The Identified Skeletal Collection of the School of Legal Medicine: a contemporary osteological collection housed in Universidad Complutense de Madrid, Spain.

ABSTRA: Osteological collections are an important resource for the development of methods to assist in the study of skeletal remains in archeological and/or forensic contexts. The aim is to describe the current characteristics of the Identified Skeletal Collection of the School of Legal Medicine and its historical context. The Identified Skeletal Collection of the School of Legal Medicine of the Complutense University of Madrid consists of 138 male and 95 female individuals, born between 1880 and 1980 and deceased between 1970 and 2009. The minimum age of the sample is perinatal and the maximum age is 97 years. The collection is an essential tool for forensic research, given that its population characteristics can be extrapolated to those of present-day Spain. Access to this collection offers unique teaching opportunities as well as provides the information necessary to develop various lines of research.

Sexual dimorphism of dental tissues in modern human mandibular molars.

OBJECTIVES: Previous studies have revealed that human permanent dental tissue proportions differ significantly between males and females, with females having relatively thicker enamel relative to overall crown area than males. The aims of this study are to investigate sexual dimorphism in permanent mandibular molars and to determine whether such differences can be used to estimate sex in modern humans reliably. MATERIALS AND METHODS: The permanent mandibular molars used in this study (n = 51) originate from 36 individuals of known sex from a Spanish anthropological collection. Eight variables were assessed from two-dimensional (2D) mesial planes of section obtained from microtomographic scans. Binary stepwise logistic regression was then applied to the data. RESULTS: Male molars possess significantly greater quantities of dentine than females, both absolutely and proportionally. Females differed significantly from males by having greater relative enamel thickness. Logistic regression identified the proportion of dentine (relative dentine area [RDA]) as the most important sex discriminator, which can be used to correctly classify specimens with an overall accuracy rate of 74.36%. DISCUSSION: These results confirm that sexual dimorphism in mandibular molar size is a result of males having a greater amount of dentine, both absolutely and proportionally. The findings suggest that 2D measurements of RDA may be useful for sex determination, although further research is required to test the reliability of these predictive techniques across different populations.

Modern humans sex estimation through dental tissue patterns of maxillary canines.

OBJECTIVES: Dental tissue proportions of human permanent canines is one of only a few sexually dimorphic features that is present in childhood and maintained in adults, offering the opportunity for this to be used in sex determination. This study assesses dental tissue volumes and surface areas of maxillary permanent canines in a sample of known sex to provide new data and to explore the potential of these variables as reliable sexual estimators. MATERIALS AND METHODS: The teeth studied here derive from 56 individuals (27 females and 29 males) of known sex and age, and of different geographic origins. The teeth were scanned and three-dimensional (3D) measurements (volumes and surface areas) were obtained. In addition, a discriminant function analysis was applied. RESULTS: The results presented here concur with those previously published in relation to both size and dental tissue patterns. Male maxillary canines have a greater dentine component, whereas female enamel is thicker, leading to a difference in dental size in favor of males. Discriminant functions were calculated using these histological variables successfully identifying sex in between 87.5% and 93.75% of the known-sex hold-out sample, with 92.3% correctly assigned when all functions were applied together. DISCUSSION: The present study supports that methods for sex determination based on dental tissue measurements can achieve high allocation accuracies, being especially useful in the case of subadults or when no other appropriate method is available.

Contribution of dental tissues to sex determination in modern human populations.

