Measuring the General and Specific Domains of Self-Esteem: The Short-form of the State Self-Esteem Scale

Self-esteem is a crucial human nature feature for understanding the social dimensions of individuals' self-concept. One of its characteristics is peoples' malleability to adapt to social contexts, that is, the state self-esteem (SSE). Individuals express SES in three different factors: performance; social success; and physical appearance. Along with three studies, we present evidence of validity of the Short-Form of State Self-Esteem Scale (SSES-S) that measures contextual fluctuations in individuals' self-esteem. In Study 1 (N = 300), we found that the structure of the SSES-S was organized into three correlated factors that exhibited convergent-discriminant validity with measures of trait self-esteem and human values. In Study 2 (N = 281), confirmatory factor analysis indicated that a bifactor measurement model better fit the description of the factorial structure of the SSES-S, which also showed incremental validity concerning trait self-esteem for predicting one criterion. In Study 3 (N = 160), we experimentally manipulated contextual information about self-achievement and showed that the SSES-S is sensitive enough to detect transient fluctuations in self-esteem, especially in the achievement factor. We discussed the limitations and scope of the SSES-S, as its specific focus on measuring undergraduate students' state self-esteem and its implications distinguishing the general and particular domains of this construct.

Distributive justice criteria and social categorization processes predict healthcare allocation bias

OBJECTIVES

Drawing on theories of distributive justice and intergroup discrimination, we examined how much distributive justice criterion and racial group membership contribute to bias in healthcare allocation decisions, by testing a theoretical model that specifies perceived stereotypicality and individual responsibility as a serial mediation process in the relationship between disease's contraction controllability (controllable vs. non-controllable) and bias in medical decision-making.

METHOD

White Portuguese medical students (N = 213) participated in an online experimental study conducted in two phases. In phase 1, we manipulated the cause of disease contagion and the salience of patient's racial categorization, and measured the stereotypicality of behaviour. In phase 2, we assessed perceived responsibility and likelihood of recommending medical treatment.

RESULTS

Controllable (vs. non-controllable) contraction behaviours in phase 1 were perceived as more stereotypic. As a spillover effect, more stereotypical behaviours in phase 1 predicted more patient's responsibility for their disease in phase 2. Importantly, controllable behaviours of disease contraction in phase 1 negatively affected recommendations for medical treatment in phase 2; and this negative effect was serially mediated by the stereotypicality of behaviour and patient responsibility. Furthermore, patients' skin colour moderated this process, meaning that perceptions of controllable behaviour as more stereotypic were stronger for Black than for White patients.

CONCLUSIONS

This research shows how stereotyping and social categorization bias allocation decisions through the patient's level of responsibility in decision-making processes. The findings are discussed in light of principles of distributive justice and the literature on intergroup relations with respect to racial disparities in health care.

Neuroticism, stress, and rumination in anxiety and depression of people with Vitiligo: An explanatory model

Psychological impacts of Vitiligo have been demonstrated, and associations of the skin disease with anxiety and depression disorders have already been shown. However, it is still unclear the role of individuals' personality factors, such as neuroticism, stress, and rumination, as well as sociodemographic characteristics of people with Vitiligo in such disorders. We conducted a study in a community sample of individuals with Vitiligo (N = 324) aiming to test the hypothesis that neuroticism, stress, and rumination are subjacent to these individuals' anxiety and depression symptomatology. We also explored whether individuals' gender might favor the onset or worsening of the psychological consequences of such disorders. Results showed that the relationship between neuroticism, anxiety and depression was mediated by stress and rumination (brooding), being this effect moderated by the participants' gender. Specifically, women's reflection and stress seemed to be important mechanisms to predict their anxiety and depression symptoms, whereas brooding predicts such disorders' symptomatology in men with Vitiligo. These findings may guide future research and clinical interventions for this population, for which it is necessary to consider the psychological consequences of the disease and not just its physiological aspects.

