Evaluating the reactogenicity of COVID-19 vaccines from network-meta analyses.

BACKGROUND: Evidence-based reassurances addressing vaccine-related concerns are crucial to promoting primary vaccination, completion of the primary series, and booster vaccination. By summarizing and comparing the reactogenicity of COVID-19 vaccines authorized by the European Medicines Agency, this analysis aims to support in-formed decision-making by the lay public and help overcome vaccine hesitancy. RESEARCH DESIGN AND METHODS: A systematic literature review identified 24 records reporting solicited adverse events for AZD1222, BNT162b2, mRNA-1273, NVX-Cov2373, and VLA2001 in individuals aged 16 or older. Network meta-analyses were conducted for each solicited adverse events reported for at least two vaccines that were not compared head-to-head but could be connected through a common comparator. RESULTS: A total of 56 adverse events were investigated through network meta-analyses within a Bayesian framework with random-effects models. Overall, the two mRNA vaccines were found to be the most reactogenic vaccines. VLA2001 had the highest likelihood of being the least reactogenic vaccine after the first and second vaccine dose, especially for systemic adverse events after the first dose. CONCLUSIONS: The reduced chance of experiencing an adverse event with some COVID-19 vaccines may help to overcome vaccine hesitancy in population groups with concerns about the side effects of vaccines.

Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration.

BACKGROUND AND AIMS: In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options. APPROACH AND RESULTS: This was a retrospective, multicenter study of 105 naive AIH patients treated with budesonide as the first-line drug. The control group included 276 patients treated with prednisone. Efficacy was assessed using logistic regression and validated using inverse probability of treatment weighting propensity score. The median time to biochemical response (BR) was 3.1 months in patients treated with budesonide and 4.9 months in those with prednisone. The BR rate was significantly higher in patients treated with prednisone (87% vs. 49% of patients with budesonide, p < 0.001). The probability of achieving BR, assessed using the inverse probability of treatment weighting propensity score, was significantly lower in the budesonide group (OR = 0.20; 95% CI: 0.11-0.38) at any time during follow-up, and at 6 (OR = 0.51; 95% CI: 0.29-0.89) and 12 months after starting treatment (0.41; 95% CI: 0.23-0.73). In patients with transaminases <2 × upper limit of normal, BR was similar in both treatment groups. Prednisone treatment was significantly associated with a higher risk of adverse events (24.2% vs. 15.9%, p = 0.047). CONCLUSIONS: In the real-life setting, the use of budesonide as first-line treatment is low, and it is generally prescribed to patients with perceived less disease activity. Budesonide was inferior to prednisone as a first-line drug but was associated with fewer side effects.

Significant heterogeneity in the diagnosis and long-term management of Wilson disease: Results from a large multicenter Spanish study.

There is uncertainty regarding Wilson's disease (WD) management. OBJECTIVES: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers. METHODS: Data on WD patients followed at 32 Spanish hospitals were collected. RESULTS: 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response. CONCLUSIONS: Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored.

Non-pharmacologic direct cost of a simplified strategy with glecaprevir/pibrentasvir for 8 weeks in naïve non-cirrhotic patients with hepatitis C implemented in clinical practice. The Just SIMPLE Study.

BACKGROUND AND OBJECTIVE: The emergence of highly tolerable, effective, and shorter duration direct-acting antivirals (DAAs) regimens offers the opportunity to simplify hepatitis C virus management but medical costs are unknown. Thus, we aimed to determine the direct medical costs associated with a combo-simplified strategy (one-step diagnosis and low monitoring) to manage HCV infection within an 8-week glecaprevir/pibrentasvir (GLE/PIB) regimen in clinical practice in Spain. PATIENTS AND METHODS: Healthcare resources and clinical data were collected retrospectively from medical charts of 101 eligible patients at 11 hospitals. Participants were adult, treatment naïve subjects with HCV infection without cirrhosis in whom a combo-simplified strategy with GLE/PIB for 8 weeks were programmed between Apr-2018 and Nov-2018. RESULTS: The GLE/PIB effectiveness was 100% (CI95%: 96.2-100%) in the mITT population and 94.1% (CI95%: 87.5-97.8%) in the ITT population. Three subjects discontinued the combo-simplified strategy prematurely, none of them due to safety reasons. Five subjects reported 8 adverse events, all of mild-moderate intensity. Combo-simplified strategy mean direct costs were 754.35±103.60€ compared to 1689.42€ and 2007.89€ of a theoretical 12-week treatment with 4 or 5 monitoring visits, respectively; and 1370.95€ and 1689.42€ of a theoretical 8-week with 3 or 4 monitoring visits, respectively. Only 4.9% of the subjects used unexpected health care resources. CONCLUSIONS: 8-week treatment with GLE/PIB combined with a combo simplified strategy in real-life offers substantial cost savings without affecting the effectiveness and safety compared to traditional approaches.

