A Self-Reported Study on Explanatory Variables of Stress in Multiple Sclerosis Patients: Exploring the Effect of Physical Conditions and Emotion Regulation Processes.

BACKGROUND: Multiple sclerosis (MS)-linked stress is frequent, multidetermined and facilitates the onset/exacerbation of MS. However, few explanatory models of stress analysed the joint explanatory effect of emotion regulation and clinical outcomes of MS in those patients. OBJECTIVE: This study explored whether self-reported MS-related conditions (number of relapses, fatigue and global disability) and specific emotion regulation processes (experiential avoidance and self-compassion) explain stress symptoms in MS patients. METHODS: The MS sample comprised 101 patients with MS diagnosis receiving treatment in hospitals and recruited through the Portuguese MS Society. The no-MS sample included 134 age-, sex- and years of education-matched adults without MS recruited from the general Portuguese population. Both samples did not report other neurological disorders. Data were collected using self-response measures. RESULTS: All potential explanatory variables differed significantly between samples, with higher scores found in MS patients. In MS clinical sample, those variables and years of education correlated with stress symptoms and predicted stress symptoms in simple linear regression models. These results allowed their selection as covariates in a multiple linear regression model. Years of education, the number of relapses, fatigue and experiential avoidance significantly predicted 51% of stress symptoms' total variance. CONCLUSIONS: This study provides preliminary evidence on the importance of clinicians and researchers considering the simultaneous contribution of years of education, the number of perceived relapses, fatigue and experiential avoidance as factors that can increase vulnerability to stress in MS patients. Psychological intervention programmes that tackle these factors and associated stress symptomatology should be implemented.

Notificación de incidencias relacionadas con la atención sanitaria en niños hospitalizados / Notificação de incidentes relacionados à assistência à saúde em crianças hospitalizadas / Notification of incidents related to health care in hospitalized children

Objetivo: Analizar la ocurrencia de incidentes relacionados con la atención de la salud en niños hospitalizados. Material y método: Investigación exploratoria, descriptiva y cuantitativa realizada a partir de una base de datos de reportes de incidentes y eventos adversos que involucran a niños realizada entre 2016 y 2018, desde un hospital docente, perteneciente al Sistema Único de Salud (SUS), ubicado en Salvador - Bahía. Los datos fueron analizados en el programa STATA versión 12. Resultados: Durante el período de estudio se reportaron 126 incidentes. La mayoría de los niños que sufrieron incidentes tenían entre 0 y 3 años (57,14%); eran hombres (58,73%); y pertenecía a la raza negra (87,92%). Los incidentes ocurrieron principalmente en el turno de mañana (29,37%), y las notificaciones se identificaron en el 71,46% de los casos y fueron realizadas principalmente por enfermeras (88,10%). Los incidentes más reportados fueron caídas (29,37%); quirúrgico (23,02%); flebitis (9,52%); y lesiones cutáneas (8,73%). Hubo daños en los pacientes en el 39,68% de los casos, que fueron predominantemente leves (80%). Conclusiones: Los hallazgos indican la necesidad de crear métodos para evaluar los factores de riesgo que favorezcan la ocurrencia de incidentes como caídas y otras situaciones que comprometan la seguridad de los niños hospitalizados, ya que estos pacientes tienen peculiaridades que deben ser consideradas en la atención de la salud. (AU)

Objetivo: Analisar a ocorrência de incidentes relacionados à assistência à saúde em crianças hospitalizadas. Material e método: Pesquisa exploratória, descritiva e quantitativa realizada a partir de um banco de dados de notificações de incidentes e eventos adversos envolvendo crianças realizadas entre 2016 e 2018, de um hospital de ensino pertencente ao Sistema Único de Saúde (SUS), localizado em Salvador - Bahia. Os dados foram analisados no programa STATA versão 12. Resultados: No período do estudo foram notificados 126 incidentes. A maioria das crianças que sofreram incidentes se encontrava na faixa etária dos 0 aos 3 anos (57,14%); eram do sexo masculino (58,73%); e pertenciam à raça negra (87,92%). Os incidentes ocorreram majoritariamente no turno da manhã, (29,37%), sendo as notificações identificadas em 71,46% dos casos e foram realizadas principalmente por enfermeiros, (88,10%). Os incidentes mais notificados foram as quedas (29,37%); os cirúrgicos (23,02%); as flebites (9,52%); e as lesões de pele (8,73%). Houve dano aos pacientes em 39,68% dos casos, sendo este predominantemente de grau leve (80%). Conclusões: Os achados indicam a necessidade de criar métodos de avaliação dos fatores de risco que favorecem a ocorrência de incidentes como as quedas e demais situações que comprometem a segurança de crianças hospitalizadas, uma vez que esses pacientes apresentam peculiaridades que precisam ser consideradas no cuidado à saúde. (AU)

Objective: Analyzing the occurrence of incidents related to health care in hospitalized children. Material and method: An exploratory, descriptive and quantitative research conducted from a database of reports of incidents and adverse events involving children conducted between 2016 and 2018 from a teaching hospital belonging to the Unified Health System (SUS), located in Salvador - Bahia. The data were analyzed in the STATA version 12 program. Results: During the study period, 126 incidents were reported. Most of the children who suffered incidents were between 0 and 3 years old (57.14%); were male (58.73%); and belonged to the black race (87.92%). The incidents occurred mostly in the morning shift (29.37%), and the notifications were identified in 71.46% of the cases and were performed by nurses (88.10%). The most reported incidents were falls (29.37%); surgical (23.02%); phlebitis (9.52%); and skin lesions (8.73%). There was damage to patients in 39.68% of the cases, which was mild (80%). Conclusions: The findings indicate the need to create methods for assessing risk factors that favor the occurrence of incidents such as falls and other situations that compromise the safety of hospitalized children, since these patients have peculiarities that need to be considered in health care. (AU)

1,2,4-Trioxolane and 1,2,4,5-Tetraoxane Endoperoxides against Old-World Leishmania Parasites: In Vitro Activity and Mode of Action.

