The COVID-19 pandemic has impacted medical care in many ways; previously, a patient would enter a hospital and had an approximate idea of what would happen upon his admission, the physician informed them about it, but in the last two years this scenario has changed. Therefore, our aim was to identify if bioethical principles are present in the physician–patient relationship and the effect of these in the health care provided, through an observational and descriptive study where patients answered the validated (...) ReMePaB questionnaire that measures the presence of bioethical principles in the physician–patient relationship, on the seventh day of their hospital stay and 24 h after discharge, during the period from 1 August to 5 November 2020. In autonomy, an improvement in the score was observed in the second application compared to the first measurement; in the principle of non-vulnerability, the same scenario was observed for the first and second measurements, respectively. In the principles of beneficence, dignity, and justice, no statistically significant differences were observed. Considering the presence or absence of bioethical aspects in health care in this pandemic creates an area of opportunity to know the feelings of the patient during the care received and to maintain what is done well and improve those aspects that can be improved. (shrink)

Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010–2021.Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, (...) and IBECS. Information was extracted on research characteristics, congruence, and associated factors.Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors, individual factors, and environmental factors.Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life. (shrink)

En países como Colombia la falta de cobertura, la dispersión geográfica y el conflicto armado se han posicionado como obstáculos que impiden que una parte de la población pueda acceder a la universidad, perpetuando las desigualdades y la vulnerabilidad. Los resultados de este estudio apuntan a que la educación superior virtual puede convertirse en una alternativa útil para ofrecer oportunidades de formación a estas poblaciones si se ofrecen las condiciones adecuadas en cuanto a un contenido útil y actual, atención personalizada (...) e infraestructura accesible. Las conclusiones alcanzadas pueden orientar a las Instituciones de Educación Superior (IES) en el diseño de estrategias virtuales de calidad. (shrink)

La educación superior virtual está creciendo significativamente y se caracteriza por la necesidad de articular eficazmente la tecnología y el proceso académico e instructivo. Este estudio ha tratado de analizar los requisitos para que las instituciones ofrezcan un servicio de calidad cercano a las necesidades de los estudiantes. Para ello, se aplicó una encuesta a una muestra aleatoria de 350 estudiantes. Los resultados confirmarían la fuerte asociación entre los factores relacionados con la infraestructura tecnológica, el servicio académico y el apoyo (...) institucional. Estos resultados pueden ser una referencia para tener en cuenta por las IES cuando planifican sus programas virtuales. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

After the end of their time as a caregiver, former caregivers have needs and feelings that have been subject to little study to date. The aim of the study is to determine and analyse the feelings, perceptions and practices of former caregivers in the reconstruction of their daily lives. This is a qualitative study based on the Grounded Theory developed by Charmaz. The study involved 14 former caregivers who had cared for their relative for more than 2 years and who (...) had stopped caring for them more than 2 years previously. Fourteen in-depth interviews were conducted and data were collected over 13 months between 2015 and 2017. Data were analysed using the Grounded Theory Method. In addition, this study was approved by the ethics committee of the Institut Universitari d’Investigació en Atenció Primària Jordi Gol. The former caregiver experiences a transition, which begins in the days before the death of their relative and may continue for more than 3 years. Three critical moments in the post-caring transition were found: the post-caring emptiness; the end of the period as a caregiver; and the movement towards a new life. Family and professional support is needed during this transition. Former caregivers experience a transition in the rebuilding of their daily lives; furthermore, former caregivers may be a source of support for other caregivers, which is linked to positive mental health factors. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health of former caregivers. (shrink)

While rooted in careful study of Mead’s original writings and transcribed lectures and the historical context in which that work was carried out, the papers in this volume have brought Mead’s work to bear on contemporary issues in metaphysics, epistemology, cognitive science, and social and political philosophy.

Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical (...) Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated. (shrink)

Background The COVID-19 pandemic has influenced the approach to the health-disease system, raising the question about the principles of bioethics present in physician–patient relations. The principles while widely accepted may not be sufficient for a comprehensive ethical analysis. Therefore, the aim of this study was to explore the perception of these principles and the physician–patient relationship during a hospital stay through a qualitative approach. Method Sixteen semi-structured interviews took place to know the patients’ perception during their 2020 hospitalization for COVID-19. (...) The data was analyzed through the constant comparison method, creating categories and comparing them. In the end, seven categories were established and were grouped in three: bioethical principles (dignity, charity, vulnerability, autonomy), doctor-patient relationship (participant commitment, informed consent, health staff-patient relationship) and the experience of the disease (illness, the role of the family). Results The research found that most patients described a positive experience, with the feeling of having been well cared for with no sense of discrimination or injustice done. The majority also reported that their autonomy was respected in the treatment decisions. The evaluation of these attitudes is an area of opportunity, especially when the patients' vulnerability is at risk. Conclusions The ethics of virtue offers a better reflection of how human beings manifest themselves by emphasizing the development of virtuous character and behaviors that allow them to realize their values in life. Authorized by the Research Ethics Committee with registration: DI/18/105-B/3/308. (shrink)

Regularization may be used as an alternative to dimensionality reduction when the number of variables in a model is much larger than the number of available observations. In a recent study from our group regularized regression was employed to quantify brain functional connectivity in a sample of healthy controls using a brain parcellation and resting state fMRI images. Here regularization is applied to evaluate resting state connectivity abnormalities at the voxel level in a sample of patients with schizophrenia. Specifically, ridge (...) regression is implemented with different degrees of regularization. Results are compared to those delivered by the weighted global brain connectivity method, which is based on averaged bivariate correlations and from the non-redundant connectivity method, a dimensionality reduction approach that applies supervised principal component regressions. Ridge regression is able to detect a larger set of abnormally connected regions than both GBC and NRC methods, including schizophrenia related connectivity reductions in fronto-medial, somatosensory and occipital structures. Due to its multivariate nature, the proposed method is much more sensitive to group abnormalities than the GBC, but it also outperforms the NRC, which is multivariate too. Voxel based regularized regression is a simple and sensitive alternative for quantifying brain functional connectivity. (shrink)

RESEÑA / RESSENYA / REVIEW Elogio de la razón mundana. Antropología y política en Kant, por Nuria Sánchez Madrid.

There seems to be a distinction between primary and secondary properties; some philosophers defend the view that properties like colours and values are secondary, while others criticize it. The distinction is usually introduced in terms of essence; roughly, secondary properties essentially involve mental states, while primary properties do not. In part because this does not seem very illuminating, philosophers have produced different reductive analyses in modal terms, metaphysic or epistemic. Here I will argue, firstly, that some well-known examples fail, and (...) also that there are deep reasons why such approaches should do so. Secondly, I will argue that it is acceptable to remain satisfied with the non-reductive account in terms of essence. To that end, I will indicate how such an explication could be put to use to support the claim that properties like colours and values are secondary. In a series of recent writings, Kit Fine has argued that essence cannot be reductively analysed in modal terms. Fine offers some examples to motivate his claim. I suggest that the primary/secondary distinction constitutes a philosophically interesting illustration. (shrink)

Cet article réfléchit à ce que nous dit une photo prise durant les manifestations de rue qui ont secoué le Chili à l’automne 2019. Une voiture sur laquelle a été peint un graffiti Esto es montaje aide à analyser les différentes couches de machination, de montage, de résistance, de frustrations et d’espoirs qui se sont retrouvées pendant quelques mois dans les rue de Santiago – et qui nous parlent aussi peut-être de mobilisations et d’immobilisation comparables en d’autres points du globe.

La obra de Antonio Machado muestra una conocida amplitud temática que se manifiesta, además de en su poética, en sus aportaciones a la filosofía. El presente artículo pretende acercarse a su figura desde la conjunción entre la poética y la filosofía en base a un concepto fundamental en su obra: la alteridad. Como consecuencia de la quiebra de la razón moderna, el solipsismo de corte cartesiano quedó en suspenso. Es en este momento en el que tanto en Europa como en (...) la España de finales del siglo XIX surge una tendencia hacia la alteridad o reconocimiento del otro, tal y como veremos en la obra de Machado y en personajes esenciales de su producción como Juan de Mairena así como, también, en otros autores de la generación del 98. (shrink)

