Change in demand for health-related undergraduate studies in Spain during 2015-2021: a temporal series study.

Introduction: The expansion of higher education is a worldwide phenomenon. To our knowledge, there are no studies analyzing the trends in demands of enrollment in health-related studies in Spain. Therefore, the objective was to analyze the change in demand (the number of requests for enrollment divided by the number of offered places) for undergraduate health-related studies in Spain during the period 2015-2021 as well as compare the change by region in the pre (2015-2019) and pandemic (2020-2021) period. Methods: This is an observational (ecological type) study with temporal series analyses using data from public (non-for-profit) higher education institutions from the Integrated University Information System. For the analysis by region, we calculated the demand of all twelve undergraduate health-related degrees and the percentages of change between both periods using the Wilcoxon test. The Joinpoint Regression program was used to analyze the trends in demand for each degree during the 7-year period. Results: Significant (p < 0.001) increases in demand during the pandemic period were observed in all regions. During the pandemic, medicine, biomedicine, nursing, odontology and pharmacy presented a higher demand in comparison with data collected before the pandemic started. In contrast, this pattern was not confirmed in the following cases: physiotherapy, occupational therapy, podiatry, psychology, social work, human nutrition and dietetics. By regions, Navarra, Asturias, and La Rioja presented the most drastic changes. In regions with the biggest number of universities, such as Catalonia, Andalusia and Madrid, the change observed was smaller.

The impact of the COVID-19 pandemic on enrollment in undergraduate health-related studies in Spain.

The aim of this study was to determine whether the pandemic has reinforced the choice of pursuing health-related bachelor's degrees, and to identify underlying factors that could contribute to that impact. This is a cross-sectional study using an online survey of 2,344 students of nursing, physiotherapy, medicine, psychology and podiatry who started health-related bachelor's degrees after the COVID-19 outbreak in Spanish higher education institutions. The pandemic influenced the choice of these studies by increasing the desire to help others (33.2%), by increasing citizenship values (28.4%), and by increasing the desire to contribute to improving the situation of the country (27.5%). Women had a significantly greater influence on the increase in social values related to the practice of the profession produced by the pandemic, whereas men and the bachelor's degree in podiatry were more influenced by salary prospects. An increased desire to help others was significantly higher among women and nursing and medical students. Podiatry and psychology were the degrees were most influenced by the pandemic, as more students decided to pursue them, something they had previously doubted, while in nursing, psychology, and medicine the pandemic reinforced their interest in pursuing the degree the most. Students personally affected by COVID-19 reported being more influenced in reconsidering their professional path and in reinforcing their desire to pursue the health-related studies.

[The carelessness and the inhospitable. Inhabiting times of pandemic.] / El descuido y lo inhóspito. Habitar tiempos de pandemia.

The pandemic has placed us in a situation of estrangement from ourselves. We have been acutely aware of our vulnerability and fragility. Through the stories of lived experiences, we have learned about and witnessed tragic circumstances in which inhospitality and neglect have become evident. We have been shocked by the awareness of the lack of recognition, accompaniment and welcome. Institutional decisions have prioritized public health, the good for all, but have forgotten the biographies of people, full of suffering. And this has produced a moral damage, a loss of trust, a feeling of injustice that we have not been able to fight against. This is why it is necessary to build hospitality, which can be achieved through care. Care with a political dimension that takes charge of reality and transforms society. The key is a responsibility in solidarity. Faced with the possibility of dehumanizing ourselves, we seek hospitality as an alternative way of narrating lives that have to be reconstructed, that have to relearn how to take care of each other amidst the multiple possibilities of estrangement that threaten us. Hospitality is at the heart of a narrative ethics at the height of our times.

