IntroductionRheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process. The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations.MethodsThe station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with (...) clinically active nephritis about renal biopsy. A trained patient–actor and an evaluator were instructed to assess ICP skills in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form.ResultsCandidate performance varied with ICP content and was superior for potential benefit information but significantly reduced for potential complications and biopsy description. Only 17.8% of the candidates mentioned the legal perspective of ICP. Death was omitted by the majority of the candidates ; after the patient–actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior, but ≥1 negative aspect was identified in 69% of the candidates.ConclusionsEthical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency. (shrink)

Objetivo: El siguiente artículo tiene como propósito la revisión de la literatura existente cuyo enfoque sea las herramientas tecnológicas utilizadas para el abordaje del paciente con síntomas de salud mental, de manera virtual, para describir las ventajas, la eficacia, la efectividad y los beneficios de estas herramientas, a partir de la literatura encontrada. Métodos: se realizó una búsqueda en las bases de datos Pubmed, Elsevier, UpToDate, Journal of Medical Internet Research y Google Académico. Se identificó un total de 58 artículos (...) que versan sobre la eficacia y efectividad de las diferentes modalidades digitales (tales como aplicaciones, cuestionarios en línea, mensajes de texto, etc.) que tratan la salud mental. Resultados: la búsqueda realizada arrojó un total de 58 artículos. Tras la eliminación de duplicados, el número fue de 50 artículos. Después de la caracterización de la información basada en la revisión de la totalidad del contenido, fueron elegidos 30 artículos para que sirvieran como base para la construcción de la síntesis de datos. Conclusiones: las herramientas virtuales utilizadas en salud mental ofrecen un sin fin de beneficios para prestar un servicio con un acceso más sencillo a la población, de forma económica y efectiva, sin temor a que los pacientes sean estigmatizados al momento de buscar ayuda, como se pudo evidenciar en los artículos presentados. Además, las herramientas digitales utilizadas en psiquiatría han demostrado ser eficaces y seguras, sin embargo, son de reciente aparición y cuentan con una cantidad limitada de estudios que demuestren objetivamente su eficacia en esta área. (shrink)

IntroductionThe COVID-19 pandemic has forced changes in patient care in Mental Health Day Hospitals.ObjectivesTo study the interventions performed in MHDHs during the pandemic in comparison with those performed in other facilities and to analyze the new hospital admissions in both groups.MethodA retrospective multicenter cohort study comparing the interventions received by a group of 161 patients admitted in MHDHs during the lockdown period in Spain with the interventions of another group of 109 patients who were treated at other facilities during lockdown.ResultsMHDHs (...) reduced their face-to-face interventions during lockdown just as much as other facilities but implemented telematic intervention methods to a greater extent. Patients attached to MHDHs during lockdown were admitted significantly less and presented fewer urgent consultations in the following 6 months.ConclusionThe use of telepsychiatry made it feasible to adapt MHDHs to periods of lockdown, being useful to improve the continuity of care during the pandemic. In addition, it was possible to maintain a reduction in hospital admissions in patients treated at MHDHs. (shrink)

Chagas disease or American trypanosomiasis is an important health problem in Latin America. Due to the mobility of Latin American population around the world, countries without vector presence started to report disease cases. We developed a deterministic compartmental model in order to gain insights into the disease dynamics in a scenario without vector presence, considering congenital transmission and transmission by blood transfusion. The model was used to evaluate the epidemiological effect of control measures. It was applied to demographic data from (...) Spain and sensitivity analysis was performed on model parameters associated with control strategies. (shrink)

The aim of this paper is to analyze the philosophical arguments that underpin the four political transformations of Mexico. This analysis provides a detailed account of the difficulties Mexico has had for consolidating the principles of freedom and equality. In what follows, I track the origin of the Mexican left in the 19th century from authors, such as Ignacio Ramírez, to concerns that appear within two contrasting moral Cartillas, the first one written by Alfonso Reyes, and the second one, that (...) of Fourier, brought to Mexico by Plotinus Rhodakanaty. Subsequently, I propose a possible link between anarchism and the political and moral philosophy that underpins the ideology of Andrés Manuel López Obrador. I shall highlight the tensions within the ideology of the fourth transformation, especially those existing between government centralization and the weakening of some institutions, the latter, a premise inherited from the anarchist ideology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Meeting the Great Bliss Queen: Buddhists, Feminists, and the Art of the SelfBrian KarafinMeeting the Great Bliss Queen: Buddhists, Feminists, and the Art of the Self. By Anne Carolyn Klein. Boston: Beacon, 1995. 307 pp.“When the iron bird flies and carriages run on wheels, the dharma will come to the land of the red man”: this saying attributed to the semilegendary founder of Buddhism in Tibet, Padmasambhava, stands as (...) an oft-cited marker for the sense that the meeting between Tibetan Buddhism and North American culture was somehow a [End Page 227] fated one, a confluence emergent from some karmic relationship or mythical dependent-arising. Karmic connection or historical product of the near-simultaneous exile of Tibetans from their homeland in 1959 and the burgeoning of Western interest in Eastern religions and philosophies, the encounter of these two mutually and exotically other traditions is, nearing the second Christian millennium, proceeding apace. Especially since the 1989 awarding of the Nobel Peace Prize to the spiritual and temporal leader of the Tibetans—and now international pop icon—the Fourteenth Dalai Lama, the Western fascination for things Tibetan has exponentially increased, transforming what had been the preserve of scholars and eccentric spiritual seekers into a media sensation.The reception of Tibetan Buddhism in the West has proceeded in stages and phases that overlap and mutually affect each other, from pop phantasms of Tibet as a mythical Shangri-La (as in James Hilton’s Lost Horizon) and theosophical hopes in Tibet as the domain of the Wise Mahatmas overseeing the spiritual evolution of humanity to the relatively recent development of Tibetan studies as an academic discipline centered on the translation of texts, as well as the growing population of westerners practicing Tibetan Buddhist religion under the guidance of exiled lamas. With these latter two groups—scholars and practitioners who often overlap memberships—the phenomenon of Tibetan Buddhism in the West has reached a point where critical self-reflection is now possible. Donald Lopez’ recent Prisoners of Shangri-La: Tibetan Buddhism and the West is the first full-length critical examination of the cultural confluence I’ve been noticing thus far. Lopez represents a movement in the field of Tibetan studies from philological scholarship of texts, in which the scholarly effort consists largely of translation along with commentary that closely follows the commentarial literature of the Tibetan tradition being translated, to cultural criticism of the underlying dynamics in the encounter itself.This critical self-consciousness in the field of Tibetan studies is likewise the motivating impetus behind Anne Klein’s recent work as represented by the book under review here. Klein, like Lopez, was a student of the dean of American Tibetan studies, Jeffrey Hopkins, at the University of Virginia. As such, her early work followed Hopkins in pursuing an essentially philological approach to Tibetan tradition with a focus on the philosophical scholasticism of the Gelukpa lineage. Klein’s three philological-philosophical books—Knowledge and Liberation; Knowing, Naming, and Negation; and Path to the Middle—are excellent examples of the genre of translation/commentary above mentioned, treating the Sautrantika and Madhyamika tenet systems in which the Gelukpa tradition systematized Indian Buddhist philosophy for the purposes of monastic study and debate. Meeting the Great Bliss Queen is something else entirely; in this work Klein blazes a trail out from recondite translation work toward cultural critique and psychosocial self-reflection in which the previously submerged subtext of the encounter between the Tibetan tradition and the Western psyche and society is allowed to surface and its issues probed and reflected upon.Klein frames her work in terms of a dialogue between Buddhism (by which she mainly means meditation practices and some associated philosophy) and feminism (by which she means both academic feminist theory and her own autobiographical [End Page 228] experience as a Western woman personally experiencing the confluence of Western and Tibetan exigencies). Klein is a salient example of a scholar-practitioner, someone who occupies positions both in the academic field of Tibetan studies and in the population of students of Tibetan lamas in exile. As such, she is exactly situated to embark on such a project of cultural and psychological reflection. She knows... (shrink)