Morte digna como direito: visibilidade jurídica da finitude / Dignified death as a right: the legal visibility of finitude / La muerte digna como derecho: visibilidad jurídica de la finitud

Resumo O direito à morte digna é majoritariamente ignorado pelo ordenamento brasileiro. Essa invisibilidade do processo de finitude e suas consequências são tema deste estudo, que objetiva realizar um levantamento exploratório para identificar pontos relevantes que devem ser desenvolvidos para garantir um processo de finitude digno. Foram analisadas 50 publicações, mediante levantamento online e físico de obras publicadas até março de 2023. Os estudos analisados expressam preocupação com dilemas éticos do cuidar do ser humano em finitude, mas não analisam formas existentes de tutela da finitude nem quais searas ainda são carentes de normatização para dar eficácia a esse cuidado. Espera-se que esta pesquisa contribua para fortalecer o olhar crítico ao tema, considerando as atuais tutelas da finitude, os limites legais do Estado e os potenciais passos futuros para fazer avançar os estudos aplicados à atualização prática do ordenamento brasileiro.

Abstract The right to a dignified death is largely overlooked by Brazilian law. This neglect of the end-of-life process and its ramifications is the focus of this study, which aims at an exploratory survey to identify pertinent aspects requiring development to ensure a dignified end-of-life experience. In total, 50 publications were examined with online and physical surveys of works published up to March 2023. They express concerns regarding ethical dilemmas in caring for individuals nearing the end of life, yet they do not delve into existing mechanisms for safeguarding end-of-life dignity or identify areas that still lack standardization to ensure effective care. This study should contribute to the enhancement of critical perspectives on the issue of end-of-life experiences, considering current safeguards, the legal boundaries set by the State, and potential future strides toward advancing studies aimed at the practical update of the Brazilian legal system.

Resumen El derecho a una muerte digna es ampliamente ignorado por el ordenamiento jurídico brasileño. Esta invisibilidad del proceso de finitud y sus consecuencias son el objeto de este estudio, que tiene como objetivo realizar una encuesta exploratoria para identificar los puntos relevantes que deben desarrollarse para garantizar un proceso de finitud digno. Se analizaron 50 publicaciones a través de una encuesta online y física de obras publicadas hasta marzo de 2023. Los estudios analizados expresan preocupación por los dilemas éticos de la atención a seres humanos en finitud, pero no analizan las formas de protección a la finitud existentes ni cuáles son las áreas que aún necesitan regulación para hacer efectiva esta atención. Se espera que esta investigación contribuya a fortalecer la visión crítica de la finitud, considerando la protección actual de la finitud, los límites jurídicos del Estado y los posibles pasos futuros para avanzar en los estudios aplicados a la actualización práctica del sistema jurídico brasileño.

Question, Intercommunication, and Meaning Generation: Precision of Life Value Education in Ideological and Political Courses for Medical Students / 中国医学伦理学

Medical students differ greatly in their thinking and cognition of the value and pursuit of life existence. The mainstream values are positive and pragmatic, but they are also characterized by decentralization, diversification, individualization and variability. Value education needs to be object-centered, take care of students’ individual lives, understand and answer their real questions to be more accurate and effective. In the intelligent technology society, the education of life value of medical students in the ideological and political courses should rely on the intelligent technology platform to achieve the precise coupling of object and value goal through the form of question exchange. It is necessary to transcend the limitations of medical science perspective, realize accurate life value education, face the nihilistic challenge of life value, understand the systematic and dialectical significance of life events, and return to the original intention and mission of medical science to take care of life itself.

