Empirical Bioethics and the Health 'Brain-Drain': a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors.

The health 'brain drain' (HBD) is an issue of significant global bioethical concern, resulting in severe maldistribution of healthcare workers (HCWs) and gross inequities in health service provision. The ethics of the HBD and its possible mitigation strategies are, however, complex and areas of active ongoing bioethical debate. South Africa faces a dire and worsening HBD crisis, and use a mitigation strategy of compulsory community service, or 'comserve', for most HCWs. While there is some literature on HCWs' comserve experiences and the various 'push and pull' factors affecting their migratory decisions, there is a notable gap regarding their personal values, beliefs and ethics regarding the HBD and comserve, which, as this research supports, play a prominent role in migratory decisions. This empirical bioethics research aims to explore this among a group of South African doctors who recently completed comserve, as well as how their experiences affected their situation on the individualist-collectivist continuum. This was done qualitatively using semistructured interviews with 11 participants and analysed using reflexive thematic analysis under a methodology of critical realism. Themes identified were 'Special Duties'; 'Freedom and Autonomy'; 'Justice and Accountability'; and 'The Individualist-Collectivist Continuum'. Participants use a variety of ethical theories to discuss the HBD and oppose or support comserve, which play a significant role in their migratory decisions. Most find the policy to be theoretically ethically justifiable but note that procedures undermine this. There are also several factors that appear to affect participants' position on the individualist-collectivist continuum, with some paradoxical effects on the HBD.

Applying the theory of planned behaviour to understand mental health professionals' intentions to work using a human rights-based approach in acute inpatient settings.

BACKGROUND: There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person's human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding. AIM: To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals' intentions to work using a human rights-based approach. METHOD: Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals' intentions to use human rights-based approaches. RESULTS: Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables. CONCLUSION: There could be factors outside of the individual clinician's control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

SOMATIC (PERSONAL) HUMAN RIGHTS: THE RATIO OF MEDICAL AND LEGAL CATEGORIES.

OBJECTIVE: The aim: To find out the peculiarities of somatic (personal) human rights, while combining the basic principles of medicine and law. PATIENTS AND METHODS: Materials and methods: Formal-logical methods of analysis and synthesis allowed to reveal the content of the concepts that make up the subject of research, to classify them, as well as to formulate intermediate and general conclusions. The systematic method allowed to study the role and significance of somatic rights among other human rights and freedoms. Using the historical method, the doctrinal basis of the study was analyzed, and the main periods of the formation of somatic rights in the works of scientists. The application of the above-mentioned methods necessitates the inclusion of an activity method in the research methodology (this method, becoming a logical continuation of the integral structural-functional method, involves the study of somatic rights through the development of medicine). CONCLUSION: Conclusions: We consider it expedient to use the term «somatic rights¼ and not «personal rights¼, firstly, due to the explanation of the danger of possible pluralism in social and humanitarian knowledge and the terminological similarity of the definition of «personal¼ rights with «personal¼ human rights and, secondly, due to the fact that when justifying the legal scientificity of the term «personal¼ rights, the main semantic load lies in the word «personality¼; these are rights that have an individual, «purely personal character¼.

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century.

BACKGROUND: People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce. METHODS: The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome. RESULTS: The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas. DISCUSSION: Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world. CONCLUSIONS: Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.

Whose side are you on? Complexities arising from the non-combatant status of military medical personnel.

Since the mid-1800s, clergy, doctors, other clinicians, and military personnel who specifically facilitate their work have been designated "non-combatants", protected from being targeted in return for providing care on the basis of clinical need alone. While permitted to use weapons to protect themselves and their patients, they may not attempt to gain military advantage over an adversary. The rationale for these regulations is based on sound arguments aimed both at reducing human suffering, but also the ultimate advantage of the nation-state fielding non-combatant staff. However, this is sometimes not immediately apparent to combatant colleagues. Clinicians in the armed force are also military officers, owing a "dual loyalty" that can create conflict if their non-combatant status is not well understood. Historical examples of doctors breaching their responsibilities include prioritisation of combat capability over the rights of individual soldiers (as occurred when scarce medical resources were allocated to soldiers more likely to return to battle in preference to those most likely to die without them), use of physicians to facilitate prisoner interrogation, medical research or treatment to enhance physical performance at the expense of health, application of Medical Rules of Eligibility according to factors other than clinical need, provision of treatment contingent upon support for military objectives, and use of medical knowledge to enhance weapons. However, not being a combatant party to a conflict does not imply that the non-combatant clinician cannot act in the national interest. Indeed, by adhering to the same universal ethics as their civilian colleagues, military clinicians provide optimal care to their own troops, facilitate freedom of action in host nations, and build positive international relationships during the conflict and in the post-conflict state.

