A internet como coadjuvante no empoderamento dos pacientes que vivem com o HIV/Aids / The Internet as an adjunct to the empowerment of patients living with HIV / Aids

Resumo Este trabalho discute o uso da internet como instrumento de pesquisa em saúde num grupo de pacientes que vivem e convivem com o HIV/Aids. A literatura sobre o tema em questão mostra a internet como um dos meios de comunicação mais acessados para busca de informações sobre saúde nos dias atuais, inclusive para o grupo entrevistado. É um estudo qualitativo que envolve entrevistas semiestruturadas. Os pacientes entrevistados pela pesquisa estão em tratamento ambulatorial para HIV/Aids e participam de um grupo de apoio no mesmo hospital onde realizam seu tratamento. Em contraposição com os dados teóricos levantados, no grupo pesquisado muitos preferem o uso de outras mídias e alguns não fazem uso da internet para pesquisas sobre saúde. A análise das entrevistas revelou que o conhecimento adquirido pela internet ou por outras mídias não afeta o respeito do profissional médico. Pelo contrário, parece valorizar a relação médico-paciente e a confiança no conhecimento médico. Apesar de utilizarem vários meios de comunicação, consideram que a principal fonte de informação ainda é aquela oferecida pelo profissional médico ou outro profissional de saúde qualificado. Além disso, o empoderamento, obtido por meio dos conhecimentos adquiridos na internet, contribuiu para o diálogo com o médico durante a consulta. Pelo contrário, fortalecido pela confiança que o profissional médico transmite ao conduzir o encontro clínico.

Abstract This paper discusses the use of the Internet as a tool for health research in a group of patients living with HIV / Aids. The literature shows the internet as one of the most accessed media for searching for health information in the present day, including the group interviewed. We conducted a qualitative study involving 11 semi-structured interviews. All patients interviewed are HIV positives and in treatment for HIV/Aids. They are members of a support group at the same hospital they are outpatients. In opposition to theoretical data, among those interviewed, many prefer the use of other medias. Some of the interviewed in this study does not use the Internet as a mean to research health subjects. The analysis of the interviews revealed that knowledge acquired through the internet or other media, does not affect the respect of the medical professional. On the contrary, it seems to value the physician-patient relationship and the trust in medical knowledge. Despite using several means of communication, they consider that the main source of information still is the one offered by the medical professional or another qualified health professional. Moreover, that empowerment, gained through the knowledge acquired on the internet, contributed to the dialogue with the physician during the appointment. Thus, for the interviewees, the physician-patient relationship has not been compromised; on the contrary, strengthened by the trust that the medical professional shows in conducting the clinical encounter.

Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE

Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

As inter-relações saúde e trabalho na abordagem clinica e individual / The inter-relation ships between work and health in the approach individual clinical

JUSTIFICATIVA E OBJETIVOS: A importância do trabalho e das suas condições no processo de adoecimento ganhou destaque no novo código de ética médica: o medico deve empenhar-se pela melhor adequação do trabalho ao ser humano e esclarecer o trabalhador sobre as condições de trabalho que ponham em risco sua saúde. A maioria das doenças relacionadas ao trabalho manifesta-se a partir de sintomas e sinais de doenças comuns e muitas doenças crônicas são agravadas pelas condições de trabalho. CONTEÚDO: São discutidos os principais aspectos da anamnese ocupacional de interesse para o clínico no diagnóstico diferencial e que podem influenciar diretamente na eficácia ou não do tratamento. CONCLUSÃO: Pelo fato que muitas doenças crônicas comuns na prática clínica podem ser desencadeadas ou agravadas pelo trabalho, a conduta adequada, em alguns casos, requer o afastamento ou mudança das atividades de trabalho do paciente-trabalhador.

