Factors that cause women with osteoporosis to fall.

Objective: To analyze and compare intrinsic and extrinsic factors that cause falls among women receiving treatment for osteoporosis. Subjects and methods: A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale-International (FES-I) and investigated the extrinsic factors for falls. Results: We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n=71, 49.5%), a faller group (FG; 1 fall, n=42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n=31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P<.005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P=.015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P=.028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P<.001). Conclusion: Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.

Buccal mucosa graft vaginoplasty: A viable option demonstrated step-by-step.

INTRODUCTION: Persistent cloaca, defined as confluence of the rectum, the vagina and the urethra into a single common channel, has an estimated incidence of 1/50,000 live births. We describe the buccal mucosa graft vaginoplasty for a 11 year old female with cloaca, who underwent at the age of 11 months a Peña repair. We performed the vaginoplasty after the onset of uterine pain due to the beginning of menstruation. MATERIAL AND METHODS: We accessed the lower lip for superficial dissection to harvest the graft. The donor site has been kept with as much submucosal fat as possible to avoid damage to the buccinatoria muscles. A second graft was further obtained from the cheek. Both grafts were submitted to multiple small sections to produce a mesh graft and increase its size. A arciform incision anterior to the anal canal and posterior to the urethra was performed followed by consecutive dissection with eletrocautery to gain profundity. The mesh-graft was placed over the neovaginal cavity and sutured with 4.0 PDS monofilament suture used to suture and then quilt the graft in place. The vaginal capacity was confirmed by ease of a two-digit insertion. Haemostasis was confirmed before the insertion of a soft vaginal mold. The patient remained with an indwelling urinary catheter. The mold was equivalent to 24Fr and had 13 cm of profundity and Foley tube were removed after 14 days postoperatively. RESULTS: Patient had an excellent postoperative course and had been instructed to perform vaginal dilatation every 3 h during the day. Current follow up is 10 months. DISCUSSION: Buccal mucosal grafting has advantages over the use of keratinized skin flaps and intestinal flaps. Buccal mucosa is ideal for female genital reconstruction, given its color, texture, lack of hair and mild mucous production. In our particular case, we connected the neovagina after two months of adequate healing to the native 1/3 through laparoscopic approach. CONCLUSIONS: BMG vaginoplasty is a viable alternative to treat females with cloaca at adolescence.

Factors that cause women with osteoporosis to fall

ABSTRACT Objectives: To analyze and compare intrinsic and extrinsic factors that cause falls among women receiving treatment for osteoporosis. Subjects and methods: A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale-International (FES-I) and investigated the extrinsic factors for falls. Results: We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n = 71, 49.5%), a faller group (FG; 1 fall, n = 42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n = 31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P < .005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P = .015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P = .028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P < .001). Conclusion: Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.

Stress fractures.

Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

Physiological and Ankle Functions Are Discriminating Factors for the Risk of Falls in Women in Treatment of Osteoporosis.

INTRODUCTION: Elderly women with osteoporosis are at risk of falls and fractures. OBJECTIVE: To compare the intrinsic factors of falls, including ankle evaluation, in a group of elderly women in treatment for osteoporosis compared with a control group. METHODS: A cross-sectional study of elderly women in treatment for osteoporosis (TG) was paired with a control group (CG) not in treatment. All groups completed a questionnaire and underwent a bone mineral density test; the mini-mental state examination (MMSE); physical performance tests; lower-limb strength and power, ankle, and muscle architecture evaluations; and a physiological profile assessment (PPA). RESULTS: A total of 128 women were included (68 TG, 60 CG); the mean age was 71.55 ± 3.07 years; TG had a worse performance in the intrinsic factors in the MMSE, plantarflexions range of motion, gait speed, plantarflexions peak isometric strength, and short physical performance battery (p < 0.05 for all). PPA stratification (proprioception and lower-limb strength) presented a greater risk of falls in the TG, with proprioception increasing the risk by 2.4 times. CONCLUSION: Patients undergoing treatment for osteoporosis are influenced by intrinsic factors of falls, many being present in the CG. PPA and ankle strength and flexibility tests are more discriminative for evaluating fall risks in patients in treatment for osteoporosis.

