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)

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)

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)

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)

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)

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)

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)

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.

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

Este artículo es un intento de dilucidación y delimitación historiográfico-conceptual que pretende aportar un enfoque alternativo a los estudios sobre la teoría política realista. Mi propósito es presentar un bosquejo del sentido histórico del concepto de realismo político situándolo en los contextos de la Realpolitik alemana y de la escuela realista de las relaciones internacionales. De este modo, pretendo mostrar las relaciones contextuales del realismo político, la localización de su antagonismo con el liberalismo y la invención retrospectiva de una tradición (...) realista como resultado de una serie de apropiaciones intelectuales y políticas. This article is a historiographical and conceptual attempt of clarification and delimitation to offer an alternative view to the studies of the realist political theory. I pretend to put forward an outline of the historical sense of the concept of political realism, placing it on the contexts of German Realpolitik and the realist school of international relations. Thus, I pretend to show the contextual relations of political realism, the location of its antagonism against liberalism and the retrospective invention of a realist tradition as a result of a set of intellectual and political additions. (shrink)

In Enactive Psychiatry, de Haan puts forward the enactive approach as a promising theory to solve the integration problem in psychiatry by articulating the physiological, socio-cultural, experiential, and existential dimensions of human sense-making. The author provides a valuable and accessible introduction to the enactive theory, a rich analysis of the classical descriptivist-normativist debate, and a guideline for personalized diagnosis. However, the addition of the existential dimension to the enactive theory adds (ad hoc) tensions with regard to the life-mind approach.

L’affaire Weinstein et le mouvement #MeToo ont mis la question des violences sexuelles au premier plan. Depuis, le consentement renvoie naturellement au consentement sexuel et amoureux, envisagé comme un sésame de l’égalité entre femmes et hommes. Pourtant, il est bien difficile à définir, et soulève trois problèmes. Le problème juridique, bien connu de celles et ceux qui suivent l’actualité, peut être résumé ainsi: que faire pour que les cas de viol, d’agression et de harcèlement sexuels soient efficacement punis ? Le (...) deuxième problème est moral : comment penser des relations amoureuses et sexuelles qui ne soient pas fondées sur des normes sociales sexistes et inégalitaires ? Enfin, le problème politique : comment ne pas reconduire les injustices de genre qui se manifestent dans les rapports amoureux et sexuels ? La magistrale analyse du consentement que propose Manon Garcia revisite notre héritage philosophique, plongeant au cœur de la tradition libérale, mettant à nu ses impensés et ses limites. De John Locke aux théoriciennes féministes françaises et américaines, en passant par Michel Foucault et les débats sur la pratique du BDSM, c’est une nouvelle cartographie politique de nos vies privées que dessine cet essai novateur. Au terme de ce livre, il s’agira en somme, pour reprendre la formule de Gloria Steinem, d’« érotiser l’égalité » plutôt que la domination : en ce sens, le consentement sexuel, conçu comme conversation érotique, est sans doute l’avenir de l’amour et du sexe. (shrink)

En principio, la poesía considerada como génesis del arte árabe, y, más tarde, la prosa de adab surgieron con la idea de ciencia que destacaba el dominio de la belleza, idea que se proyectaría después sobre la música. Por otra parte, la aportación griega al legado filosófico y científico árabe clásico, cuya sombra aparece reflejada sobre los primeros tratados de los filósofos y teóricos musicales, entre los que se encuentran al-Kindi (s. IX)y al-Farabi (s. X), germinó en la concepción de (...) un nuevo sentido sobre la "belleza". De esta forma, y desde un observatorio que tiene como punto de referencia el mundo clásico griego, los nuevos parámetros surgirían como consecuencia de su propia identidad e idiosincrasia, en los que el patrimonio poético y musical, unido al pensamiento religioso y filosófico, complementarían la taracea de un nuevo concepto, "estética musical". El estudio de la música medieval árabe revela que la armonía entre el contenido poético, lingüístico, rítmico y melódico caminaron en paralelo, produciéndose un equilibrio, una relación armónica, y, en definitiva cósmica que les llevó a acuñar un cierto ideal estético basado en la belleza y la emoción artística que despertaba como reflejo de una armonía entre cuerpo y alma, y que facilitaría la unión con lo infinito y la divinidad. (shrink)

Review of: José Ferreirós. 2016. Mathematical knowledge and the interplay of practices. Princeton: Princeton University Press.

La différence entre les êtres humains et les autres espèces n'est-elle vraiment qu'une différence de complexité? Ne ressemble-t-elle pas plutôt à ce que l'on nomme en linguistique une nuance? Car un terme proche d'un autre ne signifie pourtant pas la même chose que lui de manière plus complexe. Il suggère tout autre chose malgré des points de recoupement. Il convient de le démontrer en dénonçant une représentation trop caricaturale de l'être humain.

Contemporary literature distinguishes two ways to defend the claim that cognition is a matter of representations: one, cognition involves representation-hungry tasks; two, cognition involves a complex form of informational covariation between subcomponents of a system with an adaptive function. Each of these conceptions involves a different notion of representation, and promotes a particular view of the architecture of cognition. But despite the differences, each of them aims to support the claim that cognition is a matter of representations on architectural constraints. (...) The objective of this article is twofold: one, it is argued that architectural constraints do not entail either of those two ways to defend the claim that cognition is a matter of representations; two, it is claimed that both notions of representation share an objectionable common element – namely, the idea of a model that grounds the representational reading– that must be abandoned, in favor of a more economical explanation in terms of causal relations, in order to get a clear view of cognition. (shrink)