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The digital development of this century is transforming our society and, in parallel, the knowledge society. These new transmission platforms represent a different way of understanding the process of transmitting and receiving knowledge. The Wiki space is increasingly established in virtual higher education classrooms. The objective of this work was to implement the use of the Wiki space in the conventional teaching methodology of university studies and assess the degree of satisfaction of the student and its adequacy in the teaching process. A survey of 22 items was carried out to assess the opinion of 174 students regarding the use and capabilities of the Wiki tool. Our results show that 98.2% rated the use of Wiki space positively. 83.3% of the students were able to promote self-learning, and 73.0% considered this a helpful resource to promote the teaching-learning process. 65.2% considered that the use of ICTs in higher education should be increased. In conclusion, the use of Wiki in the higher education teaching classroom has gained significant acceptance by students who consider it an innovative experience that favors learning and the critical search for information, increasing the motivation for the subject. ABSTRACT The digital development of this century is transforming our society and, in parallel, the knowledge society. These new transmission platforms represent a different way of understanding the process of transmitting and receiving knowledge. The Wiki space is increasingly established in virtual higher education classrooms. The objective of this work was to implement the use of the Wiki space in the conventional teaching methodology of university studies and assess the degree of satisfaction of the student and its adequacy in the teaching process. A survey of 22 items was carried out to assess the opinion of 174 students regarding the use and capabilities of the Wiki tool. Our results show that 98.2% rated the use of Wiki space positively. 83.3% of the students were able to promote self-learning, and 73.0% considered this a helpful resource to promote the teaching-learning process. 65.2% considered that the use of ICTs in higher education should be increased. In conclusion, the use of Wiki in the higher education teaching classroom has gained significant acceptance by students who consider it an innovative experience that favors learning and the critical search for information, increasing the motivation for the subject.

Most immune system polymorphisms have undergone molecular evolution largely due to natural selection driven primarily by host-pathogen interactions, showing significant human geographic expansion s...

Introduction The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC = .70; CI = .60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC = .78, CI = .67). Conclusions The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus.

School violence is a social issue of particular interest both for intervention and research. Attitudes towards violence have been reported in the literature as relevant variables for evaluation, prevention, and intervention in this field. This study aims to examine in-depth attitudes toward school violence. The sample consists of 96 participants from Spanish Elementary Education and Compulsory Secondary Education schools. A qualitative study was conducted through focus groups and thematic analysis of the data. The results identify a habitual set of attitudes towards violence in children. These are related to violence as a way to feel better or increase self-esteem, as leisure or fun, perceived as legitimate, when violence is exercised against those who are different, when it has no consequences, to resolve conflicts, to socialize, and to attract the attention of peers. These results could serve as a basis for the creation of evaluation tools, as well as the design of prevention and intervention plans based on attitude modification.

Background In accordance with parental legal duties, parents and guardians should be informed about health issues relevant to child health. Current Spanish legislation acknowledges autonomy from 16 years or emancipated minors. This study analyses the information given to the parents or legal guardians of minors over 14 years of age attending a tertiary-level general hospital emergency department on psychoactive substance intoxication (alcohol, cannabis, benzodiazepines). Material and methods The medical records of minors treated in the emergency department of a tertiary-level hospital, between 2016 and 2017, were reviewed. A survey of medical and nursing professionals from the emergency services was also conducted. Results Of the medical records that mentioned that the minor attended the emergency department with friends (11.5%), 5 (9.6%) did not specify if the parents or guardians were called. Of the 26 medical records (50%) in which there was no mention of whether if the minor attended alone or accompanied, 22 (42.3%) made no mention of informing parents. The study data show that 28 of the 35 respondents (80%) always notified if the minor had not been accompanied to the emergency department by a parent or guardian. Conclusions There is lack of information relating to informing parents/guardians, as well as a discrepancy between the data provided by health professionals and the medical reports analysed.