Stress fractures

ABSTRACT Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

Muscle stretching changes neuromuscular function involved in ankle stability.

It has been postulated that the mechanical and neurophysiological effects induced by stretching decrease maximal muscle strength and power. Additionally, the reduction in neural input and muscle stiffness can affect the joint stabilization process. However, there is no evidence available to support this hypothesis. Thus, the aim of this study is to analyze the influence of static stretching on dynamic joint stability. Twenty physically active female university students (22.8 ± 5.3 years; 58 ± 8.8 kg; 1.62 ± 0.07 m) performed a series of static-passive stretching exercises for the peroneus longus and brevis muscles (four repetitions of 30 s). Before and after the stretches, electromyography was performed on both muscles during simulated ankle sprain. Mathematical algorithms calculate the latency and the electromyography activity (RMS). After stretching, the latency increased from 66ms to 73 ms (p = 0.003) for the peroneus brevis muscle and from 70 ms to 79 ms (p = 0.001) for the peroneus longus muscle. The RMS, calculated 100 ms after the simulation, decreased in the peroneus brevis muscle, from 25.05 to 18.16 (p = 0.001), and in the peroneus longus muscle, from 22.84 to 15.61 (p = 0.001). Muscle stretching changed the motor responses of both muscles. The increase in latency and the decrease in RMS indicate that static stretching influences the neuromuscular function involved in the joint stabilization process.

Human Tridimensional Neuronal Cultures for Phenotypic Drug Screening in Inherited Peripheral Neuropathies.

Length-dependent axonal degeneration is the pathologic hallmark of several neurodegenerative disorders, including inherited peripheral neuropathies (Charcot-Marie-Tooth (CMT) disease). CMT is currently an untreatable disorder. This is partially due to lack of translational models suitable for drug discovery. In vitro models of CMT have been hindered by the 2D configuration of neuronal cultures, which limits visualization and orientation of axons. To overcome these limitations, we cultured induced pluripotent stem cell (iPSC)-derived spinal motor neurons as 3D spheroids, which grow axons in a centrifugal fashion when plated. Using these iPSC-derived spinal spheroids, we demonstrate neurofilament deposits in motor neuron axons of three patients with CMT2E, caused by mutations in the NEFL gene. This phenotype is partially reversed by two kinase inhibitors. In summary, we developed a human tridimensional in vitro system that models length-dependent axonopathies, recapitulates key pathophysiologic features of CMT2E, and should facilitate the identification of new therapeutic compounds for CMT.

Força de preensão manual e funcionalidade em idosos longevos: um estudo transversal / Hand grip strength and functionality in the long-lived elderly: a cross-sectional study / Fuerza de presión manual y la funcionalidad en ancianos longevos: un estudio transversal

OBJETIVO: analisar a relação entre a força de preensão manual e a medida de independência funcional de idosos longevos. MÉTODO: estudo quantitativo transversal, desenvolvido com 72 longevos da atenção primária de Curitiba, PR, Brasil. O levantamento de dados ocorreu entre agosto e dezembro de 2015. Realizaram-se análises descritivas e de associação entre variáveis. RESULTADOS: 22 (30,6%) longevos apresentaram redução da força de preensão manual; e quanto à medida de independência funcional, 51 (70,8%) eram independentes e 21 (29,2%) moderadamente dependentes. Houve associação significativa entre a força de preensão manual e a medida de independência funcional cognitiva (p=0,021). DISCUSSÃO: são fundamentais os cuidados gerontológicos relacionados à prática de atividade física e participação em oficinas de estimulação cognitiva, adaptados à escolaridade dos longevos. CONCLUSÃO: diante da associação entre a funcionalidade e a força de preensão manual, recomenda-se a avaliação desses aspectos nas consultas de enfermagem aos longevos, em diferentes contextos de atendimento