En este artículo se va a estudiar la relación que existe en Leibniz entre verdad eterna, razón soberna y libertad divina. Si la razón soberana se puede constituir como juez supremo es porque contiene unas verdades eternas que Dios no ha creado sino que pertenecen a la misma esencia divina. Estas verdades en cuanto esencias, tienden a existir en la medida de su perfección, pero no existirán necesariamente, sino que Dios las pone en la existencia mediante un acto libre. Ante (...) la posibilidad de pensar que Dios pudiera verse obligado a elegir aquello que mejor, Leibniz sostendrá que Dios elige crear siempre lo mejor en un primer decreto máximamente libre y voluntario. de este modo el resto de sus elecciones son también máximamente libres y racionales. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 30.4 (2000) 102-122 [Access article in PDF] How To Tell a Mestizo from an Enchirito® Colonialism and National Culture in the Borderlands Michael Hames-garcia I began to think, "Yes, I'm a chicana but that's not all I am. Yes, I'm a woman but that's not all I am. Yes, I'm a dyke but that doesn't define all of me. Yes, I come from working class origins, but I'm (...) no longer working class. Yes, I come from a mestizaje, but which parts of that mestizaje get privileged? Only the Spanish, not the Indian or black." I started to think in terms of mestiza consciousness. What happens to people like me who are in between all of these different categories? What does that do to one's concept of nationalism, of race, ethnicity, and even gender? I was trying to articulate and create a theory of a Borderlands existence.... I had to, for myself, figure out some other term that would describe a more porous nationalism, opened up to other categories of identity. —Gloria E. Anzaldúa, InterviewsOne of the most crucial questions facing leftist activists and intellectuals today is the question of nationalism and its relation to liberation struggles. 1 A century ago, the period [End Page 102] of nation-state consolidation in Europe seemed to come to an end with the unification of Germany and Italy. European leftists of the era tended to address "the national question" primarily with regard to those European nations that were shut out or suppressed by nation-state formation. Debates about national culture resurfaced in a revolutionary context when independence movements swept Africa and Asia during and after World War II, and a substantial body of literature attempting to integrate anticolonial struggle, national liberation, and socialism arose from the capitalist "periphery." Much of this literature, and the wars for independence out of which it grew, adapted the language of nationalism to its own purposes. These movements gave new hope that national liberation struggles would prove compatible with greater human freedom and equality. Despite that hope, the destructive effects of nationalism are today visible everywhere: for example, the devastating wars in the Balkans, the repression of indigenous peoples by national bourgeoisie throughout the Americas, religious-national strife between Sinhalese and Tamils in Sri Lanka, the vertiginous intensification of national chauvinism in the United States, Western Europe, and Australia. Simultaneously, and in the context of feminist criticisms of nationalism [see, for example, Chatterjee, Nation; Lutz et al.; Mosse], attempts to unite the struggle to liberate "the nation" from colonial or neocolonial domination with progressive struggles against capitalist exploitation and against sexual- and gender-based domination continue [see, for example, Trask]. In Latin America, anticapitalist struggles lauded by Western socialists regularly take the form of national liberation struggles, such as the EZLN (Ejército Zapatista de Liberación Nacional [Zapatist National Liberation Army]) in Mexico and the FSLN (Frente Sandinista de Liberación Nacional [Sandinist National Liberation Front]) in Nicaragua. Additionally, lesbian and gay activists and theorists in the United States have frequently sought to appropriate nationalist rhetoric even as black and Chicano nationalist movements have been on the decline [see, for example, Berlant and Freeman; Moraga 145-74].Debates about anticolonial struggle and "Third World" nationalism may seem at first to be an odd context into which to introduce the work of Gloria Anzaldúa. Critical writing on Anzaldúa's work has tended not to consider its relevance to debates on the relations among capitalism, colonialism, and national culture. 2 Instead, her major work, Borderlands/La Frontera, is usually discussed (or, more often than not, simply cited) as a contribution to feminist and antiracist discussions about the construction of the self within multiple contexts of domination and about that self's resistance to oppression and struggle for recognition. 3 While acknowledging the importance of Anzaldúa's contributions to these discussions, this essay examines Borderlands as offering a forward-looking alternative to nationalism, specifically, to Chicano cultural nationalist positions articulated during the... (shrink)

In spite of the fact that the Z.F. universe is not well-ordered, it behaves in some respects like the ordinals. It is possible to define on it the usual operations of addition, multiplication and exponentiation, which enjoy similar properties to those on the ordinals. Further when restricted to the ordinals, the operations coincide, so that ordinal arithmetic can be regarded as a restriction of the universe arithmetic. But more than that, rank which retracts the universe of sets onto the ordinals (...) is a homomorphism between the universe arithmetical structure 〈V,+,·,exp〉 and the ordinal arithmetical structure 〈Ord, +, ·,exp〉. (shrink)

The construction of the phenomenological project of psychopathology began in the 1920s. Husserl’s philosophical elaborations, which started to be drawn a few decades earlier, had a broad repercussion on the historical and cultural context of the time and was eventually incorporated into several disciplines, including psychopathology. Particularly in this field, phenomenology had a significant impact, because its epistemological foundations was a close match to the rigorous purposes of a scientific investigation of mental disorders.The phenomenological contribution has established an irrevocable and (...) unique conception of the psychiatric object. The innovation brought... (shrink)

En el presente artículo me ocupo de la discusión acerca de cuán exigentes son nuestras obligaciones de contribuir con dinero y tiempo a las agencias humanitarias que asisten a personas en situación de pobreza extrema en el mundo. Defiendo una posición intermedia, moderada, frente a la posición extrema formulada por Peter Singer y frente a la posición según la cual nuestras obligaciones son mínimas. La objeción principal contra esas dos posiciones es que, cuando analizan la situación en que los potenciales (...) donantes se encuentran frente a las personas en situación de pobreza extrema, omiten el carácter iterativo que es propio de esa situación. La posición moderada, en cambio, tiene en cuenta ese carácter, gracias a que entiende a nuestras obligaciones hacia los pobres globales como obligaciones imperfectas. In this article I engage in the debate about the demandingness of our duties to contribute with money and time to humanitarian agencies that assist people who live in extreme poverty around the world. I defend an intermediate, moderate, view against Peter Singer's extreme view, and also against the view according to which our duties are minimal. The main objection regarding those two views is that, when they analyze the situation in which potential donors are vis-à-vis people who live in extreme poverty, they miss its distinctive iterative character. The moderate view, on the contrary, pays heed to that character, thanks to its account of our duties towards the global poor as imperfect duties. (shrink)