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

The multi-depot k-traveling repairman problem

In this paper, we study the multi-depot k-traveling repairman problem. This problem extends the traditional traveling repairman problem to the multi-depot case. Its objective, similar to the single depot variant, is the minimization of the sum of the arrival times to customers. We propose two distinct formulations to model the problem, obtained on layered graphs. In order to find feasible solutions for the largest instances, we propose a hybrid genetic algorithm where initial solutions are built using a splitting heuristic and a local search is embedded into the genetic algorithm. The efficiency of the mathematical formulations and of the solution approach are investigated through computational experiments. The proposed models are scalable enough to solve instances up to 240 customers

su(1,1) Algebraic approach of the Dirac equation with Coulomb-type scalar and vector potentials in D + 1 dimensions

We study the Dirac equation with Coulomb-type vector and scalar potentials in D + 1 dimensions from an su(1, 1) algebraic approach. The generators of this algebra are constructed by using the Schr\"odinger factorization. The theory of unitary representations for the su(1, 1) Lie algebra allows us to obtain the energy spectrum and the supersymmetric ground state. For the cases where there exists either scalar or vector potential our results are reduced to those obtained by analytical techniques

Topographical and Physicochemical Contrast in Photopatterned SU-8 Films for Microfabrication of Multilayer Structures

During SU-8 standard photolithography process, a patterned topography is formed with a characteristic height profile produced by the different shrinkage of the UV exposed and masked regions. We study the change of wettability, film solubility, and topographic modifications on SU-8 films of different thicknesses and show its relevance in the formation of spinning-flow arrays on top layers made from positive photoresists. Also, considerable contrast in film solubility and surface energy as observed from contact angle measurements is produced. Interface diffusion of the photoresists was also observed and followed by Rutherford Back Scattering. We discuss the derivations of the mentioned effects concerning the limitations to multilayered microfabrication processes and possibilities to take advantage of the surface profiles obtained

Influence of Inspiratory Muscle Training on Ventilatory Efficiency and Cycling Performance in Normoxia and Hypoxia

The aim of this study was to analyse the influence of inspiratory muscle training (IMT) on ventilatory efficiency, in normoxia and hypoxia, and to investigate the relationship between ventilatory efficiency and cycling performance. Sixteen sport students (23.05 +/- 4.7 years; 175.11 +/- 7.1 cm; 67.0 +/- 19.4 kg; 46.4 +/- 8.7 ml·kg-1·min-1) were randomly assigned to an inspiratory muscle training group (IMTG) and a control group (CG). The IMTG performed two training sessions/day [30 inspiratory breaths, 50% peak inspiratory pressure (Pimax), 5 days/week, 6-weeks]. Before and after the training period subjects carried out an incremental exercise test to exhaustion with gas analysis, lung function testing, and a cycling time trial test in hypoxia and normoxia. Simulated hypoxia (FiO2 = 16.45%), significantly altered the ventilatory efficiency response in all subjects (p < 0.05). Pimax increased significantly in the IMTG whereas no changes occurred in the CG (time group, p < 0.05). Within group analyses showed that the IMTG improved ventilatory efficiency (VE/VCO2 slope; EqCO2VT2) in hypoxia (p < 0.05) and cycling time trial performance [WTTmax (W); WTTmean (W); PTF(W)] (p < 0.05) in hypoxia and normoxia. Significant correlations were not found in hypoxia nor normoxia found between ventilatory efficiency parameters (VE/VCO2 slope; LEqCO2; EqCO2VT2) and time trial performance. On the contrary the oxygen uptake efficiency slope (OUES) was highly correlated with cycling time trial performance (r = 0.89; r = 0.82; p < 0.001) under both conditions. Even though no interaction effect was found, the within group analysis may suggest that IMT reduces the negative effects of hypoxia on ventilatory efficiency. In addition, the data suggest that OUES plays an important role in submaximal cycling performance.(VLID)3080991Version of recor

Effects of cytomegalovirus infection in human neural precursor cells depend on their differentiation state

© 2015, Journal of NeuroVirology, Inc. Cytomegalovirus (CMV) is the most common cause of congenital infection in developed countries and a major cause of neurological disability in children. Although CMV can affect multiple organs, the most important sequelae of intrauterine infection are related to lesions of the central nervous system. However, little is known about the pathogenesis and the cellular events responsible for neuronal damage in infants with congenital infection. Some studies have demonstrated that neural precursor cells (NPCs) show the greatest susceptibility to CMV infection in the developing brain. We sought to establish an in vitro model of CMV infection of the developing brain in order to analyze the cellular events associated with invasion by this virus. To this end, we employed two cell lines as a permanent source of NPC, avoiding the continuous use of human fetal tissue, the human SK-N-MC neuroblastoma cell line, and an immortalized cell line of human fetal neural origin, hNS-1. We also investigated the effect of the differentiation stage in relation to the susceptibility of these cell lines by comparing the neuroblastoma cell line with the multipotent cell line hNS-1. We found that the effects of the virus were more severe in the neuroblastoma cell line. Additionally, we induced hNS-1 to differentiate and evaluated the effect of CMV in these differentiated cells. Like SK-N-MC cells, hNS-1-differentiated cells were also susceptible to infection. Viability of differentiated hNS-1 cells decreased after CMV infection in contrast to undifferentiated cells. In addition, differentiated hNS-1 cells showed an extensive cytopathic effect whereas the effect was scarce in undifferentiated cells. We describe some of the effects of CMV in neural stem cells, and our observations suggest that the degree of differentiation is important in the acquisition of susceptibility.CONACYT (CB16782 and #120452), PROMEP (103.5/10/7697), and FAI-UASLP (C12-FAI-03-62.62).Peer Reviewe

Paleoseismological evidence of holocene activity of the Los Tollos fault (Murcia, se Spain): a lately formed quaternary tectonic feature of the eastern betic shear zone

The Los Tollos Fault is a recent and important feature of the Eastern Betic Shear Zone, one of the major tectonic structures in South Iberia accommodating the convergence between Nubian and Eurasian plates in the western Mediterranean. The Los Tollos Fault became active by the end of Middle Pleistocene introducing some paleogeographical modifications. Previously mapped as a secondary normal fault related to the Carrascoy Fault, recent research evidences that the Los Tollos Fault is an independent Holocene active left-lateral reverse fault extending for at least 15 km. Data analysis from 4 trenches dug across the fault has revealed the occurrence of at least two paleo-earthquake events during the Holocene. The most recent event is dated between 2,740 and 2,140 yr BP (8th to 2nd centuries BC). The size of the paleoevents is calculated to be Mw 6.3 – 6.6 following empirical regressions on surface rupture length. The recurrence interval is estimated to be between 2,200-6,860 years, fitting a slip rate for the fault between 0.12 and 0.17 mm/yr. Such parameters highlight the Los Tollos Fault as a tectonic structure with a considerable activity located relatively close to densely populated areas. These seismogenic parameters should be considered in future reassessments of the seismic hazard of the regionThis work forms part of the research activities carried out in the FASEGEO Project (CGL2009-09726) funded by the Spanish Ministry of Science and Innovatio

Hepatic Carcinoma—Associated Fibroblasts Promote an Adaptative Response in Colorectal Cancer Cells That Inhibit Proliferation and Apoptosis: Nonresistant Cells Die by Nonapoptotic Cell Death

AbstractCarcinoma-associated fibroblasts (CAFs) are important contributors of microenvironment in determining the tumor’s fate. This study aimed to compare the influence of liver microenvironment and primary tumor microenvironment on the behavior of colorectal carcinoma. Conditioned medium (CM) from normal colonic fibroblasts (NCFs), CAFs from primary tumor (CAF-PT) or liver metastasis (CAF-LM) were obtained. We performed functional assays to test the influence of each CM on colorectal cell lines. Microarray and gene set enrichment analysis (GSEA) were performed in DLD1 cells cultured in matched CM. In DLD1 cells, CAF-LM CM compared with CAF-PT CM and NCF led to a more aggressive phenotype, induced the features of an epithelial-to-mesenchymal transition more efficiently, and stimulated migration and invasion to a greater extent. Sustained stimulation with CAF-LM CM evoked a transient G2/M cell cycle arrest accompanied by a reduction of apoptosis, inhibition of proliferation, and decreased viability of SW1116, SW620, SW480, DLD1, HT-29, and Caco-2 cells and provoked nonapoptotic cell death in those cells carrying KRAS mutations. Cells resistant to CAF-LM CM completely changed their morphology in an extracellular signal-regulated protein kinase-dependent process and depicted an increased stemness capacity alongside the Wnt pathway stimulation. The transcriptomic profile of DLD1 cells treated with CAF-LM CM was associated with Wnt and mitogen-activated protein kinase pathways activation in GSEA. Therefore, the liver microenvironment induces more efficiently the aggressiveness of colorectal cancer cells than other matched microenvironments do but secondarily evokes cell death. Resistant cells displayed higher stemness capacity