Emotional dissonance and exhaustion among healthcare professionals: the role of the perceived quality of care

Objectives The aim of this exploratory study was to analyze the association between emotional dissonance and emotional exhaustion among healthcare professionals, and the mediating role of the perceived quality of care in this relationship. Material and Methods Self-report questionnaires were administered to 724 healthcare workers. The measurement model was tested and the mediation hypothesis was verified through hierarchical multiple regression analyses. Bootstrapping was used to construct confidence intervals to evaluate the mediation effects. Results Emotional dissonance was significantly related to emotional exhaustion, and the perceived quality of care was negatively related to emotional exhaustion. The perceived quality of care had a partial mediating effect on the relationship between emotional dissonance and emotional exhaustion. Emotional dissonance had a significant effect on emotional exhaustion, and the perceived quality of care was a mediating factor in this relationship among healthcare professionals. Conclusions The management of the perceived quality of care may be helpful in the prevention of burnout and distress in the workplace. Int J Occup Med Environ Health. 2019;32(6):841–5

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Caratterizzazione strutturale e funzionale di AHb1 ed AHb2, emoglobine non simbiontiche da Arabidopsis thaliana

Le globine costituiscono una famiglia evolutiva di grandi dimensioni. Il numero di famiglie globiniche note \ue8 cresciuto progressivamente a partire dagli anni \u201970, quando esso si limitava principalmente alla mioglobina (Mb) e all\u2019emoglobina (Hb) dei vertebrati, e alle leg-emoglobine (legHbs) o emoglobine simbiontiche (sHbs), delle piante leguminose. La recente scoperta di nuovi membri in diverse ed antiche forme di vita, ha permesso di ampliare ulteriormente gli orizzonti evolutivi del mondo globinico ed ha inoltre rinvigorito le ricerche delle funzioni globiniche oltre al classico immagazzinamento e trasporto di ossigeno. In particolare, la scoperta nel mondo vegetale delle cosiddette emoglobine non simbiontiche (nsHbs), presenti anche in piante non leguminose, ha permesso di trovare un chiaro razionale filogenetico per le emoglobine simbiontiche (sHbs), la cui origine evolutiva era rimasta fino ad allora estremamente difficile da spiegare. Sia le sHbs, che le nsHbs, infatti, si sarebbero evolute a partire da un\u2019emoglobina vegetale primordiale, che avrebbe poi originato per duplicazione genica e successiva divergenza delle sequenze, due classi filogenetiche, denominate classe 1 e classe 2. Si ritiene che nelle leguminose, dove si ritrovano i principali esempi di emoglobine di trasporto dell\u2019ossigeno nelle piante, le emoglobine di classe 2 sarebbero andate incontro ad una specializzazione funzionale notevole, evolvendosi interamente nelle cosiddette leg-emoglobine (legHbs), proteine coinvolte nella simbiosi tra queste piante ed i batteri azotofissatori, e denominate pertanto anche emoglobine simbiontiche (sHbs). La specializzazione funzionale delle legHbs (o sHbs) avrebbe trovato i suoi determinanti molecolari non solo nella divergenza della struttura primaria rispetto agli altri membri di classe 2, ma anche, e soprattutto, in una differente organizzazione strutturale del ferro eminico: infatti, mentre le altre emoglobine vegetali, in assenza di ligandi esogeni, presentano esacoordinazione del ferro, le legHbs presentano pentacoordinazione del ferro, lasciando libero il sesto sito di coordinazione. Mentre le legHbs, essendo note da tempo, sono state ben caratterizzate, le Hb esacoordinate, essendo state scoperte pi\uf9 recentemente, non sono state ancora associate ad una funzione fisiologica univoca nelle piante; quello che si pu\uf2 escludere con certezza, sulla base della loro ubiquitarieta\u2019 nel mondo vegetale, \ue8 che queste emoglobine siano in qualche modo coinvolte nel processo simbiontico, e pertanto, esse vengono anche denominate genericamente Hbs non simbiontiche (nsHbs). Come per le sHbs, che vengono sovraespresse specificamente a livello del nodulo radicale, anche per le nsHbs vi \ue8 tessuto-specificit\ue0 dell\u2019espressione, ma questa specificit\ue0 \ue8 classe-dipendente, ossia varia a seconda della classe considerata: infatti, i prodotti genici di classe 1 vengono sovraespressi in condizioni di ipossia o in presenza di NO3 -, a livello delle radici o delle foglie delle rosette; i geni di classe 2, invece, vengono indotti in condizioni di ipotermia in tutta la pianta. L\u2019ubiquitariet\ue0 delle nsHbs nel mondo vegetale, da un lato, e