El "paciente sano": desafíos éticos de la medicina preventiva / The ethical challenge of "healthy patients"

This paper deals with the phenomenon of the "healthy patient", an ethical issue receiving increased attention at a global level. The genesis of this phenomenon rests in the contradiction between a higher availability of technical and scientific resources for prevention and, paradoxically, the tendency towards an accelerated classification of healthy people as being at risk of developing disease. This manuscript focus on the ethical implications of the "healthy patient", using a theoretical and philosophical approach. Therefore, this research aims to set forth the phenomenon of the "healthy patient" and its fundamental ethical problem, interpreting it as a contradiction between the perennial goal of medicine to maintain and promote health and the increasing use of technology. Thus, it can be hypothesized that the early classification of individuals as subjects at risk is a problem of time. Finally an interpretation from a philosophical point of view will be presented to offer a better understanding of the ethical problem of the "healthy patient" and to elucidate possible strategies of action for physicians and their patients.

Factors Influencing Intention to Receive Examination of Diabetes Complications

PURPOSE: The purpose of this study was to understand the situation of diabetes patients receiving examinations for diabetes complications and to explore the factors influencing their intention to receive examinations for diabetes complications. METHODS: A cross-sectional study was performed that included 251 diabetes patients who visited outpatient clinics in Southern Taiwan. A survey using a self-administered questionnaire was conducted from October 2015 to January 2016. The questionnaire included items on demographic characteristics, perceived susceptibility to diabetes complications, perceived seriousness of diabetes complications, perceived benefits of taking action to receive diabetes complication examinations, perceived barriers to taking action to receive diabetes complication examinations, and the intention to receive diabetes complication examinations. The data were analyzed using regression analysis. RESULTS: The percentage of participants who received fundus, foot, and kidney examinations was 67.7%, 61.4%, and 73.3%, respectively. Every point increase on the perceived barriers to taking action to receive diabetes complication examinations scale increased the intention to receive a foot examination in the following year by 0.91 times (p = .002), and every point increase on the perceived susceptibility to diabetes complications scale increased the intention to receive a kidney examination in the following year by 1.19 times (p = .045). CONCLUSIONS: Nurses should shoulder the responsibility to increase patients' intention to receive examination of diabetes complications. The results of this study can be used to promote nurses' care efficacy in preventing diabetes complications. They can also provide medical institutions with information to establish prevention and control policies for diabetes complications.

Coping, executive functioning, inhibitory control and decision-making in a sample of depressed suicidal patients

Introduction: Suicidal behavior has been associated with several risk factors, including depression, maladaptive coping, and neuropsychological dysfunction. This study aimed to evaluate coping orientations, executive functioning, attentional capabilities and decision-making in depressed suicidal patients. Methods: Two groups were selected: 32 depressed patients with history of suicide attempt and 30 depressed patients without history of suicide attempt. The Beck Depression Inventory and the COPE Inventory scales were applied, as well as the following neuropsychological tests: Wisconsin Card Sorting Test, Stroop Test, and a modified Iowa Gambling Task. Results: The results indicate a higher level of dysfunction in the executive functioning, mental control, and decision-making domains, and lower levels of orientation to active and reflective coping strategies, humor, and positive signification in the suicidal group. Conclusions: These results indicate that there are neuropsychological differences between depressed patients with and without history of suicide attempt, which may contribute significantly to the occurrence of suicidal behavior. However, the processes involved and the way they contribute to the phenomenon are aspects that still need further clarification.