AIM: to analyze the relationship between the manual grip strength and the functional independence measure of long-lived elderly. METHOD: a cross-sectional quantitative study, developed with 72 patients from primary care in Curitiba, PR, Brazil. Data were collected between August and December 2015. Descriptive and association analyzes were performed between variables. RESULTS: 22 (30.6%) had a decrease in manual grip strength; and regarding functional independence, 51 (70.8%) were independent and 21 (29.2%) were moderately dependent. There was a significant association between the manual grip strength and the cognitive functional independence measure (p=0.021). DISCUSSION: the gerontological care related to the practice of physical activity and participation in workshops of cognitive stimulation adapted to the schooling of the long-lived elderly people is fundamental. CONCLUSION: considering the association between the functionality and the manual grip strength, it is recommended to evaluate these aspects in the nursing consultations of the long-lived elderly, in different contexts of care

OBJETIVO: analizar la relación entre la fuerza de presión manual y la medida de independencia funcional de ancianos longevos. MÉTODO: estudio cuantitativo transversal, desarrollado con 72 longevos de la atención primaria de Curitiba, PR, Brasil. Los datos se recogieron entre agosto y diciembre de 2015. Se realizaron análisis descriptivos y de asociación entre las variables. RESULTADOS: 22 (30,6%) longevos presentaron reducción de la fuerza de presión manual; y referente a la medida de independencia funcional, 51 (70,8%) eran independientes y 21 (29,2%) moderadamente dependientes. Hubo una asociación significativa entre la fuerza de presión manual y la medida de independencia funcional cognitiva (p=0,021). DISCUSIÓN: son fundamentales los cuidados gerontológicos relacionados a la práctica de actividad física y participación en talleres de estimulación cognitiva, adaptados a la escolaridad de los longevos. CONCLUSIÓN: debido a la asociación entre la funcionalidad y la fuerza de presión manual, se recomienda que se les evalúen esos aspectos en las consultas de enfermería a los longevos, en diferentes contextos de atendimiento

Health Promotion and Education: A Study of the Effectiveness of Programs Focusing on the Aging Process.

Considering the population aging and the failure of biologistic and hospital-based treatment model, health promotion programs based on scientific evidence are necessary. A comprehensive review of literature was performed, aiming to identify and analyze health promotion and education experiments focused on the aging process. Papers published in eight databases, together with the database of the Pan-American Health Organization, were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. A total of 22 studies were included, the majority of which adopted a quantitative approach, with a sample larger than 100 elderly or pre-retirement individuals. The majority of studies reported positive results in terms of health promotion and education. One study obtained minimum improvement and one reported that no statistically significant improvement had occurred. The positive effects most indicated by authors were: general or self-perceived improvement in physical health, improvement in psychosocial aspects and in relation to the aging process, improvement in adherence to preventative actions and in healthy conduct and lifestyle, increase in level of physical activity, improvement in quality of life and/or physical well-being, and improvement in activities of daily living or reduction of the risk of developing disabilities.

Aplicativos para tablets sensíveis ao toque para melhorar vocabulário, processamento auditivo central e habilidades de interação social entre pré-escolares / Multitouch tablet applications for ennhancing vocabulary, central auditory processing and prosocial skills among preschoolers

