[Digital health in Latin America: current legislation and ethical aspectsSaúde digital na América Latina: legislação atual e aspectos éticos]. / Salud digital en América Latina: legislación actual y aspectos éticos.

Objectives: Describe the current legislation on electronic medical records (EMR) and telehealth in Latin American countries and analyze the treatment of confidentiality and professional secrecy. Methods: Between March and September 2022, a survey of the regulations in force in 21 Latin American countries was conducted at two levels: the existence of legislation on EMR and telehealth, and the treatment of confidentiality and professional secrecy in EMR and telehealth. A data extraction form was prepared for each country. Data were collected from official on-line sources. The information was analyzed qualitatively and synthesized in tables when possible. Results: The use of EMR is legally regulated in 16 countries. Nineteen countries have legislation on telehealth. All the countries analyzed safeguard confidentiality and professional secrecy through regulations. However, confidentiality and professional secrecy are mentioned in 11 countries in the context of telehealth, and in only nine countries in the context of EMR. Conclusions: Since the start of this century, Latin America has made progress in the legislation of digital tools for health care, such as EMR and telehealth. There is also interest in ethical issues related to the use of EMR and telehealth, particularly confidentiality and professional secrecy, aspects that should be strengthened in digital health.

Objetivo: Descrever a legislação vigente sobre prontuários eletrônicos e telessaúde nos países da América Latina e analisar o tratamento da confidencialidade e do sigilo profissional. Métodos: Entre março e setembro de 2022, realizou-se um levantamento sobre a regulamentação vigente nos 21 países latino-americanos incluídos no estudo, em dois níveis: i) existência de legislação sobre prontuários eletrônicos e telessaúde; e ii) tratamento da confidencialidade e do sigilo profissional em prontuários eletrônicos e telessaúde. Uma planilha para extração de dados foi elaborada para cada país. Os dados foram coletados de fontes oficiais disponíveis on-line. Foi realizada uma análise qualitativa das informações, que foram resumidas em tabelas, quando possível. Resultados: O uso dos prontuários eletrônicos é legalmente regulamentado em 16 países. Quanto à telessaúde, 19 países têm legislação sobre essa ferramenta. Todos os países analisados protegem a confidencialidade e o sigilo profissional por meio de regulamentação. No entanto, no contexto da telessaúde, eles são mencionados em 11 países; já no contexto dos prontuários eletrônicos, em apenas 9 países. Conclusões: Desde o início dos anos 2000, a América Latina vem avançando em relação à legislação sobre ferramentas digitais na atenção à saúde, como prontuários eletrônicos e telessaúde. Há também interesse nas questões éticas relacionadas ao uso de prontuários eletrônicos e telessaúde, especialmente em relação à confidencialidade e ao sigilo profissional, embora esses aspectos precisem ser reforçados na saúde digital.

More ethics in the laboratory, please! Scientists' perspectives on ethics in the preclinical phase.

In recent years there have been calls to improve ethics in preclinical research. Promoting ethics in preclinical research should consider the perspectives of scientists. Our study aims to explore researchers' perspectives on ethics in the preclinical phase. Using interviews and focus groups, we collected views on ethical issues in preclinical research from experienced (n = 11) and early-stage researchers (ESRs) (n = 14) working in a gene therapy and regenerative medicine consortium. A recurring theme among ESRs was the impact of health-related preclinical research on climate change. They highlighted the importance of strengthening ethics in relations within the scientific community. Experienced researchers were focused on technicalities of methods used in preclinical research. They stressed the need for more safeguards to protect the sensitive personal data they work with. Both groups drew attention to the importance of the social context of research and its social impact. They agreed that it is important to be socially responsible - to be aware of and be sensitive to the needs and views of society. This study helps to identify key ethical challenges and, when combined with more data, can ultimately lead to informed and evidence-based improvements to existing regulations.

Salud digital en América Latina: legislación actual y aspectos éticos / Digital health in Latin America: current legislation and ethical aspects / Saúde digital na América Latina: legislação atual e aspectos éticos

[RESUMEN]. Objetivo. Describir la legislación vigente respecto a historia clínica electrónica (HCE) y telesalud de los países latinoamericanos y analizar el tratamiento de la confidencialidad y el secreto profesional. Métodos. Entre marzo y septiembre de 2022, se realizó un relevamiento de la reglamentación vigente en los 21 países latinoamericanos en estudio, en dos niveles: i) la existencia de legislación respecto a la HCE y la telesalud, y ii) el tratamiento de la confidencialidad y el secreto profesional en la HCE y la telesalud. Se con- feccionó una ficha de extracción de datos por país. Se recolectaron datos a partir de fuentes on-line oficiales. Se analizó cualitativamente la información y se sintetizó en forma de tablas cuando fue posible. Resultados. El uso de la HCE está reglamentado legalmente en 16 países. Para el caso de telesalud, son 19 países los que cuentan con legislación en referencia a esta herramienta. Todos los países analizados resguardan la confidencialidad y el secreto profesional a través de reglamentaciones. Sin embargo, en el contexto de telesalud se mencionan en 11 países, en tanto en el contexto de la HCE, solo en 9 países. Conclusiones. Desde el inicio del segundo milenio América Latina ha avanzado respecto a la legislación de herramientas digitales en la atención en salud como la HCE y la telesalud. Se observa a su vez un interés por las cuestiones éticas relacionadas con el uso de la HCE y la telesalud, en particular de la confidencialidad y secreto profesional, aunque dichos aspectos deben ser fortalecidos en la salud digital.

