Degenerative aortic stenosis in women: challenges and perspectives

Degenerative aortic stenosis is currently a public health problem. Affecting the elderly population, this pathology has been showing an increasing prevalence as a direct result of the population aging. In this context, women have a greater life expectancy, corresponding to most of the population with degenerative aortic stenosis. Specific characteristics of this pathology in females are present in the diagnosis, pathophysiology, anatomical aspects, imaging and in therapeutic approach. Women present a more severe disease with less valve calcification than men, more concentric ventricular remodeling, higher transvalvular gradients, and less myocardial fibrosis. Less evident symptoms mean that these patients are referred later for surgical or percutaneous therapeutic treatment. The greater comorbidity presented by females and possibly due to the smaller body surface, bring specific aspects that affect the surgery results, leading to higher mortality rates and, more often, the prosthesis-patient mismatch. Percutaneous valve implantation is a good alternative, with better results in females, when compared to surgery, both in the treatment of native valves and in the treatment of a previously implanted bioprosthesis' dysfunction. The challenges encountered for the treatment of aortic stenosis in women and their possible solutions are described in this article, focusing on the observed difference of aortic stenosis in females and their possible solutions.

Degenerative Aortic Stenosis in Women: Challenges and Perspectives

Abstract Degenerative aortic stenosis is currently a public health problem. Affecting the elderly population, this pathology has been showing an increasing prevalence as a direct result of the population aging. In this context, women have a greater life expectancy, corresponding to most of the population with degenerative aortic stenosis. Specific characteristics of this pathology in females are present in the diagnosis, pathophysiology, anatomical aspects, imaging and in therapeutic approach. Women present a more severe disease with less valve calcification than men, more concentric ventricular remodeling, higher transvalvular gradients, and less myocardial fibrosis. Less evident symptoms mean that these patients are referred later for surgical or percutaneous therapeutic treatment. The greater comorbidity presented by females and possibly due to the smaller body surface, bring specific aspects that affect the surgery results, leading to higher mortality rates and, more often, the prosthesis-patient mismatch. Percutaneous valve implantation is a good alternative, with better results in females, when compared to surgery, both in the treatment of native valves and in the treatment of a previously implanted bioprosthesis' dysfunction. The challenges encountered for the treatment of aortic stenosis in women and their possible solutions are described in this article, focusing on the observed difference of aortic stenosis in females and their possible solutions.

The Mediation of Harmonious Passion for Work in the Servant Leadership and Work Intentions Relationship: A Longitudinal Study / La mediación de la pasión armoniosa por el trabajo en la relación entre el liderazgo de servicio y las intenciones laborales: Un estudio longitudinal

Abstract This study evaluated the relationship between servant leadership and work intentions, mediated by passion for work, in a longitudinal study. Data were collected in three waves, with three-month intervals in between, totaling a six-month data collection period. The total sample consisted of 479 workers of both genders (70.4% women) from all Brazilian regions. The results of the cross-lagged panel analysis showed that the servant leadership positively predicted work intentions. In addition, passion for work partially mediated the relationship between servant leadership and work intentions. However, contrary to expectations, this mediation was negative. The results are discussed according to the Passion for Work Assessment Model, which provided theoretical support for the investigation.

Resumen El estudio evaluó la relación entre el liderazgo de servicio y las intenciones laborales, mediadas por la pasión por el trabajo, en un estudio longitudinal. Los datos se recopilaron en tres oleadas, con intervalos de tres meses entre ellos, totalizando un periodo de recopilación de datos de seis meses. La muestra total estuvo constituida por 479 trabajadores de todas las regiones brasileñas y de ambos sexos (70,4% mujeres). Los resultados del análisis de panel rezagado cruzado mostraron que el liderazgo de servicia predijo positivamente las intenciones de trabajo. Además, la pasión por el trabajo medió parcialmente la relación entre el liderazgo de servicia y las intenciones laborales. Sin embargo, contrariamente a lo esperado, esta mediación fue negativa. Los resultados se discuten a la luz del Modelo de Evaluación de la Pasión por el Trabajo, que brindó soporte teórico para la investigación.