To confront sexual violence, we must train non-forensic experts to perform medico-legal evaluations.

Sexual violence is a global crisis. Forensic evaluations are critical for obtaining evidence and increasing the likelihood of accessing justice, as many cases fail due to lack of evidence or poor evidence. In some countries, only board-certified forensic specialists are authorized to conduct forensic evaluations. However, the high number of sexual violence cases coupled with the shortage of forensic physicians make that restriction a fundamental impediment to a rights-based response to sexual violence crimes. Governments and regulatory bodies should expand the pool of those capable of conducting forensic sexual violence evaluations by partnering with clinicians of different specialties and facilitating their training.

Policy Makers', NGO, and Healthcare Workers' Accounts of Migrants' and Refugees' Healthcare Access Across Europe-Human Rights and Citizenship Based Claims.

Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.

Rights of the Dying Child: The Nurses' Perception.

AIM: The Charter of the Rights of the Dying Child was formulated as a professional guide for caring the child in the final stages. The study examines the nurses' degree of agreement with the Charter's principles and their perception of the implementation of those principles in hospital. MATERIALS AND METHODS: A multicenter, cross-sectional study to observe the nurses' positions about the 10 rights outlined in the Charter, using an online questionnaire in 5 pediatric hospitals in northern Italy. RESULTS: A total of 119 nurses (44.9%) completed the questionnaire. The majority (range: 86.6-100%) expressed their agreement with the Charter's principles (Likert ≥4). Lower ratings were reported in Charter's principles implementation items (range: 42.9-89.1%). Being older and working in a smaller hospital lead the nurses to overlook the child's right to be informed and to be given the opportunity to make decisions about his/her own life and death (p = 0.02, p < 0.01). Postgraduate training induced greater awareness of the dying child (p = 0.01). CONCLUSIONS: This study highlights the value of the Charter of the Rights of the Dying Child as a reference guideline for nurses working in pediatric hospitals. Better training is important to improve the nurse's communication skills and the pediatric palliative care should be offered to all families that have a child with incurable disease mostly in the end of life.

Consentimento para processamento de dados de pesquisa em prontuários médicos / Consent for processing medical records data / Consentimiento para el procesamiento de datos de investigación en registros médicos

Resumo O manuseio de dados de pesquisa de prontuários médicos é uma preocupação que envolve questões éticas e legais. O objetivo deste artigo é fornecer uma descrição do processamento para a utilização de dados pessoais contidos em prontuários médicos, além de oferecer uma visão geral da legislação vigente sobre o manuseio desses dados, contribuindo para ampliar o entendimento da obrigatoriedade do consentimento para o manuseio prontuários médicos com finalidade de pesquisa. A agência brasileira que normatiza a análise ética em pesquisa com humanos despachou correspondência específica aos seus comitês locais tratando do assunto. No entanto, tal correspondência carece de revisão em virtude dos novos sentidos e significados estabelecidos na legislação mais recente, segundo a qual a finalidade de pesquisa científica é condição de exceção para o tratamento de dados pessoais sem o fornecimento de consentimento do titular.

Abstract Processing medical record data involves ethical and legal challenges. This study proposes a processing description for using personal data obtained from medical records, as well as offers a general view of the current legislation on handling this type of data, contributing to further our understanding regarding consent when using medical records for research purposes. The Brazilian agency responsible for the ethical standards on research with humans issued a specific guideline on the subject to its local committees; however, such guidelines require a review based on the new meanings and senses established by the more recent legislation, according to which scientific research presents an exception to data processing without express consent by its titulary.

Resumen El manejo de datos de investigación provenientes de registros médicos es una preocupación que implica cuestiones éticas y legales. El objetivo de este artículo es brindar una descripción del procesamiento para el uso de datos personales contenidos en los registros médicos, además de ofrecer una visión general de la legislación vigente sobre el manejo de estos datos y así contribuir a ampliar la comprensión del consentimiento obligatorio para el manejo de registros médicos con fines de investigación. La agencia brasileña que regula el análisis ético en investigaciones con humanos envió una correspondencia específica a sus comités locales abordando el tema. Sin embargo, dicha correspondencia requiere una revisión debido a los nuevos sentidos y significados establecidos en la más reciente legislación, según la cual la finalidad de la investigación científica es una condición de excepción para el tratamiento de datos personales sin el suministro del consentimiento del titular.

