[The importance of self-regulation: Analysis of the activity of the medical ethics and deontology commission in Cordoba]. / Importancia de la autorregulación: análisis de la actividad de la comisión de ética y deontología médica en Córdoba.

OBJECTIVE: to analyse the activity of the Medical Ethics and Deontology Commission (MEDC) of the College of Physicians of Cordoba regarding conflictive situations in the profession from 2013 through 2021. MATERIAL AND METHODS: cross-sectional observational study, in which 83 cases of complaints submitted to the College were collected. RESULTS: the incidence was 2.6 complaints‰ members/year, with a total of 92 doctors reported. 61.4% were submitted by the patient, 92.8% of which were addressed to a single doctor. 30.1% were in the speciality of family medicine, 50.6% in the public sector and 72% in outpatient care. In 37.7% the chapter of the Code of Medical Ethics concerned was chapter IV (quality of medical care). In 89.2% of cases the parties came to make a statement, with a higher risk of disciplinary proceedings being observed when the statement was both, oral and written (OR:4.61; p=0.026). The median resolution time was 63 days, significantly longer in cases proposed for disciplinary proceedings (146 days vs. 58.50 days; OR:1.01; p=0.008). The MEDC found 15.7% (n=13) to be in breach of ethics, with 15 doctors being disciplined (16.3%) and 4 sanctioned (26.7%) with a warning and temporary suspension from practice. CONCLUSIONS: The role of the MEDC is fundamental in the self-regulation of professional practice. Inappropriate behaviour during patient care or between colleagues has serious ethical implications, disciplinary repercussions for the physician, and it particularly undermines patients' trust in the medical profession.

Importancia de la autorregulación: análisis de la actividad de la comisión de ética y deontología médica en Córdoba / The importance of self-regulation: Analysis of the activity of the medical ethics and deontology commission in Cordoba

Objetivo: analizar la actividad de la Comisión de Ética y Deontología Médica (CEDM) del Colegio Ofi-cial de Médicos de Córdoba, respecto a situaciones conflictivas en la profesión en el período 2013-2021.Material y métodos: estudio observacional transversal, en el que finalmente se recogieron 83 casos de re-clamaciones presentadas ante el Colegio. Resultados: la incidencia fue de 2,6 reclamaciones‰ colegiados/año, con un total de 92 médicos denunciados. El 61,4% fueron presentadas por el paciente, dirigidas en un92,8% a un solo médico. El 30,1% fue en la especialidad de medicina de familia, siendo el 50,6% en el ám-bito público y el 72% en asistencia ambulatoria. En el 37,7% el capítulo del Código de Deontología Médicaafectado fue el IV (calidad de la atención médica). En el 89,2% las partes acudieron a declarar, observán-dose mayor riesgo de expediente disciplinario cuando la declaración era oral y escrita (OR:4,61; p=0,026).La mediana de los plazos de resolución fue de 63 días, significativamente mayores en los casos propuestospara expediente disciplinario (146 días vs. 58,50 días; OR:1,01; p=0,008). La CEDM dictaminó infraccióndeontológica en el 15,7% (n=13), siendo expedientados 15 médicos (16,3%) y 4 sancionados (26,7%) me-diante apercibimiento y suspensión temporal del ejercicio. Conclusiones: La función de la CEDM resultafundamental en la autorregulación del ejercicio profesional. Los comportamientos inapropiados durantela asistencia al paciente o entre compañeros, conllevan graves implicaciones éticas, repercusiones discipli-narias para el médico, y especialmente, socavan la confianza de los pacientes en la profesión médica.(AU)

Objective: to analyse the activity of the Medical Ethics and Deontology Commission (MEDC) of the Co-llege of Physicians of Cordoba regarding conflictive situations in the profession from 2013 through 2021.Material and methods: cross-sectional observational study, in which 83 cases of complaints submitted tothe College were collected. Results: the incidence was 2.6 complaints‰ members/year, with a total of 92doctors reported. 61.4% were submitted by the patient, 92.8% of which were addressed to a single doctor.30.1% were in the speciality of family medicine, 50.6% in the public sector and 72% in outpatient care.In 37.7% the chapter of the Code of Medical Ethics concerned was chapter IV (quality of medical care).In 89.2% of cases the parties came to make a statement, with a higher risk of disciplinary proceedingsbeing observed when the statement was both, oral and written (OR:4.61; p=0.026). The median resolutiontime was 63 days, significantly longer in cases proposed for disciplinary proceedings (146 days vs. 58.50days; OR:1.01; p=0.008). The MEDC found 15.7% (n=13) to be in breach of ethics, with 15 doctors beingdisciplined (16.3%) and 4 sanctioned (26.7%) with a warning and temporary suspension from practice.Conclusions: The role of the MEDC is fundamental in the self-regulation of professional practice. Inappro-priate behaviour during patient care or between colleagues has serious ethical implications, disciplinaryrepercussions for the physician, and it particularly undermines patients’ trust in the medical profession.(AU)

Effects of a Semisynthetic Catechin on Phosphatidylglycerol Membranes: A Mixed Experimental and Simulation Study.

