Analysis of relationship of psychosocial factors with patient safety culture in a Brazilian hospital: Study with structural equation modeling analysis.

INTRODUCTION AND OBJECTIVES: The scenario of the health system can develop physical and emotional impacts on health professionals, due to work overload and failure to manage the system. It is necessary to consolidate the theory that the safety of care provided by health services is affected by organizational conditions. The aim of this study is to assess whether safety culture is related to job satisfaction, depressive symptoms, and burnout syndrome among hospital professionals. MATERIALS AND METHODS: This is an analysis with structural equation modeling, conducted in a teaching hospital in Brazil. Data collection was made via psychometric instruments, which sought to analyze job satisfaction (Job Satisfaction Survey), depressive symptoms (Patient Health Questionnaire), burnout syndrome (Maslach Burnout Inventory), as well as the relationship between this factors and patient safety culture (Safety Attitudes Questionnaire). The Pearson correlation coefficient (r) and the partial least squares structural equation modeling (PLS-SEM) were used for analysis. RESULTS: A higher work satisfaction was associated with a higher perception of safety culture (r=0.69; P<0.001). Depressive symptoms and burnout dimensions showed an inverse relationship with the safety culture (P<0.05). PLS-SEM enabled us to understand the behavior of this association. Thus, satisfaction at work and the absence of burnout proved to be predictive factors for the implementation of an ideal patient safety culture (P<0.001). CONCLUSIONS: Patient safety culture is related to job satisfaction and burnout among hospital professionals. These findings suggest that the psychosocial work environment influences the quality of care provided.

Reverse transcriptase droplet digital PCR to identify the emerging vesicular virus Senecavirus A in biological samples.

Senecavirus A (SVA) belonging to the family Picornaviridae, genus Senecavirus was incidentally isolated in 2002 from the PER.C6 (transformed foetal retinoblast) cell line. However, currently, this virus is associated with vesicular disease in swine and it has been reported in countries such as the United States of America, Canada, China, Thailand and Colombia. In Brazil, the SVA was firstly reported in 2015 in outbreaks of vesicular disease in swine, clinically indistinguishable of Foot-and-mouth disease, a contagious viral disease that generates substantial economic losses. In the present work, it was standardized a diagnostic tool for SVA based on RNA reverse transcriptase droplet digital PCR (RT-ddPCR) using one-step and two-step approaches. Analytical sensitivity and specificity were done in parallel with real-time PCR, RT-qPCR (one-step and two-step) for comparison of sensitivity and specificity of both methods. In the standardization of RT-ddPCR, the double-quenched probe and the temperature gradient were crucial to reduce background and improve amplitude between positive and negative droplets. The limit of detection and analytical specificity of techniques of one-step techniques showed superior performance than two-step methods described here. Additionally, the results showed 94.2% concordance (p < 0.001) for RT-ddPCR and RT-qPCR using the one-step assay approach and biological samples from Brazilian outbreaks of Senecavirus A. However, ddRT-PCR had a better performance than RT-PCR when swine serum pools were tested. According to the results, the one-step RT-ddPCR and RT-qPCR is highlighted to be used as an auxiliary diagnostic tool for Senecavirus A and for viral RNA absolute quantification in biological samples (RT-ddPCR), being a useful tool for vesicular diseases control programs.

The main spoilage-related psychrotrophic bacteria in refrigerated raw milk.

Refrigerated raw milk may contain psychrotrophic microorganisms that produce thermoresistant exoproteases and lipases, which may compromise the quality of processed fluid milk and dairy products during storage. The aim of this work was to quantify and identify the deteriorating psychrotrophic microbiota in Brazilian refrigerated raw milk using genetic diversity analysis. The mean psychrotrophic count was 1.1 × 104 cfu/mL. Of the total isolates, 47.8 and 29.8% showed deteriorating activity at 35°C within 48 h and 7°C within 10 d, respectively. Among the proteolytic species, more isolated by this study were Lactococcus lactis (27.3%), Enterobacter kobei (14.8%), Serratia ureilytica (8%), Aerococcus urinaeequi (6.8%), and Bacillus licheniformis (6.8%). Observed among lipolytics were E. kobei (17.7%), L. lactis (15.6%), A. urinaeequi (12.5%), and Acinetobacter lwoffii (9.4%). The isolates S. ureilytica, E. kobei, Pseudomonas spp., and Yersinia enterocolitica potentially produced alkaline metalloprotease (aprX). Despite the low counts, a considerable portion of the psychrotrophic microbiota presented spoilage potential, which reaffirms the need for rigor in the control of contamination and the importance of rapid processing as factors that maintain the quality of milk and dairy products.

