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Methods Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023–2027.Results The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013–2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients’ falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients’ falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data.Conclusions The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023–2027.

El período de transición se define como un proceso activo, planificado y multidisciplinario que abarca distintas necesidades médicas, psicosociales y educativas de la población adolescente con el objetivo de prevenir complicaciones y favorecer la adherencia al tratamiento. El objetivo primordial es entrenar a las adolescencias con diabetes mellitus (DM) para que adquieran la autonomía e independencia necesarias para un adecuado control de su enfermedad. Estas aptitudes no se alcanzan en la mayoría de las personas antes de los 16-18 años. Los programas de educación terapéutica en personas con DM1 en la etapa de la adolescencia tienen por objetivos facilitar el proceso de transición, lograr la autonomía y el empoderamiento con el fin de prevenir riesgos de complicaciones agudas como la cetoacidosis, la depresión y la interacción de la medicación con sustancias como el alcohol, entre otros. La adolescencia es una etapa biológica y social en la cual se producen cambios significativos, a los que se le agrega el paso del equipo de cuidados en salud pediátrico al del adulto. Esta etapa es considerada un momento de grandes desafíos en el cuidado de la DM que debe planificarse y que requiere de la preparación del paciente y su familia. De esta manera, los posibles riesgos podrían superarse unificando criterios entre los servicios pediátricos y los de los adultos. Estas recomendaciones brindan herramientas que sirvan a los profesionales especializados en DM a realizar programas de educación en la transición para reducir el abandono del tratamiento y las complicaciones asociadas en pacientes adolescentes con DM1 durante la transición de equipos pediátricos a equipos de adultos. Para ello, se realizó una búsqueda bibliográfica de las publicaciones en el tema de los últimos 5 años y se seleccionaron las más relevantes. Los distintos artículos sugieren que la transición de la atención pediátrica a la de adultos debe comprender un cronograma de detección de complicaciones, apoyo psicológico, actividades de pares con tiempo acordados, y desaconsejan una transferencia repentina e imprevista. Esto incluye la realización de programas de educación que acompañen esta etapa de vulnerabilidad.

Background This study aimed to evaluate the influence of maternal diabetes in the risk of neurodevelopmental disorders in offspring in the prenatal and postnatal periods. Methods This cohort study included singleton gestational diabetes mellitus (GDM) pregnancies >22 weeks’ gestation with live newborns between 1991 and 2008. The control group was randomly selected and matched (1:2) for maternal age, weeks of gestation and birth year. Cox regression models estimated the effect of GDM on the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and maternal type 2 diabetes mellitus (T2DM). Moreover, interaction between maternal T2DM and GDM-ADHD relationship was evaluated. Results Children (n=3,123) were included (1,073 GDM; 2,050 control group). The median follow-up was 18.2 years (interquartile range, 14.2 to 22.3) (n=323 with ADHD, n=36 with ASD, and n=275 from women who developed T2DM). GDM exposure was associated with ADHD (hazard ratio [HR]crude, 1.67; 95% confidence interval [CI], 1.33 to 2.07) (HRadjusted, 1.64; 95% CI, 1.31 to 2.05). This association remained significant regardless of the treatment (diet or insulin) and diagnosis after 26 weeks of gestation. Children of mothers who developed T2DM presented higher rates of ADHD (14.2 vs. 10%, P=0.029). However, no interaction was found when T2DM was included in the GDM and ADHD models (P>0.05). GDM was not associated with an increased risk of ASD (HRadjusted, 1.46; 95% CI, 0.74 to 2.84). Conclusion Prenatal exposure to GDM increases the risk of ADHD in offspring, regardless of GDM treatment complexity. However, postnatal exposure to maternal T2DM was not related to the development of ADHD.

