RESUMO
Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries.
RESUMO
Peroxiredoxins (Prx) are enzymes that efficiently reduce hydroperoxides through active participation of cysteine residues (CP, CR). The first step in catalysis, the reduction of peroxide substrate, is fast, 107 - 108â¯M-1s-1 for human Prx2. In addition, the high intracellular concentration of Prx positions them not only as good antioxidants but also as central players in redox signaling pathways. These biological functions can be affected by post-translational modifications that could alter the peroxidase activity and/or interaction with other proteins. In particular, inactivation by hyperoxidation of CP, which occurs when a second molecule of peroxide reacts with the CP in the sulfenic acid form, modulates their participation in redox signaling pathways. The higher sensitivity to hyperoxidation of some Prx has been related to the presence of structural motifs that disfavor disulfide formation at the active site, making the CP sulfenic acid more available for hyperoxidation or interaction with a redox protein target. We previously reported that treatment of human Prx2 with peroxynitrite results in tyrosine nitration, a post-translational modification on non-catalytic residues, yielding a more active peroxidase with higher resistance to hyperoxidation. In this work, studies on various mutants of hPrx2 confirm that the presence of the tyrosyl side-chain of Y193, belonging to the C-terminal YF motif of eukaryotic Prx, is necessary to observe the increase in Prx2 resistance to hyperoxidation. Moreover, our results underline the critical role of this structural motif on the rate of disulfide formation that determines the differential participation of Prx in redox signaling pathways.
Assuntos
Oxirredução , Peroxirredoxinas/genética , Processamento de Proteína Pós-Traducional/genética , Tirosina/genética , Domínio Catalítico/genética , Cisteína/genética , Dissulfetos/química , Humanos , Mutação/genética , Nitratos/metabolismo , Peroxidase/genética , Peróxidos/metabolismo , Peroxirredoxinas/efeitos dos fármacos , Peroxirredoxinas/metabolismo , Ácido Peroxinitroso/farmacologia , Transdução de Sinais/efeitos dos fármacosRESUMO
STUDY OBJECTIVES: Work-family conflict is a threat to healthy sleep behaviors among employees. This study aimed to examine how Work-to-Family Conflict (demands from work that interfere with one's family/personal life; WTFC) and Family-to-Work Conflict (demands from family/personal life that interfere with work; FTWC) are associated with several dimensions of sleep among information technology workers. METHODS: Employees at a U.S. IT firm (n = 799) provided self-reports of sleep sufficiency (feeling rested upon waking), sleep quality, and sleep maintenance insomnia symptoms (waking up in the middle of the night or early morning) in the last month. They also provided a week of actigraphy for nighttime sleep duration, napping, sleep timing, and a novel sleep inconsistency measure. Analyses adjusted for work conditions (job demands, decision authority, schedule control, and family-supportive supervisor behavior), and household and sociodemographic characteristics. RESULTS: Employees who experienced higher WTFC reported less sleep sufficiency, poorer sleep quality, and more insomnia symptoms. Higher WTFC also predicted shorter nighttime sleep duration, greater likelihood of napping, and longer nap duration. Furthermore, higher WTFC was linked to greater inconsistency of nighttime sleep duration and sleep clock times, whereas higher FTWC was associated with more rigidity of sleep timing mostly driven by wake time. CONCLUSIONS: Results highlight the unique associations of WTFC/FTWC with employee sleep independent of other work conditions and household and sociodemographic characteristics. Our novel methodological approach demonstrates differential associations of WTFC and FTWC with inconsistency of sleep timing. Given the strong associations between WTFC and poor sleep, future research should focus on reducing WTFC.