Dysregulation of the AP2M1 phosphorylation cycle by LRRK2 impairs endocytosis and leads to dopaminergic neurodegeneration.

Mutations in the kinase LRRK2 and impaired endocytic trafficking are both implicated in the pathogenesis of Parkinson's disease (PD). Expression of the PD-associated LRRK2 mutant in mouse dopaminergic neurons was shown to disrupt clathrin-mediated endocytic trafficking. Here, we explored the molecular mechanism linking LRRK2 to endocytosis and found that LRRK2 bound to and phosphorylated the µ2 subunit of the adaptor protein AP2 (AP2M1), a core component of the clathrin-mediated endocytic machinery. Analysis of human SH-SY5Y cells and mouse neurons and tissues revealed that loss of LRRK2 abundance or kinase function resulted in decreased phosphorylation of AP2M1, which is required for the initial formation of clathrin-coated vesicles (CCVs). In contrast, overexpression of LRRK2 or expression of a Parkinson's disease-associated gain-of-function mutant LRRK2 (G2019S) inhibited the uncoating of AP2M1 from CCVs at later stages and prevented new cycles of CCV formation. Thus, the abundance and activity of LRRK2 must be calibrated to ensure proper endocytosis. Dysregulated phosphorylation of AP2M1 from the brain but not thyroid tissues of LRRK2 knockout and G2019S-knockin mice suggests a tissue-specific regulatory mechanism of endocytosis. Furthermore, we found that LRRK2-dependent phosphorylation of AP2M1 mediated dopaminergic neurodegeneration in a Drosophila model of PD. Together, our findings provide a mechanistic link between LRRK2, AP2, and endocytosis in the pathogenesis of PD.

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain.

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain.

Vapor-Phase Plotting of Organosilane Chemical Gradients.

Vapor-phase plotting of organosilane-based self-assembled monolayer (SAM) gradients is demonstrated for the first time. Patterned SAMs are formed by delivering gas-phase organotrichlorosilane precursors to a reactive silica surface using a heated glass capillary. The capillary is attached via a short flexible tube to a reservoir containing the precursor dissolved in toluene. The proximal end of the capillary is positioned at an experimentally optimized distance of 30 µm above the substrate during film deposition. The capillary is mounted to a stepper-motor-driven X, Y plotter for raster scanning above the surface. Two different organotrichlorosilane precursors are employed in this initial demonstration: n-octyltrichlorosilane and 3-cyanopropyltrichlorosilane. The dependence of SAM deposition on ambient relative humidity, capillary-substrate separation, raster-scanning speed, and solvent viscosity and volatility is explored and optimum deposition conditions are identified. The optimized procedures are used to plot uniformly modified square "pads" and gradients of the silanes. Film formation is verified and the gradient profiles are obtained by sessile drop water contact angle measurements, spectroscopic ellipsometry measurements of film thickness, and X-ray photoelectron spectroscopy mapping. The resolution of the plotting process is currently in the millimeter range and depends on capillary diameter and distance from the substrate surface. Vapor-phase plotting affords a unique direct-write method for producing patterned and chemically graded SAMS that may find applications in microfluidic devices, planar chromatography, and optical and electronic devices.

Interferon-free treatments in patients with hepatitis C genotype 1-4 infections in a real-world setting.

AIM: To investigated the real-world effectiveness and safety of various regimens of interferon-free treatments in patients infected with hepatitis C virus (HCV). METHODS: We performed an observational study to analyze different antiviral treatments administered to 462 HCV-infected patients, of which 56.7% had liver cirrhosis. HCV RNA after 4 wk of treatment and at 12 wk after treatment sustained virologic response (SVR) as well as serious adverse events (SAEs) was analyzed first for the whole cohort and then separately in patients who met or did not meet the inclusion criteria of a clinical trial (CT-met and CT-unmet, respectively). RESULTS: The most frequently prescribed treatment was simeprevir/sofosbuvir (36.4%), followed by sofosbuvir/ledipasvir (24.9%) and ombitasvir/paritaprevir/ritonavir (r)/dasabuvir (19.9%). Ribavirin (RBV) was administered in 198 patients (42.9%). SVRs occurred in 437/462 patients (94.6%). The SVRs ranged between 93.3% and 100% for genotypes 1-4. SVRs were achieved in 96.2% patients in the CT-met group vs 91.9% patients in the CT-unmet group (P = 0.049). Undetectable HCV RNA at week 4 occurred in 72.9% of the patients. In the univariate analysis, the factors associated with SVRs were lower liver stiffness, absence of cirrhosis, higher platelet count, higher albumin levels, no RBV dose reduction, undetectable HCV RNA at week 4 and CT-met group. In the multivariate analysis, only albumin was an independent predictor of treatment failure (P = 0.04). Eleven patients (2.4%) developed SAEs; 5.2% and 0.7% of the patients in the CT-unmet and CT-met groups, respectively (P = 0.003). CONCLUSION: A high proportion of patients with HCV infection achieved SVRs. For patients who did not meet the CT criteria, treatment regimens must be optimized.

