Involvement and Autonomy of Minors in Medical Settings: Perceptions of Children Undergoing Surgery and Parents.

Informed consent presupposes competence and represents a formal decision by an informed person who has the legal capacity to accept medical action or participate in research. Our aim was to analyze the perceptions of minors and their parents about the age at which they consider that a minor is competent for making health decisions. A descriptive observational study was carried out in 302 minors between 12 and 17 years of age undergoing elective surgery, and 302 parents (range 30 to 62 years). Two semistructured questionnaires were designed, one for the minors and the other, for the parents. A total of 20.1% of minors and 31.1% of parents believe that patients should not make decisions related to their health until they are 18 years old. A total of 74.9% of the minors surveyed consider that from 16 years of age, the minor is empowered to make decisions. In parents, this percentage is 60%. In the pediatric setting, each case and situation must be examined individually to determine if the minor meets the condition of maturity to decide. The ideal is to promote the minor's participation in decision-making, giving them the opportunity to participate in the process in a manner appropriate to their capacity.

Occupational Exposure to Inhalational Anesthetics and Teratogenic Effects: A Systematic Review.

(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to analyze the teratogenic effects of inhalational anesthetics in conditions of actual use, determining any association with spontaneous abortion or congenital malformations. (2) Methods: A systematic review was carried out according to the PRISMA statement based on PICO (problem of interest-intervention to be considered-intervention compared-outcome) (Do inhalational anesthetics have teratogenic effects in current clinical practice?). The level of evidence of the selected articles was evaluated using the SIGN scale. The databases used were PubMed, Embase, Scopus, Web of Science, Google academic and Opengrey. Primary studies conducted in professionals exposed to inhalational anesthetics that evaluate spontaneous abortions or congenital malformations, conducted in any country and language and published within the last ten years were selected. (3) Results: Of the 541 studies identified, 6 met all inclusion criteria in answering the research question. Since many methodological differences were found in estimating exposure to inhalational anesthetics, a qualitative systematic review was performed. The selected studies have a retrospective cohort design and mostly present a low level of evidence and a low grade of recommendation. Studies with the highest level of evidence do not find an association between the use of inhalational anesthetics and the occurrence of miscarriage or congenital malformations. (4) Conclusions: The administration of inhalational anesthetics, especially with gas extraction systems (scavenging systems) and the adequate ventilation of operating rooms, is not associated with the occurrence of spontaneous abortions or congenital malformations.

A COVID Dilemma: How to Manage Pregnancies in Case of Severe Respiratory Failure?

To date, the impact of the COVID-19 pandemic on the world's health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was aware of its impact on vulnerable individuals, including pregnant women. The purpose of this paper is to highlight scientific pitfalls and ethical dilemmas emerging from management of severe respiratory distress in pregnant women in order to add evidence to this topic through an ethical debate. In the here-presented paper, three cases of severe respiratory syndrome are analyzed. No specific therapeutic protocol was available to guide physicians in a cost-benefit balance, and unequivocal conduct was not a priori suggested from scientific evidence. However, vaccines' advent, viral variants lurking on the horizon and other possible pandemic challenges make it necessary to maximize the experience gained through these difficult years. Antenatal management of pregnancies complicated by COVID-19 infection with severe respiratory failure is still heterogeneous and ethical concerns must be pointed out.

El proceso de muerte en la pandemia por coronavirus / O processo de morte na pandemia por coronavírus / The death process in the coronavirus pandemic

La muerte es un proceso biográfico, sociocultural y biológico que se vive de una forma individual, pero que se comparte con los seres queridos. Sabemos que morimos y al ser dependientes y relacionales otras personas participan de nuestra propia muerte. No somos seres aislados, sino que interaccionamos al convivir con los demás con quienes compartimos sentimientos y vivencias, por lo que nuestros actos se desarrollan en relación con quienes nos acompañan. Es la razón por la que, en la mayoría de las ocasiones, desterramos morir en soledad y la muerte de un amigo o de un familiar la percibimos como algo nuestro originando una cierta sensación de pérdida que, a su vez, manifestamos de forma íntima o compartida. Durante la pandemia por coronavirus, como consecuencia de la elevada tasa de contagio y el consiguiente peligro para la salud pública las autoridades sanitarias han adoptado medidas de aislamiento también en pacientes en fase terminal, por lo que se ha llevado a cabo la privación del derecho al acompañamiento y al apoyo espiritual o religioso recogido en numerosas legislaciones sobre derechos de los pacientes. La soledad se ha intentado solventar con el uso de medios electrónicos, pero esta práctica no ha sustituido el contacto físico necesario en estas situaciones. La adopción de medidas estrictas para prevenir la transmisión de la enfermedad no debe ser impedimento para facilitar un entorno compasivo durante el fallecimiento de estos pacientes.