La pandemia nos ha colocado en una situación de extrañamiento hacia nosotros mismos. Hemos sido muy conscientes de nuestra vulnerabilidad y fragilidad. A través de los relatos de las experiencias vividas hemos conocido y asistido a circunstancias trágicas en las que se han puesto de manifiesto lo inhóspito y el descuido. Nos ha conmocionado la toma de conciencia sobre la falta de reconocimiento, de acompañamiento, de acogida. Las decisiones institucionales han primado la Salud Pública, el bien de todos, pero se han olvidado de las biografías de las personas, llenas de sufrimiento. Y esto ha producido un daño moral, una pérdida de la confianza, una sensación de injusticia ante la que no se ha podido luchar. Por eso es necesaria una construcción de la hospitalidad que se puede lograr a través del cuidado. Un cuidado con dimensión política que se haga cargo de la realidad y que transforme la sociedad. La clave es una responsabilidad solidaria. Ante la posibilidad de deshumanizarnos buscamos la hospitalidad como forma alternativa de narrar las vidas que tienen que reconstruirse, que tienen que reaprender cómo cuidarnos mutuamente en medio de las múltiples posibilidades de extrañamiento que nos amenazan. La hospitalidad es el corazón de una ética narrativa a la altura de nuestro tiempo.

El descuido y lo inhóspito. Habitar tiempos de pandemia / The carelessness and the inhospitable. Inhabiting times of pandemic

La pandemia nos ha colocado en una situación de extrañamiento hacia nosotros mismos. Hemos sido muy conscientes de nuestravulnerabilidad y fragilidad. A través de los relatos de las experiencias vividas hemos conocido y asistido a circunstancias trágicas enlas que se han puesto de manifiesto lo inhóspito y el descuido. Nos ha conmocionado la toma de conciencia sobre la falta de recono-cimiento, de acompañamiento, de acogida. Las decisiones institucionales han primado la Salud Pública, el bien de todos, pero se hanolvidado de las biografías de las personas, llenas de sufrimiento. Y esto ha producido un daño moral, una pérdida de la confianza, unasensación de injusticia ante la que no se ha podido luchar. Por eso es necesaria una construcción de la hospitalidad que se puedelograr a través del cuidado. Un cuidado con dimensión política que se haga cargo de la realidad y que transforme la sociedad. Laclave es una responsabilidad solidaria. Ante la posibilidad de deshumanizarnos buscamos la hospitalidad como forma alternativa denarrar las vidas que tienen que reconstruirse, que tienen que reaprender cómo cuidarnos mutuamente en medio de las múltiplesposibilidades de extrañamiento que nos amenazan. La hospitalidad es el corazón de una ética narrativa a la altura de nuestro tiempo.(AU)

The pandemic has placed us in a situation of estrangement from ourselves. We have been acutely aware of our vulnerability andfragility. Through the stories of lived experiences, we have learned about and witnessed tragic circumstances in which inhospitalityand neglect have become evident. We have been shocked by the awareness of the lack of recognition, accompaniment and welcome.Institutional decisions have prioritized public health, the good for all, but have forgotten the biographies of people, full of suffering.And this has produced a moral damage, a loss of trust, a feeling of injustice that we have not been able to fight against. This is why itis necessary to build hospitality, which can be achieved through care. Care with a political dimension that takes charge of reality andtransforms society. The key is a responsibility in solidarity. Faced with the possibility of dehumanizing ourselves, we seek hospitalityas an alternative way of narrating lives that have to be reconstructed, that have to relearn how to take care of each other amidstthe multiple possibilities of estrangement that threaten us. Hospitality is at the heart of a narrative ethics at the height of our times.(AU)

Recomendaciones sobre aspectos éticos de la investigación cualitativa en la salud / Recommendations on ethical aspects of qualitative research in health

Desde el punto de vista ético, la investigación cualitativa debe cumplir un conjunto de requisitos éticos que son comunes a cualquier tipo de investigación. Además, presenta una serie de problemas peculiares que son abordados en 13 recomendaciones que inciden principalmente en los siguientes puntos: la necesidad de que las relaciones entre el investigador y los sujetos participantes en la investigación se caractericen por la confianza mutua y la integridad profesional; la obligación de informar de las características de la investigación como un proceso abierto que podría hacer necesario solicitar un nuevo consentimiento o revisarlo durante el proceso de investigación; la exigencia de informar y verificar que el participante comprende la diferencia entre investigación y acto terapéutico. Los investigadores han de tener especial cuidado en la publicación de los resultados para mantener la confidencialidad y evitar estigmatización (AU)

