Relación de la calidad de vida profesional y el burnout en médicos de atención primaria

ObjetivoConocer la relación, si es que la hay, entre la calidad de vida profesional (CVP) y burnout de facultativos de atención primaria.DiseñoEstudio transversal mediante cuestionario CVP-35 y MBI (Maslach Burnout Inventory), por correo postal.ÁmbitoTres centros urbanos y 3 zonas de atención rural. Participó un total de 131 profesionalesMedicionesDel CVP-35 se obtienen puntuaciones que van de 0 (mínimo) a 10 (máximo). El cuestionario Maslach clasifica en nivel alto, medio y bajo de cada dimensión.ResultadosContestó a la encuesta el 71,7%. La edad media era de 44 años y la media de tarjetas sanitarias, 1.339. El número de consultas/día fue de 37; en cuanto las visitas domiciliarias, realizaban una diaria. El valor medio de la CVP fue de 4,48 (intervalo de confianza [IC] del 95%, 4,08-4,88). La percepción de la demanda tuvo una puntuación de 5,9 (IC del 95%, 5,6-6,1); la motivación intrínseca del profesional se situó en 6,5 (IC del 95%, 6,2-6,7) y el apoyo de los directivos en 3,8 (IC del 95%, 3,6-4,1). En cuanto al cuestionario MBI, se observó una despersonalización alta en el 54,3%, cansancio emocional alto en un 56,2% y realización personal alta en el 9,3%. La correlación mayor fue entre las demandas en el puesto y el cansancio emocional (r=0,6; p<0,0001), la motivación intrínseca y la realización personal (r=0,46; p<0,0001) y la calidad de vida profesional frente al cansancio emocional (r=−0,4; p<0,0005).ConclusionesLa CVP y el burnout miden dimensiones diferentes pero relacionadas. Por tanto, su utilidad es diferente en función de los objetivos. Con estos instrumentos se pueden identificar elementos clave de la gestión de personas que pueden mejorar la calidad de vida profesional.ObjectiveTo know the relationship, if this exists, between the quality of professional life (CPL) and the burnout of primary health care staff.DesignTransversal study employing CVP-35 test and MBI (Maslach Burnout Inventory), both sent by postmail.Setting3 urban centers and 3 rural centers. Total: 131 professionals.MeasuresIn the CVP-35 test, scores from 0 (minimum) to 100 (maximum) are obtained. Maslach categorised each dimension into high, medium and low level.Results71.7% answered. Medium age 44 years, average of 1339 sanitary cards. The number of visits/day was 37, home visits 1 per day. The CVP average was 4.48 (95% CI, 4.08-4.88). The damage perception in the post 5.9 (95% CI, 5.6-6.1); the professional intrinsic motivation 6.5 (95% CI, 6.2-6.7), and the manager support 3.8 (95% CI, 3.6-4.1). MBI: high depersonalization 54.3%, emotional exhaustion (r=0.6; P<.0001), intrinsic motivation, and personal accomplishment (r=0.46; P<.0001) and profesional quality of life front emotional fatigue (r= −0.4; P<.0005).ConclusionsCPL and burnout measure different but related dimensions. Therefore, its utility is dependent on the objectives. Target elements, which can improve the quality of professional life, can be identified from these tools

Respuesta de material genético de Paulownia spp a tratamiento silvicultural, como estrategia para evaluar su adaptabilidad a condiciones climáticas de estepa espinosa Montano Bajo, Ecuador/Response of Paulownia spp genetic material to silviculture, as a s

El propósito de la investigación consistió en estudiar la respuesta de Paulownia elongata, P. fortunei y un híbrido (Paulownia fortunei x elongata) a un sistema de recepa y evaluar el desempeño de los brotes juveniles, como estrategia para confirmar su adaptabilidad a las condiciones bioclimáticas de estepa espinosa Montano Bajo. El ensayo se instaló en diciembre del 2 015, en una plantación clonal de dos años de edad, plantada por INIAP y ESPOCH en la granja Tunshi, Ecuador. Se establecieron 9 bloques por especie para un total de 27 parcelas experimentales, con 9 observaciones por parcela neta. El tratamiento silvicultural ejecutado fue poda de renovación/recepa, realizando un corte del tallo en bisel a dos centímetros de altura desde el suelo. Las variables evaluadas fueron: Días a la brotación, número de brotes por tocón, diámetro a la base del brote y altura del brote. Los tres materiales estudiados respondieron positivamente a la práctica silvicultural, 90% de tocones brotados a los 61 días de haber realizado el ensayo. A los 29 días de la recepa ya se encontraron brotes epicórmicos en las tres especies de Paulownia, presentando entre 1 y 13 brotes por tocón. En crecimiento dasométrico, P. fortunei experimentó el mayor promedio en altura (81,85 cm), seguida por P. elongata (70,51 cm) y Paulownia hibrido (65,53 cm), siendo 3,5 veces mayor a los promedios de altura y 4 veces mayor en diámetro a la altura de la base del tallo, de los reportados en el primer año de evaluación. Estos resultados avizoran probables comportamientos adecuados y adaptación como una especie forestal-agroforestal de interés para características similares del sitio de estudio. This study is aimed to evaluate the response Paulownia elongata, P. fortunei and hibrid (Paulownia fortunei x elongata) to renewal pruning system and evaluate to develop the juvenile sprout of plants as a strategy to assess its adaptability to the bioclimatic conditions of thorny steppe Montano Bajo, Ecuador. The essay was install in December, 2 015 in one clonal plantation two years old, establish by INIAP and ESPOCH in Tunshi farm, Ecuador. This was established in nine blocks per species for a total of 27 experimental plots with nine observations per net plot. The selviculture treatment executed was renewal pruning, making a bevel cut stem two feet high from the ground. The variables evaluated were: Days sprouting, number of sprouts per stump diameter at the base of the outbreak and height of the outbreak. The three materials studied responded positively to silvicultural practice and 90% of erupted stumps at 61 days responded to development essay. At 29 days from the development the recepa presented epicormics sprout in the three Paulownia species; P. fortunei experienced the greatest average height (81,85 cm), followed by P. elongata (70,51 cm) and hybrid Paulownia (65,53 cm), being 3,5 times greater than the average height and 4 times greater in diameter at the base than those reported in the first year evaluation, these results foresee probable behaviors adapted and adequate as a forestry-agroforestry species of interest from the site of study. Palabras clave: recepa, poda, silvicultura, dendroenergía. Keywords: recepa, pruning, silviculture, wood energy

Third-order nonlinear optical response and photoluminescence characterization of tellurite glasses with different alkali metal oxides as network modifiers

Studies of the third-order nonlinear optical properties in TeO(2)-MO-R(2)O glasses with three different alkali metal oxides R(2)O (R - Li, Na, K) as network modifiers and two network intermediates MO (M - Zn, Mg) are reported. The influence of such modifiers and intermediates on the nonlinear optical properties of these glasses was investigated using the standard Z-scan and the thermally managed Z-scan techniques under femtosecond pulse excitation at 800 nm. For different modifiers and intermediates, the nonlinear refraction indices n(2) of these glasses varied in the range 1.31-2.81 (x10(-15) cm(2)/W). It was found that n(2) increases as the ionic radius of both network modifiers and intermediates decreases. Furthermore, the measurements show that the contribution from thermo-optical effects to the nonlinear refraction index is negligible for all of the studied glass compositions. In addition, the effect of modifiers and intermediates in the formation of localized states in the vicinity of the optical bandgap was also studied through photoluminescence experiments. These experiments revealed the presence of two emission bands (red and blue) originating from these localized states that can be populated after optical excitation and subsequent relaxation

Cannabinoid pharmacology/therapeutics in chronic degenerative disorders affecting the central nervous system.

The endocannabinoid system (ECS) exerts a modulatory effect of important functions such as neurotransmission, glial activation, oxidative stress, or protein homeostasis. Dysregulation of these cellular processes is a common neuropathological hallmark in aging and in neurodegenerative diseases of the central nervous system (CNS). The broad spectrum of actions of cannabinoids allows targeting different aspects of these multifactorial diseases. In this review, we examine the therapeutic potential of the ECS for the treatment of chronic neurodegenerative diseases of the CNS focusing on Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and amyotrophic lateral sclerosis. First, we describe the localization of the molecular components of the ECS and how they are altered under neurodegenerative conditions, either contributing to or protecting cells from degeneration. Second, we address recent advances in the modulation of the ECS using experimental models through different strategies including the direct targeting of cannabinoid receptors with agonists or antagonists, increasing the endocannabinoid tone by the inhibition of endocannabinoid hydrolysis, and activation of cannabinoid receptor-independent effects. Preclinical evidence indicates that cannabinoid pharmacology is complex but supports the therapeutic potential of targeting the ECS. Third, we review the clinical evidence and discuss the future perspectives on how to bridge human and animal studies to develop cannabinoid-based therapies for each neurodegenerative disorder. Finally, we summarize the most relevant opportunities of cannabinoid pharmacology related to each disease and the multiple unexplored pathways in cannabinoid pharmacology that could be useful for the treatment of neurodegenerative diseases.pre-print578 K

Photo-astrometric distances, extinctions, and astrophysical parameters for Gaia DR2 stars brighter than G = 18

Combining the precise parallaxes and optical photometry delivered by Gaia's second data release (Gaia DR2) with the photometric catalogues of PanSTARRS-1, 2MASS, and AllWISE, we derive Bayesian stellar parameters, distances, and extinctions for 265 million stars brighter than G=18. Because of the wide wavelength range used, our results substantially improve the accuracy and precision of previous extinction and effective temperature estimates. After cleaning our results for both unreliable input and output data, we retain 137 million stars, for which we achieve a median precision of 5% in distance, 0.20 mag in V-band extinction, and 245 K in effective temperature for G<14, degrading towards fainter magnitudes (12%, 0.20 mag, and 245 K at G=16; 16%, 0.23 mag, and 260 K at G=17, respectively). We find a very good agreement with the asteroseismic surface gravities and distances of 7000 stars in the Kepler, the K2-C3, and the K2-C6 fields, with stellar parameters from the APOGEE survey, as well as with distances to star clusters. Our results are available through the ADQL query interface of the Gaia mirror at the Leibniz-Institut f\"{u}r Astrophysik Potsdam (gaia.aip.de) and as binary tables at data.aip.de. As a first application, in this paper we provide distance- and extinction-corrected colour-magnitude diagrams, extinction maps as a function of distance, and extensive density maps, demonstrating the potential of our value-added dataset for mapping the three-dimensional structure of our Galaxy. In particular, we see a clear manifestation of the Galactic bar in the stellar density distributions, an observation that can almost be considered a direct imaging of the Galactic bar.Comment: 25 pages, 23 figures + appendix, accepted for publication in A&A. Data (doi:10.17876/gaia/dr.2/51) are available through ADQL queries at gaia.aip.d

Cost-utility model of brivaracetam in the adjunctive treatment of patients with epilepsy in Spain

