The moderating role of work experience in the effect of ethical culture on whistleblowing in healthcare professionals and the effect of organizational trust on whistleblowing.

OBJECTIVE: This study aims to determine the moderator role of work experience in the impact of ethical culture perceptions of healthcare professionals on their whistleblowing tendencies. It is also to reveal the effect of organizational trust on whistleblowing. METHODS: The population of the study consists of health personnel working in the public or private sector in Turkey. The sample of the study consists of 481 health workers who voluntarily participated in the survey. Data were collected using the convenience sampling technique. In collecting data, whistleblowing, organizational trust, and ethical culture scales were used. In the analysis of the data, descriptive statistics, factor analysis, correlation analysis, and path analysis in the structural equation model were performed. RESULTS: The findings reveal that organizational trust has an impact on ethical culture and that some sub-components of organizational trust and ethical culture have an impact on whistleblowing. In addition, it has been determined that the group of health professionals with low work experience has a moderating role in the effect of applicability on internal whistleblowing. CONCLUSION: To handle the whistleblowing mechanism internally in health institutions, it is important to clearly show the ethical rules to the employees. On the other hand, it has been seen that the professional experiences of the employees can be used as a tool for whistleblowing to work.

Determinantes das irregularidades na gestão pública municipal: o caso dos municípios do estado de São Paulo / Determinantes de las irregularidades en la gestión pública municipal: el caso de los municipios del estado de São Paulo / Determinants of irregularities in municipal public management: the case of municipalities in the state of São Paulo

Resumo O controle externo municipal exercido pelos Tribunais de Contas permite, por meio da divulgação dos relatórios de auditoria, conhecer as irregularidades encontradas nas contas dos governos municipais. Elas têm sido analisadas empiricamente, do ponto de vista de sua classificação em termos de gravidade, mas poucos são os estudos que visam identificar os fatores que influenciam tais falhas. Constatada essa lacuna, o principal objetivo deste estudo é identificar fatores que possam influenciar lapsos na gestão pública municipal apontados pela auditoria do Tribunal de Contas. Este artigo contribui para aprofundar a pesquisa em torno desse tema e para a melhoria da gestão nos municípios. Trata-se de uma análise exploratória, baseada em modelos econométricos para dados em painel. A amostra inclui 179 municípios paulistas, com dados relativos aos anos de 2011, 2013, 2015, 2017 e 2019. Os resultados sugerem que as recomendações e as determinações do Tribunal de Contas, bem como lacunas nos controles internos, influenciam irregularidades em municípios pequenos, médios e grandes. O volume de transferências legais e constitucionais recebidas influenciam os municípios pequenos e médios, ao passo que o produto interno bruto (PIB) municipal tem influência nos municípios médios.

Resumen El control municipal externo que ejercen los Tribunales de Cuentas permite, a través de la divulgación de informes de auditoría, conocer las irregularidades encontradas en las cuentas de los gobiernos municipales. Estas han sido analizadas empíricamente, desde el punto de vista de su clasificación en términos de gravedad, pero existen pocos estudios que tengan como objetivo identificar los factores que influyen en tales fallas. Verificada esta brecha, el objetivo principal de este estudio es identificar factores que puedan influir en las fallas en la gestión pública municipal señalados por la auditoría del Tribunal de Cuentas. Este artículo contribuye a profundizar en la investigación sobre este tema y a mejorar la gestión en los municipios. Se trata de un análisis exploratorio, basado en modelos econométricos para datos de panel. La muestra incluye 179 municipios de São Paulo, con datos de los años 2011, 2013, 2015, 2017 y 2019. Los resultados sugieren que las recomendaciones y determinaciones del Tribunal de Cuentas, así como las lagunas en los controles internos, influyen en las irregularidades en los municipios, pequeños, medianos y grandes. El volumen de transferencias legales y constitucionales recibidas influye en los municipios pequeños y medianos, mientras que el producto interno bruto (PIB) municipal influye en los municipios medianos.

Abstract The municipal external control exercised by the Courts of Accounts reveals the irregularities found in the accounts of municipal governments through the disclosure of audit reports. They have been empirically analyzed from the point of view of their classification in terms of severity, but few studies aim to identify the factors that influence such failures. Having verified this gap, the main objective of this study is to identify factors that may influence lapses in municipal public management pointed out by the audit of the Court of Accounts. This article contributes to further research on this topic and to improving management in municipalities. This is an exploratory analysis based on econometric models for panel data. The sample includes 179 municipalities in São Paulo, with data for 2011, 2013, 2015, 2017, and 2019. The results suggest that the recommendations and determinations of the Court of Accounts and gaps in internal controls influence irregularities in small, medium, and large municipalities. The volume of legal and constitutional transfers received influences small and medium-sized municipalities, while the municipal gross domestic product (GDP) influences medium-sized municipalities.

