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Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
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Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
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Badu IK, Asante D, Agyemang ED, Kwaku Duah K, Adokoh CK, Girela-Lopez E. Diatoms in maggots; a potential tool for drowning diagnosis - A preliminary study. Med Sci Law 2024:258024241241374. [PMID: 38557251 DOI: 10.1177/00258024241241374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Advanced putrefaction causes extensive loss of soft tissue, rendering it difficult to use the diatom test as a reliable diagnostic tool for drowning investigations. A positive diatom test in carrion insect larvae may provide significant assistance in overcoming the challenge of decomposition. The studies determined the utility of diatom test in carrion larvae on severely decomposed bodies. A modified acid digestion method involving nitric acid, K2Cr2O7 and HCl, was used to digest the blowfly larvae feeding on piglet carrion previously drowned in freshwater and sea water, respectively. Extracted diatom frustules were analysed and characterised using light microscopy coupled to a digital camera. Diatoms recovered from maggots on sea-drowned piglets were similar to diatoms from sea water (drowning medium). Centric diatoms recovered in maggots were higher (200 ± 60 diatoms/ mL) than pennate diatoms (80 ± 20 diatoms/mL). Isolated diatoms common to both maggots and water samples included Coscinodiscus sp. and Navicular spp. Albeit, there were no diatoms recovered from maggots on freshwater-drowned piglets. The findings of this study suggest that the diatom test is still a reliable diagnostic tool to determine if drowning was involved in the death of a fully decomposed body. This is the first study that isolated diatoms from maggots feeding on drowned bodies. It serves as the basis for further research into the utility of maggots for drowning investigations.
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Affiliation(s)
- I K Badu
- Department of Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - D Asante
- Department of Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - E D Agyemang
- Department of Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - K Kwaku Duah
- Department of Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - C K Adokoh
- Department of Forensic Sciences, University of Cape Coast, Cape Coast, Ghana
| | - E Girela-Lopez
- Section of Legal and Forensic Medicine, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
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Seco-Calvo J, Lantaron E, Martinez J, Escobar G, Esteve E, Franco-Sierra M, Garcia P, Girela-Lopez E, Gomez M, Barbero F, Lopez D, Lopez S, Martinez B, Dominguez A, Salvat I, Perez S, Medrano E. Spanish version of the Dundee Ready Education Environment Measure (DREEM) applied to undergraduate physical therapy students in Spain using Google Form. Med Teach 2023; 45:119-120. [PMID: 35439105 DOI: 10.1080/0142159x.2022.2058923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | | | | | | | | | | | - Pablo Garcia
- Universidad Complutense de Madrid, Plaza Ramon y Cajal, Madrid, Spain
| | - Eloy Girela-Lopez
- Universidad de Cordoba Facultad de Medicina y Enfermeria, Sección de Medicina Legal y Forense, Cordoba, Spain
| | | | | | | | | | | | - Ana Dominguez
- Universidad Europea Miguel de Cervantes, Health Sciences, Valladolid, Spain
| | | | | | - Esther Medrano
- Universidad Europea Miguel de Cervantes, Health Sciences, Valladolid, Spain
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Vallejo Valdivieso PA, Zambrano Pincay GH, Beltran-Aroca CM, Girela-Lopez E. Relationship between Child Abuse and Delinquent Behavior in Male Adolescents Deprived of Liberty. Int J Environ Res Public Health 2022; 19:16666. [PMID: 36554547 PMCID: PMC9779293 DOI: 10.3390/ijerph192416666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED The objective is to identify the prevalence of child abuse and criminal behavior among young male prisoners in Ecuador. METHOD A total of 425 young people between 12 and 18 years of age, deprived of liberty from different centers for adolescent offenders in Ecuador, were used. The level of abuse to which they had been subjected in childhood was evaluated, as well as the risk factors present in their history. The relationship between abuse, risk factors, and criminal behavior was analyzed. RESULTS A high prevalence of the different types of abuse was found in the mean age of 15.03 years standard deviation (SD = 1.34). CONCLUSION In addition, a relationship was discovered between the abuse suffered during childhood and the risk factors present in criminal behavior during adolescence, which was demonstrated in this article. The practical implications of these results are discussed, taking into consideration their relevance for prevention.
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Affiliation(s)
| | | | - Cristina M. Beltran-Aroca
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Cordoba, 14004 Cordoba, Spain
| | - Eloy Girela-Lopez
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Cordoba, 14004 Cordoba, Spain
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Beltran-Aroca CM, Labella F, Font-Ugalde P, Girela-Lopez E. Assessment of Doctors' Knowledge and Attitudes Towards Confidentiality in Hospital Care. Sci Eng Ethics 2019; 25:1531-1548. [PMID: 30604354 DOI: 10.1007/s11948-018-0078-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
The physician's duty of confidentiality is based on the observance of the patient's privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients' data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents (37.5%) with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital (74%). The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups (≤ 30 vs. ≥ 51 years) and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Fernando Labella
- Sección de Oftalmología, Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Pilar Font-Ugalde
- Sección de Bioestadística, Departamento de Medicina, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Eloy Girela-Lopez
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
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Beltran-Aroca CM, Girela-Lopez E, Collazo-Chao E, Montero-Pérez-Barquero M, Muñoz-Villanueva MC. Confidentiality breaches in clinical practice: what happens in hospitals? BMC Med Ethics 2016; 17:52. [PMID: 27590300 PMCID: PMC5009672 DOI: 10.1186/s12910-016-0136-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice. METHODS By means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology. RESULTS Following 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent (54,6 %) were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient's clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas (37.9 %), such as corridors, elevators, the cafeteria, stairs, and locker rooms. CONCLUSIONS In addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches (9.5 %), thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine, Faculty of Medicine and Nursing, University of Córdoba, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Eloy Girela-Lopez
- Section of Legal and Forensic Medicine, Faculty of Medicine and Nursing, University of Córdoba, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Eliseo Collazo-Chao
- Section of Legal and Forensic Medicine, Faculty of Medicine and Nursing, University of Córdoba, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
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