Abstract Introduction: the components of school menus is an important area in health strategies. Objectives: the aim of this study was to analyse differences in adherence to recommended food frequencies and other characteristics of school meals in educational centres according to the type of school and neighbourhood income. Method: schools in the city of Barcelona with a lunch service were offered a three-year review. In the three academic years, 341 schools participated: 175 were public and 165 were private. To identify any differences, the Pearson Chi-squared test or Fisher exact test were used, as appropriate. Statistical analyses were performed with the STATA SE/15 programme. Results: no statistically significant differences were found by the socioeconomic level of the school neighbourhood. Private and subsidised schools showed lower adherence to recommendations on pasta (11.1 %), red and processed meat (24.7 %), total meat (7.4 %) and fresh fruit (12.1 %), and lower use of the recommended cooking oil (13.1 %). In contrast, public schools showed lower adherence to the recommended type of frying oil (16.9 %). Conclusions: in private and subsidised schools, improvements should be recommended on the frequency of intake of certain foods. Future studies should examine the causes of lower adherence to certain recommendations in these centres.

Resumen Introducción: la oferta de menús escolares es un área relevante en las estrategias de salud. Objetivos: analizar las diferencias en el cumplimiento de las frecuencias recomendadas de alimentos y otras características del comedor escolar en los centros educativos según su titularidad y la renta del barrio. Métodos: se ofreció la revisión trienal a los centros escolares de la ciudad de Barcelona que disponían de servicio de comedor. En los tres cursos académicos, participaron 341 centros: 175 públicos y 165 de titularidad privada. Para observar si existían diferencias, se utilizó la prueba de Pearson Chi-cuadrado o el test exacto de Fisher según el caso. Los análisis se realizaron con el programa estadístico STATA SE/15. Resultados: no se encontraron diferencias significativas según el nivel socioeconómico del barrio del centro educativo. Los centros educativos privados y concertados presentaban un menor cumplimiento en la pasta (11,1 %), las carnes rojas y procesadas (24,7 %), la carne total (7,4 %) y la fruta fresca (12,1 %), así como un menor uso del aceite recomendado para cocinar (13,1 %). Por el contrario, en los centros educativos públicos se observaba un menor cumplimiento en la recomendación del tipo de aceite para freír (16,9 %). Conclusiones: en los centros privados y concertados es necesario recomendar mejoras en la adecuación de las raciones. Se debería indagar en las causas que pueden explicar esta menor adecuación en varios aspectos como en el cumplimiento de las adecuaciones en estos centros.

Resumen El Real Decreto-ley 2/2023, de 16 de marzo, de medidas urgentes para la ampliación de derechos de los pensionistas, simplifica las actuaciones que conducen al alta médica en los trabajadores que permanecen en situación de incapacidad temporal entre un año y año y medio de duración. Aunque puede ser eficiente en muchos casos, en los procesos de incapacidad temporal de especial complejidad, el hecho de perder el trabajo de un equipo colegiado como el Equipo de Valoración de Incapacidades, podría dificultar la toma de decisiones eficaces, justas y eficientes. Se expone la definición de estos procesos de especial complejidad y la necesidad de poner a disposición del médico inspector una serie de datos laborales para la mejora en el proceso de la toma de decisiones sobre el alta médica, así como abrir legalmente la posibilidad del trabajo en equipo para evaluar determinados supuestos.

Abstract Royal Decree-Law 2/2023, of March 16, on urgent measures to expand the rights of pensioners, simplifies the actions that lead to medical discharge in workers who remain in a situation of temporary disability between one year and one year and medium duration. Although it can be efficient in many cases, in temporary disability processes of special complexity, the fact of losing the work of a collegiate team such as the Disability Assessment Team could make it difficult to make effective, fair, and efficient decisions. The definition of these particularly complex processes is explained and the need to make a series of labor data available to the medical inspector to improve the decision-making process regarding medical discharge, as well as legally open the possibility of work in team to evaluate certain assumptions.