The global impact of adverse childhood experiences on criminal behavior: A cross-continental study

BACKGROUND

Adverse Childhood Experiences (ACEs) have been associated with a greater risk of later criminal offending. However, existing research in this area has been primarily conducted in Western developed countries and cross-cultural studies are rare.

OBJECTIVES

This study examined the relationship between ACEs and criminal behaviors in young adults living in 10 countries located across five continents, after accounting for sex, age, and cross-national differences.

PARTICIPANTS AND SETTING

In total, 3797 young adults aged between 18 and 20 years (M = 18.97; DP = 0.81) were assessed locally in community settings within the 10 countries.

METHOD

The ACE Questionnaire was used to assess maltreatment and household dysfunction during childhood and a subset of questions derived from the Deviant Behavior Variety Scale (DBVS) was used to determine past-year criminal variety pertaining to 10 acts considered crime across participating countries.

RESULTS

Physical and sexual abuse, physical neglect, and household substance abuse were related to criminal variety, globally, and independently across sexes and countries ranked differently in the United Nations Human Development Index (HDI). In addition, three out of five experiences of household dysfunction were related to criminal variety, but subsequent analyses indicate that some forms of household dysfunction only hold statistical significance among males or females, or in countries ranking lower in the HDI.

CONCLUSIONS

This research strengthens the finding that there are cross-cultural mechanisms perpetuating the cycle of violence. It also indicates that forms of household dysfunction have an impact on criminal behavior that is shaped by gender and the country's levels of social well-being.

People’s social value depends on their sexual orientation and gender identity

Abstract The present study aimed to investigate discrimination against transsexuals. A experimental study was carried out that consisted in the presentation of a fictitious news about photos of a person that were leaked according to the victim’s gender assigned at birth (male vs. female), their sexual orientation and gender identity (heterosexual vs. homosexual vs. transsexual), resulting in six experimental conditions. The measure of discrimination used was the allocation of the indemnification amount. The study included 300 cisgender heterosexual participants of both genders, randomly allocated in one of the six experimental conditions. The results enhanced the evidence that people tend to value their own group and discriminate against transsexual people. Variations were found regarding the target gender and the discriminator’s gender. The findings were discussed based on the Social Identity Theory and the threat to distinctiveness.

ASSOCIAÇÃO ENTRE TIPO SANGUÍNEO ABO E RESULTADO DO RT-PCR PARA SARS-COV-2

Introdução

Estudos apontam relação entre grupos sanguíneos e diversas condições clínicas como, por exemplo, eventos trombóticos, doença de von Willebrande doenças infecciosas como SARS-CoV-1, H. pylori entre outros. Associação entre maior susceptibilidade à COVID-19 e pior evolução em indivíduos do grupo sanguíneo A vem sendo estudada por diversos grupos.

Objetivo

Neste estudo, analisamos a correlação entre os grupos sanguíneos ABO e resultado do teste para o vírus SARS-CoV-2 por RT-PCR em um laboratório de análises clínicas com grande fluxo de amostras representativas das cinco regiões do Brasil.

Material e métodos

Os dados foram obtidos do banco de dados do laboratório referente a 20 anos de registro, analisados de forma anonimizada e de acordo com as regras que regem a lei geral de proteção de dados (LGPD). Os registros possuem um identificador numérico único que leva em conta CPF e data de nascimento e todas as análises foram feitas considerando-se esta identificação. Foram obtidas as tipagem sanguínea ABO/Rh e os resultados de RT-PCR para SARS-CoV-2. Para este último, os indivíduos foram classificados “covid-positivo”quando ao menos um exame resultou positivo. Os demais foram considerados “covid-negativo”. As análises foram realizadas no banco de dados obtido do cruzamento do banco de indivíduos únicos com tipagem sanguínea e ao menos um teste para COVID-19. Análise estatística foi realizada do teste chi-quadrado de Pearson e V-quadrado de Cramér.

