Maltrato infantil: conocimiento y actitud del cirujano dentista: marco legal y revisión de la literatura / Child abuse: knowledge and attitude of the dentist: legal framework and review of the literature

El maltrato, abuso y la negligencia a los niños constituyen un fenómeno social que desafortunadamente está extendido por todo el mundo sin barreras étnicas, geográficas ni de contexto social. En Chile, hasta el año 2012 el 71 % de los niños sufría algún tipo de maltrato al interior de su familia. Las lesiones cráneo-faciales y de cuello ocurren en más de la mitad de los casos. El Odontólogo tiene la obligación legal, moral y ética como ciudadano y profesional de la salud de notificar a las autoridades competentes los casos sospechosos de maltrato. Objetivo: Evaluar cuál es el conocimiento del cirujano dentista sobre maltrato infantil y cuál ha sido su actitud frente a la detección y reporte del maltrato infantil. Búsqueda bibliográfica en PUBMED utilizando palabras clave: "child abuse" and "dentistry". Se encontraron 132 artículos, de los cuales fueron 15 atingentes con texto completo. Estudios realizados en varios países informaron de las dificultades de los odontólogos en el diagnóstico, la documentación y la denuncia de casos con sospecha de abuso a las autoridades, además de la necesidad de mayor formación en el tema. Dada la importancia del tema, el papel del odontólogo al trabajar directamente con niños y adolescentes, y el aumento en el reporte de casos sospechosos de violencia, se sugiere fuertemente realizar una vigilancia respecto a conocimiento y actitudes entre los odontólogos en Chile.

Abuse and neglect of children constitutes a social phenomenon that unfortunately is spread throughout the world without ethnic, geographical or social context barriers. In Chile, until 2012, 71 % of children suffered some type of abuse within their family. Skull-facial and neck injuries occur in more than half of the cases. The Dentist has a legal, moral and ethical obligation as a citizen and health professional to notify the authorities of suspected cases of abuse. The objective of the study was to evaluate the extent of the dental surgeons´ knowledge regarding child abuse and their attitude towards the detection and reporting of child abuse. Bibliographic search in PUBMED using keywords: "child abuse" and "dentistry". In the study, 132 articles were found, of which 15 were full text. Studies in several countries reported the difficulties of dentists in the diagnosis, documentation and reporting of cases of suspected abuse to the authorities, in addition to the need for further training in the subject. Given the importance of this issue, the role of the dentist working directly with children and adolescents, and the increase in the reporting of suspected cases of violence, it is strongly suggested to monitor the knowledge and attitudes among dentists in Chile.

Aspectos médico-legales de la muerte súbita cardíaca durante el ejercicio: reporte de caso / Legal medical aspects of sudden cardiac death during exercise: case report

Resumen Las muertes súbitas se encuentran dentro de las indicaciones de autopsia médico legal de Costa Rica, según el Reglamento de Autopsias Hospitalarias y Médico Legales publicada el 12 de Marzo de 1987. Para establecer el criterio de muerte súbita debemos conocer inicialmente la definición médico legal, su importancia y la finalidad por la cual se realiza, ésta se define como toda muerte de origen no violento, la cual se desarrolla de manera rápida e inesperada, en una persona que no presentaba ninguna patología médica y por la cual era improbable su muerte; ahora bien estas muertes podrían presentar cierta posibilidad de haber sido provocadas por algún tipo de crimen, por esta razón, se debe descartar toda aquella causa de muerte de origen violento. Existen múltiples causas de muertes súbitas, sin embargo las cardíacas en definitiva son las más frecuentes, en este artículo se abordará las muertes súbitas cardiacas de causa no ateroesclerótica durante el ejercicio ya que ante el advenimiento de las nuevas políticas de prevención y promoción de la salud, al realizar deporte se han logrado identificar ciertas patologías cardíacas que en algunos de los casos se evidencian por medio de una muerte súbita, el médico legal es el encargado de esclarecer y brindarle a los familiares de la persona fallecida la causa precisa de su muerte y de esta manera determinar la manera de muerte desde un punto de vista médico legal.

Abstract The indications of forensic autopsy in relation to sudden deaths in Costa Rica, are according to the Regulation of Autopsies in Hospital or in Forensic Department, published on March 12, 1987. To establish the criteria of sudden death we must know mainly its forensic definition, the importance and the purpose for which it is carried out, it is defined as any non-violent, rapid and unexpected death, in a person who did not present any medical pathology and for which his death was unlikely; these deaths could be caused by some type of crime, the forensic is in relation to determinate all those causes of violent death. There are multiple causes of sudden deaths, however, the cardiac are the most frequent, in this article will be discussed cardiac pathologies that could cause a sudden death during the exercise. The forensic pathologist is the responsible for clarifying the precise cause of his death and determine the manner of death.

