Daniela Converso

Control of muscle mitochondria by insulin entails activation of Akt2-mtNOS pathway: implications for the metabolic syndrome.

Background In the metabolic syndrome with hyperinsulinemia, mitochondrial inhibition facilitates muscle fat and glycogen accumulation and accelerates its progression. In the last decade, nitric oxide (NO) emerged as a typical mitochondrial modulator by reversibly inhibiting citochrome oxidase and oxygen utilization. We wondered whether insulin-operated signaling pathways modulate mitochondrial respiration via NO, to alternatively release complete glucose oxidation to CO2 and H2O or to drive glucose storage to glycogen. Methodology/Principal Findings We illustrate here that NO produced by translocated nNOS (mtNOS) is the insulin-signaling molecule that controls mitochondrial oxygen utilization. We evoke a hyperinsulinemic-normoglycemic non-invasive clamp by subcutaneously injecting adult male rats with long-lasting human insulin glargine that remains stable in plasma by several hours. At a precise concentration, insulin increased phospho-Akt2 that translocates to mitochondria and determines in situ phosphorylation and substantial cooperative mtNOS activation (+4–8 fold, P<.05), high NO, and a lowering of mitochondrial oxygen uptake and resting metabolic rate (−25 to −60%, P<.05). Comparing in vivo insulin metabolic effects on gastrocnemius muscles by direct electroporation of siRNA nNOS or empty vector in the two legs of the same animal, confirmed that in the silenced muscles disrupted mtNOS allows higher oxygen uptake and complete (U-14C)-glucose utilization respect to normal mtNOS in the vector-treated ones (respectively 37±3 vs 10±1 µmolO2/h.g tissue and 13±1 vs 7.2±1 µmol 3H2O/h.g tissue, P<.05), which reciprocally restricted glycogen-synthesis by a half. Conclusions/Significance These evidences show that after energy replenishment, insulin depresses mitochondrial respiration in skeletal muscle via NO which permits substrates to be deposited as macromolecules; at discrete hyperinsulinemia, persistent mtNOS activation could contribute to mitochondrial dysfunction with insulin resistance and obesity and therefore, to the progression of the metabolic syndrome.

Low Back Pain and Associated Presenteeism among Hospital Nursing Staff

Low Back Pain and Associated Presenteeism among Hospital Nursing Staff: Angelo d’ERRICO, et al. Department of Epidemiology, Local Health Unit TO3, Italy—

Evaluating the Psychometric Properties of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) among Italian Nurses: How Many Factors Must a Researcher Consider?

Background The Maslach Burnout Inventory (MBI) is the mainstream measure for burnout. However, its psychometric properties have been questioned, and alternative measurement models of the inventory have been suggested. Aims Different models for the number of items and factors of the MBI-HSS, the version of the Inventory for the Human Service sector, were tested in order to identify the most appropriate model for measuring burnout in Italy. Methods The study dataset consisted of a sample of 925 nurses. Ten alternative models of burnout were compared using confirmatory factor analysis. The psychometric properties of items and reliability of the MBI-HSS subscales were evaluated. Results Item malfunctioning may confound the MBI-HSS factor structure. The analysis confirmed the factorial structure of the MBI-HSS with a three-dimensional, 20-item assessment. Conclusions The factorial structure underlying the MBI-HSS follows Maslach’s definition when items are reduced from the original 22 to a 20-item set. Alternative models, either with fewer items or with an increased number of latent dimensions in the burnout structure, do not yield better results to justify redefining the item set or theoretically revising the syndrome construct.

La relazione con i pazienti in sanità: quali risorse lavorative per attenuare l’impatto degli stressor sociali?

