ABSTRACT
Autonomy is an inherent condition of every ethical act. This attribution is expressed, when decisions are made, as capacity. Physician-patient alliance is defied when there is a reasonable doubt of patients’ ability to make a choice, an extraordinarily complex scenario. As a response, in the last few decades multiple tools have been developed aiming to determine in a standardized fashion whether capacity is present or not. In the present article, we present a classification of the most well-known tools and discuss their usefulness, the implications for standardization of capacity, and make recommendations for their use, based in evidence.
Subject(s)
Humans , Mental Competency , Personal Autonomy , Decision Making , Disability Evaluation , Informed Consent , Patient Participation , Physician-Patient Relations , Interviews as Topic/methods , Reproducibility of Results , Comprehension , Ethics, Medical , Neuropsychological TestsABSTRACT
Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization.
Subject(s)
Humans , Female , Adult , Middle Aged , Vascular Diseases/congenital , Coronary Vessel Anomalies/diagnostic imaging , Vascular Diseases/surgery , Vascular Diseases/diagnostic imaging , Coronary Angiography , Coronary Vessel Anomalies/surgeryABSTRACT
Introduction: Suicide is a complex phenomenon and seems to be paradoxical from an evolutionary standpoint, considering the multiple associated risk factors and the differences in suicide rates among countries. Suicide risks are usually attributed to economic hardship and low quality of life. However, some studies have shown an inverse relationship. Objective: To compare suicide rates reported for different countries to date with economic and quality of life indicators. Method: Suicide rates reported for 82 countries by the World Health Organization (WHO) were correlated with 2008 purchasing power parities (PPPs) and human development indexes (HDIs) published by the World Bank and the United Nations, respectively. Results: A positive correlation was observed between suicide rates, PPPs and HDIs (r = 0.3601 and r = 0.366, respectively p < 0.01). Conclusions: The positive correlation observed (i.e., suicide rates increased with economic and quality of life indicators) seem to be contradictory on the surface. We propose that interpreting these data from an evolutionary perspective could contribute to a deeper understanding of this phenomenon. Nevertheless, there are a myriad of factors that could be contributing to these results, thus further research is needed to understand suicide at a global scale.
Introducción: El suicidio es un fenómeno complejo y evolucionariamente en apariencia paradojal, siendo conocidos los múltiples factores de riesgo asociados y las diferencias de tasas existentes entre los países. Comúnmente se atribuye mayor riesgo a dificultades económicas y peor calidad de vida, sin embargo, algunos estudios mostrarían una tendencia inversa. Objetivo: Comparar las tasas de suicidio de distintos países publicadas hasta la fecha, con algunos indicadores económicos y de calidad de vida objetivos. Métodos: Se correlacionaron las tasas de suicidio de 82 países publicados por la Organización Mundial de la Salud, con la paridad de poder de compra (PPP) e índice de desarrollo humano (HDI) del año 2008 publicados por el Banco Mundial y las Naciones Unidas respectivamente. Resultados: Se obtuvo una correlación positiva entre tasas de suicidio con PPP e HDI (r = 0,3601 y r = 0,366 respectivamente, p < 0,01). Conclusión: La correlación positiva observada, es decir, mientras mejores indicadores económicos y de calidad de vida, habría mayores tasas de suicidio, son en apariencia contradictorios. Proponemos que la comprensión de estos datos desde una perspectiva evolucionaria podría contribuir a un mejor entendimiento de éstos. Sin embargo, son múltiples los factores que podrían estar involucrados en este resultado, por lo que es necesaria mayor investigación para poder entender de mejor manera el fenómeno del suicidio a nivel mundial.