Leishmaniasis remains one of the ten Neglected Tropical Diseases with significant morbidity and mortality in humans. Current treatment of visceral leishmaniasis is difficult due to a lack of effective, non-toxic, and non-extensive medications. This study aimed to evaluate the selectivity of 12 synthetic endoperoxides (1,2,4-trioxolanes; 1,2,4,5-tetraoxanes) and uncover their biochemical effects on Leishmania parasites responsible for visceral leishmaniasis. The compounds were screened for in vitro activity against L. infantum and L. donovani and for cytotoxicity in two monocytic cell lines (J774A.1 and THP-1) using the methyl thiazol tetrazolium assay. Reactive oxygen species formation, apoptosis, and mitochondrial impairment were measured by flow cytometry. The compounds exhibited fair to moderate anti-proliferative activity against promastigotes of the 2 Leishmania species, with IC50 values ranging from 13.0 ± 1.7 µM to 793.0 ± 37.2 µM. Tetraoxanes LC132 and LC138 demonstrated good leishmanicidal activity on L. infantum amastigotes (IC50 13.2 ± 5.2 and 23.9 ± 2.7 µM) with low cytotoxicity in mammalian cells (SIs 22.1 and 118.6), indicating selectivity towards the parasite. Furthermore, LC138 was able to induce late apoptosis and dose-dependent oxidative stress without affecting mithocondria. Compounds LC132 and LC138 can be further explored as potential antileishmanial chemotypes.

Associação de características sociodemográficas com fatores de risco cardiovascular em homens hipertensos / Asociación de características sociodemográficas con factores de riesgo cardiovascular en hombres hipertensos / Association of sociodemographic characteristics with cardiovascular risk factors in hypertensive men

Objetivo: investigar a associação de características sociodemográficas com fatores de risco cardiovascular em homens hipertensos. Método: estudo transversal efetuado com 80 homens entrevistados e avaliados clinicamente. Dados analisados descritivamente e pelos testes Qui-Quadrado de Person ou Exato de Fisher. O nível de significância estatística foi de 5%. Resultados: houve maior prevalência de tabagismo em ?60 anos (p=0,002), nível insuficiente de atividade física em ?60 anos (p=0,017), fumantes passivos em brancos (p=0,026) e sem companheira (p=0,039) e consumo excessivo de álcool no final de semana em brancos (p=0,043) e homens com menor escolaridade (p=0,041). Conclusão: foi observada a associação de características sociodemográficas com elevada prevalência de fatores de risco cardiovascular descontrolados em homens hipertensos.

Objetivo: investigar la asociación de características sociodemográficas con factores de riesgo cardiovascular en hombres hipertensos. Método: estudio transversal realizado con 80 hombres entrevistados y evaluados clínicamente. Datos analizados descriptivamente y por pruebas de Persona de Fisher o Chi-Cuadrado Exacto. El nivel de significación estadística fue del 5%. Resultados: hubo mayor prevalencia de tabaquismo en ?60 años (p=0,002), nivel insuficiente de actividad física en ?60 años (p=0,017), fumadores pasivos en blancos (p=0,026) y sin pareja (p=0,039) y consumo excesivo de alcohol en fin de semana en blancos (p=0,043) y hombres con menor escolaridad (p=0,041). Conclusión: se observó la asociación de características sociodemográficas con una alta prevalencia de factores de riesgo cardiovascular no controlados en hombres hipertensos.

Objective: to investigate the association of sociodemographic characteristics with cardiovascular risk factors in hypertensive men. Method: a cross-sectional study was conducted with 80 men interviewed and clinically evaluated. Data were analyzed descriptively and by Fisher's Exact or Person Chi-Square tests. The level of statistical significance was 5%. Results: there was a higher prevalence of smoking in ?60 years (p=0.002), insufficient level of physical activity in ?60 years (p=0.017), passive smokers in whites (p=0.026) and without a partner (p=0.039), and excessive consumption of alcohol at the weekend in whites (p=0.043) and men with lower schooling (p=0.041). Conclusion: sociodemographic characteristics were associated with a high prevalence of uncontrolled cardiovascular risk factors in hypertensive men.

Proteostasis in dendritic cells is controlled by the PERK signaling axis independently of ATF4.

In stressed cells, phosphorylation of eukaryotic initiation factor 2α (eIF2α) controls transcriptome-wide changes in mRNA translation and gene expression known as the integrated stress response. We show here that DCs are characterized by high eIF2α phosphorylation, mostly caused by the activation of the ER kinase PERK (EIF2AK3). Despite high p-eIF2α levels, DCs display active protein synthesis and no signs of a chronic integrated stress response. This biochemical specificity prevents translation arrest and expression of the transcription factor ATF4 during ER-stress induction by the subtilase cytotoxin (SubAB). PERK inactivation, increases globally protein synthesis levels and regulates IFN-ß expression, while impairing LPS-stimulated DC migration. Although the loss of PERK activity does not impact DC development, the cross talk existing between actin cytoskeleton dynamics; PERK and eIF2α phosphorylation is likely important to adapt DC homeostasis to the variations imposed by the immune contexts.

