Efeitos do tratamento com alarme para enurese no autoconceito de crianças / Effects of alarm treatment for enuresis on children's self-concept / Efectos del tratamiento con alarma para enuresis en el autoconcepto de niños

O objetivo do estudo foi avaliar a eficácia do tratamento comportamental para enurese com uso de alarme, realizado à distância, e avaliar efeitos da intervenção no autoconceito dos participantes. Trata-se de um ensaio clínico com delineamento quase-experimental de grupos. Trinta e uma crianças com enurese primária monossintomática participaram (M(idade)=8,3; DP=1,3), 15 meninos (48,3%). Para avaliar a enurese, foi utilizado o Formulário de Avaliação da Enurese; para o autoconceito, a Escala de Autoconceito Infantojuvenil; para instruções sobre o tratamento, o Guia de Pais. A taxa de sucesso no tratamento foi de 71%. Houve diferença estatisticamente detectável na variação do autoconceito pessoal pré e pós-intervenção (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01), independentemente do desfecho, e diferenças no autoconceito social entre as médias de crianças que tiveram sucesso no tratamento (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). A proposta de tratamento da enurese apresentada é viável e eficaz e impactou positivamente o autoconceito das crianças avaliadas. (AU)

The objective of the study was to evaluate the efficacy of enuresis alarm therapy, performed at a distance, and to evaluate the effects of the intervention on the participants' self-concept. This is a clinical trial with a quasi-experimental group design. Thirty-one children with mono-symptomatic primary enuresis participated (M(age)=8.3, SD=1.3), 15 boys (48.3%). Assessments were made using the Enuresis Evaluation Form; Child-Juvenile Self-Concept Scale; and the Parents' Guide, for treatment instructions. Treatment success rate was 71%. There was a statistically significant difference in the variation of the personal self-concept before and after intervention (M=4.8, SD=1.9; vs M=6.1, SD=1.9; p=0.01), regardless of the outcome (M=9.8, SD=1.9 vs M=0.5, SD=1.5; p=0.03), and differences in the social self-concept among the means of children who had successful treatment (M=9.8, SD=1.9 vs M=0.5, DP=1.5; p=0.03). The proposed enuresis treatment is feasible and effective, and positively impacted the self-concept of the children evaluated. (AU)

El objetivo del estudio fue evaluar la eficacia del tratamiento comportamental para Enuresis, con uso de alarma, realizado a distancia, y evaluar también los efectos de la intervención en el autoconcepto de los participantes.Se trata de un ensayo clínico con delineamiento casi experimental de grupos. Participaron 31 niños con enuresis primaria monosintomático (M(edad)=8,3; DP=1,3), 15 varones (48,3%). Para evaluar la enuresis fue utilizado el Formulario de Evaluación de Enuresis, para el autoconcepto; Escala de Autoconcepto Infanto Juvenil, para instrucciones sobre el tratamiento; Guía de Padres. La tasa de éxito del tratamiento fue de 71%. Hubo diferencia estadísticamente detectable en la variación del autoconcepto personal antes y después de la intervención (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01) independiente de los resultados, y diferencias en el autoconcepto social entre el promedio de los niños que tuvieron un tratamiento exitoso (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). La propuesta del tratamiento de enuresis presentada es viable y eficaz e impactó positivamente en el autoconcepto de los niños evaluados. (AU)

Enurese noturna: associações entre gênero, impacto, intolerância materna e problemas de comportamento / Nocturnal enuresis: associations between gender, impact, maternal intolerance and behavior problems / Enuresis nocturna: asociaciones entre género, impacto, intolerancia materna y problemas de conducta

O objetivo deste estudo foi identificar correlações entre as variáveis gênero, problemas de comportamento e impacto apresentados por crianças e adolescentes e nível de intolerância das mães ante a enurese. Nas avaliações, utilizaram-se os seguintes instrumentos: escala de impacto, preenchida pela criança e pelo adolescente, inventário de comportamentos para crianças e adolescentes e escala de tolerância, ambos destinados às mães. Participaram 31 crianças e adolescentes com enurese com idades entre 6 e 15 anos (M = 8,84 e DP = 2,08) e suas respetivas mães. Foram identificadas correlações estatisticamente significativas entre intolerância e impacto, e ainda entre impacto e idade. A média dos problemas de comportamento atingiu nível clínico, sendo os do tipo internalizante mais frequentes. Não foram encontradas associações entre problemas de comportamento e impacto ou intolerância, nem diferenças de gênero para todas variáveis analisadas. Na amostra avaliada, mães mais intolerantes têm filhos mais impactados, e o nível de intolerância delas parece aumentar à medida que a criança ou o adolescente ficam mais velhos.

