Characteristics and Treatment of Medical Device Related Infections

Medical device related infections are becoming an increasing prevalent area of infectious disease. They can be attributed to a multitude of factors from an increasing elderly population with reduced immunological status to increasing microbial resistance and evolution. Of greatest significance is the failure of standard antimicrobial regimens to eradicate biomaterial-related infections due to the formation of microbial biofilms consisting of extracellular polymeric substances. Biofilms form and thrive at the abiotic device surface where nutrients are more concentrated and symbiotic colonies can be formed. The formation of a biofilm matrix occurs in a series of steps beginning with reversible attachment of bacteria to the surface of the substrate and terminating in dispersion of mature biofilm microcolonies that aim to colonise fresh surfaces high in nutrients. Mature biofilms can resist 10-1000 times the concentrations of standard antibiotic regimens that are required to kill genetically equivalent planktonic forms. The extent of the infection and the pathogen(s) present can be attributed to both the form and location of the device. It is important that preventative measures and treatment strategies relate to combating the causative microorganisms. Preventative measures include: the use of anti-infective biomaterials that can be coated or incorporated with standard or innovative antimicrobials; modified anti-adhesive medical devices; environmental sterilisation protocols and prophylactic drug therapy. Treatment of established infection may require removal of the device or if deemed possible the device may be salvageable through the initiation of antimicrobial therapy. The increasing spectre of antibiotic resistance and medical device related infections are a large and increasing burden on health care systems and the patient’s quality of life and long term prognosis. As an infectious disease it represents one of the most difficult challenges facing modern science and healthcare.

Challenges of minimizing heat loss at birth: A narrative overview of evidence-based thermal care interventions

Evidence-based thermal care recommendations designed to minimize heat loss immediately at birth are readily available however, hypothermia still persists as a global challenge especially when caring for the most immature and smallest preterm infants. In this narrative overview we aim to provide the reader with a succinct summary of the causes and consequences of hypothermia, the extent of the problem (rates of hypothermia), principles of good thermal care, delivery room preventative measures, the research evidence underpinning existing interventions, current issues in practice, and the way forward. Due to the plethora of research literature available in this subject area, our article will focus primarily on evidence derived from systematic reviews and randomized or quasi-randomized controlled trials assessing the effectiveness of interventions to prevent hypothermia in the most vulnerable (preterm/low birth weight) infants where the intervention or combination of interventions is applied immediately at birth. © 2014.

