Bioética social, deberes del Estado derecho y deberes civiles en la vacunación COVID-19 / Bioética social, deveres do Estado de direito e deveres civis na vacinaçãoCOVID-19 / Social Bioethics, Duties of the State, Civil Rights and Duties in COVID-19 Vaccination

Resumen: La industria biotecnológica ha desarrollado en tiempo récord varias vacunas que están a disposición de los Gobiernos para ser adquiridas, distribuidas y aplicadas a la sociedad civil para frenar la pandemia del COVID-19. La población debe confiar en las vacunas como medio para adquirir la inmunidad de rebaño, de lo contrario tendremos que adquirir la inmunidad por contagio. La bioética centrada en la ética clínica amplía su visión a una bioética social que reconoce los derechos fundamentales a la salud, la vida y los deberes del Estado a la adquisición, distribución, acceso, aplicación y vigilancia de la vacunación durante la pandemia del COVID-19. Se reconocen el derecho a la autonomía y a las libertades individuales y los deberes civiles de responsabilidad, compromiso y solidaridad ante las políticas de salud pública. La bioética social es un actor dentro de la pandemia que se relaciona con las personas, las comunidades, el Estado y la salud pública y que se argumenta a través de la ética personal y de responsabilidad. El objetivo de este artículo es dar a conocer la importancia de la bioética social, integrada a los deberes del Estado, los derechos y deberes civiles en la vacunación contra la enfermedad COVID-19.

Abstract: The biotechnology industry has developed several vaccines in record time that are available to governments to be acquired, distributed and applied to civil society to stop the COVID-19 pandemic. The population must rely on vaccines as a means of acquiring herd immunity, otherwise we will have to acquire immunity by contagion. Bioethics focused on clinical ethics broadens its vision to social bioethics that recognizes the fundamental rights to health, life and the duties of the State regarding the acquisition, distribution, access, application and surveillance of vaccination during the COVID-19 pandemic. 19. The right to autonomy and individual freedoms and the civil duties of responsibility, commitment and solidarity in the face of public health policies are recognized. Social bioethics is an actor within the pandemic that is related to people, communities, the State and public health and that is argued in terms of personal ethics and responsibility. The objective of this article is to publicize the importance of social bioethics, integrated into the duties of the State, civil rights and duties in vaccination against the COVID-19 disease.

Resumo: A indústria de biotecnologia desenvolveu várias vacinas em tempo recorde que estão à disposição dos governos para serem compradas, distribuídas e aplicadas à sociedade civil para conter a pandemia do coronavírus.COVID-19. A população deve contar com as vacinas como meio de adquirir imunidade de rebanho, caso contrário teremos que adquirir imunidade por contágio. A bioética voltada para a ética clínica amplia sua visão para uma bioética social que reconheça os direitos fundamentais à saúde, à vida e aos deveres do Estado na aquisição, distribuição, acesso, aplicação e vigilância da vacinação durante a pandemia de COVID-19. São reconhecidos o direito à autonomia e as liberdades individuais e os deveres civis de responsabilidade, compromisso e solidariedade diante das políticas públicas de saúde. A bioética social é um ator dentro da pandemia que se relaciona com as pessoas, as comunidades, o Estado e a saúde pública e que se argumenta através da ética e responsabilidade pessoal. O objetivo deste artigo é dar a conhecer a importância da bioética social, integrada aos deveres do Estado, os direitos e deveres civis na vacinação contra a doença COVID-19.

Os desafios da COVID-19 aos Direitos Humanos / COVID-19's Challenges to Human Rights / Desafíos de COVID-19 a los derechos humanos

A pandemia de COVID-19, na tripla crise que desencadeou ­sanitária, económica e social ­, tem provocado o maior retrocesso na implementação dos Direitos Humanos de que há memória desde a sua Declaração Universal, em 1948. Esta avaliação decorre da amplitude e profundidade do recuo na realização dos direitos humanos que se verifica actualmente em três planos, correspondendo, de uma forma genérica, às três gerações de direitos: no plano individual, contemplando os direitos civis e políticos; no social, os direitos económicos e sociais; e no global, os direitos de titularidade colectiva ou de solidariedade. Deter-nos-emos, sucessivamente, nestes diferentes planos, considerando algumas das mais comuns e impactantes medidas sanitárias implementadas em cada um e que constituem transgressões aos direitos humanos, reflectindo sobre as eventuais condições de legitimação ética das medidas adoptadas. Paralelamente, importa considerar que as medidas sanitárias implementadas não só vêm atingindo o respeito pelos Direitos Humanos, mas têm igualmente originado áreas de conflito entre diferentes direitos, em relação aos quais não é eticamente legítimo optar por uns em detrimento de outros. Defende-se ser necessário avançar para uma nova abordagem dos direitos humanos, destacando a sua complementaridade e sustentabilidade nos deveres ­num modelo integrado ­o que, por sua vez, deverá contribuir para a articulação de todos os direitos e seu respectivo cumprimento.

