Pharmacist care in hospital emergency departments: a consensus paper from the Spanish hospital pharmacy and emergency medicine associations. / Atención farmacéutica en los servicios de urgencias: documento de posicionamiento de la Sociedad Española de Farmacia Hospitalaria (SEFH) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES).

OBJECTIVES: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. MATERIAL AND METHODS: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. RESULTS: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. CONCLUSION: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.

OBJETIVO: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarios mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. METODO: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. RESULTADOS: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. CONCLUSIONES: El desarrollo del conjunto de actividades e indicadores de atención farmacéutica en urgencias, priorizados por grado de relevancia para la unidad, es la base para el desarrollo de esta cartera de servicios en los hospitales españoles, y sirve como guía tanto para farmacéuticos como para gestores, médicos y enfermeros de la unidad a fin de mejorar la farmacoterapia los pacientes atendidos en los servicios de urgencias.

Biosignature stability in space enables their use for life detection on Mars.

Two rover missions to Mars aim to detect biomolecules as a sign of extinct or extant life with, among other instruments, Raman spectrometers. However, there are many unknowns about the stability of Raman-detectable biomolecules in the martian environment, clouding the interpretation of the results. To quantify Raman-detectable biomolecule stability, we exposed seven biomolecules for 469 days to a simulated martian environment outside the International Space Station. Ultraviolet radiation (UVR) strongly changed the Raman spectra signals, but only minor change was observed when samples were shielded from UVR. These findings provide support for Mars mission operations searching for biosignatures in the subsurface. This experiment demonstrates the detectability of biomolecules by Raman spectroscopy in Mars regolith analogs after space exposure and lays the groundwork for a consolidated space-proven database of spectroscopy biosignatures in targeted environments.

Prevalencia de acontecimientos adversospor medicamentos en los servicios de urgencias. Proyecto multicéntrico FARM-URG / Prevalence of adverse drug events in emergency departments. FARM-URG multi-center project

Objetivo: Los acontecimientos adversos por medicamentos son una causaconocida de asistencia a los servicios de urgencias. El objetivo del proyectoFARM-URG, impulsado por el Grupo de Trabajo REDFASTER de la SociedadEspañola de Farmacia Hospitalaria, es evaluar estos acontecimientos adversos mediante cortes periódicos. En este estudio se muestran los resultadosdel primer registro. Sus objetivos fueron determinar la prevalencia de acontecimientos adversos respecto al total de pacientes atendidos y caracterizarlos.Método: Estudio multicéntrico transversal realizado en los servicios deurgencias de hospitales españoles. La identificación y registro de pacientesse obtuvo a partir del censo de pacientes atendidos en urgencias en elmomento del corte (16 de junio de 2020). Se revisaron las historias clínicasretrospectivamente y se registraron los datos en la plataforma REDCap®.Resultados: En este corte FARM-URG de 2020 participaron 13 hospitales, que evaluaron 772 pacientes, de los cuales 57 (7,4%) habían consultadopor un acontecimiento adverso por medicamentos. El grupo de fármacosantitrombóticos fue responsable de la mayor parte de estos episodios, siendoacenocumarol (22,8%) el principal fármaco implicado. (AU)

Objective: Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by theREDFASTER working group of the Spanish Society of Hospital Pharmacy.Its aim is to evaluate these adverse events through regular prevalencemeasurements. The present study shows the results of the first observations.The goal was to determine the prevalence of adverse drug events withrespect to the total number of patients treated in emergency departmentsand carry out a description of the different events identified.Method: This is a multicenter cross-sectional study carried out in theemergency room of 13 Spanish hospitals. The identification and registration of patients were obtained from the emergency department patientcensus at the time of the first prevalence measurement (16 June 2020). TheREDCap® platform was used for patient registration.Results: The 2020 FARM-URG registry, which included 13 hospitals,evaluated 772 patients, of whom 57 (7.4%) consulted for adverse drugevents. Antithrombotic drugs were responsible for most of these episodes, acenocoumarol being the main drug involved (22.8%). (AU)

Prevalence of adverse drug events in emergency departments. FARM-URG multi-center project.

