Lleialtats contraposades? El compromís dels metges amb l'hospital i amb la professió.

Aquest treball ha estat motivat per l'interès a aprofundir el coneixement de les relacions entre els metges i l'hospital on treballen, com a aspecte central de la gestió dels hospitals. Al llarg dels darrers anys, diferents actors del sistema sanitari espanyol i català han manifestat, de manera reiterada, que els metges hospitalaris se senten desil·lusionats i descontents com a professionals i poc compromesos amb l'hospital on exerceixen. Els metges viuen una exigència creixent com a professionals i com a membres de l'hospital, que també està sotmès a una pressió per millorar-ne la seva eficiència. La doble demanda de lleialtat que viuen els metges ―aquesta exigència de compromís amb la professió i amb l'organització― i la manera com són capaços de compatibilitzar aquests dos compromisos són els aspectes sobre els quals he centrat el meu treball. Per portar a terme aquest estudi, he analitzat el grau de compromís dels metges amb l'hospital i amb els seus focus més rellevants: el servei i el cap de servei. He analitzat també el grau de compromís amb la professió i les diferents formes de compatibilitzar els dos compromisos. Per a això, he utilitzat el qüestionari de Meyer, Allen i Smith (1993) de compromís organitzatiu i professional, adaptat i validat per al context català, i l'he enviat a 1.650 metges de nou hospitals de la xarxa d'utilització pública de Catalunya i n'he obtingut un 40,3% de respostes. D'altra banda, he tingut entrevistes semiestructurades i converses informals sobre la matèria amb diversos facultatius, la qual cosa el que juntament amb els meus coneixements i experiència professional en el sector, m'ha permès aprofundir en els resultats obtinguts de l'anàlisi quantitativa. Com a conclusions més importants del meu treball, destaco que, des d'una perspectiva global, els metges se senten compromesos amb l'hospital, i aquest compromís, que fonamentalment és de caràcter afectiu i degut a la percepció dels sacrificis que han fet al llarg de la seva trajectòria, s'incrementa amb el temps, al llarg de la seva carrera professional. Es confirma la importància del servei i del cap de servei com a focus del compromís dels metges, en què destaca que el vincle amb el servei és intens, i per contra, el lligam amb el cap de servei és més feble i decau amb la trajectòria professional del metge. De la mateixa manera, també es confirma la intensitat del compromís dels metges amb la seva professió. Finalment, s'obtenen quatre clústers, que corresponen a quatre patrons de resposta diferents dels metges amb relació a la demanda de doble compromís, i només un dels clústers expressa una incompatibilitat clara entre els dos compromisos.Este trabajo ha estado motivado por el interés en profundizar en el conocimiento de las relaciones entre los médicos y el hospital en el que trabajan, como aspecto central de la gestión de los hospitales. En el curso de los últimos años, diferentes actores del sistema sanitario español y catalán han manifestado de manera reiterada que los médicos hospitalarios se sienten desilusionados y descontentos como profesionales y poco comprometidos con el hospital en el que ejercen. Los médicos viven una exigencia creciente como profesionales y como miembro del hospital, sometido también a una presión para mejorar su eficiencia. La doble demanda de lealtad que viven los médicos, esta exigencia de compromiso con la profesión y con la organización, y la manera en que son capaces de compatibilizar estos dos compromisos, es el aspecto sobre el que he centrado mi trabajo. Para llevar a término este estudio he analizado el grado de compromiso de los médicos con el hospital y con los focos más relevantes, el servicio i el jefe de servicio. He analizado también el grado de compromiso con la profesión y las diferentes formes de compatibilidad de los dos compromisos. Para ello he utilizado el cuestionario de Meyer, Allen i Smith (1993) de compromiso organizativo y profesional, adaptado y validado