Importance of the ebp (endocarditis- and biofilm-associated pilus) locus in the pathogenesis of Enterococcus faecalis ascending urinary tract infection.

BACKGROUND: We recently demonstrated that the ubiquitous Enterococcus faecalis ebp (endocarditis- and biofilm-associated pilus) operon is important for biofilm formation and experimental endocarditis. Here, we assess its role in murine urinary tract infection (UTI) by use of wild-type E. faecalis OG1RF and its nonpiliated, ebpA allelic replacement mutant (TX5475). METHODS: OG1RF and TX5475 were administered transurethrally either at an ~1 : 1 ratio (competition assay) or individually (monoinfection). Kidney pairs and urinary bladders were cultured 48 h after infection. These strains were also tested in a peritonitis model. RESULTS: No differences were observed in the peritonitis model. In mixed UTIs, OG1RF significantly outnumbered TX5475 in kidneys (P=.0033) and bladders (P< or =.0001). More OG1RF colony-forming units were also recovered from the kidneys of monoinfected mice at the 4 inocula tested (P=.015 to P=.049), and 50% infective doses of OG1RF for kidneys and bladder (9.1x10(1) and 3.5x10(3) cfu, respectively) were 2-3 log(10) lower than those of TX5475. Increased tropism for the kidney relative to the bladder was observed for both OG1RF and TX5475. CONCLUSION: The ebp locus, part of the core genome of E. faecalis, contributes to infection in an ascending UTI model and is the first such enterococcal locus shown to be important in this site.

Relative contributions of Enterococcus faecalis OG1RF sortase-encoding genes, srtA and bps (srtC), to biofilm formation and a murine model of urinary tract infection.

Deletion mutants of the two sortase genes of Enterococcus faecalis OG1RF were constructed. srtC (renamed here bps for biofilm and pilus-associated sortase) was previously shown to be necessary for the production of Ebp pili and important for biofilm formation and endocarditis. Here, we report that a srtA deletion mutant showed a small (5%) yet significant (P = 0.037) reduction in biofilm relative to OG1RF, while a DeltasrtA Deltabps double mutant showed a much greater reduction (74% versus OG1RF and 44% versus the Deltabps mutant). In a murine urinary tract infection (UTI), the 50% infective doses of both the DeltasrtA Deltabps and Deltabps mutants were approximately 2 log10 greater than that of OG1RF or the DeltasrtA mutant. Similarly, approximately 2 log10 fewer bacteria were recovered from the kidneys after infection with the Deltabps mutant (P = 0.017) and the DeltasrtA Deltabps double mutant (P = 0.022) compared to wild-type strain OG1RF. In a competition UTI, the Deltabps mutant was slightly, but not significantly, less attenuated than the DeltasrtA Deltabps double mutant. Fluorescence-activated cell sorter analysis with Ebp-specific antibodies confirmed that a minority of OG1RF cells express Ebp pili on their surface in vitro and that Bps has a major role in Ebp pilus biogenesis but also indicated a function for SrtA in surface localization of the pilus subunit protein EbpA. In conclusion, deletion of bps had a major effect on virulence in murine UTIs, as well as biofilm; deletion of srtA from OG1RF had little effect on these phenotypes, but its deletion from a bps mutant had a pronounced effect on biofilm, suggesting that Bps and/or the proteins it anchors may compensate for the loss of some SrtA function(s).

Relative contributions of Enterococcus faecalis OG1RF sortase-encoding genes, srtA and bps (srtC), to biofilm formation and a murine model of urinary tract infection.

Deletion mutants of the two sortase genes of Enterococcus faecalis OG1RF were constructed. srtC (renamed here bps for biofilm and pilus-associated sortase) was previously shown to be necessary for the production of Ebp pili and important for biofilm formation and endocarditis. Here, we report that a srtA deletion mutant showed a small (5%) yet significant (P = 0.037) reduction in biofilm relative to OG1RF, while a DeltasrtA Deltabps double mutant showed a much greater reduction (74% versus OG1RF and 44% versus the Deltabps mutant). In a murine urinary tract infection (UTI), the 50% infective doses of both the DeltasrtA Deltabps and Deltabps mutants were approximately 2 log10 greater than that of OG1RF or the DeltasrtA mutant. Similarly, approximately 2 log10 fewer bacteria were recovered from the kidneys after infection with the Deltabps mutant (P = 0.017) and the DeltasrtA Deltabps double mutant (P = 0.022) compared to wild-type strain OG1RF. In a competition UTI, the Deltabps mutant was slightly, but not significantly, less attenuated than the DeltasrtA Deltabps double mutant. Fluorescence-activated cell sorter analysis with Ebp-specific antibodies confirmed that a minority of OG1RF cells express Ebp pili on their surface in vitro and that Bps has a major role in Ebp pilus biogenesis but also indicated a function for SrtA in surface localization of the pilus subunit protein EbpA. In conclusion, deletion of bps had a major effect on virulence in murine UTIs, as well as biofilm; deletion of srtA from OG1RF had little effect on these phenotypes, but its deletion from a bps mutant had a pronounced effect on biofilm, suggesting that Bps and/or the proteins it anchors may compensate for the loss of some SrtA function(s).

