[The challenges of the ethics of personalism to clinical toxicology]. / Etyka personalistyczna wobec wyzwan toksykologii klinicznej.

The fields of philosophical anthropology and the ethics of personalism overlap in the area of many difficult personal situations involving clinical toxicology. These therapeutic situations need an integral, multidimensional, and personal approach for both the patient and the toxicologist. This means that man is treated not only as a physical (biological) being but also there is an appreciation for the mental sphere, which includes rational, emotional, and spiritual elements while not forgetting that the human person is also part of the human community. Studying such an individual's personal decision as suicide, we must realize that it's not just physiological or biochemical poisons but also includes the poisoning of the psyche, as well as poisoning relationships with loved ones (family), poisoning social relations (in school or the workplace) and poisoning the spirit, in other words, there is no meaning in life itself, nor the meaning of God's existence, nor the meaning of faith, hope and love. Not only is there a greater "variety of poisons" than before, they are much more extensive and deep. For example, we can name environmental pollution, industrial poisons, chemical waste, genetic modification, powerful medications, or even the toxic social environment of evil ideas, malicious manipulation of the human mind (destructive religious sects). In approaching the challenges of clinical toxicology, the doctor must not only be a specialist in chemistry, biochemistry and pharmacology. What then is of future of toxicology because of this human dimension (anthropological, ethical and spiritual) of this teaching? As today marks the occasion of the 45th anniversary of the Clinic of Toxicology CM UJ, should we shape the ethos of young doctors who want to deal with toxicology seriously?

Pesquisa de alcoholismo y análisis bioético del daño que representa en una población cubana / Screening of alcoholism and bioethical analysis of damage provoked in Cuban population

OBJETIVO: Realizar un análisis bioético de las personas que ingieren bebidas alcohólicas, encontradas al pesquisar una población cubana. MÉTODOS: El estudio realizado fue observacional, descriptivo y longitudinal. Se aplicó una encuesta original elaborada por los autores y validada por psicólogos y psiquiatras, para medir los conocimientos generales acerca del alcoholismo y los aspectos bioéticos, a 200 personas con más de 15 años, pertenecientes al consultorio del médico de familia No. 13. Para el pesquisaje masivo de alcoholismo se utilizaron cuestionarios, como son: el Cuestionario de Identificaciones Diagnósticas y la prueba de Chronic Alcoholism General Evaluation. Los pacientes con consumo perjudicial y dependencia alcohólica son tratados por el médico de la familia, la psiquiatra y los trabajadores sociales que previamente son entrenados por estos, lo cual es un trabajo novedoso en nuestro país, que tiene una gran repercusión social. RESULTADOS: El sexo masculino se ha comportado como el mayor consumidor de alcohol, ya que el 12,5 por ciento de los hombres tiene un consumo dañino y el 15 por ciento un consumo de riesgo, y en las mujeres solo el 0,5 por ciento tiene un consumo de riesgo. El 62 por ciento (134 personas) del total de la población, considera que el alcoholismo es una enfermedad. El 75 por ciento de la población, considera que los pacientes que ingieren bebidas alcohólicas son discriminados socialmente. CONCLUSIONES: Los resultados obtenidos por los cuestionarios son bastantes similares, lo cual corrobora la eficiencia de estos. Los principios bioéticos son violados debido a la discriminación hacia los pacientes afectados por el alcohol. El trabajo de conjunto con los trabajadores sociales tiene una gran repercusión social, en el caso que nos ocupa se obtuvieron muy buenos resultados con la intervención de estos(AU)

OBJECTIVE: To carry out a bioethical analysis of persons consuming alcohol founded at the screening of Cuban population. METHODS: A longitudinal, descriptive and observational study was conducted as well as the implementation of a original survey designed by authors validated by psychologists and psychiatrists to measure the general knowledges on the alcoholism and the bioethical features and applied in 200 persons aged over 15 from the No. 13 family physician consulting room. For massive screening of alcoholism authors used questionnaires including: the Questionnaire of Diagnostic Identifications and the Chronic Alcoholism General Evaluation. Patients with a harmful consumption and alcoholic dependence are treated by family physician, the psychiatrist and the social workers with previously are trained by this specialists, being a novel work in our country and a with a significant social repercussion. RESULTS: The male sex has been the greater consumer of alcohol since the 12.5 percent of men has a harmful consumption and the 15 percent a risk consumption and in the women only the 0.5 percent has a risk consumption. The 62 percent (134 persons) of total population considers that alcoholism is a disease. The 75 percent of population considers that the patients consuming alcohol are socially discriminate. CONCLUSIONS: The results obtained by questionnaires are very similar, corroborating its effectiveness. The main bioethical principles are infringed due to discrimination of patients affected by alcohol. The joint work with social workers has a significant social repercussion; in present case it was possible to obtain good results with their intervention(AU)