The aim of the study was to identify correlations between the following variables: gender, behavior problems and impact suffered by children/adolescents and the intolerance of their mothers to enuresis. Assessment was made through: impact scale, responded by the child/adolescent, child behavior checklist and tolerance scale, both answered by the mothers. Participated 31 children and adolescents with enuresis aged between 6 and 15 years (M = 8.84 and SD = 2.08) and their mothers. Statistically significant correlations between intolerance and impact were identified, and also between age and impact. The mean rate of behavior problems reached a clinical level, presenting mostly internalizing problems. No associations between behavior problems and impact or intolerance, or gender differences for all variables analyzed were found. In this sample, the more intolerant mothers have most impacted children, and their mothers' intolerance level seems to increase as the child or adolescent get older.

El objetivo del estudio fue identificar correlaciones entre las variables: género, problemas de comportamiento e impacto presentados por niños/adolescentes y la intolerancia de sus madres frente a la enuresis. Fueron utilizados: escala de impacto, completada por el niño/adolescente, inventario de comportamientos para la infancia y adolescencia y escala de tolerancia, dirigidos a las madres. Participaron 31 niños y adolescentes con enuresis, con edades entre 6 y 15 años (M = 8,84 y DP = 2,08) y sus madres respectivas. Se identificaron correlaciones estadísticamente significativas entre la intolerancia y el impacto, y también entre la edad y el impacto. La media de los problemas de comportamiento llegó a nivel clínico, siendo el tipo más frecuente o de interiorización. No se encontró asociación entre problemas de conducta y impacto o intolerancia, ni diferencias de género en todas las variables analizadas. En la muestra madres más intolerantes tienen niños más impactados y la intolerancia parece aumentar a medida que el niño o adolescente crece.

Expression of the marA, soxS, acrB and ramA genes related to the AcrAB/TolC efflux pump in Salmonella entérica strains with and without quinolone resistance-determining regions gyrA gene mutations

Several studies have been conducted in recent years to elucidate the structure, function and significance of AcrB, MarA, SoxS and RamA in Salmonella enterica. In this study, the relative quantification of acrB, soxS, marA and ramA genes expression was evaluated in 14 strains of S. enterica, with or without accompanying mutations in the quinolone resistance-determining regions of the gyrA gene, that were exposed to ciprofloxacin during the exponential growth phase. The presence of ciprofloxacin during the log phase of bacterial growth activated the genes marA, soxS, ramA and acrB in all S. enterica strains analyzed in this study. The highest expression levels for acrB were observed in strains with gyrA mutation, and marA showed the highest expression in the strains without mutation. Considering only the strains with ciprofloxacin minimum inhibitory concentration values < 0.125 [1]g/mL (sensitive to ciprofloxacin), the most expressed gene in the strains both with and without mutations was acrB. In the strains with ciprofloxacin minimum inhibitory concentration values > 0.125 [1]g/mL (low susceptibility), with and without mutations in gyrA, the most expressed gene was marA. In this study, we observed that strains resistant to nalidixic acid may express genes associated with the efflux pump and the expression of the AcrAB-TolC pump genes seems to occur independently of mutations in gyrA.

Plasmid-mediated quinolone resistance (PMQR) and mutations in the topoisomerase genes of Salmonella enterica strains from Brazil

The objective of this study was to identify mutations in the Quinolone Resistance Determining sources Regions (QRDR) of the gyrA, gyrB, parC, and parE genes and to determine if any of the qnr variants or the aac(6')-Ib-cr variant were present in strains of Salmonella spp. isolated in Brazil. A total of 126 Salmonella spp. strains from epidemic (n = 114) and poultry (n = 12) origin were evaluated. One hundred and twelve strains (88.8%) were resistant to nalidixic acid (NAL) and 29 (23.01%) showed a reduced susceptibility to ciprofloxacin (Cip). The mutations identified were substitutions limited to the QRDR of the gyrA gene in the codons for Serine 83, Aspartate 87 and Alanine 131. The sensitivity to NAL seems to be a good phenotypic indication of distinguishing mutated and nonmutated strains in the QRDR, however the double mutation in gyrA did not cause resistance to ciprofloxacin. The qnrA1 and qnrB19 genes were detected, respectively, in one epidemic strain of S. Enteritidis and one strain of S. Corvallis of poultry origin. Despite previous detection of qnr genes in Brazil, this is the first report of qnr gene detection in Salmonella, and also the first detection of qnrB19 gene in this country. The results alert for the continuous monitoring of quinolone resistance determinants in order to minimize the emergence and selection of Salmonella spp. strains showing reduced susceptibility or resistance to quinolones.

