Euthanasia Attitudes Questionnaire in Medical Personnel (AHE-PM) / Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

Abstract The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient's emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient's subjective emotional suffering.

Resumen La eutanasia voluntaria activa se define como la petición de un paciente que quiere morir y la acción que es llevada a cabo por otra persona para provocar dicha muerte. El derecho a morir es un dilema sobre el que se debate a nivel internacional. Algunos países y estados ya cuentan con leyes que regulan una de las aplicaciones más comunes de este derecho. Los datos aportados por estos países ponen de manifiesto la importancia de un marco bioético que permita limitar algunas de sus aplicaciones. En este sentido, la evaluación de las actitudes hacia la eutanasia en personal médico permitirá conocer las actitudes de estos profesionales y cómo estos pueden enfrentarse a dichas solicitudes, o no, sea de muerte asistida por parte de los pacientes o su entorno. Además, se ha reportado en la bibliografía diferentes actitudes según la experiencia o el sexo de los trabajadores, por lo que es de relevancia su exploración diferencial. Por ello, el objetivo del presente trabajo un instrumento de evaluación de actitudes hacia la eutanasia diseñado y validado por y para profesionales médicos en ejercicio. En esta línea, los objetivos de este estudio son obtener una escala corta con propiedades psicométricas adecuadas, que proporcione información relevante sobre las actitudes hacia la eutanasia, así como la posible evaluación de algunas prácticas médicas relacionadas con ésta que pueden ser bioéticamente dudosas. La muestra estaba compuesta por 419 profesionales de la medicina procedentes de tres provincias del sur de España. Se siguió una doble estrategia en el diseño. Por un lado, un diseño psicométrico con un análisis factorial exploratorio y confirmatorio. Se dividió la muestra en dos submuestras aleatorias para realizar de forma paralela ambos análisis. Se utilizaron los estadísticos KMO, Bartlett, RMSEA, RMRS, CFI, NNFI, GFI y AGFI para explorar el ajuste de modelos. Po otro lado, se utilizó un diseño asociativo descriptivo para la comparación de grupos mediante la t de Student, ANOVA, Tukey y la prueba d de Cohen. Se extrae una escala de seis ítems (AE-PM) y dos factores. El primero de ellos está centrado en las actitudes hacia la eutanasia para aliviar el sufrimiento por cuestiones médicas y el segundo para aliviar el sufrimiento emocional del paciente. Respecto al estudio de las diferencias, no se observaron diferencias significativas según el sexo del profesional ni la antigüedad en la profesión. La escala (AHE-PM) es útil para la exploración rápida de las actitudes hacia la eutanasia en médicos, un grupo profesional con limitado tiempo libre que, además, puede encontrarse con relativa frecuencia ante solicitudes de eutanasia voluntaria activa. Los dos factores obtenidos permiten evaluar, por un lado, las actitudes desde una perspectiva bioética. Es de especial relevancia en estas situaciones el conocimiento de las actitudes del personal médico hacia la eutanasia, exponiéndolo a un dilema bioético y personal. La autoconciencia de estos profesionales sobre sus propias actitudes hacia la eutanasia y su adaptación a los códigos éticos vigentes podría minimizar el impacto generado por estas situaciones y, por tanto, mejorar la relación terapéutica y la calidad asistencial. Por otro lado, el instrumento aporta información sobre la posible recomendación de estas prácticas bajo aparente justificación médica y/o en situaciones basadas en el sufrimiento emocional subjetivo del paciente. Estudios previos indican que los profesionales se ven afectados emocionalmente cuando se enfrentan a los conceptos de muerte y eutanasia en pacientes terminales. En este sentido, la escala también podría servir de evaluación de actitudes y el trabajo en planes de prevención de salud laboral en los centros sanitarios.

Profiles of lateral violence in nursing personnel of the Spanish public health system.