[ABSTRACT]. Objectives. Describe the current legislation on electronic medical records (EMR) and telehealth in Latin Ame- rican countries and analyze the treatment of confidentiality and professional secrecy. Methods. Between March and September 2022, a survey of the regulations in force in 21 Latin American countries was conducted at two levels: the existence of legislation on EMR and telehealth, and the treatment of confidentiality and professional secrecy in EMR and telehealth. A data extraction form was prepared for each country. Data were collected from official on-line sources. The information was analyzed qualitatively and synthesized in tables when possible. Results. The use of EMR is legally regulated in 16 countries. Nineteen countries have legislation on telehealth. All the countries analyzed safeguard confidentiality and professional secrecy through regulations. However, confidentiality and professional secrecy are mentioned in 11 countries in the context of telehealth, and in only nine countries in the context of EMR. Conclusions. Since the start of this century, Latin America has made progress in the legislation of digital tools for health care, such as EMR and telehealth. There is also interest in ethical issues related to the use of EMR and telehealth, particularly confidentiality and professional secrecy, aspects that should be strengthened in digital health.

[RESUMO]. Objetivo. Descrever a legislação vigente sobre prontuários eletrônicos e telessaúde nos países da América Latina e analisar o tratamento da confidencialidade e do sigilo profissional. Métodos. Entre março e setembro de 2022, realizou-se um levantamento sobre a regulamentação vigente nos 21 países latino-americanos incluídos no estudo, em dois níveis: i) existência de legislação sobre prontuários eletrônicos e telessaúde; e ii) tratamento da confidencialidade e do sigilo profissional em prontuários eletrônicos e telessaúde. Uma planilha para extração de dados foi elaborada para cada país. Os dados foram coletados de fontes oficiais disponíveis on-line. Foi realizada uma análise qualitativa das informações, que foram resumidas em tabelas, quando possível. Resultados. O uso dos prontuários eletrônicos é legalmente regulamentado em 16 países. Quanto à telessaúde, 19 países têm legislação sobre essa ferramenta. Todos os países analisados protegem a confidencialidade e o sigilo profissional por meio de regulamentação. No entanto, no contexto da telessaúde, eles são mencionados em 11 países; já no contexto dos prontuários eletrônicos, em apenas 9 países. Conclusões. Desde o início dos anos 2000, a América Latina vem avançando em relação à legislação sobre ferramentas digitais na atenção à saúde, como prontuários eletrônicos e telessaúde. Há também interesse nas questões éticas relacionadas ao uso de prontuários eletrônicos e telessaúde, especialmente em relação à confidencialidade e ao sigilo profissional, embora esses aspectos precisem ser reforçados na saúde digital.

Bioethics of somatic gene therapy: what do we know so far?

OBJECTIVE: To provide a systematic overview of bioethical debate on somatic gene therapy as documented in the scientific literature. METHODS: We performed a systematic review of reasons, following Strech and Sofaer approach, which is a method to systematically identify and classify arguments (reasons) used in the scientific literature. We identified 217 eligible publications retrieved from PubMed, Lilacs, PhilPapers, and Google Scholar. A meta-synthesis was performed to analyze the data. RESULTS: We extracted 189 arguments. Arguments were grouped into 23 categories. Twelve categories were classified as research-related, including the risk/benefit ratio, priorities and limits, informed consent, review, and monitoring. Eleven were classified as society-related, including population impact, human identity, public perception, human health. CONCLUSION: Our study provides a database of existing challenges and arguments of somatic gene therapy and may serve as the basis of normative analysis. By presenting collected arguments, we contribute to the discussion about the ethics and social dimensions of somatic gene therapy.

Consentimiento informado y directivas anticipadas: análisis comparado de la legislación en América Latina / Consentiment informat i directives anticipades: anàlisi comparada de la legislació a Amèrica Llatina / Informed consent and living wills: comparative analysis of the legislation in Latin America

Objetivos: Describir la forma en que se establecen normativamente el consentimiento informado (CI) y las directivas anticipadas (DA) en países latinoamericanos en relación a la asistencia en salud y la investigación, y su análisis desde la bioética. Métodos: Se realizó un análisis comparativo de las normativas vigentes de los 21 países latinoamericanos respecto al CI y las DA. Se confeccionaron reportes de extracción de datos que fueron diseñados antes de iniciar el proceso de investigación para cada país. Se analizaron cualitativamente similitudes y diferencias respecto a variables predefinidas. Se realizaron tablas para sintetizar la información donde fue posible.Resultados:Dieciocho países latinoamericanos prevén una norma específica para el uso del CI en el ámbito clínico. Seis países han incorporado normativas respecto al uso del CI en la virtualidad. Respecto al uso del CI en investigación, 20 países latinoamericanos prevén una norma específica para este ámbito. En el caso de la exposición académica, son 6 países los que nombran esta situación en la normativa. Siete países latinoamericanos cuentan con normativa para establecer DA.Conclusiones:América Latina ha presentado una notable evolución en torno a normar dos de los más importantes instrumentos del ejercicio de la autonomía, como los son el CI y las DA. La legislación sobre ambos instrumentos no garantiza mayor autonomía en salud, pero su existencia como reguladora de acciones para la toma de decisiones constituye el primer paso para su ejercicio.(AU)