Prevalence and factors associated with erectile dysfunction in patients with chronic kidney disease on conservative treatment.

Population with chronic kidney disease (CKD) has had many problems, and some of these have arisen from sexual disorders. The present study intends to determine the prevalence and the associated factors with erectile dysfunction (ED) among patients with CKD on conservative treatment (CKDCT). This transversal study was conducted from May 2013 to December 2015. The tools used were: medical records and the International Index of Erectile Function. Data were analyzed by univariate and multivariate logistic regression analysis. Among 245 patients that have participated of this study, ED was present in 71.02% and it was severe in 36.73%. Age greater than 50 years, body mass index lower than 25, diabetes mellitus, stages IV/V of CKD, cardiac conduction disturbances, benign prostatic hyperplasia, smoking, alcohol use, albumin <3.5 g per 100 ml and creatinine clearance between 15 and 29 ml min-1 per 1.73 m2 were associated with ED. Time of CKD was the only variable associated with ED independent of the presence of other factors. ED prevalence in patients with CKDCT is high and it is severe in more than half of them. Several factors are associated with ED in this population but the principal one is the time of CKD.

In-house validation of PremiTest, a microbiological screening test with solvent extraction, for the detection of antimicrobial residues in poultry muscles.

PremiTest, a microbial inhibition test for the screening of antimicrobial residues, was validated according to the criteria established by Decision 2002/657/EC. Sensitivity, detection capability (CCß), specificity, selectivity, robustness and applicability were evaluated. The methodology involves the technique of solvent extraction, which increases the detection capability of the test for a wider range of antibiotics. The following CCß values in poultry muscle were found: penicillin G ≤ 12.5 µg kg(-1), total sulfonamides ≤ 75 µg kg(-1), erythromycin 75 µg kg(-1) and lincomycin 50 µg kg(-1). The detection capability of chlortetracycline was equal to its maximum residue limit (100 µg kg(-1)) and the method did not detect gentamicin (1000 µg kg(-1)), for which no MRL is established in poultry muscle. Specificity evaluated in relation to different analytes and matrices did not detect any interferences in the tests results; whilst the robustness showed that the pH neutralisation point of the extract affects the analytical results and the kits' performance. Only the screening of tetracyclines requires the analysis of extracts without pH neutralisation. The results of the validation process showed that this method is acceptable for screening ß-lactam, sulfonamide and macrolide antimicrobial groups in the National Residues and Contaminants Control Programme (PNCRC), and that for this it is fit for purpose.

Nutrient flux associated with the emergence of Quesada gigas Olivier (Hemiptera: Cicadidae) in an urban ecosystem.

Large-bodied arthropods, such as cicadas, can be able to reallocate significant amounts of nutrients during adult emergence. Evidence suggests that Quesada gigas Olivier emergence constitutes an important nutrient flux from belowground to aboveground. The purpose of this study was to estimate the amount of nitrogen, proteins, and lipids resulting from the emergence of Q. gigas in an urban ecosystem in Central Brazil. Adult specimens captured from September to November 2006 were weighed and submitted to biochemical analysis. Population density was approximately 4,200 individuals per hectare. Mean individual dry mass was 1.03 g and contained 12.6% proteins, 8.4% lipids, and 5% nitrogen. Total biomass input from the species was 4.3 kg ha(-1) y(-1), with a consequent annual reallocation of approximately 545 g of proteins, 363 g of lipids, and 216 g of nitrogen per hectare. The data obtained suggest that Q. gigas emergence can cause significant translocation of nutrients from belowground to aboveground, and is therefore an important biological event for ecosystem function.

Increased endothelin-1 reactivity and endothelial dysfunction in carotid arteries from rats with hyperhomocysteinemia.