Estresse ocupacional relacionado à assistência de enfermagem em terapia intensiva / Estrés ocupacional relacionado con la atención de enfermería en cuidados intensivos / Occupational stress related to nursing care in intensive care

Objetivo estimar a prevalência de estresse ocupacional entre profissionais de enfermagem que atuam em Unidade de Terapia Intensiva e identificar sua associação com variáveis sociodemográficas, profissionais e relacionadas à assistência de enfermagem. Método estudo transversal, realizado em um hospital de ensino de Salvador, Bahia, Brasil, com 54 profissionais. Os dados foram coletados entre fevereiro e março de 2020 por meio da Escala Bianchi de Stress e analisados pelo Programa Stata. Resultados a prevalência de estresse ocupacional em nível médio ou alto foi de 57,4%. Maiores níveis de estresse foram associados significativamente ao menor tempo de formação (p-valor=0,05), ser enfermeiro (p-valor=0,00), enfrentar a morte do paciente (p-valor=0,01), atender aos familiares dos pacientes críticos (p-valor=0,00) e atender às necessidades dos familiares (p-valor=0,00). Conclusão a elevada prevalência de estresse ocupacional, bem como os fatores associados identificados, foram informações essenciais para implementação de estratégias preventivas.

Objetivo estimar la prevalencia del estrés ocupacional entre los profesionales de enfermería que trabajan en la Unidad de Cuidados Intensivos e identificar su asociación con variables sociodemográficas, profesionales y de cuidados de enfermería. Método estudio transversal, realizado en un hospital de enseñanza en Salvador, Bahía, Brasil, con 54 profesionales. Los datos fueron recopilados entre febrero y marzo de 2020 utilizando la Escala de Estrés de Bianchi y analizados por el Programa Stata. Resultados la prevalencia del estrés ocupacional a nivel medio o alto fue del 57,4%. Los niveles de estrés más altos se asociaron significativamente con un tiempo de entrenamiento más corto (p-valor-0,05), ser una enfermera (p-valor-0,00), enfrentar la muerte del paciente (p-valor-0,01), atender a los familiares de los pacientes en estado crítico (p-value-0,00) y satisfacer las necesidades de los miembros de la familia (p-valor-0,00). Conclusión la alta prevalencia del estrés ocupacional, así como los factores asociados identificados, fueron información esencial para la aplicación de estrategias preventivas.

Objective to estimate the prevalence of occupational stress among nursing professionals working in the Intensive Care Unit and to identify its association with sociodemographic, professional and nursing care-related variables. Method cross-sectional study, conducted in a teaching hospital in Salvador, Bahia, Brazil, with 54 professionals. Data were collected between February and March 2020 using the Bianchi Stress Scale and analyzed by the Stata Program. Results the prevalence of occupational stress at medium or high level was 57.4%. Higher stress levels were significantly associated with shorter training time (p-value=0.05), being a nurse (p-value=0.00), facing patient death (p-value=0.01), attending to critically ill patients' relatives (p-value=0.00) and meeting the needs of family members (p-value=0.00). Conclusion the high prevalence of occupational stress, as well as the associated factors identified, were essential information for the implementation of preventive strategies.

Consumo de bebida alcoólica, tabaco e drogas ilícitas em ingressantes universitários da área de enfermagem / Consumption of alcoholic beverages, tobacco and illicit drugs among university freshmen in the nursing field / Consumo de bebidas alcohólicas, tabaco y drogas ilícitas entre estudiantes universitarios de primer año en el campo de la enfermería

Objetivo: Descrever o consumo de bebida alcoólica, tabaco e drogas ilícitas em ingressantes universitários da área de enfermagem. Método: Estudo descritivo, com 119 ingressantes de uma universidade pública, em Salvador-BA. Utilizou-se o AUDIT e instrumentos para caracterização sociodemográfica, consumo de tabaco e drogas ilícitas. Os dados foram analisados por estatística descritiva. Resultados: A idade média foi 20 anos (dp 4). Predominaram mulheres, classe social C, raça/cor negra e solteiras(os). Nenhum estudante fumava, mas 17,6% eram fumantes passivos e um consumia droga ilícita. Cinquenta e cinco por cento usavam bebida alcoólica e destes 33,2% consumiam mais que cinco doses em uma ocasião. Classificaram-se na Zona I do AUDIT 89,9%, na II 8,4% e na III 1,7%. Conclusão: Com o predomínio da Zona I, sugere-se a monitorização do consumo de drogas durante a formação e as ações de prevenção e controle devem ser instituídas de forma coletiva e individual. O estudo ilumina a importância do cuidado em enfermagem e saúde destinado a proteção dos universitários quanto ao uso abusivo de drogas.

Objective: Describe the consumption of alcoholic beverages, tobacco and illicit drugs among university freshmen in the nursing field. Method: Descriptive, quantitative study, with 119 entering a public university, in Salvador-Ba. AUDIT and instruments were used for sociodemographic characterization, tobacco consumption and illicit drugs. Data analyzed by descriptive statistics. Results: The average age was 20 years (SD 4). Women, social class C, black race / color and single women predominated. No student smoked, but 17.6% were passive smokers and one used illicit drugs. Fifty-five percent used alcohol and of these 33.2% consumed more than five drinks on one occasion. AUDIT's Zone I was 89.9%, II 8.4% and III 1.7%. Conclusion: With the predominance of Zone I, monitoring of drug use during training is suggested, and prevention and control actions should be instituted collectively and individually. It highlights the importance of nursing and health care aimed at protecting university students from drug abuse.

