Influence of aquaculture waste on fatty acid profiles and gonad maturation of wild fish aggregations at fish farms.

Wild fish belonging to four species belonging to different trophic groups were captured at three distances from fish farm facilities: long distance (>5 Km), medium distance (1.5 Km) and close to sea-cages. Flesh, brain, liver and gonads were sampled for fatty acid analysis. Fish aggregated near sea-cages showed accumulation of fatty acids of vegetable origin in the studied tissues, due to surplus feed consumption or via predation of fish that consumed the feed. Gonads accumulated vegetable fatty acids in different manner in the different species, and the species least and most influenced by fish-feeds were selected for gonad histological examination. Results showed an acceleration of the final stages of the oocyte development in fish aggregated near fish farms compared to fish captured at long distance. Differences in oocyte development were more acute in the species which incorporated higher quantities of vegetable fatty acids.

The short-term effects of farmed fish food consumed by wild fish congregating outside the farms.

We simulated in the laboratory the possible effects on fatty acids and immune status of wild fish arriving for the first time in the vicinity of a sea-cage fish farm, shifting their natural diet to commercial feed consumption, rich in fatty acids of vegetable origin. The flesh fatty acid profile of golden mullet specimens was altered after 2weeks of commercial feed consumption, showing an increase in fatty acids of vegetable origin. The serum peroxidase and bactericidal activities, and head-kidney leucocyte phagocytic capacity, increased after eight weeks of the new diet, while the respiratory burst activity decreased. The extent of these changes cannot be considered large enough to regard them as compromising the health status of fish. More research is needed in order to elucidate whether the rapid assimilation of the dietary fatty acids could harm the immune status of fish when feeding for longer periods than two months.

Mediterranean fouling communities assimilate the organic matter derived from coastal fish farms as a new trophic resource.

Currently, the lipid content of fish feeds includes high amounts of terrestrial vegetable oils, rich in n-6 fatty acids and poor in n-3 fatty acids. Sinking organic matter in the shape of fragmented pellets and fish faeces could be ingested by the surrounding fauna attracted to the submerged structures of aquaculture facilities or living in natural benthic habitats. Fatty acids contained in feed pellets were used as trophic markers to shed light on the assimilation and incorporation of aquaculture wastes by the invertebrate fauna associated to sea-cages. Eighteen macroinvertebrate species, and zooplankton, seaweeds and sediments were collected from two fish farms, one of which (control) had not been used as such for two years. This study demonstrates that macroinvertebrate fauna present in fouling can take up sinking organic matter from farms. Further research should be directed at assessing the potential implications of aquaculture production for the surrounding ecosystem.

La gestión de riesgos en Atención Primaria: estudio de la morbilidad / Management of risks in Primary Health Care: morbidity study

OBJETIVO. Identificar en las reclamaciones económicas en Atención Primaria, a través de los diagnósticos clínicos, el análisis de las causas, la intensidad del daño ocasionado y las medidas que se pueden adoptar para evitar su repetición. MATERIAL Y MÉTODOS. Es un estudio observacional, descriptivo y transversal, que analiza la morbilidad que ha dado origen a las reclamaciones económicas (443 en Atención Primaria) presentadas contra el Insalud en el período 1995-2001, utilizando la CIE-9 modificada. RESULTADOS. En la distribución de las reclamaciones por grupos diagnósticos, el de traumatismos es el más numeroso, con el 26,40% del total de casos, seguido por problemas cardiovasculares (19,40%), tumores (10,60%) y problemas nerviosos y respiratorios (7,70% y 6,50%). El error diagnóstico es el motivo más frecuente de reclamación (62,75%); el resultado de muerte se produjo en el 40,60% del total de sucesos reclamados. El mayor número de fallecimientos (87,20%) se produce en las reclamaciones por problemas cardiovasculares; le siguen tumores (46,80%), aparato respiratorio (65,50%) y traumatismos (15,40%). El síndrome coronario agudo representa el 65% de los siniestros de su grupo, valorándose como práctica clínica inadecuada la observada en 36 de los casos de infarto agudo de miocardio (IAM). En los otros grupos, los porcentajes de práctica clínica inadecuada fueron: traumatismos el 58,20%, tumores el 32%, aparato respiratorio el 34,5%, aparato genitourinario el 54,5%. Organización o dotación incorrecta se encontró en el 70% de los accidentes en centros de salud. CONCLUSIONES. Los porcentajes de práctica clínica inadecuada detectados en las reclamaciones ponen de relieve la necesidad de mejorar la práctica clínica en Atención Primaria, para lo que es conveniente implantar la metodología de la gestión de riesgos clínicos

