Clinical empathy in a medium and high-risk Brazilian unit.

BACKGROUND: Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. RESEARCH AIM: To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. RESEARCH DESIGN: Single-center survey study. PARTICIPANTS AND RESEARCH CONTEXT: The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains' punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. ETHICAL CONSIDERATIONS: This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants' confidentiality and anonymity were protected. FINDINGS: Median empathy was 117 (IQR 113-124). The domain of Walking in the Patient's Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient's Shoes was not included in the model. CONCLUSIONS: In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient's Shoes, in this case, the neonate, and provide more empathic care to them.

Investigation of Unprecedented Sites and Proposition of New Ligands for Programmed Cell Death Protein I through Molecular Dynamics with Probes and Virtual Screening.

Cancer immunotherapy has attracted increasing attention over the last few years. Programmed cell death protein 1 (PD-1) promotes self-tolerance and inhibits immune responses by modulating the T-cell function. The interaction between PD-1 and programmed cell death ligand-1 (PD-L1) leads to immune exhaustion, protecting cancer cells from destruction. Here, we computationally designed a novel ligand named 1508 that binds to an unprecedented PD-1 cavity identified by MixMD and defined by amino acid residues Lys78 to Val97. We showed through a set of MD simulations totaling 12.5 µs that ligand 1508 establishes frequent cation-π and hydrogen bonding interactions with amino acid residues Lys78 and Arg86, respectively, and stabilizes the PD-1 C'D loop in a conformation that does not favor PD-1-PD-L1 complex formation. This study highlights the power of MixMD in exposing new cavities prone to protein-protein complex inhibition and establishes the basis for the design of new molecules that target the PD-1 C'D cavity as an alternative for exploring the modulation of the PD-1-PD-L1 complex in cancer therapy.

Discovery of New Zika Protease and Polymerase Inhibitors through the Open Science Collaboration Project OpenZika.

The Zika virus (ZIKV) is a neurotropic arbovirus considered a global threat to public health. Although there have been several efforts in drug discovery projects for ZIKV in recent years, there are still no antiviral drugs approved to date. Here, we describe the results of a global collaborative crowdsourced open science project, the OpenZika project, from IBM's World Community Grid (WCG), which integrates different computational and experimental strategies for advancing a drug candidate for ZIKV. Initially, molecular docking protocols were developed to identify potential inhibitors of ZIKV NS5 RNA-dependent RNA polymerase (NS5 RdRp), NS3 protease (NS2B-NS3pro), and NS3 helicase (NS3hel). Then, a machine learning (ML) model was built to distinguish active vs inactive compounds for the cytoprotective effect against ZIKV infection. We performed three independent target-based virtual screening campaigns (NS5 RdRp, NS2B-NS3pro, and NS3hel), followed by predictions by the ML model and other filters, and prioritized a total of 61 compounds for further testing in enzymatic and phenotypic assays. This yielded five non-nucleoside compounds which showed inhibitory activity against ZIKV NS5 RdRp in enzymatic assays (IC50 range from 0.61 to 17 µM). Two compounds thermally destabilized NS3hel and showed binding affinity in the micromolar range (Kd range from 9 to 35 µM). Moreover, the compounds LabMol-301 inhibited both NS5 RdRp and NS2B-NS3pro (IC50 of 0.8 and 7.4 µM, respectively) and LabMol-212 thermally destabilized the ZIKV NS3hel (Kd of 35 µM). Both also protected cells from death induced by ZIKV infection in in vitro cell-based assays. However, while eight compounds (including LabMol-301 and LabMol-212) showed a cytoprotective effect and prevented ZIKV-induced cell death, agreeing with our ML model for prediction of this cytoprotective effect, no compound showed a direct antiviral effect against ZIKV. Thus, the new scaffolds discovered here are promising hits for future structural optimization and for advancing the discovery of further drug candidates for ZIKV. Furthermore, this work has demonstrated the importance of the integration of computational and experimental approaches, as well as the potential of large-scale collaborative networks to advance drug discovery projects for neglected diseases and emerging viruses, despite the lack of available direct antiviral activity and cytoprotective effect data, that reflects on the assertiveness of the computational predictions. The importance of these efforts rests with the need to be prepared for future viral epidemic and pandemic outbreaks.

Essential oil of Croton zehntneri and its main constituent anethole block excitability of rat peripheral nerve.