[EN] Objective This study aims to assess the cost utility of Brivaracetam compared with the third-generation anti-epileptic drugs used as standard care. Methods A cost utility analysis of Brivaracetam was carried out with other third-generation comparators. The treatment pathway of a hypothetical cohort over a period of 2 years was simulated using the Markov model. Data for effectiveness and the QALYs of each health status for epilepsy, as well as for the disutilities of adverse events of treatments, were analyzed through a studies review. The cost of the anti-epileptics and the use of medical resources linked to the different health statuses were taken into consideration. A probabilistic sensitivity analysis was performed using a Monte Carlo simulation. Results Brivaracetam was shown to be the dominant alternative, with Incremental Cost Utility Ratio (ICUR) values from -11,318 for Lacosamide to -128,482 for Zonisamide. The probabilistic sensitivity analysis validates these results. The ICUR sensitivity is greater for increases in the price of Brivaracetam than for decreases, and for Eslicarbizapine over the other adjunctives considered in the analysis. Conclusions Treatment with Brivaracetam resulted in cost effective and incremental quality adjusted life years come at an acceptable cost.Barrachina Martínez, I.; Vivas-Consuelo, D.; Reyes-Santias, F. (2020). Cost-utility model of brivaracetam in the adjunctive treatment of patients with epilepsy in Spain. Expert review of pharmacoeconomics & outcomes research (Online). 1-10. https://doi.org/10.1080/14737167.2021.1838899S110WHO | Epilepsy: aISBN public health imperative. ISBN 978-92-4-151593-1. World Health Organization. 2019. Printed in Thailand.Ngugi, A. K., Kariuki, S. M., Bottomley, C., Kleinschmidt, I., Sander, J. W., & Newton, C. R. (2011). Incidence of epilepsy: A systematic review and meta-analysis. Neurology, 77(10), 1005-1012. doi:10.1212/wnl.0b013e31822cfc90Henning, O., Landmark, C. J., Henning, D., Nakken, K. O., & Lossius, M. I. (2019). Challenges in epilepsy—The perspective of Norwegian epilepsy patients. Acta Neurologica Scandinavica, 140(1), 40-47. doi:10.1111/ane.13098Brodie, M. J. (2005). Diagnosing and predicting refractory epilepsy. Acta Neurologica Scandinavica, 112(s181), 36-39. doi:10.1111/j.1600-0404.2005.00507.xGarcía-Ramos, R., Pastor, A. G., Masjuan, J., Sánchez, C., & Gil, A. (2011). FEEN: Informe sociosantario FEEN sobre la epilepsia en España. Neurología, 26(9), 548-555. doi:10.1016/j.nrl.2011.04.002Kwan, P., & Brodie, M. J. (2000). Early Identification of Refractory Epilepsy. New England Journal of Medicine, 342(5), 314-319. doi:10.1056/nejm200002033420503Brodie, M. J. (2008). Epilepsy: randomised trials and genetic tribulations. The Lancet Neurology, 7(1), 7-8. doi:10.1016/s1474-4422(07)70301-0French, J. A. (2006). Refractory Epilepsy: One Size Does Not Fit All. Epilepsy Currents, 6(6), 177-180. doi:10.1111/j.1535-7511.2006.00137.xLaxer, K. D., Trinka, E., Hirsch, L. J., Cendes, F., Langfitt, J., Delanty, N., … Benbadis, S. R. (2014). The consequences of refractory epilepsy and its treatment. Epilepsy & Behavior, 37, 59-70. doi:10.1016/j.yebeh.2014.05.031Giordano, C., Marchiò, M., Timofeeva, E., & Biagini, G. (2014). Neuroactive Peptides as Putative Mediators of Antiepileptic Ketogenic Diets. Frontiers in Neurology, 5. doi:10.3389/fneur.2014.00063European Medicines Agency. Committee for Medicinal Products for Human Use (CHMP). Briviact brivaracetam. Assessment Report EMA/CHMP/822086/2015 Nov.Markham, A. (2016). Brivaracetam: First Global Approval. Drugs, 76(4), 517-522. doi:10.1007/s40265-016-0555-6Willems, L. M., Bauer, S., Rosenow, F., & Strzelczyk, A. (2019). Recent advances in the pharmacotherapy of epilepsy: brivaracetam and perampanel as broad-spectrum antiseizure drugs for the treatment of epilepsies and status epilepticus. Expert Opinion on Pharmacotherapy, 20(14), 1755-1765. doi:10.1080/14656566.2019.1637420Craig, D., Rice, S., Paton, F., Fox, D., & Woolacott, N. (2013). Retigabine for the Adjunctive Treatment of Adults with Partial-Onset Seizures in Epilepsy with and without Secondary Generalization. PharmacoEconomics, 31(2), 101-110. doi:10.1007/s40273-012-0018-1Charokopou, M., Harvey, R., Srivastava, K., Brandt, C., & Borghs, S. (2019). Relative performance of brivaracetam as adjunctive treatment of focal seizures in adults: a network meta-analysis. Current Medical Research and Opinion, 35(8), 1345-1354. doi:10.1080/03007995.2019.1584501Chhatwal J. Changing cycle lengths in state-transition models: doing it the right way; [cited 2018 Jan 23]. Available from: https://www.ispor.org/News/Connections_methodology_state-transition-models.PDFMulhern, B., Rowen, D., Snape, D., Jacoby, A., Marson, T., Hughes, D., … Brazier, J. (2014). Valuations of epilepsy-specific health states: a comparison of patients with epilepsy and the general population. Epilepsy & Behavior, 36, 12-17. doi:10.1016/j.yebeh.2014.04.011Kristian, B., Wachtmeister, K., Stefan, F., & Forsgren, L. (2013). Retigabine as add-on treatment of refractory epilepsy - a cost-utility study in a Swedish setting. Acta Neurologica Scandinavica, 127(6), 419-426. doi:10.1111/ane.12077Vera-Llonch, M., Brandenburg, N. A., & Oster, G. (2008). Cost-effectiveness of Add-on Therapy with Pregabalin in Patients with Refractory Partial Epilepsy. Epilepsia, 49(3), 431-437. doi:10.1111/j.1528-1167.2007.01279.xSimoens, S. (2010). Pharmacoeconomics of anti-epileptic drugs as adjunctive therapy for refractory epilepsy. Expert Review of Pharmacoeconomics & Outcomes Research, 10(3), 309-315. doi:10.1586/erp.10.18Wijnen, B. F. M., van Mastrigt, G. A. P. G., Evers, S. M. A. A., Gershuni, O., Lambrechts, D. A. J. E., Majoie, M. H. J. M., … de Kinderen, R. J. A. (2017). 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Cannabinoid pharmacology/therapeutics in chronic degenerative disorders affecting the central nervous system

