Taking Care of Those Who Care: Attending Psychological Needs of Health Workers in a Hospital in Madrid (Spain) During the COVID-19 Pandemic.

PURPOSE OF REVIEW: We aim to review evidence of the psychological impact of the COVID-19 pandemic on healthcare professionals and the effects of the psychological crisis interventions and measures implemented to manage stress. RECENT FINDINGS: Mental health problems are frequently encountered in health professionals during emergencies and often prevail over the following years. Results show health professionals exhibited symptoms of depression, anxiety, emotional distress, burnout, post-traumatic stress and poor sleep quality. In response to acute responses to stress, it is crucial to provide psychoeducation, mindfulness and coping resources. These interventions can improve resilience and self-efficacy of professionals, as well as help to prevent anxiety, depression and quality of sleep. The need for intervention programmes targeting the mental health of vulnerable populations has been widely acknowledged. We described a psychological support plan designed and implemented with the aim of providing mental health care for health professionals. Such programmes should be easily accessible to professionals, preferably in their own work environments.

[Clinical Ethics Consultation: current European models and novel approaches in Spain]. / Consultoría en ética clínica: modelos europeos y nuevas propuestas en España.

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospital setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been questioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, which has proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America, its implementation in Europe is still marginal. In this document we present the general characteristics of CEC services, comparing their potential advantages and risks to those of HECs. We will then share relevant European experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share our recent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise the minimum requirements that such a CEC service must meet in order to carry out its consulting activity: organisational flexibility, well-trained professionals, with sufficient clinical experience, economical support, and organisational dependency on HECs.

Consultoría en ética clínica: modelos europeos y nuevas propuestas en España / Clinical Ethics Consultation: current European models and novel approaches in Spain

Los Comités de Ética Asistencial (CEAS) han constituido hasta la actualidad el único modelo de resolu-ción de conflictos éticos en el entorno hospitalario en España, aunque su utilidad para mejorar la prácticaclínica diaria ha sido puesta en duda. La Consultoría individual en Ética Clínica (CEC) es un modelo comple-mentario al CEAS, eficaz para ayudar a tomar decisiones ético-clínicas complejas a tiempo real. Aunque laCEC está muy extendida en el ámbito estadounidense, todavía goza de poca popularidad en Europa. En elpresente trabajo se describen las características generales de los servicios de CEC, remarcando sus ventajasy potenciales riesgos comparándolos con los del modelo basado exclusivamente en los CEAS. En segundolugar, se recogen las experiencias y modelos de CEC en diversos países europeos, y también presentamos lasiniciativas más recientes llevadas a cabo en nuestro país. Tras ello, se propone una estrategia de implanta-ción de un servicio de CEC para un hospital universitario de tamaño medio y se resumen las característicasmínimas que este servicio de CEC debe tener para poder llevar a cabo eficazmente su labor consultiva: fle-xibilidad organizativa, composición por profesionales formados en Bioética, con gran experiencia clínica,remunerados específicamente para esta tarea y con dependencia organizativa del CEAS.(AU)

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospi-tal setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been ques-tioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, whichhas proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America,its implementation in Europe is still marginal. In this document we present the general characteristics ofCEC services, comparing their potential advantages and risks to those of HECs. We will then share relevantEuropean experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share ourrecent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise theminimum requirements that such a CEC service must meet in order to carry out its consulting activity: or-ganisational flexibility, well-trained professionals, with sufficient clinical experience, economical support,and organisational dependency on HECs.(AU)

Historia y futuro de las pandemias / History and future of pandemics

Este artículo presenta una historia general de las epidemias históricas y de las nuevas enfermedades emergentes, señalando sus factores desencadenantes. Se afirma que las epidemias son inevitables, y que su riesgo aumenta en proporción al tamaño, la complejidad y el poder tecnológico de nuestras sociedades. La historia enseña que las epidemias han sido casi siempre desencadenadas por cambios en el ambiente ocasionados por las propias actividades humanas. Las enfermedades infecciosas son manifestación de una interacción ecológica entre la especie humana y otra especie de microorganismos. Y las epidemias son resultado del cambio en algún factor ambiental capaz de influir en esa interacción. Las catástrofes epidémicas son inevitables: en primer lugar, porque no podemos evitar formar parte de cadenas tróficas en las que comemos y somos comidos por los microbios; en segundo lugar, porque las infecciones son mecanismos evolutivos y factores reguladores del equilibrio ecológico, que regulan sobre todo el tamaño de las poblaciones; y, en tercer lugar, porque las intervenciones técnicas humanas, al modificar los equilibrios previos, crean equilibrios nuevos que son más vulnerables. De este modo las sociedades humanas son más vulnerables cuanto más complejas. Y los éxitos humanos en la modificación de condiciones ambientales conservan, o más bien aumentan, el riesgo de catástrofes epidémicas. Todas las necesarias medidas de vigilancia y control epidemiológico imaginables pueden disminuir los daños que producen las epidemias, pero nunca podrán evitarlas.