BACKGROUND: Workplace violence in healthcare settings has long been studied in scientific literature, particularly in the nursing profession. Research has explored mostly user violence probably for its high prevalence and impact on health and job satisfaction. Yet this focus may overshadow another dangerous type of workplace violence: coworker violence. Exerted by co-workers with similar status, lateral violence differs from that yielded by a co-worker with a higher rank, known as vertical. This study aims to deepen the knowledge about lateral violence perceived by nurses and its interaction with other variables commonly associated with workplace violence in healthcare: burnout, job satisfaction, and self-perceived health. METHOD: A random block sampling was performed, prompting a total sample of 925 nursing professionals from 13 public hospitals located in the southeast of Spain. The sample distribution (mean and standard deviation) and the response percentages according to the study variables of the ad-hoc questionnaire were analyzed and classified with cluster analysis. RESULTS: Through the cluster analysis, two subgroups were obtained: Cluster 1, composed of 779 participants, with low scores in the variables used for the classification, high levels of both extrinsic and intrinsic satisfaction, low levels of emotional exhaustion and cynicism, and low rates of somatization, anxiety, social dysfunction and depression; and Cluster 2, composed of 115 participants and characterized by moderate-high scores in the variables used for the classification, moderate extrinsic satisfaction, and low intrinsic satisfaction, high emotional exhaustion and cynicism and lower somatization, anxiety, social dysfunction, and depression scores. Excluded cases amounted to 31. CONCLUSION: Nursing professionals who experience lateral violence reveal a lower intrinsic satisfaction, feeling less self-accomplished in their job, and less positive work experience. Emotional exhaustion rises as a concerning progressive and long-term outcome of experiencing this type of violence.

Attitudes Towards School Violence: A Qualitative Study With Spanish Children.

School violence is a social issue of particular interest both for intervention and research. Attitudes towards violence have been reported in the literature as relevant variables for evaluation, prevention, and intervention in this field. This study aims to examine in-depth attitudes toward school violence. The sample consists of 96 participants from Spanish Elementary Education and Compulsory Secondary Education schools. A qualitative study was conducted through focus groups and thematic analysis of the data. The results identify a habitual set of attitudes towards violence in children. These are related to violence as a way to feel better or increase self-esteem, as leisure or fun, perceived as legitimate, when violence is exercised against those who are different, when it has no consequences, to resolve conflicts, to socialize, and to attract the attention of peers. These results could serve as a basis for the creation of evaluation tools, as well as the design of prevention and intervention plans based on attitude modification.

Attitudes of Healthcare Professionals and General Population Toward Vaccines and the Intention to Be Vaccinated Against COVID-19 in Spain.

Background: To achieve herd immunity, the acceptance of the COVID-19 vaccine by the population, especially healthcare professionals, plays a key role. The objective of the present paper is to address the differences in attitudes among Spanish healthcare professionals compared with the general population regarding COVID-19 vaccination. Methods: This cross-sectional study included data from 2,136 adults (n = 664 healthcare professionals) from an online survey conducted from May 6 to June 9, 2021. The Vaccination attitudes examination scale was used to measure the negative attitudes toward vaccines. Four subscales: mistrust of vaccine benefit, worries about the unforeseen future effect, concerns about commercial profiteering, and preference for natural immunity were calculated. Generalized linear mixed models were conducted to study these associations. Results: Between 10.2 and 22.6% of the subjects showed high levels of negative attitudes toward vaccines. However, only 1.5% of our sample (2.1% among healthcare professionals) refused to get the COVID-19 vaccine when it was offered because they chose otherwise. Retired people showed the lowest concerns and the highest trust in vaccines. No statistically significant effects were found between working in a healthcare field and having higher positive attitudes toward vaccines. Conclusion: Low levels of rejection against the COVID-19 vaccine were identified in the present sample. However, despite being at a higher risk, health care professionals did not show higher positive attitudes toward vaccines. Furthermore, refusal percentage to vaccination was higher among healthcare professionals compared with non-healthcare professionals. Developing a strategy to increase positive attitudes against the COVID-19 vaccine should be an objective for public health policy.

Tough Love Lessons: Lateral Violence among Hospital Nurses.

