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The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

First, this paper estimates the dimensions of the market for cannabis in Spain using data on the extent of consumption and the main patterns of use of consumers. Then the paper reviews the hypothetical production and distribution costs of these drugs in different production regimes under different legal conditions. The review shows that current prices of cannabis in the illegal market could be notably reduced if production and distribution of cannabis were decriminalized and even more if they were performed by legal enterprises. Thirdly, we examine the relationship between prices and consumption levels by analysing the price elasticity of demand. A fall in the prices of cannabis products will likely result in an increase in the number of users and in the total amount consumed. Lastly we consider several alternatives for the taxation of cannabis derivatives to counteract the likely fall in prices, and their pros and cons.

During their medical studies, students must acquire basic competencies in different areas of knowledge, one of which is infectious diseases. Training in infectious diseases is essential for general medical practice and for academic or professional expertise in many areas of medicine, both medical and surgical. The vast amount of knowledge that is continuously generated about infectious diseases requires a well-structured undergraduate medical education program and framed in a setting dominated by globalization. The incorporation of Spain to the European higher education area has forced medical schools to adapt their curriculum and to establish the content and learning objectives of all courses of study. In this paper, we discuss the implications of the integration of the Spanish university system in the European higher education area («Bologna Process») in the teaching of infectious diseases in the Degree of Medicine, and describe the learning program in infectious diseases of the University Miguel Hernández of Elche (Alicante, Spain) based on learning outcomes and competencies., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Although it seems that the issue of law and bioethics has been much debated today, still raising doubts and conflicts among the nursing staff on what their regulation must relationship between law and bioethics, or that we should know about informed consent and advance directive, if the Jehovah's Witnesses can refuse the treatments, and how these decisions affect the person and how it relates to the principle of autonomy, which are covered by a legal framework that gives greater freedom and autonomy to the patient's decision. The Jehovah's Witnesses are a Christian community descended from a group of scholars, who base their beliefs on a particular interpretation of the Bible and that, in Spain, like other denominations, are registered in the Registry of Religious Entities of the Directorate General of Religious Affairs of the Ministry of Justice. Therefore, this paper intends to analyze through a literature review the ethical and legal concepts within the existing legal framework, and how the decisions made by people, even still risking their life, must be accepted andprotected by a legalremedy, without prejudice to the exceptions provided by law.

During the second half of the 19th century, Spanish authorities began developing specific programs on the safety of certain foods intended for human consumption. This paper analyses the key features that gave rise to the inclusion of the veterinarian in the administrative structure responsible for safeguarding public health. Among the aspects covered, special focus is put on the relationship between human and animal medicine at a time when growing public alarm in relation to certain zoonoses contributed to shaping the notion of veterinary public health. The appearance of a disease in pigs that was transmissible through the consumption of parasitized meat set the scene for veterinary inspection to be associated with the protection of public health. The outbreaks of trichinosis all over Spain in the 1870's proved the existence of contagium animatum in a pre-bacteriology era, and this led to the introduction of improvements in food inspection. In this sense, microscopic examination of pork products encouraged the modernization of inspection tasks undertaken by veterinarians, which had previously focused on the organoleptic evaluation of meat and fish and on unveiling fraud. The introduction of microscopes was widely accepted and established a watershed between acceptable and unacceptable methods of carrying out the examination of meat. Furthermore, this "technological" method of diagnosis brought veterinary medicine closer to other more prestigious health professions, at least in theory. Among other aspects, the acceptance of trichinae as an exogenous cause of disease contributed to 19th century doctors learning about the idea of pathogenic microorganisms from veterinarians. At a social level, the use of the microscope was seen as a way of preventing the transmission to people of an animal disease that was very much in the public eye at the time. From the political point of view, the process -analysed in this paper from the perspective of veterinarians in Barcelona- allows a glimpse of the contrast between the desire of some Catalan veterinarians to modernize their profession and what was happening in others parts of Spain.

This paper examines the relationship between the public image of Pedro Gonzólez de Velasco (1815-1882), famous for his anatomical collections and his Anthropological Museum, founded in 1875 in Madrid, and the popular legend related to the death, embalming and exhumation of his daughter Concepción. The doctor who is committed to the nation becomes a mad scientist, and his official biography is transformed into an urban legend. Beyond the merely anecdotal, I show how the aesthetics associated with female corpses and artificial women organize cultural imaginaries, bringing together medical discourses and literary and artistic representations.

Revista ROL de Enfermería was the first journal of nurses and adressed to nursing published with the birth of Spanish democracy, indexed soon Medline/PubMed. This paper analyzes the changes in the structure and function of the magazine. Highlights two facts. The journal ROL expresses the transformation of the new universitary nursing, and how was adapting to scientific standards: although not increased the number of original articles, was normalizing their structure, bibliography or citations pattern, and also the scientific writing style.

IVF may entail the accumulation of surplus human embryos. Although Spanish law provides several possible destinations, assisted reproduction clinics, that often have to decide what to do with them, look for criteria to help them to make their decisions as reasonably as possible. The aim of this paper is to provide legal and ethical reasons to help them to decide.

