Burnout levels among Portuguese family doctors: a nationwide survey

AIM: To characterise the prevalence of burnout syndrome in a sample of family doctors (FDs) working in the Portuguese National Health System. DESIGN: Cross-sectional survey. SETTING: Primary healthcare centres from the 18 continental districts and two archipelagos of Portugal. METHOD: The Portuguese version of the Maslach Burnout Inventory-Human Services Survey was sent to 40 randomly selected healthcare centres and distributed to the FDs employed. Socio-demographic and work-related data were also collected. Participants were classified as having high, average or low levels of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) dimensions of burnout. RESULTS: 371 questionnaires were sent, of which 153 (83 women, age range 29-64 years; response rate 41%) returned. One-quarter (25.3%, 95% CI 18.6% to 33.1%) of FDs scored high for EE, 16.2% (10.7% to 23.2%) for DP and 16.7% (11.1% to 23.6%) for lack of PA. On multivariate analysis, being married, of older age, having many years of practice or working in a personalised healthcare unit tended to be associated with increased burnout components. Men tended to present higher EE and DP but lower lack of PA than women. Finally, the prevalence (95% CI) of burnout ranged between 4.1% (1.5% to 8.6%) and 32.4% (25.0% to 40.6%), depending on the definition used. CONCLUSIONS: High burnout is relatively common among Portuguese FDs. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among Portuguese FDs

Proteins as promising biobased building blocks for preparing functional hybrid protein/synthetic polymer nanoparticles

The pursuit of sustainable and environmentally friendly materials has been powered by environmental concerns and the decline in oil reserves. Among the different routes toward this end, the replacement of oil-based materials by renewable materials stands out. In this way, protein based materials have gained interest. This review article summarizes the progress achieved in the synthesis of hybrid protein/synthetic polymer nanoparticles which have the potential to be used in industrial applications. Although technical achievements and efficacy proofs concerning the increased compatibility of polymer/protein are already available, practical implementation in industry still represents an additional challenge and should be the focus of interest in future research. The available literature supports the potential of hybrid protein/polymer nanoparticles in the production of ecofriendly alternatives for large scale applications as coatings, paints, adhesives and films.Fil: Cencha, Luisa Guadalupe. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Allasia, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Ronco, Ludmila Irene. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Luque, Gisela Carina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Picchio, Matías Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Minari, Roque Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Gugliotta, Luis Marcelino. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; Argentin

EDUCAÇÃO INFANTIL EM TEMPOS DE PANDEMIA: O PAPEL DA FORMAÇÃO CONTINUADA DOS PROFESSORES PARA GARANTIR O PERCURSO EDUCATIVO

As incertezas provocadas pela Covid-19 afetaram as relações na escola da infância, esse relato de experiência apresenta um fragmento dos caminhos trilhados na formação continuada dos professores da Rede Municipal de Ensino de Curitiba, em um dos Centros Municipais de Educação Infantil, o qual buscou refletir como a educação pode fazer sentido nesse novo formato virtual e como as possibilidades de desenvolver aprendizagens com foco na formação dos docentes; promovendo o uso das tecnologias de informação e comunicação, dando continuidade ao processo de ensino e aprendizagem. Foram criadas estratégias formativas, em contexto, aprofundando os saberes sobre os processos de aprendizagem das crianças, a importância do brincar, a documentação pedagógica, na qual as mini-histórias revelaram os processos de aprendizagem das práticas pedagógicas cotidiana

HELICOBACTER PYLORI AND THE ATHEROGENIC PROCESS IN CARDIOVASCULAR DISEASE

Background: Conventional risk factors do not explain completely the atherogenic process. Chronic Helicobacter pylori (HP) infection may cause arterial inflammation and has been epidemiologically linked to the occurrence of atherosclerosis. Studies about the association of HP infection with peripheral arterial disease are limited. Objective: Evaluate the presence of HP using a monoclonal antibody anti-HP in the atherosclerotic plaques of the superficial femoral artery in patients submitted to amputation above-knee. Material and methods: We searched for the presence of HP in 29 non-consecutive patients with Leriche-Fontaine grade IV lower limb ischemia, submitted to amputation above-knee. Femoral artery was isolated and an atherosclerotic plaque specimen immediately distal to the amputation level, was removed, fixed in formalin and evaluated for HP, using a mono clonal antibody, anti-HP. Results: The mean age of the 29 patients was 82 years. 18 were men (62.1 %). Risk factors for cardiovascular disease were present in the majority of patients. Only one patient had known history of HP infection in the past. Morbidity rate was 30%. The mortality rate was 13.8 % (4 cases). In all cases, anti-HP showed no evidence of HP at the atherosclerotic plaque. Discussion/Conclusion: HP infection has been associated both epidemiologically and pathogenetically with atherosclerosis. However, HP was not found in this study at the atherosclerotic plaques of the superficial femoral artery

Herschel Observations of Extraordinary Sources: Analysis of the HIFI 1.2 THz Wide Spectral Survey toward Orion KL. I. Methods

