¿Está la virtud en el punto medio? La incertidumbre del CIN2 y el papel del VPH / Is virtue at the midpoint? The uncertainty of CIN2 and the role of HPV

Objetivo: La biopsia guiada por colposcopia (BGC) marca el manejo de la neoplasia intraepitelial cervical. El objetivo de este estudio fue evaluar la concordancia de los resultados entre la BGC y la escisión amplia de la zona de transformación (LLETZ, large loop excision of the transformation zone), y la utilidad del genotipado del virus del papiloma humano (VPH) para seleccionar a las pacientes con riesgo de lesión intraepitelial escamosa de alto grado/neoplasia intraepitelial cervical 3 (HSIL/CIN3). Método: Se compararon los resultados de la BGC y de la LLETZ, siendo esta última el método de referencia. Se evaluó la relación del genotipo del VPH con el diagnóstico final de HSIL/CIN3. Resultados: La precisión de la biopsia comparada con LLETZ fue del 61,4%. La tasa de concordancia fue del 64,4% para CIN1, del 31,4% para CIN2 y del 77,4% para CIN3. La tasa global de sobrediagnóstico fue del 18,68% y la de subdiagnóstico del 19,89%. En mujeres menores de 30 años, la concordancia fue del 62,79% (CIN1 65%, CIN2 39,58% y CIN3 73,08%), la tasa de sobrediagnóstico del 22,67% y la tasa de subdiagnóstico del 15,11%. La infección por VPH16 tuvo una odds ratio de 3,86 para el diagnóstico final de HSIL/CIN3+. Conclusiones: El diagnóstico de CIN2 por BGC parece insuficiente para seleccionar a las pacientes para tratamiento escisional, principalmente en mujeres jóvenes. El hallazgo de VPH16 es un factor de riesgo de HSIL/CIN3+ independientemente del resultado de la biopsia.

Objective: Colposcopy-guided biopsy (CGB) is a basic tool for the management of cervical intraepithelial neoplasia. The aim of this study is to evaluate the concordance of results between CGB and large loop excision of the transformation zone (LLETZ), and the usefulness of human papillomavirus (HPV) genotyping to select patients at risk of H-SIL/CIN3. Method: The results of colposcopy-guided biopsy and LLETZ were compared, with LLETZ being the gold standard. The relationship of HPV genotype to the final diagnosis of CIN3 was assessed. Results: The accuracy of CGB compared to LLETZ was 61.4%. The concordance rate was 64.4% for CIN1, 31.4% for CIN2 and 77.4% for CIN3. The overall overdiagnosis rate was 18.68% and underdiagnosis rate was 19.89%. In women under 30 years of age the concordance rate was 62.79% (CIN1 65%, CIN2 39.58% and CIN3 73.08%), and the rate of overdiagnosis and underdiagnosis was 22.67% and 15.11%, respectively. HPV16 infection had an odds ratio of 3.86 for the final diagnosis of CIN3+ and the result was significant regardless of the biopsy result. Conclusions: The CGB result as CIN2 is inaccurate and seems insufficient to select patients for excisional treatment, mainly in young women. HPV16 infection is a risk factor for CIN3+ regardless of the colposcopy-guided biopsy result.

Group Positive Affect and Beyond: An Integrative Review and Future Research Agenda.

Group positive affect is defined as homogeneous positive affect among group members that emerges when working together. Considering that previous research has shown a significant relationship between group positive affect and a wide variety of group outcomes (e.g., behaviors, wellbeing, and performance), it is crucial to boost our knowledge about this construct in the work context. The main purpose is to review empirical research, to synthesize the findings and to provide research agenda about group positive affect, in order to better understand this construct. Through the PsycNET and Proquest Central databases, an integrative review was conducted to identify articles about group positive affect published between January 1990 and March 2019. A total of 44 articles were included and analyzed. Finding suggests that scholars have been more interested in understanding the outcomes of group positive affect and how to improve the productivity of groups than in knowing what the antecedents are. A summary conclusion is that group positive affect is related to leadership, job demands, job resources, diversity/similarity, group processes, and contextual factors, all of which influence the development of several outcomes and different types of wellbeing at the individual and group levels. However, with specific combinations of other conditions (e.g., group trust, negative affect, and interaction), high levels of group positive affect could cause harmful results. Conclusions shed light on group positive affect research and practice and might help Human Resources professionals to initiate empirically-based strategies related to recruitment, group design and leadership training.

Epidemiological Study and Cost Analysis of Suicide in Spain: Over 100 Years of Evolution.