This article presents a general history of historical epidemics, and new emerging diseases, pointing out their triggers. It is claimed that epidemics are inevitable, and that their risk increases in proportion to the size, complexity, and technological power of our societies. History teaches that epidemics have almost always been triggered by changes in the environment caused by human activities themselves. Infectious diseases are manifestations of an ecological interaction between the human species and another species of microorganisms. And epidemics are the result of a change in some environmental factor capable of influencing that interaction. Epidemic catastrophes are inevitable: firstly, because we cannot help but be part of trophic chains in which we eat and are eaten by microbes; secondly, because infections are evolutionary mechanisms and regulatory factors of ecological balance, which regulate especially the size of populations; and thirdly, because human technical interventions, in changing previous balances, create new balances that are more vulnerable. In this way human societies are more vulnerable the more complex. And human successes in modifying environmental conditions retain, or rather increase, the risk of epidemic catastrophes. All necessary epidemiological surveillance and control measures imaginable can lessen the damage caused by epidemics, but they can never prevent them.

El humanismo y la enseñanza de las humanidades médicas / Humanism and the teaching of medical humanities

En los años 60 culminó la medicina científica, pero comenzó a criticarse su deshumanización. Con el fin de humanizar a los profesionales surgió un conjunto de disciplinas denominadas «humanidades médicas». Se esperaba que su enseñanza promoviera capacidades y actitudes humanamente significativas: capacidades de comprensión, compasión, cuidado, afrontamiento del dolor y de la muerte y actitudes de responsabilidad, solidaridad, respeto y aceptación de las personas. En este artículo se recuerda el origen y la definición de las humanidades médicas. Se suministra un análisis del humanismo como movimiento de toma de conciencia de la importancia del ser humano y fomento de todo lo que puede desarrollarlo y mejorarlo. Se señalan las materias que deben estar presentes en un programa de enseñanza de humanidades médicas, se revisan posibles estrategias docentes y se encara la pregunta de quién puede enseñar estas materias, dejándolas abiertas a un conjunto de profesionales que cumplan ciertos requisitos

Scientific medicine culminated in the 1960s. Nevertheless, at the same time it began to be criticized on the account of dehumanization. That is why, in order to humanize the professionals, a set of disciplines called "medical humanities" emerged. It was hoped that their teaching would promote humanly meaningful capacities and attitudes: capacities of understanding, compassion, care, coping with pain and death, and attitudes of responsibility, solidarity, respect and acceptance of people. This article recalls the origin and definition of the medical humanities. It provides an analysis of humanism as a movement born to raise awareness of the importance of the human being and to promote all that can develop and improve it. It also indicates the subjects that must be present in a program of teaching of medical humanities. Possible teaching strategies are reviewed as well. And It finally addresses the question of who can teach these subjects, leaving them open to a set of professionals who meet certain requirements

El ensayo Ars Medica de John Locke, y la influencia de sus ideas médicas sobre la filosofía empirista / The John Locke's Ars Medica essay, and the influence of his medical ideas on the empirical philosophy

Se presenta, analiza y traduce por primera vez al castellano, el ensayo Ars Medica escrito por John Locke en 1669. Este ensayo muestra los problemas médicos que dieron origen al conjunto de la filosofía de Locke; y ofrece claves esenciales para comprender los motivos, las metas y los rasgos de la teoría del conocimiento empirista. Ideas originariamente médicas que tuvieron una repercusión directa en la obra posterior de Locke fueron: 1) Confianza en la perfectibilidad de la ciencia y elucidación del papel que la reflexión filosófica podía desempeñar en ello. 2) Rechazo del conocimiento deducido de principios, hipótesis o máximas. 3) El método «histórico simple» para edificar el conocimiento; que intentaba registrar los hechos descriptivamente, renunciando al estudio de las causas últimas. 4) Una clasificación tripartita de las ciencias que instaura la semiótica, ciencia médica por antonomasia, y la define como un mero conocimiento de los signos de las cosas, que no pretende discernir las esencias ni las sustancias. Locke, en su epistemología, generaliza para todo el conocimiento científico la teoría médica de los signos de las enfermedades. Convierte todo conocimiento posible se en mero saber descriptivo de signos. Y atribuye al conocimiento un carácter probabilístico y pragmático (AU)

