Structure and morphology of red pigments based on sepiolite.

Sepiolite is an important raw fibrous material. A method to prepare red pigments based on sepiolite through the thermal treatment of sepiolite with sulfur and sodium sulfide hydrate is reported. Sepiolite was heated until 800 °C in order to remove zeolitic water, the first coordinated water, the second coordinated water, and structural hydroxyls. Several [S/Na2S]molar ratios in the range 0.5-7 were employed. The properties of these pigments were studied by different analytical techniques, such as colorimetric analysis, thermal analysis, Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction and scanning electron microscopy. The samples with [S/Na2S] = 0.5 and 1, corresponding to high contents of sodium sulfide in the synthesis procedure, exhibit high values of the colorimetric parameter CIE a* and a maximum reflectance in the visible zone belonging to red, based on the red colour of the samples. Under the reducing conditions of the synthesis, sulfur forms polysulfides of the general formula [Sx]2-. The sodium sulfide reacts with the excess S to form polysulfides as well. From the polysulfides, the radical anions of the general formula [Sx/2]˙- originate and they are identified as the chromophore groups responsible for the color in the sulfur-based pigment analogues of ultramarines. The red colour of the samples could be mainly attributed to the presence of S4 and S4˙- identified by FTIR.

A comprehensive study from the micro- to the nanometric scale: Evaluation of chilling injury in tomato fruit (Solanum lycopersicum).

Tomato fruit is susceptible to chilling injury (CI) during its postharvest handling at low temperature. The symptoms caused by this physiological disorder have been commonly evaluated by visual inspection at a macro-observation scale on fruit surface; however, the structure at deeper scales is also affected by CI. This work aimed to propose a descriptive model of the CI development in tomato tissue under the micro-scale, micro-nano-scale and nano-scale approaches using fractal analysis. For that, quality and fractal parameters were determined. In this sense, light microscopy, Environmental Scanning Electron Microscopy (ESEM) and Atomic Force Microscopy (AFM) were applied to analyse micro-, micro-nano- and nano-scales, respectively. Results showed that the morphology of tomato tissue at the micro-scale level was properly described by the multifractal behaviour. Also, generalised fractal dimension (Dq=0) and texture fractal dimension (FD) of CI-damaged pericarp and cuticle were higher (1.659, 1.601 and 1.746, respectively) in comparison to non-chilled samples (1.606, 1.578 and 1.644, respectively); however, FD was unsuitable to detect morphological changes at the nano-scale. On the other hand, lacunarity represented an appropriate fractal parameter to detect CI symptoms at the nano-scale due to differences observed between damaged and regular ripe tissue (0.044 and 0.025, respectively). The proposed multi-scale approach could improve the understanding of CI as a complex disorder to the development of novel techniques to avoid this postharvest issue at different observation scales.

Hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: experience in a pediatric oncological institution. / Cistitis hemorrágica tras trasplante alogénico de progenitores hematopoyéticos: experiencia en un centro oncológico pediátrico.

OBJECTIVE: To analyze the risk factors associated with hemorrhagic cystitis (HC) severity and the treatment strategies available in HC patients following allogeneic hematopoietic stem cell transplantation (AHSCT). MATERIALS AND METHODS: A retrospective study of medical records was carried out. Patients with HC following AHSCT treated from 2017 to 2021 were divided into two groups according to severity -mild and severe. Demographic data, disease-specific characteristics, urological sequelae, and overall mortality were compared between both groups. The hospital's protocol was used for patient management. RESULTS: 33 episodes of HC were collected in 27 patients, 72.7% of whom were male. HC incidence following AHSCT was 23.4% (33/141). 51.5% of HCs were severe (grades III-IV). Severe graft host disease (GHD) (grades III-IV) and thrombopenia at HC onset were associated with severe HC (p= 0.043 and p= 0.039, respectively). This group had longer hematuria times (p< 0.001) and required more platelet transfusions (p= 0.003). In addition, 70.6% required bladder catheterization, but only 1 case needed percutaneous cystostomy. None of the patients with mild HC required catheterization. No differences were found in terms of urological sequelae or overall mortality. CONCLUSIONS: Severe HC could be predicted thanks to the presence of severe GHD or thrombopenia at HC onset. Severe HC can be managed with bladder catheterization in most of these patients. A standardized protocol may help reduce the need for invasive procedures in patients with mild HC.