Objectius: Descriure la manera com s'estableixen normativament el consentiment informat (CI) i les directives anticipades (DA) en països llatinoamericans en relació amb l'assistència en salut i la investigació, i la seva anàlisi des de la bioètica. Mètodes: Es va realitzar una anàlisi comparativa de les normatives vigents dels 21 països llatinoamericans respecte al CI i les DA. Es van confeccionar reports d’extracció de dades que van ser dissenyats abans d’iniciar el procés de recerca per a cada país. Es van analitzar qualitativament similituds i diferències respecte de variables predefinides. Es van fer taules per sintetitzar la informació on va ser possible.Resultats:Divuit països llatinoamericans preveuen una norma específica per a l'ús del CI a l'àmbit clínic. Sis països han incorporat normatives respecte a l'ús del CI a la virtualitat. Pel que fa a l'ús del CI eninvestigació, 20 països llatinoamericans preveuen una norma específica per a aquest àmbit. En el cas de l'exposició acadèmica, són 6 països els que nomenen aquesta situació a la normativa. Set països llatinoamericans tenen normativa per establir DA.Conclusions:Amèrica Llatina ha presentat una notable evolució al voltant de normar dos dels instruments més importants de l'exercici de l'autonomia, com els són el CI i les DA. La legislació sobre tots dos instruments no garanteix més autonomia en salut, però la seva existència com a reguladora d'accions per a la presa de decisions constitueix el primer pas per al seu exercici.(AU)

Objectives: To describe how informed consent (IC) and living wills (LW) are legally established in Latin American countries in relation to health care and research, and to analyse that from bioethics. Methods: A comparative analysis of the current regulations of the 21 Latin American countries regarding CI and LW was carried out. Data extraction reports were prepared before starting the research process for each country. Similarities and differences were qualitatively analyzed according to predefined variables. Tables were made to synthesize the information where possible.Results:Eighteen Latin American countries provide a specific criteria for IC use in clinical setting. Six countries have incorporated regulations regarding the use of ICin virtually environment. Regarding the use of IC in research, 20 Latin American countries provide a specific regulation. In the case of the academic exposure, 6 countries name this situation in their regulations. Seven Latin American countries have regulations to establish LW.Conclusions:Latin America has presented a notable evolution around regulating two of the most important instruments of the exercise of autonomy, such as the CI and the DA. The legislation on both instruments does not guarantee that there is greater autonomy in health, but its existence as a regulator of actions for decision-making constitutes the first step for its exercise.(AU)

How to embed ethics into laboratory research.

Health-related innovation in biotechnology requires anticipating potential bioethical implications. In this article, we present a strategy to embed ethics in a group of early-stage researchers performing research in gene therapy and regenerative medicine in the laboratory phase. We conducted a series of focus group meetings with early-stage researchers who work in biotechnology laboratories. The objective was to reflect on the bioethical challenges of their own work and to promote the integration of research ethics with laboratory practice. The activity was assessed with questionnaires completed by the researchers before and after the meetings, and the analyses of the focus groups' content. As a result of the focus group series, all participants changed their perspectives about ethical issues regarding their planned research, developed the ability to reflect and debate on research ethics and had increased awareness of ethical issues in their own research activities. Half of them made changes in their research work. The study provides a concrete strategy to embed ethics and to strengthen responsibility in laboratory research. It is a strategy that allows to perform ethics reflection "on site" and in "real time" and complements the classic strategy of ethics assessment of the research protocol before starting the research procedure.

Shared decision making in mental health: a novel approach.

The health system tends to underestimate the ability to make decisions of people with mental illnesses, characterizing them as vulnerable and adopting a stigmatizing attitude towards this vulnerability. Therefore, their autonomy, in the classical sense of the term, is reduced or nullified. Another way to respond to vulnerability is by promoting autonomy, conceiving it as contextual and autonomy in a relational way. This could be beneficial for people with mental suffering because it allows analyzing what conditions could improve or harm the exercise of autonomy and consider the help of others in decision-making. The shared decision-making process is a form of collaboration between professionals, patients and/or family members, in which the available evidence is shared with the patient and contextualized when faced with the task of making decisions in the medical environment.

