An inter-laboratory study of DNA-based identity, parentage and species testing in animal forensic genetics.

The probative value of animal forensic genetic evidence relies on laboratory accuracy and reliability. Inter-laboratory comparisons allow laboratories to evaluate their performance on specific tests and analyses and to continue to monitor their output. The International Society for Animal Genetics (ISAG) administered animal forensic comparison tests (AFCTs) in 2016 and 2018 to assess the limitations and capabilities of laboratories offering forensic identification, parentage and species determination services. The AFCTs revealed that analyses of low DNA template concentrations (≤300 pg/µL) constitute a significant challenge that has prevented many laboratories from reporting correct identification and parentage results. Moreover, a lack of familiarity with species testing protocols, interpretation guidelines and representative databases prevented over a quarter of the participating laboratories from submitting correct species determination results. Several laboratories showed improvement in their genotyping accuracy over time. However, the use of forensically validated standards, such as a standard forensic short tandem repeat (STR) kit, preferably with an allelic ladder, and stricter guidelines for STR typing, may have prevented some common issues from occurring, such as genotyping inaccuracies, missing data, elevated stutter products and loading errors. The AFCTs underscore the importance of conducting routine forensic comparison tests to allow laboratories to compare results from each other. Laboratories should keep improving their scientific and technical capabilities and continuously evaluate their personnel's proficiency in critical techniques such as low copy number (LCN) analysis and species testing. Although this is the first time that the ISAG has conducted comparison tests for forensic testing, findings from these AFCTs may serve as the foundation for continuous improvements of the overall quality of animal forensic genetic testing.

Contribution of the Economic Crisis to the Risk Increase of Poor Mental Health in a Region of Spain.

Previous research suggests that the economic crisis can affect mental health. The purpose of this study was to analyse the association of risk of poor mental health with various socioeconomic, demographic, health, quality of life, and social support variables; and to evaluate the contribution of socioeconomic variables most affected by the beginning of the economic crisis (employment situation and income) on the changes in the prevalence of the risk of poor mental health between 2005 and 2010. A study of prevalence evolution in adult population residents of the Valencian Community in the Spanish Mediterranean was conducted. We studied 5781 subjects in 2005 and 3479 in 2010. Logistic regression models have been adjusted to analyse the association between variables. A standardisation procedure was carried out to evaluate which part of the changes in overall prevalence could be attributed to variations in the population structure by age, sex, employment status, and income between the years under study. The prevalence of GHQ+ increased from 2005 to 2010, in both men and women. Several variables were closely associated with the risk of poor mental health (sex, age, country of birth, number of nonmental chronic diseases, social support, disability, cohabitation in couple, employment status, and income). The changes produced as a result of the onset of the economic crisis in income and unemployment (increase in low income and in unemployment rates) contributed to the increase of poor mental health risk. This could confirm the sensitivity of mental health to the economic deterioration caused by the crisis.

Is recession bad for your mental health? The answer could be complex: evidence from the 2008 crisis in Spain.

BACKGROUND: We explored the impact of 2008 recession on the prevalence of mental health problems in Spain. METHODS: Repeated cross-sectional survey design. Datasets from 2006 and 2011 were used, and temporal change was examined. The study was conducted on the economically active population (16-64 years old). The two surveys included 29,478 and 21,007 people, obtaining a 96 and 89.6% response rate, respectively. Multiple logistic regression models were adjusted to identify poor mental health risk factors. A standardisation analysis was performed to estimate the prevalence of people at risk of poor mental health (GHQ+). RESULTS: The prevalence of GHQ+ following the crisis increased in men and decreased in women. Two logistic regression analyses identified GHQ+ risk factors. From 2006 to 2011, unemployment rose and income fell for both men and women, and there was a decline in the prevalence of somatic illness and limitations, factors associated with a higher prevalence of GHQ+. After controlling for age, the change in employment and income among men prompted an increase in the prevalence of GHQ+, while the change in somatic illness and limitations tended to mitigate this effect. After the recession, unemployed men showed a better level of somatic health. The same effects were not detected in women. CONCLUSIONS: The economic recession exerted a complex effect on mental health problems in men. The reduction of prevalence in women was not associated with changes in socioeconomic factors related to the economic crisis nor with changes in somatic health.

Poder, estigma y coerción. Escenarios para una practica no autoritaria en salud mental / Power, stigma, and coercion. Scenarios for a non-authoritarian practice in mental health

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How does family intervention improve the outcome of people with schizophrenia?

