The Identified Skeletal Collection of the School of Legal Medicine: a contemporary osteological collection housed in Universidad Complutense de Madrid, Spain.

ABSTRA: Osteological collections are an important resource for the development of methods to assist in the study of skeletal remains in archeological and/or forensic contexts. The aim is to describe the current characteristics of the Identified Skeletal Collection of the School of Legal Medicine and its historical context. The Identified Skeletal Collection of the School of Legal Medicine of the Complutense University of Madrid consists of 138 male and 95 female individuals, born between 1880 and 1980 and deceased between 1970 and 2009. The minimum age of the sample is perinatal and the maximum age is 97 years. The collection is an essential tool for forensic research, given that its population characteristics can be extrapolated to those of present-day Spain. Access to this collection offers unique teaching opportunities as well as provides the information necessary to develop various lines of research.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs.

OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Balance del asesoramiento médico-legal hospitalario mediante análisis factorial exploratorio / Balance of hospital legal medical counselling through exploratory factor analysis

Introducción: El estudio de los enfoques de la medicina legal ha sido ampliamente afrontado en publicaciones en el ámbito de la justicia. Sin embargo, la temática de los servicios de medicina legal hospitalaria ha sido escasamente abordada en investigaciones; no atendiendo a la importancia que tienen estos servicios para el perfeccionamiento de la gestión del riesgo legal de los sistemas sanitarios. Objetivo: Reconocer la estructura factorial de las prestaciones del servicio de medicina legal en un hospital de alto nivel, entre los demandantes de consulta por problemas derivados de la actividad asistencial del hospital. Material y método: Se realizó un estudio descriptivo transversal con una muestra de 1.213 expedientes abiertos durante los años 2007 y 2017. Se efectuó un análisis factorial exploratorio por extracción de componentes principales con Rotación Varimax. Resultados: La media de expedientes fue de 110,27 por año con una desviación típica de 39,51. El análisis factorial mostró la bidimensionalidad de la utilidad del registro (carta de servicios de medicina legal y fundamento médico-legal de las consultas), con la existencia de dos factores subyacentes que, sumados, explicaron el 68,04% de la varianza total. Conclusiones: Se ha obtenido una estructura factorial simplificada a dos factores con una confiabilidad elevada del cuestionario de registro. Por su naturaleza registral y facilidad de empleo, es aconsejable considerar su utilización en la evaluación de la demanda de asesoramiento al servicio de medicina legal hospitalaria por parte de los diferentes usuarios que acuden por problemas relacionados con las actividades habituales del hospital. (AU)

Introduction: The study of legal medicine approaches has been widely addressed in publications in the field of justice. However, the subject of hospital legal medicine services has been scarcely addressed in research; not attending to the importance of these services for the improvement of the legal risk management of health systems. Objective: To recognize the factorial structure of the benefits of the legal medicine service in a high-level hospital, among those seeking consultation for problems arising from the hospital's healthcare activity. Material and method: A descriptive cross-sectional study was carried out with a sample of 1213 files opened during the years 2007 and 2017. An exploratory factor analysis was performed by extraction of main components with varimax rotation. Results: The average of records was 110.27 per year with a standard deviation of 39.51. The factorial analysis showed the two-dimensionality of the usefulness of the registry (letter of legal medicine services and medical-legal basis of the consultations), with the existence of two underlying factors that, added together, explained 68.04% of the total variance. Conclusions: A simplified factor structure to two factors has been obtained with a high reliability of the registration questionnaire. Due to its registry nature and ease of use, it is advisable to consider its use in evaluating the demand for advice to the hospital legal medicine service by the different users who come for problems related to the usual activities of the hospital. (AU)

[Utility of the classification analysis in the typology of the the suicide attempt in a hospital population.] / Utilidad del análisis de clasificación en la tipología del intento de suicidio en una población hospitalaria.

OBJECTIVE: Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid. METHODS: In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated. RESULTS: Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting. CONCLUSIONS: The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature.