Atención de la salud en domicilio: aportes desde la bioética / Healthcare at Home: Contributions from Bioethics / Assistência médica domiciliar: contribuições da bioética

Resumen: El objetivo de este artículo es considerar los posibles desafíos éticos que implica la atención de la salud en domicilio desde la perspectiva bioética. Para esto se llevó a cabo una revisión bibliográfica en la base de datos Lilacs, un trabajo descriptivo y un análisis conceptual. Los principales resultados arrojan que tras una distinción analítica de tres categorías éticas diferenciales: intimidad del hogar, intimidad personal (en relación al hogar) e intimidad compartida. La última, en la que el profesional de la salud se involucra activamente, es en aquella en la que se debe actuar con responsabilidad ética, dado que se pueden generar conflictos de intereses, sobre todo en el ámbito afectivo-emocional del paciente o familia. Las diferencias pueden traducirse en tres enunciaciones normativas particulares a la atención domiciliaria: el reconocimiento a la particularidad de cada hogar, el trabajo sobre la autonomía relacional y la estrategia de cooperación y de ayuda mutua. Si entendemos a la bioética como una disciplina que consiste en el análisis crítico y la reflexión sistemática de las prácticas en torno a la salud, este artículo es de gran interés, pues reflexiona y analiza las particularidades de la atención de la salud en el contexto del hogar, una modalidad que se está extendiendo en la región y el mundo por sus virtudes para el paciente y el sistema de salud.

Abstract: The objective of this article is to consider the possible ethical challenges involved in the delivery of healthcare at home from the bioethics perspective. In order to do so a bibliographic review of the Lilacs database, a descriptive work, and a conceptual analysis were carried out. The main results after an analytical distinction show that three ethical categories can be differentiated: home intimacy, personal intimacy (with regards to home) and shared intimacy. The latter, in which the health professional gets actively involved, is the one which requires acting with ethical responsibility since conflicts of interests may arise, particularly in the patients' or their families' affective-emotional realm. The differences may translate into three normative assertions particular to healthcare at home: recognition of the particularity of each home, work on the relational autonomy and the mutual help and cooperation strategy. This article turns of particular interest if we understand bioethics as a discipline that involves critical analysis and systematic reflection of healthcare related practices, since it reflects upon and analyzes the home healthcare practices, a modality that is growing in the region and in the world due to its virtues both for the patient and for the health systems.

Resumo: O objetivo deste artigo é considerar os possíveis desafios éticos envolvidos na assistência médica domiciliar a partir de uma perspectiva bioética. Para isso, foi realizada uma revisão bibliográfica na base de dados Lilacs, um trabalho descritivo e uma análise conceituai. Os principais resultados mostram que, após uma distinção analítica de três categorias éticas diferenciais: intimidade do lar, intimidade pessoal (em relação ao lar) e intimidade compartilhada. Na última, em que o profissional de saúde está envolvido ativamente, é onde é necessário agir com responsabilidade ética, uma vez que podem ser gerados conflitos de interesse, principalmente no âmbito afetivo-emocional do paciente ou da família. As diferenças podem ser traduzidas em três declarações normativas específicas para o atendimento domiciliar: o reconhecimento da particularidade de cada domicílio, o trabalho sobre a autonomia relacional e a estratégia de cooperação e ajuda mútua. Se entendemos a bioética como uma disciplina que consiste em uma análise crítica e uma reflexão sistemática das práticas em torno da saúde, este artigo é de grande interesse, pois reflete e analisa as particularidades da assistência à saúde no contexto do lar, uma modalidade que está se espalhando na região e no mundo por suas virtudes para o paciente e o sistema de saúde.

Descripción socioeconómica de trabajadores de reparto en motocicleta y su relación con las colisiones viales / Socioeconomic description of motorcycle delivery workers and their relation to road chashes

Introducción: La cadetería en motocicletas es una actividad frecuente en las grandes ciudades que presentan gran vulnerabilidad respecto a los accidentes de tránsito. El objetivo de este trabajo es conocer las características sociodemográficas y laborales de los trabajadores de reparto en motocicleta. Materiales y Métodos: se realizó un estudio descriptivo y transversal. Se realizó un muestreo no probabilístico intencional. Se utilizó una encuesta heteroadministrada y los datos obtenidos se analizaron con software Statistical Package for the Social Sciences (SPSS 20). Para la georreferenciación del barrio de residencia y de la ubicación del accidente, se utilizó el software Sistema de Información Geográfica (ArcGIS). Resultados: fueron encuestados 104 cadetes. Se trató de una población joven y principalmente masculina (promedio 30,2 años). El 54,8% refirió ser jefe de familia, con 2,4 dependientes en promedio. El 69% protagonizó un accidente de tránsito en su vehículo mientras estaban trabajando. Se halló asociación estadística significativa entre la ocurrencia de accidentes y: tiempo que conduce una moto (p 0,042); forma de cobro por su trabajo como cadete (p 0,028); km recorridos por día (p 0,039); poseer algún factor de riesgo (p 0,027). Conclusiones: los resultados obtenidos permitieron reflexionar acerca de las condiciones laborales de estos trabajadores, cuya realidad compleja condiciona sus posibilidades de inserción laboral y de seguridad vial.

delivery of products using motorcycles is a common activity in large cities. Delivery workers are greatly vulnerable to traffic accidents. The aim of this work is to understand the personal and occupational characteristics of delivery workers. Materials and Method: A descriptive cross-sectional study was conducted. An intentional non-probabilistic sampling was performed. A survey was used and the data obtained were analyzed using Statistical Package for Social Sciences (SPSS 20) software. Geographic Information System (ArcGIS) software was used for georeferencing neighborhood of residence and the location of the accident. Results: 104 delivery workers were surveyed. This was a young population and mostly male -30.2 years in average; 54.8% reported being head of the family, with 2.4 dependents on average; 69% were involved in an accident in their vehicle during their work. A statistically significant association between the occurrence of accidents and the time they have spent driving a motorcycle (p 0.042); the form of payment for their delivery work (p 0.028); the kilometers traveled per day (p 0.039); and the existence of any risk factors (p 0.027) was found. Conclusion: The results obtained allowed to reflect on the working conditions of these people, whose complex reality affects their chances of employment and road safety.

