Knowledge and attitudes of health care workers from intensive care units regarding nosocomial transmission of influenza: a study on the immediate pre-pandemic period

The transmission of influenza in health care settings is a major threat to patients, especially those with severe diseases. The attitude of health care workers (HCWs) may influence the transmission of countless infections. The current study aimed to quantify knowledge and identify attitudes of HCWs involved in intensive care units (ICUs) regarding the risk of nosocomial influenza transmission. A questionnaire was applied through interviews to HCWs who worked in one of the five ICUs from a teaching hospital. Questions about influenza were deliberately dispersed among others that assessed several infectious agents. Forty-two HCWs were interviewed: nine physicians, ten nurses and 23 nursing technicians or auxiliaries. Among the 42 HCWs, 98% were aware of the potential transmission of influenza virus in the ICUs, but only 31% would indicate droplet precautions for patients with suspected infection. Moreover, only 31% of them had been vaccinated against influenza in the last campaign (2008). Nursing technicians or auxiliaries were more likely to have been vaccinated, both by univariate and multivariable analysis. When asked about absenteeism, only 10% of the study subjects stated that they would not go to work if they had an influenza-like illness. Those findings suggest that, in non-pandemic periods, influenza control in hospitals requires strategies that combine continuous education with changes in organizational culture.Federal University of São Paulo Course of Health Care InfectionsSão Paulo State University Botucatu Medical School Department of Tropical DiseasesUNIFESP, Course of Health Care InfectionsSciEL

Investigating the Effects of a Task-Specific Fatigue Protocol on Hand Tracking Performance Using a Wrist Robotic Device

The purpose of this work was to evaluate the effects of a dynamic submaximal fatigue protocol and forearm/hand anthropometrics on hand tracking performance. Participants traced a 2:3 Lissajous curve using a haptic wrist robotic device (WristBot). This same curve was traced before the fatigue (baseline), during the fatigue protocol, and after the fatigue protocol. Post fatigue trials were completed at 0, 1, 2, 4, 6, 8, and 10 minutes after the cessation of the fatigue protocol. Overall tracking performance and movement smoothness decreased immediately. Directional biases in the normal and longitudinal component of tracking error were present after the fatigue protocol. Proximal forearm circumference and forearm length had a negative correlation with movement smoothness. Hand tracking performance decreased due to the submaximal fatigue protocol. Those with a larger proximal forearm circumference and longer forearm length had better movement smoothness performance which can be applied to the workplace where hand and wrist are predominately used

Emergency science: epistemological insights on the response to COVID-19 pandemics

The response to the current COVID-19 pandemics require reflections on the validity of scientific knowledge. While non-pharmacological measures for disease control are providing a worldwide natural experiment, it is highly advised to submit research findings to the scrutinity of renowed epistemologic theories. One should also consider the loosening of methodological criticism in time when diffusion of results is urgently required. Though criticism is perhaps most precious principle of scientific thinking and practice, scientists must find a way into relative consensus that can be translated into public health policies

Colonização nasal por staphylococcus aureus resistente à meticilina e mortalidade em pacientes de uma unidade de terapia intensiva