Background The management of liver transplantation has become a complex process involving different healthcare professionals. Teamwork, standardisation and definition of the best practices are essential for success, patient satisfaction and society’s favourable perception of transplantation programmes.ISO 9001:2015 certification provides the necessary elements to help implement a quality management system (QMS) to ensure that patient care is performed with the highest guarantees of clinical quality and safety. The aim of this study is to describe the steps, strengths and limitations in the implementation of a QMS in a liver transplant programme (LTP).Project management method This included analysing the starting point, setting up a working group, training, defining the scope of certification, preparing documentation, and conducting an internal and external audit, which culminated in the ISO 9001 quality certification award. The scope of QMS includes all the processes of LTP, from referral of candidates to long-term follow-up after transplantation.Results The project was structured in seven phases that took place between 2008 and 2011. The implementation of QMS led to the generation of all the necessary documentation to meet the requirements of the standard, including internal and legal requirements related to the transplant activity. The establishment of indicators to measure the effectiveness of processes, risk management and the identification of incidents allows us to implement measures devoted to avoiding the deficiencies and to meet the established objectives.Conclusion ISO 9001:2015 certification has contributed to the adaptation of a new quality and safety culture focused on the patient. All activities are protocolised, everything is recorded, measured, and verified, and all steps are taken as planned. Work is carried out in terms of continuous improvement. This has led to less variability in daily clinical practice and a better understanding of work dynamics.

Type 2 diabetes (T2D) is a major cardiovascular risk factor (CVRF). Diabetes confers two to four times more cardiovascular risk (CVR). The risk is even higher in patients with T2D who have suffered an acute myocardial infarction (AMI) or cerebrovascular accident (CVA). The dyslipidemia of T2D consists of high fasting triglycerides, with greater postprandial excursion, low levels of HDLc and qualitative alterations of LDLc and HDLc. Appropriate glycemic control in T2D greatly improves lipoprotein abnormalities. Lipid-lowering therapy is key to reducing CVR in T2D. The CVR reduction achieved with statins is based on the reduction of LDLc. In patients who persist with an altered lipid profile despite high- dose statins, the addition of other lipid-lowering agents to reduce atherogenic lipoproteins may be considered.

La demencia es un problema de salud pública que actualmente afecta a 50 millones de personas en todo el mundo. La causa más frecuente (70% de los casos) y conocida es la enfermedad de Alzheimer, pero existen otras enfermedades neurológicas que pueden producir demencia. En 2021, la ikastola Jaso de Pamplona puso en escena un musical sobre la enfermedad de Alzheimer, sobre cómo afecta al personaje principal de la obra y cómo lo estigmatiza, exponiendo, además, diversas circunstancias que se dan en el día a día de las personas que sufren de una u otra forma las consecuencias de esta trágica enfermedad. Se trata de una historia en la que todos somos protagonistas y responsables, pues puede afectar a uno de los nuestros e incluso a nosotros mismos. Este artículo versa sobre Ximur, un musical escolar en euskera sobre la enfermedad de Alzheimer, cómo se llegó hasta aquí, cómo se hizo y el proyecto didáctico sobre prevención de las demencias para ikastolas y colegios que le acompañó.

Abstract Patients with liver diseases are at high risk for the development of acute respiratory distress syndrome (ARDS). The liver is an important organ that regulates a complex network of mediators and modulates organ interactions during inflammatory disorders. Liver function is increasingly recognized as a critical determinant of the pathogenesis and resolution of ARDS, significantly influencing the prognosis of these patients. The liver plays a central role in the synthesis of proteins, metabolism of toxins and drugs, and in the modulation of immunity and host defense. However, the tools for assessing liver function are limited in the clinical setting, and patients with liver diseases are frequently excluded from clinical studies of ARDS. Therefore, the mechanisms by which the liver participates in the pathogenesis of acute lung injury are not totally understood. Several functions of the liver, including endotoxin and bacterial clearance, release and clearance of pro-inflammatory cytokines and eicosanoids, and synthesis of acute-phase proteins can modulate lung injury in the setting of sepsis and other severe inflammatory diseases. In this review, we summarized clinical and experimental support for the notion that the liver critically regulates systemic and pulmonary responses following inflammatory insults. Although promoting inflammation can be detrimental in the context of acute lung injury, the liver response to an inflammatory insult is also pro-defense and pro-survival. A better understanding of the liver–lung axis will provide valuable insights into new diagnostic targets and therapeutic strategies for clinical intervention in patients with or at risk for ARDS.