Esta pesquisa objetivou detectar e intervir em dificuldades de linguagem e comportamento em crianças frequentando pré-escolas, para prevenir problemas futuros, como o baixo desempenho acadêmico. Foram avaliadas 195 crianças em diversos comportamentos, 193 em vocabulário expressivo e receptivo e 187 em processamento auditivo central. Assim, 88 delas constituem o grupo experimental e foram envolvidas em uma intervenção para o desenvolvimento e refinamento de linguagem e comportamento por meio de atividades desenvolvidas em aplicativos usados em tablets e orientação fornecida a seus pais e professores por uma equipe profissional de fonoaudiólogos, psicólogos e psicopedagogos. As outras 99 crianças constituem o grupo controle. A fase de pós-teste aconteceu no início de 2015. Para o desenvolvimento e refinamento de vocabulário, processamento auditivo central e habilidades pró-sociais, um conjunto de atividades baseadas em aplicações que funcionam em tablets foram usadas e categorizadas em jogos, livros interativos por meio do toque, personagens respondendo ou repetindo o discurso da criança, discriminando e classificando diferentes sons e tarefas para lidar com emoções e sentimentos. Durante a fase de intervenção, após cada sessão, as crianças forneceram devolutivas sobre os aplicativos usados. Seus pais também foram requisitados a comentar, por meio de um questionário semiestruturado, sobre mudanças possíveis ou melhora no que se refere à linguagem e às habilidades comportamentais. A devolutiva deles e nossa observação sugerem que essas atividades aumentaram os comportamentos pró-sociais, como colaboração e maior apreciação para atividades sociais, e forneceram às crianças formas novas de expressão, englobando habilidades de discriminação auditiva e vocabulário.

This research aimed to detect and intervene in difficulties of language and behavior in four-year old children, attending preschools to prevent future problems such as academic underachievement. 195 children were evaluated in behavior, 193 in expressive and receptive vocabulary and 187 in central auditory processing. So, 88 constitute the experimental group and were engaged in an intervention for the development and refinement of language and behavior through activities developed in software used in tablets and orientation provided to their parents and teachers by a professional team of speech therapists, psychologists and psycho pedagogues. The other 99 children constitute the control group. Post-test phase took place in the beginning of 2015. For the development and refinement of vocabulary, central auditory processing and pro-social behavior skills, a set of activities based on applications that run on multitouch tablets were used and categorized into games; interactive touch books; characters responding or repeating the children`s speech; discriminating and classifying different sounds and tasks on dealing with emotions and feelings. During the intervention phase, after each session, the children provided us with feedback on the applications used. Their parents were also asked to comment, through a semi-structured questionnaire, on possible changes or improvements regarding children's language and behavioral skills. So far, their feedback and our observations suggest these activities increased pro-social behaviors such as collaboration and augmented appreciation for social activities, and provided children with novel forms of expression encompassing vocabulary and auditory discrimination skills.

Aplicativos para tablets sensíveis ao toque para melhorar vocabulário, processamento auditivo central e habilidades de interação social entre pré-escolares / Multitouch tablet applications for ennhancing vocabulary, central auditory processing and prosocial skills among preschoolers

Esta pesquisa objetivou detectar e intervir em dificuldades de linguagem e comportamento em crianças frequentando pré-escolas, para prevenir problemas futuros, como o baixo desempenho acadêmico. Foram avaliadas 195 crianças em diversos comportamentos, 193 em vocabulário expressivo e receptivo e 187 em processamento auditivo central. Assim, 88 delas constituem o grupo experimental e foram envolvidas em uma intervenção para o desenvolvimento e refinamento de linguagem e comportamento por meio de atividades desenvolvidas em aplicativos usados em tablets e orientação fornecida a seus pais e professores por uma equipe profissional de fonoaudiólogos, psicólogos e psicopedagogos. As outras 99 crianças constituem o grupo controle. A fase de pós-teste aconteceu no início de 2015. Para o desenvolvimento e refinamento de vocabulário, processamento auditivo central e habilidades pró-sociais, um conjunto de atividades baseadas em aplicações que funcionam em tablets foram usadas e categorizadas em jogos, livros interativos por meio do toque, personagens respondendo ou repetindo o discurso da criança, discriminando e classificando diferentes sons e tarefas para lidar com emoções e sentimentos. Durante a fase de intervenção, após cada sessão, as crianças forneceram devolutivas sobre os aplicativos usados. Seus pais também foram requisitados a comentar, por meio de um questionário semiestruturado, sobre mudanças possíveis ou melhora no que se refere à linguagem e às habilidades comportamentais. A devolutiva deles e nossa observação sugerem que essas atividades aumentaram os comportamentos pró-sociais, como colaboração e maior apreciação para atividades sociais, e forneceram às crianças formas novas de expressão, englobando habilidades de discriminação auditiva e vocabulário.(AU)

