabalho foi favorável à segurança do paciente.Conclusões: O ambiente de trabalho é favorável à prática de enfermagem, os profissionais aprovam a qualidade do cuidado e os indicadores apontam redução dos eventos adversos e da permanência hospitalar.Palavras-chave: Ambiente de instituições de saúde. Segurança do paciente. Qualidade da assistência à saúde. Satisfação no emprego. Avaliação de resultados da assistência ao paciente

Staphylococcus aureus Protein A Binds to Osteoblasts and Triggers Signals That Weaken Bone in Osteomyelitis

Osteomyelitis is a debilitating infectious disease of the bone. It is predominantly caused by S. aureus and is associated with significant morbidity and mortality. It is characterised by weakened bones associated with progressive bone loss. Currently the mechanism through which either bone loss or bone destruction occurs in osteomyelitis patients is poorly understood. We describe here for the first time that the major virulence factor of S. aureus, protein A (SpA) binds directly to osteoblasts. This interaction prevents proliferation, induces apoptosis and inhibits mineralisation of cultured osteoblasts. Infected osteoblasts also increase the expression of RANKL, a key protein involved in initiating bone resorption. None of these effects was seen in a mutant of S. aureus lacking SpA. Complementing the SpA-defective mutant with a plasmid expressing spa or using purified protein A resulted in attachment to osteoblasts, inhibited proliferation and induced apoptosis to a similar extent as wildtype S. aureus. These events demonstrate mechanisms through which loss of bone formation and bone weakening may occur in osteomyelitis patients. This new information may pave the way for the development of new and improved therapeutic agents to treat this disease

Extracellular Administration of BCL2 Protein Reduces Apoptosis and Improves Survival in a Murine Model of Sepsis

Severe sepsis and septic shock are major causes of morbidity and mortality worldwide. In experimental sepsis there is prominent apoptosis of various cell types, and genetic manipulation of death and survival pathways has been shown to modulate organ injury and survival.We investigated the effect of extracellular administration of two anti-apoptotic members of the BCL2 (B-cell lymphoma 2) family of intracellular regulators of cell death in a murine model of sepsis induced by cecal ligation and puncture (CLP). We show that intraperitoneal injection of picomole range doses of recombinant human (rh) BCL2 or rhBCL2A1 protein markedly improved survival as assessed by surrogate markers of death. Treatment with rhBCL2 or rhBCL2A1 protein significantly reduced the number of apoptotic cells in the intestine and heart following CLP, and this was accompanied by increased expression of endogenous mouse BCL2 protein. Further, mice treated with rhBCL2A1 protein showed an increase in the total number of neutrophils in the peritoneum following CLP with reduced neutrophil apoptosis. Finally, although neither BCL2 nor BCL2A1 are a direct TLR2 ligand, TLR2-null mice were not protected by rhBCL2A1 protein, indicating that TLR2 signaling was required for the protective activity of extracellularly adminsitered BCL2A1 protein in vivo.Treatment with rhBCL2A1 or rhBCL2 protein protects mice from sepsis by reducing apoptosis in multiple target tissues, demonstrating an unexpected, potent activity of extracellularly administered BCL2 BH4-domain proteins

fisheries and tourism social economic and ecological trade offs in coral reef systems

Coastal communities are exerting increasingly more pressure on coral reef ecosystem services in the Anthropocene. Balancing trade-offs between local economic demands, preservation of traditional values, and maintenance of both biodiversity and ecosystem resilience is a challenge for reef managers and resource users. Consistently, growing reef tourism sectors offer more lucrative livelihoods than subsistence and artisanal fisheries at the cost of traditional heritage loss and ecological damage. Using a systematic review of coral reef fishery reconstructions since the 1940s, we show that declining trends in fisheries catch and fish stocks dominate coral reef fisheries globally, due in part to overfishing of schooling and spawning-aggregating fish stocks vulnerable to exploitation. Using a separate systematic review of coral reef tourism studies since 2013, we identify socio-ecological impacts and economic opportunities associated to the industry. Fisheries and tourism have the potential to threaten the ecological stability of coral reefs, resulting in phase shifts toward less productive coral-depleted ecosystem states. We consider whether four common management strategies (unmanaged commons, ecosystem-based management, co-management, and adaptive co-management) fulfil ecological conservation and socioeconomic goals, such as living wage, job security, and maintenance of cultural traditions. Strategies to enforce resource exclusion and withhold traditional resource rights risk social unrest; thus, the coexistence of fisheries and tourism industries is essential. The purpose of this chapter is to assist managers and scientists in their responsibility to devise implementable strategies that protect local community livelihoods and the coral reefs on which they rely