OBJECTIVES: Accurate sex estimation is an essential step for the reconstruction of the biological profile of human remains. Earlier studies have shown that elements of the human permanent dentition are sexually dimorphic. The aims of this study are to determine the degree of sexual dimorphism in the dental tissue volumes and surface areas of mandibular canines and to explore its potential for reliable sex determination. METHOD: The teeth included in this study (n = 69) were selected from anthropological collections from Spain, South Africa and Sudan. In all cases, the sex of the individuals was known. The teeth were scanned and three-dimensional (3D) measurements (volumes and surfaces areas) were obtained. Finally, a dsicriminant function analysis was applied. RESULTS: Our results showed that sexual dimorphism in canine size is due to males having greater amounts of dentine, whereas enamel volume does not contribute significantly to overall tooth size dimorphism. Classification accuracy of the multivariable equations tested on slightly worn teeth ranged from 78 to 90.2% for the crossvalidation, and from 71.43 to 84.62% for the hold-out sample validation. When all functions were applied together, the sex was correctly assigned 92.30% of the time. CONCLUSIONS: Our results suggest that the 3D variables from mandibular canine dental tissues are useful for sex determination as they present a high degree of dimorphism. The results obtained show the importance of 3D dental tissue measurements as a methodology in sex determination, which application should be considered as a supplemental method to others.

Utility of Failure Mode and Effect Analysis to Improve Safety in Suctioning by Orotracheal Tube.

OBJECTIVE: The objective of the study was to use the Failure Mode and Effect Analysis (FMEA) tool to analyze the technique of secretion suctioning on patients with an endotracheal tube who were admitted into an intensive care unit. MATERIALS AND METHODS: Brainstorming was carried out within the service to determine the potential errors most frequent in the process. After this, the FMEA was applied, including its stages, prioritizing risk in accordance with the risk prioritization number (RPN), selecting improvement actions in which they have an RPN of more than 300. RESULTS: We obtained 32 failure modes, of which 13 surpassed an RPN of 300. After our result, 21 improvement actions were proposed for those failure modes with RPN scores above 300. CONCLUSIONS: FMEA allows us to ascertain possible failures so as to later propose improvement actions for those which have an RPN of more than 300.

Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010.

INTRODUCTION: The effort to increase patient safety has become one of the main focal points of all health care professions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. OBJECTIVES: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. MATERIAL AND METHOD: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. RESULTS: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. CONCLUSION: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred.

Sexual dimorphism in the enamel-dentine junction (EDJ) of permanent canines of European modern humans.

OBJECTIVES: Dental anthropological investigations into sexual dimorphism have conventionally concentrated on evaluating the dimensions and configuration of the enamel cap of canines. However, the morphology of the crown dentine surface can be closely linked to that of the enamel surface. This link can facilitate examination of crown morphology even when the enamel surface is slightly worn. Here, we determine if the morphology of the enamel-dentine junction (EDJ) differs within (maxillary vs. mandibular) and between a sample of male (n = 26) and female (n = 21) contemporary human permanent canines from Europe. METHODS: The morphological data of the EDJ were gathered employing a template comprising 96 landmarks and sliding semilandmarks. Subsequently, the data underwent analysis through form space principal component analysis following Procrustes registration, utilizing standard 3D geometric morphometric techniques. RESULTS: Significant differences in the morphology of the EDJ were observed between the sexes, particularly concerning the overall shape of the crown, the symmetry of the mesial and distal edges, and the development of the distal accessory ridge. CONCLUSIONS: Sex differences in the morphology of the EDJ could relate in part to retention of the canine-premolar honing complex in males. Our results indicate that analyses of the permanent canine EDJ may potentially provide a novel method for estimating the sex of adult and nonadult skeletons.

The clinical safety of disabled patients: proposal for a methodology for analysis of health care risks and specific measures for improvement.

The clinical risks associated with health care have been a known factor since ancient times, and their prevention has constituted one of the foundations of health care. However, concern for the risks involved in health care treatments has risen very significantly in recent years, becoming a modern current of concern for clinical health care risks which is referred to by the name of "patient safety" in the scientific literature. Unfortunately, there are no studies on patient safety in dental practice or case studies of adverse events in this practice. In addition to the lack of studies on adverse events in regular dental practice, there are even fewer references to treatment for disabled patients. In this article, we provide a "proposal for analysis" of the clinical risks associated with treating disabled patients, which will make it possible to evaluate the health care risks associated with the treatment of patients who have a specific disability, at one determined moment and in one specific environment.

Determining sex by bone volume from 3D images: discriminating analysis of the tali and radii in a contemporary Spanish reference collection.

The discriminant power of bone volume for determining sex has not been possible to determine due to the difficulty in its calculation. At present, new advancements based on 3D technology make it possible to reproduce the bone digitally and calculate its volume using computerized tools, which opens up a new window to ascertaining the discriminant power of this variable. With this objective in mind, the tali and radii of 101 individuals (48 males and 53 females) of a contemporary Spanish reference collection (twentieth century) (EML 1) were scanned using the Picza 3D Laser Scanner. Calculated for the tali were total volume, the volume of the posterior region, which includes the posterior calcaneal facet and other three volumes of the anterior region. Calculated for the radius were total volume, volume of the radius head, volume of the diaphysis, and volume of the distal end. The data are presented for all of the variables, distinguishing between the right and left side. The data were processed using the statistical program PASW Statistics 18, thereby obtaining classification functions for sex which accurately classify 90.9 % of tali and 93.9 % of radii on the basis of their total left and right volume, respectively. Studying the volume in different regions of the bone shows that the diaphysis of the right radius possesses a high level of discriminant power, offering classification functions which accurately classify 96.9 % of the sample. The validation test performed on a sample of 20 individuals from another contemporary Spanish reference collection (EML 2) confirms the high discriminant power of the volume obtaining an accurate classification rate of 80-95 % depending on the variable studied.

Patient safety and dentistry: what do we need to know? Fundamentals of patient safety, the safety culture and implementation of patient safety measures in dental practice.

Although concern for patient safety is inherent to the practice of the health care professions, its transformation into a specific body of knowledge is relatively recent and thus patient safety may be considered as a comparatively 'new' discipline. Its main objectives are to avoid the occurrence of preventable adverse events (accidents, errors and complications) associated with health care and to limit the impact of inevitable adverse events. Despite these simple definitions, patient safety is multifaceted, quite complex in nature and includes many key elements. Thus, it cannot be simply defined as the provision of safe health care or the protection of patients from harm by health care providers because there are economic, fiscal, social, cultural and organisational aspects of a patient safety climate. It is essential for all health care practitioners and health care organisations to become more familiar with the general context of patient safety, to actively participate in efforts to implement patient safety measures in daily practice and to establish a patient safety culture.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs.

OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Patient safety in dentistry: dental care risk management plan.

OBJECTIVES: Although the safety of patients has been one of the inherent concerns of dental practice, but because the proposals made in the field of dentistry are few and improperly structured, this paper constitutes an attempt to present a proposal titled "Plan for Dental Health Care Risk Management, " promoted by the General Council of Dentists of Spain, including a description of the proposed work methodology. DESIGN: The "risk management plan " proposed in this paper is based on applying the basic concepts dealt with in patient safety to the field of dentistry, due to the fact that the available bibliography contains no specific "health care risk management plan " for dentistry specifically. RESULTS AND CONCLUSIONS: In order to implement health care risk management in the field of dental care provided at any level throughout Spain, a seven-step plan which covers the main objectives in Patient Safety is provided.

Professional liability in oral surgery: legal and medical study of 63 court sentences.

OBJECTIVES: Dentistry, like all other health care professions, has in recent years been subjected to an increase in legal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of their frequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongst these areas of activity is that of oral surgery. STUDY DESIGN: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance or higher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptive and comparative statistical study by cross-referencing certain variables provides us with a clear and accurate picture of the lawsuit profile. RESULTS AND CONCLUSIONS: Implantological surgery was the practice subject to the most claims due to surgery (55.6 percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling against the professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18 sentences), the highest amount having been €24,000, an important factor to take into account when contracting professional civil liability insurance.

[Analysis of judicial sentences against psychiatrists dictated by appellate courts in Spain between 1992 and 2007]. / Análisis de las sentencias judiciales contra psiquiatras resueltas en segunda instancia en España entre 1992 y 2007.

Sentences against psychiatrists dictated in appellate or higher courts of Spain in the period from 1992 to 2007 were analyzed. Decisions were gathered for 13 of the 17 autonomous communities and statistical analysis yielded the following results: in more than 50% of cases, the decision was unfavorable for the psychiatrist, but the damages never exceeded € 600,000. The most frequent condition in the series was personality disorders (48.9%). The most frequent reasons for seeking legal redress were monitoring errors and negligence; no cases were brought to trial for therapeutic errors. The patient died in 58.3% of cases. It is noteworthy that 10% of the sentences cited defects in patient information or informed consent. The psychiatric health care teams in both the public and private sector should maximize monitoring of institutionalized patients and optimize installations to provide special security measures for the patients.

[Defensive medicine in hospital emergency services.] / Medicina defensiva en los Servicios de Urgencias Hospitalarias.

OBJECTIVE: Hospital emergency services have specific care characteristics that make them more vulnerable to the risk of legal claims. The fact of suffering a legal claim for professional practice is a very traumatic event. The objective of this study was to find out the opinion of the professionals of the hospital emergency services in Spain on the importance of practices associated with defensive medicine. METHODS: Survey of 1,449 professionals from public and private hospital emergency services throughout the national territory was made, in the period between March 13th and April 3rd, 2017. A univariate analysis was performed to identify variables in relation to the practice of defensive medicine, and the determination of the groups of greater association (chi2 test) to evaluate these variables. RESULTS: 96.1% expressed the need to strengthen their medical-legal training. 91.3% of the cases felt more legal pressure and 88.7% declared that they act conditioned by the threat of judicial claim. Regarding patient treatments, 89.8% stated that they perform diagnostic tests that may not be necessary and 63% of professionals stated that they extend the stay of patients in the emergency department. As for the healthcare organization, 88% declared that they do not feel protected by the structure and 79.1% do not felt support from the center's management. CONCLUSIONS: Practices associated with defensive medicine are frequent in our country, with a high proportion of criminal proceedings, and the two main causes are dispensable diagnostic tests and unnecessary prolongation of length of stay.

OBJETIVO: Los Servicios de Urgencias Hospitalarias presentan características asistenciales específicas que los hacen más vulnerables al riesgo de reclamaciones legales. El hecho de sufrir una reclamación judicial por la praxis profesional es un evento muy traumático. El objetivo de este estudio fue conocer la opinión de los profesionales de los Servicios de Urgencias Hospitalarias en España sobre la importancia de las prácticas asociadas a la medicina defensiva. METODOS: Se realizó un estudio mediante encuesta a 1.449 profesionales de Servicios de Urgencias Hospitalarias públicas y privadas de todo el territorio nacional, en el periodo comprendido entre el 13 de marzo y el 3 de abril de 2017. Se realizó un análisis univariante para la identificación de variables en relación con la práctica de la medicina defensiva, así como la determinación de los grupos de mayor asociación (test χ2) para evaluar estas variables. RESULTADOS: Un 96,1% expresaron la necesidad de fortalecer su formación médico-legal. Un 91,3% de los casos sintió mayor presión legal y un 88,7% declaró actuar condicionado por la amenaza de reclamación judicial. En lo referente a los tratamientos a los pacientes, un 89,8% afirmó realizar pruebas diagnósticas que podrían no ser necesarias y un 63% de los profesionales declaró alargar la estancia de los pacientes en las Urgencias. En cuanto a la organización sanitaria, un 88% manifestó no sentirse protegido por la estructuray un 79,1% no sintió el respaldo de la dirección del centro. CONCLUSIONES: Las prácticas asociadas a la medicina defensiva son frecuentes en nuestro país, con una alta proporción de procedimientos penales, y las dos causas principales son las pruebas diagnósticas prescindibles y la prolongación innecesaria de los tiempos de estancia.

Geometric Morphometrics of the human cervical vertebrae: sexual and population variations.

