Xenophobia and medicine (profession of a doctor): can the two coexist in the 21st century? / Xenofobia y medicina (profesión del médico): ¿pueden ambas coexistir en el siglo XXI? / Xenofobia e medicina (profissão de um doutor): podem os dois coexistirem no Século 21?

Abstract: This study was conducted to reveal how physicians view the access of refugees, who have difficulties in accessing health services and who may experience various health rights violations, to health services and to discuss the case in terms of medical ethics and deontology. Xenophobia, which is one of the main causes of discrimination in health, needs to be evaluated. In this context, quantitative research methods were used to measure the xenophobia levels of physicians working in Eskişehir province. Stratified sampling method was used to evaluate the views of the physicians. The study data were collected through the Xenophobia Scale developed by Kees Van Der Veer et al. and a questionnaire created by the researchers. The age distribution of the physicians in the study was 38,069±10,337. The distribution of the scores obtained from the xenophobia scale was found to be high (56.20±11.54). Of the physicians in the study, 34.3% stated that they would not want to provide health services for refugees if they were given the right to choose. They mainly thought that health services should not be provided free of charge for refugees and should be provided in separate places, refugees affected the access of the citizens of the Turkish Republic to health services negatively, the number of children should be limited, refugees would increase violence in health and public health problems, and that there should be an interpreter in health institutions. "Refugees do not deserve discrimination in health services" in terms of medical ethics. "Physicians should reach a common consensus against all kinds of discrimination while carrying out their profession." When xenophobia shows its effect in the field of health, it turns into a phenomenon that damages human dignity, causes all kinds of inequality, and moves medicine away from its deontology.

Resumen: Se realizó este estudio para revelar cómo ven los médicos el acceso de refugiados con dificultades para acceder a servicios de salud y que sufren violaciones a sus derechos de salud, y para discutir el caso desde la ética médica y la deontología. La xenofobia es una de las principales causas de discriminación en cuidados de salud, por lo que necesita ser evaluada. En este contexto, se usaron métodos de investigación cuantitativa para medir los niveles de xenofobia de médicos que trabajan en la provincia de Eskişehir. Se usó un método de muestra estratificada para evaluar los puntos de vista de los médicos. Los datos del estudio fueron recolectados mediante la escala de Xenofobia desarrollada por Kees Van Der Veer y colaboradores, y mediante un cuestionario creado por los investigadores. La distribución de la edad de los médicos que participaron en el estudio fue de 38,069±10,337. Se encontró que la distribución de los puntajes obtenidos de la escala de xenofobia fue alta (56.20±11.54). De los médicos del estudio, 34.3% manifestó que no proporcionarían servicios de salud a los refugiados si se les diera el derecho a elegir. Principalmente pensaban que los servicios de salud no debieran proporcionarse gratis a los refugiados, debiera hacerse en lugares separados, los refugiados restringen el acceso a los servicios de salud de los ciudadanos de la República de Turquía, debiera limitarse el número de niños, los refugiados incrementan los problemas de violencia y salud pública y debiera haber intérpretes en las instituciones de salud. De acuerdo con la ética médica, "los refugiados no merecen ser discriminados en los servicios de salud". "Los médicos debieran llegar a un consenso común en contra de toda clase de discriminación mientras que cumplen con su profesión". Cuando la xenofobia muestra sus efectos en el campo de la salud, se transforma en un fenómeno que daña la dignidad humana, causa toda clase de desigualdades y lleva a la medicina a apartarse de su deber.