OBJECTIVE: Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by  the REDFASTER working group of the Spanish Society of Hospital  Pharmacy. Its aim is to evaluate these adverse events through regular  prevalence measurements. The present study shows the results of the first observations. The goal was to determine the prevalence of adverse drug  events with respect to the total number of patients treated in emergency  departments and carry out a description of the different events identified. METHOD: This is a multicenter cross-sectional study carried out in the emergency room of 13 Spanish hospitals. The identification and  registration of patients were obtained from the emergency department  patient census at the time of the first prevalence measurement (16 June  2020). The REDCap® platform was used for patient registration. RESULTS: The 2020 FARM-URG registry, which included 13 hospitals, evaluated 772 patients, of whom 57 (7.4%) consulted for  adverse drug events. Antithrombotic drugs were responsible for most of  these episodes, acenocoumarol being the main drug involved (22.8%).  Nine (15.8%) adverse drug events were caused by inappropriate drug  prescriptions according to the STOPP-START criteria. Nineteen (33.0%)  patients returned to the emergency service within 30 days from discharge. CONCLUSIONS: Adverse drug events are a frequent cause of emergency department visits and are commonly associated with a  significant percentage of re-visits. The FARM-URG project has been created with the purpose of obtaining dynamic and updated information on such  events.

Objetivo: Los acontecimientos adversos por medicamentos son una causa conocida de asistencia a los servicios de urgencias. El objetivo del  proyecto FARM-URG, impulsado por el Grupo de Trabajo REDFASTER de la  Sociedad Española de Farmacia Hospitalaria, es evaluar estos  acontecimientos adversos mediante cortes periódicos. En este estudio se  muestran los resultados del primer registro. Sus objetivos fueron  determinar la prevalencia de acontecimientos adversos respecto al total de pacientes atendidos y caracterizarlos.Método: Estudio multicéntrico transversal realizado en los servicios de urgencias de hospitales españoles. La identificación y registro de  pacientes se obtuvo a partir del censo de pacientes atendidos en urgencias en el momento del corte (16 de junio de 2020). Se revisaron las historias  clínicas retrospectivamente y se registraron los datos en la plataforma  REDCap®.Resultados: En este corte FARM-URG de 2020 participaron 13 hospitales, que evaluaron 772 pacientes, de los cuales 57 (7,4%) habían consultado por un acontecimiento adverso por medicamentos. El grupo de  fármacos antitrombóticos fue responsable de la mayor parte de estos  episodios, siendo acenocumarol (22,8%) el principal fármaco implicado.  Nueve (15,8%) de los acontecimientos adversos fueron causados por  fármacos con prescripción inapropiada según los criterios STOPP-START.  Diecinueve (33,0%) pacientes volvieron a visitar el servicio de urgencias  antes de los 30 días del alta.Conclusiones: Los acontecimientos adversos por medicamentos son un motivo frecuente de visita a los servicios de urgencias y están  asociados a un importante porcentaje de visitas posteriores tras el alta. El  proyecto FARM-URG nace con el propósito de obtener información  periódicamente para la posible implementación de medidas preventivas.

The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study.

AIM: To explore the experience of both the mothers and the fathers regarding the care received during delivery in cases of stillbirth. DESIGN: A hermeneutic phenomenological study based on semi-structured interviews with eleven mothers and fathers who experienced stillbirth. PARTICIPANTS: A purposive sample was recruited in Hospital XXX of XX and through a local pregnancy loss support organization. METHODS: Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis. FINDINGS: Four main categories identified: 1) denial of grief, 2) the life and death paradox, 3) guilt, and 4) go through and overcome the loss. The parents manifested a lack of recognition of their loss and their parenthood. Although the midwife was the highest valued professional, not all the experiences were positive and the parents would have appreciated being accompanied by trained people with good communication skills. They also referred to in-hospital logistic barriers that complicated the process, as well as the fact that these births occurred in the same place where healthy deliveries were attended. CONCLUSION: Findings highlight the importance of tailoring support systems according to mothers' and fathers' needs. Promoting social and institutional recognition of this kind of loss and training healthcare professionals in the accompaniment of this type of mourning is useful to plan comprehensive care to facilitate the initiation and subsequent evolution of healthy mourning.