BACKGROUND AND PURPOSE: There are interactions between endothelin-1 (ET-1) and endothelial vascular injury in hyperhomocysteinemia (HHcy), but the underlying mechanisms are poorly understood. Here we evaluated the effects of HHcy on the endothelin system in rat carotid arteries. EXPERIMENTAL APPROACH: Vascular reactivity to ET-1 and ET(A) and ET(B) receptor antagonists was assessed in rings of carotid arteries from normal rats and those with HHcy. ET(A) and ET(B) receptor expression was assessed by mRNA (RT-PCR), immunohistochemistry and binding of [(125)I]-ET-1. KEY RESULTS: HHcy enhanced ET-1-induced contractions of carotid rings with intact endothelium. Selective antagonism of ET(A) or ET(B) receptors produced concentration-dependent rightward displacements of ET-1 concentration response curves. Antagonism of ET(A) but not of ET(B) receptors abolished enhancement in HHcy tissues. ET(A) and ET(B) receptor gene expressions were not up-regulated. ET(A) receptor expression in the arterial media was higher in HHcy arteries. Contractions to big ET-1 served as indicators of endothelin-converting enzyme activity, which was decreased by HHcy, without reduction of ET-1 levels. ET-1-induced Rho-kinase activity, calcium release and influx were increased by HHcy. Pre-treatment with indomethacin reversed enhanced responses to ET-1 in HHcy tissues, which were reduced also by a thromboxane A(2) receptor antagonist. Induced relaxation was reduced by BQ788, absent in endothelium-denuded arteries and was decreased in HHcy due to reduced bioavailability of NO. CONCLUSIONS AND IMPLICATIONS: Increased ET(A) receptor density plays a fundamental role in endothelial injury induced by HHcy. ET-1 activation of ET(A) receptors in HHcy changed the balance between endothelium-derived relaxing and contracting factors, favouring enhanced contractility.

Chronic ethanol intake modulates vascular levels of endothelin-1 receptor and enhances the pressor response to endothelin-1 in anaesthetized rats.

BACKGROUND AND PURPOSE: The contribution of endothelin-1 (ET-1) to vascular hyper-reactivity associated with chronic ethanol intake, a major risk factor in several cardiovascular diseases, remains to be investigated. EXPERIMENTAL APPROACH: The biphasic haemodynamic responses to ET-1 (0.01-0.1 nmol kg(-1), i.v.) or to the selective ETB agonist, IRL1620 (0.001-1.0 nmol kg(-1), i.v.), with or without ETA or ETB antagonists (BQ123 (c(DTrp-Dasp-Pro-Dval-Leu)) at 1 and 2.5 mg kg(-1) and BQ788 (N-cis-2,6-dimethyl-piperidinocarbonyl-L-gamma-methylleucyl1-D-1methoxycarbonyltryptophanyl-D-norleucine) at 0.25 mg kg(-1), respectively) were tested in anaesthetized rats, after 2 weeks' chronic ethanol treatment. Hepatic parameters and ET receptor protein levels were also determined. KEY RESULTS: The initial hypotensive responses to ET-1 or IRL1620 were unaffected by chronic ethanol intake, whereas the subsequent pressor effects induced by ET-1, but not by IRL1620, were potentiated. BQ123 at 2.5 but not 1 mg kg(-1) reduced the pressor responses to ET-1 in ethanol-treated rats. Conversely, BQ788 (0.25 mg kg(-1)) potentiated ET-1-induced increases in mean arterial blood pressure in control as well as in ethanol-treated rats. Interestingly, in the latter group, increases in heart rate, induced by ET-1 at a dose of 0.025 mg kg(-1) were enhanced following ETB receptor blockade. Finally, we observed higher levels of ETA receptor in the heart and mesenteric artery and a reduction of ETB receptor protein levels in the aorta and kidney from rats chronically treated with ethanol. CONCLUSIONS AND IMPLICATIONS: Increased vascular reactivity to ET-1 and altered protein levels of ETA and ETB receptors could play a role in the pathogenesis of cardiovascular complications associated with chronic ethanol consumption.

Gender-specific vascular effects elicited by chronic ethanol consumption in rats: a role for inducible nitric oxide synthase.