Osmotic-shock produced by vitrification solutions improves immature human oocytes in vitro maturation.

BACKGROUND: During cytoplasmic oocyte maturation, Ca(2+) currents are vital for regulating a broad range of physiological processes. Recent studies have demonstrated that DMSO and EG cause large transient increases in intracellular Ca(2+) in mouse oocytes. The CP used in vitrifying protocols also increases the intracellular calcium transient. The aim of this study is to evaluate the effects of vitrifying time (before and after IVM) and exposure to the vitrification solutions and ionomycin on oocyte quality and embryonic development. METHODS: 221 GV-oocytes unsuitable for IVF-ICSI cycles were randomly distributed into one of the following three groups. G1 (control group): 41 GV-oocytes IVM until MII; G2: 43 oocytes vitrified at GV stage and IVM until MII stage; and G3: 53 GV-oocytes IVM until MII and then vitrified. In order to clarify the effect of vitrification solutions (VS) on human oocyte IVM through the intracellular Ca(2+) oscillation, the following two groups were also included. G4: 43 GV-oocytes exposed to VS and IVM until MII; and G5: 41 GV-oocytes exposed to ionomycin and IVM until MII. All GV-oocytes that reached MII-stage were parthenogenetically activated to assess oocyte viability. IVM was performed in IVF-medium (24-48 h). Chemical treatment (ionomycin) and osmotic treatment (vitrification solutions) were performed without liquid-N2 immersion. The following rates were evaluated: survival (SR), in-vitro maturation (IVMR), activation (AR), development to 2-cell (DRC), development to morula (DRCM) and development to blastocyst (DRB). Ratios between the different treatment groups were compared using contingency tables analysis (chi-square test). RESULTS: A high survival rate was obtained in G2 (95.5 %) and G4 (96.6 %). In-vitro maturation rate was significantly higher for G4 (86 %) and G2 (83.7 %) compared to G1 (63.4 %), G3 (56.6 %) and G5 (48.8 %). DRCM was significantly higher for G1 and G2 compared to G3 (G1: 15.8 %, G2: 20.7 % and G3: 0 %). DRB was only obtained for the oocytes vitrified before IVM (G2: 3.4 %). AR was also significantly higher for G2 and G4 compared to G5 (G2: 80.5 %, G4: 86.5 % and G5: 55 %). DRCM and DRB were only obtained in G2 and G4. DRCM was significantly higher for oocytes vitrified at GV stage (G2) and for oocytes exposed to the VS in G4 compared to the oocytes exposed to the ionomycin in G5 (G2: 20.7 %; G4: 37.5 % and G5: 0 %). CONCLUSIONS: Vitrifying GV-oocytes improves their IVM. Further investigation could look to increase the oocyte pool and improve fertility preservation options.

Lipofilización del almidón de Dioscorea rotundata P. y su posible uso como agente emulsificante / Lipophilitation of dioscorea rotundata P. starch and its possible use as an emulsifying agent

Objetivo: evaluar la capacidad emulsificante de almidón nativo, hidrolizados e hidrolizados˗lipofilizados a partir del tubérculo de ñame (Dioscorea rotundata). Método: el almidón se obtuvo por el método de rayado y decantación convencionales. Se evaluó el almidón de ñame nativo, que se hidrolizó en medio ácido (40 g almidón+100 mL Agua+3.4 g HCl por 6 horas a 50 °C). Parte del almidón hidrolizado se lipofilizó a dos niveles (10 y 15 mL) mediante reacción con anhídrido dodecenil succínico (DDSA). La capacidad emulsificante se calculó mezclando 25 mL de aceite de maíz, 25 mL de agua y 1 g de almidón por triplicado con fuerte homogenización ( Ultra Turrax®), midiéndose la cantidad de material aún emulsificado luego de 24 horas. Resultados: se apreciaron variaciones de las propiedades en la comparación del almidón nativo. Los porcentajes de sustitución de los almidones, se observa fácilmente la tendencia esperada, es decir, en tanto mayor cantidad de reactivo, mayor sustitución. Se demuestra que la lipofilización del almidón incrementa su capacidad emulsificante. Conclusiones: los almidones lipofilizados con anhidro dodecenil succínico (DDSA) pueden considerarse una nueva alternativa de materia prima en la industria cosmética(AU)