Assuntos
Conflito Familiar/psicologia , Saúde Ocupacional , Distúrbios do Início e da Manutenção do Sono/psicologia , Sono/fisiologia , Carga de Trabalho/psicologia , Actigrafia/métodos , Adulto , Estudos Transversais , Características da Família , Relações Familiares/psicologia , Feminino , Humanos , Informática , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Fatores de TempoRESUMO
Peroxiredoxins are cys-based peroxidases that function in peroxide detoxification and H2O2-induced signaling. Human Prx2 is a typical 2-Cys Prx arranged as pentamers of head-to-tail homodimers. During the catalytic mechanism, the active-site cysteine (CP) cycles between reduced, sulfenic and disulfide state involving conformational as well as oligomeric changes. Several post-translational modifications were shown to affect Prx activity, in particular CP overoxidation which leads to inactivation. We have recently reported that nitration of Prx2, a post-translational modification on non-catalytic tyrosines, unexpectedly increases its peroxidase activity and resistance to overoxidation. To elucidate the cross-talk between this post-translational modification and the enzyme catalysis, we investigated the structural changes of Prx2 after nitration. Analytical ultracentrifugation, UV absorption, circular dichroism, steady-state and time-resolved fluorescence were used to connect catalytically relevant redox changes with tyrosine nitration. Our results show that the reduced nitrated Prx2 structurally resembles the disulfide-oxidized native form of the enzyme favoring a locally unfolded conformation that facilitates disulfide formation. These results provide structural basis for the kinetic analysis previously reported, the observed increase in activity and the resistance to overoxidation of the peroxynitrite-treated enzyme.
Assuntos
Dissulfetos/química , Proteínas de Homeodomínio/química , Proteínas de Homeodomínio/ultraestrutura , Nitrocompostos/química , Ácido Peroxinitroso/química , Sítios de Ligação , Oxirredução , Ligação Proteica , Conformação ProteicaRESUMO
INTRODUCTION: Hepatitis C (HCV) continues to be the leading indication for liver transplantation (LT). Sustained virological response (SVR) rates to pegylated interferon (PEG-IFN) and ribavirin (RBV) therapy for recurrent HCV in Genotype 1 (G1) LT recipients have been disappointing (30-40%). Experience with triple therapy using protease inhibitors (PI) boceprevir (BOC), telaprevir (TVR) in these patients has been limited. MATERIAL AND METHODS: This national multicenter retrospective study included 76 patients (64 male, mean age 57 ± 6 years), treated for G1 HCV recurrence with either BOC (n = 41) or TVR (n = 35), who were non-responders or relapsers (n = 54), treatment naïve (n = 22) or had fibrosing cholestatic HCV (n = 3). 53 patients were on cyclosporine, 22 on tacrolimus and one patient on prednisone alone. RESULTS: On treatment virologic response was observed in 84% (64/76), 83% in BOC and 85% in TVR group. A higher week 4 response after starting triple therapy (RVR) was noted in TVR group 25/35 (81%) as compared to BOC group 26/41 (63%); p value = 0.02. The end of treatment response was 78% and 75% in BOC and TVR group, respectively. SVR 12 weeks after treatment discontinuation was observed in 59.5% (22/37); 58.3% in the BOC group and 61.5% in TVR group. Treatment was discontinued early in 23 patients (serious adverse effects n = 19, treatment failure n = 4). Infections occurred in 5 patients with 2 deaths (all in BOC). Anemia was the most common side effect (n = 55, 72%) requiring erythropoietin and RBV dose reduction. In the BOC group, cyclosporine dose reduction was 2.2 ± 1.0 fold and 8.6 ± 2.4 fold with tacrolimus. In TVR group, dose reduction was 3.0 ± 1.4 with cyclosporine and 12 ± 5.7 fold with tacrolimus. CONCLUSIONS: PI-based triple therapy appears more effective in producing HCV-RNA clearance than dual therapy. Tolerability is a serious issue and drug-drug interactions are manageable with close monitoring.