OBJETIVO: Las personas que intentan suicidarse no constituyen un grupo homogéneo. Numerosos estudios acreditan distintos subtipos de individuos con intentos de suicidio. Una de las principales aplicaciones del análisis de clasificación es la segmentación y selección de las características del sujeto. El objetivo de este estudio fue identificar grupos de sujetos con intentos de suicidio y descubrir las relaciones entre ellos en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: En un estudio de caso-control se aplicó la técnica de árbol de clasificación basado en el algoritmo CHAID (Chi-square automatic interaction detector), incluido en el programa SPSS 23.0, sobre una muestra de 201 sujetos ingresados en un hospital de alta complejidad de Madrid. Se evaluaron la impulsividad, la conflictividad de pareja, los antecedentes psiquiátricos y la depresión. RESULTADOS: Se obtuvieron tres subtipos o perfiles diferenciables del sujeto vinculados al intento de suicidio (perfil alto 144 casos 71,64%, medio 35 casos 17,41% y bajo 22 casos 10,94% de patrones básicos de riesgo), con alto valor de aplicación al ámbito clínico. CONCLUSIONES: Las tipologías encontradas permiten adecuar medidas preventivas sobre el intento de suicidio y realizar intervenciones clínicas focalizadas de carácter preventivo y predictor.

[Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid.] / Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid.

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation.

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural.

Spanish allele and haplotype database for 32 X-chromosome Insertion-Deletion polymorphisms.

X-chromosome markers have been proved to be decisive both complementing and solving kinship analysis, particularly when autosomal markers are not able to produce adequate likelihood ratios between different hypothesis. On the other hand, Pereira et al., (2012) have demonstrated that 32 Insertion/Deletion (InDel) markers located on the X-Chromosome have a very important power of discrimination in human populations, being a novel tool in the forensic and population fields. So, the aim of the present work was testing the forensic and population genetic efficiency of the 32 X-InDel polymorphisms in the Spanish population, and subsequently build an allele/haplotype frequencies database. To accomplish this objective, a total of 555 samples comprising male individuals from 13 Spanish regions were analysed for the above mentioned 32 X-InDels in two independent laboratories. A pairwise FST analysis was performed in order to understand if the studied Spanish sub-populations present significant differences among them, detecting possible population substructure. Also, linkage disequilibrium analyses were computed to investigate the presence of association between markers in the Spanish population. After Bonferroni correction, the absence of significant differences among the studied regions supports a global Spanish population database. Concerning LD, besides previously reported linked markers MID356-MID357 and MID3690-MID3719-MID2089, we also detected significant association between MID3703-MID3774, even after Bonferroni correction. Finally, after computing allele and haplotype frequencies, forensic efficiency parameters were calculated (PDmales = 99.999976 %; PDfemales = 99.99999999998 %). Mean exclusion chance values for duos were 0.999 and trios 0.99999. These results reinforce the suitability of the 32 X-InDels marker set both in identification and kinship studies.

Eleven Basic Procedures/Practices for Dental Patient Safety.

OBJECTIVES: This study aimed to help alleviate the shortage of reliable information on clinical care issues; the Spanish Observatory of Dental Patient Safety (OESPO) has resorted to the study of legal claims by patients and searched those which produced clinical problems. METHODS: Based on OESPO data, this article proposes 11 basic procedures/practices for dental patient safety to help mitigate most preventable adverse events. RESULTS: The sample of the OESPO is large (415 adverse events studied), but it has the bias of a judicial source. However, the results provide an interesting approach to clinical safety in dentistry. When studying in detail the causes that led to preventable adverse events, it can be seen that most of these (and most severe) events have been caused by a small number of erroneous behaviors. CONCLUSIONS: Most preventable adverse events during the dental health care are produced by a relatively small number of causes. Therefore, a few basic safety procedures can reduce significantly these preventable adverse events.

Dentists Survey on Adverse Events During Their Clinical Training.

BACKGROUND: Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS: A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS: Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS: The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS: Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.

Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid / Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. MÉTODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation

Utilidad del análisis de clasificación en la tipología del intento de suicidio en una población hospitalaria / Utility of the classification analysis in the typology of the the suicide attempt in a hospital population

OBJETIVO: Las personas que intentan suicidarse no constituyen un grupo homogéneo. Numerosos estudios acreditan distintos subtipos de individuos con intentos de suicidio. Una de las principales aplicaciones del análisis de clasificación es la segmentación y selección de las características del sujeto. El objetivo de este estudio fue identificar grupos de sujetos con intentos de suicidio y descubrir las relaciones entre ellos en la población hospitalaria de un área de la Comunidad de Madrid. MÉTODOS: En un estudio de caso-control se aplicó la técnica de árbol de clasificación basado en el algoritmo CHAID (Chi-square automatic interaction detector), incluido en el programa SPSS 23.0, sobre una muestra de 201 sujetos ingresados en un hospital de alta complejidad de Madrid. Se evaluaron la impulsividad, la conflictividad de pareja, los antecedentes psiquiátricos y la depresión. RESULTADOS: Se obtuvieron tres subtipos o perfiles diferenciables del sujeto vinculados al intento de suicidio (perfil alto 144 casos 71,64%, medio 35 casos 17,41% y bajo 22 casos 10,94% de patrones básicos de riesgo), con alto valor de aplicación al ámbito clínico. CONCLUSIONES: Las tipologías encontradas permiten adecuar medidas preventivas sobre el intento de suicidio y realizar intervenciones clínicas focalizadas de carácter preventivo y predicto