Death is a biographical, sociocultural and biological process that is lived individually and shared with loved ones. The human being knows that he dies and as a relational and dependent living being, other people participate in his death. We are not isolated beings, but we interact living with others with whom we share feelings and experiences, so our actions are developed in relation to those who accompany us. It is the reason why, in most cases, we banish death alone without the company of our loved ones and why we perceive the death of a friend or relative as our own, causing a certain sense of loss. During the coronavirus pandemic, as a consequence of the high contagion rate and the consequent danger to public health, the authorities have adopted isolation measures also in terminal patients, for which they have been deprived of the right to accompaniment and spiritual or religious support included in legislations on the rights of patients. Solitude has been tried to solve with the use of electronic means, but this practice has not replaced the necessary physical contact in these situations. The adoption of strict measures to prevent the transmission of the disease should notbe an impediment to facilitating a compassionate environment during dying process in these patients.

A morte é um processo biográfico, sociocultural e biológico vivido individualmente, mas compartilhado com os entes queridos. Sabemos que morremos e, por sermos dependentes e relacionais, outras pessoas participam de nossa própria morte. Não somos seres isolados, mas interagimos convivendo com outras pessoas com quem compartilhamos sentimentos e experiências, por isso as nossas ações se desenvolvem em relação a quem nos acompanha. É por isso que, na maioria das vezes, evitamos morrer sozinhos, sem a companhia de nossos entes queridos, e percebemos a morte de um amigo ou familiar como nossa, causando um certo sentimento de perda que, por sua vez, manifestamos de forma íntima ou compartilhada. Durante a pandemia do coronavírus, em decorrência do alto índice de contágio e consequente perigo para a saúde pública, as autoridades sanitárias adotaram medidas de isolamento também em pacientes em fase terminal, razão pela qual foram privados do direito de acesso, acompanhamento e espiritual ou apoio religioso incluído em várias legislações sobre os direitos dos pacientes. Tem-se tentado fazer face à solidão com o uso de meios eletrônicos, mas essa prática não substitui o contato físico necessário nessas situações. A adoção de medidas estritas para prevenir a transmissão da doença não deve ser um impedimento para facilitar um ambiente compassivo durante a morte desses pacientes.

Pretransplant ascites and encephalopathy and their influence on survival and liver graft rejection in alcoholic cirrhosis disease.

INTRODUCTION: The Child-Pugh and model for end-stage liver disease (MELD) scores are widely used to predict the outcomes of liver transplant (LT). Both have similar prognostic values in most cases, although their benefits might differ in some specific conditions. The aim of our study was to analyze the influence of pre-transplant ascites and encephalopathy in post-transplant liver rejection development and survival in alcohol cirrhosis (AC) patients undergoing LT to determine the usefulness of the Child-Pugh score for the assessment of prognosis in such patients. MATERIAL AND METHODS: Two hundred and eighty-one AC patients, classified according to viral infections and pre-transplant complications, were analyzed. Acute (AR) and chronic (CR) liver rejections and Child-Pugh, MELD and albumin-bilirubin (ALBI) scores were studied in all cases. RESULTS: Similar AC rejection percentages were observed in ascites or encephalopathy groups (18.5% and 16.5%, p = 0.735), although a higher but not statistically significant AC rate was observed in patients with grade III ascites (p = 0.777) and with grade II encephalopathy (p = 0.089). Chronic rejection was only developed by 9.1% of AC patients, regardless of the presence of ascites (6.2%) or encephalopathy (5.5%). The presence of ascites and encephalopathy complications did not seem to influence post-transplant survival. Neither the Child-Pugh nor the ALBI score can be considered the best for predicting patient survival in the short or long term. CONCLUSIONS: Ascites and encephalopathy do not seem to influence AC or CR in patient survival, regardless of the presence of viral infections, so in our study neither the Child-Pugh nor ALBI score seems to be the best score to predict the outcomes of these patients.