Maltrato a estudiantes de medicina del Paraguay en 2022: encuesta multicéntrica

Introducción: los estudiantes de medicina son propensos a recibir maltratos de sus colegas, personal administrativo y pacientes. Objetivo: determinar las características del maltrato a estudiantes de medicina del Paraguay en 2022. Metodología: se aplicó un diseño observacional, de corte transversal. Se incluyó a estudiantes de medicina, de ambos sexos, que aceptaban participar de la encuesta telemática. El muestreo fue por conveniencia. Se midieron variables demográficas. La percepción del maltrato fue evaluada según cuatro componentes (psicológico, físico, académico y sexual) utilizando el cuestionario de Munayco-Guillén F et al, previamente validado. El estudio contó con la aprobación del Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: el cuestionario fue contestado por 214 estudiantes, siendo 146 mujeres (edad media 24 ± 3 años) y 68 varones (edad media 25 ± 5 años). La mayoría reside en Asunción (29,4%) y asiste a universidades privadas (92%). La media ± DE del maltrato psicológico fue 1,89 ± 1,02, la del físico fue 1,64 ± 0,89, la del académico fue 2,01 ± 1,11 y la del sexual fue 1,4 ± 0,83. Aplicando puntos de corte en los percentiles 60 y 70, el maltrato fue leve en 126 estudiantes (58,9%), moderado en 24 (11,2%) y grave en 64 (29,9%). El motivo principal para no denunciarlo fue el miedo a ser señalado por los demás o recibir represalias (17,3%). Discusión: se detectó maltrato leve en 58,9%, moderado en 11,2% y grave en 29,9% de los estudiantes de medicina. Se requiere aplicar medidas de prevención y contención de los maltratos.

Introduction: medical students are prone to mistreatment from their colleagues, administrative staff, and patients. Objective: to determine the characteristics of the mistreatment of medical students in Paraguay in 2022. Method: an observational, cross-sectional design was applied. Medical students of both sexes who agreed to participate in the online survey were included. Sampling was for convenience. Demographic variables were measured. The perception of abuse was evaluated according to four components (psychological, physical, academic, and sexual) using the previously validated questionnaire by Munayco-Guillén F et al. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: the questionnaire was answered by 214 students, 146 being women (mean age 24 ± 3 years) and 68 men (mean age 25 ± 5 years). The majority reside in Asunción (29.4%) and attend private universities (92%). The mean ± SD of psychological abuse was 1.89 ± 1.02, physical abuse was 1.64 ± 0.89, academic abuse was 2.01 ± 1.11, and sexual abuse was 1.4 ± 0. 83. Applying cut-off points at the 60th and 70th percentiles, the abuse was mild in 126 students (58.9%), moderate in 24 (11.2%), and severe in 64 (29.9%). The main reason for not reporting it was fear of being singled out by others or receiving reprisals (17.3%). Discussion: mild abuse was detected in 58.9%, moderate in 11.2%, and severe in 29.9% of medical students. It is necessary to apply measures to prevent and contain abuse.

Panorama das denúncias e processos éticos odontológicos no estado de Santa Catarina / Overview of dental complaints and ethical proceedings in the State of Santa Catarina

O Código de Ética Odontológica pode ser entendido como um conjunto de normas de comportamento que se estabelecem no desenvolvimento do exercício profissional e regem a sua prática. Com isto, almeja-se evidenciar a natureza ética do trabalho e garantir valores importantes para a sociedade no contexto da prática profissional. O objetivo deste estudo foi verificar as denúncias e processos éticos no Conselho Regional de Odontologia de Santa Catarina (CRO-SC), relacionando-os às suas causas. A pesquisa, após a aprovação pelo Comitê de Ética em Pesquisa da UFSC, apurou as denúncias e os processos éticos instaurados junto ao CRO-SC no período de janeiro de 2013 a dezembro de 2017, verificando sua evolução, identificando suas motivações e averiguando as respectivas situações processuais. Os resultados obtidos mostraram um aumento de 7,1% para 60,7% nas denúncias e de 6,2% para 58,4% nos processos éticos. A maior causa de denúncias foi devido à publicidade irregular (65%), originando 68% dos processos éticos com base nesta irregularidade; 39,2% das denúncias resultaram na abertura de processos éticos; 17% foram arquivadas; 21,3% dos processos éticos instaurados foram encerrados, por julgamento ou arquivamento, e 74,7% estão em tramitação. Cerca de 20,3% das denúncias foram classificadas como outras infrações; 4,8% como exercício ilegal da profissão, 2,4% como exercício irregular da profissão e 7,4% como provável erro técnico. Os resultados indicam a importância de uma mudança na visão do cirurgião-dentista em relação aos valores éticos e sociais na Odontologia a fim de conduzir seu trabalho sob uma perspectiva mais humanizada.