BACKGROUND AND PURPOSE: Epidemiological data suggest that the risk of ethanol-associated cardiovascular disease is greater in men than in women. This study investigates the mechanisms underlying gender-specific vascular effects elicited by chronic ethanol consumption in rats. EXPERIMENTAL APPROACH: Vascular reactivity experiments using standard muscle bath procedures were performed on isolated thoracic aortae from rats. mRNA and protein for inducible NO synthase (iNOS) and for endothelial NOS (eNOS) was assessed by RT-PCR or western blotting, respectively. KEY RESULTS: In male rats, chronic ethanol consumption enhanced phenylephrine-induced contraction in both endothelium-intact and denuded aortic rings. However, in female rats, chronic ethanol consumption enhanced phenylephrine-induced contraction only in endothelium denuded aortic rings. After pre-incubation of endothelium-intact rings with L-NAME, both male and female ethanol-treated rats showed larger phenylephrine-induced contractions in aortic rings, compared to the control group. Acetylcholine-induced relaxation was not affected by ethanol consumption. The effects of ethanol on responses to phenylephrine were similar in ovariectomized (OVX) and intact (non-OVX) female rats. In the presence of aminoguanidine, but not 7-nitroindazole, the contractions to phenylephrine in rings from ethanol-treated female rats were greater than that found in control tissues in the presence of the inhibitors. mRNA levels for eNOS and iNOS were not altered by ethanol consumption. Ethanol intake reduced eNOS protein levels and increased iNOS protein levels in aorta from female rats. CONCLUSIONS AND IMPLICATIONS: Gender differences in the vascular effects elicited by chronic ethanol consumption were not related to ovarian hormones but seemed to involve the upregulation of iNOS.

The balloon catheter induces an increase in contralateral carotid artery reactivity to angiotensin II and phenylephrine.

1. The effects of balloon injury on the reactivity of ipsilateral and contralateral carotid arteries were compared to those observed in arteries from intact animals (control arteries). 2. Carotid arteries were obtained from Wistar rats 2, 4, 7, 15, 30 or 45 days after injury and mounted in an isolated organ bath. Reactivity to angiotensin II (Ang II), phenylephrine (Phe) and bradykinin (BK) was studied. Curves were constructed in the absence or presence of endothelium or after incubation with 10 microm indomethacin, 500 microm valeryl salicylate or 0.1 microm celecoxib. 3. Phe, Ang II and BK maximum effects (Emax) were decreased in ipsilateral arteries when compared to control arteries. No differences were observed among pD2 or Hill coefficient. 4. Emax to Phe (4 and 7 days) and to Ang II (15 and 30 days) increased in the contralateral artery. In addition, Phe or Ang II reactivity was not significantly different in aorta rings from control or carotid-injured animals. 5. The increased responsiveness of contralateral artery was not due to changes in carotid blood flow or resting membrane potential. The endothelium-dependent inhibitory component is not present in the contraction of contralateral arteries and it is not related to superoxide anion production. 6. Indomethacin decreased contralateral artery responsiveness to Phe and Ang II. Valeryl salicylate reduced the Ang II response in contralateral and control arteries. Celecoxib decreased the Phe Emax of contralateral artery. 7. In conclusion, decreased endothelium-derived factors and increased prostanoids appear to be responsible for the increased reactivity of contralateral arteries after injury.

Characterization of atypical Erwinia carotovora strains causing blackleg of potato in Brazil.

AIMS: To determine the characteristics of bacteria associated with the blackleg disease of potato in Brazil and compare them with species and subspecies of pectolytic Erwinia. METHODS AND RESULTS: Biochemical and physiological characteristics of 16 strains from blackleg-infected potatoes in State of Rio Grande do Sul, Brazil, were determined and differentiated them from all the E. carotovora subspecies and E. chrysanthemi. Pathogenicity and maceration ability of the Brazilian strains were greater than those of E. carotovora subsp. atroseptica, the causal agent of potato blackleg in temperate zones. Analyses of serological reaction and fatty acid composition confirmed that the Brazilian strains differed from E. carotovora subsp. atroseptica, but the sequence of 16S rDNA gene and the 16S-23S intergenic spacer (IGS) region confirmed the Brazilian strains as pectolytic Erwinia. Restriction analysis of the IGS region differentiated the Brazilian strains from the subspecies of E. carotovora and from E. chrysanthemi. A unique SexAI restriction site in the IGS region was used as the basis for a primer to specifically amplify DNA from the Brazilian potato blackleg bacterium in PCR. CONCLUSIONS: The bacterium that causes the blackleg disease of potato in Brazil differs from E. carotovora subsp. atroseptica, the blackleg pathogen in temperate zones. It also differs from other subspecies of E. carotovora and from E. chrysanthemi and warrants status as a new subspecies, which would be appropriately named E. carotovora subsp. brasiliensis. SIGNIFICANCE AND IMPACT OF THE STUDY: The blackleg disease of potato is caused by a different strain of pectolytic Erwinia in Brazil than in temperate potato-growing regions. The Brazilian strain is more virulent than E. carotovora subsp. atroseptica, the usual causal agent of potato blackleg.

