Intention to leave, depersonalisation and job satisfaction in physicians and nurses: a cross-sectional study in Europe.

The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires' construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention.

Preparedness activities and research needs in addressing emerging infectious animal and zoonotic diseases.

Emerging infectious animal and zoonotic diseases can inflict significant losses on animal production and public health, and threaten the safety and security of the food system. Threat analysis (forecasting), which monitors the measurable risk indicators of disease emergence, should be in place before the emergence of any threat. Animal and public health authorities develop and regularly re-evaluate disease preparedness, response and recovery plans, based on the 'One Health' principle. These plans should include surveillance, biosecurity measures, communication channels and training for personnel. Scenarios for outbreaks of natural emerging infectious disease or bioterrorist events should be prepared and practised. National and international legislation should be regularly updated to provide a robust legal basis to manage outbreaks. Reference laboratories should have reliable and validated diagnostic tools for rapid, high-throughput testing. Strict biosafety, biocontainment and biosecurity control measures must be implemented in laboratories in order to prevent the accidental or malicious release of pathogens. The pharmaceutical industry should be incentivised to develop vaccines and/or antiviral drugs against disease outbreaks. Conventions between public authorities and the pharmaceutical industry should guarantee adequate stockpiling of the pharmaceuticals needed to control large-scale outbreaks. In the early phase of disease emergence (early warning), veterinarians and stakeholders play an important role in early detection at the farm level. Upon notification, veterinary authorities must take rapid response measures to limit disease spread. National and international short- and medium-term strategic research agendas should be developed, based on a comprehensive gap analysis and horizon scan. This planning will help to guide funding agencies and non-governmental organisations in their quest to support relevant research.

Les maladies animales infectieuses et les zoonoses émergentes ont un coût élevé pour la santé animale et la santé publique, en plus d'entraîner d'importantes pertes de production dans les élevages et de menacer la sécurité des systèmes de production alimentaire. Une analyse des menaces (anticipation), grâce au suivi d'indicateurs mesurables du risque d'émergence des maladies animales, devrait être en place avant que ces menaces n'émergent. Les autorités en charge de la santé animale et de la santé publique développent et réévaluent régulièrement des plans de préparation, de réponse et de récupération vis-à-vis de maladies, sur la base du principe « Une seule santé ¼. Ces plans doivent inclure des mesures de surveillance et de biosécurité, en plus de se doter de moyens de communication et de formation du personnel. Il convient d'élaborer et de mettre en pratique des scénarios d'émergence de maladies infectieuses, que celle-ci soit d'origine naturelle ou d'origine bioterroriste. Les législations nationales et internationales en la matière doivent être actualisées régulièrement afin de fournir un fondement juridique solide à la gestion des émergences. Les laboratoires de référence doivent disposer d'outils diagnostiques fiables et validés permettant la réalisation de tests rapides et à haut débit. Des mesures strictes de contrôle de la biosécurité, du bioconfinement et de la biosûreté doivent être appliquées dans les laboratoires pour prévenir toute libération accidentelle ou malintentionnée d'agents pathogènes. L'industrie pharmaceutique doit être incitée au développement de vaccins et d'antiviraux pour maîtriser les maladies émergentes. Les conventions entre les autorités publiques et l'industrie pharmaceutique doivent permettre de garantir la constitution de stocks suffisants de produits pharmaceutiques pour maîtriser les émergences de grande ampleur. Lors des premières phases d'émergence d'un foyer (alerte précoce), les vétérinaires et autres acteurs de terrain jouent un rôle important dans la détection précoce au niveau des élevages. Dès la notification d'un foyer, les autorités vétérinaires doivent réagir rapidement afin d'en limiter la propagation. Il convient de développer des programmes nationaux et internationaux de recherche stratégique à court et moyen terme, basés sur un examen exhaustif des lacunes et sur une analyse prospective complète. Cette planification contribuera à fournir aux agences de financement et aux organisations non gouvernementales des orientations leur permettant de déterminer quel soutien apporter à la recherche.