Reanimación cardiopulmonar (RCP) en el lugar de trabajo. normativas de capacitación en medicina del trabajo / Cardiopulmonary resuscitation inthe workplaceTraining regulations in occupational medicine

Tanto en personas adultas como en jóvenes y niños, aprender primeros auxilios y reanimación cardiopulmonar (RCP) hace la diferencia entre la vida y la muerte en toda actividad humana. Se debe capacitar a cada trabajador en su lugar de labor. Puede suceder en escuelas, universidades, en la práctica deportiva, en la actividad aeroportuaria, en una aeronave, en la actividad de la seguridad privada, gimnasios, centros comerciales, oficinas, como en los templos, radios, estudios televisivos, recitales, aeropuertos, hoteles y en todo otro lugar donde se encuentren muchas personas circulando. También es muy útil saber qué hacer ante un problema de salud en el hogar. Se expone cómo realizar la capacitación en RCP y Primeros Auxilios en el trabajo.

Both in adults, as in young people and children, learning first aid and cardiopulmonary resuscitation (RCP) makes the difference between life and death in all human activity. Each worker must be trained in their workplace. It can happen in schools, universities, in sports practice, in the airport activity, in an aircraft, in the activity of private security, gyms, shopping centers, offices, as in temples, radios, television studios, recitals, airports, hotels and everywhere else where there are many people circulating. It is also very useful to know what to do when faced with a health problem at home. It is exposed how to perform CPR and First Aid training at work.

La violencia obstétrica: un fenómeno vinculado a la violación de los derechos elementales de la mujer / Obstetric violence: a phenomenon linked to the violation of the basic rights of women

ResumenEl presente artículo resulta de un trabajo de revisión bibliográfica en el que analizamos la violencia obstétrica como forma de violencia contra la mujer y de violación a los derechos humanos, con gran frecuencia ignorada, llegando a ser en ocasiones desestimado un tema de gran actualidad e interés para la bioética. La violencia obstétrica como violencia simbólica contra la mujer manifiesta la asimetría existente entre hombres y mujeres siendo imprescindible el desarrollo normativo encargado de regular el conjunto de prácticas en los procesos reproductivos de las mujeres a la par que permita alertar sobre la importancia del respeto de los derechos sexuales y reproductivos, definiendo a la salud sexual y reproductiva como una parte inalienable, integral e indivisible de los derechos humanos universales. No obstante los logros conseguidos desde estas iniciativas, las desigualdades de género siguen afectando los servicios de salud reproductiva en gran parte del mundo.

AbstractThe present article comes of a bibliographic review labour in which we analyse obstetric violence as a way of violence against women and as violation of the human rights, which are frequently ignored, sometimesbecomingrejecteda subject of greatcurrent interestfor bioethics. Obstetric violence as symbolic violence against women reveals the asymmetry which is between men and women and the legal development in charge of legislating the set of practices in the women reproductive processes is essential in order to alert about the importance of the respect of sexualand reproductive rights as an inalienable, comprehensible and indivisible of the universal human rights. Despite the achievements from these initiatives, gender inequalities still affect reproductive health services in large part of the world.

Psiquiatría y Ley de Enfermedades Profesionales en Chile: revisión histórica y crítica de una relación compleja / Psychiatry and occupational diseases act in Chile: historical and critical review of a complex relationship

The Work Accidents and Occupational Diseases Act exists in Chile since 1968. It uses a single model for the understanding and management of both somatic diseases like silicosis and psychiatric disorders. During the last decade in Chile, the consultation rates due to psychiatric conditions of probable labor origin has rose over 1,000%, a factor that underscored the deficiencies of this model. The aim of this paper is to analyze the consequences of the application of this act in the psychiatric field for almost 50 years after its promulgation. This article contains an historical overview and an epistemological debate based on the authors’ experience dealing with clinical and administrative work both in occupational psychiatry departments and in regulatory entities. The development of occupational mental health in Chile is examined as part of an historical process that initially did not consider the relationship between work and mental suffering as relevant. The application of a single causality model in psychiatry, as well as the effects of building a psychiatric nosology upon legal rather than medical criteria is contested.

Derechos de los pacientes con enfermedades que se asocien con discapacidad: marco legal actual / Rights of persons with conditions associated with disability: current legal framework

Este estudio de revisión tiene como objetivo promover la diseminación de la legislación vigente en nuestro país que protege los derechos de los pacientes con enfermedades que pueden producir discapacidad. Se analizan los artículos de las leyes que resguardan los derechos de estas familias para que sean más accesibles a los profesionales de la salud que las asisten. Argentina posee una amplia legislación dedicada a protegerlos, pero no es claramente reconocida por el ciudadano en general. La propuesta es difundir esta información en el ambiente médico para que los profesionales de la salud puedan ayudar al paciente a reconocer sus derechos a través del empoderamiento.

The objective of this review study is to promote the dissemination of the legislation in force in Argentina for the protection of the rights of persons with conditions that might cause disability. Articles of bills and laws that protect the rights of these families are reviewed, so that health care providers assisting them have better access to them. Argentina has a wide range of laws and regulations dedicated to protecting them, but they are generally not clearly recognized by citizens. The aim is to disseminate this information in the medical setting so that health care providers can help patients recognize their rights through empowerment.

Definición de nanomateriales para Colombia / Definition of Nanomateriais for Colombia / Definição de nanomateriais para a Colômbia

Debido a la creciente producción y uso de nanomateriales para actividades de investigación y desarrollo en Colombia, es necesario establecer una definición del término nanomaterial que facilite la toma de decisiones en torno a iniciativas de carácter regulatorio y de normatividad. Se presenta la definición de nanomateriales para Colombia que ha adoptado el Consejo Nacional Asesor de Nanociencia y Nanotecnología adscrito a la Red Colombiana de Nanociencia y Nanotecnología.

Due to the increasing production and use of nanomaterials in research and development activities in Colombia, it is necessary to define the nanomaterial term in order to facilitate decision-making process regarding initiatives with a regulatory or normative character. This article presents the nanomaterials definition that has been adopted by the National Advisory Council for Nanoscience and Nanotechnology, a Colombian Network of Nanoscience and Nanotechnology.

Dada a crescente produção e utilização de nanomateriais para a pesquisa e desenvolvimiento na Colombia, é urgente estabelecer uma definição do termo de nanomaterial para facilitar a tomada de decisão sobre iniciativas na regulamentação e as leis. É apresentada uma definição de nanomateriais para a Colombia que aprovou o Conselho Consultivo Nacional de Nanociência e Nanotecnologia ligado à Rede Colombiana de Nanociência e Nanotecnologia.

Violencia obstétrica desde la perspectiva de la paciente

Objetivo: Determinar la prevalencia de violencia obstétrica en la sala de partos del Hospital General del Oeste “Dr. José Gregorio Hernández” de Caracas durante el período comprendido entre junio y octubre de 2012. Métodos: Estudio prospectivo y descriptivo, en el que se investigó , la posibilidad de ocurrir violencia obstétrica en 326 pacientes, atendidas por partos, cesáreas y abortos. Se aplicó un cuestionario de 15 preguntas orientado a conocer la opinión de las pacientes en cuanto a la atención recibida y si tenían conocimientos acerca de la violencia obstétrica. Resultados: La prevalencia de violencia obstétrica fue de 26,3 %, predominando la violencia psicológica. Cuando hubo agresión verbal o maltrato los responsables fueron el obstetra, el anestesiólogo, y las enfermeras. El 34,4 % de las pacientes no recibió información adecuada sobre los procedimientos que les practicarían, mientras que al 65,6 % les fueron realizados procedimientos médicos o quirúrgicos sin solicitarles el consentimiento informado por escrito. Fue informada agresión física en 0,9 % de los casos. En el 80,1 % desconoce los mecanismos de denuncia. Conclusiones: La mejor contribución que se puede hacer para enfrentar eficazmente el problema de la violencia contra la mujer, incluida la violencia obstétrica, es promover su prevención.

Objective: To determinate the prevalence of obstetric violence in the Labor Area of the General Hospital of the West “Dr. Jose Gregorio Hernandez” in Caracas during June to October of 2012. Methods: Prospective and descriptive study, to investigated the possibility of obstetric violence occur in 326 patients attended by deliveries, cesarean sections and abortions. A questionnaire of 15 questions aimed at getting feedback from the patients for the care and whether they had knowledge of obstetric violence was applied. Results: Obstetric violence prevalence was 26.3 %, prevailing the psychological violence. When verbal aggression or maltreatment occurred the responsible was the physicians and nurses. 34.4 % of the patient not received adequate information about the procedures that will be performed, while 65.6 % were realized medical or surgical procedures without request the informed consent. Physical violence was informed in 0.9 % of the cases. The 80.1 % was unaware about the denunciation mechanisms. Conclusions: The best contribution that will be doing to confront effectively the gender violence, included obstetric violence, is to promote it´s prevention.

Consideration of Indonesian new social security system through the laws / 国際保健医療

  The Government of Indonesia (GOI) implemented a social security program, however, not all the population are covered as the Constitute of the Republic of Indonesia guarantee at its article 28th and obligate the GOI provide social security to all population. <BR>  In 2004, the GOI introduced a new social security system targeting all population in order to achieve an improved coverage and integrated it into a unified system. The GOI has introduced a National Health Insurance System ahead of other social security systems on the 1st January 2014.<BR>  It is also obligated foreigners who have lived in Indonesia for more than 6 months to participate. However, dissemination of the new system to the public was not enough at the timing of the introduction. Especially for foreigners as there is not enough information in any foreign language.<BR>  The new system follows some parts of the previous program which was introduced for lower income population in 2005, the focuses are prioritizing on primary care and introducing a payment system for health care services. For accessing the health care services under the insurance system, all insurance holders have to attend the primary care institution at the beginning. Improving the quality and quantity of primary care service institutions requires important key factors to enhance the system and to increase the coverage.<BR>  This article reviews the previous social security system and studies the laws and regulations relating to it, especially the new national health insurance system which was introduced in January 2014. It also discusses the challenges in enhancing the health insurance system and achieving Universal Health Coverage.

Nurse attitudes in relation to health care ethics and legal regulations for nursing / Actitudes de las enfermeras en relación con la ética de la salud y las regulaciones legales de enfermería / Atitudes das enfermeiras com relação à ética em saúde e às regulamentações legais de enfermagem

The nursing environment is full of situations under ethical and legal constraints. Therefore this study focused on the knowledge, position and attitudes of nurses in relation to healthcare ethics and nursing legal regulations. We conducted a pretest and posttest study using a specific questionnaire administered to a convenience sample of nurses who worked in a healthcare system in Principado de Asturias, a northern state of Spain and were enrolled in a continuing nursing education program about ethical and legal aspects in the nursing profession. The main findings suggest that nurses are very concerned about situations that create ethical and legal conflicts but do not feel sufficiently trained. In general, they demonstrated sufficient knowledge to address the most frequent ethical and moral situations of nursing work, and the training received during a postgraduate course in ethics and legislation provided them with greater knowledge and tools to solve the dilemmas. In conclusion, although the nurses have university-level education about professional deontology, bioethics and nursing legislation, they require periodic continuing education.

El ámbito de la enfermería está llena de situaciones clínicas que comportan limitaciones éticas y legales. Por ello, este estudio se centró en demostrar el conocimiento, posicionamiento y actitudes de las enfermeras en relación con la las regulaciones ético legales inherentes a la práctica de enfermería. Se realizó un estudio pretest y posttest, mediante un cuestionario específico administrado a una muestra de conveniencia de las enfermeras que trabajaban en un sistema de salud en el Principado de Asturias de España, y que se habían inscrito en un curso de educación continua sobre los aspectos éticos y legales en la de enfermería profesional. Las principales conclusiones indican que las enfermeras están muy preocupadas por las situaciones que generan conflictos éticos y legales, pero no se sienten suficientemente capacitadas para resolverlas. En general, demostraron conocimientos suficientes para hacer frente a las situaciones ético-morales más frecuentes del trabajo enfermero, y la formación recibida durante un curso de posgrado en la ética y la legislación les proporcionó un mayor conocimiento y herramientas para resolver otros dilemas éticos. En conclusión, aunque las enfermeras tienen conocimientos aprendidos en la universidad sobre deontología profesional, bioética y legislación en enfermería, se requiere de una educación continua en el ámbito ético-legal en enfermería.

O âmbito da enfermagem está cheio de situações clínicas que comportam limitações éticas e legais. Por isso, este estudo se centrou em demonstrar o conhecimento, posicionamento e atitudes das enfermeiras com relação às regulamentações ético-legais inerentes à prática de enfermagem. Realizou-se um estudo pré-teste e pós-teste, mediante um questionário específico administrado a uma amostra de conveniência das enfermeiras que trabalhavam num sistema de saúde no Principado de Astúrias, Espanha, e que se inscreveram num curso de educação continuada sobre os aspectos éticos e legais da enfermagem profissional. As principais conclusões indicam que as enfermeiras estão muito preocupadas com situações que geram conflitos éticos e legais, porém não se sentem suficientemente capacitadas para resolvê-las. Em geral, demonstraram conhecimentos suficientes para fazer frente às situações ético-morais mais frequentes do trabalho de enfermagem, e a formação recebida durante um curso de pós-graduação em ética e legislação lhes proporcionou um maior conhecimento e ferramentas para resolver outros dilemas éticos. Em conclusão, ainda que as enfermeiras tenham conhecimentos aprendidos na universidade sobre deontologia profissional, bioética e legislação em enfermagem, se requer uma educação continuada no âmbito ético-legal em enfermagem.

Enfermedades respiratorias laborales en Chile: Ley 16.744 / Work related respiratory diseases in Chile – Law 16.744

Since 1968 Chile has two separate systems to manage the health problems of Chileans. One is devoted to prevent and care for all kind of diseases, from gestation to death, and the other one is devoted exclusively to work-related diseases and accidents. The last one has been very successful in lowering the work related accidents below 5 percent, rate that is similar to those of developed countries. The system has been replicated in other Latin-American countries. Occupational diseases, on the other hand, had been neglected by the system (although not in its design). The current article visit the most relevant aspects of the system and focus on the role of respiratory diseases specialists in the diagnosis and management of work related respiratory diseases.

Desde 1968 Chile cuenta con dos sistemas paralelos para manejar los problemas de salud de la población. Uno está orientado a prevenir y curar todo tipo de enfermedades, desde la gestación hasta la muerte; el otro está diseñado para preocuparse de las enfermedades y accidentes relacionados con la actividad laboral. Este último sistema ha sido muy exitoso en disminuir la accidentabilidad laboral, la que se ubica actualmente bajo el 5 por ciento, frecuencia similar a la observada en países desarrollados. Este sistema ha sido copiado en otros países de Latinoamérica. Las enfermedades ocupacionales han sido descuidadas por el sistema, aun cuando fueron adecuadamente consideradas en el cuerpo legal. El presente artículo presenta los aspectos más relevantes de este sistema y destaca el papel de los especialistas en enfermedades respiratorias en el diagnóstico y manejo de las enfermedades respiratorias ocupacionales.

Hearing Injury Evaluation: Current Status and Medicolegal Considerations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In disability rating of hearing injury, there are some medicolegal considerations, such as discrepancy in estimating values between McBride system and the American Medical Association system, and difficulties in judging the hearing level in boundary cases. We have therefore felt the need of complementary hearing disability evaluation methods that reflect reality. As a first step, we have pointed out current situation and problems in legal advisory cases of hearing injury. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory on hearing injury for 121 cases for courts (group A) or insurance companies (group B). Eleven cases of 'aggravation of disability' were excluded. Data were summarized and tested statistically. We have used unpaired t-test for continuous variables such as age, hearing, hearing disability, disability rating, Fisher's exact test for dichotomous variable such as gender, group (A/B), and Pearson's correlation test for correlation coefficients between continuous variables. RESULTS: Subjects were more frequently males (3:1) and in the fifth decade of life. The averages of audiometry were around 40 dB. There were significant differences in hearing and disability rating between younger and older group. Group B is significantly older than group A. The type of disability or accident did not influence hearing and disability rating. CONCLUSION: This paper could help figure out the current situation with respect to medicolegal considerations of hearing injury discrepancies in disability rating and could also serve well to recognize the necessity for a complementary hearing disability evaluation method, especially for borderline hearing level.

Complementation of Disability Rating System on Hearing Injury: Application of Linear Regression Analysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to the correlation between hearing injury and McBride disability rating presented by previous studies, there are over/underestimated cases particularly in the 40 dB hearing range compared to other ranges. In this study, we reviewed the overestimated and underestimated data and propose a complementation scheme for a disability rating system by using the linear regression analysis. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory for 121 cases of hearing injury, for which disability had to be rated. We reviewed all but excluded 11 cases for the aggravation of disability. A regression equation was produced from a linear regression analysis that used the percent of hearing handicap (AAO-HNS/AMA-1979 formula) as an independent variable (x) and McBride disability rating (%) as a dependent variable (y), following the Pearson correlation test. Iterative calculation was performed for overestimated (18) and underestimated (8) cases. RESULTS: Appropriate disability ratings were 14% for the cases overestimated to 20% and 11% for those underestimated to 5%. Appropriate disability ratings for the 20% of overestimated cases were changed to 14%, and for the 5% of the underestimated cases, the disability ratinb 11%. Iterative calculation showed that the Pearson correlation index was improved from 0.8866 to 0.9065 and the determination coefficient of regression analysis (adjusted R-square) was improved from 0.784 to 0.8202. CONCLUSION: The common range of hearing injury, which falls between 30-40 dB corresponds to the percentage of hearing handicap of 7.5-22.5%. A fairer assessment of ability rating would be possible by complementing some parts of this hearing range.

Mediação do direito à saúde pelo Tribunal de Justiça: análise da demanda / Mediation of the right to health by the Court of Justice: analysis of the demand / Mediación del derecho a la salud por Tribunal de Justicia: análisis de la demanda

Trata-se de estudo com o objetivo compreender como o Tribunal de Justiça do Estado de Mato Grosso tem contribuído na efetivação do direito à saúde, ao atuar como mediador formal no sentido de responder às necessidades de saúde demandadas por pessoas e famílias no contexto do Sistema Único de Saúde. Constitui estudo qualitativo, descritivo-exploratório, desenvolvido como análise documental. A base documental encontra-se arquivada em "banco de dados de domínio público", constituindo-se em arquivos acessíveis e disponibilizados no Portal Institucional do Tribunal de Justiça do Estado de Mato Grosso. As decisões judiciais compuseram nosso corpus de dados. Nossos resultados apontam que o judiciário tem buscado resolver contendas no âmbito do próprio poder público, limitando sua função mediadora na garantia do direito à saúde, sendo este direito tomado de forma reduzida ao fornecimento de alguns insumos e procedimentos.

This study is aimed to understand how the Court of the state of Mato Grosso has contributed in the effectuation of the right to health, while acting as a mediator formal towards to respond to health needs required by people and families in the context of the public health system in Mato Grosso. Study is qualitative, descriptive and exploratory analysis of documents developed as. The document base is stored in "database of public domain", thus becoming accessible files and made available on the Institutional Portal of the Court of the state of Mato Grosso. Judicial decisions comprised our sample data. The results indicate that the judiciary has sought to resolve disputes within the public administration itself, limiting its mediating function to guarantee the right to health, being this right taken in a reduced form of to provide certain inputs and procedures.

Este estudio tiene como objetivo entender cómo el Tribunal de Justicia del estado de Mato Grosso ha contribuido en la efectuación del derecho a la salud, cuando actua como mediador formal en el sentido de atender las necesidades de salud exigidas por las personas y familias en el contexto del Sistema Único de Salud. Estudio cualitativo, descriptivo-exploratório desarrollado com análisis de documentos. La base de los documentos se presente em "base de datos de dominio público", que constituyen en archivos accesibles y disponibles en el Portal Institucional del Tribunal de Justiça do Estado de Mato Grosso. Las decisiones de los tribunales conforman nuestro corpus de datos. Nuestros resultados señalan que el poder judicial ha tratado de resolver las disputas dentro de la propia administración pública, limitando su papel de mediador para garantizar el derecho a la salud, y este derecho puesto de forma reducida en el suministro de ciertos insumos y procedimientos.

Sexualidad y drogas: aspectos medicolegales de interés para el médico general integral / Sexuality and drugs: Medical and legal aspects of interest for general doctors

Introducción: Los aspectos médicolegales en relación con la sexualidad y el uso indebido de drogas forman parte de los procedimientos médicolegales y constituyen elementos de especial interés para el trabajo del médico general integral. Objetivo: Motivar la reflexión acerca de los aspectos medicolegales en relación con la sexualidad y el uso de drogas, de interés para el Médico General Integral. Método: Se realizó una revisión comentada sobre las bases conceptuales relacionadas con la sexualidad y el uso indebido de drogas así como de las diferentes situaciones que se pueden presentar con esta asociación. Resultados: Se describen diferentes problemas médicos, sociales, jurídicos y éticos, asociados a la sexualidad y el uso de drogas que repercuten en el hombre como unidad bio-psico-socio-espiritual-cultural. Se explican los delitos que aparecen en el Código Penal cubano, relacionados con la sexualidad que son poco conocidos. Conclusiones: Los efectos dañinos de las drogas sobre la sexualidad, son descritos así como los diferentes tipos de delitos sexuales. Se describen especificidades que el médico debe conocer en relación con la asociación entre el consumo de alcohol y otras drogas, y los delitos sexuales. Se establecen los tipos de violación que pueden darse bajo el efecto de las drogas, así como los efectos propiciados por el efecto desinhibitorio que el alcohol provoca, tales como los embarazos inesperados y las infecciones de transmisión sexual, incluyendo el VIH/SIDA. Se recoge el protocolo de actuación para el examen de las presuntas víctimas de delitos sexuales.

Introduction: Several medical legal aspects associated to sexuality and the uses of drugs are part of the medical-legal procedure. It is very important for the Medicine Doctors work. Objective: To provoke the reflection about the problems associated to sexuality and the use of drugs in order to have Medicine Doctors be aware of some legal aspects of interest for their work. Methods: A comment revision about the conceptual basis of the sexuality and the use of drugs, and the several situations with this association was held. Results: Different medical, social, legal and ethical problems associated to sexuality and the use of drugs that have repercussion on man as a biological, social, spiritual and cultural unit, are presented in order to have Medicine Doctors be aware of some legal aspects of interest for their work. It has been made special emphasis in sexual crimes according to the Cuban penal code and how these crimes are defined and classified. Other less known crimes related to sexuality that appear in our penal code are also explained in detail. Conclusions: Are given about the destructive effect of drugs on man's sexuality and the different types of sexual crimes included in the Cuban penal code. The association between alcohol and drug consumption and sexual crimes, types of sexual abuses under drug effects and non-inhibited effects of alcohol propitiating undesired pregnancy and sexual infections including AIDS. The steps to follow according to medical practice during the physical exam of a presumed victim of sexual crime are also recommended in this paper.

