Burnout and Long-term Sickness Absence From the Teaching Function: A Cohort Study

Background@#The present objective was to verify whether burnout (emotional exhaustion [EE], depersonalization [DP] and low professional efficacy [PE]) is a risk factor for long-term sickness absence (LTSA; ≥30 consecutive days) from the teaching role. @*Methods@#This was a prospective cohort study with two years of follow-up that investigated 509 elementary and high-school teachers. Burnout was identified by Maslach Burnout Inventory. Poisson regression with robust variance was used to adjust for possible confounders. @*Results@#The incidence of LTSA was 9.4%. High EE levels were associated with LTSA in the crude analysis, but the association lost statistical significance after adjustments (for sex, age, perception of work-life balance, general self-rated health, chronic pain and depression). High DP levels were associated with this outcome, even after all adjustments (relative risk = 1.80; 95% confidence interval: 1.05–3.09). Low PE levels were not related to LTSA. @*Conclusion@#The results reinforce the need to improve teachers' work conditions to reduce burnout, particularly DP, and its consequences.

Epidermal growth factor receptor-activating mutation(E746_T751>VP) in pancreatic ductal adenocarcinoma responds to erlotinib, followed by epidermal growth factor receptor resistance-mediating mutation (A647T): A case report and literature review

Despite recent advances in treatment with multidrug chemotherapy regimens, outcomes of patients with advanced pancreatic ductal adenocarcinoma (PDAC) remain very poor. Treatment with targeted therapies has shown marginal benefits due to intrinsic or acquired resistance. Actionable mutations, while detected infrequently in patients with PDAC, are becoming increasingly used in personalized medicine. Here, we describe an epidermal growth factor receptor (EGFR)-activating mutation (E746_T751>VP) to erlotinib, a first-generation tyrosine kinase inhibitor (TKI), in a patient with metastatic PDAC. After an initial partial response to erlotinib for 12 months, the patient's disease progressed with emergence of the EGFR A647T mutation. Certainly, the patient also progressed after switching therapy to a third-generation EGFR TKI (osimertinib). This case illustrates the posttreatment evolution of EGFR A647T-mediated resistance to the first- and third-generation TKIs. To our knowledge, this is the first case to report the aforementioned activating and resistance-mediated mutations. In summary, genomic analysis performed in this patient with PDAC on the tumor biopsy and peripheral blood provided tools to understand mechanisms of response and resistance to targeted therapy with EFGR TKIs

Serum levels of MIP-1beta and RANTES in HIV-1 subtype CRF01_AE infected patients with different rates of disease progression.

The beta-chemokines have been shown to inhibit HIV replication in vitro. To evaluate the role of serum beta-chemokines in disease progression and their anti-viral role in vivo, we determined serum levels of macrophage inflammatory protein-1beta (MIP-1beta) and regulated upon activation normal T-cell expressed and secreted (RANTES) of twenty HIV-1 subtype CRF01_AE infected patients: nine progressors (PRs, follow-up CD4+ cell count < 200/mm3 and progression to AIDS or death) and eleven slower progressors (SPs, asymptomatic and/or follow-up CD4+ cell counts > 350/mm3 at the end of follow-up) and determined their plasma viral loads. The subjects were followed for at least 36 months. All had initial CD4 values > 350 cells/mm3. In this longitudinal study, serum levels of MIP-1beta and RANTES in specimens obtained either early or later in the course of HIV infection did not differ significantly between progressors and slower progressors (p > 0.05). There were no significant changes in serum MIP-1beta and RANTES levels over time in either patient group (p > 0.05). No significant associations were observed between plasma viral loads and the measured beta-chemokines (r = -0.205, p = 0.21 for MIP-1beta and r = -0.12, p = 0.492 for RANTES). The results suggest these chemokines do not play a major systemic role in control of viremia or protection against the progression of HIV disease.

Níveis de colesterol total versus fatores regionais de três cidades do Paraná / Total cholesterol level versus regional factors on three cities of Paraná state

A hipercolesterolemia é um dos principais fatores de risco para doenças cardiovasculares. Avaliamos os níveis de colesterol total em três cidades do Paraná Douradina, Cianorte e Guaíra. Douradina apresenta de um modo geral característica mais voltada para o cotidiano rural. Realidade diferente foi constatada em Cianorte, considerada hoje um pólo industrial. Guaíra é uma região preparada para o turismo e com grande atividade comercial. Foram analisadas amostras de 600 indivíduos, sendo 200 de cada localidade,distribuídos previamente em diferentes faixas etárias e gênero. Em Douradina observaram-se as menores taxas de colesterol (186,9 ± 2,9 mg/dl), seguido por Cianorte (203,1 ± 1,4 mg/dl) e Guaíra (219,7 ± 3,2 mg/dl). Concluiu-se que houve uma variação de colesteroltotal nas diferentes cidades, mostrando que hábitos regionais influenciam nos níveis de colesterol total sérico.