Limits of Life and the Habitability of Mars: The ESA Space Experiment BIOMEX on the ISS.

BIOMEX (BIOlogy and Mars EXperiment) is an ESA/Roscosmos space exposure experiment housed within the exposure facility EXPOSE-R2 outside the Zvezda module on the International Space Station (ISS). The design of the multiuser facility supports-among others-the BIOMEX investigations into the stability and level of degradation of space-exposed biosignatures such as pigments, secondary metabolites, and cell surfaces in contact with a terrestrial and Mars analog mineral environment. In parallel, analysis on the viability of the investigated organisms has provided relevant data for evaluation of the habitability of Mars, for the limits of life, and for the likelihood of an interplanetary transfer of life (theory of lithopanspermia). In this project, lichens, archaea, bacteria, cyanobacteria, snow/permafrost algae, meristematic black fungi, and bryophytes from alpine and polar habitats were embedded, grown, and cultured on a mixture of martian and lunar regolith analogs or other terrestrial minerals. The organisms and regolith analogs and terrestrial mineral mixtures were then exposed to space and to simulated Mars-like conditions by way of the EXPOSE-R2 facility. In this special issue, we present the first set of data obtained in reference to our investigation into the habitability of Mars and limits of life. This project was initiated and implemented by the BIOMEX group, an international and interdisciplinary consortium of 30 institutes in 12 countries on 3 continents. Preflight tests for sample selection, results from ground-based simulation experiments, and the space experiments themselves are presented and include a complete overview of the scientific processes required for this space experiment and postflight analysis. The presented BIOMEX concept could be scaled up to future exposure experiments on the Moon and will serve as a pretest in low Earth orbit.

Response of Methanogenic Archaea from Siberian Permafrost and Non-permafrost Environments to Simulated Mars-like Desiccation and the Presence of Perchlorate.

Numerous preflight investigations were necessary prior to the exposure experiment BIOMEX on the International Space Station to test the basic potential of selected microorganisms to resist or even to be active under Mars-like conditions. In this study, methanogenic archaea, which are anaerobic chemolithotrophic microorganisms whose lifestyle would allow metabolism under the conditions on early and recent Mars, were analyzed. Some strains from Siberian permafrost environments have shown a particular resistance. In this investigation, we analyzed the response of three permafrost strains (Methanosarcina soligelidi SMA-21, Candidatus Methanosarcina SMA-17, Candidatus Methanobacterium SMA-27) and two related strains from non-permafrost environments (Methanosarcina mazei, Methanosarcina barkeri) to desiccation conditions (-80°C for 315 days, martian regolith analog simulants S-MRS and P-MRS, a 128-day period of simulated Mars-like atmosphere). Exposure of the different methanogenic strains to increasing concentrations of magnesium perchlorate allowed for the study of their metabolic shutdown in a Mars-relevant perchlorate environment. Survival and metabolic recovery were analyzed by quantitative PCR, gas chromatography, and a new DNA-extraction method from viable cells embedded in S-MRS and P-MRS. All strains survived the two Mars-like desiccating scenarios and recovered to different extents. The permafrost strain SMA-27 showed an increased methanogenic activity by at least 10-fold after deep-freezing conditions. The methanogenic rates of all strains did not decrease significantly after 128 days S-MRS exposure, except for SMA-27, which decreased 10-fold. The activity of strains SMA-17 and SMA-27 decreased after 16 and 60 days P-MRS exposure. Non-permafrost strains showed constant survival and methane production when exposed to both desiccating scenarios. All strains showed unaltered methane production when exposed to the perchlorate concentration reported at the Phoenix landing site (2.4 mM) or even higher concentrations. We conclude that methanogens from (non-)permafrost environments are suitable candidates for potential life in the martian subsurface and therefore are worthy of study after space exposure experiments that approach Mars-like surface conditions.

Midwives' experience of delivery care in late foetal death: A qualitative study.

