Biomedical subjects

E Osuna

Publications and source records attributed to E Osuna.

At least 37 records · Page 2Linked to original sources

PubMed1998

The right to information for the terminally ill patient.

OBJECTIVES: To analyse the attitudes of medical personnel towards terminally ill patients and their right to be fully informed. DESIGN: Self-administered questionnaire composed of 56 closed questions. SETTING: Three general hospitals and eleven health centres in Granada (Spain). The sample comprised 168 doctors and 207 nurses. RESULTS: A high percentage of medical personnel (24.1%) do not think that informing the terminally ill would help them face their illness with greater serenity. Eighty-four per cent think the patient's own home is the best place to die: 8.9% of the subjects questioned state that the would not like to be informed of an incurable illness. CONCLUSION: In our opinion any information given should depend on the patient's personality, the stage of the illness and family circumstances. Our study confirms that a hospital is not the ideal environment for attending to the needs of the terminally ill and their families.

Attitude of Health Personnel↗

PubMed1998

Informed consent. Evaluation of the information provided to patients before anaesthesia and surgery.

The procedure for obtaining informed consent is often poorly appreciated by patients. The aim of this paper is to evaluate the verbal information given as part of the informed consent process before anaesthesia and surgery. A total of 300 randomly chosen patients (141 male and 159 female) were asked their opinion between 1993 and 1995 at the University of Murcia Hospital (Murcia, Spain). One hundred and fifty of these patients received scheduled surgery and the other 150 received emergency surgery. In general, the patients were not happy with the information they had received concerning their pathology and treatment. Although they had signed the consent documents, the patients did not feel they had really understood the risks involved in the surgery they had undergone.

Adolescent↗

PubMed1998

[Preoperative information and informed consent in surgically treated patients].

OBJECTIVE: Providing information is an important part of the doctor-patient relationship. In hospital practice today, patients and/or their families are sometimes given seriously inadequate information. Our aim was to analyze the quality of information received by patients before anesthesia and surgery. PATIENTS AND METHODS: The opinion of 300 patients (141 men and 159 women) at Hospital Universitario "Virgen de la Arrixaca" (Murcia, Spain) was studied from 1993 to 1995. The sample was a stratified random one with sex and age as the classifying variables. Surgery was scheduled in 150 cases and emergency in 150. Mean age was 42.88 +/- 1.20 years (SD = 20.84; range 3-90 years). RESULTS: Patients were unfamiliar with risks of surgery and anesthesia in 19% and 18.3% of the cases, respectively. No information was received by 69.3% of patients regarding surgical risks and an even higher 75% of patients received no information on risks of anesthesia. In 3.6% of scheduled operations, neither patient nor family members were required to sign a consent from, though these cases involved patients under 18 years of age. For emergency surgery this percentage was 5.4%. Lack-of-information percentages are higher in operations requiring local or regional anesthesia. CONCLUSIONS: We must underline the poor quality of patient knowledge about medical procedures and the scarce information provided. Even fewer patients known about the risks of anesthesia. A patient's signing of an informed consent form does not correspond to real knowledge of the risks involved in the procedure.

Aged↗

PubMed1997

Epidemiology of suicide in elderly people in Madrid, Spain (1990-1994).

The progressive aging of the population as a whole, the frequent appearance of degenerative diseases, and the greater frequency of suicide among persons older than 65 years than in younger age groups, are worrisome issues that deserve investigation. The aim of this study was therefore to analyze different epidemiological and social factors that influence suicide behaviour in elderly subjects in Madrid (Spain) during a 5-year period from January 1990 to December 1994. Post-mortem reports on all deaths that were examined at the Institute of Forensic Medicine in Madrid were studied. All cases of suicide in subjects aged > or = 65 years during these years (N = 461) were studied through the autopsy records and information from the coroner's inquest. Variables corresponding to demographic, clinical and interpersonal factors, method of suicide, scene of death, season, month and time of suicide were registered. In both sexes, jumping from a height was the most frequent method (63.6%). Family members had noted symptoms of depression in almost half of the cases (49.5%). Coexisting physical disorders were present in 68.9% of the subjects. Health care professionals have an important role to play in-suicide prevention.

Aged↗

PubMed1995

Usefulness of myosin in the postmortem diagnosis of myocardial damage.

In some situations the postmortem diagnosis of myocardial infarction is made difficult by the brief course of the fatal episode or by interferences caused by autolysis. In such cases, biochemical indices may provide a useful adjunct to morphological studies. Myosin is the main component of the contractile apparatus of muscle cells, so its determination may well be useful to evaluate myocardial injury. The purpose of the present study was to establish the diagnostic efficacy of postmortem myosin heavy chain determinations using monoclonal antibodies and to compare this data with structural findings used to diagnose acute myocardial ischaemia. We studied 105 cadavers with a mean age of 61.63 +/- 2.21 years. Cases were allocated to 1 of 7 diagnostic groups depending on the probable intensity of myocardial damage and cause of death. The highest serum and pericardial fluid values of myosin heavy chains were seen in subjects who showed morphological evidence of myocardial ischaemia. Mean pericardial fluid/serum ratios differed significantly between subjects with and without observable signs of heart damage.

Analysis of Variance↗

PubMed1995

Creatine kinase BB and neuron-specific enolase in cerebrospinal fluid in the diagnosis of brain insult.

Cerebrospinal fluid (CSF) markers provide useful information about the extent of brain damage. These biochemical indices may also be used when postmortem histopathological examination does not confirm antemortem brain insult. Seven biochemical parameters--creatine kinase (CK), creatine kinase BB isoenzyme (CK-BB), lactate dehydrogenase (LDH), gamma-glutamyltransferase, aldolase, leucine aminopeptidase (LAP), and neuron-specific enolase (NSE)--were analyzed in CSF from 82 cadavers. Case studies were categorized into one of four diagnostic groups. There were 15 cases of head trauma, 23 of hypoxia (hangings, carbon monoxide, and drug poisonings), 23 sudden cardiac death, and 21 miscellaneous cases. The degree of craniocerebral trauma was graded. In CSF there was a statistically significant correlation between the severity of craniocerebral trauma and levels of CK, CK-BB, aldolase, LDH, and LAP. CSF CK-BB [median U/L (range)] for the groupings of head trauma, hypoxia, sudden cardiac death, and miscellaneous were, respectively, 873 (1-12,100), 26 (2-2,780), 16 (1-42), and 18 (0-2,780). Corresponding CSF CK levels were 9,370 (28-67,842), 101 (18-36,840), 180 (10-29,622), and 264 (17-26,556). There were no statistical significant differences among the NSE concentrations in the four diagnostic groups. The testing of biochemical markers could be a reliable indicator of the degree of brain insult in support of morphological studies.

Adolescent↗

PubMed1995

Biochemical assessment of acute myocardial ischaemia.

AIMS: To evaluate the efficacy of biochemical parameters in different fluids in the diagnosis of myocardial infarction of different causes, analysed after death. METHODS: The myoglobin concentration and total creatine kinase (CK) and creatine kinase MB isoenzyme (CK-MB) activities were measured in serum, pericardial fluid, and vitreous humour from seven diagnostic groups of cadavers classified according to the severity of myocardial ischaemia and cause of death. Lactate dehydrogenase (LDH) and myosin were measured only in serum and pericardial fluid, and cathepsin D only in pericardial fluid. Routine haematoxylin and eosin and acridine orange staining were used for microscopy studies of heart tissue. RESULTS: In pericardial fluid there were substantial differences between the different groups with respect to CK, CK-MB, and LDH activities and myosin concentrations. The highest values were found in cases with morphological evidence of myocardial ischaemia. CONCLUSIONS: Biochemical parameters, which reach the pericardial fluid via passive diffusion and ultrafiltration due to a pressure gradient, were thus detectable in this fluid earlier than in serum in cases with myocardial ischaemia. These biochemical parameters may be of use for ruling out myocardial ischaemia in those controversial cases in which reliable morphological findings are lacking.

Adolescent↗

PubMed1995

Violence in the family setting: an analysis of mistreatment of minors and women.

Family structure is one of the most important reference models in the learning of antisocial patterns of behaviour, and has been described as one of the major socialization agencies for children. Violence in the family setting is a fact in Spanish society, and must be analysed within the wider framework of social violence. We studied the incidence of physical and psychological abuse in the family setting. Our analysis included the incidence of all types of aggression which required medical attention in the city of Murcia (Spain) between February and June 1991. We detected a total of 191 victims of probable mistreatment in the family setting, involving persons who ranged in age from three to 68 years. After a detailed study of the type of lesions together with the personal and sociofamilial circumstances, the rate of abuse was 25.16 per 100,000 inhabitants per year.

Adolescent↗

PubMed1995

Legal status of persons with chronic mental illness admitted to psychiatric hospitals.

Psychiatric patients have been, and continue to be, victims of social rejection, a phenomenon that has led to their de facto marginalization. The historical evolution of Western society has been characterized by a tendency to move from laws that preferentially protect society from a perceived threat from individuals with mental illness towards laws intended to protect and defend the interests of these individuals. The spirit of the current legislative framework is to protect persons with mental illness and to guarantee the protection of each and every one of their rights. However, it should be recognized that promulgation of a new law is not tantamount to its enforcement. The purpose of this study was to investigate the actual legal status of persons admitted to psychiatric hospitals.

Adult↗

PubMed1994

Study of the enzymatic activity of GGT, LDH, PAP and PSA in semen stains: application to age calculation.

The conditions under which semen stains are stored can markedly affect the stability of some of their biochemical parameters. Because of the resistance of semen to processes of degradation and denaturation, the age of the stain may, under optimum conditions, be calculated. We studied six series of semen stain placed on absorbent natural cloth under three different storage temperatures: 5 degrees C (refrigerator), 18-25 degrees C (room temperature), and 38 degrees C (incubator). Seminal fluid was obtained from nonvasectomized and vasectomized individuals aged 25-40 years (mean age 30 +/- 0.32 years, SD 3.06). A total of 240 strains were divided into groups depending on the duration of storage: 24, 48 or 72 h, 1 week, 1, 2, 4 or 6 months. Eluates were analyzed for gamma glutamyltransferase (GGT), lactate dehydrogenase (LDH), prostatic acid phosphatase (PAP), and p30 or prostate specific antigen (PSA). The results of regression analyses showed that a large proportion of the dependent variable (age of the stain) was explained by the rest of the biochemical markers tested. Calculation of the age of the semen stain thus requires consideration of several biochemical parameters.

Adult↗

PubMed1994

Medicolegal problems associated with do not resuscitate orders.

The use and potential abuse of the do not resuscitate (DNR) order has wide-ranging ethical, legal and economic implications. A DNR order is essential for clear communication between health care professionals, but the order itself may affect the care that patients subsequently receive. In addition, the DNR order may be a crucial therapeutic decision point in the care of the critically ill. Although general guidelines exist for withholding resuscitative measures from the terminally ill and general principles have been established, Spanish legislation is ambiguous on a number of points, forcing medical professionals to make difficult choices. This has led to the systematic, indiscriminate application of resuscitative measures, motivated in many cases by the desire to avoid a possible future lawsuit. We believe clearer and more precise legislation should be developed to bring Spanish criteria into line with those of international organizations that provide a common set of guidelines on important issues relating to the right to life and the right to refuse treatment.

Beneficence↗

PubMed1994

Placing medical information in the hands of the judiciary: medicolegal problems.

The purpose of this study was to analyse the potential problems associated with sending hospital patients' medical records to different levels of the judiciary. Transmittal of such information may create a conflict between the duty to cooperate with the legal system and the patient's right to privacy. In our analysis of a total of nearly 380 such transmittals of medical histories in Spain, we found that approximately 90% involved possible negligence on the part of the hospital administration. In view of the current mobility of populations in different countries, and the increasing availability of medical data on electronic databases, we believe a coherent system of in-house regulations and international legislation should be passed to create a systematized framework for the protection of the patient's right to privacy.

Confidentiality↗

PubMed1993

Psychological traits and criminal profiles.

The aim of this study was to determine whether certain personality traits in adolescents and children were significantly associated with juvenile maladjustment, and, if so, whether these psychological variables could be used in individual criminological classification. We studied a total of 303 subjects (185 males, 118 females) ranging in age from 11 to 21 years inclusive. All subjects were from centres under the administration of the juvenile court and from the Murcia City Penitentiary (Spain). Impulsivity and attention-perception were found to be highly diagnostic of maladjustment, and thus appear to be complementary traits that provide a useful means of classifying individuals for criminological prognosis. In addition, different personality traits were found to be effective in distinguishing subgroups characterized by different patterns of criminal behaviour.

Adolescent↗

PubMed1992

Efficacy of cerebro-spinal fluid biochemistry in the diagnosis of brain insult.

Postmortem biochemical indices may provide a useful adjunct to morphological studies in the identification of antemortem brain insult. We studied 34 routine medico-legal cases categorising them into one of four diagnostic groups. There were 11 cases of head trauma, 7 of 'hypoxia' (3 hangings and 4 carbon monoxide or drug poisonings), 7 sudden cardiac deaths and 9 miscellaneous cases. Survival time and postmortem interval was known for each case. The degree of cranio-cerebral trauma was graded. Cerebro-spinal fluid (CSF) and vitreous humour were analysed for calcium, glucose, total proteins, aldolase, aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyltransferase (GGT), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase BB isoenzyme (CK-BB). CK-BB was also measured in superior vena cava serum. In CSF there was a significant correlation between the severity of cranio-cerebral trauma and levels of aldolase, CK-BB, AST, ALT and total proteins. CSF CK-BB, median units/l (range), for the groupings of head trauma, hypoxia, sudden cardiac death and miscellaneous were respectively 823 (2-3431); 96 (2-187); 4 (2-25); 5 (1-69). Corresponding serum CK-BB levels were 240 (28-322); 390 (26-411); 180 (20-482); 79 (18-530).

Alanine Transaminase↗

PubMed1992

Doctors' death experience and attitudes towards death, euthanasia and informing terminal patients.

In daily practice physicians are professionally obliged to interpret ethical precepts and laws in emergency situations under extreme pressure when resuscitation measures leave little or no time to consider deontological issues. The extent to which extraprofessional experiences influence physicians' attitudes towards death and terminal patients is a difficult issue to approach with precision. The purpose of this study was to analyse the influence of some personal biographical circumstances on physicians' attitudes towards death and terminal patients. A total of 153 doctors ranging in age from 22 to 77 years (mean 38.24; SD 13.08) were randomly chosen. Physicians, as an integral part of society, cannot be expected to be immune to the influences which mould our attitudes. We suggest that young physicians and medical students should receive information and training aimed at equipping them to face death and dying patients.

Adaptation, Psychological↗

PubMed1992

Family violence as a determinant factor in juvenile maladjustment.

The family is one of the major socialization agencies for children. Parents are one of the most important models from whom the child and adolescent acquire a wide variety of behavior patterns, attitudes, values, and norms. The aim of this study was to determine the importance of factors related to family conflicts in the genesis of social maladjustment. A total of 189 young people (110 boys and 79 girls) from training schools connected with the juvenile court in Murcia (Spain) were studied. The subjects' ages ranged from 11 to 18 years (mean 13.51, SD 0.16). Our sample comprised a group of minors who experienced a high incidence of intrafamilial pathology, which was found to be a significant discriminant factor. Aggressive behavior, rules, norms, values, opinions, and attitudes toward aggressivity can be learned in the family setting.

Adolescent↗

PubMed1992

The relationship between the perception of alcohol and drug harmfulness and alcohol consumption by university students.

University students find themselves at a stage when many attitudes and habits undergo change and consolidation, and it is during this period when patterns of consumption of toxic substances are partially or definitively established. A group of 955 university students (328 medical students, 347 students of veterinary medicine, and 280 law students) were studied. Sex and religion played a decisive role in determining the relation between the use of toxic substances and the subjects' attitude toward consumption in our sample. Also, the three campuses were found to differ significantly with regard to students' assessment of harmfulness and patterns of consumption.

Adult↗

PubMed1992

Personality traits in juvenile maladjustment.

The aim of this study was to establish the role of some personality traits, measured by psychological tests, in minors and adolescents experiencing problems in their social integration. We studied 189 subjects (110 male, 79 female) ranging in age from 11 to 18 years. All the subjects were from centers under the administration of the juvenile court of Murcia, Spain. Each subject underwent individual clinical psychological examination as well as psychometric and psychological studies. Our results show a statistically significant association between the scores on some of the tests used and variables related to familial and social maladjustment. These personality traits define a set of individuals with a characteristic profile, for whom unfavorable biographical events have made integration in, and adaptation to, the established social milieu difficult.

Adolescent↗