La seguridad social: Un derecho y una obligación para el odontólogo y sus trabajadores / Social security: A right and obligation for the dentist and his workers

La seguridad social es un derecho encaminado a asegurar el bienestar de los ciudadanos que forman parte de una comunidad, y su objetivo principal es brindar a las personas aseguradas un conjunto de medidas públicas que ayuden a la protección de su salud por accidentes de trabajo o enfermedad laboral, desempleo, invalidez, vejez o muerte. De acuerdo con nuestra legislación, toda persona que preste servicios laborales a otro, tiene derecho a ser registrado ante el seguro social para que, en caso de accidente o enfermedad laboral, exista una ins- tancia que asista al trabajador afectado a recuperar su salud sin afectar su economía familiar. Es bastante frecuente que el odontólogo tenga trabajadores a su cargo, quien al fungir como patrón tiene obligaciones específicas ante el Instituto de Seguridad Social que de no cumplir, puede traer consigo sanciones y amonestaciones al profesional. El objetivo del presente artículo es informar al odontólogo sus derechos y obligaciones ante el seguro social mediante una revisión de las normas y leyes que lo imponen (AU)

Social security is a right aimed at ensuring the well-being of citizens who are part of community, and its main objective is to provide insured persons with a set of public measures that help protect their health, due to accidents at work and occupational disease, unemployment, disability, old age or death. In accordance with our legislation, any person who provides labor services to another has the right to registered with the social security so that, in the event of an accident or occupational disease, there is an instance that assists the affecter worker to recover his health without affecting his familiar economy. It is quite common for the dentist to have workers under his charge, who, acting as an employer, have specific obligations with the Social Security Institute, which, if not fulfilled, can bring sanctions and reprimands to the professional. The aim of this article is to inform dentists about their rights and obligations with the Social Security Institute through a review of the laws that impose it (AU)

Compromissos diante da violência doméstica: olhar de universitários como cidadãos e futuros profissionais / Responsibilities in the face of intimate partner violence: the perspectives of college students as citizens and future professionals

Objetivo: analisar o conhecimento de universitários sobre os compromissos, profissionais e cidadãos, diante da violência doméstica contra a mulher. Métodos: pesquisa qualitativa realizada nas casas do estudante da Universidade Federal do Rio Grande, em Rio Grande/RS, no ano de 2019. Foram convidados, aleatoriamente, dois homens e duas mulheres de cada casa, totalizando 28 participantes. Todos responderam a entrevistas semiestruturadas e o corpus foi analisado segundo a Análise de Conteúdo. Resultados: enquanto alguns universitários não aproximavam a temática com seus cursos de graduação, outros a reconheciam como importante tema de debate e compromisso com a formação profissional. Como cidadãos, mencionaram o dever de debater o assunto entre amigos, denunciar casos de violência, oferecer apoio à mulher; embora apresentassem dúvidas sobre essa conduta. Conclusão: o reconhecimento dos compromissos frente à violência doméstica contra a mulher é uma das estratégias de enfrentamento.

Objective: to analyze the knowledge of college students regarding their responsibility, as future professionals and citizens, in the face of intimate partner violence. Methods: a qualitative study was conducted in the undergraduate residence halls at the Federal University of Rio Grande, Rio Grande, RS, Brazil, in 2019. Two men and two women from each residence hall were randomly invited, totaling 28 students. All the participants answered semi-structured interviews, and Content Analysis was used to interpret the corpus. Results: some students did not relate the topic to their undergraduate programs, but others recognized it was related to their professional field and as an important subject to be debated. As citizens, they considered being responsible for discussing it with their friends, reporting violence cases, and providing support to victims, though they had doubts about it. Conclusion: recognizing one's responsibilities in the face of intimate partner violence is one strategy to combat it.

O termo de consentimento livre esclarecido na visão dos médicos da rede pública municipal de saúde de um município paulista: um estudo sobre a ética e suas implicações jurídicas em saúde / The Informed Consent term in the viewpoint of physicians from the municipal public health network of a São Paulo state municipality: a study of ethics and its legal implications in health