Resultados e discussão

Foram identificados 66.181 indivíduos que realizaram tipagem sanguínea e ao menos um teste para SARS-CoV-2. A distribuição global dos grupos ABO é a que segue: grupo O 44%, grupo A 41%, grupo B 11% e grupo AB 4%, compatível com a distribuição dos grupos no Brasil (O 45%, A 42%, B 10% e AB 3%).Do total de indivíduos estudado, 21% (13.617) apresentou ao menos um resultado positivo para SARS-CoV-2, distribuídos da seguinte forma por grupo sanguíneo: tipo O 42%, A 42%, B 12% e AB 4%. A distribuição dos grupos sanguíneos entre os indivíduos negativos para SARS-CoV-2 foi: tipo O 44%, A 41%, B 11% e AB 4%. As análises consideraram grupo ABO e Rh. Foi realizado um teste chi-quadrado de independência de variáveis e verificou-se associação positiva entre o tipo sanguíneo e a infecção por COVID-19 (χ2 = 27,273, df = 7, p = 0,0002975).O teste pós-hoc de comparação entre status de COVID-19 e tipo sanguíneo sugere associação entre o tipo B- e infecção por COVID-19 (p = 0.0407700).Entretanto, este dado não foi confirmado por análise adicional pelo teste V de Cramér, sugerindo que o efeito observado está provavelmente associado ao grande número de amostras do que uma associação real entre as variáveis.Sabe-se que a testagem para COVID-19 pode resultar em falso negativo quando realizada fora da janela de maior sensibilidade para detecção do vírus. Deve-se considerar que, na presente análise, a informação sobre início dos sintomas e data de realização do teste não está disponível. Entretanto, o grande número de casos analisados diminui o impacto da ausência desta informação. Outro ponto importante a ser considerado é que não foram avaliados parâmetros de evolução clínica dos pacientes, sendo os dados restritos à presença ou não de diagnóstico positivo para COVID-19.

Conclusão

Não foi demonstrada associação entre o tipo sanguíneo e a suscetibilidade a infecções por COVID-19 no grupo analisado.

From conservatism to support for gay conversion therapy: the role of prejudice and beliefs about same-sex sexuality

Support for Gay Conversion Therapy may be motivated by homophobic prejudice driven by conservative groups. We propose that Support for Gay Conversion Therapy (SGCT) is motivated by conservatism and that this relationship is mediated by prejudice against gay individuals. We tested these hypotheses in three studies. In Study 1 (N = 249), we found that conservative values predict SGCT, and that this effect is partly mediated by prejudice. In Study 2 (N = 247), we replicated this mediation and found that ethical-religious and psychological essentialist beliefs differently moderated it. Study 3 (N = 210) went further by experimentally showing the political consequences of SGCT. We showed that more conservative individuals tend to absolve psychologists who practice sexual conversion, and that both prejudice and conservative-motivated SGCT mediated this effect. We discussed these results by emphasizing the psychosocial process that motivates SGCT.

The effect of gender and male distinctiveness threat on prejudice against homosexuals

Positive distinctiveness threat is central for understanding ingroup bias, but its role in gender differences in the expression of sexual prejudice is not yet satisfactorily elucidated. We analyzed this issue by proposing that sexual prejudice is a defensive reaction to ensure intergroup distinctiveness, so that heterosexual men are more prejudiced against homosexuals than heterosexual women because they strive more for positive distinctiveness. In Study 1 (N = 232), we found that men exhibited more prejudice against gay men than lesbians, while women did not significantly differentiate their prejudice against these target groups. In Study 2, we manipulated the target group of prejudice (gay men vs. lesbians) in a sample of heterosexual men (N = 79) and confirmed that they differentiated more between heterosexual men and gay men than between heterosexual women and lesbians. In Study 3 (N = 177), we manipulated the threat to the distinctiveness between the ingroup (i.e., heterosexual men and heterosexual women) and the outgroup (i.e., gay men and lesbians) and demonstrated that the perceived distinctiveness mediates the relationship between gender and sexual prejudice in men but not in women. Finally, in Study 4 (N = 75), we manipulated the distinctiveness threat for men and women and measured sexual prejudice by using an implicit measure. The results showed more implicit prejudice in men than in women when intergroup distinctiveness was threatened (vs. affirmed). Our results have important implications for understanding sexual prejudice by shedding light on the role played by the distinctiveness threat of gender differences in expressing homophobia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Anxiety associated with COVID-19 and concerns about death: Impacts on psychological well-being