Background and Objective: Liver transplantation (LT) is a proven effective treatment of severe liver disease. The aim of this paper is to analyze the results of LT in Spain during the period 1984-2012., Patients and Method: We analyze the results of the database of Spanish Liver Transplant Registry., Results: A total of 20,288 transplants were performed in 18,568 patients. The median age of the donor and recipient increased during the analysis period: 25 years (95% confidence interval [95% CI] 18-40) and 47 years (95% CI 34-55), respectively, in the period 1984-1994 compared to 59 years (95% CI 33-65; P<.05) and 55 years (95% CI 48-61; P<.01), respectively, in the period 2010-2012. The most frequent indications were liver cirrhosis (63.18%) and hepatocellular carcinoma (19.62%). The overall patient and graft survival was respectively 85.1 and 77.8% in the first year, 72.6 and 63.5% the fifth year and 62 and 52.6% in the tenth year. First year patients and graft survival increased respectively from 77.8 and 66.3% in the period 1984-1994 to 88.5 and 83% in 2010-2012 (P<.01). Donor and recipient age, etiology of underlying disease, and hepatitis C virus serological status, were factors associated with decreased survival in univariate and multivariate analysis., Conclusions: Results of LT improved significantly over the review period, despite a progressive increase in donor and recipient age., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Introduction: Since the 80s two lineages of type B viruses are co - circulating in the world. Antigenic differences between them are important and it leads to lack of cross-reactivity. The impact on the burden of disease due to influenza B virus, poor foresight in estimating which of the two lineages of B viruses circulate in the season, and the consequent lack of immunity in case of including the wrong strain make that the availability of the quadrivalent vaccine is very useful. The aim of this paper is to analyze the past influenza seasons in Spain to assess the burden of disease, divergence between the vaccine strain and the circulating B and viral characteristics associated with type B in each seasonal epidemic., Material and Methods: Review of all reports issued by the Influenza Surveillance System in Spain since the 2003-2004 season to 2012-2013., Results: Over the past influenza seasons, although type A was present mostly, circulation of influenza B virus in each season was observed, even being co - dominant in some of them. In a high number of seasons the divergence between the vaccine strain and the circulating strain lineage has been observed, Conclusions: The protective effect of influenza vaccine has varied depending on the type / subtype of influenza virus studied. The vaccine effectiveness against influenza infection by influenza B virus has varied greatly depending on the season analyzed.

In this paper, we analyse the contribution of the anatomical school of José Escolar (1913-1998) to embryology during the first two decades of the Francoist dictatorship. Special attention is paid to the process by which the Spanish group, with the support of the new Superior National Research Council, made contact with the German morphology being developed by Hugo Spatz (1888-1979) at the Max Planck-Institut für Hirnforschung. Our study reveals the numerous influences that finally led to the anatomy and embryology of Escolar. In Spain, we found a direct influence of the Gegenbaurian morphology of Gumersindo Sánchez Guisande (1894-1976) and the neuroanatomy of Juan José Barcia Goyanes (1901-2003), full of references to studies by Braus. International contacts of the "Escolarian group", first with North America and then with Germany, created a homogeneous group with a single anatomy (functional and ontophylogenetic) but with so many research interests that subspecialisations had to be developed. An important embryological work resulted from an intense relationship with the German anatomical community during the 1950s. Escolar worked in this field on the development of the amygdala and allocortex, Fernando Reinoso studied the embryology of the diencephalon and Smith Victor Agreda, along with the German scientist Rudolf Diepen, made some important discoveries on the development of the hypothalamic-pituitary system.

Alter Laboratories and the group of companies developed by Juan José Alonso Grijalba (1894-1962) under Franco's regime held the Catholic social doctrine as the foundation of his business. This pharmacist was a strong advocate and propagandist of these ideas. In this paper, we outline the biography of this entrepreneur, describe his ideological principles, and analyze how these theories were implemented in the Alter Laboratories in their economic, cultural-recreational, and moral-religious dimensions. The business approach revealed by the writings of Juan José Alonso is a "patriarchal patronage"; his goal appears to have been the conversion of Alter into a "factory convent" with the programmatic foundations of Catholic humanism, in which the employer assumes a clearly despotic role and the intervention of workers is reduced to accepting the standards and perks offered by the employer.

This paper explores the major role of suicide in the cultural criticism deployed by 19th century Spanish doctors by analysing the most important theoretical models that inspired their contributions to its aetiology. In the first half of the century, the most commonly debated causal factor was the passions, which were thought to stand in a permanent tension with a free, reflexive and conscious self, in accordance with the spiritualist doctrine that was then dominant. In the context of a growing somatisation of moral and intellectual phenomena, the notion of suicide as an act of free will was later modified, and it became considered the consequence of certain organic disturbances. However, this process did not alter the central role of suicidal behaviour within 19th-century cultural criticism, because the advent of degeneration theory meant that doctors finally had a doctrine that allowed them to combine biological determinism with the extended perception of a moral and social crisis threatening the stability and achievements of bourgeois society.

Federico Olóriz introduced in Spain a method of identification based on fingerprints that is now used in various other countries. Among the numerous studies he performed for this purpose is a hitherto unpublished experiment reported in this paper. The objective was to test whether fleshy parts of fingers that undergo manipulation can maintain their dermal folds in a manner that permits their correct identification. Olóriz found that dermal folds produced by a simple ligation did not pose serious identification problems, while alterations resulting from sharp elements generated greater but in some way surmountable difficulties. A brief biography of Olóriz is first provided, with a summary of his studies on Anthropology and, in greater detail, his dedication to Forensic Anthropology, which led to the development of the so-called "Olóriz Method" of identification by means of fingerprints.

Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are <130mg/dL for children and young adults, <100mg/dL for adults, and <70mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease., (Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

Towards the end of the 19th century, new medico-psychological approaches were applied to mediumship through the scientific study of spiritualist phenomena. The spiritualist idea of the medium was replaced with the notion of the medium as an unstable human being capable of emanating psychic forces unconsciously. This paper analyses the redefinition of mediumship through the polemical articles of the Catalan physician Victor Melcior. On one hand, this microhistory allows the local debate to be placed within the scientific international context, describing the relationships among spiritualism, medicine and psychopathology at that time. On the other hand, it permits analysis of the reactions of some spiritualists to Melcior's theories and of the consequences of this debate for spiritualism in general.

