Medicolegal aspects of documentation and the electronic health record / Aspectos medicolegales de la documentación y la historia clínica electrónica

Introduction: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum.Methods: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. Results: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. Conclusion: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.(AU)

Introducción: Los momentos de mayor actividad en el hospital a menudo se enfrentan con los mayores desafíos en cuanto a la documentación completa y exhaustiva del evento de atención al paciente. La transición casi completa a la historia clínica electrónica (HCE) iba a ser la solución a una serie de preocupaciones sobre la documentación de los proveedores. Está claro que la HCE proporciona confiabilidad, reproducibilidad, integración, toma de decisiones basada en la evidencia y contribución multidisciplinaria en todo el espectro de la atención médica.Métodos: El uso de un consenso de opinión de expertos complementado con una revisión de la literatura enfocada permite una presentación equilibrada de los datos basada en la evidencia.Resultados: La documentación no es una herramienta perfecta, ya que se han planteado problemas de eficiencia, confiabilidad, uso de maniobras abreviadas y la posibilidad de un mayor riesgo medicolegal. La solución es la atención al detalle de la documentación y la creación de sistemas que faciliten la excelencia. El enfoque en los sistemas de documentación electrónica debe incluir evaluación continua, mejora continua, participación de un equipo multidisciplinario de atención al paciente y receptividad de los proveedores en el desarrollo y las operaciones de la HCE. Conclusión: El uso más eficaz de la HCE como herramienta de gestión de riesgos requiere conocimiento de la documentación, análisis específicos, mejora del producto y desarrollo conjunto de recursos clínico-comerciales.(AU)

Medicolegal aspects of documentation and the electronic health record.

INTRODUCTION: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum. METHODS: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. RESULTS: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. CONCLUSION: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.

Prevalence of elder abuse in the community and care settings: An umbrella review.

OBJECTIVE: Elder abuse, an important human rights issue and public health problem, contributes to increased disability and mortality. In the last decades, several reviews have synthesized primary studies to determine its prevalence. This umbrella review aimed to estimate the worldwide overall prevalence rate of elder abuse in the community and care setting. METHODS: Following prospective registration at PROSPERO (CRD42021281866) we conducted a search of eight electronic databases to identify systematic reviews from inception until 17 January 2023. The corrected covered area was calculated to estimate the potential overlap of primary studies between reviews. The quality of the selected reviews was assessed using a modified AMSTAR-2 instrument. We extracted data on the prevalence of any type of elder (people aged 60 years old or older) abuse in the community and care setting. RESULTS: There were 16 systematic reviews retrieved between 2007 and 2022, out of which ten captured prevalence globally, three in Iran, one in Turkey, one in China and one in Brazil. The 16 reviews included 136 primary studies in total between 1988 and 2020. The overlapping of studies between reviews was found to be moderate (5.5%). The quality of reviews was low (2, 12.5%) or critically low (14, 87.5%). The estimated range of global prevalence of overall elder abuse was wide (1.1-78%), while the estimations of specific abuse prevalence ranged from 0-81.8% for neglect, 1.1-78.9% for psychological abuse, 0.7-78.3% for financial abuse, 0.1-67.7% for physical abuse, and 0-59.2% for sexual abuse. CONCLUSIONS: Although the low quality of the evidence and the heterogeneity of the phenomenon makes it hard to give precise prevalence data, it is without a question that elder abuse is a prevalent problem with a wide dispersion. The focus of attention should shift towards interventions and policymaking to prevent this form of abuse.

Maltreatment history and internalizing and externalizing symptoms in out-ofhome care: a three-level meta-analysis / La historia del maltrato y los síntomas internalizantes y externalizantes en acogimiento fuera del hogar: un meta-análisis de tres niveles

Background/Aim: Young people in care may show significant mental health difficulties because of previous adverse experiences, such as maltreatment or violence. However, no meta-analyses have been conducted on this topic. We aim to identify the role of previous maltreatment in current symptoms of children and adolescents in out-of-home care. Method: A search in Academic Search Complete, PsycArticles, PsycInfo, Psychology and Behavioral Sciences Collection, ERIC, Medline, Web of Science and Scopus databases was conducted. Studies were included if they were empirical and quantitative, involved school-aged children and adolescents, assessed maltreatment before placement in care and current internalizing and externalizing symptoms. Multiple effect sizes were extracted from each primary study, and a three-level meta-analysis for each type of maltreatment associated with internalizing and externalizing symptoms was conducted. Results: The search yielded 122 effects sizes from 28 studies. Results indicated significant overall effects of general maltreatment (r = .260), abuse (emotional/physical) (r = .135) and sexual abuse (r = .247) on internalizing symptoms. In relation to externalizing symptoms, overall effects of abuse (emotional/physical) (r = .097) and sexual abuse (r = .187) were identified. The overall effect sizes of neglect were neither significant for internalizing or externalizing symptoms. A set of moderators was tested, and significant effects were found for the type of maltreatment measure on internalizing symptoms and for gender on externalizing symptoms. Conclusions: This study provides new insights beyond previous systematic reviews, as we were able to disentangle the associations between maltreatment and internalizing and externalizing symptoms in out-of-home care. (AU)

