Hypoxic environments as refuge against predatory fish in the Amazonian floodplains

Several groups of Amazonian fishes exhibit behavioral, morphological and physiological characteristics that allow occupying hypoxic environments, despite the energetic costs of living in such harsh conditions. One of the supposed advantages of occupying hypoxic habitats would be a lower predation pressure resulting from a lower number of piscivorous fishes in those environments. We tested this hypothesis in an area of the Amazon River floodplain through gill net fishing in normoxic and hypoxic habitats. From the 103 species caught, 38 were classified as piscivores. We found no difference in the number of piscivorous species captured in hypoxic and normoxic habitats (χ2 = 0.23; p = 0.63; df = 1) but piscivorous individuals were more numerous in normoxic than in hypoxic sampling stations (χ2 = 104.4; p < 0.001; df = 1). This indicates that environments submitted to low oxygen conditions may in fact function as refuges against piscivorous fishes in the Amazonian floodplains

Work ability in nursing: relationship with psychological demands and control over the work

OBJECTIVE: to evaluate the association between psychological demands, control over the work and the reduction of work ability of nursing professionals. METHOD: this cross-sectional study involved 498 nursing professionals of a university hospital in the State of Rio Grande do Sul, Brazil. Data collection was carried out in 2009 using the Brazilian versions of the Work Ability Index and Job Stress Scale, with logistic regression models used for the data analysis. RESULTS: the prevalence of 43.3% for reduced work ability and 29.7% for high-strain in the job (high psychological demand and low control) were observed. The chances for professionals presenting reduced work ability under high-strain were higher and significant when compared to those classified as being under low-strain, even after adjusting for potential confounders, except for age and gender. CONCLUSION: a high prevalence of reduced work ability was observed. This evidence indicates the need for investigation and detailed analysis of the psychosocial aspects of the professionals with regard to the health/disease process of nursing professionals

Fatores influenciando a estrutura e distribuição espacial dos peixes nos Igarapés de cabeceira do Parque Nacional do Jaú, Amazônia Central

The aim of this study was to investigate the influence of spatial variation in river channels and habitats on the distribution of fish communities in the headwater streams of the Jaú River System, a blackwater tributary of the Negro River. Collections and measurements were made in 34 headwater streams during the period of November-December, 1998. Fish were captured with fish traps and hand nets along standard reaches of two meanders. Data on benthic habitat structure, stream depth and width were collected along lateral transects in each sample reach. A total of 66 fish species from 24 families were collected and classified into seven trophic guilds: allocthonous insectivore, autochthonous insectivore, general insectivore, piscivore, detritivorous planktivore, detritivorous insectivore and insectivorous piscivore. Variations in the distribution and diversity of bottom substrates were important factors influencing fish community structures in these systems. Also, variation in stream size explained the observed variability in fish communities. © 2014, Instituto Internacional de Ecologia. All right reserved

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe