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OBJECTIVE: The identification and diagnosis of children with attention deficit hyperactivity disorder (ADHD) traits is challenging during the preschool stage. Neuropsychological measures may be useful in early assessments. Furthermore, analysis of event-related behavior appears to be an unmet need for clinical treatment planning. Conners' Kiddie Continuous Performance Test (K-CPT) is the most popular well-established neuropsychological measurement but lacks event markers to clarify the heterogeneous behaviors among children. This study utilized a novel commercially available neuropsychological measure, the ΣCOG, which was more game-like and provided definite event markers of individual trial in the test. METHODS: Thirty-three older preschool children (14 were diagnosed with ADHD, mean age: 66.21 ± 5.48 months; 19 demonstrated typical development, mean age: 61.16 ± 8.11 months) were enrolled and underwent comprehensive medical and developmental evaluations. All participants underwent 2 versions of neuropsychological measures, including the K-CPT, Second Edition (K-CPT 2) and the ΣCOG, within a short interval. RESULTS: The study indicated the omissions and response time scores measured in this novel system correlated with clinical measurement of the behavioral scales in all participants and in the group with ADHD; additionally, associations with the traditional K-CPT 2 were observed in commissions and response time scores. Furthermore, this system provided a within-task behavioral analysis that identified the group differences in the specific trial regarding omission and commission errors. CONCLUSIONS: This innovative system is clinically feasible and can be further used as an alternative to the K-CPT 2 especially in research by revealing within-task event-related information analysis.
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BACKGROUND: Professional self-concept consists of one's judgments, attitudes about oneself professionally, and one's own perception as a professional. A positive professional self-concept can support students and new nurses throughout their nursing careers. OBJECTIVE: To describe levels of self-concept among pre-licensure undergraduate students. PARTICIPANTS/SETTING: The participants were nursing students in a Bachelor of Science in Nursing program in the United States. DESIGN/METHODS: This is a cross-sectional correlational study with self-report instruments, including demographics and the Professional Self-Concept of Nurses Instrument. Data (N = 103) were analyzed with SPSS/WIN 29.0. Descriptive statistics and professional self-concept scores were examined with independent t-tests, ANOVA, and Pearson's correlations. RESULTS: Most participants were female (n = 90), with a mean age of 20 years (SD = 1). The mean professional self-concept of nurses score was 78 (SD = 7), ranging from 27 to 108, and professional self-concept was positively correlated with receiving tutoring through the university's program, working as a tutor for nursing students or students in prerequisite classes, transferring into the nursing program, and participating in campus nursing organizations. Professional self-concept was negatively correlated with advancement in semesters of the nursing program, being a first-generation college student, having a family member who is a nurse, GPA, and having clinical-related work experience in healthcare. CONCLUSIONS: Higher levels of exposure to nursing may be related to lower professional self-concept. This is important to recognize and it may generalize to other nursing schools and health-related departments. Schools of nursing should enhance students' resilience by promoting self-concept. Our findings also shade light on self-care and the mental health of healthcare professionals.
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Bacharelado em Enfermagem , Autoimagem , Estudantes de Enfermagem , Humanos , Estudos Transversais , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Feminino , Masculino , Adulto Jovem , Inquéritos e Questionários , Estados Unidos , AdultoRESUMO
BACKGROUND: A growing body of research supports dispositional mindfulness as important in influencing physical and mental health as well as physical activities in patients with chronic illnesses. Knee osteoarthritis (OA), which often causes health problems, is one of the most common chronic illnesses, but less is known about dispositional mindfulness in relation to this condition. OBJECTIVE: To explore possible associations between dispositional mindfulness and physical and mental health as well as physical activity in knee OA patients. METHODS: For this cross-sectional study, we recruited a purposive sample of orthopedic clinic patients in hospitals in Southern Taiwan. Instruments included the Mindful Attention Awareness Scale (MAAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health-related characteristics were also measured. Demographic statistics, bivariate correlations, and multiple linear regression informed our exploration of potentially related factors for dispositional mindfulness. RESULTS: Participants with knee OA (N = 250) were mostly elderly (88%), female (70.5%), and married (84%). Marital status, perceived health status, depression, and physical activity were associated with dispositional mindfulness. Better perceived health, lower depression, and greater physical activity were significantly associated with greater dispositional mindfulness. However, the severity of symptoms, fear of falling, and exercise self-efficacy did not reach statistical significance in relation to dispositional mindfulness. CONCLUSION: Greater emphasis should be placed on the cultivation of mindfulness to enhance individuals' perceived health, decrease their depressive mood, and promote their engagement in physical activity, which could indirectly alleviate their experience of pain and improve their physical function, yielding better quality of life and well-being. Future research should focus on interventions to apply dispositional mindfulness in order to determine whether dispositional mindfulness can effectively improve physical and mental health as well as physical activity in those with knee OA.
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Atenção Plena , Osteoartrite do Joelho , Humanos , Feminino , Idoso , Estudos Transversais , Qualidade de Vida/psicologia , Acidentes por Quedas , Medo , Doença CrônicaRESUMO
AIMS AND OBJECTIVES: To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID-19. BACKGROUND: Healthcare providers caring for COVID-19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. DESIGN: A cross-sectional study. METHODS: In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID-19 by analysing their responses to an online self-report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. RESULTS: The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID-19 patients. The mediators were use of approach-oriented coping strategies and current mental health status. Specifically, use of approach-oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. CONCLUSIONS: Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach-oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. RELEVANCE TO CLINICAL PRACTICE: Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach-oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor members of the public were involved in the design or execution of the study.
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COVID-19 , Humanos , COVID-19/epidemiologia , Qualidade de Vida , Estudos Transversais , Pessoal de Saúde/psicologia , PandemiasRESUMO
Objective@#To investigate the association between maternal parenting styles and quality of life among preschools,to provide a scientific theoretical basis for interventions targeting at prmoting early life health.@*Methods@#From May to July, 2021, a stratified cluster sampling method was used to enroll 4 233 child mother dyads from 14 preschools in Chengdu. An online questionnaire survey was administered to collect socio demographic information, maternal parenting styles, and children s quality of life.@*Results@#The overall score of quality of life was (80.17±9.81) among preschool children in Chengdu. In the multivariate linear regression models, maternal emotional warmth were significantly associated with higher scores in emotional functioning, social functioning, school functioning, psychosocial health summary score, and total scores ( β coefficients in the high level group were 2.63 , 4.95 , 12.05, 6.54,4.88, P <0.05). In contrast, both maternal rejection and overprotection were significantly associated with lower scores in physical functioning, emotional functioning, social functioning, school functioning, psychosocial health summary score, and the total scores of children s quality of life (for rejection: β coefficients in the high level group were -9.39, -10.82, -7.12 , -6.04 , -8.00, and -8.35 , respectively; for overprotection: β coefficients in the high level group were -6.71, -5.85, -3.08 , -2.39 , -3.77, and - 4.51 , respectively, P <0.05). The associations between high level of maternal rejection and children s emotional functioning showed significant gender differences( β =-3.23, P <0.05).@*Conclusion@#Maternal parenting style has a significant impact on children s quality of life. Interventions targeting at maternal parenting styles may be beneficial to improve the quality of life in preschool children.
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BACKGROUND: Nurses practicing in long-term care or rehabilitation settings face unique challenges from prolonged or repeated exposure to stressors, given their extended time with patients. This puts them at risk for compassion fatigue, burnout, and secondary traumatic stress, which can lead to decreased resilience and sleep problems. AIM: The aim of this study was to examine relationships among resilience, professional quality of life, sleep, and demographics in nurses working in long-term care or rehabilitation settings, and to investigate whether demographics, professional quality of life, and sleep quality are significant predictors of nurses' resilience. METHODS: In this cross-sectional study, we used the following measures: demographics, the Connor-Davidson Resilience Questionnaire, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Scale (ProQOL). Data were analyzed with SPSS v25. Data analysis consisted of descriptive statistics, bivariate correlations, and multiple regression. RESULTS: Participants (N = 120) were mostly female (85%) and registered nurses (90%). Mean scores were 52.13 for resilience and 7.53 for sleep quality. Mean ProQOL subscale scores were 41.78 for compassion satisfaction, 22.28 for compassion fatigue, and 23.92 for secondary traumatic stress. Multiple regression models showed that compassion satisfaction, burnout, and secondary traumatic stress significantly predicted resilience (ß = 0.69, ß = -0.61, and ß = -0.34, respectively, all p < .05). CONCLUSIONS: Resilience is important in nurses' personal and professional lives because it helps to protect nurses from the negative consequences of stressors. Strategies, resources, and workplace support can promote self-care and resilience.
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Esgotamento Profissional , Fadiga de Compaixão , Enfermeiras e Enfermeiros , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Assistência de Longa Duração , Masculino , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In Taiwan, illegal drug use is a critical health problem during adolescence. Schools playa vital role in preventing students' illegal drug use. Accordingly, we developed and evaluated a school-based, drug-use prevention program integrating the theory of planned behavior (TPB) and health literacy for junior high school students. AIM: This study aimed to use a theory-based program to prevent students from illegal drug use in Taiwanese junior high school students. METHODS: We recruited 648 junior high school students aged around 13-14 years (grades 7 to 8 students) from 14 selected schools: N = 323 in the experimental group, N = 325 in the comparison group. The experimental group received 10 45-min sessions of a theory-based drug-use prevention program. The comparison group received traditional didactic teaching and drug refusal skill training. We used a generalized estimating equation (GEE) to analyze data. RESULTS: Results of paired t-tests indicated that drug-use health literacy and TPB-related variables improved in the experimental group. The GEE analyses indicated that participants in the experimental group also demonstrated significantly improved health literacy (p < 0.001) compared to the comparison group, especially for functional (p < 0.001) and critical health literacy (p = 0.017). The experimental group also showed significant post-intervention improvement in terms of subjective norm scores (p = 0.024). CONCLUSION: Study results demonstrated the effectiveness of a drug-use prevention program on health literacy and subjective norm through integrating the Theory of Planned Behavior and health literacy. The study supports that the future implementation of similar programs for junior high school students can integrate health literacy and subjective norms as two critical program components.
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Letramento em Saúde , Preparações Farmacêuticas , Adolescente , Humanos , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Escolar , Instituições Acadêmicas , Estudantes , TaiwanRESUMO
Objective:To characterize the mortality rate of residents in Minhang District of Shanghai from January to April in 2016-2020, and to determine the change in the epidemic Coronavirus Disease 2019 (COVID-19) in 2020. Methods:Data of mortality surveillance was collected from the death registry of Shanghai residents. Cause of death was coded and classified per the International Classification of Diseases (ICD-10). The standardized mortality rate was calculated based on the standard population of China in 1990. The analysis was performed by Excel 2016 and SPSS 20.0. Results:From 2016 to 2020, the average crude mortality rate of residents was 281.75/100 000 from January to April in Minhang District of Shanghai, and the standardized mortality rate was 66.57/100 000. The top five causes of death in the latest five years were cardiovascular diseases, tumor, respiratory diseases, endocrine diseases, and injury and poisoning. The mortality rate was the lowest from January to April in 2020 in the past five years; furthermore, the mortality rate of respiratory system diseases has decreased significantly. Conclusion:Sex, age, place and causes of death in residents are consistent from January to April across years in Minhang District of Shanghai. However, there are minor differences in 2020, which may be attributable to the epidemic of COVID-19.