Objetivo: describir el consumo de bebidas alcohólicas, tabaco y drogas ilícitas entre los estudiantes universitarios de primer año en el campo de la enfermería. Método: Estudio descriptivo, con 119 estudiantes de primer año de una universidad pública, en Salvador-Ba. AUDIT e instrumentos fueron utilizados para la caracterización sociodemográfica, el consumo de tabaco y las drogas ilícitas. Los datos se analizaron mediante estadística descriptiva. Resultados: la edad media fue de 20 años (DE 4). Predominaron las mujeres, la clase social C, la raza / color negro y las solteras. Ningún estudiante fumaba, pero el 17.6% eran fumadores pasivos y uno usaba drogas ilícitas. El 55% consumió alcohol y de estos 33.2% consumió más de cinco bebidas en una ocasión. La Zona I de AUDIT fue 89.9%, II 8.4% y III 1.7%. Conclusión: Con el predominio de la Zona I, se sugiere monitorear el uso de drogas durante el entrenamiento y las acciones de prevención y control deben instituirse de manera colectiva e individual. El estudio resalta la importancia de la enfermería y la atención médica destinadas a proteger a los estudiantes universitarios del abuso de drogas.

Incidência e caracterização das flebites notificadas eletronicamente em um hospital de ensino / Incidencia y caracterización de la flebitis notificada electrónicamente en un hospital de enseñanza / Incidence and characterization of electronically notified phlebitis in a teaching hospital

Objetivo: analisar a incidência e as notificações de flebite em um hospital de ensino. Método: estudo observacional retrospectivo, realizado em Salvador, Bahia, Brasil. Os dados foram coletados com base nas notificações de incidentes relacionados à assistência à saúde, ocorridas no período de janeiro/2016 a dezembro/2017. Realizou-se análise descritiva. Resultados: foram notificados 277 casos de flebite, com incidência variando entre 1,45% e 26,09% no período do estudo. A maioria das flebites ocorreu em indivíduos adultos (63,27%); raça negra (66,06%); e com baixo nível de escolaridade (53,43%). O uso prolongado de medicamentos e/ou uso de medicamento irritante (52%) foram citados como principais causas do evento; 95,31% foram classificados como não graves. Conclusão: a incidência de flebite variou no período de estudo, e as notificações em um hospital de ensino apontaram para danos à saúde da maioria dos pacientes com flebites notificadas.

Objetivo: analizar la incidencia y las notificaciones de flebitis en un hospital de enseñanza. Método: estudio retrospectivo de observación, realizado en Salvador, Bahía, Brasil. Los datos se reunieron sobre la base de los reportes de incidentes relacionados con la asistencia de la salud, que ocurrieron entre enero/2016 y diciembre/2017. Se realizó un análisis descriptivo. Resultados: se notificaron 277 casos de flebitis, con una incidencia que oscila entre el 1,45% y el 26,09% en el período de estudio. La mayoría de las flebitis ocurrieron en individuos adultos (63,27%); de raza negra (66,06%); y con bajo nivel de escolaridad (53,43%). El uso prolongado de medicamentos y/o el uso de medicamentos irritantes (52%) fueron citados como las principales causas del evento; el 95,31% se clasificó como no grave. Conclusión: la incidencia de la flebitis varió durante el período de estudio, y los reportes en un hospital de enseñanza señalaron el daño a la salud de la mayoría de los pacientes con flebitis reportados.

Objective: to analyze the incidence and notifications of phlebitis in a teaching hospital. Method: retrospective observational study, held in Salvador, Bahia, Brazil. The data was collected based on the notifications of incidents related to health assistance, which occurred in the period from January/2016 to December/2017. A descriptive analysis was conducted. Results: 277 cases of phlebitis were notified, with incidence ranging from 1.45% to 26.09% in the study period. Most phlebitis occurred in adult individuals (63.27%); black race (66.06%); and with low schooling level (53.43%). Prolonged use of medication and/or use of irritant medication (52%) were cited as the main causes of the event; 95.31% were classified as non-serious. Conclusion: the incidence of phlebitis varied during the study period, and the reports at a teaching hospital pointed to damage to the health of most patients with phlebitis reported.

Incidentes relacionados à assistência à saúde em idosos hospitalizados / Healthcare-related incidents in hospitalized elderly people

Objetivo: analisar notificações de incidentes relacionados à assistência à saúde em idosos hospitalizados. Método: trata-se de um estudo quantitativo, descritivo e exploratório, em um hospital público de ensino, com dados de incidentes relacionados à assistência à saúde em idosos hospitalizados, coletados por meio de formulários. Realizou-se análise exploratória e descritiva dos dados. Resultados: registraram-se 296 notificações, predominando: flebite, 28,21% (n=79); problemas relacionados a cirurgias, 19,93% (n=59); lesões de pele, 17,23% (n=5) e quedas, 13,51% (n=40). Classificou-se a maioria dos incidentes como de grau leve, 57,77% (n=171). Conclusão: encontraram-se taxas de notificações menores do que a descrita na literatura. Destaca-se, no entanto, a importância do estímulo à notificação, planejamento e execução de ações voltadas para idosos, a partir do cenário identificado.(AU)

Objective: to analyze reports of healthcare-related incidents in hospitalized elderly people. Method: this is a quantitative, descriptive and exploratory study in a public teaching hospital, with data on healthcare-related incidents in hospitalized elderly people, collected through forms. Exploratory and descriptive analyses of the data were performed. Results: there were 296 recorded notifications, predominantly: phlebitis, 28.21% (n=79); problems related to surgeries, 19.93% (n=59); skin lesions, 17.23% (n=5) and falls, 13.51% (n=40). Most incidents were classified as mild, 57.77% (n=171). Conclusion: there were lower rates of notifications than those described in the literature. However, the importance of encouraging notification, planning and execution of actions focused on the elderly person is highlighted from the identified scenario.(AU)

