Diagnóstico de la inserción de la ética en la carrera de medicina en Brasil / Diagnosis of ethics issues in undergraduate medicine curriculum in Brazil

Objetivo. Realizar el diagnóstico sobre la inserción de temas relacionados con la ética en cursos de pregrado de medicina en Brasil. Materiales y métodos. Estudio de corte transversal, retrospectivo histórico y exploratorio descriptivo. Se analizaron proyectos pedagógicos de 175 escuelas de Brasil. Se realizó una búsqueda activa en los documentos a través del análisis de aparición de términos con base en indexadores De CS/MeSH. Los datos se correlacionaron con las informaciones relativas a los modelos pedagógicos de aprendizaje utilizados: metodologías activas(discusiones tutoriales en pequeños grupos y proyecto pedagógico integrado en módulos/ejes) o metodologías tradicionales (clases expositivas para grupo numeroso y proyecto pedagógico separado por disciplinas), y se realizaron los siguientes análisis: frecuencia de la inserción de temas agrupados y carga horaria media semestral de estos temas. Resultados. En los currículos analizados se observó que 95 cursos de pregrado en medicina utilizaban metodologías tradicionales de aprendizaje. Los temas agrupados más frecuentes fueron: ética médica; conducta profesional; deontología médica; procedimientos éticos; teología, filosofía, sociología y humanismo; ética en investigación; bioética en salud colectiva; y donación, muerte y eutanasia. La prueba de correlación de Spearman entre la presencia de metodologías activas y tradicionales fue Ps= 0,814 (α = 0,014; IC 95%). Conclusión. Más del 80% de escuelas con metodología activa presentan una carga horaria sobre ética de 50-100 h, mientras que más del 60% de escuelas con metodología tradicional destinan una carga horaria inferior a 50 h para estos temas (AU)

Aim. To overview of ethics issues inclusion in CGM in Brazil, both in courses with active learning processes and traditional lecture learning methodologies. Materials and methods. This is a cohort, retrospective historical and descriptive exploratory study. We analyzed curricula and teaching projects of 175 medical schools of Brazil. The remaining 31 CGM were excluded either because of incomplete information or refusal to participate in the study. Active search for information was done on institutional sites and on documents through institutional occurrence analysis of terms based on DeCS/MeSH descriptors. Information was correlated according to learning educational model: active learning methodologies (MA) –tutorials discussions with integrated curriculum into core modules– or traditional lecture learning methodologies (MT) –with classes for large groups separated by disciplines– and reviewed by: occurrence frequency of ethical themes and average hourly load per semester of these themes. Results. It was observed that 95CGM used MT. The most frequent ethical themes were: medicalethics; professional conduct; medical responsibility; ethical procedures; theology, philosophy, sociology and humanism; ethics in research; bioethics in public health; and organ transplantation, death and euthanasia. Spearman’s rank correlation test between MA and MT occurrence resulted Ps = 0814(α= 0.014; 95% CI). Conclusion. Over 80% of MA schools utilizing thematic working hourly load between 50-100 h while more than 60% of MT schools used less than 50 h in curriculum time (AU)

[Ethical aspects of biomedical research. frequent concepts in written norms]. / Aspectos éticos de la investigación biomédica. Conceptos frecuentes en las normas escritas.

Most codes and declarations pertaining to the ethics of research involving human subjects have been formulated in response to specific events mostly of a painful or embarrassing nature. Several concepts appearing repeatedly in their texts are highlighted in this paper: principles of respect for persons, beneficence and justice, vulnerability and research propriety. Along with some comments on current revisions of many international guidelines and the role of bioethics committees, a plea is made to have a proactive rather than a reactive stance in ethical regulation of biomedical research.

[The bioethics challenge of equity: its significance in public health]. / El desafío bioético de la equidad: su relevancia en Salud Pública.

This paper presents the bioethical discourse as a stimulus to dialogue between beliefs, ideologies, rationalities, and persons. Among its dominant themes, it may be distinguished between those related to communities and those related to individuals. Although equity belongs into the former, it finds expression in individual life as solidarity and empathy. It is possible to formulate guidelines for research in social science and epidemiology distinguishing between values, principles and behavior rules, which find expression in the notion that bioethical reflection must anticipate challenges and dangers and not simply respond to technoscientific developments.

[Bioethics in the context of global health programs]. / La bioética en el contexto de los programas globales de salud.

This work describes the Regional Program on Bioethics of the Pan American Health Organization (PAHO)/World Health Organization (WHO), as well as the Program's main achievements. The Program was established in 1994 under a three-way agreement with the University of Chile and the Government of Chile. The Program's objective is to thematically link the work of the PAHO/WHO units and representatives in each country, in close cooperation with local public and private organizations. The Program investigates such subjects as the health of poor people, priority-setting, the growth of the private sector, salaries and incentives in the public sector, investment in hospitals, health sector reform, professional education, and working together for development. Finally, the direction and heading of the Program are presented. Its efforts are carried out as promotional, support, and service activities. These activities take the form of technical assistance for personnel training, public information dissemination, ethical situation analysis in research and services, reviewing curricula and professional practice standards, and advising on specific plans and programs.