Evidências de validade da escala de engajamento na carreira no contexto militar / Validity evidence of the career engagement scale in the military context / Evidencias de validez de la escala de compromiso profesional en el contexto militar

O engajamento na carreira associa-se a comportamentos proativos capazes de intensificar o desenvolvimento da carreira. Este estudo buscou reunir evidências de validade de estrutura interna da Escala de Engajamento na Carreira e de suas relações com variáveis externas, em contexto militar. A amostra foi composta por 467 militares do Exército Brasileiro, de ambos os sexos (94,4% do sexo masculino), majoritariamente pertencentes à linha bélica (82,4%) e provenientes de diferentes estados, com destaque para o Rio de Janeiro (39,2%). Os participantes responderam a escalas de engajamento na carreira, adaptabilidade de carreira, autoeficácia geral percebida, satisfação com a carreira e percepção atual do desenvolvimento profissional, de forma on-line. As análises fatoriais confirmatórias evidenciaram que o modelo de dois fatores de 1ª ordem com um fator de 2ª ordem apresentou os melhores índices de ajustes, diferindo do modelo original do instrumento. A Escala de Engajamento na Carreira obteve correlação significativa e positiva alta com a adaptabilidade de carreira e significativa e positiva moderada com a autoeficácia, a satisfação com a carreira e o desenvolvimento profissional. Concluiu-se que as evidências de validade obtidas possibilitam o uso futuro da escala na avaliação do engajamento na carreira no contexto militar.(AU)

Career engagement is associated with proactive behaviors capable of enhancing career development. The study sought to gather evidence of the internal structure validity of the Career Engagement Scale and its relations to external variables in a military context. The sample consisted of 467 soldiers of the Brazilian Army, of both sexes (94.4% male), belonging mainly to the war line (82.4%) and coming from different states, with emphasis on Rio de Janeiro (39.2%). The participants answered on-line the scales for measuring career engagement, career adaptability, perceived general self-efficacy, satisfaction with the career and current perception of professional development. The confirmatory factor analyses showed that the model of two factors of 1st order with a factor of 2nd order was the one that presented the best fit indexes, differing from the original model of the instrument. The Career Engagement Scale obtained a significant and positive high correlation with career adaptability and a significant and positive moderate correlation with self-efficacy, career satisfaction, and professional development. We concluded that the validity evidence obtained allow the future use of the scale for evaluating career engagement in the military context.(AU)

El compromiso profesional se asocia con comportamientos proactivos capaces de mejorar el desarrollo profesional. El estudio buscó recolectar evidencias de validez de la estructura interna de la Escala de Compromiso Profesional y de sus relaciones con variables externas en un contexto militar. La muestra estaba compuesta por 467 soldados del Ejército Brasileño, de ambos sexos (94,4% hombres), en su mayoría pertenecientes a la línea de guerra (82,4%), provenientes de diferentes estados, con énfasis en Río de Janeiro (39,2%). Los participantes respondieron a las escalas de compromiso profesional, adaptabilidad profesional, autoeficacia general percibida, satisfacción con la carrera y percepción actual del desarrollo profesional en línea. Los análisis factoriales confirmatorios mostraron que el modelo de dos factores de 1er orden con un factor de 2do orden fue el que presentó mejores índices de ajustes, diferenciándose del modelo original del instrumento. La Escala de Compromiso Profesional obtuvo una alta correlación significativa y positiva con la adaptabilidad a la carrera y una correlación significativa y positiva moderada con la autoeficacia, la satisfacción profesional y el desarrollo profesional. Se concluyó que las evidencias de validez de la escala permiten su uso futuro en la evaluación del compromiso profesional, en el contexto militar.(AU)