The development of HIV research laboratories in the Royal Thai Army Medical Department.

The development of HIV research laboratories at the Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Army Medical Department in supporting of HIV-1 vaccine trials in Thailand was implemented in 1991. The collaboration between AFRIMS, Royal Thai Army Medical Department, and the US Military HIV Research Program with the ultimate goal to conduct the HIV-1 vaccine trial phase III. The HIV serology lab was set up for surveillance program in military recruits. Then, there was a need to strengthen more on the existing laboratories by training personnel to cope with the confidentiality of the lab results, specimen processing and data management which are critical. Later on, the necessary laboratory for measuring of vaccine immunogenicity was developed, such as lymphoproliferation assay. Additionally, a molecular biology lab was also developed. The HIV research laboratory management must include an ability to deal with some problems, such as late specimen receiving, fluctuating of power supply, technical staffs maintained. Good laboratory practices and safety must be strictly implemented. Communication network among facilities also played an important role in HIV laboratory strengthening at AFRIMS.

In vitro susceptibility of Thai seronegative donor CD8+ T lymphocytes to human immunodeficiency virus-1 (HIV-1) infection.

To determine whether CD8+ T lymphocytes from Thai donor cells are susceptible to HIV-1 infection, undepleted peripheral blood mononuclear cells (PBMC) and CD8-enriched PBMC were infected with HIV-1 Thai subtype B and CRF01_AE (E) primary isolates. Virus kinetics in HIV-1 infection of CD4+ and CD8+ T lymphocytes peaked at day 7 or 10 post infection (pi); the TCID50 used for cell infection was proportional to the level of p24 production in the cultures. We also found that the level of p24 antigen in the supernatants of infected undepleted PBMC was significantly higher than that of infected CD8-enriched PBMC. Interestingly, both single positive T lymphocytes (CD4+ and CD8+ T lymphocytes) as well as double positive CD4+/CD8+ T lymphocytes were infected with HIV-1. The double positive T lymphocytes in PBMC were found only in the presence of both CD4+ and CD8+ T lymphocytes. The majority of p24+/CD4-/CD8- T lymphocytes were HIV-1 infected CD4 down-modulated PBMC. This report provides direct evidence that single positive CD8+ T lymphocytes and double positive CD4+/ CD8+ T lymphocytes from Thai donors can be infected with HIV-1 subtypes B and E in vitro.

High frequency of HIV-1 and hepatitis C co-infection among young Thai men: evidence for a changing pattern of HIV transmission in Thailand.

To assess whether patterns of HIV transmission have changed in Thailand, we tested for antibody to hepatitis C virus (HCV) as a marker for parenterally acquired infection among HIV-infected and uninfected young Thai men. Antibody to HCV was present in 49.5% of HIV-infected men and 2.2% among uninfected men. These data suggest that a significant number of HIV infections among young men in Thailand may be associated with injection drug use.

A joint clinical research center in Thailand: role in HIV vaccine development.

In 1992 the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, collaborated with the Phramongkutklao Army Medical Center to set up the Joint Clinical Research Center (JCRC). The purpose of the Center is to conduct clinical research in support of HIV vaccine development and testing. To date, eight HIV vaccine-related research protocols have been conducted at the JCRC, involving 1,668 volunteers. The JCRC has been, and continues to be, a key site for the transfer of clinical trial expertise to new sites at universities, government clinics and hospitals in Thailand and other countries. Overall rates of follow-up have been excellent, while protocol violations and data clarification errors have been minimal.

Plasmodium coatneyi-infected rhesus monkeys: a primate modelfor human cerebral malaria

Although several animal models for human cerebral malaria have been proposed in the past, name have shown pathological findings that are similar to those seen in humans. In order to develop an animal model for human cerebral malaria, we studied the pathology of brains of Plasmodium coatneyi (primate malaria parasite)-infected rhesus monkeys. Our study demonstrated parazitized erythrocyte (PRBC) sequestration and cytoadherence of knobs on PRBC to endothelial cells in cerebral microvessels of these monkeys. This similar to the findings een in human cerebral malaria. Crebral microvessels with sequestred PRBC were shown by immunohistochemistry to possess CD36, TSP and ICAM-1. These proteins were not evident in cerebral microvessels of uninfected control monkeys. Our study indicates, for the first time, that rhesus monkeys infected with P. coatneyi can be used as a primate model to study human cerebral malaria

Possible consequences of in creasing life expectancy in Brazil: the perspective of a European historical demographer