Resumo: Esse estudo foi realizado para mostrar como médicos veem o acesso de refugiados -que tem dificuldades em acessar serviços de saúde e que podem experimentar diversas violações em direitos à saúde- a serviços de saúde e para discutir o situação em termos de ética médica e deontologia. Xenofobia, que é uma das principais causas de discriminação na saúde, necessita ser avaliada. Nesse contexto, métodos de pesquisa quantitativa foram utilizados para medir os níveis de xenofobia de médicos trabalhando na província de Eskisehir. Métodos de amostragem estratificada foram utilizados para avaliar o ponto de vista dos médicos. Os dados do estudo foram coletados através da Escala de Xenofobia desenvolvida por Kees Van Der Veer et al. e um questionário criado pelos pesquisadores. A distribuição etária dos médicos no estudo foi 38,069±10,337. A distribuição dos escores obtidos na escala de xenofobia foi alta (56.20±11.54). Dos médicos no estudo, 34,3% afirmaram que eles poderiam não querer prestar serviços de saúde para refugiados se fosse dado a eles o direito de escolher. Eles principalmente pensam que serviços de saúde não deveriam ser fornecidos gratuitamente para refugiados e que deveriam ser fornecidos em lugares separados, que refugiados afetam negativamente o acesso de cidadãos da República Turca a serviços de saúde, que o número de crianças deveria ser limitado, que os refugiados poderiam aumentar a violência na saúde e os problemas de saúde pública, e que deveria haver um intérprete nas instituições de saúde. "Refugiados não merecem ser discriminados em serviços de saúde" em termos de ética médica. "Médicos deveriam alcançar um consenso contra todas as formas de discriminação quando no exercício de sua profissão". Quando a xenofobia mostra seus efeitos no campo da saúde, ela se transforma em um fenômeno que danifica a dignidade humana, causa todas as formas de desigualdades e afasta a medicina para longe de sua deontologia.

Evaluation of moral intelligence of healthcare professionals via the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" / Evaluación de la inteligencia moral de profesionales de la salud a través de la "Encuesta para medir la inteligencia moral en la prestación de servicios de salud" / Avaliação da inteligência moral de professionais de saúde via "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde"

Abstract: Moral intelligence -through which an individual makes mental evaluation before taking action about a decision- is important in individual-centered healthcare. Using Lawshe Method, we designed the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" with "equality", "empathy", "moral intelligence", "justice", "tolerance", "self-control", and "politeness" dimensions (α=.966). Age of the population (physicians and nurses) was 36.44±9.52, consisting 517 (65.5%) women, 538 married participants, 653 employed in public hospitals, and 352 had work experience of 8 hours/day. Using dimensions of this survey as skills is expected to ensure due diligence about rights and dignity in healthcare services.

Resumen: La inteligencia moral, mediante la cual un individuo realiza una evaluación mental antes de tomar medidas sobre una decisión, es importante en la atención médica centrada en el individuo. Usando el método Lawshe, diseñamos la "Encuesta para medir la inteligencia moral en la provisión de servicios de salud" con dimensiones de "igualdad", "empatía", "inteligencia moral", "justicia", "tolerancia", "autocontrol" y "cortesía" (α=.966). La edad de la población (médicos y enfermeras) era de 36.44±9.52, que consistía en 517 (65,5%) mujeres, 538 participantes casados, 653 empleados en hospitales públicos y 352 tenían una experiencia laboral de 8 horas/día. Se espera que el uso de las dimensiones de esta encuesta como habilidades garantice la debida diligencia sobre los derechos y la dignidad en los servicios de atención médica.

Resumo: Inteligência moral -através da qual um individuo faz uma avaliação mental antes de agir frente a uma decisão- é importante em cuidados à saúde centrados na pessoa. Usando o Método Lawshe, nós elaboramos o "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde" com as dimensões "igualdade", "empatia", "inteligência moral", "justiça", "tolerância", "autocontrole" e "polidez (α=.966). A idade da população (médicos e enfermeiras) foi 36.44±9.52 anos, consistindo de 517 (65.5%) mulheres, 538 participantes casados, 653 empregados em hospitais públicos e 352 tinham experiência de trabalho 8 horas/dia. Usando dimensões deste levantamento como habilidades, espera-se que garanta a devida presteza sobre direitos e dignidade em serviços de cuidados à saúde.

