Alimentos para usos médicos especiales en la Unión Europea: una actualización legislativa incompleta / Foods for special medical purposes in the European Union: an incomplete legislative update

Este artículo analiza el desarrollo, desde 1989 hasta 2019, de la legislación de la Unión Europea sobre los alimentos para usos médicos especiales dirigidos a pacientes y examina cómo desde 1997 los organismos científicos competentes de la Unión Europea y de los Estados Unidos de América han establecido valores de referencia de la dieta, así como niveles de ingesta superior tolerable para vitaminas y minerales basados en su seguridad. La actualización, mediante el Reglamento (UE) 2016/128, de la legislación de la Unión Europea de esta categoría de alimentos parece adecuada en el caso de los lactantes. Sin embargo, para los pacientes mayores de un año, los mínimos y máximos de vitaminas y minerales por 100 kcal de la Directiva 1999/21/CE no fueron modificados en este Reglamento, ignorando así los valores de referencia de la dieta y los niveles de ingesta superior tolerable del periodo 1997-2015, establecidos ambos por los citados organismos científicos

This article analyses, from 1989 until 2019, the development of the European Union legislation on food for special medical purposes, aimed at patients, and examines how from 1997 the competent scientific bodies of the European Union and the United States of America have established dietary reference values, as well as tolerable upper intake levels for vitamins and minerals based on their safety. The update, through the Regulation (EU) 2016/128, of the European Union legislation on this food category seems appropriate in the case of infants. However, for patients older than one year, the minimums and maximums of vitamins and minerals per 100 kcal from the Directive 1999/21/EC were not modified in this Regulation, thus ignoring the dietary reference values and the tolerable upper intake levels from the period 1997-2015, both established by the aforementioned scientific bodies

Propuesta de un diseño de carrera profesional para la enfermería militar / A proposal for military nursing career design

Introducción: En ausencia, en la actualidad, de un modelo de carrera profesional para enfermería militar se propone un diseño que, buscando la excelencia profesional, dé respuesta a las necesidades de la organización. Objetivo: Diseñar una propuesta de carrera profesional para la enfermería militar. Material y Métodos: Se diseñó un modelo de carrera profesional basado en tres variables, contempladas por la Ley de Carrera Militar: capacitación para asumir puestos de mayor responsabilidad, ascenso a sucesivos empleos militares y ocupación de destinos. Población y muestra: Personal en activo en la Escala de Oficiales Enfermeros (E.O.E.). Recogida de datos: Se obtuvieron datos, a través de la Dirección General de Personal, de la situación actual de la E.O.E. (años de servicio, empleos, efectivos/empleo, años/empleo). Se realizó una búsqueda de información en relación con todos los modelos propuestos en España por las Comunidades Autónomas (CC.AA.), así como, la legislación militar y civil de aplicación en este ámbito. Resultados: Se propone un modelo de carrera profesional en base a cinco grados correspondiendo con otros tantos empleos militares. Se describen las funciones y tipo de destino a ocupar de acuerdo al nivel de desempeño profesional. Conclusiones: Es preciso desarrollar un modelo de carrera profesional para la enfermería militar que oriente la trayectoria individual de sus componentes, la catalogación de puestos, los sistemas de evaluación y la formación precisa para alcanzar diversos niveles competenciales en base a las necesidades de las Fuerzas Armadas

Introduction: Due to the current inexistence of a specific professional career for the military nurses, this paper aims to propose a design that both stresses professional excelence and meets the needs of the organisation. Objectives: To design a proposal for the military nursing career. Materials and Methods: This new model for professional career was based on the three dimensions considered by the "Ley de Carrera Militar" (Military Career Law): abiltation to assume positions of higher responsibility, promotion to successive military positions and destination occupation. Population and Sample: Serving staff in the Official Military Nurse Scale (OMNS). Data gathering: Data were obtained through the "Dirección General de Personal" concerning current situations (service years, positions, effectives/ position, years/position). An information search was conducted through all the models proposed in Spain by the Autonomous Communities, and the relevant legislation, both military and civil. Results: The proposed model of nursing professional career is based on five degrees corresponding to the same number of military positions. The functions and type of destination are described according to the level of professional performance. Conclusions: It seems necessary to introduce a new model of professional career useful to guide the individual trajectory of the military nurses, the position lists, the evaluation systems and the required training to reach the different performance levels according to the needs of the Armed Forces

Reflexión en torno al informe sobre consentimiento informado en pediatría del Comité de Bioética de la Academia Americana de Pediatría (2016) / Reflection on the report on the informed consent in paediatrics by the Bioethics Committee of the American Academy of Pediatrics (2016)

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[Medicolegal aspects of tumor boards]. / Medizinrechtliche Aspekte von Tumorboards.