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Background: Resilience is crucial for students in health schools as care becomes more complex and as the adjustment to meet patient, environmental, and professional demands with success can seem a daunting challenge. Self-care activities can support the development of resilience in the student population. The purpose of this study is to explore and describe self-care practices, health-promoting behaviors, and resilience among students, faculty, and staff of the health professional schools at a large metropolitan university. Method: This was a cross-sectional study of data from 148 participants. Analysis included descriptive statistics, t tests, analysis of variance, crosstabs, and Pearson correlations. Results: Resilience was lower among students than among faculty and staff. The most frequent self-care activities were humor and music. Resilience was significantly correlated with the self-care behaviors of praying (p = .006), healthy sleeping habits (p = .024), reading (p = .007), and mindful acceptance (p = .025); yoga and meditation were not significantly correlated with resilience.
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Docentes/psicologia , Ocupações em Saúde/educação , Resiliência Psicológica , Autocuidado/métodos , Adulto , Estudos Transversais , Docentes/estatística & dados numéricos , Feminino , Ocupações em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado/classificação , Autocuidado/estatística & dados numéricos , Inquéritos e Questionários , TexasRESUMO
Composite beads are packed in the anode chamber of a microbial fuel cell (MFC), providing more area for microbial attachment and growth, increasing the efficiency of removal of toluene from toluene-contaminated groundwater. The composite beads were fabricated by integrating carbon coke (CC) with a relatively large specific surface area to which microorganisms easily adhere with conductive carbon black (CCB), which has low electrical resistance. Since the advantages of both are complementary, the power generation of MFC is improved. The single layer-packed anode MFC (SP-MFC) completely degraded 200 mg L-1 of toluene - 2.3 times faster than the non-packed anode MFC (NP-MFC). The high power density (44.9 mW m-3) and oxidation peak (1 mA), with low internal resistance (207 Ω) revealed that SP effectively improved the power generation efficiency. A composition ratio (CRCCB:CC) of composite beads of one to two yielded the best performance with a removal efficiency of 100 % - 76 % faster than CC. The closed circuit voltage of CR1:2 MFC reached 340 mV, which was 16 times that of CC; the power density and oxidation peak reached 103 mW m-3 and 1.38 mA, respectively. Therefore, CR1:2 effectively increased the overall removal efficiency and power generation of the MFC.
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Fontes de Energia Bioelétrica , Eletroquímica/instrumentação , Eletrodos , Água Subterrânea/química , Tolueno/metabolismo , Bactérias/metabolismo , Fontes de Energia Bioelétrica/microbiologia , Carbono/química , Células Imobilizadas/metabolismo , Coque , Eletroquímica/métodos , Purificação da Água/instrumentação , Purificação da Água/métodosRESUMO
PURPOSE: To explore the influence of S100 calcium binding protein A4 (S100A4) knockout (KO) on methionine-choline-deficient (MCD) diet-induced non-alcoholic fatty liver disease (NAFLD) in mice. MATERIALS AND METHODS: S100A4 KO mice (n=20) and their wild-type (WT) counterparts (n=20) were randomly divided into KO/MCD, Ko/methionine-choline-sufficient (MCS), WT/MCD, and WT/MCS groups. After 8 weeks of feeding, blood lipid and liver function-related indexes were measured. HE, Oil Red O, and Masson stainings were used to observe the changes of liver histopathology. Additionally, expressions of S100A4 and proinflammatory and profibrogenic cytokines were detected by qRT-PCR and Western blot, while hepatocyte apoptosis was revealed by TUNEL staining. RESULTS: Serum levels of aminotransferase, aspartate aminotransferase, triglyceride, and total cholesterol in mice were increased after 8-week MCD feeding, and hepatocytes performed varying balloon-like changes with increased inflammatory cell infiltration and collagen fibers; however, these effects were improved in mice of KO/MCD group. Meanwhile, total NAFLD activity scores and fibrosis were lower compared to WT+MCD group. Compared to WT/MCS group, S100A4 expression in liver tissue of WT/MCD group was enhanced. The expression of proinflammatory (TNF-α, IL-1β, IL-6) and profibrogenic cytokines (TGF-β1, COL1A1, α-SMA) in MCD-induced NAFLD mice were increased, as well as apoptotic index (AI). For MCD group, the expressions of proinflammatory and profibrogenic cytokines and AI in KO mice were lower than those of WT mice. CONCLUSION: S100A4 was detected to be upregulated in NAFLD, while S100A4 KO alleviated liver fibrosis and inflammation, in addition to inhibiting hepatocyte apoptosis.
