Archive for 28 febrero 2011

Investigación participativa con pueblos originarios

febrero 28, 2011

Hace mucho que insistimos con esta propuesta. Y puede hacerse, si hay voluntad para ello.

A process for the inclusion of Aboriginal People in health research: Lessons from the Determinants of TB Transmission project.

Jody Boffa, Malcolm King, Kathleen McMullin, Richard Long.

Social Science & Medicine 72 (2011) 733-738

Mail: richard.long@ualberta.ca

“Introduction
It has been 10 years since Smith (1999) wrote that “research is probably one of the dirtiest words in the Indigenous world’s vocabulary” (p.1), and great strides have been made to repair its image.
Aboriginal research organizations have developed at universities in a number of countries, Aboriginal researchers are more often involved in the research, and Indigenous Peoples’ Health has been recognized as a human right through the Health and Human Rights Team of the World Health Organization. In 2006, when the Determinants of TB Transmission (DTT) project began, the Institute of Aboriginal Peoples’ Health (IAPH – one 13 CIHR institutes) had just released its draft Guidelines for Health Research Involving Aboriginal People (CIHR, 2007). These along with other international guidelines, for example those  of  the  National  Health  and  Medical  Research  Council  of Australia (2003) and the Health Research Council of New Zealand
(2010),  reflect the principles of  Ownership,  Control,  Access  and Possession (“OCAP”) described by Schnarch, 2004. In this seminal work, which he describes as a “wake up call for researchers” (p.80), he highlights six common themes put forth in First Nations-driven policy documents to ensure relevance and usefulness to communities:
 Research should provide clear benefit to First Nations Peoples and Communities
 Research should help develop capacity in meaningful ways
 Research should increase First Nations control of information and research processes
 Research should respect sovereignty/jurisdiction/rights of First Nations
 Research should support self-determination
 Research should support cultural preservation and development”

La conclusión es que este tipo de trabajo es más dificultoso pero que puede hacerse.

Trabajo interesante sobre el ajuste de expectativas

febrero 26, 2011

Uno se pregunta qué valor real tienen las declaraciones de voluntad anticipadas, al ver que las personas reajustan sus expectativas cuando les sucede una desgracia grave, con respecto a las que tenían antes de que ésta les ocurriera. Este ajuste, al disminuir la diferencia entre realidad presente y expectativas, mejora la calidad de vida.

En el trabajo “A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority” Bruno et al. estudian 65 personas con locked-in syndrome. Los resultados son bastante sorprendentes, y vale la pena incorporarlos a los debates sobre decisiones anticipadas, suicidio asistido, eutanasia, etc. Préstese atención al lapso de un año que parecería tardar la adaptación.

Abstract

Objectives Locked-in syndrome (LIS) consists of anarthria and quadriplegia while consciousness is preserved. Classically, vertical eye movements or blinking allow coded communication. Given appropriate medical care, patients can survive for decades. We studied the self-reported quality of life in chronic LIS patients.

Design 168 LIS members of the French Association for LIS were invited to answer a questionnaire on medical history, current status and end-of-life issues. They self-assessed their global subjective well-being with the Anamnestic Comparative Self-Assessment (ACSA) scale, whose +5 and −5 anchors were their memories of the best period in their life before LIS and their worst period ever, respectively.

Results 91 patients (54%) responded and 26 were excluded because of missing data on quality of life. 47 patients professed happiness (median ACSA +3) and 18 unhappiness (median ACSA −4). Variables associated with unhappiness included anxiety and dissatisfaction with mobility in the community, recreational activities and recovery of speech production. A longer time in LIS was correlated with happiness. 58% declared they did not wish to be resuscitated in case of cardiac arrest and 7% expressed a wish for euthanasia.

Conclusions Our data stress the need for extra palliative efforts directed at mobility and recreational activities in LIS and the importance of anxiolytic therapy. Recently affected LIS patients who wish to die should be assured that there is a high chance they will regain a happy meaningful life. End-of-life decisions, including euthanasia, should not be avoided, but a moratorium to allow a steady state to be reached should be proposed.

BMJ Open
A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority
OPEN ACCESS

  1. Marie-Aurélie Bruno1,
  2. Jan L Bernheim2,
  3. Didier Ledoux1,
  4. Frédéric Pellas3,
  5. Athena Demertzi1,
  6. Steven Laureys1

En http://bmjopen.bmj.com/content/early/2011/02/16/bmjopen-2010-000039.full

Medicina Social Vol 5, No 3

febrero 1, 2011

Vol 5, No 3 (2010)

Tabla de contenidos

Editoriales

¿Pueden los seguros garantizar el acceso universal a los servicios de salud? Resumen PDF
Asa Cristina Laurell 184 – 185
Acerca de deudas malvadas y de responsabilidad global. El ejemplo haitiano muestra cómo un sistema de deudas externas empuja a un pueblo desprotegido a una catástrofe Resumen PDF
Thomas Gebauer 186 – 188
Von bösen Schulden und globaler Verantwortung. Das Beispiel Haiti zeigt, wie das System der Auslandsschulden die Menschen schutzlos einer Katastrophe ausliefert Resumen PDF
Thomas Gebauer 189 – 191

Investigación Original

Participación multisectorial en la respuesta nacional para la prevención y atención a la epidemia del VIH/SIDA, República de Cuba, 2007-2008 Resumen PDF
Isora Ramos Valle, Isabel Louro Bernal, Ana Teresa Farinas Reinoso, Susana Llanuso, Nereida Rojo Pérez 192 – 202
Los usuarios con osteoartrosis de rodilla, UNISALUD, Colombia: una mirada desde la epidemiología crítica Resumen PDF
Diana Camargo Rojas, Beatriz Mena Bejarano 203 – 214
La unidad de reducción de daños de la ciudad de Santo André, Sao Paolo, Brasil: una evaluación Resumen PDF
Silvia Moreira Silva Moreira Silva, Cássia Baldini Soares Baldini Soares, Vilmar Ezequiel Santos Ezequiel Santos 215 – 221

Medicina Social en la Práctica: Estudios de Casos de Activismo en Salud

Guatemala: un análisis de los obstáculos para un acceso universal en salud. Cientos de personas viviendo con VIH / SIDA caen entre las fracturas del sistema cada mes Resumen PDF
Richard Stern, Lidice Lopez Tocon 222 – 231

Temas y Debates

Después de la revolución: un modelo fantaseado de la atención sanitaria Resumen PDF
Matt Dumont 232 – 234

Noticias y eventos

Publicación de la serie de cinco volúmenes: La medicina social en México Resumen PDF
Florencia Peña, Beatriz León Parra 235 – 240