The Code of Dental Ethics can be understood as a set of behavioral norms that are established in the development of professional practice and govern its practice. With this, it aims to highlight the ethical nature of work and ensure important values for society in the context of professional practice. The purpose of this study was to verify the complaints and ethical processes in the Regional Dentistry of Santa Catarina (CRO-SC), relating them to their causes. The research, after approval by UFSC's Research Ethics Committee, found the complaints and the ethical processes established with the CRO-SC from January 2013 to December 2017, verifying their growing, identifying their motivations and ascertaining the respective procedural situations. The results obtained showed an increase from 7.1% to 60.7% in complaints and from 6.2% to 58.4% in ethical processes. The main cause of complaints was due to irregular advertising (65%), resulting in 68% ethical processes based on this irregularity; 39.2% of the complaints resulted in the opening of ethical processes; 17% were archived; 21.3% of the ethical proceedings initiated were closed by judgment or filing, and 74.7% are in progress. About 20.3% of the complaints were classified as other infringements; 4.8% as illegal exercise of profession, 2.4% as exercise irregular profession and 7.4% as a probable technical error. The results indicate the importance of a dentist's view of the ethical and social values in dentistry in order to conduct their work from a more humanized perspective.

Faltas frecuentes a la Ley 576 de 2000 presentadas al Tribunal de Ética Profesional de Medicina Veterinaria y Zootecnia en Colombia durante el periodo 2014-2017 / Frequent Infringements of Law 576 of 2000 Presented to the Tribunal of Professional Ethics Veterinary Medicine and Zootechnics in Colombia during the 2014-2017 Period / Ofensas frequentes à Lei 576 de 2000 submetidas ao Tribunal de Ética Profissional de Medicina Veterinária e Zootecnia na Colômbia durante o período 2014-2017

Resumen La medicina veterinaria como profesión en Colombia se remonta a 1884. En 1985 se conformó el Consejo Profesional de Medicina Veterinaria y Zootecnia y Zootecnia de Colombia (Comvezcol), y posteriormente, mediante la Ley 576 de 2000, se creó el código de ética para el ejercicio profesional de la medicina veterinaria, medicina veterinaria y zootecnia y zootecnia, así como el Tribunal Nacional de Ética Profesional (Trinadep), con el fin de tramitar las quejas, adelantar investigaciones e instruir las acciones disciplinarias contra los profesionales de las ciencias animales. En Colombia no se han encontrado reportes que permitan realizar un análisis de las faltas al código de ética, por lo cual en este artículo se busca describir las faltas más frecuentes denunciadas en el periodo 2014-2017. Para ello se realizó un estudio retrospectivo de las sanciones impuestas por el Trinadep por infracción de la Ley 576 de 2000. Según los datos obtenidos durante el periodo de estudio, se sancionaron 96 profesionales, de los cuales el 53,13 % fueron médicos veterinarios, y el 42,71 % fueron médicos veterinarios zootecnistas. Se observó una mayor tasa de infracción en hombres (75 %). Los artículos 5 (22,3 %), 13 (20,56 %), 61 (19,51 %), 27 (12,2 %) y 20 (9,06 %) fueron los que más se infringieron. Estos datos permiten concluir que es necesaria la concientización de estudiantes y profesionales en algunos aspectos del desempeño profesional, como lo son el diligenciamiento adecuado de la historia clínica y los consentimientos informados, el uso debido de ayudas diagnósticas y el uso de terapéuticas acordes con el individuo.

Abstract Veterinary medicine as a profession in Colombia dates back to 1884. In 1985, the Professional Council of Veterinary Medicine and Zootechnics of Colombia (Comvezcol) was formed, and subsequently, through Law 576 of 2000, the code of ethics for the professional practice of veterinary medicine and zootechnics was created, along with the National Tribunal of Professional Ethics (Trinadep), in order to process complaints, conduct investigations, and determine disciplinary actions against animal science professionals. In Colombia, no reports were found that would allow analyzing non-compliance with the code of ethics; consequently, this article seeks to describe the most frequent infringements reported in the period 2014-2017. To this end, a retrospective study of the sanctions imposed by Trinadep was carried out regarding non-compliance with Law 576 of 2000. According to the data obtained during the study period, 96 professionals were sanctioned; 53.13% of them were veterinarians, and 42.71% were zootechnical veterinarians. A higher rate of infraction was observed in men (75%). Articles 5 (22.3%), 13 (20.56%), 61 (19.51%), 27 (12.2%), and 20 (9.06%) were the most frequently infringed. These data allow concluding that it is necessary to raise awareness among students and professionals on some aspects of professional performance, such as the proper completion of clinical history and informed consents, the proper use of diagnostic aids, and the use of therapeutics in accordance with the individual.

Resumo A medicina veterinária como profissão na Colômbia remonta-se a 1884. Em 1985 conformou-se o Conselho Profissional de Medicina Veterinária e Zootecnia da Colômbia (Comvezcol), e posteriormente, mediante Lei 576 de 2000, foi criado o código de ética para a prática profissional da medicina veterinária e zootecnia, bem como o Tribunal Nacional de Ética Profissional (Trinadep), a fim de processar reclamações, conduzir investigações e instruir ações disciplinares contra profissionais das ciências animais. Na Colômbia não tem se encontrado relatórios que permitissem uma análise das violações do código de ética, pelo qual este artigo visa descrever as violações mais frequentes no período 2014-2017. Para isso, foi realizado um estudo retrospectivo das sanções impostas pelo Trinadep por violações da Lei 576 de 2000. De acordo com os dados obtidos durante o período de estudo, 96 profissionais foram sancionados, dos que 53,13% foram médicos veterinários e 42,71% foram médicos veterinários zootécnicos. Observou-se maior taxa de infracção em homens (75%). Os artigos 5 (22,3 %), 13 (20,56 %), 61 (19,51 %), 27 (12,2 %) e 20 (9,06 %) foram os mais violados. Estes dados permitem concluir que é necessária a sensibilização de alunos e profissionais em alguns aspectos do desempenho profissional, como são o preenchimento adequado da anamnese e o consentimento informado, o uso correto de auxílios diagnósticos e o uso de terapêuticas acordes com o indivíduo.

A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients.

BACKGROUND AND OBJECTIVE: In Spain, data suggest that 13.8% of adults have diabetes. Two important aspects in diabetes management are mild hypoglycemic episodes and poor treatment adherence. This study assesses the impact of missed insulin doses and prevalence of mistimed and reduced insulin doses and mild hypoglycemia in patients with type 2 diabetes treated with basal insulin analogues in Spain, and compares the data collected to pooled data from 8 other European countries (OECs). MATERIALS AND METHODS: GAPP2 was an international, online, cross-sectional study of diabetic patients aged ≥40 years treated with long-acting insulin analogues and their healthcare professionals. Patients and healthcare professionals were recruited from online research panels. Data reported in Spain are compared to pooled data from 8 OECs. RESULTS: In Spain, 1-3% of patients reported they had reduced, missed, or mistimed at least one insulin does in the previous month. Significantly more OEC patients reported dosing irregularities (15-23%; all P<0.01). In Spain, 77% of patients were worried and 59% felt guilty for missing a dose of basal insulin, while 24% reported that they were very worried about nocturnal hypoglycemia. Significantly fewer OEC patients reported worrying (47%; P<0.01) and feeling guilty (37%; P<0.01) about missing an insulin dose, or worry about nocturnal hypoglycemia (12%; P<0.01). CONCLUSIONS: In Spain, patients with type 2 diabetes report fewer dosing irregularities and hypoglycemic episodes as compared to patients from OECs. However, Spanish patients appear to have a reduced quality of life related to hypoglycemia as well as worry and guilt related to insulin dosing irregularities.