Years of life lost due to premature deaths associated with air pollution: an ecological time-series study

ABSTRACT BACKGROUND: Exposure to air pollutants is associated with hospital admissions due to cardiovascular diseases and premature deaths. OBJECTIVE: To estimate years of life lost (YLL) due to premature deaths and their financial costs. DESIGN AND SETTING: Ecological time-series study carried out in São José dos Campos, Brazil, in 2016. METHODS: Data on deaths among residents of this city in 2016 were assessed to estimate the financial cost of premature deaths associated with air pollution. The diagnoses studied were ischemic heart disease, congestive heart failure and cerebrovascular disease, according to YLL. The fractions attributable to deaths associated with air pollutant exposure and to each potential year of life lost were calculated using negative binomial regression with lags of 0-7 days between exposure and outcome. Nitrogen dioxide, particulate matter (PM10) and ozone concentrations were included in the model and adjusted for temperature, humidity and seasonality. RESULTS: Exposure to particulate matter was significant at lag 3 days. There were 2177 hospitalizations over the study period, with 201 deaths (9.2%). Premature deaths led to 2035.69 years of life lost. A 10 μg/m3 increase in PM10 concentrations was correlated with 8.0% of the hospitalizations, which corresponded to 152.67 YLL (81.67 for males and 71.00 for females). The cost generated was approximately US$ 9.1 million in 2016. CONCLUSION: In this first study conducted in a medium-sized Brazilian city, using the YLL methodology, we identified an excess expense attributable to air pollution.

Propiedad intelectual, patentes y salud: una mirada desde la Bioética / Intellectual Property, Patents, and Health: a Look from Bioethics / Propriedade intelectual, patentes e saúde: uma perspectiva a partir da Bioética

Resumen: Artículo de carácter reflexivo y argumentativo que busca confrontar referentes conceptuales desde la Bioética y el derecho para dar solución a estos interrogantes: ¿son los derechos de propiedad intelectual la antítesis de otros derechos? ¿Existe un conflicto de principios bioéticos en dicha tensión? ¿Cómo abordar desde la Bioética este choque de miradas? ¿Es necesario un cambio de paradigma para transformar el individualismo imperante de la contemporaneidad y evitar los daños de una guerra de rapiñas que se enmascara detrás de un eufemismo de la competencia de mercados y la propiedad intelectual? Entre argumentos, cuestionamientos y disensos se busca un abordaje a estos dilemas con un enfoque bioético. Se deja sobre la mesa la cooperación con una base de empatía y compasión para desviarse del camino del individualismo pernicioso y la voracidad subsecuente del dinero y el poder. Por ello, la Bioética como puente hacia al futuro es la disciplina llamada manifestar dicha cooperación, no solo en los ámbitos disciplinarios, sino entre los diferentes actores sociales, entre los protagonistas de esta obra, para que su final no sea trágico, sino esperanzador y saludable.

Summary: This is a reflexive and argumentative article which intention is to confront conceptual references from bioethics and the right to solve the following questions: are intellectual property rights the antithesis of other rights? Is there a conflict of bioethical principles in this discussion? How to address from Bioethics this difference in point of views? Is a paradigm shift necessary to transform the prevailing individualism of contemporaneity and avoid the damages of a war of plunder masked behind a euphemism of market competition and intellectual property? Between arguments, questions and dissents, an approach to these dilemmas is sought with a bioethical approach. Cooperation is on the table based on empathy and compassion to divert it from the path of pernicious individualism and the subsequent voracity of money and power. Therefore bioethics, as a bridge to the future is the discipline called to manifest this cooperation, not only in disciplinary areas, but between the different social stakeholders, among those main players of this work, so that its end is not tragic, but hopeful and healthy.

Resumo: Artigo reflexivo e argumentativo que busca confrontar referências conceituais da Bioética e do direito para resolver as seguintes questões: os direitos de propriedade intelectual são a antítese de outros direitos? Existe um conflito de princípios bioéticos nessa tensão? Como abordar este choque de perspectivas a partir da Bioética? É necessária uma mudança de paradigma para transformar o individualismo predominante da contemporaneidade e evitar os danos de uma briga que se mantém mascarada por trás de um eufemismo de concorrência de mercado e propriedade intelectual? Entre argumentos, perguntas e dissensos, busca-se uma abordagem desses dilemas com uma abordagem Bioética. A cooperação é deixada sobre a mesa com uma base de empatia e compaixão para se desviar do caminho do individualismo pernicioso e da subsequente voracidade do dinheiro e do poder. Portanto, a Bioética, como ponte para o futuro, é a disciplina convocada a manifestar tal cooperação, não apenas nos campos disciplinares, mas entre os diferentes atores sociais, entre os protagonistas deste trabalho, para que seu fim não seja trágico, mas esperançoso e saudável.