Background: Alterations in the spinal column and obesity are on the rise, causing great concern in health and educational strata. This paper aims to take a step further and study in detail the relationship of the presence of scoliotic hump in obese schoolchildren., Objective: was to determine the relationship between prevalence of types of variables hump and sociodemographic, anthropometric, and functional-side dominance., Methods: The sample consisted of 2,822 schoolchildren in Spain, analyzed in 2010 with an average age of 8.5 years (SD: 1.792). Analyzed for Adams test, BMI, Edinburgh inventory, deep flexion test, and demographic questionnaire, we used the SPSS 20.0 (descriptive and test multivariate binary logistic regression)., Results: The number of subjects who had scoliosis was 1,023 (36.3%), obesity occurred in 359 (12.7%) cases, and after regression including associations regarding gender, (adjusted OR: 2.044; 1.731-2.413), age (adjusted OR: 1.121; 1.070-1.174), presence of obesity (adjusted OR: 0.676; 0.518-0.882), and flexibility (adjusted OR: 1.015; 1.001-1.029)., Conclusions: The female participants were twice as likely to have hump. The prevalence with respect to age indicates that any schoolchild with a year of chronological age has 1.12 times higher risk of developing hump and subjects carrying the school supplies backpack have less risk of hump.

Introduction: This paper analyzes, by a descriptive study, the closing of the Basic Hospital of the Defence the restructuration of the Santa María del Rosell University Hospital, and the moving of both to a new hospital: the Santa Lucía University Hospital. This process was carried out in coordination with a coincident objective: the creation of an only management staff for the area. The aim is the analysis of the opening of a hospital complex that coincided with the restructuration of the health area., Methodology: This paper analyzes the actions in relation to the scheduling, training and moving, that concerned above 600 hospital beds and 275.000 inhabitants. Analyzes the intervention in infrastructures, logistics and training. The whole process is seen from de nursery point of view, as a professional stratus that knows the roles of the hospital and personnel. The period of the study comprises since October2010, beginning of the activity in the new hospital, to November 2011, moment of the effective culmination of the move., Result: The result of the works carried out was the transfer of people and roles in a very short time (eleven months). All the patients were moved without any event., Conclusion: During the whole process healthcare continuity was obtained, whit the less economic impact, as in patients and professionals. From the point of view of future and practical implications, the basis for a modern and qualified provision of services have been established; and best results from means provided have been obtained in relation to health care quality.

Objective: This article aims to provide a quantitative and qualitative description of the publications on Nuclear Medicine (NM) in journals from other disciplines, between 2000 and 2009., Material and Methods: A retrospective descriptive study was carried out including the years 2000-2009 in three internal medicine journals (IM) and in three related specialty journals (RS). The criteria used are that some of the authors were located professionally in a Service, Unit or Central MN and/or that the title of the article or at least its content made a reference to some specific aspect of NM. Date of publication, the magazine section, thematic, data of the authors, province and referral hospital were collected., Results: A total of 186 articles were found, 81 in IM journals and 105 in RS. The IM journal articles came from 43 different hospitals. Vall d'Hebron (Barcelona, Spain) was the hospital with the largest volume. Twenty-four provinces were identified, Barcelona and Madrid standing out among them with 20 and 17 articles, respectively. In the RS journals, 59 hospitals/centers had participated, Vall d'Hebron standing out with 51 articles. There were 9 foreign articles. The articles were distributed into 19 provinces, Barcelona and Madrid standing out with 32 papers and 20 papers, respectively., Conclusions: There are at least twice as many articles in the RS Journals than in the IM ones. «Original» articles are the most frequent. The Clinical and Translational Oncology journal in RS and Medicina Clínica in IM stand out with the highest number of articles. No specific topic prevailed., (Copyright © 2013 Elsevier España, S.L.U. and SEMNIM. All rights reserved.)

The aim of this paper is to describe the available methods to quantify the main health and social harms related to alcohol consumption in the population and to provide recommendations to improve research on these issues. Methods using individual and aggregate level data for the study of the relationship between alcohol consumption and related harms are taken into account, highlighting their strengths and weaknesses. Methodological aspects to quantify the magnitude and trends of alcohol-related and alcohol-attributable mortality, including alcohol dependence, acute intoxication, injury, violent behavior, disease burden and social costs are widely considered. There are often discrepancies between the study results mainly due to the difficulty of adequately measuring alcohol consumption and its relationship to health conditions. In the future we must strengthen research on the effect of drinking patterns and context in chronic diseases using appropriate controls, clarify the relationship of alcohol use disorders and other mental disorders , improve the measurement of alcohol intoxication when acute problems occurs, periodically quantify the disease burden and social costs attributable to alcohol (using country- specific attributable fractions) and develop valid and comparable methods and indicators for monitoring alcohol-related harm.

The impact on health of alcohol in a given society is mainly related with the volume and pattern of drinking, and these are related with individual factors, but also with environmental factors, among which public policies are important determinants. Public policies may favour or reduce alcohol use, and thus have a substantial preventive capacity. The effectiveness of policies to prevent the harm caused by alcohol has been reviewed in recent documents, which provide evidence to extract recommendations. This paper reviews the most effective policies to reduce the harm caused by alcohol, with an emphasis in the use of taxes to increase its cost, availability regulation, and policies on drinking and driving. The regulation of alcohol promotion and publicity is also assessed, as well as the detection and treatment of alcohol abuse and dependence. The state of alcohol related policies in Spain is analysed, as well as the obstacles, for the adoption of policies more prone to prevention, and recommendations for the future are made.

