When you operate on friends and relatives: results of a survey among surgeons

Objective: We designed a questionnaire to collect data on surgeons' views and experiences of operating on friends or relatives

Subjects and Methods: A link to a 38-item online survey was sent to all 16,849 members of the Professional Board of German Surgeons [Bund Deutscher Chirurgen, BDC] several times. Standard interview software was used

The questionnaire collected a wide variety of information concerning how surgeons have experienced, think about and deal with the situation when they operate on friends or relatives

Results: Of the 16,849 BDC members notified of the survey, 1,643 completed the questionnaires [9.8%]

Of these, 1,275 [77.6%] had previously performed surgery on friends or relatives. Overall, the surgeons willingly accepted doing so without experiencing any difficulties. However, the sur-geons frequently used different techniques when operating on friends and relatives [123 [10%] when self-assessed compared to 527 [35%] when observed by others]. Out of the whole sample, 506 [30.8%] would appreciate having a guideline or ethical code and 370 [41.2%] of those who have not yet operated on friends and relatives would like to have such an ethical code

Conclusion: Most of the surgeons who responded accepted the task of operating on friends or relatives. Performing surgery on friends or relatives was a complex matter because objectivity was not guaranteed. Negative implications on personal relationships were rare. We recommend that this matter should be well considered and discussed with the patient and an ethical guideline or code Should be Created

Determinantes sociales de salud como herramienta para una mejor intervención de enfermería / Social determinants of health as a tool for a better nursery intervention

Las investigaciones en el campo de la enfermería se han detenido en conocer y profundizar en los factores de riesgo que pueden afectar de una u otra forma al individuo, familia o comunidad. Pueden existir factores de riesgo en cualquier ambiente que propicie la aparición de enfermedad, como el ambiente físico (agentes infecciosos, fármacos o sustancias químicas), psíquico (estrés), social (comportamientos y estilos de vida, características socioeconómicas, modo de vida, nivel de vida) y factores hereditarios. Para el personal de enfermería el reconocimiento de los factores de riesgo es relevante porque permite identificarlos y corregir sus efectos, por lo que es importante resaltar un enfoque de riesgo a través del método científico de la profesión que es Proceso de Atención de Enfermería y su resolutividad radica en contemplar acciones desde la implicación motivacional de los participantes, con adecuación a los grupos poblacionales por edades, a las características personológicas y grupales, basadas en las influencias micro y macrosociales como expresión de la situación social del desarrollo en un contexto de acciones salubristas que contribuyen a la mejora del estado de salud de la población, a traves de los determinantes sociales de la salud , que constituyen el marco global que explican en que medida la complejidad de la estratificación y la vulnerabilidad de la sociedad y su impacto sobre la salud. Los determinantes estructurantes: ingreso, educación, sexualidad, género y etnicidad conforman una base explicativa, más allá de la tradicional fundamentación lineal, causa-efecto, en el impacto en la salud, al involucrar determinaciones intermediarias que condicionan diferencias en la vulnerabilidad, exposición y en la respuesta de salud.

Investigations in the nursery field have stopped in knowing and deepening in the risk facts that could affect, in one or another way, the individual, the family or the community. There might be risk facts in any setting favoring diseases, like physical environment (infectious agents, drugs or chemical substances), psychic condition (stress), and social background (behavior and life styles, socioeconomic characteristics, way of life, level of life) and inherited facts. For the nursery staff, recognizing risk facts is relevant because it allows their identification and correcting their effects. That is why it is very important to highlight a risk approach through the profession's scientific method, Nursery Care Process. Its capacity of solving is inherent in taking in to account actions from the point of view of the participants motivational implication, adapting them to population groups ordered by age, personal and group characteristics, based on the micro and macro-social influences as expression of the developmental social situation in a context of health actions contributing to improve the populations health status, all of that through the Health Social Determinants, the global framework explaining the dimension of the society stratification and vulnerability complexness and its impact on health. The structural determinants: entering, education, sexuality, genre and ethnicity, conform an explaining base, besides the traditional lineal explanation, cause-effect, of the health impact, when involving intermediary determinants conditioning vulnerability, exposition and health answer.

La ética en el paciente pediátrico portador de enfermedades crónicas no transmisibles / Ethics in the pediatric patient carrying a no transmisible chronic disease

Un dilema importante en nuestra práctica médica pediátrica es la atención del niño portador de Enfermedades Crónicas no Transmisibles, entidades que afectan permanentemente al niño, por lo que tienen limitaciones en varios aspectos de su vida, a las que se añade en muchos casos un pronóstico sombrío y a veces fatal; y que también repercuten en la familia y en el ambiente próximo en que éstos de desarrollan, generando en los padres y familiares múltiples interrogantes, lo que distorsiona toda la dinámica familiar y por lo que todos sus miembros deben encontrar en nosotros no sólo atención médica, sino además un gran respeto y comprensión que contribuya a disminuir la estigmatización que habitualmente condicionan estas enfermedades. Se analizan los problemas éticos que involucran tanto al médico como a la familia, situaciones en las que se hace necesario tomar decisiones en las que el derecho a la autonomía no puede siempre ejercerlo el paciente pediátrico por razones obvias de la edad; y el uso del consentimiento informado; todo ello sin olvidar que por difícil que resulte en ocasiones, es ineludible regir nuestra actuación por los principios de la ética del médico pediatra en sentido general y máxime en el caso que nos ocupa, combinado con la ética del niño y de su familia, porque es un derecho social en nuestro sistema y un principio ético de nuestra medicina, que como expresara Fidel en el concepto de Revolución: No debemos violar jamás.

An important dilemma in our pediatric medical practice is the atention of the child carrying a no Transmisible Chronic Disease, permanently affecting the child and limiting several aspects of his life, to which is added, in many cases, a somber and sometimes fatal prognosis. All of these facts strike on the family and on the environment where they grow up, generating many questions among parents and relatives, and deforming familiar dynamics. That is why all the members of their families have to find in the health care workers not only medical attention, but also a great respect and comprenhesion contributing to diminish the stigmatization generated by these diseases. We analize ethic problems that involve not only the doctor but the family, situations in which there have to be taken desicions in which, for obvious age reasons, the autonomy right not always can be excerted by the pediatric patient; and the informed consent is needed; all of this without forgeting that, even if it is sometimes very difficult, it is unavoidable to direct our performance fy the principles of the pediatric doctor´s etics in general sense, combining it with the ethics of the child and his family because it is a social right in our system and an ethic principle of our medicine that, as Fidel said in the concept of Revolution We should never violate.

A busca de uma identidade para o médico de família / In search of identity for the family doctor

Este artigo reflete algumas preocupações em relação ao médico de família, no sentido de se perguntar quem é esse sujeito dentro de uma formação médica “biologizante”, que não valoriza a atenção primária, deixando confuso seu ideal de profissão. Tem o objetivo de disponibilizar uma discussão que, na inter-relação entre educação e trabalho, invoca uma reflexão sobre a identidade profissional do médico de família. Realiza uma abordagem qualitativa sobre as práticas dos médicos de família do município do Rio de Janeiro enquanto objeto de análise. Resulta em considerações que refletem a reprodução de um modelo de atenção tradicional, fazendo crer que a educação permanente é uma estratégia importante na busca do acolhimento da população.

This paper discusses some concerns about the family doctor, wondering who is this subject within a biologicist medical formation, who does not valueprimary attention, making his professional ideal confused. It aims to present a discussion that, in theinter-relation between education and work, demands reflection on the professional identity of the familydoctor. It carries out a qualitative approach on family doctors’ practices in the City of Rio de Janeiro, as object of analysis. As a result, it presentsconsiderations that reflect the reproduction of a traditional attention model, leading to the idea that continuing education is an important strategy in the search of population reception.

Cuidador familiar de seqüelados de acidente vascular cerebral: significado e implicações / Family caregiver of stroke sequel patients: meanings and implications

Este artigo reflete algumas preocupações em relação ao médico de família, no sentido de se perguntar quem é esse sujeito dentro de uma formação médica “biologizante”, que não valoriza a atenção primária, deixando confuso seu ideal de profissão. Tem o objetivo de disponibilizar uma discussão que, na inter-relação entre educação e trabalho, invoca uma reflexão sobre a identidade profissional do médico de família. Realiza uma abordagem qualitativa sobre as práticas dos médicos de família do município do Rio de Janeiro enquanto objeto de análise. Resulta em considerações que refletem a reprodução de um modelo de atenção tradicional, fazendo crer que a educação permanente é uma estratégia importante na busca do acolhimento da população.

The brain vascular accident (BVA) is one of the main death causes worldwide. Due to the impairments imposed by the BVA, there is the family caregiver. This work aims to analyze the meaning and implications of being a caregiver of a stroke sequel person. It is a qualitative research, carried out with five caregivers in Londrina–PR, from August to December 2005. Data were collected in semi–structured interviews and were subjected to discourse analysis proposed by Martins and Bicudo. From the analysis of interviews seven categories arouse: turning to the being cared, describing care, presenting changes, spirituality support, understanding the meaning of care, expressing the needs to take care and future perspectives. Results revealed that being a family caregiver is a complex phenomenon, that creates in the subjects feelings of happiness and along with feelings of fear, anxiety and revolt.