Objetivo: analizar informes de incidentes relacionadas a la atención en salud en ancianos hospitalizados. Método: se trata de un estudio cuantitativo, descriptivo y exploratorio en un hospital público de enseñanza, con datos sobre incidentes relacionados a la atención em salud en ancianos hospitalizados, recogidos a través de formularios. Se realizó un análisis exploratorio y descriptivo de los datos. Resultados: se registraron 296 notificaciones, principalmente: flebitis, 28,21% (n-79); problemas relacionados con las cirugías, 19,93% (n-59); lesiones cutáneas, 17,23% (n-5) y caídas, 13,51% (n-40). La mayoría de los incidentes fue clasificada como leve, 57,77% (n-171). Conclusión: se encontraron tasas de notificaciones más bajas que las descritas en la literatura. Sin embargo, se destaca la importancia de fomentar la notificación, planificación y ejecución de las acciones dirigidas a los ancianos, desde el escenario identificado.(AU)

Autocuidado de indivíduos com insuficiência cardíaca / Autocuidado de individuos con insuficiencia cardiaca / Self-care of individuals with heart failure

Objetivo: descrever o nível de autocuidado de indivíduos com insuficiência cardíaca (IC). Método: estudo descritivo, realizado num ambulatório de cardiologia em Salvador, Bahia, no período de setembro e outubro de 2017 e em janeiro de 2018. Foram feitas entrevistas gravadas utilizando instrumento próprio e aplicado a Escala Europeia de comportamento do autocuidado na Insuficiência Cardíaca (EEAIC). Resultados: a amostra foi composta por 43 indivíduos, do sexo masculino (53,5%), entre 51 a 60 anos (34,9%), raça/cor autodeclarada negra (46,5%), vivendo com companheiro(a) (51,2%), baixa escolaridade (ensino fundamental incompleto 41,9%) e baixa renda (39,5%). Com relação ao autocuidado, o valor médio do score na EEAIC foi de 30,1 (±7,4). Evidenciou-se que 46,5% dos entrevistados apresentaram capacidade inadequada para o autocuidado (score total entre 31 a 50 pontos). Conclusão: o comportamento de autocuidado foi de moderado à insatisfatório sugerindo implementação de práticas educativas efetivas para capacitar os indivíduos no manejo da doença.

Objective: to describe the self-care level of individuals with heart failure. Method: a descriptive study, performed in a cardiology outpatient clinic in Salvador, Bahia, during the period of September and October, 2017 and January, 2018. Recorded interviews were performed using appropriate instruments and applying the European Heart Failure Self-Care Behavior Scale (EHFScBs). Result: the sample comprised 43 individuals of the male gender (53.5%), between the ages of 51 and 60 years (34,9%), self-declared race/skin color black (46.5%), living with a partner (51.2%), low schooling (incomplete primary education 41.9%) and low income (39.5%). In relation to self-care, the average EHFScBs score was of 30.1 (±7.4). It was evidenced that 46.5% of the interviewed parties presented inadequate self-care capacity (total score between 31 and 50 points). Conclusion: self-care behavior was between moderate and unsatisfactory, suggesting the implementation of effective educational practices to enable individuals to handle the disease.

Objetivo: describir el nivel de autocuidado de individuos con insuficiencia cardiaca (IC). Método: estudio descriptivo, realizado en un ambulatorio de cardiología en Salvador, Bahia, en el periodo de septiembre a octubre de 2018. Fueron realizadas entrevistas grabadas utilizando instrumento propio y aplicado la Escala Europea de comportamiento del autocuidado en la Insuficiencia Cardiaca (EEAIC). Resultados: la muestra fue compuesta por 43 individuos, del sexo masculino (53,5%), entre 51 a 60 años (34,9%), raza/color de piel auto declarada negra (46,5%), viviendo con compañero(a) (51,2%), baja escolaridad (enseñanza fundamental incompleta 41,9%) y baja renta (39,5%). Con relación al autocuidado, el valor promedio del puntaje en el EEAIC fue de 30,1 (±7,4). Se evidenció que 46,5% de los entrevistados presentaron capacidad inadecuada para el autocuidado (puntaje total entre 31 a 50 puntos). Conclusión: el comportamiento del autocuidado fue de moderado a insatisfactorio, sugiriendo la implementación de prácticas educativas efectivas para capacitar los individuos en el manejo de la enfermedad.

Dynamics of psychopharmaceutical use and relationship with psychoanalytic psychotherapy in the mental health interface: an integrative review / Dinâmica de uso de psicofármacos e a relação com a psicoterapia psicanalítica na interface da saúde mental: uma revisão integrativa

INTRODUCTION: Drug use has been discussed by various authorities and health professionals, and a change in attitude. Among them, psychoanalysts and psychotherapists recognize the importance that the theme has been having in recent decades, considering the rational use of psychotropic drugs as supporting psychoanalytic treatment. OBJECTIVE: To analyze the use of psychotropic drugs and their relationship with psychoanalytic psychotherapy in the interface of mental health. METHODS: This is an integrative review of the MEDLINE Database based on a statement of preferred reports for systematic methods and meta-analyzes (PRISMA) through the descriptors: Psychotropic Drugs and Psychoanalysis Drug Therapy and Drug Misuse and Drug Use and Signs and Symptoms, filtering the results by title and summary specificity and only studies available in their full version and conducted in humans were detected. RESULTS: 42 articles were selected for final analysis. The object of article analysis was submitted to the analyst who treats his patients and conducts clinical trials with drug interaction, as well as therapeutic transfer complement as a clinical resource for treatment of psychoanalytic sessions. In addition, the results of this drug interaction were evidenced as supporting factors in the clinical treatment of clients exposed to the clinical session. FINAL CONSIDERATIONS: The use of psychoactive drugs and psychoanalytic psychotherapy Shows as an association capable of proving interaction and integration of the personality aspects and the psychological structure of the individual. It is a clinical condition that can be stimulated in the mental health treatment of individuals suffering from mental / emotional distress.