Alcance de la calidad de vida en atención médica / Quality of life reach in medical care / Alcance da qualidade de vida no atendimento médico

Resumen La expresión calidad de vida tiene un uso cada vez más generalizado en la práctica biomédica, sobre todo en situaciones de final de la vida. La experiencia demuestra que, muchas veces, esa expresión se emplea con alcances muy diversos, en ocasiones contrapuestos. En el presente artículo se exponen los resultados de una revisión bibliográfica que muestra las diferentes posturas y se propone una delimitación del tema. El análisis compara los términos "calidad de vida", "dignidad humana" y "valor de la vida humana".

Abstract The term quality of life has increasingly widespread use in biomedical practice, especially in end-of-life situations. Experience shows that the expression is often used with very different -and sometimes conflicting- scopes. The present article presents the results of a literature review that show diverse positions, while delimitating the subject. The analysis compares the terms "quality of life," "human dignity," and "value of human life".

Resumo A expressão "qualidade de vida" tem um uso cada vez mais generalizado na prática biomédica, em especial em situações de final da vida. A experiência demonstra que, muitas vezes, essa expressão é empregada com alcances muito diversos, em ocasiões contrapostos. Neste artigo, são apresentados os resultados de uma revisão bibliográfica que mostra os diferentes posicionamentos e é proposta uma delimitação da temática. A análise compara as expressões "qualidade de vida", "dignidade humana" e "valor da vida humana".

Impact of life meaning and school adjustment on mobile phone addiction of female college students / 中国学校卫生

Objective@#The research was to investigate the intermediary effect of school adjustment between famale college students’ life meaning and mobile phone addiction and to provide reference for mobile phone addiction prevention.@*Methods@#Totally 1 355 female college students in Jinan City were investigated with Life Meaning Scale, School Adjustment Scale and Mobile Phone Addiction Scale.@*Results@#Score of freshmen’ mobile phone addiction (34.02±7.87) was significantly lower than that of sophomores’ and junior’(36.67±8.03, 37.19±10.40)(F=4.58, P<0.05). Female college students’ life meaning and school adjustment were negatively correlated with mobile phone addiction(r=-0.50, -0.58, P<0.01). Female college students’ life meaning was positively correlated with school adjustment(r=0.51, P<0.01). Having a sense of life meaning and seeking a sense of life meaning could jointly explain 24% of the variation in mobile phone addiction. School adjustment played a complete mediating role between life meaning and mobile phone addiction in female college students.@*Conclusion@#Female college students’ life meaning can affect mobile phone addiction through school adjustment.

Impacto de la inactividad física en la mortalidad y los costos económicos por defunciones cardiovasculares: evidencia desde Argentina / Impact of physical inactivity on mortality and the economic costs of cardiovascular deaths: evidence from Argentina / Impacto da inatividade física na mortalidade e custos econômicos por mortes cardiovasculares: evidências provenientes da Argentina

RESUMEN Objetivo Estimar la mortalidad y los costos económicos por enfermedades cardiovasculares atribuibles a la inactividad física en Argentina. Métodos Se estimó la mortalidad atribuible (MA) a la inactividad física como el producto entre la fracción atribuible poblacional (FAP) y el número de muertes originadas por las enfermedades cardiovasculares asociadas. Se realizó una valoración del valor estadístico de la vida (VEV) siguiendo el enfoque del capital humano, bajo el cual el VEV se estimó mediante la productividad perdida por muerte prematura. Se calcularon los costos económicos empleando la MA y el VEV, estratificando por sexo, grupo de edad y nivel de actividad física. Se empleó un análisis de sensibilidad para evaluar cómo varían los costos en tres escenarios posibles. Resultados La MA a la actividad física baja y moderada varió entre 33 (18 a 24 años) y 7 857 (> 84 años) defunciones anualmente en ambos sexos. El VEV se encontraba entre I$ 441 005 (dólares internacionales) (18 a 24 años) y I$ 4 121 (> 84 años). La valoración de los costos totales por sexo indica que las pérdidas económicas ascendieron a I$ 752,5 millones para los hombres y a I$ 444,5 millones para las mujeres. Conclusión Las pérdidas económicas variaron entre 0,61% del PIB para el escenario mínimo, 0,85% para el escenario medio, y 1,48% para el escenario máximo. Se recomienda fortalecer el desarrollo de políticas públicas orientadas a la reducción del sedentarismo en Argentina.

ABSTRACT Objective Estimate mortality and economic costs from cardiovascular diseases attributable to physical inactivity in Argentina. Methods Attributable mortality (AM) from physical inactivity was estimated as the product of the population attributable fraction and the number of deaths caused by associated cardiovascular diseases. Value of statistical life (VSL) was calculated using the human capital approach, in which VSL was estimated through lost productivity from premature death. Economic costs were calculated using AM and VSL, stratifying by sex, age group, and physical activity level. A sensitivity analysis was used to evaluate how costs vary in three possible scenarios. Results AM from low and moderate physical activity ranged from 33 (18 to 24 years) to 7 857 (>84 years) deaths annually in both sexes. VSL ranged from I$441 005 (international dollars) (18 to 24 years) to I$4,121 (>84 years). Assessment of total costs by sex indicates that economic losses amounted to I$752.5 million for men and I$444.5 million for women. Conclusion Economic losses ranged from 0.61% of GDP for the minimum scenario, 0.85% for the average scenario, and 1.48% for the maximum scenario. Stronger public policy-making aimed at reduction of sedentary lifestyles in Argentina is recommended.

RESUMO Objetivo Estimar a mortalidade e os custos econômicos por doenças cardiovasculares atribuíveis à inatividade física na Argentina. Métodos Foi estimada a mortalidade atribuível à inatividade física como o produto entre a fração atribuível populacional (FAP) e o número de mortes por doenças cardiovasculares associadas. Foi realizada uma avaliação do valor estatístico da vida (VEV) segundo o enfoque do capital humano em que o VEV foi estimado pela produtividade perdida por morte prematura. Foram calculados os custos econômicos empregando a mortalidade atribuível e o VEV, estratificados por sexo, faixa etária e nível de atividade física. Foi feita uma análise de sensibilidade para avaliar a variação dos custos nos três cenários possíveis. Resultados A mortalidade atribuível a um nível baixo e moderado de atividade física variou entre 33 (18 a 24 anos) e 7 857 (>84 anos) mortes ao ano em ambos os sexos. O VEV foi de 441 005 dólares internacionais (18 a 24 anos) a 4 121 dólares internacionais (>84 anos). A avaliação dos custos totais por sexo indicou que as perdas econômicas atingiram 752,5 milhões de dólares internacionais no sexo masculino e 444,5 milhões de dólares internacionais no sexo feminino. Conclusão Os prejuízos econômicos variaram entre 0,61% do PIB no cenário mínimo, 0,85% no cenário intermediário e 1,48% no cenário máximo. Recomenda-se o reforço na elaboração de políticas públicas orientadas à redução do sedentarismo na Argentina.

Desarrollos recientes en la jurisprudencia sobre el derecho a morir / Recent case law about the right to die

This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide.