OBJECTIVE: Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid. METHODS: In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated. RESULTS: Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting. CONCLUSIONS: The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature

Odontología forense: en evolución constante / Forensic dentistry: In constant evolution

No disponible

Utilidad de los actuales sistemas de escáner intraoral en la identificación forense / Utility of current intraoral scanner systems for forensic identification

No disponible

Decisiones al final de la vida: resultados del cuestionario validado por expertos / End-of-life decisions: results of the expert-validated questionnaire

Objetivo: Examinar los conocimientos y actitudes, en la etapa final de la vida, sobre los cuidados paliativos, el documento de instrucciones previas, los cuidados psicofísicos, el suicidio médicamente asistido y el acompañamiento espiritual. Método: Estudio transversal efectuado en la población usuaria de un centro de salud de atención primaria de la Comunidad Autónoma de Madrid. Participaron 425 personas seleccionadas mediante un muestreo sistemático aplicado a las hojas de consulta de los/las profesionales sanitarios/as. Se analizaron 42 variables del cuestionario autoadministrado. Resultados: La población madrileña encuestada presentó las siguientes características: estudios superiores 58%, 51-70 años 47%, casados/as 60%, y mujeres 61%. Al 91% les gustaría decidir sobre sus cuidados al final de la vida. El 58% de los/las encuestadas conoce los cuidados paliativos y el 53% solicitaría acompañamiento espiritual. Conocen las instrucciones previas (50%), pero no tienen efectuado el documento. El 54% están a favor de legalizar la eutanasia y el 42% el suicidio asistido. Conclusiones: La población madrileña estudiada decidirá los cuidados al final de la vida y solicitará acompañamiento espiritual. Sobresalen los partidarios de la eutanasia frente al suicidio asistido. Desearían recibir cuidados paliativos y efectuarían las instrucciones previas. Para contrastar la opinión de la población y dar a conocer los recursos sociosanitarios de la Comunidad Autónoma de Madrid deberían realizarse encuestas en diferentes áreas sanitarias de atención primaria

Objective: To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. Method: A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. Results: The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. Conclusion: Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid

Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters / Typologies of Madrid's citizens (Spain) at the end-of-life: cluster analysis

Objetivo: Establecer tipologías de la población general madrileña ante el final de la vida, mediante un análisis de clusters. Método: A la muestra (N = 425), perteneciente a un centro de salud de la Comunidad Autónoma de Madrid, se le aplicó el programa SPAD 8. Se efectuó una técnica de análisis de correspondencias múltiples, seguida de un análisis de conglomerados para lograr un dendograma jerárquico ascendente. Previamente se realizó un estudio transversal con los resultados de un cuestionario. Resultados: Se identificaron cinco clusters. Cluster 1: grupo que no respondió a numerosas preguntas del cuestionario (5%). Cluster 2: partidarios de recibir cuidados paliativos y de la eutanasia (40%). Cluster 3: se oponen al suicidio asistido y no solicitarían ayuda espiritual (15%). Cluster 4: partidarios de recibir cuidados paliativos y del suicidio asistido (16%). Cluster 5: contrarios al suicidio asistido y solicitarían ayuda espiritual (24%). Conclusiones: Sobresalieron estos cuatro clusters. Los clusters 2 y 4 eran partidarios de recibir cuidados paliativos, la eutanasia (2) y el suicidio asistido (4). Los clusters 4 y 5 practicaban mucho sus creencias y sus familiares no habían recibido cuidados paliativos. Por el contrario, los clusters 3 y 5 se oponían a la eutanasia y mayormente al suicidio asistido. Apenas practicaban sus creencias los clusters 2 y 3. Los clusters 2, 4 y 5 no efectuaron el documento de instrucciones previas. Este estudio se podría tener en cuenta para elegir los cuidados que mejoren la calidad del final de la vida