Antecedentes/Objetivos: Los niños y adolescentes de protección presentan problemas significativos en la salud mental debidos a experiencias previas adversas como el maltrato o la violencia. A pesar de ello no se han realizado meta-análisis sobre esto. Se diseñó una revisión meta-analítica con el objetivo de conocer el papel que desempeña el maltrato sufrido en los síntomas que experimentan los niños y adolescentes en acogida fuera del hogar. Método: Se llevó a cabo una búsqueda bibliográfica en las bases de datos Academic Search Complete, PsycArticles, PsycInfo, Psychology y Behavioral Sciences Collection, ERIC, Medline, Web of Science y Scopus. Se incluyeron los estudios que eran empíricos y cuantitativos, concernían a niños y adolescentes en edad escolar, evaluaban el maltrato antes de que fuesen dados en acogida y también los síntomas actuales internalizantes y externalizantes. De cada estudio primario se extrajeron varios tamaños del efecto y se ejecutaron meta-análisis de tres niveles para cada tipo de maltrato asociado con síntomas internalizantes y externalizantes. Resultados: La búsqueda arrojó 122 tamaños de efecto provenientes de 28 estudios. Los resultados mostraron efectos generales significativos del maltrato general (r = .260), el abuso (físico/emocional) (r = .135) y el abuso sexual (r = .247) en los síntomas internalizantes. En cuanto a los síntomas externalizantes se encontraron efectos globales del abuso (emocional/físico) (r = .097) y abuso sexual (r = .187). Los tamaños del efecto globales de la negligencia fueron no significativos tanto ni para los síntomas internalizantes como para los externalizantes. También se estudiaron los efectos de moderadores, hallándose efectos significativos del tipo de medida del maltrato en los síntomas internalizantes y del género en los síntomas externalizantes. Conclusiones: ... (AU)

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis.

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.

Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis.

Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle-Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.PROSPERO registration: CRD42023394120.

In this study protocol, we propose to quantitatively summarise the existing literature on the relationship between child maltreatment and resilience with regard to mental health consequences and psychosocial functioning later in life.This preregistered systematic review and meta-analysis will establish the procedures to investigate associations between an overall classification of child maltreatment and its different associated subtypes, and a global/trait classification of resilience and its different domains in adults.This protocol will further determine the analytical approach to explore and summarise effect moderators and mediators of the association between child maltreatment and resilience in adulthood.The resulting synthesis, that will be based on this protocol, could enhance our understanding of the strength of the association between child maltreatment and resilience and inform prevention strategies and clinical interventions to improve health and psychosocial functioning in adult survivors.

The influence of childhood emotional neglect experience on brain dynamic functional connectivity in young adults.

Background: Childhood emotional neglect (CEN) confers a great risk for developing multiple psychiatric disorders; however, the neural basis for this association remains unknown. Using a dynamic functional connectivity approach, this study aimed to examine the effects of CEN experience on functional brain networks in young adults.Method: In total, 21 healthy young adults with CEN experience and 26 without childhood trauma experience were recruited. The childhood trauma experience was assessed using the childhood trauma questionnaire (CTQ), and eligible participants underwent resting-state functional MRI. Sliding windows and k-means clustering were used to identify temporal features of large-scale functional connectivity states (frequency, mean dwell time, and transition numbers).Result: Dynamic analysis revealed two separate connection states: state 1 was more frequent and characterized by extensive weak connections between the brain regions. State 2 was relatively infrequent and characterized by extensive strong connections between the brain regions. Compared to the control group, the CEN group had a longer mean dwell time in state 1 and significantly decreased transition numbers between states 1 and 2.Conclusion: The CEN experience affects the temporal properties of young adults' functional brain connectivity. Young adults with CEN experience tend to be stable in state 1 (extensive weak connections between the brain regions), reducing transitions between states, and reflecting impaired metastability or functional network flexibility.

We focus solely on the childhood emotional neglect experience and its long-term effects on brain function.Eligible participants with and without childhood emotional neglect were identified through a large-scale screen among young adults.The results found childhood emotional neglect experiences have a long-term impact on brain flexibility.

Reabilitação cognitiva à pessoa com acidente vascular cerebral: intervenção do enfermeiro especialista em enfermagem de reabilitação / Cognitive rehabilitation for people with stroke: intervention by the rehabilitation nurse