Objectives: to assess the emulsifying capacity of the native starch, the hydrolyzed and hydrolyzed-lipophilyzed products from the tuber Yam (Dioscorea rotundata), Methods: the starch was obtained by the conventional method of grating and decant. Native yam starch was evaluated. It was hydrolyzed in an acid medium (40 g starch+100 mL water+3,4 g HCl for 6 hours at 50 °C). Part of the hydrolyzed starch was lipophilyzed at two levels (10 and 15 mL) through reaction with dodecenyl succinic anhydride (DDSA). The emulsifying capacity was calculated by mixing 25 mL of corn oil, 25 mL of water and 1 g of starch in triplicate with strong homogenization (Ultra Turrax®), and the amount of material still emulsified after 24 hours was then measured. Results: there were observed variations in the native starch properties. It was easy to observe the expected tendency in the substitution percentages of starches, that is, the more reagent, the more substitution. The results showed that the lipophilitation of starch increases the emulsifying capacity. Conclusions: the starches lipophilyzed with dodecenyl succinic anhydride (DDSA) are raw materials that can be considered as a new alternative in the cosmetics industry(AU)

Satisfacción laboral del personal de enfermería en un hospital de gineco-obstetricia del Instituto Mexicano del Seguro Social / Work satisfaction of nursing staff in a gyneco-obstetric hospital

Introducción: la satisfacción del trabajador en instituciones de salud es considerada por el Modelo de Administración por Calidad Total del Instituto Mexicano del Seguro Social como contribuyente para el logro de las metas de la unidad; eleva la calidad de la atención y mejora los procesos internos del servicio de salud que se ofrece a derechohabientes. Objetivo: evaluar la satisfacción laboral del personal de enfermería de un hospital de gineco-obstetricia, a través de las dimensiones: a) institucional, b) desarrollo, capacitación y actualización, c) comunicación y d) salud y condiciones laborales. Metodología: estudio transversal, comparativo. La muestra constituida por 212 enfermeras de los tres tumos, quienes emitieron su opinión por encuesta autoadministrada bajo consentimiento informado. La confiabilidad del instrumento alcanzó 0.799 alfa de Cronbach. Se aplicaron medidas de resumen y tendencia central para la etapa descriptiva y medidas de inferencia estadística ANOVA y R de Pearson. Resultados: en la evaluación institucional, comunicación, salud y condiciones laborales existió mayor satisfacción; y en desarrollo, capacitación y actualización, se tuvo el índice menor. En general se encontró un alto porcentaje de personal satisfecho con su trabajo 4.04. Conclusiones: la remuneración económica, salud y condiciones laborales, presentó altos niveles de insatisfacción, se coincide con Briseño quien detectó bajo salario y pocas posibilidades de ascenso, condiciones que producen mayor insatisfacción entre el personal de enfermería.

Background: worker' satisfaction in health institutions is considered by the Administration Model for Total Quality of the Instituto Mexicano del Seguro Social as contributor for the goal achievement of the unit; it increases the quality and improves the internal processes of the health Services that are offered to their members. Objective: to evaluate the work satisfaction of the nursing staff in a gyneco-obstetric hospital, throughout the dimensions: a) institutional, b) development, training, and updating, c) communication, and d) health and working conditions. Methodology: comparative, transversal study. Sample constituted by 212 nurses from three shifts, who gave their opinion by survey self-administered under informed consent. The confidence of the instrument reached 0.799 Cronbach's alfa. Central tendency and other measurements were applied for the descriptive phase, and ANOVA and Pearson's R for measurements of inferential statistic. Results: there was a major satisfaction on the institutional evaluation, communication, health, and working conditions; and in the development, training, and updating, the minor index was obtained. In general, it was found a high percentage of satisfied personnel with their work in 4.04. Conclusions: economic compensation, health, and working conditions showed high levels of insatisfaction, coincident with Briseño who detected low salary and few possibilities of ascending, conditions that produce major insatisfaction among the nursing personnel.

Serum levels of soluble vascular cell adhesion molecule are related to hyperdynamic circulation in patients with liver cirrhosis.