Assuntos
Antivirais/uso terapêutico , Doença Hepática Terminal/cirurgia , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Transplante de Fígado/efeitos adversos , Oligopeptídeos/uso terapêutico , Prolina/análogos & derivados , Inibidores de Proteases/uso terapêutico , Ativação Viral/efeitos dos fármacos , Antivirais/efeitos adversos , Canadá , Proteínas de Transporte/antagonistas & inibidores , Proteínas de Transporte/metabolismo , Interações Medicamentosas , Quimioterapia Combinada , Doença Hepática Terminal/virologia , Feminino , Hepacivirus/enzimologia , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Humanos , Imunossupressores/uso terapêutico , Peptídeos e Proteínas de Sinalização Intracelular , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/efeitos adversos , Prolina/efeitos adversos , Prolina/uso terapêutico , Inibidores de Proteases/efeitos adversos , RNA Viral/sangue , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Proteínas não Estruturais Virais/antagonistas & inibidores , Proteínas não Estruturais Virais/metabolismoRESUMO
Peroxiredoxins (Prx) are efficient thiol-dependent peroxidases and key players in the mechanism of H2O2-induced redox signaling. Any structural change that could affect their redox state, oligomeric structure, and/or interaction with other proteins could have a significant impact on the cascade of signaling events. Several post-translational modifications have been reported to modulate Prx activity. One of these, overoxidation of the peroxidatic cysteine to the sulfinic derivative, inactivates the enzyme and has been proposed as a mechanism of H2O2 accumulation in redox signaling (the floodgate hypothesis). Nitration of Prx has been reported in vitro as well as in vivo; in particular, nitrated Prx2 was identified in brains of Alzheimer disease patients. In this work we characterize Prx2 tyrosine nitration, a post-translational modification on a noncatalytic residue that increases its peroxidase activity and its resistance to overoxidation. Mass spectrometry analysis revealed that treatment of disulfide-oxidized Prx2 with excess peroxynitrite renders mainly mononitrated and dinitrated species. Tyrosine 193 of the YF motif at the C terminus, associated with the susceptibility toward overoxidation of eukaryotic Prx, was identified as nitrated and is most likely responsible for the protection of the peroxidatic cysteine against oxidative inactivation. Kinetic analyses suggest that tyrosine nitration facilitates the intermolecular disulfide formation, transforming a sensitive Prx into a robust one. Thus, tyrosine nitration appears as another mechanism to modulate these enzymes in the complex network of redox signaling.
Assuntos
Eritrócitos/enzimologia , Proteínas de Homeodomínio/metabolismo , Nitrogênio/metabolismo , Estresse Oxidativo/fisiologia , Ácido Peroxinitroso/metabolismo , Animais , Domínio Catalítico , Echinococcus granulosus/enzimologia , Ativação Enzimática/fisiologia , Escherichia coli/enzimologia , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Proteínas de Homeodomínio/genética , Humanos , Peróxido de Hidrogênio/metabolismo , Oxirredução , Processamento de Proteína Pós-Traducional/fisiologia , Estrutura Terciária de Proteína , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Transdução de Sinais/fisiologia , Tiorredoxinas/genética , Tiorredoxinas/metabolismo , Tirosina/metabolismoRESUMO
The transition from regular use of cyclosporine to the newer calcineurin-inhibitors, such as tacrolimus, has been suggested as a contributing factor to the "era effect" of worsening outcomes of post-transplant HCV recurrence. This retrospective medical chart review of 458 patients was undertaken to evaluate the role of immunosuppressant choice (cyclosporine vs. tacrolimus) in determining virologic response and clinical outcomes of post-liver transplant HCV infection recurrence. Our results showed that patients undergoing interferon-based treatment taking cyclosporine have significantly better odds (OR: 2.59, P = 0.043) of presenting a sustained viral response (66.7%) compared to tacrolimus (52.8%). This did not result in a significant effect on post-liver transplantation clinical events including HCV-related deaths, graft loss, fibrosing cholestatic hepatitis, hepatocellular carcinoma or graft rejection. Other variables, which showed a significant relationship with the achievement of sustained viral response included donor age (OR 0.96, P = 0.001) and HCV genotype 1 infection (OR 0.05, P < 0.001). The observed significant increase in the odds of acute/hyperacute (OR 6.49, P = 0.001) and chronic rejection (OR 10.45, P < 0.001) in the cyclosporine to tacrolimus switch group, accompanied by an increase in the odds of HCV-related death (OR 2.30, P < 0.047) compared to tacrolimus merits further study. A significant increase (P < 0.044) in new-onset diabetes mellitus with tacrolimus (28.3%) compared to cyclosporine (18.7%) was also observed. Pre-transplant diabetes mellitus was associated with a significantly increased likelihood of graft fibrosis (HR 1.95, P = 0.003).
