Validation of a new screening questionnaire for disordered eating behaviors in men.

PURPOSE: The aim of this study was to develop an instrument to identify disordered eating behaviors (DEB) in college men (hereafter, DEBM-Q). METHODS: A two-stage project consisting of a diagnostic scale construction (n1 = 9 for interviews, n2 = 9 for cognitive laboratory) and a validation study with a cross-sectional sample (N = 570) was carried out. Both semi-structured interviews and a cognitive laboratory with nine participants were conducted to obtain DEBM-Q items. DEBM-Q was applied to 570 freshmen male in Mexico City. Psychometric characteristics and internal consistency (Cronbach's alpha) were analyzed. An item-total correlation value greater than 0.30 was determined, and factor loads greater than 0.40 were considered valid. Exploratory factor analysis (EFA, n1 = 297) and confirmatory factor analysis (CFA, n2 = 273) were performed. RESULTS: Two fixed factors explaining 55.08% of the total variance were extracted. Factor 1, "Drive for Thinness" (8 items), explained 30.84% of the variance, whereas factor 2, "Drive for Muscularity" (8 items), explained 24.23% of the variance. Cronbach's alpha for the whole questionnaire was 0.84. DEBM-Q was correlated with the Dutch Food Restriction Scale (RS) (r = 0.52, p < 0.001), Eating Disorder Examination-Questionnaire (EDE-Q) (r = 0.46, p < 0.001), Emotional Eating Scale (EES) (r = 0.18, p < 0.001), and Negative Affect Subscale (PANAS-X) (r = 0.11, p < 0.005). CONCLUSION: DEBM-Q is a valid and practical short screening tool (16 items) allowing early identification of disordered eating in young men, thereby facilitating clinical management. LEVEL OF EVIDENCE: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Embryo donation among Latin-Americans who have attended assisted reproduction techniques: a first empirical approach.

OBJECTIVE: To determine whether Latin Americans who have undergone assisted reproduction techniques would donate embryos. METHODS: This is a multinational cross-sectional study, involving 602 patients. We invited the Latin American Network of Assisted Reproduction centers. Those who accepted received the instrument distributed among the patients who agreed by signing the informed consent form. In total, 261 men and 341 women participated from seven countries. RESULTS: Patients would donate their embryos as follows: treatment with embryonic stem cells (73.6%), heterosexual couples (63.8%), Assisted Reproduction Techniques (ART) research (57%), scientific or basic research (55.3%), research with embryonic stem cells (55.2%), premenopausal women (53.8%), single women (45.1%), people with disabilities (25.4%), lesbians (25.3%), menopausal women (25.2%), lesbian couples (24.6%), gay couples (19.6%), senile women (15.1%). CONCLUSIONS: The results favor embryos donation for research purposes, and a little less for clinical purposes, contrary to what was thought in qualitative studies conducted among Latin American populations.

Gender, disasters and mortality: Earthquake in Mexico City, September 19th, 2017. / Género, desastres y mortalidad: Sismo en Ciudad de México, 19/septiembre/2017.

This paper aimed to explain why more women died in the earthquake of September 19, 2017, in Mexico City. We adopted a mixed quantitative-qualitative method, with epidemiological and statistical data and a hemerographic review about the influence of gender on earthquake-derived mortality. In the quantitative part, the results show that the difference in deaths among women compared to those among men cannot be attributed to population distribution or randomization issues. In the qualitative part, the results show that many data are evidencing that gender is an essential social determinant that can explain why more women die than men after an earthquake. Therefore, we recommend that these data be considered responsibly to improve future prevention and intervention actions.

El objetivo de este trabajo fue explicar por qué murieron más mujeres en el sismo del 19 de septiembre de 2017 en la Ciudad de México. La metodología fue mixta, cuantitativa con datos epidemiológicos y estadísticos, y cualitativa con una revisión hemerográfica sobre la influencia del género en la mortalidad derivada de los sismos. Los resultados indican para la parte cuantitativa que la diferencia en las defunciones entre las mujeres respecto de las presentadas entre los hombres no puede atribuirse ni a cuestiones de distribución poblacional ni al azar. Los resultados indican para la parte cualitativa que hay muchos datos que indican que el género es un determinante social importante para explicar por qué es más frecuente que mueran más mujeres que hombres tras un sismo. Se recomienda entonces que deben considerarse estos datos de manera responsable para mejorar las acciones de prevención y de intervención a futuro.

