Burnout en médicos de atención primaria de la provincia de Cáceres

ObjetivosAnalizar el grado de desgaste profesional en médicos de atención primaria de nuestra provincia y la influencia de diversos factores.DiseñoEstudio transversal, descriptivo y analítico.EmplazamientoProvincial, atención primaria.SujetosTodos los médicos de primaria de la provincia de Cáceres (n = 255).MedicionesCuestionario autoadministrado y anónimo, Maslach Burnout Inventory, que valora: despersonalización (DP), autoestima (PA) y agotamiento emocional (AE); variables sociodemográficas, sociolaborales, preguntas personales y medidas adoptadas si hay estrés laboral. Análisis mediante t de Student y Anova (medias) y ji-cuadrado o Fisher (porcentajes).Resultados principalesUn total de 157 cuestionarios válidos (tasa de respuesta, 62%). La edad media es 41,5 ± 7,2 años; 75% varones, 80,2% casados, 73,2% propietarios, 48,9% ejercen en núcleos urbanos, presión asistencial media de 40,5 ± 16,5 pacientes/día.Los valores medios obtenidos fueron: DP, 8,3 ± 5,8; PA, 35,2 ± 8,4; AE, 22 ± 11,3; un 65,8% presentó elevadas puntuaciones en alguna de las tres.Para AE las medias fueron significativamente superiores en varón, propietario, de centro urbano, más de 10 años de antigüedad o atendía a más de 40 pacientes/día.Un 50% presentaba alteraciones psicofísicas en los 3 meses previos; el 33% soporta mucha burocracia; ambos grupos muestran medias < PA y > AE. Dedicar < 2 h/día al ocio asocia > AE y ser tutor un nivel significativamente superior de burnout. Alteraciones en la esfera familiar o sociolaboral asocian niveles elevados de DP y AE (p < 0,001).ConclusionesCoincidiendo con otros estudios, encontramos un nivel moderado de desgaste profesional en nuestros encuestados. La antigüedad, conflictividad sociolaboral y familiar, y ciertas características personales y laborales se asocian con niveles altos de desgaste.ObjectivesTo analyse the degree of professional burnout in primary care doctors from our province and the effect of various factors.DesignDescriptive and analytic cross-sectional study.SettingPrimary care (PC) in the provinceParticipantsAll the PC doctors in the province of Cáceres (n=255).Main measurements and resultsSelf-administered anonymous questionnaire: the Maslach Burnout Inventory that evaluates Depersonalisation (DP), Self-esteem (SE), and Emotional Exhaustion (EE); social and personal variables, work data, personal questions and measures taken if there was work stress. Student´s t test, ANOVA (means), and Chi-square or Fisher test (percentages) were used. 157 valid questionnaires were returned (62% response rate). Mean age was 41.5 years old±7.2; 75% were male, 80.2% married, 73.2% had tenure, 48.9% worked in towns, and their mean case-load was 40.5±16.5 patients/day. Mean values found were: DP, 8.3±5.8; SE, 35.2±8.4; EE, 22±11.3; 65.8% scored high on one of the three. For EE mean scores were significantly higher in men, doctors with tenure, in towns, those with >10 years seniority or who saw >40 patients a day. 50% had had psycho-physical disorders in the previous 3 months; 33% withstood a lot of bureaucracy; both groups had <SE and >EE averages. Dedicating <2 hours a day to leisure was associated with >EE; and being a tutor with a significantly higher level of burnout. Disorders in the family or social/work sphere were associated with high levels of DP and EE (P<.001).ConclusionsLike other studies, we found a moderate level of burnout in our sample. Seniority, social/labour or family conflict, and certain personal and job characteristics were associated with high burnout