The COVID-19 pandemic, in the triple crisis it triggered ­health, economic and social ­has caused the greatest setback in the implementation of Human Rights since its Universal Declaration, in 1948. This assessment stems from its amplitude and the depth of the reversion in the realization of human rights that is currently verified on three levels, corresponding, in a generic way, to the three generations of rights: on the individual level, contemplating civil and political rights; in the social, economic and social rights; and overall, collective ownership rights. We will successively focus on these different plans, considering some of the most common and impactful sanitary measures implemented in each one and which constitute human rights violations, reflecting on the possible conditions for the ethical legitimacy of the adopted measures.At the same time, it is important to consider that the sanitary measures implemented have not only negatively affected the due respect for Human Rights, but have also given rise to areas of conflict between different rights, in relation to which it is not ethically legitimate to opt for some to the detriment of others. It is argued that it is necessary to move towards a new approach to human rights, highlighting their complementarity and sustainability of duties ­in an integrated model ­which, in turn, should contribute to the articulation of all rights and their respective fulfillment.

La pandemia COVID-19, en la triple crisis que desencadenó -sanitaria, económica y social ­ha provocado el mayor retroceso en la implementación de los Derechos Humanos desde su Declaración Universal, en 1948. Esta apreciación se deriva de su amplitud y la profundidad del retroceso en la realización de los derechos humanos que actualmente se verifica en tres niveles, correspondientes, de manera genérica, a las tres generaciones de derechos: a nivel individual, contemplando los derechos civiles y políticos; en los derechos sociales, económicos y sociales; y, en general, derechos de propiedad colectiva. Nos centraremos sucesivamente en estos diferentes planes, considerando algunas de las medidas sanitarias más comunes e impactantes implementadas en cada uno y que constituyen violaciones a los derechos humanos, reflexionando sobre las posibles condiciones para la legitimidad ética de las medidas adoptadas.Al mismo tiempo, es importante considerar que las medidas sanitarias implementadas no solo hanlogrado afectar negativamente el respeto a los Derechos Humanos, sino que también han dado lugar a áreas de conflicto entre diferentes derechos, en relación con los cuales no es éticamente legítimo optar por algunos en detrimento de los demás. Se argumenta que es necesario avanzar hacia un nuevo enfoque de los derechos humanos, destacando su complementariedad y sostenibilidad de deberes -en un modelo integrado ­que, a su vez, debe contribuir a la articulación de todos los derechos y su respectivo cumplimiento.

Análisis de datos basados en evidencia para la caracterización epidemiológica de leishmaniasis en Paraguay: I - Leishmaniasis tegumentaria

Resumen La leishmaniasis es una enfermedad desatendida, transmitida por dípteros de los géneros Phlebotomus y Lutzomyia. Existen tres formas clínicas principales de leishmaniasis: una visceral, y dos tegumentarias, las cuales se dividen en leishmaniasis cutánea (LC) y leishmaniasis mucocutánea (LM), todas presentes en Paraguay. El objetivo de este trabajo es describir las características epidemiológicas de la leishmaniasis tegumentaria en Paraguay. Aquí analizamos datos epidemiológicos de leishmaniasis tegumentaria (incluyendo LC y ML), tomados desde el 2006 hasta el 2017. La identidad de los pacientes se mantuvo confidencial. Un total de 2.918 casos positivos de leishmaniasis fueron estudiados. El pico de casos reportados se dio en el 2007. Una vista general muestra una disminución en la tendencia de leishmaniasis tegumentaria, donde los varones son más afectados que las mujeres, y el área endémica está localizada en las zonas este y noreste de Paraguay. Los casos en el Chaco (al oeste del Río Paraguay) están en aumento. La incidencia de leishmaniasis tegumentaria para el país es de 4 personas por 100.000 habitantes. Esta es considerada una enfermedad ocupacional ya que el 67% de los pacientes infectados fueron trabajadores rurales. Durante el periodo de estudio, la LC fue más común que la LM, excepto en los años 2010, 2014 y 2017. La mayoría de los pacientes afectados por LM son de avanzada edad. Conclusión. Remarcamos que la leishmaniasis no está restringida a las áreas húmedas del este de Paraguay, debido a que está también presente en zonas xerofíticas de Paraguay y Bolivia. Los trabajadores rurales de sexo masculino comprenden el grupo más susceptible. La alta frecuencia de LM en algunos años indica que es necesario que las agencias nacionales lleven a cabo más programas de educación en salud para prevenir o reducir la carga de LC (y por consiguiente también de LM) en el país.

Abstract Leishmaniasis is a neglected disease transmitted by sandflies of the genera Phlebotomus and Lutzomyia. There are three main clinical forms of leishmaniasis: one visceral and two tegumentary, differentiated between cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (ML), all present in Paraguay. The objective of this work is to describe the epidemiologic characteristics of tegumentary leishmaniasis in Paraguay. Here we analyzed epidemiological data of tegumentary leishmaniasis (including CL and ML), taken from 2006 to 2017. Patients' identities were kept confidential. A total of 2,918 cases of positive leishmaniasis infection were studied. The peak of reported cases was in 2007. An overview shows a decrease in the trend of tegumentary leishmaniasis, where males are more affected than females, and the endemic area located on the east and north-eastern parts of Paraguay. Cases in the Chaco (west of Paraguay river) are increasing. The incidence of tegumentary leishmaniasis for the country is 4 persons per 100,000 inhabitants. This is considered an occupational disease since 67% of the infected patients were rural workers. During the period of study CL was more common than ML, except for the years 2010, 2014, and 2017. Most of the patients affected by ML are elders. Conclusion. We remark that leishmaniasis is not only restricted to the humid area of eastern Paraguay, since it is also present in xerophytic areas of Paraguay and Bolivia. Male rural workers are the most susceptible group. The high frequency of ML in some years indicates that more educational programs have to be carried out by national agencies to prevent and reduce the burden of CL (and thus also ML) in the country.

O processo legislativo e a regulamentação do Serviço Social no Brasil: uma análise documental / The legislative process and the regulation of Social Work in Brazil: a documentary analysis

Resumo: A partir de uma pesquisa documental sobre o processo que culminou na aprovação da Lei nº 8.662/93, este artigo analisa certos elementos de indefinição presentes nesse aparato legal articulando-o ao percurso legislativo. São analisados documentos produzidos pela categoria e emitidos pela Câmara e pelo Senado para compreender os efeitos de algumas perdas que se deram entre o projeto original e a lei promulgada, apontando possíveis impactos para a definição das atribuições do Serviço Social.

Abstract: From a documentary research on the process that culminated in the approval of the Law nº 8.662/93, this article analyzes certain elements of indefinition present in the legal apparatus articulating it to the legislative process. We analyze documents produced by the category and of issued by of the Chamber and of the Senate to analyze effects some losses between the original bill and law enacted, also pointing out the impact for the definition of the and duties of the Social Work.

The roles of doctors, nurses, and industrial hygienists in the healthcare management services in Korea: a comparison of the opinions of specialized health management institutions and entrusted enterprises