Género, desastres y mortalidad: Sismo en Ciudad de México, 19/septiembre/2017 / Gender, disasters and mortality: Earthquake in Mexico City, September 19th, 2017

Resumen El objetivo de este trabajo fue explicar por qué murieron más mujeres en el sismo del 19 de septiembre de 2017 en la Ciudad de México. La metodología fue mixta, cuantitativa con datos epidemiológicos y estadísticos, y cualitativa con una revisión hemerográfica sobre la influencia del género en la mortalidad derivada de los sismos. Los resultados indican para la parte cuantitativa que la diferencia en las defunciones entre las mujeres respecto de las presentadas entre los hombres no puede atribuirse ni a cuestiones de distribución poblacional ni al azar. Los resultados indican para la parte cualitativa que hay muchos datos que indican que el género es un determinante social importante para explicar por qué es más frecuente que mueran más mujeres que hombres tras un sismo. Se recomienda entonces que deben considerarse estos datos de manera responsable para mejorar las acciones de prevención y de intervención a futuro.

Abstract This paper aimed to explain why more women died in the earthquake of September 19, 2017, in Mexico City. We adopted a mixed quantitative-qualitative method, with epidemiological and statistical data and a hemerographic review about the influence of gender on earthquake-derived mortality. In the quantitative part, the results show that the difference in deaths among women compared to those among men cannot be attributed to population distribution or randomization issues. In the qualitative part, the results show that many data are evidencing that gender is an essential social determinant that can explain why more women die than men after an earthquake. Therefore, we recommend that these data be considered responsibly to improve future prevention and intervention actions.

Novel methods of qualitative analysis for health policy research.

BACKGROUND: Currently, thanks to the growing number of public database resources, most evidence on planning and management, healthcare institutions, policies and practices is becoming available to everyone. However, one of the limitations for the advancement of data and literature-driven research has been the lack of flexibility of the methodological resources used in qualitative research. There is a need to incorporate friendly, cheaper and faster tools for the systematic, unbiased analysis of large data corpora, in particular regarding the qualitative aspects of the information (often overlooked). METHODS: This article proposes a series of novel techniques, exemplified by the case of the role of Institutional Committees of Bioethics to (1) massively identify the documents relevant to a given issue, (2) extract the fundamental content, focusing on qualitative analysis, (3) synthesize the findings in the published literature, (4) categorize and visualize the evidence, and (5) analyse and report the results. RESULTS: A critical study of the institutional role of public health policies and practices in Institutional Committees of Bioethics was used as an example application of the method. Interactive strategies were helpful to define and conceptualise variables, propose research questions and refine research interpretation. These methods are additional aids to systematic reviews, pre-coding schemes and construction of a priori diagrams to survey and analyse social science literature. CONCLUSIONS: These novel methods have proven to facilitate the formulation and testing of hypotheses on the subjects to be studied. Such tools may allow important advances going from descriptive approaches to decision-making and even institutional assessment and policy redesign, by pragmatic reason of time and costs.

[Between Huxley and Orwell: Big Data and Health]. / Entre Huxley y Orwell: Big Data y salud.

When in 1966 the United Nations stated in its International Covenant on Civil and Political Rights, the ideal of a free human being with respect to his privacy through the prohibition of arbitrary interference in his private life, it was not possible to imagine the impact of global unlimited connectivity, autonomy of new information technologies, the development of huge interconnected databases, the independent and unrestricted circulation of data, which have led to ethical and legal questions arising from this to treat personal and health data.

Psicoanálisis y bioética: psicanálise e bioética / Psychoanalysis and bioethics

Este trabajo busca cómo articular el psicoanálisis y la bioética. Para ello, se revisa cuáles marcos podrían ser adecuados, optando por la transdisciplina. Para una aproximación transdisciplinaria se requiere romper con algunos puntos de la ortodoxia de cada una de las disciplinas que intentan relacionarse, así como el requerimiento de un eje transdisciplinar que no se restrinja a reunir unas visiones de un modo reductible, ni sometible, ni complementario (en el sentido de agregable), sino que las reorganice en un nuevo nivel epistemológico, distinto. El trabajo propone que los puntos de ruptura de la ortodoxia de la relación entre psicoanálisis y bioética podrían ser la realidad tecnocientífica contemporánea y el papel del psicoanalista en un comité de ética. Finalmente, se propone que un posible eje transdisciplinario entre psicoanálisis y bioética puede ser la deliberación, metodología propuesta para la bioética (en cuanto ética de la responsabilidad) por Diego Gracia Guillén.