John Locke's essay Ars Medica of 1669, is presented, analyzed and translated into Spanish. This essay shows the medical problems that prompted Locke's philosophy and provides essential clues to understanding the motives, aims and characteristics of the empiricist's theory of knowledge. Ideas originated in medicine that profoundly influenced subsequent Locke's works were: 1) Trust in the perfectibility of science and elucidation of the role that philosophical thinking could play. 2) Rejection of knowledge deduced from principles, hypotheses or maxims. 3) Reliance on a «plain historical method» for the production of knowledge, which tried to register facts descriptively, while abandoning the study of ultimate causes. 4) Use of a three-part classification of the sciences that enthrones semiotics, medical science par excellence, and defines it as a mere knowledge of the signs of things, that is not intended to discern either essences or substances. Locke, in his epistemology, applies to all scientific knowledge the medical theory of the signs of illnesses. He envisions all possible science as a mere descriptive knowledge of signs; and thinks that knowledge is probabilistic, analogous and pragmatic (AU)

Assessment of physical impairments in leprosy patients: a comparison between the world health organization (who) disability grade and the Eye-Hand-Foot score.

This cross-sectional study assessed the grade of physical impairments in 61 individuals with leprosy receiving multidrug therapy (MDT) under the Brazilian Unified Health System (SUS), and residing in Campina Grande, Paraíba State, Brazil. Impairments were assessed using the disability grade (DG) standardized by the WHO, and the EHF score (Eye-Hand-Foot sum of impairment scores). Impairments were detected in 25 (41%) of the subjects. A total of 14 (23%) patients scored DG 1, while 11 (18%) were assigned DG 2. The EHF score ranged from 1 to 10 points in the group of patients with physical impairments, with a mean score of 3.6 points. The majority of individuals with impairments were affected in at least two sites. We conclude that the EHF score showed overlapping impairments in the segments examined and may be more appropriate than the DG classification system for describing the degree of physical impairment of leprosy patients.

Assessment of physical impairments in leprosy patients: a comparison between the world health organization (who) disability grade and the Eye-Hand-Foot Score / Avaliação de incapacidades físicas em pessoas com hanseníase: comparação entre o grau de incapacidade e o Eye-Hand-Foot Score

This cross-sectional study assessed the grade of physical impairments in 61 individuals with leprosy receiving multidrug therapy (MDT) under the Brazilian Unified Health System (SUS), and residing in Campina Grande, Paraíba State, Brazil. Impairments were assessed using the disability grade (DG) standardized by the WHO, and the EHF score (Eye-Hand-Foot sum of impairment scores). Impairments were detected in 25 (41 percent) of the subjects. A total of 14 (23 percent) patients scored DG 1, while 11 (18 percent) were assigned DG 2. The EHF score ranged from 1 to 10 points in the group of patients with physical impairments, with a mean score of 3.6 points. The majority of individuals with impairments were affected in at least two sites. We conclude that the EHF score showed overlapping impairments in the segments examined and may be more appropriate than the DG classification system for describing the degree of physical impairment of leprosy patients.

Este estudo transversal avaliou a extensão das incapacidades físicas em 61 pessoas com hanseníase, em uso de poliquimioterapia (PQT), assistidos pelo Sistema Único de Saúde do Brasil, residentes em Campina Grande, Paraíba, Brasil. As incapacidades foram avaliadas por meio do grau de incapacidade (GI) preconizado pela OMS e pelo cálculo da soma das incapacidades - Eye-Hand-Foot impairment score (EHF score); incapacidades foram diagnosticadas em 41 por cento dos sujeitos. Os GI 1 e 2 foram atribuídos, respectivamente, para 23 por cento e 18 por cento deles. No grupo de pacientes com incapacidades físicas o EHF score variou de 1 a 10 pontos e exibiu a média igual a 3,6 pontos. A maioria das pessoas com incapacidades possuía, pelo menos, duas partes do corpo afetadas. O EHF score evidenciou sobreposição de comprometimentos nos segmentos examinados e se mostrou mais apropriado que o sistema de classificação do GI para descrever a extensão das incapacidades físicas dos pacientes.

Dopamine innervation in the thalamus: monkey versus rat.

