Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches.

Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the reexamination of assumptions and practices under pinning global health partnerships. Medicine's role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs. Additionally, research partnerships often benefit the better-resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how "decolonized" perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transfor mative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.

Dermatological games: Part 2. What has changed 40 years on?

In this two-part report, we review and critically appraise 'Dermatological games' by J. A. Cotterill, a seminal article published in 1981, which attempted to explain the interaction between dermatologists and patients using Berne's game theory. Part 1 described and critically appraised the educational value of Cotterill's original list of games in relation to how they apply to dermatology practice. In Part 2, a list of new 'games' that might be observed in current dermatological practice is introduced. The relevance of Cotterill's paper and an explanation for why his article remains relevant to dermatology practice and training today is scrutinized, in order to stimulate discussion and improve patient care.

O papel da argumentação em processos deliberativos nas instâncias de controle social do Sistema Único de Saúde / Role of argumentation in deliberative processes in social control instances of the Brazilian National Health System / El papel de la argumentación en procesos deliberativos en las instancias de control social del Sistema Brasileño de Salud

Este artigo tem como objetivo discutir teoricamente o papel da argumentação nos processos deliberativos que se dão no interior das instâncias colegiadas de controle social do Sistema Único de Saúde (SUS). Baseia-se em uma leitura dos processos de participação social em saúde a partir da Teoria do Agir Comunicativo e localiza a deliberação pública dentro de um arcabouço dialógico de oferecer e receber razões para justificar posições a partir de argumentos. Defende-se que a argumentação é constitutiva da deliberação na medida em que a qualidade da primeira influencia a qualidade da segunda. Apresentam-se duas grandes correntes contemporâneas da teoria da argumentação, a Pragma-Dialética e a Nova Retórica. Defende-se uma combinação das duas abordagens como ferramenta para a compreensão dos determinantes comunicativos da deliberação e, consequentemente, para melhor entendimento das escolhas feitas no processo de formulação e implantação de políticas públicas de saúde.(AU)

This article aims at theoretically discussing the role of argumentation in deliberative processes that occur in social control board instances of the Brazilian National Health System (SUS). Social health participation processes were analyzed based on the Theory of Communicative Action. This article considers public deliberation under a dialogic framework of providing and receiving reasons to justify opinions based on arguments. We support that argumentation is part of deliberation, since the quality of the former influences the quality of the latter. Two great contemporary currents of the Argumentation Theory are presented: Pragma-Dialectics and New Rhetoric. We argue that a combination of both approaches helps understand deliberation's communicative determinants and consequently further understand the choices made in the process of creation and implementation of public health policies.(AU)

El objetivo de este artículo es discutir teóricamente el papel de la argumentación en los procesos deliberativos que se realizan en el interior de las instancias colegiadas de control social del Sitema Brasileño de Salud (SUS). Se basa en una lectura de los procesos de participación social en salud a partir de la Teoría del Actuar Comunicativo y localiza la deliberación pública dentro de una estructura dialógica de ofrecer y recibir razones para justificar posiciones a partir de argumentos. Se defiende que la argumentación es constitutiva de la deliberación en la medida en que la calidad de la primera influye sobre la calidad de la segunda. Se presentan dos grandes corrientes contemporáneas de la teoría de la argumentación, la Pragma-dialéctica y la Nueva Retórica. Se defiende una combinación de los dos abordajes como herramienta para la comprensión de los determinantes comunicativos de la deliberación y, consecuentemente, para un mejor entendimiento de las elecciones realizadas en el proceso de formulación e implantación de políticas públicas de salud.(AU)

Traducir el pensamiento en acción: Interfaces cerebro-máquina y el problema ético de la agencia / Translating thought into action: brain-computer interfaces and the ethical problem of agency / Traduir el pensament en acció: Interfícies cervell-màquina i el problema ètic de l'agència

En este artículo, nos proponemos dos objetivos: el primero, describir la teoría clásica de la agencia intencional y cómo la neurotecnología de las interfaces cerebro-máquina desafía los requisitos de la teoría clásica de la agencia y de la consciencia corporal. La neurotecnología de las interfaces cerebro-máquina funciona implantando electrodos directamente en el área de la corteza motora del cerebro que controla el movimiento, y está diseñada para detectar las señales neuronales asociadas con la intención de moverse, que son después decodificadas por un algoritmo en un computador en tiempo real. Así, una persona podría pensar en mover su pierna o su brazo y la máquina recibiría la información de su pensamiento para traducir el pensamiento en acción, mediante prótesis internas o exoesqueletos. Esto es posible y sus aplicaciones se proyectan tanto sobre la rehabilitación de la funcionalidad motora, como sobre la posibilidad de mejoramiento (enhancement) de las capacidades humanas. Ambas aplicaciones dan lugar a numerosas implicaciones éticas, pero destacamos principalmente una, que denominamos: el problema ético de la agencia. El segundo objetivo del artículo es explorar brevemente la ética algorítmica en el contexto de las interfaces cerebro-máquina y cómo se entienden en este ámbito la autonomía, la responsabilidad y la privacidad informacional. Finalmente, abogamos por la necesidad de un marco ético de principios que regule la neurotecnología, y en tal sentido apelamos a los nuevos neuroderechos