O Termo de Consentimento Livre e Esclarecido é um instrumento utilizado no âmbito profissional em diversas áreas. Na medicina, tem sido empregado como uma forma de garantia de direitos para os pacientes e para os profissionais. Por meio desse documento promove-se o direito à informação, o direito à autonomia, o direito à vida, o direito de escolha, o direito de consentir ao seu tratamento e à promoção do direito à saúde. Sua composição expressa questões que envolvem a ética em termos de principialismo. O estudo tem por objetivo analisar a importância, atribuída por médicos de uma rede municipal de saúde, da utilização do TCLE. Trata-se de um documento que consiste, por meio de seus pressupostos, na execução de desdobramentos jurídicos bem como seus efeitos. O estudo é exploratório e de abordagem qualitativa. Participaram do estudo 26 médicos que atuam em serviços da atenção primária à saúde no interior do Estado de São Paulo. A coleta de dados foi realizada por meio de entrevista semiestruturada. Os resultados evidenciam a escassez de estruturas para a compreensão da totalidade do que constitui o TCLE e da sua aplicabilidade na atuação profissional, mormente em relação às questões jurídicas, abarcando como alternativa para esta lacuna de conhecimento a realização de atividades no âmbito da educação permanente, através de minicursos, palestras e outras

The Free and Informed Consent Form is an instrument used in the professional scope in several areas. In medicine, it serves as a way of guaranteeing rights for patients and professionals. This document promotes the right to information, the right to be autonomous, the right to live, the right to choose, the right to consent to their treatment and the promotion of the right to health. Its composition expresses that it involves ethics in terms of principlism. The purpose of the study is to examine just how important IC (informed consent) is to physicians in a municipal health network. It is a document that employs the execution of legal developments alongside their effects through its presuppositions. The research takes a qualitative exploratory approach. The study included twenty-six physicians who work in primary health care services in the interior of São Paulo's state. Semi-structured interviews served as the way to gather information. The findings reveal a scarcity of structures for comprehending the entirety of what the IC is and its applicability in professional practice, particularly in legal matters, with activities in the field of permanent education serving as an alternative to this knowledge gap

Local deliberative approach to the bioethical controversies: An opportunity for the proper implementation of neonatal screening / [Enfoque local deliberativo de las controversias bioéticas: una oportunidad para la adecuada implementación de la tamización neonatal].

Introduction: The controversial characteristics of neonatal screening influenced by bioethical considerations make its implementation complex. Colombia is not an exception in this sense and local circumstances complicate the panorama. Objective: To establish how bioethical controversies on neonatal screening are approached at a local level as a basis for deliberating on the must-be of this activity in Colombia. Materials and methods: A survey immersed in an interpretative investigation with descriptive and deliberative components of analysis was applied to approach the values exposed by officials of the Colombian Instituto Nacional de Salud. Results: The compulsory offer of screening by the nation, regardless of its opportunity cost and the consent for the use in research of results and residual samples, were not controversial, but, in contrast, the type of information and the consent to authorize screening did arise controversy. The more experienced officials preferred mandatory screening (17.7 vs. 11.79 years on average, p=0.007). Surprisingly, despite the risk of discrimination, keeping the neonate as the purpose, there was agreement on giving all the information to parents and medical records. Another controversial aspect was the follow-up of cases without hiding their identification where officials with more experience in bioethical aspects preferred the use of codes (4.5 vs. 1.26 years on average, p=0.009). In this context, strategies such as informed dissent, specialized advice or public health programs that appreciate diversity would allow to rescue even seemingly opposite values. Conclusion: A local approach regarding what ought to be in neonatal screening based on a deliberative bioethical perspective allowed to present an implementation proposal for this activity

Introducción. Las características controversiales de la tamización neonatal influenciadas por consideraciones bioéticas hacen compleja su implementación. Colombia no es ajena a esta situación y las circunstancias locales complican el panorama. Objetivo. Determinar cómo se abordan en el contexto local las controversias bioéticas en torno a la tamización neonatal como fundamento de las deliberaciones sobre el deber ser de esta actividad en Colombia. Materiales y métodos. Se aplicó una encuesta en el marco de un estudio interpretativo con dos componentes de análisis, uno descriptivo y otro deliberativo, en torno a los valores expuestos por funcionarios del Instituto Nacional de Salud. Resultados. La oferta obligatoria de la tamización por parte de la nación, independientemente del costo de oportunidad y el consentimiento para el uso de sus resultados y de las muestras residuales en la investigación, no suscitaron controversias, pero sí el tipo de información y la autorización para hacer la tamización. Los funcionarios con mayor experiencia expresaron su preferencia por una tamización obligatoria (17,7 Vs. 11,79 años en promedio; p=0,007). Sorpresivamente, a pesar del riesgo de discriminación, teniendo como fin el neonato, hubo acuerdo en entregar toda la información a padres e historia clínica. Otro aspecto controversial fue la identificación de los pacientes en el seguimiento, frente a lo cual los funcionarios de mayor experiencia en aspectos bioéticos prefirieron el uso de códigos (4,5 Vs. 1,26 años en promedio; p=0,009). En este contexto, estrategias como el disentimiento informado, el asesoramiento especializado o los programas de salud pública que aprecien la diversidad permitirían rescatar valores, incluso aquellos aparentemente opuestos. Conclusión. La aproximación local al deber ser de la tamización neonatal desde una perspectiva bioética deliberativa permitió ajustar una propuesta para su implementación.