Las enfermedades animales infecciosas y las zoonosis emergentes pueden causar pérdidas cuantiosas en los ámbitos de la producción animal y la salud pública, además de amenazar la higiene y la seguridad de los sistemas alimentarios. El análisis (pronóstico) de amenazas, que consiste en seguir de cerca indicadores cuantificables del riesgo de aparición de enfermedades animales, es algo que debería estar implantado antes de que surja toda amenaza. Las autoridades sanitarias y zoosanitarias definen y periódicamente reevalúan planes de preparación, respuesta y recuperación frente a enfermedades, basándose para ello en el principio de «Una sola salud¼. Estos planes deben incluir labores de vigilancia y medidas de seguridad biológica, además de prever cauces de comunicación y actividades de formación del personal. También hay que elaborar y aplicar planes para hipotéticos brotes infecciosos, ya sean de origen natural u obra de bioterroristas. Asimismo, a fin de contar con sólidas bases jurídicas para combatir la aparición de enfermedades, es preciso actualizar periódicamente la legislación nacional e internacional. Los laboratorios de referencia deben contar con herramientas de diagnóstico fiables y validadas que permitan efectuar pruebas rápidas y de alto rendimiento. Es preciso implantar en los laboratorios estrictas medidas de control de la protección, la contención y la seguridad biológicas para evitar toda liberación accidental o malintencionada de patógenos. Hay que incentivar asimismo a la industria farmacéutica para que desarrolle vacunas y fármacos antivirales contra las enfermedades emergentes. Por otra parte, las autoridades públicas deben suscribir con el sector farmacéutico convenios que garanticen la constitución de reservas suficientes de los productos farmacéuticos requeridos para hacer frente a la aparición de brotes de grandes dimensiones. En las primeras fases de la aparición de un foco (alerta rápida), los veterinarios y otros interlocutores cumplen una importante función para detectar con prontitud la patología dentro de las explotaciones. Al recibir notificación, las autoridades veterinarias deben reaccionar con rapidez para poner coto a la propagación de la enfermedad. Por último, a partir de un análisis exhaustivo de las carencias existentes y de un estudio prospectivo completo, es preciso elaborar planes nacionales e internacionales de investigación estratégica a corto y medio plazo. Tal planificación ayudará a orientar a los organismos de financiación y las organizaciones no gubernamentales (ONG) en su labor de apoyo a las investigaciones de interés.

Plexin-B1 signalling promotes androgen receptor translocation to the nucleus.

Semaphorins and their receptors plexins have diverse roles in many cancers affecting tumour growth, metastasis and angiogenesis. Plexin-B1, the receptor for semaphorin4D (Sema4D), has been implicated in prostate cancer where mutation of the gene and overexpression of the protein occur. It is not clear, however, as to which of the several Sema4D-activated signalling pathways downstream of plexin-B1 function in prostate cancer progression. We show here that Sema4D/plexin-B1 increases the expression of androgen-responsive genes and activates the transcriptional activity of the androgen receptor (AR). Activation of plexin-B1 results in phosphorylation of AR at Serine 81, a site that is phosphorylated by nuclear kinases. Cell fractionation and immunocytochemistry studies demonstrated that the proportion of cells with AR in the nucleus increases significantly upon Sema4D treatment. The N-terminal (AF-1) domain of AR, which contains binding sites for transcription regulators, is not required for this response. Depletion of AR suppressed Sema4D-induced anchorage-independent growth of LNCaP and LNCaP-LN3 cells, demonstrating the functional significance of these findings. These results show that Sema4D/plexin-B1 signalling promotes the translocation of AR to the nucleus and thereby enhances AR transcriptional activity. Plexin-B1 is therefore a promising target for cancer therapy, especially in low androgen situations such as those imposed by androgen deprivation therapy.

Effect of egg turning and incubation time on carbonic anhydrase gene expression in the blastoderm of the Japanese quail (Coturnix c. japonica).

1. The gene expression of carbonic anhydrase, a key enzyme for the production of sub-embryonic fluid (SEF), was assessed in turned and unturned eggs of the Japanese quail. The plasma membrane-associated isoforms CA IV, CA IX, CA XII, CA XIV, and the cytoplasmic isoform CA II, were investigated in the extra-embryonic tissue of the blastoderm and in embryonic blood. 2. Eggs were incubated at 37.6 degrees C, c.60% RH, and turned hourly (90 degrees ) or left unturned. From 48 to 96 h of incubation mRNA was extracted from blastoderm tissue, reverse-transcribed to cDNA and quantified by real-time qPCR using gene-specific primers. Blood collected at 96 h was processed identically. 3. Blastoderm CA IV gene expression increased with the period of incubation only in turned eggs, with maxima at 84 and 96 h of incubation. Only very low levels were found in blood. 4. Blastoderm CA II gene expression was greatest at 48 and 54 h of incubation, subsequently declining to much lower levels and unaffected by turning. Blood CA II gene expression was about 25-fold greater than in the blastoderm. 5. The expression of CA IX in the blastoderm was the highest of all isoforms, yet unaffected by turning. CA XII did not amplify and CA XIV was present at unquantifiable low levels. 6. It is concluded that only gene expression for CA IV is sensitive to egg turning, and that increased CA IV gene expression could account for the additional SEF mass found at 84 to 96 h of incubation in embryos of turned eggs.