Padrões de concordância entre múltiplos informantes na avaliação dos problemas comportamentais de adolescentes: implicações clínicas / Agreement patterns between multiple informants in adolescents' behavioral assessment: clinical implications

Uma avaliação abrangente inclui informações advindas de múltiplos informantes, inclusive do próprio adolescente, que oferece uma perspectiva única sobre o caso. Buscando verificar padrões de concordância entre pais e adolescentes na avaliação dos problemas dos últimos e discutir as implicações clínicas das divergências, as autoavaliações de 66 adolescentes encaminhados para atendimento psicológico, expressas na resposta ao YSR, foram comparadas às avaliações feitas pelos respectivos pais sobre os comportamentos dos filhos, expressas nas respostas ao CBCL. O relato dos pais apontou mais problemas emocionais/comportamentais em termos de escores e na quantidade de casos que atingiram a faixa clínica dos instrumentos. Discutem-se razões para a concordância entre informantes ser maior na Escala de Externalização e implicações que discrepâncias trazem para o clínico. Conclui-se que a avaliação feita por múltiplos informantes é importante, independentemente das divergências, pois conhecer os comportamentos em diferentes contextos é fundamental para elaborar diagnósticos completos e intervenções adequadas. (AU)

A comprehensive assessment includes information obtained with multiple informants, including the adolescent himself, who offers a unique perspective of the case. In order to verify agreement patterns between parents and youths on the assessment of behavioral problems, and to discuss the clinical implications of the differences, the self-report of 66 adolescents referred for psychological treatment, on the YSR, was compared with the parents' report of their children's behavior, on the CBCL. Parents reported more behavioral problems in terms of scores and in number of clinical cases identified by the instruments. The possible reasons for the higher agreement found between informants on the Externalizing Problems scale is discussed, as well as the clinical implications of the differences. It is concluded that the use of multiple informants on the assessment process is important, regardless of the divergences, because knowing behaviors in different contexts is crucial to elaborate complete diagnostics and adequate interventions. (AU)

Detection of quinolone-resistance mutations in Salmonella spp. strains of epidemic and poultry origin

Mutations into codons Aspartate-87 (62 percent) and Serine-83 (38 percent) in QRDR of gyrA were identified in 105 Salmonella strains resistant to nalidixic acid (94 epidemic and 11 of poultry origin). The results show a high incidence of mutations associated to quinolone resistance but suggest association with others mechanisms of resistance.

Ciprofloxacin susceptibility reduction of salmonella strains isolated from outbreaks

The antimicrobial susceptibility of 212 Salmonella strains isolated from patients and foods was evaluated and 45 percent were found to be resistant to nalidixic acid. Nalidixic acid resistant strains showed a higher minimal inhibitory concentration for ciprofloxacin than sensitive strains. During the study an increase of strains with reduced susceptibility to ciprofloxacin was also observed.

Avaliação microbiológica de alimentos isentos de registrono Ministério da Saúde / Microbiological analysis of foods exempt of legal registration procedures

O objetivo deste trabalho foi avaliar o padrão higiênico-sanitário de alimentos comercializados na Regiãode Londrina cadastrados no Ministério da Saúde, porém, dispensados de registro, conforme a RDC nº.23 da Agência Nacional de Vigilância Sanitária (ANVISA). Os alimentos foram escolhidos de acordo comas sugestões da Vigilância Sanitária de Londrina, PR, que levou em consideração o risco epidemiológico.Os padrões microbiológicos foram avaliados conforme a RDC nº. 12 da ANVISA. Contagens de E. colie S. aureus acima do permitido foram observadas respectivamente em 11 (18,3%) e 13 (21,6%) dos 60alimentos analisados. Os demais resultados microbiológicos estavam dentro do estabelecido pela RDCnº. 12. Ficou clara a necessidade de maior fiscalização do processamento e armazenagem de váriosalimentos analisados, em especial, sorvetes, massas recheadas, pães de queijo, lasanha, doces comcreme e salgados recheados. Esses resultados serão encaminhados às Vigilâncias Regional e Municipalalertando sobre a real potencialidade desses alimentos veicularem doenças e na intenção de abrir umadiscussão sobre a liberação ou não de registro desses alimentos junto ao Ministério da Saúde. Alémdisso, os resultados obtidos confirmam que a análise microbiológica do produto final é um instrumentoessencial de validação e verificação das Boas Práticas de Fabricação (BPF) e da Análise de Perigos ePontos Críticos de Controle (APPCC).

The aim of this study was to analyze the sanitary quality of foods commercialized in Londrina, Paraná that are exempt of Brazilian Health Ministry registration procedures, according to Resolution n°. 23 from the National Sanitary Administration Agency (ANVISA). The food categories analyzed were chosenaccording to ANVISA, Londrina, PR which took the epidemiological risk in account. Microbiologicalstandards were evaluated according to ANVISA Resolution n°. 12. Escherichia coli and coagulase positive Staphylococcus counts were above standards in 11 (18.3%) and 13 (21.6%) of food samples analyzed, respectively. The others microbiological results were in conformity to ANVISA Resolution n°.12. These results indicate inadequate sanitary conditions during food processing especially for ice-cream, stuffed pasta, "pães de queijo", lasanha, cream felled pastries, and "salgado recheado". The results could help the State and Local Sanitary Administration Agencies to evaluate the potentiality of these foods cause food-borne diseases and the adequacy of their liberation from Brazilian Health Ministry registration procedures. The results also show that microbiological analysis of the final product is a valuable validation and verification procedure for the GMP and HACCP system.