Aspectos críticos contextuales de un hospital de alta complejidad / Critical contextual aspects of a highly complex hospital / Aspectos críticos contextuais de um hospital de alta complexidade

Este artículo presenta los resultados parciales de un análisis FODA realizado en el Instituto Nacional del Tórax, con el fin de generar información sobre los aspectos críticos que afectan la gestión estratégica de un hospital público de alta complejidad, y abrir una reflexión ética sobre tales procesos. Para su determinación se usaron focus group, entrevistas en profundidad, propuestas por el equipo Directivo del Hospital y discusiones en torno al ámbito contextual. Las entrevistas individuales y grupales tuvieron una duración de una hora y veinte minutos aproximadamente y se realizaron en dependencias del hospital. La conceptualización de los datos, se hizo desde la Teoría Fundamentada. El estudio muestra, de acuerdo con la percepción de los entrevistados, que hay aspectos contextuales, tales como reglas del juego, stakeholders y cultura país, cuya tensión ética con la organización, afectan el quehacer del Instituto Nacional del Tórax, en cuanto hospital público de alta complejidad.

This article presents the partial results of a SWOT analysis at the National Chest Institute, in order to generate information on critical issues affecting the strategic management of a public hospital of high complexity, and open an ethical reflection on such processes. For their determination were used: focus groups, interviews, proposed by the management team of the Hospital and discussions on the contextual level. The Individual and group interviews lasted about an hour and twenty minutes and were performed at hospital units. The conceptualization of the data was made from Grounded Theory. The study shows, according to the perception of the interviewees, their contextual issues such as rules, stakeholders and cultural country, whose ethical tension with the organization, affect the work of the National Chest Institute as a high complexity public hospital.

objetivo: Este artigo apresenta resultados parciais de uma análise FOFA realizada no Instituto Nacional de Tórax do Chile, com a finalidade de gerar informações sobre os aspectos críticos que afetam a gestão estratégica de um hospital público de alta complexidade, e gerar uma reflexão ética sobre tais processos. Método: para sua determinação fora utilizado o focus group, entrevistas em profundidade propostas pela equipe de gestão do hospital e discussões acerca do escopo contextual. A conceitualização dos dados, foi feita a partir da Teoria Fundamentada. Conclusões: o estudo demonstra que, de acordo com a percepção dos entrevistados, há aspectos contextuais, tais como as regras do jogo, stakeholders e a cultura do país, cuja tensão ética com a organização afetam o trabalho do Instituto Nacional do tórax, enquanto hospital público de alta complexidade.

The levels of selection debate: taking into account existing empirical evidence / El debate sobre niveles de selección: teniendo en cuenta la evidencia empírica existente

For over five decades the dominant neo-Darwinian view is that natural selection acts only at the genic and organismal levels, but the ignored empirical evidence of multilevel selection occurring in nature obtained over the last fifty years does not agree with it. A long exchange of mathematical and theoretical arguments about the levels at which natural selection acts constitutes what is known as the 'levels of selection debate'. The large amount of empirical evidence, studied by quantitative genetics means, specifically contextual analysis, indicates that natural selection acts on levels of the biological hierarchy above and below that of the gene and organism, from the molecular to the ecosystem level, thus supporting what is called the multilevel selection theory. Beyond theoretical arguments, if empirical evidence for multilevel selection and contextual analysis results are carefully examined, the debate on the levels of selection is easily resolved: natural selection occurs in nature at different levels of biological hierarchy. This text provides an overview of such empirical evidence.

Por más de cinco décadas la visión neo-darwinista dominante de la selección natural es que esta actúa únicamente a nivel génico y organísmico, pero la ignorada evidencia empírica de selección multinivel ocurriendo en la naturaleza obtenida durante los últimos cincuenta años no es consecuente. Un largo intercambio de argumentaciones matemáticas y teóricas sobre los niveles en los que actúa la selección natural constituye lo que se denomina como el "debate de los niveles de selección". La gran cantidad de evidencia empírica, estudiada mediante métodos de genética cuantitativa, específicamente el análisis contextual, indica que la selección natural actúa en niveles de la jerarquía biológica por encima y por debajo del nivel del gen y organismo, desde el nivel molecular hasta el ecosistémico, apoyando así lo que se denomina la teoría de selección multinivel. Más allá de argumentos teóricos, si se examina cuidadosamente la evidencia empírica de selección multinivel y los resultados del análisis contextual, se resuelve de forma sencilla el debate de los niveles de selección: la selección natural ocurre en la naturaleza en diferentes niveles de la jerarquía biológica. Este texto ofrece una revisión general de dicha evidencia empírica.