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.

Diagnostic Application of Postmortem Cardiac Troponin I Pericardial Fluid/Serum Ratio in Sudden Cardiac Death.

In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.

Age and education as factors associated with medication literacy: a community pharmacy perspective.

BACKGROUND: Aging implies a higher prevalence of chronic pathologies and a corresponding increase in medication. The correct adherence and use of the medication are prerequisites for reducing risks of disease progression, comorbidity, and mortality. Medication literacy (ML) is the specific ability to safely access and understand the information available concerning medication, and to act accordingly. Currently, there are few specific instruments that ascertain the extent of ML in the general population. The aim of this work was to analyse ML in a large cohort of pharmacy customers. METHODS: A total of 400 community pharmacy clients were analyzed to assess the level of ML (documental and numeracy) through the validated MedLitRxSE tool. RESULTS: The results showed that out of a total of 400 community pharmacy clients only 136 (34%) had an adequate degree of ML, while the rest of the clients (n = 264; 66%) were adjudged not to have this ability. Statistically significant differences were found between the different age groups in terms of ML (P < 0.001; OR = 0.312; 95% CI: 0.195-0.499), the 51-65 and >65-year age groups having a lower frequency of adequate ML (23.5 and 7.1%, respectively) than the rest of the age groups. A statistically significant increase in adequate ML was observed as the academic level of the clients increased (P < 0.001; OR = 15.403; 95% CI: 8.109-29.257). Multivariate logistic regression confirmed the influence of both variables on ML. CONCLUSIONS: An inadequate ML level was found in community pharmacy clients over the age of 51, and also in those with primary or non-formal studies. Our data add to our knowledge about ML, and should pharmacists and other health professionals to adopt new strategies to prevent, or at least reduce, errors in taking medicines, thus avoiding the undesirable effects of any misuse.

Proteomics in Deaths by Drowning: Diagnostic Efficacy of Apolipoprotein A1 and α-1Antitrypsin, Pilot Study.

Drowning is one of the leading causes of death worldwide. The pathophysiology of drowning is complex and, sometimes, interpretation of the circumstances of death in the autopsy becomes the main source of information in its diagnosis. New advances in medical research, such as proteomics, especially in forensic pathology, are still in the development. We proposed to investigate the application of Mass Spectrometry-based technologies, to identify differentially expressed proteins that may act as potential biomarkers in the postmortem diagnosis of drowning. We performed a pilot proteomic experiment with the inclusion of two drowned and two control forensic cases. After applying restrictive parameters, we identified apolipoprotein A1 (ApoA1) and α-1 antitrypsin as differentially expressed between the two diagnostic groups. A validation experiment, with the determination of both proteins in 25 forensic cases (16 drowned and 9 controls) was performed, and we corroborated ApoA1 higher values in the drowning group, whereas α-1 antitrypsin showed lower levels. After adjusting by confounder factors, both remained as predictive independent factors for diagnosis of drowning (p = 0.010 and p = 0.022, respectively). We constructed ROC curves for biomarkers' levels attending at the origin of death and established an ApoA1 cut-off point of 100 mg/dL. Correct classification based on the diagnosis criteria was reached for 73.9% of the cases in a discriminant analysis. We propose apolipoprotein A1 (with our cutoff value for correct classification) and α-1 antitrypsin as valuable biomarkers of drowning. Our study, based on forensic cases, reveals our proteomic approach as a new complementary tool in the forensic diagnosis of drowning and, perhaps, in clinical future implications in drowned patients. However, this is a pilot approach, and future studies are necessary to consolidate our promising preliminary data.

Impact of the Human Microbiome in Forensic Sciences: a Systematic Review.