Aims: Analize the value given by physicians to the hemoglobin A1C (A1C) as a diagnosis tool and follow-up in type 2 Diabetes patients and their cut point levels for diagnosis and therapeutic targets according medical speciality. Methods: A self-administered survey was conducted including physicians who attended at the Argentine Diabetes Congress (2010). They were grouped by speciality: Nutrition, Diabetologists, Endocrinologists, Internal Medicine, Generalists Physician and other. Statistical analysis: descriptive statistics, Chi2 test, ANOVA (Student-Newman-Keuls post hoc). Software: MedCalc 2009. Results: 743 surveys, mean age 43,3+10,4 years. 69,3% female. A 32,9% of the surveyed physicians did not consider A1c useful for diagnostic purposes. The mean A1C cut point for diagnosis was 6,56 + 0,42%.; 25% of the surveyed considered A1C >7 as value for diagnosis. Objective treatment A1C 6,7 ± 0,43%, with no differences by group p = 0,79. The 72,5% said greater flexibility in target value in the elderly, CVD risk and hypoglycemia. The 87,9% A1C considered valuable to assess cardiovascular risk.

Temporomandibular disorders are a common pathology affecting up to 70% of the population, with a maximum incidence in young patients. We used a sample of twenty patients recruited in the Maxillofacial Surgery Service of the University Hospital of Salamanca (Spain), who met the inclusion criteria, with unilateral painful symptomatology of more than three months’ duration. All patients were randomly treated by intramuscular and intra-articular injections of botulinum toxin (100 U) in eight predetermined points. Pain symptomatology was assessed by the visual analog scale (VAS) at the different locations, together with joint symptomatology, at baseline and six weeks after treatment. Adverse effects were also evaluated. In 85% of the patients, pain upon oral opening improved and 90% showed improvement in pain upon mastication. A total of 75% of the patients reported improvement in joint clicking/noise. Headaches improved or disappeared in 70% of the patients treated. Despite the limitations of the study and the preliminary results, intramuscular and intra-articular infiltrations with botulinum toxin were effective in the treatment of symptoms associated with temporomandibular disorders (TMDs), with minimal adverse effects.

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson’s disease patients (Parkinson’s Holter). The effectiveness of these monitoring devices for improving clinical control is not known.Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson’s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months.The primary outcome is the efficiency of the Parkinson’s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor–patient contacts will be analysed. The noninferiority of the Parkinson’s Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective.Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson’s Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Trial registration NCT04176302; https://clinicaltrials.gov/show/NCT04176302

Purpose: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the ‘absolute diagnostic reliability’ of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. Methods: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the ‘absolute reliability’ criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel’s classification systems. Results: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer’s classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer’s classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. Conclusion: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

In the parameter estimation of limit extreme value distributions, most employed methods only use some of the available data. Using the peaks-over-threshold method for Generalized Pareto Distribution (GPD), only the observations above a certain threshold are considered; therefore, a big amount of information is wasted. The aim of this work is to make the most of the information provided by the observations in order to improve the accuracy of Bayesian parameter estimation. We present two new Bayesian methods to estimate the parameters of the GPD, taking into account the whole data set from the baseline distribution and the existing relations between the baseline and the limit GPD parameters in order to define highly informative priors. We make a comparison between the Bayesian Metropolis–Hastings algorithm with data over the threshold and the new methods when the baseline distribution is a stable distribution, whose properties assure we can reduce the problem to study standard distributions and also allow us to propose new estimators for the parameters of the tail distribution. Specifically, three cases of stable distributions were considered: Normal, Lévy and Cauchy distributions, as main examples of the different behaviors of the tails of a distribution. Nevertheless, the methods would be applicable to many other baseline distributions through finding relations between baseline and GPD parameters via studies of simulations. To illustrate this situation, we study the application of the methods with real data of air pollution in Badajoz (Spain), whose baseline distribution fits a Gamma, and show that the baseline methods improve estimates compared to the Bayesian Metropolis–Hastings algorithm.