Fisiología de los vasos sanguíneos peneanos: endotelio y disfunción eréctil

Erectile dysfunction (ED) is considered as an early sign of endothelial dysfunction and cardiovascular disease. The present review gives an overview of the physiological factors involved in the regulation of penile vasculature with special regard to the role of the vascular endothelium. Sympathetic nerves maintain flaccidity and mediate detumescence through the release of the vasoconstrictor noradrenaline that down-regulates its own release and that of nitric oxide (NO). The sympathetic cotransmitter neuropeptide Y (NPY) enhances noradrenergic vasoconstriction and also elicits non-NO endothelium-dependent relaxations. &fnof;&iquest;1- adrenoceptor-mediated vasoconstriction involves Ca2+ influx through L-type and receptor-operated (ROC) Ca2+ channels, as well as Ca2+ sensitization mechanisms mediated by protein kinase C (PKC), tyrosine kinases (TKs) and Rho kinase (RhoK) in penile small arteries. Rho kinase (RhoK) can regulate Ca2+ entry in addition to its role in Ca2+ sensitization. Vasodilatation of penile arteries and large veins during erection is mediated by neurally-released NO and the subsequent increased arterial inflow and shear stress activates endothelial NO production through Aktphosphorylation of endothelial NO synthase (eNOS). cyclic guanonin 3L- monophosphate (cGMP)-stimulated K+ efflux through Ca2+-activated (KCa) and voltage-dependent Ca2+ (Kv) channels is involved in the NO relaxant responses of penile arteries and veins, respectively. Phoshodiesterase type 5 (PDE5) inhibitors are potent vasodilators of penile arteries and increase the effects of basally released endothelial NO. Endothelium-dependent relaxations of penile small arteries include an endothelium-derived hyperpolarizing factor (EDHF)-type response which is impaired in diabetes and hypertension associated ED. The changes in structure and function in the penile vasculature in cardiovascular risk situations leading to ED remain to be elucidated.Se considera la disfuncion erectil (DE) una manifestacion temprana de disfuncion endotelial y enfermedad cardiovascular. En el presente trabajo se resumen los factores fisiologicos implicados en la regulacion de los vasos sanguineos peneanos, con especial referencia al papel del endotelio vascular. Los nervios simpaticos mantienen la flacidez y median la detumescencia a traves de la liberacion de noradrenalina que regula su propia liberacion y la de oxido nitrico (NO). El cotransmisor simpatico neuropeptido Y (NPY) potencia la vasoconstriccion noradrenergica y tambien produce relajacion endotelial no mediada por NO. La vasoconstriccion ƒ¿1-adrenergica esta mediada por la entrada de Ca2+ a traves de canales tipo L y canales operados por receptor, asi como tambien mecanismos de sensibilizacion al Ca2+ mediados por la proteina kinasa C (PKC), tirosina kinasas y la kinasa Rho (RhoK). La RhoK puede regular la entrada de Ca2+ ademas de su papel en la sensibilizacion al Ca2+. La vasodilatacion de las arterias y venas grandes durante la ereccion esta mediada por NO de origen nervioso y el posterior incremento del influjo de sangre arterial y shear-stress activa la produccion de NO endotelial a traves de la fosforilacion Akt de la enzima NOS endotelial (eNOS). El eflujo de K+ estimulado por el guanosin monofosfato ciclico (GMPc) a traves de canales de K+ activados por Ca2+ (KCa) y por voltaje (Kv) esta implicado en el efecto relajante del NO en arterias y venas peneanas. Los inhibidores de la fosfodiesterasa tipo 5 (PDE5) son potentes vasodilatadores de las arterias peneanas que incrementan los efectos del NO endotelial liberado basalmente. Las respuestas relajantes dependientes del endotelio incluyen una respuesta de tipo factor hiperolarizante derivado del endotelio (EDHF) en las arterias peneanas pequenas que esta alterada en la DE asociada a la diabetes y la hipertension. Los cambios en estructura y funcion de los vasos sanguineos penenanos en situaciones de riesgo cardiovascular que ocasionan DE estan todavia por clarificar

Development of a natural preservative obtained from male chestnut flowers: Optimization of a heat-assisted extraction technique

The aim of this work was to optimize the conditions for the extraction of phenolic compounds (PC) from male chestnut flowers using heat-assisted extraction in developing extracts rich in PC for potential industrial application as a natural ingredient. The study conditions of time (t), temperature (T), solvent (S, water-ethanol mixtures) and solid-to-liquid ratio (S/L) were optimized. The responses used were obtained from the quantification of the fourteen major individual PC identified by HPLC-DAD-ESI/MS (seven hydrolysable tannins and seven flavonoids). The recovery of hydrolysable tannins was higher than that of flavonoids, with trigalloyl-HHDP-glucoside being the major one. The conditions that maximized the PC content were t = 20.0 ± 37.7 min, T = 25.0 ± 5.7 °C, S = 0.0 ± 8.7% ethanol and S/L = 82.8 g L -1 , producing an extract with 86.5 mg PC g -1 of extract. The results highlight the potential of valorising chestnut flower agro-residues as a productive source of PC for the development of bio-based ingredients for food/pharmaceutical/cosmeceutical industrial applications able to compete with synthetic compounds.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) and FEDER under Programme PT2020 for providing financial support to CIMO (UID/AGR/ 00690/2013), a Caleja (SFRH/BD/93007/2013) grant, and an L. Barros contract. The authors are also grateful to the FEDER-Interreg España-Portugal programme for financial support through the project 0377_Iberphenol_6_E; to the European Regional Development Fund (ERDF) through the Regional Operational Program North 2020, within the scope of Project NORTE-01-0145-FEDER-023289: DeCodE. The authors thank the GAIN (Xunta de Galicia) for providing financial support (P.P. 0000 421S 140.08) to M.A. Prieto through a postdoctoral (modality B) graninfo:eu-repo/semantics/publishedVersio