Enfoque local deliberativo de las controversias bioéticas: una oportunidad para la adecuada implementación de la tamización neonatal / Local deliberative approach to the bioethical controversies: An opportunity for the proper implementation of neonatal screening

Resumen: Introducción. Las características controversiales de la tamización neonatal influenciadas por consideraciones bioéticas hacen compleja su implementación. Colombia no es ajena a esta situación y las circunstancias locales complican el panorama. Objetivo. Determinar cómo se abordan en el contexto local las controversias bioéticas en torno a la tamización neonatal como fundamento de las deliberaciones sobre el deber ser de esta actividad en Colombia. Materiales y métodos. Se aplicó una encuesta en el marco de un estudio interpretativo con dos componentes de análisis, uno descriptivo y otro deliberativo, en torno a los valores expuestos por funcionarios del Instituto Nacional de Salud. Resultados. La oferta obligatoria de la tamización por parte de la nación, independientemente del costo de oportunidad y el consentimiento para el uso de sus resultados y de las muestras residuales en la investigación, no suscitaron controversias, pero sí el tipo de información y la autorización para hacer la tamización. Los funcionarios con mayor experiencia expresaron su preferencia por una tamización obligatoria (17,7 Vs. 11,79 años en promedio; p=0,007). Sorpresivamente, a pesar del riesgo de discriminación, teniendo como fin el neonato, hubo acuerdo en entregar toda la información a padres e historia clínica. Otro aspecto controversial fue la identificación de los pacientes en el seguimiento, frente a lo cual los funcionarios de mayor experiencia en aspectos bioéticos prefirieron el uso de códigos (4,5 Vs. 1,26 años en promedio; p=0,009). En este contexto, estrategias como el disentimiento informado, el asesoramiento especializado o los programas de salud pública que aprecien la diversidad permitirían rescatar valores, incluso aquellos aparentemente opuestos. Conclusión. La aproximación local al deber ser de la tamización neonatal desde una perspectiva bioética deliberativa permitió ajustar una propuesta para su implementación.

Abstract: Introduction: The controversial characteristics of neonatal screening influenced by bioethical considerations make its implementation complex. Colombia is not an exception in this sense and local circumstances complicate the panorama. Objective: To establish how bioethical controversies on neonatal screening are approached at a local level as a basis for deliberating on the must-be of this activity in Colombia. Materials and methods: A survey immersed in an interpretative investigation with descriptive and deliberative components of analysis was applied to approach the values exposed by officials of the Colombian Instituto Nacional de Salud. Results: The compulsory offer of screening by the nation, regardless of its opportunity cost and the consent for the use in research of results and residual samples, were not controversial, but, in contrast, the type of information and the consent to authorize screening did arise controversy. The more experienced officials preferred mandatory screening (17.7 vs. 11.79 years on average, p=0.007). Surprisingly, despite the risk of discrimination, keeping the neonate as the purpose, there was agreement on giving all the information to parents and medical records. Another controversial aspect was the follow-up of cases without hiding their identification where officials with more experience in bioethical aspects preferred the use of codes (4.5 vs. 1.26 years on average, p=0.009). In this context, strategies such as informed dissent, specialized advice or public health programs that appreciate diversity would allow to rescue even seemingly opposite values. Conclusion: A local approach regarding what ought to be in neonatal screening based on a deliberative bioethical perspective allowed to present an implementation proposal for this activity.

Research ethics guidelines and moral obligations to developing countries: Capacity-building and benefits.

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit-sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity-building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity-building, nurture respectful and trusting partnerships that benefit all stakeholders in international research.

Do doctors have a moral duty to work in the public health sector? Ethical considerations regarding the social obligations of medicine. / ¿Tiene el médico el deber moral de trabajar en el sector público de salud? Consideraciones éticas sobre las obligaciones sociales del médico.