Ms. hebr. oct. 13 - Maʾalōt ha-midōt

Vorbesitzer: Aloy. Cipelli

Low correlation between self-report and medical record documentation of urinary tract infection symptoms.

BACKGROUND Correlations between symptom documentation in medical records and patient self-report (SR) vary depending on the condition studied. Patient symptoms are particularly important in urinary tract infection (UTI) diagnosis, and this correlation for UTI symptoms is currently unknown. METHODS This is a cross-sectional survey study in hospitalized patients with Escherichia coli bacteriuria. Patients were interviewed within 24 hours of diagnosis for the SR of UTI symptoms. We reviewed medical records for UTI symptoms documented by admitting or treating inpatient physicians (IPs), nurses (RNs), and emergency physicians (EPs). The level of agreement between groups was assessed using Cohen κ coefficient. RESULTS Out of 43 patients, 34 (79%) self-reported at least 1 of 6 primary symptoms. The most common self-reported symptoms were urinary frequency (53.5%); retention (41.9%); flank pain, suprapubic pain, and fatigue (37.2% each); and dysuria (30.2%). Correlation between SR and medical record documentation was slight to fair (κ, 0.06-0.4 between SR and IPs and 0.09-0.5 between SR and EDs). Positive agreement was highest for dysuria and frequency. CONCLUSION Correlation between self-reported UTI symptoms and health care providers' documentation was low to fair. Because medical records are a vital source of information for clinicians and researchers and symptom assessment and documentation are vital in distinguishing UTI from asymptomatic bacteriuria, efforts must be made to improve documentation.

Deployed military women: A second look at gender-specific infections

This descriptive, cross-sectional study addressed the relationship between variables of deployed military women and prevalence of gender-specific infections. The analysis of secondary data will look at the last deployment experience of 880 randomly selected U.S. military women who completed a mailed questionnaire (Deployed Female Health Practice Questionnaire (FHPQ)) in June 1998. The questionnaire contained 191 items with 80 data elements and one page for the subject's written comments. The broad categories of the questionnaire included: health practices, health promotion, disease prevention and treatment, reproduction, lifestyle management, military characteristics and demographics. The research questions are: (1) What is the prevalence of sexually transmitted diseases (STD), urinary tract infections (UTI) and vaginal infections (VI) related to demographic data, military characteristics, behavioral risk factors and health practices of military women during their last deployment? and (2) What are the differences between STD, UTI and VI related to the demographic data, military characteristics, behavioral risk factors and health practices of military women during their last deployment. The results showed that (1) STDs were found to be significantly associated with age and rank but not location of deployment or military branch; (2) UTI were found to be significantly associated with intrauterine device (IUD) use, prior UTI and type of items used for menses management, but not education or age; and (3) VI were significantly associated with age, rank and deployment location but not ethnicity or education. Although quantitative research exploring hygiene needs of deployed women continues, qualitative studies may uncover further “hidden” issues of importance. It cannot be said that the military has not made proactive changes for women, however, continued efforts to hone these changes are still encouraged. Mandatory debriefings of “seasoned” deployed women soldiers and their experiences would benefit leadership and newly deployed female soldiers with valuable “lessons learned.” Tailored hygiene education material, prevention education classes, easy access website with self-care algorithms, pre-deployment physicals, revision of military protocols for health care providers related to screening, diagnosing and treatment of gender-specific infections and process changes in military supply network of hygiene items for women are offered as recommendations. ^

Nosocomial infections and their relationship to non-traditional risk factors in a medical intensive care unit