Numerous studies relate differences in microbial communities to human health and disease; however, little is known about microbial changes that occur postmortem or the possible applications of microbiome analysis in the field of forensic science. The aim of this review was to study the microbiome and its applications in forensic sciences and to determine the main lines of investigation that are emerging, as well as its possible contributions to the forensic field. A systematic review of the human microbiome in relation to forensic science was carried out by following PRISMA guidelines. This study sheds light on the role of microbiome research in the postmortem interval during the process of decomposition, identifying death caused by drowning or sudden death, locating the geographical location of death, establishing a connection between the human microbiome and personal items, sexual contact, and the identification of individuals. Actinomycetaceae, Bacteroidaceae, Alcaligenaceae, and Bacilli play an important role in determining the postmortem interval. Aeromonas can be used to determine the cause of death, and Corynebacterium or Helicobacter pylori can be used to ascertain personal identity or geographical location. Several studies point to a promising future for microbiome analysis in the different fields of forensic science, opening up an important new area of research.

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.

Analysis of the information in mandatory reporting in victims of gender violence.

The healthcare professional plays a key role in the detection and subsequent channeling of a situation of violence to a judicial level for appropriate investigation. The mandatory reporting of gender violence has become a controversial issue among health care practitioners and victims. The objective of this study was to analyze the quality of the way in which injury reports on victims of gender violence is completed, through an analysis of the information they include, the readability and the degree to which the document can be understood. A retrospective study in a sample of 197 injury reports were performed from health services (primary care, hospital services and emergency services). We analyzed 22 variables related to the content, readability of the document, the victim's identification data as well as identification of the doctor responsible for assistance, the moment of assistance and the characteristics of the injury. The most frequent deficiencies in the data are identification of the doctor responsible for medical attention, the date on which the aggression occurred, a description of the injuries and the judgment of compatibility between the cause of injury (according to the victim) and the actual injury they have. The injury reports do not conform to the legal requirements needed in a document of such extraordinary importance. Greater awareness in health professionals concerning the importance of the injury report as a medicolegal document is needed so that the correct information can be provided to the relevant judicial authority.

Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process.

The information process is considered a core element in decision- making and an obligatory matter of concern for the health professional. Rather than information per se, we should perhaps mention the need for communication between the health professional and the patient, which should be appropriate to each specific case and situation. Interaction and communication during the relationship generates a degree of trust that contributes to improving care quality and health-related results. The aim of this study is to know the perception of professionals on the quality of communication and its impact on the decision-making process of the patient and the degree of involvement of health professionals in the process of communication with the patient. A sample of 2186 health professionals (1578 nurses, 586 physicians, and 22 pharmacists) was studied. A questionnaire composed of 20 items dealing with the process of communication with the patient and obtaining informed consent was administered. Our study revealed the high consideration that professionals hold of their communication skills with patients since almost 80% of those surveyed, think they are sufficiently skilled in this area. Professionals refers that nurses are most skilled at communicating with patients. Communication in the clinical relationship must not only serve as a way for the professional to obtain information from the patient on their pathology, but also as a means to inform patients so that they understand their illness. Patients also like to feel that they are being listened to and are co-participants in the care process. Communication should be a continuous object of study for all health professionals, both in primary and specialised attention.

Caesarean delivery: conflicting interests.

Within the maternal-fetal relationship, interests may sometimes diverge. In this paper, a pregnant woman's refusal to undergo a caesarean delivery, which was recommended both to save the life of the fetus and to minimize risks to her, is described. The legal aspects involved in the conflict between maternal autonomy and fetal well-being are analysed. The patient requested an abortion because of the poor condition of the fetus; however, according to Spanish legislation, the possibility of abortion was rejected as the pregnancy was in its 27th week. The woman still persisted in her refusal to accept a caesarian delivery. After the medical team sought guidance on the course to follow, the Duty Court authorized a caesarean delivery against the wishes of the patient. From a legal point of view, at stake were the freedom of the woman - expressed by the decision to reject a caesarean delivery - and the life of the unborn child. In clinical treatment, the interests of the fetus are generally aligned with those of the pregnant woman. When they are not, it is the pregnant woman's autonomy that should be respected, and coercion should form no part of treatment, contrary to the decision of this court.