The endocannabinoid system (ECS) exerts a modulatory effect of important functions such as neurotransmission, glial activation, oxidative stress, or protein homeostasis. Dysregulation of these cellular processes is a common neuropathological hallmark in aging and in neurodegenerative diseases of the central nervous system (CNS). The broad spectrum of actions of cannabinoids allows targeting different aspects of these multifactorial diseases. In this review, we examine the therapeutic potential of the ECS for the treatment of chronic neurodegenerative diseases of the CNS focusing on Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. First, we describe the localization of the molecular components of the ECS and how they are altered under neurodegenerative conditions, either contributing to or protecting cells from degeneration. Second, we address recent advances in the modulation of the ECS using experimental models through different strategies including the direct targeting of cannabinoid receptors with agonists or antagonists, increasing the endocannabinoid tone by the inhibition of endocannabinoid hydrolysis, and activation of cannabinoid receptor-independent effects. Preclinical evidence indicates that cannabinoid pharmacology is complex but supports the therapeutic potential of targeting the ECS. Third, we review the clinical evidence and discuss the future perspectives on how to bridge human and animal studies to develop cannabinoid-based therapies for each neurodegenerative disorder. Finally, we summarize the most relevant opportunities of cannabinoid pharmacology related to each disease and the multiple unexplored pathways in cannabinoid pharmacology that could be useful for the treatment of neurodegenerative diseases