Pesquisa de alcoholismo y análisis bioético del daño que representa en una población cubana / Screening of alcoholism and bioethical analysis of damage provoked in Cuban population

OBJETIVO: Realizar un análisis bioético de las personas que ingieren bebidas alcohólicas, encontradas al pesquisar una población cubana. MÉTODOS: El estudio realizado fue observacional, descriptivo y longitudinal. Se aplicó una encuesta original elaborada por los autores y validada por psicólogos y psiquiatras, para medir los conocimientos generales acerca del alcoholismo y los aspectos bioéticos, a 200 personas con más de 15 años, pertenecientes al consultorio del médico de familia No. 13. Para el pesquisaje masivo de alcoholismo se utilizaron cuestionarios, como son: el Cuestionario de Identificaciones Diagnósticas y la prueba de Chronic Alcoholism General Evaluation. Los pacientes con consumo perjudicial y dependencia alcohólica son tratados por el médico de la familia, la psiquiatra y los trabajadores sociales que previamente son entrenados por estos, lo cual es un trabajo novedoso en nuestro país, que tiene una gran repercusión social. RESULTADOS: El sexo masculino se ha comportado como el mayor consumidor de alcohol, ya que el 12,5 por ciento de los hombres tiene un consumo dañino y el 15 por ciento un consumo de riesgo, y en las mujeres solo el 0,5 por ciento tiene un consumo de riesgo. El 62 por ciento (134 personas) del total de la población, considera que el alcoholismo es una enfermedad. El 75 por ciento de la población, considera que los pacientes que ingieren bebidas alcohólicas son discriminados socialmente. CONCLUSIONES: Los resultados obtenidos por los cuestionarios son bastantes similares, lo cual corrobora la eficiencia de estos. Los principios bioéticos son violados debido a la discriminación hacia los pacientes afectados por el alcohol. El trabajo de conjunto con los trabajadores sociales tiene una gran repercusión social, en el caso que nos ocupa se obtuvieron muy buenos resultados con la intervención de estos

OBJECTIVE: To carry out a bioethical analysis of persons consuming alcohol founded at the screening of Cuban population. METHODS: A longitudinal, descriptive and observational study was conducted as well as the implementation of a original survey designed by authors validated by psychologists and psychiatrists to measure the general knowledges on the alcoholism and the bioethical features and applied in 200 persons aged over 15 from the No. 13 family physician consulting room. For massive screening of alcoholism authors used questionnaires including: the Questionnaire of Diagnostic Identifications and the Chronic Alcoholism General Evaluation. Patients with a harmful consumption and alcoholic dependence are treated by family physician, the psychiatrist and the social workers with previously are trained by this specialists, being a novel work in our country and a with a significant social repercussion. RESULTS: The male sex has been the greater consumer of alcohol since the 12.5 percent of men has a harmful consumption and the 15 percent a risk consumption and in the women only the 0.5 percent has a risk consumption. The 62 percent (134 persons) of total population considers that alcoholism is a disease. The 75 percent of population considers that the patients consuming alcohol are socially discriminate. CONCLUSIONS: The results obtained by questionnaires are very similar, corroborating its effectiveness. The main bioethical principles are infringed due to discrimination of patients affected by alcohol. The joint work with social workers has a significant social repercussion; in present case it was possible to obtain good results with their intervention

Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?

BACKGROUND: Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. OBJECTIVES: The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. METHODS: Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. RESULTS: With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of 'need' is transformed into the principle of 'economic demand'. CONCLUSION: Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

The struggle for dignity by people with severe functional disabilities.

The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.