Background. Nosocomial infections are a source of concern for many hospitals in the United States and worldwide. These infections are associated with increased morbidity, mortality and hospital costs. Nosocomial infections occur in ICUs at a rate which is five times greater than those in general wards. Understanding the reasons for the higher rates can ultimately help reduce these infections. The literature has been weak in documenting a direct relationship between nosocomial infections and non-traditional risk factors, such as unit staffing or patient acuity.^ Objective. To examine the relationship, if any, between nosocomial infections and non-traditional risk factors. The potential non-traditional risk factors we studied were the patient acuity (which comprised of the mortality and illness rating of the patient), patient days for patients hospitalized in the ICU, and the patient to nurse ratio.^ Method. We conducted a secondary data analysis on patients hospitalized in the Medical Intensive Care Unit (MICU) of the Memorial Hermann- Texas Medical Center in Houston during the months of March 2008- May 2009. The average monthly values for the patient acuity (mortality and illness Diagnostic Related Group (DRG) scores), patient days for patients hospitalized in the ICU and average patient to nurse ratio were calculated during this time period. Active surveillance of Bloodstream Infections (BSIs), Urinary Tract Infections (UTIs) and Ventilator Associated Pneumonias (VAPs) was performed by Infection Control practitioners, who visited the MICU and performed a personal infection record for each patient. Spearman's rank correlation was performed to determine the relationship between these nosocomial infections and the non-traditional risk factors.^ Results. We found weak negative correlations between BSIs and two measures (illness and mortality DRG). We also found a weak negative correlation between UTI and unit staffing (patient to nurse ratio). The strongest positive correlation was found between illness DRG and mortality DRG, validating our methodology.^ Conclusion. From this analysis, we were able to infer that non-traditional risk factors do not appear to play a significant role in transmission of infection in the units we evaluated.^

Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética

Objetivo: Comunicar un caso de cetoacidosis inducida por corticoides y gatifloxacina y discutir los mecanismos de esta inusual y seria complicación. Caso clínico: Mujer de 32 años, ingresa por neumonía adquirida en la comunidad de 5 días de evolución. Antecedentes: AR probable diagnosticada 4 meses antes tratada con metotrexate y corticoides intermitente. Examen físico: regular estado general, IMC 21, Tº 38ºC, FR 32/min, derrame pleural derecho, FC 96/min, PA 110/70, artralgias sin artritis. Exámenes complementarios: Hto 23%, GB 16300/mm3, VSG 96mm/1ºh, glucemia 0.90mg/dl, función hepática y amilasa normales, uremia 1.19g/l, creatinina 19mg/l. Hemocultivos (2) y esputo positivos para Neumococo penicilina-sensible. La neumonía responde a gatifloxacina. Deteriora la función renal hasta la anuria con acidosis metabólica. Se interpreta como glomerulonefritis lúpica rápidamente progresiva por proteinuria de 2g/24hs, FR (+) 1/1280, FAN (+) 1/320 homogéneo, Anti ADN (+) , complemento bajo: C3 29.4mg/dl y C4 10mg/dl, Ac anti Ro, La, Scl70, RNP y anticardiolipinas positivos. Se indica metilprednisolona EV (3 bolos 1g), complicándose con hiperglucemias de >6 g/l y cetoacidosis con cetonuria (+); Ac anti ICA y antiGAD negativos con HbA1C 5.2%. Es tratada en UTI (insulina y hemodiálisis). La paciente mejora, se desciende la dosis de corticoides, con normalización de la glucemia sin tratamiento hipoglucemiante. Comentarios 1) La presencia de HbA1C nomal, Ac anti ICA y GAD negativos permite descartar con razonable grado de certeza una diabetes tipo1 asociada al lupus. 2) El desarrollo de la cetoacidosis durante el tratamiento con corticoides y gatifloxacina y su resolución posterior avalan el rol etiológico de los mismos. 3) La cetoacidosis puede explicarse por estimulación de la gluconeogénesis y la insulinoresistencia a nivel de receptor y post-receptor generada por los fármacos potenciado por el estado inflamatorio relacionado con el lupus y la sepsis.