This research aimed to detect and intervene in difficulties of language and behavior in four-year old children, attending preschools to prevent future problems such as academic underachievement. 195 children were evaluated in behavior, 193 in expressive and receptive vocabulary and 187 in central auditory processing. So, 88 constitute the experimental group and were engaged in an intervention for the development and refinement of language and behavior through activities developed in software used in tablets and orientation provided to their parents and teachers by a professional team of speech therapists, psychologists and psycho pedagogues. The other 99 children constitute the control group. Post-test phase took place in the beginning of 2015. For the development and refinement of vocabulary, central auditory processing and pro-social behavior skills, a set of activities based on applications that run on multitouch tablets were used and categorized into games; interactive touch books; characters responding or repeating the children`s speech; discriminating and classifying different sounds and tasks on dealing with emotions and feelings. During the intervention phase, after each session, the children provided us with feedback on the applications used. Their parents were also asked to comment, through a semi-structured questionnaire, on possible changes or improvements regarding children's language and behavioral skills. So far, their feedback and our observations suggest these activities increased pro-social behaviors such as collaboration and augmented appreciation for social activities, and provided children with novel forms of expression encompassing vocabulary and auditory discrimination skills.(AU)

[Sensitivity profile of Staphylococcus spp. and Streptococcus spp. isolated from toys used in a teaching hospital playroom]. / Perfil de sensibilidade de Staphylococcus spp. e Streptococcus spp. isolados de brinquedos de brinquedoteca de um hospital de ensino.

OBJECTIVE: To evaluate the presence of microorganisms of the genus Staphylococcus and Streptococcus on toys in the playroom of a teaching hospital, as well to as analyze the antimicrobial from the isolated strains. METHODS: Samples were collected from 60 toys, using wet swabs, soon after being used by the children. The samples were inoculated in enriched and selective agar for isolation and later identification of the microorganisms. Antibiogram testing was performed by agar diffusion technique. RESULTS: The genus Staphylococcus was present in 87.0% (52/60) of the toys. Seventythree strains were isolated, with 29.0% (21/73) coagulase-positive and 71.0% (52/73) coagulase-negative. Among the coagulase-negative strains, 90.4% were resistant to penicillin, 65.4% to oxacillin, 28.8% to clarithromycin, 61.5% to clindamycin, and none to vancomycin. Among the coagulase-positive strains, 76.2% were resistant to penicillin, 23.8% to oxacillin, 23.8% to clarithromycin, 47.6% to clindamycin, and none to vancomycin. The genus Streptococcus was not detected in any of the evaluated toys. CONCLUSIONS: Toys can be contaminated with potentially pathogenic bacteria with antimicrobial resistance, representing a possible source of nosocomial infection for patients who are already debilitated.

Perfil de sensibilidade de Staphylococcus spp. e Streptococcus spp. isolados de brinquedos de brinquedoteca de um hospital de ensino / Sensitivity profile of Staphylococcus spp. and Streptococcus spp. isolated from toys used in a teaching hospital playroom