Intracerebroventricular effects of angiotensin II on a step-through passive avoidance task in rats.

A wealth of evidence indicates that angiotensin II (Ang II) is involved in learning and memory. However, the precise role of this peptide in these cognitive processes is still controversial, with data indicating either an inhibitory or an enhancing action. The present study was designed to further investigate the effects of intracerebroventricular injections of Ang II (0.5, 1 or 3nmol/5microl) on a step-through passive avoidance task in male adult Wistar rats. When administered pretraining, Ang II did not affect the acquisition of passive avoidance, but markedly improved avoidance performance when given before the retrieval test. The latter effect was observed in retest sessions performed up to 72h after training. Administration of the peptide five minutes after training impaired retention of inhibitory avoidance. Therefore, Ang II may exert opposite effects on passive avoidance memory according to its interference with brain mechanisms leading to the storage or retrieval of this aversively motivated task.

Vascular non-endothelial nitric oxide induced by swimming exercise stress in rats.

1. Herein, we report the effects of acute or chronic forced swimming on vascular responsiveness to angiotensin (Ang) II. 2. The possible involvement of locally produced substances, such as nitric oxide (NO) and prostanoids, in these effects were studied in rat thoracic aorta and superior mesenteric arteries. 3. Chronic, but not acute, swimming reduced the efficacy (maximal effect; Emax) of AngII in thoracic aorta and mesenteric arteries, either with intact or denuded endothelium. 4. The efficacy of AngII was reduced in the presence of indomethacin in mesenteric arteries, but not in the aorta, from either control or chronically stressed rats. 5. Treatment with NG-monomethyl-l-arginine reversed the effect of chronic stress on the response to AngII, suggesting that chronic stress may increase non-endothelial NO activity in both the aorta and mesenteric arteries. 6. The effects of acute and chronic stress on vascular reactivity were selective for AngII because no changes were observed on the effects of phenylephrine.

Angiotensin actions on the isolated rat uterus during the estrous cycle: influence of resting membrane potential and uterine morphology.

The involvement of AT1 and AT2 receptor subtypes in the response of the isolated rat uterus to angiotensin II (AngII) was studied throughout the estrous cycle. The AngII potency varied during the different estrous cycle phases, as indicated by significantly different pD2 values. No significant differences were observed in AngII metabolism among different estrous phases. Morphological analysis indicated that external and internal myometrium layers were thicker during estrus. In addition, the highest resting membrane potential was also observed during this phase, when compared with the proestrus and diestrus phases. The AngII-induced uterine contractions were blocked by losartan. Different losartan pD2 values were observed. PD123319 had no effect on the contractile response to AngII. The results also indicate that estrous cycle-dependent changes in AngII potency are correlated with uterine morphological and/or membrane potential changes.

Influence of estrogen and/or progesterone on isolated ovariectomized rat uterus. Responsiveness to Ang II.

Steroids hormones can influence several functions of the uterus, including agonist-induced contractions. The aim of this work is to study the influence of hormonal replacement on angiotensin II (Ang II) and losartan responsiveness on the isolated rat uterus. The Ang II pD(2) values are: 9.69 +/- 0.07 for vehicle-treated animals, 8.85 +/- 0.06 for estrogen-treated animals, 10.12 +/- 0.03 for progesterone-treated animals and 8.90 +/- 0.03 for estrogen-and-progesterone-treated animals. The losartan pD(2)' values are: 8.43 +/- 0.03 for vehicle-treated animals, 8.21 +/- 0.03 for estrogen-treated animals, 7.83 +/- 0.05 for progesterone-treated animals and 8.70 +/- 0.09 for estrogen-and-progesterone-treated animals. There is not a correlation between Ang II pD(2) and losartan pD(2)' values, suggesting that the hormones affect Ang II and losartan binding by different mechanisms in rat uterus.