This article discusses whether physicians have social obligations and whether these obligations imply a moral duty to work in the public sector. The article focuses on the context of the Chilean health system, which has an unequal distribution of physicians to the detriment of the public sector, thus making the issue a particularly pressing one. After addressing arguments from different ethical theories and some empirical evidence, the article concludes that the physician has some social obligations in relation to a fair distribution of health resources, and that professional excellence should incorporate cultivating virtues related to social justice. In addition, it is argued that the moral duty to work in the public sector can be placed in the context of prima facie obligations which admit exceptions and allow the possibility of conflict with other professional obligations.

El presente artículo discute si los médicos tienen obligaciones sociales, y si de éstas se puede desprender un deber moral de trabajar en el sector público de salud. La discusión se sitúa en el marco del sistema de salud chileno en tanto presenta una desigual distribución de médicos en desmedro del sector público de salud, lo cual confiere especial relevancia al tema en cuestión. Tras evaluar argumentos procedentes de distintas teorías éticas y de la evidencia empírica, se concluye que el médico tiene obligaciones sociales en relación con una repartición justa de los recursos sanitarios, y que la excelencia profesional debiera incorporar el cultivo de virtudes orientadas a una mayor justicia social. Asimismo, se plantea que el deber moral de trabajar en el sector público de salud se sitúa en un plano de obligaciones prima facie que admiten excepciones y la posibilidad de conflicto con otras obligaciones profesionales.

El derecho a la alimentación: algunos elementos para su análisis / The right to food: some elements for analysis

Este artículo presenta el tema del derecho a la alimentación a partir de cuatro aspectos: a) contenido del derecho, b) obligaciones de los Estados para hacerlo efectivo; c) elementos, vías y recursos para su exigibilidad y justiciabilidad y d) reconocimiento y garantía en el derecho interno venezolano. Se parte de la definición del Primer Relator Especial de Naciones Unidas para el Derecho a la Alimentación, Jean Ziegler; se examinan las obligaciones básicas de los Estados en la materia; se presentan los mecanismos que posibilitan la vigilancia del cumplimiento del Derecho y se muestran las iniciativas normativas venezolanas sobre este derecho llevadas a cabo desde 1999. La revisión documental realizada permite afirmar que: 1) la Constitución de 1999 no reconoce expresamente el derecho a la alimentación; 2) el Estado venezolano se encuentra en mora con los instrumentos internacionales que ha suscrito y ratificado en materia de derecho a la alimentación; 3) la realización del derecho a la alimentación, en Venezuela es una tarea pendiente que requiere de normas, políticas, programas, mecanismos y compromisos que permitan su efectivo cumplimiento(AU)

This article examines the topic of the right to food from four aspects: a) content of the law, b) obligations of the States to make it effective, c) elements, mechanisms and media for his enforceability and justiciability; d) recognition and guarantee in the internal Venezuelan right. It is assumed the definition of the First Special Relator of United Nations for the Law to the Food, Jean Ziegler; the basic obligations of the States: to respect, to protect and to fulfil are examined; it present the mechanisms that make possible the monitoring compliance with of the fulfillment of the Law and shows the normative Venezuelan initiatives on this right that has been carried out from 1999. The documentary revision shows that: 1) The Constitution of 1999 does not recognize expressly the right to the Food. 2) The Venezuelan State is failing with the international instruments that it has signed and ratified about the right to the food, and 3) unfortunately, the accomplishment of the right to the food, in Venezuela, is a hanging task that it needs of procedure, policies, programs, mechanisms and commitments that allow his effective fulfillment(AU)

Standard of care, institutional obligations, and distributive justice.

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine two types of institutional contexts: (1) public research agencies - agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care.

Responsabilidad legal de los residentes de Anestesiología y Reanimación / Legal liabilities of anesthesiology and resuscitation residents

Introducción: las obligaciones y la responsabilidad legal de los residentes en general y los de nuestra especialidad en particular, constituyen un tema muy complejo y ambiguo, pues como médicos deben asumir tareas específicas y como personal en formación su participación es muy limitada. Este hecho está dado, porque los errores médicos que ocurren en Anestesiología cuestan vidas y constituyen una de las principales causas de demandas en el mundo las cuales se han incrementado progresivamente en los últimos años. Objetivos: hacer una puesta al día sobre la responsabilidad legal de los Residentes de Anestesiología y Reanimación. Desarrollo: son obligaciones de los médicos residentes nacionales o extranjeros que cursen una especialidad, además de las que señalan las leyes respectivas de cada país, participar en el estudio y tratamiento de los pacientes que se les encomienden, siempre sujetos a las indicaciones y supervisión de los especialistas o profesores adscritos a la unidad médica receptora de residentes. Se debe tener en cuenta que las leyes son las mismas para todos los médicos con especialidad o sin ella, durante la residencia médica. Existen al menos tres situaciones que dan lugar a responsabilidad del residente: Falta de vigilancia en la asistencia o por la dirección del tutor y extralimitación por parte del Hospital, del Sistema de Salud o por parte del residente. Conclusiones: las obligaciones del residente, así como su responsabilidad legal, es un problema de todos y hay que prevenir para no tener que lamentar.