Objetivo: Observar a presença de microrganismos dos gêneros Staphylococcus e Streptococcus em brinquedos de uma brinquedoteca de unidade pediátrica hospitalar, bem como analisar o perfil de resistência aos antimicrobianos das cepas isoladas. Métodos: Foram realizadas coletas de 60 brinquedos, utilizando swab umedecido em solução fisiológica, logo após a utilização pelas crianças. As amostras coletadas foram semeadas em meios de cultura para proporcionar o isolamento dos microrganismos e posterior identificação. Foi realizado o antibiograma para todas as bactérias identificadas, com a técnica de difusão em agar. Resultados: O gênero Staphylococcus estava presente em 87% (52/60) dos brinquedos analisados. Foram isoladas 73 cepas, sendo 29% (21/73) de Staphylococcus coagulasepositiva e 71% (52/73) de Staphylococcus coagulase-negativa. Neste estudo, 90,4% das cepas coagulase-negativas apresentaram resistência à penicilina, 65,4% à oxacilina, 28,8% à claritromicina, 61,5% à clindamicina e nenhuma à vancomicina. Das cepas coagulase-positivas, 76,2% apresentaram resistência à penicilina, 23,8% à oxacilina, 23,8% à claritromicina, 47,6% à clindamicina e nenhuma à vancomicina. Não foram detectadas bactérias do gênero Streptoccocus nos brinquedos estudados. Conclusões: Os resultados obtidos demonstraram que os brinquedos podem apresentar contaminação por bactérias potencialmente patogênicas com resistência aos antimicrobianos, representando uma possível fonte de infecção nosocomial para pacientes que normalmente já se encontram debilitados...

Objective: To evaluate the presence of microorganisms of the genus Staphylococcus and Streptococcus on toys in the playroom of a teaching hospital, as well to as analyze the antimicrobial resistance from isolated strains. Methods: Samples were collected from 60 toys, using wet swabs, soon after being used by the children. The samples were inoculated in enriched and selective agar for isolation and later identification of the microorganisms. Antibiogram testing was performed by agar diffusion technique. Results: The genus Staphylococcus was present in 87.0% (52/60) of the toys. Seventy-three strains were isolated, with 29.0% (21/73) coagulase-positive and 71.0% (52/73) coagulasenegative. Among the coagulase-negative strains, 90.4% were resistant to penicillin, 65.4% to oxacillin, 28.8% to clarithromycin, 61.5% to clindamycin, and none to vancomycin. Among the coagulase-positive strains, 76.2% were resistant to penicillin, 23.8% to oxacillin, 23.8% to clarithromycin, 47.6% to clindamycin, and none to vancomycin. The genus Streptococcus was not detected in any of the evaluated toys. Conclusions: Toys can be contaminated with potentially pathogenic bacteria with antimicrobial resistance, representing a possible source of nosocomial infection for patients who are already debilitated...

Dialética de sentimentos do enfermeiro intensivista sobre o trabalho na Terapia Intensiva / Dialectic feelings of the intensive care nurse about the work in Intensive Care

Objetivo: Identificar a percepção dos enfermeiros intensivistas sobre o trabalho no cenário da Terapia Intensiva e discutir fatores motivadores da permanência no trabalho em Terapia Intensiva. Métodos: A presente pesquisa, de caráter qualitativo-descritivo, tem como objeto a percepção do enfermeiro intensivista sobre o trabalho numa Unidade de Terapia Intensiva (UTI). A pesquisa desenvolveu-se numa UTI particular do Rio de Janeiro com dez enfermeiros. A técnica de coleta foi a entrevista semiestruturada, ocorrida de junho a agosto de 2008. Utilizou-se da análise de conteúdo para tratar os dados. Resultados: Os resultados revelaram que o enfermeiro intensivista tem afinidade com tecnologia dura e gosta do cuidado direto ao paciente. Verificou-se que há aspectos que resultam em prazer e sofrimento, o que revela uma percepção dialética sobre o trabalho. Conclusão: Concluiu-se que este trabalho é, predominantemente, fator de prazer para os enfermeiros devido ao status que o setor ocupa no ambiente hospitalar.