Situations of public calamity, such as that caused by COVID-19 pandemic, strongly impact mental health, especially among people who feel most anxious about the imminence of death, as highlighted by the Terror Management Theory. In this research, we investigated how and under which conditions concerns about death itself and anxiety are related to psychological well-being. Specifically, we assessed the role of fear caused by the prominence of death (contextual and dispositional) in anxiety and well-being during the pandemic. Participants were 352 Brazilians, who answered a measurement of fear of death and read a news story about COVID-19. The manipulated news brought the idea of death to prominence (vs. non-prominence). After reading the news, the participants answered scales of anxiety and psychological well-being. The results showed that individual differences in fear of death related to well-being, and that this relationship was mediated by anxiety in face of COVID-19. Contrastingly, the manipulation of the salience of death in the news did not affect this relationship. These results contribute to the understanding of a psychological process related with fluctuations in individuals' well-being during the pandemic, offering insights for future studies that can promote better coping conditions during this period of world crisis.

Association between Anti-prejudice Norm and Attitudes towards Minority Groups

Abstract In this study we investigated the relationship between the anti-prejudice norm and the expression of attitudes towards minority groups. Participated 100 people who evaluated a list with 16 target groups of prejudice, answering two questions: indicate the groups that feel less prejudice; and which ones do you prefer. The results showed that there are different levels of prejudice depending on the target-group, with the women, blacks and people with disabilities being the most protected by the norm. A hierarchical analysis of clusters evidenced an organization of the groups, classified as naturalised, blamed, sexual and political minorities. The anti-prejudice norm and the attitudes presented a strong and positive relation (r = 0.65, p < 0.001). A multilevel logistic regression analysis showed that this relation was moderated by the type of group. These results contribute to the studies on the expression of prejudice, besides demonstrating the role of norms in the understanding of the phenomenon.

Black people are convicted more for being black than for being poor: The role of social norms and cultural prejudice on biased racial judgments

Black and poor people are more frequently convicted of committing crimes. However, the specific role played by skin color and social class in convicting a person has yet to be clarified. This article aims to elucidate this issue by proposing that belonging to a lower social class facilitates the conviction of black targets and that this phenomenon is because information about social class dissimulates racial bias. Study 1 (N = 160) demonstrated that information about belonging to the lower classes increases agreement with a criminal suspect being sentenced to prison only when described as being black. Furthermore, Studies 2 (N = 170) and 3 (N = 174) show that the anti-prejudice norm inhibits discrimination against the black target when participants were asked to express individual racial prejudice, but not when they expressed cultural racial prejudice. Finally, Study 4 (N = 134) demonstrated that lower-class black targets were discriminated against to a greater degree when participants expressed either individual or cultural prejudice and showed that this occurs when racial and class anti-prejudice norms are salient. The results suggest that social class negatively affects judgments of black targets because judgment based on lower class mitigates the racist motivation of discrimination.

A Dyadic Approach to Understanding the Link Between Sexual Functioning and Sexual Satisfaction in Heterosexual Couples

Researchers have demonstrated that several dimensions of sexual functioning (e.g., sexual desire, arousal, orgasm) are associated with the sexual satisfaction of individuals in a committed mixed-sex (male-female) relationship. We extended this research by comparing a dyadic model that included both own (i.e., actor effect) and partner (i.e., partner effect) domains of sexual functioning to an individual model that included only actor effects. Participants were 124 mixed-sex couples who completed online measures of sexual functioning and sexual satisfaction. Data analysis using the actor-partner interdependence model (APIM) and structural equation modeling (SEM) indicated that the dyadic model had a better fit than the individual model. Women's sexual desire and orgasm and men's erectile functioning were significant positive predictors of both own and partner's sexual satisfaction. These results are discussed in terms of the importance of taking a dyadic approach to research and clinical work related to sexual satisfaction.