From the ethical point of view, qualitative research must meet a set of ethical requirements that are common to any type of research. In addition, it presents a series of unique problems that are addressed in 13 recommendations that impact primarily on the following points: the need for relations between the researcher and the subjects participating in research should be characterized by mutual trust and professional integrity, the obligation to inform of the characteristics of research as an open process that could make it necessary to request a new consent form or review the existing consent form during the investigation process; the requirement to provide information and verify that the participant understands the difference between research and therapeutic act. Researchers should take special care when publishing the results to maintain patient confidentiality and to avoid stigmatization (AU)

[The ethical aspects of population screening programme of rare diseases]. / Recomendaciones sobre los aspectos éticos de los programas de cribado de población para enfermedades raras.

The Committee on Ethics of the Instituto de Investigación de Enfermedades Raras (CEIIER) of the Spanish National Institute of Health Carlos III, presents this article dealing with ethical guidelines regarding the implementation of screening population programmes with special emphasis on genetic screening. After a critical review it has been addressed 24 recommendations concerning 14 topics: evaluation of the opportunity of the programme, including ethical analysis besides scientific evidences and cost/benefits issues; the need to differentiate between research and public health intervention and to built a specific and comprehensive programme; the creation of an interdisciplinary working group which control its implementation and prepare a protocol including justification, development, therapeutic or preventive actions and follow-up activities; the review of the programme by an independent Ethical committee; the guarantee of the voluntary, universal and equitable population access, which requires sufficient information on the programme and their specific relevant facts, as incidental detection of heterozygous state in minors in newborn screening and the relevance of non directive genetic counselling specially in prenatal screening offered to pregnant women; considerations regarding future uses of samples for research purposes; total quality and periodic programme evaluation; guarantee of personal data confidentiality and the conflict of interest statement of the members of all the Committees involved in the programme.

Aspectos éticos del cribado genético neonatal / No disponible

La expansión de los programas de cribado genético neonatal modifica el criterio ético básico que ha justificado estas intervenciones: la detección precoz para ofrecer un tratamiento o un beneficio clínico al niño. Al incluir enfermedades en la que la relación entre beneficio y daño esta menos clara, se generan ciertos interrogantes, como la ansiedad de los padres por los falsos positivos, el tipo de información y asesoramiento que deben recibir, si estos datos realmente suponen una mejora, la posibilidad de solicitar un consentimiento informado, y si se compensan adecuadamente los costes a largo plazo, en términos no sólo económicos, sino también de calidad de vida (AU)

The expansion of newborn genetic screening programs modifies the basic ethical criterion which has justified these interventions: the early detection to provide a treatment or a clinical benefit to the child. By including disease in which the relationship between benefit and damage is less clear, some questions arise, such as anxiety of parents for false positives, the type of information and advice that should be provided, if these data really represent an improvement, the possibility of demanding an informed consent, and if the long-term costs are properly compensated, not only economic terms but also in quality of life (AU)

Recomendaciones sobre los aspectos éticos de los programas de cribado de población para enfermedades raras / The ethicals aspects of population screening programme of rare diseases