Resumen El presente paper busca enriquecer la gestión del conocimiento alentando procesos culturales que integren los valores humanos laborales a los de las organizaciones empresarias. El objetivo es describir los valores laborales de los trabajadores de América Latina, indagando específicamente la diferencia entre los valores declarados y los realmente priorizados, el grado de relevancia personal asignado al comportamiento ético en el contexto laboral y la etapa de desarrollo moral en la que suelen ubicar a “los otros”. La tipología del estudio fue exploratoria y descriptiva, el enfoque teórico transdisciplinario, la naturaleza temporal sincrónica. El muestreo no probabilístico incluyó sujetos voluntarios que respondieron un cuestionario disponible online. Las motivaciones laborales de 423 trabajadores latinoamericanos, de diversos niveles jerárquicos, en empresas productivas y de servicios, revelan que la actitud general frente al trabajo es central. Las técnicas de análisis estadísticos revelan que priorizan primero el salario, luego la seguridad, muy cerca figuran las oportunidades de avance y poseer un trabajo interesante; en menor nivel de importancia aparecen las motivaciones sociales y el prestigio. La mayoría de las personas afirman tener interés en oponerse a situaciones inmorales; sin embargo, al indagar las etapas de desarrollo de “los otros”, prevalece que la sociedad rige sus comportamientos éticos según premios o castigos, o imitando a otros, minimizando el respeto por los derechos ajenos o principios propios.

Abstract This paper seeks to enrich knowledge management by encouraging cultural processes that integrate human labor values with those of business organizations. The objective is to describe Latin American workers´ labor values, specifically investigating the difference between the stated values and those which are really prioritized, the personal relevance degree assigned to ethical behavior in the labor context and the moral development stage in which they tend to put “the others”. The typology o was exploratory and descriptive, the theoretical approach, the transdisciplinary and the temporal nature, synchronous. The non-probability sampling method included volunteers who answered an online questionnaire. The work motivations of 423 Latin American workers, of different hierarchical levels, in productive and services businesses, reveal that the general attitude towards work is central. Statistical analysis techniques disclosed that they prioritize the salary in the first place, then safety and very close to them, the opportunities to access progress and to have an interesting job while social motivations and prestige appear to a lesser degree. Most people claim to have an interest in opposing immoral situations. However, when investigating the stages of development of “the others”, it concludes that society governs their ethical behaviors according to rewards or punishments, or by imitating others, minimizing respect for other people´s rights or their own principles.

Abstract Introduction: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. Methods: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). Results: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. Conclusion: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.

Resumo Introdução: O manejo do hiperparat-ireoidismo secundário (HPTS) é uma tarefa desafiadora com diversos fatores que contribuem para o fracasso do tratamento. A terapia calcimimética revolucionou o manejo do HPTS, levando a alterações nas indicações e no momento apropriado da paratireoidectomia (PTX) em todo o mundo. Métodos: Comparamos taxas de resposta às abordagens clínica vs. cirúrgica do HPTS em pacientes em diálise de manutenção (DRC 5D) e pacientes transplantados renais (TxR). Foi realizada uma análise retrospectiva dos achados de um ano de acompanhamento. Pacientes com DRC 5D foram divididos em 3 grupos de acordo com a estratégia de tratamento: paratireoidectomia, manejo clínico sem cinacalcete (denominado padrão - P) e com cinacalcete (P + CIN). Os pacientes com TxR foram divididos em 3 grupos: PTX, CIN (uso de cinacalcete) e observação (OBS). Resultados: Na DRC 5D, encontramos uma redução significativa do paratormônio (PTH) em todos os grupos. Apesar de todos os grupos apresentarem um PTH mais elevado no início do estudo, identificamos uma redução mais acentuada no grupo PTX. Com relação ao HPTS grave, a diferença entre os grupos foi evidentemente maior: 31%, 14% e 80% dos grupos P, P + CIN e PTX atingiram níveis adequados de PTH, respectivamente (p< 0,0001). Com relação à população TxR, embora a diferença não tenha sido tão impressionante, também foi observada uma taxa maior de sucesso no grupo PTX. Conclusão: A PTX ainda parece ser a melhor escolha de tratamento para o HPTS, especialmente em pacientes com doenças prolongadas em cenários sem recursos.

In this study, aluminum alloy 7075 (AA7075) nanopowders were prepared by High-Energy Ball Milling (HEBM) in a bath of isopropyl alcohol. The process was investigated in different milling times and silicon carbides (SiC) reinforcement percentual. The effects of these parameters on the samples were characterized by X-ray diffraction (XRD), Laser Diffraction (LD), Scanning Electron Microscopy (SEM), and Energy Dispersive Spectroscopy (EDS). The XRD analyses showed that as the grinding time increases, the micro deformation also increases, while the crystallite and particle size decrease until a constant value at 480 min. If the percentual of SiC reinforcement increases until 5 percent, there is a minimum change in the results compared to AA 7075 milling 480 min with no reinforcement. On the other hand, when the AA7075 was milled for 480 min and reinforced by 10 percent SiC, the best structural refinement result was achieved.

In this work, composite powders of aluminum alloy 7075 (AA7075) reinforced by 2 weight percent of nanosized particles of silicon carbide (SiC), titanium nitride (TiN), and zinc oxide (ZnO) were produced in a bath of isopropyl alcohol by high energy ball milling during 480 min at 25 ºC, 900 rpm, and Balls-to-Powder Weight Ratio (BPR) of 20:1. The techniques of X-Ray Diffraction (XRD), Laser Diffraction Method (LDM), Scanning Electron Microscopy (SEM), and microanalysis of Energy Dispersive Spectroscopy (EDS) were used to characterize the powders as received and processed. Then, the composites were hot extruded and characterized by XRD, SEM, and microhardness Vickers (HV). The milling process reduces the crystallite and particle size to around 30 nm and 10 µm, respectively. After extrusion, a fine microstructure and good consolidation were found for all bars, except for AA7075 as received. The ranging microhardness values were from 97 HV to 121 HV.

Resumo A evolução dos ambientes virtuais de aprendizagem destaca a importância do papel dos líderes para melhorar tanto o desenvolvimento das instituições quanto o alcance das metas e objetivos por elas estabelecidos. Nesta pesquisa, utilizando uma metodologia descritiva e quantitativa por meio de um estudo transversal baseado na aplicação do questionário: Adaptação do VAL-ED ao contexto universitário, pudemos estudar as principais evidências usadas para avaliar o e- liderança no Ensino Superior Online na Espanha, o que permitirá avançar tanto em uma melhor compreensão da eficácia dos comportamentos de liderança focados no aprendizado, quanto em que medida as diferentes evidências disponíveis para as pessoas que interagem com os gerentes são determinantes na avaliação do desempenho da gestão da aprendizagem no Ensino Superior em contextos de formação online. estabelecidos pesquisa questionário VALED VAL ED universitário Espanha aprendizado online

Resumen La evolución de los entornos de aprendizaje virtuales destaca la importancia del rol de los líderes para la mejora tanto del desarrollo de las instituciones, como el logro de las metas y objetivos que estas se marcan. En esta investigación, utilizando una metodología descriptiva y de corte cuantitativo mediante un estudio transversal basado en la aplicación del cuestionario: Adaptación del VAL-ED al contexto universitario, hemos podido estudiar las principales evidencias que se utilizan para evaluar el e-liderazgo pedagógico en la Educación Superior on-line en España, lo que permitirá avanzar tanto en una mejor comprensión de la efectividad de los comportamientos de liderazgo centrados en el aprendizaje, así como en qué medida, las diferentes evidencias con las que cuentan las personas que interactúan con los directivos, son determinantes a la hora de valorar el desempeño de la gestión del aprendizaje en la Educación Superior en contextos formativos on-line. instituciones marcan investigación cuestionario VALED VAL ED universitario eliderazgo e online on line España medida directivos online. line.

Abstract The evolution of virtual learning environments highlights the importance of the role of leaders in enhancing both the development of institutions and the achievement of their goals and objectives. In this research In this research, using a descriptive and quantitative methodology through a cross-sectional study based on the application of the questionnaire: Adaptation of the VAL-ED to the university context, we have been able to study the main evidence used to evaluate pedagogical e-leadership in on-line Higher Education in Spain, which will allow us to advance both in a better understanding of the effectiveness of leadership behaviors focused on learning, as well as to what extent, the different evidences available to the people who interact with managers, are determinants when assessing the performance of learning management in Higher Education in on-line formative contexts. objectives crosssectional cross sectional questionnaire VALED VAL ED context eleadership e online line Spain extent managers contexts

Resumen: Introducción: Los cuidados paliativos en México son contemplados como una necesidad en todos los niveles de atención. La nutrición e hidratación en estos enfermos hacia sus últimos días de vida es controversial. Objetivo: Identificar las recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida. Material y métodos: Se realizó una búsqueda documental sobre la nutrición e hidratación hacia el final de la vida tomando como marco temporal las últimas horas y/o los últimos días de vida del enfermo en el contexto hospitalario. Resultados: Con los criterios de búsqueda seleccionados se identificaron 83 documentos. No se encontraron metaanálisis. Existen dos revisiones sistematizadas de la literatura, un ensayo clínico, cuatro guías de práctica clínica, cuatro reportes de caso y 17 revisiones. Se desglosan los resultados relevantes de lo seleccionado. Conclusiones: Se identifica que existen controversias de fondo sobre la alimentación al final de la vida. Sobre la hidratación existe cierto consenso. Es indispensable contar con un nutriólogo dentro de los servicios de cuidados paliativos de la Nación.

Abstract: Introduction: Palliative care in Mexico is considered a necessity at all levels of care. Nutrition and hydration in these patients towards the last days of life is controversial. Objective: To identify evidence-based recommendations on nutrition and hydration in the last days of life. Material and methods: A documentary search on nutrition and hydration towards the end of life was carried out taking as a time frame the last hours and/or the last days of life of the patient in the hospital context. Results: With the selected search criteria, 83 documents were identified. No meta-analyses were found. There are two systematized literature reviews, one clinical trial, four clinical practice guidelines, four case reports and 17 reviews. The relevant results of the selected documents are broken down. Conclusions: It is identified that there are fundamental controversies about feeding at the end of life. On hydration there is some consensus. It is essential to have a nutritionist within the palliative care services of the Nation.

Resumen La lesión de la mucosa asociada a cristales es un cuadro clínico importante en un subconjunto de pacientes urémicos a los que se les administran resinas de intercambio catiónico como el sulfonato de poliestireno sódico (Kayexalate) y sevelamer para el tratamiento de la hiperpotasemia y la hiperfosfatemia, respectivamente. La necrosis colónica en estos pacientes es rara, pero puede estar asociada a una lesión gastrointestinal mortal, con una tasa de mortalidad del 33%. Los secuestrantes de ácidos biliares son otro tipo de resina que teóricamente son biológicamente inertes. Se presentan dos casos de colitis asociada a cristales. El primer paciente tenía antecedentes de múltiples intervenciones quirúrgicas y patologías del tracto gastrointestinal, y estaba en manejo con colestiramina. Se realizó una sigmoidectomía en la que se encontraron varios focos de cristales. El segundo paciente tenía antecedente de enfermedad renal crónica que requirió el uso de Kayexalate y se presentó al servicio de urgencias con una hemorragia grave del tracto gastrointestinal inferior. Se realizó una colectomía parcial en la que se detectaron cambios morfológicos relacionados con el depósito de cristales. Las resinas pueden producir un amplio espectro de lesiones mortales de la mucosa, por lo que el diagnóstico precoz es fundamental para disminuir la mortalidad y mejorar el pronóstico. Sin embargo, es incierto si el consumo de colestiramina y Kayexalate, así como el depósito de sus cristales en el tracto gastrointestinal son el factor causal de la lesión de las mucosas. Por tanto, la presencia de resinas debería ayudar a establecer el diagnóstico correcto y el tratamiento médico oportuno para evitar resultados nocivos.

Abstract Crystal-associated mucosal injury is a crucial clinical picture in a subset of uremic patients who are given cation exchange resins such as sodium polystyrene sulfonate (Kayexalate) and sevelamer to treat hyperkalemia and hyperphosphatemia, respectively. Colonic necrosis in these patients is rare but may be associated with fatal gastrointestinal injury, with a mortality rate of 33%. Bile acid sequestrants are another type of resin that is theoretically biologically inert. Two cases of colitis associated with crystals are presented. The first patient had a history of multiple surgeries and pathologies of the gastrointestinal tract and was treated with cholestyramine. A sigmoidectomy was performed in which several crystal foci were found. The second patient had a history of chronic kidney disease requiring Kayexalate and attended the emergency department with severe lower GI bleeding. A partial colectomy was performed in which morphological changes related to the deposit of crystals were detected. Resins can cause a broad spectrum of malignant mucosal lesions, so early diagnosis is essential to reduce mortality and improve prognosis. However, it is uncertain whether the consumption of cholestyramine and kayexalate, as well as the deposition of their crystals in the GI tract, are the causative factor of mucosal damage. Therefore, resins should help establish the correct diagnosis and prompt medical treatment to avoid harmful results.

ABSTRACT Background: Prognostic factors in previously healthy young patients with COVID-19 remained understudied. Objective: The objective of the study was to identify factors associated with in-hospital death or need for invasive mechanical ventilation (IMV) in young (aged ≤ 65 years) and previously healthy patients with COVID-19. Methods: We conducted a prospective cohort study that included patients admitted with COVID-19. The primary outcome was in-hospital death/need for IMV. Secondary outcomes included need for IMV during follow-up, days on IMV, length of stay (LOS), hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP), and pulmonary embolism (PE). Bivariate and multivariate analyses were performed. Results: Among 92 patients, primary outcome occurred in 16 (17%), death in 12 (13%), need for IMV in 16 (17%), HAP/VAP in 7 (8%), and PE in 2 (2%). Median LOS and IMV duration were 7 and 12 days, respectively. Independent associations were found between the primary outcome and male sex (Adjusted odds ratio [aOR] 7.1, 95%CI 1.1-46.0, p < 0.05), D-dimer levels > 1000ng/mL (aOR 9.0, 95%CI 1.6-49.1, p < 0.05), and RT-PCR Ct-value ≤ 24 on initial swab samples (aOR 14.3, 95%CI 2.0-101.5, p < 0.01). Conclusions: In young and non-comorbid COVID-19 patients, male sex, higher levels of D-dimer, and low SARS-CoV-2 RT-PCR Ct-value on an initial nasopharyngeal swab were independently associated with increased in-hospital mortality or need for IMV.

ABSTRACT Background: Relatively low SARS-CoV-2 reinfection rates have been reported in vaccinated individuals, but updates considering the Omicron variant are lacking. Objective: The objective of the study was to provide a current estimate of the SARS-CoV-2 reinfection rate in a highly immunized population. Methods: A prospective cohort of Mexican hospital workers was followed (March 2020-February 2022). Reinfection was defined as the occurrence of two or more episodes of COVID-19 separated by a period of ≥ 90 days without symptoms. The reinfection rate was calculated as the number of reinfection episodes per 100,000 persons per day. Results: A total of 3732 medical consultations were provided to 2700 workers, of whom 1388 (51.4%) were confirmed COVID-19 cases. A total of 73 reinfection cases were identified, of whom 71 (97.3%) had completed their primary vaccination series and 22 (30.1%) had had a booster dose before the second episode. The overall reinfection rate was 23.1 per 100,000 persons per day (as compared to a rate of 1.9 per 100,000 persons per day before the Omicron wave). Conclusions: The SARS-CoV-2 reinfection rate rose significantly during the Omicron wave despite a high primary vaccination coverage rate. Almost one-third of reinfected workers had a vaccine booster ≥ 14 days before the last COVID-19 episode.

Resumo Fundamento A classificação funcional da New York Heart Association (NYHA) é o sistema de classificação mais utilizado para a insuficiência cardíaca (IC), enquanto o teste de exercício cardiopulmonar (TECP) é o padrão ouro para a avaliação do estado funcional na IC. Objetivo Analisar a correlação e a concordância entre as classes da NYHA e as variáveis do TECP. Métodos Foram selecionados pacientes com IC com indicação clínica para TECP e fração de ejeção (FE) < 50%. A correlação (coeficiente de Spearman) e a concordância (kappa) entre a classificação da NYHA e as classificações baseadas no TECP foram analisadas. Um valor de p < 0,05 foi considerado significativo. Resultados No total, foram incluídos 244 pacientes no estudo. A idade média foi de 56±14 anos, e a FE média foi de 35,5%±10%. A distribuição de pacientes de acordo com a classificação da NYHA foi a seguinte: classe I (31,2%), classe II (48,3%), classe III (19,2%) e classe IV (1,3%). A correlação (r) entre as classes da NYHA e de Weber foi de 0,489 (p < 0,001), e a concordância foi de 0,231 (p < 0,001). A correlação (r) entre as classes da NYHA e ventilatórias (inclinação da ventilação minuto/produção de dióxido de carbono [VE/VCO2]) foi de 0,218 (p < 0,001), e a concordância foi de 0,002 (p = 0,959). A correlação de Spearman entre as classes da NYHA e do escore TECP foi de 0,223 (p = 0,004), e a concordância kappa foi de 0,027 (p = 0,606). Conclusão Foi identificada uma associação moderada entre as classes da NYHA e de Webber, embora a concordância tenha sido baixa. As classes ventilatórias (inclinação VE/VCO2) e do escore TECP apresentaram uma associação fraca e uma baixa concordância com as classes da NYHA.

Abstract Background The New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF. Objective This study aimed to analyze correlation and concordance between NYHA classes and CPET variables. Methods HF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant. Results In total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO2] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606). Conclusion There was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO2slope) and CPET score classes had a weak association and a low concordance with NYHA classes.

Abstract Introduction Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method A descriptive, cross-sectional study of requests to the ECC of Málaga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.

Resumen Introducción Los intentos de suicidio constituyen el factor de riesgo más predictivo de todos los casos de suicidio consumado. La mayoría de las personas que intentan suicidarse reciben atención en los Servicios de Urgencias Extrahospitalarios (SUE) donde se gestionan y clasifican estas demandas. Objetivo Validar la clasificación del Centro Coordinador de Urgencias y Emergencias (CCUE) para detectar las demandas relacionadas con la conducta suicida. Método Se llevó a cabo un estudio descriptivo y transversal de las demandas al CCUE de Málaga (España) realizadas durante 2013 y 2014. Para su clasificación se tuvo en cuenta la categorización en el CCUE al responder la llamada y el juicio clínico del profesional sanitario cuando atiende al demandante in situ, considerando éste como patrón de referencia. Para evaluar la validez del sistema de clasificación se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN). Resultados El total de demandas sanitarias analizadas fue de 112,599. Los indicadores de validez del sistema de clasificación para las demandas por conductas de suicidio fueron una sensibilidad = 44.78%, especificidad = 99.34%, VPP = 46.91% y VPN = 99.28%. Discusión y conclusión El sistema de clasificación del CCUE presenta una capacidad más baja para detectar presencia de conducta suicida comparada con una capacidad más alta para identificar su ausencia en las demandas recibidas. Los SUE aportan información relevante sobre las demandas por conducta suicida ya que pueden ser uno de los primeros lugares a los que acuden las personas con este problema. Por ello, sería de gran utilidad mejorar los sistemas de clasificación de las demandas por conducta suicida.