Condiciones para el acceso universal a la salud en América Latina: derechos sociales, protección social y restricciones financieras y políticas / Conditions for universal access to health in Latin America: social rights, social protection and financial and political constraints

Tras una sucinta problematización de la equidad en salud, sus determinantes sociales y sectoriales, se analizan aspectos macroeconómicos del comportamiento reciente del gasto en salud en la región. Dadas las importantes tensiones contemporáneas respecto de los derechos y la definición de prestaciones de salud, se tratan tres experiencias emblemáticas, de sistemas de salud muy diversos: Chile, Colombia y México. Ellas abarcan distintos aspectos: la garantía de las prestaciones, la reducción de formas de racionamiento implícitas y/o de barreras de entrada, o bien aspectos de calidad.

After a brief review of the concept of health equity and its social and sectoral determinants, some macroeconomic aspects of health expenditure in Latin America are considered. Given the significant contemporary tensions with regard to social rights and the definition of health benefits, three emblematic experiences are analyzed in very different health systems, namely those of Chile, Colombia and Mexico. They cover different aspects, such as the guarantee of health benefits, the reduction of forms of implicit rationing and/or barriers to admission, and also aspects related to the quality of services.

Awareness of Community Health Nurses on Legal Aspects of Health Care

The study on awareness of community health nurses on legal aspects of health care was conducted to analyze the nurses knowledge on the laws related to the health care. Health care laws serve as a hallmark in maintaining the equilibrium in the delivery of health care services. It goes without saying that this particular field of activities calls for a sound technical and legal knowledge. In the current scenario the nursing service is widened and deals with various issues on legal aspects of health care. To keep abreast with such developments and to face the changing challenge, it is essential that the nurses are equipped with updated knowledge on laws related to health care. This will enhance safe health care delivery in an unbiased standardized way. Therefore this study was conducted to determine the awareness of nurses in public health sector on legal aspects of health care. Using nonexperimental descriptive research design, with the objectives 1. To determine the level of knowledge on legal aspects among nurses, 2. To associate the level of knowledge score of nurses with the variables such as (a) age (b) academic education (c) work experience (d) exposure to in-service education. Comparing the private and government health care sectors, the government health centers has meager turnover of nurse than the other private health care centers. Thus the consistency of the samples would be maintained. Via convenient nonprobability sampling technique 180 community health nurses were selected as samples. To measure the awareness of nurses’ knowledge on legal aspects, the researcher developed a questionnaire after a wide search of literature and with the experts’ opinion. The syllabus of the student nurses was also perused. The content validity, the reliability of the tool was measured using Test and Retest method. Generally health care system is governed by the laws, rules, regulations and other jurisprudence that cover a wide range of legal concerns, from healthcare law, mental health, public health, technology and medical care, to medicine, and the entire healthcare field, including specific laws governing the health industry: physicians, nurses, hospitals and health systems, health maintenance organizations, health insurers,managed care companies, nursing facilities, home care providers, social services and the relationship among them and patients. So, to cover all the aspects of health care laws, the investigator classified the legal aspects into four headings, they are 1.Sources of Law. 2. Laws on Health care Personnel. 3. Laws on Information management and 4.Laws of Protection in health care sector. The study revealed that among the nurses in the assessed public health care areas, only 11.7% nurses had the expected adequate level of knowledge on Legal Aspects of Health Care while the remaining 88.3% nurses had a moderate level of knowledge. Therefore, the result shows that nurses have moderate knowledge on legal aspects of health care, and they need more enhancement of knowledge through continuing nursing education and by maximum utilization of the library.