OBJETIVO: Analizar factores de riesgo asociados a la gravedad de la cistitis hemorrágica (CH) y estrategias de tratamiento en pacientes con CH tras trasplante alogénico de progenitores hematopoyéticos (TAPH). MATERIAL Y METODOS: Estudio retrospectivo de historias clínicas. Los pacientes con CH tras TAPH tratados entre 2017 y 2021 se dividieron en dos grupos según la gravedad del cuadro (leve y grave). Se compararon datos demográficos, características específicas de la enfermedad, secuelas urológicas y mortalidad global entre ambos grupos. Se utilizó el protocolo del hospital para el manejo de los pacientes. RESULTADOS: Se recogieron 33 episodios de CH en 27 pacientes, de los cuales el 72,7% fueron varones. La incidencia de CH tras TAPH fue del 23,4% (33/141). El 51,5% de las CH fueron graves (grados III-IV). La enfermedad de injerto contra huésped (EICH) grave (grados III-IV) y la trombopenia al inicio se asociaron a CH grave (p= 0,043 y p= 0,039, respectivamente). Este grupo tuvo mayor tiempo de hematuria (p< 0,001) y necesitó más transfusiones de plaquetas (p= 0,003). Además, el 70,6% precisó sondaje vesical, pero solo un caso cistostomía percutánea. Ningún paciente con CH leve precisó sondaje. No hubo diferencias en las secuelas urológicas ni en la mortalidad global. CONCLUSIONES: Una CH más grave podría predecirse por la presencia de EICH grave o trombopenia al inicio del cuadro. La CH grave puede manejarse con sondaje vesical en la mayoría de estos pacientes. Seguir un protocolo estandarizado puede reducir la necesidad de procedimientos invasivos en pacientes con CH leve.

[Outcome of complaints by patients due to the refusal of Primary Care Physicians to agree to a treatment request]. / Reclamaciones por la negativa del médico de primaria a aceptar una petición del paciente.

OBJECTIVE: To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient. METHODS: Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018. RESULTS: A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed. CONCLUSIONS: Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints.

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

[Portfolio of services and basic table of quality indicators for Headache Units: a consensus study]. / Cartera de servicios y cuadro basico de indicadores de calidad para las unidades de cefalea: estudio de consenso.

AIM: To develop a proposal for a portfolio of services and a set of indicators for Headache Units. DEVELOPMENT: Qualitative study that applied techniques of consensus with the participation of 15 professionals who are experts in the treatment of headaches (experience of 15 years) and in quality assurance. The description of the indicators included: statement, definition, standard, type of indicator, dimension, source, level of evidence, and clarification of terms. The proposal for a portfolio of services included the following areas: clinical management, patient-centered care, community involvement, knowledge management, translational research, and social dissemination. The proposal converged in 13 indicators exploring five dimensions. CONCLUSIONS: This proposal contributes to ensure and assess the level of quality of a Headache Unit or outpatient clinic.

TITLE: Cartera de servicios y cuadro basico de indicadores de calidad para las unidades de cefalea: estudio de consenso.Objetivo. Elaborar una propuesta de cartera de servicios para una unidad de cefalea y un conjunto basico de indicadores de calidad asistencial en cefalea. Desarrollo. Estudio que aplico tecnicas de busqueda de consenso con participacion de un total de 15 profesionales expertos en tratamiento de cefaleas (experiencia de mas de 15 años) y en gestion de calidad. La descripcion de los indicadores incluyo: enunciado, definicion, estandar, tipo de indicador, dimension, fuente, nivel de evidencia y aclaraciones de terminos. La propuesta de cartera de servicios incluyo los siguientes ambitos: gestion clinica, atencion centrada en el paciente, implicacion comunitaria, gestion del conocimiento, investigacion traslacional y difusion social. La propuesta se concreto en 13 indicadores que abarcaban cinco dimensiones. Conclusiones. Esta propuesta contribuye a asegurar y evaluar el nivel de calidad de una unidad de cefaleas o de las consultas monograficas de cefaleas.