Não conformidades observadas em depósitos de hipermercados e supermercados da região leste do município de São Paulo / Non conformities observed in deposits of hypermarkets and supermarkets in the eastern region of the city of São Paulo

Manter um estoque de produtos pode trazer diversos benefícios ao estabelecimento, no entanto, o armazenamento realizado de forma inadequada pode causar danos à saúde e gerar insatisfação por parte do consumidor, bem como levar a perdas econômicas. Neste trabalho, foram levantadas as irregularidades verificadas nos depósitos, incluindo câmaras frias, de hipermercados e supermercados inspecionados por equipe da vigilância sanitária da região Leste do Município de São Paulo no período de 2011 a 2013. Verificou-se que as não conformidades mais comumente encontradas nos depósitos secos foram as más condições em que produtos impróprios para o consumo eram mantidos e, em câmaras frias, a ausência de planilhas de controle de temperatura dos equipamentos. Outras situações que infringem normas referentes às Boas Práticas de Fabricação e Manipulação de Alimentos foram observadas de forma expressiva nos estabelecimentos, como más condições de higiene ambiental, desorganização, disposição inadequada dos produtos e presença de pragas. Os resultados indicam que os cuidados higienicossanitários no armazenamento são tão importantes quanto nas etapas de fabricação e transporte para que não sejam comprometidas a qualidade e segurança dos produtos, devendo, para isso, ocorrer ações como capacitação contínua dos colaboradores e manutenção constante da estrutura física.

Storing products can bring many benefits to commercial establishments, however, storage made improperly may cause harm to healthy and bring insatisfaction by consumers, as well as leading to economic losses. In this work, were raised irregularities verified in deposits, including cold chambers of hypermarkets and supermarkets inspected by the health surveillance team of the east zone of São Paulo city from 2011 to 2013. It was found that the most common non compliances found in dry deposits were the bad conditions that unfit for consumption products were maintained and, in cold chambers, the absence of equipments temperature control spread sheets. Other situations that infringe Good Manufacturing Practices rules were observed meaningly in the establishments, such as bad hygiene conditions, disorganization, products improper arrangement and presence of pests. Results indicate that hygienic sanitary caution in storage is as important as at manufacture and transportation stages, so that products quality and safety is not compromised, shall, for that occur actions like continuous employee training and constant maintenance of physical infrastructure.

Caracterización de las mujeres maltratadas por su pareja desde la perspectiva de género / Gender Perspective Characterization of Women Battered by their Partners

Fundamento: el estudio de la violencia desde la perspectiva de género aporta una nueva lectura en el comportamiento de las mujeres que rompen o no con relaciones abusivas. Objetivo: caracterizar desde la perspectiva de género a las mujeres que han sido maltratadas por su pareja. Métodos: estudio descriptivo, realizado en el policlínico Área V del municipio Cienfuegos en el año 2010. Fueron estudiadas 21 mujeres que denunciaron el delito y 42 maltratadas que no lo denunciaron, pertenecientes al mismo consultorio. Las variables analizadas fueron: edad, nivel educacional, color de la piel, tipología de la violencia, móvil para denunciar o no, tipificación, estereotipo, identidad y roles de género, tiempo de la relación violenta, percepción del apoyo de los grupos mediatizadores y del equipo básico de salud, reacciones emocionales y trastornos psicofisiológicos. Resultados: al analizar las variables para cada grupo, no se encontraron diferencias significativas en cuanto a las características identificativas, tiempo de la relación violenta y percepción del apoyo del equipo básico de salud. Sí fueron significativas estadísticamente las diferencias halladas con respecto al tipo de violencia, identidad genérica, patrones estereotipados, desempeño de roles, reacciones emocionales negativas, y percepción de los grupos mediatizadores. Conclusiones: el maltrato conyugal repercute de manera negativa en la salud de las mujeres que sufren de violencia íntima, fundamentalmente en las que no denuncian el delito.

Background: The study of violence from a gender perspective provides a new approach on the behavior of women who decide to end or sustain abusive relationships. Objective: To characterize, from a gender perspective, women who have been battered by their partners. Methods: A descriptive study was conducted in the Area V Polyclinic of Cienfuegos in 2010 including 21 women who reported the crime and 42 battered women who did not denounced it, both groups belonging to the same consultation area. The variables analyzed were age, educational level, skin color, type of violence, mobile to make or not the report, characterization, stereotypes, gender identity and roles, lasting time of the violent relationship, perception of the support of mediating groups and basic health team and emotional and psychophysiological reactions. Results: By analyzing these variables for each group, no significant differences were found in terms of the identifying features, lasting time of the violent relationship and perceived support of the basic health team. Differences found in respect to the type of violence were indeed statistically significant, as well as those in gender identity, stereotyped patterns, roles playing, negative emotional reactions, and perceptions of mediating groups. Conclusions: Partners abuse has a negative impact on the health of women experiencing intimate violence, basically in the cases of those who do not report the crime.