The aim of this article is twofold: Firstly, we intend to describe the classical theory of intentional agency and to analyze how the neuro-technology of brain-machine interfaces (BCI) challenges the demands of that classical theory of agency and body consciousness. BCI neuro-technology works by implanting electrodes directly into the motor brain cortex that controls movement and detect neuronal signals associated with the intention to move, what is decoded by an algorithm on a computer in real time. Thus, someone could simply think about moving a leg or an arm and the tool (a prosthesis or exoskeleton) would receive the information to translate thought into action. This is yet feasible and its applications could involve rehabilitation of motor function and the possibility of enhancing human abilities. Both applications give rise to various several ethical implications but mainly to one that we call "the ethical problem of agency". Secondly, we briefly explore the ethics of algorithms in the context of BCI neuro-technology and the way autonomy, responsibility, and informational privacy are understood. Finally, we advocate the need for an ethical framework of principles governing neuro-technology, such as the new neuro-rights

En aquest article, ens proposem dos objectius: el primer, descriure la teoria clàssica de l'agència intencional i com la neurotecnologia de les interfícies cervell-màquina desafia els requisits de la teoria clàssica de l'agència i de la consciència corporal. La neurotecnologia de les interfícies cervell-màquina funciona implantant elèctrodes directament en l'àrea de l'escorça motora del cervell que controla el moviment, i està dissenyada per a detectar els senyals neuronals associades amb la intenció de moure's, que són després decodificades per un algoritme en un computador en temps real. Així, una persona podria pensar a moure la seva cama o el seu braç i la màquina rebria la informació del seu pensament per a traduir el pensament en acció, mitjançant pròtesis internes o exoesquelets. Això és possible i les seves aplicacions es projecten tant sobre la rehabilitació de la funcionalitat motora, com sobre la possibilitat de millorament (enhancement) de les capacitats humanes. Totes dues aplicacions donen lloc a nombroses implicacions ètiques, però destaquem principalment una, que denominem: el problema ètic de l'agència. El segon objectiu de l'article és explorar breument l'ètica algorítmica en el context de les interfícies cervell-màquina i com s'entenen en aquest àmbit l'autonomia, la responsabilitat i la privacitat informacional. Finalment, advoquem per la necessitat d'un marc ètic de principis que reguli la neurotecnologia, i en tal sentit apel·lem als nous neuro-drets

Ethics and HIV prevention research: An analysis of the early tenofovir PrEP trial in Nigeria.

In 2004, the first ever multi-sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre-exposure prophylaxis-'PrEP'). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and protocol. While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized.

Los niños y la comprensión del mundo mental de los otros: Teorías explicativas / Children and their understanding in relation with others' mental world: Explanatory Theories

Resumen El objetivo del artículo consistió en revisar, desde el punto de vista teórico, los planteamientos filosóficos y psicológicos que han servido de base para comprender la mente de los Otros por parte de los niños. Se inicia con el concepto de intencionalidad de Brentano (1874-1995), el cual diferencia el mundo físico del mental asumiendo que la mente necesita de objetos para funcionar. Desde la psicología, se abordaron tres teorías: (a) la Teoría de la Simulación o perspectiva de la Primera Persona, propuesta por Gordon (1992), Goldman (1993), Jhonson (1988) y Harris (1995); (b) la Teoría-Teoría o perspectiva de la Tercera Persona, propuesta por Baron-Cohen (2000), Leslie (1987) y Wellman (1995/1990), entre otros, y finalmente, (c) la Teoría de la Intersubjetividad propuesta por Trevarthen (1974, 1979, 1998) como preámbulo a la propuesta de Gómez (1998, 2005) y de Reddy (2008), denominada la perspectiva de la Segunda Persona. Los debates entre estas perspectivas permiten analizar sus diferencias, aportando la posibilidad de enriquecer la mirada acerca de la comprensión de las otras mentes en los niños. En conclusión, se comprende que la teoría de la mente es un concepto que se ha estudiado desde diferentes ópticas, todas las cuales se relacionan a su vez con el concepto de mente. Palabras clave: mente, teoría de la mente, estados mentales, desarrollo cognitivo, filosofía de la mente.