Factores de riesgo psicosociales asociados a preeclampsia en mujeres mexicanas: análisis comparado en tres Estados / Psychosocial risk factors associated to pre-eclampsia among mexican women: a comparative analysis in three States / Fatores de risco psicossociais associados a pré-eclâmpsia em mulheres mexicanas: análise comparada em três Estados

Objetivo Analizar comparativamente los factores de riesgo psicosociales asociados con preeclampsia en mujeres mexicanas residentes de tres Estados. Método Estudio de casos y controles en 336 mujeres puérperas con y sin preeclampsia (130 del Estado de México, 114 de Yucatán y 92 de Veracruz). Se aplicaron dos cuestionarios y 5 escalas tipo Likert previamente validadas. Se llevó a cabo análisis estadístico comparativo mediante el software SPSS ver 20. Las variables cuantitativas se analizaron con Kruskal Wallis, las categóricas con frecuencias, el riesgo con razón de Momios (OR); IC de 95%. El riesgo se ajustó con regresión logística con a= 0.05. Resultados El análisis reveló violencia leve en los 3 Estados, con mayor frecuencia en el Estado de México y Veracruz (OR: 3.53; IC 95%: 1.13 - 10.97). La depresión, fue un hallazgo significativo para preeclampsia. Existe de 1 a 2 veces más riesgo para esta enfermedad en embarazadas del Estado de México que sufren algún grado de depresión (OR: 1.66; IC 95%: 1.058 - 2.607) y de 3 a 4 veces más riesgo cuando hay trastorno depresivo mayor (OR: 3.67; IC 95%: 1.23 - 10.89). En mujeres veracruzanas que reportaron algunas veces sintomatología depresiva está presente 3 veces más el riesgo de preeclampsia (OR: 3.12; IC 95%: 1.077 - 9.083) y 7.4 veces más riesgo cuando tienen menos de 5 consultas prenatales (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusiones Se identificaron la depresión, sintomatología depresiva, violencia y el número de consultas prenatales menor a 5 como factores de riesgo psicosociales asociados a preeclampsia. Estos resultados permitirán proponer un modelo de intervención integral de enfermería para disminuirlos.

Objective To comparatively analyze the psychosocial risk factors associated to pre-eclampsia among Mexican women living in three States. Method This is a cases and controls study with 336 pregnant women with and without pre-eclampsia (130 from the State of Mexico, 114 from the state of Yucatan, and 92 from the state of Veracruz). Two questionnaires were administered, and 5 previously validated Likert type scales were used. A statistical comparative analysis was performed using SPSS v.20 software. Quantitative variables were analyzed with the Kruskal-Wallis procedure, categorical variables with frequencies calculation, and the associated risk with odds ratios in the 95% confidence interval. The associated risk was further adjusted through logistic regression a = 0.05). Results The analysis revealed a mild level of violence in all three States. States which reflected more frequency of violence risks were Mexico and Veracruz (OR: 3.53; IC 95%: 1.13 - 10.97). Depression was a significant finding associated to pre-eclampsia. A 1 to 2 times higher risk of associated pre-eclampsia was found among pregnant women with some degree of depression in the State of Mexico (OR: 1.66; IC 95%: 1.058 - 2.607), and this risk was 3 to 4 times higher in the presence of major depressive disorder (OR: 3.67; IC 95%: 1.23 - 10.89). Among women from the state of Veracruz who sometimes reported having depressive symptoms, the risk of pre-eclampsia association was 3 times higher (OR: 3.12; IC 95%: 1.077 - 9.083), while this risk was 7.4 times higher when these women had less than 5 prenatal assessment visits (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusions Depression, depressive symptomatology, violence, and less-than-5 prenatal assessment visits were all identified as psychosocial risk factors associated to pre-eclampsia. These findings will support proposals for a corresponding nursing integral intervention model to address the related risk factors.