This paper seeks how to articulate psychoanalysis and bioethics. To do this, it is reviewed what might be an appropriate framework, choosing transdiscipline. For a transdisciplinary approach it is proposed that is required to break some orthodoxy points of each of the disciplines that try to relate, and also the requirement of a transdisciplinary axis that is not restricted to gather some insights in a reducible or bringing under, complimentary (in the sense of mere aggregation), but that reorganize into a new epistemological level, a different one. The paper proposesthat breakpoints of orthodoxy of the relationship between psychoanalysis and bioethics could be the actual contemporary technoscience, and the role of the psychoanalyst in an ethics committee. Finally, it is proposed that a possible transdisciplinary axis between psychoanalysis and bioethics can be deliberation, a proposed methodology for bioethics (understanding it as an ethics of responsibility) done by Diego Gracia Guillén.

Este artigo procura como articular a psicanálise e a bioética. Para fazer isso, se revê quais enquadramentos poderiam ser adequados, optando pela transdisciplina. Para uma abordagem transdisciplinar é necessário quebrar alguns pontos da ortodoxia de cada uma das disciplinas que tentam se relacionar, bem como a exigência de um eixo transdisciplinar que não se restringe a reunir visões de uma forma redutível, nem passíveis nem complementares (no sentido de agradável), mas que sejam reorganizadas num novo nível epistemológico, diferente. O documento sugere que os pontos de quebra da ortodoxia da relação entre psicanálise e bioética podem ser a realidade tecnociência contemporânea e o papel do psicanalista em um comité de ética. Finalmente, propõe-se que um possível eixo transdisciplinar entre a psicanálise e a bioética pode ser a deliberação, metodologia proposta para a bioética (como ética da responsabilidade) por Diego Gracia Guillén.

Liberdade e ética: o trabalho de Benjamin Libet / Freedom and ethics: Benjamin Libet's work

Una idea fundamental para sostener conceptos éticos fundamentales, tales como el de autonomía, responsabilidad etc., lo es la "libertad". La aporía determinismo/libertad ha estado presente en la filosofía desde el mundo antiguo. Sin embargo, tras el desarrollo de las neurociencias, se ha planteado que la libertad es una mera ilusión y que los seres humanos estamos determinados neurobiológicamente en nuestro actuar. Este trabajo presenta los trabajos pioneros de Benjamín Libet sobre este tema (una aproximación que utilizó electroencefalografía y electromiografía), a la vez que realiza una crítica sobre las interpretaciones del propio Libet...

A fundamental idea to sustain basic ethical concepts such as autonomy, responsibility, etc., is "liberty". The determinism/freedom aporia has been present in philosophical tradition since ancient world. However, after the development of neuroscience, it has been argued that freedom is merely an illusion and human beings are neurobiologically determined in our actions. This paper presents the pioneering work of Benjamin Libet on this subject (an approach that used electroencephalography and electromyography), also a critique on Libet interpretations of his results...

Uma ideia fundamental para sustentar conceitos éticos fundamentais, tais como autonomia, responsabilidade, etc., é a "liberdade". A aporia determinismo/liberdade tem sido presente na filosofia desde o mundo antigo. No entanto, após o desenvolvimento da neurociência, tem-se argumentado que a liberdade é uma mera ilusão e que nós seres humanos estamos neurobiologicamente determinados em nossas ações. Este artigo apresenta os estudos pioneiros de Benjamin Libet sobre este assunto (una abordagem que utilizou eletroencefalografia e eletroneuromiografia), enquanto realiza uma crítica sobre as interpretações do próprio Libet...

Aspectos sociales y legales de la fecundación in vitro / Social and legal issues related to in vitro fertilization

El trabajo aborda aspectos sociales y legales de la fecundación in vitro, entendidos como un marco general para poder aplicar las técnicas de reproducción humana asistida en general. Para el caso de los aspectos sociales, se revisan dos temas fundamentales: el parentesco y la familia. Respecto a las cuestiones legales, dado que prácticamente hay un vacío general con relación a los elementos regulatorios, se hacen algunas puntualizaciones sobre un marco general para el contexto actual. En el tema del parentesco, se retoman estudios clásicos, etnografías hechas sobre la infertilidad y sobre las nuevas tecnologías en reproducción humana. El tema se liga con el de la familia, donde se tratan los cambios que han surgido en el mundo contemporáneo tras la modificación en las nociones sobre lo que es el parentesco. Una conclusión general es que todo lo humano es producto de una construcción, de modo que los criterios que se han tenido para construir conceptos como "parentesco" o "familia" han cambiado sustancialmente desde la llegada de las técnicas de reproducción asistida. Siendo esto así, habrá que buscar la mejor manera de regular la aplicación de estas técnicas, pudiendo ser una orientada por principios.

The work deals with social and legal aspects of IVF, understood as a general framework to apply the techniques of assisted human reproduction in general. Regarding the social aspects, two fundamental issues are reviewed, kinship and family. Regarding the legal issues, since there is practically no legal regulation, some remarks on a general framework for the current context are made. On the issue of kinship, classical studies are taken up, ethnographies made on infertility and on new technologies in human reproduction. Kinship is linked with the family, where the changes that have emerged in the modern world following the shift in notions about what is kinship are discussed. A general conclusion is that everything is a product of human construction so that the former criteria to build concepts such as kinship or family have changed substantially since the advent of assisted reproductive techniques. This being so, we must find the best way to regulate the application of these techniques, and maybe the best would be a legal framework oriented by principles.

Hechos, valores, deberes... y neuronas / Facts, values, duties and neurons

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[Neuroethics as the neuroscience of ethics]. / Neuroetica como neurociencia de la etica.

INTRODUCTION: The neurosciences have developed at a stunningly fast rate. Key points accounting for this progression include the introduction of functional neuroimaging techniques and the boost resulting from the Decade of the Brain project. This expansion has also allowed new disciplines such as neuroethics to appear. DEVELOPMENT: Those who have worked on neuroethics can be divided into three groups (neuroreductionists, neurosceptics and neurocritics), and each group has its own standpoint as regards what neuroethics is, with several scopes and limitations in their proposals. CONCLUSIONS: Neuroethics is a discipline that, prior to the year 2002, was understood only as an ethics of neuroscience (a branch of bioethics). As of that date, however, it is also understood as a neuroscience of ethics (a new discipline). Neuroreductionism proposes that all ethical life has a basis in the brain that determines ethical actions; neuroscepticism holds that neuroscience cannot be considered a normative function; and neurocriticism considers that the neuroscientific advances cannot be ignored and must be taken into account in some way in order to draw up ethical theories.

TITLE: Neuroetica como neurociencia de la etica.Introduccion. El desarrollo que han tenido las neurociencias ha avanzado de una manera rapida y espectacular. Puntos clave para ello son la introduccion de las tecnicas de neuroimagen funcional y el empuje del proyecto 'decada del cerebro'. Este desarrollo tambien ha permitido que surjan nuevas disciplinas como la neuroetica. Desarrollo. Quienes han trabajado en neuroetica pueden dividirse en tres grupos (neurorreduccionistas, neuroescepticos y neurocriticos), y cada grupo tiene diferentes posturas de lo que es la neuroetica, con varios alcances y limitaciones en sus propuestas. Conclusiones. La neuroetica es una disciplina que antes del año 2002 se entiende en exclusiva como una etica de la neurociencia (una rama de la bioetica) y, a partir de esa fecha, se entiende tambien como una neurociencia de la etica (una nueva disciplina). El neurorreduccionismo propone que toda la vida etica tiene una base cerebral que determina los actos eticos, el neuroescepticismo argumenta que no se puede considerar la neurociencia como una funcion normativa y el neurocriticismo considera que los avances neurocientificos no se pueden ignorar y se deben tomar en cuenta de algun modo para la elaboracion de las teorias eticas.

Neuroética como neurociencia de la ética / Neuroethics as the neuroscience of ethics

Introducción. El desarrollo que han tenido las neurociencias ha avanzado de una manera rápida y espectacular. Puntos clave para ello son la introducción de las técnicas de neuroimagen funcional y el empuje del proyecto ‘década del cerebro’. Este desarrollo también ha permitido que surjan nuevas disciplinas como la neuroética. Desarrollo. Quienes han trabajado en neuroética pueden dividirse en tres grupos (neurorreduccionistas, neuroescépticos y neurocríticos), y cada grupo tiene diferentes posturas de lo que es la neuroética, con varios alcances y limitaciones en sus propuestas. Conclusiones. La neuroética es una disciplina que antes del año 2002 se entiende en exclusiva como una ética de la neurociencia (una rama de la bioética) y, a partir de esa fecha, se entiende también como una neurociencia de la ética (una nueva disciplina). El neurorreduccionismo propone que toda la vida ética tiene una base cerebral que determina los actos éticos, el neuroescepticismo argumenta que no se puede considerar la neurociencia como una función normativa y el neurocriticismo considera que los avances neurocientíficos no se pueden ignorar y se deben tomar en cuenta de algún modo para la elaboración de las teorías éticas (AU)

Introduction. The neurosciences have developed at a stunningly fast rate. Key points accounting for this progression include the introduction of functional neuroimaging techniques and the boost resulting from the Decade of the Brain project. This expansion has also allowed new disciplines such as neuroethics to appear. Development. Those who have worked on neuroethics can be divided into three groups (neuroreductionists, neurosceptics and neurocritics), and each group has its own standpoint as regards what neuroethics is, with several scopes and limitations in their proposals. Conclusions. Neuroethics is a discipline that, prior to the year 2002, was understood only as an ethics of neuroscience (a branch of bioethics). As of that date, however, it is also understood as a neuroscience of ethics (a new discipline). Neuroreductionism proposes that all ethical life has a basis in the brain that determines ethical actions; neuroscepticism holds that neuroscience cannot be considered a normative function; and neurocriticism considers that the neuroscientific advances cannot be ignored and must be taken into account in some way in order to draw up ethical theories (AU)

Bioética latinoamericana o bioética en Latinoamérica / Latin American bioethics or bioethics in Latin America / Bioética latinoamericana ou bioética na América Latina

El desarrollo de la Bioética en Latinoamérica ha enfrentado un problema que la Filosofía afrontó hacia mediados del siglo XX: la originalidad de pensamiento. En el trabajo se recuerdan la visión pesimista de Salazar Bondy y la optimista de Zea respecto a la filosofía, como marco antecedente para presentar posturas contemporáneas optimistas y pesimistas en relación con una "Bioética latinoamericana". Se destacan paralelismos entre filósofos pesimistas y bioeticistas pesimistas a través de metáforas como el trasplante de ideas. Posteriormente se hace un recorrido sobre los estudios sociales de la ciencia y algunas extensiones que podrían hacerse hacia la Filosofía y la Bioética. Se finaliza considerando que no hay una propuesta "autóctona" de "Bioética latinoamericana", y que lo que realmente puede elaborarse es una "Bioética en Latinoamérica"...

Development of bioethics in Latin America has faced a problem that philosophy faced previously by the middle of the twentieth century: originality of thought. This paper recalls the pessimistic view of Salazar Bondy and optimistic one of Zea about philosophy, as a historical framework to show optimistic and pessimistic contemporary views regarding a "Latin American bioethics". The paper highlights parallels between pessimistic philosophers and pessimistic bioethicists through metaphors like ideas transplantation. Subsequently, the paper traces a path on social studies of science and some extensions that could be made into philosophy and bioethics. It ends by considering that there is not a "native" proposal of "Latin American bioethics," and that it can really be developed as "bioethics in Latin America."...

O desenvolvimento da bioética na América Latina enfrentou um problema com o qual se deparou a filosofia em meados do século XX: a originalidade de pensamento. No trabalho é lembrada a visão pessimista de Salazar Bondy e a otimista de Zea a respeito da filosofia, como marco antecedente para a apresentação de posturas contemporâneas otimistas e pessimistas em relação a uma "bioética latino-americana". São destacados paralelismos entre filósofos pessimistas e bioeticistas pessimistas através de metáforas como o transplante de idéias. Posteriormente é feito um percurso nos estudos sociais da ciência e sobre algumas extensões que poderiam ser feitas à filosofia e à bioética. Finaliza considerando que não há uma proposta "autóctone" de "bioética latino-americana", e o que realmente pode ser feito é uma "bioética na América Latina"...