AIM: To explore the experiences of midwives regarding the attention given during labour in late foetal death. DESIGN: Qualitative research using a hermeneutic-interpretative phenomenological approach was carried out. Data were collected through focus groups, audio-recorded, transcribed verbatim, and analyzed using the van Manen approach. SETTING AND PARTICIPANTS: Three focus group with a purposive sample of 18 midwives from 10 public hospitals and 1 primary health centre in Madrid, Spain were conducted. FINDINGS: Two main themes were identified: Professionals for Life Not Death; and Organizing the Work Without Guidelines. Midwives felt there is a lack of social awareness related to the possibility of antepartum death that keeps the mourning hidden and affects the midwives´ practice during the late foetal death process. Midwives recognize difficulties in coping with a process that ends in death: organizations are not prepared for these events (not suitable rooms), there is lack of training to cope with them, and lack of continuity in the attention received by the parents when they are discharged. CONCLUSION: Midwives need to be trained in mourning and communication skills to guarantee good practice when attending late foetal death. Intervention guidelines and support mechanisms are required, not only for the parents, but also for the healthcare professionals.

Proceso de atención al parto en la muerte fetal tardía / Delivery care process in late fetal death

Objetivo: analizar la evidencia disponible acerca del proceso de atención al parto en la muerte fetal tardía, que permita conocer la experiencia y las necesidades de madres y padres, y la experiencia y dificultades de los profesionales que atienden estos casos. Método: revisión narrativa de estudios cualitativos publicados desde 2005 hasta agosto de 2017 en las bases de datos Pubmed, Cinahl, Embase, Scielo, Cuiden y Lilacs en el campo de la muerte fetal tardía, atendiendo a su definición en el contexto español (a partir de 28 semanas de gestación) y en el internacional (a partir de la semana 24 de gestación). Se llevó a cabo un análisis temático de los artículos seleccionados, identificándose cuatro áreas temáticas en función a la experiencia de las madres y padres, por un lado, y dos áreas temáticas según la experiencia de los profesionales. Resultados: se seleccionaron siete artículos cualitativos (cuatro análisis de contenido, dos análisis fenomenológicos y una teoría fundamentada). Los temas identificados respecto a la experiencia de madres y padres estuvieron relacionados con un diagnóstico devastador, comienzo de la despedida, construcción de la maternidad y la paternidad, e impacto de la actuación de los profesionales. Los temas identificados en relación a la experiencia de los profesionales fueron impacto personal y profesional, y manejo del caso. Conclusiones: esta revisión pone de manifiesto tanto lo traumático de la experiencia de las madres y padres que sufren una pérdida fetal tardía como la afectación personal de los profesionales que les atienden, que presentan dificultades para afrontar adecuadamente el caso, y demandan formación específica para ayudar de forma eficiente en el proceso de duelo

Objective: to analyze the evidence available about the delivery care process in late fetal death, allowing to learn about the experience and needs of mothers and fathers, and the challenges for the professionals managing these cases. Method: a narrative review of qualitative studies published from 2005 to August, 2017 in the following databases: Pubmed, Cinahl, Embase, Scielo, Cuiden and Llilacs, on the area of late fetal death, according to its definition in the Spanish setting (from 28 gestation weeks onwards), and in the international setting (from week 24 of gestation). A themed analysis was conducted on the articles selected, and four theme areas were identified, based on the experience of mothers and fathers on one hand, and two theme areas according to the experience of professionals. Results: seven qualitative articles were selected: four content analyses, two phenomenological analyses, and one grounded theory. The themes identified regarding the experience of mothers and fathers were associated with a devastating diagnosis, the initial goodbye, building maternity and paternity, and the impact of the action by professionals. The themes identified associated with the experience of professionals were: personal and professional impact, and case management. Conclusions: this review shows the traumatic experience of mothers and fathers suffering a late fetal loss, as well as the personal impact on those professionals managing them, who will be faced with difficulties for addressing the case adequately, and demand specific training to help in the mourning process in an efficient way

Publisher Correction: Geochemical constraints on the Hadean environment from mineral fingerprints of prokaryotes.

