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1.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(8): 538-544, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS-Express | IBECS | ID: ibc-FGT-5931

RESUMEN

OBJETIVO: Analizar el nivel de preparación, conocimiento y experiencia sobre la violencia de género de las/os tutoras/es médicas/os y las/os residentes de medicina de familia de las Unidades Docentes de Atención Familiar y Comunitaria de Galicia. MÉTODO: Estudio descriptivo transversal en las siete Unidades Docentes de Atención Familiar y Comunitaria de Galicia. Se utilizó el cuestionario Physician Readiness Manage Intimate Violence Survey (PREMIS), en su versión validada en español. Esta encuesta permite recoger información de las/os profesionales sanitarios de atención primaria sobre sus actitudes, conocimientos y prácticas con respecto a la violencia de género. Se realizó análisis estadístico descriptivo y comparativo de los datos. RESULTADOS: Se recibieron 159 cuestionarios, 72,32% procedían de mujeres, 59,1% de las respuestas fueron de médicas/os tutoras/es. Se apreció que existían diferencias estadísticamente significativas en la detección/diagnóstico de violencia a favor que aquellas/os profesionales que tenían conocimiento del protocolo de violencia de género o que habían recibido formación sobre esta materia (p < 0,01). En la autopercepción de la formación sobre violencia de género se observaron peores resultados con significación estadística en aquellas/os profesionales con mayor carga asistencial (p < 0,05). CONCLUSIONES: Haber recibido formación o conocer el protocolo de atención sanitaria se asocia con una mayor detección de casos de violencia de género. Se ha constatado déficit en formación en violencia de género tanto en tutoras/es como en residentes de medicina de familia, especialmente en los que tienen mayor carga asistencial, por lo que es una prioridad desarrollar estrategias de formación médica en este campo


OBJECTIVE: To analyse the level of preparation, knowledge and experience of gender violence of medical tutors and family medicine trainees of the Teaching Units of Family and Community Care of Galicia. METHODS: Descriptive cross-sectional study conducted in the 7 Teaching Units of Family and Community Care in Galicia. The Physician Readiness Manage Intimate Violence Survey (PREMIS), in its validated version in Spanish was used. This survey allows the collection of information from primary health care professionals about their attitudes, knowledge, and practices as regards gender violence. A descriptive and comparative statistical analysis was performed on the data. RESULTS: Out of a total of 159 questionnaires received, 72.32% came from women, and 59.1% of the responses were from doctors / tutors. It was noted that there were statistically significant differences in the detection / diagnosis of violence by those professionals who were aware of the gender violence protocol or who had received training in this area (P<.01). In the self-perception of gender violence training, statistically significant worse results were observed in those professionals with greater care burden (P<.05). CONCLUSIONS: Having received training or knowing the health care protocol on gender violence is associated with greater detection of cases of gender violence. There has been a deficit in training in gender-based violence both in tutors and in family medicine residents, especially in those with greater care burden, so it is a priority to develop medical training strategies in this field

2.
Semergen ; 45(8): 510-515, 2019.
Artículo en Español | MEDLINE | ID: mdl-31326240

RESUMEN

OBJECTIVE: To analyse the profile of Family Doctors who gain access to positions, both to the general quota, as well those reserved for teaching tutors of Family and Community Medicine, by means of a relocation competition. MATERIAL AND METHODS: A descriptive observational study was conducted in which 2 comparison groups were established: A Non-Teaching group that did not include Family Doctors who did not request or gain access to tutor positions, and a Teaching group with those that gained access to positions reserved for tutors. The information was obtained from the marks of the relocation competition carried out in Galicia in 2018. A total of 426 General Practitioners that entered the examination were included, of which 301 were female (70.7%) and 125 (29.3%) males. The variables were the obtaining of a position reserved for tutor, gender, and the merits considered in the competition: professional experience, training, scientific publications, and Galician language. The non-parametric statistics tests of Mann-Whitney and Kruskal-Wallis were used, after checking for non-normal distribution. RESULTS: Statistically significant differences were found in the distribution by gender in favour of males in the Teaching group compared to the Non-Teaching group (P<.01). The Teaching group obtained better results in training and publications. The females obtained statistically significant results in their favour in the training variable, and the males in experience. CONCLUSIONS: For the choice of teaching places in relocation interviews and examinations, publications and training had an important weighting; but, taking the gender perspective into account, a lower percentage of women had gained access to teaching positions due to having lower score in the experience category.


