Search

Video Abstract1_kzgflof2Kaltura

Video Abstract1_d8pq0rzsKaltura

The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) were found to be effective in predicting the outcomes of Diverticular Disease (DD). We ascertain whether fecal calprotectin (FC) can further aid in improving risk stratification. A three‐year international, multicentre, prospective cohort study was conducted involving 43 Gastroenterology and Endoscopy centres. Survival methods for censored observations were used to estimate the risk of acute diverticulitis (AD) in newly diagnosed DD patients according to basal FC, DICA, and CODA. The net benefit of management strategies based on DICA, CODA and FC in addition to CODA was assessed with decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions. At the first diagnosis of diverticulosis/DD, 871 participants underwent FC measurement. FC was associated with the risk of AD at 3 years (HR per each base 10 logarithm increase: 3.29; 95% confidence interval, 2.13–5.10) and showed moderate discrimination (c‐statistic: 0.685; 0.614–0.756). DICA and CODA were more accurate predictors of AD than FC. However, FC showed high discrimination capacity to predict AD at 3 months, which was not maintained at longer follow‐up times. The decision curve analysis comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other. FC measurement could be used as a complementary tool to assess the immediate risk of AD. In all other cases, treatment strategies based on the CODA score alone should be recommended.

ObjectiveTo investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA).DesignA multicentre, prospective, international cohort study.Setting43 gastroenterology and endoscopy centres located in Europe and South America.Participants2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications.InterventionsA 3-year follow-up was performed.Main outcome measuresTo predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score).ResultsThe 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p<0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p<0.001), respectively. The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10% and <2.5% in CODA B; >10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).ConclusionsDICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score.Trial registration numberNCT02758860.

Purpose: The purpose of this research was to investigate the influence of abusive supervision on work engagement, stress and turnover intention of subordinates. It was also proposed that work engagement and stress mediate the relationship between abusive supervision and turnover intention. Self-determination theory and the job demands-resources (JD-R) model provide the theoretical framework for the hypotheses. Design/methodology/approach: The sample of this study consisted of 172 employees from public and private companies operating in different sectors of the economy. The hypotheses were tested through multiple regression analysis. Findings: The results show that abusive supervision negatively influences engagement and contributes to increasing subordinates' stress and turnover intention. The study also found that the relationship between abusive supervision and turnover intention is mediated by engagement, but not by stress. Research limitations/implications: Data was obtained from a convenience sample and cannot, therefore, be generalized. Practical implications: The study results suggest that employees are prone to leave an organization when they are subordinated to abusive leaders, corroborating the idea that workers choose organizations but leave their leaders. This, in turn, reinforces the importance of adopting proper leadership selection and training processes. Originality/value: This research addresses the dark side of the relationship between superiors and subordinates, which has been scarcely examined in the Brazilian literature. It also draws attention to different harmful consequences associated with dysfunctional behaviors of professionals that hold leadership positions in organizations.

Purpose: This study analyzes the impact of purpose-oriented leadership and leader cultural intelligence on engagement and burnout among expatriates undertaking long-term corporate assignments, grounded on social psychology frameworks on interpersonal bias. Design/methodology/approach: A survey was conducted with corporate expatriates from 21 different nationalities, who work for large multinational companies and were on assignment in 23 distinct countries – including Brazil, China, Japan and the UK Partial Least Squares Structural Equation Modeling was used to evaluate the proposed hypotheses. Findings: Results indicate that leader cultural intelligence is associated with lower burnout and higher engagement among expatriates, and that purpose-oriented leadership is associated with higher expatriate engagement but not with lower burnout. Originality/value: This research contributes to the field by highlighting specific leader attributes that can foster successful expatriation: cultural intelligence and purpose-oriented leadership. The study adds to knowledge on leader–follower relationships amid national and cultural diversity by pointing to actionable leader qualities that can foster expatriate engagement and prevent his/her burnout.

As of September 2022, nearly 1.3 billion doses of COVID-19 vaccine products have been administered in Latin America and the Caribbean, where 27% of global COVID-19 deaths have occurred. This study aimed to estimate the effectiveness of COVID-19 vaccines against lab-confirmed COVID-19 related hospitalizations and deaths among adults in Argentina, Brazil, Chile, and Colombia.

W marcu 2010 r. wprowadzono do stosowania w Brazylii 10-walentną skoniugowaną szczepionkę przeciwko pneumokokom (pneumococcal conjugate vaccine; PCV10). Podstawą dopuszczenia jej do obrotu było wykazanie, że w zakresie wskaźników immunologicznych dotyczących skuteczności w zapobieganiu zakażeniom pneumokokowym nie była ona gorsza od szczepionki 7-walentnej. Schemat dawkowania PCV10 obejmuje podanie trzech podstawowych dawek w wieku 2, 4 i 6 miesięcy oraz dawki przypominającej w wieku 12 miesięcy. W czasie wprowadzania szczepionki na rynek zaproponowano szczepienie pojedynczą dawką wszystkich dzieci w wieku 12–23 miesięcy, nieobjętych podstawowym cyklem szczepień. Analizowano skuteczność szczepionki PCV10 w profilaktyce inwazyjnych chorób pneumokokowych u dzieci w Brazylii.

Anal incontinence is a common and multifactorial pathology that affects patients’ lives and imposes considerable socioeconomic consequences.

Neste estudo de caso de natureza exploratória, desenvolvido em uma grande empresa do setor jornalístico, o objetivo foi analisar fatores de atração e perda de jovens que voluntariamente optaram por deixar a organização. A fundamentação teórica para a pesquisa foi construída a partir dos seguintes pilares: aspirações de trabalho e carreira da chamada geração Y, fatores de atração e retenção e cultura organizacional, tendo em vista a identificação da necessidade de adaptação da cultura da empresa aos novos desafios estratégicos e competitivos que vem enfrentando. O levantamento de dados foi feito por meio de 17 entrevistas em profundidade com jovens da geração Y que pediram demissão após pelo menos um ano de estágio e/ou trabalho na empresa. Como principais fatores de atração, destacaram-se a imagem e a reputação do principal jornal da empresa, que muito contribui para a construção de sua marca empregadora. Por outro lado, alguns traços da cultura organizacional apresentaram contraste com aspectos valorizados pelos participantes, indicando incongruência de valores, que pode estar levando a organização a perder jovens talentos, considerados importantes ante a necessidade de renovar seu quadro funcional e sua cultura. Com relação às motivações pessoais para deixar a empresa, foram identificados três grupos de jovens – idealistas, carreiristas e imediatistas –, orientados por anseios e perspectivas profissionais distintos.

In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12–23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children.

As relações de gênero no universo do trabalho ainda são marcadas por importantes assimetrias, especialmente quando se trata do nível salarial e do acesso a posições de maior responsabilidade dentro das organizações. Neste estudo, procura-se investigar se a percepção de desigualdade na distribuição e nos critérios de alocação de recompensas aplicados às mulheres influencia sua satisfação com o trabalho e sua identificação com a organização em que atuam. Além disso, verifica-se se o sentido do trabalho modera os efeitos da percepção de desigualdade de gênero sobre as atitudes das mulheres, intensificando-o entre aquelas para as quais a orientação para o trabalho está mais centralmente vinculada à sua identidade. No estudo, analisam-se essas relações em uma amostra de 172 mulheres com nível de instrução superior completo, que atuam na cidade do Rio de Janeiro em diversos tipos de organizações e em diferentes segmentos de mercado. Os resultados observados sugerem que a percepção de desigualdade tem impacto negativo sobre as atitudes das mulheres com relação a seu emprego e às organizações que as empregam; o sentido do trabalho apresenta os efeitos moderadores teorizados; e, por meio de seus efeitos sobre as atitudes das mulheres, a percepção de desigualdade afeta significativamente sua intenção de deixar a empresa.

ABSTRACTRubella virus infection is typically diagnosed by the identification of rubella virus-specific immunoglobulin M (IgM) antibodies in serum, but approximately 50% of serum samples from rubella cases collected on the day of rash onset are negative for rubella virus-specific IgM. The ability to detect IgM in sera and oral fluids was compared with the ability to detect rubella virus RNA in oral fluids by reverse transcription-PCR (RT-PCR) by using paired samples taken within the first 4 days after rash onset from suspected rubella cases during an outbreak in Peru´. Sera were tested for IgM by both indirect and capture enzyme immunoassays (EIAs), and oral fluids were tested for IgM by a capture EIA. Tests for IgM in serum were more sensitive for the confirmation of rubella than the test for IgM in oral fluid during the 4 days after rash onset. RT-PCR confirmed more suspected cases than serum IgM tests on days 1 and 2 after rash onset. The methods confirmed approximately the same number of cases on days 3 and 4 after rash onset. However, a few cases were detected by serum IgM tests but not by RT-PCR even on the day of rash onset. Nine RT-PCR-positive oral fluid specimens were shown to contain rubella virus sequences of genotype 1C. In summary, RT-PCR testing of oral fluid confirmed more rubella cases than IgM testing of either serum or oral fluid samples collected in the first 2 days after rash onset; the maximum number of confirmations of rubella cases was obtained by combining RT-PCR and serology testing.

ABSTRACTMost persons with rubella virus-specific immunoglobulin M (IgM)- or IgG-positive sera tested positive (98% [n= 178] and 99% [n= 221], respectively) using paired filter paper dried blood spot (DBS) samples, provided that DBS indeterminate results were called positive. For persons with IgM- or IgG-negative sera, 97% and 98%, respectively, were negative using DBS.

Laparoscopic surgery has demonstrated advantages over conventional open procedures. Specifically, avoiding an abdominal incision and allowing the complete inspection of the abdominal cavity, as well as the ability to obtain a biopsy sample, are some of the reasons that made this method of stoma creation advantageous. The creation of stomas by laparoscopy is one of the simpler laparoscopic procedures and is associated with a shorter learning curve compared with other colorectal procedures. This section discusses the indications, methods, and complications associated with the laparoscopic creation of stomas.

PURPOSE: This study assessed the efficacy of anterior overlapping sphincteroplasty and parameters predictive of a successful outcome. METHODS: Clinical findings and physiologic investigations of female patients who underwent anterior overlapping sphincteroplasty for fecal incontinence between 1988 and 1996 were reviewed. The extent of sphincter damage was assessed at needle electromyography as the number of quadrants exhibiting decreased motor unit potentials. Prolonged pudendal nerve terminal motor latencies were those of greater than 2.2 ms. The size of the endoanal ultrasound defect was assessed as degrees circumference of the external sphincter in which viable muscle was absent. Patients were reviewed by telephone questionnaire and were asked to grade the outcome of their surgery as excellent or good (success) or fair or poor (failure). Incontinence was graded using a scoring system of 0 (perfect continence) to 20 (complete incontinence). RESULTS: There were 100 patients who had an overlapping sphincteroplasty; complete follow-up information was obtained for 77 patients at a median of 24 (range, 2–96) months. The median age was 47 (range, 25–80) years and they had a median duration of incontinence of four (range, 0.1–39) years. Prior sphincteroplasty had been performed in 30 patients with a median of one (range, 1–7) operations. Investigations performed included electromyography (n=49), pudendal nerve terminal motor latency (n=71), endoanal ultrasound (n=49), and manometry (n=67). Sixty percent of patients had improved continence and 42 (55 percent) considered their surgery to have been successful as attested to by a significant decrease in their incontinence score (from 15.1±4.5 to 4.3±4.2;P<0.0001). Neither patient age, parity, prior sphincteroplasty, cause or duration of incontinence, extent of electromyography damage, size of the endoanal ultrasound defect, nor any manometric parameter correlated with outcome. However, 62 percent of 59 patients with bilaterally normal pudendal nerve terminal motor latencies had a successful outcome compared with only 16.7 percent of 12 patients with unilateral or bilateral prolonged pudendal nerve terminal motor latencies (P<0.01). CONCLUSION: Bilateral normal pudendal nerve terminal motor latencies are the only factors predictive of long-term success after overlapping sphincteroplasty.

AIM: The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions for elective colorectal surgery. METHODS: All eligible patients were prospectively randomized to receive either 4 1 of standard polyethylene glycol (PEG) solution or 90 ml of sodium phosphate (NaP) as mechanical bowel preparation for colorectal surgery. A detailed questionnaire was used to assess patient compliance. In addition, the surgeons, blinded to the preparation, intraoperatively evaluated its quality. Postoperative septic complications were also assessed. The calcium serum level was monitored before and after bowel preparation. Statistical analysis was performed using the Wilcoxon's rank-sum test and Fisher's exact test. RESULTS: Two hundred patients, well matched for age, gender, and diagnosis, were prospectively randomized to receive either PEG or NaP solutions for elective colorectal surgery. All patients completed all phases of the trial. There was a significant decrease in serum calcium levels after administration of both NaP (mean, 9.3-8.8 mg/dl) and PEG (9.2-8.9 mg/dl), respectively (P<0.0001), with no clinical sequelae. However, patient tolerance to NaP was superior to PEG: less trouble drinking the preparation (17vs.32 percent;P<0.0002), less abdominal pain (12vs.22 percent;P=0.004), less bloating (7vs.28 percent), and less fatigue (8vs.17 percent), respectively. Additionally, 65 percent of patients who received the NaP preparation stated they would repeat this preparation again compared with only 25 percent for the PEG group (P<0.0001). Ninety-five percent of patients who received the NaP solution tolerated 100 percent of the solution compared with only 37 percent of the PEG group (P<0.0001). For quality of cleansing, surgeons scored NaP as “excellent” or “good” in 87 compared with 76 percent after PEG (P=not significant). Rates of septic and anastomotic complications were 1 percent and 1 percent for NaP and 4 percent and 1 percent for PEG, respectively (P=not significant). CONCLUSION: Both oral solutions proved to be equally effective and safe. However, patient tolerance of the small volume of NaP demonstrated a clear advantage over the traditional PEG solution.

This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil.