Access to abortion under the heath exception: a comparative analysis in three countries.

BACKGROUND: Despite Britain, Colombia, and some Mexican states sharing a health exception within their abortion laws, access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of similar health exception laws and consequences for access to legal abortion. Our research adds to previous literature by comparing implementation of similar abortion laws across countries to identify strategies for full implementation of the health exception. METHODS: We conducted a cross-country comparative descriptive study synthesizing data from document and literature review, official abortion statistics, and interviews with key informants. We gathered information on the use and interpretation of the health exception in the three countries from peer-reviewed literature, court documents, and grey literature. We next extracted public and private abortion statistics to understand the application of the law in each setting. We used a matrix to synthesize information and identify key factors in the use of the law. We conducted in-depth interviews with doctors and experts familiar with the health exception laws in each country and analyzed the qualitative data based on the previously identified factors. RESULTS: The health exception is used broadly in Britain, somewhat in Colombia, and very rarely in Mexican states. We identified five factors as particularly salient to application of the health exception in each setting: 1) comprehensiveness of the law including explicit mention of mental health, 2) a strong public health sector that funds abortion, 3) knowledge of and attitudes toward the health exception law, including guidelines for physicians in providing abortion, 4) dissemination of information about the health exception law, and 5) a history of court cases that protect women and clarify the health exception law. CONCLUSIONS: The health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion result in wide access for women in Britain to nearly no access in Mexican states. Our findings highlight the difference between theoretical and real access to legal abortion. The interpretation and application of the health exception law are pivotal to expanding real access to abortion.

Comparison of Health Examination Survey Methods in Brazil, Chile, Colombia, Mexico, England, Scotland, and the United States.

Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007-2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States-countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18-64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.

The UK Foundation Programme for newly qualified doctors: a SWOT analysis / O Foundation Programme do Reino Unido para médicos recém-formados: uma análise utilizando a matriz DAFO / El Foundation Programme del Reino Unido para los médicos recién titulados: un análisis utilizando la matriz DAFO

Introduction: After completing a five year undergraduate degree, all newly qualified doctors in the United Kingdom undertake a two-year Foundation Programme which aims to provide them with the necessary experience, supervision and guidance to prepare them for a career in clinical medicine. Foundation Doctors are paid members of the team and undertake a variety of clinical rotations with supervision from senior colleagues, a process that is regulated by a UK Foundation Programme Office. Objective: This paper aims to provide a reflective analysis of this programme to greater inform the international audience. Methods: A critical reflective analysis utilising the SWOT format (Strength, Weaknesses, Opportunities and Threats), conducted by two Foundation Doctors working in the UK. Results and Discussion: We identified a well-established programme which enabled graduates to gain a broad range of clinical experience as a paid doctor but one with considerable variation at both individual and group level. Long-standing shortcomings of being a junior-doctor including long hours and excessive paperwork were still prevalent. We highlighted potential opportunities and threats within the current system, some of which were dependent upon larger political systems governing the NHS in the UK. Conclusion: The Foundation Programme is a robust approach to the training and development of early career doctors. Further research and a deeper international dialogue on the best-practice in this field is needed.

Introdução: Depois de completar os cinco anos do curso de graduação em medicina, todos os médicos recém-formados no Reino Unido cursam o Foundation Programme, com duração de dois anos, que visa proporcionar-lhes a experiência, supervisão e orientação necessárias para prepará-los para uma carreira clínica em medicina. Os médicos cursando o Foundation Programme são membros remunerados das equipes dos serviços e realizam várias rotações clínicas supervisionadas por médicos experientes, um processo que é regulado pelo UK Foundation Programme Office. Objetivo: Este trabalho visa fornecer uma análise reflexiva sobre o Foundation Programme para maior informar o público internacional. Métodos: Uma análise crítica e reflexiva utilizando a matriz DAFO (Debilidades, Ameaças, Fortalezas e Oportunidades) realizada por dois jovens médicos cursando o Foundation Programme do Reino Unido. Resultados e Discussão: Trata-se de um programa bem estabelecido, que permite aos graduados obterem uma ampla gama de experiência clínica, como médicos remunerados, porém com variações consideráveis, tanto a nível individual como coletivo. Problemas persistentes para os jovens médicos incluem jornadas longas de trabalho e ainda um predomínio de burocracia excessiva. Oportunidades e ameaças potenciais foram destacadas dentro do sistema atual, algumas delas dependentes do macro contexto político que rege o NHS no Reino Unido. Conclusão: O Foundation Programme é uma robusta iniciativa para a formação e desenvolvimento de médicos em início de carreira. São necessárias maiores investigações e um diálogo internacional mais aprofundado sobre as melhores práticas nesta área.