Percepção da “morte digna” por estudantes e médicos / Perception of “dignified death” for students and doctors / Percepciones de estudiantes y médicos sobre la “muerte digna”

A morte é a cessação definitiva da vida no corpo. Os avanços técnico-científicos da medicina conseguiram prolongá-la. O objetivo do presente estudo foi conhecer a percepção de estudantes e profissionais da medicina acerca da “morte digna”. Levantaram-se as diferenças entre os grupos e seus correlatos, valendo-se de variáveis demográficas. Participaram 398 respondentes, distribuídos equitativamente entre estudantes e médicos da cidade de Porto Velho, dos quais 57,8% eram do gênero masculino, com média etária de 34,5 anos. Os participantes responderam à chamada “escala de percepção de morte digna” (EPMD) e questões demográficas. Os resultados indicaram que os médicos preferiram morrer no hospital (74%) e os estudantes, em casa (74%); esses últimos tiveram maior média na EPMD (M = 5,6; DP = 0,6). Apesar das limitações, este estudo favorece a reflexão sobre práticas futuras, inerentes à concepção de morte digna por integrantes da saúde, auxiliando a relação médico-paciente.

Death is the definitive end of life in the body. The technological advances of medicine have made it possible to prolong the process of dying. This study aimed to discover the perception of medical students and medical professionals about a good death, and analyzed the differences between the groups and their correlates based on demographic variables. A total of 398 people, equally divided among medical students and doctors, participated in the study. Most of the participants were male (57.8%), with a mean age of 34.5. They responded to the GDPS (Good Death Perception Scale) and demographic questions. Results indicated that doctors preferred to die in a hospital (74%) and students at home (74%). The latter obtained a higher mean GDPS score (M = 5.6, SD = 0.6). Despite its limitations, this study allows the consideration of future practices inherent to the conception of a good death by health professionals, improving the doctor-patient relationship.

La muerte es la cesación definitiva de la vida en el cuerpo. Los avances técnico-científicos de la medicina lograron posponerla. El objetivo del presente estudio fue conocer la percepción de estudiantes y profesionales de la medicina con respecto a la muerte digna. Se registraron las diferencias entre los grupos y sus correlatos con variables demográficas. Participaron 398 personas divididas equitativamente entre estudiantes y médicos de la ciudad de Porto Velho (RO). Del total, 57,8% eran de género masculino, con a edad promedio de 34,5 años. Estos respondieron la EPMD (Escala de Percepción de Muerte Digna) y preguntas demográficas. Los resultados indicaron que los médicos prefieren morir en el hospital (74%) y los estudiantes en sus casas (74%); éstos presentaron una media mayor en la EPMD (M = 5,6; DP = 0,6). A pesar de las limitaciones, este estudio propone pensar prácticas futuras inherentes a la concepción de muerte digna de parte de los profesionales de la salud, colaborando en la relación médico-paciente.

Value-based medicine: concepts and application / 한국역학회지

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.

La fecundidad: rrimera realidad humana: una visión sobre la persona desde lévinas / Fertility: th fiirst human reality: a vision of the person according to levinas / A fecundidade:prrimeira realidade humana: uma visão sobre a pessoa a partir de lévinas

En este artículo se inicia un espacio de reflexión que tiene como centro la fecundidad, articulando para ello diversos campos de acción cuya fundamental referencia es la persona, lo que nos permite acceder al sentido relacional que se le otorga a la fecundidad desde el libro del Génesis. De esta manera, el ser humano se nos descubre como un ser para el otro, introduciéndonos en el planteamiento ético de Lévinas y, por extensión, en una reflexión sobre el sentido de la fecundidad como filiación y fraternidad, aspectos que muestran la existencia en la condición humana de una finalidad, dignidad, valor-bien y deber.

A space for reflection centered on fertility is initiated in this article by tying in several fields of action where the person is the fundamental reference. This gives a sense of the relational meaning of fertility from the Book of Genesis. In this way, the human being is shown as having responsibility for the other, introducing the reader to Levinas's ethical approach and, by extension, to reflection on the meaning of fertility as filiation and fraternity, aspects that show the existence of purpose, dignity, value- good and duty in the human condition.

Neste artigo, inicia-se um espaço de reflexão que tem como centro a fecundidade; articula, para isso, diversos campos de ação cuja fundamental referência é a pessoa, o que nos permite aceder ao sentido relacional que é outorgado à fecundidade a partir do livro de Gênesis. Dessa maneira, o ser humano é descoberto como um ser para o outro, o que nos introduz na proposição ética de Lévinas e, por extensão, em uma reflexão sobre o sentido da fecundidade como filiação e fraternidade, aspectos que mostram a existência, na condição humana, de uma finalidade, dignidade, valor-bem e dever.