Introduction: The Practices in Emergency and Rescue medication For Epilepsy managed with Community administered Therapy (PERFECT™) Initiative was set up in 2011 to gain a better understanding of how prolonged convulsive seizures are managed, and rescue medication is administered, in out-of-hospital settings across Europe. This paper explores the initial research findings for Spain., Material and Methods: A review was made of existing clinical guidelines, guidance to schools, and relevant policy and legal frameworks, as well as a survey of 20 healthcare professionals who treat children with prolonged convulsive seizures in Spain., Results: Existing clinical guidelines pertain mainly to the hospital setting, and contain very little information on how prolonged seizures should be managed outside of the hospital. Guidance for schools is unclear as to whether teachers are allowed to administer rescue medication to children, and there is no legal obligation for school staff to administer medication to children under their care. As a result of such uncertainty, whether or not children who experience prolonged seizures receive their rescue medication during school hours depends mostly on the resources and training available in each school., Conclusions: There is a need for more explicit guidance covering educational and healthcare settings, clearer information to parents and schools, and more systematic training to be made available to caregivers. This is to ensure that all children at risk of a prolonged convulsive seizure receive rescue medication in a timely manner, regardless of where their seizure occurs., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system., (Copyright © 2014. Published by Elsevier Espana.)

This paper addresses the proposition that even though there appears to be unanimity on the biomedical diagnosis of obesity, it is insufficient or not precise enough, since it is necessary to know more about the consequences of different lifestyles in ways of eating and the impact of lifestyles on the health of the population. Therefore, the paper reflects on how the biomedical ideation of obesity contributes to make body weight and food into what from a rather reductionist and controversial approach is defined as a "social problem." Lastly, the standardization of international strategies against obesity is considered, linked to its classification as a global epidemic, in order to reflect on the effects of dealing with a limited view of culture and food. The ideas articulated in this work are part of the theoretical problematization phase of the topic, prior to the implementation of the research project entitled a socio-anthropological approach to childhood obesity in three case studies: Spain, Mexico and Cuba.

The way a person will develop over the lifespan is largely determined by the first few years of life. A substantial share of the inequalities in health and socioeconomic status observed in adult life originate during childhood (and even while in utero). In this paper, we first review the literature on the impact of childhood conditions throughout the life cycle. We next discuss some of the social and biological mechanisms behind the transmission of the effects of poverty during the prenatal period, childhood, and adulthood. We then analyze several international experiences aimed at reducing intergenerational transmission of poverty. The article ends with some critical thoughts and policy recommendations to avoid the possible long-term effects of the current crisis on the health and socioeconomic status of the "children of the crisis" in Spain., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

The disbalance between the number of candidates to liver transplant and the number of liver grafts leads to waiting list mortality. Two potential ways of increasing the number of liver grafts are split liver transplantation and the transplantation of grafts from non-heart beating donors. Both of them were discussed in a consensus meeting of the Spanish Society of Liver Transplantation in October 2012. This paper outlines the conclusions of that meeting., (Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.)

Background: Biobank certification ISO 9001:2008 aims to improve the management of processes performed. This has two objectives: customer satisfaction and continuous improvement. This paper presents the impact of certification ISO 9001:2008 on the sample transfer process in a Spanish biobank specialising in kidney patient samples. The biobank experienced a large increase in the number of samples between 2009 (12,582 vials) and 2010 (37,042 vials)., Methods: The biobank of the Spanish Renal Research Network (REDinREN), located at the University of Alcal&aacute;, has implemented ISO standard 9001:2008 for the effective management of human material given to research centres. Using surveys, we analysed two periods in the &ldquo;sample transfer&rdquo; process. During the first period between 1-10-12 and 26-11-12 (8 weeks), minimal changes were made to correct isolated errors. In the second period, between 7-01-13 and 18-02-13 (6 weeks), we carried out general corrective actions., Results: The identification of problems and implementation of corrective actions for certification allowed: a 70% reduction in the process execution time, a significant increase (200%) in the number of samples processed and a 25% improvement in the process. The increase in the number of samples processed was directly related to process improvement., Conclusion: The certification of ISO standard 9001:2008, obtained in July 2013, allowed an improvement of the REDinREN biobank processes to be achieved, which increased quality and customer satisfaction.

This paper deals with the arguments justifying the Government's passage of the Sovereign Ordinance of 7 May 1915, which officially established a course and qualification in Nursing in Spain; and examines how and why Medical and Surgical practicantes (medical assistants) reacted to this decision. The ordinance legalized nurses' care practices, thereby providing official recognition for a healthcare profession other than that of practicante. The Government based its approval on three arguments: the physicians' recommendations; deficiencies in the basic and professional training of practicantes"; and the fact that the nursing profession emerged as a new path providing Spanish women with an opportunity to acquire training and join the labour force. The new legislation was met with outrage by practicantes, who opposed it in the belief that it equated nurses' scope of practice to their own and thus jeopardized their future employment prospects. Additionally, they contended that nurses would be legally qualified to perform the same medical practices as they did, despite receiving their degrees in a shorter period of time with a less prolonged internship, at a lower economic cost and through less effort. Professional associations of practicantes immediately launched a campaign against the Sovereign Ordinance, meeting with the Minister of Public Instruction to request its repeal, organizing a massive telegram campaign directed at the minister, and requesting the nullity of the ordinance before the Supreme Court, which would reject the appeal by the practicantes two years later. Professional associations also used their press organs to publish the arguments of prominent practicantes, who vehemently voiced their opposition in extremist, uncompromising, radical, and ironic terms, arising from a strong gender ideology in tune with the patriarchal mentality of the era and the dominant position that male hegemony conferred to practicantes.