A mortalidade por Acidente Vascular Cerebral (AVC) no mundo e em Portugal, encontra-se em decréscimo nas últimas décadas. Contudo, a taxa de incidência tem apresentado um comportamento contrário. Do AVC decorrem alterações neurológicas, constituindo-se como um acontecimento crítico que despoleta no indivíduo/família, um processo de transição. As alterações da função cognitiva, apresentam impacto na funcionalidade, autonomia e qualidade de vida: provocam uma redução na eficiência do funcionamento, diminuição da performance nas Atividades da Vida Diária (AVD) e dificuldade de adaptação. A reabilitação cognitiva baseia-se na neuroplasticidade, ou seja, promove processos de reestruturação, investindo na capacidade do Sistema Nervoso Central em modificar-se e reorganizar-se a nível estrutural e funcional. Os cuidados do Enfermeiro Especialista em Enfermagem de Reabilitação (EEER) à pessoa com AVC, iniciam-se com uma avaliação neurológica sistematizada e criteriosa, para mensuração dos défices e dos ganhos em saúde obtidos através da implementação de programas de reabilitação que incluam a dimensão cognitiva. Estes planos de cuidados contemplam a execução de tarefas terapêuticas exercitadas repetidamente, relacionadas com o autocuidado e/ou direcionadas para o treino da função lesada. As estratégias de intervenção do EEER podem ser de reestruturação ou compensatórias e é a sua mobilização conjugada que torna o programa de reabilitação mais efetivo. Sobre a reabilitação cognitiva, não existem estudos que comprovem inequivocamente as vantagens e os ganhos em saúde e da funcionalidade da pessoa. No entanto, por não existir impacto negativo, devem ser implementados estes programas de reabilitação, porque haverá maior probabilidade de trazer algum benefício comparativamente com a não atuação. O Relatório de Estágio constitui-se como um instrumento metodológico, que sintetiza as aprendizagens e demonstra o desenvolvimento de competências comuns e específicas do EEER, através da descrição, análise e reflexão das atividades realizadas durante o Ensino Clínico, que decorreu em contexto hospitalar e comunitário.

Mortality from Stroke in the world and in Portugal has been decreasing in recent decades. However, the incidence rate has shown an opposite behavior. A stroke results in neurological changes, constituting a critical event that triggers a transition process in the individual/family. Changes in cognitive function have an impact on functionality, autonomy, and quality of life: it causes a reduction in functioning efficiency, decreased performance in Activities of Daily Living (ADL) and difficulty in adapting. Cognitive rehabilitation is based on neuroplasticity, which promotes restructuring processes, investing in the ability of the Central Nervous System to modify and reorganize itself at a structural and functional level. The care provided by the Nurse Specialist in Rehabilitation Nursing (EEER) to the person with stroke begins with a systematic and careful neurological assessment, to measure the deficits and health gains obtained through the implementation of rehabilitation programs that include the cognitive dimension. These care plans contemplate the execution of therapeutic tasks exercised repeatedly, related to self-care and/or directed to the training of the injured function. The EEER intervention strategies can be restructuring or compensatory and it is their combined mobilization that makes the rehabilitation program more effective. About cognitive rehabilitation, there are no studies that unequivocally prove the advantages and gains in health and functionality of the person. However, as there is no negative impact, these rehabilitation programs should be implemented, as they will be more likely to bring some benefit compared to not acting. This report is a methodological instrument, which summarizes the learning and demonstrates the development of common and specific competences of the RNS, through the description, analysis and reflection of the activities carried out during the internships, which took place in a hospital and community context.

Is it the Child’s Fault? Maternal Attributions in Child Abuse and Neglect / ¿Es Culpa del Niño? Atribuciones Maternas en el Abuso y la Negligencia Infantil

Background: Among the parental cognitions explaining maladaptive parenting, attributions about a child’s misbehavior seem important. However, there is little research on neglectful parents, and the different patterns of parental attributions associated with child abuse and child neglect are still underexplained. The current study examines parental attributions associated with child abuse and child neglect. Method: Mothers (N = 218) were asked to evaluate vignettes describing child transgressions, half of which were followed by situational information. Child abuse and child neglect were evaluated through mothers’ and professionals’ reports. Results: Preliminary results indicated that the child’s age and maternal socioeconomic status were significantly correlated with attributions and child abuse and neglect scores and thus were controlled in the models. The results from hierarchical regressions indicated that dispositional attributions were associated with higher abuse scores (reported by mothers), even in the presence of situational information. Likewise, dispositional attributions were associated with higher neglect scores (reported by professionals), but the effect was no longer significant in the presence of situational information. Conclusions: These findings contribute to the current socio-cognitive approaches to child maltreatment and provide relevant input for understanding the different attributional mechanisms underlying child abuse and neglect.(AU)

Antecedentes: Entre las cogniciones parentales que explican la parentalidad desadaptativa, las atribuciones sobre el comportamiento del niño parecen importantes. Sin embargo, hay pocas investigaciones sobre los padres negligentes, y los patrones de atribuciones parentales que se asocian con el abuso y la negligencia siguen sin explicarse. Éste estudio examina las atribuciones parentales asociadas con el abuso y la negligencia infantil. Método: La muestra estaba compuesta por 218 madres que evaluaron viñetas que describían transgresiones infantiles, la mitad con información situacional. Abuso y negligencia se evaluaron a través de informes de madres y profesionales. Resultados: Los resultados indicaron que la edad del niño y el estatus socioeconómico estaban correlacionados con las atribuciones y con el abuso y negligencia, por lo que fueron controlados en los modelos. Los resultados de las regresiones jerárquicas indicaron que las atribuciones disposicionales se asociaron con el abuso (informes de madres), incluso en presencia de información situacional. Las atribuciones disposicionales se asociaron con la negligencia (informes de profesionales), pero no hay efecto en presencia de información situacional. Conclusiones: Estos hallazgos corroboran a los actuales enfoques sociocognitivos del maltrato infantil y proporcionan aportaciones relevantes para entender los diferentes mecanismos atribucionales que subyacen al abuso y la negligencia infantil.(AU)

Infracción del deber de cuidado y responsabilidad penal del profesional de la salud

Introducción: A pesar de su antigüedad la cuestión de la responsabilidad jurídico-penal del profesional de la salud adquiere cada vez mayor importancia en el orden teórico y práctico, en cuyo escenario se pone de manifiesto una excesiva judicialización de la actividad médica como mecanismo de tutela de los derechos del paciente. Objetivo: Sistematizar las diferentes posturas teóricas que en la actualidad se aprecian en torno a la judicialización de la actividad médica y las causas que la estimulan. Método: Se llevó a cabo un estudio de carácter documental a través de una revisión bibliográfica exhaustiva en buscadores bibliográficos como Scopus, SciELO, Google Académico y PubMed. La indagación de carácter argumentativa y exploratoria se realizó el 16 de marzo de 2023 y de los 30 artículos encontrados que abordaron la problemática de la mala praxis médica, solo 11 fueron elegidos para el estudio según criterios de selección. Desarrollo: Se sistematizaron las posturas teóricas sobre la judicialización de la actividad médica y las causas que la estimulan; además se determina la correcta interpretación de la lex artis como mecanismo de heterointegración normativa del deber de cuidado del ejecutor de actos médicos, en aras de evitar excesos en la aplicación de la ley penal en este ámbito de actuación profesional. Consideraciones finales: Una mayor intervención del Derecho Penal en el ejercicio de la Medicina no es el paradigma político criminal más eficiente en aras de proteger la vida e integridad del paciente frente a hechos de mala praxis médica.

Introduction: Legal and criminal liability of the health professionals, regardless its antiquity, at present has becoming more and more theoretical and practical relevance in which an excessive judicialization of medical activity is revealed as a mechanism for the protection of patient rights. Objective: Systematization of the different theoretical positions that are currently identified around the judicialization process of medical activity and the likely causes that stimulate it. Method: A documentary study was carried out through an exhaustive bibliographic review in bibliographic search engines such as Scopus, SciELO, Google Scholar and PubMed. The argumentative and exploratory research was conducted on March 16, 2023 and of the 30 articles found concerning medical malpractice, only 11 were chosen for the study with strict selection criteria. Development: The theoretical positions on the judicialization of medical activity and the causes that stimulate it were systematized; in addition, the correct interpretation of the lex artis was presented as a mechanism of normative heterointegration of the duty of care by the medical personnel, in order to avoid excesses in the application of the criminal law in this area of professional activity. Final considerations: A much greater intervention of criminal law in the practice of medicine is not the most efficient policy to protect the life and integrity of the patient in the face up to the medical malpractice.

Introdução: Apesar de sua idade, a questão da responsabilidade jurídico-penal do profissional de saúde adquire cada vez maior importância na ordem teórica e prática, cenário em que se revela uma excessiva judicialização da atividade médica como mecanismo de proteção dos direitos. do paciente. Objetivo: Sistematizar as diferentes posições teóricas que se apreciam atualmente em torno da judicialização da atividade médica e as causas que a estimulam. Método: Foi realizado um estudo documental por meio de revisão bibliográfica exaustiva em buscadores bibliográficos como Scopus, SciELO, Google Acadêmico e PubMed. A investigação argumentativa e exploratória foi realizada no dia 16 de março de 2023 e dos 30 artigos encontrados que abordavam o problema da impericía médica, apenas 11 foram escolhidos para o estudo de acordo com os critérios de seleção. Desenvolvimiento: Foram sistematizados os posicionamentos teóricos sobre a judicialização da atividade médica e as causas que a estimulam; Além disso, determina-se a correta interpretação da lex artis como mecanismo de heterointegração normativa do dever de cuidado do executor de atos médicos, a fim de evitar excessos na aplicação do direito penal neste campo de atuação profissional. Considerações finais: Uma maior intervenção do Direito Penal no exercício da Medicina não é o paradigma político criminal mais eficiente a fim de proteger a vida e a integridade do paciente contra atos de imperícia médica.

Trastorno límite de la personalidad (TLP), experiencias adversas tempranas y sesgos cognitivos: una revisión sistemática

Introducción: La investigación actual y los artículos rastreados sobre adversidad temprana y sesgos cognitivos en pacientes con trastorno límite de la personalidad (TLP) evidencian la relación entre estas variables y la gravedad de los síntomas clínicos de este trastorno. Objetivo: Revisar sistemáticamente la evidencia de la relación entre adversidad temprana, sesgos cognitivos y agudización de los síntomas del TLP. El vacío investigativo tiene que ver con el tipo específico de adversidad temprana y su relación con el tipo específico de sesgos cognitivos y el curso del TLP de pacientes con este diagnóstico. Metodología: Se realizó una revisión sistemática de la literatura y para reportar la evidencia se utilizó la versión 2020 de la declaración Prisma. Las bases de datos consultadas fueron Scopus, Pubmed, Web of Science y PsycInfo. En la búsqueda también se incluyeron bases de datos de literatura gris como Google Académico, Open Gray y WorldCat. Resultados: En total se incluyeron en el estudio 13 artículos que satisficieron criterios de originalidad, temática estudiada (adversidad temprana, funcionamiento cognitivo y sintomatología límite) y población indicada (pacientes con diagnóstico de TLP). Conclusiones: Si bien existe evidencia de que la adversidad temprana en general es un factor de riesgo para el TLP, se necesita más investigación para comprender los tipos específicos de adversidad que pueden estar más fuertemente relacionados con el desarrollo del TLP. Si bien algunos estudios han identificado sesgos cognitivos en individuos con TLP, poco se conoce sobre el modo en que estos sesgos se desarrollan y cambian con el tiempo, o según la etapa de exposición del paciente a la adversidad temprana.