Bárbara, una posible donante de órganos / Barbara, a potential organ donnor

This article presents the case of a 47 year old woman, on encephalic death state, who had not expressed her willing or acceptance for organ donation. The case is described as a narrative, contextualized, and in an anonymous way. A bioethical analysis of the family decision making and of the role of transplant coordinator is proposed. This presentation, with the description of its whole context and of the factors that influenced decisions, has the purpose to contribute to the development of deliberation competencies and to increase the awareness of the ethics problems of family decisions, of the conditions of anonymous organ assignation and of the of the end of life's meanings.

Se presenta el caso de una mujer de 47 años, en muerte encefálica y sin expresiones previas sobre su voluntad de ser donante de órganos. El caso se expone como una narración contextualizada, anonimizada y seguida de un análisis bioético de las decisiones familiares y del rol del coordinador de trasplantes. La presentación, con una descripción del contexto y de los factores que condicionan las decisiones, tiene el propósito de contribuir al desarrollo de la capacidad deliberativa y a tomar mayor conciencia del problema ético de las decisiones familiares, del anonimato de la asignación de órganos y del sentido del final de la vida.

Perspectiva clínica de la consciência del riesgo en la accidentalidad laboral: un estudio cualitativo / Clinical perspective of risk awareness in occupational accidents: a qualitative study

Objetivo. Este estudio analizó el fenómeno de la accidentalidad laboral en un grupo de 10 trabajadores de una empresa productora de papel, cuyas acciones conllevaron a un accidente incapacitante. Método. Se utilizó una entrevista semi-estructurada y se analizó la información siguiendo el enfoque cualitativo de tipo constructivo-interpretativo. El análisis comprensivo de las entrevistas permitió identificar que, aunque en la empresa se siguieran los lineamientos del Sistema General de Riesgos Profesionales en Colombia, los trabajadores accidentados tuvieran el conocimiento completo de los riesgos y el deseo de protegerse, no lograron articular estos aspectos para dirigir sus acciones en el momento de la situación de riesgo. Resultados. Se evidenció que el problema se ubica en el nivel de la conciencia de sí mismo como valor de vida y no en el de la cognición como conocimiento o información. Aunque este es necesario, no es suficiente para mantener la protección total. Se concluye que ser consciente del riesgo no es lo mismo que saber sobre la existencia de riesgos o preocuparse por sus consecuencias para el bienestar personal; es algo que se sitúa justamente en el momento concreto y presente en el que el trabajador debe pensarse a sí mismo para actuar, manteniendo viva y presente la necesidad de salvaguardar su integridad física. Conclusión. Los resultados pueden ser considerados en los planes de protección empresarial para favorecer en los trabajadores una mejor visión y comprensión de sí mismos frente a su protección y cuidado.

Objective. This study analyzed the phenomenon of workplace accidents which had disabling consequences, in a group of 10 workers from a paper manufacturing company. Method. A semi-structured interview was used, which analyzed the information, following the qualitative constructive-interpretative approach. The comprehensive nature of the analysis of the interviews enabled us to determine that, although the company complied with the guidelines of te Colombian General System of Professional Risks ( Sistema General de Riesgos Profesionales en Colombia ), the workers who suffered the accidents were completely aware of the risks and were willing to use protection, but did not take the necessary action when the risk situation arose. Results. It was clear that the problem lay in 'the awareness that one has of the value of life' and not in the area of comprehension, as with knowledge or information. Although this is necessary, it is not sufficient to maintain a level of total protection. It was concluded that being aware of the risk is not the same as knowing that risks exist or being concerned about their consequences for the wellbeing of personnel; it is something which takes place just at the precise moment when the worker must think of himself when taking action, firmly keeping in mind the need to safeguard his physical integrity. Conclusion. The results can be considered in corporate protection plans to give workers a better vision and comprehension of themselves with regard to their care and protection.