Abstract This paper aims to review the philosophical and psychological approaches as basis for the study related to the ability to understand others' minds by children, based on a theoretical point of views. This paper begins establishing differences between physical and mental world based on the idea that the mind need objects in order to function, according to the concept of intentionality conducted by Brentano (1874/1995). From the psychology point of view three theories are addressed: (a) The Simulation Theory or First Person perspective, introduced by Gordon (1992), Goldman (1993), Jhonson (1988) and Harris (1995); (b) TheoryTheory or Third Person perspective, introduced by Baron-Cohen (2000), Leslie (1987) and Wellman (1995/1990) among others and finally (c) The Intersubjectivity theory introduced by Trevarthen (1974, 1976, 1979, 1998) as a preamble of the proposal introduced by Gómez (1998, 2005) and Reddy (2008) called the Second Person perspective. Debates between these perspectives let us to analyze their differences and also, enrich our understanding of others' minds by children. As a conclusion, Theory of Mind has been studied based on different point of views related to the concept of mind.

El pensamiento ecoético de Robert Spaemann: ética de la benevolencia y cuidado del mundo natural / Thee coethical thought of Robert Spaemann: ethics of benevolence and thecare of the natural world

En este trabajo se pretende dar a conocer las reflexiones del filósofo alemán contemporáneo Robert Spaemann, en materia referente a ecología. Para ello, en primer lugar, se expone la categoría ética fundamental de su pensamiento (el amor benevolente), como extensible también al mundo natural. Seguidamente, abordaremos la propuesta de jerarquización universal de ese amor benevolente en el ordo amoris. Una vez tratado cómo ha de extenderse dicho amor racional para con todos los seres, expondremos su visión del mundo en dos posibles intereses de la razón: uno dominativo, otro, contemplativo. Finalmente, nos ocuparemos del concepto de Mitsein como propuesta para nuestro trato con el mundo natural que nos rodea

In this work we intend to show the reflections of the contemporary philosopher Robert Spaemann in what refers to ecology. For this reason, in first place, I will make use of the fundamental ethical category of his thought (benevolent love), as extensible also to the natural world. Following that, I will propose a universal hierarchy of the benevolent love in the ordo amoris. Once we have talked about how to extend this rational love to all beings, I will present Spaemann’s view of the world based on two interests of the reason: one dominative and the other one contemplative. To end, I will explain the concept of Mitsein as a proposal for our interaction with the surrounding world

El pensamiento ético de José Martí en la formación del médico cubano / The ethical thought of José Marti in the training of the Cuban physician

RESUMEN El pensamiento ético de José Martí juega un papel fundamental en la formación integral de las nuevas generaciones de profesionales de la salud. Este trabajo analiza varias ideas martianas acerca del humanismo, la solidaridad y la moral, a la luz de las actuales necesidades de la formación de estos profesionales en Cuba. La aplicación creadora de su pensamiento humanista en las nuevas circunstancias históricas demanda un mayor esfuerzo por parte de los educadores (AU).

ABSTRACT The ethical thought of José Marti plays an important role in the professional training of the new generations of health professionals. This work analyses several Jose Marti's ideas on humanism, solidarity and moral values, in the light of the current necessities of these professionals´ training in Cuba. The creative application of his humanist thought in the new historical circumstances demands a greater effort of the educators (AU).

El pensamiento ético de José Martí en la formación del médico cubano / The ethical thought of José Marti in the training of the Cuban physician

RESUMEN El pensamiento ético de José Martí juega un papel fundamental en la formación integral de las nuevas generaciones de profesionales de la salud. Este trabajo analiza varias ideas martianas acerca del humanismo, la solidaridad y la moral, a la luz de las actuales necesidades de la formación de estos profesionales en Cuba. La aplicación creadora de su pensamiento humanista en las nuevas circunstancias históricas demanda un mayor esfuerzo por parte de los educadores (AU).

ABSTRACT The ethical thought of José Marti plays an important role in the professional training of the new generations of health professionals. This work analyses several Jose Marti's ideas on humanism, solidarity and moral values, in the light of the current necessities of these professionals´ training in Cuba. The creative application of his humanist thought in the new historical circumstances demands a greater effort of the educators (AU).