Introduction: the legal obligations and liabilities to be complied with by all residents, particularly by residents from our specialty, constitute a very complex and ambiguous subject, for as physicians they should carry out specific tasks, while as in-training personnel their participation is very limited. This is due to the fact that in anesthesiology medical errors cost lives, and they are one of the main reasons for legal complaints worldwide, which have gradually increased in recent years. Objective: update the legal liabilities of anesthesiology and resuscitation residents. Results: it is the obligation of national and foreign physicians serving a residency, besides those contained in their country's legislation, to participate in the study and treatment of the patients assigned to them under the guidance and supervision of specialists or professors from the health institution sponsoring the residency. It must be borne in mind that during the residency period the legislation is the same for both specialist and nonspecialist physicians. There are at least three situations which give rise to residents' liability: inattention while caring for patients, deficient guidance by the tutor and overstepping of authority by the hospital, the health system or the resident. Conclusions: the obligations and legal liabilities of residents are everyone's responsibility. Precautions should be taken so that regrettable events do not occur.

"AYITI CHERI": CULTURAL ORIENTATION OF EARLY ADOLESCENTS IN RURAL HAITI.

Adolescents are an emerging population in Haiti, particularly after the deadly 2010 earthquake. The steady penetration of U.S. culture into this poor, disaster-prone country begs the question: Do today's adolescents possess a similar fondness for their home country, culture, and traditional family values as did Haitians of old? Or are they more oriented towards U.S. culture? Early adolescents (n = 105, M = 12.87 yrs, SD = .86) in rural Haiti reported their cultural orientation towards Haitian culture and U.S. culture as well as their family obligations beliefs. Findings revealed high Haitian orientation, very high family obligations (boys especially), and very low U.S. orientation, although adolescents who interacted more frequently with U.S. tourists and those who consumed more U.S. fast food had higher U.S. culture orientation. Despite severe challenges, rural Haitian early adolescents demonstrate remarkable allegiance to their home country, culture, and traditional family values.

La falacia terapéutica / A falácia terapêutica / The therapeutic misconception

La falacia terapéutica tiene servido para negar la legítima esperanza de pacientes ?sujetos de investigación? que se incorporan a estudios clínicos Fase III para obtener beneficios clínicos directos. Esta ?falacia? busca ratificar los esfuerzos de investigadores en negar la diferencia entre estudios terapéuticos que benefician directamente los afectados e estudios no terapéuticos, que incorporan sujetos a investigaciones totalmente aisladas de sus necesidades. En países con populaciones pobres, precaria educación y acceso a servicios médicos, se intentan reclutar participantes ofreciendo terapias no disponibles localmente; obvio abuso das legítimas esperanzas de estos pacientes de acceder a estas indispensables terapias que les son prometidas al interior de las investigaciones. Así, la falacia terapéutica torna-se un modo de justificar a negativa de ofrecer beneficios médicos a los reclutados constituyendo sesgo de trasgresión ética, especialmente nos países en los cuales el participante no tienen expectativa de tratamiento. Esta justificada expectativa de los reclutados que ingresan en estudios clínicos aleatorios es argumento adicional contra el uso de placebo.

A falácia terapêutica tem servido para negar a legítima esperança de pacientes ?sujeitos da pesquisa? que se incorporam a estudos clínicos Fase III para obter benefícios clínicos diretos. Esta ?falácia? busca ratificar os esforços de pesquisadores em negar a diferença entre estudos terapêuticos que beneficiam diretamente os afetados e estudos não terapêuticos, que incorporam sujeitos a pesquisas totalmente distanciadas de suas necessidades. Em países com populações pobres, precária educação e acesso a serviços médicos, se tentam recrutar participantes oferecendo terapias não disponíveis localmente; óbvio abuso das legítimas esperanças destes pacientes terem acesso às indispensáveis terapias, prometidas pelas pesquisas. Assim, a falácia terapêutica torna-se um modo de justificar a negativa de oferecer benefícios médicos aos recrutados constituindo viés de transgressão ética, especialmente nos países nos quais o participante não tem expectativa de tratamento. Esta justificada expectativa daqueles que ingressam em estudos clínicos randomizados constitui argumento adicional contra o uso de placebo.