A pesar de las rotundas recomendaciones a favor de la medicina china por parte de la Organización Mundial de la Salud desde 1979, nos enfrentamos a uno de los momentos en los que se pone en tela de juicio con mayor severidad las herramientas terapéuticas de la medicina china y todo su cuerpo de conocimiento. Realizando una breve comparación del recorrido histórico al que han sido sometidas tanto la medicina occidental como la medicina china, y el análisis de la situación actual de la medicina china en los sistemas de salud de China y otros países asiáticos así como en occidente, se pretende establecer una observación en las diferencias del desarrollo del conocimiento que han dado lugar a enfoques tan dispares. Los intentos de acercamiento de dichos enfoques en la actualidad desde la hegemonía de uno de los puntos de vista sobre el otro, son pretexto de discordia y lucha, en lugar de constituir los horizontes del nuevo reto en términos de ampliación de los propios límites de la ciencia llamada a su evolución.

The purpose of this paper is to shed light on the effect of corporate social responsibility performance on earnings management. We also examine the moderating role of family ownership on the association between earnings management and socially responsible performance. Based on an international sample of 6,442 firm-year observations from 2006 to 2014, we use several validated analysis and panel-data regression models. We find that social and environmental performance is positively related with earnings management; firms with a greater socially responsible performance show a higher discretionary behavior by promoting actions that mask the real financial and economic performance of the firm. However, we find that this positive relation is lower – moderated - in family-owned firms, mainly because of the fact that family firms show a greater socially responsible behavior aimed to preserve their socioemotional endowments and are negatively associated with earnings management practices.

Introduction: arterial hypertension (AH) and diabetes mellitus (DM) are diseases of high prevalence which are frequently associated. Objective: to provide useful information and relevant knowledge to support clinical practices that aim at optimizing the diagnosis and offering appropriate therapeutic decisions. Methodology: these Guidelines for Clinical Practice were created based on the evidence available, large clinical trials published in the last years and adapted diagnostic and therapeutic resources in our country, The outcomes of our effort resulted in a set of recommendations, focusing on special situations such as pregnancy, childhood, the elderly, and chronic complications.

6 voices in 10 minutes: Experiences in education in Argentina Strategies of Group Therapeutic Education The therapeutic education in Diabetes is an intervention that involves active participation of the patient in self-control and decision making with the acquisition of knowledge and skills. For the learning process, it is necessary to take educational, psychological and behavioral interventions, with a variety of learning methods. Group education favors the interchange of experiences, emulation, interaction, coexistence between peers. It stimulates the learning processes and it must include the resolution to problematic situations and stress and anxiety management. It generates an exponential learning. The educator must establish a relationship based on trust and collaboration, identify strategies to help modify habits, and prevent complications. Most of the international guidelines recommend group therapeutic education with an individual complement. It is also important to incorporate ICT tools (Information Communication Technology) such as monitoring and self-care strategies through email, WhatsApp and educational videos, among others.