Asunto(s)
Medicina Comunitaria/educación , Docentes Médicos , Medicina Familiar y Comunitaria/educación , Selección de Personal , Femenino , Humanos , Masculino , España
3.
Cuad Bioet ; 28(92): 71-81, 2017.
Artículo en Español | MEDLINE | ID: mdl-28342435

RESUMEN

Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient's values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine.


Asunto(s)
Oncología Médica/ética , Neoplasias/terapia , Cuidado Terminal/ética , Planificación Anticipada de Atención , Comunicación , Humanos , Oncología Médica/métodos , Principios Morales , Neoplasias/mortalidad , Neoplasias/patología , Cuidado Terminal/métodos
6.
J Forensic Leg Med ; 15(6): 353-5, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18586202

RESUMEN

Whiplash injury has been a continuous source of controversy due to its association with litigation. We studied the incidence of whiplash associated disorder (WAD) in two similar socioeconomic areas and carried out a retrospective study based on the hypothesis that the Spanish law 30/1995 might have an affect on the incidence and duration of cervical symptoms and the persistence of impairment. More than 10,000 patients injured in traffic accidents were studied over a period three years. Of these, only patients with an initial diagnosis of whiplash injury were included in the study. Patients with other injuries were excluded. The patients were classified into two groups: Galicia-Spain and North-Central Portugal (depending on where the accident took place and the medico-legal evaluation procedure in force). Statistical analysis was made using SPSS 13.0 and Statistix 8.0. We found a statistically significant difference between Spain and Portugal in the incidence of WAD and in the duration of symptoms. The incongruities caused by the compulsory application of Spanish law arise from the fact that evaluation on a points scale of impairment does not always reflect the functional state of the injured person.


Asunto(s)
Compensación y Reparación/legislación & jurisprudencia , Lesiones por Latigazo Cervical/economía , Lesiones por Latigazo Cervical/epidemiología , Accidentes de Tránsito , Femenino , Humanos , Incidencia , Masculino , Portugal/epidemiología , Recuperación de la Función , Estudios Retrospectivos , España/epidemiología , Factores de Tiempo , Lesiones por Latigazo Cervical/terapia
7.
J Forensic Leg Med ; 15(6): 368-72, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18586206

RESUMEN

Immunohistochemical detection of mediators of inflammation, such as P-Selectin, has been proposed to assess vitality of wounds. Forty-five incised cutaneous wounds (24 vital, 14 post-mortem, seven with induced autolysis/putrefaction) were immunostained with antibodies against P-Selectin and CD31. The percentage of stained lumina for P-Selectin out of the total of CD31 positive vessels (P-S/CD31 index) was calculated at both edges of every specimen. In vital samples, the P-S/CD31 index ranged from 10.7% to 71.4% at the wound edge, and was 12.5-58.8% for the opposite margin, with a ratio between both indices of 0.37-1.77 (mean: 0.94). In post-mortem cases, the index ranged from 22.5% to 69.2% at the wound edge, and was 28-89.5% at the opposite margin, with a ratio between both indices of 0.76-1.9 (mean: 0.96). Differences between ratios were not statistically significant and thus precluded any assessment of vitality. The analysis of P-Selectin/CD31 immunoreactivity in skin wounds was not useful for the diagnosis of vitality when evaluating both edges for each specimen. Moreover, P-Selectin has been detected in post-mortem injuries and it is not specific to vital injuries. Microscopic evaluation becomes difficult after autolysis/putrefaction.


Asunto(s)
Selectina-P/metabolismo , Piel/metabolismo , Heridas y Traumatismos/patología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos/análisis , Biomarcadores/metabolismo , Femenino , Patologia Forense , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Selectina-P/inmunología , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/inmunología , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Piel/lesiones
8.
J Clin Forensic Med ; 13(6-8): 341-3, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17029919

RESUMEN

The incidence of congenital complete heart block is estimated in 1 of 2500-20,000 births. Many cases are isolated (found in an otherwise normal heart) and the pathology of the heart conduction system is variable. We report a 51-year-old man with the diagnosis of complete heart block, with a permanent pacemaker. No family history of rhythm disturbances was available. The patient presented and endocarditis after replacement of the pacemaker battery. The prognosis was poor and the patient died three months later. Autopsy examination showed signs of shock, of septic origin. The heart was hypertrophic (450g) and the left ventricle thickened. Histopathological examination of the heart conduction system showed that the sinus and atrioventricular nodes were normal, but the His bundle was interrupted and replaced by fibrous tissue. No inflammatory signs were present. Loss of conducting fibres and their replacement by fibrous tissue is the most common pathological process in complete heart block. In this case His bundle was mostly affected, different to Lev's disease where the process is more distal (branching atrioventricular bundle) and to Lenegre's disease, which shows a diffuse damage in the conducting system.