Procesamiento de las expresiones faciales en personas con esquizofrenia: análisis dinámico de la información visual / Processing of Facial Expressions in People with Schizophrenia: Dynamic Analysis of Visual Information

INTRODUCCIÓN: Las personas con esquizofrenia presentan deficiencias en su desempeño social. El procesamiento emocional explica los aspectos relacionados con percibir y utilizar emociones faciales para un adecuado manejo social. Los movimientos oculares son un indicador del estatus cognitivo de un sujeto. OBJETIVOS: Evaluar los movimientos oculares que realiza una persona con esquizofrenia cuando procesa una emoción facial, teniendo en cuenta su funcionamiento social. MÉTODOS: Se realizó un estudio de tipo analítico, observacional y cuantitativo. Incluyó entrevistas semiestructuradas y tests validados en Argentina, y luego el seguimiento de movimientos oculares a 38 personas (19 con diagnóstico de esquizofrenia y 19 sujetos sanos). Se analizaron todos los datos con sistema estadístico R. RESULTADOS: El análisis de la duración total de fijaciones por sujeto por región de interés mostró las dificultades que presentan las personas con esquizofrenia para utilizar los lugares de la cara e interpretar la emoción. En la evaluación de la identificación de emociones, las personas con esquizofrenia tuvieron mayor cantidad de errores y de consignas sin respuestas. CONCLUSIONES: En comparación con controles, las personas con esquizofrenia utilizan una estrategia diferente y deficiente de la recogida de la información visual para identificar la expresión emocional, que puede ser medida y posiblemente estandarizada, como método de evaluación cognitiva.

INTRODUCTION: People with schizophrenia have deficits in their social performance. Emotional processing explains aspects related to the perception and use of facial emotions for a proper social performance. Ocular movements are an indicator of the cognitive status of a person. OBJECTIVES: To evaluate the ocular movements made by a person with schizophrenia when processing a facial emotion, taking into account the social functioning. METHODS: An observational, quantitative and analytical study was conducted, including semi-structured interviews and tests validated in Argentina, as well as eyetracking to 38 people (19 diagnosed with schizophrenia and 19 healthy subjects). All data were analyzed through R statistical program. RESULTS: The analysis of the total duration of fixations per subject and region of interest showed the difficulties people with schizophrenia have to use the places of the face and to interpret emotion. In the assessment of the identification of emotions, people with schizophrenia had the highest number of errors and unanswered items. CONCLUSIONS: When compared to controls, people with schizophrenia use a different and poor strategy of collecting visual information to identify emotional expression, that can be measured and possibly standardized as a method of cognitive assessment.

[Psychiatric hospitalizations of child-youth population: An epidemiological study of Bahía Blanca City, Argentina]. / Hospitalizaciones psiquiátricas de población infanto-juvenil: un estudio epidemiológico de la ciudad de Bahía Blanca, Argentina.

INTRODUCTION: In recent years, there has been an increase in child and adolescent psychiatric consultations. The infant-youth population is a vulnerable group due to the evolutionary moment in which they are. They are the substrate of the impact of family and social crises. It is necessary to know the prevalent disorders, and the epidemiological profle of the population in question, to collaborate with a better understanding of the phenomenon and to make appropriate family and individual approaches in the subject. MATERIALS AND METHODS: The number of children and adolescents who used the hospitalization device in the private sector of the city of Bahía Blanca, Argentina, from 2014 to 2016 is described. The medical records of hospitalized patients in the 12 to 19 year age range were analyzed. RESULTS: The target population has an average age of 16 years; Almost 90% of the population is in school; More than 60% have their own home and live with their nuclear family. The reason for admission that demanded more days of hospitalization was Destructive, Impulse Control and Behavior Disorder. The reinternation rate of this study was 31.6%. CONCLUSION: The intimate relationship of the increasing incidence of mental disorders in the child and adolescent population with the availability of families and society to contain and care for this vulnerable population is more evident.