Implicaciones del consumo de sustancias psicoactivas sobre la salud de hombres privados de libertad / Implications of psychoactive substances on the health of men deprived of liberty

Objetivo: Describir las frecuencias de consumo de alcohol y otras drogas, así como de diferentes tipos de victimización en la población reclusa de los centros penitenciarios de Castilla-La Mancha. Material y métodos: Estudio transversal analítico con una muestra de personas privadas de libertad en cuatro centros penitenciarios de Castilla-La Mancha. Se distribuyó una encuesta de victimización anónima entre un total de 425 internos, con un margen de confianza del 95%. Resultados: Las agresiones verbales se presentan como las más comunes, con un 41,4% (n=176), situándose en el extremo contrario la victimización sexual con un 7,8% (n=33). Respecto a la sustancia más habitual, destaca el cannabis con un 40,2% (n=171) de consumidores en el mes previo. Conclusiones: La victimización y el consumo de sustancias en prisión son una realidad, y se encuentra una asociación estadísticamente significativa entre ambos fenómenos. Resulta necesario su estudio para el planteamiento de medidas preventivas y mejorar la vida en prisión (AU)

Objective: To describe the frequency of the use of alcohol and other drugs, as well as different types of victimization in men deprived of liberty in the prisons of Castile-La Mancha (Spain). Material and methods: A cross-sectional study was conducted in a sample of men deprived of liberty in four prisons in Castile-La Mancha. An anonymous questionnaire on victimization was distributed among a total of 425 prisoners, with a confidence interval of 95%. Results: The most commonly reported assaults were verbal, affecting 41.4% of the prisoners (n=176) and the least common were sexual, affecting 7.8% (n=33). The most commonly consumed substance was cannabis, with 40.2% (n=171) of prisoners consuming it in the previous month. Conclusions: Victimization and substance use is a reality in prisons, and there is a statistically significant association between the two phenomena. This association should be further studied to design preventive measures and improve prison life (AU)

Analysis of response patterns on the MMPI-2 in psychiatric prison inmates / Estudio del estilo de respuesta en el MMPI-2 de penados psiquiátricos

In order to assess mental health status, and the classification of both the overreporting and underreporting scales and indexes, 102 psychiatric prison inmates deemed mentally incompetent to stand trial completed the Spanish adaptation of the MMPI-2 under standard instructions (honest responding). The results showed patterns of consistent, non-random, nor extremely acquiescent responses. Moreover, no-outlier responses were detected. In line with the psychiatric diagnosis, all the psychiatric prison inmates were classified by the basic clinical scales as clinical cases of the psychotic dyad i.e., schizophrenia and paranoid ideation. The overreporting scales and indexes (i.e., F, K, Fb, F-K, Fp, Ds and FBS) classified the participants as malingerers, whereas the L, Wsd, and Od underreporting scales as good feigners. These scales assessing impression management i.e., consciously faking good biased responses, did not classify overreporters. Thus, they are robust indicators of honest responding among psychiatric prison inmates. The implications of these results for the practice of forensic psychology are discussed (AU)

Se ha realizado un estudio ex post facto en una población de 102 penados psiquiátricos que respondieron bajo instrucciones estándar a la adaptación española del MMPI-2, con el objetivo de conocer el estado mental informado en el MMPI-2, así como el comportamiento de los indicadores de simulación y de disimulación. En los protocolos de respuesta no se observaron casos de outliers, patrones de respuestas totalmente azarosos o extremadamente aquiescentes, al tiempo que eran consistentes. Todos los penados psiquiátricos fueron clasificados, en consonancia con el diagnóstico psiquiátrico, en las escalas clínicas básicas como casos clínicos en la díada psicótica (i.e., esquizofrenia e ideación paranoide). Las escalas e índices de simulación utilizados (i.e., F, K, Fb, F-K, Fp, Ds y FBS) los clasificaron como simuladores, en tanto las escalas de medida de la disimulación L, Wsd y Od los clasificaron como disimuladores. Estas escalas, que forman parte del manejo de la impresión, esto es, de la manipulación favorable y consciente de la imagen, no informan de casos en poblaciones de simuladores. Así, éstas escalas serían indicadores robustos de no simulación. Finalmente, se discuten las implicaciones de estos resultados para la práctica forense (AU)

[Implications of psychoactive substances on the health of men deprived of liberty]. / Implicaciones del consumo de sustancias psicoactivas sobre la salud de hombres privados de libertad.