To spark a social revolution behavior analysts must embrace community-based knowledge / Para desencadear uma revolução social analistas do comportamento devem abraçar o conhecimento comunitário / Para provocar una revolución social analistas del comportamiento deben abrazar el conocimiento basado en la comunidad

This article is a critical commentary on the behavior analytical tradition regarding its attempts to deal with and interpret social phenomena and problems, focusing mainly on the choice for research questions that could lead to ‘revolutions’ both in the way we interpret such phenomena, and also by sparking broader social changes. We explored broader contexts controlling and informing behavior analysts’ choices, and provided examples. The present paper suggests that, in order to promote social changes toward a more egalitarian society while using behavior analysis, researchers and practitioners should examine more thoroughly their own decisions on which knowledge sources must be considered when taking action upon our society. Furthermore, the interpretation presented advocates for a radical social analysis of social phenomena, in agreement with radical behaviorism and contextual analysis. Such analysis should take into consideration the knowledge already produced or in production by the population that will participate in it.

O presente artigo é um comentário critico acerca da tradição analítico-comportamental em suas tentativas de lidar com e interpretar fenômenos e problemas sociais, concentrando-se principalmente na escolha por perguntas de pesquisa que poderiam levar a ‘revoluções’ tanto na maneira como interpretamos tais fenômenos, quanto na promoção de mudanças sociais em larga-escala. Foram explorados contextos amplos que controlam e informam as escolhas dos analistas do comportamento, e exemplos foram apresentados. Este estudo sugere que, para promover mudanças sociais na direção de uma sociedade mais igualitária pelo uso da análise do comportamento, pesquisadores e profissionais deveriam examinar mais meticulosamente suas próprias decisões sobre quais fontes de conhecimento deveriam ser consideradas ao intervir em sociedade. Ademais, a interpretação aqui apresentada defende uma análise social radical de fenômenos sociais, de acordo com o behaviorismo radical e análise contextual. Tal análise deveria considerar o conhecimento já produzido ou em produção pela população que dela fará parte.

Este artículo es un comentario crítico sobre el análisis conductual en sus intentos de interpretar fenómenos y problemas sociales, centrándose principalmente en la elección de temas de investigación que podrían conducir a ‘revoluciones’, tanto en la forma en que interpretamos esos fenómenos, como promoviendo el cambio social. Fueron investigados contextos amplios que controlan e influyen en las decisiones de los analistas de conducta, y se presentaron ejemplos. Este estudio sugiere que para promover el cambio social hacia una sociedad igualitaria utilizando el análisis conductual, investigadores y profesionales deben considerar con más cuidado sus propias decisiones acerca de qué fuentes de conocimiento deben utilizar para intervenir en sociedad. Además, la interpretación que aquí se presenta aboga por un análisis social radical de los fenómenos sociales, según el conductismo radical y análisis contextual. Dicho análisis debe considerar el conocimiento ya producido o en producción por la población participante.

To spark a social revolution behavior analystsmust embrace community-based knowledge / Para desencadear uma revolução social analistas do comportamentodevem abraçar o conhecimento comunitário / Para provocar una revolución social analistas del comportamientodeben abrazar el conocimiento basado en la comunidad

This article is a critical commentary on the behavior analytical tradition regarding its attempts to deal with and interpret social phenomena and problems, focusing mainly on the choice for research questions that could lead to ‘revolutions’ both in the way we interpret such phenomena, and also by sparking broader social changes. We explored broader contexts controlling and informing behavior analysts’ choices, and provided examples. The present paper suggests that, in order to promote social changes toward a more egalitarian society while using behavior analysis, researchers and practitioners should examine more thoroughly their own decisions on which knowledge sources must be considered when taking action upon our society. Furthermore, the interpretation presented advocates for a radical social analysis of social phenomena, in agreement with radical behaviorism and contextual analysis. Such analysis should take into consideration the knowledge already produced or in production by the population that will participate in it.(AU)