OBJECTIVE: Society has changed during the last 100 years of evolution; however, some problems, such as suicide, remain. The objective here is to carry out a long-term epidemiological study in Spain, and to calculate the social and labor costs of 2016. METHOD: Epidemiological data were obtained from official data obtained between 1906 - 2016. The calculation of the costs of suicides included the social costs and the costs of production losses (labor costs). The latter were obtained by the human capital method, taking into account the unemployment rate. The economic growth rate stood at 2.6% per year. RESULTS: The suicide rate was between 4 and 8% per year. The evolution during these 100 years had three periods. Until 1940 it had slight increases, and then it decreased until 1980 and, subsequently, the rate increased until it reached almost 8% in 2016. The costs of the suicides were 2,167 million € of economic losses for society, or its equivalent of 607 € for suicide. CONCLUSIONS: Public health policies aimed at the prevention of suicide should be increased, and supported by the economic costs they mean for society.

Coaching-Based Leadership Intervention Program: A Controlled Trial Study.

In spite of the potential benefits that coaching-based leadership interventions can bring to organizations, basic questions remain about their impact on developing coaching skills and increasing psychological capital (PsyCap), work engagement and in- and extra-role performance. In a controlled trial study, 41 executives and middle managers (25 in the experimental group and 16 in the waiting-list control group) from an automotive sector company in Spain received pre-assessment feedback, a coaching-based leadership group workshop, and three individual executive coaching sessions over a period of 3 months. The intervention program used a strengths-based approach and the RE-GROW model, and it was conducted by executive coaching psychologists external to the organization. Participants (N = 41) and their supervisors (N = 41) and employees (N = 180) took part in a pre-post-follow up 360-degree assessment during the research period. Quantitative data were analyzed using Analyses of Variance (ANOVA) with a 2 × 2 design, paired-samples t-tests, and univariate analyses between groups. Results indicated that the intervention program was successful in increasing the participants' coaching-based leadership skills, PsyCap, work engagement, and in- and extra-role performance. Qualitative measures were also applied, and results from individual responses provided additional support for the study hypotheses. Regarding practical implications, the results suggest that the Coaching-based Leadership Intervention Program can be valuable as an applied positive intervention to help leaders develop coaching skills and enhance well-being and optimal functioning in organizations.

Analyzing the risk factors influencing surgical site infections: the site of environmental factors.

BACKGROUND: Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management. METHODS: We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay. RESULTS: Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors. CONCLUSION: Our results suggest the importance of environmental and surface contamination control to prevent SSI.

CONTEXTE: La lutte contre les infections du site opératoire (ISO) passe entre autres par des études visant à clarifier la nature de nombreux facteurs essentiels de contrôle. Nous avons donc cherché à examiner le lien entre divers facteurs de risque, notamment de nature environnementale, et les ISO, dans une optique de prévention. MÉTHODES: Nous avons mené une étude longitudinale prospective afin de recenser les ISO parmi tous les patients ayant subi une intervention chirurgicale en 2014 dans 8 hôpitaux de la côte méditerranéenne de l'Espagne. Nous nous sommes penchés sur les facteurs de risque liés au bloc opératoire, soit le degré de contamination fongique et bactérienne, la température et l'humidité ambiantes, le renouvellement de l'air et la pression d'air différentielle, et sur les variables liées aux patients, soit l'âge, le sexe, la comorbidité, l'état nutritionnel et le fait d'avoir reçu ou non une transfusion. Les autres facteurs pris en compte ont été l'antibioprophylaxie, le type de rasage (électrique ou manuel), la santé physique d'après la classification de l'American Society of Anesthesiologists, le type et la durée d'intervention et le séjour préopératoire. RÉSULTATS: Les ISO superficielles étaient le plus souvent associées à des facteurs environnementaux, comme la contamination fongique (par 2 unités formant colonies) et bactérienne ou la contamination de surface. En absence de contamination du bloc opératoire, il n'y a eu aucune ISO. Les facteurs déterminants d'une ISO profonde ou touchant un organe ou une cavité étaient plus souvent associés aux caractéristiques du patient (âge, sexe, transfusion, alimentation par sonde nasogastrique et état nutritionnel mesuré par la concentration sanguine d'albumine), au type d'intervention et au séjour préopératoire. Enfin, l'antibioprophylaxie et le rasage électrique étaient des facteurs de protection contre les 2 types d'infection, tandis que la durée de l'intervention et la catégorisation de l'intervention comme étant « sale ¼ étaient des facteurs de risques communs. CONCLUSION: Nos résultats indiquent que le contrôle de la contamination environnementale et de surface est important pour prévenir les ISO.

How personal resources predict work engagement and self-rated performance among construction workers: a social cognitive perspective.