Características de los casos juzgados en el Tribunal de Ética Médica de Santander, Colombia, desde la promulgación de la Ley 100 de 1993 / Characteristics about judged medical cases in the Tribunal for Medical Ethics, Santander-Colombia, since the enactment of the Law 100th, 1993

Introducción y objetivos:Desde la promulgación de la Ley 100, de 1993, los usuarios del nuevo Sistema General de Seguridad Social en Salud aumentaron el conocimiento de sus derechos, por ende exigen mejor calidad y cumplimiento en estos servicios por parte de los profesionales de la medicina. El objetivo es identificar las características de los casos demandados ante el Tribunal Ética Médica Santander (TEMS). Metodología: Estudio descriptivo transversal aleatorizado con una muestra de 120 casos. La información fue captada y revisada por un miembro del TEMS, la cual se transcribió sin elementos de identificación de los implicados. Las variables estudiadas incluyen la descripción del demandante, del demandado y la resolución del proceso. Resultados: Se revisaron 136 casos radicados en el TEMS desde 1994 hasta 2009. El 56.6% de los afectados fueron mujeres, y el 47.1% de las demandas fueron remitidas al TEMS por un ente judicial. El 83.1% de los demandados fueron hombres, con una media de 42.12 años, de ellos el 37.5% no tenía especialidad. El tiempo entre la ocurrencia de los hechos y la radicación en el TEMS fue de 244 días en promedio; entre la radicación y el pronunciamiento fue de 761 días en promedio. El 89.5% fue acusado por infringir los artículos de la relación médico-paciente. En el pronunciamiento el 72.7% de los casos fueron absueltos por falta de méritos y 16.2% recibió condena. Conclusiones: Es relevante que se analice la relación médico-paciente y se fortalezcan las acciones de concientización sobre la integridad profesional. Así mismo, es importante revisar las características del procesamiento de los casos. [Rodríguez A, Cadena LP. Características de los casos juzgados en el Tribunal de Ética Médica de Santander, Colombia, desde la promulgación de la Ley 100 de 1993. MedUNAB 2012; 15(3):137-143].

Objective: In 1993 the Colombian government enacted a law concerning Health management by public and private institutions. We intend, in this study, identify the reasons why the doctors underwent lawsuits directed to the Medical Tribunal, beginning in 1994, the year the new Health Law was enforced. Methodology: A descriptive randomized transversal study of 136 medical lawsuits directed to the Medical Tribunal. All the information was revised by one member this study. None of the persons involved in the malpractice lawsuit was identified. The variables analyzed included the characteristics of the Defendant, the Plaintiff, the subpoena subject and process outcome. Results: Medical Tribunal Files, ranging from 1994 through 2009 were thoroughly revised. 56.6% of the alleged victims were women and 47.1% of the malpractice claims came from different sources others than their own. 83.1% of the doctors that underwent a lawsuit were male, with an average age of 42.1 years. 37.5% were generalist doctors. The average time taken for a medical lawsuit to be registered before the Medical Tribunal was 244 days, and the average time taken for the Medical Tribunal to provide the final pronouncement was about 761 days. The most common cause for a malpractice lawsuit was found to be the breaking of doctor-patient relationship. 72.7 of the doctors that underwent a lawsuit were found to be no-guilty and 16.2% were found to be guilty. Conclusions: It is very important for doctors to build a strong relation and empathy with their patients. Doctors need to be cautious with the medical or surgical procedures they perform on for their patients. Asuitable Medical Consent has to be taken for all surgical and special medical treatments. Finally doctors need to select a proper medical procedure in a prompt manner and using an accurate treatment. [Rodríguez A, Cadena LP. Characteristics about judged medical cases in the Tribunal for Medical Ethics, Santander-Colombia, since the enactment of the Law 100th, 1993. MedUNAB 2012; 15(3):137-143].

A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence / Uma abordagem racional do diagnóstico da síndrome dos ovários policísticos na adolescência

Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.

A síndrome dos ovários policísticos (SOP) é uma desordem que afeta pacientes por toda a vida e é caracterizada por hiperandrogenismo e disfunção ovariana, com um amplo leque de sintomas e sinais clínicos. Três diferentes conjuntos de critérios diagnósticos foram estabelecidos para definir essa doença em mulheres adultas, mas existem controvérsias relacionadas ao uso desses critérios na adolescência. Durante a puberdade, o critério de disfunção ovariana usado em adultos não parece aplicável, porque um padrão menstrual irregular e uma menor taxa de ovulação são eventos fisiológicos nesse período da vida. Além disso, uma maior prevalência de morfologia ovariana policística (MOP) pode ser observada nesse período, de forma que a MOP não é um critério útil para se definir a SOP em mulheres jovens. Esses achados sugerem que o hiperandrogenismo é um fator-chave para o diagnóstico da SOP na adolescência. Além disso, como a MOP não está claramente associada com o hiperandrogenismo durante esse período da vida, o termo "síndrome dos ovários policísticos" durante a adolescência cria confusão e pode ser errôneo.