Objetivo Analisar comparativamente os fatores de risco psicossociais associados com pré-eclâmpsia em mulheres mexicanas residentes de três Estados. Método Estudo de casos e controles em 336 mulheres puérperas com e sem pré-eclâmpsia (130 do Estado do México, 114 de Yucatán e 92 de Veracruz). Aplicaram-se dois questionários e 5 escalas tipo Likert previamente validadas. Levou-se a cabo análise estatística comparativa mediante o software SPSS ver 20. As variáveis quantitativas analisaram-se com Kruskal Wallis, as categóricas com frequências, o risco com razão de Momios (OR); IC de 95%. O risco ajustou-se com regressão logística com a = 0.05. Resultados A análise revelou violência leve nos 3 Estados, com maior frequência no Estado de México e Veracruz (OR: 3.53; IC 95%: 1.13 -10.97). A depressão foi um achado significativo para pré-eclâmpsia. Existe de 1 a 2 vezes mais risco para esta doença em grávidas do Estado do México que sofrem algum grau de depressão (OR: 1.66; IC 95%: 1.058 - 2.607) e de 3 a 4 vezes mais risco quando tem transtorno depressivo maior (OR: 3.67; IC 95%: 1.23 - 10.89). Em mulheres veracruzanas que reportaram algumas vezes sintomatologia depressiva está presente 3 vezes mais o risco de pré-eclâmpsia (OR: 3.12; IC 95%: 1.077 -9.083) e 7.4 vezes mais risco quando têm menos de 5 consultas pré-natais (OR: 7.42; IC 95%: 2.85 - 19.33). Conclusões Identificaram-se a depressão, sintomatologia depressiva, violência e o número de consultas pré-natais menor a 5 como fatores de risco psicossociais associados à pré-eclâmpsia. Estes resultados permitiram propor um modelo de intervenção integral de enfermagem para diminuilos.

[Level of knowledge of Quality Commitment Campaign and of "do not do" recommendations amongst general practitioners, pediatricians and nurses Primary Care]. / Grado de conocimiento de la campaña Compromiso por la Calidad y de las recomendaciones no hacer entre médicos de familia, pediatras y enfermería de Atención Primaria.

BACKGROUND: To evaluate if the Quality Commitment Campaign (QCC) was sufficiently known among primary care professionals (PC), and second, to evaluate the knowledge about certain recommendations of what should not be done in PC. METHODS: A observational study was conducted. General practitioners (GP), pediatricians (PED) and nursing (NUR) participated. A direct question was asked about whether QCC was known and a set of dichotomous questions based on the "do not do" recommendations to assess their knowledge. A sample size of 288 professionals from each group was the minimum required for a sampling error of 5%, 95% confidence level and p=0.75. The field study was conducted with the collaboration of health services and professional and scientific organizations. Data were described by frequencies and mean (standard deviation), and compared by means of ?2/Fisher or ANOVA and t-test. RESULTS: A total of 1,904 professionals (936 GP, 682 PED and 286 NUR) answered. The QCC initiative was known by 828 (43.5%) professionals: 524 (56.0%) GP, 234 (34.3%) PED and 70 (24.5%) NUR (p<0.001). All the questions were correctly answered by 652 (69.7%) GP, 631 (92.5%) PED and 116 (40.6%) NUR. Significantly more mistakes (p<0.001) were made by those who did not know the QCC, worked in the private sector or were not considered responsible for overuse. Despite not knowing the QCC, 60% GP and 90% PED answered all the questions of the test correctly. CONCLUSIONS: NUR and GP could benefit from a greater diffusion of the QCC. As could those working in the private sector and those who believe that professionals have little responsibility for unnecessary overuse.

[Public participation in health. A review of reviews]. / La participación ciudadana en salud. Revisión de revisiones.

BACKGROUND: This study aims to synthesize knowledge about the role of the public's participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services. METHODS: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016. RESULTS: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied. CONCLUSIONS: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation.

[In case of an adverse event don´t forget to say sorry]. / Si ocurrió un evento adverso piense en decir "lo siento".

