Sociocognição e saúde mental: a 'leitura do outro' no cuidado em saúde / Cognición social y salud mental: la 'lectura de la mente' en la assistencia a salud / Social cognition and mental health: the mindreading in the healthcare work

RESUMO. Teoria da mente é a habilidade sociocognitiva de inferir pensamentos, sentimentos e intenções. É uma habilidade que sustenta as relações sociais e parece particularmente relevante para o exercício de certas atividades que estão ligadas à 'leitura do outro', como a prática de profissionais que exercem o cuidado em equipamentos de saúde, como ocorre nos Centros de Atenção Psicossocial. Este estudo teórico teve o objetivo de analisar a importância das habilidades sociocognitivas para o trabalho em saúde, especialmente na saúde mental, a fim de identificar e discutir possíveis fatores que podem ter impacto na inferência que os profissionais fazem a respeito do que os usuários do serviço estão pensando, sentindo ou querendo. A análise permitiu observar as formas pelas quais a teoria da mente pode se tornar importante ferramenta para o profissional no processo terapêutico. Além disso, foi possível identificar que, no formato em que tem funcionado atualmente, o trabalho em Centros de Atenção Psicossocial tem exposto o profissional a diversos estressores que parecem produzir efeitos em suas habilidades sociocognitivas, podendo prejudicar não apenas sua saúde como também o exercício do cuidado.

RESUMEN. Teoría de la mente es la capacidad sociocognitiva de inferir pensamientos, sentimientos e intenciones. Es una habilidad que apoya las relaciones sociales y parece particularmente relevante para el ejercicio de determinadas actividades que están vinculadas a 'leer al otro', como la práctica de los profesionales que brindan atención en equipos de salud, como ocurre en los Centros de Atención Psicosocial. Este estudio teórico tuvo como objetivo analizar la importancia de las habilidades socio-cognitivas para el trabajo en salud, especialmente en salud mental, buscando identificar y discutir posibles factores que pueden incidir en la inferencia que hacen los profesionales sobre lo que piensan, sienten o sienten los usuarios del servicio. El análisis permitió observar las formas en que la teoría de la mente puede convertirse en una herramienta importante para los profesionales en el proceso terapéutico. Además, se pudo identificar que, en el formato en el que se ha operado actualmente, el trabajo en Centros de Atención Psicosocial ha expuesto a los profesionales a diversos estresores que parecen afectar sus habilidades sociocognitivas, los cuales pueden perjudicar no solo su salud sino también el ejercicio del cuidado.

ABSTRACT. Theory of mind is a social cognition ability to infer thoughts, feelings and intentions. It is a skill that underpins social relationships and seems particularly relevant to the exercise of certain activities linked to mindreading, such as healthcare practice, for example, in Psychosocial Care Centers. This theoretical study aims to analyze the importance of social cognition skills for mental health practitioners, seeking to identify and discuss possible factors that impact how these professionals infer what service users are thinking, feeling or wanting. The analysis allowed us to observe how the theory of mind can become an important tool for professionals in the therapeutic process. In particular, the study concludes that work in Psychosocial Care Centers has exposed professionals to various stressors that seem to have an effect on their social cognition skills, which can harm not only their health but also their ability to attend to the needs of service users.

Análisis de algunos comportamientos nocivos de la población cubana frente a la COVID-19 / Analysis of some harmful behaviors against COVID-19 among the Cuban population

Introducción: El mundo se enfrenta hoy a una de las pandemias más graves de la historia, la COVID-19. Objetivos: Identificar los principales comportamientos nocivos de la población cubana frente a las medidas adoptadas para evitar el contagio de la pandemia COVID-19, de diciembre a mayo de 2020. Material y Métodos: Se efectuó una revisión sistemática ordenada, mediante búsquedas electrónicas en bibliotecas de revistas médicas indexadas nacionales y extranjeras, comunicaciones oficiales de organismos internacionales, regionales, nacionales y boletines informativos de ministerios durante los últimos cinco meses de 2020 en La Habana, Cuba. Desarrollo: Se encontraron comportamientos nocivos tanto en Cuba como en otros países con cierta similitud, pues son reprobados socialmente, expresión de indisciplina social, conducta antisocial, violaciones del orden socialmente establecido que pueden tipificar delitos, aunque en la Isla carecen del dramatismo del resto de los países y no quedan impunes. Conclusiones: Los principales comportamientos nocivos encontrados se relacionan con el delito de propagación de epidemias, incremento de la indisciplina social y delitos económicos; resultantes de falta de exigencia, control, denuncia, tolerancia social y haber bajado la vigilancia revolucionaria; como expresión de un fenómeno causal complejo que incluye necesidades insatisfechas, problemas económicos, sociales, infodemia, distorsión de la comunicación y baja percepción del riesgo. Despuntaron comportamientos que distinguen al pueblo cubano como solidaridad, altruismo, bondad, humanismo, espiritualidad, capacidad compasiva, potencialidad para involucrarse que contribuyen a la transmisión de valores y tributan a la inspiración de los que cada día contribuyen a la rica historia de este país (AU)

Introduction: Currently, the world is facing one of the most serious pandemics in history, the COVID-19. Objectives: To identify the main harmful behaviors among the Cuban population against the measures adopted to avoid COVID-19 contagion from December to May 2020. Material and Methods: An ordered systematic review was performed through searches for electronic articles indexed in national and foreign medical journals; official communications from international, regional, and national organizations; and newsletters published by some ministries during last five months in Havana, Cuba. Development: Similar harmful behaviors were found in Cuba and other countries since they are socially reprehensible and express different forms of social indiscipline, antisocial behavior, and violations of the socially established order that can typify crimes. However, in the island, they lack drama and do not go unpunished compared to other countries. Conclusions: The main harmful behaviors found were associated with the crime of spreading epidemics and the increase of social indiscipline and economic crimes resulting from lack of demands, control, denunciation, social tolerance and decrease of revolutionary surveillance as an expression of a complex causal phenomenon which includes unsatisfied needs, economic and social issues, infodemic, communication distortion and low perception of risk. Some proper behaviors of the Cuban people such as as solidarity, altruism, kindness, humanism, spirituality, compassionate ability, and potential to get involved in the transmission of values, have also shown the inspiration of those people whose day-to-day commitment has contributed to the rich history of this country(AU)

Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent: efforts to 'Bridge the Gap'.

PURPOSE OF REVIEW: The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society. RECENT FINDINGS: Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country. SUMMARY: Introduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.

Appeal to the Rule of Rescue in health care: discriminating and not benevolent?

Thirty years of debate have passed since the term "Rule of Rescue" has been introduced into medical ethics. Its main focus was on whether or why medical treatment for acute conditions should have priority over preventive measures irrespective of opportunity costs. Recent contributions, taking account of the widespread reluctance to accept purely efficiency-oriented prioritization approaches, advance another objection: Prioritizing treatment, they hold, discriminates against statistical lives. The reference to opportunity costs has also been renewed in a distinctly ethical fashion: It has been stipulated that favoring help for identifiable lives amounts to a lack of benevolence for one's fellow creatures. The present article argues against both objections. It suggests that the debate's focus on consequences (deaths or severe ill health) should be reoriented by asking which aspects of such states of affairs are actually attributable to a decision maker who judges within a specific situation of choice.

[The Rule of Rescue - Irrational and Discriminating?] / Rule of Rescue vs. Rettung statistischer Leben.

State of the debate: The "Rule of Rescue" refers to the practice that, in order to save people from immediate peril, societies incur high costs largely irrespective of the fact that many more lives could be saved under alternative uses of the resources. The practice has been found difficult to explain, let alone justify, and has often been criticized. In the early literature in the context of the Oregon rationing experiment, the irrationality objection dominated in view of the obvious lack to consider opportunity costs. More recent contributions, taking account of the declining support for purely efficiency-oriented prioritization approaches, advance an equity objection: The practice discriminates against statistical lives. Intent of the present contribution: This article provides a critical assessment of both objections. Results: The following contentions result from the analysis: 1. The equity objection is unfounded; 2. Following the rule of rescue is (in a certain sense) inefficient, but it is not irrational; 3. The criticized judgments result from deep-seated shortcomings in the action-theoretical concepts used (or rather, omitted) in the literature. These shortcomings are inherent in the consequentialist framework dominating the debate and deserve more attention.

Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal / Diretrizes para um Programa de Atenção Integral ao Estomizado e Família: uma proposta de Enfermagem1 / Directivas para un Programa de Atención Integral al Ostomizado y Familia: una propuesta de Enfermería

Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

Objetivos: descrever necessidades e demandas de cuidado que marcam as práticas discursivas de clientes estomizados e familiares e discutir diretrizes para um programa de atenção integral ao cliente estomizado e sua família, organizadas por categorias macrossociológicas. Método: Criativo e Sensível, desenvolvido com dezessete sujeitos estomizados e familiares, em um ambulatório municipal. Os aspectos éticos foram atendidos. Utilizado formulário de caracterização e Dinâmicas de Criatividade e Sensibilidade: "mapa-falante", "corpo-saber" e "almanaque". Aplicada a Análise Crítica do Discurso. Resultados: as necessidades de saúde e demandas de cuidado dos estomizados e familiares, em suas múltiplas dimensões, foram constituídas no contexto domiciliar e comunitário, ambulatorial e societal, implicando em novo direcionamento para o cuidado de enfermagem. O desvelamento dos dados trouxe elementos que se constituíram em diretrizes, de abordagem macrossociológica, para o alcance da integralidade ampliada do cuidado de enfermagem. Conclusão: o cliente estomizado é único em seu gênero/peculiar do latim sui generis, levando-se a pensar em estratégia que atenda e discrimine suas especificidades. Elaborar uma Política Pública de Saúde que aperfeiçoe e reorganize as demandas de cuidado, levando em conta os aspectos biopsicossociais e espirituais desse indivíduo é meta possível e irrevogável no ensejo de melhores condições de sua saúde e bem-estar.

Objetivos: describir necesidades y demandas de cuidado que marcan las prácticas discursivas de clientes ostomizados y familiares y discutir directivas para un programa de atención integral al cliente ostomizado y su familia, organizadas por categorías macrosociológicas. Método: Creativo y Sensibles, desarrollado con diecisiete sujetos ostomizados y familiares, en un ambulatorio municipal. Los aspectos éticos fueron atendidos. Utilizado formulario de caracterización y Dinámicas de Creatividad y Sensibilidad: "mapa-hablante", "cuerpo-saber" y "almanaque". Aplicado el Análisis Crítico del Discurso. Resultados: las necesidades de salud y demandas de cuidado de los ostomizados y familiares, en sus múltiples dimensiones, fueron constituidas en el contexto domiciliar y comunitario, ambulatorio y social, implicando nuevo direccionamiento para el cuidado de enfermería. El desvelamiento de los datos trajo elementos que aportaron directivas, con aproximación macrosociológica, para el alcance de la integralidad ampliada del cuidado de enfermería. Conclusión: el cliente ostomizado es único en su género/peculiar del latín sui generis, llevándose a pensar en estrategia que atienda y discrimine sus especificidades. Elaborar una Política Pública de Salud que perfeccione y reorganice las demandas de cuidado, considerando los aspectos biopsicosociales y espirituales de ese individuo es blanco posible e irrevocable con el objetivo de mejores condiciones de su salud y bienestar.

[Economy in intensive care medicine--a contradiction?]. / Ökonomie in der Intensivmedizin--ein Widerspruch?

BACKGROUND: Medical progress and demographic changes will lead to increasing budgetary constraints in the health care system in the coming years. With respect to economic, medical, and ethical aspects, intensive care medicine has a particular role within the health system. Nonetheless, financial restriction will be inevitable in the near future. MATERIALS AND METHODS: A literature review was performed. RESULTS: In an era of economic decline accompanied by widespread recognition that healthcare costs are on a consistent upward spiral, rationalization and rationing are unavoidable. Priorization models will play a pivotal role in allocation of resources. Individual ethics (respect for autonomy, nonmaleficence, beneficence) as well as justice are essential in daily practice. CONCLUSIONS: Economic thinking and acting as well as being ethically responsible are not mutually exclusive. On the contrary, acting in an ethically responsible manner will be of considerable significance given the pressure of increasing costs in intensive care medicine.

One and done? Equality of opportunity and repeated access to scarce, indivisible medical resources.

BACKGROUND: Existing ethical guidelines recommend that, all else equal, past receipt of a medical resource (e.g. a scarce organ) should not be considered in current allocation decisions (e.g. a repeat transplantation). DISCUSSION: One stated reason for this ethical consensus is that formal theories of ethics and justice do not persuasively accept or reject repeated access to the same medical resources. Another is that restricting attention to past receipt of a particular medical resource seems arbitrary: why couldn't one just as well, it is argued, consider receipt of other goods such as income or education? In consequence, simple allocation by lottery or first-come-first-served without consideration of any past receipt is thought to best afford equal opportunity, conditional on equal medical need.There are three issues with this view that need to be addressed. First, public views and patient preferences are less ambiguous than formal theories of ethics. Empirical work shows strong preferences for fairness in health care that have not been taken into account: repeated access to resources has been perceived as unfair. Second, while difficult to consider receipt of many other prior resources including non-medical resources, this should not be used a motive for ignoring the receipt of any and all goods including the focal resource in question. Third, when all claimants to a scarce resource are equally deserving, then use of random allocation seems warranted. However, the converse is not true: mere use of a randomizer does not by itself make the merits of all claimants equal. SUMMARY: My conclusion is that not ignoring prior receipt of the same medical resource, and prioritizing those who have not previously had access to the medical resource in question, may be perceived as fairer and more equitable by society.

Using health rights to improve programme design: a Papua New Guinea case study.

The non-state sector is becoming increasingly influential in funding and implementing global health programmes. However, their disease-specific focus and vertical interventions have led to criticism that these programmes can be unsustainable and unable to achieve long-term goals. This paper demonstrates that health rights can inform programme design to guide the design of appropriate and sustainable aid-funded health programmes. It draws on UN General Comment 14, which clarified the right to health duties of states and their international partners, and which determined that 'core obligations' in health must become progressively available, accessible, acceptable and of good quality. A rights-based tool assessed the design of activities proposed for Papua New Guinea by a consortium of Australian non-government organisations. The tool revealed that none of the 36 indicators was addressed in full. Five of the 12 indicators pertaining to availability were addressed partially, as were three of 10 relating to accessibility and one of six concerning human rights concepts. As shown by the case study, failure to address the indicators in this tool will result in simplistic programme designs that can win political or financial support, but will fail to respect health rights or deliver a quality health service, available, accessible and acceptable to all.

Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations.

BACKGROUND: Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions. METHODS: With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project. RESULTS: The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately. CONCLUSIONS: Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.

[Demographic change and the need for prioritization in health care: position of the German Medical Association]. / Demografischer Wandel und Notwendigkeit der Priorisierung im Gesundheitswesen: Positionsbestimmung der Arzteschaft.

The German health care system will face major challenges in the near future. Progress in medicine as well as demographic change will combine to drastically exacerbate the scarcity of resources in the health care system. The word scarcity in this case not only refers to the availability of funds. Other resources, e.g., staff, attention, time, and organs for transplantation, are also becoming scarce. It is conceivable that, in the future, it will no longer be possible to provide medical services for all patients to the same extent as in the past. If the necessary resources are not available in the health care system, if the potential for saving resources has been more or less exhausted, and if rationing shall not be an option, the only option to resort to will be prioritization. Prioritization in the health care sector denotes a supply of services according to specific, predetermined criteria. A broad and open public debate, which would have to be accompanied as well as moderated by the Health Council ("Gesundheitsrat"), is essential for determining such criteria.

[Quality of life and ethics as basic questions in geriatric oncology]. / Lebensqualität und Ethik als wichtige Grundsatzfragen der geriatrischen Onkologie.

Optimal care for elderly cancer patients requires empathy and alertness about impaired autonomy and an exceptional quality of care. Specific to geriatric oncology is the particular need of attention and care for the patients. Most important from a conceptual point of view is to identify that this will result in additional demands. To care for these patients will require more time as any intervention must be adapted to age specific capabilities. The difficult task of shared decision-making should be preferably based on the quality of life assessment of the individual patient and their needs. The process of assessing quality of life is in itself already an act of enhancing autonomy, because it respects the individual's subjectivity. Many ethical questions arise between the contradictory contexts of paternalism and autonomy. There are conditions to be met and limits of autonomy to be considered, which differ for the elderly patients because of their vulnerability and particular dependencies. As the elderly patient is closer to death and dying, questions of care in these situations are frequently more pressing. It is important to distinguish actively intended euthanasia from the goals and concerns of modern palliative care in order to enable dying with dignity.

Evidence and values: requirements for public reimbursement of drugs for rare diseases--a case study in oncology.

INTRODUCTION: Doubts have been expressed about whether standard methods of health technology assessment are suitable for the evaluation of drugs for rare diseases. Under conditions of rarity, it may be more difficult to conduct large randomized trials in order to gather adequate evidence on efficacy, and the standard methods of economic evaluation may not adequately reflect societal preferences for the treatment of serious and/or life-threatening rare diseases. METHODS: A roundtable was held at the University of Toronto Joint Centre for Bioethics on February 18, 2008 to address these issues. While the focus was on evaluation and reimbursement decision-making for rare cancers, the discussion was broadened to consider the place of evidence and values in considering public reimbursement of drugs prescribed for rare disorders more generally. DISCUSSION: This paper explores the relevant issues in more detail, using the example of a new drug for treatment of renal cell carcinoma. CONCLUSION: There should be a greater commitment by reimbursement agencies to a fair and transparent decision-making process with appropriate community input. Criteria should be developed to validate surrogate markers for rare diseases. It should also be acknowledged that the traditional measures of benefit in economic studies do not incorporate all elements of social value. The need should be recognized to balance equity with an efficient use of resources.

[Justice in health. Comment on the theory by Norman Daniels]. / Gesundheitsgerechtigkeit. Zur Theorie von Norman Daniels.

This comment outlines the current approach of Norman Daniels and illustrates its connection to the important theory of political justice by John Rawls. Despite some conceptual imprecision and a lack of coherency between his substantial and procedural account of justice, Daniels' approach qualifies as a benchmark for other current and future theories of justice and health. The social and political implications of his theory are far reaching: We are still far from protecting our health in the way we owe it to each other.