Social anxiety disorder: studies of instrument validation for the Brazilian context

Social anxiety disorder (SAD) is a highly prevalent condition even though its recognition and diagnosis are underestimated by both patients and clinicians. In view of the importance of assessment scales for systematic diagnosis in psychiatry, the objective of this investigation was to present studies of validation for the Brazilian population of three instruments for the assessment of different aspects of SAD. The following psychometric studies were carried out: a) discriminative validity of the Mini Social Phobia Inventory (Mini-SPIN-MS), a reduced instrument for the screening of SAD; b) reliability and discriminative validity of the Brief Social Phobia Scale (BSPS), a hetero-applied instrument for the assessment of different aspects of SAD, and c) discriminative validity of the items and subscales of the Self-Statements during Public Speaking Scale (SSPS), an instrument for the assessment of cognitive aspects related to public speaking. All instruments showed excellent psychometric qualities, especially indicators of discrimination between persons with and without SAD, with diagnostic confirmation by the Structured Clinical Interview for DSM-IV (SCID-IV). It was concluded that this set of instruments, with specificity regarding their objectives, could be of great clinical usefulness, especially for the Brazilian population that, until recently, had no such resources for the measurement and assessment of the different aspects of SAD. New multicenter and intercultural studies may provide further information about cultural influences on SAD.

Organizational Learning in the Context of an Agri-Food Chain

This paper reports on the outcomes of the first stage of a longitudinal study that focused on the transformational change process being undertaken within the Supply Chain and Operations Area of a major Australian food manufacturing company. Organizational learning is an essential prerequisite for any successful change process and an organization's ability to learn is dependent on the existence of an environment within the organization that nurtures learning and the presence of key enablers that facilitate the learning process. An organization's capacity to learn can be enhanced through its ability to form and sustain collaborative relationships with its chain partners. The results show that an environment that supports organizational learning is being developed through consultative leadership and the empowerment of individuals within a culture that supports innovation and cross-functional teamwork but demands responsibility and accountability. The impact of these changes within the Supply Chain and Operations Area is evident in the significant improvement in the Area's productivity and efficiency levels over the past twelve months. The company's endeavours to engage its major supply chain partners in the learning process have been limited by the turmoil within the company. However the company has involved its supply chain partners in a series of mutually beneficial projects that have improved communication and built trust thereby laying the foundations for more collaborative chain relationships.

Determination of temperature variation during the individual steps of the production of hospital diets of modified consistency

Background & aim: Many disease outbreaks of food origin are caused by foods prepared in Food Service and Nutrition Units of hospitals, affecting hospitalized patients who, in most cases, are immunocompromised and therefore at a higher risk of severe worsening of their clinical status. The aim of this study was to determine the variations in temperature and the time-temperature factor of hospital diets. Methods: The time and temperature for the preparation of 4 diets of modified consistency were determined on 5 nonconsecutive days in a hospital Diet and Nutrition Unit at the end of preparation and during the maintenance period, portioning and distribution at 3 sites, i.e., the first, the middle and the last to receive the diets. Results and discussion: All foods reached an adequate temperature at the end of cooking, but temperature varied significantly from the maintenance period to the final distribution, characterizing critical periods for microorganism proliferation. During holding, temperatures that presented a risk were reached by 16.7% of the meats and 59% of the salads of the general diet, by 16.7% of the garnishes in the bland diet and by 20% of the meats and garnishes in the viscous diet. The same occurred at the end of distribution for 100% of the hot samples and of the salads and for 61% of the desserts. None of the preparations remained at risk temperature for a time exceeding that established by law. Conclusion: The exposure to inadequate temperature did not last long enough to pose risks to the patient.

Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

Background: Acute kidney injury (AKI) is a frequent complication in hospitalized patients, especially in those in intensive care units (ICU). The RIFLE classification might be a valid prognostic factor for critically ill cancer patients. The present study aims to evaluate the discriminatory capacity of RIFLE versus other general prognostic scores in predicting hospital mortality in critically ill cancer patients. Methods: This is a single-center study conducted in a cancer-specialized ICU in Brazil. All of the 288 patients hospitalized from May 2006 to June 2008 were included. RIFLE classification, APACHE II, SOFA, and SAPS II scores were calculated and the area under receiver operating characteristic (AROC) curves and logistic multiple regression were performed using hospital mortality as the outcome. Results: AKI, defined by RIFLE criteria, was observed in 156 (54.2%) patients. The distribution of patients with any degree of AKI was: risk, n = 96 (33.3%); injury, n = 30 (10.4%), and failure, n = 30 (10.4%). Mortality was 13.6% for non-AKI patients, 49% for RIFLE `R` patients, 62.3% for RIFLE `I` patients, and 86.8% for RIFLE `F` patients (p = 0.0006). Logistic regression analysis showed that RIFLE criteria, APACHE II, SOFA, and SAPS II were independent factors for mortality in this population. The discrimination of RIFLE was good (AROC 0.801, 95% CI 0.748-0.854) but inferior compared to those of APACHE II (AROC 0.940, 95% CI 0.915-0.966), SOFA (AROC 0.910, 95% CI 0.876-0.943), and SAPS II (AROC 0.869, 95% CI 0.827-0.912). Conclusion: AKI is a frequent complication in ICU patients with cancer. RIFLE was inferior to commonly used prognostic scores for predicting mortality in this cohort of patients. Copyright (C) 2011 S. Karger AG, Basel

Ehrlichia canis in dogs attended in a veterinary hospital from Botucatu, Sao Paulo State, Brazil