The presentation of tumor patients to tumor boards has widely developed into a medical standard. The necessary compliance to the medical standard can lead to obligatory presentation if the complexity of a case dictates that this cannot be comprehensively covered by a single treating physician. The organization of a tumor board must be so that the structure and specialist competence guarantees an adequate consultative function of the represented specialties. Tumor board members are not automatically promoted to become part of the treating team just by participation and therefore do not have a guarantor position but do have the obligation of care of a consulting physician. Tumor board decisions have a recommendation character, are not binding in the legal sense and do not relieve the treating physician from the obligation to critically scrutinize the recommendations before implementation. On the other hand the treating physician must be able to justify not following the recommendations on the basis of the medical obligation to care. The tumor board must fulfil the same requirements for documentation as any other consultative activity.

Nurses recovering from substance use disorders: a review of policies and position statements.

The authors review policy initiatives and professional organization position statements that hospital and nursing administrators should be familiar with to respond effectively to public and policy-maker concerns about substance use in healthcare settings. Detecting and addressing substance use disorders proactively and systematically are essential for 2 reasons: to protect patient safety and to enable healthcare professionals to recognize problems early and intervene swiftly. The authors identify key points and gaps in existing policy statements.

To detain or to release? Correlates of dispositions for individuals declared not criminally responsible on account of mental disorder.

OBJECTIVE: The extent to which risk assessment advances have influenced release decision-making by review boards (RBs) of individuals found not criminally responsible on account of mental disorder (NCRMD) remains unclear. Our objective is to identify the psychosocial, criminological, and risk measure correlates of RB decision-making. METHOD: Data were collected through structured interviews and file reviews conducted between October 2004 and August 2006 in the sole forensic psychiatric hospital in Quebec and in 2 civil psychiatric hospitals in a large metropolitan area designated to care for people found NCRMD. The final sample consisted of 96 men. RESULTS: Dynamic, clinical risk factors are associated with decisions to detain or release people found NCRMD, rather than traditional historical risk factors such as criminal history. CONCLUSION: Dynamic variables seem appropriate for the RBs to consider given the intention of the NCRMD legislation. Further, dynamic variables provide direction for titration of treatment and supervision. Results are discussed regarding enhancing evidence-informed RB dispositions.

'Mental health is everybody's business': roles for an intersectoral approach in South Africa.

Intersectoral action is increasingly recognized as necessary to address the social determinants of mental health. This study aims to assess South Africa's progress in intersectoral collaboration for mental health, and provide recommendations for intersectoral collaboration, to generate lessons for other low- and middle-income countries. We conducted a survey of the existing mental health system in South Africa using the World Health Organization Assessment Instrument for Mental Health Systems. We also conducted 96 semi-structured interviews and 12 focus group discussions with a range of stakeholders at national, provincial and district level. Data were analysed thematically to understand the roles and responsibilities of different sectors in realizing the right to mental health. A range of key sectors were identified as having roles in mental health promotion, illness prevention and service delivery. In discussing South Africa's progress, respondents gave several suggestions about how to formulate an intersectoral response in this context, including increasing high level political commitment, and using leadership from the health sector. We outline roles and responsibilities for various sectors and lessons that can be learnt from this context. These include the importance of developing programmes alongside legislation, employing targeted awareness-raising to engage sectors, and developing a structured approach to intersectoral action.

Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008 / European Guideline of Cardiovascular Disease Prevention in the Clinical Practice. Spanish Adaptation of the CEIPC 2008

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[Possibilities of medical opinionating in cases associated with "exposure to direct danger of death or serious health damage"]. / Mozliwosci opiniowania lekarskiego w sprawach o "narazenie na bezposrednie niebezpieczenstwo utraty zycia lub ciezkiego uszczerbku na zdrowiu".

In the opinion of some forensic medicine experts, assessment of potential consequences in keeping with Article 160 of the Polish Penal code, which refers to the crime of "exposure to direct danger of death or severe health damage", lies within the competence of medicolegal specialists. This view is accepted by courts and prosecution offices. However, the knowledge of physicians in the field of predicting consequences which did not occur is only somewhat better than that of lawyers. In simple cases, e.g. in trauma involving a sensitive area of the body, passing an opinion confirming a serious danger is not associated with any major problems. Similarly, no problems arise when passing an opinion on the lack of such a danger e.g. in the case of traumawithout any injuries. In complex cases, however, which include the majority of medical error cases, passing an opinion on exposure to direct danger of death or severe health damage may be not feasible.

The participation of Anatomy Departments in the continuing professional development of surgeons

We have divided this article into five sections organised as follows. The first section expresses our views concerning the relevance of anatomy to the training of clinicians and surgeons. The second section analyses clinicians and surgeons perceptions about the relevance of anatomy for their training and is based upon the results of a questionnaire. The third section discusses whether surgeons or anatomists should be organising Continuing Professional Development (CPD) courses. The fourth section attempts to define the criteria for organising and developing surgical training courses. The fifth, and final, section outlines our experiences of planning and initiating surgical training courses (AU)

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[Medico-legal opinion in establishing "exposure to direct danger of death or grave detriment to health"]. / Opiniowanie sadowo-lekarskie a ustalanie "narazenia na bezposrednie niebezpieczenstwo utraty zycia lub ciezki uszczerbek na zdrowiu".

