RESUMO
Social participation in health is related to the ability of collectives to intervene in the healthcare system. From a bioethical perspective, the relevance of social participation in health has been emphasized due to its positive effects at the level of social groups, the healthcare structure, and democratic political systems. To ensure social participation in health, bioethics advocates for the incorporation of deliberation as a tool for making binding decisions. The aim of this essay is to reflect on social participation in the history of Chile's healthcare system from a bioethical perspective. The main reflections indicate that participation is consultative in nature, lacking deliberation and, therefore, the distribution of power. Additionally, social participation has been redefined under the label of "citizen," promoting an instrumental, individual, and client-oriented character in healthcare. To subvert this situation, it is necessary to incorporate bioethical reflections into the healthcare structure to enable communities to consistently influence the healthcare system.
La participación social en salud se relaciona con la capacidad de intervención de los colectivos en el sistema sanitario. Desde la bioética, se ha enfatizado en la relevancia de la participación social en salud debido a los efectos positivos a nivel de los grupos sociales, de la estructura sanitaria y de los sistemas políticos democráticos. Para asegurar la participación social en salud, la bioética aboga por la incorporación de la deliberación como herramienta para la toma de decisiones vinculantes. El objetivo del presente ensayo es reflexionar sobre la participación social en la historia del sistema de salud de Chile desde la óptica de la bioética. Las principales reflexiones indican que la participación es de tipo consultiva, sin deliberación y, por tanto, sin distribución de poder. Asimismo, la participación social fue resignificada por la etiqueta de "ciudadana", potenciando el carácter instrumental, individual y clientelar en salud. Para subvertir esta situación, se requiere incluir reflexiones bioéticas en la estructura sanitaria con el propósito que las comunidades puedan incidir de manera consistente en el sistema de salud.
Assuntos
Bioética , Participação Social , Humanos , Chile , Temas Bioéticos , Atenção à SaúdeRESUMO
RESUMEN La participación social en salud se relaciona con la capacidad de intervención de los colectivos en el sistema sanitario. Desde la bioética, se ha enfatizado en la relevancia de la participación social en salud debido a los efectos positivos a nivel de los grupos sociales, de la estructura sanitaria y de los sistemas políticos democráticos. Para asegurar la participación social en salud, la bioética aboga por la incorporación de la deliberación como herramienta para la toma de decisiones vinculantes. El objetivo del presente ensayo es reflexionar sobre la participación social en la historia del sistema de salud de Chile desde la óptica de la bioética. Las principales reflexiones indican que la participación es de tipo consultiva, sin deliberación y, por tanto, sin distribución de poder. Asimismo, la participación social fue resignificada por la etiqueta de "ciudadana", potenciando el carácter instrumental, individual y clientelar en salud. Para subvertir esta situación, se requiere incluir reflexiones bioéticas en la estructura sanitaria con el propósito que las comunidades puedan incidir de manera consistente en el sistema de salud.
ABSTRACT Social participation in health is related to the ability of collectives to intervene in the healthcare system. From a bioethical perspective, the relevance of social participation in health has been emphasized due to its positive effects at the level of social groups, the healthcare structure, and democratic political systems. To ensure social participation in health, bioethics advocates for the incorporation of deliberation as a tool for making binding decisions. The aim of this essay is to reflect on social participation in the history of Chile's healthcare system from a bioethical perspective. The main reflections indicate that participation is consultative in nature, lacking deliberation and, therefore, the distribution of power. Additionally, social participation has been redefined under the label of "citizen," promoting an instrumental, individual, and client-oriented character in healthcare. To subvert this situation, it is necessary to incorporate bioethical reflections into the healthcare structure to enable communities to consistently influence the healthcare system.
RESUMO
PURPOSE: This study was designed to examine the effects of cycling position (seated or standing) during level-ground and uphill cycling on gross external efficiency (GE) and economy (EC). METHODS: Eight well-trained cyclists performed in a randomized order five trials of 6-min duration at 75% of peak power output either on a velodrome or during the ascent of a hill in seated or standing position. GE and EC were calculated by using the mechanical power output that was measured by crankset (SRM) and energy consumption by a portable gas analyzer (Cosmed K4b(2)). In addition, each subject performed three 30-s maximal sprints on a laboratory-based cycle ergometer or in the field either in seated or standing position. RESULTS: GE and EC were, respectively, 22.4 +/- 1.5% (CV = 5.6%) and 4.69 +/- 0.33 kJ x L(-1) (CV = 5.7%) and were not different between level seated, uphill seated, or uphill standing conditions. Heart rate was significantly ( < 0.05) higher in standing position. In the uphill cycling trials, minute ventilation was higher ( < 0.05) in standing than in seated position. The average 30-s power output was higher ( < 0.01) in standing (803 +/- 103 W) than in seated position (635 +/- 123 W) or on the stationary ergometer (603 +/- 81 W). CONCLUSION: Gradient or body position appears to have a negligible effect on external efficiency in field-based high-intensity cycling exercise. Greater short-term power can be produced in standing position, presumably due to a greater force developed per revolution. However, the technical features of the standing position may be one of the most determining factors affecting the metabolic responses.