O presente artigo é um comentário critico acerca da tradição analítico-comportamental em suas tentativas de lidar com e interpretar fenômenos e problemas sociais, concentrando-se principalmente na escolha por perguntas de pesquisa que poderiam levar a ‘revoluções’ tanto na maneira como interpretamos tais fenômenos, quanto na promoção de mudanças sociais em larga-escala. Foram explorados contextos amplos que controlam e informam as escolhas dos analistas do comportamento, e exemplos foram apresentados. Este estudo sugere que, para promover mudanças sociais na direção de uma sociedade mais igualitária pelo uso da análise do comportamento, pesquisadores e profissionais deveriam examinar mais meticulosamente suas próprias decisões sobre quais fontes de conhecimento deveriam ser consideradas ao intervir em sociedade. Ademais, a interpretação aqui apresentada defende uma análise social radical de fenômenos sociais, de acordo com o behaviorismo radical e análise contextual. Tal análise deveria considerar o conhecimento já produzido ou em produção pela população que dela fará parte.(AU)

Este artículo es un comentario crítico sobre el análisis conductual en sus intentos de interpretar fenómenos y problemas sociales, centrándose principalmente en la elección de temas de investigación que podrían conducir a ‘revoluciones’, tanto en la forma en que interpretamos esos fenómenos, como promoviendo el cambio social. Fueron investigados contextos amplios que controlan e influyen en las decisiones de los analistas de conducta, y se presentaron ejemplos. Este estudio sugiere que para promover el cambio social hacia una sociedad igualitaria utilizando el análisis conductual, investigadores y profesionales deben considerar con más cuidado sus propias decisiones acerca de qué fuentes de conocimiento deben utilizar para intervenir en sociedad. Además, la interpretación que aquí se presenta aboga por un análisis social radical de los fenómenos sociales, según el conductismo radical y análisis contextual. Dicho análisis debe considerar el conocimiento ya producido o en producción por la población participante.(AU)

Toma de perspectiva y teoría de la mente: aspectos conceptuales y empíricos. Una propuesta complementaria y pragmática