Introduction: Insulin therapy is an effective tool to achieve the glycemic goal (A1c). The percentage of people with T2D treated with insulin and the regimens used vary by country. Aim: To identify the frequency, types and schemes of insulin therapy in the treatment of type 2 diabetes in Argentina. Material and methods: Descriptive, observational cross-sectional study in people with T2D in 28 centers treated by specialists in Argentina (FRADYC III Group) year 2018. It was evaluated: clinical examination, laboratory and treatment in routine practice. Univariate analysis and multiple logistic regression were performed, any value of p

Introduction: Glycemic goal achievement is a matter of great health impact. Adequate glycemic control prevents and decreases diabetes chronic complications and prolongs survival. Aims: To investigate the percentage of people with Type 2 Diabetes (T2D) who reach the treatment goal (A1c) and the variables associated with achieving the glycemic goal. Material and methods: Multicenter, descriptive, observational cross-sectional study in 28 centers specialized in Diabetes in Argentina (FRADYC III Group), year 2018. Physical examination, laboratory and treatment of T2D were evaluated in routine practice. The glycemic goal was A1c < 7%. We evaluated adherence to pharmacological treatment with the Morisky-Green-Levine test and quality of life with the WHO-5 test, considering a low well-being score of less than 50 and symptoms of depression less than 28. Univariate analysis and multiple logistic regression of factors associated with lower achievement of treatment goals were performed. We considered age groups (under 50 ys, between 50 to 65 ys and over 65 ys). Any value of p< 0.05 (2 tails) was considered significant with the STATA Intercooler Software.

Introduction: arterial hypertension (AH) and diabetes mellitus (DM) are chronic medical conditions of high prevalence, which are often associated. Conclusions: AH increases the progression and development of chronic micro and macro vascular complications related to DM. The impact of Hypertension treatment is highly significant in reducing morbidity and mortality in people with diabetes mellitus. Therefore, proper early treatment and therapeutic target goals should be individualized according to age group, comorbidities, and target organ damage. The goal is to achieve Blood Pressure (BP)

Los murciélagos hematófagos se distribuyen en Latinoamérica, desde México hasta el norte de Argentina (Greenhall et al. 1983, Greenhall et al. 1984, Greenhall & Schutt 1996). Estos murciélagos contribuyen a regular las poblaciones de fauna silvestre de las que se alimentan (González Christen 2003). Las especies Diphylla ecaudata y Diaemus youngi también contribuyen en el mantenimiento de la salud de las poblaciones ya que solo atacan individuos débiles o enfermos (Horváth 2010). De las tres especies (D. ecaudata, D. youngi y Desmodus rotundus) que se distribuyen en México, D. rotundus es la más común y la que se alimenta de diversas especies de mamíferos silvestres, así como de ungulados domésticos (Johnson et al. 2014).

This article proposes a narratological approach to the issue of violence in the relationships between men and women in María de Zayas and Alonso de Castillo Solorzano’s short stories. The study of the narrative frame, of the spatio-temporal framework, of the characters, the reasons, the manifestations and the writing of violence point to the same conclusion: the purpose of defending women in Zayas and the search of variety in the service of entertainment in Castillo Solórzano.

Objectives: to analyze therapeutic modalities in T1DM and its relation to glycemic control. Results: 514 patients were evaluated, aged 40,6±14,6 years, 55,1% female, and duration of DM1 17,4±12,0 years, mean A1C was 8,0±1,5%, mean fasting blood sugar 147,2±69,1 mg/dL, and self-monitoring frequency 3,3±1,5 times a day. A1c was

In order to reinforce and develop the skills of the postgraduate students in the so-called “Energy from Biomass” subject within the European Masters in Renewable Energies, the BERA Group (Biomass, Evaluation, Resources and Use) of the CIRCE Research Institute (Centre for the Research of Energy Resources and Consumptions) carries out a series of practical sessions oriented to motivate and orientate the student in the execution of group work and presentations in a limited period of time. In this manner, the students must face similar situations to the ones that they would confront during the carrying out of real projects in the field of Renewable Energies in a business and/or research environment. The different teaching sessions analyzed in the present paper are oriented to achieve a main objective which is to consolidate the acquired knowledge in the theoretical sessions, as well as attaining a not less important objective: joining different disciplines of Engineering and Economy, which is very advisable due to the diversity of the students in the Master. This paper presents the basis for the session preparation, their desired objectives and the conclusions obtained by the teaching staff after their implementation.