Esforço e recompensa no trabalho do enfermeiro residente em unidades especializadas / Effort and reward in the work of nurse resident in specialized units / Esfuerzo y recompensa en el trabajo del enfermero residente en unidades especializada

Objetivou-se neste estudo identificar os esforços e as recompensas no trabalho de residentes de enfermagem em unidades especializadas, verificando a possível associação com o risco de estresse ocupacional. Pesquisa quantitativa, exploratória, descritiva, cujos dados foram coletados mediante um questionário autoaplicado contendo questões sobre esforços e recompensas no trabalho. Participaram do estudo 16 residentes de enfermagem de um hospital público situado no município do Rio de Janeiro, em 2008. Os esforços apontados pelo grupo acarretam estresse ocupacional, sendo alguns deles: pressão do tempo, interrupções e incômodos, muita responsabilidade no trabalho, carga pesada de trabalho e esforço físico. As principais recompensas foram o respeito da chefia e colegas, apoio em momentos difíceis, tratamento justo e chances futuras no trabalho. Concluiu-se pela necessidade de diagnosticar e monitorar os esforços e fortalecer as recompensas de modo a minimizar o estresse ocupacional e promover a saúde física e mental do grupo.

This study aimed both at identifying the efforts and rewards in the work of the nurse resident in specialized units, and checking its possible association with occupational stress. An exploratory quantitative and descriptive research piece of research. Data were collected through closed questionnaires on effort and reward in the work. Sixteen nursing residents from a public hospital in Rio de Janeiro district in 2008 took part in it. The demands pointed by the group cause occupational stress according to some of them: time pressure, interruptions and disturbances, a lot of responsibility in the work, a heavy work load and physically demanding. The rewards were the respect of superiors and colleagues, adequate support in difficult situations, fairly treated and work prospects. Conclusions show that it is necessary to diagnose and monitor the efforts as well as strengthen the rewards to minimize occupational stress and promote the physical and mental health of the group.

Se objetivó en este estudio identificar los esfuerzos y las recompensas en el trabajo del enfermero residente enunidades especializadas, verificando la posible asociación con el riesgo de estrés ocupacional. Investigación cuantitativa, exploratoria, descriptiva, cuyos datos fueron recolectados mediante un cuestionario autoaplicado cerrado conteniendo cuestiones sobre esfuerzos y recompensas en el trabajo. Participaron del estudio 16 residentes de enfermería de un hospital público localizado en el municipio de Rio de Janeiro – Brasil, en 2008. Los esfuerzos apuntados por el grupo provocan estrés laboral siendo algunos de ellos: presión del tiempo, interrupciones e incómodos, mucha responsabilidad en el trabajo, carga pesada de trabajo y esfuerzo físico. Las principias recompensas fueron la admiración del patrón y pares, el soporte en tiempos embarazosos, atención recto y oportunidad adelante en el trabajo. Se concluyó por la necesidad de diagnosticar y monitorar los esfuerzos y fortalecer las recompensas de modo a minimizar el estrés ocupacional y promover la salud física y mental del grupo.

Riscos ocupacionais enfrentados pelo trabalhador de enfermagem no setor de hemodiálise / Riesgos laborales enfrentados por los trabajadores de enfermería en una unidad de hemodiálisis / Occupational risks faced by the nursing worker in a unit of hemodialysis

A) identificar os principais riscos ocupacionais aos quais estão expostos os trabalhadores de enfermagem do setor de hemodiálise; b) verificar a utilização de medidas de segurança; e c) analisar as dificuldades e facilidades para o uso do Equipamento de Proteção Individual (EPI). Métodos: Pesquisa qualitativa, exploratória e descritiva, realizada no setor de Hemodiálise de um Hospital Universitário. Participaram dessa pesquisa vinte profissionais de enfermagem. Os dados, coletados através da entrevista semiestruturada, foram analisados por meio da análise de conteúdo. Resultados: Originaram-se três categorias, a saber: riscos ocupacionais enfrentados pelos profissionais de enfermagem; desafios na utilização do EPI pelos profissionais de enfermagem; e baixa adesão dos profissionais de enfermagem ao uso do EPI. Conclusão: O ambiente de trabalho e o apoio gerencial têm um papel considerável na adequação entre treinamento e aderência às recomendações de proteção.