Direitos dos docentes de enfermagem na contemporaneidade: análise a partir de grupo focal / Rights of nursing teachers in the contemporany: analysis from focal group / Derechos de los profesores de enfermería en la contemporánea: análisis desde un grupo focal

Objetivo: verificar a percepção dos docentes universitários de enfermagem acerca dos seus direitos laborais e discutir tais direitos na contemporaneidade. Método: pesquisa descritiva e exploratória de abordagem qualitativa realizada em universidades públicas situadas no município do Rio de janeiro. Os participantes do estudo foram 14 docentes de enfermagem lotados em duas universidades públicas. Para a coleta de dados foi utilizado o grupo focal e os dados foram analisados à luz da técnica de análise de conteúdo. Resultados: emergiram três categorias: os direitos do docente de enfermagem nas universidades públicas no contexto neoliberal; educação como direito de todos para o desenvolvimento do Brasil; e direitos laborais sob a ótica dos docentes de enfermagem: respeito ao contrato de trabalho. Conclusão: destaca-se a necessidade de respeito aos direitos humanos, para a promoção da qualidade de vida no contexto do trabalho do docente

Objective: to verify the perception of university nursing professors about their labor rights and to discuss these rights in contemporary times. Method: descriptive and exploratory research with a qualitative approach carried out in public universities located in the city of Rio de Janeiro. Study participants were 14 nursing professors working at two public universities. For data collection, the focus group was used and the data were analyzed in the light of the content analysis technique. Results: three categories emerged: the rights of nursing professors in public universities in the neoliberal context; education as a right for all for the development of Brazil; and labor rights from the perspective of nursing professors: respect for the employment contract. Conclusion: the need to respect human rights is highlighted, in order to promote quality of life in the context of the teacher's work

Objetivo: verificar la percepción de los profesores universitarios de enfermería sobre sus derechos laborales y discutir esos derechos en la contemporaneidad. Método: investigación descriptiva y exploratoria con enfoque cualitativo realizada en universidades públicas ubicadas en la ciudad de Río de Janeiro. Los participantes del estudio fueron 14 profesores de enfermería que trabajaban en dos universidades públicas. Para la recolección de datos se utilizó el grupo focal y los datos fueron analizados a la luz de la técnica de análisis de contenido. Resultados: surgieron tres categorías: los derechos de los profesores de enfermería en las universidades públicas en el contexto neoliberal; la educación como derecho de todos para el desarrollo de Brasil; y derechos laborales en la perspectiva de los profesores de enfermería: respeto al contrato de trabajo. Conclusión: se destaca la necesidad de respetar los derechos humanos, con el fin de promover la calidad de vida en el contexto del trabajo docente

Need for an Australian Indigenous disability workforce strategy: review of the literature.

PURPOSE: To identify approaches for developing workforce capacity to deliver the National Disability Insurance Scheme (NDIS) to Indigenous people with disability in Australian rural and remote communities. METHOD: A narrative review of peer-reviewed and gray literature was undertaken. Searches of electronic databases and websites of key government and non-government organizations were used to supplement the authors' knowledge of literature that (a) focused on Indigenous peoples in Australia or other countries; (b) referred to people with disability; (c) considered rural/remote settings; (d) recommended workforce strategies; and (e) was published in English between 2004 and 2014. Recommended workforce strategies in each publication were summarized in a narrative synthesis. RESULTS: Six peer-reviewed articles and 12 gray publications met inclusion criteria. Three broad categories of workforce strategies were identified: (a) community-based rehabilitation (CBR) and community-centered approaches; (b) cultural training for all workers; and (c) development of an Indigenous disability workforce. CONCLUSION: An Indigenous disability workforce strategy based on community-centered principles and incorporating cultural training and Indigenous disability workforce development may help to ensure that Indigenous people with a disability in rural and remote communities benefit from current disability sector reforms. Indigenous workforce development requires strategies to attract and retain Aboriginal workers. Implications for Rehabilitation Indigenous people with disability living in rural and remote areas experience significant access and equity barriers to culturally appropriate supports and services that enable them to live independent, socially inclusive lives. A workforce strategy based on community-centered principles has potential for ensuring that the disability services sector meets the rehabilitation needs of Aboriginal people with disability living in rural and remote areas. Cultural training and development of an Indigenous disability workforce may help to ensure a culturally safe disability services sector and workforce.