Meiose e viabilidade polínica em acessos de Capsicum annuum e Capsicum baccatum / Meiosis and pollen viability in accessions of Capsicum annuum and Capsicum baccatum

O objetivo deste trabalho foi estudar o comportamento meiótico e a viabilidade polínica em quatro acessos das espécies Capsicum annuum e Capsicum baccatum. Em todos os acessos, foram observados 12 bivalentes, confirmando o número e nível de ploidia relatados na literatura para essas espécies. Os resultados mostraram uma divisão celular normal, porém algumas anormalidades foram detectadas, tais como migração precoce dos cromossomos em metáfases I e II, cromossomos retardatários em anáfase I e divisão assincrônica. Os acessos estudados apresentaram um índice meiótico variando de 75,6 a 93,6 por cento, e a viabilidade polínica em todos os acessos foi superior a 90 por cento, demonstrando que as irregularidades meióticas observadas não comprometeram a viabilidade destes.

The objective of this research was to study the meiotic behavior and pollen viability in four accessions of species Capsicum annuum and Capsicum baccatum. In all accessions, twelve bivalents were observed, confirming the number and ploidy level reported in the literature for these species. The results showed a normal cell division although some abnormalities had been detected, as early chromosome migration at metaphases I and II, later chromosomes at anaphase I and asynchronous division. The studied accessions presented a meiotic index (MI) that varied from 75.6 to 93.6 percent and the pollen viability in all accessions was higher than 90 percent, demonstrating that the meiotic irregularities observed didn't affect their viability.

Irregularidades menstruales y de hormonas sexuales en mujeres que se les diagnosticó la diabetes tipo 1 antes de la menarquia o después de esta / Menstruation disorders and sexual hormones in women diagnosed with type 1 diabetes before menarche or after it

INTRODUCCIÓN: la diabetes mellitus tipo 1 es una enfermedad crónica, cada vez más frecuente, que afecta todo el organismo. El conocimiento de la función del eje gonadal en diabéticos, hoy día gana mayor importancia, no solo por la repercusión de esta enfermedad en la salud reproductiva. OBJETIVO: identificar la frecuencia de irregularidades menstruales, determinar los niveles de hormonas sexuales y establecer la influencia de esta enfermedad sobre la edad de la menarquia. MÉTODOS: se realizó un estudio descriptivo transversal a 74 mujeres con edades entre 15 y 35 años, todas atendidas en el Centro de Atención al Diabético de Ciudad de La Habana, Cuba. Distribuidas en 2 grupos: A y B, ambos con n= 37; A: diagnosticadas como diabéticas antes de la presentación de la menarquia y B: posterior a esta. Se confeccionó un cuestionario de datos generales e historia clínica puberal y menstrual; se determinó glucemia en ayunas, hemoglobina glucocilada y hormonas sexuales; se compararon los grupos mediante la t de Student y chi cuadrado. RESULTADOS: se obtuvo una elevada frecuencia de dismenorrea, menorragia y tensión premenstrual, además de la pérdida de correlación entre algunas hormonas sexuales. La presencia más temprana de diabetes mellitus tipo 1 determinó mayor edad de la menarquia, niveles más bajos de gonadotropinas (LH y FSH) y oligoamenorrea. CONCLUSIONES: que la diabetes mellitus tipo 1 diagnosticada antes de la menarquia parece interferir en la maduración y función posterior del eje gonadal femenino, lo cual condiciona más frecuencia de dismenorrea e irregularidades menstruales(AU)