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Animais , Camundongos , Apoptose , Aspartato Aminotransferases , Western Blotting , Cálcio , Proteínas de Transporte , Colesterol , Colágeno , Citocinas , Fibrose , Hepatócitos , Marcação In Situ das Extremidades Cortadas , Inflamação , Fígado , Cirrose Hepática , Hepatopatia Gordurosa não Alcoólica , TriglicerídeosRESUMO
Bloodstream infections (BSIs) due to vancomycin-resistant Enterococcus faecium (VREfae) remain a therapeutic challenge. This study aimed to evaluate mortality from BSIs due to VREfae in Central Taiwan.We retrospectively analyzed patients with significant VREfae BSIs in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2014.Of the 152 patients with Enterococcal BSI, 56 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI and 20 (13.2%) patients were associated with polymicrobial bacteremia. VREfae BSI was observed in 36 (23.7%) patients. Van A (100%) is the prevalence genotype, and ST 17 (41.7%) is the predominant ST type among 36 VREfae isolates during the study period. The 30-day mortality rate was 13.2% (20/152). The multivariate logistic regression analysis showed that the onset of VREfae BSI in the ICU (odds ratio [OR]â=â4.2, 95% confidence interval [CI]â=â1.7-10.0, Pâ=â.002) was a significant risk factor for 30-day mortality, whereas an appropriate antimicrobial therapy was a protective factor for 30-day mortality (ORâ=â0.33, 95% CIâ=â0.14-0.79, Pâ=â.013).Our results underscore the need to assist patients who are admitted to ICUs with VREfae BSIs. We emphasize the use of an appropriate antimicrobial therapy for VREfae BSI with the aim to treat more patients with these infections.
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Bacteriemia/microbiologia , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/fisiopatologia , Resistência a Vancomicina , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Técnicas Bacteriológicas , Feminino , Genótipo , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia , Adulto JovemRESUMO
OBJECTIVES@#To establish a novel multiplex amplification system which comprises 24 Y-STR loci.@*METHODS@#otal 24 Y-STR gene loci, concluding DYS531, DYS630, DYS622, DYS552, DYS510, DYS449, DYS459a/b, DYS446, DYS443, DYS635, DYS587, DYS527a/b, DYS460, Y-GATA-A10, DYS520, DYS557, DYS522, DYS481, DYS570, DYS385a/b, DYS444, were chosen for establishing the fluorescence multiplex amplification system. The specificity, identity, sensitivity, balance of the amplification, anti-interference and accuracy of the system were detected and the gene diversity was investigated in the population of Guangdong.@*RESULTS@#No band was found in nonhuman and female samples that were tested by the established multiplex amplification system. The same genotyping results were obtained from different tissues of the same person. Complete profiles could be obtained from more than 0.1 ng of the standard sample 9948. The loss of alleles was found when the common inhibitors such as hemoglobin and calcium ion were added 120-200 μmol/L and 1.5-2.0 mmol/L respectively to the system which with a strong anti-interference to the indigo, humic acid and EDTA. The typing of 24 Y-STR system could give the reliable results when 146 unrelated male individuals were detected and compared with the Yfiler system parallelly. The haplotype diversity (HD) of the population in Guangdong reached 0.999 72 that was better than the result retained from Yfiler system, which the HD was 0.998 58.@*CONCLUSIONS@#The fluorescence amplification system with 24 Y-STR loci established in present study has a wildly application prospect and can be used for cases inspection, paternity tests and Y-STR database construction.