Asunto(s)
Fascículo Atrioventricular/patología , Bloqueo Cardíaco/patología , Autopsia , Diagnóstico Diferencial , Medicina Legal , Bloqueo Cardíaco/congénito , Sistema de Conducción Cardíaco/patología , Humanos , Masculino , Persona de Mediana Edad
9.
Hum Exp Toxicol ; 25(5): 279-81, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16758771

RESUMEN

We have developed a new technique to determine the concentration of hypoxanthine [Hx] in a reverse phase column using a modified high-performance liquid chromatography (HPLC) method that is faster and more reliable than those previously described. In this paper we present a formula for estimating the post mortem interval (PMI) based on this HPLC method by applying the inverse prediction method. The regression line obtained by changing the variables gives PMI = 0.183 [Hx] + 0.599 (PMI in hours, [Hx] in micromol/L, R2 = 0.531, P < 0.05).


Asunto(s)
Hipoxantinas/análisis , Cuerpo Vítreo/química , Cromatografía Líquida de Alta Presión/métodos , Medicina Legal , Humanos , Cambios Post Mortem , Reproducibilidad de los Resultados
10.
Int J Legal Med ; 117(6): 356-60, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14586623

RESUMEN

The efficiency of immunohistochemical techniques for the diagnosis of vitality of wounds decreases for lesions occurring fairly close to death. We analyzed the expression of fibronectin (FN) and tenascin (TN) in wounds inflicted in abdominal skin of 12 adult rats. An incised injury was made at 5, 10 or 15 min before death and another at 5 min after sacrifice, and collected after 45 min. Formalin-fixed paraffin-embedded sections from a total of 36 samples (mean 1.5 per wound) were immunostained following the streptABC technique. Microscopic examination revealed a reticular pattern staining in 18 out of 20 vital samples for FN, 16 out of 20 for TN, 2 out of 16 postmortem samples for FN and 3 out of 16 for TN. Intracellular staining of muscle fibres was observed in 7 out of 20 vital and 5 out of 16 postmortem samples. FN and TN were detected in most of the vital injuries but they are not completely specific. Postmortem staining occurred in a few cases probably related to a passive extravasation of these molecules from damaged blood vessels. Reactivity of muscle fibres occurs both in vital and postmortem lesions, and is not useful in the diagnosis of vitality.


Asunto(s)
Fibronectinas/metabolismo , Músculo Esquelético/lesiones , Músculo Esquelético/metabolismo , Piel/lesiones , Piel/metabolismo , Tenascina/metabolismo , Animales , Medicina Legal , Inmunohistoquímica , Masculino , Músculo Esquelético/ultraestructura , Cambios Post Mortem , Ratas , Piel/ultraestructura
11.
Int J Legal Med ; 116(2): 109-12, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12056517

RESUMEN

Demonstrating the vital character of an injury and estimation of the age are routine tasks in forensic pathology and although many different techniques have been applied to this problem none have been found to be completely satisfactory. Apoptosis, an active genetically controlled process, is the major mechanism by which homeostasis of a number of physiological systems in the body is regulated and changes in the rate following different kinds of stimuli have prompted us to test it as an indicator of vitality. We used an in situ end-labelling technique (Apop-Tag) in 30 human surgical skin injuries with age since injury ranging from 3 min to 8 h and found that apoptotic keratinocytes are found in over 50% of the cases with a post-infliction interval of at least 120 min. Apoptosis was not seen in injuries less than 120 min old or in normal skin, which was used as an external control. These results suggest that apoptosis could be a useful indicator for the intravital occurrence of injuries and could help to estimate the date of the skin injuries in some cases. The importance of strict technical control is stressed and the necessity of a complementary technique to confirm apoptosis is discussed.