Croton zehntneri is an aromatic plant native to Northeast Brazil and employed by local people to treat various diseases. The leaves of this plant have a rich content of essential oil. The essential oil of C. zehntneri samples, with anethole as the major constituent and anethole itself, have been reported to have several pharmacological activities such as antispasmodic, cardiovascular, and gastroprotective effects and inducing the blockade of neuromuscular transmission and antinociception. Since several works have demonstrated that essential oils and their constituents block cell excitability and in view of the multiple effects of C. zehntneri essential oil and anethole on biological tissues, we undertook this investigation aiming to characterize and compare the effects of this essential oil and its major constituent on nerve excitability. Sciatic nerves of Wistar rats were used. They were mounted in a moist chamber, and evoked compound action potentials were recorded. Nerves were exposed in vitro to the essential oil of C. zehntneri and anethole (0.1-1 mg/mL) up to 180 min, and alterations in excitability (rheobase and chronaxie) and conductibility (peak-to-peak amplitude and conduction velocity) parameters of the compound action potentials were evaluated. The essential oil of C. zehntneri and anethole blocked, in a concentration-dependent manner with similar pharmacological potencies (IC50: 0.32 ± 0.07 and 0.22 ± 0.11 mg/mL, respectively), rat sciatic nerve compound action potentials. Strength-duration curves for both agents were shifted upward and to the right compared to the control curve, and the rheobase and chronaxie were increased following essential oil and anethole exposure. The time courses of the essential oil of C. zehntneri and anethole effects on peak-to-peak amplitude of compound action potentials followed an exponential decay and reached a steady state. The essential oil of C. zehntneri and anethole caused a similar reduction in conduction velocities of the compound action potential waves investigated. In conclusion, we demonstrated here that the essential oil of C. zehntneri blocks neuronal excitability and that this effect, which can be predominantly attributable to its major constituent, anethole, is important since these agents have several pharmacological effects likely related to the alteration of excitability. This finding is relevant due to the use of essential oils in aromatherapy and the low acute toxicity of this agent, which exhibits other effects of potential therapeutic usefulness.

Adolescents' healthcare decisional capacity in the clinical context: a theoretical study and model.

OBJECTIVE: To provide a theoretical study and model for the bioethical foundations of the factors that influence adolescents' healthcare decisional capacity. SOURCES: Materials from diverse sources, including indexed articles in recognized databases and official government documents, were examined for a purposefully selected sample. The research consisted of two stages: selection of documents and reflective thematic analysis, followed by the preparation of a report. The analysis adopted a phenomenological stance and a reflective view compatible with human rights. To reduce bias and ensure the robustness of the results, measures such as data triangulation were employed. Ethical measures were taken to ensure data integrity, including considerations of anonymity and conflicts of interest in the selected studies. SUMMARY OF THE FINDINGS: It was possible to list intrinsic and extrinsic factors of the adolescent patient that influence their decisional capacity regarding health. A theoretical model was developed to discuss these factors for evaluation by means of an infographic. CONCLUSIONS: It seems clear that the evaluation of healthcare decisional capacity of adolescents must position itself ethically regarding the tension between the moral duty to respect the self-determination of the able subject and the need to protect adolescents decidedly unable to make a specific health decision at a given time.

Empathic Care of Neonates: A Critical Literature Review.

Clinical empathy is a multidimensional ability to feel the patient's suffering, branched into components such as cognitive, emotional, and action, which results in benefits for patients, parents, health professionals, medical students, and others. The authors performed a critical review of the literature about empathy in neonatal care, in 2 databases, and analyzed the co-occurrence of keywords in the last 10 years. Nine articles were included in the qualitative synthesis. They highlight the interconnection between empathy, communication, ethics, and palliative care. Empathy was analyzed in situations that included pain, death, and suffering in the neonate, especially related to critically ill neonates. Strategies such as self-reflection and digital storytelling may help increase the clinical empathy education of health professionals. There are gaps in research considering the measurement of clinical empathy in neonatal care, and this measurement should be encouraged. To change care practices, education on empathy for health professionals, especially physicians, should be improved.

Informed consent for HIV screening in the emergency departments and human rights in patient care: seeking the right balance. / Consentimento informado para a testagem do HIV em unidades de pronto-socorro e direitos humanos dos pacientes: à procura de equilíbrio.

HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.