We recently identified the thalamic dopaminergic system in the human and macaque monkey brains, and, based on earlier reports on the paucity of dopamine in the rat thalamus, hypothesized that this dopaminergic system was particularly developed in primates. Here we test this hypothesis using immunohistochemistry against the dopamine transporter (DAT) in adult macaque and rat brains. The extent and density of DAT-immunoreactive (-ir) axons were remarkably greater in the macaque dorsal thalamus, where the mediodorsal association nucleus and the ventral motor nuclei held the densest immunolabeling. In contrast, sparse DAT immunolabeling was present in the rat dorsal thalamus; it was mainly located in the mediodorsal, paraventricular, ventral medial, and ventral lateral nuclei. The reticular nucleus, zona incerta, and lateral habenular nucleus held numerous DAT-ir axons in both species. Ultrastructural analysis in the macaque mediodorsal nucleus revealed that thalamic interneurons are a main postsynaptic target of DAT-ir axons; this suggests that the marked expansion of the dopamine innervation in the primate in comparison to the rodent thalamus may be related to the presence of a sizable interneuron population in primates. We remark that it is important to be aware of brain species differences when using animal models of human brain disease.

Distribution of the dopamine innervation in the macaque and human thalamus.

We recently defined the thalamic dopaminergic system in primates; it arises from numerous dopaminergic cell groups and selectively targets numerous thalamic nuclei. Given the central position of the thalamus in subcortical and cortical interplay, and the functional relevance of dopamine neuromodulation in the brain, detailing dopamine distribution in the thalamus should supply important information. To this end we performed immunohistochemistry for dopamine and the dopamine transporter in the thalamus of macaque monkeys and humans to generate maps, in the stereotaxic coronal plane, of the distribution of dopaminergic axons. The dopamine innervation of the thalamus follows the same pattern in both species and is most dense in midline limbic nuclei, the mediodorsal and lateral posterior association nuclei, and in the ventral lateral and ventral anterior motor nuclei. This distribution suggests that thalamic dopamine has a prominent role in emotion, attention, cognition and complex somatosensory and visual processing, as well as in motor control. Most thalamic dopaminergic axons are thin and varicose and target both the neuropil and small blood vessels, suggesting that, besides neuronal modulation, thalamic dopamine may have a direct influence on microcirculation. The maps provided here should be a useful reference in future experimental and neuroimaging studies aiming at clarifying the role of the thalamic dopaminergic system in health and in conditions involving brain dopamine, including Parkinson's disease, drug addiction and schizophrenia.

The primate thalamus is a key target for brain dopamine.

The thalamus relays information to the cerebral cortex from subcortical centers or other cortices; in addition, it projects to the striatum and amygdala. The thalamic relay function is subject to modulation, so the flow of information to the target regions may change depending on behavioral demands. Modulation of thalamic relay by dopamine is not currently acknowledged, perhaps because dopamine innervation is reportedly scant in the rodent thalamus. We show that dopaminergic axons profusely target the human and macaque monkey thalamus using immunolabeling with three markers of the dopaminergic phenotype (tyrosine hydroxylase, dopamine, and the dopamine transporter). The dopamine innervation is especially prominent in specific association, limbic, and motor thalamic nuclei, where the densities of dopaminergic axons are as high as or higher than in the cortical area with the densest dopamine innervation. We also identified the dopaminergic neurons projecting to the macaque thalamus using retrograde tract-tracing combined with immunohistochemistry. The origin of thalamic dopamine is multiple, and thus more complex, than in any other dopaminergic system defined to date: dopaminergic neurons of the hypothalamus, periaqueductal gray matter, ventral mesencephalon, and the lateral parabrachial nucleus project bilaterally to the monkey thalamus. We propose a novel dopaminergic system that targets the primate thalamus and is independent from the previously defined nigrostriatal, mesocortical, and mesolimbic dopaminergic systems. Investigating this "thalamic dopaminergic system" should further our understanding of higher brain functions and conditions such as Parkinson's disease, schizophrenia, and drug addiction.

Los modelos del razonamiento moral y la investigación de la ética utilizando internet: la "red de conciencia virtual", un proyecto de investigación inspirado en el coherentismo / Moral rationalle models and the investigation of ethics, using the internet: the

A investigação em ética pode ser feita utilizando-se três diferentes modelos de raciocínio. O dedutivo que formula princípios gerais para deduzir normas particulares e juizos inviduais. O indutivo, que observa os casos e as práticas habituais para induzir normas e princípios. E o "coherentismo", que reúne as experiências morais mais significativas e as proporções éticas mais fiéis para elaborar um sistema coerente. Assim as teorias principalistas são mais dedutivas, enquanto que os procedimentos casuístas são mais indutivos. Este artigo analisa as vantagens e inconvenientes de cada um destes sistemas, concluindo que o coherentismo é o sistema mais apropriado para responder as interrogações morais da vida cotidiana...