Shprintzen-goldberg craniosynostosis: craniofacial and oral characteristics, diagnosis, and clinical management of a very rare syndrome / Craniossinostose de shprintzen-goldberg: características craniofaciais e orais, diagnóstico e manejo clínico de uma síndrome muito rara

ABSTRACT Shprintzen-Goldberg craniosynostosis syndrome, characterized by craniosynostosis and marfanoid habitus, is a very rare entity described in 75 individuals worldwide. This study aimed to present a case report of a 6-year-old female Brazilian child with Shprintzen-Goldberg's craniosynostosis syndrome. We described the craniofacial and oral characteristics and its clinical management, comparing to the existing literature. The patient presented with intellectual disability, craniosynostosis, ocular proptosis, low-set anomalous ears, and other skeletal and connective tissue defects. Oral features included malocclusion, micrognathia, pseudo-cleft palate, dental caries, and inefficient biofilm control. The treatment started with guidance on cariogenic foods, oral hygiene, and an indication to discontinue bottle feeding. Subsequently, the carious lesions were restored with composite resins, and the patient was referred for orthopedic surgery, orthodontic treatment, speech therapy, and nutritional counseling. The patient was followed for 5 years. This case report emphasizes the importance of knowing the craniofacial and oral characteristics for the diagnosis and clinical management of a female child with a rare Shprintzen-Goldberg's craniosynostosis syndrome. The case also highlights the need for oral health care in individuals with intellectual disabilities.

RESUMO A síndrome Shprintzen-Goldberg é uma entidade muito rara descrita em 75 pessoas, caracterizada por craniossinostose e habitus marfanóide. O objetivo deste estudo é apresentar o relato de um caso clínico de uma criança brasileira de 6 anos com síndrome da craniossinostose de Shprintzen-Goldberg, apresentando as características craniofaciais e orais e seu manejo clínico, comparando com a literatura. O paciente apresentava deficiência intelectual, craniossinostose, proptose ocular, orelhas anômalas de implantação baixa e outros defeitos esqueléticos e do tecido conjuntivo. As características orais incluíram má oclusão, micrognatia, pseudo fenda palatina, atividade de cárie e controle ineficiente do biofilme. O tratamento foi iniciado com orientações sobre alimentos cariogênicos, higiene oral e indicação de suspensão do uso de mamadeira. Em seguida, as lesões cariosas foram restauradas com resina composta e o paciente encaminhado para cirurgia ortopédica, tratamento ortodôntico, fonoaudiologia e nutricionista. O paciente foi acompanhado periodicamente por 5 anos. Este relato de caso enfatiza a importância do conhecimento das características craniofaciais e orais para o diagnóstico e manejo clínico de uma criança do sexo feminino com síndrome de craniossinostose de Shprintzen-Goldberg rara, destacando a necessidade de cuidados com a saúde bucal em indivíduos com deficiência intelectual.

Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement

BACKGROUND: Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS: Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS: Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE (CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS: Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

Person-organization fit and turnover intentions: organizational trust as a moderator / Compatibilidade indivíduo-organização e intenção de rotatividade: moderação da confiança na organização / Compatibilidad individuo-organización y la intención de salida: moderación de la confianza en la organización

This study examined the relationship between person-organization fit and turnover intentions, along with the moderating effect of organizational trust. The sample consisted of 381 workers of both genders (61% female) and average age of 39.23, who answered the on-line versions of organizational values, organizational trust and turnover intention measures. The results showed that the higher the person-organization fit related to conservatism and harmony values, the lower the turnover intention. Trust in the organization's ethical standards moderated the relationship between person-organization fit related to dominance and autonomy values and turnover intention. It was concluded that a reduced trust in the organization's ethical standards contributes to accentuate the negative relation between person-organization fit associated with such values and turnover intention. (AU)