This paper aims to examine the socio-economic determinants of alcohol-impaired drinking in Spanish adolescents. In particular, we are interested in analysing the impact of the family and school environment. To do it, we used the Spanish Survey on Drug Use in the School Population for the year 2008, carried out by the Spanish Government’s Delegation for the National Plan on Drugs. This survey with 30,183 students between 14 and 18 years of age (M = 15.6; SD = 1.17) constitutes a representative sample of the Spanish student population. Of these, 6.7% reported having driven under the influence of alcohol, this behaviour being more frequent among boys (10.6%) than girls (2.9%). Logistic regressions reveal that informative campaigns at school could significantly reduce the likelihood of alcohol-impaired driving (OR = 0.82), especially among males (OR = 0.73) and among younger students (OR = 0.66). Our results also suggest that although parents’ education has no significant impact, parent’s alcohol abuse increase notably the probability of driving after drinking (OR = 2.22 for mothers and OR = 2.81 for fathers).

Objective: "Medicina Paliativa" is the official journal of the Spanish Society of Palliative Care ("Sociedad Española de Cuidados Paliativos"; SECPAL) and it reflects the interests, also on bioethics, of the professionals caring terminal people. We want to know what the bioethical questions they discuss and their approaches are., Methods: From all the published articles in "Medicina Paliativa" from 1994 to 2013 we selected those referred to bioethics topics. We analysed: number of publications, author, subtype of article, year of publication, topic, philosophic approach, and the presence of answers and discussion. Qualitative topics were reviewed and agreed by at least two authors., Results: There were 60 (9%) publications with bioethics profile from a total of 672 analyzed articles. A majority were signed by only one author. 31 (51%) were published as letter. The most relevant topics were: euthanasia, dignity, proportionality of treatment and care, sedation, principles of bioethics, and information. The orientation of these papers was, in a majority, according to principles of palliative care. Most bioethics topics have been answered and even answered back., Conclusion: Bioethics is an interesting topic in palliative care. The arguments usually fit the principles of palliative care.

Introduction: Infectious diseases are a major cause of morbidity and mortality in the workplace. Worker vaccination against a number of infectious diseases is considered the most effective strategy of primary prevention to control them., Sources: A literature review was performed in Medline and websites of Spanish scientific societies were consulted to detect workers vaccination recommendations. The inclusion criteria was that the recommendation had been made from January 2007 to October 2012., Development: Seventeen papers were selected and websites of the Ministry of Health, Spanish Society of Chemotherapy, Spanish Society of Preventive Medicine, Public Health and Hygiene, and Vaccinology Spanish Association provided relevant information to our review. Groups of workers at increased risk of acquiring infectious diseases during their professional activity were determined, and vaccination recommendations were established (vaccination against tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, pneumococcus, meningococcus, measles, rubella, mumps, chickenpox, influenza, Haemophilus influenzae b, typhoid, polio, tuberculosis and rabies)., Conclusions: Epidemiological changes in recent years, with the re-emergence of some diseases such as whooping cough, measles or mumps, force the exposed workers (especially the health care workers) to check their immune status.

Due to severe mental illness, such as a diagnosis of bipolar disorder, people's quality of life may be seriously compromised and they may bear the risk of losing opportunities and being socially isolated as a result of stigma and discrimination. Early diagnosis is crucial, as a recovery process is possible with appropriate medical and psychosocial treatment. A person affected by such circumstances, with adequate training, can learn to handle his condition by himself and become expert by experience. This article depicts how learning among peers, based to a large degree on empathy, enables and promotes self management and, at the same time, a larger political and social consciousness. This has been affirmed by the virtual community of bipolarweb since 2002 and, subsequently, as a further development by the Fundación Mundo Bipolar. This foundation, which offers a training program for people affected by bipolar disorder, engages in several activities and goals which are described in this paper. It also has developed a multidisciplinary program for the training of trainers. Some features of these programs are summarized, with a special emphasis on the fact that trained students are encouraged to give lectures for high school students. This paper summarizes qualitative evaluations made by participants that have followed each of the sessions of the training programs.

In October 2011 the Court of Justice of the European Union pronounced the sentence in the case Brüstle v. Greenpeace. This sentence resolves the preliminary ruling interposed by the Bundesgerichtshof. The object of the preliminary ruling was the interpretation of the expression "human embryos", on 44/98/CE Guideline, in order to resolve the litigation between Brüstle, a German neurobiologist, and Greenpeace. Brüstle have patented a process for obtaining stem cells using cells originally extracted from human embryos, Greenpeace have filed a lawsuit against this patent. The article analyzes the meaning of this sentence in the light of the discrimination of the pre-implantation embryos in Spanish law. The content of the Biopatent Guideline, the Opinions of the European Group on Ethics of Science and New Technologies related to it, the EUJC verdict and the Conclusions of the General Advocate are analyzed. We will pay special attention to the final verdict given on November 27, 2012, by the German Federal Court of Justice. The paper also considers the repercussion of Brüstle case at the European level, examining the activity of the European Parliament, in the frame of the discussion of the program Horizon 2020, and the citizen's initiative "One of us". At the Spanish level, the paper underlines the need to reform the laws of Human Assisted Reproduction and of Biomedical Investigation.