Nasopharyngeal colonization with Methicillin-resistant Staphylococcus aureus (MRSA) is common in critically ill patients, but its effect on patient prognosis is not fully elucidated. A retrospective cohort study was carried out enrolling 122 patients from an intensive care unit who were screened weekly for nasopharyngeal colonization with MRSA. The outcomes of interest were: general mortality and mortality by infection. Several exposure variables (severity of illness, procedures, intercurrences and MRSA nasopharyngeal colonization) were analyzed through univariate and multivariable models. Factors significantly associated with mortality in general or due to infection were: APACHE II and lung disease. The performance of surgery predicted favorable outcomes. MRSA colonization did not predict mortality in general (OR=1.02; 95%CI=0.35-3.00; p=0.97) or by infectious causes (OR=0.96; 95%CI=0.33-2.89; p=0.96). The results suggest that, in the absence of severity of illness factors, colonization with MRSA is not associated with unfavorable outcomes.La colonización nasofaríngea por el Staphylococcus aureus resistente a la meticilina (Methicillin-resistant S.aureus - MRSA) es común en pacientes críticamente enfermos, pero su efecto sobre el pronóstico no está completamente esclarecido. Fue realizado un estudio de Cohorte retrospectivo con 122 pacientes de una Unidad de Terapia Intensiva que realiza semanalmente exámenes para constatar la colonización nasofaríngea por MRSA. Lo encontrado de interés fue: mortalidad general y mortalidad por causas infecciosas. Diversas variables de exposición (gravedad, procedimientos ocurrencias y colonización nasofaríngea por MRSA) fueran analizadas en modelos univariados y multivariados. Los factores asociados significativamente a la mortalidad en general o por causas infecciosas fueran: APACHE II y enfermedad pulmonar. La realización de cirugía predijo mejor el pronóstico. La colonización por MRSA no predijo la mortalidad en general (OR=1.02; IC95%=0.35-3.00; p=0.97) o por causas infecciosas (OR=0.96; IC95%=0.33-2.89; p=0.96). Los resultados sugieren que, en la ausencia de factores de gravedad, la colonización por MRSA no se asocia al peor pronóstico.A colonização de nasofaringe por Staphylococcus aureus, resistente à meticilina (Methicillin-resistant S.aureus - MRSA), é comum em pacientes criticamente doentes, mas seu significado prognóstico não é inteiramente conhecido. Realizou-se estudo de coorte retrospectivo com 122 pacientes de uma unidade de terapia intensiva que realizaram triagem semanal para colonização por MRSA. Os desfechos de interesse foram: mortalidade geral e mortalidade por infecção. Diversas variáveis de exposição (gravidade, procedimentos, intercorrências e colonização nasofaríngea por MRSA) foram analisadas em modelos univariados e multivariados. Fatores significativamente associados à mortalidade geral ou por infecção foram: APACHE II e doença pulmonar. A colonização por MRSA não foi preditora de mortalidade geral (OR=1,02; IC95%=0,35-3; p=0,97) ou por infecção (OR=0,96; IC95%=0,33-2,89; p=0,96). Os resultados sugerem que, na ausência de fatores de gravidade, a colonização por MRSA não caracteriza pior prognóstico

ACTIVE CONTROL FOR THE RE-ENTRY OPERATION OF FLEXIBLE RISERS

International audienceThis paper presents an active control dedicated to a re-entry problem found in the offshore oil industry. The re-entry operation consists in connecting the bottom of a very long pipeline to the wellhead, by dynamically modifying the pipeline top position, which is linked to a floating device (vessel or plat- form). These long pipelines are usually called risers, because they are used to rise the drilling mud or the hydrocarbons from the wellhead to the platform. Nowadays the re-entry operation is done manu- ally. The use of an active control intends to reduce the operation time, and to make it possible even under bad weather conditions. The considered offshore structure can be analyzed as a cable submerged in a flow. A convenient model is given by the Bernoulli's historical cable equation, completed with a damping factor, that linearly depends on the structure speed. The damping factor is developed in series around zero, to get an approximate solution. The corresponding model turns out to be differentially flat[1], a property directly used in the control design, providing an extension to previous works of Petit and Rouchon [2], Thull et al [3], and Sabri [4]. This paper presents an overview of the results of [5]. Furthermore it contains material concerning a new tracking system, that uses the system inversion to define the feedback control

ACTIVE CONTROL AND MOTION PLANNING FOR OFFSHORE STRUCTURES

This paper presents an active control dedicated to the positioning of vertical offshore structures. The trajectory planning and the closed loop system use a convenient model given by the Bernoulli's historical cable equation, completed with a damping factor, that linearly depends on the structure speed. Its solution is directly used in the control design, providing an extension to previous works on control of heavy chains and offshore structures

Age Determination and Body Length Relationship of Two-Spot Red Snapper (Lutjanus bohar)

Otolith study on fifty two-spot red snappers (Lutjanus bohar) in the Davao Gulf, Philippines, was conducted to describe their growth pattern, determine the age structure, and estimate their age at sexual maturity. Samples were obtained from Toril and Bankerohan Public Markets in Davao from Februay to June 2015. Fish morphometrics, otolith extraction, and age determination followed. Length-weight relationship showed that L. bohar follows isometric growth pattern (b = 3.0015). Somatic and otolith morphometrics gave significant correlations where otolith length and total length relationship had the highest R2 value (R2= 0.9382). Out of the samples, twenty-one of the sagittal otoliths ranges from three to seven years old. The parameters obtained from the age-at-length data fitted to von Bertalanffy growth function were K = 0.81 and L∞ = 28.9 cm, with estimated age at maturity of six years old. The growth performance index (φ = 2.83) revealed that L. bohar in Davao Gulf has a faster growth rate. Faster growth rate leading to earlier maturity and smaller size-at-maturity may indicate the effects of environmental factors and fishing pressure to slow-growing fishes. We recommend studying the population ecology of L. bohar in Davao Gulf and considering a larger sample size in future researches

Suicide attempts among adolescents: epidemiological aspects of patients cared for in a university hospital psychiatric emergency unit between 1988 and 2004