Catechins have been shown to display a great variety of biological activities, prominent among them are their chemo preventive and chemotherapeutic properties against several types of cancer. The amphiphilic nature of catechins points to the membrane as a potential target for their actions. 3,4,5-Trimethoxybenzoate of catechin (TMBC) is a modified structural analog of catechin that shows significant antiproliferative activity against melanoma and breast cancer cells. Phosphatidylglycerol is an anionic membrane phospholipid with important physical and biochemical characteristics that make it biologically relevant. In addition, phosphatidylglycerol is a preeminent component of bacterial membranes. Using biomimetic membranes, we examined the effects of TMBC on the structural and dynamic properties of phosphatidylglycerol bilayers by means of biophysical techniques such as differential scanning calorimetry, X-ray diffraction and infrared spectroscopy, together with an analysis through molecular dynamics simulation. We found that TMBC perturbs the thermotropic gel to liquid-crystalline phase transition and promotes immiscibility in both phospholipid phases. The modified catechin decreases the thickness of the bilayer and is able to form hydrogen bonds with the carbonyl groups of the phospholipid. Experimental data support the simulated data that locate TMBC as mostly forming clusters in the middle region of each monolayer approaching the carbonyl moiety of the phospholipid. The presence of TMBC modifies the structural and dynamic properties of the phosphatidylglycerol bilayer. The decrease in membrane thickness and the change of the hydrogen bonding pattern in the interfacial region of the bilayer elicited by the catechin might contribute to the alteration of the events taking place in the membrane and might help to understand the mechanism of action of the diverse effects displayed by catechins.

Suicidal Behavior and Its Relationship with Postmortem Forensic Toxicological Findings.

Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.

3,4,5-Trimethoxybenzoate of Catechin, an Anticarcinogenic Semisynthetic Catechin, Modulates the Physical Properties of Anionic Phospholipid Membranes.

3,4,5-Trimethoxybenzoate of catechin (TMBC) is a semisynthetic catechin which shows strong antiproliferative activity against malignant melanoma cells. The amphiphilic nature of the molecule suggests that the membrane could be a potential site of action, hence the study of its interaction with lipid bilayers is mandatory in order to gain information on the effect of the catechin on the membrane properties and dynamics. Anionic phospholipids, though being minor components of the membrane, possess singular physical and biochemical properties that make them physiologically essential. Utilizing phosphatidylserine biomimetic membranes, we study the interaction between the catechin and anionic bilayers, bringing together a variety of experimental techniques and molecular dynamics simulation. The experimental data suggest that the molecule is embedded into the phosphatidylserine bilayers, where it perturbs the thermotropic gel to liquid crystalline phase transition. In the gel phase, the catechin promotes the formation of interdigitation, and in the liquid crystalline phase, it decreases the bilayer thickness and increases the hydrogen bonding pattern of the interfacial region of the bilayer. The simulation data agree with the experimental ones and indicate that the molecule is located in the interior of the anionic bilayer as monomer and small clusters reaching the carbonyl region of the phospholipid, where it also disturbs the intermolecular hydrogen bonding between neighboring lipids. Our observations suggest that the catechin incorporates well into phosphatidylserine bilayers, where it produces structural changes that could affect the functioning of the membrane.

Interaction of Docetaxel with Phosphatidylcholine Membranes: A Combined Experimental and Computational Study.