BACKGROUND: There is strong evidence of the efficacy of family psychosocial interventions for schizophrenia, but evidence of the role played by the attitudes of relatives in the therapeutic process is lacking. METHOD: To study the effect of a family intervention on family attitudes and to analyse their mediating role in the therapeutic process 50 patients with schizophrenia and their key relatives undergoing a trial on the efficacy of a family psychosocial intervention were studied by means of the Affective Style Coding System, the Scale of Empathy, and the Relational Control Coding System. Specific statistical methods were used to determine the nature of the relationship of the relatives' attitudes to the outcome of family intervention. RESULTS: Family psychosocial intervention was associated with a reduction in relatives' guilt induction and dominance and an improvement in empathy. Empathy and lack of dominance were identified as independent mediators of the effect of family psychosocial intervention. The change in empathy and dominance during the first 9 months of the intervention predicted the outcome in the following 15 months. CONCLUSION: Relatives' empathy and lack of dominance are mediators of the beneficial effect of family psychosocial intervention on patient's outcome.

Psychometric behaviour of the strengths and difficulties questionnaire (SDQ) in the Spanish national health survey 2006.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is a tool to measure the risk for mental disorders in children. The aim of this study is to describe the diagnostic efficiency and internal structure of the SDQ in the sample of children studied in the Spanish National Health Survey 2006. METHODS: A representative sample of 6,773 children aged 4 to 15 years was studied. The data were obtained using the Minors Questionnaire in the Spanish National Health Survey 2006. The ROC curve was constructed and calculations made of the area under the curve, sensitivity, specificity and the Youden J indices. The factorial structure was studied using models of exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA). RESULTS: The prevalence of behavioural disorders varied between 0.47% and 1.18% according to the requisites of the diagnostic definition. The area under the ROC curve varied from 0.84 to 0.91 according to the diagnosis. Factor models were cross-validated by means of two different random subsamples for EFA and CFA. An EFA suggested a three correlated factor model. CFA confirmed this model. A five-factor model according to EFA and the theoretical five-factor model described in the bibliography were also confirmed. The reliabilities of the factors of the different models were acceptable (>0.70, except for one factor with reliability 0.62). CONCLUSIONS: The diagnostic behaviour of the SDQ in the Spanish population is within the working limits described in other countries. According to the results obtained in this study, the diagnostic efficiency of the questionnaire is adequate to identify probable cases of psychiatric disorders in low prevalence populations. Regarding the factorial structure we found that both the five and the three factor models fit the data with acceptable goodness of fit indexes, the latter including an externalization and internalization dimension and perhaps a meaningful positive social dimension.Accordingly, we recommend studying whether these differences depend on sociocultural factors or are, in fact, due to methodological questions.

Nefroureterectomía abierta y laparoscópica en tumores uroteliales del tracto urinario superior: experiencia inicial / Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience

Objetivo: El desarrollo de la laparoscopia en urología permite el abordaje de tumores del tracto urinario superior con una seguridad oncológica cada vez mayor, aunque todavía se sigue considerando el abordaje abierto como la técnica de elección. Presentamos nuestra experiencia laparoscópica en los últimos 4 años frente a la técnica abierta. Material y métodos: Entre 1995 y 2009 se ha realizado un total de 95 nefroureterectomías por tumor, 70 por vía abierta y 25 laparoscópicas. El abordaje por lumbotomía con desinserción endoscópica del uréter ha sido el más frecuente en cirugía abierta, y en laparoscopia, se ha realizado en todos los casos un acceso transperitoneal, con rodete vesical en la mayoría de los casos (56%). Resultados: En las nefroureterectomías abiertas la media de tiempo quirúrgico fue 205 (130-300) min, con una media de sangrado de 525 (100-1.800) ml y transfusión en 17 (24,2%) ocasiones. La media de estancia fue 8,4 (3-30) días. En las nefroureterectomías laparoscópicas, la media de tiempo quirúrgico fue 189 (120-270) min, con una media de sangrado de 130 (100-400) ml y transfusión en 4 (16%) ocasiones. La media de estancia fue 4,5 (2-28) días. Conclusiones: Los pacientes intervenidos por laparoscopia presentaron una menor tasa de transfusión y una estancia hospitalaria más corta. El control oncológico fue similar con ambas técnicas, si bien la laparoscopia precisa de un mayor seguimiento y mayor número de casos (AU)

Purpose: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. We present our experience with the laparoscopic approach hover the past four years and compare it to open surgery. Materials and methods: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out for tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). Results: Mean procedure time for the open nephroureterectomies was 205 (130-300) min, with a mean blood loss of 525 (100-1,800) ml and 17 (24.2%) transfusions. The mean hospital stay was 8.4 (3-30) days. Mean procedure time for the laparoscopic nephroureterectomies was 189 (120-270) min, with a mean blood loss of 130 (100-400) ml and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. Conclusions: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although a longer follow-up and a larger series of cases are still needed for the laparoscopic approach (AU)

[Laparoscopic radical nephrectomy. Procedure, results, and complications]. / Nefrectomía radical laparoscópica. Técnica, resultados y complicaciones.

Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program.

Self-reported chronic mental health problems and mental health service use in Spain.

OBJECTIVES: To determine the prevalence of self-reported chronic mental health problems (MHPs) and mental health service use and their determinants, among the Spanish population over 14 years of age. METHODS: Data from the 1999 Spanish Survey on Disabilities, Deficiencies, and State of Health were used. The survey is a cross-sectional study based on a multi-stage stratified sample of all the non-institutionalized Spanish population aged over 14 years (n=59,101, 11% non-responders). Multivariate logistic regression analysis were used. RESULTS: 10.7% of the Spanish population suffer from an MHP. The highest prevalences were found in women, divorced/separated persons, those with a lower level of education and income, and those suffering from a chronic somatic problem. The number of days of daily activity lost was 2-fold greater among those with an MHP than among those with a chronic somatic problem. Greater use of mental health services was associated with loss of daily activity, having a higher level of education, invalidity or disability. The probability of MHP being referred from primary to mental healthcare is reduced if somatic comorbidity is present. CONCLUSION: MHPs have a high prevalence and a significant repercussion on the patient's life. An inverse relationship was found between certain risk factors for MHPs and the use of services, which suggests inequality. Problems of accessibility are identified.

Nefrectomía radical laparoscopica. Técnica, resultados y complicaciones / Laparoscopic radical nephrectomy. Procedure, results, and complications

El tratamiento de elección del carcinoma renal de células claras es un tratamiento quirúrgico, siendo un tumor que no responde a quimioterapia, radioterapia o inmunoterapia. Dicho tratamiento quirúrgico ha ido variando a lo largo del tiempo en los últimos 40 años, debido sobre todo al desarrollo y universalización de los sistemas de diagnóstico como la ecografía y la TAC. Como consecuencia directa, la cirugía conservadora de parénquima deja de ser empleada solamente en pacientes monorrenos y comienza a extenderse sus indicaciones en pacientes con tumores de hasta 4 cm de diámetro, demostrando ser una alternativa segura y eficaz a la nefrectomía radical. El otro hito importante en el desarrollo del tratamiento quirúrgico del cáncer renal es sin duda la revolución iniciada en la década de los 90 con el inicio de la cirugía renal laparoscópica, que ha venido implantándose en los últimos 20 años aproximadamente. En unos comienzos dubitativos en lo que a seguridad oncológica se refiere, actualmente contamos con series lo suficientemente extensas en tiempo de seguimiento y tamaño muestral, como para pensar que se trata de una técnica lo suficientemente fiable. El desarrollo de la tecnología ha ayudado a que la técnica laparoscópica ya no se vea como una técnica de futuro, sino de absoluta actualidad que debería estar implantada en la mayoría de los servicios de Urología. Toda implantación de una nueva técnica suele acarrear una serie de complicaciones que debemos estar dispuestos a asumir y a intentar poner todos los medios a nuestro alcance para evitarlas. Ante esta situación, es fundamental desarrollar un programa de formación y de inicio en la técnica llevado a cabo con sentido común, en el cual la selección de los pacientes y de las patologías a abordar es primordial (AU)

Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program (AU)

Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience.

OBJECTIVE: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. This article describes our experience of the laparoscopic approach over the past four years compared to open surgery. MATERIALS AND METHODS: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out to remove tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). RESULTS: The mean procedure time for open nephroureterectomies was 205 min (130-300), with a mean blood loss of 525 ml (100-1,800) involving 17 (24.2%) transfusions. The mean hospital stay was 8.4 days (3-30). The mean procedure time for the laparoscopic nephroureterectomies was 189 min (120-270), with a mean blood loss of 130 ml (100-400) and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. CONCLUSIONS: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although laparoscopy requires greater monitoring and a larger caseload.