BACKGROUND: Workplace violence is a growing social problem among many professions, but it particularly affects the health sector. Studies have mainly focused on evaluating user violence toward health professionals, with less attention being paid to other sources of conflict, such as co-workers themselves. There are different manifestations of this violence in what has been called a context of tolerated or normalized violence among co-workers. However, its effects are far from being tolerable, as they have an impact on general health and job satisfaction and contribute to burnout among professionals. Based on this idea, and following the line of the previous literature, nursing staff are a population at high risk of exposure to workplace violence. For this reason, the present study aims to evaluate exposure to lateral violence or violence among co-workers in nursing staff in public health services and the relationship of this exposure with some of the most studied consequences. (2) Methods: A cross-sectional associative study was carried out in which scales of workplace violence (HABS-CS), burnout (MBI-GS), job satisfaction (OJS), and general health (GHQ-28) were applied to a sample of 950 nursing staff from 13 public hospitals located in the southeast of Spain. (3) Results: The results show that nursing staff have a high exposure to violence from their co-workers, which is more common in male nurses. Greater exposure is observed in professionals with between 6 and 10 years of experience in the profession, and it is not characteristic of our sample to receive greater violence when they have less experience or are younger. A positive correlation is observed with high levels of burnout and a negative correlation with general health and job satisfaction. (4) Conclusions: The results of this work contribute to increasing the scientific evidence of the consequences of a type of workplace violence frequent among nursing staff and to which less attention has been paid in relative terms to other types of prevalent violence. Organizations should be aware of the importance of this type of workplace violence, its frequency and impact, and implement appropriate prevention policies that include the promotion of a culture that does not reward violence or minimize reporting. A change of mentality in the academic environment is also recommended in order to promote a more adequate training of nursing staff in this field.

Rating criteria of the causal nexus in Whiplash Associated Disorders: A study of interrater reliability / Criterios para el establecimiento del nexo causal en síndrome de latigazo cervical: un estudio de concordancia interobservadores

Introducción: El diagnóstico del síndrome de latigazo cervical está sujeto a criterios ambiguos, algunos de ellos de naturaleza subjetiva, que impide un alto porcentaje de acuerdo interjueces, y compromete seriamente la replicabilidad de los diagnósticos. El objetivo de este estudio es evaluar la concordancia interjueces de 4 expertos en medicina legal, quienes establecen el nexo causal de los pacientes que han sufrido un accidente de tránsito. Material y método: Trescientos pacientes que sufrieron un accidente de circulación fueron evaluados por 4 expertos en medicina legal. Realizaron 2 valoraciones del nexo causal, una sin estudio de la biomecánica y otra con este estudio. El grado de concordancia de las valoraciones fue calificado con el coeficiente de correlación intraclase (ICC) y el índice de concordancia (IC). Resultados: Los resultados de la valoración previa al estudio biomecánico de la lesión arrojan valores moderados-altos (ICC=0,70; CI=0,60). Asimismo, los valores observados en la valoración con el estudio de la biomecánica también indican un acuerdo moderado-alto (ICC=0,78, CI=0,67). Conclusiones: El estudio de la biomecánica mejora la concordancia de forma leve. A pesar de ello, el citado estudio no ayuda a reducir la proporción de casos dudosos y la mejora no alcanza niveles aceptables. Se observan diferencias significativas entre las clasificaciones, lo que sugiere que la metodología de valoración propuesta no es lo suficientemente uniforme como para alcanzar consenso. (AU)

Introduction: The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method: 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results: The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC=.70; CI=.60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC=.78, CI=.67). Conclusions: The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus. (AU)

Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study.