The Ego-Defensive Role of Legitimacy: How Threat-Based Justifications Protect the Self-Esteem of Discriminators

This article analyzes the ego-defensive role played by legitimation, by examining the hypothesis that threat-based justifications attenuate the negative effect on an individual's self-esteem caused by his or her becoming aware of his or her own discriminatory behavior. Across three studies (including a pilot experiment), participants who were led to believe that they had acted in a discriminatory way experienced a decrease in their self-esteem. In Study 1 ( N = 116), this effect was nullified when discrimination was justified by either symbolic or realistic threat perceptions. Study 2 ( N = 250) replicated this pattern of results and went further by showing that discrimination affects self-esteem only in more egalitarian individuals, whereas for those less egalitarian, it affects their social image. According to the ego-defensive role of legitimation, a meta-analytical integration of the results confirmed that the influence of discrimination in depressing self-esteem is moderated by threat-based justifications.

Justifying treatment bias: The legitimizing role of threat perception and immigrant-provider contact in healthcare

OBJECTIVE

Immigrants tend to receive a lower quality of healthcare, which can be a sign of healthcare bias. We examined whether this bias in medical care is associated with a legitimizing process involving two psychosocial factors: threat perception and level of intergroup contact.

METHOD

One hundred eighty six Portuguese health professionals (55.6% clinicians; 44.4% nurses; 78.5% female; Mage = 45.83, range = 23 and 71) completed a questionnaire on prejudiced attitudes toward immigrants, perceptions of health-specific threats, bias in medical practice and level of contact with immigrant patients.

RESULTS

For healthcare providers who have more contact with immigrant patients, the perceived health threat mediated the relationship between prejudiced attitudes and treatment bias. In contrast, for healthcare providers with less contact with immigrant patients, the perceived threat was not associated with treatment bias.

CONCLUSIONS

These findings help to understand the persistence of lower quality medical treatment among immigrants, providing guidelines for future research. In particular, they suggest that perceiving immigrants as a threat to public health is indicative of the providers' engagement in a legitimizing process of self-reported biased treatment, making this engagement necessary only for providers with greater levels of contact with immigrant patients. (PsycINFO Database Record

Fatores Legitimadores da Discriminação: Uma Revisão Teórica

RESUMO O presente artigo apresenta uma revisão teórica sobre os fatores legitimadores da discriminação identificados em teorias clássicas da Psicologia Social. Nesse sentido, analisamos como esses mecanismos são tratados em quatro perspectivas teóricas: as diferenças individuais; os conflitos de interesses; o processo de categorização; e os processos identitários. Orientamos nossa análise seguindo a ideia de que as teorias analisadas têm explicado a discriminação "intergrupal" recorrendo a fatores legitimadores das desigualdades sociais, ainda que a referência a esses fatores não tenha sido feita de forma explícita. Finalmente, propomos que o recurso a fatores justificadores da discriminação representa o mecanismo através do qual o preconceito leva à discriminação, sendo as percepções de ameaça realista e simbólica alguns dos importantes fatores legitimadores da discriminação.

O papel de representações sociais sobre a natureza da homossexualidade na oposição ao casamento civil e à adoção por famílias homoafetivas

Analisaram-se as relações entre preconceito, apoio a políticas discriminatórias contra homossexuais e representações sociais sobre a natureza da homossexualidade. Participaram da pesquisa 297 estudantes do último ano de psicologia, serviço social e direito. Os resultados mostram que as representações sobre a homossexualidade baseadas em crenças religiosas, moralistas e psicológicas predizem o maior apoio às políticas discriminatórias contra os homossexuais, nomeadamente a oposição ao casamento e à adoção de crianças por casais homoafetivos. A crença na natureza cultural da homossexualidade prediz o menor apoio a essas políticas. As relações verificadas são mediadas pelo preconceito flagrante contra homossexuais. Esses resultados mostram o papel desempenhado por representações sobre a natureza dos grupos sociais na manutenção de preconceitos e práticas discriminatórias contra minorias sociais.