Esclerosis múltiple. : nuestra experiencia

Objetivos: analizar la experiencia obtenida y evaluar los resultados urodinámicos del estudio de 18 pacientes con esclerosis múltiple. Material y Métodos: se estudiaron 18 casos, valorándose la historia clínica, ecografía vesical y renal, analizándolos urodinámicamente con uroflujometría, residuo post miccional (RPM), cistotonometría y electromiografía esfinteriana. Urocultivo y antibiograma de orina. Resultados: del análisis de todas las variables se desprende que la vejiga hiperactiva se presentó en 10 casos con un predominio del síndrome frecuencia-urgencia, vejiga hipotónica-hiporrefléxica en 5 pacientes, disinergia detrusor-esfínter en 4 casos y 9 pacientes con infección urinaria que desencadenaban crisis de espasticidad. Todos fueron tratados con anticolinérgicos de acción vesical inmuno-modulación (brotes-recaídas) e inmuno-supresión en la enfermedad progresiva, de rehabilitación y terapia de apoyo psicológico. Conclusión: la vejiga hiperactiva es el tipo de consecuencia urinaria de la esclerosis en placa con los síntomas de frecuencia-urgencia y que, con tratamiento multimodal mejoran en un alto porcentaje.

Frecuencia de resangrado en los primeros veintiún días luego de ruptura de aneurisma cerebral no sometido a tratamiento quirúrgico

Objetivo: Determinar la frecuencia de resangrado en los primeros 21 días como complicación de una ruptura de aneurisma cerebral. Diseño: Estudio descriptivo, retrospectivo Materiales y método: Se analizó una muestra pacientes obtenida de la base de datos de Unidad de Terapia Intensiva (UTI) del Hospital Central que habían sufrido una hemorragia subaracnoidea (HSA) por ruptura de aneurisma cerebral en el período comprendido entre junio de 2006 a enero de 2010. Se identificó el número de pacientes que sufrieron un resangrado como complicación del evento no sometido a tratamiento quirúrgico durante los 21 días posteriores al mismo. Resultados: Se analizó una muestra de 81 pacientes, 44 mujeres (54%) y 37 hombres (46%), edad media de 51 años (DS+/-14). Se registraron 6 resangrados (7,4%) en los 44 meses de seguimiento. El 50% de los resangrados (3 pacientes) acontecieron durante las primeras 24 horas. El 50% (3 pacientes) ocurrieron en mujeres. La edad media en la que apareció la complicación fue 52 años (DS+/-14). Conclusión: La frecuencia de resangrado luego de una ruptura de aneurisma es del 7,4%, con un pico de aparición en las primeras 24 horas.

Estrés laboral en el personal de enfermería de alto riesgo

El estrés es una de las manifestaciones más características de la vida moderna y una de las causas principales de agotamiento del organismo. Sin importar la edad, el sexo o la profesión, influye provocando diferentes trastornos. El estrés es una respuesta adaptativa en la cual el cuerpo de la persona se prepara y ajusta ante una situación amenazante. Nos es grato presentar nuestra Tesis de Ciclo de Licenciatura en Enfermería de la Universidad Nacional de Cuyo realizado en el hospital pediátrico "Dr. Humberto Notti" ubicado en el departamento de Guaymallén de la provincia de Mendoza año 2012. El tema investigado fue "Estrés laboral en el personal de enfermería de alto riesgo" que comprende el servicio de: "Unidad de Terapia intensiva Pediátrica". El presente trabajo de investigación pretende determinar si los enfermeros del servicio de alto riesgo (UTI) manifiestan estrés laboral y cuáles son los factores que lo favorecen para así poder aportar datos que sirvan de base para promover la salud ocupacional.

Efecto sobre el rendimiento productivo y calidad de la canal de la inclusión de guisantes (Pisum sativum) y alberjón (Vicia narbonensis) en el pienso de lechones y cerdos de cebo