Percepciones de los estudiantes sobre el desarrollo del pensamiento crítico-reflexivo a través del portafolio de prácticas / Perceptions of Students about the Development of Critical-Reflective Thinking through the Portfolio of Practices / Percepções dos alunos sobre o desenvolvimento do pensamento crítico-reflexivo através da sua carteira de práticas

Introducción: la formación y adquisición de pensamiento crítico-reflexivo en los estudiantes de enfermería es fundamental para formar profesionales reflexivos, donde las intervenciones y acciones son resultado de la interrogación constante y del pensamiento crítico, para adquirir el principio de aprender a aprender. Uno de los métodos que han surgido para fomentar cualquier modalidad de pensamiento crítico-reflexivo en los estudiantes es el portafolio. Objetivo: conocer las percepciones de los estudiantes sobre el desarrollo del pensamiento crítico-reflexivo a través del portafolio de prácticas. Material y métodos: estudio descriptivo cualitativo. La recolección de los datos se realizó a través de los portafolios y los cuestionarios de los estudiantes de Enfermería de cuarto curso de la Escuela Universitaria de Enfermería Cruz Roja, que realizaron prácticas durante 2013-2014. Los resultados se examinaron con el análisis de contenido. Resultados: los estudiantes consideran que el pensamiento crítico generado al realizar el portafolio les ayuda principalmente para el razonamiento reflexivo en la acción y también a integrar el conocimiento. Conclusiones: los estudiantes perciben que el pensamiento crítico-reflexivo constituye un instrumento esencial en el proceso de superación de contradicciones que se encuentran presentes en los procesos de enseñanza-aprendizaje durante sus prácticas clínicas.

Introduction: Training and acquisition of critical-reflective thinking in nursing students is essential to form reflective practitioners, where interventions and actions are the result of constant questioning and critical thinking, to acquire the principle of learning to learn. One of the methods that have emerged to encourage any form of reflective critical thinking in students is the portfolio. Objective: To know the perceptions of students about the development of critical-reflective thinking through the portfolio of practices. Material and Methods: A qualitative descriptive study. Data collection was conducted through questionnaires portfolios and nursing students of 4th year of the School of Nursing Red Cross, who conducted practices during course 2013-2014. The results were analyzed using content analysis. Results: Students consider that critical thinking generated when performing portfolio, helps them mainly for reflective thinking in action and also to integrate knowledge. Conclusions: Students perceive that the critical-reflective thinking is an essential tool in the process of overcoming contradictions that are present in the teaching and learning processes during their clinical practice.

Introdução: formação e aquisição de pensamento crítico-reflexivo em estudantes de enfermagem é essencial para formar profissionais reflexivos, onde as intervenções e ações são o resultado da constante questionamento e pensamento crítico, para adquirir o princípio de aprender a aprender. Um dos métodos que surgiram para encorajar qualquer forma de pensamento crítico reflexivo em estudantes é a carteira. Objetivo: conhecer a percepção dos estudantes sobre o desenvolvimento do pensamento crítico-reflexivo através da sua carteira de práticas. Material e Métodos: estudo descritivo, qualitativo. A coleta de dados foi realizada por meio de questionários carteiras e estudantes de enfermagem de 4o ano da Escola de Enfermagem da Cruz Vermelha, que conduziu práticas durante o curso 2013-2014. Os resultados foram analisados por meio de análise de conteúdo. Resultados: Os alunos consideram que o pensamento crítico gerado durante a execução da carteira, ajuda-os principalmente para o aprofundamento da reflexão em ação e também para integrar o conhecimento. Conclusões: os alunos percebem que o pensamento crítico-reflexivo é uma ferramenta essencial no processo de superação das contradições que estão presentes em processos de ensino e aprendizagem durante a sua prática clínica.

Ética de la investigación desde el pensamiento indígena: derechos colectivos y el principio de la comunalidad / Ethics of research from indigenous thinking: collective rights and the principle of comunalidad / Ètica de la investigació des del pensament indígena: drets col·lectius i el principi de la comunalitat

Desde hace unas décadas, son frecuentes las investigaciones científicas con pueblos indígenas en diversos campos del conocimiento: cuestiones genéticas, lingüísticas, jurídicas, etnográficas, investigaciones sobre sus plantas medicinales, sus ritos y tradiciones, entre otras. Es importante no solo abrir espacios de discusión y análisis para conocer aspectos regulatorios y éticos para su protección, sino para asumir dichas investigaciones desde sus cosmovisiones y epistemologías. Éstas son en esencia relacionales, con valores como pluralidad, diversidad, reciprocidad, complementariedad, compartencia. Todos estos valores se engloban en el principio de comunalidad, que reafirma la apuesta por los derechos colectivos de las poblaciones indígenas, más allá de la vivencia individual de los Derechos Humanos. Esta mirada diferente a la ética de la investigación es el objetivo de este artículo, como un campo aún por explorar