en el contexto catalán, y lo he enviado a 1.650 médicos de 9 hospitales de la red de utilización pública de Catalunya, obteniendo un 40,3% de respuestas. Por otro lado, he mantenido entrevistes semiestructuradas y conversaciones informales sobre la temática con diversos facultativos, lo que junto con mi conocimiento y experiencia profesional en el sector me ha permitido profundizar en los resultados obtenidos en el análisis cuantitativo. Como a conclusiones más importantes de mi trabajo destaco que desde una perspectiva global, los médicos se sienten comprometidos con el hospital y este compromiso, que fundamentalmente es de carácter afectivo y debido a la percepción de los sacrificios que han efectuado a lo largo de su trayectoria, se incrementa con el tiempo, en el curso de su carrera profesional. Se confirma la importancia del servicio y del jefe de servicio como foco del compromiso de los médicos, destacando la intensidad del vínculo con el servicio y por el contrario, que el vínculo con el jefe de servicio es más débil y decae a través de la trayectoria profesional del médico. De la misma manera, también se confirma la intensidad del compromiso de los médicos con su profesión. Finalmente, se obtienen cuatro clústeres, que corresponden a cuatro patrones de respuesta diferentes de los médicos en relación a la demanda de doble compromiso y sólo uno de los clústeres expresa una clara incompatibilidad entre los dos compromisos.This work has been motivated by an interest in exploring the relationships between doctors and the hospital in which they work, as a central aspect of hospital management. In the last few years, different actors from the Spanish and Catalan health care system have reiterated that hospital doctors feel disappointed and dissatisfied as professionals and little committed to the hospital where they work. Doctors are coming under increasing demands as professionals and as members of hospitals, which are also under pressure to improve efficiency. The double demand of loyalty that doctors are experiencing - demands of commitment to the profession and to the organisation - and the way in which they are able to make both commitments compatible are the aspects on which I have focused my work. In order to carry out this study, I have analysed the degree of doctors' commitment to their hospital and its most relevant focal point: the service and the service manager. I have also analysed the degree of commitment to the profession and the different forms of making both commitments compatible. To do so, I have used the Meyer, Allen and Smith (1993) organisational and professional commitment questionnaire, adapted and validated for the Catalan context; I sent it to 1,650 doctors at nine hospitals in the public health network throughout Catalonia, and have obtained 40.3% responses. On the other hand, I have conducted semi-structured interviews and held informal conversations on the matter with several doctors, which, along with my knowledge and professional experience in the sector, has allowed me to further examine the quantitative analysis results obtained. As the most important conclusions of my work from a global perspective, I emphasise that doctors are committed to their hospitals and that this commitment which is fundamentally affective in nature - and the perception of the sacrifices that doctors make throughout their career - increases throughout their professional career. The importance of the service and the service manager as a focus of doctors' commitment is confirmed, which emphasises that the bond with the service is intense, whereas, on the contrary, the bond with the service manager is weaker and decreases throughout a doctor's professional careers. In the same way, the intensity of doctors' commitment to their profession is also confirmed. Finally, four clusters are obtained corresponding to four patterns of different answer from doctors in relation to this double commitment, and only one of the clusters expresses a clear incompatibility between both commitments