Traditionally, research focussing on psychosocial factors in the construction industry has focused mainly on the negative aspects of health and on results such as occupational accidents. This study, however, focuses on the specific relationships among the different positive psychosocial factors shared by construction workers that could be responsible for occupational well-being and outcomes such as performance. The main objective of this study was to test whether personal resources predict self-rated job performance through job resources and work engagement. Following the predictions of Bandura's Social Cognitive Theory and the motivational process of the Job Demands-Resources Model, we expect that the relationship between personal resources and performance will be fully mediated by job resources and work engagement. The sample consists of 228 construction workers. Structural equation modelling supports the research model. Personal resources (i.e. self-efficacy, mental and emotional competences) play a predicting role in the perception of job resources (i.e. job control and supervisor social support), which in turn leads to work engagement and self-rated performance. This study emphasises the crucial role that personal resources play in determining how people perceive job resources by determining the levels of work engagement and, hence, their self-rated job performance. Theoretical and practical implications are discussed.

The dark and bright sides of self-efficacy in predicting learning, innovative and risky performances.

The objective of this study is to analyze the different role that efficacy beliefs play in the prediction of learning, innovative and risky performances. We hypothesize that high levels of efficacy beliefs in learning and innovative performances have positive consequences (i.e., better academic and innovative performance, respectively), whereas in risky performances they have negative consequences (i.e., less safety performance). To achieve this objective, three studies were conducted, 1) a two-wave longitudinal field study among 527 undergraduate students (learning setting), 2) a three-wave longitudinal lab study among 165 participants performing innovative group tasks (innovative setting), and 3) a field study among 228 construction workers (risky setting). As expected, high levels of efficacy beliefs have positive or negative consequences on performance depending on the specific settings. Unexpectedly, however, we found no time x self-efficacy interaction effect over time in learning and innovative settings. Theoretical and practical implications within the social cognitive theory of A. Bandura framework are discussed.

Physical properties, mechanical behavior, and electron microscopy study of a new α-TCP block graft with silicon in an animal model.

This study reports the characterization process and in vivo application of a new block bone graft of α-TCP with silicate in three different percentages in the aim of determining the influence of the silicate. Three groups of cylindrical implants (6 ± 0.01 mm diameter, 8 ± 0.01 mm length) with varying Si composition were studied: A: 3 wt % C(2) S; B: 1.5 wt % C(2) S; C: 100 wt % TCP-0 wt % C(2) S. These were implanted randomly in critical size defects in New Zealand rabbits. X-ray diffraction analysis was performed to determine the crystalline phases of the different compositions. Histomorphometric analysis produced one measurement of bone-to-implant contact. Comparing the α-TCPss ceramics, the trial found improved mechanical properties due to the silicon content in solid solution as well as densification. Previous studies have shown that the mechanical strengths of sintered ceramics correlate to densification as well as grain size and mechanical properties. Because of its mechanical and biological behavior, the study has shown α-TCP with C(2) S to be an alternative to other bone graft substitutes for use in bone reconstructive surgery in the fields of veterinary, medicine, and oral and maxillofacial surgery.

Linking transformational leadership to nurses' extra-role performance: the mediating role of self-efficacy and work engagement.

AIMS: This paper is a report of a social cognitive theory-guided study about the link between supervisors' transformational leadership and staff nurses' extra-role performance as mediated by nurse self-efficacy and work engagement. BACKGROUND: Past research has acknowledged the positive influence that transformational leaders have on employee (extra-role) performance. However, less is known about the psychological mechanisms that may explain the links between transformational leaders and extra-role performance, which encompasses behaviours that are not considered formal job requirements, but which facilitate the smooth functioning of the organization as a social system. METHODS: Seventeen supervisors evaluated nurses' extra-role performance, the data generating a sample consisting of 280 dyads. The nurses worked in different health services in a large Portuguese hospital and the participation rate was 76·9% for nurses and 100% for supervisors. Data were collected during 2009. A theory-driven model of the relationships between transformation leadership, self-efficacy, work engagement and nurses' extra-role performance was tested using Structural Equation Modelling. RESULTS: Data analysis revealed a full mediation model in which transformational leadership explained extra-role performance through self-efficacy and work engagement. A direct relationship between transformational leadership and work engagement was also found. CONCLUSION: Nurses' supervisors with a transformational leadership style enhance different 'extra-role' performance in nurses and this increases hospital efficacy. They do so by establishing a sense of self-efficacy but also by amplifying their levels of engagement in the workplace.

Long-term clinical experience with pure bicarbonate peritoneal dialysis solutions.