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

Attitudes towards School Violence Questionnaire, revised version: CAHV-28 / Cuestionario de Actitudes hacia la Violencia Escolar, versión revisada: CAHV-28

School coexistence/violence is often the subject of social alarm. There is no consensus on the prevalence of violent behavior in the classroom, but there does seem to be about its differences according to sex, socioeconomic level, or the importance of preventive interventions for its reduction. Models consider attitudes towards violence as an indicator of risk for its expression. The objectives of this study are to explore the psychometric properties of the revised version of Cuestionario de Actitudes Hacia la Violencia [Attitudes towards Violence Questionnaire] (CAHV-25) in primary and secondary education students, proposing a version of four scales and a total of 28 items, along with the exploration of their significance as a function of sex and academic cycle. A qualitative review of CAHV-25 and a psychometric study of the revised version in each of its original dimensions was carried out, obtaining the fit indicators of exploratory and confirmatory factor analysis. In addition, the scale was studied as a function of sex and educational stage se in school children (N = 600) of the Region of Murcia (Spain). The four dimensions show better psychometric properties in their revised version. Attitudes towards violence are more present in males and in secondary school. As conclusions, the proposed version optimizes the detection of attitudes towards violence in schoolchildren and suggests more specific school violence prevention programs

La convivencia/violencia escolar, a menudo, es objeto de alarma social. No parece existir consenso en la prevalencia de conductas violentas en las aulas, pero sí en sus diferencias según sexo, nivel socioeconómico o la importancia de las intervenciones preventivas para su disminución. Los modelos sitúan a las actitudes hacia la violencia como un indicador de riesgo para la manifestación de dichas conductas. Los objetivos del presente estudio son explorar las propiedades psicométricas de la versión ampliada del Cuestionario de Actitudes Hacia la Violencia (CAHV-25) en alumnos de Educación Primaria y Secundaria, proponiendo una versión dividida en cuatro escalas y 28 ítems en total, junto a la exploración de la significación según sexo y etapa académica. Se ha llevado a cabo una revisión cualitativa del cuestionario CAHV-25 y se realizó un estudio psicométrico de la misma para cada una de sus dimensiones originales obteniendo los indicadores de ajuste de Análisis Factorial Exploratorio y Confirmatorio en menores de Educación Primaria y Secundaria (N = 600) de la Región de Murcia (España). Los resultados indican que las cuatro dimensiones tienen mejores propiedades psicométricas en su versión revisada. Las actitudes hacia la violencia son mayores en varones y en Secundaria. Se concluye que la versión propuesta permite maximizar la detección de actitudes hacia la violencia en menores escolarizados, sirviendo de base para el planteamiento de posibles programas de prevención de violencia escolar más específicos

Problemas de información a los padres y tutores en la asistencia a urgencias en menores de 14 a 17 años por consumo de sustancias psicoactivas / Issues with information given to parents and guardians on medical care in the emergency department relating to minors aged from 14 to 17 years due to psychoactive substance

INTRODUCCIÓN: El cumplimiento de los deberes de la patria potestad exige a los padres y/o tutores estar informados de aquellos aspectos relevantes relacionados con la salud del menor. La legislación actual reconoce la autonomía a partir de los 16 años o menores emancipados. En este trabajo se analiza la información que reciben los padres o tutores legales de los menores mayores de 14 años que acuden a un servicio de urgencias hospitalario general de tercer nivel por intoxicación aguda por alcohol y otras drogas de abuso incluidos medicamentos como las benzodiacepinas si se consumen con fines recreativos. MATERIAL Y MÉTODOS: Se revisaron las historias clínicas de los menores atendidos en el servicio de urgencias de un hospital de tercer nivel durante los años 2016 y 2017 para conocer la información referida a los padres y se entrevistó a los médicos y enfermeros de dicho servicio para conocer la información que daban a los padres/tutores. RESULTADOS: En las historias clínicas en las que se citaba que el menor iba acompañado por amigos (11,5%), 5 de ellas (9,6%) no especificaban si se había realizado el aviso a padres/tutores. De las 26 historias clínicas (50%) en las que no había especificación del acompañamiento, en 22 (42,3%) tampoco existía especificación del aviso. Mientras que 28 de los 35 encuestados (80%) afirma avisar siempre que el menor no hubiera ido acompañado por sus padres o tutores. CONCLUSIONES: Se pone de manifiesto la existencia de una falta de información de tipo asistencial relativa al aviso a padres/tutores, así como una discrepancia entre los datos proporcionados por los médicos y enfermeros y los obtenidos en las historias clínicas