O "excepcionalismo" da infecção pelo HIV diz respeito ao fato de essa doença ser considerada tão diferente das demais e de que sua testagem necessita de uma abordagem especial em relação ao consentimento informado. Frequentemente, pessoas infectadas pelo HIV visitam unidades de assistência à saúde, sobretudo prontossocorros, anos antes de receberem um diagnóstico, sem terem sido testadas nessas oportunidades. Existe considerável interesse público em ampliar a testagem para o HIV em prontos-socorros. Por se tratar de ambiente sensível, cuja missão principal é o cuidado de urgências e emergências, há questionamentos quanto a esse ser um local apropriado para um programa de rastreamento universal, notadamente por questões éticas. Assim, os "direitos humanos dos pacientes" (DHP) constituem referencial teórico essencial para a análise de conflitos éticos que surgem no encontro clínico, fortalecendo a efetiva aplicação dos direitos humanos ao cuidado em saúde.

Development of New Potential Inhibitors of ß1 Integrins through In Silico Methods-Screening and Computational Validation.

Integrins are transmembrane receptors that play a critical role in many biological processes which can be therapeutically modulated using integrin blockers, such as peptidomimetic ligands. This work aimed to develop new potential ß1 integrin antagonists using modeled receptors based on the aligned crystallographic structures and docked with three lead compounds (BIO1211, BIO5192, and TCS2314), widely known as α4ß1 antagonists. Lead-compound complex optimization was performed by keeping intact the carboxylate moiety of the ligand, adding substituents in two other regions of the molecule to increase the affinity with the target. Additionally, pharmacokinetic predictions were performed for the ten best ligands generated, with the lowest docking interaction energy obtained for α4ß1 and BIO5192. Results revealed an essential salt bridge between the BIO5192 carboxylate group and the Mg2+ MIDAS ion of the integrin. We then generated more than 200 new BIO5192 derivatives, some with a greater predicted affinity to α4ß1. Furthermore, the significance of retaining the pyrrolidine core of the ligand and increasing the therapeutic potential of the new compounds is emphasized. Finally, one novel molecule (1592) was identified as a potential drug candidate, with appropriate pharmacokinetic profiles, similar dynamic behavior at the integrin interaction site compared with BIO5192, and a higher predicted affinity to VLA-4.

Computationally-obtained structural insights into the molecular interactions between Pidilizumab and binding partners DLL1 and PD-1.

Pidilizumab is a monoclonal antibody tested against several types of malignancies, such as lymphoma and metastatic melanoma, showing promising results. In 2016, the FDA put Pidilizumab's clinical studies on partial hold due to emerging evidence pointing to the antibody target uncertainty. Although initial studies indicated an interaction with the PD-1 checkpoint receptor, recent updates assert that Pidilizumab binds primarily to Notch ligand DLL1. However, a detailed description of which interactions coordinate antibody-antigen complex formation is lacking. Therefore, this study uses computational tools to identify molecular interactions between Pidilizumab and its reported targets PD-1 and DLL1. A docking methodology was validated and applied to determine the binding modes between modeled Pidilizumab scFvs and the two antigens. We used Molecular Dynamics (MD) simulations to verify the complexes' stability and submitted the resulting trajectory files to MM/PBSA and Principal Component Analysis. A set of different prediction tools determined scFv interface hot-spots. Whereas docking and MD simulations revealed that the antibody fragments do not interact straightforwardly with PD-1, ten scFv hot-spots, including Met93 and Leu112, mediated the interaction with the DLL1 C2 domain. The interaction triggered a conformational selection-like effect on DLL1, allowing new hydrogen bonds on the ß3-ß4 interface loop. The unprecedented structural data on Pidilizumab's interactions provided novel evidence that its legitimate target is the DLL1 protein and offered structural insight on how these molecules interact, shedding light on the pathways that could be affected by the use of this essential immunobiological. Communicated by Ramaswamy H. Sarma.

Production and Shelf-Life Study of Probiotic Caja (Spondias mombin L.) Pulp Using Bifidobacterium animalis ssp. Lactis B94.

The highly nutritional caja fruit (Spondias mombin L.) is an accessible source of vitamins and antioxidants that are indispensable for the human diet. The objective of the present work was to study the production of a probiotic caja pulp using Bifidobacterium animalis ssp. lactis B94. Firstly, a kinetic study was performed on the fermentation of the caja pulp with Bifidobacterium animalis ssp. lactis B94 to determine the optimum conditions of the process. Growth kinetics revealed that the ideal time for ending the fermentation would be at 22 h because it corresponds to the end of the exponential phase. Both the whole pulp and the probiotic pulp were characterized for pH, acidity, total soluble solids, water content, phenolic content, reducing carbohydrates, ascorbic acid, and total carotenoids. Physicochemical characterization revealed similar results between the whole and the probiotic pulp. The stability test demonstrated that the probiotic pulp is stable and preserved the probiotic attributes of the final product. In conclusion, our results reveal that caja pulp can be considered a favorable medium for the Bifidobacterium animalis ssp. lactis B94 growth and consequently can be explored biotechnologically for new food products.

Effects of long-term frozen storage on the quality and acceptance of gluten-free cassava pasta.

Cold storage conditions during long-term periods can be critical for the quality of gluten-free products. The objective of this work was to elaborate gluten-free pasta using cassava starch and study the influence of different storage conditions on the textural and sensorial properties of gluten-pasta compared to regular pasta. Samples were initially frozen at two different temperatures, -50 °C and -150 °C, and then stored for six months at -25 °C. Physicochemical and rheological analyses were used to characterize the pasta dough. Then microbiological, instrumental texture, and sensorial analysis were used to further characterize the pasta throughout the cold storage period of 6 months. The gluten-free pasta's nutritional composition showed low fat and protein content and high crude fiber, carbohydrates, and energy value content in relation to the gluten-containing pasta. Both kinds of pasta dough presented a pseudoplastic behavior; however, the wheat flour pasta presented lower apparent viscosity. The texture profile of frozen pasta during the evaluation period did not significantly vary when comparing the two freezing temperatures. Although the firmness, chewability, and cohesiveness parameters slightly decreased during the storage, losses of firmness were not detected by the judges at the sensorial analysis. Finally, cassava starch pasta had a high acceptance. According to the purchase intention research, the judges routinely consume gluten-free pasta, showing the high commercialization potential of the obtained product.

Comparative study of alpha- and beta-pinene effect on PTZ-induced convulsions in mice.

Convulsions occur in response to a loss of balance between excitatory and inhibitory neurotransmitters, and the treatment for this condition consists in restore such lost balance. Many anticonvulsant drugs present side effects which may limit their use. This fact has stimulated the search for new sources of treatment from aromatic plants. Many monoterpenes commonly present in essential oils are known because of their anticonvulsant properties. The anticonvulsant effect of α- and ß-pinene, two structural isomers, is still little studied. Thus, the present work evaluated the anticonvulsant effect of α- and ß-pinene in pentylenetetrazole-induced convulsions model. Initially, the oral LD50 for α- and ß-pinene was estimated. Following the oral administration, a mild sedation was observed and no deaths were recorded; the LD50 estimated for both monoterpenes was greater than 2 000 mg/kg, p.o. Further, animals were orally treated with α-pinene (100, 200 and 400 mg/kg), ß-pinene (100, 200 and 400 mg/kg) and the equimolar mixture of α- and ß-pinene (400 mg/kg) and subjected to the pentylenetetrazole-induced convulsions model. In this model, only the dose of 400 mg/kg of the compounds was able to significantly decrease the seizure intensity. The latency of first convulsion was significantly increased by the mixture of α- and ß-pinene (400 mg/kg). In addition, ß-pinene and the mixture of the two monoterpenes, both at a dose of 400 mg/kg, significantly increased the time of death of animals. The treatment with ß-pinene and the equimolar mixture of the two monoterpenes significantly reduced hippocampal nitrite level and striatal content of dopamine (DA) and norepinephrine (NE). Taken together, the results suggest that α-pinene appears to be devoid of anticonvulsant action. This fact, however, seems to be dependent on the chemical structure of the compound, since pretreatment with the ß-pinene increased the time of death pf PTZ-treated mice, which seems to depend on the ability of the compound to reduce nitrite concentration and NE and DA content, during the pentylenetetrazole-induced seizure.

Cuidado Centrado na Criança e sua interface com os direitos humanos do paciente pediátrico: uma crítica ao modelo de Cuidado Centrado na Família / Child-centered care and its intersection with the human rights of the pediatric patient: a critique of family-centered care / La atención dirigida al niño y sus interfaces con los derechos humanos de los pacientes pediátricos: una crítica de la atención centrada en la familia

Objetivo: analisar comparativamente o Cuidado Centrado na Criança e o Cuidado Centrado na Família sob a ótica dos direitos humanos do paciente pediátrico. Metodologia: é um trabalho de cunho teórico, cuja análise do modelo do Cuidado Centrado na Criança é realizada a partir das teorizações de Coynee a análise do Cuidado Centrado na Família fundamenta-se nas investigações de Arango e nos estudos de Almasri, An e Palisano e Law. Resultados: a partir da análise comparativa dos dois modelos de cuidado em saúde, percebeu-se que o modelo do Cuidado Centrado na Criança é o que se encontra em maior consonância com a efetivação dos direitos humanos do paciente pediátrico. Conclusão: faz-se necessária a incorporação do modelo do Cuidado Centrado na Criança nas práticas de cuidados pediátricos para a adequada realização dos direitos humanos do paciente pediátrico, cabendo aos profissionais de saúde o dever de envolver ativamente a criança no seu cuidado a fim de que seus interesses sejam o ponto de partida para o planejamento e para a provisão de cuidados.

Objective: comparative analysis of child-centered care and family-centered care from the perspective of human rights of pediatric patients. Methods: thisis a theoretical work whose analysis of the model of child-centered care is based on the theories of Coyne and the analysis of the model of family-centered care is based on the research of Arango and the studies of Almasri, An and Palisano and Law. Results: from the comparative analysis of the two health care models, it appears that the child-centered care model is most consistent with the realization of the human rights of pediatric patient. Conclusion: it is necessary to integrate the child-centered care model into pediatric nursing practiceto adequately realize the human rights of pediatric patients. It is up to health professionals to actively involve children in their care so that their interests are the starting point for planning and delivering care.

Objetivo: comparar la atención centrada en el niño y la atención centrada en la familia desde la perspectiva de los derechos humanos de los pacientes pediátricos. Metodología: trabajo teórico cuyo análisis del modelo de cuidado centrado in el niño se basa sobre las teorías de Coyne, mientras que el análisis del cuidado centrado en la familia se basa en las investigaciones de Arango y los estudios de Almasri, An and Palisano y Law. Resultados: del análisis comparativo de los dos modelos de atención a la salud, se percibió que el modelo de Atención Centrada en el Niño es el más acorde con la realización de los derechos humanos del paciente pediátrico. Conclusión: es necesario incorporar el modelo de Atención Centrada en el Niño en las prácticas de atención pediátrica para la adecuada realización de los derechos humanos de los pacientes pediátricos, y corresponde a los profesionales de la salud involucrar activamente a los niños en su cuidado para que sus intereses sean el punto de partidade planificación y prestación de cuidados.

Electrophysiologic alterations in the excitability of the sciatic and vagus nerves during early stages of sepsis.

BACKGROUND: Nonspecific and delayed diagnosis of neurologic damage contributes to the development of neuropathies in patients with severe sepsis. The present study assessed the electrophysiologic parameters related to the excitability and conductibility of sciatic and vagus nerves during early stages of sepsis. MATERIALS AND METHODS: Twenty-four hours after sepsis induced by cecal ligation and puncture (CLP) model, sciatic and vagus nerves of septic (CLP group) and control (sham group) rats were removed, and selected electric stimulations were applied to measure the parameters of the first and second components of the compound action potential. The first component originated from fibers with motor and sensory functions (Types Aα and Aß fibers) with a large conduction velocity (70-120 m/s), and the second component originated from fibers (Type Aγ) with sensorial function. To evaluate the presence of sensorial alterations, the sensitivity to non-noxious mechanical stimuli was measured by using the von Frey test. Hematoxylin and eosin staining of the nerves was performed. RESULTS: We observed an increase of rheobase followed by a decrease in the first component amplitude and a higher paw withdrawal threshold in response to the application of von Frey filaments in sciatic nerves from the CLP group compared to the sham group. Differently, a decrease in rheobase and an increase in the first component amplitude of vagal C fibers from CLP group were registered. No significant morphologic alteration was observed. CONCLUSION: Our data showed that the electrophysiologic alterations in peripheral nerves vary with the fiber type and might be identified in the first 24 h of sepsis, before clinical signs of neuromuscular disorders.

Disclosure de incidentes de segurança do paciente sob a ótica do Direito do Paciente / Disclosure of patient safety incidents from the Patients' Rights perspective / Disclosure de incidente de seguridad del paciente desde la perspectiva del Derecho del Paciente

Objetivo: demonstrar a incidência dos princípios e direitos dos pacientes no processo de disclosure, que comumente não está associado a esses direitos, mas sim a obrigações profissionais e institucionais. Metodologia: tratou-se de pesquisa teórica, cujo escopo consiste em desenvolver aportes teóricos concernentes ao campo do Direito do Paciente, de modo a participar da sua consolidação e da sua incidência prática. O marco teórico empregado se dividiu em dois eixos: i) disclosure e cultura do disclosure; ii) Direito do Paciente. Resultados: destacam-se os seguintes pontos positivos do disclosure quando integrado ao Direito do Paciente: i) o disclosure é um aspecto significante que impacta o engajamento e o envolvimento do paciente; ii) aumento da confiança do paciente/familiar em relação à instituição de saúde; iii) contribui para o incremento da qualidade no cuidado em saúde; iv) alívio da culpa do profissional de saúde envolvido no evento adverso; v) os pacientes são compensados financeiramente de forma mais rápida e adequada. Conclusão: o disclosure é a resposta adequada, transparente e empática a um incidente que causa danos ao paciente, bem como é uma ferramenta de efetivação dos seus direitos.

Objective: to show the influence of patients' principles and rights on the process of disclosure, which is commonly associated not with these rights but with professional and institutional obligations. Methods: this is a theoretical research that aims to contribute to the field of patients' rights and to participate in its consolidation and practical impact. The theoretical framework was divided into two axes: i) disclosure and disclosure culture; ii) patients' rights. Results: the positive aspects of disclosure when integrated into patients' rights are: i) disclosure is an important aspect that affects patient engagement and participation; ii) it increases patient/family trust in the health care institution; iii) it contributes to improving the quality of health care; iv) it relieves the health care professionals involved in the adverse event of their guilt; v) patients are financially compensated more quickly and appropriately. Conclusion: disclosure is the appropriate, transparent, and compassionate response to an incident that causes harm to the patient and a tool to enforce the patients' rights.

Objetivo: demostrar el impacto de los principios y derechos de los pacientes en el proceso de disclosure, que comúnmente no se asocia a estos derechos, pero sí a las obligaciones profesionales e institucionales. Metodología: se trata de una investigación teórica, cuyo objetivo es desarrollar aportes teóricos en el campo del Derecho del Paciente, para participar en su consolidación y su impacto práctico. El marco teórico utilizado se dividió en dos ejes: i) disclosure y cultura de disclosure; ii) Derecho del Paciente. Resultados: los siguientes aspectos positivos de disclosure se destacan cuando se integran en la Ley del Paciente: i) disclosure es un aspecto significativo que impacta el compromiso y la participación del paciente; ii) aumento de la confianza del paciente/familia en la institución de salud; iii) contribuye al aumento de la calidad de la atención en salud; iv) alivio de la culpa del profesional de la salud involucrado en el evento adverso; v) los pacientes son compensados económicamente de forma más rápida y adecuada. Conclusión: disclosure es la respuesta adecuada, transparente y empática a un incidente que causa daño al paciente, además de ser una herramienta para hacer valer sus derechos.

Desigualdades e direitos sociais no contexto da pandemia da COVID-19: solidariedade internacional como referencial bioético

Objetivo/Contexto. Este artigo tem como objetivo discorrer acerca dos impactos da pandemia da COVID-19 sobre os direitos sociais - direito à saúde, direito ao trabalho, direito à educação e direito à alimentação adequada. Metodologia/Abordagem. O enfoque metodológico que sustenta esta pesquisa é teórico, cujo escopo consiste em desenvolver aportes teóricos e aplicá-los a determinado objeto. Resultados/Descobertas. O artigo apresenta uma contribuição teórica ao debate sobre as repercussões na esfera da desigualdade social, e propor a solidariedade internacional como um referencial bioético universal para fundamentar medidas globais de enfrentamento a tais impactos. Discussão/Contribuições/Conclusões. Conclui-se que o referencial da solidariedade internacional confere aporte teórico e ferramenta discursiva e normativa com vistas ao fortalecimento dos esforços globais para enfrentar os efeitos da pandemia da COVID-19.

Propósito/Contexto. Este artículo tiene como objetivo discutir los impactos de la pandemia por COVID-19 en los derechos sociales: el derecho a la salud, al trabajo, a la educación y a una alimentación adecuada. Metodología/Enfoque. El enfoque metodológico que sustenta la elaboración de este artículo es teórico, cuyo alcance es desarrollar aportes también teóricos y aplicarlos a un objeto particular Resultados/Hallazgos. El artículo hace una contribución teórica al debate en lo que respecta a las repercusiones en el ámbito de la desigualdad social y propone la solidaridad internacional como un marco bioético universal para apoyar medidas globales y abordar tales impactos. Discusión/Conclusiones/Contribuciones. Se concluye que el marco de solidaridad internacional brinda sustento teórico y una herramienta discursiva y normativa con miras a fortalecer los esfuerzos globales para enfrentar los efectos de la pandemia por COVID-19.

Purpose/Context. This article aims to discuss the impacts of the COVID-19 pandemic on social rights - the right to health, the right to work, the right to education and the right to adequate food. Methodology/Approach. The methodological theoretical that supports this article is theoretical research, whose scope is to develop theoretical contribu-tions and apply them to a particular object. Results/Findings. It makes a theoretical contribution to the debate on the re-garding the repercussions in the sphere of social inequality and propose the international solidarity as a universal bioethical framework to support global measures to address such impacts. Discussion/Conclusions/Contributions. It is concluded that the international solidarity framework provides theoretical support and a discursive and norma-tive tool with a view to strengthening global efforts to face the effects of the COVID-19 pandemic.

Tomada de Decisão Apoiada como mecanismo de direitos humanos das pessoas com deficiência intelectual: as contribuições da escola

Neste estudo, considera-se que a escola constitui um espaço oportuno para fortalecer o direito à autodeterminação das pessoas com deficiência intelectual, por meio do endosso dos mecanismos formais e comunitários da Tomada de Decisão Apoiada (TDA). Objetiva-se, aqui, discutir a TDA como uma alternativa profícua para reforçar os direitos das pessoas com deficiência intelectual e apontar as contribuições da escola para ampliar esse mecanismo. Trata-se de pesquisa teórica, embasada na produção de conhecimento internacional. A escola participa com contribuições diretas (na orientação das famílias e na inclusão efetiva e apoiada dos estudantes com deficiência no processo de ensino-aprendizagem) e com contribuições indiretas (na construção de uma cultura de respeito aos direitos das pessoas com deficiência). Em uma sociedade capacitista, o estabelecimento da TDA passa, necessariamente, por uma mudança cultural em que a pessoa com deficiência seja reconhecida como indivíduo capaz e autônomo, que tem direito de decidir sobre a própria vida. Essa mudança cultural precisa ser iniciada na escola para que as gerações cresçam sabendo lidar com as diversidades, respeitando os distintos modos de existir e de se colocar no mundo.

Aspectos jurídicos-sanitários da Segurança do Paciente / Legal and health issues relatedto Patient Safety / Aspectos legales y sanitarios de la Seguridad del Paciente

Os impactos dos danos associados aos cuidados em saúde sobre os sistemas de saúde enunciam que a conscientização acerca da sua gravidade é urgente. Os Cadernos Ibero-Americanos de Direito Sanitário, na vanguarda em nosso país, dedicam um número para aprofundar as reflexões sobre os aspectos jurídico-sanitários da Segurança do Paciente, reconhecendo que é um dos temas mais importantes da área da Saúde e do Direito.

The impact of health care-related harms on health care systems demonstrates the urgent need for awareness of their severity. The Iberoamerican Journal of Health Law, pioneer in Brazil, dedicates an issue to deepen the reflection on the legal-sanitary aspects of patient safety, recognizing that it is one of the essential issues in the field of health and law.

Los impactos de los daños asociados con la atención de la saluden los sistemas de salud indican que es urgente tomar conciencia de su gravedad. Los Cuadernos Iberoamericanos de Derecho Sanitario, a la vanguardia en Brasil, dedican un número a profundizar en las reflexiones sobre los aspectos jurídico-sanitarios de laseguridad del paciente, reconociendo que es uno de los temas más importantes en el ámbito de la salud y el derecho.

Organizações de Pacientes e seu papel na implementação de direitos nos cuidados em saúde / Patient organizations and their role in the implementation of rights in health care / Las organizaciones de pacientes y su rol en la implementación de los derechos en el cuidado de la salud

Objetivo: analisar o papel das organizações de pacientes (OPs) e seus modos de atuação, quanto à implementação de direitos nos cuidados em saúde. Metodologia: tratou-se de pesquisa teórica e documental, realizada a partir do levantamento de literatura especializada nas bases de dados Google Scholar e SciELO, utilizando os descritores organização de pacientes, patient organizations e organizaciones de pacientes. Enquanto recorte de pesquisa, foram analisados os artigos sobre OPs. Complementarmente, foram utilizados o Relatório da União Europeia sobre os Direitos dos Pacientes e o documento do Fórum Europeu de Pacientes sobre OPs. Resultados: após análise prévia, selecionamos 28 artigos científicos que tratavam direta ou indiretamente da temática do artigo. Os documentos e artigos selecionados possibilitaram analisar o papel e o modo de atuação das OPs quanto à implementação de direitos nos cuidados em saúde. Conclusões: concluiu-se que é preciso ampliar o espectro de participação social das OPs na direção da luta pelos direitos dos pacientes, transformando-a numa prática não setorial e incidente em todos os níveis de cuidado, acarretando melhores resultados na saúde.

Objective: to analyze the role of patient organizations (POs) and their modes of action regarding the implementation of rights in health care. Methodology: it is a theoretical and documentary research, carried out based on the survey of specialized literature in Google Scholar and SciELO databases, using the descriptors organização de pacientes, patient organizations e organizaciones de pacientes. As a research focus, articles on POs were analyzed. In addition, the European Union Report on Patients' Rights and the European Patients' Forum document on POs were used. Results: after prior analysis, we selected 28 scientific articles that dealt directly or indirectly with the subject of the article. The documents and articles selected made it possible to analyze the role and mode of action of POs regarding the implementation of rights in health care. Conclusions: it was concluded that it is necessary to broaden the spectrum of social participation of POs towards the fight for patients' rights, transforming it into a non-sectoral practice that is incident at all levels of care, resulting in better health outcomes.

Objetivo: analizar el papel de las organizaciones de pacientes (OPs) y sus modos de actuación frente a la implementación de los derechos en los cuidados de salud. Metodología: se trata de una investigación teórica y documental, realizada a partir del levantamiento de literatura especializada en las bases de datos Google Scholar y SciELO, utilizando los descriptores organização de pacientes, patient organizations e organizaciones de pacientes. Como recorte de investigación, se analizaron artículos sobre PB. Además, se utilizaron el Informe de la Unión Europea sobre los Derechos de los Pacientes y el documento del Foro Europeo de Pacientes sobre OPs. Resultados: después un análisis previo, se seleccionaron 28 artículos científicos que trataran directa o indirectamente del tema del artículo. Los documentos y artículos seleccionados permitieron analizar el papel y el modo de actuación de las OPs frente a la implementación de los derechos en salud. Conclusiones: se concluyó que es necesario ampliar el espectro de participación social de las OPs hacia la lucha por los derechos de los pacientes, transformándola en una práctica no sectorial e incidente en todos los niveles de atención, redundando en mejores resultados en salud.

Consentimento informado para a testagem do HIV em unidades de pronto-socorro e direitos humanos dos pacientes: à procura de equilíbrio / Informed consent for HIV screening in the emergency departments and human rights in patient care: seeking the right balance

Resumo O "excepcionalismo" da infecção pelo HIV diz respeito ao fato de essa doença ser considerada tão diferente das demais e de que sua testagem necessita de uma abordagem especial em relação ao consentimento informado. Frequentemente, pessoas infectadas pelo HIV visitam unidades de assistência à saúde, sobretudo prontossocorros, anos antes de receberem um diagnóstico, sem terem sido testadas nessas oportunidades. Existe considerável interesse público em ampliar a testagem para o HIV em prontos-socorros. Por se tratar de ambiente sensível, cuja missão principal é o cuidado de urgências e emergências, há questionamentos quanto a esse ser um local apropriado para um programa de rastreamento universal, notadamente por questões éticas. Assim, os "direitos humanos dos pacientes" (DHP) constituem referencial teórico essencial para a análise de conflitos éticos que surgem no encontro clínico, fortalecendo a efetiva aplicação dos direitos humanos ao cuidado em saúde.

Abstract HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.