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Feminino , Humanos , Masculino , Alelos , Povo Asiático/genética , China , Cromossomos Humanos Y/genética , Fluorescência , Genética Populacional , Genótipo , Haplótipos/genética , Reação em Cadeia da Polimerase Multiplex , Reação em Cadeia da Polimerase , Polimorfismo Genético , SoftwareRESUMO
BACKGROUND: Acinetobacter baumannii complex (A. baumannii) has been isolated worldwide. The rapid spread of multidrug-resistant A. baumannii complex (MDRAB) in clinical settings has made choosing an appropriate antibiotic to treat these infections and executing contact precautions difficult for clinicians. Although controlling the transmission of MDRAB is a high priority for institutions, there is little information about MDRAB control. Therefore, this study evaluated infection control measures for A. baumannii infections, clusters and outbreaks in the literature. METHODS: We performed a review of OVID Medline (from 1980 to 2015), and analyzed the literature. RESULTS: We propose that both infection control programs and antibiotic control programs are essential for control of MDRAB. The first, effective control of MDRAB infections, requires compliance with a series of infection control methods including strict environmental cleaning, effective sterilization of reusable medical equipment, concentration on proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance. The second strategy, effective antibiotic control programs to decrease A. baumannii, is also of paramount importance. CONCLUSION: We believe that both infection control programs and antibiotics stewardship programs are essential for control of MDRAB infections.
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Infecções por Acinetobacter/prevenção & controle , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Controle de Infecções/métodos , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/transmissão , Antibacterianos/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , HumanosRESUMO
BACKGROUND: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing. METHODS: Clinical and laboratory data from patients with candidemia were collected retrospectively at a tertiary medical center in Taiwan from July 1, 2009 to June 30, 2012 (a 36-month period). Demographics, clinical characteristics, and drug susceptibility of the invading Candida species of patients at the onset of candidemia were analyzed and compared with previous study from January 1, 2001 to June 30, 2003 (a 30-month period). RESULTS: A total of 209 episodes of candidemia in 205 patients were identified in this study period. When compared with the previous study period, more patients were admitted for medical conditions at percentages ranging from 49.5% to 69.8%; the incidence rate of health care-associated candidemia increased from 0.76 to 1.14 per 1000 discharges; the proportion of Candida albicans in patients with candidemia decreased from 64.8% to 43.6% whereas the proportion of Candida glabrata increased greatly from 1.1% to 21.6% and the proportions of Candida tropicalis and Candida parapsilosis were slightly elevated (19.8-22.0% and 2.2-7.3%, respectively). All of the C. albicans isolates remained susceptible to fluconazole, whereas 66.7% of C. glabrata isolates were dose-dependent susceptible, and 4.4% of C. glabrata isolates and 11.6% C. tropicalis isolates were resistant. There was one C. glabrata and one Candida guilliermondii resistant to echinocandin. The predictors for 30-day mortality included the high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, use of parenteral nutrition, underlying malignancy, liver cirrhosis, and neutropenia whereas candidemia by C. parapsilosis or C. glabrata is a favorable predictor when compared with C. albicans. CONCLUSION: The distribution of Candida species in candidemia was changed. Although C. albicans remained the major species, the isolation of non-C. albicans spp., especially C. glabrata, increased. Patients with candidemia still had high mortalities due to severity of illness and underlying conditions.
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Antifúngicos/farmacologia , Candida/classificação , Candida/isolamento & purificação , Candidemia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/efeitos dos fármacos , Candidemia/microbiologia , Candidemia/mortalidade , Candidemia/patologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Demografia , Feminino , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise de Sobrevida , Taiwan/epidemiologia , Centros de Atenção Terciária , Adulto JovemRESUMO
Filipina nurses represent the majority of all internationally educated nurses recruited to work in the US. Although the hiring of Filipina nurses is not a new practice in US hospitals, very few studies have detailed how these nurses have adjusted to US nursing practices. This study examines how Filipina nurses transition into their role as nurses and adapt to nursing practice in the US. Following a qualitative approach, 31 Filipina nurses were interviewed as participants. The data were audio-taped and transcribed verbatim, using the method of constant comparison. Analysis revealed that transitioning from Philippine to US nursing practice formed the basis of the social adaptation process, which occurred in three stages: pre-arrival, early adaptation, and late adaptation. Participant-recommended strategies to address adaptation needs experienced at each of these stages are shared. All participants experienced challenges while adjusting to the US healthcare system and cultural landscape.