Introduction: Current research and articles on early adversity and cognitive biases in patients with borderline personality disorder (BPD) demonstrate the relationship between these variables and the severity of the clinical symptoms of this disorder. Objective: The aim was to systematically review the evidence of the relationship between early adversity, cognitive biases, and exacerbation of symptoms of borderline personality disorder. The research gap concerns the particular type of early adversity and its relationship with the specific type of cognitive biases and the course of BPD in patients with this diagnosis. Methodology: We conducted a systematic literature review, and the Prisma statement version 2020 was used to report the evidence. The databases consulted were Scopus, Pubmed, Web of Science, and PsycInfo. Gray literature databases, such as Google Scholar, Open Gray, and WorldCat, were also included in the search. Results: We included 13 articles in the study that met the criteria for originality, studied theme (early adversity, cognitive functioning, and borderline symptomatology), and target population (patients diagnosed with a personality disorder). Conclusions: We found that while there is evidence that early adversity, in general, is a risk factor for BPD, further research is needed to understand the specific types of adversity that may be more strongly related to the development of BPD. In addition, although some studies have identified cognitive biases in individuals with BPD, little is known about how these biases develop and change over time or according to the stage of the patient's exposure to early adversity.

Notifications of physical, sexual and emotional violence and neglect against children in Brazil, 2011-2019: an ecological time-series study / Notificaciones de violencia física, sexual, psicológica y negligencia practicada contra niños en Brasil, 2011-2019: estudio ecológico de serie temporal / Notificações de violência física, violência sexual, violência psicológica e negligência praticadas contra crianças no Brasil, 2011-2019: estudo ecológico de série temporal

ABSTRACT Objective To describe the temporal trend of notifications of physical, sexual and emotional violence and neglect against children in Brazil between 2011 and 2019. Methods This was an ecological time-series study based on notifications of violence against children aged 0-9 years held on the Brazilian Notifiable Health Conditions Information System. Age-adjusted notification rates were calculated for Brazil as a whole, by national macro-region and by sex. Trends were assessed using Joinpoint Regression. Results We analyzed 88,820 notifications of physical violence, 87,141 notifications of sexual violence, 52,359 notifications of emotional violence and 166,664 notifications of neglect. A rising trend was identified for notifications of physical, sexual and emotional violence and neglect for Brazil as a whole and for both sexes. Neglect accounted for the highest rate (95.24 notifications per 100,000 children in 2019). The Northeast and Southeast macro-regions had rising trends for all forms of violence. Conclusion Notifications of physical, sexual and emotional violence and neglect showed rising trends in Brazil in the period studied.

RESUMEN Objetivo Describir la tendencia temporal de notificaciones de violencia física, sexual, psicológica y negligencia practicada contra niños en Brasil entre 2011 y 2019. Métodos Estudio ecológico de series temporales de notificaciones registradas en el Sistema de Información de Agravamientos de Notificación contra niños (0-9 años). Se calcularon las tasas de notificación ajustadas por edad para Brasil por macrorregión y sexo. Se analizó la tendencia mediante regresión joinpoint. Resultados Se incluyeron 88.820 notificaciones de violencia física, 87.141 de violencia sexual, 52.359 de violencia psicológica y 166.664 de negligencia. Se identificó una tendencia ascendente de las notificaciones de violencia física, sexual y psicológica y de negligencia para Brasil y para ambos sexos. La negligencia tuvo la tasa más alta (95,24 notificaciones por 100.000 en 2019).Noreste y Sureste presentaron tendencia creciente en todos los tipos de violencia. Conclusión Las notificaciones de violencia contra los niños mostraron tendencia creciente entre 2011 y 2019 en Brasil.

RESUMO Objetivo Descrever a tendência temporal das notificações de violência física, violência sexual, violência psicológica e negligência praticadas contra crianças no Brasil, entre 2011 e 2019. Métodos Estudo ecológico de série temporal, sobre notificações de violência contra crianças de 0 a 9 anos no Sistema de Informação de Agravos de Notificação. Taxas de notificação ajustadas por idade foram calculadas para Brasil, macrorregiões nacionais e sexo. Analisou-se a tendência das taxas por regressão joinpoint. Resultados Foram analisadas 88.820 notificações de violência física, 87.141 de violência sexual, 52.359 de violência psicológica e 166.664 notificações de negligência. Identificouse tendência crescente de notificações de violência física, sexual, psicológica e negligência, para o Brasil e ambos os sexos. Negligência apresentou a maior taxa [95,24 notificações/100 mil crianças (2019)]. Nordeste e Sudeste apresentaram tendência crescente para todas as violências. Conclusão Notificações de violência física, sexual, psicológica e negligência contra crianças apresentaram tendência crescente no Brasil, no período.

Who judges medical practice?

Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

Responsabilidad médica profesional, guías para la práctica clínica y lex artis. La importancia de seguir las recomendaciones de las guías clínicas / Professional medical liability, clinical practice guidelines and Lex Artis. The importance of following clinical practice guidelines recommendations

Resumen La responsabilidad médica profesional es el resultado de mala praxis médica, la cual puede deberse a negligencia, impericia o imprudencia. Se conoce como lex artis al conjunto de conocimientos y habilidades que han sido universalmente aceptados por los pares, los cuales deben ser diligentemente aplicados en la situación específica de un paciente determinado. Entonces, lex artis es fundamentalmente todo lo contenido en las guías para la práctica clínica. Judicialmente hablando, en México el ejercicio de la medicina es una obligación de medios, mas no de resultados. Por consiguiente, apegarse a las recomendaciones de las guías para la práctica clínica es más efectivo para defenderse de una demanda legal por mala praxis.

Abstract Professional medical liability is the result of medical malpractice, which may be due to negligence, incompetence or carelessness. Lex Artis is the set of skills and knowledge that have been universally accepted by peers, which must be diligently applied in the specific situation of a given patient. Thus, Lex Artis is essentially everything contained in clinical practice guidelines. Judicially speaking, the practice of medicine in Mexico is an obligation of means, but not of results. Therefore, adherence to clinical practice guidelines recommendations is the most effective way to defend oneself against a malpractice lawsuit.

Uma leitura crítica das emergências em saúde global: o caso da epidemia de zika de 2016 / A critical view of the global health emergencies: the 2016 zika epidemic case

Resumo O estudo da definição de agendas e prioridades da saúde global tem sido, nos últimos anos, uma das prioridades de uma literatura crítica que visa identificar as dimensões políticas da governança global em saúde, e que enfatiza os pontos de tensão, exclusão e desigualdade. O presente ensaio se posiciona nesta leitura crítica da saúde global, focando a construção da categoria de emergência de importância internacional. Considerando em específico o caso do surto de zika e de síndromes congênitas no Brasil, em 2016, explora as condições que possibilitam a construção de uma emergência. Questionamos os fatores e condições em torno desse evento de saúde pública que eventualmente foram considerados no processo decisório, e que vão além dos dados materiais mais objetivos relativos à epidemiologia do zika, à sua morbi-mortalidade ou à sua associação com as malformações congênitas. Concluímos que o contexto securitário e a crescente importância do risco na saúde global são condições importantes para entender as declarações de emergência.

Abstract The study of global health agenda-setting and issue-prioritization has been one of the key aspects of a critical literature that, in recent years, has aimed to identify the political dimensions of global health governance and to shed light on points of tension, exclusion, and inequality. This essay speaks to this critical global health literature, focusing on the construction of the category of emergencies of international concern. Considering the case of the outbreak of zika and congenital syndrome in Brazil in 2016, it explores the conditions enabling the construction of an emergency. We question the factors and conditions around this public health event that were considered during the decision-making process and that transcended material, more objective data regarding zika's epidemiology, its morbimortality, or its association with congenital malformations. We conclude that the securitized context and the growing relevance of risk to global health are important conditions for understanding emergency declarations.

Judicialización en cardiología y cirugía cardiovascular: estudio observacional transversal en materia de responsabilidad patrimonial en la sanidad pública española / Litigation in cardiology and cardiovascular surgery: A cross-sectional observational study of liability in the spanish public healthcare system

Introducción: la sobrestimación por los facultativos del riesgo a una demanda judicial tiene, entre otras consecuencias, la intensificación de la medicina defensiva. El objetivo del trabajo fue analizar las características de las sentencias sobre la responsabilidad médica en España en la asistencia sanitaria pública en las especialidades de cardiología y cirugía cardiovascular.Material y métodos: estudio observacional transversal cuyo objetivo fue analizar las sentencias dictadas en la jurisdicción contencioso-administrativa por los Tribunales Superiores de Justicia entre el período 2008-2020, en las especialidades de cardiología y cirugía cardiovascular. Las variables fueron administrativas, clínicas, judiciales e indemnizatorias.Resultados: se analizaron 1.015 sentencias, de las cuales 47 (4,63%) se refirieron a las especialidades de cardiología y cirugía cardiovascular. Ambas obtuvieron porcentajes de frecuencia similares, cardiología 22 (2,16%) y cirugía cardiovascular 25 (2,46%). El 74,1% de las sentencias fueron desestimatorias en primera instancia y el 75% en segunda instancia. Los 2 motivos de sentencia estimatoria más frecuentes fueron la pérdida de oportunidad 6 (42,85%) y la mala praxis diagnóstica y/o terapéutica 5 (35,71%). Los daños reclamados fueron: fallecimiento 21 (44,68%) y secuelas 26 (55,32%). La mediana de las indemnizaciones fue 30.000 euros.Conclusiones: la baja frecuencia de las demandas en cardiología y cirugía cardiovascular indica que se trata de especialidades de «bajo riesgo» de litigiosidad. La inmensa mayoría de las sentencias son, además, desestimatorias de la pretensión de los pacientes. Los datos contribuyen a estructurar el papel de las demandas judiciales y a aumentar el conocimiento de los profesionales en la dimensión médico-legal de la asistencia sanitaria. (AU)