Introducción: Al finalizar el curso de pregrado de cinco años en medicina, los médicos recién titulados en el Reino Unido participarán del Foundation Programme, con duración de dos años, destinado a darles la experiencia, la supervisión y la orientación necesarias para prepararlos para una carrera clínica en la medicina. Los médicos que atienden el Foundation Programme son miembros pagos de los equipos del servicio y realizan diversas rotaciones clínicas supervisadas por médicos con experiencia, un proceso que está regulado por el UK Foundation Programme Office. Objetivo: Este estudio tiene como objetivo proporcionar un análisis reflexivo sobre el Foundation Programme para mejor informar al público internacional. Métodos: Análisis crítico y reflexivo usando la matriz DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades) realizado por dos jóvenes médicos que atienden al Foundation Programme del Reino Unido. Resultados y Discusión: Se trata de un programa bien establecido que permite a los graduados obtener una amplia gama de experiencia clínica, como médicos remunerados, pero con variaciones considerables, tanto al nivel individual como colectivo. Problemas persistentes para los médicos jóvenes incluyen largas horas de trabajo y aún el predominio de una burocracia excesiva. Potenciales oportunidades y amenazas se han destacado en el sistema actual, algunos de ellos dependientes del macro contexto político que rige el NHS en el Reino Unido. Conclusión: El Foundation Programme es una iniciativa robusta para la formación y desarrollo de los médicos en inicio de carrera. Se requiere una mayor investigación y un diálogo internacional más profundizado sobre las mejores prácticas en esta área.

Entre Londres e Paris, 1945-1975: formação da psicanálise contemporânea / Between London and Paris, 1945-1975: the formation of contemporary psychoanalysis / Entre Londres y Paris, 1945-1975: formación del psicoanálisis contemporáneo

Traçando um panorama da Psicanálise entre 1945 e 1980, este artigo busca situar nele as obras de Jean Laplanche, Jean-Bertrand Pontalis, André Green, Joyce McDougall e Betty Joseph.

Dibujando un panorama del Psicoanálisis entre 1945 y 1980, este artículo trata de localizar en el mismo las obras de Jean Laplanche, Jean-Bertrand Pontalis, André Green, Joyce McDougall y Betty Joseph.

Sketching a broad view of the development of Psychoanalysis between 1945 and 1980, this paper offers some suggestions about the place occupied in it by the works of Jean Laplanche, Jean-Bertrand Pontalis, André Green, Joyce McDougall and Betty Joseph.

Principles of British health visiting / Princípios do modelo britânico do visitador em saúde / Los princípios del modelo británico del visitador de salud

In an international context, it is sometimes helpful to consider how concepts are understood in different countries, and to explore some different roles. Such knowledge rarely transfers directly from one country or place to another, but to hear about developments from elsewhere can spark ideas and thinking that may be helpful for local developments. This paper gives some brief background about how the health visiting profession developed in Great Britain, and then explains the values and principles that underpin its practice today. Some parallels are drawn with the health situation in modern Brazil.

Em um contexto internacional, muitas vezes, é importante considerar como os conceitos são compreendidos nos diferentes países e explorar algumas de suas distintas funções. Esse conhecimento raramente pode ser transferido de um país ou de uma localidade para outra, mas ouvir outras experiências de desenvolvimento, de quaquer parte do mundo, pode despertar idéias e pensamentos que sejam úteis ao desenvolvimento local. Este artigo apresenta um breve histórico sobre como a profissão de visitador em saúde se desenvolveu na Grã-Bretanha, explicando os valores e princípios que, atualmente, servem de base à sua prática, estabelecendo-se alguns paralelos com a atual situação da saúde no Brasil contemporâneo.

En el contexto internacional, muchas veces es importante considerar como los conceptos son comprendidos en los diferentes países y explorar algunas de sus diferentes funciones. Ese conocimiento raramente puede ser transferido de un país o de una localidad para otra, no obstante, escuchar las experiencias de desarrollo, de cualquier parte del mundo, posibilitan despertar ideas y pensamientos que pueden ser útiles para el desarrollo local. Este artículo presentó un breve histórico sobre como la profesión de visitador de salud se desenvolvió en Gran Bretaña, explicando los valores y principios que actualmente sirven de bases para su práctica y estableciendo algunos paralelos con la actual situación de salud de Brasil contemporáneo.

Identity, genealogy, and the social family: the case of donor insemination.

In this paper I discuss whether or not biographical information concerning the sperm donor should be disclosed to children conceived through donor insemination. Policies of disclosure for example in the context of adoption, have been justified on the basis of a notion of identity which emphasizes genetic ties. This notion of identity and the policies of disclosure of information concerning biological parents based on it, have been criticized by many writers, including feminists, as reinforcing explanations of human organization and development based on biological determinism rather than on ideas such as social construction. Further, this notion of identity is seen to emphasize the importance of genetic parenthood over the commitment involved in bringing up a child as a social parent. While agreeing with these criticisms of that particular notion of identity, I argue that the notion of identity as a whole should not be summarily rejected. Rather, it should be re-interpreted using a sociological approach incorporating the notion of narrative. This second narrative notion of identity is developed with reference to the situation of some groups of children, who like those born from donor insemination, generally do not have any knowledge of their biological parent[s], for example adoptees, the children of the disappeared in Argentina and child migrants. In this paper, policies of disclosure which allow these children to gain some knowledge of their biological parents are discussed in light of the two notions of identity. It is argued that disclosure may be justified on the basis of a narrative notion of identity. This allows for the rigid dichotomy created between biological determinism and social construction: the importance of social parents to the child is emphasized, however the desire a child may have to know something about her or his biological parent is not denied or dismissed.