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Detección y seguimiento de malos tratos en personas mayores en un hospital terciario: experiencia de 3 años / Three years experience in the detection and follow-up of violence against the elderly in a tertiary hospital

Objetivos. La Comisión Contra la Violencia del Hospital Clínico San Carlos (Madrid) puso en marcha en 2012 un plan integral de detección y seguimiento de los casos de sospecha de malos tratos al adulto mediante un registro hospitalario. En este estudio se valoran los resultados de los primeros 3años analizando las diferencias en función de la edad (menores y mayores de 65años). Material y métodos. De acuerdo con el registro se han comparado los resultados de mayores y menores de 65años relativos a: sexo, lugar del registro, responsable de la notificación, historia de violencia previa, tipo de maltrato, recursos empleados y seguimiento. También se recogió la tasa de fallecidos en el primer año. El procesamiento y análisis de los datos se realizó mediante el paquete estadístico SPSS 18.0. Resultados. El número registrado de casos de sospecha durante los 3años (2013-2015) fue de 172. GrupoA (15-64años): 140 casos. GrupoB (>65años): 32 (22,8%). Sexo: GrupoA: 93,5% mujeres. GrupoB: 78,1% (p=0,014). Lugar del registro: GrupoA: urgencias: 90,7%, hospitalización: 6,4%, consultas externas: 3,0%. GrupoB: urgencias: 65,6%, hospitalización: 31,6%, consultas externas: 2,8% (p=0,001). Notificación: Grupo A: trabajador social: 25%, médico: 67,8%, enfermera: 6,4%. Grupo B: trabajador social: 65,2%, médico: 28,1, enfermera: 6,2. (p<0,001). Historia de violencia previa: GrupoA: 62,1%. GrupoB: 68,7%. Tipo de maltratos: GrupoA: físicos: 56,4%, psíquicos: 2,8%, físicos +psíquicos: 30,4%, físicos +psíquicos +económicos: 10,1%. GrupoB: físicos: 31,1%, psíquicos: 5,1%, negligencia: 18,7%, físicos +psíquicos: 10,1, físicos +psíquicos +económicos: 9,8, económicos: 25,1 (p<0,0001). Recursos empleados y seguimiento: Parte de lesiones: GrupoA: 63,5%. GrupoB: 31,2% (p=0,001). Medidas de protección judicial: GrupoA: 12,8. GrupoB: 15,6 (p=0,773). Orden de alejamiento: GrupoA: 2,1. GrupoB: 6,25 (p=0,235). Fallecieron al año de seguimiento más de un tercio de los pacientes del grupoB y ningún paciente en el grupoA. Conclusiones. La urgencia médica es el lugar donde más se detecta el problema. Existe historia de violencia previa en más de la mitad de los casos en ambos grupos de edad. Retrato robot de la víctima: mujer anciana, con importante deterioro físico y cognitivo. El abuso económico y la negligencia son más frecuentes en la población anciana. En nuestra serie fallecen al año más de un tercio de los pacientes ancianos víctimas de malos tratos. El registro hospitalario es fundamental para la detección y el seguimiento del maltrato en el anciano (AU)