BACKGROUND: This study aimed to identify the difference of perception about the role of appointing health officers by comparing and analyzing the response of entrustment workplace (EW) and specialized health management institution (SI). This is considered an important aspect of an institutional assessment to improve the quality of health management services. METHODS: A survey questionnaire was mailed to 122 SIs and 319 EWs nationwide. The questionnaire survey was about the general characteristics of SIs and EWs and main occupations for each evaluation item. In total, 81 SIs (66.4%) and 30 EWs responded to the questionnaire. A logistic regression analysis was performed to compare the opinions of SI and EW. RESULTS: Based on the analysis, the items showing statistically significant differences were as follows. Doctors’ main tasks survey: “Guidance on their wearing personal protective equipment (PPE)” (OR: 4.58), “Guidance of improvement of work environment (WE)” (OR: 3.33), etc.; Nurses’ main tasks survey: “Guidance on their wearing PPE” (OR: 3.86), “Guidance for programs on health process in confined space (CS)” (OR: 0.36), “Guidance on the hearing conservation program (HCP)” (OR: 0.28), etc.; Industrial hygienist (IH)‘s main tasks survey: “Guidance of work through inspection (WTI)” (OR: 0.15), “Guidance on the improvement of WE” (OR: 0.32), “Management confirmation of substances used by process and Material Safety Data Sheet (MSDS)” (OR: 0.08), “Guidance on posting or keeping of MSDS and warning signs” (OR: 0.03), “Prevention of dust-induced medical problems” (OR: 0.28), “Guidance for programs of health process in CS” (OR: 0.39), etc. CONCLUSIONS: It is necessary to educate the EWs to recognize the need for physicians to perform tasks, such as wearing a PPE, and instruction to improve WE. As for nurses’ tasks, such as education about the CS and the noise work, educating the nurses of the SI is regarded necessary as the demand of the EWs is considered. With respect to the unique tasks of IH, such as WE management and instructions for wearing PPE, among several other tasks of IH, training should be provided for improved IH recognition.

Development of practical curriculum for dental coordinator based on DACUM / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to analyze the duties of dental coordinators using the DACUM technique and to develop a practical training course for dental coordinators based on the results. METHODS: The curricula for clinic coordinators across 20 educational institutions were analyzed. A board of DACUM specialists was assembled to analyze the role of dental coordinators and to develop a practical curriculum. RESULTS: First, after analysis, we selected 8 duties and 34 tasks that should comprise the role of a dental coordinator, and the number of major tasks was 21. Second, the educational program for dental coordinators developed in this study consisted of a total of 60 hours, including 42 hours of lecture and 18 hours of practice. A pre-requisite curriculum and a final curriculum were developed, and the detailed educational contents and supplies were outlined for each subject. Third, after comparing it with the existing clinic coordinator curricula from 20 educational institutions, the curriculum based on DACUM contained 11 additional fields. CONCLUSIONS: This study developed a more specialized, detailed, and practical dental coordinator curriculum based on DACUM. It is expected that more dental coordinators could be trained more professionally with this curriculum, and it could lead to further improvement of the curriculum.

The Level of Performance, Frequency and Educational Needs of Nursing Activities in Long-term Care Hospital / 재활간호학회지

PURPOSE: This study was to explore the level of core nursing activities performed by long-term care hospital nurses and to investigate the frequency and educational needs of major nursing activities. METHODS: A cross-sectional descriptive research design was used. The subjects were 155 nurses working at seven long-term care hospitals in Korea. Data were collected in 2018 from September 15 to October 16 using a structured questionnaire. Data were analyzed using the SPSS program. RESULTS: The mean age of nurses was 45.19±10.99 years and the mean career of long-term care hospital was 49.84±40.52 months. Monitoring activity was shown as the highest score in the performance level and frequency, whereas infection control received the highest score in educational needs. A scatter plot revealed that physical examination, respiratory care, wound care, communication and education showed overall high scores in the performance level, frequency, and educational needs. Emergency care and infection control were the activities that were performed less frequently but had high performance level and educational needs. CONCLUSION: It is important to establish rules for requisite and delegable activities considering the performance level and frequency of nursing activities in long-term care hospitals in order to improve the quality of patient care.

Changing Concept of Drug Dispensing Revealed by Text Mining of Past and Present Guidelines / 社会薬学

Drug dispensing is a statutory and designated duty of a pharmacist. We aimed to examine the changes in the nature of drug dispensing using a text mining method. Our corpus consisted of text documents from “Chozai Shishin”, the most standard manual for dispensing drugs in Japan, Editions 1 to 13 (Japan Pharmaceutical Association), and we used the KH Coder software for text mining. We constructed networks showing the association between frequent word co-occurrence and edition number, and co-occurrence relations for frequent words in each edition. We found that “patient” superseded “dispensing” as a frequent term over time. “Dispensing” was another frequent term with a highly centralized node in each edition. Accordingly, we targeted the term “dispensing” for network analysis to depict its co-occurrence relations. We found that the range of related words for “dispensing” broadened from “preparation” and “compounding” to include “patient adherence instructions”, “assessment”, “medical treatment”, and “information provision”. Accordingly, we concluded that the content of “dispensing”, which is a pharmacist’s duty, has expanded from the duties of “dispensing drugs” to include “responding to patients” within the definition of “dispensing”, and we were able to present this finding as objective data by using the mechanical method known as text mining.

Changing Concept of Drug Dispensing Revealed by Text Mining of Past and Present Guidelines / 社会薬学

Drug dispensing is a statutory and designated duty of a pharmacist. We aimed to examine the changes in the nature of drug dispensing using a text mining method. Our corpus consisted of text documents from “Chozai Shishin”, the most standard manual for dispensing drugs in Japan, Editions 1 to 13 (Japan Pharmaceutical Association), and we used the KH Coder software for text mining. We constructed networks showing the association between frequent word co-occurrence and edition number, and co-occurrence relations for frequent words in each edition. We found that “patient” superseded “dispensing” as a frequent term over time. “Dispensing” was another frequent term with a highly centralized node in each edition. Accordingly, we targeted the term “dispensing” for network analysis to depict its co-occurrence relations. We found that the range of related words for “dispensing” broadened from “preparation” and “compounding” to include “patient adherence instructions”, “assessment”, “medical treatment”, and “information provision”. Accordingly, we concluded that the content of “dispensing”, which is a pharmacist’s duty, has expanded from the duties of “dispensing drugs” to include “responding to patients” within the definition of “dispensing”, and we were able to present this finding as objective data by using the mechanical method known as text mining.

Discussions on management of retirees rehired at Beijing Children's Hospital / 中华医院管理杂志

The authors presented the management procedure, post duties, remuneration and risk sharing mechanism for rehired retirees of the hospital. Problems found in such a work were analyzed for the hospital, with recommendations raised on the management, namely better remuneration and job environment for their devoted service to patients.

A organização e a prática da Vigilância em Saúde em municípios de pequeno porte / Organization and practice of the health surveillance in small municipalities

Resumo O processo de descentralização do Sistema de Saúde delegou responsabilidades para os municípios que antes eram de nível federal. Uma dessas tarefas descentralizadas é a Vigilância em Saúde para a qual os municípios recebem verba federal. Municípios de pequeno porte têm dificuldade de responder a essa tarefa pela falta de capacitação e pela escassez de recursos financeiros e humanos, acarretando a sobreposição de funções. O objetivo desta pesquisa é discutir as consequências dessa sobreposição de responsabilidades sobre o desempenho do papel da vigilância em saúde em quatro pequenos municípios da região do Vale do Rio Caí (RS). Trata-se de pesquisa qualitativa do tipo estudo de caso, com coleta de dados por meio de grupos focais com os profissionais da vigilância, entrevistas com os secretários municipais de saúde e consulta a documentos de gestão municipal. Os dados foram interpretados na perspectiva de análise de conteúdo. Como resultados emergiram duas categorias analíticas explicativas do funcionamento da vigilância em saúde nesses pequenos municípios: desvalorização da vigilância e falta de planejamento na vigilância. Esses resultados permitiram discutir criticamente o papel da vigilância para alcançar a integralidade das práticas; os modelos de gestão e de atenção à saúde definidores das prioridades dos serviços de saúde; e a pertinência do processo de descentralização e delegação de tarefas da vigilância para a responsabilidade de municípios de pequeno porte.

Abstract The decentralization process of the Health System entrusted the municipalities with responsibilities that used to be at federal level. One of these decentralized duties is the Health Surveillance for which the municipalities receive federal budget. Small municipalities struggle to meet this duty because of the lack of capacitation and the shortage of human and financial resources, producing the overlapping of duties. The aim of this research is to discuss the consequences of these duties overlapping the performance of the health surveillance role in four small municipalities in the region of Vale do Rio Caí (RS). It is both a case and a qualitative study, with data gathering through focus groups with surveillance professionals, interviews with municipal health secretaries, and consultation of municipal management documents. Data were interpreted in the content analysis perspective. Two analytical categories that explain the health surveillance functioning in these small municipalities emerged as outcomes: surveillance devaluation and lack of planning in surveillance. These outcomes enabled the critical discussion of the surveillance role in order to achieve practice comprehensiveness; the health care and management models that define health services' priorities, and the relevance of the process of decentralization and entrusting surveillance duties to small municipalities' responsibility.