Las leguminosas grano presentan un perfil nutricional de gran interés para alimentación de ganado porcino, debido principalmente a su elevado contenido proteico. Sin embargo, la presencia de factores antinutritivos (FAN), que según el género difieren en calidad y cantidad, condiciona la absorción de la proteína, el nutriente más valorado. El objetivo de esta Tesis Doctoral ha sido el estudio del efecto de los principales FAN de guisante y alberjón sobre el rendimiento productivo, de canal y de piezas nobles, cuando sustituyen a la soja, parcial o totalmente, durante la fase estárter y el periodo de engorde de cerdos grasos. Con este motivo se llevaron a cabo 4 ensayos con machos castrados y la misma línea genética: híbrido Duroc x (Landrace x Large white). En el ensayo 1, se estudió la influencia de distintos niveles de inhibidores de proteasas (IP) en el pienso sobre la productividad de lechones durante la fase estárter (40 a 61 días de edad). Para ello, se utilizaron tres variedades de guisantes de invierno que contenían diferentes cantidades de IP, tanto de tripsina (IT) como de quimotripsina (IQ) [unidades de tripsina inhibida/mg (UTI), unidades de quimotripsina inhibida/mg (UQI): 9,87- 10,16, 5,75-8,62 y 12,55-15,75, para guisantes Cartouche, Iceberg y Luna, respectivamente] más elevadas que en la harina de soja 47 (HnaS) y en la soja extrusionada (SE) (UTI/mg - UQI/mg: 0,61-3,56 y 2,36-4,65, para HnaS y SE, respectivamente). El diseño experimental fue al azar, con cuatro tratamientos dietéticos que diferían en las fuentes proteicas y en la cantidad de IP, enfrentando un pienso control de soja a otros tres piensos con guisantes de invierno de las variedades indicadas, que sustituían parcialmente a la soja. Cada tratamiento se replicó cuatro veces, siendo la celda con 6 lechones la unidad experimental. Los animales que consumieron el pienso con guisante Cartouche tuvieron más ganancia media diaria (GMD) que el resto (P < 0,001) con el mismo consumo medio diario (CMD) e índice de conversión (IC). No hubo diferencias significativas entre los animales del pienso control y los que consumieron piensos con guisantes Iceberg y Luna. En el ensayo 2 la leguminosa objeto de estudio fue el alberjón y su FAN el dipéptido _Glutamyl-S-Ethenyl-Cysteine (GEC). El diseño y el periodo experimental fueron los mismos que en el ensayo 1, con cuatro dietas que variaban en el porcentaje de alberjones: 0%, 5%, 15% y 25%, y de GEC (1,54% del grano). Los lechones que consumieron el pienso con 5% tuvieron un CMD y GMD más elevado (P < 0,001), con el mismo IC que los animales pertenecientes al tratamiento 0%. Los índices productivos empeoraron significativamente y de manera progresiva al aumentar el porcentaje de alberjones (15 y 25%). Se obtuvieron ecuaciones de regresión con estructura polinomial que fueron significativas tanto para el nivel de alberjón como para la cantidad de GEC presente en el pienso. El ensayo 3 se efectuó durante el periodo de engorde, sustituyendo por completo la soja a partir de los 84 días de edad con las tres variedades de guisantes de invierno, observando el efecto sobre el rendimiento productivo, de canal y piezas nobles. El diseño, en bloques completos al azar, tuvo cuatro tratamientos según el guisante presente en el pienso y, por lo tanto, los niveles de IP: Control-soja, Cartouche, Iceberg y Luna, con 12 réplicas de 4 cerdos por tratamiento. De 84 a 108 días de edad los animales que consumieron los piensos Control-soja e Iceberg, tuvieron el mismo CMD y GMD, empeorando en los cerdos alimentados con Luna y Cartouche (P < 0,05). El IC fue igual en los tratamientos Control-soja e Iceberg, ocupando una posición intermedia en Cartouche y peor en los cerdos del pienso Luna (P < 0,001). De 109 a 127 días de edad la GMD y el IC fueron iguales, con un CMD más elevado en Control-soja e Iceberg que en los cerdos que consumieron Cartouche y Luna (P < 0,05). No hubo diferencias significativas durante el acabado (128 a 167 días de edad). Globalmente el CMD y GMD fueron más elevados en los cerdos que comieron los piensos Iceberg y Control-soja, empeorando por igual en los que comieron Cartouche y Luna (P < 0,05); el IC fue el mismo en todos los tratamientos. No se observaron diferencias en los datos relacionados con peso y rendimiento de canal y piezas nobles (jamón, paleta y chuletero), ni del contenido de grasa intramuscular en el lomo y proporción de ácidos grasos principales (C16:0, C18:0, C18:1n-9) en la grasa subcutánea. En el ensayo 4, realizado durante el periodo de engorde (60 a 171 días de edad), se valoró el efecto de dietas con distintos niveles de alberjones, y en consecuencia de su factor antinutritivo el dipéptido GEC, sobre el rendimiento productivo y la calidad de la canal y piezas nobles. El diseño fue en cuatro bloques completos al azar, con cuatro tratamientos según el porcentaje de inclusión de alberjón en el pienso: 0%, 5%, 15% y 25%, con 12 réplicas por tratamiento y cuatro cerdos en cada una de ellas. El tratamiento con 5% mejoró la GMD al final de la fase de cebo (152 días de vida) y, junto con el 0%, presentaron los resultados más favorables de peso e IC al final del ensayo (171 días de vida). Del mismo modo, el peso y rendimiento de canal fueron más elevados en los cerdos alimentados con los tratamientos 0% y 5% (P < 0,001). Piensos con el 15 y 25% de alberjones empeoraron los resultados productivos, así como el rendimiento y peso de canal. Sucedió lo mismo con el peso de las piezas nobles (jamón, paleta y chuletero), significativamente superior en 0% y 5% frente a 15% y 25%, siendo los cerdos que consumieron este último pienso los peores. Por el contrario el rendimiento de jamón y chuletero fue más elevado en los cerdos de