BACKGROUND: In accordance with parental legal duties, parents and guardians should be informed about health issues relevant to child health. Current Spanish legislation acknowledges autonomy from 16 years or emancipated minors. This study analyses the information given to the parents or legal guardians of minors over 14 years of age attending a tertiary-level general hospital emergency department on psychoactive substance intoxication (alcohol, cannabis, benzodiazepines). MATERIAL AND METHODS: The medical records of minors treated in the emergency department of a tertiary-level hospital, between 2016 and 2017, were reviewed. A survey of medical and nursing professionals from the emergency services was also conducted. RESULTS: Of the medical records that mentioned that the minor attended the emergency department with friends (11.5%), 5 (9.6%) did not specify if the parents or guardians were called. Of the 26 medical records (50%) in which there was no mention of whether if the minor attended alone or accompanied, 22 (42.3%) made no mention of informing parents. The study data show that 28 of the 35 respondents (80%) always notified if the minor had not been accompanied to the emergency department by a parent or guardian. CONCLUSIONS: There is lack of information relating to informing parents/guardians, as well as a discrepancy between the data provided by health professionals and the medical reports analysed

Operative Treatment of Ankle Fractures: Predictive Factors Affecting Outcome.

Purpose Surgical management of ankle fractures has been extensively studied in literature but studies investigating validated clinical results are lacking and controversial. The purpose of this study was to evaluate functional and health-related quality of life (HRQL) outcomes after surgically treated ankle fractures and to detect some of their predictors. Methods Two hundred sixty-six skeletally mature patients who underwent surgery for an isolated ankle fracture from 2006 to 2017 were retrospectively identified from our hospital records and included in the study. All patients were evaluated at one, three, six and 12 months post-injury with clinical and radiographic examination. Outcome measures recorded at final two years minimum follow-up included patient-reported pain, patient satisfaction, functional (American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score) and quality of life (Short Form (SF) 36 score) status. Results Patient satisfaction score was 8.4 out of 10, Visual Analogue Scale mean score was 2.3, complication rate was 36.5% and mean AOFAS ankle-hindfoot score was 87.3. Mean SF36-physical summary score was 77.9 and SF36-mental summary score was 81.1. The injury demonstrated a significant effect on physical function, role-physical, bodily pain and social functioning SF-36 subdomains. Functional outcome was significantly related to occupation, syndesmotic lesion, number of fractured malleoli and delay to surgery. Main predictors of quality of life were age, occupation, cause of injury, syndesmotic lesion, number of fractured malleoli and waiting time to surgery. Conclusions Ankle fractures have a considerable impact on functional and quality of life status of patients. Occupation, presence of syndesmotic injury, Pott's classification and surgery delay must be considered as predictors of final outcome.

Development and validation of a method for analysing of duloxetine, venlafaxine and amitriptyline in human bone.

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of venlafaxine, amitriptyline and duloxetine in human bone. Pulverized samples were incubated in methanol for 1 h under ultrasonication, after the addition of sertraline as internal standard. The samples were centrifuged, and the supernatants were evaporated. Samples were then resuspended in 0.1 M phosphate buffer pH 6 and subjected to solid phase extraction. Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.3-1 ng/mg (depending on the drug) to 500 ng/mg. The mean absolute recoveries ranged from 92.6% to 96.2%, the matrix effect from 76.9% to 103.3% and process efficiency from 74% to 95.9% depending on the analyte. The intra- and inter-assay accuracy values were always better than 20%. The validated method was then successfully applied to real bone samples from forensic cases in which toxicological analysis for these drugs in blood had been positive. Drugs were detected in bone in all blood positive results, the approximate concentrations being 36.4 ng/mg for amitriptyline, 19.3-3 ng/mg for duloxetine and 4.6-2 ng/mg for venlafaxine.

Development and validation of a gas chromatography-mass spectrometry method for opiates and cocaine in human bone.

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of opioids (6-monoacetylmorphine, morphine, methadone and tramadol) and cocaine and its major metabolite in human bone. After the addition of nalorphine as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were subjected to solid phase extraction and the analytes were eluted using 2 ml of dichloromethane/isopropanol/ammonia (78:20:2). Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.3-1 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries ranging from 66% to 110%, the matrix effect from 62% to 121% and process efficiency from 61% to 89% depending on the analyte. The intra- and inter-assay accuracy values were always better than 20%. The validated method was then successfully applied to real bone samples from forensic cases in which toxicological analysis for these drugs in blood was positive. Drugs were detected in bone in 12 of the 15 blood positive results. The approximate concentration range was 3-5 ng/g for 6-monoacetylmorphine, 3-7 ng/g for morphine, 14-28 ng/g for methadone and 6 ng/g and 11 ng/g for tramadol and benzoylecgonine.

Postmortem Cholesterol Levels in Peripheral Nerve Tissue: Preliminar Considerations on Interindividual and Intraindividual Variation.

The study reports the evolution of the demyelinization process based on cholesterol ([CHOL]) levels quantified in median nerve samples and collected at different times-from death from both right and left wrists. The statistical data show that the phenomenon evolves differently in the right and left nerves. Such a difference can reasonably be attributed to a different multicenter evolution of the demyelinization. For data analysis, the enrolled subjects were grouped by similar postmortem intervals (PMIs), considering 3 intervals: PMI < 48 hours, 48 hours < PMI < 78 hours, and PMI > 78 hours. Data obtained from tissue dissected within 48 hours of death allowed for a PMI estimation according to the following equations: PMI = 0.000 + 0.7623 [CHOL]right (R = 0.581) for the right wrist and PMI = 0.000 + 0.8911 [CHOL]left (R = 0.794) for the left wrist.At present, this correlation cannot be considered to be definitive because of the limitation of the small size of the samples analyzed, because the differences in the sampling time and the interindividual and intraindividual variation may influence the demyelinization process.

[Ethical Dilemmas in Practice of Medicine Child]. / Dilemas Éticos en la Práctica de la Medicina Infantil.

After reviewing the existing bibliography in the last 20 years, we concluded that there is a lack of information regarding the ethical conflicts that affect to pediatrics in their daily practice. It produces certain degree of uncertainty in these professionals at the time of solving these problems. We made a systematic search in the main data bases, finding more than 150 articles related, of which 80 were considered outstanding. After studying them, we have found 40 ethical dilemmas, related to some principle of solution and that we described in this article. Through them we can find such important dilemmas as those related to physical disability, palliative care or consent from children.

Asociación entre victimización por bullying y consumo de sustancias entre la población universitaria de España / Association between bullying victimization and substance use among college students in Spain

Este estudio tiene como objetivo analizar la prevalencia y la asociación entre victimización y consumo de sustancias psicoactivas entre la población universitaria en el sureste de España en una muestra de 543 estudiantes universitarios seleccionados aleatoriamente (405 mujeres y 138 hombres con una media de edad de 22,6 años). Estudio transversal analítico, la recogida de los datos se llevó a cabo por medio de una encuesta anónima que recogía información acerca de victimización y consumo de drogas durante los últimos 12 meses. Los resultados muestran que un 62,2% de los estudiantes había sufrido algún tipo de victimización y un 82,9% había consumido alguna sustancia psicoactiva, con una asociación estadísticamente significativa entre ambas variables analizadas. Además, el análisis de regresión logística mostró que el consumo de sustancias psicoactivas se relacionaba con diferentes tipos de victimización. Nuestros hallazgos confirman la necesidad de implementar programas para prevenir la relación entre victimización y consumo de sustancias

The purpose of this study is to analyze the prevalence and association between victimization and substance use among the university population in the southeast of Spain in a sample of 543 randomly selected college students (405 females and 138 males with an average age of 22.6 years). As a cross-sectional study, data was collected through an anonymous survey to assess victimization and drug use over the last 12 months. Results indicated that 62.2% of college students reported bullying victimization and 82.9% consumed some type of psychoactive substance, and found a statistically significant association between both variables measured. Additionally, logistic regression analysis confirmed the association between psychoactive substance use and different types of victimization. Our findings confirm the need for prevention to prevent this relation between victimization and substance use

Association between bullying victimization and substance use among college students in Spain. / Asociación entre victimización por bullying y consumo de sustancias entre la población universitaria de España.