Introduction: the high prevalence of cardiovascular diseases in the modern society brings a high prescription of platelet antiaggregation and anticoagulant medications. These treatments have been related to an increased incidence of upper gastrointestinal bleedings (UGB). Our aim was to estimate the fraction of UGB's presented to our hospital that was related to this kind of treatments and describe their clinical features in our environment. Material and methods: a retrospective search was performed in the archives of our hospital of all the patients with diagnosis of UGB admitted during the period 2004-2007 both years inclusive. Patients on antiplatelet and/or anticoagulant treatment were included. We analyzed the information regarding the use of medication, the bleeding lesion, the severity of the bleeding, recurrences, mortality and their clinical features. Results: we found 523 episodes of UGB. Of these 137 (26.1%) were patients receiving platelet antiaggregation or anticoagulant drugs. The patients were male 60.2%, and had a mean age of 75.6 (± 10.8) years. The 65.5% (74) had HBP, 43.4% (49) diabetes mellitus and 37.2% (42) dislypemia and 13.3% (22) dementia. The drug most frequently implicated was ASA in 36.3% (41), followed by acenocumarol in 27.4% (31), clopidogrel 18.6% (21), double therapy (ASA + clopidogrel) in 6.2% (7), triple therapy (ASA + clopidogrel + acenocumarol) in 0.9% (1), triflusal 4.4% (5), low molecular weight heparin 5.3% (5), and ticlopidine in one patient (0.9%). Only 36.3% (41) were on treatment with proton pump inhibitors. There were 24 recurrences and 4 deaths. Conclusions: the 26.1% of the UGB attended in our environment were of iatrogenic origin. We also found a low use of proton pump inhibitors.Introducción: la alta prevalencia de la patología cardiovascular en las sociedades modernas conlleva una elevada prescripción y uso de medicamentos antiagregantes y anticoagulantes. Estos tratamientos se han relacionado con un aumento de la incidencia de hemorragias digestivas altas (HDA). Nuestro objetivo fue evaluar la proporción de HDA relacionadas con tratamientos antiagregantes o anticoagulantes y describir las características clínicas de estos pacientes en nuestro medio. Material y métodos: se realizó una búsqueda retrospectiva en los archivos de nuestro hospital de todos aquellos pacientes con diagnóstico de hemorragia digestiva alta, ingresados en el periodo 01/01/2004-31/12/2007. Incluimos los pacientes en tratamiento con antiagregantes y/o anticoagulantes. Analizamos la información referente a los fármacos que tomaban, la lesión sangrante subyacente, la gravedad de la hemorragia, las recidivas, la mortalidad y las características clínicas. Resultados: se recogieron 523 episodios de HDA, de los cuales 137 (26,1%) eran pacientes en tratamiento antiagregante y/o anticoagulante. Los pacientes incluidos eran hombres en el 60,2% de los casos y tenían una media de edad de 75,6 (±10,8) años. El 65,5% (74) de ellos presentaba HTA, el 43,4% (49) diabetes mellitus (DM) tipo 2, el 37,2% (42) dislipemia y el 13,3% (15) demencia. El fármaco más frecuentemente implicado fue el ácido acetilsalicílico en el 36,3% (41), seguido del acenocumarol en el 27,4% (31), el clopidogrel en el 18,6% (21), doble antiagregación (AAS + clopidogrel) en 6,2% (7), triple terapia (AAS + clopidogrel + acenocumarol) en 1 (0,9%), triflusal en el 4,4% (5), heparinas de bajo peso molecular en el 5,3% (6) y ticlopidina en un paciente (0,9%). Únicamente el 36,3% (41) recibían tratamiento con inhibidores de la bomba de protones. Hubo un total de 24 recidivas y 4 muertes. Conclusiones: el 26,1% de las hemorragias digestivas altas atendidas en nuestro medio son de origen iatrogénico. Llama la atención el bajo grado de gastroprotección.