Documentos médicos / Medical documents

O artigo ressalta os aspectos jurídicos dos documentos médicos, privilegiando a sua vocação como meios de prova em processos judiciais. Procurase trazer uma abordagem prática da questão dos documentos médicos, com vistas ao exercício profissional cotidiano e sem que se pretenda minimizar a importância da investigação aprofundada da matéria, e muito menos desvalorizar a finalidade principal desses documentos que decorre da sua natureza médica. Os principais instrumentos que retratam os cuidados prestados ao paciente, quais sejam Prontuário Médico, Termo de Consentimento Informado, Atestados e Receituário, são comentados sob o enfoque legal, buscando-se apontar quais características lhe conferem legitimidade jurídica

This article emphasizes the legal aspects of medical documents, giving priority to their potential use as evidence in legal proceedings. It seeks to provide a practical approach to the issue of medical documents, which is addressed to everyday professional practice but has no intention of minimizing the importance of a thorough investigation of the matter, and much less underestimating the main purpose of these documents arising from its medical nature. The main instruments that reflect the care delivered to the patient, namely, Medical Chart, Informed Consent Form, Certificates and Prescriptions, are discussed under the legal point of view, aiming to point out which features grant them legal legitimacy

Distinct attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with alzheimer disease / Atitudes distintas de profissionais de diferentes especialidades médicas relacionadas à autonomia e aspectos jurídicos no cuidado de pacientes com demência

The evaluation of competence of Alzheimer disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. Objectives: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer disease and practitioners competence to interfere with decision-making autonomy. Methods: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers. Results: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer disease. Conclusions: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

A avaliação da competência de pacientes com doença de Alzheimer (DA) para assumir responsabilidadespessoais ou coletivas e as implicações legais resultantes constituem um tema relevante. Objetivos: O objetivo do estudo foi analisar as diferentes atitudes de profissionais de diferentes áreas de formação frente à incapacidade de pacientes com doença de Alzheimer e sua competência para interferir com autonomia para tomada de decisões. Métodos: Profissionais das diferentes áreas de atuação (Neurologia, Psiquiatria e Geriatria e Medicina geral) foram entrevistados por um dos autores, depois de serem apresentados a um caso clínico fictício, no qual alguns tópicos foram levantados: [1] Juízo crítico e capacidade do paciente para tomar decisões relacionadas ao seu cotidiano; [2] Papel do médico na escolha e nomeação de cuidadores e tutores. Resultados: A resposta a primeira questão não evidenciou grandes divergências quando ao grau de incapacidade, mas 25% dos entrevistados chamaram atenção para o fato de que os pacientes devem ser ouvidos e avaliados, independentemente da opinião externada pelos cuidadores e representantes legais. Na resposta ao segundo quesito ficou evidente a falta de informações sobre aspectos legais e éticos relacionados aos tutores e cuidadores. Conclusões: Aspectos legais constituem um tópico que deve ser incorporado ao treinamento profissional para aprimorar condutas no tratamento de longo prazo de pacientes com demência.

Muerte súbita en el deporte: Aspectos legales acerca de su prevención / Sudden death in sport: Legal aspects on prevention / A morte súbita no desporto: Aspectos legais sobre prevenção

La prevención de la muerte súbita durante las prácticas deportivas, en la mayoría de los países, es un aspecto de interés episódico que recrudece cada vez que un atleta muere en una competencia. En la actualidad, y con una gran diversidad de recursos diagnósticos y terapéuticos, es incomprensible que aún no se haya implementado una sistematización consensuada que equilibre la necesidad de evitar estos eventos desgraciados con la disponibilidad de los recursos existentes. Sólo la ley garantiza la continuidad de las decisiones. Sin embargo, ésta no es una problemática sólo de la Argentina, ya que la mayoría de los países (aún los más desarrollados) carecen de este marco regulatorio. En el presente artículo se analizan aspectos legislativos pertinentes y deseables. Se ha tomado el ejemplo italiano como modelo para una propuesta local, dado que es el único avalado por la presentación de resultados a largo plazo.

Prevention of sudden death during sports promotes only transient concern in the majority of countries when an athlete dies in the field. Currently, it is difficult to accept the absence of a consensus-based systematic approach which balances the need to prevent these dramatic deaths with the availability of resources. In an organized community, only the law warranties the continuity of decisions. However, this is not just a problem in Argentina as in the majority of developed countries there is not a proper regulation. This article analyzes legal aspects and takes the Italian regulation (the only one endorsed by long-term results) as a model for a local proposal.

Na maioria dos países, a prevenção da morte súbita durante a prática desportiva promove única preocupação transitória, quando um atleta morre em campo. Atualmente, é difícil aceitar a ausência de uma abordagem sistemática baseada no consenso que equilibra a necessidade de evitar essas mortes dramáticas com a disponibilidade de recursos. Em uma comunidade organizada, somente a lei garante continuidade às decisões. No entanto, este não é apenas um problema na Argentina, como na maioria dos países desenvolvidos não há uma regulamentação adequada. Este artigo analisa os aspectos jurídicos e leva para o direito italiano (o único suportado pelo longo prazo) como um modelo para uma proposta local.