The purpose of this study is to analyze the prevalence and association between victimization and substance use among the university population in the southeast of Spain in a sample of 543 randomly selected college students (405 females and 138 males with an average age of 22.6 years). As a cross-sectional study, data was collected through an anonymous survey to assess victimization and drug use over the last 12 months. Results indicated that 62.2% of college students reported bullying victimization and 82.9% consumed some type of psychoactive substance, and found a statistically significant association between both variables measured. Additionally, logistic regression analysis confirmed the association between psychoactive substance use and different types of victimization. Our findings confirm the need for prevention to prevent this relation between victimization and substance use.

Este estudio tiene como objetivo analizar la prevalencia y la asociación entre victimización y consumo de sustancias psicoactivas entre la población universitaria en el sureste de España en una muestra de 543 estudiantes universitarios seleccionados aleatoriamente (405 mujeres y 138 hombres con una media de edad de 22,6 años). Estudio transversal analítico, la recogida de los datos se llevó a cabo por medio de una encuesta anónima que recogía información acerca de victimización y consumo de drogas durante los últimos 12 meses. Los resultados muestran que un 62,2% de los estudiantes había sufrido algún tipo de victimización y un 82,9% había consumido alguna sustancia psicoactiva, con una asociación estadísticamente significativa entre ambas variables analizadas. Además, el análisis de regresión logística mostró que el consumo de sustancias psicoactivas se relacionaba con diferentes tipos de victimización. Nuestros hallazgos confirman la necesidad de implementar programas para prevenir la relación entre victimización y consumo de sustancias.

Importancia de la biomecánica del impacto en la valoración pericial del síndrome del latigazo cervical / The importance of the impact biomechanics on the assessment of whiplash injury

Argumentos de diferente naturaleza (impacto epidemiológico, indefinición diagnóstica, ausencia de pruebas objetivas de daño) justifican la necesidad de la biomecánica del impacto en el diagnóstico médico-legal de causalidad del síndrome postraumático cervical (whiplash associated dissorders) en terminología anglosajona. Su investigación biomecánica tiene dos etapas bien definidas de interés médico-legal: la investigación en laboratorio (animales, cadáveres, y fundamentalmente voluntarios) y el estudio de colisiones reales, a lo que ha contribuido el desarrollo de dispositivos de recogida de datos. Esta investigación ha permitido identificar parámetros físicos de la colisión (cambio de velocidad, aceleración) relacionados con el riesgo de lesiones cervicales, así como otros factores de riesgo. Aunque la utilización médico-legal de los umbrales que delimitan el riesgo de lesión poblacional no es pacífica en la literatura, existen suficientes evidencias que permiten individualizar estos umbrales de riesgo de lesión en el diagnóstico médico-legal de la causalidad, si bien exige un profundo conocimiento (AU)

Arguments of a diverse nature ranging from epidemiological to diagnostic justify the need to include the biomechanics of impact as part of the medico legal diagnosis of the cause of cervical post-traumatic syndrome (whiplash associated disorders). Biomechanical research comprises two distinct stages of forensic interest: firstly, laboratory research, using animals, corpses, and volunteers and, secondly, the study of actual collisions. This has contributed to the development of data collection devices which have helped to identify the physical parameters of an impact such as changes in velocity and acceleration in relation to the risk of whiplash injuries as well as other risk factors. Although the literature regarding the forensic use of thresholds that define the risk of injury is not population specific, there is sufficient evidence to individualise these thresholds of risk of injury in the medico legal diagnosis of causality, although this requires further research (AU)

Epidemiology, Evolution, and Long-Term Survival of Alcoholic Cirrhosis Patients Submitted to Liver Transplantation in Southeastern Spain.

