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Objectives: To evaluate the impact of a mentoring programme for medical students doing a palliative care rotation, aimed at improving coping with death and attitudes towards the suffering produced by illness. Methods: A quasi-experimental study without a control group was carried out on second-year medical students. Five 1-h group sessions were conducted. Attitudes towards grief and coping with death were assessed before the mentoring programme began and afterwards, using the Brief Humanizar Scale and the Bugen's Coping with Death Scale, respectively. Results: In terms of the sense of grieving as measured by the Brief Humanizar Scale, the mean score for the ‘Burden’ factor was 7 points and for the ‘Change’ factor it was 28.6, indicating that suffering makes more sense as a lever for positive change than as a burden. Regarding Bugen's Coping with Death Scale, the mean score was 127.8 points before the mentoring programme and 139.2 afterwards. Hence, the score after the mentoring programme increased by 11.4 points, improving strategies to cope with death. Conclusion: Medical professionals must cope with death and end-of-life patients. In addition to scientific knowledge, students need to acquire competencies for better coping with the death of patients, with mentoring programmes helping to enhance this process of learning.

Este trabajo analiza el deterioro del Estado de Derecho en Polonia desde las elecciones de 2015, en las que el partido ultraconservador Ley y Justicia consiguió la mayoría legislativa y accedió al Gobierno. Desde entonces, esta situación le ha permitido llevar a cabo modificaciones legislativas que han acabado afectando a la independencia judicial en el país. Entre otros factores, la modificación de la composición del Tribunal Constitucional y el Tribunal Supremo o la politización del Consejo Nacional del Poder Judicial, órgano constitucional encargado de los nombramientos judiciales, han contribuido al deterioro del Estado de Derecho en Polonia. Ante esta situación, comienza a producirse una reacción en forma de diálogo entre el TJUE y el TEDH, de forma que ambos Tribunales se aluden mutuamente a través de sus sentencias y desarrollan el concepto de «tribunal establecido por ley». Como resultado de dicha interacción, se amplía el contenido del derecho a un tribunal establecido por la ley y se establece que las irregularidades producidas en el procedimiento de nombramiento de los jueces pueden provocar el menoscabo de aquel derecho. Se acaba incluyendo así la legalidad del procedimiento de nombramiento de los jueces al contenido del derecho a un tribunal establecido por la ley. Recibido: 25 octubre 2022 Aceptado: 22 febrero 2023

Abstract Brain cholesterol metabolism has been described as altered in Parkinson’s disease (PD) patients. Serum lipid levels have been widely studied in PD with controversial results among different populations and age groups. The present study is aimed at determining if the serum lipid profile could be influenced by the genetic background of PD patients. We included 403 PD patients (342 sporadic PD patients, 30 GBA-associated PD patients, and 31 LRRK2-associated PD patients) and 654 healthy controls (HCs). Total cholesterol, HDL, LDL, and triglycerides were measured in peripheral blood. Analysis of covariance adjusting for sex and age (ANCOVA) and post hoc tests were applied to determine the differences within lipid profiles among the groups. Multivariate ANCOVA revealed significant differences among the groups within cholesterol and LDL levels. GBA-associated PD patients had significantly lower levels of total cholesterol and LDL compared to LRRK2-associated PD patients and HCs. The different serum cholesterol levels in GBA -associated PD might be related to diverse pathogenic mechanisms. Our results support the hypothesis of lipid metabolism disruption as one of the main PD pathogenic mechanisms in patients with GBA-associated PD. Further studies would be necessary to explore their clinical implications.

Resumen: Objetivo: Averiguar si la derivación telefónica desde Atención Primaria a consultas externas de Medicina Interna (CCEE de MI) reduce días de espera, con respecto a la derivación presencial. Averiguar la aceptación de la consulta telefónica por parte de los médicos de familia (MF) de Atención Primaria y de sus pacientes. Diseño: Ensayo clínico controlado aleatorizado sin enmascaramiento. Emplazamiento: Área de Gestión Sanitaria Norte de Huelva. Participantes: Ciento cincuenta y cuatro pacientes. Intervenciones: Los pacientes de los MF del grupo experimental fueron derivados vía telefónica (salvo cumplimiento criterios exclusión) y los del grupo control vía presencial. Mediciones: Número de días desde la solicitud de derivación hasta la consulta en MI. Número de derivaciones telefónicas y presenciales. Número de médicos y de pacientes rechazados. Causas de los rechazos. Resultados: Diferencia estadísticamente significativa, estimándose en 27 (21-34) días entre ambos grupos. De los 58 MF, 8 prealeatorización, y 6 de los 20 asignados al grupo experimental rechazaron participar por «suponer consumo excesivo de tiempo y esfuerzo». Para un 50% de los pacientes derivados por los 14 MF que quedaron finalmente en el grupo experimental se rechazó la vía telefónica, siendo la complejidad de los pacientes la principal causa. Conclusiones: La derivación telefónica reduce considerablemente los días de espera para CCEE de MI, elimina las principales barreras de la consulta telefónica a tiempo real, no supuso un mayor gasto de tiempo ni de esfuerzo para los médicos y no se consideró tan beneficiosa en pacientes complejos. Abstract: Aim: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. Design: No blind randomized controlled clinical trial. Setting: Northern Huelva Health District. Participants: 154 patients. Interventions: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. Measurements: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. Results: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered “excessive time and effort consuming”. 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. Conclusions: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an “excessive time and effort consuming” to General Practitioners and was not all that beneficial to complex patients Palabras clave: Derivación, Telemedicina, Atención Primaria, Medicina Interna, Lista de espera, Continuidad asistencial, Keywords: Referral, Telemedicine, Primary Health Care, Internal Medicine, Waiting list, Continuity of patient care