la tessuto-specificit\ue0 dell\u2019espressione, dall\u2019altro, sottolineano la grande importanza funzionale di queste proteine e la presenza di ruoli diversi tra i membri di questa famiglia. Denominatore comune, tuttavia, della funzionalit\ue0 delle nsHbs \ue8 senza dubbio, il possesso di un\u2019elevatissima affinit\ue0 per l\u2019ossigeno, di molto superiore a quella della controparte simbiontica, e riconducibile principalmente ad una ridotta costante cinetica di dissociazione dell\u2019ossigeno (koff). I residui stabilizzatori della tasca distale dell\u2019eme giocano un ruolo chiave nel determinare la ridotta koff del ligando, stabilendo un legame idrogeno con il ligando stesso e, pertanto, rallentandone la cinetica di dissociazione. La necessit\ue0 per una stabilizzazione chimica dell\u2019ossigeno sar\ue0 tanto maggiore, quanto maggiore sar\ue0 la parziale carica negativa sull\u2019ossigeno, o, in altre parole, quanto pi\uf9 l\u2019ossigeno sar\ue0 attivato. Evidenze riguardanti funzioni enzimatiche antiche basate sull\u2019attivazione dell\u2019ossigeno stanno diventando progressivamente pi\uf9 numerose; una di queste, \ue8 rappresentata dalla conversione enzimatica diossigenasica, definita funzione NOD, dell\u2019\ub7NO a nitrato, rilevata nelle flavoemoglobine batteriche e successivamente confermata ed estesa anche alla Hb e Mb. In tutti i casi finora esaminati, la funzione NOD ed il meccanismo catalitico associato sembrano dipendere pesantemente dal grado di attivazione dell\u2019ossigeno. Nel complesso, quindi, le due prerogative imprescindibili per la funzionalit\ue0 di una nsHb sono l\u2019esacoordinazione e l\u2019alta affinit\ue0 per l\u2019ossigeno. Lo studio in vitro delle implicazioni strutturali e funzionali di queste due propriet\ue0 pu\uf2 restituire importanti informazioni circa il ruolo di queste proteine in vivo, ed eventualmente confermare o smentire il loro possibile coinvolgimento in attivit\ue0 enzimatiche di tipo NOD. Con questo obiettivo, ci si \ue8 pertanto rivolti ad uno studio di struttura e funzione per due nsHb da Arabidopsis thaliana, denominate AHb1 ed AHb2. Mediante tecniche spettroscopiche di assorbimento UV-Vis e di Raman risonante \ue8 stato possibile dimostrare che, in assenza di ligando, il grado di esacoordinazione varia tra le due proteine e che, mentre AHb1 \ue8 presente come miscela di due forme, una esacoordinata, e l\u2019altra pentacoordinata, AHb2, nelle stesse condizioni, \ue8 completamente esacoordinata. Inoltre, l\u2019analisi spettroscopica in dicroismo circolare della regione Soret per le due proteine ha evidenziato significative differenze tra le due isoforme anche a livello dell\u2019organizzazione strutturale della tasca di legame dell\u2019eme, sottolineando, d\u2019altra parte, la vicinanza filogenetica di AHb2 alle legHbs. L\u2019analisi del comportamento autoossidativo di AHb1 in funzione del pH ha evidenzato cinetiche pi\uf9 rapide rispetto a quelle delle proteine di trasporto, suggerendo per questa isoforma un grado di specializzazione funzionale che va verso l\u2019attivazione, pi\uf9 che verso la stabilizzazione dell\u2019ossigeno. Le evidenze risultanti dall\u2019autoossidazione, in particolare relativamente all\u2019attivazione del ligando ed al grado di polarizzazione del legame ferro-ligando, hanno trovato conferma nello studio Raman dei complessi di AHb1 con CO...not availabl

From clinical to molecular diagnosis: relevance of diagnostic strategy in two cases of branchio-oto-renal syndrome - case report

Background Branchio-oto-renal syndrome (BOR) is an autosomal dominant disorder characterized by deafness, branchiogenic malformations and renal abnormalities. Pathogenic variants in EYA1, SIX1 and SIX5 genes cause almost half of cases; copy number variants (CNV) and complex genomic rearrangements have been revealed in about 20% of patients, but they are not routinely and commonly included in the diagnostic work-up. Case presentation We report two unrelated patients with BOR syndrome clinical features, negative sequencing for BOR genes and the identification of a 2.65 Mb 8q13.2-13.3 microdeletion. Conclusions We highlight the value of CNV analyses in high level of suspicion for BOR syndrome but negative sequencing for BOR genes and we propose an innovative diagnostic flow-chart to increase current detection rate. Our report confirms a mechanism of non-allelic homologous recombination as causing this recurrent 8q13.2-13.3 microdeletion. Moreover, considering the role of PRDM14 and NCOA2 genes, both involved in regulation of fertility and deleted in our patients, we suggest the necessity of a longer follow-up to monitor fertility issues or additional clinical findings