Este estudo teve por objetivo analisar, comparativamente, a distribuição temporal de todos os casos de pacientes adolescentes, com idade entre 10 e 24 anos, atendidos no setor de urgências psiquiátricas de um grande hospital geral universitário, após tentativas de suicídio e uso/abuso de substâncias psicoativas, durante o período de 1988 a 2004. Estudou-se, especificamente, os casos de tentativas de suicídio, considerando sua distribuição quanto à idade, sexo e método utilizado. A partir de um estudo de casos, apontam-se dados sobre os motivos desencadeantes das tentativas e sobre as histórias de vida desses pacientes, possivelmente relacionados à ocorrência desse comportamento. Os dados foram obtidos por meio de um levantamento retrospectivo de todos os casos de pacientes adolescentes atendidos no setor de urgências psiquiátricas do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo, no período de 1988 a 2004, após tentativas de suicídio e uso/abuso de substâncias psicoativas, e de dez histórias clínicas obtidas por meio de entrevistas realizadas com pacientes adolescentes, selecionados ao acaso, atendidos no setor por tentativas de suicídio. Os resultados mostraram uma forte correlação positiva entre os números de casos anualmente atendidos por tentativas de suicídio e os devidos ao uso/abuso de substâncias psicoativas, tanto para os adolescentes do sexo masculino (r=0,70, p=0,0037), quanto para os do sexo feminino (r=0,81, p=0,0002). As tentativas de suicídio foram significativamente mais freqüentes no sexo feminino, e o método mais utilizado para esse comportamento foi o envenenamento, preferencialmente com medicamentos. As histórias clínicas mostraram que a maioria desses adolescentes era proveniente de lares desestruturados (broken-homes), predominantemente por separação dos pais, e que a tentativa ocorreu com mais freqüência após discussão com pessoas significativas do núcleo sócio-familiar. Sem ignorar os problemas metodológicos existentes, é razoável supor que os fatos observados neste trabalho refletem a ocorrência de suicídio e uso/abuso de substâncias psicoativas na população geral, ou indicam, ao menos, que eles evidenciam um sério problema médico-psicológico em nível assistencial entre os adolescentes e adultos jovens.The objective of this study was to perform a comparative analysis of the temporal distribution of all cases involving adolescents between 10 and 24 years of age cared for in the psychiatric emergency unit of a large university hospital during the period from 1988 to 2004, as a result of attempted suicide or the use/abuse of psychoactive substances. Cases of attempted suicide, in particular, were studied by taking into consideration their distribution according to age, gender, and attempted method of suicide. By using case studies, data were collected in respect of the motives which triggered the suicide attempt as well as the life history of these patients which could possibly be related to the occurrence of this behavior. Data were obtained from a retrospective survey of all cases of adolescent patients who had attempted suicide and who had used/abused psychoactive substances and who attended the psychiatric emergency unit of the Clinical Hospital of the Faculty of Medicine at the University of São Paulo in Ribeirão Preto, between 1988 and 2004, and also from 10 clinical histories obtained by means of interviews with adolescent patients, selected at random, attending the unit as a result of attempted suicide. The results showed a strong positive correlation between the number of cases involving suicide attempts and the number of cases involving psychoactive substance use/abuse for both male (r=0.70; p=0.0037) and female adolescents (r=0.81; p=0.002). Suicide attempts were found to be significantly more frequent among female adolescents, where the preferred method of suicide is poisoning, using prescription drugs. The clinical histories of the cases analyzed showed that the majority of these adolescents come from broken-homes, predominantly as a result of parental separation, and that the suicide attempts were often the result of arguments with close family members. Being aware of the methodological issues, it is reasonable to suppose that the facts observed in this study would be reflected in the general population or, at least, that they indicate a serious medical-psychological problem at the welfare level among adolescents and young adults.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State

Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks

Estratégias de marketing utilizadas na indústria farmacêutica

Este trabalho teve por finalidade identificar e analisar as estratégias de marketing utilizadas na indústria farmacêutica, com embasamento teórico em marketing, marketing de relacionamento, marketing de serviços e marketing de fidelização. A pesquisa de campo foi realizada com o objetivo de identificar as estratégias de marketing utilizadas na fidelização de clientes e analisar o impacto das diferentes estratégicas utilizadas, ambas no segmento farmacêutico. O questionário foi aplicado em Pediatras que atuam no Distrito Federal e demonstrou que as estratégias de marketing usualmente empregadas pelos laboratórios formam um sistema complexo. A análise realizada levou em consideração o perfil do pediatra (sexo, idade, grau acadêmico, tempo de atuação, participação em eventos e atendimento semanal). Pode-se observar que devido as opiniões, dentre os diversos perfis existentes, serem distintas, há a necessidade de análises mais aprofundadas sobre o impacto da utilização das diferentes estratégias para cada perfil existente