BACKGROUND: Alcoholic cirrhosis (AC) is a common cause of death among individuals abusing alcohol. In the last resort, liver transplantation (LT) is considered the only solution to save the patient's life, generating socioeconomic and public health problems. Clinical and sociodemographic characteristics, rejection frequency, and short- and long-term graft survival are not well known in end-term AC patients undergoing LT. The aim was to determine the sociodemographic and clinical characteristics, their incidence in LT, main pre- and posttransplant complications, and short- and long-term post-transplant graft survival in AC patients in southeastern Spain. METHODS: The medical records of 1,026 patients who underwent LT over the last 23 years were retrospectively reviewed, and demographic data and posttransplant survivals were analyzed and compared. Biochemical characteristics, major pre- and posttransplant complications and short- and long-term survivals were analyzed in a total of 398 male patients with AC undergoing LT. RESULTS: AC and viral cirrhosis are the main indications for LT in our study. Mostly represented in our study are AC men without associated viral infections with a mean age of 53.06 years. Main pretransplant complications in AC patients are ascites (78.3%) and encephalopathy (43.5%), while acute graft rejection is the most common liver posttransplant complication (26.6%), nevertheless with low graft loss frequency (1.1%). AC and autoimmune cirrhosis show the best posttransplant survival in both the short and long term. Patients with AC included on the waiting list for LT were Child-Pugh class B (52.1%) and Model for End-Stage Liver Disease score of 10 to 19 (71.2%). The highest percentage of AC patient survival was observed at 1 year posttransplant (81.2%) and progressively decreased over time up to 10 years posttransplant (69.6%). Pretransplant complications such as ascites and encephalopathy did not have an influence on the percentage of posttransplant survivals, although better survival rates were observed in nonviral AC patients. CONCLUSIONS: AC without viral infections is the main indication for LT in southeastern Spain although its frequency has decreased in last decade. AC is a good indication for LT for its high survival rate and few posttransplant complications. Despite having a high percentage of pretransplant complications (ascites and encephalopathy) but does not appear to influence survivals being observed posttransplant survival rates above those expected. Conversely, viral infections in the patient with AC decrease patient survivals. The main future goals are design new strategies to detect, treat, and reduce AC frequency in our population and know alcoholic recidivism rate posttransplant in our population.

Prevalence and patterns of traditional bullying victimization and cyber-teasing among college population in Spain.

BACKGROUND: Traditional bullying victimization and the growing number of cyber-teasing victims during the last decade is a major public health concern. The objective of this study was to examine the relationship between students' experiences of traditional bullying victimization and cyber-teasing and the sociodemographic characteristics of a sample composed of college students in Spain. METHODS: In the fall of 2014, 543 sixth-grade students from southeast Spain completed an anonymous survey on their experience of both kinds of to ascertain any relationship with sociodemographic characteristics, including gender, nationality, economic problems, family conflicts and alcohol and cannabis use. RESULTS: A total of 62.2% of the students reported to having suffered traditional bullying victimization and 52.7% reported that they had been subject to cyber-teasing. 40.7% of participants had been victims of traditional bullying victimization and cyber-teasing in the past 12 months. Most (65.7%) of the victims were at the same time cyber-teasing victims; 77.6% of cyber-teasing victims were also victimized in a different manner. Traditional bullying victimization was higher among boys than among girls, while female students were more likely to have been subjected to cyber-teasing than male students. The characteristics that most heavily influenced suffering traditional bullying victimization were economic problems, family conflicts and cannabis use. CONCLUSIONS: Our findings confirm overlapping results in the risk factors that influence suffering both traditional bullying victimization and cyber-teasing: there was a strong influence of certain sociodemographic and individual characteristics of the college population, suggesting that specific policies are necessary to improve college students' environment in Spain.