Job Perception and the Need for Job Improvement among School Nutrition Teachers in Seoul / 대한지역사회영양학회지

OBJECTIVES: The objectives of the study were to investigate the school nutrition teachers' perception on their job and to find out recommendations needed for its improvement in order to provide a quality foodservice and nutrition education at schools. METHODS: A total of 219 school nutrition teachers in Seoul were surveyed using self-administered questionnaires. RESULTS: The perceived importance of the 16 job duties was rated 3.8 based on a 5-point scale (1: very unimportant - 5: very important). The importance of six duties including nutrition management, production management, nutrition education, and food safety management were rated over 4 point but that of record-keeping for documents, official reporting, and service management was rated the lowest. Importance-Performance Analysis showed that nutrition management, receiving/storage management, production management, menu management, food safety management, and equipment/facilities management should be emphasized to maintain the current performance of duties. The performance of the nutrition education and counseling needed to be improved since the importance scores were greater than average but the performance scores were lower than the average. Official reporting and miscellaneous jobs were rated the highest for simplification need. More than half of the respondents agreed that equipment/facilities management, miscellaneous jobs, service staff supervision, and service line supervision could be allocated to other school departments. CONCLUSIONS: School nutrition teachers should invest more time and resources on their core job duties such as nutrition management, production management, food safety management, and nutrition education for providing quality foodservice and nutrition education. To reflect the environmental changes of school foodservice, a reasonable staffing index of school nutrition teachers needs to be developed. In addition, hiring an assistant or implementing school nutrition teacher internship programs can be useful to reduce workloads of the nutrition teachers.

Percepción ciudadana sobre deberes y derechos relacionados con el cuidado de la salud / Citizen perception of healthcare rights and duties

Introducción: en los últimos años varios autores han llamado la atención sobre cómo se olvida con frecuencia que, si bien todo individuo tiene derecho a que el Estado adopte medidas que vayan en beneficio de su salud, al propio tiempo se le debe educar en el deber de actuar en su vida cotidiana, de modo que su comportamiento no resulte nocivo para otros. Objetivo: realizar una propuesta de deberes ciudadanos para el cuidado de la salud. Métodos: se realizó una investigación descriptiva de corte transversal de enero a Junio de 2009 en el Policlínico Ángel Machaco Ameijeira. El universo de estudio fue de 21 326 habitantes con edad igual o superior a los 18 años, residentes en los Consejos Populares D´Beche, Nalón y Mañana y Habana Nueva, atendidos por 47 consultorios médicos de la familia (CMF). Se diseñó un muestreo no probabilístico, polietápico en tres fases: consultorios, familias e integrantes. Se utilizaron la revisión documental, los grupos nominales y la entrevista. Para el procesamiento se usaron frecuencias absolutas y relativas. La disposición al cumplimiento de deberes se evaluó mediante el cálculo del valor promedio de los puntos obtenidos en la escala Likert. Resultados: se reconoció la existencia de deberes para el cuidado de la salud. Se elaboró una propuesta de 15 deberes que fue sometida a consulta. La disposición para el cumplimiento de deberes relacionados con el autocuidado no sobrepasó el 80 por ciento y entre los deberes relacionados con la salud colectiva fueron prioritarios los relacionados con la salud ambiental. Conclusiones: Se reconoce la validez de los deberes propuestos y la necesidad de continuar las transformaciones que se realizan desde el sistema de salud, e incluir la autorresponsabilidad y el cumplimiento de deberes para la salud colectiva como renovado enfoque de la participación comunitaria

Introduction: in recent years several authors have drawn our attention to the often forgotten balance between healthcare rights and duties: every individual has the right to enjoy the benefits provided by the State in the field of healthcare, and the duty to restrain from causing harm to other individuals. Objective: develop a proposal of citizen duties in the field of healthcare. Methods: a descriptive cross-sectional study was conducted from January to June 2009 at Angel Machaco Ameijeiras polyclinic. The study universe was composed of 21 326 persons aged 18 and over from the People's Councils of D'Beche, Nalón, Mañana and Habana Nueva, who were cared for at 47 family doctor's consultation offices. A multi-stage non-probabilistic sampling procedure was designed for three phases: consultation offices, families and members. Use was made of document review, nominal groups and interviews. Processing was based on absolute and relative frequencies. Willingness to fulfill duties was evaluated by mean value estimation of the scores obtained on the Likert scale. Results: the existence of healthcare duties was acknowledged. A proposal of 15 duties was developed and subjected to consultation. Willingness to fulfill self-care duties did not exceed 80 percent. Among collective health duties, there was a predominance of those related to environmental health. Conclusions: there is recognition of the validity of the duties proposed and the need for continued transformation of the health system, including self-responsibility and the fulfillment of collective health duties as a renewed approach to community participation