Blue-green to near-IR switching electroluminescence from Si-rich silicon oxide/nitride bilayer structures

Blue green to near-IR switching electroluminescence (EL) has been achieved in a metal-oxide-semiconductor light emitting device, where the dielectric has been replaced by a Si-rich silicon oxide/nitride bilayer structure. To form Si nanostructures, the layers were implanted with Si ions at high energy, resulting in a Si excess of 19%, and subsequently annealed at 1000 °C. Transmission electron microscopy and EL studies allowed ascribing the blue-green emission to the Si nitride related defects and the near-IR band with the emission of the Si-nanoclusters embedded into the SiO2 layer. Charge transport analysis is reported and allows for identifying the origin of this twowavelength switching effect

A protein-coding gene expression atlas from the brain of pregnant and non-pregnant goats

Background: The brain is an extraordinarily complex organ with multiple anatomical structures involved in highly specialized functions related with behavior and physiological homeostasis. Our goal was to build an atlas of protein-coding gene expression in the goat brain by sequencing the transcriptomes of 12 brain regions in seven female Murciano-Granadina goats, from which three of them were 1-month pregnant. Results: Between 14,889 (cerebellar hemisphere) and 15,592 (pineal gland) protein-coding genes were expressed in goat brain regions, and most of them displayed ubiquitous or broad patterns of expression across tissues. Principal component analysis and hierarchical clustering based on the patterns of mRNA expression revealed that samples from certain brain regions tend to group according to their position in the anterior-posterior axis of the neural tube, i.e., hindbrain (pons and medulla oblongata), midbrain (rostral colliculus) and forebrain (frontal neocortex, olfactory bulb, hypothalamus, and hippocampus). Exceptions to this observation were cerebellum and glandular tissues (pineal gland and hypophysis), which showed highly divergent mRNA expression profiles. Differential expression analysis between pregnant and non-pregnant goats revealed moderate changes of mRNA expression in the frontal neocortex, hippocampus, adenohypophysis and pons, and very dramatic changes in the olfactory bulb. Many genes showing differential expression in this organ are related to olfactory function and behavior in humans. Conclusion: With the exception of cerebellum and glandular tissues, there is a relationship between the cellular origin of sampled regions along the anterior-posterior axis of the neural tube and their mRNA expression patterns in the goat adult brain. Gestation induces substantial changes in the mRNA expression of the olfactory bulb, a finding consistent with the key role of this anatomical structure on the development of maternal behavior

Building a network of TP53 and IGHV testing reference centers across Spain: the Red53 initiative

© The Author(s) 2021.Among the different biomarkers predicting response in chronic lymphocytic leukemia (CLL), the most influential parameters are the mutational status of the IGHV genes and the presence of TP53 gene disruptions. Nevertheless, these important assessments are not readily available in most centers dealing with CLL patients. To provide this molecular testing across the country, the Spanish Cooperative Group on CLL (GELLC) established a network of four analytical reference centers. A total of 2153 samples from 256 centers were analyzed over a period of 30 months. In 9% of the patients, we found pathological mutations in the TP53 gene, whereas 48.96% were classified as IGHV unmutated. Results of the satisfaction survey of the program showed a Net Promoter Score of 85.15. Building a national network for molecular testing in CLL allowed the CLL population a broad access to complex biomarkers analysis that should translate into a more accurate and informed therapeutic decision-making.This work was supported in part by Janssen Pharmaceutical Companies of Johnson & Johnson. MC holds a contract from Ministerio de Ciencia, Innovación y Universidades (RYC-2012-12018)

Histone H1 depletion triggers an interferon response in cancer cells via activation of heterochromatic repeats

Histone H1 has seven variants in human somatic cells and contributes to chromatin compaction and transcriptional regulation. Knock-down (KD) of each H1 variant in breast cancer cells results in altered gene expression and proliferation differently in a variant specific manner with H1.2 and H1.4 KDs being most deleterious. Here we show combined depletion of H1.2 and H1.4 has a strong deleterious effect resulting in a strong interferon (IFN) response, as evidenced by an up-regulation of many IFN-stimulated genes (ISGs) not seen in individual nor in other combinations of H1 variant KDs. Although H1 participates to repress ISG promoters, IFN activation upon H1.2 and H1.4 KD is mainly generated through the activation of the IFN response by cytosolic nucleic acid receptors and IFN synthesis, and without changes in histone modifications at induced ISG promoters. H1.2 and H1.4 co-KD also promotes the appearance of accessibility sites genome wide and, particularly, at satellites and other repeats. The IFN response may be triggered by the expression of noncoding RNA generated from heterochromatic repeats or endogenous retroviruses upon H1 KD. In conclusion, redundant H1-mediated silencing of heterochromatin is important to maintain cell homeostasis and to avoid an unspecific IFN response

Priorización de medidas para la consolidación de la toma de decisiones compartidas en las prestaciones del Sistema Nacional de Salud español

Identify and prioritize according to their relevance, measures, interventions and indispensable instruments to support the establishment of a strategic framework in the Spanish National Health System to enable the responsible and informed exercise of the autonomy of its users and patients for shared decision-making. Group consultation, structured according to procedures adapted from brainstorming techniques, nominal group and Rand consensus method. The 10 panellists proposed 53 possible actions focusing on "macro" structural measures (legal support and explicit prioritization of shared decision-making on health policy, curricular measures of the teaching system and dynamisation of cultural change), "meso" (generation and dissemination of accredited information by specific research lines and instruments to help shared decision-making), and "micro" activities (measures to stimulate the introduction of shared decision-making in the agency relationship with citizen and users of the healthcare system). The consensus emerging from the consultation points to the need to incorporate into the strategic priorities of health policy, structural measures that support and encourage the development of shared decision-making in a number of specific areas of evolution and change in the relationship between health professionals and patients as an attribute of quality in access to the benefits and services of the public healthcare system