This study aims to carry out the first geometric morphometric analysis of the 3D size and shape of the full series of cervical vertebrae delving into variability related to sex and population background. For this reason, we analyzed the cervical vertebrae of both males and females belonging to Europeans, Africans, and Greenland Inuit. We 3D-scanned a total of 219 cervical vertebrae of males and females of three different modern human populations (European, African, and Inuit). A minimum of 72 landmarks and curve semilandmarks were positioned in each of the 3D vertebral models. Landmark configurations were analyzed following the standards of 3D Geometric Morphometrics to test for size and shape differences related to sex or population variation. Results show that male cervical vertebrae are consistently larger than in females while no regular shape differences are observed between males and females in any of the populations. Sex differences in cervical lordosis are thus not supported at the skeletal level of the 3D shape. On the other hand, there is no evidence for population-specific differences in size while shape does vary considerably, possibly also in relation to eco-geographic factors of overall trunk shape. Cervical vertebrae in cold-adapted Inuit were consistently shorter than in Europeans and Africans. The cervical spine may show a different pattern than the thoracic and lumbar spine, which might be related to stronger integration with the cranium, head mobility, and soft-tissue dependence. Our findings suggest that morpho-functional interpretations of the cervical spine based on vertebral skeletal morphology requires caution.

Eleven Basic Procedures/Practices for Dental Patient Safety.

OBJECTIVES: This study aimed to help alleviate the shortage of reliable information on clinical care issues; the Spanish Observatory of Dental Patient Safety (OESPO) has resorted to the study of legal claims by patients and searched those which produced clinical problems. METHODS: Based on OESPO data, this article proposes 11 basic procedures/practices for dental patient safety to help mitigate most preventable adverse events. RESULTS: The sample of the OESPO is large (415 adverse events studied), but it has the bias of a judicial source. However, the results provide an interesting approach to clinical safety in dentistry. When studying in detail the causes that led to preventable adverse events, it can be seen that most of these (and most severe) events have been caused by a small number of erroneous behaviors. CONCLUSIONS: Most preventable adverse events during the dental health care are produced by a relatively small number of causes. Therefore, a few basic safety procedures can reduce significantly these preventable adverse events.

[Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid.] / Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid.

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation.

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural.

[Utility of the classification analysis in the typology of the the suicide attempt in a hospital population.] / Utilidad del análisis de clasificación en la tipología del intento de suicidio en una población hospitalaria.

OBJECTIVE: Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid. METHODS: In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated. RESULTS: Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting. CONCLUSIONS: The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature.

OBJETIVO: Las personas que intentan suicidarse no constituyen un grupo homogéneo. Numerosos estudios acreditan distintos subtipos de individuos con intentos de suicidio. Una de las principales aplicaciones del análisis de clasificación es la segmentación y selección de las características del sujeto. El objetivo de este estudio fue identificar grupos de sujetos con intentos de suicidio y descubrir las relaciones entre ellos en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: En un estudio de caso-control se aplicó la técnica de árbol de clasificación basado en el algoritmo CHAID (Chi-square automatic interaction detector), incluido en el programa SPSS 23.0, sobre una muestra de 201 sujetos ingresados en un hospital de alta complejidad de Madrid. Se evaluaron la impulsividad, la conflictividad de pareja, los antecedentes psiquiátricos y la depresión. RESULTADOS: Se obtuvieron tres subtipos o perfiles diferenciables del sujeto vinculados al intento de suicidio (perfil alto 144 casos 71,64%, medio 35 casos 17,41% y bajo 22 casos 10,94% de patrones básicos de riesgo), con alto valor de aplicación al ámbito clínico. CONCLUSIONES: Las tipologías encontradas permiten adecuar medidas preventivas sobre el intento de suicidio y realizar intervenciones clínicas focalizadas de carácter preventivo y predictor.

Dentists Survey on Adverse Events During Their Clinical Training.

BACKGROUND: Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS: A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS: Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS: The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS: Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.