Situación epidemiológica de la infección por el VIH en el área de salud del policlínico Héroes del Moncada / Epidemiologic situation of HIV-infection in the health area of Héroes del Moncada Polyclinic

La pandemia del VIH/SIDA continúa representando el peor de los flagelos que amenaza la vida de millones de personas en el mundo. Se realizó un estudio retrospectivo descriptivo en los 42 sujetos infectados por el VIH que pertenecen al área de salud del policlínico comunitario Héroes del Moncada para describir el comportamiento de esta epidemia en esta área de salud. La tasa de prevalencia de seropositivos en la citada área era de 0,16 por ciento, muy por encima de la que se reporta en el país que es de 0,006 por ciento. Entre los infectados predominó el sexo masculino con el 69 por ciento aunque se encontró una tendencia hacia el incremento de las mujeres afectadas. El rango de edad de los enfermos estuvo entre los 18 y 56 años y el 88 por ciento de ellos se encontraba entre los 18 y 49 años. En más de la mitad de los infectados la enfermedad estaba en la etapa de SIDA. Se comprobó que los grupos de mayor riesgo eran los hombres que tenían sexo con otros hombres pero que se consideran heterosexuales así como los sujetos con un bajo nivel de escolaridad. Se produjeron 8 fallecimientos, 7 de ellos con una supervivencia de más de 10 años. Los resultados alcanzados demostraron que a pesar de que Cuba exhibe uno de los índices más bajo de incidencia de infección por el VIH la epidemia no ha sido detenida, se mantienen, por tanto, como principales medidas de combate las de prevención y promoción de salud(AU)

The pandemic of the VIH/SIDA continues representing the worst in the flagelos that threatens the life of millions of people in the world. He/she was carried out a descriptive retrospective study in the 42 fellows infected by the VIH that belong to the area of health of the policlínico community Heroes of the Moncada to describe the behavior of this epidemic in this area of health. The prevalencia rate of seropositive in the mentioned area was of 0,16 percent, very above which is reported in the country that is of 0,006 percent. Among those infected the masculine sex it prevailed with 69 percent although he/she was a tendency toward the increment of the affected women. The range of the sick persons age was between the 18 and 56 years and 88 percent of them it was between the 18 and 49 years. In more than half of those infected the illness it was in the stage of AIDS. He/she was proven that the groups of more risk were the men that had sex with other men but that they are considered heterosexual as well as those subject with a low escolaridad level. 8 deaths took place, 7 of them with a survival of more than 10 years. The reached results demonstrated that although Cuba exhibits one of the lowest indexes in infection incidence for the VIH the epidemic it has not been stopped, they stay, therefore, as main combat measures those of prevention and promotion of saludLa pandemic of the VIH/SIDA continues representing the worst in the flagelos that threatens the life of millions of people in the world. He/she was carried out a descriptive retrospective study in the 42 fellows infected by the VIH that belong to the area of health of the policlínico community Heroes of the Moncada to describe the behavior of this epidemic in this area of health. The prevalencia rate of seropositive in the mentioned area was of 0,16 percent, very above which is reported in the country that is of 0,006 percent. Among those infected the masculine sex it prevailed with 69 percent although he/she was a tendency toward the increment of the affected women. The range of the sick persons age was between the 18 and 56 years and 88 percent of them it was between the 18 and 49 years. In more than half of those infected the illness it was in the stage of AIDS. He/she was proven that the groups of more risk were the men that had sex with other men but that they are considered heterosexual as well as those subject with a low escolaridad level. 8 deaths took place, 7 of them with a survival of more than 10 years. The reached results demonstrated that although Cuba exhibits one of the lowest indexes in infection incidence for the VIH the epidemic it has not been stopped, they stay, therefore, as main combat measures those of prevention and promotion of health(AU)

Los principios bioéticos en la atención primaria de salud: apuntes para una reflexión / Biooethical principles in primary health care: some reflections

Se realizó un estudio teórico basado en varias técnicas cualitativas, opinión de expertos en el tema y búsqueda bibliográfica, para la comprensión de los principios de la bioética en la atención primaria de salud, teniendo en cuenta el cambio de paradigma que se está dando en la concepción de la medicina

Aspectos bioéticos del ingreso domiciliario / Bioethical aspects of home care

Se llevó a cabo un estudio prospectivo en 10 consultorios pertenecientes a la policlínica "Armando García" de Santiago de Cuba, en el que analizaron los aspectos bioéticos que deben tener en cuenta el médico y la enfermera de la familia en el ingreso domiciliario, el cual abarcó desde diciembre de 1995 hasta igual mes de 1996. Se aplicó una encuesta a los 26 pacientes ingresados con esta modalidad de atención, cuyo grupo mayoritario estuvo integrado por menores de 1 año y los de 61 a 80 años. Las visitas domiciliarias se efectuaron con la frecuencia requerida de acuerdo con la prioridad del grupo y afección presentada. Mediante la encuesta realizada al personal médico y de enfermería, se comprobó que sólo el 36 (por ciento) posee conocimientos sobre los aspectos bioéticos, adquiridos por medio de la literatura especializada, conversatorios y conferencias(AU)

A prospective study was carried out in 10 physicians' offices of "Armando García" polyclinics in Santiago de Cuba, with the aim of analyzing the bioethical aspects that the family physicians and nurses should take into consideration in the home care situation. The study covered from December 1995 to December 1996. The twenty-six patients who were provided home care were surveyed. The majority was composed by 61-80 y age group and under one-year olds. Home visits were paid at required frequency according to the priority given to the group and the disease. The survey made among the medical and nursing staff proved that only 36 percent of them has adequate level of knowledge on the bioethical aspects, knowledge acquired mainly from specialized literature, talks and conferences(AU)