The antineoplastic drug Docetaxel is a second generation taxane which is used against a great variety of cancers. The drug is highly lipophilic and produces a great array of severe toxic effects that limit its therapeutic effectiveness. The study of the interaction between Docetaxel and membranes is very scarce, however, it is required in order to get clues in relation with its function, mechanism of toxicity and possibilities of new formulations. Using phosphatidylcholine biomimetic membranes, we examine the interaction of Docetaxel with the phospholipid bilayer combining an experimental study, employing a series of biophysical techniques like Differential Scanning Calorimetry, X-Ray Diffraction and Infrared Spectroscopy, and a Molecular Dynamics simulation. Our experimental results indicated that Docetaxel incorporated into DPPC bilayer perturbing the gel to liquid crystalline phase transition and giving rise to immiscibility when the amount of the drug is increased. The drug promotes the gel ripple phase, increasing the bilayer thickness in the fluid phase, and is also able to alter the hydrogen-bonding interactions in the interfacial region of the bilayer producing a dehydration effect. The results from computational simulation agree with the experimental ones and located the Docetaxel molecule forming small clusters in the region of the carbon 8 of the acyl chain palisade overlapping with the carbonyl region of the phospholipid. Our results support the idea that the anticancer drug is embedded into the phospholipid bilayer to a limited amount and produces structural perturbations which might affect the function of the membrane.

Heavy Metals and Trace Elements in Human Breast Milk from Industrial/Mining and Agricultural Zones of Southeastern Spain.

Human breast milk is the most complete foodstuff for infants but can also be a potential source of exposure to toxic chemicals. The aim of this study was to assess the levels of metal pollution in the breast milk of women living in agricultural and industrial/mining areas of the Region of Murcia (Spain) that are well known for their cases of environmental pollution. Human milk samples were collected from 50 mothers and inorganic contaminants were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). The mean or maximum concentrations of the different inorganic elements analyzed in breast milk, with the exception of manganese, exceeded the maximum limits established by the WHO and could constitute a high risk for pregnant mothers and their children. The breast milk of women living in the industrial/mining zone presented the highest levels of aluminum, zinc, arsenic, lead, mercury and nickel. On the contrary, the highest concentrations of manganese, chromium and iron were determined in the milk of women living in the agricultural zone. These results suggested and confirmed different profiles of environmental contamination of these areas.

Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models.

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.

KIR2DL2/S2 and KIR2DS5 in alcoholic cirrhotic patients undergoing liver transplantation.

INTRODUCTION: The molecular mechanisms underlying alcoholic liver fibrosis and cirrhosis are not completely understood. Hepatic fibrosis involves the interplay of diverse cells and factors, including hepatic stellate cells (HSCs), Kupffer, NK cells, and T-lymphocyte subsets. Killer-cell immunoglobulin-like receptors (KIR) are membrane receptors involved in mediation between NK and activated HSCs, regulating NK cell function through their interaction with HLA-I molecules. The aim of this study was to analyse the genetic association between KIR genes and the susceptibility to or protection from alcoholic cirrhosis (AC) in a cohort of male AC patients undergoing liver transplantation (LT) with and without concomitant viral infections. MATERIAL AND METHODS: KIR genotyping was performed in nuclear DNA extracted from 281 AC patients and compared with 319 male controls. RESULTS: Significant differences between total AC patients and healthy controls were only found in the case of KIR2DL2 and KIR2DS5. KIR2DL2 was significantly underrepresented in non-viral AC patients (52.6% vs. 63.3%; p = 0.015), while patients heterozygous for KIR2DL2 were also underrepresented in the non-viral AC group compared with controls (p = 0.034). KIR2DS5 was overrepresented in this group compared with healthy controls (p = 0.002). All these observations were only evident in AC patients older than 54 years old. CONCLUSIONS: Our data suggest a contrary effect of KIR2DL2 and KIR2DS5 in AC patients older than 54 years, in whom the presence of KIR2DL2 appears to be protective against AC, whereas the presence of KIR2DS5 seems to promote the fibrotic process, particularly in patients with no associated viral infection.

Occurrence of Organochlorine Pesticides in Human Tissues Assessed Using a Microextraction Procedure and Gas Chromatography-Mass Spectrometry.