Em 1985, as pessoas com mais de 60 anos de idade representavam 6,6% da populaçäo total do Brasil, enquanto na República Federativa da Alemanha esta proporçäo era, em 1984, de 20,3%; em 1950 havia chegado aos 14,5%. Esta proporçäo näo será alcançada no Brasil, nem mesmo no ano 2000, pois se prevê que as pessoas acima de 60 anos comporäo 8,8% da populaçäo total. Da mesma forma, no período 1982/84 a expectativa de vida ao nascer na República Federativa da Alemanha era de 70,8 anos, para homens, e de 77,5 para mulheres. No Brasil, para 1980/85, foi de 61,0 e 66,0, respectivamente. Com este pano de fundo entende-se porque o debate sobre o envelhecimento da sociedade com os seus múltiplos problemas - médicos, econômicos, individuais e sociais - tem demorado a assumir qualquer destaque no Brasil. Embora sejam importantes no Brasil estas consideraçöes, elas constituem, no entanto, presentemente, apenas um lado da história. Para um europeu estudioso de demografia histórica com a vantagem de uma visäo de 300 a 400 anos, o outro lado da história é igualmente importante. O fato de a longevidade estar 10 anos mais baixa no Brasil näo significa que ninguém nesse país viva até a idade avançada. Em 1981, pessoas de 65 anos ou mais representaram 34,4% do total de óbitos; ao mesmo tempo a mortalidade infantil representou 22,1% da mortalidade geral. Estas e as mortes "prematuras" entre jovens e adultos säo responsáveis pela baixa cifra da vida média. Na Europa, por outro lado, as mortes "prematuras" já näo desempenham importante papel. Mais da metade das mulheres (52,8%) da Alemanha sobreviveram até 80 anos de idade, de 1982/84, e quase metade dos homens (47,3%) sobreviveram até 75 anos. A durabilidade da vida é hoje garantida de tal forma que teria sido inconcebível há poucas geraçöes. O tripé clássico de "peste, fome e guerra" ameaçava os nossos antepassados em todos os lugares e todo o tempo. A transiçäo radical de uma vida anteriormente incerta para a vida segura atual, resultando da repressäo daquele tripé, levou a conseqüências imprevistas para o convívio em comunidade. Nossos antepassados eram obrigados a viver em sociedade, bem integrados na busca de sua sobrevivência física, e subordinar seus dejetos pessoais aos valores comuns; mas, agora, ao menos na sua maior parte, estas pressöes desapareceram...(AU) -

Mortality problems in Brazil and in Germany: past - present - future: learning from each other?

Estudo realizado em 1984, por um professor suiço-alemäo, especializado em demografia histórica, com a finalidade de promover diálogo mútuo entre países desenvolvidos e em desenvolvimento, sobre demografia. Três pontos säo destacados: 1. Tomando a mortalidade infantil de Säo Paulo no período de 1908 a 1983, como exemplo, é mostrado que o Brasil tem ao seu dispor excelente e variada literatura de pesquisa sobre o assunto, que é injustificavelmente desconhecida pela maioria dos europeus. E enfatizado que o Brasil näo depende do conhecimento dos autores europeus para explicaçöes concernentes aos fatores que, sob vários aspectos, estäo implicados: podem ser considerados, pelos europeus, dois aspectos do Brasil, a este respeito. No primeiro torna-se evidente que o conhecimento do europeu, do ponto de vista médico-biológico, näo é apropriado para se chegar a conclusöes sobre os problemas atuais do Brasil e que quaisquer conclusöes poderäo ser extrapoladas em apenas alguns poucos casos. O segundo aspecto refere-se à reinterpretaçäo da história da mortalidade infatil nos países europeus, até as últimas décadas, que em sentido mais abrangente mostra uma situaçäo semelhante à brasileira. 2. Um diálogo frutífero só poderia ser realizado se ambos os interessados apresentassem francamente seus problemas. Por este motivo, o estudo faz referências enfática aos atuais problemas do europeu em relaçäo a estudos da morte e do morrer - problemas que surgem perto da fronteira das transiçöes demográfica e epidemiológica: o envelhecimento da populaçäo, as doenças crônicas incuráveis como as principais causas de morte e o problema do idoso. O Brasil parece estar se aproximando da situaçäo européia, neste particular, e há de se defrontar com estes problemas mais cedo ou mais tarde. Uma discussäo já com vistas ao futuro, parece ser proveitosa. 3. O estudo näo pretende apresentar um quadro deprimente de problemas que se alternam sucessivamente. Apesar da cautela que se deve ter quando se faz prognóstico, há boas razöes para um certo otimismo quanto ao futuro: em primeiro lugar, em relaçäo ao desenvolvimento dos países europeus - presumindo que se continui a seguir as tendências atuais de desenvolvimento - e mesmo em relaçäo ao Brasil