Effect of psychosocial work environment and job satisfaction on burnout syndrome among specialist physicians

OBJECTIVES: To describe the prevalence of burnout syndrome according to medical specialty and to examine the impact of work psychosocial risk factors, job satisfaction and professional characteristics on burnout syndrome among specialist physicians throughout Spain. METHODS: A cross-sectional survey was carried out among 1,021 Spanish physicians. The outcome variables were the 3 dimensions of burnout syndrome: emotional exhaustion, depersonalization, and personal accomplishment. The explanatory variables were work psychosocial risk factors and job satisfaction evaluated by a stress scale specifically designed for physicians. Adjusted odds ratios and their 95% confidence intervals were calculated by logistic regression. RESULTS: The probability of high emotional exhaustion and depersonalization were greater in physicians exposed to a high level of contact with suffering and death and to a negative impact of work on home life. The probability of high emotional exhaustion was greater among physicians with a high work overload. The risk of low personal accomplishment was higher among physicians with low professional satisfaction and those without training activities. Dissatisfaction with relationships with patients and relatives had a negative effect on the 3 dimensions of burnout. CONCLUSIONS: Psychosocial work environment and job satisfaction have a negative effect on burnout syndrome, especially on emotional exhaustion and depersonalization.     

Sentinel lymph node biopsy in selected cases of ductal carcinoma <Emphasis Type="Italic">in situ</Emphasis>

Introduction  

Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB).     

Patient education during hospital admission due to exacerbation of chronic obstructive pulmonary disease: Effects on quality of life—Controlled and randomized experimental study

The objective of this study was to assess the effectiveness of an education program and telephone call follow-up at improving the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD).

Expressão de Proteína-1 Relacionada a Receptor de Lipoproteína de Baixa Densidade (LRP1) em Monócito em Correlação com EIMC em Pacientes Mexicanos Hipertensos

BackgroundArterial hypertension (HTA) represents a major risk factor for cardiovascular morbidity and mortality. It is not yet known which specific molecular mechanisms are associated with the development of essential hypertension.ObjectiveIn this study, we analyzed the association between LRP1 monocyte mRNA expression, LRP1 protein expression, and carotid intima media thickness (cIMT) of patients with essential hypertension.MethodsThe LRP1 monocyte mRNA expression and protein levels and cIMT were quantified in 200 Mexican subjects, 91 normotensive (NT) and 109 hypertensive (HT). Statistical significance was defined as p < 0.05.ResultsHT patients group had highly significant greater cIMT as compared to NT patients (p=0.002) and this correlated with an increase in the expression of LRP1 mRNA expression (6.54 vs. 2.87) (p = 0.002) and LRP1 protein expression (17.83 vs. 6.25), respectively (p = 0.001). These differences were maintained even when we divided our study groups, taking into account only those who presented dyslipidemia in both, mRNA (p = 0.041) and proteins expression (p < 0.001). It was also found that Ang II mediated LRP1 induction on monocytes in a dose and time dependent manner with significant difference in NT vs. HT (0.195 ± 0.09 vs. 0.226 ± 0.12, p = 0.046).ConclusionAn increase in cIMT was found in subjects with hypertension, associated with higher mRNA and LRP1 protein expressions in monocytes, irrespective of the presence of dyslipidemias in HT patients. These results suggest that LRP1 upregulation in monocytes from Mexican hypertensive patients could be involved in the increased cIMT. (Arq Bras Cardiol. 2021; 116(1):56-65)     

Thyrotropin,follitropin, and chorionic gonadotropin expressed as a single multifunctional unit reveal remarkable permissiveness in receptor-ligand interactions

The glycoprotein hormones [chorionic gonadotropin (CG), FSH, LH, and TSH] are composed of a common alpha-subunit and a hormone-specific beta-subunit. Subunit assembly is vital to the in vivo function of these hormones. However, recent in vitro studies using double domain (beta-alpha) and triple domain (beta-beta-alpha) single chains have shown that gonadotropin receptor recognition can accommodate conformationally modified ligands. To investigate the extent of flexibility of ligand-receptor interactions, we constructed a single chain tetramer containing three different beta-subunits (TSHbeta, FSHbeta, and CGbeta) and a single alpha-subunit. This analog was inefficiently secreted from transfected Chinese hamster ovary cells, but surprisingly, the protein exhibited all activities comparable to the corresponding heterodimers. Because the alpha-subunit presumably cannot form the entire array of heterodimeric contacts with all beta-subunits simultaneously in the tetra-domain analog, the data show that the complete quaternary subunit-subunit interactions are essential for the efficient intracellular trafficking of the glycoprotein hormones, but not for receptor recognition. From an evolutionary perspective, the organization of such a multifunctional analog is consistent with the hypothesis that glycoprotein hormone genes were originally linked in tandem and subsequently evolved as independent genes. Our results also indicate that both gonadal and thyroid stimulatory functions can be combined in a unique analog.