Resumen Introduccion El cumplimiento de los deberes de la patria potestad exige a los padres y/o tutores estar informados de aquellos aspectos relevantes relacionados con la salud del menor. La legislacion actual reconoce la autonomia a partir de los 16 anos o menores emancipados. En este trabajo se analiza la informacion que reciben los padres o tutores legales de los menores mayores de 14 anos que acuden a un servicio de urgencias hospitalario general de tercer nivel por intoxicacion aguda por alcohol y otras drogas de abuso incluidos medicamentos como las benzodiacepinas si se consumen con fines recreativos. Material y metodos Se revisaron las historias clinicas de los menores atendidos en el servicio de urgencias de un hospital de tercer nivel durante los anos 2016 y 2017 para conocer la informacion referida a los padres y se entrevisto a los medicos y enfermeros de dicho servicio para conocer la informacion que daban a los padres/tutores. Resultados En las historias clinicas en las que se citaba que el menor iba acompanado por amigos (11,5%), 5 de ellas (9,6%) no especificaban si se habia realizado el aviso a padres/tutores. De las 26 historias clinicas (50%) en las que no habia especificacion del acompanamiento, en 22 (42,3%) tampoco existia especificacion del aviso. Mientras que 28 de los 35 encuestados (80%) afirma avisar siempre que el menor no hubiera ido acompanado por sus padres o tutores. Conclusiones Se pone de manifiesto la existencia de una falta de informacion de tipo asistencial relativa al aviso a padres/tutores, asi como una discrepancia entre los datos proporcionados por los medicos y enfermeros y los obtenidos en las historias clinicas.

The information received by patients about the severity of their condition, the type of tests to be performed, or the average waiting time in the service are factors that influence their degree of satisfaction and, therefore, their possible anger and/or aggressiveness. Users' discomfort can sometimes lead to violence towards health workers, and this, in turn, can lead to the commonly associated physical and psychological consequences. Our main objective is to explore the relationship between the waiting time, patients' perceived satisfaction with the service, as well as the other variables under study. We used a cross-sectional design was used to evaluate 320 hospital patients in the Region of Murcia (Spain). Our indicate that receiving information about their process, waiting time until the doctor's consultation, the degree of satisfaction with the professional, and the resolution of the doubts are predictors of the degree of overall patient satisfaction with the clinical experience., La información recibida por los pacientes sobre la gravedad de su condición, el tipo de pruebas a realizar o el tiempo promedio de espera en el servicio son factores que influyen en el grado de satisfacción. La incomodidad de los usuarios a veces puede conducir a la violencia hacia los trabajadores de salud, y esto, a su vez, a las consecuencias físicas y psicológicas comúnmente asociadas. Nuestro objetivo es explorar la relación entre el tiempo de espera, la satisfacción del paciente con el servicio y otras variables de interés. Se utilizó un diseño transversal para evaluar a 320 pacientes hospitalarios en la Región de Murcia (España). Los resultados indican que recibir información sobre su proceso, el tiempo de espera hasta la consulta, el grado de satisfacción con el profesional y la resolución de dudas son predictores del grado de satisfacción general del paciente con la experiencia clínica.

Background: Workplace violence is a growing social problem among many professions, but it particularly affects the health sector. Studies have mainly focused on evaluating user violence toward health professionals, with less attention being paid to other sources of conflict, such as co-workers themselves. There are different manifestations of this violence in what has been called a context of tolerated or normalized violence among co-workers. However, its effects are far from being tolerable, as they have an impact on general health and job satisfaction and contribute to burnout among professionals. Based on this idea, and following the line of the previous literature, nursing staff are a population at high risk of exposure to workplace violence. For this reason, the present study aims to evaluate exposure to lateral violence or violence among co-workers in nursing staff in public health services and the relationship of this exposure with some of the most studied consequences. (2) Methods: A cross-sectional associative study was carried out in which scales of workplace violence (HABS-CS), burnout (MBI-GS), job satisfaction (OJS), and general health (GHQ-28) were applied to a sample of 950 nursing staff from 13 public hospitals located in the southeast of Spain. (3) Results: The results show that nursing staff have a high exposure to violence from their co-workers, which is more common in male nurses. Greater exposure is observed in professionals with between 6 and 10 years of experience in the profession, and it is not characteristic of our sample to receive greater violence when they have less experience or are younger. A positive correlation is observed with high levels of burnout and a negative correlation with general health and job satisfaction. (4) Conclusions: The results of this work contribute to increasing the scientific evidence of the consequences of a type of workplace violence frequent among nursing staff and to which less attention has been paid in relative terms to other types of prevalent violence. Organizations should be aware of the importance of this type of workplace violence, its frequency and impact, and implement appropriate prevention policies that include the promotion of a culture that does not reward violence or minimize reporting. A change of mentality in the academic environment is also recommended in order to promote a more adequate training of nursing staff in this field.

