Revelaciones de la pandemia de COVID-19.

"Societies unveil their entrails during a crisis and hide or conceal them in normal situations" is the premise of this essay that offers a propositional critique of the foundations of civilization by characterizing some revelations from the COVID-19 pandemic that seriously compromises the globalized world. Especially the neoliberal myth as the only way of human progress, and technological development as the essence of social progress and main reason for scientific research. Among the significant revelations is the dismantling of the Welfare state and public health services, which render the population's vulnerability in the face of pandemics. Planetary devastation favors its emergence, and the correlation between the despondency of human activities and the (fleeting) improvement of planetary life, which denotes the radical incompatibility between the permanence of neoliberal capitalism that degrades everything and preservation and care of life in its infinite diversity, including human life! Another notion of human progress is proposed: the rise of values involved in the coexistence, and the spiritual, intellectual, and moral growth of the human condition in harmony with the planetary ecosystem. Regarding the deep reasons for the catastrophe, it is argued that it is humanity itself by its way of being, thinking, acting, living together and relating to the planet. Therefore, the conclusion reached is the urgent need to undertake an alternative path in the search for another possible world, hospitable and dignifying for all forms of life.

Bajo la premisa de que «las sociedades revelan sus entrañas en momentos críticos y las ocultan o encubren en situaciones de normalidad¼, este ensayo emprende, a partir de caracterizar algunas revelaciones de la pandemia de COVID-19 ­que ha puesto en jaque al mundo globalizado­, una crítica propositiva de los basamentos de la civilización. En particular, el mito neoliberal como camino único de progreso humano y el del desarrollo tecnológico como esencia del progreso social y razón principal del quehacer científico. Dentro de las revelaciones significativas destaca el desmantelamiento del Estado de bienestar y de los servicios públicos de salud, que hacen vulnerable a la población ante las pandemias; la devastación planetaria, que favorece su emergencia; y la correlación entre el desplome de las actividades humanas y la mejoría (fugaz) de la vida planetaria, que denota la incompatibilidad radical entre la permanencia del capitalismo neoliberal, que todo lo degrada, y la preservación y el cuidado de la vida en su infinita diversidad… ¡la humana incluida! Se propone otra idea de progreso humano: el auge de los valores implicados en la superación espiritual, intelectual, moral y de convivencia en armonía con el ecosistema planetario. Respecto a las razones profundas de la catástrofe, se argumenta que es la propia humanidad por su forma de ser, de pensar, de actuar, de convivir y de relacionarse con el planeta. Por tanto, la conclusión a la que se llega es la urgente necesidad de emprender un camino alternativo en la búsqueda de otro mundo posible, hospitalario y dignificante para todas las formas de vida.

Revelaciones de la pandemia de COVID-19 / Revelations from the COVID-19 pandemic

Resumen Bajo la premisa de que «las sociedades revelan sus entrañas en momentos críticos y las ocultan o encubren en situaciones de normalidad¼, este ensayo emprende, a partir de caracterizar algunas revelaciones de la pandemia de COVID-19 —que ha puesto en jaque al mundo globalizado—, una crítica propositiva de los basamentos de la civilización. En particular, el mito neoliberal como camino único de progreso humano y el del desarrollo tecnológico como esencia del progreso social y razón principal del quehacer científico. Dentro de las revelaciones significativas destaca el desmantelamiento del Estado de bienestar y de los servicios públicos de salud, que hacen vulnerable a la población ante las pandemias; la devastación planetaria, que favorece su emergencia; y la correlación entre el desplome de las actividades humanas y la mejoría (fugaz) de la vida planetaria, que denota la incompatibilidad radical entre la permanencia del capitalismo neoliberal, que todo lo degrada, y la preservación y el cuidado de la vida en su infinita diversidad ¡la humana incluida! Se propone otra idea de progreso humano: el auge de los valores implicados en la superación espiritual, intelectual, moral y de convivencia en armonía con el ecosistema planetario. Respecto a las razones profundas de la catástrofe, se argumenta que es la propia humanidad por su forma de ser, de pensar, de actuar, de convivir y de relacionarse con el planeta. Por tanto, la conclusión a la que se llega es la urgente necesidad de emprender un camino alternativo en la búsqueda de otro mundo posible, hospitalario y dignificante para todas las formas de vida.

Abstract “Societies unveil their entrails during a crisis and hide or conceal them in normal situations” is the premise of this essay that offers a propositional critique of the foundations of civilization by characterizing some revelations from the COVID-19 pandemic that seriously compromises the globalized world. Especially the neoliberal myth as the only way of human progress, and technological development as the essence of social progress and main reason for scientific research. Among the significant revelations is the dismantling of the Welfare state and public health services, which render the population’s vulnerability in the face of pandemics. Planetary devastation favors its emergence, and the correlation between the despondency of human activities and the (fleeting) improvement of planetary life, which denotes the radical incompatibility between the permanence of neoliberal capitalism that degrades everything and preservation and care of life in its infinite diversity, including human life! Another notion of human progress is proposed: the rise of values involved in the coexistence, and the spiritual, intellectual, and moral growth of the human condition in harmony with the planetary ecosystem. Regarding the deep reasons for the catastrophe, it is argued that it is humanity itself by its way of being, thinking, acting, living together and relating to the planet. Therefore, the conclusion reached is the urgent need to undertake an alternative path in the search for another possible world, hospitable and dignifying for all forms of life.

Colonialism, science, and health.

In addition to genocide, slavery, and the dispossession of indigenous people, colonialism, as a form of control, meant the suppression of traditional knowledge. The imposition of Christianity, the modern Western paradigm, and modern science that followed perpetrated this suppression. The universal role held by modern science is supported neither by epistemic nor social aspects. It is ineffective and complicit in the collapse of civilization, and it is worsened by comprehensive and unifying ideas to be reduced to an input-process of technological innovation for the benefit of social control industries such as the military, information technology, communication, or health. Furthermore, it suppresses ancestral knowledge related to health and medicine that may be beneficial and must be researched (stimulant medicines). Coupled with the health industry, it promotes the medicalization of life, spreading uncertainty, anxiety, and unease. Therefore, it is an instrument of neocolonialism that imposes its priorities, supplanting problems in subordinated countries, and extracts substantial resources, which is detrimental to social policies and programs. The biggest objection to the universality of modern science is derived from its empiricist and reductionist nature. Through the practically impossible idea of a unifying and explanatory knowledge, it impedes researchers the understanding of the complexity of the world and their historical moment and to act accordingly. It transforms great creative and liberating potential to submissiveness for the interests of capital and its representatives.

El colonialismo, como forma de dominación, significó, además de genocidio, esclavitud o despojo de pueblos originarios, la supresión de saberes tradicionales perpetrada por la imposición del cristianismo, del paradigma moderno occidental y de la ciencia moderna que le siguió. El carácter universal detentado por la ciencia moderna no se sostiene en lo epistémico ni en lo social; es inoperante con y cómplice del colapso civilizatorio; se empobrece de ideas comprensivas e integradoras para reducirse al insumo-proceso de la innovación tecnológica en provecho de las industrias del control social (militar, informática, de comunicación o de la salud); y suprime saberes ancestrales de la esfera de la salud que encierran beneficios y posibilidades que es preciso investigar (medicina estimulante). Aunada a la industria de la salud, impulsa la medicalización de la vida, preñándola de incertidumbre, angustia y desasosiego. Es instrumento del neocolonialismo al imponer sus prioridades, que suplantan las propias de los países subordinados y sustraen cuantiosos recursos en detrimento de políticas y programas sociales. La mayor objeción a la universalidad de la ciencia moderna deriva de su carácter empirista y reduccionista que, al condicionar la imposibilidad práctica de un conocimiento integrador y explicativo, aleja a los investigadores del entendimiento de la complejidad del mundo, de su momento histórico y de actuar en consecuencia, y transforma la gran potencialidad creativa y liberadora de este enorme contingente en docilidad a los designios de los intereses del capital y sus agentes.

El bien vivir: ¿cuidado de la salud o proyecto vital? Primera parte / To live well: health care or life project? Part I

Resumen: En este trabajo sobre del bien vivir —aspiración humana universal y fin último en el ideal de la atención a la salud— se confrontan dos opciones para su consecución: cuidado de la salud y proyecto vital. Se inicia con un recuento de las expresiones de la degradación humana en el mundo actual propiciada por las desigualdades sociales, cuya intensidad y omnipresencia revelan una quiebra civilizatoria. Con este marco se argumenta cómo la medicalización de la vida, que reduce el cuidado de la salud a la lógica de la lucha contra las enfermedades y la impone como prioridad vital, empobrece el bien vivir (vida digna, satisfactoria y serena), con la industria de la salud como principal beneficiaria. La influencia de la medicalización en el modo de vivir ha convertido la obsesión por estar sano y el horror a la enfermedad en un medio de control social al servicio del poder que mantiene y profundiza las desigualdades; de ahí su promoción incesante. Se arguye cómo esa preocupación por la salud, lejos de aproximar al bien vivir, introduce por senderos de angustia, inseguridad y desasosiego. Al final, se hacen consideraciones sobre los inconvenientes de que el cuidado de la salud polarice la atención y las energías vitales de los profesionales de la salud y de los usuarios de los servicios, y se descuide la responsabilidad ética, que atañe a todos, de la búsqueda de un mundo hospitalario e incluyente.

Abstract: To live well is a universal human aspiration as well as the ultimate goal of the services that take care of people's health. In this paper, two different ideas are discussed about how to achieve it: health care and life project. Part I begins with a detailed account of human degradation and the social inequities responsible for the unprecedented social and cultural breakdown of the actual society. Under this interpretative framework, the medicalization of human life as result of the alienating consumerism is analyzed as well as the excesses it entails from both health care institutions and health services users. By exploring the reasons of medicalization, it becomes clear that its influence in our actual lifestyles has driven us to be obsessed with being healthy and horrified of diseases; this works as a very effective mean of social control from the powers that maintain and deepen inequality. As such, the first to benefit from it is the health industry. This constant concern for health takes us away from our goal of living well since it causes anxiety, insecurity and disquietude. In conclusion, different considerations about the inconveniences of devoting all our energies towards health care are offered and it is suggested that instead we all have the responsibility of creating a more hospitable and inclusive world.

[To live well: health care or life project? Part I]. / El bien vivir: ¿cuidado de la salud o proyecto vital? Primera parte.

To live well is a universal human aspiration as well as the ultimate goal of the services that take care of people's health. In this paper, two different ideas are discussed about how to achieve it: health care and life project. Part I begins with a detailed account of human degradation and the social inequities responsible for the unprecedented social and cultural breakdown of the actual society. Under this interpretative framework, the medicalization of human life as result of the alienating consumerism is analyzed as well as the excesses it entails from both health care institutions and health services users. By exploring the reasons of medicalization, it becomes clear that its influence in our actual lifestyles has driven us to be obsessed with being healthy and horrified of diseases; this works as a very effective mean of social control from the powers that maintain and deepen inequality. As such, the first to benefit from it is the health industry. This constant concern for health takes us away from our goal of living well since it causes anxiety, insecurity and disquietude. In conclusion, different considerations about the inconveniences of devoting all our energies towards health care are offered and it is suggested that instead we all have the responsibility of creating a more hospitable and inclusive world.

El reduccionismo científico y el control de las conciencias: Parte II / Scientific reductionism and social control of mind: Part II

En esta segunda parte se analizan los vínculos de subordinación del quehacer científico con lo que se designa como la lógica del poder y la dominación, a través de dar prioridad absoluta a los hechos sobre las ideas y favorecer el conocimiento capitalizable por la innovación tecnológica, la cual es decisiva en la rentabilidad y competitividad de las grandes empresas (los intereses de lucro que gobiernan el planeta), y base de los mecanismos de control político-social de las conciencias y de la disidencia. La crítica del reduccionismo científico reconoce la necesidad de otra idea de progreso humano que reoriente a los científicos a fin de conferirle a sus saberes (ideas) un poder liberador y cuestionador -diluido y desvirtuado entre miríadas de hechos- imprescindible en la búsqueda de sociedades deliberativas, pluralistas, incluyentes, igualitarias, justas y colaborativas donde primen la dignidad humana y el respeto al ecosistema planetario.

In the second part of this essay, the progressive subordination of scientific endeavor and knowledge of business and profit is pointed out. For instance, the way facts are prioritized over concepts and ideas in scientific knowledge can translate into technological innovation, central to enterprise competitiveness and key to social mechanisms of control (military, cybernetic, ideological). Overcoming the scientific reductionism approach indicates recognizing the need to define progress in another way, one that infuses scientific knowledge with real liberating and inquisitive power. Power is essential in the search for a more collaborative, inclusive and pluralistic society where respect for human dignity and care for the ecosystem that we live in are prioritized.

El reduccionismo científico y el control de las conciencias: Parte I / Scientific reductionism and social control of mind: Part I

En esta primera entrega acerca del reduccionismo científico (RC) se parte de una definición convencional: «el todo no es más que la suma de las partes¼. El RC en las ciencias de la vida sostiene que el conocimiento de lo complejo debe ser, obligadamente, a través de sus componentes más simples, o que un sistema complejo solamente puede explicarse por medio de la reducción hasta sus partes fundamentales. Se distinguen tres tipos de reduccionismo: ontológico, teórico y metodológico. Los orígenes del RC se remontan a los primeros humanos en sus intentos de entender los sucesos naturales más influyentes y perturbadores para la supervivencia. La permanencia del RC como el modo de ser de la ciencia hasta nuestros días, de acuerdo con E. Morin, deriva del predominio del paradigma de disyunción, reducción, simplificación y exclusión. El holismo, que ha preservado la idea de la complejidad como enfoque de los fenómenos vitales, ha sido el rival del RC a lo largo del tiempo. Desde esta perspectiva, el discurso científico reduccionista, no solo tiene escasa relevancia en la solución de los grandes problemas de la humanidad (la degradación omnímoda de todo lo existente, las desigualdades, la exclusión progresiva de sectores mayoritarios de la población y la devastación de ecosistemas), sino que hace contribuciones decisivas (casi siempre involuntarias) al mantenimiento del statu quo.

The first part of this essay starts from the conventional premise of reductionism, which states 'the whole is nothing more than the sum of its parts'. According to scientific reductionism (SR), knowledge of the complex can only be achieved through simpler components, which means complex systems are explained by reduction to its most basic parts. Three kinds of SR are defined: ontological, theoretical and methodological. SR origins dwell within the efforts made by early humans to understand natural phenomena and its importance to survival. According to E. Morin, the reason behind SR being the favorite approach in science comes from the dysjunction, reduction, simplification and exclusion paradigm. The holistic approach as opposed to SR studies vital phenomena from the idea of complexity. From this perspective, not only does SR have almost no relevance in the solution of humanity's greatest problems like society inequality, human dignity and environmental degradation, it also contributes to maintain the statu quo.

[Scientific reductionism and social control of mind. Part I]. / El reduccionismo científico y el control de las conciencias. Parte I.

The first part of this essay starts from the conventional premise of reductionism, which states 'the whole is nothing more than the sum of its parts'. According to scientific reductionism (SR), knowledge of the complex can only be achieved through simpler components, which means complex systems are explained by reduction to its most basic parts. Three kinds of SR are defined: ontological, theoretical and methodological. SR origins dwell within the efforts made by early humans to understand natural phenomena and its importance to survival. According to E. Morin, the reason behind SR being the favorite approach in science comes from the dysjunction, reduction, simplification and exclusion paradigm. The holistic approach as opposed to SR studies vital phenomena from the idea of complexity. From this perspective, not only does SR have almost no relevance in the solution of humanity's greatest problems like society inequality, human dignity and environmental degradation, it also contributes to maintain the statu quo.

[Scientific reductionism and social control of mind. Part II]. / El reduccionismo científico y el control de las conciencias. Parte II.

In the second part of this essay, the progressive subordination of scientific endeavor and knowledge of business and profit is pointed out. For instance, the way facts are prioritized over concepts and ideas in scientific knowledge can translate into technological innovation, central to enterprise competitiveness and key to social mechanisms of control (military, cybernetic, ideological). Overcoming the scientific reductionism approach indicates recognizing the need to define progress in another way, one that infuses scientific knowledge with real liberating and inquisitive power. Power is essential in the search for a more collaborative, inclusive and pluralistic society where respect for human dignity and care for the ecosystem that we live in are prioritized.

[Role of creative discussion in the learning of critical reading of scientific articles]. / Papel de la discusión creadora en el aprendizaje de la lectura crítica de artículos científicos.

OBJECTIVE: To compare two active educational strategies on critical reading (two and three stages) for research learning in medical students. MATERIAL AND METHODS: Four groups were conformed in a quasi-experimental design. The medical student group, related to three stages (critical reading guide resolution, creative discussion, group discussion) g1, n = 9 with school marks > 90 and g2, n = 19 with a < 90, respectively. The two-stage groups (guide resolution and group discussion) were conformed by pre-graduate interns, g3, n = 17 and g4, n = 12, who attended social security general hospitals. A validated and consistent survey with 144 items was applied to the four groups before and after educational strategies. Critical reading with its subcomponents: interpretation, judgment and proposal were evaluated with 47, 49 and 48 items, respectively. The case control studies, cohort studies, diagnostic test and clinical trial designs were evaluated. Nonparametric significance tests were performed to compare the groups and their results. A bias calculation was performed for each group. RESULTS: The highest median was obtained by the three-stage groups (g1 and g2) and so were the medians in interpretation, judgment and proposal. The several research design results were higher in the same groups. CONCLUSIONS: An active educational strategy with three stages is superior to another with two stages in medical students. It is advisable to perform these activities in goal of better learning in our students.

[Validate an instrument constructed to assess mentorship assessment in master programs]. / Construcción y validación de un instrumento para evaluar la labor docente de asesoría en programas de maestría en el área de la salud.

BACKGROUND: The mentorship assessment is important to the students. There is not an instrument that evaluates the professors' skills to assess students. Our objective was to build and validate an instrument to evaluate the teaching labor on assessment of Master's degree (MD) students in Education and to compare with other programs of MD. METHODS: Construct and validate an instrument to evaluate mentorship assessment (EMA) was carried out. It was answered by the students to evaluate their own teachers in four programs of MD. The instrument measure four indicators: opening, disposition, respect and expertise with a total of 50 items. RESULTS: The global scoring obtained in EMA didn't point out the statistical significant differences among the different programs of MD with the Kruskal-Wallis test, however statistical significant differences were found with chi(2) p < 0.05 when compared each program in favor of the MD in education. CONCLUSIONS: The instrument EMA showed validity and consistency.

[The evolution of teaching education in the health area]. / La evolución de la formación docente en el área de la salud.

OBJECTIVES: To evaluate the performance through time of the Centro de Investigación Educativa y Formación Docente (Educational Research and Teaching Education Center) at the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security), Nuevo León Office using as an indicator the ability for critical reading of theoretical texts of education. MATERIAL AND METHODS: A comparative cross-sectional study was made among professors with and without teaching education, as well as among the several generations of professors that took teaching education courses at the Centro de Investigación Educativa y Formación Docente. A previously validated instrument was used to measure the ability for critical reading. It was applied to 358 professors, 107 with teaching education at the Centro de Investigación Educativa y Formación Docente in Monterrey and 251 without teaching education, at the IMSS Nuevo León Office. RESULTS: It was found that the previous teaching education constitutes a "positive risk" with an odds ratio of 17.66 (CI 9.02-34.12). Statistically significant differences were also found between not educated professors (median of 15) and educated professors (median of 35). In the scale, the grades at random and very low predominated in not educated professors, while the educated ones were located in the low and average. CONCLUSION: Professors at the Centro de Investigación Educativa y Formación Docente are improving their teaching labor using research as a means of self-criticism.

Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México / Violence against women: knowledge and attitudes of healthcare providers at the Mexican Institute of Social Security in Morelos, Mexico

OBJETIVO: Evaluar la actitud afectiva, cognoscitiva y conductual del personal médico del Instituto Mexicano del Seguro Social del estado de Morelos, México, hacia la identificación y canalización de mujeres maltratadas que acuden a consulta médica, así como identificar las barreras institucionales y de la práctica médica que dificultan el manejo dentro de los servicios de salud de las mujeres maltratadas. MATERIAL Y MÉTODOS: De septiembre a diciembre de 1999 se realizó un estudio transversal mediante un cuestionario de autoaplicación que se proporcionó a 269 médicos y médicas generales, especialistas y estudiantes de pre y posgrado que laboran en 30 unidades de salud, de primer y segundo nivel de atención, del Instituto Mexicano del Seguro Social del estado de Morelos. El instrumento se diseñó para evaluar el nivel de conocimiento sobre violencia doméstica y la actitud del personal médico hacia la atención, en la consulta, de mujeres maltratadas. Se construyó un índice de conocimiento, además de un análisis multivariado de los datos. RESULTADOS: El 90 por ciento de los entrevistados nunca ha recibido capacitación en violencia contra la mujer. La actitud afectiva y cognoscitiva del personal médico que recibió capacitación sobre el tema fue más favorable hacia la identificación y atención de mujeres maltratadas que llegan a consulta médica, en comparación con los que no la recibieron. Sobre el nivel de conocimiento acerca del tema, 21 por ciento de los entrevistados mostró un nivel bajo, 63 por ciento medio y 16 por ciento alto. En el personal médico, con nivel de conocimiento medio y alto, se observó 2.1 y 6 veces -respectivamente- una actitud afectiva más favorable respecto a la identificación y canalización de casos de mujeres maltratadas en comparación con el personal con nivel de conocimiento bajo. Las médicas mostraron 2.3 veces mejor actitud para identificar y canalizar mujeres maltratadas. El personal médico con interés por capacitarse...

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63 percent) showed a moderate degree of knowledge on the subject, whereas 21 percent were slightly knowledgeable and 16 percent were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being...

[Violence against women: knowledge and attitudes of the the medical staff at the Mexican Institute of Social Security, Morelos, Mexico]. / Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México.

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63%) showed a moderate degree of knowledge on the subject, whereas 21% were slightly knowledgeable and 16% were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being trained, as compared with specialist physicians. Training on violence against women should be included in graduate medical, nursing, social service, psychology, and other public health areas. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

[The performance of professors of Medicine as an indicator of the influence of an educational training course]. / El desempeño de profesores de Medicina como indicador de la influencia de un curso de formación docente.

OBJECTIVE: To compare the educational environments created by the professors who attended the Regional Center of Teachers Training to those who did not attend it. MATERIAL AND METHODS: An instrument was developed to explore the educational environment that every professor creates for students with indirect technique, with double statements in accordance to the passive and participative focus of the education they approached of the type and frequency of activities carried on regularly in the educational process, validated by rounds of experts, with a final version of 60 statements and six indicators. The instrument was applied to 480 residents (students) from the different specialization courses in 10 hospitals from a Delegation of the Mexican Institute of Social Security corresponding to 82 professors evaluated. For the statistic analysis was used Chi 2 with Yates correction, the odds ratio with confidence intervals and the U of Mann Whitney. The Kuder Richardson test was used to determine the instruments consistency. RESULTS: There were no significant differences (p > .50) when comparing the educational environment created by the professors who attended the training courses at the Center and those who did not attend. The odds ratio to evaluate if training creates a more participative environment for students was of 1.84 (IC 0.94-2.92). CONCLUSION: There are limitations in the courses for teachers training and that is because a profound change has not been accomplished in the graduates to allow a turn in their teaching experience to an education that promotes the elaboration of knowledge (participative) by the students, when they return to their medical units. It is necessary to reorient the educational process.

El desempeño de profesores de Medicina como indicador de la influencia de un curso de formación docente / The performance of professors of Medicine as an indicator of the influence of an educational training course

OBJECTIVE: To compare the educational environments created by the professors who attended the Regional Center of Teachers Training to those who did not attend it. MATERIAL AND METHODS: An instrument was developed to explore the educational environment that every professor creates for students with indirect technique, with double statements in accordance to the passive and participative focus of the education they approached of the type and frequency of activities carried on regularly in the educational process, validated by rounds of experts, with a final version of 60 statements and six indicators. The instrument was applied to 480 residents (students) from the different specialization courses in 10 hospitals from a Delegation of the Mexican Institute of Social Security corresponding to 82 professors evaluated. For the statistic analysis was used Chi 2 with Yates correction, the odds ratio with confidence intervals and the U of Mann Whitney. The Kuder Richardson test was used to determine the instruments consistency. RESULTS: There were no significant differences (p > .50) when comparing the educational environment created by the professors who attended the training courses at the Center and those who did not attend. The odds ratio to evaluate if training creates a more participative environment for students was of 1.84 (IC 0.94-2.92). CONCLUSION: There are limitations in the courses for teachers training and that is because a profound change has not been accomplished in the graduates to allow a turn in their teaching experience to an education that promotes the elaboration of knowledge (participative) by the students, when they return to their medical units. It is necessary to reorient the educational process.

Capacitación y desempeño laboral en enfermería: Parte II Efecto de la capacitación en el desempeño de la jefa de piso / Trainig and working nurse performance: Part II The impact of empoweringon the performance of principal nurse

Con el propósito de explorar el desempeño en la categoría de jefe de piso de enfermería, se realizó este estudio en dos hospitales generales de zona de Aguascalientes. Como variables de confusión potenciales se tomaron en cuenta antigüedad en el cargo, nivel de escolaridad (técnico o licenciatura) y turno. Se procedió a la aplicación del CAL (Cuestionario de ambiente laboral) para explorar el trabajo de la jefa de piso mediante la opinión de sus subordinados ­ante diversos aspectos del ambiente de trabajo­, con base a los siguientes indicadores: confianza, respeto, apoyo, superación, eficiencia y satisfacción. Se incluyó un criterio externo para desempeño (opinión sistematizada de la jefa de enfermeras) y se observó que el poder de discriminación del instrumento era satisfactorio. En total se evaluaron 63 jefas de piso; se aplicó el instrumento a todo el personal de enfermería subordinado, en los dos hospitales y los tres turnos. No se encontraron diferencias significativas al comparar las puntuaciones obtenidas por los grupos en diferentes etapas del programa; tampoco diferencias estadísticas con las otras variables consideradas (antigüedad en el cargo, nivel de escolaridad y turno). Por lo anterior se concluye que los cursos para directivos de enfermería no parecen tener una influencia favorable; el ambiente laboral que prevalece dentro de la institución provoca una especie de uniformidad en las actividades; las diferencias individuales se diluyen, aun las que podrían expresarse por desigualdades en la antigüedad, la escolaridad o el turno; además, se reconoce la limitación de un estudio transversal para dar respuesta a las interrogantes planteadas.

This study describes working administrative nurse personal performance in two hospitals in the state of Aguascalientes, México, and took into consideration educational level (technical or bachelor's degree), time of experience in charge, and the shift worked as three variables of potential confusion. The LAQ (Labor Ambience Questionnaire) was applied in order to explore administrative nurse personal performance within the laboral environment in the areas of confidence, support, job satisfaction, respect, and efficiency and selfimprovement attitudes. External performance criteria were included to observe the satisfactory discriminatory power of the instrument. We applied the LAQ to all subordinating nurse personnel of sixty-three administrative nurses at two hospitals during the three shifts. No significant differences were found in comparing the groups as to different degree programs, and no significant differences were found either in terms of incharge experience, technical or bachelor's degree level, and shift. The conclusions was that training courses for administrative nurses do not appear to influence nurse personal performance, because the working ambience of the institution reflected more closely the laboral conditions and influenced the uniformed performance.

Etica y conocimiento médico alrededor de la reproducción / Ethics and medical knowledge in reproduction

Considerando la relación desigual entre médicos y pacientes, donde éstos están subordinados y por tanto en riesgo permanente de ser víctimas de excesos; que tal relación no genera conflicto, o éste es mínimo, al basarse en el "efecto social" de las distribuciones de formas de poder, favoreciendo que las desigualdades no se vivan como tales, sino como legítimas, fundadas en la razón y en la universidad, se analizan las implicaciones éticas del conocimiento médico. Se parte de que el error médico es una acción u omisión que denota un proceder inapropiado, cuyos determinantes más inmediatos son la negligencia, la ignorancia y la impericia. Se define a la iatrogenia como los daños causados por el proceder médico, considerándose dos variantes, la intrínseca (inevitable, propia de los riesgos del correcto proceder) y la extrínseca (evitable, atribuible al error). Se identifican y ejemplifican cinco variantes de error médico: el error de enfoque (apreciación equivocada o insuficiente de la complejidad que entraña la situación del paciente o del propio médico); el error de interpretación (se asignan significados equivocados a la información obtenida o disponible); errores de juicio (es un discernimiento equivocado al evaluar la credibilidad de la información, en la integración diagnóstica, al jerarquizar los problemas, al definir su gravedad, tanto en el momento como en su evolución, al definir las prioridades de acción y los requerimientos de atención); error de desición (seleccionar y asumir una conducta que no es la más pertinente a las circunstancias del paciente, implican omisiones o acciones con relación al tiempo y pertinencia que pueden tener una consecuencia ineficaz o contraproducente); y error de ejecución (realizar acciones ineficaces o que provoquen malestar o daño). Al considerar que detrás del error hay una insuficiencia de conocimiento, se define al camino del conocimiento como el del perfeccionamiento de la experiencia. El que tiene que ver principalmente con enfoques, métodos y procedimientos; considerados como tales son caminos abiertos donde el refinamiento y la sutileza son inacabados mientras la experiencia se despliegue. El progreso de la experiencia se finca en la lectura crítica de las fuentes de información y en la incorporación de la investigación como medio de aprendizaje. Lo anterior facilita la obtención de una experiencia reflexiva que le permitirá trascender a lo social y lo cultural, a lo familiar y a lo ambiental