BACKGROUND: Disclosing information to a patient who is a victim of an adverse event (AE) presents some particularities depending on the legal framework in the country where the AE occurred. The aim of this study is to identify the limits and conditions when apologizing to a patient who has suffered an AE. METHODS: A consensus conference involving 26 professionals from different autonomous communities, institutions, and profiles (health, insurance, inspection, academic) with accredited experience in patient safety management systems and criminal law. RESULTS: Open disclosure should include an apology expressed in neutral terms (showing empathy and regret for what has happened) without the informant being identified as responsible for the damage, blaming third parties, or offering compensation on behalf of the insurance company. The professional who feels most directly involved in the incident is usually the least likely to report it and apologise. The informant profile must conform to the type and severity of the AE. The rules and conditions of liability insurance advise against providing specific information on the amount of compensation. CONCLUSIONS: The apology should be offered in terms of the regulatory framework in force in each country. In Spain, an appropriate response of empathy for the patient is warranted, expressing regret for what happened (apologising), which can facilitate the relationship with the patient, mitigate their mistrust, and reduce the number of disputes.

Correlación clínica del triage con el diagnóstico clínico de ingreso y egreso realizado en los pacientes que acuden al servicio médico de urgencias de un hospital privado / Clinical correlation of triage with clinical diagnosis at entering and discharge in patients assisting to emergency room of a private hospital

Resumen: OBJETIVO: determinar la correlación del triage por niveles de ingreso a urgencias y la reclasificación del triage de acuerdo con el diagnóstico de egreso de urgencias. MATERIAL Y MÉTODO: estudio observacional, descriptivo y transversal, realizado en el Hospital Ángeles Clínica Londres, Ciudad de México. Se incluyeron pacientes mayores de 18 años que acudieron al servicio de urgencias de la Clínica Londres de enero a febrero de 2016. RESULTADOS: se incluyeron en el estudio 144 pacientes. Respecto a la frecuencia de niveles de ingreso se reportó clasificado en color naranja a 4% de los pacientes, en amarillo a 56%, en verde a 33%, en azul a 7%. Al egreso se clasificó en color rojo a 4%, en anaranjado a 22%, en amarillo a 28%, en verde a 21% y en azul a 25%. CONCLUSIONES: no existe correlación del triage de ingreso por niveles con la reclasificación triage de egreso hospitalario, con lo que se comprueba la hipótesis nula. De acuerdo con los niveles triage de ingreso y egreso encontramos una subclasificación de 100% del nivel I (rojo), 80% del nivel II (anaranjado), 50% del nivel III (amarillo), 37% del nivel IV (verde) y 72% del nivel V (azul).

Abstract: OBJECTIVE: To determine the correlation of triage by levels at entering to emergency room and the reclassification of triage according to the diagnosis of emergency discharge. MATERIAL AND METHOD: An observational, descriptive and cross-sectional study, done at Hospital Angeles Clínica Londres, Mexico City. Patients older tan 18 years who assisted to the emergency room of Clinica Londres from January to February 2016 were included. RESULTS: There were included 144 patients. About the frequency of levels at entering 4% of patients were classified as orange color, 56% to yellow, 33 to green and 7% to blue. At discharge 4% was classified as red, 22% as orange, 28% as yellow, 21 as green and 25% as blue. CONCLUSIONS: There was no correlation of triage at entering by levels with reclassification of triage at discharge, with proves the null hypothesis. According to levels of triage at entering and discharge we found a subclassification of 100% of level I (red), 80% of level II (orange), 50% of level III (yellow), 37% of level IV (green) and 72% of level V (blue).

Clinical significance of the ABCB1 and ABCG2 gene expression levels in acute lymphoblastic leukemia.

