Evaluating the Knowledge and Practice of Limitation of Therapeutic Effort in Health Workers at a Health Care Institution for Cancer Patients in Medellín, 2018Avaliação do conhecimento e da prática da limitação de esforço terapêutico em equipe de atendimento de uma instituição prestadora de serviços de saúde para pacientes oncológicos de Medellín, 2018Limitation of therapeutic effort is any action that involves suspending or not initiating medical treatment or therapeutic measures in patients who will not receive any clinical benefit. In Latin America, (...) some research has proven a lack of familiarization and disagreement with the subject and its practices. The present study tried to objectify the knowledge of LTE of healthcare personnel at an institute in Medellín using a self-administered survey that allowed conducting a cross-sectional descriptive study with non-probabilistic sampling. Within the results, 56.5 % of respondents understood the concept of LTE, and 90 % applied it actively. However, there were discrepancies regarding the core concepts of the definition and practice.Para citar este artículo / To reference this article / Para citar este artigoVallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, Cruz MA. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. 2020;24:177-87. DOI: https://doi.org/10.5294/pebi.2020.24.2.5Recibido: 19/07/2019Aceptado: 08/08/2020Publicado: 27/11/2020. (shrink)

In December, the National Data Guardian 1 for health and care in England, Dame Fiona Caldicott, published the outcomes of a public consultation about the Caldicott Principles and the role of Caldicott Guardians.1 The Caldicott Principles are good practice guidelines which have been used by health and social care organisations in the UK since 1997 to ensure that people’s data are kept safe and used in an ethical way.2 The role of the Caldicott Guardian is well-established in the UK. Caldicott (...) Guardians are senior people which support the upholding of the Caldicott Principles within organisations. In response to views expressed during the consultation the NDG has added an eighth Caldicott Principle to the existing seven and will use her statutory powers to issue guidance about the appointment of Caldicott Guardians for health and adult social care organisations. The new eighth Caldicott Principle is: ‘Inform patients and service users about how their confidential information is used’. It provides that: > A range of steps should be taken to ensure no surprises for patients and service users, so they can have clear expectations about how and why their confidential information is used, and what choices they have about this. These steps will vary depending on the use: as a minimum, this should include providing accessible, relevant and appropriate information - in some cases, greater engagement will be required. The NDG explains that the introduction of the new principle was prompted by consideration of the role that the legal concept of ‘reasonable expectations’ should play in shaping the circumstances under which health and care data may be legitimately shared. The NDG does not envisage that this principle will establish reasonable expectations as a legal basis in its own right …. (shrink)

Legal battles continue in the UK over the Government’s plans to transport asylum seekers arriving on British shores to Rwanda in East Africa. Originally announced as a system for ‘processing’ asylum seekers, the Government has subsequently made it clear that there would not be an option for asylum seekers to return to the UK. The arrangement forms part of a deal between the UK and Rwanda, with the UK promising to invest £120 m in economic growth and development in Rwanda, (...) along with financing the cost of the ‘offshored’ asylum operation.1 The Government states that the policy is designed to break the business model of people traffickers involved in facilitating hazardous trips across the Channel in small, overcrowded and unseaworthy craft, leading to multiple drownings. Critics argue that the policy will do nothing to stop desperate people from seeking refuge in the UK, that transferring already traumatised people to Rwanda – which has been criticised for its human rights record – is inhumane and potentially outwith international law. Medical bodies, including the BMA, along with refugee organisations have expressed serious concerns about the health impact of such a system of ‘offshoring’. An equivalent system in Australia has been notorious for the devastating health impacts on those ‘offshored’ to the Pacific islands of Manus and Naura. Unusually in the UK the offshoring proposals have been greeted by unanimous condemnation by the Church of England. The lawfulness of the process is also subject to question. On the 14 July, a plane carrying a small number of asylum seekers to Rwanda was halted shortly before take-off following an intervention by the European Court of Human Rights. The ECtHR, part of the Council of Europe, of which the UK is still a member, said an Iraqi man known as KN faced ‘a real …. (shrink)

Alexithymic traits, which entail finding it difficult to recognize and describe one’s own emotions, are linked with poor trait emotional intelligence and difficulties in identifying and managing stressors. There is evidence that alexithymia may have detrimental consequences for wellbeing and health, beginning in adolescence. In this cross-sectional study, we investigated the prevalence and incidence of alexithymia in teenage girls, testing the statistical power of TEI and student burnout to discriminate between high- and low-alexithymic subjects. A sample of 884 female high (...) school students attending three Italian academic-track high schools completed self-report measures of alexithymia, school burnout, and TEI. Main descriptive statistics and correlational analysis preceded the discriminant analysis. The mean alexithymia scores suggest a high prevalence of alexithymia in female adolescents; as expected, this trait was negatively correlated with TEI and positively associated with school burnout. Participants with high vs. low alexithymia profiles were discriminated by a combination of TEI and burnout scores. High scores for the emotionality and self-control dimensions of TEI were strongly associated with membership of the low alexithymia group; high scores for the emotional exhaustion dimension of school burnout were indicative of membership of the high alexithymia group. These findings suggest crucial focuses for educational intervention: efforts to reduce the risk of emotional exhaustion and school burnout should especially concentrate on enhancing emotional awareness and self-control skills, both strongly associated with low levels of alexithymia. (shrink)

The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

This article's main goal is to highlight the conflicts but also the similarities between religion and politics that exists in different subjects, views or situations. This study will have a theoretical part but also an empirical part. The empirical part will be supported by the theoretical part of the study in which we will try to demonstrate the assumptions written above. The empirical part will analyze concrete case being the church's reaction to the legislative proposal of legalizing prostitution. Choosing this (...) topic for discussion, in the context of the relations between the Romanian Orthodox Church and politics, is a scientific approach that aims to highlight and underline the reactions that the Romanian Orthodox Church (BOR) has to the controversial legislative proposals in Romania and elsewhere, such as the legalization of prostitution. Through our research we aim to achieve a brief overview of this topic, analyzing the reactions that BOR has, in the written press in Romania, on the issue of legalizing prostitution. Also, the theme may be considered a good source of knowledge on the Romanian society and how it accepts or not such a legislative proposal. (shrink)

We live in an era of unprecedented interconnectivity and challenges that require global mindsets and creative approaches. While research on global identification has increased in recent years, the question of whether it can facilitate creativity remains largely unexplored. Moreover, despite the evidence linking multicultural experiences and global identities, migrant populations have been overly underrepresented in this area of research. We examine the association between global culture identification and creativity in the Alternate Uses Test, across two different samples residing in Spain: (...) a host national and majorly student sample and a culturally diverse immigrant sample. Additionally, we test the predictive value of ethnic identification and host culture identification. Regression analyses reveal that global culture identification positively predicts creativity among host national participants, and host culture identification predicts creativity among immigrant participants. Our results suggest that developing a cultural identity that transcends the one acquired through enculturation has the potential of facilitating creative behavior. (shrink)

The existence of a strong link between socio-economic background and individual preferences has been documented among both children and grown-ups. Here, we study whether such a correlation persists even in a highly homogeneous population of young adults: university students. Our findings indicate that participants living in an area characterized by a high socio-economic environment tend to trust more and are more inclined to reciprocate higher levels of trust, as compared to those coming from less wealthy neighborhoods. This behavioral difference is, (...) at least in part, driven by heterogeneities in beliefs: subjects from the most affluent part of the city have more optimistic expectations on their counterpart’s trustworthiness than those living in a lower socio-economic environment. By contrast, no significant differences emerge in other preferences: generosity, risk attitudes, and time preferences. Finally, we do not find any systematic evidence of out-group discrimination based on neighborhood identity. (shrink)

Previous research has shown positive relationships between fitness level and different cognitive abilities and academic performance. The purpose of this study was to explore the relationships between logical–mathematical intelligence and mathematical competence with physical fitness in a group of pre-adolescents. Sixty-three children from Castro del Río, aged between 11 and 12 years, participated in this research. The Superior Logical Intelligence Test and the EVAMAT 1.0–5 battery were used. Physical fitness was evaluated by the horizontal jump test, the 4×10 meter speed–agility (...) test, and the Course Navette test. The analyses showed positive relationships between physical fitness with logical–mathematical intelligence and mathematical competence. Specifically, linear regression analyzes indicated that the 4×10 speed–agility test significantly predicted mathematical competence and the horizontal jump test significantly predicted logical–mathematical intelligence. These results are in agreement with previous research, highlighting the importance of improving physical fitness from an early age due to its benefits for intellectual and academic development. (shrink)

