Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

OBJETIVO: Avaliar a evidência de validade clínico­causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso­controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1. RESULTADOS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

Influence of hydroclimatic variability on dengue incidence in a tropical dryland area.

Dengue is an endemic disease in more than 100 countries, but there are few studies about the effects of hydroclimatic variability on dengue incidence (DI) in tropical dryland areas. This study investigates the association between hydroclimatic variability and DI (2008-2018) in a large tropical dryland area. The area studied comprehends seven municipalities with populations ranging from 32,879 to 2,545,419 inhabitants. First, the precipitation and temperature impacts on interannual and seasonal DI were investigated. Then, the monthly association between DI and hydroclimatic variables was analyzed using generalized least squares (GLS) regression. The model's capability to reproduce DI given the current hydroclimatic conditions and DI seasonality over the entire time period studied were assessed. No association between the interannual variation of precipitation and DI was found. However, seasonal variation of DI was shaped by precipitation and temperature. February-July was the main dengue season period. A precipitation threshold, usually above 100 mm, triggers the rapid DI rising. Precipitation and minimum air temperature were the main explanatory variables. A two-month-lagged predictor was relevant for modeling, occurring in all regressions, followed by a non-lagged predictor. The climate predictors differed among the regression models, revealing the high spatial DI variability driven by hydroclimatic variability. GLS regressions were able to reproduce the beginning, development, and end of the dengue season, although we found underestimation of DI peaks and overestimation of low DI. These model limitations are not an issue for climate change impact assessment on DI at the municipality scale since historical DI seasonality was well simulated. However, they may not allow seasonal DI forecasting for some municipalities. These findings may help not only public health policies in the studied municipalities but also have the potential to be reproducible for other dryland regions with similar data availability.

Field-evolved resistance to chlorpyrifos by Spodoptera frugiperda (Lepidoptera: Noctuidae): Inheritance mode, cross-resistance patterns, and synergism.

BACKGROUND: Fall armyworm (FAW), Spodoptera frugiperda (Smith), is an economically important pest worldwide. In this study, we selected a genotype of FAW resistant to chlorpyrifos from a field-collected population, characterized the genetic basis of resistance, and evaluated cross-resistance and mechanisms of resistance using synergists. RESULTS: The LD50 values of chlorpyrifos for the resistant (Clorp-R) and susceptible (Sus) FAW genotypes were 24.26 and 0.023 µg per larva, respectively, representing a resistance ratio > 1050-fold. The LD50 values of chlorpyrifos against heterozygotes were 3.34 and 4.00 µg per larva, suggesting that resistance is autosomally inherited. The chlorpyrifos resistance in FAW was influenced by few genes, with the minimum numbers of segregations being 1.74 and 1.88. On chlorpyrifos-sprayed plants and leaves, Clorp-R and heterozygote genotypes showed >95% and >52% survival, respectively, whereas the Sus genotype had no survival, indicating that the resistance is incompletely dominant at the field rate of chlorpyrifos. The Clorp-R genotype presented some cross-resistance to acephate, but low cross-resistance to thiodicarb, methomyl, chlorfenapyr, flubendiamide, methoxyfenozide, spinetoram, and teflubenzuron. The synergists piperonyl butoxide, diethyl maleate, and S,S,S-tributyl phosphorotrithiotate did not have relevant effects on the Clorp-R genotype, suggesting a minor role for metabolic resistance. CONCLUSIONS: The inheritance of chlorpyrifos resistance in FAW was characterized as autosomal, incompletely dominant, and polygenic, with metabolic resistance playing a small role in the detoxification of chlorpyrifos. Low cross-resistance between chlorpyrifos and other mode of action (MoA) insecticides occurs in FAW, highlighting the importance of considering the rotation of MoA as a strategy to delay resistance. © 2021 Society of Chemical Industry.

Fitness Cost of Chlorpyrifos Resistance in Spodoptera frugiperda (Lepidoptera: Noctuidae) on Different Host Plants.

Spodoptera frugiperda (J. E. Smith, 1797) is a polyphagous pest of global relevance due to the damage it inflicts on agricultural crops. In South American countries, this species is one of the principal pests of maize and cotton. Currently, S. frugiperda is also emerging as an important pest of soybeans and winter cereals in Brazil. Chemical control is one of the main control tactics against S. frugiperda, even though resistance against numerous modes of action insecticides has been reported. To support insect resistance management programs, we evaluated the fitness costs of resistance of S. frugiperda to the acetylcholinesterase inhibitor chlorpyrifos. Fitness costs were quantified by comparing biological parameters of chlorpyrifos-resistant and -susceptible S. frugiperda and their F1 hybrids (heterozygotes) on non-Bt cotton, non-Bt maize, non-Bt soybean, and oats. The results revealed that the chlorpyrifos-resistant genotype showed lower pupa-to-adult and egg-to-adult survivorship and reduced larval weights on oats; longer neonate-to-pupa and egg-to-adult developmental periods, and lower pupal weights and fecundity on maize; lower pupal weights on soybean; and reduced fecundity on cotton compared with the chlorpyrifos-susceptible genotype. Fitness costs also affected fertility life table parameters of the resistant genotype, increasing the mean length of a generation on cotton and maize and reducing the potential for population growth on all hosts. These findings suggest fitness costs at the individual and population levels of chlorpyrifos resistance in S. frugiperda, indicating that removal of the selective agent from the environment would result in reduced resistance and opportunities for the restoration of susceptibility.