El Comité de Ética del Instituto de Investigación de EnfermedadesRaras (CEIIER) del Instituto de Salud Carlos III, dentro de lasactividades que desarrolla, ha preparado el presente documento derecomendaciones éticas con respecto a la puesta en marcha de programasde cribado de población, con especial referencia a los cribadosgenéticos. Basándose en una revisión crítica se han elaborado 24recomendaciones concernientes a 14 apartados que inciden principalmenteen los siguientes puntos: la evaluación de la pertinencia delprograma, incorporando al proceso el análisis ético, de las evidenciascientíficas y de la oportunidad de los costes; la necesidad de diferenciarentre investigación e intervención y de que el programa seaespecífico e integral; la creación de un grupo de trabajo interdisciplinarque controle su desarrollo y elabore un protocolo de programaque incluya su justificación, desarrollo y ejecución incluyendo lasactividades terapéuticas o preventivas y actividades de seguimiento;la revisión necesaria del programa por un Comité de Ética independiente;la garantía de acceso voluntario, universal y equitativo querequiere de la información sobre el programa y hechos específicos silos hubiera, como la detección accidental del estado heterocigoto enmenores en los programas de cribado neonatal y las necesidades deconsejo genético; la consideración del uso futuro de las muestrasremanentes; la calidad total y evaluación periódica del programa; lasgarantías de confidencialidad de los datos de carácter personal; ladeclaración de conflictos de intereses de los miembros de losComités implicados en el programa(AU)

The Committee on Ethics of the Instituto de Investigación deEnfermedades Raras (CEIIER) of the Spanish National Institute ofHealth Carlos III, presents this article dealing with ethical guidelinesregarding the implementation of screening population programmeswith special emphasis on genetic screening. After a critical review ithas been addressed 24 recommendations concerning 14 topics: evaluationof the opportunity of the programme, including ethical analysisbesides scientific evidences and cost/benefits issues; the need todifferentiate between research and public health intervention and tobuilt a specific and comprehensive programme; the creation of aninterdisciplinary working group which control its implementationand prepare a protocol including justification, development, therapeuticor preventive actions and follow-up activities; the review of theprogramme by an independent Ethical committee; the guarantee ofthe voluntary, universal and equitable population access, which requiressufficient information on the programme and their specific relevantfacts, as incidental detection of heterozygous state in minors innewborn screening and the relevance of non directive genetic counsellingspecially in prenatal screening offered to pregnant women; considerationsregarding future uses of samples for research purposes;total quality and periodic programme evaluation; guarantee of personaldata confidentiality and the conflict of interest statement of themembers of all the Committees involved in the programme(AU)

[Ethical aspects of neonatal genetic screening]. / Aspectos éticos del cribado genético neonatal.

The expansion of newborn genetic screening programs modifies the basic ethical criterion which has justified these interventions: the early detection to provide a treatment or a clinical benefit to the child. By including diseases in which the relationship between benefit and damage is less clear, some questions arise, such as anxiety of parents for false positives, the type of information and advice that should be provided, if these data really represent an improvement, the possibility of demanding an informed consent, and if the long-term costs are properly compensated, not only in economic terms but also in quality of life.

[Ethics guidelines for the creation and use of registries for biomedical research purposes]. / Directrices éticas sobre la creación y uso de registros con fines de investigación biomédica.

The clinical information stored in registries and records of different types is a fundamental tool for biomedical research. Up until just a few years ago, hardly any limitations existed on the creation and use of epidemiological registries or the use of information from pre-existing records for research purposes. This situation has changed substantially due mainly to the growing importance current laws place upon the safeguarding of the privacy and confidentiality of personal data. Although the legal framework is already quite explicit, a certain degree of leeway exists for ethical debate and prudence advice for the purpose of conducting valid, useful research with this information which will also respect the rights of the subjects and the laws in force. These guidelines deal with those aspects which have been considered relevant from an ethical standpoint in the handling of records and registries for research-related purposes, including not only the use but also the creation proper of the registries. A total of twenty-four recommendations are provided, grouped into ten sections: warranting of the creation of registry, organization and definition of responsibilities, scientific validity of the research project, ethical requirements of the collections of anonymous and anonymized data, ethical requirements of the registries including personal data, uses of medical records for research purposes, use of historical records of deceased individuals, contact with the research subjects, notification of results and review by a Research Ethics Committee.