[Attempted suicide in females: a prospective study]. / La conducta suicida en mujeres: un estudio prospectivo.

BACKGROUND: A previous suicide attempt is one of the strongest predictors of future suicidal behavior. AIM: To explore the evolution of suicidal tendencies in women who attempted suicide 5 to 7 years earlier. PATIENTS AND METHODS: Ninety two women aged 37 +/- 9 years old, that attempted suicide between 1989 and 1991 were followed and reassessed in 1997. RESULTS: In the study period two women committed suicide and 30 attempted suicide. Forty three percent of new self harm behaviors occurred during the first year after the first suicide attempt and the harming method was similar. CONCLUSIONS: In this study, 34% of women with previous suicide attempts, repeated this behavior, using similar methods.

[Influence of maternal feeding restrictions on the mother-daughter dyad]. / Influencia de la restricción alimentaria sobre la díada madre-hija.

Alimentary restraint, cognitive variable related to eating behavior and obesity, is reportedly a valuable predictor for the development of therapeutic strategies. This paper addresses the relationship between maternal restraint and several psychological variables in their daughters (alexithymia, neuroticism, extraversion). From the study of 35 mother-daughter dyads it can be concluded that daughters of highly restrained mothers tend to present high scores in the Restraint scale of the Three Factor Eating Questionnaire of Stunkard and Messick, translated into Spanish and validated as Cuestionario de Conducta Alimentaria. Daughters of highle restrained mothers present also higher scores in the Neuroticism scale of the revised version of the Eysenck Personality Questionnaire. Daughters of mothers with low Restraint scores are in average higher than those of their mothers, although lower than those belonging to daughters of highle restrained mothers. Previous observations on the positive correlation between Disinhibition and Hunger of the Three Factor Eating Questionnaire are confirmed. These results add an additional risk factor for obesity (mothers with high Restraint) and contribute to delineate a set of psychometric indicators which might be useful in the diagnosis and prognosis of eating and body weight disorders.

[Medical treatment of obesity from a multi professional perspective]. / El tratamiento médico de la obesidad desde una perspectiva multidisciplinaria.

Obesity is a serious condition affecting the physical and psychological well being of a large number of individuals. There are many therapeutic options for the disease and their judicious selection is critical. The best results are obtained with well-organised multi professional programs. The aims of the treatment must be defined balancing risks and benefits. Eating behaviour patterns must be considered for the proper selection of therapy. Diet is an essential therapeutic component and has to be individually prescribed for each patient. Pharmacological agents inhibit appetite, increase thermogenesis or inhibit gastrointestinal absorption of nutrients. As these medications have important side effects and complications, extreme care must be taken for their prescription.

Psycholexicology: psychiatric discourse and nosological entities.

This paper presents the field of psycholexicology as an area of study concerned with etimology, meaning, and social legitimacy of the terms employed in psychiatric discourse, conceived of as the disciplinary foundation of clinical and research psychiatry. The influence of semantic constraints on structure and usage of psychopathological diagnosis is emphasized. Work in progress related to translation and cultural biases in terminology is briefly described.

[Bioethical dimensions of medical care in the elderly]. / Dimensiones bioéticas del cuidado médico en el anciano.

This editorial examines the challenges posed by the current epidemiological transition towards ageing of societies, against the background of medical technologies: life-saving, life-sustaining and life-enhancing. Increased life expectancy among the elderly, compression of morbidity in the last year of life, cost containment in health-care delivery and humane treatment are elements of the dilemma facing modern medicine confronted to the aged. Technical success and medicalization of life are doomed to failure if the necessary reflection on what is proper, what is good and what is fair or just is not incorporated into everyday practice. These bioethical dimensions' should be reformulated at the level of the individual professional, the institutional environment and the social milieu. Aside from gloomy predictions about the future, the challenges imposed by treatment of the elderly are seen as invigorating stimuli for the continuous improvement of medical care.

Theoretical medicine: a proposal for reconceptualizing medicine as a science of actions.

The main task of a critical theory of medicine should be to develop a perspectival, context-fair, and multidimensional science of actions which integrates both diversity and heterogeneity within medicine without eliminating either one. Such a theory should employ diversity in the following areas: (1) in systems, subsystems, and professions, because different medical professions embody different health-care subsystems, thereby influencing the way manpower is utilized, (2) in actors, (e.g., patients, health-care experts, and society), processes, and situations, because each actor potentially conceptualizes health, illness, and desired outcomes differently; and (3) in models of medicine (i.e., as an object science versus an action science). Situational influences modify concepts and explanatory models; even the particular terms, such as illness, disease, and sickness, are not necessarily concordant with each other.

[Effects of estrogen supplementation on psychological variables in climacteric women]. / Estrógenos en climaterio femenino: efecto sobre variables psicológicas.