Asunto(s)
Apoptosis , Piel/lesiones , Piel/patología , Adulto , Anciano , Femenino , Medicina Legal , Humanos , Etiquetado Corte-Fin in Situ , Queratinocitos/ultraestructura , Masculino , Persona de Mediana Edad
12.
Int J Legal Med ; 115(2): 76-8, 2001 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11724434

RESUMEN

We report a case of congenital cystic adenomatoid malformation (CCAM) of the lungs resulting in sudden death immediately after birth. The case is extremely unusual because of the diffuse bilateral involvement. The extensive involvement of both lungs could explain the abrupt onset of the symptoms and the ineffectiveness of resuscitation attempts. The presence of cartilage as a part of the malformation adds interest to the case, since it is seldom found in this malformation and to the best of our knowledge has been reported only exceptionally in a type II CCAM.


Asunto(s)
Malformación Adenomatoide Quística Congénita del Pulmón/patología , Autopsia , Resultado Fatal , Humanos , Íleon/patología , Recién Nacido , Pulmón/patología , Masculino
13.
Am J Forensic Med Pathol ; 22(3): 275-7, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11563739

RESUMEN

Blunt abdominal trauma can cause rapid death resulting from serious injuries of internal organs. The liver is commonly involved and may show tearing, usually in its upper surface, resulting in hemoperitoneum eventually leading to death. Minor trauma implies serious liver damage only when previous pathologic changes causing enlargement of the organ are present. The case of a 25-year-old woman who died as a consequence of a minor road accident is reported. At autopsy, the body showed no external injuries, the only relevant finding being a massive hemoperitoneum from the rupture of an unusually large liver cell adenoma. Liver cell adenomas carry a serious risk of spontaneous rupture, which may result in the death of the patient. The occurrence of the rupture after a minor blunt abdominal trauma is highly unusual.


Asunto(s)
Adenoma de Células Hepáticas/patología , Hemoperitoneo/patología , Neoplasias Hepáticas/patología , Hígado/lesiones , Heridas no Penetrantes/complicaciones , Accidentes de Tránsito , Adenoma de Células Hepáticas/complicaciones , Adulto , Autopsia , Femenino , Hemoperitoneo/etiología , Humanos , Neoplasias Hepáticas/complicaciones , Rotura
14.
Am J Forensic Med Pathol ; 22(3): 278-84, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11563740

RESUMEN

Myocardial samples of hearts with histologic findings of acute myocardial infarction (group A), sudden coronary deaths without histologic changes (group B), and chronic ischemic heart disease (group C) were analyzed to investigate the appearance of apoptosis in acute and chronic ischemic cardiac disorders. This analysis involved the morphologic detection of DNA strand breaks in myocyte nuclei by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay and the biochemical determination of DNA laddering in the myocardium using archival formalin-fixed, paraffin-embedded tissue sections of human myocardium. The authors demonstrated that apoptosis of myocardial cells could occur after ischemic myocardial cell injury. In all documented cases of acute myocardial infarction (group A), the infarcted area included extensive presence of both apoptosis and necrosis. In the tissue bordering on and away from the obviously infarcted areas, positive nuclei were intermingled with nonstained normal myocytes. The number of positive nuclei decreased with the distance from the infarction foci. In group B, myocardial samples showed focal or diffuse nuclear positivity of varying degrees for apoptosis, confirming the presence of myocardial ischemic cell death, whereas the histologic diagnosis remained inconclusive. This finding suggests that apoptosis could be used as a marker for acute ischemic injury. In group C, stained nuclei were dispersed with intermingled normal cardiomyocytes.


Asunto(s)
Apoptosis , Muerte Súbita Cardíaca/patología , Isquemia Miocárdica/patología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Estudios de Casos y Controles , Enfermedad Crónica , Fragmentación del ADN , Electroforesis en Gel de Agar , Femenino , Antropología Forense/métodos , Humanos , Etiquetado Corte-Fin in Situ , Masculino , Persona de Mediana Edad
15.
J Forensic Sci ; 46(2): 209-14, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11305419

RESUMEN

The relation between the potassium concentration in the vitreous humor, [K+], and the postmortem interval has been studied by several authors. Many formulae are available and they are based on a correlation test and linear regression using the PMI as the independent variable and [K+] as the dependent variable. The estimation of the confidence interval is based on this formulation. However, in forensic work, it is necessary to use [K+] as the independent variable to estimate the PMI. Although all authors have obtained the PMI by direct use of these formulae, it is, nevertheless, an inexact approach, which leads to false estimations. What is required is to change the variables, obtaining a new equation in which [K+] is considered as the independent variable and the PMI as the dependent. The regression line obtained from our data is [K+] = 5.35 + 0.22 PMI, by changing the variables we get PMI = 2.58[K+] - 9.30. When only nonhospital deaths are considered, the results are considerably improved. In this case, we get [K+] = 5.60 + 0.17 PMI and, consequently, PMI = 3.92[K+] - 19.04.