INTRODUÇÃO: O consumo de medicamentos tem sido discutido por diversas autoridades e profissionais da saúde, proporcionando uma mudança de postura desses. Dentre eles, os psicanalistas e psicoterapeutas reconhecem a tamanha importância que o tema tem tomado nas últimas décadas, considerando o uso racional de psicofármacos como coadjuvantes do tratamento psicanalítico. OBJETIVO: Analisar o uso de psicofármacos e sua relação com a psicoterapia psicanalítica na interface da saúde mental. MÉTODO: Trata-se de uma revisão integrativa na Base de Dados MEDLINE realizada de acordo com a declaração de relatórios preferenciais para avaliações sistemáticas e metanálises (PRISMA), através dos descritores Psychotropic Drugs AND Psychoanalysis Therapy AND Drug Misuse AND Drug Utilization AND Signs and Symptoms, filtrando os resultados por especificidade em título e resumo e selecionando apenas estudos disponíveis em sua versão completa e realizados com seres humanos. RESULTADOS: Selecionaram-se 42 artigos para análise final. O objeto de análise dos artigos foi o sujeito analista que trata seus pacientes e realiza observações clínicas com interação medicamentosa, bem como complemento de transferência terapêutica como recurso clínico para o tratamento na sessão psicanalítica. Ademais, os resultados dessa interação medicamentosa foram evidenciados como coadjuvantes no tratamento clínico dos clientes expostos à sessão clínica. CONSIDERAÇÕES FINAIS: O uso de psicofármacos e psicoterapia psicanalítica apresentou-se como uma associação capaz de prover interação e integração dos aspectos da personalidade e da estrutura psíquica do sujeito. Trata-se de condição clínica que deverá ser estimulada em tratamento de saúde mental de sujeitos acometidos por sofrimento mental/emocional.

At the crossway of ER-stress and proinflammatory responses.

Immune cells detect specific microbes or damage to tissue integrity in order to initiate efficient immune responses. Abnormal accumulation of proteins in the endoplasmic reticulum (ER) can be seen as a sign of cellular malfunction and stress that triggers a collection of conserved emergency rescue programs. These different signaling cascades, which favor ER proteostasis and promote cell survival, are collectively known as the unfolded protein response (UPR). In recent years, a synergy between the UPR and inflammatory cytokine production has been unraveled, with different branches of the UPR entering in a cross-talk with specialized microbe sensing pathways, which turns on or amplify inflammatory cytokines production. Complementary to this synergetic activity, UPR induction alone, can itself be seen as a danger signal, and triggers directly or indirectly inflammation in different cellular and pathological models, this independently of the presence of pathogens. Here, we discuss recent advances on the nature of these cross-talks and how innate immunity, metabolism dysregulation, and ER-signaling pathways intersect in specialized immune cells, such as dendritic cells (DCs), and contribute to the pathogenesis of inflammatory diseases.

Repercussões da educação permanente nas práticas assistenciais dos profissionais de enfermagem / Repercusiones de la educación continua en las prácticas asistenciales de los profesionales de enfermería / Repercussions of permanent education in the assistance practices of nursing professionals

Objetivo analisar as repercussões das atividades de educação permanente nas práticas assistenciais dos profissionais de enfermagem. Método pesquisa qualitativa, realizada em um hospital universitário de grande porte localizado no município de Salvador, Bahia, Brasil. Foram entrevistados 17 profissionais de enfermagem, entre os meses de setembro e dezembro de 2017. Os dados coletados por meio de entrevista semiestruturada foram processados no software IRAMUTEQ. Resultados obteve-se um percentual de retenção do texto de 80,3%, 320 Unidades de Contexto Elementares e 5 classes lexicais. Os entrevistados atribuíram à participação nas atividades de educação permanente um papel relevante, com repercussões positivas para a assistência de enfermagem. Conclusão a participação em atividades de educação permanente levou à sensibilização sobre as necessidades educativas e, assim, pôde favorecer maior satisfação com o trabalho e melhor qualidade na assistência, visto que os profissionais de enfermagem passaram a sentir-se mais qualificados e atualizados.

Objetivo analizar las repercusiones de las actividades de educación continua en prácticas asistenciales de profesionales de enfermería. Método investigación cualitativa, en hospital universitario de gran porte en Salvador, Bahia, Brasil. Se entrevistaron a 17 profesionales de enfermería, entre septiembre y diciembre de 2017. Datos recogidos por medio de entrevista semiestructurada, procesados en el software IRAMUTEQ. Resultados se obtuvo porcentaje de retención del texto de 80,3%, 320 Unidades de Contexto Elementales y cinco clases lexicales. Entrevistados atribuyeron papel relevante a la participación en las actividades de educación continua, con repercusiones positivas para atención de enfermería. Conclusión la participación en actividades de educación continua llevó a la sensibilización sobre necesidades educativas y, así, se pudo favorecer mayor satisfacción con el trabajo y mejor calidad en la atención, ya que los profesionales de enfermería pasaron a sentirse más cualificados y actualizados.

Objective to analyze the repercussions of the activities of permanent education on nursing assistance practices. Method qualitative research performed in a large university hospital located in the city of Salvador, Bahia, Brazil. 17 nursing professionals were interviewed between September and December 2017. The data collected through a semi-structured interview were processed in IRAMUTEQ software. Results the percentage obtained was 80.3% text retention, 320 Elementary Context Units and 5 lexical classes. The interviewees attributed to the participation in the activities of permanent education a relevant role, with positive repercussions for nursing care. Conclusion participation in activities of permanent education led to the awareness of educational needs and, thus, could favor greater satisfaction with work and better quality of care, as the nursing professionals began to feel more qualified and updated.

SunRiSE - measuring translation elongation at single-cell resolution by means of flow cytometry.