los tratamientos 25% y 15% que en los que consumieron los piensos con 5% y 0% (P < 0,001); en el rendimiento de paletas se invirtieron los resultados, siendo mayores en los animales de los tratamientos 0% y 5% (P < 0,001). Se obtuvieron ecuaciones de regresión polinomial, para estimar las cantidades de inclusión de alberjones y de GEC más favorables desde el punto de vista productivo, así como los contrastes ortogonales entre los distintos tratamientos. ABSTRACT The grain legumes have a nutritional profile of great interest to feed pigs, mainly due to high protein content. However, the presence of antinutritional factors (ANF), which differ in quality and quantity according to gender, hinder the absorption of the protein, the most valuable nutrient. The aim of this thesis was to study the effect of the main ANF of pea and narbon vetch (NV) on productive performance, of the carcass and main lean cuts, when replacing soybean, partially or totally, during the starter phase and the fattening period of heavy pigs. For this reason were carried four trials with barrows and the same genetic line: Duroc hybrid x (Landrace x Large white). In trial 1, was studied the influence of different levels of protease inhibitors (PI) in the diet over productivity of piglets during the starter phase (40-61 days of age). For this, were used three varieties of winter peas containing different amounts of PI, both trypsin (TI) and chymotrypsin (CI) [inhibited units/mg trypsin (TIU), inhibited units/mg chymotrypsin (CIU): 9.87 - 10.16, 5.75 - 8.62 and 12.55 - 15.75, for peas Cartouche, Iceberg and Luna, respectively] higher than in soybean meal 47 (SBM) and soybeans extruded (SBE) (TIU/mg - CIU/mg: 0.61 - 3.56 and 2.36 - 4.65 for SBM and SBE, respectively). The design was randomized with four dietary treatments differing in protein sources and the amount of PI, with a control diet of soybean and three with different varieties of winter peas: Cartouche, Iceberg and Luna, which partially replace soybean. Each treatment was replicated four times, being the pen with 6 piglets the experimental unit. Pigs that ate the feed with pea Cartouche had better growth (ADG) than the rest (P < 0.001), with the same average daily feed intake (ADFI) and feed conversion ratio (FCR). There were no significant differences between piglets fed with control diet and those fed Iceberg and Luna diets. In trial 2 the legume under study was the NV and your ANF the dipeptide _Glutamyl FAN-S-Ethenyl-Cysteine (GEC). The experimental period and the design were the same as in trial 1, with four diets with different percentage of NV: 0%, 5%, 15% and 25%, and from GEC (1.52% of the grain). The piglets that consumed the feed containing 5% had higher ADG and ADFI (P < 0.05), with the same FCR that pigs belonging to the 0% treatment. Production rates worsened progressively with increasing percentage of NV (15 and 25%). Were obtained regression equations with polynomial structure that were significant for NV percentage and amount of GEC present in the feed. The test 3 was carried out during the fattening period, completely replace soy from 84 days of age with three varieties of winter peas, observing the effect on the yield, carcass and main lean cuts. The design, randomized complete blocks, had four treatments with different levels of PI: Control-soy, Cartouche, Iceberg and Luna, with 12 replicates of 4 pigs per treatment. From 84 to 108 days of age the pigs fed with Control-soy and Iceberg feed, had the same ADFI and ADG, worsening in pigs fed with Luna and Cartouche (P < 0.05). The FCR was similar in diets Control-soy and Iceberg, occupying an intermediate position in Cartouche and worse in pigs fed with Luna (P < 0.001). From 109-127 days of age the ADG and FCR were equal, with higher ADFI in pigs fed with Control-soy and Iceberg, regarding pigs fed with Cartouche and Luna (P < 0.05). There was no difference in the finishing phase (128-167 days of age). In global period, the ADFI and ADG were higher in pigs that ate Control-soy and Iceberg, and worse in those who ate Cartouche and Luna. The FCR was the same in all treatments. No significant differences were observed in the data related to weight and carcass yield, main lean cuts (ham, shoulder and loin chop) and intramuscular fat loin content and major fatty acids proportion (C16:0, C18:0, C18:1n-9) of subcutaneous fat. In experiment 4, made during the fattening period (60-171 days of age), was assessed the effect of diets with different levels of NV, and consequently of GEC, in the performance and quality of carcass and main lean cuts. There was a completely randomized design with four dietary treatments differing in percentage of NV: 0%, 5%, 15% and 25%, with 12 replicates per treatment and four pigs each. Treatment with 5% improved the ADG at the end of the fattening phase (152 days of age) and, together with 0%, showed the most favorable body weight and FCR at the end of the trial (171 days of age). Similarly, the weight and performance of carcass were higher for pigs fed with diets 0% and 5% (P < 0.05). Diets with 15 and 25% worsened the productive and carcass results. The weight of the main lean cuts (ham, shoulder and loin chop) was significantly higher in 0% and 5% vs 15% and 25%.The diet 25% was the worst of all. By contrast the performance of ham and loin chop was higher in pigs fed with diets 25% and 15%, that those who ate diets with 5% and 0% (P < 0.001); the results of shoulder performance were reversed, being greater in pigs feed with diets 0% and 5% (P < 0.001). Polynomial regression equations were obtained to estimate the percentage of NV and GEC more favorable from the point of view of production, and orthogonal contrasts between treatments.