Diminished neurogenic femoral artery vasoconstrictor response in a Zucker obese rat model: differential regulation of NOS and COX derivatives

Objective: Peripheral arterial disease is one of the macrovascular complications of type 2 diabetes mellitus. This study addresses femoral artery regulation in a prediabetic model of obese Zucker rats (OZR) by examining cross-talk between endothelial and neural factors. Methods and Results: Arterial preparations from lean (LZR) and OZR were subjected to electrical field stimulation (EFS) on basal tone. Nitric oxide synthase (NOS) and cyclooxygenase (COX) isoform expression patterns were determined by immunohistochemical labelling and Western blotting. Results indicate significantly reduced noradrenergic contractions in preparations from OZR compared with those of LZR. Functional inhibition of endothelial NOS (eNOS) indicated a predominant role of this isoform in LZR and its modified activity in OZR. Neural (nNOS) and inducible NOS (iNOS) were activated and their expression was higher in femoral arteries from OZR. Neurotransmission modulated by largeconductance Ca2+-activated (BKCa) or voltage-dependent (KV) K+ channels did not seem compromised in the obese animals. Endothelial COX-1 and COX-2 were expressed in LZR and an additional adventitial location of COX-2 was also observed in OZR, explaining the higher COX-2 protein levels detected in this group. Prostanoids derived from both isoforms helped maintain vasoconstriction in LZR while in OZR only COX-2 was active. Superoxide anion inhibition reduced contractions in endothelium-intact arteries from OZR. Conclusions: Endothelial dysfunction led to reduced neurogenic vasoconstriction in femoral arteries from OZR. In a setting of obesity, NO-dependent nNOS and iNOS dilation activity could be an alternative mechanism to offset COX-2- and reactive oxygen species-mediated vasoconstriction, along with impaired endothelial NO relaxation

Implementación de un sistema b-learning en la enseñanza práctica de Fisiopatología

Fac. de FarmaciaFALSEsubmitte

Role of Neural NO Synthase (nNOS) Uncoupling in the Dysfunctional Nitrergic Vasorelaxation of Penile Arteries from Insulin-Resistant Obese Zucker Rats

Objective: Erectile dysfunction (ED) is considered as an early sign of vascular disease due to its high prevalence in patients with cardiovascular risk factors. Endothelial and neural dysfunction involving nitric oxide (NO) are usually implicated in the pathophysiology of the diabetic ED, but the underlying mechanisms are unclear. The present study assessed the role of oxidative stress in the dysfunctional neural vasodilator responses of penile arteries in the obese Zucker rat (OZR), an experimental model of metabolic syndrome/prediabetes. Methods and Results: Electrical field stimulation (EFS) under non-adrenergic non-cholinergic (NANC) conditions evoked relaxations that were significantly reduced in penile arteries of OZR compared with those of lean Zucker rats (LZR). Blockade of NO synthase (NOS) inhibited neural relaxations in both LZR and OZR, while saturating concentrations of the NOS substrate L-arginine reversed the inhibition and restored relaxations in OZR to levels in arteries from LZR. nNOS expression was unchanged in arteries from OZR compared to LZR and nNOS selective inhibition decreased the EFS relaxations in LZR but not in OZR, while endothelium removal did not alter these responses in either strain. Superoxide anion production and nitro-tyrosine immunostaining were elevated in the erectile tissue from OZR. Treatment with the NADPH oxidase inhibitor apocynin or acute incubation with the NOS cofactor tetrahydrobiopterin (BH4) restored neural relaxations in OZR to levels in control arteries, while inhibition of the enzyme of BH4 synthesis GTP-cyclohydrolase (GCH) reduced neural relaxations i

Impacto de la implementación del aprendizaje basado en problemas en combinación con las prácticas de laboratorio clínico y virtual de Fisiopatología para el desarrollo de competencias profesionales

Sección Deptal. de Fisiología (Farmacia)Fac. de FarmaciaFALSEsubmitte

Implementación del aprendizaje basado en problemas (ABP) en la enseñanza práctica de la fisiología del sistema digestivo

Sección Deptal. de Fisiología (Farmacia)Fac. de FarmaciaFALSEsubmitte

Óxido nítrico y disfunción eréctil

Óxido nítrico y disfunción eréctil