Errores humanos autorreferenciados por automovilistas de la ciudad de Bahía Blanca, Argentina / Human errors self-reported by automobilists from bahia blanca, Argentina

OBJETIVO: Describir los tipos de errores que referencian los conductores de automóviles que circularon en la ciudad de Bahía Blanca durante el período septiembre 2014 y abril de 2015. MÉTODO: Estudio descriptivo de corte transversal de tipo cuantitativo. Se definió una muestra por conveniencia y se confeccionó una encuesta en formato digital, de tipo estructurada, dirigida a los automovilistas, teniendo como base el "Driver Behaviour Questionnaire" en la versión traducida al español. Luego fue validada mediante el método Delphi. Se analizó con software estadístico SPSS. RESULTADOS: El 30% al realizar un giro, estuvo a punto de chocar con una bicicleta o moto. Un 36,3% sostuvo que por ir distraído, se dio cuenta tarde de que el vehículo de adelante redujo su velocidad debiendo frenar bruscamente para evitar el choque, el 25,3% se olvida de utilizar el guiñe antes de girar o cambiar de carril. El 80,2% usa siempre el cinturón de seguridad. El 11,4% pasa los semáforos en rojo. Un 43,9% utiliza el celular mientras maneja y el 22,9% de los encuestados reconoce que alguna vez condujo por encima del límite legal de alcohol. El 38% se impacienta y acelera bruscamente a la salida de un semáforo y un 62,7% se impacienta y se adelanta de forma arriesgada a un vehículo lento. CONCLUSIONES: El manejo es una situación compleja que requiere de múltiples habilidades pero fundamentalmente una conciencia de respeto y solidaridad sumado a un enfático control punitorio sobre errores voluntarios graves.

OBJECTIVE: To describe the types of errors reported by drivers who commuted in the city of Bahia Blanca between September 2014 and April 2015. METHOD: Quantitative descriptive cross-sectional study. A convenience sample was defined, and a structured digital survey, based on the Spanish-translated version of the "Driver Behaviour Questionnaire", was constructed and then validated using the Delphi method. Data were analyzed with SPSS statistical software. RESULTS: Of the automobilists surveyed, 30% reported having nearly colliding with a bicycle or motorcycle while making a turn; 36.3% said they have had to brake suddenly to avoid a collision because they were distracted and did not realize the vehicle in front of them had slowed down; and 25.3% had forgotten to use the turn signal before turning or changing lanes. In addition, only 80-2% of respondents always wear a seat belt; 11-4% do not respect red lights; 43.9% use their phones while driving; and 22.9% admit driving while intoxicated over the legal alcohol limit. Finally, 38% report being impatient and accelerating out of a traffic light, while 62.7% have riskily passed a slower vehicle, due to impatience. CONCLUSIONS: Driving an automobile is a complex situation that requires multiple skills and, most fundamentally, a sense of respect and solidarity with other drivers, coupled with punitive control of serious yet preventable human errors.

Programa de formación profesionalizante en salud mental comunitaria: una experiencia de posgrado en atención primaria / Board skills program in community mental health: postgraduate experience in primary care

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Análisis contextual - relacional del sujeto: Herramienta para la entrevista psiquiátrica / Contextual - relational analysis of a patient: Tool for the psychiatric interview

La entrevista médica es el momento en que se produce y reproduce en acto la Medicina. La evidencia muestra que existen limitaciones del modelo médico dominante. Es necesaria una reconfiguración de la práctica y de las herramientas que ayuden a un abordaje eficaz y accesible. Se presenta una herramienta práctica para la historia clínica que permita recolectar información mostrando la interacción con el sujeto, con las dimensiones contextuales y que acompañan al síntoma que presenta. Se desarrolló un instrumento a manera de esquema que permite incluir información relacionada tanto con cuestiones estáticas como dinámicas de las personas. Resulta una síntesis entre el genograma, el ecomapa y la Matriz de Procesos Críticos (Breilh, 2003). El esquema plantea una nueva herramienta que debe resultar en utilidad, practicidad y posibilidad de explorar nuevas dimensiones y debe convertirse en indispensable para el abordaje integral de la persona que consulta y su familia.

The interview is the most important for the overall assessment of a person suffering from a mental illness. The data relieved in the interview between subject and physician, will be key to start the diagnostic and therapeutic process. Even knowing its usefulness, psychiatric interview often reduced to explore the symptom, taking into account the use of qualifiers manuals as the only evaluative instance. The approach to the context of a subject and their social relations, in general, is relegated to other mental health professionals. This problem situation develops under the predominantly biological paradigm of modern Medicine. Evidence shows that there are limitations of the dominant medical model specifically in the way that the therapeutics forms are carried out. One of the hypothesis has to do with the actual diagnosis approach that presents limits when the professionals try to understand a person and its context. The main tools used in clinical practice are the genogram and ecomap, outline shaped structures that allow placing a lot of information that is easily recovered. The genogram shows family and relations between its members in a schematic way; and ecomap details the social activities of the subject and environments that are important in their daily lives. The daily use of these tools allows to evaluate some important aspects of the person, but have limitations since both are static, covering a limited set of dimensions of the patient's life and do not allow to reveal the cultural, social and family of the subject frames. In the literature there are not tools that improve instances of the two that have been presented, only the theoretical developments. A reconfiguration of practice and concomitantly of the tools to support effective and accessible approach is necesary. The aim of this article is to show a practical tool that shows information about the interaction of the subject with the contextual and relational dimensions. It is then necessary a pragmatic Context-Relational Analysis (CRA), which will allow to work in the clinical setting. CRA it explain if we understand that the context of the subject is where they conducts relations with other subjects, institutions, social groups; these relationships are conditioned in some way by this context, and in turn, this will provide conditions for the subject relates. The context of a subject is all that aspect concerning its active reality, that is, the culture in which he lives, political and economic conditions in effect; everything that defines a social structure. This context is providing ideas, images and actions that are building and rebuilding the life of that subject. Then we have the relational aspect, the dimension in which the subject constructs along with other subjects a common space. The ways of relating are specific to a place and a time, so when times changing also do it the modalities of formation of subjectivity. The relevance of this aspect of the psyche is so important that mental health is conceived as learning reality and the ability to maintain dialectical and transformative relationships that allow manage and resolve contradictions and internal conflicts of the individual and those of this with the social context. A synthesis of the genogram, ecomap and Critical Process Matrix (Breilh, 2003) is proposed like a tool in a scheme form that includes information related to both static and dynamic issues of people. The scheme proposes a new tool that should be practical and with the ability to explore new dimensions. This approach must become essential to the integral care to consulting person and his family especially in the psychiatric field.

