Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia

Background: To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. Objective: To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Methods: Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. Results: The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. Conclusions: The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Antecedentes: En Colombia y Latinoamérica no se cuenta con registros publicados de temas abordados desde los metodos del diálogo deliberativo frente a temas de salud sobre la población pediátrica. Objetivo: El diálogo deliberativo fue utilizado para deliberar sobre el derecho a la muerte digna en niñas, niños y adolescentes, sus criterios de exclusión, y el marco de acción de los cuidados paliativos pediátricos. Métodos: Investigación acción participativa recurriendo a la metodología Deliberative Poll. Resultados: Redacción de un documento de recomendaciones de Política Pública en torno a la eutanasia en población pediátrica y entrega del mismo al Ministerio de Salud y Protección Social de Colombia días previos a la expedición de la Resolución que reglamentó el derecho a morir con dignidad para esta población; así mismo, las conclusiones de este ejercicio posibilitaron la estructuración de una guía metodológica para la realización de Cabildos Ciudadanos en donde se integra a niñas, niños y adolescentes. Conclusiones: el diálogo deliberativo puede constituirse en una alternativa costo-eficiente para reemplazar o complementar metodologías de participación empleadas en la construcción de lineamientos y políticas públicas en salud.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia.

Background: To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. Objective: To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Methods: Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. Results: The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. Conclusions: The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Antecedentes: En Colombia y Latinoamérica no se cuenta con registros publicados de temas abordados desde los metodos del diálogo deliberativo frente a temas de salud sobre la población pediátrica. Objetivo: El diálogo deliberativo fue utilizado para deliberar sobre el derecho a la muerte digna en niñas, niños y adolescentes, sus criterios de exclusión, y el marco de acción de los cuidados paliativos pediátricos. Métodos: Investigación acción participativa recurriendo a la metodología Deliberative Poll. Resultados: Redacción de un documento de recomendaciones de Política Pública en torno a la eutanasia en población pediátrica y entrega del mismo al Ministerio de Salud y Protección Social de Colombia días previos a la expedición de la Resolución que reglamentó el derecho a morir con dignidad para esta población; así mismo, las conclusiones de este ejercicio posibilitaron la estructuración de una guía metodológica para la realización de Cabildos Ciudadanos en donde se integra a niñas, niños y adolescentes. Conclusiones: el diálogo deliberativo puede constituirse en una alternativa costo-eficiente para reemplazar o complementar metodologías de participación empleadas en la construcción de lineamientos y políticas públicas en salud.

Effectiveness of Sex Education Interventions in Adolescents: An Overview.

The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations.

Universidad y conducta suicida: respuestas y propuestas institucionales, Bogotá 2004-2014 / University and suicidal behavior: institutional response and actions, Bogotá 2004-2014

RESUMEN Objetivo Analizar las respuestas institucionales frente a la conducta suicida de estudiantes de cinco universidades de Bogotá y su relación con los lineamientos de la Política Nacional de Salud Mental (PNSM), de la Atención Primaria Integral en Salud (APS) y los planes establecidos para su abordaje y, a partir de estos, formular recomendaciones para la acción. Métodos Estudio cualitativo de tipo exploratorio-descriptivo basado en la consulta a la memoria de 66 agentes universitarios quienes aportaron acerca del hecho suicida y sus características, y sobre las respuestas y propuestas institucionales asumidas en cinco universidades de Bogotá. Se utilizaron entrevistas semiestructuradas. Resultados Las universidades participantes presentan comprensiones heterónomas frente al fenómeno del suicidio y mecanismos de atención diferentes principalmente direccionados al apoyo administrativo y a la prevención de contagio del comportamiento suicida. Conclusiones Los suicidios consumados de estudiantes le han servido a las universidades para reflexionar sobre esta problemática y a partir de ello se ha hecho más visible el problema de la deshumanización en la formación, el papel del bienestar universitario y los servicios de salud. Emerge con fuerza el tema de la conveniencia de las redes de trabajo interinstitucional e intersectorial, la psicoeducación, la corresponsabilidad, así como la activa participación de los jóvenes en la discusión y formulación de enfoques y programas orientados hacia su bienestar.(AU)

ABSTRACT Objective To analyze the institutional responses and actions towards suicidal behavior of students from five universities in Bogotá, and their relation with the National Mental Health Policy (NMHP), the Comprehensive Primary Health Care Guidelines (APS), and the plans established for approaching this issue, to finally make suggestions based on them. Methods Qualitative, exploratory-descriptive study based on the experiences of 66 university workers, who provided inputs on suicide and its characteristics; this study is also grounded on the institutional response of five universities in Bogotá. Semi-structured interviews were also used. Results Participating universities have a heteronomous understanding of the phenomenon of suicide, as well as different attention mechanisms, which are mainly directed to administrative support and the prevention of suicidal behavior contagion. Conclusions The consummate suicides of students have served the universities to reflect upon this problem, which has made more visible the problem of dehumanization in training, and the role of university well-being and health services. The appropriateness of inter-institutional and intersectoral networks, psychoeducation, co-responsibility, and the active participation of young people in the discussion and formulation of welfare-oriented approaches and programs are strong aspects that arise from this reflection.(AU)

Suicide in University students in Bogotá, Colombia, 2004-2014. / Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004­2014.

We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 - 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 - 27 years, with 62% of the cases in the 19 - 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004-2014 / Suicide in University students in Bogotá, Colombia, 2004-2014

Resumen Estudio cualitativo, exploratorio, descriptivo y retrospectivo en cinco universidades de Bogotá, Colombia, para conocer la magnitud, las principales características y significados y el impacto del suicidio de estudiantes universitarios. Se realizaron 66 entrevistas semiestructuradas a personal institucional. Se identificaron 45 casos de suicidio consumado en el período 2004 - 2014. El 69% de los casos fueron hombres y el 31% mujeres. El rango de edad estuvo entre 17 y 27 años; 62% entre 19 y 22 años. Las formas más frecuentes de cometer el suicidio fueron el ahorcamiento y el envenenamiento, seguidos del lanzamiento al vacío, el uso de armas de fuego y el consumo de sustancias psicoactivas. El 52% de los casos eligió el lugar de residencia para cometer el hecho; el 16% eligió el campus universitario. Áreas de conocimiento: el 44% pertenecía a ciencias sociales y humanas y el 22% a ingenierías. Motivos y procesos desencadenantes del suicidio identificados, el principal grupo se relaciona con lo familiar, en especial desintegración familiar, ruptura de relaciones de pareja e intolerancia a opciones sexuales diferentes. Los entrevistados expresaron diversos significados del suicidio, tanto positivos: acto de valor y ejercicio de la autonomía, como negativos: impotencia, desadaptación y derrota.

Abstract We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 – 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 – 27 years, with 62% of the cases in the 19 – 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

[University and suicidal behavior: institutional response and actions, Bogotá 2004-2014]. / Universidad y conducta suicida: respuestas y propuestas institucionales, Bogotá 2004-2014.

OBJECTIVE: To analyze the institutional responses and actions towards suicidal behavior of students from five universities in Bogotá, and their relation with the National Mental Health Policy (NMHP), the Comprehensive Primary Health Care Guidelines (APS), and the plans established for approaching this issue, to finally make suggestions based on them. METHODS: Qualitative, exploratory-descriptive study based on the experiences of 66 university workers, who provided inputs on suicide and its characteristics; this study is also grounded on the institutional response of five universities in Bogotá. Semi-structured interviews were also used. RESULTS: Participating universities have a heteronomous understanding of the phenomenon of suicide, as well as different attention mechanisms, which are mainly directed to administrative support and the prevention of suicidal behavior contagion. CONCLUSIONS: The consummate suicides of students have served the universities to reflect upon this problem, which has made more visible the problem of dehumanization in training, and the role of university well-being and health services. The appropriateness of inter-institutional and intersectoral networks, psychoeducation, co-responsibility, and the active participation of young people in the discussion and formulation of welfare-oriented approaches and programs are strong aspects that arise from this reflection.

OBJETIVO: Analizar las respuestas institucionales frente a la conducta suicida de estudiantes de cinco universidades de Bogotá y su relación con los lineamientos de la Política Nacional de Salud Mental (PNSM), de la Atención Primaria Integral en Salud (APS) y los planes establecidos para su abordaje y, a partir de estos, formular recomendaciones para la acción. MÉTODOS: Estudio cualitativo de tipo exploratorio-descriptivo basado en la consulta a la memoria de 66 agentes universitarios quienes aportaron acerca del hecho suicida y sus características, y sobre las respuestas y propuestas institucionales asumidas en cinco universidades de Bogotá. Se utilizaron entrevistas semiestructuradas. RESULTADOS: Las universidades participantes presentan comprensiones heterónomas frente al fenómeno del suicidio y mecanismos de atención diferentes principalmente direccionados al apoyo administrativo y a la prevención de contagio del comportamiento suicida. CONCLUSIONES: Los suicidios consumados de estudiantes le han servido a las universidades para reflexionar sobre esta problemática y a partir de ello se ha hecho más visible el problema de la deshumanización en la formación, el papel del bienestar universitario y los servicios de salud. Emerge con fuerza el tema de la conveniencia de las redes de trabajo interinstitucional e intersectorial, la psicoeducación, la corresponsabilidad, así como la activa participación de los jóvenes en la discusión y formulación de enfoques y programas orientados hacia su bienestar.