This work focuses on the development, validation and application of an analytical method for the determination of twenty organochlorine pesticides (OCPs) in human tissues using salting-out liquid-liquid extraction and dispersive liquid-liquid microextraction for sample preparation and gas chromatography-mass spectrometry to analyze the obtained extracts. Measurement of the concentration levels of these toxics in tissues can be used to assess the risk of the population to exposure. The linearity of the proposed method was verified in the 10-1,000 ng/g range. The sensitivity was evaluated calculating the limits of detection (LODs) for 20 OCPs (α-, ß-, γ- and δ-hexachlorocyclohexane (HCH), α- and ß-endosulfan, endosulfan sulfate, aldrin, dieldrin, endrin, endrin ketone, endrin aldehyde, α- and γ-chlordane, 4,4'-dichlorodiphenyltrichloroethane, 4,4'-dichlorodiphenyldichloroethylene (DDE), 4,4'-dichlorodiphenyldichloroethane, heptachlor, heptachlor epoxide and methoxychlor), most of them being found between 1.0 and 16 ng/g. The intra- and interday precisions were <12% for relative standard deviation values. The accuracy of the method was evaluated by recovery studies, which gave recovery percentages in the 85-109% range. Seven different tissues (liver, kidney, heart, spleen, lung, brain and abdominal fat) from eight autopsies were analyzed, and only three cases were seen to have ß-HCH and 4,4'-DDE in abdominal fat, while 4,4'-DDE was also detected in the heart of one case. The rest of the samples were free of the studied OCPs at least above the corresponding LODs.

La especialidad de Medicina Legal y Forense en España: La consolidación por el sistema de residencia / Legal and Forensic Medicine Specialty in Spain: the consolidation by the medical residency system

No disponible

Dual stir bar sorptive extraction coupled to thermal desorption-gas chromatography-mass spectrometry for the determination of endocrine disruptors in human tissues.

The validation of a procedure for the determination of six alkylphenols (APs), 4-tert-butylphenol, 4-pentylphenol, 4-tert-octylphenol, 4-hexylphenol, 4-octylphenol and 4-nonylphenol, and three bisphenols (BPs), bisphenol A, bisphenol F and bisphenol Z, in seven human organs and tissues (kidney, liver, heart, lung, spleen, brain and abdominal fat) obtained from eight autopsies is presented. Previously ground samples were treated by salt-assisted liquid-liquid extraction (SALLE) for isolation of the analytes and then pre-concentrated using dual stir bar sorptive extraction (SBSE), allowing two different extraction conditions for the same sample. Finally, thermal desorption was used as the injector system in combination with gas chromatography coupled to mass spectrometry (GC-MS). To determine BPs, derivatization using acetic anhydride was required, although this step was not necessary for the APs. Two parallel extractions of the contaminants with the stir bars were performed, followed by thermal desorption and chromatographic analysis. The procedure provided quantification limits between 0.050 and 4.0 ng g-1 for APs and from 0.26 to 2.6 ng g-1 for BPs. Repeatability and reproducibility values were lower than 15% in all cases. The accuracy of the procedure was established by a recovery study, which provided values in the 85.8-115% range for APs and 83.6-120% for BPs. Samples were analyzed with the proposed methodology and data were processed by ANOVA tests to study the behaviour and bioaccumulation of these compounds in human tissues or organs. In addition, discriminant analysis detected age- and sex-dependent differences in bioaccumulation.

Combined determination of B-type natriuretic peptide and high-sensitivity troponin I in the postmortem diagnosis of cardiac disease.

Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for detection of myocardial injury, is a sensitive biochemical marker. B-type natriuretic peptide (BNP) is a reliable tool for diagnosing heart failure, and for establishing prognosis or disease severity. We aimed to evaluate the diagnostic efficacy of the postmortem determination of BNP in serum alone or in addition to other biomarkers, such as hs-cTnI and MB isoenzyme of creatine kinase (CK-MB), to ascertain whether its determination improves the post-mortem diagnosis of heart failure-associated causes of death. This study involved 133 cadavers with a mean age of 58.2 (± 17.6) years and a mean postmortem interval of 12.8 (±6.6) h. Cases were assigned into two diagnostic groups, according to the cause of death: cardiac deaths (N = 62) and control (N = 71). In the cardiac group, two categories were established according to morphological features of the heart: 'ischemic deaths' (N = 39), and 'congestive heart' (n = 23). Both hs-cTnI and BNP were useful in diagnosing cardiac deaths, whereas CK-MB did not have any diagnostic relevance. hs-cTnI is higher in cases which acute ischemia as the principal pathology, while the presence of high BNP values is significantly related with chronic cardiac situations with significant ventricular overload. Our findings show that postmortem determination of hs-cTnI and BNP provides valuable information; hs-cTnI is useful for diagnosis of cardiac deaths, mainly with ischemic implications, and BNP gave better results for the diagnosis of congestive heart failure.

Shared decision-making in outpatients with mental disorders: Patients´ preferences and associated factors.