OBJECTIVES: The aim of this prospective study was to collect long-term experience in incident peritoneal dialysis (PD) patients treated with pure bicarbonate-buffered PD fluids. METHODS: The metabolic parameters acidosis, acid-base status, adequacy, fluid balance, nutritional markers, calcium, phosphorus, parathyroid hormone (PTH), and general laboratory work and medication were compared between incident PD patients in two groups: one treated with a 34 mmol/L bicarbonate-buffered PD fluid (BIC), the other with a 35 mmol/L lactate-buffered PD fluid (LAC). The observation period included 5 visits from 1 month (visit 1) until 12 months (visit 5) after the start of dialysis treatment. For the descriptive analysis, means and standard deviations were calculated. Student's t-test and linear mixed models were used to compare the two treatment groups. RESULTS: 36 patients were followed for 12 months, 18 in the BIC group and 18 in the LAC group. Statistically significant differences between the groups (at the end of study) were found. In BIC group, venous plasma bicarbonate was 27.4 +/- 2.3 mmol/L, base excess 0.8 +/- 2.2 mmol/L, and pH 7.31 +/- 0.05; in LAC group, venous bicarbonate was 25.9 +/- 2.4 mmol/L, base excess -0.6 +/- 2.1 mmol/L, and pH 7.30 +/- 0.04. No patient from the BIC group needed oral bicarbonate, in contrast to 4 patients in the LAC group. Whereas peritoneal urea and creatinine clearances did not differ between the groups, there was better renal solute clearance in the BIC group, accompanied by better-preserved diuresis at 12 months (1333 +/- 935 mL with BIC vs 839 +/- 556 mL with LAC). The reverse was true for ultrafiltration. CONCLUSIONS: Pure bicarbonate-buffered PD solutions were superior in correcting metabolic acidosis and they allowed omission of oral bicarbonate. The minor ultrafiltration with bicarbonate-buffered PD solutions was counterbalanced by better-preserved residual renal function with these solutions.

Experimental type 2 diabetes induces enzymatic changes in isolated rat enterocytes.

Diabetes in humans and in experimental animals produces changes in the function and structure of the small intestine. The authors determined the activity of intestinal disaccharidases (maltase and sucrase) and of 6-phosphofructo-1-kinase (PFK-1) in enterocytes isolated from the small intestine of male Wistar rats (2.5 to 3 months old) with experimental nonobese type 2 diabetes, induced by streptozotocin (STZ) injection on the day of birth (n0-STZ) or on the 5th day of life (n5-STZ), with different degrees of hyperglycemia and insulinemia (n0-STZ and n5-STZ models). The glycemia (mmol/L) of the diabetic rats (n0-STZ: 8.77 +/- 0.47; n5-STZ: 20.83 +/- 0.63) was higher (P <.01) than that of the nondiabetic (ND) rats (5.99 +/- 0.63); on the contrary, the insulinemia (ng/mL) was significantly lower in both n0-STZ (1.74 +/- 0.53; P <.05) and n5-STZ (1.12 +/- 0.44; P <.01) diabetic rats than in normal rats (3.77 +/- 0.22). The sucrase and maltase activities (U/g protein) in diabetic rats (n0-STZ: 89 +/- 9 and 266 +/- 12; n5-STZ: 142 +/- 23 and 451 +/- 57) were significantly higher than those in the ND group (66 +/- 5 and 228 +/- 22). The PFK-1 activities (mU/mg protein) in the diabetic models (n0-STZ: 14.89 +/- 1.51; n5-STZ: 13.35 +/- 3.12) were significantly lower (P <.05) than in ND rats (20.54 +/- 2.83). The data demonstrated enzymatic alterations in enterocytes isolated from the small intestine of n0-STZ rats that are greater (P <.05) than in the more hyperglycemic and hypoinsulinemic n5-STZ animals. The results also show that nonobese type 2-like diabetes in the rat produces modifications that favor an increase in glucose absorption rates.

Safety attitudes and their relationship to safety training and generalised self-efficacy.

This paper studies safety attitudes, their relationship with safety training behaviour, and generalised self-efficacy. From a sociotechnical perspective, training programs might be used as a mechanism for enhancing attitudes, especially to improve safety and occupational health. Also, self-efficacy allows to enhance training effectiveness. The aim of this paper is to validate a safety attitude scale and to examine its relationship to safety training behaviour and self-efficacy in organisational settings. With data from 140 employees, results show a conceptually meaningful 3-factor solution. Hierarchical multiple regression analysis shows a main effect of safety training behaviour and levels of self-efficacy on safety attitude. Study limitations and its implications on safety training design are also discussed.