Who Establishes the Presence of a Mental Disorder in Defendants? Medicolegal Considerations on a European Court of Human Rights Case.

Legal insanity is a peculiar element of criminal law, because it brings together two very different disciplines: psychiatry and psychology on the one hand and the law on the other. One of the basic questions regarding evaluations of defendants concerns the question of who should establish "true mental disorder," the judge or the behavioral expert? This question is complicated, and in this contribution it will be explored based on a Dutch case that was eventually decided by the European Court of Human Rights (ECtHR). We will argue that the ECtHR provides a valuable legal framework. Based on its merits, the framework could also be of interest to countries outside the Court's jurisdiction.

A compreensão da deficiência a partir das teorias dos modelos médico e social / Understanding of disability from the teories of medical and social models / La comprensión de la discapacidad desde las teorías de los modelos médico y social

Ao longo da história da humanidade diversos paradigmas influenciaram o modo como a sociedade entendia a deficiência. O presente estudo buscou compreender o fenômeno da deficiência a partir da revisão teórica dos principais modelos de concepção do tema: o modelo médico e o modelo social. O primeiro, apresenta a deficiência como responsabilidade individual, através da ênfase do corpo com lesão ou seu "mau funcionamento", seja ele físico ou intelectual. O segundo, designa que a maior intervenção a ser feita não é ao nível do indivíduo e suas lesões, mas na sociedade que tem dificuldade de abarcar a totalidade das diversidades. A compreensão desse fenômeno está em constante evolução, assim como as mudanças em relação as práticas relacionadas às pessoas com deficiência. Neste contexto, faz-se necessário debates sobre a deficiência como categoria de análise, tanto para a psicologia social quanto para subsidiar políticas públicas.

Throughout human history, several paradigms have influenced the way society understands disability. The present study sought to understand the phenomenon of disability based on a theoretical review of the main models for designing the theme: the medical model and the social model. The first presents disability as an individual responsibility, by emphasizing the injured body or its "malfunction", whether physical or intellectual. The second designates that the greatest intervention to be carried out is not at the level of the individual and ir injuries, but in society, which has difficulty embracing the totality of diversities. The understanding of this phenomenon is constantly evolving, as well as changes in practices related to people with disabilities. In this context, it is necessary to discuss disability as a category of analysis, both for social psychology and to support public policies.

A lo largo de la historia de la humanidad, varios paradigmas han influido la forma en que la sociedad entiende la discapacidad. El presente estudio buscó comprender el fenómeno de la discapacidad a partir de la revisión teórica de los principales modelos de diseño del tema: el modelo médico y el modelo social. El primero presenta la discapacidad como una responsabilidad individual, al enfatizar el cuerpo lesionado o su "mal funcionamiento", ya sea físico o intelectual. El segundo, designa que la mayor intervención a realizar no es a nivel del individuo y sus heridas, sino en la sociedad, que tiene dificultad para abarcar la totalidad de las diversidades. La comprensión de este fenómeno está constante evolución, así como los cambios las prácticas relacionadas con las personas con discapacidad. En este contexto, es necesario discutir la discapacidad como categoría de análisis , tanto para la psicología social como para apoyar políticas públicas.

An Unwilling Partnership With the Great Society Part II: Physicians Discover Malnutrition, Hunger and the Politics of Hunger.

The civil rights and social legislation of the Great Society following the Civil Rights Act of 1964 was slow to provide relief for black in the South. Mississippi Senator James Eastland led an effort to defund Head Start, including his state's program, Child Development Group of Mississippi (CDGM), a program with a strong medical component. A senatorial committee, including Robert Kennedy, came to investigate CDGM in 1967. The unimaginable poverty, hunger, malnutrition and chronic disease found in black families was vehemently denied by Eastland. Visits of physician groups then corroborated the findings. The Mississippi delegation made sure that food relief never came and funding for CDGM ceased. Health services were lost to 6000 impoverished children. The epic television documentary, Hunger in America, soon premiered on network television. It triggered ongoing efforts to address health disparities, including implementation of the National Nutrition and Health Survey (NHANES). Similar physician leadership is needed to address the lasting health disparities in our country.

Human rights at work: Physical standards for employment and human rights law.

This review focuses on the human rights dimensions of creating and implementing physical standards for employment for prospective and incumbent employees. The review argues that physical standards for employment engage two fundamental legal concepts of employment law: freedom of contract and workplace human rights. While the former promotes an employer's right to set workplace standards and make decisions of whom to hire and terminate, the latter prevents employers from discriminating against individuals contrary to human rights legislation. With reference to applicable human rights legislative regimes and their judicial interpretation in Canada, the United States, the United Kingdom, and Australia, this review demonstrates the judicial preference for criterion validation in testing mechanisms in the finding of bona fide occupational requirements. With particular attention to the Supreme Court of Canada decision in Meiorin, this review argues that an effective balance between workplace safety and human rights concerns can be found, not in applying different standards to different groups of individuals, but in an approach that holds employers to demonstrating a sufficient connection between a uniform physical standard of employment and the actual minimum requirements to perform the job safety and efficiently. Combined with an employer's duty to accommodate, such an approach to lawful physical standards for employment conceives of worker and public safety and workplace diversity as emanating from a shared concern for human rights.

[Conflicts between nursing ethics and health care legislation in Spain]. / Conflictos entre la ética enfermera y la legislación sanitaria en España.

OBJECTIVE: To identify the ethical conflicts that may arise between the nursing codes of ethics and the Royal Decree-law 16/2012 modifying Spanish health regulations. METHOD: We conducted a review and critical analysis of the discourse of five nursing codes of ethics from Barcelona, Catalonia, Spain, Europe and International, and of the discourse of the Spanish legislation in force in 2013. Language structures referring to five different concepts of the theoretical framework of care were identified in the texts: equity, human rights, right to healthcare, access to care, and continuity of care. RESULTS: Codes of ethics define the function of nursing according to equity, acknowledgement of human rights, right to healthcare, access to care and continuity of care, while legal discourse hinges on the concept of beneficiary or being insured. CONCLUSIONS: The divergence between the code of ethics and the legal discourse may produce ethical conflicts that negatively affect nursing practice. The application of RDL 16/2012 promotes a framework of action that prevents nursing professionals from providing care to uninsured collectives, which violates human rights and the principles of care ethics.

Denúncias de violência financeira contra idosos no Brasil: 2011-2018 / Complaints of financial violence against the elderly in Brazil: 2011-2018 / Informes de violencia financiera contra las personas mayores en Brasil: 2011- 2018

Objetivo: Analisar a violência financeira contra idosos no Brasil nos anos de 2011 a 2018. Método: Pesquisa exploratória, descritiva, comparativa e quantitativa. Os dados foram adquiridos junto ao "Disque Direitos Humanos - Disque 100 do Ministério da Mulher, da Família e dos Direitos Humanos" (MMFDH). Os dados adquiridos foram organizados no software Microsoft Excel 2016® for Windows®, sendo implementada análise estatística descritiva. Resultados: Foi identificado o universo de 119.440 registros com média e desvio-padrão (14.930±5.249,3). A região Nordeste (NE) registrou a maior preponderância com 39,1% (n=46.711) e o estado de Minas Gerais (MG) registrou a maior preponderância com 10,4% (n=12.458). Retenção de salário/bens foi o crime com a maior preponderância registrando 65,3% (n=77.955) e subtração/invalidação/ocultação e documentos a menor com 0,9% (n=1.055). Considerações finais: Foi verificado aumento na frequência de registros de denúncias de violência contra o idoso no recorte histórico e geográfico analisados.

Objective: To analyze financial violence against the elderly in Brazil from 2011 to 2018. Method: Exploratory, descriptive, comparative and quantitative research. The data were acquired from the "Dial Human Rights - Dial 100 of the Ministry of Women, Family and Human Rights" (MMFDH). The acquired data were organized in Microsoft Excel 2016® for Windows® software, and descriptive statistical analysis was implemented. Results: The universe of 119.440 records with mean and standard deviation (14,930±5,249.3) was identified. The Northeast Region (NE) registered the greatest preponderance with 39.1% (n=46.711) and the state of Minas Gerais (MG) registered the greatest preponderance with 10.4% (n=12.458). Withholding of wages/goods was the crime with the highest preponderance registering 65.3% (n=77.955) and the smallest subtraction/invalidation/concealment and documents with 0.9% (n=1.055). Final considerations: There was an increase in the frequency of records of reports of violence against the elderly in the analyzed historical and geographic context.