Objective: To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. Method: The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. Results: Five clusters stand out. Cluster 1: a group who preferred not to answer numerous questions (5%). Cluster 2: in favour of receiving palliative care and euthanasia (40%). Cluster 3: would oppose assisted suicide and would not ask for spiritual assistance (15%). Cluster 4: would like to receive palliative care and assisted suicide (16%). Cluster 5: would oppose assisted suicide and would ask for spiritual assistance (24%). Conclusions: The following four clusters stood out. Clusters 2 and 4 would like to receive palliative care, euthanasia (2) and assisted suicide (4). Clusters 4 and 5 regularly practiced their faith and their family members did not receive palliative care. Clusters 3 and 5 would be opposed to euthanasia and assisted suicide in particular. Clusters 2, 4 and 5 had not completed an advance directive document (2, 4 and 5). Clusters 2 and 3 seldom practiced their faith. This study could be taken into consideration to improve the quality of end-of-life care choices

Elaboración de un cuestionario sobre conocimientos y actitudes de la población madrileña frente al final de la vida / Design of a questionnaire on the knowledge and attitudes of the population of Madrid (Spain) facing the end-of-life

Objetivo: Elaborar y validar un cuestionario sobre los conocimientos y las actitudes de la población general en la Comunidad Autónoma de Madrid (España) ante la fase final de la vida. Método: Diseño de un cuestionario estructurado y autoadministrado, validado por un grupo de siete expertos/as profesionales de la Sanidad Madrileña. Valorado mediante una prueba piloto en atención primaria. Resultados: El cuestionario final constaba de 42 preguntas divididas en seis módulos: 1) decisiones y cuidados psicofísicos al final de la vida; 2) cuidados paliativos; 3) eutanasia y suicidio asistido; 4) documento de instrucciones previas; 5) dimensión espiritual; y 6) datos sociodemográficos. Conclusiones: El cuestionario ha resultado un método indirecto útil para conocer la opinión sobre el final de la vida en la población de la Comunidad Autónoma de Madrid. Si fuera aplicado en atención primaria y hospitalaria podrían establecerse comparaciones entre los usuarios de distintas comunidades autónomas

Objective: To create and validate a questionnaire about knowledge and attitudes of the general population in Madrid (Spain) about life's end stage. Method: A descriptive study designed as a structured self-administered questionnaire, validated by seven Madrid Health Service professional experts and assessed through a pilot study. Results: The questionnaire consisted of 42 questions, divided into six modules: 1) decisions and psychological-physical care at life's end; 2) palliative care; 3) euthanasia and assisted suicide; 4) advance directives document; 5) spiritual factors; and 6) socio-demographic data. Conclusions: The questionnaire was a useful, indirect method to ascertain the opinion of life's end in the Autonomous Region of Madrid. If it were applied in primary health care and hospital care, comparisons could be made among users in different autonomous regions of Spain

[Typologies of Madrid's citizens (Spain) at the end-of-life: cluster analysis]. / Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters.

OBJECTIVE: To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. METHOD: The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. RESULTS: Five clusters stand out. Cluster 1: a group who preferred not to answer numerous questions (5%). Cluster 2: in favour of receiving palliative care and euthanasia (40%). Cluster 3: would oppose assisted suicide and would not ask for spiritual assistance (15%). Cluster 4: would like to receive palliative care and assisted suicide (16%). Cluster 5: would oppose assisted suicide and would ask for spiritual assistance (24%). CONCLUSIONS: The following four clusters stood out. Clusters 2 and 4 would like to receive palliative care, euthanasia (2) and assisted suicide (4). Clusters 4 and 5 regularly practiced their faith and their family members did not receive palliative care. Clusters 3 and 5 would be opposed to euthanasia and assisted suicide in particular. Clusters 2, 4 and 5 had not completed an advance directive document (2, 4 and 5). Clusters 2 and 3 seldom practiced their faith. This study could be taken into consideration to improve the quality of end-of-life care choices.

Utilidad de análisis modal de fallos y efectos para mejorar la seguridad en el movilización del paciente crítico intubado / Usefulness of failure mode and effects analysis for improving mobilization safety in critically ill patients

Abstract Introduction: Patient safety has become a core value in health organizations, requiring the use of significant resources in order to avoid accidents during hospital stay. Health care can create risks, and patient safety is the most important objective in care quality. Failure Mode and Effects Analysis (FMEA) is a preventive tool that helps anticipate potential errors and adverse events, setting up barriers to prevent them from happening, or mitigating their effects or, in the event they do happen, mitigating their impact on the most vulnerable link in health care, namely, the patient. Objectives: To analyze, using the FMEA tool, mobilization of intubated critical ill patients in the Intensive Care Unit. Method: A brainstorming session was held within the service to identify the most frequent potential errors in the process. Subsequently, the FMEA method with its different phases was applied, prioritizing risk according to the RPN (Risk Priority Number) index and selecting improvement actions for those with an RPN greater than 300. Results: The result was the identification of 101 failure modes, of which 46 exceeded the RPN of 300. As a result of this work, 63 improvement actions have been proposed for those failure modes with NPR scores above 300. Conclusion: The conclusion of the study is that FMEA was a useful tool for anticipating potential failures in the process and proposing improvement actions for those that exceeded an RPN of 300.