Background: Police officers have become an important part of psychiatric patients´ care; however, few studies have assessed the Police´s attitudes toward these patients. Our aim is to analyze the effect of the stigma associated with different mental illnesses on police officers.Methods: the attitudes of 927 officers of the Spanish National Police Force towards a person with schizophrenia or depressive disorder in the role of person in need of assistance, victim, witness, or suspect, were assessed by means of the Attribution Questionnaire adapted to the police context. Different socio-demographic variables were also collected. Results: Police officers expressed more willingness to help, felt more pity and considered psychiatric patients to be less responsible for their situation than people who were not described as being mentally ill. They also showed increased feelings of anger and avoidance, greater danger perception and need for segregation and coercion for medical treatment, especially in schizophrenia. Being a woman, the elderly and having more working experience, are associated with less stigmatizing attitudes among officers. Conclusions: Police officers have certain attitudes about mental illness particularly schizophrenia, that require special attention, as they may disrupt police action. We found several factors associated with the persistence of these stigmatizing attitudes in the Police that can guide us to implement training programs to promote attitude changing especially at the beginning of the professional career.

Objectives The aim of this study was to analyze alcoholic cirrhosis in women who were to undergo liver transplant, including their biochemical and clinical characteristics, main complications, survival rates, and main causes of death compared with men with alcoholic cirrhosis. Materials and methods Our study included 400 patients with alcoholic cirrhosis, which we divided according to sex and viral infections. Biochemical parameters and the presence and degree of ascites and encephalopathy, liver function status, and liver rejection and survival rates were analyzed from 1 to 10 years and the main cause of death at 10 years. Results Patients with nonviral alcoholic cirrhosis and liver transplant had significantly better survival rates (84.1%) at 1 year versus those with viral alcoholic cirrhosis (74.5%; P = .036). Men with nonviral alcoholic cirrhosis (14%) and women with hepatitis C virus (29%) had the lowest short-term survival rates. In long-term survival analysis, the lowest rate was observed in women with nonviral alcoholic cirrhosis (26.1%), and the highest rate was observed in women with hepatitis C virus (42.9%). Liver graft failure was one of the main causes of death in male patients (19.5%). Conclusions Women with alcoholic cirrhosis showed a higher rate of ascites and encephalopathy but lower liver graft rejection than men with alcoholic cirrhosis. Survival rates were similar between men and women, although slightly lower in women who had hepatitis C virus.

Recent studies have confirmed the wide consumption of tobacco and alcohol in our society and the strong addiction generated by these substances, which is responsible for high public health expendit...

Post-mortem biochemistry as a tool for the establishment of post-mortem interval (PMI) and the nature of death is very useful in Legal Medicine. Currently, several matrices are used for these inves...