This study investigated the etiology of canine ehrlichiosis and possible clinical and epidemiological data associated with the infection in 70 dogs suspect of ehrlichiosis attended at the Veterinary Hospital of the Sao Paulo State University in Botucatu city during 2001 and 2002. Dogs were evaluated by clinical-epidemiological and hematological data and molecular analysis by partial amplification and DNA sequencing of the ehrlichial dsb gene. E. canes DNA was amplified and sequenced in 28 (40.0%) dogs. Dogs younger than 12 months old showed significantly higher infection rates (65.0%; P < 0.05). Diarrhea, apathy, and anorexia were the major clinical signs observed in 55.2% (P = 0.05), 47.0% (P > 0.05), and 42.4% (P > 0.05) of the PCR-positive dogs, respectively. Twenty-five anemic (<5.5 x 10(6) RBC.mu L(-1)), and 8 leukopenic (<5.5 x 10(3) WBC.mu L(-1)) dogs were PCR-positive (P > 0.05). All 28 PCR-positive dogs showed thrombocytopenia (<175 x 10(3) platelets.mu L(-1)) and revealed statistical significance (P < 0.05). E. canis was the only Ehrlichia species found in dogs in the studied region, with higher infection rates in younger dogs, and statistically associated with thrombocytopenia.

Economic theories of the family and discrimination in a social context: Entitlements of Kondh tribal females in India

Economic theories of the family and gender discrimination within the family are examined in the context of Kondh dominated tribal villages in rural western Orissa, India, drawing on results from a survey of 106 wives. The survey involved direct interviews using a structured questionnaire. This article examines the relevance of economic unitary and bargaining theories of the family in this social context, drawing on background literature. Using the survey results, socioeconomic influences on the status of wives within their families are analyzed and the entitlements of female and male children are compared and analyzed. Because of cultural embedding, it is suggested that the relevance of economic theories of the family depend significantly on cultural context. In many cases, it seems that poverty has a negative influence on the social empowerment of females but it is not the only influence nor always a sufficient condition for discrimination against females.

Injury and alcohol: a hospital emergency department study

A pilot survey was undertaken of injury presentations to a public hospital emergency department to determine patterns of alcohol use in this population. Of the 402 injury presentations in the study period, a total of 236 injury cases were interviewed, of whom 45% (n=107) and 29% (n=69) had consumed alcohol 24 and 6 hours prior to injury. Mean age for all injury presentations was 35.1 years, and 32.6 years for alcohol injury cases. For both injury groups, males were significantly younger than females. Recent alcohol ingestion was three times more common among male than female injury presentations, but with females drinking at significantly lower levels. Of males who had consumed alcohol 6 hours prior to injury, nearly 70% were drinking at NHMRC harmful levels and 61% had drunk more than eight standard drinks. Overall, alcohol-involved injury cases commonly occurred among low-income, single males around 30 years of age who were regular heavy drinkers who were drinking heavily in licensed premises prior to their injury, and who sustained injury through intentional harm. In addition, one in five of the alcohol-involved injury cases were aged 15-18 years, i.e. below the legal age of purchase. The high proportion of hazardous and harmful drinkers among those who had consumed alcohol within the last 6 hours, and the injury sample overall, highlights the need for further research to explore the relationship between the occurrence of injury and the drinking patterns and environments associated with injury. Further research is also required to assess the efficacy of early and brief interventions for alcohol and drug use within the emergency ward setting. This information would enable appropriate public health interventions to be initiated.

Memory awareness and schematization: Learning in the university context

Following the application of the remember/know paradigm to student learning by Conway et al. (1997), this study examined changes in learning and memory awareness of university students in a lecture course and a research methods course. The proposed shift from a dominance of 'remember' awareness in early learning to a dominance of 'know' awareness as learning progresses and schematization occurs was evident for the methods course but not for the lecture course. The patterns of remember and know awareness and proposed associated levels of schematization were supported by a separate measure of the quality of student learning using the SOLO (Structure of Observed Learning Outcomes) Taxonomy. As found by previous research, the remember-to-know shift and schematization of knowledge is dependent upon type of course and level of achievement. Findings are discussed in terms of the utility of the methodology used, the theoretical implications and the applications to educational practice. Copyright (C) 2001 John Wiley & Sons, Ltd.

The relationship of a clonal outbreak of Enterococcus faecium vanA to methicillin-resistant Staphylococcus aureus incidence in an Australian hospital

Australian isolates of vancomycin-resistant enterococci (VRE) have been widely scattered geographically, predominantly polyclonal and of the VanB phenotype. Forty-nine VRE were isolated from 47 patients in our hospital from October 1996 to December 1999. Forty-four of these VRE were Enterococcus faecium with a vanA glycopeptide resistance genotype. Four isolates were pathogenic. Thirty-five VRE were from an outbreak in the Renal and Infectious Diseases Units over a four-month period. Pulsed-field gel electrophoresis (PFGE) demonstrated that 41 of the 49 VRE were indistinguishable or closely related. Enhanced environmental cleaning, strict contact isolation of colonized patients and reducing inpatient admissions terminated the epidemic. Cohorting of methicillin-resistant Staphylococcus aureus (MRSA)-positive patients was restricted because VPE patients occupied the isolation facilities. This resulted in a statistically significant increase in MRSA infections across the hospital. VRE epidemics have the ability to influence the epidemiology of other nosocomial pathogens when infection control resources are exhausted. (C) 2001 The Hospital Infection Society.