Objetivo: Analizar la violencia financiera contra las personas mayores en Brasil de 2011 a 2018. Método: Investigación exploratoria, descriptiva, comparativa y cuantitativa. Los datos fueron adquiridos del "Dial de Derechos Humanos - Dial 100 del Ministerio de la Mujer, la Familia y los Derechos Humanos" (MMFDH). Los datos adquiridos se organizaron en el software Microsoft Excel 2016® para Windows® y se implementó un análisis estadístico descriptivo. Resultados: Se identificó el universo de 119,440 registros con media y desviación estándar (14,930 ± 5,249,3). La Región Nordeste (NE) registró la mayor preponderancia con 39,1% (n=46.711) y el estado de Minas Gerais (MG) registró la mayor preponderancia con 10,4% (n=12.458). La retención de salarios/bienes fue el delito con mayor preponderancia registrando 65.3% (n=77.955) y la menor resta/invalidación/ocultación y documentos con 0.9% (n=1.055). Consideraciones finales: Hubo un aumento en la frecuencia de registros de denuncias de violencia contra el adulto mayor en el contexto histórico y geográfico analizado.

Rol social de la enfermería profesional en la Vicaría de la Solidaridad, Chile 1976-1992 / Social role of professional nursing within the Vicaría de la Solidaridad, Chile 1976-1992 / O papel social da enfermagem profissional na Vicaría de la Solidaridad, Chile 1976-1992

RESUMEN Introducción: Durante la dictadura militar en Chile hubo cambios sociales en la política de seguridad social que significaron persecuciones, torturas y muerte de miles de personas, situación que impulsó la creación de la Vicaría de la Solidaridad, la cual implementó distintos programas dentro de los cuales estuvo el área de salud. Objetivo: Develar el rol social de la enfermería profesional en la Vicaría de la Solidaridad en Chile, años 1976-1992. Metodología: Investigación cualitativa, diseño historia de vida, con entrevistas en profundidad a cinco enfermeras y un enfermero, integrantes de la Vicaría, seleccionados por muestreo intencionado. Como sustento teórico, se utilizó la Teoría de Margaret Newman. Se realizó análisis textual y conceptual. Se cumplieron las implicancias éticas y consentimiento informado. Resultados: Se develan las metacategorías: a)función asistencial, b)función educativa, c)función administrativa y, d)función investigación. Discusión: La esencia social de la enfermería es la ejecución de acciones coherentes con el contexto en el que se encuentra para favorecer la protección y engrandecimiento de la dignidad humana. Existe coherencia entre los resultados obtenidos y la literatura sobre el tema propuesto. Conclusión: Las enfermeras se caracterizaron por poseer un profundo compromiso social y deber ético, así como habilidades de observación, coordinación, análisis, liderazgo y toma de decisiones, que las transformaron en agentes de cambio en la población. Este estudio abre una línea de investigación sobre la historia de la enfermería en Chile y su acción social en momentos de crisis.

ABSTRACT Introduction: During the Chilean military dictatorship there were social changes in the social security politics which led to persecutions, tortures, and the death of thousands of people. A consequence of this situation was the creation of an organization called Vicaría de la Solidaridad which implemented diverse programs in the area of health. Objective: To unveil the social role of professional nursing within the Vicaría de la Solidaridad, Chile 1976-1992. Methodology: This is a qualitative research with a history of life design which used in depth interviews to five female nurses and one male nurse of the Vicaría, and which were intentionally selected. The theory of Margaret Newman was used as the theoretical foundation. A text and concept analysis was carried out. Ethical requirements were fulfilled, and the information consent from the participants was obtained. Results: From the analysis, the following categories emerged: a)function of assistance; b)function of education; c)function of management; and d) function of research. Discussion: The social essence of nursing includes carrying out context mediated actions aimed at favoring the protection and enhancement of human dignity. Coherence was found between the findings of this study and the literature on the topic. Conclusion: Nurses were characterized by their profound social compromise and sense of ethical duty. Nurses counterweighted the social problems during those years using their skills of observation, coordination, analysis, leadership, and decision-making. This study opens a research line on the history of nursing in Chile and its actions during times of crisis.