A criança e seus pais: alguns interrogantes sobre as funções parentais na atualidade / Some questions about the parental functions in current days / L’enfant, ses parents et quelques interrogations sur les fonctions parentales dans l’actualité

Os autores pretendem discutir neste artigo as possíveis mudanças ocorridas na operação das funções materna e paterna pelas modificações nas configurações familiares atuais e suas possíveis implicações nos processos de constituição subjetiva. Para alcançar este objetivo, iniciam por um breve apanhado a respeito dos caminhos dessa constituição, a partir de autores lacanianos. Posteriormente questionam, à luz da teoria da constituição do sujeito, os possíveis efeitos ocorridos pelas transformações dos papeis exercidos tradicionalmente pela mãe e pelo pai. A concepção da infância é considerada a partir dos efeitos constitutivos do exercício parental na atualidade.

The authors intend to discuss in this article the possible changes in the operation of the maternal and paternal functions by the current changes in family structures and their possible implications in the processes of subjective constitution. To accomplish this goal, they begin by a brief overview about the paths of this constitution, from Lacanian authors. Subsequently they question, in light of the theory of the constitution of the subject, the possible effects brought up by the transformations occurring in the roles traditionally exercised by the mother and father. The conception of childhood is considered from the constitutive effects of exercise parental nowadays.

Les auteurs ont l'intention de discuter dans cet article les changements éventuels dans le fonctionnement des fonctions maternelle et paternelle par les changements actuels dans les structures familiales et leurs implications possibles dans les processus de constitution subjective. Pour ce faire, ils commencent par un bref aperçu sur les moyens de cette constitution, par des auteurs lacaniens. Par la suite remis en question, à la lumière de la théorie de la constitution du sujet, les effets possibles des transformations qui se sont produites dans les rôles traditionnellement exercés par la mère et le père. La conception de l'enfance est considérée depuis les effets constitutifs de l'exercice parental d'aujourd'hui.

A Survey on the Foodservice Management Job of School Dietitians and the Uses of Preprocessed and Processed Foods: Focused on Seoul, Gyeonggi and Incheon Areas

This survey's purpose was to understand the duties of the school dietitians' foodservice management and to identify the uses of preprocessed and processed food in Seoul Metropolitan area schools. The survey was distributed either via e-mail or in person to nutrition teachers and dietitians working at lementry, middle and high shools who participated in training sessions in Seoul, Gyeonggi and Incheon areas from December 2006 until June 2007. Four-hundred fifty-nine out of the total 760 schools that completed the surveys were analyzed. The following summarizes the main duties of school dietitians related to foodservice management: hygiene (100%), nutrition (99.8%), nutrition education (97.2%), cost (96.9%), and food production process control (96.3%). Preprocessed foods were ordered as the following: seafood (2.89)>poultry (2.78)>seeds (2.37). processed foods comprised the following order: pastes (4.94)>kimchi (4.91)>dressing materials (4.50). Based on these results, elementary schools must improve methods for developing effective study materials for nutrition education which are appropriate for each grade.

A Survey on the Foodservice Management Job of School Dietitians and the Uses of Preprocessed and Processed Foods: Focused on Seoul, Gyeonggi and Incheon Areas

This survey's purpose was to understand the duties of the school dietitians' foodservice management and to identify the uses of preprocessed and processed food in Seoul Metropolitan area schools. The survey was distributed either via e-mail or in person to nutrition teachers and dietitians working at lementry, middle and high shools who participated in training sessions in Seoul, Gyeonggi and Incheon areas from December 2006 until June 2007. Four-hundred fifty-nine out of the total 760 schools that completed the surveys were analyzed. The following summarizes the main duties of school dietitians related to foodservice management: hygiene (100%), nutrition (99.8%), nutrition education (97.2%), cost (96.9%), and food production process control (96.3%). Preprocessed foods were ordered as the following: seafood (2.89)>poultry (2.78)>seeds (2.37). processed foods comprised the following order: pastes (4.94)>kimchi (4.91)>dressing materials (4.50). Based on these results, elementary schools must improve methods for developing effective study materials for nutrition education which are appropriate for each grade.