Introduction: The overestimation by physicians of the risk of a lawsuit has, among other consequences, the stepped-up of defensive medicine. To analyze the characteristics of medical liability rulings in Spain in public health care in the specialties of cardiology and cardiovascular surgery.Materials and methods: Cross-sectional observational study analyzing the rulings handed down in the contentious-administrative jurisdiction by the High Courts of Justice in the period 2008-2020, in the specialties of cardiology and cardiovascular surgery. The variables were administrative, clinical, judicial, and compensatory.Results: A total of 1015 rulings were analyzed; 47 (4.63%) involved to the specialties of cardiology and cardiovascular surgery. Both obtained similar frequency percentages, cardiology 22 (2.2%) and cardiovascular surgery 25 (2.5 %). A total of 74.1 % of the rulings were dismissed in the first instance and 75% in the second instance. The two grounds for finding against the defendent were loss of chance 6 (42.85%) and diagnostic and/or therapeutic malpractice 5 (35.71%). Damages were usually claimed: death 21 (44.68%) and sequelae 26 (55.32%). The median award was 30,000 euros.Conclusions: The low frequency of claims in cardiology and cardiovascular surgery indicates that these are “low risk” specialties for litigation. The vast majority of the rulings are, moreover, dismissive of the patients' claims. The data help to structure the role of lawsuits and to increase professionals' knowledge of the medical-legal dimension of health care. (AU)

¿Quién juzga la actuación médica? / Who judges medical practice?

Resumen Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

Abstract Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Perfil da Violência contra o Idoso em uma Cidade do Sul de Santa Catarina / Profile of Violence against the Elderly in a City in Southern Santa Catarina

Introdução: De acordo com a OMS (Organização Mundial de Saúde), os maus-tratos na terceira idade podem ser caracterizados como ato único ou repetido, ou, ainda, ausência de ação apropriada que cause dano, sofrimento ou angústia e que ocorram dentro de um relacionamento de confiança. A violência contra o idoso costuma ser categorizada em 5 tipos, sendo eles: violência física, psicológica, sexual, abuso financeiro e negligência. O presente estudo objetivou caracterizar o perfil epidemiológico da violência contra o idoso na cidade de Tubarão/SC. Métodos: A presente pesquisa trata-se de um estudo epidemiológico com delineamento transversal. A população em estudo consiste em idosos, vítimas de violência que realizaram o registro do caso de abuso na Delegacia de Prote- ção à Criança, Adolescente, Mulher e Idoso durante o período de janeiro de 2013 a dezembro de 2019. Resultados: Foi encontrada uma prevalência de 31,7% de casos de violência sendo classificados como negligência. As principais vítimas eram do sexo feminino (58,7%), e 51% das vítimas apresentavam algum tipo de limitação física ou cognitiva. Os principais agressores foram os familiares das vítimas, em 87,3% dos casos, sendo o domicílio o principal local de ocorrência da violência (83,7%). Conclusão: Foi possível caracterizar os idosos vítimas de violência na cidade de Tubarão/SC, em um período de 6 anos, com foco no perfil epidemiológico da vítima e de seus agressores, identificando variáveis como sexo, faixa etária, estado civil, além dos tipos de violência praticados e o local de ocorrência das mesmas.

Introduction: According to the WHO (World Health Organization), elder abuse can be a single or repeated act or even lack of appropriate action that causes harm, suffering, or distress and that occurs within a relationship of trust. Violence against the elderly usually classifies into five types, namely: physical, psychological, sexual, financial abuse, and neglect. The present study aimed to characterize the epidemiological profile of violence against the elderly in Tubarão/SC. Methods: This research is an epidemiological study with a cross-sectional design. The study population consists of elderly victims of violence who made the registration of the case of abuse at the Police Station for the Protection of Children, Adolescents, Women, and the Elderly during the period from January 2013 to December 2019. Results: A prevalence of 31.7% of cases of violence classified as neglect was found. Predominantly, the victims were female (58.7%), and 51% had some physical or cognitive limitation. The main aggressors were the victims' relatives in 87.3% of the cases, and the home was the most frequent place where the violence occurred (83.7%). Conclusion: It was possible to characterize the elderly victims of violence in the city of Tubarão/SC over six years, focusing on the epidemiological profile of the victim and their aggressors, identifying variables such as gender, age group, marital status, in addition to the types of violence committed and the place of their occurrence.