Body privacy in gynecology obstetrics / Privacidad del cuerpo en obstetricia ginecológica / Privacidade corporal em ginecologia e obstetrícia

Abstract This study aimed to develop a scale to ethically evaluate the privacy of the body in gynecology and obstetrics. It was carried out in a university research and application hospital and in a private hospital in Turkey. A stratified sample was adopted with a total of 2,159 participants, including physicians, nurses, and midwives, OB/GYN patients, surgical patients, internal medicine patients, and healthy individuals. The Lawshe method was used. The results showed that physical space is important in protecting privacy; the participants perceived privacy as a right; women, married people, primary school graduates, older people and those closest to rural culture are more sensitive to privacy than others; Among healthcare providers, physicians are more privacy conscious than nurses and midwives; no participant had in-depth knowledge of patient rights and relevant legislation. The body privacy scale in gynecology and obstetrics proved to be a valid and reliable scale. With it, the privacy of the body in obstetrics and gynecology can be evaluated in future research, as well as the perceptions of body privacy of those who receive and provide medical care. By applying this scale, the privacy of gynecological and obstetric patients can be protected and the results reflected in clinical practice. This scale can also be used in education and in improving ethical sensitivity in physicians.

Resumen Este estudio tuvo como objetivo desarrollar una escala para evaluar éticamente la privacidad del cuerpo en ginecología y obstetricia. Se realizó en un hospital universitario de investigación y aplicación y en un hospital privado en Turquía. Se adoptó un muestreo estratificado con un total de 2.159 participantes, incluidos médicos, enfermeras y parteras, pacientes de ginecología y obstetricia, pacientes quirúrgicos, pacientes de medicina interna e individuos sanos. Se usó el método Lawshe. Los resultados mostraron que el espacio físico es importante en la protección de la privacidad; los participantes percibieron la privacidad como un derecho; las mujeres, las personas casadas, los titulados de la escuela primaria, personas mayores y los más cercanas a la cultura rural son más sensibles a la privacidad que otros; entre los proveedores de atención médica, los médicos tienen mayor conciencia de la privacidad que enfermeras y parteras; ningún participante tenía un conocimiento profundo de los derechos de los pacientes y de la legislación pertinente. La escala de la privacidad corporal en ginecología y obstetricia mostró ser una escala válida y confiable. Con ella, la privacidad del cuerpo en ginecología y obstetricia se puede evaluar en futuras investigaciones, así como las percepciones de privacidad corporal de aquellos que reciben y proporcionan atención médica. Aplicando esta escala, se puede proteger la privacidad de pacientes ginecológicos y obstétricos y reflejar los resultados en la práctica clínica. Esta escala también se puede utilizar en educación y en mejorar la sensibilidad ética en los médicos.

Resumo Esse estudo objetiva desenvolver uma escala para avaliar eticamente a privacidade do corpo em ginecologia e obstetrícia. Ele foi conduzido em um hospital universitário e em hospital privado na Turquia. Uma amostra estratificada foi adotada com um total de 2159 participantes, incluindo médicos, enfermeiras e parteiras, pacientes de obstetrícia, ginecologia, cirúrgicos e de medicina interna, e indivíduos saudáveis. O método Lawshe foi utilizado. Os resultados mostraram que o espaço físico é importante para proteger a privacidade; os participantes consideraram a privacidade como um direito; mulheres, pessoas casadas, com escolaridade primária completa, pessoas mais velhas e aquelas mais próximas da cultura rural são mais sensíveis à privacidade que outras; entre os profissionais de saúde, médicos são mais conscientes da privacidade que enfermeiras e parteiras; nenhum participante tinha conhecimento aprofundado dos direitos de pacientes e da legislação relevante. A escala de privacidade corporal em ginecologia e obstetrícia provou ser uma escala válida e confiável. Com ela, a privacidade do corpo em obstetrícia e ginecologia pode ser avaliada em pesquisas futuras bem como as percepções de privacidade corporal daqueles que recebem e fornecem cuidados médicos. Aplicando essa escala, a privacidade de pacientes ginecológicos e obstétricos pode ser protegida e os resultados refletidos na prática clínica. Essa escala pode também ser usada em educação e em melhorar a sensibilidade ética de médicos.

Patients' Perceptions of Nursing Care in a University Hospital.

Patient satisfaction with nursing is an important indicator of the quality of the nursing services. This study used The Patient Perception of Hospital Experience With Nursing (PPHEN) scale (Dozier, Kitzman, Ingersol, Holmberg, & Schultz, 2001) to determine the nursing care perception of patients in a Turkish tertiary care hospital. The study design was descriptive comparative and used convenience sampling. In total, 566 patients volunteered to take part in the study. The patient satisfaction level with nursing was found to be below average; patient satisfaction showed no meaningful differences between genders, marital status, or the clinics where the patient was hospitalized, but significantly higher levels of satisfaction were found with higher levels of education, younger age, higher incomes, and being employed. Overall, the patients considered that nursing care needs improvement, especially in terms of the provision of information and psychosocial support.

Head Transplantation: The Ultimate Level that Medicine has not yet Achieved.

The process of head transplantation is reviewed according to Cartesian philosophy. Recent developments in head transplantation were followed with great interest in the media and society. The surgeon Sergio Canavero stated that he could perform head transplantation. His ethical approaches to the procedure are evaluated, and the methodological suitability of the procedure with regard to the scientific ethics is discussed. The perception of the head transplantation process in the media and society is described as a phenomenon, and the relationship between society and science is evaluated. Ethical duties and responsibilities are highlighted as an area of knowledge. According to the perspective of Cartesian philosophy, it is not yet possible to perform head transplantation under the conditions of today’s medicine.

New concept in clinical care: proposal of a moral intelligence scale / Nuevo concepto en atención clínica: propuesta de una escala de inteligencia moral / Novo conceito em atenção clínica: proposta de uma escala de inteligência moral

Abstract: Effective communication, especially of those health professionals in management positions, contributes to the entire process of treating patients and can transform the quality of service into the processes of diagnosis, treatment and care. Managers with moral intelligence are able to distinguish right from wrong and can facilitate the relationship between health professionals and patients. The purpose of this study is to develop a scale to measure moral intelligence. The measurement tool created by the Lawshe method was applied to 789 health professionals. Following the calculations of the Content Validity Ratio and the Content Validity Index, the scale included 77 items. After applying it, with the subsequent exploratory and confirmatory factor analysis, the scale received its final form with 47 items. The Cα value of the scale is 0.966. The scale has seven dimensions, and they have been defined as "equality", "empathy", "moral intelligence", "justice", "tolerance", "self-control" and "kindness". The Cα values for these dimensions are determined respectively as 0.922, 0.910, 0.874, 0.859, 0.799, 0.840 and 0.772; demonstrating that the scale allows to study the moral intelligence of nurses and doctors. The scale developed had high Cronbach alpha values for each component and element, indicating that the scale provides a survey with high validity to measure the moral intelligence of doctors and nurses. Factor analysis shows a statistically valid distribution of items and components. Taking into account the moral intelligence parameters in the provision of health services will contribute to accurately diagnose disorders, reduce patient anxiety, ensure a shorter hospital stay, reduce the number of patients transferred to other health centers, to prevent negligence, save time and achieve better workforce planning.

Resumen: La comunicación efectiva, especialmente de aquellos profesionales de la salud en puestos directivos, contribuye a todo el proceso de tratamiento de los pacientes y puede transformar la calidad del servicio en los procesos de diagnóstico, tratamiento y atención. Los gerentes con inteligencia moral son capaces de distinguir lo correcto de lo incorrecto y pueden facilitar la relación entre los profesionales de la salud y los pacientes. El propósito de este estudio es desarrollar una escala para medir la inteligencia moral. La herramienta de medición creada por el método Lawshe se aplicó a 789 profesionales de la salud. Siguiendo los cálculos de la Relación de Validez del Contenido y el Índice de Validez del Contenido, la escala incluyó 77 ítems. Después de aplicarlo, con el posterior análisis factorial exploratorio y confirmatorio, la escala recibió su forma final con 47 ítems. El valor Cα de la escala es 0,966. La escala tiene siete dimensiones, y se han definido como "igualdad", "empatía", "inteligencia moral", "justicia", "tolerancia", "autocontrol" y "amabilidad". Los valores de Cα para estas dimensiones se determinan respectivamente como 0.922, 0.910, 0.874, 0.859, 0.799, 0.840 y 0.772; demostrando que la escala permite estudiar la inteligencia moral de enfermeras y médicos. La escala desarrollada tenía altos valores alfa de Cronbach para cada componente y elemento, lo que indica que la escala proporciona una encuesta con alta validez para medir la inteligencia moral de médicos y enfermeras. El análisis factorial muestra una distribución estadísticamente válida de ítems y componentes. Tomar en cuenta los parámetros de inteligencia moral en la provisión de servicios de salud contribuirá a diagnosticar trastornos con precisión, reducir la ansiedad de los pacientes, garantizar una estadía más corta en el hospital, reducir el número de pacientes transferidos a otros centros de salud, prevenir la negligencia, ahorrar tiempo y lograr una mejor planificación de la fuerza laboral.

