Preventing Self-Harm From Repeat Foreign-Body Ingestion.

Mental health disorders in adolescents present some of the most challenging of all ethical dilemmas. This is particularly true when they lead to self-injurious behavior that can only be prevented by either limiting the freedom of the adolescent or forcing treatments on them that they do not want. Intentional and repeated foreign-body ingestion (FBI) in youth is a poorly understood self-injurious behavior that can be life-threatening. It poses unique clinical and ethical challenges. Ingestion of sharp or magnetic objects increases the need for endoscopic retrieval or surgical intervention with associated risks, including perforation and anesthesia-related adverse events. When behavior modification efforts fail to prevent recurrent FBI, the cumulative risk of medical intervention mounts. Sometimes, as a last resort, doctors consider surgical procedures that limit jaw movement and may physically prevent recurrent FBI. In this Ethics Rounds article, we present a case in which doctors consider whether it is in the best interest of a teenager with this behavior to undergo orthodontic jaw wiring as a next step in treatment of repeated FBI. Doctor commentary on the ethical decision-making process is provided.

Relação entre trabalho especializado e técnico: o caso da ortodontia à luz da bioética clínica amplificada / The relationship between specialized and technical work: the case of orthodontics from the perspective of amplified clinical bioethics / Relación entre trabajo especializado y técnico: el caso de la ortodoncia a la luz de la bioética clínica amplificada

Na reorganização da saúde bucal, percebe-se, como desafio ético-político, a transição para as relações em equipe. Aplicou-se pesquisa exploratório-descritiva de abordagem qualitativa, que coletou dados por meio de entrevistas semiestruturadas com 11 ortodontistas, analisados por Análise Textual Discursiva. Evidenciam-se problemas éticos como: ideologia do profissionalismo; confusão de competências com o trabalho técnico; e hierarquização em contraposição à construção de liderança. À luz da bioética clínica amplificada desvela-se uma tendência à persistência de saberes e fazeres tradicionais. A busca pela superação da mercantilização e hierarquização sugere uma prática cogestionada e capacitada à deliberação, a partir da solidariedade, diálogo e cooperação, da graduação à formação lato sensu.(AU)

In the reorganization of the oral health field, the transition to team relationships is an ethical-political challenge. This is an exploratory, descriptive and qualitative study, and gathered data through semi-structured interviews with 11 orthodontists who were examined through discursive analysis. The results disclosed ethical problems, such as the ideology of professionalism, confusion of competences with technical work, and hierarchy in opposition to the construction of leadership. Amplified clinical bioethics revealed a tendency to stick to traditional knowledge and procedures. The search to overcome commercialization and hierarchy suggests that practice is becoming co-managed and qualified for deliberation, based on solidarity, dialogue and cooperation, from undergraduate to lato sensu graduate courses.(AU)

En la reorganización de la salud bucal se percibe como desafío ético-político la transición para las relaciones en equipo. Se aplicó una encuesta exploratorio-descriptiva de abordaje cualitativo que colectó datos por medio de entrevistas semi-estructuradas con 11 especialistas en ortodoncia, analizados por Análisis Textual Discursivo. Se evidencian problemas éticos tales como: ideología del profesionalistmo, confusión de competencias con el trabajo técnico, la jerarquización en oposición a la construcción del liderazgo. A la luz de la bioética clínica amplificada se desvela una tendencia a la persistencia de saberes y haceres tradicionales. La búsqueda por la superación de la mercantilización y jerarquización sugiere una práctica co-gestionada y capacitada para la deliberación, a partir de la solidariedad, diálogo y cooperación, de la graduación a la formación lato sensu.(AU)

Odontología y Ética: sobreoferta y sobreterapia / Dentistry and Ethics: Oversupply and Overtherapy

RESUMEN: Esta revisión está concebida con el propósito de analizar la situación actual de la odontología en Colombia. La revisión se centra en la inoperancia y desregulación del estado sin un modelo planificador sobre la estructura del sistema de salud actual, como causa principal de la sobreoferta profesional, así como del sobretratamiento. Está dividida en dos grandes secciones (orígenes y consecuencias), en los que se busca hacer conexas situaciones concomitantes. En orígenes se trata sobre el tema ético, la realidad desregulatoria e inoperante de los mandos y gremios profesionales, el nivel de evidencia humildemente traducido a la práctica diaria y la necesaria autodeterminación profesional que guie hacia una mejor caracterización entre el paciente saludable y el paciente enfermo, que restrinja el sobretratamiento que está cada vez más cerca a la iatrogenia. En la sección consecuencias, algunos ejemplos de excesos facultativos que se ven reflejados en terapias sin justificación y redundantes que vulneran al paciente. El cambio por un mejor rumbo a futuro debe originarse en la autodeterminación de aquellos objetores de conciencia comprometidos con responsabilidad compartida: El estado Colombiano y sus entes reguladores, los programas académicos que impactan en la conciencia de sus orientados, como el profesional con una meditación íntima y autocrítica que venza los escenariosterapéuticos en contravía del paciente saludable.

ABSTRACT: This review was conceived with the purpose of analysing the current situation of dentistry in Colombia, The review focuses on the inoperability and deregulation of the state without a regulatory model for an actual health system structure as a principal cause of the professional oversupply and over-treatment. It is divided into two major sections (origins and consequences), which seek to make concomitant situations related. In origins, the ethical issue, the deregulatory and inoperative reality of the professional commands and guilds, the level of evidence humbly translated into daily practice and the necessary professional self-determination that guides a better characterization between the healthy patient and the sick patient trying to restricts the over-treatment that is increasingly close to iatrogeny. In consequences section, some facultative excesses examples that are reflected in redundant therapies without justification that victimizes patients. The change for a better course for the future must originate in the selfdetermination of those conscientious objectors committed with shared responsibility: The Colombian state and its regulatory bodies, academic programs that impact on the conscience of its orientated, and the professional with an intimate meditation and self-criticism that overcomes the therapeutic scenarios in wrong way of the healthy patient.

Adherence in orthodontic settings: understanding practitioner views in a UK sample.

OBJECTIVE: To explore predictors of adherence in adult orthodontic patients as reported by orthodontists in the UK. MATERIALS AND METHODS: Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of experience each (M  =  14.7; SD  =  1.73) completed a questionnaire regarding the importance they give to a number of factors signaled in the literature as adequate predictors of adherence. This cross-sectional quantitative and exploratory survey consisted of four parts, requesting orthodontists to rate a list of predictors of adherence on (1) evaluation-how important they thought the predictor was to assess patient adherence, (2) application-the extent to which they used each predictor to assess adherence in their daily practice, (3) open-ended questions to collect any other perceived predictors of adherence, and (4) demographics. RESULTS: All participating orthodontists agreed that patients' regularity in attending appointments, maintenance of good oral hygiene, and utilization of dental appliances are the most important factors for predicting adherence. In the open-ended portion of the questionnaire, orthodontists also highlighted perceived cost of treatment as an important factor. The remaining factors included in the questionnaire were also rated as important or utilized, though they yielded a more varied pattern of response. CONCLUSIONS: Appointment keeping, cooperating in the use of removable appliances, and oral hygiene were rated as the most important factors by orthodontists when assessing adherence in adult patients. The perceived cost of treatment was also highlighted by orthodontists as an important factor for adherence.