A) identificar los principales riesgos laborales a los que están expuestos los trabajadores de enfermería de una unidad de hemosiálisis; b) verificar el uso de medidas de seguridad; y c) analizar las dificultades y facilidades para el uso del equipamiento de protección individual (EPI). Métodos: Estudio cualitativo, exploratorio y descriptivo, realizado en una unidad de hemodiálisis de un hospital universitário. Participaron veinte profesionales de enfermería. Los datos, recolectados a través de la entrevista semi-estructurada, fueron analizados por medio de la análisis de contenido. Resultados: Fueron originadas trés categorias: los riesgos laborales enfrentados por los profesionales de enfermería; desafíos en la utilización del EPI por los profesionales de enfermería; y baja adhesión de los profesionales de enfermería al uso del EPI. Conclusión: El ambiente laboral y el apoyo gerencial tienen un papel importante en la adecuación entre el entrenamiento y la adhesión a las recomendaciones de protección.

Objectives: a) to identify the main occupational hazards affecting nursing workers at hemodialysis units; b) to identify safety procedures; and c) to analyze difficulties and easinesses in the use of personal protective equipment (PPE). Methods: Qualitative, exploratory and descriptive research, carried out at the Hemodialysis Unit at a teaching hospital. Twenty nursing professionals took part in the research. Data collection was made on the basis of a semistructured interview and data analysis on the basis of content analysis. Results: Three categories emerged: occupational hazards among nursing professionals; challenges in the use of PPE by nursing professionals; and low compliance levels to PPE by nursing professionals. Conclusion: Workplace setting and management support play an outstanding role between training and compliance to protective directions.

Digenea in the surubim Pseudoplatystoma corruscans (Spix and Agassiz, 1829) (Siluriformes: Pimelodidae) of the upper São Francisco River, State of Minas Gerais, Brazil

The specimens of surubim, Pseudoplatystoma corruscans (Spix and Agassiz, 1829), an important food fish with high commercial value in the Upper São Francisco River, were collected downstream from the Três Marias Dam, in the municipality of Três Marias, State of Minas Gerais, Brazil. Thirty-six individuals were examined and among the parasites, four species of Digenea were found: Witenbergia witenbergi Vaz, 1932 and Tylodelphys sp. (metacercarie), both with prevalence above 10 percent, followed by Acanthostomum gnerii (Szidat, 1958) and Acanthostomum sp.. The total length of the hosts did not influence the parasite prevalence. Witenbergia witenbergi occurred only in female hosts and the abundance of Tylodelphys sp. was higher in the males. These Digenea were recorded for the first time in P. corruscans, and their known geographic distribution has been expanded to the São Francisco Basin in Brazil.

Espécimes de surubim, Pseudoplatystoma corruscans (Spix e Agassiz, 1829), importante peixe na pesca profissional e de maior valor comercial, do Alto Rio São Francisco, foram coletados à jusante da barragem de Três Marias, município de Três Marias, Minas Gerais. Foram examinados 36 indivíduos e dentre outros parasitos, foram encontradas quatro espécies de Digenea: Witenbergia witenbergi Vaz, 1932 e Tylodelphys sp. (metacercárias) ambas com prevalência superior a 10 por cento, seguidas por Acanthostomum gnerii (Szidat, 1958) e Acanthostomum sp.. O comprimento total dos hospedeiros não influenciou a prevalência e a abundância parasitária. Witenbergia witenbergi ocorreu apenas em hospedeiros fêmeas e a abundância de Tylodelphys sp. foi mais elevada nos hospedeiros machos. Esses Digenea foram registrados pela primeira vez em P. corruscans e tiveram sua distribuição geográfica conhecida ampliada para a bacia do São Francisco, Brasil.