Resumo: A comunicação efetiva, especialmente dos profissionais da saúde em cargos diretivos, contribui com todo o processo de tratamento dos pacientes e pode transformar a qualidade do serviço nos processos de diagnóstico, tratamento e atenção. Os gerentes com inteligência moral são capazes de distinguir o certo do errado e podem facilitar a relação entre os profissionais da saúde e os pacientes. O propósito deste estudo é desenvolver uma escala para medir a inteligência moral. A ferramenta de mensuração criada pelo Método Lawshe foi aplicada a 789 profissionais da saúde. Seguindo os cálculos da Relação de Validade de Conteúdo e o Índice de Validade de Conteúdo, a escala incluiu 77 itens. Depois de aplica-la, com a análise fatorial exploratória e confirmatória posterior, a escala recebeu sua forma final com 47 itens. O valor C! da escala é 0,966. A escala tem sete dimensões que foram definidas como "igualdade", "empatia", "inteligência moral", "justiça", tolerância", "autocontrole" e "amabilidade". Os valores de C! para estas dimensões foram, respectivamente, determinados como 0,922, 0,910, 0,874, 0,859, 0,799, 0,840 e 0,772, demonstrando que a escala permite estudar a inteligência moral de enfermeiras e médicos. A escala desenvolvida tinha altos valores de alfa de Cronbach para cada componente e elemento, o que indica que proporciona uma pesquisa com alta validade para medir a inteligência moral de médicos e enfermeiras. A análise fatorial mostra uma distribuição estatisticamente válida de itens e componentes. Ter em conta os parâmetros de inteligência moral na provisão de serviços de saúde contribuirá para diagnosticar transtornos com precisão, reduzir a ansiedade dos pacientes, garantir uma permanência mais curta no hospital, reduzir o número de pacientes transferidos para outros centros de saúde, prevenir a negligência, salvar tempo e lograr um melhor planejamento da força de trabalho.

Validity and reliability of a quality-of-life assessment instrument in children aged between 6 and 11 years.