Esquizofrenia y empleo: identificación de necesidades a partir de un grupo natural / Schizophrenia and employment: identification of needs from a natural group

Objetivo: La identificación de las necesidades reales en el ámbito del empleo en la esquizofrenia. Método: Se estudió un grupo natural compuesto por cuatro amigas que padecen esquizofrenia. Las sesiones fueron grabadas en vídeo y posteriormente transcritas. Se construye un modelo de relaciones percibidas entre las necesidades macro, las limitaciones personales y los sentimientos. Resultados: Los resultados muestran la marcada dificultad para acceder a experiencias constructivas y exitosas de empleo, la precariedad y baja calidad de las condiciones laborales, los sentimientos de fracaso y resignación, y la búsqueda de ocupación en el entorno familiar. De estos factores se deriva un estado de aislamiento, dependencia, marginación y pobreza. Discusión: Las dificultades, necesidades y consecuencias identificadas son graves, impiden una vida autónoma y digna, y subrayan la necesidad de recursos adecuados para la integración laboral de las personas con enfermedad mental en nuestro medio (AU)

Relationship between family attitudes and social functioning in schizophrenia: a nine-month follow-up prospective study in Spain.

The objective was to study the relationship between family attitudes and social functioning in schizophrenia. A cohort of 80 patients was followed-up for 9 months after their hospitalization. The relatives' critical attitude and poor empathic attitude were measured by means of the Semantic Differential and the Questionnaire of Empathy, respectively. Time of useful work and social relations of the patients were measured before admission and at the end of follow-up. Symptoms, premorbid adjustment, and other course and demographic factors were also measured. Significant relationships were found between the relatives' poor empathic attitude and the patients' occupational functioning and social relations. These associations were maintained after controlling for the effects of other prognostic factors. These results suggest that empathy in the relative is an independent predictor of social functioning in people with schizophrenia. Different attitudinal dimensions of family attitudes might show different relationships with the social and clinical outcomes in this disorder.

[Quality of the physician-patient relation and results of clinical encounters in primary care in Alicante: a study with focal groups]. / Calidad de la relación médico paciente y resultados de los encuentros clínicos en atención primaria de Alicante: un estudio con grupos focales.

BACKGROUND: The relationship between the quality of the physician-patient relationship and the outcomes of the clinical encounters in primary care are examined. METHOD: Focus groups of physicians and patients. A total of 24 professionals and 22 patients took part. RESULTS: The physicians perceived a relationship to exist between the scarcity of healthcare resources (short length of time with each patient, care-providing overload, lack of specific resources, lack of training), conflicts with "difficult" patients and the influence of the psychosocial factors in the clinical encounter and error, burnout, defensive medicine and the low quality of the services. Communication/examination-related problems during the clinical interview and by negative feelings acted as intermediary factors in this relationship. The patients perceived a relationship to exist between an operating pattern characterized by short office visits scheduled at an overloaded pace and physician, patient communications problems and error and conflict in the clinical encounter. There is also a relationship between the physician's humanist attitude and a better outcome of the health problems. The objectives and priorities of the health care system, out of touch with the needs of the community, are seen as being key determining factors as regards the lacks considered to exist. CONCLUSIONS: The physician-patient relationship processes play a mediating role between the health care resources and the outcomes of the clinical encounters. Improving the care provided and the physician-patient relationship in primary care requires a multi-dimensional approach and view which goes beyond the measures taken regarding individual physician and patient-related factors.

Calidad de la relación médico paciente y resultados de los encuentros clínicos en atención primaria de Alicante: un estudio con grupos focales / The quality of the physician-patient relationship and results of the clinical encounters in primary care in Alicante: a focal groups study

