RESUMO
Resumo O objetivo deste artigo é avaliar a relação entre eventos estressores ocorridos no último ano na família de crianças e adolescentes com indicativos de problemas de saúde mental em uma amostra de estudantes de duas escolas de uma cidade no sul do Brasil. Estudo transversal com 1.075 estudantes matriculados em duas escolas públicas de ensino fundamental (uma estadual e outra municipal). Foi utilizado o Strengths and Difficulties Questionnaire para avaliação de fatores emocionais e comportamentais da criança, e a Escala de Avaliação de Reajustamento Social de Holmes e Rahe (1967) para avaliar os eventos estressores. Foram utilizados o teste qui-quadrado e a regressão de Poisson, com ajuste robusto para variância, expressando os resultados em razão de prevalências (RP) e intervalos de confiança de 95%. As chances de apresentar problemas de hiperatividade foram 1,42 (IC 95% 1,10-1,83) vezes maiores no tercil intermediário e 1,37 (IC 95% 1,06-1,78) no tercil superior, quando comparados ao tercil inferior. Quanto aos problemas de relacionamento, as chances foram de 1,49 (IC 95% 1,15-1,93) vezes maiores no tercil superior ao serem comparados com o tercil inferior. Os resultados sugerem que fatores ambientais podem ser fortemente relacionados à etiologia dos transtornos mentais na infância e adolescência.
Abstract The scope of this article is to evaluate the relationship between stressor events that occurred last year in the family of children and adolescents that are indicative of mental health problems in a sample of students from two schools in a city in southern Brazil. It involved a cross-sectional study with 1,075 students enrolled in two public elementary schools. The Strengths and Difficulties Questionnaire was used to assess emotional and behavioral factors of the child and the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe (1967) to assess stressor events. The chi-square and Poisson regression test with robust variance adjustment for expressing the results in the prevalence ratio (PR) and confidence intervals of 95% were used. The chances of presenting problems of hyperactivity were 1.42 (95% CI 1.10 to 1.83) times higher in the intermediate tercile and 1.37 (95% CI 1.06-1.78) in the higher tercile compared with the lower tercile. With respect to relationship problems the chances were of 1.49 (95% CI 1.15 to 1.93) times higher in the higher tercile when compared with the lower tercile. The results suggest that environmental factors may be strongly related to the etiology of mental disorders in childhood and adolescence.
Assuntos
Humanos , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Infecções Estafilocócicas/microbiologia , Staphylococcus/classificação , Técnicas de Tipagem Bacteriana , Coagulase/genética , Impressões Digitais de DNA/métodos , DNA Bacteriano/análise , Eletroforese em Gel de Campo Pulsado , Genótipo , Resistência a Meticilina , Reprodutibilidade dos Testes , Staphylococcus/enzimologia , Staphylococcus/genéticaRESUMO
Objetivos Determinar la prevalencia de colonización nasal de Staphylococcus aureus, la susceptibilidad a antibióticos de los aislamientos y su posible asociación con factores de riesgo, en los residentes del Hogar Asilo de Ancianos San Pedro Claver de la ciudad de Cartagena de Indias durante el segundo semestre del año 2007. Métodos Con el debido consentimiento informado, para cada sujeto participante se tomaron hisopados nasales por una única vez durante el estudio. Se identificaron cepas de Staphylococcus aureus usando métodos clásicos y se determinó la susceptibilidad a antibióticos de los aislamientos mediante el método de difusión por disco según los estándares del CLSI. La información recolectada de las historias clínicas y con ayuda de un cuestionario se utilizó para analizar la asociación con factores de riesgo potenciales usando el programa SPSS 13.0 para Windows. Resultados Se obtuvieron 11 aislamientos positivos para Staphylococcus aureus, de un total de 69 individuos participantes, lo que correspondió a una prevalencia de 15,9 por ciento. No se detectaron cepas resistentes a meticilina. La portación nasal de Staphylococcus aureus estuvo asociada significativamente con limitaciones en el nivel de movilidad y con la presencia de lesiones cutáneas. No se encontró asociación significativa con otros de los diferentes factores de riesgo analizados. Conclusiones. La portación nasal de S. aureus encontrada en este estudio es mucho más baja que las reportadas en estudios similares en Colombia y otros países, teniendo en cuenta que la población estudio es vulnerable a la colonización con este patógeno.