OBJECTIVES: Acute lymphoblastic leukemia (ALL) is a clonal disease that accounts for 20% of acute leukemias in adults. A high percentage of adult patients (ranging from 70 to 80%) reach complete remission; however, the 5-year survival rate is only 20-40%. One of the main obstacles to treatment success is the drug resistance of leukemic cells. Therefore, our research group analyzed the ABCB1 and ABCG2 gene expression levels in 61 patients diagnosed with ALL and assessed whether the levels affected the clinical parameters and 40-month survival rate. METHODS: The ABCB1 and ABCG2 gene expression levels were analyzed using real-time polymerase chain reaction in 61 patients diagnosed with ALL and 99 healthy donors as controls. The association between ABCB1 and ABCG2 gene expression levels and clinical variables was determined using the Chi-square test and Fisher's exact test. Overall survival (OS) was determined using the Kaplan-Meier method. RESULTS: The results showed high ABCB1 and ABCG2 gene levels, which were 4.5 and 2.3 times the levels of healthy donors, respectively. A total of 52% of the study patients expressed high ABCB1 levels and were significantly associated with the high-risk patient group and a decreased 40-month survival rate of 78%. Only 49% of the patients expressed high ABCG2 gene levels. No association was found between the clinical parameters and the ABCG2 gene expression levels. CONCLUSIONS: Early detection of ABCB1 gene expression levels could be important for the diagnosis and monitoring of ALL patients.

[Proposals for the study of the second victim phenomenon in Spanish Primary Care Centres and Hospitals]. / Propuestas para el estudio del fenómeno de las segundas víctimas en España en atención primaria y hospitales.

OBJECTIVE: To identify the Spanish studies conducted since 2014 on second victims. Its main objective was to identify a global response to the second victim problem, assessing the impact of adverse events (AE) on caregivers and developing of a set of tools to reduce their impact. METHOD: Descriptive studies in which a sample of managers and safety coordinators from Hospitals and Primary Care were surveyed to determine the activities being carried out as regards second victims, as well as a sample of health professionals to describe their experience as a second victims. Qualitative studies are included to design a guide of recommended actions following an AE, an online awareness program on this phenomenon, an application (app) with activities on safety that are the responsibility of the managers, and a web tool for the analysis of AEs. RESULTS: A total of 1,493 professionals (managers, safety coordinators and caregivers) from eight Spanish regions participated. The guide of recommendations, the online program, and the developed applications are accessible on the website: www.segundasvictimas.es, which has received more than 2,500 visits in one year. DISCUSSION: Study results represent a starting point in the study of the second victim phenomenon in Spain. The tools developed raise the awareness of the medical healthcare community about this problem, and provide professionals with basic skills to manage the impact of AEs.

[How do primary care patients perceive information for involving themselves in self-care?]. / ¿Cómo perciben los pacientes de las consultas de Atención Primaria la información para implicarse en su autocuidado?

BACKGROUND: Analyze if patients receive information from their GPs to engage in self-management (medication,physical exercise or diet). METHODS: A descriptive study in which 2,401 randomly selected, primary care patients were interviewed by telephone. A short scale of 6 questions was used to analyze if they received information for self-care. Statistics included analyzing differences according to age,sex, occurrence of security incidents, whether they regularly attended the physician's surgery and length of consultation time. RESULTS: A total of 2,350 patients responded (97.9%response rate). A total of 1,253 (34.6%) of respondents obtained 5 or more points on the scale (percentile 50).Receiving information about foreseeable prognosis increased satisfaction (OR 11.2 (95% 8.3-15.3). Consultation time length (p<0.01), regularly visiting physicians(p<0.01), and not suffering an adverse event (p<0.01)were associated with higher scores on the scale. CONCLUSIONS: Patients report they receive directions for the proper management of medication at home, but claim that they receive less information to engage in healthy behaviors.

Vida cotidiana y preeclampsia: Experiencias de mujeres del Estado de México / Daily life and pre-eclampsia: Experiences of women at the State of Mexico / Vida cotidiana e pré-eclâmpsia: Experiências de mulheres do Estado do México