BACKGROUND: The beneficial effects of estrogen supplementation in climacteric women are clear. However, their psychological effects are not well documented. AIM: To study the effects of estrogen supplementation on psychological variables in climacteric women. SUBJECTS AND METHODS: Forty postmenopausal women were divided in two groups to receive a daily dose of 2 mg oestradiol valerate and 2.5 mg medroxyprogesterone acetate or an identical placebo during six months. Initially and at the end of the treatment period, they were subjected to a psychiatric interview and the Graffar, Hamilton and Eysenk personality tests were applied. Also, an Analysis of Verbal Behavior was used, that results in hope and hopeless scores. RESULTS: There were no differences in the initial assessment between the two treatment groups. In women receiving hormonal supplementation, the Hamilton score decreased from 11.2 to 4.9 (p < 0.002) and in women receiving placebo from 8.1 to 5.3 (NS). No other significant changes in psychological tests were observed. CONCLUSIONS: Hormonal supplementation decreases the Hamilton depression score in postmenopausal women.

[The psychological investigation of personality toward a multidimensional definition of characteristics]. / La investigación psicofisiológica de personalidad: hacia una definición multidimensional de rasgos.

This paper makes a proposal on the psychophysiological study of personality, characterized by the articulation of physiological, behavioral and subjective discourses, in the perspective of the descriptive, the explanatory and the predictive aims of personality theory. A definition of a trait is proposed, based not only on persistency but on the concordant configuration of features in the three methodical discourses of the psychophysiological enterprise. Studies on the augmenting-reducing dimension are commented in view to their relevance for an integrative theory of behavior.

Anxiety and hostility in written verbal samples of male and female subjects. A content analytic study.

Nonclinical populations of male and female subjects of middle socioeconomic level and different age ranges were assessed by means of the content analysis method developed by Gottschalk and associates. Verbal samples consisted of written productions in response to a standard ambiguous instruction to narrate a dramatic or interesting life experience and were scored for anxiety and hostility. Results show that the method shows no influence of gender under the conditions of this study and can be employed for diagnostic purposes, assuming that personality factors and psychopathological influences might have a more pronounced impact on affect scores.

[Suicidal behavior in Chilean women. The epidemiological web of societal and individual factors]. / Zachowania samobójcze kobiet chilijskich. Epidemiologiczny splot czynników spolecznych i indywidualnych.

Presented study concerned epidemiology and psychological factors of suicide behavior aiming at establishing preventive measures and criteria for crisis intervention.

[Personality dimensions and cerebral evoked potential]. / Dimensiones de personalidad y potencial evocado cerebral.

Eysenck's personality theory postulates 3 orthogonal dimensions of personality: extraversion (E), neuroticism (N) and psychoticism (P), predicting conductual and physiological predispositions to suffer mental illness. Biological bases of Eysenck's personality traits have been documented electrophysiologically. Psychoticism, the latest described dimension, is controverted, since there is some evidence of common factors with the other two. In order to assess the relation between Eysenck's dimensions and sensorial reactivity and information encoding processes we studied 20 healthy young subjects (mean age 28.5 years) with flash visual cortical evoked potentials (VEP, 3 intensities, peak to peak amplitude of III, IV-V-VI, VII components), and auditory cognitive evoked potentials (odd ball paradigm, P300 latency). There was a positive correlation between N and P dimensions (Spearman, r = 0.52), between N and VEP amplitude at high intensity (r = 0.58) and a negative correlation between E and P300 latency (r = 0.58). In short we found that P is not an independent dimension, but is related to sensorial reactivity. E dimension was related to encoding processes supporting Eysenck's observations about memory and learning differences.

Dimensiones de personalidad y potencial evocado cerebral / Personality dimensions and cerebral evoked potential

La teoría de la personalidad de Eysenck postula 3 dimensiones ortogonales de personalidad: extraversion (E), neuroticismo (N), psicoticismo (P). Formula predicciones conductuales y fisiológicas relacionadas a la predisposición a ciertos trastornos. La base biológica de las dimensiones E y N se ha evidenciado en diferencias electrofisiológicas. La dimensión P, agregada posteriormente, ha sido más controvertida, postulándose que no es independiente de las dimensiones antes descritas. Con objetivo de estudiar las dimensiones de Eysenck, en particular P, en relacion a la reactividad sensorial y a procesos de codificación se registró potencial evocado visual (PEV) por flash a 3 diferentes intensidades y P300 auditiva en 20 voluntarios sanos (x28,5; ds 9,4 años). Se midió amplitud peak to peak y latencia de los componentes III, IV-V-VI y VII de PEV y de P300 mediante programa cursor. Hubo correlación positiva entre dimensiones N y P (spearman). r=0,52), entre P y amplitud del PEV (r=o,58) a intensidad alta y negativa entre E y latencia de P300 (r=0,58). Según nuestros hallazgos, la dimensión P no es independiente y demostró relación con la reactividad sensorial. La dimensión E se relacionó a la velocidad de codificación, apoyando las aseveraciones de Eysenck sobre memoria y aprendizaje