RESUMO Introdução: Durante a ditadura militar no Chile, houve mudanças sociais na política de segurança social que significaram perseguição, tortura e morte de milhares de pessoas, uma situação que levou à criação da Vicaría de la Solidaridad, que implementou diferentes programas, incluindo a saúde. Objetivo: Revelar o papel social da enfermagem profissional na Vicaría de la Solidaridad no Chile, 1976-1992. Metodologia: Pesquisa qualitativa, desenho de história de vida, com entrevistas em profundidade com cinco enfermeiras e um enfermeiro, membros da Vicaría, selecionadas por amostragem propositada. A teoria de Margaret Newman foi utilizada como base teórica. Foi realizada uma análise textual e conceptual. As implicações éticas e o consentimento informado foram cumpridos. Resultados: Desvelam-se as meta-categorias: a)função assistencial, b)função educativa, c)função administrativa e d)função pesquisa. Discussão: A essência social da enfermagem é a execução de ações condizentes com o contexto em que se encontra, favorecendo a proteção e a valorização da dignidade humana. Há coerência entre os resultados obtidos e a literatura sobre o tema proposto. Conclusão: As enfermeiras caracterizaram-se por possuir um profundo compromisso social e dever ético, bem como habilidades de observação, coordenação, análise, liderança e toma-da de decisão, o que as transformou em agentes de câmbio da população. Este estudo abre uma linha de pesquisa sobre a história da enfermagem no Chile e sua ação social em tempos de crise.

Identificação de situações e condutas bioéticas na atuação profissional em saúde / Evidence of bioethical discourse and behaviors in health professions / Identificación de situaciones y conductas bioéticas en la práctica profesional en salud

Resumo O objetivo deste estudo foi identificar na literatura situações e condutas bioéticas na atuação profissional em saúde. Trata-se de revisão integrativa de artigos científicos indexados nas bases de dados da Biblioteca Virtual em Saúde e publicados entre 2014 e 2019. Utilizaram-se os descritores "pessoal de saúde", "prática profissional", "ética profissional", "discurso" e "bioética". Foram selecionados 21 estudos para a discussão, destacando-se cinco categorias de análise: bioética durante a formação profissional; bioética como forma de humanizar a saúde; relações interprofissionais, direitos e deveres de trabalhadores e pacientes; bioética nas decisões que permeiam o início e o fim da vida; e tomada de decisões na saúde. A autonomia do paciente foi o princípio bioético mais abordado em diversas circunstâncias clínicas, especialmente nos dilemas relativos ao fim da vida.

Abstract This study aimed to identify bioethical situations and behaviors in health professions reported in the literature. This integrative review of scientific articles indexed in the Virtual Health Library databases, published between 2014 and 2019, used the following keywords: "health personnel," "professional practice," "ethics, professional," "discourse," and "bioethics." Twenty-one studies were selected for discussion, with five categories identified in the analysis: bioethics during professional training; bioethics as a form of humanizing healthcare; interprofessional relationships, rights and duties of patients and professionals; bioethics in decisions in the beginning and end of life; and decision making in healthcare. Patient autonomy was the bioethical principle most often addressed in various clinical circumstances, especially in end-of-life dilemmas.

Resumen El objetivo de este estudio fue identificar en la literatura situaciones y conductas bioéticas de la práctica profesional en salud. Se trata de una revisión integradora de artículos científicos indexados en las bases de datos de la Biblioteca Virtual en Salud, publicados entre 2014 y 2019. Se utilizaron los descriptores "personal de salud", "práctica profesional", "ética profesional", "discurso" y "bioética". Se seleccionaron 21 estudios para discusión y, del análisis, surgieron cinco categorías: bioética durante la formación profesional; bioética como forma de humanizar la salud; relaciones interprofesionales, derechos y deberes de los trabajadores y pacientes; bioética en las decisiones que permean el inicio y el final de la vida; y toma de decisiones en salud. La autonomía del paciente fue el principio bioético más abordado en diversas circunstancias clínicas, especialmente en los dilemas al final de la vida.