OBJECTIVE: To describe the frequency of the use of alcohol and other drugs, as well as different types of victimization in men deprived of liberty in the prisons of Castile-La Mancha (Spain). MATERIAL AND METHODS: A cross-sectional study was conducted in a sample of men deprived of liberty in four prisons in Castile-La Mancha. An anonymous questionnaire on victimization was distributed among a total of 425 prisoners, with a confidence interval of 95%. RESULTS: The most commonly reported assaults were verbal, affecting 41.4% of the prisoners (n=176) and the least common were sexual, affecting 7.8% (n=33). The most commonly consumed substance was cannabis, with 40.2% (n=171) of prisoners consuming it in the previous month. CONCLUSIONS: Victimization and substance use is a reality in prisons, and there is a statistically significant association between the two phenomena. This association should be further studied to design preventive measures and improve prison life.

Analysis of response patterns on the MMPI-2 in psychiatric prison inmates.

In order to assess mental health status, and the classification of both the overreporting and underreporting scales and indexes, 102 psychiatric prison inmates deemed mentally incompetent to stand trial completed the Spanish adaptation of the MMPI-2 under standard instructions (honest responding). The results showed patterns of consistent, non-random, nor extremely acquiescent responses. Moreover, no-outlier responses were detected. In line with the psychiatric diagnosis, all the psychiatric prison inmates were classified by the basic clinical scales as clinical cases of the psychotic dyad i.e., schizophrenia and paranoid ideation. The overreporting scales and indexes (i.e., F, K, Fb, F-K, Fp, Ds and FBS) classified the participants as malingerers, whereas the L, Wsd, and Od underreporting scales as good feigners. These scales assessing impression management i.e., consciously faking good biased responses, did not classify overreporters. Thus, they are robust indicators of honest responding among psychiatric prison inmates. The implications of these results for the practice of forensic psychology are discussed.

Se ha realizado un estudio ex post facto en una población de 102 penados psiquiátricos que respondieron bajo instrucciones estándar a la adaptación española del MMPI-2, con el objetivo de conocer el estado mental informado en el MMPI-2, así como el comportamiento de los indicadores de simulación y de disimulación. En los protocolos de respuesta no se observaron casos de outliers, patrones de respuestas totalmente azarosos o extremadamente aquiescentes, al tiempo que eran consistentes. Todos los penados psiquiátricos fueron clasificados, en consonancia con el diagnóstico psiquiátrico, en las escalas clínicas básicas como casos clínicos en la díada psicótica (i.e., esquizofrenia e ideación paranoide). Las escalas e índices de simulación utilizados (i.e., F, K, Fb, F-K, Fp, Ds y FBS) los clasificaron como simuladores, en tanto las escalas de medida de la disimulación L, Wsd y Od los clasificaron como disimuladores. Estas escalas, que forman parte del manejo de la impresión, esto es, de la manipulación favorable y consciente de la imagen, no informan de casos en poblaciones de simuladores. Así, éstas escalas serían indicadores robustos de no simulación. Finalmente, se discuten las implicaciones de estos resultados para la práctica forense.

The role of a professional dental organization in the resolution of malpractice claims the professional dentist college in the region of Murcia (Spain).

The aim of this paper is to study the role of a professional dental organization in the resolution of malpractice claims in Murcia (southeast of Spain). We analysed all the claims presented to the College of Dentists during the last sixteen years (n = 84). Professional behaviour was demonstrated as adequate in 29 cases and as malpractice in 55 (32 cases were considered technically correct but with information failures and in 23 cases technical errors were observed). The written informed consent was absent in 40 cases, although information was supplied verbally in 30 cases of the 40. The distribution of the dental interventions performed in the claim cases was: surgery, 20 cases (23.80%), prosthetic, 36 cases (42.85%) and endodontic, 28 cases (33.33%). Only in 22 cases (26.19%) was a final agreement reached between the parties. The Dental College could improve these results, acting as a real arbitral court and minimizing the problems for professionals and the claimers.