resumen está disponible en el texto completo

Abstract: The present work completes an exhaustive revisión of the delimitation of the ability of perspective taking from different points of view. First, perspective taking is defined as the ability of an individual to interpret his/hers emotional and mental states and those of others. Additionally, the term has also been used in medical settings to refer to a tactic intended to stop certain limiting feeling and/or thoughts and instead move feelings and thoughts towards a different direction. At the same time, perspective taking is considered to be at the heart of psychological phenomena such as empathy, that is, the capacity to distinguish what individuals know about themselves in a certain situation (how someone thinks, feels and behaves), self-awareness, interpersonal relations, and various social skills deficits. Second, this ability is conceptualized as a metacognition and it is assumed that the object of study is the theory of the mind. Third, from a developmental perspective, data have shown that children four to five years old, without any psychological disabilities, have the ability to take somebody else's perspective. We reviewed different studies regarding the development of the abilities to express and interpret emotions as precursors to perspective taking. Subsequently, we revised and analyzed the tests or strategies most commonly used to evaluate the ability of perspective taking. Typically, the capacity of an individual to have "a theory of the mind" is determined through tests of false beliefs (such as the classic test of Sally-Anne, the "Smarties" test, "M&M's", and the "Maxi's" Test). Múltiple variations of the tests of false beliefs have been conducted with flashcards or photographs, with characters in oral stories, and through the use of games. Additionally, over the last few years the focus of this body of research has evolved towards the elaboration and validation instruments to measure empathy. Among them are the tests of Empathy Quotient (EQ), the Friendship Questionnaire (FQ), and reading the "mind" in the eyes. It is important to note that these efforts have been focused mostly on individuals with Asperger" s Syndrome or those with higher verbal capabilities. From this latter perspective, we propose empirical evidence that points out to differences in the ability of perspective taking between children with or without autism. This is also shown in the results of previous studies, in which different levels of perspective taking skills were seen between children diagnosed with autism, and those diagnosed with Down Syndrome. It is important to note that this was not true when their verbal skills were not considered as a variable. Likewise, other studies showed that children with autism were not the only ones that failed the theory of the mind tests, but that these tests were also failed by those children with deficits in language and cognitive skills. In this article, we present the results of a study that replicates previous findings which show that typical developing children per-form better in perspective taking tests, followed by children diag-nosed with Down Syndrome, and subsequently by children with autism. It was also noted that the typical developing children showed the highest level of verbal discrimination, followed by the children diagnosed with Down Syndrome, and finally the children diagnosed with autism. One important finding in this study is that all children benefited from the use of contextual prompts, which improved the number of correct responses across all the theory of the mind tests. Additionally, the data varied depending on the type of tests utilized to measure perspective taking skills. In this article, we have also reviewed the different explanations for the origins and development of perspective taking, among which the theory of the mind prevails. The ability to take some-one else's perspective is explained by the development or matura-tion of an innate and specialized module of representations and knowledge, and the formation of conceptual structures of a higher order or meta-representations. Additionally, the ability to ignore perceptual information, salient or not, and to combine simultaneously various contexts are considered prerequisites. In other words, perspective taking speaks to the relationship between psychological constructs such as perception and knowledge. Additionally, it has been hypothesized that shared, joint, or independent attention can be a prerequisite for conversation, and may be the basis of a theory of the mind. In any case, the origins of the development of such a theory have been especially ubiquitous in terms of the executive function and possible relations with cerebral lesions or alterations. However, some authors consider that the process of central coherence may be relatively independent of a theory of the mind. The research of Baron-Cohen et al. has concentrated on identifying existing neurological deficits or organic changes such as bilateral lesions or the role of testosterone on the quality of social interactions and the restrictive social interests of individuals with autism. A similar interest exists in researching the difference in perspective taking and empathy abilities exhibited by members of the opposite sex. Continuing with the neurological foundations of the empathy is of full present time the discoveries regarding «mirror neurons¼ and this recent study with monkeys proposes a specific cerebral area for the formation of the meta-representation. These neurons discharge both when the individual performs an action and when the individual observes another person performing the same action. Finally, even in the light of all the above, other sources point toward the social root of perspective taking skills. Additionally, as indicated by the research of Howlin, Baron-Cohen & Hadwin, it is considered perspective taking includes five different levels: a) simple visual perspective taking, b) the knowl-edge that different individuals can have separately the same thoughts, and c) understanding that "seeing leads to learning," followed by d) the ability to predict actions based on valid beliefs, and finally e) the ability to predict false beliefs. In the light of all of the above, once the radical conclusions of these investigations are viewed critically, the theory of the mind is viewed as a disputable theory of the delimitation of the cause and development of such skills. In addition, to the perspective taking tests themselves, the pre-requisite skills of perspective taking need to be extensively ana-lyzed. In fact, it has been shown that, in order to have an adequate performance on these tests of false beliefs, individuals should be able: 1. to remember and adequately retell their own past desires, thoughts, and past actions; 2. to retain an object in their mind, perceive a second object, and form a relationship between the two, as in a "symbolic function"; 3. to demonstrate the ability to pretend; and 4. to identify the role of age and verbal abilities in children as pre-requisites for an accurate performance on tests of false beliefs, and interpretations of the world. Lastly, we propose a pragmatic and complementary analysis the Theory of Mind based in the functional-contextual analysis of behavior. First, it is considered that perspective taking requires or is closely related to other social behaviors (such as taking turns when talking, initiating verbal responses in interpersonal relations, and the capacity for empathy). In the same manner, theory of mind requires an adequate level of simple and complex conditional discriminations, and these should be analyzed in terms of stimulus control and equivalence relations. In other words, this ability to infer thoughts, feeling, and emotions of others exists if the following prerequisites are present: 1. the processes of the classical conditioning of the emotions, 2. a generalized imitation, and 3. the development of functional classes. Without these experiences or the capability to be affected by them, children (i.e. children with generalized autism) do not develop language adequately. Second, perspective taking implies that an observer's previous experiences and observations with certain events determine his/ her reaction to responses emitted by others in similar circumstances. Finally, from a contextual perspective, it is considered that a speaker's relational frames play a role in this process (for the discriminations I/you, here/there, now/later). These relational properties are abstracted through multiple exemplars or multiple learning opportunities to speak from one's own perspective in relation to others.