BACKGROUND AND OBJECTIVES: The importance of work and working conditions in the disease process was highlighted in the new code of medical ethics: Physicians should consider the better adaptation of job to workers and clarify the employee on the work conditions and your health. Most occupational diseases present symptoms and signs of common diseases and many chronic diseases are aggravated by working conditions. CONTENTS: This paper discusses the main aspects of occupational anamnesis interesting in the clinician and the differential diagnosis with occupational disease and chronic diseases, the job can be influence the effectiveness in the treatment. CONCLUSION: Many chronic diseases common in clinical practice may be triggered or aggravated by work. The appropriated approach in some cases requires the removal or changing the work activities of patient-worker.

Breaking patient confidentiality: comparing Chilean and French viewpoints regarding the conditions of its acceptability / Ruptura de la confidencialidad: una comparación entre las perspectivas chilena y francesa respecto a las condiciones de su aceptabilidad

Para examinar las condiciones bajo las cuales una muestra de participantes del público general y de profesionales de la salud chilenos considera aceptable que un médico rompa la confidencialidad para proteger al cónyuge de un paciente que padece una enfermedad de transmisión sexual (ETS), doscientos siete participantes (personas del público general y profesionales de la salud), evaluaron la aceptabilidad de dicha ruptura en 48 escenarios, que consistieron en todas las posibles combinaciones de 5 factores (gravedad de la enfermedad, tiempo que se toma conversar sobre la enfermedad con el paciente, intento del paciente por informar a su cónyuge sobre su enfermedad, intento del paciente por adoptar una conducta de protección hacia su cónyuge, y decisión del médico de consultar a un especialista en ETS). Un análisis de racimos reveló grupos de participantes que encontraron la ruptura de la confidencialidad oscilando entre “siempre aceptable” y “nunca aceptable”. A pesar de las diferencias de legislación y códigos de ética, las muestras de público general no difirieron mucho en sus convicciones personales respecto a las circunstancias de protección o ruptura de la confidencialidad del paciente. En contraste, los médicos chilenos apoyaron menos que los franceses mantener un completo respeto a la confidencialidad del paciente en todos los casos...

To examine the conditions under which lay people and health professionals living in Chile and France find it acceptable for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD), 207 lay persons and healthcare professionals indicated the acceptability of breaking confidentiality in 48 scenarios combining five factors: disease severity, time taken to discuss this with the patient, patient’s intent to inform his spouse about the disease, patient’s intent to adopt protective behaviors, and physician’s decision to consult an STD expert. A cluster analysis revealed groups that found breaking confidentiality “always acceptable”, requiring “consultation with an expert”, “depending on the many circumstances”, and “never acceptable” (11%)”. Despite differences in legislation and ethics codes, Chilean and French lay people showed similar personal convictions regarding the circumstances in which breaking patient confidentiality is acceptable. In contrast, Chilean physicians were much less supportive than French physicians of complete respect of patientconfidentiality in all cases...

Homeopatia: prática médica humanística: [revisão] / Homeopathy: a humanistic approach to medical practice: [review]

Na última década, o modelo médico vigente busca resgatar um incremento na relação médico-paciente, com propostas de humanização nas áreas da educação, assistência e política médica. Valorizar características holísticas das práticas não convencionais em saúde sugere a incorporação de aspectos diversos das ciências humanas no entendimento do processo de adoecimento do indivíduo, ressaltando que o interesse do médico por aspectos aparentemente não relacionados ao órgão acometido (história de vida do paciente, personalidade, interesses etc.) deve ser acrescentado à consulta médica técnica e não-humanizada. Tendo em vista que a homeopatia utiliza esta ampla abordagem semiológica como prática inerente, empregando a totalidade de sintomas característicos do enfermo para avaliar o desequilíbrio orgânico e escolher o meio de tratamento, a prática clínica homeopática tem muito a contribuir com o humanismo da medicina.