Objectives Determining Staphylococcus aureus nasal carriage, antibiotic susceptibility and association with potential risk factors in residents from the Hogar Asilo de Ancianos San Pedro Claver nursing-home in Cartagena during the second semester of 2007. Methods Nasal swabs were taken from each person participating in the study after they had signed an informed consent form. Staphylococcus aureus strains were identified by classical methods; antibiotic susceptibility was determined by disk diffusion methods, according to CLSI standards. SPSS for Windows 13.0 statistical package was used for analysing data collected from medical records and from a questionnaire for analysing association with potential risk factors. Results 11 Staphylococcus aureus isolates were obtained from 69 participants, corresponding to 15.9 percent prevalence. No methicillin-resistant strains were detected. Staphylococcus aureus nasal carriage was significantly associated with limited mobility and skin lesions. There was no significant association with the other risk factors analysed. Conclusions Staphylococcus aureus nasal carriage found in this study was lower than that reported from other similar studies in other countries, taking into account that this is a population at risk for colonisation by this pathogen.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portador Sadio , Instituição de Longa Permanência para Idosos , Casas de Saúde , Staphylococcus aureus/isolamento & purificação , Antibacterianos/farmacologia , Colômbia , Interpretação Estatística de Dados , Resistência a Meticilina , Testes de Sensibilidade Microbiana , Nariz/microbiologia , Fatores de Risco , Staphylococcus aureus/efeitos dos fármacosRESUMO
Os autores descrevem um caso de emergência de patógenos multiresistentes em paciente com fibrose cística tratada com vancomicina inalada. Paciente do sexo feminino de dez anos de idade, com fibrose cística cronicamente infectada por Staphylococcus aureus resistente à meticilin, com piora progressiva da doença pulmonar. Foi submetida a tratamento com vancomicina por via inalatória com melhora clínica, mas o complexo B. cepacia foi isolado no escarro e Enterococcus faecium resistente à vancomicina, em cultura de swab retal durante o tratamento. Os autores concluíram que o uso da vancomicina por via inalatória deve ser evitado em pacientes com fibrose cística, pois isso pode contribuir com o aparecimento de Enterococcus sp. resistente à vancomicina e, portanto, aumentar o risco de aparecimento de cepas de Staphylococcus aureus resistente à vancomicina.
Assuntos
Humanos , Feminino , Criança , Fibrose Cística , Enterococcus faecium , Meticilina , Resistência a Meticilina , Staphylococcus aureus , Resistência a VancomicinaRESUMO
BACKGROUND: This study aimed (a) to provide information on methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization ratio in residents of nursing homes; (b) to determine the effect of hand-washing education given to nursing home residents and employees on nasal carriage of Staphylococcus aureus (NCSA) and (c) to obtain probable risk factors for MRSA colonization of residents in two nursing homes. METHODS: Seventy-nine volunteers (24 females and 55 males) from Bolu nursing homes were included in the study. Nasal samples were taken with sterile swabs from the anterior nares. Staphylococcus aureus strains were identified using classical methods and genotyping of methicillin resistant strains was done using Arbitrary Primed PCR (AP-PCR). Antibiotic susceptibilities were determined by disk diffusion methods according to NCCLS standards. After first nasal samples were taken, all employees and residents of nursing homes were educated about the methods of hand hygiene over two days. RESULTS: With hand-washing education, the decrease of NCSA rate (initially 43; after education, 21) was significant (p 0.05). MRSA carriage was significantly correlated with presence of skin lesions, prior hospitalization within the last six months, and antibiotics usage within the last six months. AP PCR results suggested that residents' carriage of MRSA was the result of the same source. CONCLUSION: MSSA and MRSA colonization rates were found to be 38and 5in nursing homes, respectively. These ratios can decrease with simple precautions like hand-washing after a short education period.
ANTECEDENTES: Este estudio tiene como propósito: (a) ofrecer información sobre la tasa de colonización Staphylococcus aureus resistentes a la meticilina (SARM) y el de Staphylococcus aureus susceptibles a la meticilina (SASM) de residentes en hogares de ancianos; (b) determinar el efecto de la educación del lavado de manos brindada a los residentes y empleados, sobre la portación nasal de Staphylococcus aureus (PNSA); y (c) obtener los factores de riesgo probables por la colonización de SARM en los residentes de dos hogares de ancianos. MÉTODOS: Setenta y nueve voluntarios (24 hembras y 55 varones) de los hogares de ancianos Bolu fueron incluidos en el estudio. Se tomaron muestras nasales con hisopos estériles, de 1/3 orificios nasales anteriores. Se identificaron cepas de Staphylococcus aureus usando métodos clásicos; y la genotipificación de las cepas resistentes a la meticilina se realizó por medio de la técnica de la reacción en cadena de la polimerasa con iniciadores arbitrarios (AP-PCR). Las susceptibilidades antibióticas se determinaron mediante métodos de difusión por disco de acuerdo con los estándares del NCCLS. Después que se tomaron las primeras muestras nasales, todos los empleados y los residentes de los hogares de ancianos recibieron instrucción sobre métodos de higiene de las manos durante dos días. RESULTADOS: Con la educación del lavado de manos, la disminución de la tasa de PNSA (inicialmente 43%; después del entrenamiento 21%) fue significativa (p < 0.05), mientras que la disminución de la tasa de portación de SARM (inicialmente 5%; después del entrenamiento 1%) no fue significativa (p > 0.05).
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Casas de Saúde/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Infecções Estafilocócicas/epidemiologia , Desinfecção das Mãos , Nariz/microbiologia , Resistência a Meticilina , Staphylococcus aureus/genética , Avaliação de Programas e Projetos de Saúde , Capacitação em Serviço , Fatores de Risco , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Medição de Risco , Reação em Cadeia da Polimerase , Staphylococcus aureus/efeitos dos fármacos , TurquiaRESUMO
We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46, p = 0.001; 100 vs. 33, p = 0.0049 and 76 vs. 50, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Antibacterianos , Doenças Ósseas Infecciosas , Artropatias , Resistência a Meticilina , Infecções Estafilocócicas , Teicoplanina , Idoso de 80 Anos ou mais , Antibacterianos , Artrite Infecciosa , Artroplastia , Doença Crônica , Osteomielite , Infecções Relacionadas à Prótese , Estudos Retrospectivos , Teicoplanina , Resultado do TratamentoRESUMO
Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.