Asunto(s)
Potasio/análisis , Cuerpo Vítreo/química , Adulto , Autopsia , Femenino , Medicina Legal , Humanos , Masculino , Cambios Post Mortem , Valores de Referencia , Análisis de Regresión , Sensibilidad y Especificidad , Factores de Tiempo
16.
J Forensic Sci ; 46(2): 363-6, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11305442

RESUMEN

The estimation of stature from of a variety of bones is an important aspect of forensic work. In order to obtain reliable results, it is important to have comparative data obtained from the same population group as the skeletal remains. However, lack of up to date information on the population groups of Southern Europe makes the estimation of stature from bones in this area subject to possible error. In this study, the stature of 104 healthy adults from Spain was measured, and an anteroposterior teleradiograph of the right lower and the right upper limb of every subject in the study was made in order to measure the lengths of the femur, tibia, fibula, humerus, cubitus and ulna. Pearson's regression formulae were obtained for both limbs. In males, we found the femur to be the most accurate predictor of stature (R = 0.851), whereas in females best results were obtained with the tibia (R = 0.876).


Asunto(s)
Estatura , Huesos/anatomía & histología , Adulto , Antropometría , Huesos/diagnóstico por imagen , Femenino , Medicina Legal/métodos , Humanos , Masculino , Radiografía , Análisis de Regresión , España
17.
J Forensic Sci ; 45(4): 920-2, 2000 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10914599

RESUMEN

Coronary sinus thrombosis is an unusual but potentially serious complication of the use of central venous devices. We report a fatal case of coronary sinus thrombosis in relation to a malpositioned central venous catheter. The death occurred very soon following the beginning of symptoms and the cause could not be suspected. Direct trauma of the catheter on the coronary sinus endothelium seems the most probable cause of the thrombosis.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Trombosis Coronaria/etiología , Muerte Súbita Cardíaca/etiología , Taponamiento Cardíaco/etiología , Causas de Muerte , Niño , Trombosis Coronaria/diagnóstico , Medicina Legal , Humanos , Masculino
18.
Int J Legal Med ; 112(1): 15-21, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9932736

RESUMEN

Recently described Y-STR polymorphisms can be analysed as informative haplotypes which are useful in the forensic field. In order to include these systems in our forensic routine, we have carried out a population study in Galicia (NW Spain) analysing seven Y-STR polymorphisms (DYS19, DYS389-I, DYS389-II, DYS390, DYS393 and DYS385: two loci). The results were compared with other population studies. In addition various alleles for each system (except DYS385) were sequenced and the corresponding allelic ladders constructed.


Asunto(s)
Haplotipos , Paternidad , Cromosoma Y , Genética de Población , Humanos , Masculino , Polimorfismo Genético , España
20.
Int J Legal Med ; 110(5): 273-7, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9297584

RESUMEN

Since 1992 the Spanish and Portuguese Working Group (GEP) of the International Society for Forensic Haemogenetics (ISFH) has been organizing collaborative exercises on DNA profiling with the aim of making progress on standardization and discussing technical and statistical problems in DNA analysis. A total of four exercises (GEP-92 to GEP-95) have been carried out until now. A consequence of these exercises was the creation of a quality control programme in Spain and Portugal in 1995 which was carried out simultaneously with the GEP-95 exercise. The number of participating laboratories increased from 10 in the first exercise (GEP-92) to 19 in the last exercise (GEP-95). Despite this increasing number of participating laboratories, results remained satisfactory. In the last exercises, all the laboratories used PCR-based DNA polymorphisms with an increasing number of markers obtaining good results. SLPs were used by only 30% of laboratories in the last two exercises but the results indicated a good level of expertise in most of these laboratories. The reasons for these successful results are the common use of the EDNAP protocol for SLP analysis and commercially available kits or common sequenced allelic ladders for PCR-based DNA polymorphisms.


Asunto(s)
Medicina Legal , Cooperación Internacional , Laboratorios/normas , Polimorfismo Genético , Manchas de Sangre , Humanos , Paternidad , Portugal , Control de Calidad , Estándares de Referencia , Reproducibilidad de los Resultados , España
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