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Médicos Graduados Estrangeiros/psicologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Ajustamento Social , Adulto , Feminino , Humanos , Entrevistas como Assunto , Filipinas/etnologia , Texas , Estados UnidosRESUMO
The purpose of this study was to identify the prevalence of fungal colonization in water systems and to evaluate the effect of decreasing fungal colonization by a copper-silver ionization system. Environmental samples were collected for fungal culture prospectively during a 1-year period (2011-2012) at the study hospital. A total of 392 water samples were examined from five buildings on March 1, 2011 and February 29, 2012. Fungi were isolated in 13 (3.4%) of 392 water samples from five buildings. The prevalence of fungal colonization in buildings was decreased from 4.76% (9/189) to 1.97% (4/203), a reduction of more than 40%, in pre-ionization and post-ionization treatment (p < 0.001). Thirteen (3.4%) of 392 water samples yielded fungi including Fusarium species (n = 7), Penicillium species (n = 2), Scedosporium species (n = 2), Aspergillus species (n = 1), and one unidentifiable mold. The number of isolated Fusarium species in ionized water samples (0.5% (1/203)) was statistically lower than those in nonionized (3.2% (6/189)) (p = 0.003). Our finding may determine if this ionization method can be applied for control of waterborne fungi colonization in hospital water systems.
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Cobre/farmacologia , Fungos/efeitos dos fármacos , Prata/farmacologia , Abastecimento de Água/normas , Cobre/química , Prata/química , Microbiologia da ÁguaRESUMO
BACKGROUND: Extended-spectrum ß-lactamase (ESBL)-producing bacteria coexpressing AmpC type ß-lactamase (ACBL) are associated with the laboratory issue of false susceptibility to third-generation cephalosporins. This study was to evaluate laboratory tests and clinical significance of bacteremic isolates of Escherichia coli and Klebsiella pneumoniae with both ESBL and ACBL [dual-type lactamases (DTL)]. METHODS: From 2006 to 2009, 78 E coli and 12 pneumoniae bacteremic isolates with reduced susceptibility to cefotaxime (CTX) or ceftazidime (CAZ) were identified and relevant patients' data were collected for analysis. Phenotypic and genotypic characterizations of these selected isolates were determined by inhibitor-based assays and polymerase chain reaction-based genetic analyses, respectively. RESULTS: Among the 90 isolates, 47 had DTL production. There was an increasing annual prevalence from 29% in 2006 to 56% in 2009 (p=0.02). Phenotypic assays had a sensitivity and specificity of 57% (43/76) and 93% (13/14) for ESBL detection and 95% (58/61) and 34% (10/29) for ACBL, respectively. Among the DTL-producing isolates, phenotypic assays yielded a higher false negative rate of ESBL detection than that of ACBL detection (70% versus 6%), while all false negative ESBL results were associated with ESBL genes other than bla(CTx-M). The majority of the DTL-producing isolates were in the category of resistance to CTX (47/47, 100%) and CAZ (44/47, 94%) by the Clinical and Laboratory Standards Institute (CLSI) 2010 interpretive criteria, of which many were considered intermediate or fully susceptible to CTX (25/47, 53%) and CAZ (15/47, 32%) by the previous ones (CLSI-2009). The DTL-producing isolates exhibited a lower susceptibility rate to fluoroquinolones, aztreonam, and ß-lactam/lactamase inhibitors than those with either ESBL or ACBL alone. The use of indwelling catheters or nasogastric tubes was associated with bacteremia due to the DTL isolates, but the mortality rates were not different among those due to isolates with ESBL, ACBL, or both. By multivariate analysis, Pittsburg bacteremia score and Charlson comorbidity index were the significant predictors for all-cause mortalities. CONCLUSION: Bacteremic episodes due to DTL-producing E coli and K pneumoniae became increasingly prevalent and were often associated with coresistance to antibiotics other than ß-lactams, but they were not associated with a worse prognosis than those due to ESBL- or ACBL-producing bacteria.