El objetivo de este artículo es mostrar la aplicabilidad de la metodología experimental en la investigación de estrategia empresarial. Para ello se delimita la metodología experimental, se destacan sus cualidades y limitaciones y se revisa su uso en el campo de la estrategia. La metodología utilizada es la revisión de literatura tanto de la caracterización de la metodología experimental como de su utilización en el campo de estrategia. Este artículo refleja la utilidad de la experimentación como metodología de investigación, destaca su complementariedad con otras metodologías e ilustra su abanico de aplicaciones en distintas temáticas. Además, se destaca su potencial de aplicación en los tópicos de investigación más recientes del campo de la estrategia.

Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems (p = 0.029), 19.2% lived alone (p = 0.13), and in 73.3% of cases the housing was inadequate (p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems (p = 0.001), and 10.3% lived alone (p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients’ autonomy, and to the social problems associated with the illness.

We have prepared different polymeric chiral bifunctional thioureas and squaramides by modification of the very well-known polymers of intrinsic microporosity (PIM), specifically PIM-1 and PIM-CO-1, to be used as recoverable organocatalysts. The installation of the chiral structures into the polymers has been done in two or three steps in high yields. The catalytic activity of the resulting materials has been proved in the stereoselective nitro-Michael addition and in a cascade process, which allows the synthesis of enantioenriched 4H-chromene derivatives. Squaramide II and thiourea III have been used in six cycles maintaining their activity.

Se realizó un estudio descriptivo, transversal y prospectivo con el objetivo de caracterizar aspectos en la seguridad de la sexualidad en ancianos pertenecientes a dos Consultorios Médicos del Policlínico Universitario "Hermanos Cruz" de Pinar del Río en el período 2008-2009. El universo estuvo conformado por 142 ancianos y la muestra por 100, seleccionados al azar, con su consentimiento. Para la obtención y procesamiento de la información creo una base de datos. Se aplicó una encuesta con preguntas cerradas y semiabiertas. Se obtuvo como resultado que la mayor frecuencia de los ancianos estuvo en el grupo de edades entre 70 y 74 años con predominio del sexo masculino. La mayoría de los ancianos mantuvo relaciones sexuales de forma ocasional, y la ruptura de pareja después del divorcio o la viudez fue ocasionada por desacuerdo de los familiares en más de la mitad de ellos. Un gran porcentaje convivía con sus familiares constituyendo un obstáculo frecuente en la búsqueda y mantenimiento de una nueva pareja después de los 60 años. La convivencia familiar influyó negativamente en el mantenimiento y la privacidad de la pareja lo que afecta la seguridad del anciano; se corroboró la existen de mitos y estereotipos que frecuentemente influyen de forma negativa en la práctica sexual del adulto mayor, y la mayoría evita hablar de sexualidad con otras personas.A descriptive, cross sectional and prospective study aimed at characterizing the aspects on the safety of sexuality in the elderly was conducted along the Doctor's Offices belonging to "Hermanos Cruz" University Outpatient Clinic, Pinar del Rio during 2008-2009. The target group included 142 and the sample 100 old people, who were taken at random giving their consent. To collect and process the information a database was created. Open and semi-open questions were applied for the survey. Results showed that the greatest frequency of old people were between 70-74 years old where male sex prevailed. The majority of old people maintained occasional sexual relations, the breakup of the couple after the divorce or the widowhood were provoked by the members of the family in more than a half of them. A great percentage lived with other family members, which constituted a frequent difficulty in the search and maintenance of a new couple after 60 years old. Familial cohabitation influenced negatively in the continuance and privacy of the couple, affecting the safety of the elderly; the existence of myths and stereotypes influence negatively in the elderly sexual practice, the majority of them avoid speaking to other persons about sexuality.

La búsqueda de ventajas competitivas, como una de las principales tareas de la empresa, se ha convertido en un principio de las teorías contemporáneas de dirección estratégica (Teece, Pisano y Shuen, 1997). La innovación facilita la adaptación de la empresa al entorno global competitivo, por lo que representa un papel estratégico en el desempeño empresarial. En este sentido destaca la creciente importancia de la innovación y de la utilización de los activos tecnológicos de la empresa. Precisamente, en este trabajo se estudia el efecto en los resultados de cuatro dimensiones de la estrategia de innovación tecnológica sobre una muestra de cooperativas vitivinícolas de Castilla La- Mancha./The search for competitive advantages as one of the main activities of a company has become a principle of contemporary theories on Strategic Management (Teece, Pisano and Shuen, 1997). Innovation facilitates a company//////s adaptation to the global competitive environment, representing the important strategic role that it has to play in relation to managerial performance and, as such, underlines the growing importance of innovation and the use of a company//////s technological assets. This paper therefore studies the effect of the results of four dimensions of technological innovation strategy on a sample of wine cooperatives from Castilla-La Mancha.