Assuntos
Ciclosporina/uso terapêutico , Hepatite C/complicações , Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Tacrolimo/uso terapêutico , Adulto , Antivirais/uso terapêutico , Biomarcadores/sangue , Canadá , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/virologia , Distribuição de Qui-Quadrado , Ciclosporina/efeitos adversos , Diabetes Mellitus/etiologia , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/virologia , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/mortalidade , Hepatite C/virologia , Humanos , Imunossupressores/efeitos adversos , Estimativa de Kaplan-Meier , Cirrose Hepática/imunologia , Cirrose Hepática/virologia , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/virologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , RNA Viral/sangue , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
OBJECTIVE: Abnormal uroflowmetries are common after tubularized incised plate urethroplasties (TIP), perhaps due to low compliance. We hypothesized that (1) abnormal uroflowmetries after TIP might be caused by segmental lower compliance; (2) by adding a graft to the raw area in the incised plate (TIPG), compliance might be improved by preventing secondary intention healing of the dorsal incision. METHODS: A standardized penectomy was performed in 27 adult male rabbits: 9 normal non-operated controls (G1), 6 weeks after TIP (G2: n = 9) or TIPG (G3: n = 9). A standardized isolated segment (including the whole urethroplasty in G1 and G2) was progressively distended with air (1, 2 and 3 ml) in the 3 groups. The respective intraluminal pressures were measured with a tensiometer. RESULTS: Pressure measurements were feasible and reproducible for this model. Mean pressures tended to be higher in the experimental groups (G1: 59.7 mmHg vs. G2: 79.6 mmHg vs. G3: 100.1 mmHg for 1 ml injections; G1: 233.1 mmHg vs. G2: 241 mmHg vs. G3: 308.4 mmHg for 2 ml injections and G1: 457.3 mmHg vs. G2: 429 mmHg vs. G3: 520 mmHg for 3 ml injections) without reaching the statistical significance. CONCLUSION: In this model, the elasticity of the TIP or TIPG neourethras tended to be reduced when compared to controls. The placement of an inlay graft on the dorsal incised area did not increase the compliance. This model allows the measurement of segmental intraluminal urethral pressures generated by controlled air distension and may be a useful tool to evaluate the experimental urethroplasty models.