The rate at which ribosomes translate mRNAs regulates protein expression by controlling co-translational protein folding and mRNA stability. Many factors regulate translation elongation, including tRNA levels, codon usage and phosphorylation of eukaryotic elongation factor 2 (eEF2). Current methods to measure translation elongation lack single-cell resolution, require expression of multiple transgenes and have never been successfully applied ex vivo Here, we show, by using a combination of puromycilation detection and flow cytometry (a method we call 'SunRiSE'), that translation elongation can be measured accurately in primary cells in pure or heterogenous populations isolated from blood or tissues. This method allows for the simultaneous monitoring of multiple parameters, such as mTOR or S6K1/2 signaling activity, the cell cycle stage and phosphorylation of translation factors in single cells, without elaborated, costly and lengthy purification procedures. We took advantage of SunRiSE to demonstrate that, in mouse embryonic fibroblasts, eEF2 phosphorylation by eEF2 kinase (eEF2K) mostly affects translation engagement, but has a surprisingly small effect on elongation, except after proteotoxic stress induction.This article has an associated First Person interview with the first author of the paper.

Guanabenz inhibits TLR9 signaling through a pathway that is independent of eIF2α dephosphorylation by the GADD34/PP1c complex.

Endoplasmic reticulum (ER) stress triggers or amplifies inflammatory signals and cytokine production in immune cells. Upon the resolution of ER stress, the inducible phosphatase 1 cofactor GADD34 promotes the dephosphorylation of the initiation factor eIF2α, thereby enabling protein translation to resume. Several aminoguanidine compounds, such as guanabenz, perturb the eIF2α phosphorylation-dephosphorylation cycle and protect different cell or tissue types from protein misfolding and degeneration. We investigated how pharmacological interference with the eIF2α pathway could be beneficial to treat autoinflammatory diseases dependent on proinflammatory cytokines and type I interferons (IFNs), the production of which is regulated by GADD34 in dendritic cells (DCs). In mouse and human DCs and B cells, guanabenz prevented the activation of Toll-like receptor 9 (TLR9) by CpG oligodeoxynucleotides or DNA-immunoglobulin complexes in endosomes. In vivo, guanabenz protected mice from CpG oligonucleotide-dependent cytokine shock and decreased autoimmune symptom severity in a chemically induced model of systemic lupus erythematosus. However, we found that guanabenz exerted its inhibitory effect independently of GADD34 activity on eIF2α and instead decreased the abundance of CH25H, a cholesterol hydroxylase linked to antiviral immunity. Our results therefore suggest that guanabenz and similar compounds could be used to treat type I IFN-dependent pathologies and that CH25H could be a therapeutic target to control these diseases.

Consumo de bebida alcoólica e tabagismo em homens hipertensos / Consumo de bebidas alcohólicas y tabaco en hombres hipertensos / Alcohol consumption and smoking among hypetensive men

Objetivo caracterizar o consumo de bebida alcoólica e tabagismo em homens hipertensos. Método trata-se de estudo transversal, com amostra de conveniência, sendo 130 homens entrevistados. Dados analisados em percentuais, médias e desvio padrão. Resultados a média de idade foi de 58,32 (dp=9,99). Predominaram casados, negros, baixa classe socioeconômica, ensino fundamental completo/incompleto, ativos profissionalmente. Observou-se que 37,7% eram fumantes passivos, 34,6% ex-tabagistas e 7,7% fumavam, predominando o uso de cigarro. Consumiam bebida alcoólica 52,3% dos homens, os demais nunca consumiram (18,5%) ou haviam parado (29,2%). Maior proporção consumia cerveja, bebidas destiladas e vinho, sendo o uso maior no final de semana (cerveja 32,4% vs 94,15; destilada 13,2% vs 22,0% e vinho 10,3% vs 17,6%) e excessivo para 67,6% dos homens. Conclusão houve proporção elevada de fumantes passivos e consumo excessivo de álcool no final de semana. Uma proposta terapêutica compartilhada deve combater esses fatores de risco junto aos homens.

Objetivo caracterizar el consumo de bebidas alcohólicas y tabaquismo en hombres hipertensos. Método estudio transversal, con muestra de conveniencia, siendo 130 hombres entrevistados. Datos analizados en porcentajes, medias y desviación estándar. Resultados el promedio de edad fue 58,32 (dp=9,99). Predominaron casados, negros, baja clase socioeconómica, enseñanza fundamental completa/incompleta, activos profesionalmente. Se observó que 37,7% eran fumadores pasivos, 34,6% ex tabaquistas y 7,7% fumaban, predominando el uso de cigarrillo. Consumían bebidas alcohólicas 52,3% de los hombres, los demás nunca consumieron (18,5%) o habían parado (29,2%). Mayor proporción consumía cerveza, bebidas destiladas y vino, siendo el uso mayor al final de semana (cerveza 32,4% vs 94,15, destilada 13,2% vs 22,0% y vino 10,3% vs 17,6%) y excesivo para 67,6% de los hombres. Conclusión hubo elevada proporción de fumadores pasivos y consumo excesivo de alcohol al final de semana. Propuesta terapéutica compartida debe combatir estos factores de riesgo junto a los hombres.

Objective to characterize alcohol consumption and smoking among hypertensive men. Method cross-sectional study, with a convenience sample, involving interviews with 130 men. Data were analyzed in percentage, mean and standard deviation values. Results mean age was 58.32 (SD=9.99). There was a predominance of married men, blacks, from low socioeconomic classes, with complete or incomplete primary education, who were active professionally. It was noted that 37.7% were passive smokers, 34.6% were former smokers and 7.7% were smokers, primarily of cigarettes. A total of 52.3% of the men consumed alcoholic beverages, 18.5% never consumed them and 29.2% had stopped drinking. A larger proportion of men consumed beer, distilled beverages and wine, with higher use on weekends (beer 32.4% versus 94.15%; distilled 13.2% versus 22% and 10.3% versus 17.6%) and excessive consumption in the case of 67.6% of the men. Conclusion there was a high proportion of passive smokers and excessive alcohol consumption on weekends. A shared therapeutic proposal should be adopted to combat these risk factors in men.