Introduction: Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries., Methodology: Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction., Results: 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P<.05)., Conclusions: A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Since 2010 in the Autonomous Community of Andalusia passed into law ″derechos y garantías de la dignidad de las personas en el proceso de muerte″. At national level, in Spain, it's disputed the need to legalize this delicate aspect therefore already been made some projects for legalization. This advised to review the pros and cons of some legislative implementation experiences and case mix in countries where it has already occurred. This paper undertakes the study of the implementation of the Death with Dignity Act in Oregon and highlight is what were the immediate consequences and risks that has produced a law of this nature.

INTRODUCTION. Scientific collaboration is vital for to the advance of knowledge and is especially important in health sciences. The aim of this study is to identify scientific collaboration indicators and co-authorship networks of researchers and Spanish institutions that publish on multiple sclerosis (MS) during the period 1996-2010. MATERIALS AND METHODS. The analyzed papers were obtained from Web of Science and Scopus international databases, and IBECS and IME national databases, applying specific search profiles in each one of them. In order to identify collaboration networks all signed papers were quantified and co-authored measures were obtained, as the different indexes, degree, intermediation and closeness. RESULTS. 1,613 articles were published in the period 1996-2010, 92% of them in collaboration. With 10 or more works signed in collaboration, 20 Spanish research groups in MS were identified. 64.23% of the papers were published in collaboration between Spanish institutions, and 33.85% were in collaboration with foreign institutions. The institutional participation analysis has identified a large network of institutional partnerships that integrates 27 institutions, with the Hospital Vall d'Hebron in a central position. International collaboration is headed by the U.S. and European countries, most notably the UK and Italy. CONCLUSION. The most collaborative authors, institutions, and work groups in Spanish research in MS have been identified. Despite these indicators that characterize the collaboration in this area, it is necessary to enhance cooperation between them, since this collaboration is positively related to the quality and impact of research and publications.

The Organic Law 15/1999 of 13 December on the Protection of Personal Data and the Law 41/2002 of 14 November regulating patient autonomy and rights and obligations of information and clinical documentation are the basic rules which govern the medical history in Spain. However, the lack of development of these laws regarding data protection in clinical research, particularly in terms of access to the medical history, repeatedly causes doubts about its construction by the Research Ethics Committees. Therefore, the aim of this paper is to analyze the rules which govern the access to the medical history for research purposes, with particular emphasis on the common problems that arise in the Committees for the ethical evaluation of these projects and finally setting a series of recommendations. The use for research purpose of genetic personal data contained in the medical history is also addressed in this paper. In this sense, a key contribution of the Law on Biomedical Research is relating to the specific regulation of the genetic personal data, both with respect to their production and access to the data as a support and regarding to its use for research purpose.

This paper identifies problems and analyzes those conflicts posed by the evaluation of research projects involving the collection and use of human induced pluripotent stem cells (iPS) in Spain. Current legislation is causing problems of interpretation, circular and unnecessary referrals, legal uncertainty and undue delays. Actually, this situation may cause a lack of control and monitoring, and even some paralysis in regenerative medicine and cell therapy research, that is a priority nowadays. The analysis of the current legislation and its bioethical implications, led us to conclude that the review of iPS research projects cannot be assimilated to the evaluation of research projects that involve human embryonic stem cell (hESC). In this context, our proposal is based on the review by the Research Ethics Committees and the checkout by the Spanish Comission of Guarantees for Donation and Use of Human Cells and Tissues (CGDUCTH) of human iPS cells research projects. Moreover, this article claims for a more transparent research system, by effectively articulating the Registry on Research Projects. Finally, a model of verification protocol (checklist) for checking out biomedical research projects involving human iPS cells is suggested.

Objective: The aim of this study was to analyze those factors associated with cigarette smoking in adolescent school children, in order to plan future school interventions for promoting good health strategies developed by the schools and Primary Health Care professionals., Design: Cross-sectional study with a two-stage cluster sampling., Setting: The study included 97 schools, and was carried out in 2005-06 in Catalonia (Spain)., Participants: 14-16 year-old secondary school children., Main Measures: The survey was based on a self-administered paper-based questionnaire that collected sociodemographic variables, academic level, health status, family variables, sexual relations, addictive substances, mood state, and variables related to opinions on cigarette smoking The association between these variables and smoker/non-smoker variable was analyzed, as well as factors that could increase the probability of becoming a smoker using multilevel models., Results: A total of 9340 completed questionnaires, including 4653 from males, were received from the pupils, with a mean age of 15.2 years. The results showed that 71.1% of pupils were non-smokers, 75% of whom were males and 67.3% of females. The following factors increased the probability of becoming a smoker (OR and 95%CI): being a female 0.60 (0.53-0.68), being in the 4(th) year 1.27 (1.12-1.43), low academic performance 3.38 (2.74-4.17), self-reported regular/poor health status 2.81 (2.21-3.58), smoking parents 1.68 (1.45-1.95), alcohol consumption 5.05 (4.35-5.86), having 3 or more problems of mood state 1.22 (1.05-1.41), living without parents 1.59 (1.07-2.38), agreeing with tobacco industry advertising 1.64 (1.45-1.85) and believing that tobacco acts as a relaxant 3.57 (3.23-4.17)., Conclusions: Although the majority of pupils were non-smokers, smoking was more prevalent among females. The factors associated with cigarette smoking in the adolescents included sociodemographic, sociocultural, and personal environmental factors, as well as their opinions on the habit., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction: The aim of this paper is to quantify, by means of bibliometric indicators, the scientific production of Spanish researchers and institutions publishing in national and international paediatric journals, as well as multidisciplinary and other knowledge areas publications during the period 2006-2010, and to determine their impact., Methods: The articles were obtained by applying specific search strategies in databases including, Science Citation Index-Expanded, Scopus, Índice Médico Español, and Índice Bibliográfico Español en Ciencias de la Salud., Results: A total of 7971 articles were published in 971 journals, in which 142 were from Spain and 829 were international. The most productive journals were Anales DE PEDIATRÍA (n=1257), Acta Pediátrica Española (n=456) and Evidencias en Pediatría (n=358). Articles were published mostly in English (41.04%) and in Spanish (38.18%), with the participation of 17 874 different authors from 3302 institutions. Approximately 60% of the papers were cited at least once, and 39.81% were never cited. The mean number of citations per document was 4.28 (SD=9.54). The most cited journals were Pediatrics (n=770), Pediatric Infectious Disease Journal, and Journal of Clinical Endocrinology and Metabolism (n=553)., Discussion: The number of articles progressively increased from 2006 to 2010, which confirms the consolidation and growth of Spanish pediatric research, where the results are published in a wide range of Spanish and international journals, among which stands out is the ANALES DE PEDIATRÍA, the only Spanish pediatric journal with an impact factor. The increasing internationalization of Spanish Pediatrics is also confirmed, since a sustained growth of articles published in international journals is observed, where a quarter was published in US or British journals, as well as the importance of the publication in English. There is a concern about the fact that almost 40% of the articles did not receive a citation, which should encourage authors to complete research of quality, and editors to start editorial policies addressed to increase manuscript and journal quality., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L. All rights reserved.)