Bioética y reciprocidad en el reconocimiento de derechos y deberes / Bioethics end reciprocity in the acknowledgement of right and duties / Bioética e reciprocidade no reconhecimento de direitos e deveres

Desde una perspectiva hermenéutica, se analiza el estatuto de la medicina en tanto arte de curar, considerando su particular característica de techne y sus diferencias con los demás saberes técnicos productores de obras. Esta dificultad se ve complejizada por la irrupción de las implementaciones técnicas y cambios morales en la modernidad, que amenazan su praxis efectiva y ponen en riesgo su identidad esencial. Hoy se entiende que la Medicina es más que el puro ejercicio de técnicas y saberes especializados, y que toda intervención médica responsable debe ajustarse al espacio de reconocimiento de aquella compleja y esencial multidimensionalidad de lo humano, inaprehensible para cualquier esfuerzo meramente explicativo o técnico que intente contemplar su vastedad y pluralidad.

From a hermeneutic perspective, this article analyzes the statute of medicine as a healing art, considering its particular technical characteristic and its differences with other technical knowledge that delivers goods. This difficulty is compounded by the eruption of technical implementations and moral changes of modernity, which threaten effective practice and places its essential identity at risk. Currently it is understood that Medicine is more than the mere application of techniques and specialized knowledge, and that all responsible medical interventions should adjust their definition to the complex and essentially multidimensional nature of human beings, which is not realized by mere technical explanations or techniques that attempt to envision its vastness and plurality.

A partir de uma perspectiva hermenêutica, analisa-se o estatuto da medicina enguanto arte de curar, considerando sua característica particular de techne e suas diferenças com os demais saberes técnicos produtores de obras. Esta dificuldade torna-se mais complexa com a irrupção das implementações técnicas e mudanças morais na modernidade, que ameaçam sua praxis efetiva e colocam em risco sua identidade esencial. Hoje se entende que a Medicina é mais que o puro exercício de técnicas e saberes especializados, e que todas intervenção médica responsável deve se ajustar ao espaço de reconhecimento da complexa e esencial multidimensionalidade do humano, inapreensible em qualquer esforço meramente explicativo ou técnico que procure contemplar sua vastidão e pluralidade.

Perception of the Elementary School Dietitians and Students on Nutrition Education to Set up the Roles of Nutrition Teacher : Centered on Daegu City and Gyeongbuk Province

The purpose of this study was getting information to set up the new roles focused on nutrition education for school dietitians as nutrition teachers. One hundred thirty nine school dietitians and 1169 elementary school children residing in Daegu city and Gyeongbuk province were surveyed for this study. Sixty eight percent of the school dietitians perceived 1st-3rd year of the elementary school is the most proper time to start nutrition education, and 59.0% of them wanted to practice nutrition education as a discretion teaching time. The largest proportion(79.1%) of the school dietitians expected that nutrition education is helpful to get good dietary habit. School dietitians responded that major contents that should be included in the nutrition education was balanced diet, diet and habit, managing healthy weight, dining etiquette, food safety and problems of environmental contamination. Fairly large proportion of the students(64.4%) responded nutrition education is urgently needed. The contents of the nutrition education students wanted most were cooking and healthy diet. Forty six percent of the students perceived school dietitians are responsible for nutrition education and they wanted to have nutrition education as a part of special activity class. The most preferred frequency of nutrition education was 1 hour/week and 46.2% of the students responded they wanted to participate cooking camp.

Patients' right Deferderce and Hospital Moral Duties / 中国医学伦理学

Doctor-patient right conflict should be noticed at present. Hospital administrators should strengthen ''sense of patients right" and get to the consistency of economic administrative aim and patients right protection while making choices in administration. They should realise the combination between rights and duties of health staff and reach the hermonization of society, patients and hospital beneficts.

A Research into Medical Consumers' rights and Quties——A summary of research into rights and duties ofdomestic, alien patients / 中国医学伦理学

After summing up history and current situation of qlien patients rights and duties, the paper empha-sices on domestic patients' rights and duties, It will have great theortic and practiced significance touords perfecting our newly built medical morbet. confirming medical consumers' benffits and improving medical morals basical-ly.