Escopo. Este estudo analisou o fenômeno da acidentalidade laboral em um grupo de 10 trabalhadores de uma empresa produtora de papel cujas ações conduziram a um acidente incapacitante. Metodologia. Foi utilizada uma entrevista semi-estruturada e analisou-se a informação seguindo o enfoque qualitativo construtivo-interpretativo. A análise compreensiva das entrevistas permitiu identificar que, ainda na empresa seguiram os lineamentos do Sistema Geral de Riscos Profissionais na Colômbia, os trabalhadores acidentados tiveram o conhecimento completo dos riscos e desejo de proteção, não alcançaram articular estes aspectos para conduzir suas ações no momento da situação de risco. Resultados. Foi evidente que o problema está no nível da consciência de si mesmo como valor da vida e não no da cognição como conhecimento ou informação. Ainda este é necessário, não é suficiente para manter a proteção total. Concluiu-se que ser consciente do risco não é o mesmo que conhecer sobre a existência de riscos ou se preocupar por suas conseqüências para o bem-estar pessoal; é algo que está justamente no momento concreto e presente no que o trabalhador deve pensar a si mesmo para atuar, mantendo viva e presente a necessidade de salvaguardar sua integridade física. Conclusão. Os resultados podem ser considerados nos planes de proteção empresarial, para favorecer nos trabalhadores uma melhor visão e compreensão de si mesmos frente à sua proteção e cuidado.

Factors Influencing Depression in Patients with Chronic Renal Failure / 정신간호학회지

PURPOSE: Objectives of this study were to identify factors influencing depression in patients with chronic renal failure according to patient characteristics and to provide basic data to develop nursing interventions for depression in these patients. METHODS: This descriptive correlative study was conducted using structured questionnaires with 114 patients diagnosed with chronic renal failure. Data were analyzed using t-tests, ANOVA, Pearson's correlation and multiple regression analysis with SPSS/WIN 18.0. RESULTS: 1) Level of depression was different according to the history of smoking (p<.001), past health history (p=.001), only drugs as therapy, peritoneal dialysis, hemodialysis (p=.028), and perceived health status (p<.001); 2) Significant correlations were found between depression, stress, value of life and social support; 3) multiple regression analysis showed that stress (beta=.24, t=3.41, p=.001), value of life (beta=-.46, t=-6.37, p<.001) and social support (beta=-.19, t=-2.79, p=.006) in that order contributed to depression and explained 56.4% of variance in depression. CONCLUSION: Findings from this study indicate that health professionals should provide proper management for depression for patients with chronic renal failure, as well as factors influencing depression, including stress, value of life and social support. There is also a need to implement stress management and self-help group programs for these patients.

Factors Affecting Health-Related Quality of Life in Persons with Stroke Using SF-6D

BACKGROUND: The SF-6D, derived from the SF-36, is a preference-based instrument measuring health-related quality of life (HRQOL). Using this tool, we measured the HRQOL of persons disabled by stroke dwelling in Gyeongju city and identified factors affecting the HRQOL. METHODS: As of March 2008, 991 persons who had had a stroke and were aged 50 and over were identified on the Gyeongju city disabled registry. Interviewers specifically trained for this face-to-face survey gathered pertinent information including general and clinical characteristics from June to October 2008. In addition, the health status was measured using the Modified Rankin Scale, the Barthel ADL index, and the SF-36. The SF-6D index was derived from the SF-36. We analyzed the known-group construct validity and convergent validity. Finally, we performed multiple regression analyses to identify factors affecting the HRQOL. RESULTS: Of the 991 potential subjects, 498 persons participated in the interviews (response rate: 50.3%). The SF-6D indices for females and those aged 70 and over were lower than indices for males and those aged 60 and less. Correlation coefficients between the Modified Rankin Scale, the Barthel index, and the SF-6D index were relatively high (-0.533 and 0.555, respectively) and statistically significant (P<0.001). Multiple regression analyses showed that sex, age, smoking, alcohol use, comorbidity, the Modified Rankin Scale, and the Barthel index had an effect on the SF-6D index of persons with stroke, and the Barthel index was the most important factor. CONCLUSIONS: Our results indicate that the SF-6D can be a valid tool for evaluating health states of persons disabled by stroke, and functional limitation was the main factor affecting the HRQOL.