Fundamento: En abril del año 2009 la Organización Mundial de la Salud declaró una Emergencia de Salud Pública de Importancia Internacional por la aparición de casos en humanos por un nuevo virus de la gripe A H1N1. El objetivo de este trabajo es analizar las características de los casos investigados y valorar la conformidad de los sujetos estudiados con las indicaciones y recomendaciones de la Consejería de Sanidad de Castilla y León. Métodos: Estudio epidemiológico descriptivo del total de las peticiones de laboratorio solicitadas en Castilla y León, entre las semanas epidemiológicas 44 y 50, ambas inclusive y de los casos que resultaron positivos. Resultados: Se solicitaron 588 peticiones analíticas para gripe A H1N1 (58% hombres). La edad media fue de 34,8 años (27,1% entre 15 y 44 años) y la enfermedad respiratoria crónica el factor de riesgo más frecuente (18,9%). En el 19,1% se instauró tratamiento antiviral (54,5% en las primeras 48 horas). El 42% de las peticiones cumplían criterios de gravedad y el 27,4% de las peticiones fueron positivas (53,4% varones). La edad media en las peticiones positivas fue 34,52 años (33,1% entre 15 y 44 años). En el 26,7% el factor de riesgo más frecuente fue la enfermedad respiratoria crónica, el 6,8% tenía obesidad mórbida. El 28,9% de los sujetos que dieron positivo recibió tratamiento antiviral (61,4% en las primeras 48 horas) y el 47,8% cumplían criterios de gravedad. Conclusión: La mayoría de los casos estudiados no cumplían criterios de gravedad, lo que pone de manifiesto el bajo cumplimiento de los protocolos de vigilancia en el ámbito asistencial.

Size fractionated mesozooplankton biomass, abundance and copepod grazing were investigated over an annual cycle (1998) at two stations off Cudillero (central Cantabrian Sea). Mesozooplankton biomass was higher in summer/early autumn, reaching ~3000 mg dw m-2 in September. Copepods were the most abundant taxonomic group, representing 91 and 81% of the total mesozooplankton abundance in the coastal and shelf-break station respectively. Copepod gut contents were higher in summer at the coastal station, while the shelf-break station showed maximum gut contents in April. Gut contents were linearly related to integrated chlorophyll, except in the case of large animals at the shelf break station. Copepod community carbon ingestion was higher from June to September at both stations, reaching a maximum value of ~165 mg C m-2 day-1. Calculated grazing rates translates into an average daily consumption values of 8.7% (coast) and 5.25% (shelf-break) of total chlorophyll stock, or 20% (shelf-break) of total primary production.

La literatura jurídica es una de las áreas más descuidadas en los estudios bibliométricos tanto españoles como internacionales. En este contexto, el objetivo general de la presente nota es contribuir a la comprobación de la utilidad de las bases de datos nacionales para recuperar y obtener una visión de conjunto de la bibliografía jurídica publicada en revistas españolas. Se han recuperado 447 trabajos sobre negociación colectiva y cuestiones afines publicados antes de 1995 e incluidos en la base de datos ISOC. Con un fichero informático de dichos trabajos, se ha realizado un acercamiento bibliométrico relativo a su distribución por años, número de firmas por trabajo, instituciones de procedencia, revistas y temas específicos. Se incluyen también, como caso concreto, distribuciones de las publicaciones utilizadas en un trabajo de investigación sobre un aspecto específico de la negociación colectiva. Los resultados permiten concluir la utilidad del recurso a las bases de dato s nacionales por dos razones: 1) la recuperación sistemática de la bibliografía jurídica, de carácter distinto y, como mínimo, complementaria a la obtenida mediante los procedimientos tradicionales; 2) el acercamiento bibliométrico proporciona una visión de conjunto sobre aspectos de interés para desarrollar la investigación sobre un tema jurídico determinado.