Factors contributing to medical errors and incidents among hospital nurses --nurses' health, quality of life, and workplace predict medical errors and incidents--

The purpose of this study was to examine the correlation of medical incidents and errors among nurses with factors describing their lifestyle, health, and work environment. We analyzed questionnaires completed by 6,445 female hospital nurses engaged in shift work in Japanese hospitals with general wards of more than 200 beds. Logistic regression analysis indicated that the risk for medical incidents/errors was predicted by being under treatment, absence due to sickness in the past 6 months, workplace, break times during night shift, bodily pain, and role (emotional). These results indicate that to prevent the occurrence of medical incidents/errors, it is necessary to regard current/recent illness, bodily pain, and role (emotional) as a nurse's personal problems and break times during the night shift and workplace as administrative problems.     

Accessibility to tuberculosis treatment: assessment of health service performance

The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeir?o Preto, countryside of S?o Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.     

Hepatic stellate cells regulate immune response by way of induction of myeloid suppressor cells in mice

Although organ transplants have been applied for decades, outcomes of somatic cell transplants remain disappointing, presumably due to lack of appropriate supporting stromal cells. Thus, cotransplantation with liver stromal cells, hepatic stellate cells (HSC), achieves long-term survival of islet allografts in mice by way of induction of effector T cell apoptosis and generation of regulatory T (Treg) cells. In this study we provide evidence both in vitro and in vivo that HSC can promote generation of myeloid-derived suppressor cells (MDSC). HSC-induced MDSC demonstrate potent immune inhibitory activity. Induction of MDSC is dependent on an intact interferon gamma signaling pathway in HSC and is mediated by soluble factors, suggesting that the specific tissue stromal cells, such as HSC, play a crucial role in regulating immune response by way of inflammation-induced generation of MDSC. Large amounts of MDSC can be propagated in vitro from bone marrow-derived myeloid precursor cells under the influence of HSC. CONCLUSION: Cotransplantation with in vitro generated MDSC can effectively protect islet allografts from host immune attack. Local delivery of potent immune suppressor cells for cell transplants holds great clinical application potential.     

Liver-specific mitochondrial respiratory chain complex I deficiency in fatal influenza encephalopathy

We report on a 4-year-old boy who died from influenza encephalopathy. The clinical course and microscopic findings of the autopsied liver were compatible with Reye's syndrome. We examined the mitochondrial respiratory chain function by blue native polyacrylamide gel electrophoresis (BN-PAGE), western blotting, and respiratory chain enzyme activity assays. The activity of liver respiratory chain complex (CO) I was markedly decreased (7.2% of the respective control activity); whereas, the other respiratory chain complex activities were substantially normal (CO II, 57.9%; CO III, 122.3%; CO IV, 161.0%). The activities of CO I-IV in fibroblasts were normal (CO I, 82.0%; CO II, 83.1%; CO III, 72.9%; CO IV, 97.3%). The patient was diagnosed with liver-specific complex I deficiency. This inborn disorder may have contributed to the fatal outcome. We propose that relying only on fibroblast respiratory chain complex activities may lead to the misdiagnosis of liver-specific complex I deficiency.