The therapeutic misconception has been described as the ?research subjects? unwarranted expectations of obtaining medical benefits by participating in clinical trials. Thus, researchers have found a new conceptual instrument to deny that research ought to be of benefit to subjects involved, once again disregarding the difference between therapeutic and non therapeutic clinical trials. This paper argues that patients involved in research are justified and in fact entitled to expect therapeutic benefits from their participation in research protocols, because the sick should only be recruited for such therapeutic trials as designed to improve their medical condition, and ought never to be involved in non therapeutic research and the risks involved. Insisting that therapeutic expectations research subjects constitute a misguided and erroneous attitude, is an unethical bias when applied to countries with precarious medical services. Subjects with unmet medical needs will willingly participate in research that might be the only way of obtaining badly required medication, an expectation that is obviously understandable and in no way fallacious. These justified expectations will be thwarted in those who randomly fall into the control group, thus delivering an additional argument against the use of placebos.

Consideraciones bioéticas sobre la ley de derechos y deberes en atención de salud / Discussion of some aspects of the law on rights and duties in health care

Se analiza la recientemente despachada, pero aún no promulgada Ley sobre derechos y deberes en atención de salud, cuya principal debilidad es fundarse en un derecho constitucional de protección de salud que carece de la especificidad necesaria para establecer las obligaciones del Estado en otorgar atención médica para la ciudadanía. La Ley se limita a establecer y delimitar algunos derechos de pacientes hospitalizados, en lo principal haciendo depender las obligaciones de “prestadores” de ser cumplidas en respuesta al reclamo de derechos por los pacientes. Los derechos detallados son de muy dispar envergadura, algunos de ellos no siendo más que normas reglamentarias, en tanto faltan los explícitos compromisos y garantías de cubrir los costos de medicamentos, insumos y procedimientos necesarios para otorgar atención médica esencial. La ciudadanía tiene un gasto de bolsillo en salud muy alto (40 por ciento), sin que aparezca en la presente ley un derecho a subvenciones, coberturas o regulaciones que amparen al paciente de los avatares del mercado sanitario. La autonomía del paciente es explícitamente reconocida, pero se condiciona y limita según criterios que no concuerdan con la Declaración de Lisboa ni con propuestas bioéticas ampliamente aceptadas.

The recently presented law on rights and duties in health care is analyzed and found wanting, firstly because it is based on a constitutional right to health protection that lacks specification as to the State’s duties in providing health care to its citizens. In fact, the law goes no further than establishing some rights of patients receiving hospital care, where the duties of health care providers are presented as responses to patients’ rights claims. The law discusses rights of diverse importance, some of which only require institutional regulations and ordinance, but fails to focus on warranting access to medication and procedures required to provide essential medical care. In a country where health-related out-of-pocket payment is extremely high (up to 40 percent), the present law fails to mention subsidies, coverage or regulations that ought to protect patients from the vagaries of the health market. Patient autonomy is explicitly acknowledged, but then limited and conditioned under criteria that ignore the Declaration of Lisbon and widely accepted bioethical proposals.

Conocen los usuarios sus deberes y derechos?: una evaluación posterior a una intervención / Do the users know their rights and responsibilities?: a post-intervention evaluation

Introduccion: Los derechos y deberes de los enfermos son un factor fundamental en un sistema de salud y un indicador de la calidad del servicio, por tal motivo, las instituciones prestadoras de servicios de salud tienen la responsabilidad de promover su conocimiento, no sólo en el personal asistencial y administrativo, sino también en sus usuarios, a fin de que ellos puedan exigir el cumplimiento de los mismos. Objetivo: Determinar el nivel de conocimiento de los usuarios sobre sus derechos y deberes en una institución de salud de Tercer Nivel de atención. Materiales y métodos: Se realizó un estudio descriptivo de corte trasversal luego de la implementación de un proyecto educativo que buscaba socializar entre los usuarios sus derechos y deberes. Se calculó un tamaño muestral de 369 usuarios, con un nivel de confianza del 95,0%, poder estadístico del 80,0%, prevalencia esperada de buenos conocimientos del 50,0%, y un IC 95% (45,0-55,0%). Se realizó muestreo aleatorio simple. Se solicito consentimiento informado a todos los participantes. Resultados: El 54,7% de los usuarios tenía un nivel de conocimiento bueno, el 40,5% regular y el 4,8% deficiente. El nivel de conocimientos fue mayor, con respecto a una encuesta anterior. El 10,9% de los usuarios manifestaron que habían recibido información sobre sus derechos y deberes, y de estos el 40,4% la recibieron en la ESE-HUS. Conclusiones: En su mayoría, los usuarios tenían un buen nivel de conocimientos sobre derechos y deberes de los enfermos, a pesar de no haber recibido información sobre el tema.

Introduction: Patients’ rights and responsibilities are a fundamental factor in health system and a service quality indicator of the service, for that reason, health-care institutions have the responsibility to promote ther awareness not only among health-care and management staff, but also in their users, so that these could deman their compliance. Objective: To determine the users’ level of knowledge or awareness in terms of their rights and responsibilities in a Third-Level health-care institution. Materials and methods: A transversal cut descriptive study was conducted after implementation of an educational project aimed to socialize users’ rights and obligations among patient population. A sample group of 369 users was calculated, with 95.0%, trust level, 80.0% statistical power, 50.0% expected awareness prevalence, and 95.0% (45.0-55.0%) IC. Simple random sampling was conducted. Consent in writing was obtained from all participants. Results: Fifty four point seven (54.7%) of users had good awareness level, with 40.5% acceptable and 4.8% deficient. Awareness level was higher than that for a previous sampling. 10.9% of users stated having received information regarding their rights and responsibilities, of which 40.4% obtained their knowledge at the ESE-HUS. Conclusions: Most users showed good patient’s rights and responsibilities awareness levels, despite the fact that they had not received information in that respect.

El acceso a los logros de la ciencia como tema bioético / O acesso a os benefícios da ciência como tema bioético / The access to the achievements of science as a bioethical topic

De diversos foros se vem reclamando como tema central na agenda dos países subdesenvolvidos a repartição equitativa de benefícios da ciência. Hoje o mundo vive um processo notável no que se refere ao avanço das ciências e tecnologias. Não obstante, os benefícios que deles derivam seconcentram no Norte. A iniquidade na repartição de benefícios aumenta o hiato que separa os países desenvolvidos dos subdesenvolvidos, o que, em definitivo, impõe maior dependência. Isto, além de ser um problema político, tem profundas implicações bioéticas, o que justifica que aDeclaração Universal sobre Bioética e Direitos Humanos da Unesco, de 2005, se refira reiteradamente a ele. A privatização e a mercantilização do conhecimento conspiram decididamente contra o desenvolvimento econômico e humano do Sul, vulnerando o nível de vida de suas populações.

Desde diversos foros se viene reclamando como un tema central en la agenda de los países subdesarrollados el reparto equitativo de los beneficios de la ciencia. Hoy el mundo vive un proceso notable en lo que se refiere al avance de las ciencias y las tecnologías. No obstante, losbeneficios que de ello derivan se concentran en el Norte. La inequidad en el reparto de los beneficios acrecienta la brecha que separa a los países desarrollados de los subdesarrollados, lo que en definitiva impone una mayor dependencia. Esto, a la par de ser un problema político tieneprofundas implicancias bioéticas, lo que justifica que la Declaración Universal de la UNESCO de 2005 se refiera reiteradamente a él. La privatización y la mercantilización del conocimiento conspiran decididamente contra el desarrollo económico y humano del Sur, vulnerando el nivel de vida de sus pobladores.

In many forums has been claimed the need of establishing as a central topic in the agenda of the underdeveloped countries the equitable distribution of the benefits of science. Nowadays, the world is enjoying a remarkable process about science and technology progress. Nevertheless, benefits yielded from it concentrate in the North. The inequity in the distribution of benefits increases the gap between developed and underdeveloped countries, which ultimately causes greater dependence. This, besides being a political problem has also deep consequences for bioethics, which justifies UNESCO?s Universal Declaration on Bioethics of 2005 referring to it repeatedly. The mercantile approach and privatization of knowledge strongly conspire against economic and human development in the South, infringing the standard of living of its people.

Mexican American Adolescents' Family Caregiving: Selection Effects and Longitudinal Associations With Adjustment.

One hundred ten Mexican American adolescents (12 - 17 years) who provide infant care for their older sisters were studied to determine the effects of family caregiving responsibilities on adolescents' adjustment. Controlling for prior adjustment and family context factors, providing many hours of caregiving predicted an increase in youths' school absences and disciplinary problems. Frequent conflict surrounding caregiving was associated with increased stress and depression and lower school grades. Older girls appear to select into caregiving and experience the most problematic outcomes. Strong family obligations were not protective against caregiving stress but, rather, further compromised youths' well-being for those who were highly involved in their family's care.