Objectives. The Hospital Clínico San Carlos Committee against violence established a protocol in 2012 in order to detect and follow-up violence against elderly persons. This article presents the experience after 3years of its introduction, as well as an analysis comparing the differences between those younger and older than 65years of age. Material and methods. All cases were collected during years 2013, 2014, and 2015, and were divided into two groups, A and B, according to age, younger or older than 65years. Parameters studied were: gender, place of detection (emergency department, during hospital admission, or outpatient clinics), type of professional worker who detected each case (social workers, nurses, or physicians), previous history of violence, type of aggression (physical, psychological, financial), institutional procedures once aggression was confirmed, and deaths after one year of follow-up. The SPPS v.18.0 package was used for the statistical analysis. Results. A total of 172 cases were detected, of which 140 of them were included in groupA (<65years), and 32 in groupB (>65 years, 22.8%). Gender: GroupA: women: 93.5%. GroupB: women: 78.1% (P=.014). Registration site: GroupA: emergency department: 90.7%, hospital wards: 6.4%, outpatient wards: 3.0. GroupB: emergency department: 65.6%, hospital wards: 31.6%, outpatient wards: 2.8% (P=.001). Notification: GroupA: social worker: 25%, physician: 67.8%, nurse: 6.4%. GroupB: social worker: 65.2%, physician: 28.1%, nurse: 6.2% (P<.001). Previous violence history: GroupA: 62.1%. GroupB: 68.7%. Type of abuse: GroupA: physical: 56.4%, psychological: 2.8%, physical +psychological: 30.4%, physical +psychological +economic: 10.1%. GroupB: physical: 31.1%, psychological: 5.1%, neglect: 18.7%, physical +psychological: 10.1, physical +psychological +economic: 9.8, economic: 25.1 (P<.0001). Resources employed and follow-up: Injuries: Group A: 63.5%. Group B: 31.2% (P=.001). Judicial protection measures: GroupA: 12.8. GroupB: 15.6 (P=.773). Removal order: GroupA: 2.1. GroupB: 6.25 (P=.235). More than one-third of patients in groupB, and none of the patients in groupA, died in the year of follow-up. Conclusions. There are more problems detected in the Emergency Department. There is a history of previous violence in more than half of the cases in both age groups. The profile of the victim is an elderly woman with significant physical and cognitive impairment. Economic abuse and neglect are more frequent in the elderly population. In our series, more than one-third of elderly patients who are victims of ill-treatment die each year. The hospital registry is fundamental for the detection and follow-up of abuse in the elderly (AU)

[Three years experience in the detection and follow-up of violence against the elderly in a tertiary hospital]. / Detección y seguimiento de malos tratos en personas mayores en un hospital terciario: experiencia de 3 años.

OBJECTIVES: The Hospital Clínico San Carlos Committee against violence established a protocol in 2012 in order to detect and follow-up violence against elderly persons. This article presents the experience after 3years of its introduction, as well as an analysis comparing the differences between those younger and older than 65years of age. MATERIAL AND METHODS: All cases were collected during years 2013, 2014, and 2015, and were divided into two groups, A and B, according to age, younger or older than 65years. Parameters studied were: gender, place of detection (emergency department, during hospital admission, or outpatient clinics), type of professional worker who detected each case (social workers, nurses, or physicians), previous history of violence, type of aggression (physical, psychological, financial), institutional procedures once aggression was confirmed, and deaths after one year of follow-up. The SPPS v.18.0 package was used for the statistical analysis. RESULTS: A total of 172 cases were detected, of which 140 of them were included in groupA (<65years), and 32 in groupB (>65 years, 22.8%). Gender: GroupA: women: 93.5%. GroupB: women: 78.1% (P=.014). Registration site: GroupA: emergency department: 90.7%, hospital wards: 6.4%, outpatient wards: 3.0. GroupB: emergency department: 65.6%, hospital wards: 31.6%, outpatient wards: 2.8% (P=.001). Notification: GroupA: social worker: 25%, physician: 67.8%, nurse: 6.4%. GroupB: social worker: 65.2%, physician: 28.1%, nurse: 6.2% (P<.001). Previous violence history: GroupA: 62.1%. GroupB: 68.7%. Type of abuse: GroupA: physical: 56.4%, psychological: 2.8%, physical +psychological: 30.4%, physical +psychological +economic: 10.1%. GroupB: physical: 31.1%, psychological: 5.1%, neglect: 18.7%, physical +psychological: 10.1, physical +psychological +economic: 9.8, economic: 25.1 (P<.0001). Resources employed and follow-up: Injuries: Group A: 63.5%. Group B: 31.2% (P=.001). Judicial protection measures: GroupA: 12.8. GroupB: 15.6 (P=.773). Removal order: GroupA: 2.1. GroupB: 6.25 (P=.235). More than one-third of patients in groupB, and none of the patients in groupA, died in the year of follow-up. CONCLUSIONS: There are more problems detected in the Emergency Department. There is a history of previous violence in more than half of the cases in both age groups. The profile of the victim is an elderly woman with significant physical and cognitive impairment. Economic abuse and neglect are more frequent in the elderly population. In our series, more than one-third of elderly patients who are victims of ill-treatment die each year. The hospital registry is fundamental for the detection and follow-up of abuse in the elderly.

Geochemical constraints on the Hadean environment from mineral fingerprints of prokaryotes.