During the last decade, the traditional medical model has endeavoured to retrieve an improvement in the patient-physician relationship by means of propositions for humanization in the areas of education, medical care and policies. To enhance holistic characteristics of non-conventional practices in health, the incorporation of several aspects of humanities in understanding the process of the individual's illness, stressing that the physician's interest in aspects apparently not related to the impaired organ (history of the patients life, personality, interests, etc.) should be added to the technical and less humanized consultation. Since homeopathy embraces this wide semiological approach as inherent practice, using the totality of characteristic symptoms to evaluate organic unbalance and choose means of treatment, homeopathic clinical practice can signnificantly contribute to humanism in medicine.

Decisões clínicas eticamente orientadas / Clinical decisions ethically guided

Em bioética, vários métodos de tomada de decisão em ética clínica já foram apresentados. Neste artigo, apresento um método que compatibiliza uma visão sobre a ética das decisões em medicina (o modelo conhecido como "casuístico" ou "baseado em casos") com a tese de que a medicina comporta uma moralidade interna ou especial, embora constrangida externamente pelo respeito aos direitos dos pacientes. Minha proposta é uma alternativa a concepções, como a de Robert Veatch e, em alguma medida, Diego Gracia, que procuram compatibilizar outro modelo, o principialista, com a tese liberal que toma os princípios da autonomia e da justiça como preeminentes frente aos princípios hipocráticos da beneficência e da não-maleficência. Diego Gracia, por exemplo, considera que sistemas especiais de moralidade são ilegítimos e incompatíveis com o respeito à "autonomia" dos pacientes. Defenderei, ao contrário, que a ética médica, entendida como um sistema especial de moralidade, é legítima e compatível com o respeito à liberdade das pessoas (AU)

In bioethics, several methods of decision making in clinical ethics have already been introduced. In this paper, I introduce a method that combines a conception of ethical decisions in medicine ("casuistry" or "case-based ethics") with a conception that medicine has an internal or special morality, albeit externally constrained by patient's rights. My theory is an alternative to conceptions, like Robert Veatch's and, in some way, Diego Gracia's, that combines another method, the principialist, with liberal theses that takes the principles of autonomy and justice as prior to the principles of beneficence and non-maleficence. Diego Gracia, for example, considers that special systems of morality are illegitimate and incompatible with respect of patient's autonomy. I'll defend otherwise that medical ethics, understood as a special system of morality, is legitimate and compatible with respect of people's liberty (AU)

Patients′ Trust:Concept,Dimensions and Attributes / 中国医学伦理学

The patient-physician relationship can be understood from the two aspects of patients′ trust and patients′ satisfaction.Compared with patients′ satisfaction,dimensions and attributes of patients′ trust indicate to better match with the measuring capacity of patients.Thus,the evaluation of the quality of medical services based on patients′ trust is justified theoretically.The existing literatures assert that the research on patients′ trust could help understand patient-physician relationship and eventually improve the quality of medical services.The conceptual model in this paper entails the concept,dimensions and attributes of patients′ trust.Also,this paper points out its effect on the measurement of the quality of medical services through the comparison of patients′ trust and patients′ satisfaction.

Taiwan's medical system and the privacy right in the patient physician relationship / 中国医学伦理学

In the Health-Care system,the right of privacy is an important part for protecting benefits and the trust between doctors and patients.Most of the discussion about privacy in Taiwan is modeled after the West.They assume that every individual is exiting like an atom,and separate the individual from the community.In our society and culture,we look at the individual with a totally different attitude.This paper tries to introduce the western privacy theory and extends its meaning when applying into the relationship between doctors and patients.It analyses the problem of privacy in terms of the participation and status of family members in the signing of the surgical consent form and patient physician relationship and tries to make a comparative studies of the reasonableness feasibility of the exclusion of the participation of the family in the West.

Referencing emotion-focused therapy to enhance doctors' occupational capacity / 中国医学伦理学

Apart from the direct causality link of emotion and health,emotions also affect health indirectly through hormone production,immune function,symptom perception,to seek treatment,treatment decisions and adhere to treatment,health behavior,and so.Medical professional norms also gradually require doctors helping patient to aware their emotions and use adaptive strategies to regulate their emotions.Emotion-focused therapy has important significance for this occupational capacity.