Conhecimento comum e perceção do risco na gestão territorial costeira

As zonas costeiras, pelas suas características naturais, disponibilizam à sociedade múltiplas oportunidades e serviços, o que favorece uma ocupação desmedida deste território e a ocorrência de transformações relevantes provocadas pela intervenção humana. A simultaneidade da influência das atividades e intervenções humanas e da ocorrência das funções naturais deste território, revestidas de um forte caráter dinâmico, encontra-se na base do desenvolvimento quer de conflitos do tipo socioambiental, quer de situações de risco costeiro. A contribuir para esta situação, surge também a problemática das alterações climáticas, com impactos em domínios diversos, como por exemplo biodiversidade, pesca ou turismo, com um registo de aumento e intensidade de acidentes naturais associados a fenómenos meteorológicos. Apesar da existência de um conjunto de instrumentos de preservação dos recursos naturais e de ordenamento e gestão territorial, a degradação do sistema natural costeiro é muito visível, com impactos negativos de complexa recuperação. Refira-se, também, o caráter de exceção dos planos de ordenamento da orla costeira, em particular em frentes urbanas consolidadas ou em consolidação, permitindo o contínuo aumento da urbanização na orla costeira. A atuação das entidades responsáveis pela gestão do território costeiro tem sido desenvolvida com um baixo nível de envolvimento da população e maioritariamente no sentido de dar resposta às situações de perigo que vão surgindo, com a implementação de estruturas de defesa costeira, suportadas pelo erário público, cujos impactos se traduzem num agravamento do estado da zona costeira portuguesa, em geral. A região de Aveiro é um exemplo da problemática exposta, onde se registam frequentemente episódios de perigo costeiro, considerando-se urgente a tomada de medidas que contribuam para a sustentabilidade deste território, associada a uma visão de longo prazo, e que deverão passar pela integração do risco na gestão territorial costeira. Esta investigação, com a qual se pretende aumentar o conhecimento científico, desenvolver uma abordagem integrada de diversos domínios disciplinares, demonstrar a relevância da valorização do conhecimento comum e da perceção social na gestão do território, bem como desenvolver uma ferramenta de suporte à gestão territorial da zona costeira, tem como propósito contribuir para a preservação do sistema natural costeiro e para o aumento dos níveis de segurança humana face ao risco costeiro. Nesse sentido, desenvolveu-se um estudo de perceção social em aglomerados urbanos costeiros da região de Aveiro, para avaliação da perceção do risco costeiro e da gestão do território e recolha de conhecimento comum sobre a dinâmica costeira. Concebeu-se, também, um sistema de informação geográfica que permite às entidades de gestão do território costeiro uma atuação facilitada, articulada e de caráter preventivo, suportada na integração de conhecimentos científico, técnico e comum, de perceções e aspirações, de limites, propostas e condicionantes de planos de ordenamento e gestão do território existentes, entre outra informação, e com potencialidade para evoluir simultaneamente para um sistema de aviso de acidentes. Como resultados do estudo empírico destacam-se a forte ligação da população ao mar, de caráter afetivo ou pela pretensão de utilização da praia, a desvalorização do risco costeiro, apesar do reconhecimento do recuo da linha de costa, a valorização das estruturas de defesa costeira, a escassa disponibilização de informação à população acerca do risco costeiro a que está exposta, e a importância atribuída à participação da população no processo de gestão territorial costeira. O sistema de informação geográfica foi validado para o caso da Praia de Esmoriz, permitindo identificar, por exemplo, para cada proprietário de habitação localizada em área de risco, a disponibilidade para participar no processo de gestão territorial costeira ou a abertura para aderir a um processo de relocalização da habitação. Face à pertinência do tema e à expectativa do mesmo ser considerado uma prioridade da política da atualidade, considera-se a necessidade de desenvolvimentos futuros de aprofundamento de conhecimentos em paralelo com uma aproximação ao sistema institucional de gestão territorial costeira, no sentido da minimização dos conflitos entre dinâmica costeira e uso do território e da prevenção do risco costeiro, particularmente risco de inundação e de erosão.

Microbiological quality of bivalves: relevance to food safety

Os moluscos bivalves constituem um recurso haliêutico de elevada importância na economia (inter)nacional pelas suas características organolépticas, valor nutritivo e relevância na gastronomia tradicional. Não obstante, representam um produto alimentar de elevado risco para a saúde pública. A contaminação microbiológica (autóctone e antropogénica), sendo crónica nos bancos de bivalves das zonas estuarino-lagunares, constitui uma das principais preocupações associadas à segurança alimentar. Aquando da filtração inerente aos processos de respiração e alimentação, os bivalves bioacumulam passivamente microrganismos incluindo os patogénicos. A sua colocação no mercado impõe pois, prévia salubrização para níveis microbiológicos compatíveis com a legislação em vigor, salvaguardando a saúde pública. Apesar da monitorização das áreas de apanha e produção, das medidas de prevenção e da depuração, a ocorrência de surtos associados ao consumo de bivalves tem aumentado. Tal deve-se à insuficiente monitorização da contaminação microbiológica dos bivalves, contribuindo para uma gestão ineficaz do produto e consequente sub-valorização. O presente trabalho pretendeu caracterizar o estado de desenvolvimento do sector de exploração de bivalves em Portugal do ponto de vista da segurança alimentar, e analisar os aspectos cruciais da monitorização e da depuração do produto apresentando alternativas abrangentes e aplicáveis ao sector. Assim, desenvolveu-se uma metodologia de base molecular passível de adaptação à monitorização dos bivalves das zonas conquícolas, como alternativa ao método de referência vigente do Número Mais Provável que é baseado apenas na quantificação de Escherichia coli. O mexilhão (Mytilus edulis) da Ria de Aveiro, bivalve de interesse comercial a nível (inter)nacional serviu de modelo para a comparação de protocolos de extração de DNA. Esta metodologia foi desenvolvida de modo a que os métodos de extração de DNA sejam passíveis de aplicação a outras matrizes biológicas ou ambientais. Para além da detecção e quantificação directa de bactérias patogénicas, esta metodologia poderá ser aplicada à monitorização da transferência vertical microbiana nos bancos de bivalves bem como à caracterização da dinâmica espacio-temporal das populações microbianas no ambiente e à monitorização dos processos de depuração. Foi ainda abordado o potencial da aplicação de bacteriófagos ou de enzimas líticas para a optimização dos processos de purificação. O trabalho realizado e as perspectivas futuras propostas pretendem contribuir para a dinamização e requalificação do sector de exploração de bivalves através da melhoria do nível de segurança alimentar dos moluscos bivalves comercializados para alimentação humana, valorizando este recurso.