Ricerche nazionali e internazionali hanno mostrato che gli operatori sanitari si trovano ad affrontare episodi di violenza verbale e fisica con sempre maggior frequenza. Evidenze empiriche supportano l’ipotesi che comportamenti aggressivi dei pazienti possono generare processi di burnout. Scarsi sono pero gli studi sulle risorse lavorative che consentono di attenuare l’impatto di tale stressor sociale sul benessere degli operatori nei contesti ospedalieri. Nel nostro contributo abbiamo analizzato se e in quali circostanze differenti tipi di risorse, emotive (supporto dei colleghi, supporto dei superiori) e cognitive (autonomia decisionale, significato del lavoro), moderino l’effetto negativo dell’aggressivita verbale su burnout e benessere affettivo. Lo studio, di tipo trasversale, ha coinvolto il personale sanitario di un dipartimento chirurgico (133 operatori con un tasso di partecipazione del 67%). Lo strumento di rilevazione e stato un questionario self-report. Le analisi, effettuate attraverso una regressione gerarchica moderata, hanno evidenziato l’effetto diretto dei comportamenti aggressivi come importanti predittori del burnout e del benessere affettivo. Il supporto dei colleghi e dei superiori e, in misura minore, l’attribuzione di significato al lavoro moderano l’impatto negativo sull’esaurimento emotivo. Il benessere affettivo risulta essere moderato dal supporto dei colleghi e dalla percezione di autonomia lavorativa. Inoltre si e riscontrato che l’attribuzione di significato al proprio lavoro influenza positivamente il benessere nel caso di alta aggressivita dei pazienti. Lo studio contribuisce a evidenziare gli aspetti socioorganizzativi che svolgono un’azione protettiva rispetto agli stressor sociali legati alla relazione con i pazienti nei contesti sanitari.

Relationship between job demands and psychological outcomes among nurses: Does skill discretion matter?

OBJECTIVES The aim of the present study was to assess both the direct and indirect effects (i.e., interacting with various job demands) of skill discretion on various psychological outcomes (i.e., emotional exhaustion, intention to leave, affective well-being, and job satisfaction). MATERIAL AND METHODS Data were collected by a self-reported questionnaire in 3 hospitals in Italy. The sample consisted of 522 nurses. Moderated hierarchical regression analyses were employed. RESULTS The findings highlighted the direct effect of skill discretion on reducing emotional exhaustion, intention to leave, sustaining affective well-being and job satisfaction. As regards interaction effect, the analyses indicated that skill discretion moderates the negative effect of disproportionate patient expectations on all the considered psychological outcomes. On the other hand, skill discretion was found to moderate the effect of cognitive demands on turnover intention as well as the effect of quantitative demands on emotional exhaustion and job satisfaction only in conditions of low job demands. CONCLUSIONS The study revealed some interesting findings, suggesting that skill discretion is not a resource in the pure sense, but that it also has some characteristics of a job demand. The study has relevant practical implications. Particularly, from a job design point of view, the present study suggests that job demands and skill discretion should be balanced carefully in order to sustain job well-being and worker retention.

Verbal Aggression from Care Recipients as a Risk Factor among Nursing Staff: A Study on Burnout in the JD-R Model Perspective

Among nursing staff, the risk of experiencing violence, especially verbal aggression, is particularly relevant. The present study, developed in the theoretical framework of the Job Demands-Resources model (JD-R), has two main aims: (a) to examine the association between verbal aggression and job burnout in both nurses and nurses aides and (b) to assess whether job content, social resources, and organizational resources lessen the negative impact of verbal aggression on burnout in the two professional groups. The cross-sectional study uses a dataset that consists of 630 workers (522 nurses and 108 nurses aides) employed in emergency and medical units. High associations were found between verbal aggression and job burnout in both professional groups. Moderated hierarchical regressions showed that, among nurses, only the job content level resources moderated the effects of the verbal aggression on job burnout. Among nurses aides, the opposite was found. Some resources on the social and organizational levels but none of the job content level resources buffered the effects of verbal aggression on workers burnout. The study highlights the crucial role of different types of resources in protecting nursing staff from the detrimental effects of verbal aggression on job burnout.

Antecedenti della sindrome di burnout nella sanità pubblica: fattori interpersonali e organizzativi

Determinants of the burnout syndrome in public health: interpersonal and organizational factors - The contribution illustrates the results of a research on the determinants of the burnout syndrome. This was carried out in four Piemontese hospitals in order to put into practice actions of prevention of the surveyed discomfort. The aim is to compare, besides the traditional individual factors, the determinants belonging to the interpersonal sphere and those that may be traced back to the organizational dimension. The regression analysis allow to define a sort of priority map for the following intervention, that is to locate wards and professional groups more at risk, in relation to the critical group and/or organizational state. Results also show the role that interpersonal factors play in the onset, the structuring and the evolution of the syndrome. Keywords: burnout syndrome, public health, organizational factors. Parole chiave: sindrome di burnout, sanita pubblica, fattori organizzativi.

Giustizia organizzativa, supporto sociale e burnout tra lavoratori della Sanità : effetti diretti e di moderazione

Il contributo illustra i risultati di una ricerca sul ruolo che la giustizia organizzativa e il supporto sociale - da parte di colleghi e superiori - hanno in ambito lavorativo sull’insorgere del burnout. Obiettivo e evidenziare gli effetti di queste dimensioni organizzative sull’insorgere della sindrome e, nel dettaglio, identificare gli eventuali effetti di moderazione del supporto sociale sulla relazione tra giustizia organizzativa e burnout. Lo studio e stato condotto nell’Azienda Sanitaria Ospedaliera piu grande del Piemonte e ha coinvolto 503 operatori che lavorano in tre reparti molto diversi dal punto di vista delle caratteristiche dei pazienti e dell’intensita del sistema di cure (ICU e non-ICU): medicina d’urgenza, medicina interna e radiodiagnostica. I risultati hanno messo in luce sia la presenza di effetti diretti della giustizia e del supporto sociale sul burnout, sia effetti di moderazione del supporto sociale sulla relazione tra giustizia e dimensioni del burnout, diversificati sulla base dei reparti coinvolti nell’indagine. .

Aging and Work Ability: The Moderating Role of Job and Personal Resources

Objective: Demographic changes involving western countries and later retirements due to the recent pension reforms induce a gradual aging of the workforce. This imply an increasing number of workers with health problems and a decreasing of ability to work. In this direction, the present study aims at examining the role of job and personal resources between age and work ability within nurses. Method: The study was cross-sectional and not randomized; data were collected by a self-report questionnaire during a multi-center survey conducted in two Italian hospitals in 2016. In this way, 333 nurses were reached. Results: Multiple linear regression showed that age is significantly and negatively associated to work ability, and that job resources (e.g., decision authority and meaning of work) and personal resources (e.g., hope and resilience) moderate the relationship between age and work ability. Discussion: These results highlight that investing in work and personal resources to support WA is even more relevant for those professions where high physical effort is required.

La misurazione del burnout nei contesti sanitari: validità di costrutto e invarianza fattoriale della versione italiana dello Spanish Burnout Inventory (SBI-Ita)

Introduzione. Il burnout rappresenta un rischio psicosociale rilevante nel contesto sanitario. La disponibilita di strumenti di valutazione del burnout di cui sono note le qualita psicometriche specificatamente riferite al contesto sanitario italiano e dunque importante al fine dell’affidabilita della misurazione del fenomeno. Obiettivo. Scopo del presente lavoro e quello di fornire evidenze empiriche circa le caratteristiche psicometriche della versione italiana dello Spanish Burnout Inventory (SBI-Ita) in riferimento al contesto sanitario. Metodo. Il presente lavoro si basa su dataset provenienti da due studi distinti. Lo Studio I ha coinvolto 318 lavoratori del comparto sanitario impiegati in due presidi. Lo Studio II ha coinvolto 695 medici e infermieri di una azienda sanitaria. Risultati. Dall’analisi dei dati provenienti dallo Studio I, in cui sono stati messi in competizione differenti modelli, emerge che il modello quadri-fattoriale ipotizzato da Gil-Monte (Entusiasmo per il lavoro, Esaurimento psicologico, Indolenza, Colpa) e quello che meglio intercetta la struttura soggiacente ai dati. Le analisi sui dati dello Studio II evidenziano che la struttura fattoriale e invariante tra i sottogruppi di medici e infermieri. Discussione e Conclusioni. I risultati indicano che lo SBI-Ita riporta caratteristiche psicometriche soddisfacenti rappresentando uno strumento adeguato per la misurazione del burnout nei contesti sanitari in Italia. Puo essere utilizzato proficuamente nell’ambito di rilevazioni volte alla valutazione dei rischi psicosociali in intere popolazioni lavorative (es., valutazione stress-lavoro correlato in adempimento alla L.81/08), e in fase di approfondimento diagnostico nell’ambito di interventi volti al sostegno individuale del lavoratore.