We present a comprehensive analysis of a broadband spectral line survey of the Orion Kleinmann-Low nebula (Orion KL), one of the most chemically rich regions in the Galaxy, using the HIFI instrument on board the Herschel Space Observatory. This survey spans a frequency range from 480 to 1907 GHz at a resolution of 1.1 MHz. These observations thus encompass the largest spectral coverage ever obtained toward this high-mass star-forming region in the submillimeter with high spectral resolution and include frequencies >1 THz, where the Earth's atmosphere prevents observations from the ground. In all, we detect emission from 39 molecules (79 isotopologues). Combining this data set with ground-based millimeter spectroscopy obtained with the IRAM 30 m telescope, we model the molecular emission from the millimeter to the far-IR using the XCLASS program, which assumes local thermodynamic equilibrium (LTE). Several molecules are also modeled with the MADEX non-LTE code. Because of the wide frequency coverage, our models are constrained by transitions over an unprecedented range in excitation energy. A reduced χ^2 analysis indicates that models for most species reproduce the observed emission well. In particular, most complex organics are well fit by LTE implying gas densities are high (>10^6 cm^(–3)) and excitation temperatures and column densities are well constrained. Molecular abundances are computed using H_2 column densities also derived from the HIFI survey. The distribution of rotation temperatures, T_(rot), for molecules detected toward the hot core is significantly wider than the compact ridge, plateau, and extended ridge T_(rot) distributions, indicating the hot core has the most complex thermal structure

Melanoma cutâneo : perspectivas atuais e futuras

Trabalho final de mestrado em Medicina (Dermatologia), apresentado á Faculdade de Medicina da Universidade de CoimbraO melanoma cutâneo é um tumor de incidência crescente que se desenvolve como resultado da transformação maligna dos melanócitos, surgindo, na maioria dos casos, como uma lesão de novo. Os indivíduos do sexo masculino com mais de 65 anos são duas vezes mais propensos ao seu desenvolvimento em comparação com as mulheres do mesmo estrato etário. Nesta revisão sistemática da literatura médica internacional, pesquisada na base de dados PubMed, abordaram-se as áreas mais controversas que dizem respeito ao melanoma. No que toca à prevenção primária, a associação entre a radiação UV e o melanoma cutâneo está ainda por esclarecer, mas tem sido constatado que o risco de melanoma está maioritariamente associado à exposição intermitente, aguda e intensa ao sol. Uma vez que a população subvaloriza estes conceitos, deve-se procurar enfatizar a importância da adoção de medidas protetoras aquando da exposição ao sol. As taxas de incidência do melanoma têm aumentado devido a uma maior vigilância que conduziu ao diagnóstico precoce de tumores curáveis. Por isso, nas últimas três décadas assistiu-se a um aumento da taxa de sobrevivência aos 5 anos. O conhecimento dos fatores de risco, a realização do autoexame da pele e a participação em esforços de prevenção secundária podem ajudar os doentes a combater o melanoma maligno. O exame visual da pele é o método de rastreio mais usado para diagnosticar tumores cutâneos. O ABCDE deve ser ensinado aos profissionais de saúde não diferenciados e à população em geral e complementado com a dermatoscopia. A avaliação ganglionar é um dos mais importantes indicadores de prognóstico a ser considerado na evolução do doente. A BGS é uma técnica segura, de reduzida morbilidade e que deve ser incluída nos protocolos de estadiamento, a par de vários métodos de imagem considerados igualmente adequados no estadiamento de doentes com melanoma e potencial metastização. O tratamento primário do melanoma cutâneo é a excisão cirúrgica. As margens de resseção cirúrgica são ainda controversas mas estão relacionadas com a espessura do tumor (índice de Breslow). O seguimento do melanoma permanece uma área de debate. Até à data, têm havido poucos estudos prospetivos randomizados que fundamentem um programa de seguimento em particular. Incentivar um maior consenso internacional pode melhorar os resultados para o doente e reduzir a preocupação dos clínicos e o impacto económico do melanoma nos sistemas de saúde. O papel das novas armas terapêuticas na melhoria do prognóstico destes doentes é bastante promissor. Tanto no campo da imunoterapia como com novos inibidores BRAF desenvolvidos, os resultados têm sido muito satisfatórios, com elevadas taxas de resposta e melhoria franca da sobrevivência globalCutaneous melanoma is a tumor that results from malignant transformation of melanocytes, occuring with an increasing incidence in most cases without any previous lesion (de novo). Males older than 65 years old are twice as likely to develop melanoma when compared to females in the same age group. In this systematic review of the international medical literature, a search was conducted in the PubMed database and the most controversial issues related to melanoma were focused. Regarding primary prevention, the association between UV radiation and cutaneous melanoma is still unclear, but it has been found that the risk of melanoma is mainly associated with intermittent, acute and intense sun exposure. Since the population undervalues these concepts, it should be emphasized the importance of adopting protective measures when exposed to the sun. The incidence rates of melanoma have increased due to a better surveillance that led to early diagnosis of curable tumors. So, over the past three decades there has been an increase in the 5-year survival rates. The identification of risk factors, the self-examination of the skin and the participation in secondary prevention efforts may help patients to fight malignant melanoma. Visual examination of the skin is the most commonly used screening method to diagnose cutaneous tumors. The ABCDE should be taught to the healthcare providers and to general population, as well as complemented by dermatoscopy. The lymph node evaluation is one of the most important prognostic indicators to be considered in the evolution of the patient. The sentinel lymph node biopsy is a safe technique with low morbidity that should be included in the staging guidelines, along with various imaging methods considered equally relevant for the staging of patients with melanoma and potential metastases. The primary treatment of cutaneous melanoma is surgical excision. Surgical resection margins are still debatable but are related to tumor thickness (Breslow's depth). The follow-up of melanoma remains controversial. To date there have been few randomized prospective studies that support a follow-up program in particular. To encourage a greater international consensus can improve patient outcomes and reduce the concern of the clinicians and the economic impact of melanoma in health systems. The role of the new therapeutic agents in improving the prognosis of these patients is very promising. Both in the field of immunotherapy and with new BRAF inhibitors developed, the results have been very satisfactory, with high response rates and improved overall survival