BACKGROUND: There is increasing recognition of the importance of obtaining children's reports of their health, but significant challenges remain in accomplishing these goals in a systematic, community-based approach. OBJECTIVES: The aim of study was to evaluate the validity and reliability of the culturally adapted Turkish version of the "Child Health and Illness Profile - Child Edition (CHIP-CE) (6-11) for children 6 to 11 years of age. DESIGN: Cross-sectional analytical study conducted at Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey. SETTING: Children's health and diseases clinic. PATIENTS AND METHODS: For the purpose of this study, face-to-face interviews were conducted with inpatients (children aged between 6 and 11 years staying in the hospital) and healthy children (children aged between 6 and 11 years attending a private elementary school in the spring semester of 2010-2011). The Turkish version of CHIP-CE (6-11) was administered after the original version of CHIP-CE in English was translated into Turkish, and then back translated into English. All steps in the cultural adaptation process were undertaken meticulously by an expert committee. Confirmatory factor analysis (CFA) was conducted to test construct validity. The Cronbach's alpha and item-total correlations were used to evaluate internal consistency for reliability testing. MAIN OUTCOME MEASURES: Domain scores on the CHIP-CE questionnaire, Cronbach's alpha and item-total correlations. RESULTS: The Turkish version of CHIP-CE (6-11) was administered to 235 children, including 109 (46.4%) girls and 126 (53.6%) boys receiving inpatient treatment in the hospital, and 194 healthy children, including 89 (45.9%) girls and 105 (54.1%) boys. The mean (standard deviation) age was 6.9 (1.6) years in the group of children receiving inpatient treatment, and 9.2 (1.6) years in the healthy children. In the reliability testing of the CHIP-CE form, Cronbach's alpha was 0.79 in children receiving inpatient treatment, and 0.80 in healthy children. These values indicate excellent reliability. The CFA measurement model produced results consistent with standards: c2=185.76 df=160 P=.07986 RMSEA=0.026 in the children receiving inpatient treatment, and c2=180.20 df=109 P=.00002 RMSEA=0.058 in healthy children. CONCLUSION: CHIP-CE proved to be a reliable and valid measurement instrument for children receiving treatment for various diseases and healthy children. The internal consistency of the Turkish version of CHIP-CE is acceptable. LIMITATIONS: The sample, although large and diverse, was self-selected and does not represent the population of children in Turkey.

An intervention study to assess knowledge and attitude about reproductive health among Turkish Armed Forces.

OBJECTIVE: To evaluate the influence of reproductive health training given in Turkish Armed Forces on recruits' knowledge. METHODS: This interventional study was conducted at the Basic Military Training Centre, Kutahya, Turkey, from September to October 2009, and comprised recruits of armed forces. Data was collected and assessed before and after the training sessions. The intervention programme consisted of education focusing on anatomy of the reproductive system, contraceptive methods, sexually transmitted infections, responsible parenthood, gender and violence against women. A knowledge evaluation form of 25 true-false questions and an attitude scale of 20 Likert-type items were used to collect data. SPSS 15 was used to analyse data. RESULTS: Of the 1,218 forms distributed, 1,109(91%) were returned duly filled. The overall mean age of the participants was 20.8±1.8 years (range: 20-30 years). The knowledge score mean was 66.57±12.28 before the training, and increased to 80.89±12.66 after the training with an increase of 14.32% (p<0.001). The attitude score mean was 3.72±0.45 before the training and increased to 3.95±0.49 after the training with an increase of 5.75% (p<0.001). CONCLUSIONS: The reproductive health training increased knowledge level of recruits in a military setting.

A written consent form dating back to 1524 in Bursa Ser'iye (Sharia Court) records and a proposal of a new start date for consent forms.

BACKGROUND AND OBJECTIVES: Qadi registers are important documents for Ottoman medical history re.search. "Sharia Court Records (Ser'iyye Sicilleri)" are notebooks that include the records that qadis kept with regard to their decisions and deeds. These registers are the only authentic sources from which to acquire information on rural life, away from the center of the town, and to understand the daily practices of the Ottoman society. The objective of this study is to provide evidence for the fact that the concept of informed consent on medical interventions, and hence the written consent documents arranged between patients and physicians, dates back to older times in our history when compared to the Western world. DESIGN AND SETTING: A large number of Ser'iyye (Sharia Court) record originals have been surveyed. The consent form registered as A-40. 221a in Ser'iyye (Sharia Court) Records found in Bursa has been presented here as the earliest consent document found by the authors. Transcription of the original document has been performed and analyzed. The aforementioned consent form dates back to 26/Dhu al-Qi'dah/933 (August 24, 1524). METHODS: The original version of the referenced consent document is the earliest consent document presented so far to the best of the authors' knowledge; it was found in Bursa Ser'iyye Records and evaluated accordingly. RESULTS: Based on the document, it is argued that the history of consent forms dates back about 500 years. CONCLUSION: Obtaining consent in scientific research from human beings was considered to have originated from the Nuremberg Code (1949). However, with this study, it has been shown that the concept of informed consent was already present in the Ottoman Period, during the 16th century, and that the original consent document dates back to 1524, pertaining to a surgical intervention.