Salud, complejidad y enfermedades no transmisibles

La ciencia y la producción del saber científico están cambiando, las partes no son el objetivo, es el todo y sus interrelaciones. La salud enfrenta nuevos retos que no pueden ser explicados por concepciones reduccionistas. Se reconoce el intento de agrupar variadas afecciones en las enfermedades no transmisibles que ocasionan las tres cuartas partes de las muertes en el mundo y en Cuba, constituyen uno de los grandes retos del desarrollo sostenible. Muchas de ellas, a pesar de su heterogeneidad y multicausalidad, comparten factores de riesgo -y protectores- comunes, que pueden ser revertidos con acciones integradas. Se comenta la frecuente comorbilidad de estas enfermedades con otras entidades, la polimorbilidad y el rol del envejecimiento en su aparición. Se resalta la presencia del estado inflamatorio crónico del endotelio y la disfunción de este órgano como posible vía final común de la patogenia, evolución y posterior expresión clínica de muchas de las conocidas como enfermedades no transmisibles, verdaderos síndromes sistémicos. Se dan un grupo de recomendaciones para mejorar su prevención y su control, con énfasis en la participación comunitaria, donde las ciencias sociales pueden aportar mucho para lograr mejores resultados, sin olvidar la susceptibilidad individual o de grupos a padecer determinadas enfermedades no transmisibles. Se considera que directivos, profesionales sanitarios, líderes formales e informales, personas, grupos y comunidades, deben capacitarse y actualizarse, en los conceptos y los enfoques de estas enfermedades para lograr el propósito de revertir sus efectos nocivos para la salud.

Science and the production of scientific knowledge are changing, the parts are not the objective, it is the whole and its interrelationships. Health faces new challenges that cannot be explained by reductionist conceptions. The attempt to group various conditions in non-communicable diseases that cause three quarters of deaths in the world and in Cuba is recognized as one of the great challenges of sustainable development. Many of them, despite their heterogeneity and multi-causality, share common risk -and protective- factors, which can be reversed with integrated actions. The frequent comorbidity of these diseases with other entities, polymorbidity, and the role of aging in their appearance are discussed. The presence of the chronic inflammatory state of the endothelium and the dysfunction of this organ are highlighted as a possible final common path of the pathogenesis, evolution and subsequent clinical expression of many of the so-called non-communicable diseases, true systemic syndromes. A group of recommendations are given to improve its prevention and control, with emphasis on the community participation of all, where the social sciences can contribute a lot to achieve better results, without forgetting individual or group susceptibility to suffering certain non-communicable diseases. It is considered that managers, health professionals, formal and informal leaders, people, groups and communities must be trained and updated in concepts and approaches to these diseases to achieve their purposes.

Responsabilidad personal con la salud. Conocimientos y percepciones de diferentes actores sociales / Personal Responsibility with Health. Differents Social Actors Knowledges and Perceptions

RESUMEN Fundamento el proceso de actualización del modelo económico y social cubano refrenda la necesidad de asegurar el adecuado equilibrio entre las responsabilidades que competen al Estado y al Gobierno y las correspondientes a los individuos. Se ha producido un reposicionamiento del tema de la responsabilidad personal con la salud a nivel nacional, pero se desconoce la representación social de este término en diferentes actores sociales que intervienen en la gobernanza para la salud en el nivel comunitario y local. Objetivo: explorar los conocimientos y percepciones que poseen diferentes actores sociales de la comunidad sobre la responsabilidad personal con la salud. Método: se seleccionó una muestra de 385 sujetos del área de salud Andrés Ortiz del municipio Guanabacoa en La Habana mediante criterios probabilísticos y discrecionales, compuesta por profesionales y técnicos del sector de la salud, miembros de organizaciones no gubernamentales, de organizaciones políticas, del gobierno local y de la ciudadanía pertenecientes a tres consultorios de la atención primaria de salud. Se construyeron y validaron instrumentos para la recogida de datos. Se obtuvo la información mediante entrevistas semiestructuradas y encuestas. Se realizó análisis de contenido del discurso y análisis descriptivo de los datos utilizando frecuencias absolutas y relativas. Resultados: el 100 % de los profesionales y técnicos del sector de la salud, de los miembros del gobierno local, de las organizaciones políticas y de las organizaciones no gubernamentales poseía referencias previas sobre el término, pero solo el 45 % de la ciudadanía había escuchado acerca de él. Las fuentes del conocimiento previo sobre el término difirieron entre los actores sociales. La percepción de que la responsabilidad personal con la salud debe restringirse al autocuidado individual fue mayoritaria principalmente entre la ciudadanía (83,4 %), los representantes de las organizaciones no gubernamentales (78 %), los miembros del gobierno local y dirigentes del sector salud (62,5 %), los técnicos y profesionales de la salud (59 %) y en menor proporción los profesores de ese sector (50 %). El 100 % de los representantes de las organizaciones políticas percibieron que esta responsabilidad debía tener una visión individual. Conclusiones: existen divergencias en el campo representacional de la responsabilidad personal con la salud entre los diferentes actores sociales consultados. Predominó el entorno discursivo y representacional relacionado con una responsabilidad personal limitada a la salud individual.

ABSTRACT Background: the updating process of the Cuban economic and social model support the need to ensure the proper balance between the responsibilities that concern the State and the Government and those corresponding to individuals. There has been a repositioning of the issue of personal responsibility with health at the national level, but the social representation of this term in different social actors that intervene in health governance at the community level, community and local level, is unknown. Objective: to explore the knowledge and perceptions that different social actors in the community have on personal responsibility with health. Method: a sample of 385 subjects from the Andrés Ortiz health area of ​​the Guanabacoa municipality in Havana was selected using probabilistic and discretionary criteria, composed of professionals and technicians from the health sector, members of non-governmental organizations, political organizations, and the government local and citizens belonging to three clinics of primary health care. Instruments for data collection were built and validated. The information was obtained through semi-structured interviews and surveys. Discourse content analysis and descriptive data analysis were performed using absolute and relative frequencies. Results: the 100 % of professionals and technicians from the health sector, members of local government, political organizations and non-governmental organizations had previous references to the term, but only the 45 % of the public had heard about him. The sources of prior knowledge about the term differed among social actors. The perception that personal responsibility for health should be restricted to individual self-care was the majority mainly among citizens (83.4 %), representatives of non-governmental organizations (78 %), members of the local government and leaders of the health sector (62.5 %), technicians and health professionals (59 %) and, to a lesser proportion teachers in this sector (50 %). The 100 % of the representatives of the political organizations perceived that this responsibility should have an individual vision. Conclusions: there are differences of opinion in the representational field of personal responsibility with health among the different social actors consulted. The discursive and representational environment predominated, related to personal responsibility limited to individual health.

The application value of the combination of personality responsibility theory and motivation theory in the identification of the criminal responsibility ability of the patients with mental disorders / 中国法医学杂志

Objective To explore the value of the combination of personality responsibility theory and motivation theory in the evaluation of the ability of criminal responsibility of the patients with mental disorders. Methods A retrospective analysis of our hospital in 2013 and 2014 the implementation of identification of 101 cases of patients with mental disorders of the criminal responsibility, analysis indicators include: the reflection of the basic characteristics of personality; motive; identification of illegal behavior evaluation; the capacity of criminal responsibility. Results different symptoms reflects abnormal consistency and specificity of personality integrity; when the symptoms are not at the same time, with the implementation of the illegal behavior of the motivation also has realistic and non realistic differences; personality integrity can not damage the normal and correct evaluation of the illegal act, almost all favorable personality particularity of affected persons can recognize the illegality of the behavior; the integrality and consistency of the affected personality criminal responsibility were incomplete; special personality influence for full criminal responsibility. Conclusion The combination of personality responsibility theory and motivation theory is applied to the identification of the criminal responsibility ability of the patients with mental illness. To define the identity of the actor as the actor, to identify the patient's behavior is "not control" or "no control", it is worth promoting the application in the work of mental illness judicial identification.

Personal vis-a-vis social responsibility for disparities in health status: An issue of justice.

Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary and unjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation, education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors, access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and above societal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of their own, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which there should (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates how his/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof. The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasized that assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individual responsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious, informed, and healthy choices.

O acesso aos campos elísios: a promoção da saúde ampliada e as tecnologias de melhoramento em busca da longevidade (e da imortalidade) / Access to the elysian fields: amplified health promotion and enhancement technologies in search of longevity (and immortality)

São abordadas e discutidas as tecnologias de melhoramento e sua meta de vender a possibilidade (real ou virtual) de manter e proporcionar aparência de juventude, longevidade e até imortalidade aos seres humanos como modelo de construção da noção de si mesmo. Emprega-se a ideia de "promoção de saúde ampliada" tanto no sentido de intensificação dos discursos sustentando comportamentos saudáveis como alegoria fotográfica no sentido de ampliar a sua imagem e permitir uma visão mais aproximada de detalhes políticos, ideológicos e mercantis das suas proposições. A partir de uma tipologia das ciências contra o envelhecimento feita por John Vincent em: cosméticas, médicas, biológicas e imortalistas, são enfocados os dois últimos itens e suas implicações. Ao final, propõe-se um enfoque analítico da questão, destacando estratégias biopolíticas para lidar com a finitude humana através de enfoques preemptivos sob a égide da hiperprevenção e a busca de um tipo de felicidade como autossatisfação pessoal que necessita de tecnologias de melhoramento para ser alcançada.

In this article, we discuss enhancement technologies and their goal to sell the possibility (actual or virtual) of keeping and providing appearances of youth, longevity and even immortality for human beings as a construction model of the notion of self. We employ the idea of 'amplified health promotion' in the sense of intensification of discourses supporting healthy behaviours and also as a photographic allegory, in the sense of amplifying its image in order to allow a closer view of the political, ideological and mercantile details of its proposals. Based on a typology of the anti-ageing sciences, proposed by John Vincent as cosmetic, medical, biological and immortalist, we deal with the latter two and their implications. Finally, we propose an analytical focus on the subject, emphasizing biopolitical strategies to deal with human finitude through preemptive approaches with the support of hyper-prevention, and the search of a kind of happiness as personal self-fulfillment that needs enhancement technologies to be reached.

On Health Responsibility / 中国医学伦理学

To differentiate health responsibilities in different circumstances should judge correctly the principle and conditions of responsibility division .It is deemed that the controllability view of responsibility provides the mor-al basis for health responsibility , which claims that the controllable causality is necessary condition for the judgment of responsibility .The construction of health responsibility is a multi -party participation .In face of the current re-ality of China , must build a diversified responsibility principle system: the responsibility of the government as the leading factor , the family and social responsibility as the backbone , and individual responsibility as base .

Características del desarrollo adaptativo en niños de 3 a 7 años de la ciudad de Barranquilla / Characteristics of the adaptive development in children aged 3 to 7 in Barranquilla

Desde su concepción el ser humano se enfrenta a un sin número de cambios biológicos, emocionales, cognitivos y conductuales, la secuencia de estos cambios permite que cada vez se llegue a un desarrollo y adaptación mayor frente a sus necesidades y a las necesidades externas. Por lo que surge la necesidad de esta investigación, planteándose como objetivo principal, describir las características y establecer cómo se relacionan entre sí, los aspectos del desarrollo adaptativo, en relación a las habilidades de auto ayuda y las tareas que dichas habilidades requieren en niños y niñas de 3 a 7 años que cursan los grados de párvulo a primero en instituciones oficiales de la ciudad de Barranquilla. Para la medición de las variables de estudio se utilizó el Inventario de Desarrollo Battelle. Los resultados obtenidos revelaron que los niños y niñas según su entorno pueden o no realizar ciertas tares de manera eficaz, por iniciativa y con independencia. Por consiguiente, si un niño es más autónomo en el vestido, en el auto cuidado y en la alimentación, también será autónomo en el proceso de aprendizaje, en la relación con otros niños y en la solución de dificultades presentadas en su entorno.

Since its conception, the human being faces a number of biological, emotional, cognitive and behavioral changes. The sequence of these changes leads to a bigger development and adaptation towards its needs and its external needs. Based on the above, the need for this research project is created, considering as its main objective the description of the characteristics of the adaptive development with regards to the self-help skills and the tasks required by these skills in children aged 3 to 7 who attend kindergarten and 1st grade in some public institutions in Barranquilla. In order to measure the study variables, the Battelle Developmental Inventory was used. The results obtained revealed that the girls and boys can or cannot perform certain tasks effectively on their own initiative and independently Consequently if a child is much more autonomous in his dress sense, in his self-care and his food, he will be autonomous in the learning process, in the relationship with other children and in the solution of problems arising in his environment as well.