A IMPORTÂNCIA DA FAMÍLIA NA RECUPERAÇÃO DE PACIENTES INTERNADOS NA UNIDADE DE TERAPIA INTENSIVA

A Unidade de Terapia Intensiva (UTI) é um setor do hospital destinado ao atendimento de pacientes em estado crítico, que requer cuidados complexos e controles rígidos e, por isso sempre gera um ambiente estressante, não só para a equipe que atende ao paciente mas também aos familiares e portanto induz muitas vezes ao processo de depressão. Estes fatores leva-nos a abordar a necessidade de humanização, no atendimento ao paciente, bem como de seus familiares. A preocupação com a humanização deve estar presente nas equipes de enfermagem como filosofia-diretriz e deve ser um indicador de qualidades desses serviços. Humanizar a UTI significa cuidar do paciente como um todo, englobando o contexto bio-psico-social, incorporando os valores sociais e da família, as esperanças, os culturais e as preocupações pessoais. A humanização deve fazer parte da filosofia da enfermagem. O ambiente físico, os recursos materiais e tecnológicos são importantes, porém não mais significativos do que a natureza humana. O pensamento em ações da equipe de enfermagem, alimentam a reflexão crítica e a construção de uma realidade mais humana e menos agressiva e hostil para as pessoas que diariamente convivem no hospital. A hospitalização altera a rotina não só do paciente mas também dos familiares. De certa forma, a própria hospitalização pode ser vivida como abandono ou morte, à medida que implica um afastamento das pessoas queridas, da casa, como também uma invasão de privacidade. Este trabalho procurou Identificar as necessidades dos familiares ou visitantes, frente à equipe de saúde durante o período de internação na UTI e avaliar o grau de satisfação em relação à qualidade das informações e ao suporte dados à família ou visitante. Os resultados indicam que no Hospital Heliópolis, onde o trabalho foi conduzido, os entrevistados estavam satisfeitos com a equipe multiprofissional pois os pacientes eram bem cuidados, havendo preocupação com os pacientes, e que os médicos, além de compreensivos e competentes, forneceram as informações de modo que eles pudessem compreender,. Porém deve-se ressaltar que 48% dos entrevistados apontam a necessidade de apoio psicológico.(AU)