Pobreza e direitos humanos: da mera retórica às obrigações jurídicas - um estudo crítico sobre diferentes modelos conceituais / Pobreza y derechos humanos: desde la retórica a las obligaciones legales - una descripción crítica de los marcos conceptuales / Poverty and human rights: from rhetoric to legal obligations a critical account of conceptual frameworks

Definir a pobreza como uma violação de direitos humanos envolve conceitos ainda pouco claros. Isto é especialmente problemático para aqueles que trabalham em direitos humanos e levam a sério a indivisibilidade própria destes direitos; para aqueles que procuram entender o papel central da pobreza no sofrimento de muitas vítimas de direitos humanos e se preocupam em atuar de maneira profissional neste tema, utilizando como ferramenta na luta contra a pobreza as obrigações vinculantes em direitos humanos já reconhecidas internacionalmente. O presente artigo procura esclarecer esta lacuna conceitual, apresentando um resumo crítico das principais propostas para elucidar, a partir de uma perspectiva jurídica dos direitos humanos, os conceitos pertinentes à relação entre pobreza e direitos humanos. Este artigo identifica três formas distintas de relacionar estes conceitos: (1) teorias que concebem a pobreza, por si só, como uma violação de direitos humanos; (2) teorias que definem a pobreza como uma violação de um direito humano específico, a saber, o direito a um nível de vida adequado ou o direito ao desenvolvimento; e (3) teorias que consideram a pobreza como causa ou conseqüência de violações de direitos humanos. Defenderei, em minha conclusão, que a terceira abordagem é a mais útil diante do atual estágio do Direito e da jurisprudência internacional de direitos humanos. A segunda perspectiva, no entanto, tende fortemente a promover o debate sobre pobreza e direitos humanos e, portanto, deveria ser melhor elaborada.

There is still lack of conceptual clarity in the notion of poverty as a violation of human rights. This is a problem for human rights practitioners that take the indivisibility of human rights seriously, understand the centrality of poverty in the plight of many human rights victims and want to work professionally, through binding internationally recognized human rights obligations, in the fight against poverty. This paper tries to clarify the conceptual gap. It presents a critical summary of the most important attempts to conceptually clarify the connection between poverty and human rights from an international human rights law perspective. It analyzes different conceptual frameworks, their strengths and weaknesses. The paper identifies three different models for linking both concepts: (1) theories that conceive poverty as per se a violation of human rights; (2) theories that conceptualize poverty as a violation of one specific human right, namely the right to an adequate standard of living or to development; and (3) theories that conceive poverty as a cause or consequence of human rights violations. The paper concludes that the third approach is the most useful in the current state of development of international human rights law and jurisprudence, but that the second approach has a lot of potential to push the poverty and human rights agenda forward and it should be developed further.

Todavía hay una falta de claridad conceptual en la noción de la pobreza como violación a los derechos humanos. Esto es un problema para los abogados de derechos humanos que se toman en serio la indivisibilidad de los derechos humanos, que entienden la centralidad de la pobreza en la situación apremiante de muchas víctimas de violaciones a los derechos humanos y que quieren trabajar de manera profesional, a través de las obligaciones vinculantes de derechos humanos reconocidas internacionalmente, en la lucha contra la pobreza. Este artículo intenta clarificar el vacío conceptual. Presenta un resumen crítico de los intentos más importantes de clarificar la conexión entre pobreza y derechos humanos desde la perspectiva del derecho internacional de los derechos humanos. Analiza diferentes marcos conceptuales, sus fortalezas y sus debilidades. El artículo identifica tres modelos diferentes para vincular ambos conceptos: (1) teorías que conciben a la pobreza como una violación de derechos humanos en sí misma; (2) teorías que conceptualizan a la pobreza como una violación a un derecho humano específico, a saber el derecho a un nivel adecuado de vida o al desarrollo; y (3) teorías que conciben a la pobreza como una causa o consecuencia de violaciones a los derechos humanos. El ensayo concluye que el tercer enfoque es el más útil en el estado actual de desarrollo del derecho y la jurisprudencia internacional de los derechos humanos, pero que el segundo enfoque tiene mucho potencial para empujar hacia adelante la agenda de pobreza y derechos humanos y que debe continuar siendo desarrollada.