Factors Influencing Ego-Integrity in Community Dwelling Elders / 기본간호학회지

PURPOSE: This study was done to identify the relationship of perceived health status, depression, meaning of life, and family function and to ego integrity, and to investigate the main factors influencing ego-integrity in community dwelling elders. METHOD: The research design for this study was a descriptive survey design using a convenience sampling. Data collection was done using self-report questionnaires with 157 community dwelling elders located in 3 cities, Seoul, Seosan and Gyungju. Data analysis was done using SPSS 15.0 pc+ program for descriptive statistics, Pearson correlation coefficients and stepwise multiple regression. RESULTS: There were significant differences between ego-integrity according to gender, religion, economic level and amount of spending money. Ego-integrity had significant positive correlations with perceived health status, meaning of life, family function and a negative correlations with depression. The major factors that affect ego-integrity in community dwelling elders were self-awareness and acceptance, contentedness with past and present, gender and family function, which explained 62.7% of ego-integrity. CONCLUSION: Findings from this study provide a comprehensive understanding of ego-integrity and related factors for community dwelling elders.

Factors Influencing Health Conservation among Elders / 기본간호학회지

PURPOSE: This study was conducted to determine the predictors of health conservation for elders in Korea. METHOD: Random sampling method was used and data from 113 elders were used for final analysis. Data collection was conducted through the use of questionnaires which were constructed to include Health Conservation Scale, Purpose in Life Test and Self-efficacy Scale. RESULTS: Health conservation of the elders was in the middle range. The elders of this study had few goals towards meaning in life, and were in an existential vacuum state. There was a positive correlation between health conservation, meaning in life and self-efficacy. The significant factors influencing health conservation of elders were meaning in life, education level and gender. These 3 factors explained 30.6% of health conservation of elders. CONCLUSIONS: The results indicate that health conservation is an important link with meaning in life in elders. There should be a comprehensive study in the future for in-depth understanding of health conservation of elders.

Comparison of Fate Ethics among Chinese Philosophies of Confucianism,Taoism,and Buddhis / 中国医学伦理学

The concepts of death in Chinese philosophies of Confucianism, Taoism, and Buddhism contain a wealth of ethics, and they have accumulated into the main elements of Chinese life and death ethics, but the three doctrines have many differences. Different fate ontologies: The Confucians regard charity as their ontology, the Taoists Taoism, and the Buddhists benevolence, respectively. Different values of life and death: The Confucians focus on birth value, Taoists attach the same value to live and death, and Buddhists focus on death value. Different fate attitudes: Confucians prefer life to death, Taoists is willing to both life and death, while Buddhists hates life and advocates death. Different values of beyond-the-fate: Confucians observe the concept of death from the life, Taoists observe the concept of life from the death, Buddhists observe the concept of death by abandoning the life.

Humanistic Consciousness of Existential Theory is the Premise to Enhancing Public Ethics / 中国医学伦理学

The public ethics consciousness,with medical ethics included,fundamentally depends on the gradual improvement in the self-identity of human as objective itself.However,the improvement of humanistic consciousness is a long and painful process.Former recognition of historical culture,including the humanistic ideal in traditional Chinese ethical thoughts and systemic rational thoughts in modern western society,mainly employs transcendental test of abstract anthroposophy as its cultural premise,superficially enhancing certain individuals and their thoughts,motives,and objectives to historical ontology,but actually resulting in the absence of human individuals in realistic history.The self-conscious improvement of human-oriented public ethics can only be realized by the subjective humanistic consciousness which undergoes the regression from axiology,epistemology,to existence theory,making human realize that they themselves are the utmost purpose of all values and significances.