INTRODUCTION: type 1 diabetes mellitus is a chronic disease frequent and frequent affecting the entire organism. Knowledge on gonadal axis function in diabetic persons nowadays has a great significance, not only due the repercussion of this disease in reproductive health. OBJECTIVE: to identify the menstrual irregularities frequency, to determine the sexual hormones levels and to establish the influence of this entity on the menarche age. METHODS: a cross-sectional descriptive study was conducted in 74 women aged 15 and 35, all seen in the Diabetes Care Center of Ciudad de La Habana, Cuba, which were distributed in two groups: A and B, both with n= 37; A: diagnosed with diabetes before the menarche appearance and B; after it. We designed a questionnaire of general data and puberal and menstrual medical records; we determined the presence of fasting glycemia, glycosylated hemoglobin and sexual hormones; both groups were compared using the t Student and chi2 tests. RESULTS: we achieved a high frequency of dysmenorrhea, menorrhhea and premenstrual tension, as well the loss of a correlation among some sexual hormones. Earlier presence of type 1 diabetes mellitus determined a greater age of menarche, lower levels of gonadotropins (LH and FSH) and oligomenorrhea. CONCLUSIONS: type 1 diabetes mellitus diagnosed before menarche seems to interfere with maturation and subsequent function of female gonadal axis, which conditioned a greater frequency of dysmenorrhea and menstrual irregularities(AU)

Irregularidades del borde endocárdico en el síndrome antifosfolípido / Irregularities of the endocardial edge in the antiphospholipid syndrome

Se presentó un paciente que ingresó en el Hospital Hermanos Ameijeiras con diagnóstico de síndrome antifosfolípido primario, y antecedentes de trombosis venosas profundas en miembros inferiores en la juventud, hipertensión pulmonar severa, insuficiencia tricuspídea severa, hepatopatía y colecistopatía crónica que en el ecocardiograma transtorácico de alta resolución, detectamos irregularidades en el borde endocárdico que semejaba cilios que se proyectan hacia cavidad libre ventricular, situados sobre la superficie del ventrículo izquierdo que anatómicamente es más lisa al nivel de la pared libre y de tracto de salida del ventrículo izquierdo. La etiología pudiera estar relacionada con la actividad autoinmune de los anticuerpos antifosfolípidos sobre esta superficie que provocan dichas irregularidades y que posteriormente pudieran ser los puntos de asientos de los múltiples trombos intracavitarios reportados en estos pacientes.

The case of a patient that was admitted in Hermanos Ameijeiras Hospital with primary antiphospholipid syndrome and history of deep venous thrombosis in the lower limbs during his youth, severe pulmonary hypertension, severe tricuspid insufficiency, hepatopathy and chronic colecystopathy was presented. In the high resolution tansthoracic echocadiogam, there were detected irregularities in the endocardial edge mimicking cilia that project towards the free ventricular cavity, located on the surface of the left ventricle,which is anatomically smoother at the level of the free wall and of the left ventricle outflow tract. The etiology may be related to the autoimmune activity of the antiphospholipid antibodies on this surface that cause these irregularities and that later could be the settlement sites of the multiple intracavitary thrombi reported in these patients.

Unidades de alimentação e nutrição hospitalares em cidades do Vale do Paraíba: avaliação das condições estruturais e higiênico-sanitárias / Food service hospital in cities of the Vale of Paraíba: evaluation the hygienic-sanitary conditions

O objetivo desta pesquisa foi avaliar as condições higiênico-sanitárias de Unidades de Alimentação e Nutrição (UAN) hospitalares públicas e privadas, em cidades do Vale do Paraíba com mais de cinqüenta mil habitantes. As UANs hospitalares foram caracterizadas através de inspeções, utilizando-se um checklist. Das 13 Unidades de Alimentação e Nutrição (UANs) hospitalares avaliadas 9 (69,2%) apresentaram condições inadequadas sob o ponto de vista higiênico-sanitário. Dentre as principais irregularidades estavam à freqüência e utilização de produtos inadequados para lavagem e antissepsia de mãos. As maiores inadequações apresentadas pelas UANs dos hospitais privados estavam relacionadas a processos e produtos, entre eles armazenamento incorreto dos diferentes gêneros alimentícios nos equipamentos de refrigeração; ausência de monitoração da temperatura dos alimentos frios; horário incorreto de colheita de amostras de refeições e ausência de identificação dos Pontos Críticos de Controle. Por outro lado em UANs dos hospitais públicos, as principais inadequações estavam relacionadas aos equipamentos e utensílios, entre eles: equipamentos em mau estado de funcionamento e de conservação; temperaturas inadequadas das câmaras frias e/ou refrigeradores; temperatura inadequada dos equipamentos do balcão quente. Pôde-se concluir que as condições higiênico-sanitárias da maioria das unidades de alimentação e nutrição dos hospitais públicos e privados avaliados, encontram-se inadequadas. As falhas apresentadas são consideradas críticas na produção do alimento seguro e podem comprometer a higiene dos alimentos e causar riscos à saúde.