Acute suppression of idiopathic detrusor instability with magnetic stimulation of the sacral nerve roots.

OBJECTIVE: To assess the effect of magnetic stimulation of the S3 nerve root on unstable contractions in patients with idiopathic detrusor instability. PATIENTS AND METHODS: Twelve patients with idiopathic instability were studied. The S3 nerve root was localized by mapping the response of the toe flexor muscles and anal sphincter to magnetic stimulation at different sites. Unstable contractions were provoked by rapidly infusing saline into the bladder and the effect of magnetic stimulation of S3 on contractions was assessed. RESULTS: Magnetic stimulation relieved the sensation of urinary urgency and reduced the duration and amplitude of provoked contractions in all patients. Stimulation reduced the area under the pressure/time curve by 80-98%. In some patients there was a shortlived residual suppressive effect lasting up to 90 s. CONCLUSIONS: Magnetic stimulation of S3 acutely abolishes unstable contractions in patients with idiopathic detrusor instability.

Influence of the oestrous cycle on experimental intrauterine E. coli infection in the sow.

The influence of the oestrous cycle on the onset of endometritis in the sow was studied. Ten pubertal, unmated gilts of the Belgian Negative Landrace were used. Nine gilts were inoculated into the uterus by laparotomy with a suspension of an E. coli strain isolated from the uterus of a discharging sow from a herd having many problems with vaginal discharge and a lowered fertility. One gilt was as a control inoculated with 2 ml of a PBS-solution. All sows inoculated during dioestrus developed clinical symptoms, but only 1 of the 5 gilts inoculated at standing oestrus developed a vaginal discharge. These data confirm the hypothesis that the stage of the oestrous cycle has an important influence on the onset of endometritis. The resistance to E. coli infections was higher when the gilts were inoculated during oestrus.

Water-sealed spirometer for measurements in newborns and infants.

Details are given of two spirometers for use in neonates and infants < 12 mo old. The minimum volumes are 520 and 670 ml, respectively. The maximum volume changes that can be recorded are 250 and 450 ml, respectively. The minimal detectable volume changes are 0.4 and 0.6 ml, respectively. Rebreathing of dead space gas is prevented by a fan producing a flow of 6.2 and 10.2 l/min, respectively; 100% gas mixing after injecting a gas bolus in the two spirometers is achieved in 5.7 and 6.6 s, respectively. Resistance to airflow is 0.2 kPa.l-1.s (2 cmH2O.l-1.s) at 150 ml/s in both spirometers. The frequency response of both instruments is flat to 6 cycles/s. The instruments can be easily cleaned and are suitable for bedside measurements.

Cerebral and aortic blood flow velocity patterns in preterm infants receiving prophylactic surfactant treatment.

Blood velocity in the internal carotid artery (ICA) and in the descending thoracic aorta (DAo) was investigated used Duplex-Doppler ultrasound in 14 infants of less than 30 weeks gestation, treated prophylactically with surfactant, and in 11 comparable infants with relatively mature lungs who served as controls. After surfactant administration, blood gases, pH or FiO2 were not different between the groups. Temporal mean blood velocity in the ICA was used as a relative measure of cerebral flow (TMFV-cer), and its coefficient of variation (CV-cer) was used to assess fluctuations in cerebral blood velocity. The pulsatility index (PI) in the ICA (PI-cer) and DAo (PI-DAo) was used to estimate if a left-to-right shunt was present. During surfactant instillation TMFV-cer was abnormally low and CV-cer indicated a fluctuating cerebral blood velocity. At 10 min after surfactant administration, TMFV-cer of the treated infants was higher compared to the controls, while CV-cer was stable in both groups. PI-cer and PI-DAo were abnormally high during the first hour of life after surfactant treatment, suggesting a left-to-right shunt without, however, clinical signs of a hemodynamically important ductus arteriosus. We suggest that cerebral perfusion is affected during and at 10 min after surfactant instillation. Left-to-right shunting appears to be a common event following surfactant treatment.