Hardening of concrete with a planned delayed ettringite formation

Delayed ettringite formation (DEF) in cementitious materials is widely considered as a harmful chemical reaction that causes extensive damages in hardened concrete. However, preventative measures and possible improvements in general are not extensively studied and require further attention. In this study was presented an investigation into a type of controlled DEF in places of finely dispersed crystallisation nuclei and provide evidence that the process may improve compressive strength of cementitious materials. The Alkali-Silica Reaction (ASR) in hydrated concrete was achieved with the addition of fly ash and was further accelerated with the Duggan’s test. Achieved strengths and monitoring of microstructure development conducted with electronic microscopy revealed that growth of ettringite crystals in the nuclei led to harmless internal compressive stresses, expansion of hydrated concrete and overall strengthening of the concrete matrix.

Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Background: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. Design: Systematic review with discussion of evidence gaps and future research. Data sources: Published and unpublished studies ( any language) from electronic databases ( inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. Review methods: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. Results: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. Conclusions: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

HIV-related stigma, asset inheritance and chronic poverty: vulnerability and resilience of widows and caregiving children and youth in Tanzania and Uganda

This paper develops a framework of risk and protective factors to conceptualise the relationship between HIV-related stigma, asset inheritance and chronic poverty among widows and caregiving children and youth in eastern Africa. Analysis of two qualitative studies with 85 participants in rural and urban areas of Tanzania and Uganda reveals that gendered and generational inequalities and stigmatisation sometimes led to property grabbing and chronic poverty. Human and social capital and preventative measures however may help widows and caregiving young people in HIV-affected households to safeguard land and other assets, within a wider supportive environment that seeks to tackle structural inequalities.

Evolving nature of fraud investigation and prevention

This thesis is concerned with the evolution of fraud investigation and prevention in light of the advances in computing technology. These recent advances have impacted upon traditional fraud offences as well as creating a range of new crimes. The financial significance of fraud is growing whereas law enforcement and the judicial system appear to be unable to meet the demands of these emerging crimes and its victims. This research compares the responses of our present and future investigators with those of our current business leaders from the government and the commercial sectors. This research establishes the needs of corporate decision-makers and the attitudes of police with regard to fraud. Data relating to persons arrested and convicted of fraud was also analysed to identify the issues that may be responsible for the non-reporting of offences to police by victims. The research found that victims are seeking solutions that are not available through law enforcement, for example financial compensation. Law enforcement also under-utilises the potential of proactive responses to prevent offences and they are reluctant to acknowledge the benefits of preventative measures and to incorporate this strategy within criminal investigation training programmes. The lack of deterrence offered by the judicial system does not make the situation any better. The police function is still primarily a reactive one. In order to overcome fraud and to be able to adapt to changes there needs to be collaboration between stakeholders. This requires a joint effort from the police, government, commerce and the victims of fraud. An innovative model involving stakeholders has been formulated that represents an alternative to the current system. This approach utilises the financial resources and expertise from the commercial sector as well as the skills of criminal investigators from the police. This means adopting a combined package of both reactive and proactive measures in order to minimise the impact of fraud. This model will be adaptive and will be able to accommodate any future requirements arising out of further inevitable advances in computer technology.

Improving the future from the past

This chapter will first briefly outline the definition and impact of corruption amongst the countries and communities alike. Next, it will look at some examples of corruption amongst both public and private sector and some of the measures undertaken by the decision makers to address this issue. Currently there is limited information about steps implemented by the companies and individuals in the private sector and this will be echoed in the chapter. The chapter will conclude by recommending measures that can be adopted by practitioners to alleviate the challenge of corruption.

Osteo-cise : Strong bones for life': protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

Background : Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition.

Methods : The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed.