Objetivo: Analizar la experiencia de vivir con preeclampsia en el contexto de la vida cotidiana de un grupo de mujeres del Estado de México que asisten al Hospital General de Chimalhuacán. Método: Investigación cualitativa de abordaje fenomenológico, hermenéutico con enfoque teórico de Alfred Schütz. La muestra fue definida por medio del criterio de saturación teórica. Los datos fueron recolectados a través de una entrevista semiestructurada y analizados con el método de van Manen. Seis criterios de rigor científico se utilizaron: Credibilidad, transferibilidad, consistencia, confirmabilidad, relevancia y adecuación teórico epistemológica. Resultados: Emergieron 5 categorías: 1) significado de la preeclampsia en la vida cotidiana; 2) experiencia de la dimensión física y emocional de vivir con preeclampsia; 3) interpretación del autocuidado en la vida cotidiana de la mujer con preeclampsia; 4) redes de apoyo que ayudan a sobrevivir la experiencia de tener preeclampsia; y 5) significado de los servicios de salud. Conclusiones: La preeclampsia es una enfermedad del embarazo de origen multifactorial y una de las principales causas de muerte materna en México, con impacto significativo en los servicios de salud. Se demuestra que en las mujeres con preeclampsia se potencializa su vulnerabilidad y riesgo de morir, al vivir en crisis, pues se ve trastocada y alterada su vida cotidiana, no solo en los aspectos biológicos al sentir malestares físicos y corporales, sino también en la parte emocional. Se observó la capacidad de auto-eco-socio-organización para equilibrar su entorno y vida cotidiana. Se ratificó que las redes de apoyo familiar y social son dadoras de bienestar e indispensables para fortalecer el cuidado.

Objective: To analyze the experience of living with pre-eclampsia among women at the State of Mexico who are attended at the General Hospital of Chimalhuacan. Method: This is a qualitative research with a phenomenological and hermeneutic approach with the theoretical focus of Alfred Schütz. The sample was defined using the criteria of theoretical saturation. Data were collected through a semi-structured interview and analyzed using the Van Manen method. Six scientific rigor criteria were used: credibility, transferability, consistency, confirmability, relevance, and theoretical and epistemological adequacy. Results: Five categories emerged: 1) meaning of pre-eclampsy in daily life, 2) physical and emotional experience of living with pre-eclampsy, 3) interpretation of self-care in the daily life of women with pre-eclampsy, 4) supporting networks which help women survive the experience of having pre-eclampsy, and 5) meaning of the Health Services. Conclusions: Pre-eclampsy, a multi-factorial pregnancy illness with a high impact on Health Services, is one of the main causes of maternal deaths in Mexico. Because of their living in constant crisis, women with pre-eclampsy have higher vulnerability and risk of death, and their lives are affected both physically and emotionally. Here, it was ratified that supporting networks are critical to address this problem and strengthen these women's capacity to achieve a balance in their environment and daily life.

Objetivo: Analisar a experiência de viver com pré-eclâmpsia no contexto da vida cotidiana de um grupo de mulheres do Estado do México que assistem ao Hospital General de Chimalhuacán. Método: Pesquisa qualitativa de abordagem fenomenológica, hermenêutica com enfoque teórico de Alfred Schütz. A amostra foi definida utilizando o critério de saturação teórica. Os dados foram coletados a través de uma entrevista semiestruturada e analisados com o método de Van Manen. Seis critérios de rigor científico utilizaram-se: credibilidade, transferibilidade, consistência, confirmação, relevância e adequação teórico epistemológica. Resultados: emergiram 5 categorias: 1) significado da pré-eclâmpsia na vida cotidiana, 2) experiência da dimensão física e emocional de viver com pré-eclâmpsia, 3) interpretação do autocuidado na vida cotidiana da mulher com pré-eclâmpsia, 4) redes de apoio que ajudam a sobreviver a experiência de ter pré-eclâmpsia, e, 5) significado dos serviços de saúde. Conclusões: a pré-eclâmpsia é uma doença de gravidez de origem multifatorial e uma das principais causas de morte materna no México com impacto significativo nos serviços de saúde. Mostra-se que nas mulheres com pré-eclâmpsia potencializa-se sua vulnerabilidade e risco de morrer, no viver em crise, pois vê-se modificada e alterada sua vida cotidiana, não só nos aspectos biológicos ao sentir mal-estares físicos e corporais, senão também na parte emocional. Observou-se a capacidade de auto-eco-sócio-organização para equilibrar o seu entorno e vida cotidiana. Ratificou-se que as redes de apoio familiar e social são dadoras de bem-estar e indispensáveis para fortalecer o cuidado.