"Se você pegar locais de maior periferia, esqueça!": a (falta de) atuação pelo direito humano à alimentação adequada na atenção primária à saúde / "If you're talking about poor communities, forget it!": (lack of) human rights advocacy for adequate food in primary healthcare / "Si vas a lugares de mayor marginación, ¡olvídate!": la (falta de) actuación por el derecho humano a una alimentación adecuada en la atención primaria en salud

Este estudo visou compreender as formas de atuação profissional e as propostas de ações para a efetivação do direito humano à alimentação adequada (DHAA) no contexto da atenção primária à saúde (APS). A partir da abordagem qualitativa, conduzimos entrevistas semiestruturadas (no período de maio de 2013 a julho de 2014) com profissionais da saúde que desenvolvem grupos educativos sobre alimentação e nutrição na APS da cidade de São Paulo, Brasil. Realizamos análise de conteúdo buscando identificar as ações propostas em torno da alimentação e tomando como base teórica o DHAA. Identificamos três categorias de atuação profissional a partir das propostas de ações em alimentação e nutrição. A primeira tem a alimentação como dimensão biomédica. A segunda está focada no acesso e disponibilidade de alimentos no território. A terceira tem a realidade alimentar local, dos usuários, centrada na atuação em equipe. Dentre as propostas de ações, havia aquelas para serem realizadas pelos portadores de obrigações do DHAA (profissionais da APS) e aquelas para os próprios titulares do direito executarem (usuários da APS no Sistema Único de Saúde). A alimentação em contextos de pobreza é tratada como um problema sem solução. Este estudo permitiu aproximações entre "o que fazer" e "como atuar" a partir das formas de apropriação da alimentação por meio das concepções, da atuação profissional e das propostas de ações para a efetivação do DHAA na APS. Além disso, possibilitou elucidar a necessidade de compreensão da alimentação como um direito humano e do fortalecimento da responsabilidade dos profissionais da APS como agentes portadores de obrigações do DHAA no contexto das políticas sociais.

This study aimed to understand the forms of professional work and proposed actions to achieve the human right to adequate food (HRAF) in the context of primary healthcare (PHC). Using a qualitative approach, the authors conducted semi-structured interviews (from May 2013 to July 2014) with healthcare workers that conducted educational groups on food and nutrition in PHC in the city of São Paulo, Brazil. Content analysis was performed to identify the proposed actions on food, with HRAF as the theoretical basis. We identified three categories of professional work based on the proposed actions for food and nutrition. The first approaches food as a biomedical dimension. The second focuses on access and availability of foods in the territory. The third approaches users' local food reality, centered on the team's work. The proposed actions feature those conducted by individuals with obligations towards HRAF (healthcare workers in PHC) and those performed by rights-holder (users of PHC in the Brazilian Unified National Health System). Food in contexts of poverty is treated as a problem with no solution. This study allowed approximations between "what to do" and "how to act" based on ways of grasping food through the definitions, professional work, and proposed actions to achieve HRAF in PHC. It also allowed elucidating the need to understand food as a human right and strengthening the responsibility of healthcare workers in PHC as duty-bearers towards HRAF in the context of social policies.

Este estudio tuvo el objetivo de comprender las formas de actuación profesional y las propuestas de acciones para hacer efectivo el derecho humano a una alimentación adecuada (DHAA), en el contexto de la atención primaria a la salud (APS). A partir del abordaje cualitativo, llevamos a cabo entrevistas semiestructuradas (durante el período de mayo de 2013 a julio de 2014) con profesionales de salud que desarrollan grupos educativos sobre alimentación y nutrición en la APS de la ciudad de São Paulo, Brasil. Realizamos un análisis de contenido buscando identificar las acciones propuestas en un entorno de la alimentación y tomando como base teórica el DHAA. Identificamos tres categorías de actuación profesional a partir de las propuestas de acciones en alimentación y nutrición. La primera tiene la alimentación como dimensión biomédica. La segunda está enfocada en el acceso y disponibilidad de alimentos en el territorio. La tercera tiene la realidad alimentaria local, de los usuarios, centrada en la actuación del equipo. Entre las propuestas de acciones había unas para que fueran realizadas por los portadores de obligaciones de los DHAA (profesionales de la APS) y otras para que los propios titulares del derecho las ejecutaran (usuarios de la APS en el Sistema Único de Salud). La alimentación en contextos de pobreza se trata como un problema sin solución. Este estudio permitió aproximaciones entre "qué hacer" y "cómo actuar", a partir de las formas de apropiación de la alimentación mediante concepciones, de la actuación profesional y de las propuestas de acciones para la efectivación del DHAA en la APS. Asimismo, posibilitó elucidar la necesidad de comprensión de la alimentación como un derecho humano y el fortalecimiento de la responsabilidad de los profesionales de la APS, como agentes portadores de obligaciones del DHAA, en el contexto de las políticas sociales.