OBJECTIVE. Identify the analysis of the causes, intensity of harm caused and measures that can be adopted to avoid its repetition in the economic claims in Primary Health Care through the clinical diagnoses. MATERIAL AND METHODS. This is an observational, descriptive, cross-sectional study that analyzes morbidity that has given rise to the economic claims (443 in Primary Health Care) presented against the Spanish Public Health System in the period 1995-2001, using the modified ICD-9. RESULTS. In the distribution of the claims per diagnostic groups, traumas are the most numerous, with 26.40% of all the cases, followed by cardiovascular problems (19.40%), tumors (10.60%) and nervous and respiratory problems (7.70% and 6.50%). Diagnostic error is the most frequent reason for the claim (62.75%); the result of death occurred in 40.60% of all the events with claims. The greatest number of deaths (87.20%) occurs in claims due to cardiovascular problem; followed by tumors (46.80%), respiratory tract (65.50%) and traumas (15.40%). Acute coronary syndrome represents 65% of the damage of its group, that observed in 36 of the cases of AMF being assessed as inadequate clinical practice. In the other groups, the percentages of inadequate clinical practice were: trauma 58.20%, tumors 32%, respiratory tract 34.5%, genitourinary tract 54.5%. Incorrect organization or resources were found in 70% of the accidents in health care centers. CONCLUSIONS. The percentage of inadequate clinical practice detected in the claims manifests the need to improve the clinical practice in Primary Health Care. Thus, it is convenient to introduce the clinical risk management methodology

Gestión de riesgos en Atención Primaria: casos pediátricos / Risk management in Primary Care: paediatric cases

Objetivo: valorar la seguridad de la asistencia a la población infantil, analizando los expedientesde responsabilidad patrimonial del extinguido Insalud.Material y métodos: estudio observacional, descriptivo y transversal; se analizaron los56 expedientes con edad pediátrica por un grupo de trabajo con amplia experiencia profesionalen Atención Primaria. El análisis estadístico se realizó con los programas SPSS versión11 y S-PLUS versión 6.0.Resultados: los casos pediátricos constituyen el 12,64% del total (443) de reclamacionesen Atención Primaria del período analizado (1995-2001); la edad media fue de 4,81años, siendo los varones el 57,15%. En el 53,57% de los expedientes no había documentaciónclínica o ésta era de calidad inaceptable. Se habían originado secuelas orgánicas o funcionalesen el 53,57% de las reclamaciones y el fallecimiento en el 23,21% de los casos.Había error diagnóstico en el 64,30% de los casos y una posible praxis inadecuada en el35,71% (37% en el estudio global). Aplicando la CIE-9, los grupos XVII (28,57%), VI(10,71%), VIII (8,92%), X (8,92%) y XVI (8,92%) son los prevalentes.Conclusiones: el análisis de casos pediátricos proporciona mejores resultados que losdel total en Atención Primaria. La mayoría de las reclamaciones se fundan en supuestoserrores médicos. En las áreas rurales, atendidas por médicos generales, existe un mayor riesgode praxis inadecuada. La implantación de programas de gestión de riesgos ayudará a mejorarla calidad y la seguridad de los pacientes

Objective: To assess the safety of health care to patients in paediatric age, analysing thepatrimonial responsibility dossiers against the extinguished Insalud.Material and methods: An observational, descriptive, transversal study; it were analysedall 56 dossiers in paediatric age by a work team with a large professional experience in Primary settings was conformed. A technical document with proceedings and clinical specificjudgement was accorded. The statistic analysis was made with the SPSS version 11 andS-Plus version 6.0 programs.Results: The paediatric cases accounted for 12.64% of total (443) of claims in primarycare in the analysed period (1995-2001); the average age of 4.81 years, being the males57.15%.In 53.57% of administrative dossiers there had not clinical records or its quality wasnot acceptable. Physical or organic sequelae were present in 53.75%; and death in 23.21%.Diagnostic error was identified in 64.30% of claims, and probable medical malpractice in35.71% of cases (37% in global study). According with CIE-9, groups XVII (28, 57%), VI(10.71%), VIII (8.92%),X (8.92%) and XVI (8.92%) were prevalent.Conclusions: The pediatric cases analysis give better results than that we found in theoverall number in primary care. The majority of claims are based on alleged medical errors.The rural areas deserved by general practitioners, present an increased risk of medical malpractice.When the attendant physician was paediatrician the minor percentage of malapraxiswas found. To implement specific programmes of risk healthcare management will helpto increase the quality and safety of patients