In the last few decades, scientific research with indigenous population has been more frequent in different fields: genetics, linguistics, legal, and ethnographic studies, research related to medicinal plants, their rites, and traditions, among others. For this reason it is important to know regulatory and ethical aspects for their protection, but also to assume these research from their world view and epistemologies. These are essentially relational, with values such as plurality, diversity, reciprocity, complementarity and sharing («compartencia»). All of these values are part of the commonality principle (comunalidad), which reaffirms the commitment to the collective rights of indigenous population, beyond the individual experiences of Human Rights. This different approach to research ethics is the objective of this article, as a field yet to explore

Des de fa dècades són freqüents les investigacions científiques amb poblacions indígenes en diversos camps del coneixement: qüestions genètiques, lingüístiques, jurídiques, etnogràfiques, investigacions sobre plantes medicinals, els seus rituals i tradicions, entre d’altres. És important no només obrir espais de discussió i anàlisi a fi de conèixer aspectes reguladors i ètics per a la seva protecció, sinó que cal, a més, plantejar aquestes investigacions des de les cosmovisions i epistemologies pròpies d’aquestes poblacions. Aquestes cosmovisions i epistemologies són, en essència, relacionals, i inclouen valors com ara la pluralitat, diversitat, reciprocitat, complementarietat i compartició. Tots aquests valors s’inclouen en el principi de comunalitat, que posa de relleu la defensa dels drets col·lectius de les poblacions indígenes, més enllà de la vivència individual dels Drets Humans. Aquesta mirada diferent en l’àmbit de l’ètica de la investigació és l’objectiu d’aquests article

Effect of a brief cognitive behavioural intervention on criminal thinking and prison misconduct in male inmates: Variable-oriented and person-oriented analyses.

BACKGROUND: There is some consensus on the value of cognitive-behaviourally informed interventions in the criminal justice system, but uncertainty about which components are of critical value. AIMS: To test the hypothesis that change in prisoners - criminal thinking and institutional misconduct - will both follow completion of a brief cognitive behavioural intervention. METHODS: A one-group pre-test-post-test quasi-experimental design was used to assess change on the General Criminal Thinking (GCT) scale of the Psychological Inventory of Criminal Thinking Styles among 219 male prisoners completing a 10-week cognitive behavioural intervention, referred to as 'Lifestyle Issues'. Institutional misconduct was measured for 1 year prior to completion of the course and 2 years subsequently. Using variable-oriented analysis, post-test GCT scores were compared with change in prison conduct, controlling for the pre-test thinking scores. Calculations were repeated by using person-oriented analysis. RESULTS: Prisoners who displayed a drop in GCT scores between pre-test and post-test levels were significantly more likely to show a reduction in prison misconduct, whereas prison misconduct was likely to escalate among those who displayed a rise in criminal thinking scores from pre-test to post-test. CONCLUSIONS: These findings must still be regarded as preliminary, but taken together with other work and with cognitive behavioural theory, they suggest that development of more prosocial thinking and abilities may have an early beneficial effect on institutional behaviour. Their measurement may offer a practical way in which men could be assessed for readiness to return to the community. Copyright © 2017 John Wiley & Sons, Ltd.

Ethics Teaching in Higher Education for Principled Reasoning: A Gateway for Reconciling Scientific Practice with Ethical Deliberation.

This paper proposes laying the groundwork for principled moral reasoning as a seminal goal of ethics interventions in higher education, and on this basis, makes a case for educating future specialists and professionals with a foundation in philosophical ethics. Identification of such a seminal goal is warranted by (1) the progressive dissociation of scientific practice and ethical deliberation since the onset of a problematic relationship between science and ethics around the mid-19th century, and (2) the extensive mistrust of integrating ethics in science and engineering curricula beyond its "applied," "practical," or "professional" implications. Although calls by international scientific and educational bodies to strengthen ethics teaching in scientific education over the past quarter century have brought about a notion of combining competence in a certain field with competence in ethics, this is neither entrenched in the academic community, nor fleshed out as regards its core or instruments to realize it. The legitimate goals of ethics teaching in higher education, almost settled since the 1980s, can be subsumed under the proposed seminal goal, and the latter also would safeguard content and methods of ethics interventions against the intrusion of indoctrinative approaches. In this paper, derivation of the proposed seminal goal rests on an interpretation of the Kohlbergian cognitive-developmental conception of moral adulthood consisting in autonomous principled moral reasoning. This interpretation involves, based on Kant's conception of the virtuous person, integrating questions about the "good life" into the domain of principled reasoning.