Readability of education and consent forms in assisted reproduction procedures of the Latin American Network of Assisted Reproduction (RED).

BACKGROUND: Informed consent (IC) is the process where the patient receives information provided by the medical staff to understand key aspects of any intervention to be performed on the patient and for the patient to have the right to allow (or not) that such intervention takes place. To accomplish this objective, health care workers have two groups of tools: those that evaluate the capacity (and competence) of patients and those that facilitate the information and communication process. Among these are clinical interviewing skills, relationship help, emotional support (counseling) and written forms of IC. The IC process is difficult in assisted reproduction due to the quantity and complexity of information on human fertility, developmental biology, and technology applications. The Latin American Network of Assisted Reproduction has had eight "education and consent forms in assisted reproductive procedures" since 2001. We undertook this study to measure the readability of the formal language "education and consent forms in assisted reproduction procedures" proposed by LANAR with the Flesch index validated in Spanish. METHODS: Eight files were obtained in Microsoft Word format to use tools. The INFLESZ scale was used to assess the formal linguistics readability of each of the eight forms. CONCLUSIONS: The eight forms have a readability of "somewhat difficult," which corresponds to the INFLESZ scale for specialist press and popular science texts, making them difficult to understand for an average reader. Based on this, it should be proposed to amend formal readability.

Retos de la bioética en la medicina del siglo XXI / Challenges of bioethics in twenty-first century medicine

Para plantear posibles retos de la bioética en la medicina del siglo XXI es necesario considerar que existieron algunos retos en el pasado (en el origen de esa nueva disciplina llamada bioética); que los retos se han ido modificando con el avance científico, biomédico y humanístico; considerando que los retos que pueden plantearse para el futuro serán, de diferentes maneras, resultado de este devenir histórico. Se plantean como grandes retos: los problemas no resueltos de justicia, equidad y pobreza; los retos que plantea la introducción de nuevas tecnologías con el paradigma de la nanomedicina y los retos que plantea el avance de las neurociencias con el paradigma de la neuroética.

In order to propose possible challenges of bioethics in the twenty-first century medicine, it is necessary to consider that there were some past challenges (at the origin of this new discipline called bioethics), that the challenges have been modified with scientific, biomedical and humanistic breakthroughs, considering at the same time that challenges that may arise in the future will be, in different ways, a result of this historical evolution. The major challenges would be in the future: the unsolved problems of justice, equity and poverty; the challenges posed by the introduction of new technologies with the nanomedicine paradigm; and finally, the challenges driven by breakthroughs in neurosciences with the neuroethics paradigm.

[Challenges of bioethics in twenty-first century medicine]. / Retos de la bioética en la medicina del siglo XXI.

In order to propose possible challenges of bioethics in the twenty-first century medicine, it is necessary to consider that there were some past challenges (at the origin of this new discipline called bioethics), that the challenges have been modified with scientific, biomedical and humanistic breakthroughs, considering at the same time that challenges that may arise in the future will be, in different ways, a result of this historical evolution. The major challenges would be in the future: the unsolved problems of justice, equity and poverty; the challenges posed by the introduction of new technologies with the nanomedicine paradigm; and finally, the challenges driven by breakthroughs in neurosciences with the neuroethics paradigm.

[Embryo donation in developing countries]. / Donación de embriones en países desarrollados.

In theory there are three things that can happen to surplus embryos: cryopreservation, discarding, or donation. Embryo donation has three different aims: clinical use (generally infertility therapy), research (basic biomedical research, stem cell research, etc.) or teaching (mainly used by clinical embryologists). We present a literature review that analyzes empirical data from developed countries (Germany, Australia, Belgium, Canada, Denmark, Spain, U.S.A., Finland, France, Italy, New Zealand, United Kingdom, Sweden and Switzerland) regarding the probable fate of surplus embryos. According to the literature, embryos are most often discarded or donated for research.

[The importance of literature in medical humanities]. / Importancia de la literatura dentro de las humanidades médicas.

This article emphasizes on the importance of including literature as a subject in the medical curriculum and particularly in the teaching of medical humanities. It underlines the importance of the physician-writer and the non-physician writer, who may become patients at the same time, justifying why to include this subject in teaching medicine. Finally, the article suggests four steps to create a course in this field: text selection, definition of the content, time of inclusion within the curriculum, and distancing as a methodological strategy.