Resumen Introducción: La seguridad del paciente ha adquirido un valor estratégico en las organizaciones sanitarias, empleando numerosos recursos para evitar accidentes durante la estancia hospitalaria. La asistencia sanitaria puede generar un riesgo y la seguridad del paciente es el objetivo más importante de la calidad asistencial. AMFE es una herramienta preventiva, lo que supone una anticipación a los posibles errores y eventos adversos, poniendo barreras para que no sucedan o si lo hacen mitigar sus efectos sobre la parte más vulnerable de la atención sanitaria, el paciente. Objetivos: Analizar, a través de la herramienta AMFE (Análisis Modal de Fallos y Efectos), la movilización del paciente crítico intubado en la Unidad de Cuidados Intensivos. Método: Para ello se realizó una tormenta de ideas dentro del servicio para decidir los posibles errores más frecuentes en el proceso. Posteriormente, se aplicó el método AMFE, con sus fases, priorizando el riesgo conforme al índice NPR (Numero de Priorización de Riesgo), seleccionando acciones de mejora en los que tienen un NPR mayor de 300. Resultados: Como resultado hemos obtenido 101 modos de fallo de los cuales 46 superaban el NPR de 300. Tras nuestro resultado, se han propuesto 63 acciones de mejora en aquellos modos de fallo con puntuaciones NPR superiores a 300. Conclusiones: La conclusión del estudio es que AMFE permite anticiparnos a los posibles fallos del proceso para proponer acciones de mejora en aquellos que superan un NPR de 300.

Contribution of dental tissues to sex determination in modern human populations.

OBJECTIVES: Accurate sex estimation is an essential step for the reconstruction of the biological profile of human remains. Earlier studies have shown that elements of the human permanent dentition are sexually dimorphic. The aims of this study are to determine the degree of sexual dimorphism in the dental tissue volumes and surface areas of mandibular canines and to explore its potential for reliable sex determination. METHOD: The teeth included in this study (n = 69) were selected from anthropological collections from Spain, South Africa and Sudan. In all cases, the sex of the individuals was known. The teeth were scanned and three-dimensional (3D) measurements (volumes and surfaces areas) were obtained. Finally, a dsicriminant function analysis was applied. RESULTS: Our results showed that sexual dimorphism in canine size is due to males having greater amounts of dentine, whereas enamel volume does not contribute significantly to overall tooth size dimorphism. Classification accuracy of the multivariable equations tested on slightly worn teeth ranged from 78 to 90.2% for the crossvalidation, and from 71.43 to 84.62% for the hold-out sample validation. When all functions were applied together, the sex was correctly assigned 92.30% of the time. CONCLUSIONS: Our results suggest that the 3D variables from mandibular canine dental tissues are useful for sex determination as they present a high degree of dimorphism. The results obtained show the importance of 3D dental tissue measurements as a methodology in sex determination, which application should be considered as a supplemental method to others.

[End-of-life decisions: results of the expert-validated questionnaire]. / Decisiones al final de la vida: resultados del cuestionario validado por expertos.

OBJECTIVE: To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. METHOD: A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. RESULTS: The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. CONCLUSION: Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid.

[Design of a questionnaire on the knowledge and attitudes of the population of Madrid (Spain) facing the end-of-life]. / Elaboración de un cuestionario sobre conocimientos y actitudes de la población madrileña frente al final de la vida.

OBJECTIVE: To create and validate a questionnaire about knowledge and attitudes of the general population in Madrid (Spain) about life's end stage. METHOD: A descriptive study designed as a structured self-administered questionnaire, validated by seven Madrid Health Service professional experts and assessed through a pilot study. RESULTS: The questionnaire consisted of 42 questions, divided into six modules: 1) decisions and psychological-physical care at life's end; 2) palliative care; 3) euthanasia and assisted suicide; 4) advance directives document; 5) spiritual factors; and 6) socio-demographic data. CONCLUSIONS: The questionnaire was a useful, indirect method to ascertain the opinion of life's end in the Autonomous Region of Madrid. If it were applied in primary health care and hospital care, comparisons could be made among users in different autonomous regions of Spain.