Assuntos
Bacteriemia/microbiologia , Proteínas de Bactérias/biossíntese , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/biossíntese , Idoso , Análise de Variância , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Proteínas de Bactérias/metabolismo , Cefotaxima/farmacologia , Cefotaxima/uso terapêutico , Ceftazidima/farmacologia , Ceftazidima/uso terapêutico , Distribuição de Qui-Quadrado , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Reações Falso-Negativas , Feminino , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fenótipo , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , beta-Lactamases/metabolismoRESUMO
Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus/paraphrophilus) is a small Gram-negative coccobacillus with fastidious growth requirements. It is a normal commensal of the human oropharynx and upper respiratory tract, and it can infrequently cause invasive human diseases, including bone and joint infections and subacute infective endocarditis. Cases of liver abscess caused by Aggregatibacter aphrophilus have been sparsely recorded in the English-language literature, but have not yet been reported in Taiwan. Here we present a case of Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman. She recovered uneventfully after repeated percutaneous abscess aspiration and antibiotic treatment for 5 weeks.
Assuntos
Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/microbiologia , Infecções por Pasteurellaceae/diagnóstico , Infecções por Pasteurellaceae/microbiologia , Pasteurellaceae/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , Feminino , Humanos , Fígado/diagnóstico por imagem , Abscesso Hepático Piogênico/patologia , Abscesso Hepático Piogênico/terapia , Infecções por Pasteurellaceae/patologia , Infecções por Pasteurellaceae/terapia , Radiografia Abdominal , Sucção , Taiwan , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: The incidence of invasive Group B streptococcal (GBS) infections is increasing in the elderly and immunocompromised adults in many countries worldwide. There are, however, few reports regarding the current status of the infection in northern Taiwan. This study investigated retrospectively the molecular epidemiology and clinical syndromes of the invasive GBS diseases in a tertiary care hospital in northern Taiwan over the past decade. METHODS: One hundred twenty episodes of invasive GBS disease were recorded at Cathay General Hospital, a tertiary care, teaching hospital in northern Taiwan, from January 1998 to June 2009. Clinical information was acquired from medical records. Capsular serotypes and alpha family of surface proteins were genotyped with multiplex and specific polymerase chain reaction. RESULTS: Of all episodes, 58.3% was found in the elderly (age ≥ 65), 36.1% in nonpregnant women and young adults (age 18-64), and 5.9% in the neonates (0-90 days). Case-fatality rate was 6.7%. Eighty-three (69%) of the invasive isolates were available for genotyping. In sharp contrast to the studies in southern Taiwan (1991-2004), Type Ib (26.5%) was the most frequent invasive isolate, followed by V (22.9%), III (18.1%), VI (12%), Ia (10.8%), II (6%), VIII (2.4%), and nontypable strain (1.2%). In particular, Serotype VI, which had been rarely implicated in invasive infection, emerged as a significant pathogen. A significant trend of increase in incidence was observed for the infection (p<0.0001), with concurrent increase of cases in the elderly and of Serotype Ib and VI. There was significant association with young adults of Type II and III and chronic skin conditions and older adults with Type Ia and V and chronic cardiovascular diseases. Type V was closely associated with skin and soft tissue infection. Recurrent episodes (10%) occurred most often in patients with concomitant malignancy, with an average of 314 days for recurrence. CONCLUSIONS: The incidence of GBS invasive infection among nonpregnant women and adults is rising in northern Taiwan, particularly in the elderly caused by Serotype Ib and VI. Population-based surveillance program should be implanted for assessment of the disease burden to the susceptible adult population.