Descripción de las internaciones en salud mental de una institución monovalente en la ciudad de Bahía Blanca, Argentina / Description of mental health hospitalization in a monovalent institution in te city of Bahía Blanca, Argentina

Este artículo tiene como objetivo describir el número de personas que utilizan el dispositivo hospitalario de guardia psiquiátrica e internación en el sector privado de la ciudad de Bahía Blanca en el periodo 2007 -2015. Se realizó un estudio de tipo descriptivo cuantitativo observacional, con uso de fuentes primarias para la obtención de datos. Se analizaron en la Clínica Privada Bahiense (CPB): 1) registros de las internaciones en el periodo 2007-2015 ; 2) consultas por guardia de psiquiatría en el periodo 01/07/2014-31/05/2015;3) diagnósticos de internación psiquiátrica ocurridos durante en el periodo 01/07/2014 - 31/05/2015 y sus características. Durante este último periodo se realizaron 1154 consultas a la guardia de psiquiatría y 485 internaciones. El porcentaje total de re-internación fue del 20%, teniendo en cuenta que el total de internaciones fue de 485 personas. Respecto a las personas internadas, la relación hombre-mujer fue de 1:1,35 y respecto al número de internaciones la relación hombre-mujer se mantiene muy similar, siendo 1:1,28. El presente trabajo tiene las limitaciones propias de un trabajo retrospectivo. En cuanto a las fortalezas del presente estudio, se destaca la sistematización de los datos sobre las urgencias psiquiátricas y la frecuencia de internación del sector privado. Como conclusión se plantean los siguientes interrogantes: ¿Es posible la desmanicomializacion en nuestra ciudad?, ¿Dónde serán asistidas las 40 personas que se internan, en promedio por mes?, ¿Existen redes de apoyo y programa de contención para la persona con sufrimiento mental? ¿Se ha creado proyectos de reinserción social?

This article aims at describing the number of individuals who used the private psychiatric emergency service and hospitalization in the city of Bahía Blanca in 2007-2015. A descriptive-quantitative-observational study was performed using primary sources for data collection. The following documents were analyzed at Clínica Privada Bahiense (CPB): 1) 2007-2015 hospitalization records; 2) referrals to psychiatric emergency service from 01/07/2014 to 31/05/2015; 3) psychiatric hospitalization diagnosis from 01/07/2014 to 31/05/2015 as well as the characteristics thereof. During this last period,1154 patients were referred to the psychiatric emergency service and 485 were hospitalized. The total re-hospitalization percentage was 20%, taking into account that a total of 485 patients were hospitalized. With regard to the hospitalized patients, the male/female ratio was 1:1.35 and with regard to the number of hospitalizations the male/female ratio was similar: 1:1.28. This paper has the weaknesses inherent to a retrospective work. Regarding strengths, psychiatric emergency data systematization and private sector hospitalization frequency can be highlighted. As a conclusion, the following questions arise: Is it possible to eliminate mental houses in our city?, Where will the monthly average of 40 hospitalized patients be treated?, Are there support networks and contention programs for the people with mental suffering? Have social reinsertion projects been developed?

Errores humanos autorreferenciados por los peatones del sistema vial de la ciudad de Bahía Blanca, Argentina: estudio descriptivo observacional / Human mistakes sel-referred by pedestrians in the city of Bahía Blanca, Argentina: descriptive, observational study

Introducción: los peatones representan el 22% del total mundial de fallecimientos por colisiones viales. Constituyen la población más vulnerable del sistema vial. Objetivo: describir los tipos de errores humanos autorreferenciados por los peatones que circularon en el sistema vial de la ciudad de Bahía Blanca durante el período septiembre del 2014 a abril del 2015. Metodología: estudio descriptivo observacional de corte transversal. Muestra por conveniencia. Se confeccionó una encuesta estructurada en base al Driver Behaviour Questionnaire en la versión traducida al español. Se validó mediante el método Delphi. Se analizó con software stadístico SPSS. Resultados: el 46,5% refiere no mirar a ambos lados de la calle antes de cruzar. El 22,3% refiere no ver cuando está saliendo un auto de un garaje y debe frenar bruscamente. El 32,2% refiere cruzar la calle hablando por teléfono celular y no darse cuenta si viene un vehículo. El 89,2% refiere cruzar a la vereda de enfrente por la mitad de la calle. El 69,7% refiere cruzar la calle aunque el semáforo peatonal esté en rojo. Conclusiones: las conductas que se observan en el estudio demuestran la inobservancia de las normas por parte de los peatones. Muchas de dichas conductas son condiciones que podrían generar una colisión con lesiones graves. El foco de la intervención debería orientarse al control más estricto de los peatones cuando circulan por el sistema vial.

Abstract Introduction: pedestrians represent 22% of the global number of deaths due to car accidents. They are the most vulnerable population of the road system. Objective: to describe the kinds of human mistakes self-referred by pedestrians who circulate in the road system of the city of Bahía Blanca during the September 2014- April 2015 period of time. Methodology: observational descriptive, cross-sectional study. Convenience sample. A survey was prepared based on the “Driver Behavior Questionnaire” (Spanish versión). It was validated by the Delphi method and analysed with With SPSS predictive analytics software. Results: 46.5 % declare no to look both ways before crossing the street. 22.3% state they do not see when a car is coming out of a garage and obliges it to stop abruptly. 32.2% declare to cross the street while using the cellphone and not realizing whether a vehicle is approaching. 89.2% admit they cross in the middle of the street. 69.7% affirm they cross the street on a red light. Conclusions: behaviors observed in the study demonstrate failure to observe the norms by pedestrians. Many of the above mentioned behaviors could result in collisions and cause serious lesions. Interventions should focus on stricter controls to pedestrians when they circulate in the road system.

Resumo Introdução: os pedestres são 22% do total mundial de falecimentos por colisões viárias. É a população mais vulnerável do sistema viário. Objetivo: descrever os erros humanos auto-relatados pelos pedestres que circulam no sistema viário da cidade de Bahía Blanca durante o período setembro de 2014 - abril de 2015. Metodologia: estudo descritivo observacional transversal. Amostragem por conveniência. Um questionário estruturado foi elaborado baseado na versão em espanhol do “Driver Behaviour Questionnaire”. Foi validado utilizando o método Delphi e analisado usando o software estatístico SPSS. Resultados: 46,5 % afirma não olhar para os dois lados da rua antes de atravessar. 22,3% afirma não ver quando um auto sai de uma garagem e tem que frear bruscamente. 32,2% afirma atravessar a rua conversando pelo celular e não perceber a aproximação de um veículo. 89,2% afirma atravessar a rua na metade do quarteirão. 69,7% afirma atravessar a rua mesmo quando o semáforo para pedestres está vermelho. Conclusões: as condutas observadas no estudo mostram que os pedestres não respeitam as normas. Muitas dessas condutas podem causar colisões com lesões graves. A intervenção deveria focar-se em um controle mais rigoroso dos pedestres quando circulam pelo sistema viário.

Barreras en la atención de la salud sexual en Argentina: percepción de las mujeres que tienen sexo con mujeres / Barriers to sexual health care in Argentina: perception of women who have sex with women

Objetivo El objetivo es describir las barreras en la atención de la salud sexual de las Mujeres que tienen Sexo con Mujeres (MSM) en Argentina durante el año 2013. Métodos Estudio descriptivo de corte transversal, cuantitativo. Se realizó una encuesta por internet, de abril a julio a mujeres homo y bisexuales mayores de 18 años que residen en Argentina, mediante la metodología de bola de nieve. Resultados Se encuestaron 161 mujeres, de las cuales el 97,5 % asistió alguna vez a un médico, éste no interrogo sobre su orientación sexual en el 82,8 %. El 93,6 % no recibió información; el 83,8 % percibe poco/nada de riesgo de contraer ETS. El 48,4 % desconocen métodos de protección entre mujeres. Refirieron no utilizarlos el 77,5 %, siendo los motivos: pareja estable, incomodidad y que no se consiguen. Discusión Los resultados de la presente investigación identifican la baja percepción de las MSM sobre las ETS, y la dificultad del abordaje de los profesionales de la salud en torno a esta temática.(AU)

Objective The objective is to describe the barriers to sexual health care of Women Who Have Sex with Women (WSW) in Argentina during 2013. Methods A cross-sectional, descriptive and quantitative study. An online survey was conducted using the Internet, in the period of April-July 2013, with homosexual and bisexual women over 18 living in Argentina, making use of the snowball methodology. Results A total of 161 women were surveyed. The results showed that 97.5 % had previously visited a doctor. The doctor did not ask about their sexual orientation in 82.8 % of cases. 93.6 % of the surveyed did not receive information about STDs; 83.8 % perceive little/no risk regarding STDs. 48.4 % are unaware of the methods of protection of STDs among women and 51.6 % obtained this information from websites and friends. 77.5 % reported not using protection methods. The main reasons were: stable partner, discomfort and the inability to acquire them. Discussion The results of this research allow for identifying the low perception among WSW regarding STDs, and the difficulty of approaching health professionals about this subject.(AU)