Directrices éticas sobre la creación y uso de registros con fines de investigación biomédica / Ethics guidelines for the creation and use of registries for biomedical research purposes

La información clínica almacenada en registros de diverso tipo constituye una herramienta fundamental para la investigación biomédica. Hasta hace pocos años la creación y uso de registros epidemiológicos, o la utilización de información procedente de registros pre-existentes con fines de investigación, apenas tenía limitaciones. Esta situación ha cambiado de modo sustancial debido básicamente a la creciente importancia que las leyes actuales conceden a la protección de la intimidad, la privacidad y la confidencialidad de los datos de carácter personal. Aunque el marco legal es ya muy explícito, hay un cierto espacio para la deliberación ética y el consejo prudente, al objeto de realizar con dicha información una investigación válida y útil y que, al mismo tiempo, respete los derechos de los sujetos y la legalidad vigente. En las presentes directrices se abordan aquellos aspectos que se han considerado relevantes desde un punto de vista ético en el manejo de registros con fines de investigación, incluyendo no sólo el uso sino la creación misma del registro. Se proporcionan 24 recomendaciones agrupadas en 10 apartados: justificación de la creación de un registro, organización y definición de responsabilidades, validez científica del proyecto de investigación, requisitos éticos de las colecciones de datos anónimos y de los registros anonimizados, requisitos éticos de los registros que contienen datos de carácter personal, usos de la historia clínica con fines de investigación, uso de registros históricos y de personas fallecidas, contacto con los sujetos de investigación, comunicación de resultados y revisión por un Comité de Ética de la Investigación (AU)

The clinical information stored in registries and records of different types is a fundamental tool for biomedical research. Up until just a few years ago, hardly any limitations existed on the creation and use of epidemiological registries or the use of information from pre-existing records for research purposes. This situation has changed substantially due mainly to the growing importance current laws place upon the safeguarding of the privacy and confidentiality of personal data. Although the legal framework is already quite explicit, a certain degree of leeway exists for ethical debate and prudence advice for the purpose of conducting valid, useful research with this information which will also respect the rights of the subjects and the laws in force. These guidelines deal with those aspects which have been considered relevant from an ethical standpoint in the handling of records and registries for research-related purposes, including not only the use but also the creation proper of the registries. A total of twenty-four recommendations are provided, grouped into ten sections: warranting of the creation of registry, organization and definition of responsibilities, scientific validity of the research project, ethical requirements of the collections of anonymous and anonymized data, ethical requirements of the registries including personal data, uses of medical records for research purposes, use of historical records of deceased individuals, contact with the research subjects, notification of results and review by a Research Ethics Committee (AU)

[Recommendations on the ethical aspects of specimen collections and human biobanks for biomedical research purposes]. / Recomendaciones sobre los aspectos éticos de las colecciones de muestras y bancos de materiales humanos con fines de investigación biomédica.

The collecting and storing of human biospecimens and associated data are a historical fact in medicine, but the biobank is a very recent concept. The advent of new technologies making it possible to store all types of specimens, including cells capable of staying alive outside the human body for an indefinite length of time, and to obtain scientific data of all types, including genetic information, has opened up a whole new realm of possibilities for research. All of the above has led to complex ethical issues coming to fore concerning the specimen donors, the researchers handling the specimens and society as a whole. This document is aimed at providing some recommendations to serve as a guideline and encourage responsible deliberation among all those involved, thus contributing to society's recognition and trust in the forthrightness of the research and the solidary end purposes thereof. A total of nineteen recommendations have been drafted concerning the following aspects: Biobank organization and operation, degree of specimen identification, data management guarantees, consent for taking part in research and for the incorporation of specimens into the biobank, the right to know and the right not to know, consent for transferring specimens to third parties, specimen harvesting in deceased individuals, management of the pre-existing biospecimen collections, title to and commercialization of specimens and research findings and resulting payback benefiting the community.

Los cuidados en la ética del siglo XXI / Nursing care within the ethics of the XXI century

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