Introduction: Scientific collaboration is very important, as it is the basis of the scientific development of every discipline. The aim of this paper is to identify the indicators of scientific collaboration and co-authorship networks of Spanish researchers and institutions publishing in national and international paediatric, multidisciplinary or other knowledge areas journals during the period 2006-2010., Methods: The papers studied were obtained from the databases including, Science Citation Index Expanded, Scopus, Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud, by means of applying different search profiles. All the papers signed by co-authors were quantified in order to identify the authorship and institutional collaboration networks. Furthermore the degree, betweenness index, and closeness index were obtained as a measurement of the structural analysis. Co-authorships were represented graphically by the network analysis and display software Pajek., Results: A total of 7971 articles were published during the period 2006-2010, with 90.55% completed in collaboration. Using a threshold of 10 or more co-authorships, 77 research groups in Pediatrics were identified. Most papers were published in collaboration between institutions of the same Autonomous Community (42.28%), and 14.84% with international collaboration. The analysis of institutional participation enabled a large nucleus or institutional collaboration network to be identified, with 52 linked institutions. International collaboration was led by the USA and European countries, such as United Kingdom, Germany and Italy., Discussion: Authors, institutions and the most active working groups in Spanish pediatrics were identified, which is very interesting information to establish contacts to increase the existing networks, to prevent redundancies, and to take advantage of the new emerging groups. It is necessary to promote the collaboration of Spanish researchers, especially with their international colleagues, since a positive relationship is found between international collaboration and quality and impact of publications measured by citation analysis., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L. All rights reserved.)

Introduction: The distribution of chronic obstructive pulmonary disease (COPD) in women, and its underdiagnosis and determinants in the general population, have not been well described. The EPI-SCAN study is an epidemiologic, observational study conducted at 11 Spanish centers on the general population aged 40 to 80., Patients and Method: This paper describes the rates and extrapolates the population burden from the 3,802 participants of the EPI-SCAN study., Results: With 2,005 female and 1,797 male participants, there was a lower prevalence of COPD in women (5.7%; 95%CI, 4.7-6.7) than in men (15.1%; 95%CI, 13.5-16.8; P<.05). Among the 386 participants with COPD, 114 (29.5%) were women, who were younger, currently smoked less and had lower tobacco smoke exposure, while reporting a lower level of education (P<.05). As for the respiratory symptoms, there were no differences between sexes for cough, dyspnea or wheezing, but the women with COPD reported sputum less frequently (P<.05). There were no differences in the spirometric severity of COPD between women and men. Overall, 73% of the patients with a spirometric COPD criteria were underdiagnosed, and this percentage is unevenly distributed by sex, being 1.27 times more frequent in women (86.0%) than in men (67.6%) (P<.05). By extrapolating the rates of prevalence and underdiagnosis of COPD to the general population, we estimate that there are 628,102 Spanish women between the ages of 40 and 80 with COPD, 540,168 of whom still have not been diagnosed., Conclusions: There is a greater underdiagnosis of COPD in women than in men in Spain., (Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.)