RATIONALE, AIMS AND OBJECTIVES: Over the last years, traditional paternalistic model is being questioned. Shared Decision-Making (SDM) model has been proposed as a way to improve patient-physician interaction. Little is known to what extent people with severe mental illness want to be involved in decision-making process. This study evaluates their preferences about making clinical decisions and which variables influence these desires. METHOD: One hundred seven patients with DSM diagnoses of bipolar disorder or schizophrenia and 100 Non Psychiatric Comparison (NPC) subjects recruited from mental health and primary care departments completed a self-reported questionnaire about preferences in decision-making process. Demographic and clinical information was obtained through review of available records and the Brief Psychiatric Rating Scale (BPRS). RESULTS: Patients and NPCs differed as regards their preferences about their participation in medical decisions. NPCs were 18 times more likely to prefer options about their treatment and 2 times more likely to prefer to take medical decisions by their own than psychiatric patients. The best predictors of the preference of a SDM model were a lower BPRS global score and the absence of previous compulsory admissions. CONCLUSIONS: Psychiatric patients more frequently preferred a passive role in the decision-making process. Interventions to promote SDM should be tailored to the values and needs of each patient because not everyone wants to participate to the same degree. We found several factors to take into account in patient engagement in SDM as these populations may be more vulnerable.

Bioaccumulation of Polycyclic Aromatic Hydrocarbons for Forensic Assessment Using Gas Chromatography-Mass Spectrometry.

Polycyclic aromatic hydrocarbons (PAHs) are considered xenobiotics of a potentially carcinogenic nature, being accumulated in the fatty tissue of the body. The objective of this work was the development and validation of a new analytical method to check the bioaccumulation of these toxic compounds in human organs obtained from autopsies. The contaminants were first isolated from the tissues by salt-assisted liquid-liquid extraction in acetonitrile. Because of the low concentrations of these compounds in the human body, a dispersive liquid-liquid microextraction procedure was included. The preconcentrated samples were analyzed by gas chromatography-mass spectrometry to identify the compounds. Principal component analysis was applied to show the natural clustering of forensic samples and orthogonal partial least-squares discriminant analysis to develop a multivariate regression method, which permitted the classification of samples. The quantification limits for the 13 PAHs (acenaphthylene, fluorene, phenanthrene, anthracene, pyrene, benzo(a)anthracene, chrysene, benzo(b)fluoranthene, benzo(k)fluoranthene, benzo(a)pyrene, dibenz(a,h)anthracene, benzo(g,h,i)perylene, and indeno(1,2,3-cd)pyrene) analyzed were in the 0.06-0.44 ng g-1 range, depending on the compound, while the mean intraday relative standard deviation of about 7% demonstrated the high precision of the method. Linearity was verified in the 0.5-200 ng g-1 range, and the enrichment factors were between 55 and 122. The results provided by the analysis of seven different human organs (brain, liver, kidney, lung, heart, spleen, and abdominal fat) from eight autopsies confirmed the PAH-bioaccumulation capacity of human body, fat showing the highest degree of bioaccumulation. The present work is the first study on PAH contamination in different organs obtained from autopsies, being PAH detected in most human samples at values ranged from 0 to 19 ng g-1.

Willingness of patients with SUD to participate in research: prevalence and associated factors. / Disposición para participar en investigación en población adicta: prevalencia y factores asociados.

Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and flowed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects' participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to specific vulnerabilities rather than to diagnoses.

Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico.

Disposición para participar en investigación en población adicta: prevalencia y factores asociados / Willingness of patients with SUD to participate in research: prevalence and associated factors

Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico

Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and flowed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects’ participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to specific vulnerabilities rather than to diagnoses

Valoración de la capacidad de toma de decisiones en investigación: cuándo, cómo y por qué realizarla / Assessment of decision-making capacity for research participation: when, how and why to do it

No disponible

Assessing the decision-making capacity of the addicted population to take part in research: myths, barriers, and benefits. / Valoración de la capacidad para participar en investigación en población adicta: mitos, barreras y beneficios.

Letter to the editor.

Resumen: el consentimiento informado constituye un elemento clave para una investigación ética. La población adicta puede tener deteriorada su capacidad para consentir por varios motivos. Las drogodependencias representan un campo idóneo para un análisis bioético porque implican conflictos de valores a diversos niveles. Constituyen un problema complejo en el que interaccionan intereses económicos, políticos, sociales, y sanitarios. Analizamos las implicaciones de estas cuestiones para la práctica clínica y la investigación con personas con trastornos adictivos y damos unas directrices sobre cuándo, cómo y por qué llevar a cabo valoraciones de la capacidad para participar en investigación.