A IMPORTÂNCIA DA FAMÍLIA NA RECUPERAÇÃO DE PACIENTES INTERNADOS NA UNIDADE DE TERAPIA INTENSIVA

A Unidade de Terapia Intensiva (UTI) é um setor do hospital destinado ao atendimento de pacientes em estado crítico, que requer cuidados complexos e controles rígidos e, por isso sempre gera um ambiente estressante, não só para a equipe que atende ao paciente mas também aos familiares e portanto induz muitas vezes ao processo de depressão. Estes fatores leva-nos a abordar a necessidade de humanização, no atendimento ao paciente, bem como de seus familiares. A preocupação com a humanização deve estar presente nas equipes de enfermagem como filosofia-diretriz e deve ser um indicador de qualidades desses serviços. Humanizar a UTI significa cuidar do paciente como um todo, englobando o contexto bio-psico-social, incorporando os valores sociais e da família, as esperanças, os culturais e as preocupações pessoais. A humanização deve fazer parte da filosofia da enfermagem. O ambiente físico, os recursos materiais e tecnológicos são importantes, porém não mais significativos do que a natureza humana. O pensamento em ações da equipe de enfermagem, alimentam a reflexão crítica e a construção de uma realidade mais humana e menos agressiva e hostil para as pessoas que diariamente convivem no hospital. A hospitalização altera a rotina não só do paciente mas também dos familiares. De certa forma, a própria hospitalização pode ser vivida como abandono ou morte, à medida que implica um afastamento das pessoas queridas, da casa, como também uma invasão de privacidade. Este trabalho procurou Identificar as necessidades dos familiares ou visitantes, frente à equipe de saúde durante o período de internação na UTI e avaliar o grau de satisfação em relação à qualidade das informações e ao suporte dados à família ou visitante. Os resultados indicam que no Hospital Heliópolis, onde o trabalho foi conduzido, os entrevistados estavam satisfeitos com a equipe multiprofissional pois os pacientes eram bem cuidados, havendo preocupação com os pacientes, e que os médicos, além de compreensivos e competentes, forneceram as informações de modo que eles pudessem compreender,. Porém deve-se ressaltar que 48% dos entrevistados apontam a necessidade de apoio psicológico.(AU)

CLIMA ORGANIZACIONAL E BURNOUT: UM ESTUDO COM SERVIDORES PÚBLICOS FEDERAIS

As condições inadequadas vivenciadas nas organizações afligem não só os trabalhadores da iniciativa privada, pois são igualmente encontradas no segmento estatal, contrariando a expectativa de que o aparato governamental eliminaria as condições insalubres e criaria outras melhores nas quais prevalecesse à promoção de saúde. Diante desse panorama questionou-se porque, uma vez que, pelo menos do ponto de vista da sociedade leiga, esses servidores estão submetidos a condições privilegiadas de trabalho. O presente estudo objetivou identificar e descrever possíveis relações entre o clima organizacional e o burnout em servidores públicos de uma instituição federal de ensino. Objetivou-se ainda descrever o clima organizacional predominante. A pesquisa realizada teve cunho quantitativo, tipo estudo de caso e exploratória. A coleta de dados deu-se por meio das escalas ECO (escala de clima organizacional), ECB (escala de caracterização do burnout) e um questionário sociodemográfico, todos os instrumentos autoaplicáveis eletronicamente disponíveis à instituição. Participaram do estudo 201 servidores públicos federais, com idade média de 37 anos, majoritariamente de nível superior e casados. Os resultados revelaram que cerca de um quarto dos participantes raramente experimentaram burnout, no entanto outra quarta parte deles frequentemente experimentaram altos níveis de burnout, resultado bastante expressivo. Os servidores perceberam clima organizacional mediano, destacando-se a boa coesão entre os colegas de trabalho e a percepção de baixa recompensa. Merece destaque a grande dispersão entre as percepções de clima, o que permite inferir haver subclimas não identificados nesta investigação, possivelmente ocasionados por uma força de clima fraca e pela participação dos servidores de unidades de ensino geograficamente distintas, geridas por gestores locais com relativa autonomia. Os resultados dos cálculos de correlação revelaram que, quanto menos os participantes percebem apoio da chefia e da organização, coesão entre colegas, e mais controle/pressão, mais exaustos se sentem, mais desumanizam as pessoas com quem tratam e mais se decepcionam no trabalho e vice-versa. Conforto físico menor está associado a maior desumanização e a mais decepção no trabalho e vice-versa; e que controle/pressão, relaciona-se positiva e fracamente com desumanização e vice-versa. Desta forma, a hipótese de que existe associação entre burnout e clima organizacional foi confirmada. Os resultados também revelaram que os servidores com burnout, perceberam pior clima organizacional que os seus pares sem burnout, confirmando a segunda hipótese. Esses servidores também se mostraram neutros quanto à percepção de apoio da chefia e conforto físico; não percebem controle pressão, nem recompensa; todavia percebem coesão entre os colegas. Esses resultados sugerem que os participantes têm se apoiado nessas relações para suportar a indiferença e ausência de estímulos experimentados no trabalho. Os resultados obtidos nesse estudo permitiram concluir que o clima organizacional é fraco, provavelmente influenciado por uma cultura organizacional fraca, explicando a heterogeneidade da percepção do clima organizacional pelos servidores. Além disso, embora haja burnout entre poucos participantes, há que se atentar que cerca de um quarto deles, encontra-se acometido desta síndrome e isto poderá contagiar os demais.