Background and Objective: Lung transplantation (LT) in chronic obstructive pulmonary disease (COPD) is a procedure with a high rate of morbimortality. The aim of this paper is to analyze the early and late rates of complications and mortality in COPD patients undergoing LT., Patients and Method: Retrospective study of 107 COPD patients transplanted in the Hospital Universitario La Fe, between 1991 and 2008. Preoperative variables were collected as well as all the complications, medical and surgical, occurred in the follow-up, which are expressed as mean or percentage as appropriate. The 30-day mortality and long term survival were established., Results: A total of 94 men (87.9%) and 13 women (12.1%) were transplanted with a mean age (SD) of 52.58 (8.05) years with 71% of double-lung LT. BODE score was 7.24 (1.28). The rate of primary graft dysfunction was 39.3%. The most common surgical complications were phrenic paralysis (16.8%), hemothorax (17.8%) and pleural effusion (30.8%). There was a high number of postoperative hospitalization (30%) and medical complications such as hypertension (36%), diabetes mellitus (16.7%) and renal failure (40%), secondary to treatment. Perioperative mortality was 14% and 34.5% after a year, being the most frequent causes infections (34.6%) and chronic rejection (BOS) (17.8%). Five-year survival was 40.9% with bronchiectasis and smoking history being the risk factors., Conclusions: LT is a procedure with a high early mortality rate associated with high medical and surgical complications that affect the outcome., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objective: The objectives of this paper are to analyze the Spanish scientific production in nursing, define its temporal evolution, its geographical and institutional distribution, and observe the interinstitutional collaboration., Method: We analyze a comprehensive sample of Spanish scientific production in the nursing area extracted from the multidisciplinary database SciVerse Scopus., Results: The nursing scientific production grows along time. The collaboration rate is 3.7 authors per paper and 61% of the authors only publish one paper. Barcelona and Madrid are the provinces with highest number of authors. Most belong to the hospitalary environment, followed closely by authors belonging to the university. The most institutions that collaborate, sharing authorship of articles are: University of Barcelona, Autonomous University of Barcelona and Clinic Hospital of Barcelona., Discussion: The nursing scientific production has been increasing since her incorporation at the university. The collaboration rate found is higher than found for other papers. It shows a low decrease of occasional authors. It discusses the outlook of scientific collaboration in nursing in Spain, at the level of institutions by co-authorship of papers, through a network graph. It observes their distribution, importance and interactions or lack thereof., Conclusions: There is a strong need to use international databases for research, care and teaching, in addition to the national specialized information resources. Professionals are encouraged to normalization of the paper's signature, both, surnames and institutions to which they belong. It confirms the limited cooperation with foreign institutions, although there is an increasing trend of collaboration between Spanish authors in this discipline. It is observed, clearly defined three interinstitutional collaboration patterns., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Aims: To quantify by means of bibliometric indicators the scientific productivity of Spanish researchers and institutions that publish on multiple sclerosis in national and international journals during the period 1996-2010, and to determine their impact., Materials and Methods: Papers under study were obtained from Web of Science and Scopus international databases, as well as IBECS and IME national databases, applying specific search profiles in each., Results: 1613 articles were published in 460 journals, of which 71 were Spanish and 389 non Spanish, being the most productive Revista de Neurologia (n = 204), Multiple Sclerosis (n = 102) and Neurology (n = 97). The articles have been published mostly in English (71.92%) and Spanish (27.40%), participating 4728 authors from 1224 different institutions. The 67.08% of the papers have been cited at least once, but 32.92% have not received citations. The mean number of citations per paper was 12.47 ± 28.42. The most cited journals have been Neurology (n = 1821), followed by Multiple Sclerosis (n = 1124) and Journal of Neuroimmunology (n = 890)., Conclusions: The number of papers has increased steadily from 1996 to 2010, confirming the consolidation and growth of Spanish research in multiple sclerosis, whose results are published in a Revista de Neurologia and Multiple Sclerosis. We emphasize the growing internationalization of the Spanish research on the disease, but it is worrying that a third of the papers has not been cited.

Background: Mother-to-child transmission (MTCT) during pregnancy, delivery or breastfeeding, is the main route of HIV infection in children. Strategies aimed at promoting the health of HIV infected pregnant women and MTCT prevention have reduced transmission to below 2%. This paper presents the clinical and epidemiological features of a cohort from Madrid and compares foreign-born with Spanish-born women., Method: Retrospective, observational and descriptive study on HIV infected pregnant women from South Madrid (n=70) and their offspring (n=78) who were born during the study period from August 1992 to January 2010., Results: Most pregnant women were infected by heterosexual transmission (51%). Most Spanish-born women (66%) were diagnosed before pregnancy (81%), while foreign-born women (34%) were diagnosed during pregnancy (70%). Foreign-born women had less obstetric check-ups (67%) than Spanish-born women (97%). The MTCT rate was 1.3% during the last ten years., Conclusions: Heterosexual transmission is the primary mode of acquisition of HIV infection both for Spanish-born and foreign-born pregnant women. However, the HIV infection was diagnosed earlier in Spanish-born women. There were no differences in the effectiveness of antiretroviral therapy as a preventive measure against MTCT when it is started at an early stage., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs., (Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.)

Objective: This paper sets out to analyze the dissemination and impact of Spanish research published in international scientific journals on Prison Health over the last decade., Material and Methods: Descriptive, longitudinal and retrospective analysis of scientific output. We used the Medline-Pubmed database as an information resource. We focus on the bibliometric aspects of journals, papers and authors using the indicators offered by the Web of Science, the Journal Citation Reports and the Essential Science Indicators. We identify the output of Spanish researchers, journals in which they are published, authors and main research fields., Results: From 2002 to 2011, Spanish researchers published 159 papers, that is, nearly 2% of the world's share in Prison Health. The publication profile is mainly in international journals with an average impact on JCR. The Revista Española de Sanidad Penitenciaria is the most productive journal (9.09%), although its role is not prominent. Only two authors can be considered as medium-high productive authors with 10 papers in the study time period. The co-authors network shows a dense network with 14 authors along with minor fragmented networks. As regards citations, 6 papers have been cited 15 or more times and only two can be considered as highly cited. Three main research fronts have been identified: infectious diseases, drugs and psychiatric-psychological problems., Conclusions: The Spanish research production on Prison Health represents a similar share of the world output similar to that of other disciplines (1.9%), although slightly lower (General Medicine represents 3.05%; Public Health, 2.38%; Psychiatry, 2.29%; Toxicology, 2.46%). It seems likely that this share will increase as a result of the inclusion of its main journal in Medline along with an increasing number of researchers working on this discipline at an international level. However, inclusion has not yet led to integration into high-impact journals or a larger number of citations. The average Journal Impact Factor is relatively low (2.062) and few papers are published in first-class journals (Q1). There are few articles with a good citation average according to the discipline's standard. Likewise, the collaboration pattern still shows a poor state for Spanish research on Prison Health.