Literalmente Bioética es un neologismo que significa ética de la vida y surge en la década del 70, en la enciclopedia se define como el estudio sistemático de la conducta humana en el campo de las ciencias biológicas y de la atención de salud. Se realizó un estudio prospectivo longitudinal y descriptivo para determinar el nivel de conocimiento que tienen los estudiantes de curso complementario en el curso 03-04 todos del municipio Pinar del Río; donde se les aplicó una encuesta antes y después de implementar el programa correspondiente a la asignatura de Ética y Bioética en Enfermería. Los principales indicadores a medir fueron conocimientos previos a través de cursos básicos y de especialización, vínculo de los conocimientos teóricos con la actividad práctica, así como criterios de los estudiantes respondiendo a diferentes indicadores se utilizó el método porcentual aritmético presentándose los resultados en tablas. Los contenidos y las diferentes formas satisfacen las necesidades de los patrones morales de la sociedad en el ejercicio de la profesión, se hace necesario brindar educación continuada en los aspectos éticos y reflexionar sobre la importancia del cumplimiento de los principios éticos y bioéticos con vistas a reforzar un marco de valores que deben regir la filosofía de la profesión.Bioethics is a neologism that means ethics for life and it theory was founded during the 70's; in the Encyclopedia it is defined as the systematic study of the human behaviour in the field of Biological Sciences and Health Care. A longitudinal-prospective and descriptive study was carried out to determine level of knowledge developed by the students of the complementary course during the academic course 2003 _ 2004 in Pinar del Rio Municipality, conducting a survey before and after the implementation of the syllabus corresponding to Ethics and Bioethics subjects in Nursing School. The main indicators of the study were: previous knowledge through basic courses and courses of specializations, linking of theory and practical activity, as well as student's criteria according to different points. Arithmetical percentage method was used and results were charted. It is necessary to follow a continuous education in ethical practice and reinforce ethical and bioethical principles.

Hirschsprung disease (HSCR, OMIM 142623) is a developmental disorder characterized by the absence of ganglion cells along variable lengths of the distal gastrointestinal tract, which results in tonic contraction of the aganglionic gut segment and functional intestinal obstruction. The RET proto-oncogene is the major gene for HSCR with differential contributions of its rare and common, coding and noncoding mutations to the multifactorial nature of this pathology. Many other genes have been described to be associated with the pathology, as NRG1 gene (8p12), encoding neuregulin 1, which is implicated in the development of the enteric nervous system (ENS), and seems to contribute by both common and rare variants. Here we present the results of a comprehensive analysis of the NRG1 gene in the context of the disease in a series of 207 Spanish HSCR patients, by both mutational screening of its coding sequence and evaluation of 3 common tag SNPs as low penetrance susceptibility factors, finding some potentially damaging variants which we have functionally characterized. All of them were found to be associated with a significant reduction of the normal NRG1 protein levels. The fact that those mutations analyzed alter NRG1 protein would suggest that they would be related with HSCR disease not only in Chinese but also in a Caucasian population, which reinforces the implication of NRG1 gene in this pathology.

La búsqueda de ventajas competitivas, como una de las principales tareas de la empresa, se ha convertido en un principio de las teorías contemporáneas de dirección estratégica (Teece, Pisano y Shuen, 1997). La innovación facilita la adaptación de la empresa al entorno global competitivo, por lo que representa un papel estratégico en el desempeño empresarial. En este sentido destaca la creciente importancia de la innovación y de la utilización de los activos tecnológicos de la empresa. Precisamente, en este trabajo se estudia el efecto en los resultados de cuatro dimensiones de la estrategia de innovación tecnológica sobre una muestra de cooperativas vitivinícolas de Castilla La- Mancha.

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Abstract Introduction Despite the Rowland Universal Dementia Assessment Scale (RUDAS) having significant advantages as a cognitive screening tool, particularly for minority populations, the Mini‐Mental State Examination (MMSE) test is the most widely used test for cognitive screening in Alzheimer's disease (AD). This study aimed to develop a conversion table to predict MMSE scores from observed RUDAS scores, allowing an easy‐to‐use method to compare both screening tests. Methods The equipercentile equating method was used to develop the conversion table using a training sample consisting of cognitively intact participants and individuals with early‐stage AD. The resulting conversion table was validated in two samples, comprising participants from majority and minority populations assessed in Spanish. Results The conversion table demonstrated excellent reliability with intraclass correlation coefficients of.92 in both validation samples. Conclusion This study provides a conversion table between RUDAS and MMSE scores, improving the comparability of these cognitive screening tools for use in clinical and research purposes.