Embryonic and larval development of Jundiá (Rhamdia quelen, Quoy & Gaimard, 1824, Pisces, Teleostei), a South American Catfish

The jundiá (Rhamdia quelen, Quoy & Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study

BACKGROUND

Nosocomial infections (NIs) are one of the most important causes of morbidity in neonatal intensive care units (NICUs). The aim of this study was to identify risk factors (RFs) for NIs among critically ill newborn patients in a Brazilian NICU.

METHODS

This 5-year prospective cohort study in an 8-bed NICU included all infants born in the hospital and admitted to the NICU from 1993 to 1997. Exposure variables were maternal and newborn data prospectively collected from patient records. Univariate and multivariate analyses were used to determine independent RFs associated with NIs.

RESULTS

Univariate analysis indicated gestational age, congenital abnormality, premature rupture of membranes, maternal illness, birth weight, mechanical ventilation, central venous catheter, total parenteral nutrition, peripheral venous catheter, and length of stay as possible RFs. Multivariate analysis identified 5 independent RFs for NIs: premature rupture of membranes (hazard ratio [HR] = 1.51 [95% CI, 1.15-1.99]), maternal disease (HR = 1.57 [95% CI, 1.18-2.07]), mechanical ventilation (HR = 2.43 [95% CI, 1.67-3.53]), central venous catheter (HR = 1.70 [95% CI, 1.21-2.41]), and total parenteral nutrition (HR = 4.04 [95% CI, 2.61-6.25]).

CONCLUSION

The recognition of RFs for NIs is an important tool for the identification and development of interventions to minimize such risks in the NICU.

Low frequency of replication errors in primary nervous system tumours

OBJECTIVES

Automated DNA technology was used to analyze the incidence of microsatellite instability (MIN) among the most frequent types of adult primary CNS tumours and to determine its relation with clinicopathological characteristics.

METHODS

Fifty six gliomas, 32 meningiomas and 11 schwannomas were screened for size changes at eight microsatellite loci using fluorescent polymerase chain reaction (PCR) followed by fragment analysis in an automated sequencer. A tumour was considered as MIN+ when a different electrophoretic pattern between constitutional and tumour DNA was evidenced in one or more microsatellite markers and as replication error positive (RER+) when at least 25% of the markers analyzed (2/8) showed instability. The MIN phenotype was correlated with relevant clinical and pathological parameters.

RESULTS

Globally, instability was found in 19/767 analyses (2.47%), with a higher rate among tetranuceotide than dinucleotide repeats (chi(2) test, p=0.018). Ten gliomas (17.9%), two meningiomas (6.3%), and two schwannomas (18.2%) were MIN+, whereas one glioma (1.8%), two meningiomas (6.3%), and one schwannoma (9.1%) were classified as RER+. A possible association between microsatellite instability and a shorter duration of clinical course was found in meningiomas. The MIN+ phenotype was more frequent in spinal than intracranial schwannomas (Fisher's exact test, p=0.018). No other significant association with clinical or histological features was detected.

CONCLUSIONS

Although microsatellite instability can be demonstrated at a low rate in some primary CNS tumours, a true replication error phenotype (revealed by widespread microsatellite instability at numerous loci) is uncommon and unlikely to play an important part in the pathogenesis of these neoplasms. This form of instability was more frequent in tetranucleotide than in dinucleotide repeats. To our knowledge, this is the first report of MIN in schwannomas, where it was associated with the spinal localisation of the tumour.

Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis

OBJECTIVES

To evaluate the use of inhaled nitric oxide (NO) in the management of persistent pulmonary hypertension of the newborn.

METHODS

Computerized bibliographic search on MEDLINE, CURRENT CONTENTS and LILACS covering the period from January 1990 to March 1998; review of references of all papers found on the subject. Only randomized clinical trials evaluating nitric oxide and conventional treatment were included. OUTCOMES STUDIED: death, requirement for extracorporeal membrane oxygenation (ECMO), systemic oxygenation, complications at the central nervous system and development of chronic pulmonary disease. The methodologic quality of the studies was evaluated by a quality score system, on a scale of 13 points.