BACKGROUND: In patients with liver cirrhosis, serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) have been associated with increasing fibrosis and are related to angiogenesis. AIM: To assess the possible correlation between sVCAM-1 and splanchnic and systemic haemodynamic and clinical staging of cirrhotic patients. METHODS: We assessed, using immunoassays, the serum levels of sVCAM-1, in the peripheral and hepatic vein, in all consecutive patients with liver cirrhosis, who underwent a haemodynamic study as part of its routine clinical work-up. RESULTS: We studied 86 patients [61 M/25 F; age 51.1 (8.3) years] with alcoholic (31) or viral (HBV:6, HCV:49) cirrhosis, 10 of them with hepatocellular carcinoma (Milan criteria). The mean follow-up was 391(187) days; 29 patients died or underwent transplantion during follow-up. A strong correlation in serum levels of sVCAM-1 was observed between the peripheral and the hepatic vein (r=0.8; P=0.0001). There was no correlation between levels of sVCAM-1 and hepatic venous pressure gradient. At univariate analysis, sVCAM-1 was inversely related with mean arterial pressure (r=-0.292; P=0.007), systemic vascular resistance (SVR) (r=-0.37; P=0.005) and serum sodium levels (r=-0.326; P=0.002). In multivariate linear regression only SVR remained as an independent variable associated to sVCAM-1. A correlation of sVCAM-1 with Child-Pugh scores, model for end-stage liver disease (MELD) and the clinical stage proposed in the Baveno IV consensus conference was also observed. Finally, patients who died or underwent transplantion during follow-up had significantly greater values of sVCAM-1 at baseline than those who did not [3505(1329) vs. 2488(1208) P=0.001]. CONCLUSION: This study supports a potential role of sVCAM-1 as a marker of hyperdynamic circulation, closely related to the different stage of liver cirrhosis.

Satisfacción laboral y calidad de atención de enfermería en una unidad médica de alta especialidad / Job satisfaction and quality of nursing services in a specialty medical institution

Introducción: En las instituciones que brindan servicios de salud el factor humano desempeña un papel fundamental para el otorgamiento de los servicios con calidad; relacionados estrechamente con el trato personal Objetivo: Describir los factores que intervienen en la percepción de la calidad de atención de enfermería y los que influyen en la satisfacción laboral de la enfermera. Metodología: Para la evaluación de la satisfacción laboral de la enfermera se utilizó el instrumento índice de satisfacción laboral 66 (ISL* 66), y para la medición de la satisfacción del paciente por la atención recibida del personal de enfermería, se empleó un instrumento para evaluar la calidad de la atención médica. El tamaño de la muestra calculada para proporciones fue de 91 enfermeras y 182 pacientes cuya selección se realizó al azar, en los tres turnos. Para el análisis de los datos se obtuvieron frecuencias absolutas y relativas. Resultados: La satisfacción laboral alcanzó un índice global de 3.42; los hombres y el personal de turno vespertino mostraron mayores índices de satisfacción. 50% de los usuarios encuestados considera insuficiente la calidad de atención recibida. Los índices más altos de satisfacción se encontraron en pacientes de 46 a 60 años de edad, escolaridad primaria y licenciatura. Conclusiones: La satisfacción laboral tiene relación con aspectos de desarrollo, capacitación y actualización para el desempeño; así como condiciones laborales. Y la satisfacción del usuario está ligada con el trato del personal. Se concluye que a mayor satisfacción laboral existe mayor calidad de atención por parte del personal de enfermería y por lo tanto satisfacción del paciente.

Introduction: In organizations that deliver health services, the human factor plays a fundamental role when delivering quality services, which are related narrowly to personal contact. Objective: To describe factors that intervene on the perception of Quality of Nursing Services and those that influence on nurses' job satisfaction. Methodology: Nurses' job satisfaction was evaluated through an instrument named Index of Job Satisfaction 66 (IJS'66). Patient satisfaction for received nursing services was evaluated through an instrument to evaluate the quality of medical services. The size of the randomized, calculated sample for proportions was 91 nurses and 182 patients from the three shifts. To analyze data, absolute and relative frequencies were obtained. Results: Job satisfaction reached an index of 3.42; men and evening nursing staff showed up major scores of satisfaction. 50% out of surveyed users considered the received services as good enough. The highest scores of satisfaction were found in patients between 46 a 60 year old, with elementary school and baccalaureate education. Conclusions: Job satisfaction is related with several aspects such as development, training, and up dating for the competence, as well as working conditions. User satisfaction is linked to personal contact. In conclusion, when there is a major job satisfaction, there is a major quality of delivered services from nursing staff, and therefore patient satisfaction.