The environmental conditions on the Earth before 4 billion years ago are highly uncertain, largely because of the lack of a substantial rock record from this period. During this time interval, known as the Hadean, the young planet transformed from an uninhabited world to the one capable of supporting, and inhabited by the first living cells. These cells formed in a fluid environment they could not at first control, with homeostatic mechanisms developing only later. It is therefore possible that present-day organisms retain some record of the primordial fluid in which the first cells formed. Here we present new data on the elemental compositions and mineral fingerprints of both Bacteria and Archaea, using these data to constrain the environment in which life formed. The cradle solution that produced this elemental signature was saturated in barite, sphene, chalcedony, apatite, and clay minerals. The presence of these minerals, as well as other chemical features, suggests that the cradle environment of life may have been a weathering fluid interacting with dry-land silicate rocks. The specific mineral assemblage provides evidence for a moderate Hadean climate with dry and wet seasons and a lower atmospheric abundance of CO2 than is present today.

Confocal Raman microspectroscopy reveals a convergence of the chemical composition in methanogenic archaea from a Siberian permafrost-affected soil.

Methanogenic archaea are widespread anaerobic microorganisms responsible for the production of biogenic methane. Several new species of psychrotolerant methanogenic archaea were recently isolated from a permafrost-affected soil in the Lena Delta (Siberia, Russia), showing an exceptional resistance against desiccation, osmotic stress, low temperatures, starvation, UV and ionizing radiation when compared to methanogens from non-permafrost environments. To gain a deeper insight into the differences observed in their resistance, we described the chemical composition of methanogenic strains from permafrost and non-permafrost environments using confocal Raman microspectroscopy (CRM). CRM is a powerful tool for microbial identification and provides fingerprint-like information about the chemical composition of the cells. Our results show that the chemical composition of methanogens from permafrost-affected soils presents a high homology and is remarkably different from strains inhabiting non-permafrost environments. In addition, we performed a phylogenetic reconstruction of the studied strains based on the functional gene mcrA to prove the different evolutionary relationship of the permafrost strains. We conclude that the permafrost methanogenic strains show a convergent chemical composition regardless of their genotype. This fact is likely to be the consequence of a complex adaptive process to the Siberian permafrost environment and might be the reason underlying their resistant nature.

Impacto del Reiki en el manejo del dolor por pancreatitis aguda / Impact of Reiki on the management of acute pancreatitis pain

OBJETIVO: determinar el impacto del Reiki en el manejo y percepción del dolor en pancreatitis aguda, así como la aparición de posibles efectos adversos derivados de la terapia complementaria. MATERIAL Y MÉTODO: ensayo clínico aleatorizado (tres ramas: a) Reiki impartido por maestros en la técnica, b) Reiki simulado impartido por profesionales sanitarios sin formación en la terapia de Reiki, c) Sin intervención, realizado en la unidad de Patología Digestiva del Hospital General Universitario Gregorio Marañón de Madrid). La medida del dolor se efectuó mediante la escala EVA. Otras variables de estudio: edad, sexo, zona de origen, religión, origen de la pancreatitis, tipo de analgesia, dosis recibidas, abandonos del estudio y causas de esta salida. Las pruebas de contraste de hipótesis utilizadas fueron chi cuadrado, ANOVA y el test de Kruskal-Wallis. RESULTADOS: se incluyeron para el análisis 30 pacientes, 10 en cada grupo, siendo estos homogéneos. No se produjeron diferencias estadísticamente significativas entre los tres grupos en lo que a las mediciones del dolor se refiere, ni tampoco en lo que respecta al tipo y dosis de analgésicos. CONCLUSIONES: en este estudio no se ha podido demostrar que el Reiki disminuya el dolor en 2 puntos según escala EVA, en los pacientes ingresados en nuestra unidad de hospitalización con pancreatitis aguda, si bien existe la limitación del reducido tamaño muestral