RESULTS

For infants without congenital diaphragmatic hernia, inhaled NO did not change mortality (typical odds ratio: 1.04; 95% CI: 0.6 to 1.8); the need for ECMO was reduced (relative risk: 0.73; 95% CI: 0.60 to 0.90), and the oxygenation was improved (PaO2 by a mean of 53.3 mm Hg; 95% CI: 44.8 to 61.4; oxygenation index by a mean of -12.2; 95% CI: -14.1 to -9.9). For infants with congenital diaphragmatic hernia, mortality, requirement for ECMO, and oxygenation were not changed. For all infants, central nervous system complications and incidence of chronic pulmonary disease did not change.

CONCLUSIONS

Inhaled NO improves oxygenation and reduces requirement for ECMO only in newborns with persistent pulmonary hypertension who do not have diaphragmatic hernia. The risk of complications of the central nervous system and chronic pulmonary disease were not affected by inhaled NO.

Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05 5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

[Tubular duplication of the colon: a case report and review of the literature]

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.

[Megacystis-microcolon-intestinal hypoperistalsis syndrome. A case report]

A case of intestinal pseudo-obstruction in the neonatal period is presented. It is known as Megacistis-microcolon-intestinal Hypoperistalsis Syndrome and is a rare cause of intestinal dismotility.A white female newborn weighing 3,110 g was admitted to the Neonatal Surgical Unit of the Hospital de Base with a small omphalocele and a history of biliary vomit. Abdominal X-rays revealed complete absence of intestinal gas. Exploratory laparotomy was carried out, and the findings were great distension of the bladder, a short poorly developed and malrotated bowel with a non-fixed cecum. Surgical treatment consisted of gastrostomy, sigmoid colostomy, vesicostomy and repair of the omphalocele. Multiple biopsies were done in the small and large bowel. Ganglion cells were present in all specimens. The patient did not tolerate enteral feeding, and total parenteral nutrition was readily initiated. Nonetheless, death occurred on the 51st postoperative day. This is a rare syndrome which presents itself at birth as chronic intestinal obstruction. A postmortem examination confirmed the diagnosis.

Selective surveillance for nosocomial infections in a Brazilian hospital

OBJECTIVE

To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country.

DESIGN

Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists.

SETTING

A university hospital in northeastern Brazil.

PATIENTS

All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection.

RESULTS

The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%.

CONCLUSIONS

This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.

Studies of the acetate kinase-phosphotransacetylase and the butanediol-forming systems in Aerobacter aerogenes

Mutants of Aerobacter aerogenes devoid of acetate kinase and phosphotransacetylase activities were isolated by selection for resistance to fluoroacetate on lactate medium. The mutants were used to study the role of the acetate kinase-phosphotransacetylase system in growth on acetate and glucose. Acetate kinase-negative and phosphotransacetylase-negative mutants were unable to grow on acetate minimal medium. Their growth rates on glucose minimal medium were identical with that of the parent strain under aerobic conditions, but lower growth rates were observed in the mutant strains during anaerobic growth on glucose medium. The mutants were unable to incorporate [2-(14)C]-acetate rapidly while growing on glycerol. Variations in acetate kinase and phosphotransacetylase levels during growth on glucose were studied. The specific activities of the enzymes increased approximately fivefold during aerobic growth on glucose in batch culture. The enzyme levels were also studied during anaerobic growth on glucose at constant pH (pH 5.8 and 7.0). Smaller increases in specific activities were found under these conditions. The role of acetate in the induction of the diacetyl (acetoin) reductase was investigated using a mutant deficient in both acetate kinase and phosphotransacetylase. The effect of pH on the induction of this enzyme during growth on glucose under anaerobic conditions was tested. The data support the idea that free acetic acid is the inducer for the enzymes of the butanediol-forming pathway in A. aerogenes.