Protein synthesis inhibition and GADD34 control IFN-ß heterogeneous expression in response to dsRNA.

In innate immune responses, induction of type-I interferons (IFNs) prevents virus spreading while viral replication is delayed by protein synthesis inhibition. We asked how cells perform these apparently contradictory activities. Using single fibroblast monitoring by flow cytometry and mathematical modeling, we demonstrate that type-I IFN production is linked to cell's ability to enter dsRNA-activated PKR-dependent translational arrest and then overcome this inhibition by decreasing eIF2α phosphorylation through phosphatase 1c cofactor GADD34 (Ppp1r15a) expression. GADD34 expression, shown here to be dependent on the IRF3 transcription factor, is responsible for a biochemical cycle permitting pulse of IFN synthesis to occur in cells undergoing protein synthesis inhibition. Translation arrest is further demonstrated to be key for anti-viral response by acting synergistically with MAVS activation to amplify TBK1 signaling and IFN-ß mRNA transcription, while GADD34-dependent protein synthesis recovery contributes to the heterogeneous expression of IFN observed in dsRNA-activated cells.

Detection of Mycobacterium avium subsp. paratuberculosis in kidney samples of red deer (Cervus elaphus) in Portugal: Evaluation of different methods.

Paratuberculosis or Johne's disease, caused by Mycobacterium avium subsp. paratuberculosis (Map), is a chronic granulomatous enteritis affecting both domestic and wild ruminants. The present work is part of a wider set of studies designed to assess the prevalence of paratuberculosis in free ranging red deer (Cervus elaphus). With that purpose, 877 free-ranging red deer legally hunted in the Centre-eastern Portugal were submitted to necropsy and sampled for molecular methods, microbiology and histopathology. Thirty-seven (4.2%) kidneys revealed acid-fast bacilli when screened with the Ziehl-Neelsen technique. Map was detected by IS900 polymerase chain reaction (PCR) in thirty (81.1%) of the Ziehl-Neelsen positive kidneys. Subsequent PCR and/or culture from the different organs of the 37 examined animals allowed us to detect 86.4% (32 animals) infected red deer. Our results suggest that renal involvement in Map infected deer may be underdiagnosed and thus the routine examination of this organ and its inclusion in PCR techniques designed for Map detection could substantially improve the diagnostic of paratuberculosis in red deer.

Stress level of people with psoriasis at a public hospital.

BACKGROUND: Psoriasis is a chronic dermatosis of unknown etiology with a tendency to relapse after treatment. The disease is frequently linked to psychological stress due to the embarrassment caused by the lesions. OBJECTIVE: To analyze the stress level presented by psoriasis patients followed at the Dermatology Service of a public hospital in Salvador, Bahia state, Brazil. METHODS: A cross-sectional study of a consecutive convenience sample composed of 60 participants. We used Lipp's Stress Symptoms Inventory for Adults to assess stress levels. The questionnaire identifies and classifies physical and psychological symptoms according to three stages of stress: alarming, resistance, and exhaustion. We also collected socio-demographic and clinical data that could be associated with psoriasis. RESULTS: 85% of the participants presented stress. Lipp's questionnaire results revealed that 48% were in the resistance stage and 37% in the exhaustion stage. Women presented higher levels of stress. Of the total 28 women, 64% were in exhaustion stage, 29% in the resistance stage, and only 7% presented no stress symptoms. Of the total 32 men, 44% were in resistance stage, 34% in exhaustion stage, and 22% presented no stress symptoms. Regarding physical and psychological symptoms, psychological symptomatology was prevalent (55%). CONCLUSIONS: Based on the number of patients in exhaustion stage, we can conclude that stress levels of the participants were high regardless the type of psoriasis and treatment duration.

Tempos de acesso a serviços de saúde face ao infarto do miocárdio / Access times to health services in cases of myocardial infarction

Resumo Objetivo Analisar os tempos relacionados ao acesso de homens e mulheres com infarto do miocárdio a hospitais referência em cardiologia e a correlação entre eles. Métodos Pesquisa transversal, com 100 pessoas com infarto entrevistadas em hospitais referência em cardiologia. Dados analisados por estatística descritiva e inferencial, adotando-se significância estatística. Resultados Os tempos foram elevados (decisão para atendimento, chegada ao primeiro serviço de saúde, permanência na rede de atenção e admissão em hospitais referência em cardiologia), exceto o de transporte, sobretudo para mulheres. Houve maior contribuição do tempo de decisão na composição do tempo de chegada ao primeiro serviço de saúde e do tempo de permanência na rede na composição do tempo de chegada aos hospitais referência em cardiologia. Conclusão A longa espera por atenção especializada reflete a falta de estrutura dos serviços de saúde, e o tempo de decisão elevado reflete a falta do não reconhecimento do infarto pelos participantes.

Abstract Objective To analyze the access times of men and women who are having a myocardial infarction to referral hospitals in cardiology and the correlation between them. Methods Cross-sectional research, involving 100 victims of a myocardial infarction who were interviewed at referral hospitals in cardiology. To analyze the data, descriptive and inferential statistics were used with statistical significance. Results The access times were long (decision to seek care, arrival to first health service, time in care network and admission to referral hospitals in cardiology), except for the transportation time, mainly for women. The decision time contributed more to the time it took to arrive at the first health service and the time in the care network contributed more to the time to arrive at the referral hospitals in cardiology. Conclusion The long time waiting for specialized care reflects the lack of structure of the health services and the long decision time reflects the participants’ lack of recognition of the myocardial infarction.