[Parkinsonian, cerebellar, psychotic and demential symptoms in ex-boxer: case report]. / Sintomas parkinsonianos, cerebelares, psicóticos e demenciais em ex-pugilista: relato de caso.

67 years-old male patient, ex-boxer, after the end of his sportive career, began to present neuropsychiatric manifestations possibly due to the successive brain injuries related to the boxing. In report to this case, we discuss the mean organic psychosyndromes related to the boxing.

Morphologic study of the masseter muscle of gerbil: meriones unguiculatus

El daño de los músculos masticadores relacionados con desórdenes cráneomandibulares son aspectos comunes en la clínica. Es importante contar con datos morfológicos de estos músculos en el sistema estomatognático. El propósito de este trábajo es mostrar la morfología del músculo masetero del gerbil Meriones unguiculatus, desde el nivel macroscópico hasta el de microscopía electrónica. En la observación macroscópica fueron utilizados 5 animales que fueron perfundidos con sulución de formalina al 100 por ciento. Las disecciones fueron fotografiadas. Posteriormente, los músculos fueron removidos e sumergidos en la solución de formalina, por unos pocos días. Las muestras fueron procesadas a través de técnicas histológicas convencionales y sumergidas en parafina. Cortes seriados de 6 um fueron teñidos con H. E. analizados y fotografiados con un fotomicroscopio JENAMED. Nuestros resultados mostraron que el músculo masetero presentaba 5 fascículos, los cuales se mezclaban en la porción media, y algunos husos estaban fusionados con la cápsula externa de ellos mismos, pareciendo husos gigantes

Seroconversion for Helicobacter pylori in adults from Brazil.

We studied, prospectively, seroconversion for Helicobacter pylori in adults from a developing country and investigated risk factors for the acquisition of the microorganism in this population. A group of 213 volunteers of low socioeconomic level from a district in the metropolitan area of Belo Horizonte, south-east Brazil was evaluated. Anti-H. pylori IgG antibodies were measured by ELISA using Cobas Core anti-H. pylori EIA (Roche) in serum samples collected in 1992 and in 1997. The subjects were interviewed and sociodemographic data were collected. A total of 174 (81.7%) subjects presented anti-H. pylori antibodies on the occasion of the first visit. During 56 months of follow-up, 2 of 39 seronegative adults converted to seropositive with an annual infection rate of 1.1%, and 2 of 174 seropositive subjects reverted to seronegative (0.2%/year). The prevalence of infection increased significantly with age and an inverse association was observed between prevalence of infection and educational level. In conclusion, the results of the present study demonstrate that in a developing country there is a low but continuous risk of H. pylori infection in adulthood.

Evaluation of enzyme-linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children from different age groups with and without duodenal ulcer.

BACKGROUND: Although enzyme-linked immunosorbent assay (ELISA) is highly sensitive and specific for the diagnosis of Helicobacter pylori infection in adults, their performance in children is still controversial. METHODS: A second-generation ELISA was used to evaluate the IgG response to H. pylori in the serum of 130 consecutive children who underwent upper gastrointestinal endoscopy. The presence of H. pylori was determined in antral biopsy specimens by culture, urease test, and histologic analysis. RESULTS: Sixty-eight children (all of the 20 who had duodenal ulcer) were H. pylori positive by microbiologic test. Immunoglobulin G antibodies to H. pylori were detected in 79.4% of the infected children and in 8.1% of the noninfected ones. The sensitivity of the test was higher in patients with duodenal ulcer (100%) than in those without (70.8%). When used in children of different ages the test also presented differences in sensitivity: 44.4% in children 2 to 6 years old; 76.7% in children 7 to 11 years old, and 93.1% in children 12 to 16 years old (p = 0.006). The serum immunoglobulin G concentration was significantly higher (p = 0.0003) in children with duodenal ulcer than in those without and was higher in older children than in younger ones without duodenal ulcer (p = 0.05). CONCLUSIONS: The accuracy of the test in children with duodenal ulcer and in children more than 12 years old was good; however, in children up to 12 years of age without duodenal ulcer, the sensitivity of the test was too low to be used for screening purposes or to rule out the presence of infection.