OBJECTIVE: to determine the impact of Reiki on pain management and perception in acute pancreatitis, as well as the presence of potential adverse effects associated with the complementary therapy. MATERIALS AND METHODS: randomized clinical trial, with three arms: a) Reiki training by masters in the technique, b) Mock Reiki training by Healthcare Professionals not trained in Reikitherapy, c) No intervention. Conducted at the Gastroenterology Unit of the Hospital General Universitario Gregorio Marañón. Pain measurement was conducted through the VAS Scale. Other study variables were: age, gender, area of origin, religion, cause of pancreatitis, type of analgesia, doses received, clinical trial discontinuations and their causes. The hypothesis contrast tests used were: Square chi, ANOVA, and Kruskal-Wallis test. RESULTS: thirty patients were included for analysis, 10 in each arm; these arms were homogeneous. There were no statistically significant differences among the three arms either regarding pain measurements, or in terms of type and dose of analgesics. CONCLUSIONS: it could not be demonstrated in this study that Reiki can reduce pain by 2 points in the AVS Scale, in patients hospitalized in our unit with acute pancreatitis, although there is a limitation in terms of the small sample size

From cytoplasm to environment: the inorganic ingredients for the origin of life.

Early in its history, Earth's surface developed from an uninhabitable magma ocean to a place where life could emerge. The first organisms, lacking ion transporters, fixed the composition of their cradle environment in their intracellular fluid. Later, though life adapted and spread, it preserved some qualities of its initial environment within. Modern prokaryotes could thus provide insights into the conditions of early Earth and the requirements for the emergence of life. In this work, we constrain Earth's life-forming environment through detailed analysis of prokaryotic intracellular fluid. Rigorous assessment of the constraints placed on the early Earth environment by intracellular liquid will provide insight into the conditions of abiogenesis, with implications not only for our understanding of early Earth but also the formation of life elsewhere in the Universe.

Importancia del yodo en la gestación / The significance of iodine during pregnancy

Actualmente, la deficiencia de yodo es la causa prevenible más frecuente de retraso mental y parálisis cerebral del feto y lactante, así como del retraso psicomotor en niños pequeños. Afecta, según estudios de la OMS1 y la UNICEF, a unos 2.000 millones de habitantes en todo el mundo, lo que supone la tercera parte de la población mundial actual. Además, su escaso consumo durante el embarazo puede acarrear trastornos en el funcionamiento tiroideo materno perdurables tras el embarazo. La medida más sencilla y económica, con la que se han obtenido mejores resultados en su prevención, es una adecuada yodoprofilaxis con sal yodada. Para ello, necesitamos una adecuada política sanitaria que nos respalde, mantenga informada a la población en general y a la mujer en edad fértil en particular. La matrona, como agente de salud, desempeña un importantísimo papel al respecto, pues es el profesional más cercano a las gestantes

Iodine deficiency is currently the most preventable cause of brain damage and mental retardation in both the fetus and neonate and of psychomotor impairment in young children. According to the WHO and UNICEF, iodine deficiency affects some 2000 million people worldwide, representing one-third of the world population. Limited consumption during pregnancy can also lead to lasting problems with maternal thyroid function after pregnancy. The easiest and cheapest measure with the best results in preventing iodine deficiency is iodine prophylaxis using iodized salt. To achieve this, an appropriate health policy is required that keeps the general population and, in particular, women of fertile age informed. It is here that midwives, in their role as health advocates, acquire particular importance, as they are the health professionals most suited to impart health education in pregnancy

Autonomía del Menor Maduro en su salud reproductiva / Individual choice in reproductive health for mature under-age adolescents

En la sociedad actual, los jóvenes inician cada vez más precozmente sus relaciones sexuales. Esto suscita una gran polémica en la asistencia sanitaria, al tener que atender a adolescentes en temas referentes a su salud reproductiva, sin tener un marco jurídico que indique al profesional su actuación a seguir y proteja el derecho del menor. En este artículo, se pretenden analizar los aspectos jurídicos y éticos que se contemplan actualmente en torno a la doctrina del menor maduro

Adolescents are starting sexual relationships ealier and earlier in today's society. This stirs up some controversial issues in the Health Care System. Although the adolescents' reproductive health needs are being taken care of, there is no legal framework which both advises professionals on the correct conduct to follow and protects adolescents. This article analyses the present legal and ethical aspects of mature under-age adolescents' learning process