In February 2014, the Belgian Parliament passed legislation allowing euthanasia for terminally ill children of all ages by 86 votes to 44, with 12 abstentions. The Bill became law in early March after being signed by the King, making Belgium the first country in the world to abolish age restrictions for euthanasia. Previously, the youngest age at which euthanasia was permitted was 12 years old in The Netherlands.1Euthanasia was legalised in Belgium in 2002, and the new legislation introduces amendments to (...) the law extending euthanasia to minors in certain circumstances. Euthanasia is now permissible for children of all ages where the child has a “terminal and incurable illness”, experiences “constant and unbearable physical suffering”, and death is expected to occur within a “brief period”. The child must be deemed capable of making the decision, and have the agreement of their parents.Belgian law sets no timetable for euthanasia from the point at which the patient first expresses a wish to die. As with adults seeking euthanasia, any request must be made in writing. A physician and “outsider” brought in to give a second opinion must agree upon the diagnosis and prognosis, and a paediatric psychiatrist or psychologist must certify in writing that the child possesses “the capacity of discernment”. Following this, the child's physician must meet with the parents to inform them of the outcome of the consultation and ensure they are in agreement with the child's request. The child and the family must receive psychological care and support if so desired.The move provoked heated debate and divided the medical, legal and political professions in Belgium. A group of 160 of the country's paediatricians opposed a change in the law, citing concerns about the largely subjective assessment of the “capacity of discernment”, and drawing attention to advances in …. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Civility is formed by social norms that guide our behavior and allow us to interact appropriately with others. These norms affect everyone and are learned through the socialization process. However, in the same process, people also learn gender norms that dictate how men and women should behave, leading to gender stereotypes and differentiated behavioral characteristics. The purpose of this research is to examine the relationship between gender and civility, and how we react to those who behave uncivilly given their gender. (...) The results of Study 1 showed that even in a fictional and gender-neutral society, uncivil behaviors were associated with stereotypically masculine characteristics, and those who behaved uncivilly were dehumanized. In Study 2, gender differences were observed in incivility. Women were harsher when facing uncivil transgressors than men, especially if the transgressor was another woman. Our findings support the notion that gender norms are applied to civility, leading those supposedly equal social norms to unequal perceptions and evaluations. (shrink)

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing (...) symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children, in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model, we identified three trajectories of substance use initiation in adolescence: one characterized by near-complete abstinence until late adolescence, another by earlier initiation of alcohol, nicotine, and cannabis, and another by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context. (shrink)

It is critical to remember details about meetings with healthcare providers. Forgetting could result in inadequate knowledge about ones' health, non-adherence with treatments, and poorer health outcomes. Hearing the health care provider plays a crucial role in consolidating information for recall. The recent COVID-19 pandemic has meant a rapid transition to videoconference-based medicine, here described as telehealth. When using telehealth speech must be filtered and compressed, and research has shown that degraded speech is more challenging to remember. Here we present (...) preliminary results from a study that compared memory for health information provided in-person to telehealth. The data collection for this study was stopped due to the pandemic, but the preliminary results are interesting because the pandemic forced a rapid transition to telehealth. To examine a potential memory deficit for health information provided through telehealth, we presented older and younger adults with instructions on how to use two medical devices. One set of instructions was presented in-person, and the other through telehealth. Participants were asked to recall the instructions immediately after the session, and again after a 1-week delay. Overall, the number of details recalled was significantly lower when instructions were provided by telehealth, both immediately after the session and after a 1-week delay. It is likely that a mix of technological and communication strategies by the healthcare provider could reduce this telehealth memory deficit. Given the rapid transition to telehealth due to COVID-19, highlighting this deficit and providing potential solutions are timely and of utmost importance. (shrink)

El panorama educativo actual requiere de la implementación de nuevas metodologías docentes en el Espacio Europeo de Educación Superior. El objetivo de este trabajo es presentar un estudio piloto orientado a impartir docencia al aire libre como forma de recrear el trabajo real que puede desarrollar nuestro alumnado en su futuro profesional. De este modo, pretendíamos conseguir un aprendizaje significativo en tanto que existe una interacción real con los objetos de aprendizaje. El resultado se concretó en la valoración positiva por (...) parte del alumnado al sentirse conectados con su inminente realidad laboral y la adquisición de competencias interpersonales como la cooperación y el compañerismo. (shrink)

Recent breakthroughs in stem cell differentiation and reprogramming suggest that functional human gametes could soon be created in vitro. While the ethical debate on the uses of in vitro generated gametes (IVG) was originally constrained by the fact that they could be derived only from embryonic stem cell lines, the advent of somatic cell reprogramming, with the possibility to easily derive human induced pluripotent stem cells from any individual, affords now a major leap in the feasibility of IVG derivation and (...) in the scope of their potential applications. In this paper we develop an ethical framework, rooted in recent scientific evidence, to support a robust experimental pipeline that could enable the first-in-human use of IVG. We then apply this framework to the following objectives: (1) a clarification of the genetic parenting options afforded by IVG, along with their ethical underpinnings; (2) a defence of the use of IVG to remedy infertility, broadening their scope to same-sex couples; (3) an assessment of the most far-reaching implications of IVG for multiplex parenting. These include, first, the liberation of parenting roles from the constraints of biological generations in vivo, allowing multiple individuals to engage in genetic parenting together, thus blurring the distinction between biological and social generations. Second, we discuss the conflation of IVG with sequencing technology and its implications for the possibility that prospective parents may choose among a hitherto unprecedented number of potential children. In view of these perspectives, we argue that, contrary to the exhausted paradigm according to which society lags behind science, IVG may represent instead a salient and most visible instance where biotechnological ingenuity could be used in pursuit of social experimentation. (shrink)

Hacking’s Law of Likelihood says – paraphrasing– that data support hypothesis H1 over hypothesis H2 whenever the likelihood ratio for H1 over H2 exceeds 1. But Hacking noted a seemingly fatal flaw in the LR itself: it cannot be interpreted as the degree of “evidential significance” across applications. I agree with Hacking about the problem, but I don’t believe the condition is incurable. I argue here that the LR can be properly calibrated with respect to the underlying evidence, and I (...) sketch the rudiments of a methodology for so doing. (shrink)

In this paper, we examine the scientific, legal, and ethical foundations for inclusion of transgender women athletes in competitive sport, drawing on IOC principles and relevant Court of Arbitration for Sport decisions. We argue that the inclusion of trans athletes in competition commensurate with their legal gender is the most consistent position with these principles of fair and equitable sport. Biological restrictions, such as endogenous testosterone limits, are not consistent with IOC and CAS principles. We explore the implications for recognizing (...) that endogenous testosterone values are a ‘natural physical trait’ and that excluding legally recognized women for high endogenous testosterone values constitutes discrimination on the basis of a natural physical trait. We suggest that the justificatory burden for such prima facie discrimination is unlikely to be met. Thus, in place of a limit on endogenous testosterone for women, we argue that ‘legally recognized gender’ is most fully in line with IOC and CAS principles. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Knowledge about maize varieties is the key to rural households' survival in native Mexico. Native peoples relate to nature in particular ways and they play a crucial role in maintaining biodiversity. This paper discusses the relationship between native women's accumulated knowledge on maize varieties and the laboratory analysis of the species that they manage. Fieldwork was conducted in an Otomí community, San Pablo Arriba, located in the state of Mexico.

In this essay I compare Nussbaum's and Arendt's approach to narrativity. The point of the comparison is to find out which approach is more adequate for practical philosophy: the approach influenced by cognitive theory or the one influenced by hermeneutic phenomenology. I conclude that Nussbaum's approach is flawed by methodological solipsism, which is due to her application of cognitive theory.

This Element offers an overview of some of the most important debates in philosophy and physics around the topics of emergence and reduction and proposes a compatibilist view of emergence and reduction. In particular, it suggests that specific notions of emergence, which the author calls 'few-many emergence' and 'coarse-grained emergence', are compatible with 'intertheoretic reduction'. Some further issues that will be addressed concern the comparison between parts-whole emergence and few-many emergence, the emergence of effective theories, the use of infinite limits, (...) the notion of intertheoretic reduction and the explanation of universal and cooperative behavior. Although the focus will be principally on classical phase transitions and other examples from condensed matter physics, the main aim is to draw some general conclusions on the topics of emergence and reduction that can help us understand a variety of case-studies ranging from high-energy physics to astrophysics. (shrink)

Background: Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. Objective: The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. Method: Analysis of moral competence concept was (...) done using Walker and Avant's strategy of concept analysis. Results: Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. Conclusion: Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi. (shrink)

In this work I present a detailed critique of the dignity-related arguments that have been advanced against the creation of human–nonhuman chimeras that could possess human-like mental capacities. My main claim is that the arguments so far advanced are incapable of grounding a principled objection against the creation of such creatures. I conclude that these arguments have one, or more, of the following problems: they confuse the ethical assessment of the creation of chimeras with the ethical assessment of how such (...) creatures would be treated in specific contexts, they misrepresent how a being could be treated solely as means towards others’ ends, they fall short of demonstrating how humanity’s dignity would be violated by the creation of such entities, and they fail to properly characterise the moral responsibilities that moral agents have towards other moral agents and sentient beings. (shrink)

In this volume, Veronica Roberts Ogle offers a new reading of Augustine's political thought as it is presented in City of God. Focusing on the relationship between politics and the earthly city, she argues that a precise understanding of Augustine's vision can only be reached through a careful consideration of the work's rhetorical strategy and sacramental worldview. Ogle draws on Christian theology and political thought, moral philosophy, and semiotic theory to make her argument. Laying out Augustine's understanding of the earthly (...) city, she proceeds by tracing out his rhetorical strategy and concludes by articulating his sacramental vision and the place of politics within it. Ogle thus suggests a new way of determining the status of politics in Augustine's thought. Her study clarifies seemingly contradictory passages in his text, highlights the nuance of his position, and captures the unity of his vision as presented in City of God. (shrink)