A method based on gas chromatography–mass spectrometry (GC–MS) is described for the determination of opioids (6-monoacetylmorphine, morphine, methadone and tramadol) and cocaine and its major metabolite in human bone. After the addition of nalorphine as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were subjected to solid phase extraction and the analytes were eluted using 2 ml of dichloromethane/isopropanol/ammonia (78:20:2). Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.3–1 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries ranging from 66% to 110%, the matrix effect from 62% to 121% and process efficiency from 61% to 89% depending on the analyte. The intra- and inter-assay accuracy values were always better than 20%. The validated method was then successfully applied to real bone samples from forensic cases in which toxicological analysis for these drugs in blood was positive. Drugs were detected in bone in 12 of the 15 blood positive results. The approximate concentration range was 3–5 ng/g for 6-monoacetylmorphine, 3–7 ng/g for morphine, 14–28 ng/g for methadone and 6 ng/g and 11 ng/g for tramadol and benzoylecgonine.

Proteomic techniques in bones forensic samples are increasingly, being applied. The main aim of forensic sciences is the estimation of postmortem interval. Most current techniques are useful for the first post-mortem stages. However, in the case of osseous remains, these techniques may be difficult to use due to the high level of decomposition of the sample. Our objective was to attempt to know whether there is a protein profile in human bone remains that would enable a late postmortem. interval ranging from 5 to 20 years postmortem to be estimated. A total of 40 femur bones from 40 different cadavers (data range 5–20 years) were use. Of the 275 total proteins, we excluded the circulating ones (n = 227), leaving a total of 48 proteins (29 structural and 19 functional) were found. A multiple correspondence analysis was applied on the 48 proteins. Finally selecting 32 proteins that allowed us to discriminate between the. two groups of postmortem interval. Analysis of the protein profile present in bone permits an approximation of the date of death within the studied interval, and could be used to complement other tests for estimating the postmortem interval.

Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.

Index de les obres ressenyades: Enrique BELDARRAÍN CHAPLE, Los médicos y los inicios de la antropología en Cuba.

Summary. Since the entomosarcosaprophagous community is affected by environmental variables, it needs to be studied under different environmental conditions. In addition, because most studies are usually conducted with biomodels rather than human corpses, it is necessary to verify whether or not the type of decomposing animal matter affects the decomposition process itself, as well as the related fauna. For this reason, a study was conducted on the sarcosaprophagous Diptera community in two different environments of the Region of Murcia (SE Spain), using piglet and chicken carcasses, and Schoenly traps as collecting devices. To analyse possible differences regarding faunal composition among samples, a one-way Permutational Multivariate Analysis of Variance (PERMANOVA) was applied. The results indicate significant differences concerning the bait. In this sense, Calliphoridae, Muscidae, Fanniidae and Sarcophagidae families are the main groups responsible for such differences. In terms of environment-related differences, the only species that contribute are those of the dominant families, Calliphoridae and Muscidae.

Purpose Surgical management of ankle fractures has been extensively studied in literature but studies investigating validated clinical results are lacking and controversial. The purpose of this study was to evaluate functional and health-related quality of life (HRQL) outcomes after surgically treated ankle fractures and to detect some of their predictors. Methods Two hundred sixty-six skeletally mature patients who underwent surgery for an isolated ankle fracture from 2006 to 2017 were retrospectively identified from our hospital records and included in the study. All patients were evaluated at one, three, six and 12 months post-injury with clinical and radiographic examination. Outcome measures recorded at final two years minimum follow-up included patient-reported pain, patient satisfaction, functional (American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score) and quality of life (Short Form (SF) 36 score) status. Results Patient satisfaction score was 8.4 out of 10, Visual Analogue Scale mean score was 2.3, complication rate was 36.5% and mean AOFAS ankle-hindfoot score was 87.3. Mean SF36-physical summary score was 77.9 and SF36-mental summary score was 81.1. The injury demonstrated a significant effect on physical function, role-physical, bodily pain and social functioning SF-36 subdomains. Functional outcome was significantly related to occupation, syndesmotic lesion, number of fractured malleoli and delay to surgery. Main predictors of quality of life were age, occupation, cause of injury, syndesmotic lesion, number of fractured malleoli and waiting time to surgery. Conclusions Ankle fractures have a considerable impact on functional and quality of life status of patients. Occupation, presence of syndesmotic injury, Pott's classification and surgery delay must be considered as predictors of final outcome.

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never happens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy.