La argumentación en los juicios con jurado : un estudio pragmalingüístico

Esta investigación analiza la configuración discursiva del juicio oral desde un enfoque argumentativo. En concreto, nuestro objetivo ha sido analizar de qué manera funciona la argumentación en los juicios orales con y sin jurado. Asimismo, el análisis determina la forma en cómo los operadores jurídicos adaptan estos recursos argumentativos, en función de si su destinatario es un juez profesional o un jurado lego. Este estudio, en el marco de la situación de habla institucional del juicio oral, nos va a proporcionar las principales diferencias entre ambos contextos desde una dimensión argumentativa del discurso forense. Precisamente, para describir esta progresiva enunciación argumentativa, resulta apropiado articular el análisis a partir de la sucesión de los distintos géneros procesales a lo largo del juicio oral. Ello ha favorecido un análisis discursivo que pone de manifiesto las diferentes particularidades impuestas por cada género discursivo en los dos procesos penales con jurado popular y sin él. Además, al considerar que toda la construcción lógica del discurso argumentativo está condicionada por los elementos pragmáticos de la comunicación, el análisis proyecta también una mirada discursiva desde la pragmática de la comunicación. En consecuencia, los componentes teóricos que se utilizan en el análisis muestran el carácter interdisciplinar de esta investigación. En primer lugar, la Teoría de la argumentación jurídica nos ofrece una diversidad de enfoques en constante evolución. Esa teoría se ocupa, por una parte, de analizar y reconstruir la forma de razonar de los operadores jurídicos y, por otra, de proponer y construir modelos de razonamiento adecuados, elencos de argumentos, y criterios para evaluar la solidez, valor y corrección de la argumentación jurídica. Además, la utilidad de disciplinas colindantes que se encuadran dentro del campo de la argumentación jurídica, como la filosofía del derecho, la teoría del caso, la lingüística, la lógica y la retórica, nos ha permitido una comprensión más profunda del fenómeno jurídico. Todos estos referentes teóricos convergen en un mismo planteamiento: el derecho es una actividad argumentativa. En segundo lugar, nuestro trabajo adopta la perspectiva del Análisis del discurso. Bajo esta etiqueta disciplinar se recogen teorías provenientes de distintas corrientes de investigación (Lingüística, Pragmática, Sociolingüística y Géneros discursivos) que tienen como denominador común atender al estudio de la lengua en su contexto. Con este empeño se ha realizado el estudio de las particularidades definitorias de los géneros procesales que conforman el juicio oral con jurado y sin jurado, como acontecimientos discursivos fuertemente convencionalizados que difieren, según las circunstancias del caso concreto y el tipo de órgano judicial que resulte competente para enjuiciarlo (jueces profesionales o jueces legos). El resultado es una variedad de lengua singular en un contexto formal y altamente especializado como es un juicio oral que ofrece una imagen de adecuación comunicativa a las expectativas de un nuevo participante lego, el jurado; todo ello sin perder el rigor técnico-jurídico, a la vez que se intenta contrarrestar el uso de rígidas rutinas profesionales como un obstáculo que asfixia la expresión y dificulta la comprensión de los jueces legos. Sin duda, la consecuencia más inmediata es que los géneros profesionales tienen que transformarse para ser comunicativos. En este caso, se ha demostrado el grado de elasticidad que presenta el género procesal del informe que proyectan todas las variaciones comentadas pero sin vulnerar su estructura. Como conclusión, podemos afirmar que asistimos a una adaptación comunicativa de este género procesal, con un especial esfuerzo de acomodación a un nuevo contexto y a unas nuevas circunstancias procesales sustancialmente diferentes de las que concurren en un proceso penal común. En definitiva, se trata de una adecuación de los profesionales jurídicos a la función discursiva de los jueces legos que desconocen la jerga jurídica y los hábitos de conducta forenses, y respecto de los cuales no cabe sobreentender ninguna cuestión que podría darse por supuesta en un juicio penal común

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study.

To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH 6 days vs. LOH We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

Las mujeres y el tabaco : enfoque de género en el control de la epidemia en Andalucía

YesEn este documento se podrá encontrar una presentación de la evolución histórica del fenómeno del tabaquismo en la población femenina, las dificultades y limitaciones que existen para las mujeres, las intervenciones generales sobre tabaquismo y experiencias que muestran la eficacia cuando se diseñan acciones específicas y accesibles para ellas

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)