O estudo investigou a relação da compatibilidade indivíduo-organização com a intenção de rotatividade, e o efeito moderador da confiança do empregado na organização. A amostra compôs-se de 381 trabalhadores de ambos os sexos (61% do sexo feminino), com idade média de 39,23 anos, que responderam às versões on-line de medidas de valores organizacionais, de confiança do empregado na organização e de intenção de rotatividade. Os resultados indicaram que quanto maior a compatibilidade entre o indivíduo e a organização, relacionada aos valores de conservadorismo e harmonia, menor a intenção de rotatividade. A confiança nos padrões éticos da organização moderou a relação da compatibilidade indivíduo-organização associada aos valores de autonomia e de domínio com a intenção de rotatividade. Concluiu-se que a baixa confiança nos padrões éticos da organização contribui para acentuar a relação negativa entre a compatibilidade associada a tais valores e a intenção de rotatividade. (AU)

El estudio examinó la relación entre la compatibilidad individuo-organización e la intención de salida, moderada por la confianza en la organización. La muestra fue compuesta por 381 trabajadores de ambos sexos (61% sexo femenino) con edad media de 39,23 años. Los participantes respondieron a la versión online de los instrumentos de valores organizacionales, confianza del empleado en la organización e intención de salida. Los resultados indicaron que cuanto mayor es la compatibilidad individuo-organización en lo que se refiere a valores de conservadurismo y armonía, menor es la intención de rotatividad. La confianza en los patrones éticos de la organización moderó la relación de la compatibilidad individuo-organización asociada a los valores de autonomía y dominio y la intención de rotatividad. Se concluyó que la baja confianza en los patrones éticos de la organización contribuye a acentuar la relación negativa entre la compatibilidad asociada a tales valores y la intención de rotatividad. (AU)

Testing the Two Directions of the Work-Family Interface: A Diary Study.

The work-family interface can be viewed as a process in which daily fluctuations in work demands and resources influence family functioning and behavior, and vice versa. This study aimed to test the daily processes of both directions of the work-family interface through two studies. The first study consisted of 103 male and female workers from 17 Brazilian states. The participants' ages ranged from 20 to 61 years (M = 33.68; SD = 9.13). Each participant answered a daily questionnaire over the course of 10 days, totaling 1,030 answers. The second study's sample consisted of 101 male and female workers from 15 states in Brazil. Participants' ages ranged from 20 to 62 years (M = 33.77; SD = 8.46). Each participant answered the daily questionnaire over the course of ten days, with the number of answers totaling 1,010. The first study showed that at the daily level, perceived work-related demands and social support at work were significantly related to family satisfaction. The second study indicated that at the daily level, perceived family demands and family social support showed significant associations with job satisfaction. Positive affect had a mediating role in these relationships, whereas the use of problem-solving coping strategies had a moderating role. Both studies also showed that the relationships identified remain significant when the variables were tested at different times: independent variables, mediating variable and moderator variable on one day, and the dependent variable on the following day. Day-to-day implications for organizations are discussed, and suggestions for a future research agenda on the work-family interface are presented.

Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement.

BACKGROUND: Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS: Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS: Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS: Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

The effect of perception of organizational politics on professionals' engagement: the moderating role of the psychological safety climate / Percepción de las políticas organizacionales, clima de seguridad psicológica y compromiso con el trabajo: Un análisis cruzado usando modelos jerárquicos lineales

The purpose of this research was to empirically test the hypothesis that the organizational psychological safety climate and the perception of organizational politics predict the extent to which employees feel engaged in their work. Using hierarchical linear modeling and data collected from 1,244 employees in 64 organizations, organizational level psychological safety climate and employee-level perception of organizational politics predicted employee work engagement. There was also significant cross-level interaction, so that the negative effect of the perception of organizational politics was amplified in organizations with a positive psychological safety climate. In other words, organizational psychological safety benefits the work engagement of individuals more when they perceive the existence of low organizational politics. The results offer insight into the mechanisms by which the perceived organizational context may influence employees' work engagement and highlight the importance for the perceived organizational consistency in the promotion of work engagement within their organization. Human Resource professionals and managers should promote frequent meetings with the workers and apply other practices that can boost a safe climate for the employees

El propósito de esta investigación fue probar empíricamente la hipótesis de que el clima de seguridad psicológica de la organización y la percepción de las políticas de la organización predicen hasta qué punto los empleados se sienten comprometidos con su trabajo. El uso de modelos jerárquicos lineales y los datos recopilados de 1,244 empleados en 64 organizaciones mostraron que el clima de seguridad psicológica a nivel organizativo y la percepción de la política organizacional a nivel de los empleados predijo el compromiso con el trabajo de los empleados. También hubo una inesperada interacción significativa entre los niveles, de modo que el efecto negativo de la percepción de las políticas organizacionales se amplificó en organizaciones con un clima de seguridad psicológica positivo. En otras palabras, la seguridad psicológica organizacional beneficia más el compromiso de los individuos cuando ellos perciben la existencia de políticas organizacionales bajas. Los resultados ofrecen información sobre los mecanismos por los cuales el contexto organizativo percibido puede influir en el compromiso laboral de los empleados y resaltar la importancia de la coherencia organizativa percibida en la promoción del compromiso laboral dentro de su organización

Anxiety and coping strategies during the Covid-19 pandemic: The mediating role of positive attitudes at work / Ansiedade e estratégias de enfrentamento do estresse durante a pandemia da Covid-19: a mediação das atitudes positivas sobre o trabalho / Ansiedad y estrategias de afrontamiento durante la pandemia del Covid-19: El papel mediador de las actitudes positivas en el trabajo

The world has been monitoring the emergence and advancement of COVID-19, which has mobilized the scientific community with the purpose of expanding our understanding about the disease. With regard to workers, the concern with their mental health during and after the pandemic stands out. In this connection, this investigation aimed to understand the direct effects of anxiety on stress-coping strategies in Brazilian workers during the COVID-19 pandemic, as well as the mediating role of general attitudes about work in such a relationship. The study included 339 workers of both genders (73% female) and from different professions. The results indicated that general positive attitudes about work mediated the relationship between anxiety and stress-coping strategies focused on the issue. The implications for carrying out interventions with workers in times of pandemic are discussed.

O mundo acompanha o surgimento e o avanço da COVID-19, o que tem mobilizado a comunidade científica a ampliar o conhecimento sobre a doença. No que tange aos trabalhadores, destaca-se a preocupação com sua saúde mental durante e após a pandemia. Nesse sentido, a presente pesquisa teve como objetivo investigar os efeitos diretos da ansiedade sobre as estratégias de enfrentamento do estresse em trabalhadores brasileiros, durante a pandemia da COVID-19, bem como o papel mediador das atitudes gerais sobre o trabalho em tal relação. Participaram do estudo 339 trabalhadores de ambos os sexos (73% do sexo feminino) e de diversas profissões. Os resultados indicaram que as atitudes positivas gerais sobre o trabalho mediaram a relação da ansiedade com as estratégias de enfrentamento do estresse focadas no problema. Implicações para a realização de intervenções junto aos trabalhadores em momentos de pandemia são discutidas.

El mundo está siguiendo la aparición y el avance de COVID-19, que ha movilizado a la comunidad científica para expandir el conocimiento sobre la enfermedad. Con respecto a los trabajadores, destaca la preocupación por su salud mental durante y después de la pandemia. En este sentido, la presente investigación tuvo como objetivo investigar los efectos directos de la ansiedad sobre las estrategias de afrontamiento en los trabajadores brasileños durante la pandemia de COVID-19, así como el papel mediador de las actitudes generales sobre el trabajo en Tal relación. El estudio incluyó a 339 trabajadores de ambos sexos (73% mujeres) y de diversas profesiones. Los resultados indicaron que las actitudes positivas generales sobre el trabajo mediaron la relación entre la ansiedad y las estrategias para enfrentar el estrés centradas en el problema. Se discuten las implicaciones para llevar a cabo intervenciones con trabajadores en tiempos de pandemia.

Psychometric properties of the Engaged Teachers Scale (ETS) / Propriedades psicométricas da Escala de Engajamento no trabalho de Professores (EEP) / Cualidades psicométricas de la Escala de Engagement Docente (ECD)

Work engagement is an affective-motivational condition that generates willingness, involvement at work and focused effort on the accomplishment of tasks by the employee. This study joined validity evidence for the Engaged Teachers Scale (ETS) in the Brazilian context. The sample consisted of 417 teachers, male and female (62.1% female). The confirmatory factor analyses evidenced that the original model of the instrument, which consists of 16 items distributed in four factors, showed the best fit to the data. The scale revealed invariance for sex, application type (face-to-face or online), age range and teaching experience. The internal consistency rates range between 0.66 and 0.85. Furthermore, the scale showed convergent validity indicators with work engagement and affective organizational commitment. The good psychometric qualities of the scale recommend its future use in research of engagement in teachers.

O engajamento no trabalho caracteriza-se por um estado afetivo-motivacional que gera disposição no empregado, envolvimento com o trabalho e esforço concentrado na realização das tarefas. O estudo reuniu evidências de validade da Escala de Engajamento de Professores (EEP) no contexto brasileiro. A amostra foi composta por 417 professores, de ambos os sexos (62,1% feminino). As análises fatoriais confirmatórias evidenciaram que o modelo original do instrumento, composto por 16 itens, distribuídos em quatro fatores, foi o de melhor ajuste aos dados. A escala apresentou invariância para sexo, tipo de aplicação (presencial ou online), faixa etária e tempo de docência. Os índices de consistência interna dos fatores variaram de 0,66 a 0,85. A escala apresentou, ainda, indicadores de validade convergente com o engajamento no trabalho e o comprometimento organizacional afetivo. As boas qualidades psicométricas da escala recomendam seu uso futuro na pesquisa do engajamento em professores.

El engagement laboral se caracteriza por un estado afectivo-motivacional que genera disposición en el empleado, involucramiento con el trabajo y esfuerzo concentrado en la realización de las tareas. El estudio juntó evidencias de validez de la Escala de Engagement Docente (EED) en el contexto brasileño. La muestra incluyó a 417 profesores, de ambos sexos (62,1% femenino). Los análisis factoriales confirmatorios evidenciaron que el modelo original del instrumento, compuesto por 16 ítems, distribuidos en cuatro factores, fue el de mejor ajuste a los datos. La escala mostró invariancia para sexo, tipo de aplicación (presencial o en línea), rango de edad y tiempo de docencia. Los índices de consistencia interna variaron de 0,66 a 0,85. Además, la escala presentó indicadores de validez convergente con el engagement laboral y el compromiso organizacional afectivo. Las buenas cualidades psicométricas de la escala recomiendan su uso futuro en la investigación del engagement en profesores.

Evaluation of Myocardial Ischemia with iFR (Instantaneous Wave-Free Ratio in the Catheterization Laboratory: A Pilot Study.

BACKGROUND: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia. OBJECTIVE: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. METHOD: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. RESULTS: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). CONCLUSION: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.

Evidências de validade para a escala de alegria no trabalho / Validity evidence for the joy at work scale / Evidencia de validez para la escala de alegría en el trabajo

A alegria no trabalho consiste em uma manifestação do bem-estar no trabalho, que se reflete na fusão da satisfação da vida e da satisfação com o trabalho. O presente estudo reuniu evidências de validade da Escala de Alegria no Trabalho no contexto brasileiro. A amostra foi composta por 505 trabalhadores de ambos os sexos. Eles responderam à versão brasileira da escala e a instrumentos a ela correlatos. As análises fatoriais exploratórias e confirmatórias indicaram que o modelo de melhor ajuste para a escala foi o de natureza unidimensional, composto por 14 itens. A escala apresentou correlações positivas fortes com a satisfação no trabalho, o engajamento no trabalho, o comprometimento organizacional afetivo e os afetos positivos dirigidos ao trabalho. Concluiu-se que o instrumento apresentou propriedades psicométricas que recomendam seu uso em investigações futuras destinadas a avaliar o grau de alegria no trabalho.

Joy at work is one manifestation of well-being, which is reflected in the merging of satisfaction with life and with work. The present study has gathered evidence of the validity of the Joy at Work Scale in the Brazilian context. The sample was composed of 505 workers from both genders. They answered a version of the Brazilian scale as well as other instruments related to it. Exploratory and confirmatory factor analyses indicated that the model with the best fit for the scale was the one-dimensional one, composed of 14 items. The scale presented strong positive correlations with satisfaction at work, work engagement, affective organizational commitment, and positive affects toward work. It was concluded that the instrument presented psychometric properties which recommend its use in further investigations designed to evaluate levels of joy at work.

La alegría en el trabajo es una manifestación de bienestar, que refleja en la fusión de la satisfacción con la vida y la satisfacción laboral. El presente estudio reunió evidencias de la validez de la Escala de Alegría en el Trabajo en el contexto brasileño. La muestra consistió en 505 trabajadores de ambos sexos que respondieron a la versión brasileña de la escala y a sus instrumentos Los análisis factoriales exploratorios y confirmatorios mostraron que el modelo de mejor ajuste para la escala era el de naturaleza unidimensional, compuesto por 14 ítems. La escala presentó fuertes correlaciones positivas con la satisfacción con el trabajo, el engagement en el trabajo, el compromiso organizacional afectivo y los afectos positivos dirigidos al trabajo. Se concluyó que el instrumento presentó propiedades psicométricas que recomiendan su uso en futuras investigaciones destinadas a evaluar el grado de alegría en el trabajo.

Evaluation of Myocardial Ischemia with iFR (Instantaneous Wave-Free Ratio in the Catheterization Laboratory: A Pilot Study / Avaliação de Isquemia Miocárdica na Sala de Hemodinâmica com iFR Instantaneous Wave-Free Ratio: Estudo Piloto

Abstract Background: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia Objective: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. Method: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. Results: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). Conclusion: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.

Resumo Fundamento: Instantaneous Wave-Free Ratio (iFR) é um método de avaliação funcional invasiva sem necessidade de droga vasoativa para indução de hiperemia máxima. Objetivo: Analisar a contribuição do iFR na terapêutica das lesões coronarianas com ausência ou discrepância entre os métodos diagnósticos não invasivos para isquemia e a angiografia coronária. Método: Foram estudados pacientes consecutivos com 18 anos ou mais, ambos os sexos, no período de maio de 2014 a março de 2018, com lesões coronarianas classificadas, por medição da porcentagem de diâmetro da estenose através de estimativa visual, em estenoses moderadas (41-70%) ou graves (71%-90%). O iFR ≤ 0,89 foi considerado positivo para isquemia. Empregou-se regressão logística com elastic net, tendo como variável desfecho o emprego de stent, e variáveis independentes: idade, sexo, hipertensão arterial, diabetes, dislipidemia, tabagismo, história familiar, obesidade e infarto agudo do miocárdio (IAM) prévio. Foram construídas Árvores de Classificação, Curva Roc, e gráficos Box Plot com o software R. O valor de p < 0,05 foi considerado significativo. Resultados: Foram avaliados 52 pacientes com 96 lesões obstrutivas (56 moderadas, 40 graves). O ponto de corte do iFR de 0,87 apresentou sensibilidade de 0,57 e 1-especificidade de 0,88, demonstrando boa acurácia para a reclassificação das lesões. Diabetes mellitus, dislipidemia, e presença de lesão moderada, com iFR < 0,87 foram preditores do implante de stents. Foram empregados stents em 32% das lesões de portadores de doença arterial coronariana estável e IAM com e sem supra de ST (lesões não culpadas). Conclusão: O iFR contribui para a reclassificação das lesões e diminuição do emprego de stents, auxiliando na abordagem das lesões moderadas e severas.