Maltrato en la infancia y consumo de drogas en adolescentes de preparatoria / Child abuse and drug use in high school adolescents

Resumen Objetivo: Conocer la relación entre el maltrato en la infancia y el consumo de drogas en adolescentes. Materiales y métodos: Estudio cuantitativo, descriptivo, correlacional, transversal; mediante el muestreo aleatorio estratificado, se seleccionaron a los adolescentes de preparatoria. Se aplicó una cédula de datos personales, el Cuestionario de Maltrato en la Infancia, Test de Identificación de los Trastornos Debidos al Consumo de Alcohol, validados y utilizados en población mexicana, en investigaciones previas. Este estudio se apegó al Reglamento de la Ley General de Salud en materia de investigación para la salud. Resultados: Participaron 239 adolescentes de una preparatoria pública, las edades oscilaron entre los 15 a 19 años (M = 16.41; DE= 1.04), las mujeres predominaron con 54.5%. En la variable de maltrato en la infancia y subescalas por sexo se encontró diferencia significativa en la subescala de abuso físico mostrando que los hombres (Mdn=7.00/ M=8.11, DE=3.08) presentaron mayor puntaje de abuso físico en comparación con las mujeres (Mdn=7.00/ M=7.28, DE=2.64) con una U=5760.0, p<0.032. Al correlacionar las variables de maltrato en la infancia y consumo de drogas, se encontró una correlación positiva y estadísticamente significativa del número de drogas con el total AUDIT, el consumo sensato y dañino con el puntaje total de maltrato y las subescalas de abuso sexual, negligencia emocional y negligencia física. Conclusiones: Los hombres presentaron mayor abuso físico. En la relación entre las variables de estudio se encontró que el maltrato en la infancia, se relacionó con el consumo de alcohol dañino y con el número de drogas consumidas.

Abstract Objective: To know the relationship between abuse in childhood and drug use in adolescents. Materials and methods: Quantitative, descriptive, correlational, cross-sectional study; Using stratified random sampling, high school adolescents were selected. A personal data card, the Child Abuse Questionnaire, and the Alcohol Use Disorders Identification Test were applied, validated and used in the Mexican population, in previous investigations. This study adhered to the Regulations of the General Health Law regarding health research20. Results: 239 adolescents from a public high school participated, the ages ranged from 15 to 19 years (M = 16.41; SD = 1.04), women predominated with 54.5%. In the variable of abuse in childhood and subscales by sex, a significant difference was found in the physical abuse subscale, showing that men (Mdn = 7.00/M = 8.11, SD = 3.08) had a higher physical abuse score compared to women. (Mdn = 7.00/M = 7.28, SD = 2.64) with a U = 5760.0, p <0.032. When correlating the variables of abuse in childhood and drug use, a positive and statistically significant correlation of the number of drugs with the total AUDIT, the sensible and harmful consumption with the total score of abuse and subscales of sexual abuse, emotional neglect and neglect physical. Conclusions: Men presented more physical abuse. In the relationship between the study variables, it was found that abuse in childhood was related to the consumption of harmful alcohol and the number of drugs consumed.

Analysis of reported animal abuse in Campo Magro, Paraná, Brazil / Análise de denúncias de maus-tratos aos animais no município de Campo Magro, Paraná

Animal abuse is a criminal offense in Brazil and can be dealt with by several government agencies, including municipal ones. Cases of animal abuse reported to the Department of Health Surveillance, of the Municipal Health Secretariat of Campo Magro, Paraná, Brazil, between March of 2019 and December of 2020 were analyzed to assess the most common forms of abuse and animals involved. A total of 140 complaints were received in this period; 132 were investigated, of which 81 were considered authentic. The most common form of abuse was neglect 64.2% (52/81). Cases of neglect were further classified into four types (although cases may be classified with more than one type), resulting in 106 classifications of neglect. Behavioral neglect was the most common form of neglect 33.9% (36/106). As more than one animal could be involved in each report, the 81 authentic cases involved a total of 471 animals. Dogs were the species most commonly affected 78.5% (370/471). The vast majority of animal abuse was perpetrated against adult animals. Statistically significant correlations were found between the sex and age of dogs and abuse and between species and the different forms of abuse for dogs and cats.(AU)

Os maus-tratos aos animais são considerados crime no Brasil e o atendimento desse tipo de ocorrência pode ser realizado por diferentes órgãos governamentais, incluindo os municipais. O presente trabalho analisa denúncias atendidas pelo Departamento de Vigilância em Saúde, da Secretaria Municipal de Saúde de Campo Magro, Paraná, Brasil, entre março de 2019 e dezembro de 2020 e avalia os tipos mais comuns de maus-tratos a animais e os animais envolvidos. Um total de 140 denúncias foram recebidas e 132 foram fiscalizadas, destas, 81 foram consideradas procedentes. A forma mais prevalente de maus-tratos foi a negligência com 64,2% (52/81). Os casos de negligência foram classificados em quatro diferentes tipos (cada caso pode ser classificado em mais de um tipo de negligência). O tipo mais frequente foi a negligência comportamental com 33,9% (36/106). Como mais de um animal podia estar envolvido em cada caso de maus-tratos, os 81 casos procedentes contabilizaram 471 animais envolvidos. A espécie canina foi a mais afetada, sendo 78,5% (370/471). A maior parte dos casos de maus-tratos foram cometidos contra animais adultos. Correlações estatísticas significativas foram encontradas entre o sexo e faixa etária dos cães em relação à ocorrência de maus-tratos e, também, entre a espécie e os diferentes tipos de maus-tratos para cães e gatos.(AU)