Assuntos
Hipospadia/cirurgia , Transplante de Tecidos/métodos , Uretra/fisiopatologia , Uretra/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Animais , Catéteres , Complacência (Medida de Distensibilidade)/fisiologia , Hipospadia/fisiopatologia , Masculino , Modelos Animais , Pênis/cirurgia , Coelhos , Urodinâmica/fisiologiaRESUMO
Blood-feeding insects such as mosquitoes are efficient vectors of human infectious diseases because they are strongly attracted by body heat, carbon dioxide and odours produced by their vertebrate hosts. Insect repellents containing DEET (N,N-diethyl-meta-toluamide) are highly effective, but the mechanism by which this chemical wards off biting insects remains controversial despite decades of investigation. DEET seems to act both at close range as a contact chemorepellent, by affecting insect gustatory receptors, and at long range, by affecting the olfactory system. Two opposing mechanisms for the observed behavioural effects of DEET in the gas phase have been proposed: that DEET interferes with the olfactory system to block host odour recognition and that DEET actively repels insects by activating olfactory neurons that elicit avoidance behaviour. Here we show that DEET functions as a modulator of the odour-gated ion channel formed by the insect odorant receptor complex. The functional insect odorant receptor complex consists of a common co-receptor, ORCO (ref. 15) (formerly called OR83B; ref. 16), and one or more variable odorant receptor subunits that confer odour selectivity. DEET acts on this complex to potentiate or inhibit odour-evoked activity or to inhibit odour-evoked suppression of spontaneous activity. This modulation depends on the specific odorant receptor and the concentration and identity of the odour ligand. We identify a single amino-acid polymorphism in the second transmembrane domain of receptor OR59B in a Drosophila melanogaster strain from Brazil that renders OR59B insensitive to inhibition by the odour ligand and modulation by DEET. Our data indicate that natural variation can modify the sensitivity of an odour-specific insect odorant receptor to odour ligands and DEET. Furthermore, they support the hypothesis that DEET acts as a molecular 'confusant' that scrambles the insect odour code, and provide a compelling explanation for the broad-spectrum efficacy of DEET against multiple insect species.
Assuntos
DEET/farmacologia , Repelentes de Insetos/farmacologia , Odorantes , Receptores Odorantes/genética , Receptores Odorantes/metabolismo , Animais , Aprendizagem da Esquiva/efeitos dos fármacos , Brasil , Proteínas de Drosophila , Drosophila melanogaster/classificação , Drosophila melanogaster/genética , Drosophila melanogaster/metabolismo , Ligantes , Neurônios Receptores Olfatórios/efeitos dos fármacos , Polimorfismo Genético/genética , Estrutura Terciária de Proteína , Receptores Odorantes/química , Especificidade da Espécie , Especificidade por SubstratoRESUMO
OBJECTIVES: Children with Hutchinson-Gilford Progeria Syndrome (HGPS) die of severe premature atherosclerosis at an average age of 13 years. Although the LMNA gene defect responsible for this "premature aging syndrome" has been identified, biological mechanisms underlying the accelerated atherosclerosis are unknown. We determined whether children with HGPS demonstrate abnormalities in known biomarkers for cardiovascular disease (CVD) risk. STUDY DESIGN: We quantified serum lipids, lipoproteins, C-reactive protein (CRP), and adiponectin in children with HGPS and age-matched control children. RESULTS: HDL cholesterol (P < .0001) and adiponectin (P < .001) concentrations decreased significantly with increasing age in HGPS but not in control children. There was a positive correlation between these variables in HGPS ( P < .0001) but not control children. Mean total cholesterol, LDL and HDL cholesterol, triglyceride, and median CRP levels were similar between HGPS and control children (all P > .05). CONCLUSIONS: Declining HDL cholesterol and adiponectin with advancing age may contribute to accelerated atherosclerotic plaque formation in HGPS. Several factors frequently associated with CVD risk in normal aging (elevated CRP, total and LDL cholesterol) showed no difference and are unlikely to influence CVD risk in HGPS. HDL and adiponectin may represent significant mediators and potential therapeutic targets for atherosclerosis in HGPS.
Assuntos
Arteriosclerose/etiologia , Proteína C-Reativa/metabolismo , HDL-Colesterol/sangue , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Progéria/sangue , Adiponectina , Adulto , Arteriosclerose/fisiopatologia , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , LDL-Colesterol/sangue , Colágeno/metabolismo , Feminino , Humanos , Lipídeos/sangue , Lipoproteínas/sangue , Masculino , Progéria/complicações , Progéria/genética , Medição de RiscoRESUMO
La enfermedad humana resultante de la infección por Streptococcus pneumoniae siempre ha estado asociada a un significativo grado de morbi - mortalidad como así tambien a problemas económicos. Aunque los mayores esfuerzos se dirigen al desarrollo de vacunas conjugadas polisacárido- proteínas, la naturaleza inmunogenica de las proteínas neumocóccicas, hacen que estas tambien sean blancos para nuevas estrategias de vacuna. Aunque ciertas proteínas neumocóccicas son capaces de inducir inmunidad protectora en ratones, la PspA es la unica que puede inducir anticuerpos que protegen a los ratones contra un inóculo al menos 100 veces mayor que la dosis letal 50 por ciento (DL50). La PspA aumenta la virulencia del neumococo y es capaz de inducir protección inmunológica contra la sepsis neumocóccica y la portación nasofaríngea. Aunque PspA es serológicamente variable presenta suficiente reacción cruzada como para que la inmunización con una única PspA induzca protección contra diversas cepas de Streptococcus pneumoniae. El diseño de una vacuna neumocóccica debe tener en consideración la extrema variabilidad del neumococo. Debido a la natural protección cruzada de PspA, se puede anticipar que la elección apropiada de una mezcla de diferentes PspAs o fragmentos de PspA (en posible combinación con otras proteínas del neumococo) puede ser capaz de inducir una amplia protección contra esta enfermedad (AU)
Assuntos
Criança , Pré-Escolar , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/epidemiologia , Mortalidade InfantilRESUMO
La enfermedad humana resultante de la infección por Streptococcus pneumoniae siempre ha estado asociada a un significativo grado de morbi - mortalidad como así tambien a problemas económicos. Aunque los mayores esfuerzos se dirigen al desarrollo de vacunas conjugadas polisacárido- proteínas, la naturaleza inmunogenica de las proteínas neumocóccicas, hacen que estas tambien sean blancos para nuevas estrategias de vacuna. Aunque ciertas proteínas neumocóccicas son capaces de inducir inmunidad protectora en ratones, la PspA es la unica que puede inducir anticuerpos que protegen a los ratones contra un inóculo al menos 100 veces mayor que la dosis letal 50 por ciento (DL50). La PspA aumenta la virulencia del neumococo y es capaz de inducir protección inmunológica contra la sepsis neumocóccica y la portación nasofaríngea. Aunque PspA es serológicamente variable presenta suficiente reacción cruzada como para que la inmunización con una única PspA induzca protección contra diversas cepas de Streptococcus pneumoniae. El diseño de una vacuna neumocóccica debe tener en consideración la extrema variabilidad del neumococo. Debido a la natural protección cruzada de PspA, se puede anticipar que la elección apropiada de una mezcla de diferentes PspAs o fragmentos de PspA (en posible combinación con otras proteínas del neumococo) puede ser capaz de inducir una amplia protección contra esta enfermedad
Assuntos
Criança , Pré-Escolar , Mortalidade Infantil , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/prevenção & controleRESUMO
El hospital se transforma día tras día en una comunidad cada vez más compleja, en la que diversos profesionales interactúan íntimamente con el propósito de reparar y mantener la salud del paciente. En cada una de las áreas de acción en el medio hospitalario se trata de satisfacer la demanda que la moderna tecnología impone para la correcta atención de los enfermos, y aunque el médico es el responsable mayor en el quehacer hospitalario, resulta bastante improbable que pueda relacionar sin dificultad sus conocimientos técnicos generales con los muy variados problemas prácticos que se presentan a diario y que debe enfrentar junto con los otros miembros del establecimiento. Uno de los problemas más importantes y común a todos los componentes del equipo de salud es la contaminación microbiológica y el control de las infecciones en el hospital. Su característica singular constituye el hecho de que buena parte de la responsabilidad en la producción de estas infecciones la tiene el equipo tratante, lo cual representa un caso de iatrogenia. Entre los factores más recientes que agravan el problema podemos mencionar los cambios ecológicos producidos por la aparición y el uso indiscrimanado de antibióticos y los progresos en la atención hospitalaria, factores que, si bien reflejan un avance científico, han contribuido en forma paradójica al incremento de estas infecciones. El hospital es el eslabón más importante en la cadena de transmisión, puesto que no solo da origen a microorganismos resistentes, sino que desde allí los propaga a la comunidad. Por esta razón, y por constituir el eslabón más vulnerable, las actividades de control deben estar centradas en él. Llama la atención, sin embargo, que pueda plantearse con dramatismo esta responsabilidad frente a un problema de tanta importancia, ya que desde hace más de un siglo se vienen difundiendo los conceptos de asepsia y saneamiento, los que en la actualidad consevan toda su validez. Una explicación puede ser el hecho de que si bien los conocimientos de microbiología y epidemiología nos brindan una clara perspectiva acerca del manejo de las infecciones hospitalarias, necesitan ser implementados para satisfacer los requisitos cada vez mayores de hospitales con compleja tecnología quirúrgica, clínica y farmacológica... (TRUNCADO) (AU)
Assuntos
Infecção Hospitalar/classificação , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Infecções Estafilocócicas/classificação , Infecções Estafilocócicas/virologia , Infecções Estafilocócicas/terapia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/classificação , Bactérias Anaeróbias/metabolismo , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Infecções Bacterianas/terapia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/etiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Controle de Infecções/métodos , Controle de Infecções/normas , Técnicas Bacteriológicas/normas , Técnicas Bacteriológicas/instrumentação , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagemRESUMO
Contiene: infecciones estafilocócicas, infecciones estreptocócicas,
Assuntos
Humanos , Infecção Hospitalar , Infecções Estafilocócicas , Infecções Estreptocócicas , Isolamento de Pacientes , Isoladores de PacientesRESUMO
El hospital se transforma día tras día en una comunidad cada vez más compleja, en la que diversos profesionales interactúan íntimamente con el propósito de reparar y mantener la salud del paciente. En cada una de las áreas de acción en el medio hospitalario se trata de satisfacer la demanda que la moderna tecnología impone para la correcta atención de los enfermos, y aunque el médico es el responsable mayor en el quehacer hospitalario, resulta bastante improbable que pueda relacionar sin dificultad sus conocimientos técnicos generales con los muy variados problemas prácticos que se presentan a diario y que debe enfrentar junto con los otros miembros del establecimiento. Uno de los problemas más importantes y común a todos los componentes del equipo de salud es la contaminación microbiológica y el control de las infecciones en el hospital. Su característica singular constituye el hecho de que buena parte de la responsabilidad en la producción de estas infecciones la tiene el equipo tratante, lo cual representa un caso de iatrogenia. Entre los factores más recientes que agravan el problema podemos mencionar los cambios ecológicos producidos por la aparición y el uso indiscrimanado de antibióticos y los progresos en la atención hospitalaria, factores que, si bien reflejan un avance científico, han contribuido en forma paradójica al incremento de estas infecciones. El hospital es el eslabón más importante en la cadena de transmisión, puesto que no solo da origen a microorganismos resistentes, sino que desde allí los propaga a la comunidad. Por esta razón, y por constituir el eslabón más vulnerable, las actividades de control deben estar centradas en él. Llama la atención, sin embargo, que pueda plantearse con dramatismo esta responsabilidad frente a un problema de tanta importancia, ya que desde hace más de un siglo se vienen difundiendo los conceptos de asepsia y saneamiento, los que en la actualidad consevan toda su validez. Una explicación puede ser el hecho de que si bien los conocimientos de microbiología y epidemiología nos brindan una clara perspectiva acerca del manejo de las infecciones hospitalarias, necesitan ser implementados para satisfacer los requisitos cada vez mayores de hospitales con compleja tecnología quirúrgica, clínica y farmacológica... (TRUNCADO)