This paper deals with the problem of competence of the forensic expert opinions on the exposure to "direct danger of death or grave detriment to health". According to the analysis of judicial verdicts and the comments of lawyers "direct danger" depends closely on the probability, time and number of occurrences between the behavior of the perpetrator and the threatening act. The competence of the forensic expert does not allow for the legal qualification of the act but for the assessment of from the medicolegal point of view, defining the threat and possible outcomes in a descriptive fashion. The assessment of "direct danger" should be the result of close cooperation between the judicial representative and forensic expert.

O papel das comissões de controle de infecções hospitalares / The role of the infection-control commitee

A infecção hospitalar é importante problema de saúde pública. Exigências legais reforçam o interesse pelo estabelecimento de programas de controle. Dados coletados sistematicamente, analisados e devolvidos para o corpo clínico, fazem com que todos se motivem para enfrentar seriamente o problema. Diante da necessidade de se conhecerem indicadores, melhorar a prática assistencial, padronizar medicamentos e materiais médico-hospitalares, realizar educação continuada, elaborar guias e protocolos e gerenciar "pela qualidade", equilibrando múltiplos interesses divergentes, enquadram-se as Comissões de Controle de Infecções Hospitalares - comitês de profissionais constituídos de uma equipe multidisciplinar. Urge que se redefina o termo infecção hospitalar para mantê-lo coerente com o seu significado atual. A idéia que ele traduz é a de infecção relacionada à assistência - onde quer que ela seja prestada. Cabe à CCIH conhecer a epidemiologia da instituição, controlar infecção cruzada e manter programa que promova a melhoria da qualidade assistencial e educacional: a proteção do paciente e circunstantes; a redução dos custos da assistência, financeiro e social: da dor, sofrimento, agravos psicológicos e morte. As CCIH, em integração com a Vigilância Sanitária, poderão transformar o momento da vistoria do estabelecimento em salutar troca de educação em saúde. O esforço ,dessas duas instâncias poderá ser potencializado, no sentido de alcançarem a efetividade para a melhoria da qualidade assistencial no município de Belo Horizonte. É fundamental que todos os profissionais entendam que a prevenção e o controle de infecções são questão de cidadania e direitos humanos: dependem muito mais deles próprios do que das leis que se lhes impõem. A transformação da organização é responsabilidade de todos.

Nosocomial infection is an important public health problem. Legal requirements enforces the expectation that hospitals establish formal infection control programs. Systematically collected and analyzed data on cross-infection rates showed to clinicians motivates everybody to seriously address the problem. Since it is necessary to know outcomes, to improve the quality of health care, to standardize medicines and medical supplies and equipments, to perform continuous education, to make guidelines and to manage using continuous quality improvement tools - balancing many different wishes, the infection control committee is established - being a multidisciplinary teamwork. It is high time to make the words hospital infection more understandable to present days! It means infection associated to the health care - wherever it is provided. The professional staff committees must know the epidemiology of the medical center, take prevention measures and perform a program to enhance the quality of health care and health education, to protect patients and stand-bys, to reduce health care financial and social costs; and the pain, distress, psychological harms and death. The infection control committee and the health surveillance team can exchangeknowledge on health education during the e latter work on accreditation of hospitals. In would function as a task force to improve the quality of health care in the city of Belo Horizonte. It is a key point to understand that prevention and control of nosocomial infections is much more a matter of citizenship and human rights than that of legal issues. The transformation of the organization is everybody's job!

Antropología, Teología y Etica del sufrimiento / Antropology, Teology and Ethics of suffering

El sufrimiento es experimentado por personas, no sólo por cuerpos, y tiene su origen en una amenaza a la pérdida de la integridad de la persona como ente social, psicológico y espiritual. Como cualquier situación - límite, produce conflictos internos y aislamientos del sufriente, generador de más sufrimiento a su vez. Se revisa el concepto y el significado del sufrimiento en las distintas culturas dado que las mismas han buscado dar una explicación al porqué de su presencia en el mundo a lo largo de los tiempos y, en lo posible, un camino hacia el alivio, sea por la aceptación o el descubrimiento de un significado. Si entre las metas de la medicina está el alivio del sufrimiento humano, esto debería incluir la comprensión y, de ser posible, el alivio del componente espiritual del sufrimiento, lo que implica entenderlo también desde lo cultural y lo religioso, ya que una intervención exclusivamente técnica, aún la más adecuada y avanzada, puede fallar en su intento de aliviarlo...