Fundamento: Se explora la relación entre la calidad de la relación médico paciente y los desenlaces de los encuentros clínicos en atención primaria. Método: Grupos focales de médicos y enfermos. Participaron 24 profesionales y 22 enfermos. Resultados: Los médicos percibieron una relación entre la pobreza de recursos sanitarios (escaso tiempo de consulta, exceso de carga asistencial, ausencia de recursos específicos, ausencia de formación), el conflicto con pacientes 'difíciles' y la influencia de los factores psicosociales en el encuentro clínico, con el error, el desgaste, la medicina defensiva y la baja calidad de los servicios. Esta relación estuvo mediada por problemas de comunicación/exploración en la entrevista clínica y por sentimientos negativos. Los pacientes percibieron una relación entre un funcionamiento caracterizado por consultas masificadas y de breve duración, y dificultades de comunicación en médico y paciente, con el error y el conflicto en el encuentro clínico. También una relación entre la actitud humanista del médico y un mejor desenlace de los problemas de salud. Los objetivos y prioridades del sistema sanitario alejados de las necesidades de la comunidad son percibidos como determinantes clave de las insuficiencias percibidas. Conclusiones: Los procesos de relación médico-paciente juegan un papel mediador entre los recursos sanitarios y los desenlaces de los encuentros clínicos. La mejora de la atención y de la relación médico-paciente en atención primaria requiere una visión y una actuación multidimensional que va más allá de las intervenciones sobre factores individuales del médico y del paciente (AU)

Background: The relationship between the quality of the physician-patient relationship and the outcomes of the clinical encounters in primary care are examined. Method: Focus groups of physicians and patients. A total of 24 professionals and 22 patients took part. Results: The physicians perceived a relationship to exist between the scarcity of healthcare resources (short length of time with each patient, care-providing overload, lack of specific resources, lack of training), conflicts with "difficult" patients and the influence of the psychosocial factors in the clinical encounter and error, burnout, defensive medicine and the low quality of the services. Communication/examination-related problems during the clinical interview and by negative feelings acted as intermediary factors in this relationship. The patients perceived a relationship to exist between an operating pattern characterized by short office visits scheduled at an overloaded pace and physician, patient communications problems and error and conflict in the clinical encounter. There is also a relationship between the physician's humanist attitude and a better outcome of the health problems. The objectives and priorities of the health care system, out of touch with the needs of the community, are seen as being key determining factors as regards the lacks considered to exist. Conclusions: The physician-patient relationship processes play a mediating role between the health care resources and the outcomes of the clinical encounters. Improving the care provided and the physician-patient relationship in primary care requires a multi-dimensional approach and view which goes beyond the measures taken regarding individual physician and patient-related factors (AU)

El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España / Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain

FUNDAMENTO: En el contexto de una investigación multinacional europea sobre gestión de calidad en psiquiatría de enlace (financiada por el programa BIOMED 1 de la Unión Europea), se analiza la naturaleza de la actividad asistencial de las unidades de psicosomática y psiquiatría de enlace (UPPE) de los seis hospitales generales españoles que participaron en el estudio. PACIENTES Y MÉTODO: Se estudiaron 3.608 pacientes, atendidos consecutivamente por las unidades de psiquiatría de enlace de cinco hospitales generales de la red pública (Clínico de Zaragoza, Clínico de Barcelona, General de Alicante, Ramón y Cajal de Madrid y Princesa de Madrid) y un centro privado monográfico (Instituto Dexeus de Barcelona), a partir de los datos recogidos con un instrumento de registro (CL-BDok-P) estandarizado y validado en investigaciones previas. RESULTADOS: La petición de consulta psiquiátrica se hizo a los 10,6 días (como promedio) del ingreso del paciente, la mitad de las peticiones fueron urgentes y el promedio de tiempo de respuesta de la psiquiatría de enlace fue de 1,9 días. Los principales motivos de petición de consulta fueron la existencia de síntomas psiquiátricos (50,3 por ciento), los síntomas somáticos sin explicación médica (15,2 por ciento), el abuso de sustancias (9,2 por ciento), la existencia de antecedentes psiquiátricos (8,5 por ciento), el riesgo de sucidio (6 por ciento) y el afrontamiento de la enfermedad (5,8 por ciento). Los servicios que hicieron más demandas fueron los de medicina interna (17,2 por ciento), traumatología (7,5 por ciento) y cirugía general (7,3 por ciento). Se documenta una importante actividad asistencial en pacientes a menudo 'complejos', con medidas diagnósticas e intervenciones de amplio espectro y seguimientos intrahospitalarios y al alta del paciente. Por el contrario, se ponen de manifiesto algunos problemas en el 'proceso' de intervención. CONCLUSIONES: De los resultados se infiere la indudable importancia de la psiquiatría de enlace española en el contexto de la asistencia especializada, pero también la posibilidad de mejorar su eficiencia con la propuesta de modelos integradores, de modificaciones organizativas y de la implementación de un moderno modelo de 'gestión de calidad' (AU)