Discussion : The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291

Avaliação do potencial genotóxico e citotóxico associado a queima artesanal da castanha de caju no Município de João Câmara

The Brazil is the third largest producer of cashew nuts in the world. Despite the social and economic importance of the cashew nut, its production is still carried out artisanally. One of the main problems encountered in the cashew production chain are the conditions under which the roasting of the nut occurs to obtain the kernel from the shell. In the present study was conducted a biomonitoring of the genotoxic and cytotoxicity effects associated with the elements from the cashew nut roasting in João Câmara - RN, semi-arid region of Brazil. To assess the genotoxic was used the bioassay of micronucleus (MN) in Tradescantia pallida. In addition, it was performed a comparative between the Tradescantia pallida and KU-20 and other biomarkers of DNA damage, such as the nucleoplasmic bridges (NBP) and nuclear fragments (NF) were quantified. The levels of particulate matter (PM1.0, PM2.5, PM10) and black carbon (BC) were also measured and the inorganic chemical composition of the PM2.5 collected was determined using X-ray fluorescence spectrometry analysis and the assessment of the cytotoxicity by MTT assay and exclusion method by trypan blue. . For this purpose, were chosen: the Amarelão community where the roasting occurs and the Santa Luzia farm an area without influence of this process. The mean value of PM2.5 (Jan 2124.2 μg/m3; May 1022.2 μg/m3; Sep 1291.9 μg/m3) and BC (Jan 363.6 μg/m3; May 70.0 μg/m3; Sep 69.4 μg/m3) as well as the concentration of the elements Al, Si, P, S, Cl, K, Ca, Ti, Cr, Mn, Fe, Ni, Cu, Zn, Se, Br and Pb obtained at Amarelão was significantly higher than at Santa Luzia farm. The genotoxicity tests with T. pallida indicated a significant increase in the number of MN, NBP and NF and it was found a negative correlation between the frequency of these biomarkers and the rainfall. The concentrations of 200 μg/mL and 400 μg/mL of PM2.5 were cytotoxic to MRC-5 cells. All together, the results indicated genotoxicity and citotoxicity for the community of Amarelão, and the high rates of PM2.5 considered a potential contributor to this effect, mainly by the high presence of transition metals, especially Fe, Ni, Cu, Cr and Zn, these elements have the potential to cause DNA damage. Other nuclear alterations, such as the NPBs and NFs may be used as effective biomarkers of DNA damage in tetrads of Tradescantia pallida. The results of this study enabled the identification of a serious occupational problem. Accordingly, preventative measures and better practices should be adopted to improve both the activity and the quality of life of the population. These measures are of fundamental importance for the sustainable development of this activity.

Tropical dermatology: Venomous arthropods and human skin Part II. Diplopoda, Chilopoda, and Arachnida

Members of arthropod classes Chilopoda (centipedes), Diplopoda (millipedes), and Arachnida (spiders and scorpions) cause tissue injury via bites, stings, and/or a release of toxins. A few members of the Acari subclass of Arachnida (mites and ticks) can transmit a variety of infectious diseases, but this review will cover the noninfectious manifestations of these vectors. Dermatologists should be familiar with the injuries caused by these arthropods in order to initiate proper treatment and recommend effective preventative measures. (J Am Acad Dermatol 2012;67:347.e1-9.)

Staphylococcus Aureus Contamination in a Pediatric Dental Clinic

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Education in primary school as a strategy to control dengue

A proliferação do Aedes aegypti é propiciada pelo habito de permitir a formação de criadouros em vários tipos de recipientes. Uma das formas de controla-lo é a disseminação do conhecimento sobre o vetor, por conduzir a conscientização e a tomada de medidas contra a sua proliferação. Para avaliar um método de ensino sobre o vetor e a dengue, foram comparando alunos de 5ª e 6ª séries antes e após a intervenção didática. Os alunos com intervenção foram mais aptos em reconhecerem as fases do ciclo e tiveram um discernimento maior sobre a importância dos mosquitos para a saúde. Eles também foram mais aptos em reconhecerem quais medidas de controle são mais eficientes e viáveis, repercutindo em suas residências que apresentaram duas vezes menos criadouros em relação aos que não tiveram intervenção.

Cuidadores informais de idosos em pós-operatório de cirurgia de fêmur proximal: prevenção de novas quedas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)