[Digital health in Latin America: current legislation and ethical aspectsSaúde digital na América Latina: legislação atual e aspectos éticos]

Objectives

Describe the current legislation on electronic medical records (EMR) and telehealth in Latin American countries and analyze the treatment of confidentiality and professional secrecy.

Methods

Between March and September 2022, a survey of the regulations in force in 21 Latin American countries was conducted at two levels: the existence of legislation on EMR and telehealth, and the treatment of confidentiality and professional secrecy in EMR and telehealth. A data extraction form was prepared for each country. Data were collected from official on-line sources. The information was analyzed qualitatively and synthesized in tables when possible.

Results

The use of EMR is legally regulated in 16 countries. Nineteen countries have legislation on telehealth. All the countries analyzed safeguard confidentiality and professional secrecy through regulations. However, confidentiality and professional secrecy are mentioned in 11 countries in the context of telehealth, and in only nine countries in the context of EMR.

Conclusions

Since the start of this century, Latin America has made progress in the legislation of digital tools for health care, such as EMR and telehealth. There is also interest in ethical issues related to the use of EMR and telehealth, particularly confidentiality and professional secrecy, aspects that should be strengthened in digital health.

More ethics in the laboratory, please! Scientists' perspectives on ethics in the preclinical phase

In recent years there have been calls to improve ethics in preclinical research. Promoting ethics in preclinical research should consider the perspectives of scientists. Our study aims to explore researchers' perspectives on ethics in the preclinical phase. Using interviews and focus groups, we collected views on ethical issues in preclinical research from experienced (n = 11) and early-stage researchers (ESRs) (n = 14) working in a gene therapy and regenerative medicine consortium. A recurring theme among ESRs was the impact of health-related preclinical research on climate change. They highlighted the importance of strengthening ethics in relations within the scientific community. Experienced researchers were focused on technicalities of methods used in preclinical research. They stressed the need for more safeguards to protect the sensitive personal data they work with. Both groups drew attention to the importance of the social context of research and its social impact. They agreed that it is important to be socially responsible - to be aware of and be sensitive to the needs and views of society. This study helps to identify key ethical challenges and, when combined with more data, can ultimately lead to informed and evidence-based improvements to existing regulations.

Bioethics of somatic gene therapy: what do we know so far?

OBJECTIVE

To provide a systematic overview of bioethical debate on somatic gene therapy as documented in the scientific literature.

METHODS

We performed a systematic review of reasons, following Strech and Sofaer approach, which is a method to systematically identify and classify arguments (reasons) used in the scientific literature. We identified 217 eligible publications retrieved from PubMed, Lilacs, PhilPapers, and Google Scholar. A meta-synthesis was performed to analyze the data.

RESULTS

We extracted 189 arguments. Arguments were grouped into 23 categories. Twelve categories were classified as research-related, including the risk/benefit ratio, priorities and limits, informed consent, review, and monitoring. Eleven were classified as society-related, including population impact, human identity, public perception, human health.

CONCLUSION

Our study provides a database of existing challenges and arguments of somatic gene therapy and may serve as the basis of normative analysis. By presenting collected arguments, we contribute to the discussion about the ethics and social dimensions of somatic gene therapy.

How to embed ethics into laboratory research

Health-related innovation in biotechnology requires anticipating potential bioethical implications. In this article, we present a strategy to embed ethics in a group of early-stage researchers performing research in gene therapy and regenerative medicine in the laboratory phase. We conducted a series of focus group meetings with early-stage researchers who work in biotechnology laboratories. The objective was to reflect on the bioethical challenges of their own work and to promote the integration of research ethics with laboratory practice. The activity was assessed with questionnaires completed by the researchers before and after the meetings, and the analyses of the focus groups' content. As a result of the focus group series, all participants changed their perspectives about ethical issues regarding their planned research, developed the ability to reflect and debate on research ethics and had increased awareness of ethical issues in their own research activities. Half of them made changes in their research work. The study provides a concrete strategy to embed ethics and to strengthen responsibility in laboratory research. It is a strategy that allows to perform ethics reflection "on site" and in "real time" and complements the classic strategy of ethics assessment of the research protocol before starting the research procedure.

¿Cómo perciben las personas mayores el maltrato hacia ellas?

El maltrato hacia las personas mayores es una nueva demanda para el campo sanitario. La bioética debe colaborar con la salud pública para su abordaje. Se encuestaron personas mayores de 60 años en Argentina durante el 2020 sobre sus percepciones en torno al maltrato. Se recibieron 363 respuestas. El 81% considera que no tienen el lugar que les corresponde en la sociedad y el 81,3% que no se respetan sus derechos. Las formas de maltrato son extendidas, funcionan como capas de vulnerabilidad que afectan la salud y su identificación permite actuar sobre ellas para su erradicación.

Atención de la salud en domicilio

El objetivo de este artículo es considerar los posibles desafíos éticos que implica la atención de la salud en domicilio desde la perspectiva bioética. Para esto se llevó a cabo una revisión bibliográfica en la base de datos Lilacs, un trabajo descriptivo y un análisis conceptual. Los principales resultados arrojan que tras una distinción analítica de tres categorías éticas diferenciales: intimidad del hogar, intimidad personal (en relación al hogar) e intimidad compartida. La última, en la que el profesional de la salud se involucra activamente, es en aquella en la que se debe actuar con responsabilidad ética, dado que se pueden generar conflictos de intereses, sobre todo en el ámbito afectivo-emocional del paciente o familia. Las diferencias pueden traducirse en tres enunciaciones normativas particulares a la atención domiciliaria: el reconocimiento a la particularidad de cada hogar, el trabajo sobre la autonomía relacional y la estrategia de cooperación y de ayuda mutua. Si entendemos a la bioética como una disciplina que consiste en el análisis crítico y la reflexión sistemática de las prácticas en torno a la salud, este artículo es de gran interés, pues reflexiona y analiza las particularidades de la atención de la salud en el contexto del hogar, una modalidad que se está extendiendo en la región y el mundo por sus virtudes para el paciente y el sistema de salud.

[Psychiatric hospitalizations of child-youth population: An epidemiological study of Bahía Blanca City, Argentina]

INTRODUCTION

In recent years, there has been an increase in child and adolescent psychiatric consultations. The infant-youth population is a vulnerable group due to the evolutionary moment in which they are. They are the substrate of the impact of family and social crises. It is necessary to know the prevalent disorders, and the epidemiological profle of the population in question, to collaborate with a better understanding of the phenomenon and to make appropriate family and individual approaches in the subject.

MATERIALS AND METHODS

The number of children and adolescents who used the hospitalization device in the private sector of the city of Bahía Blanca, Argentina, from 2014 to 2016 is described. The medical records of hospitalized patients in the 12 to 19 year age range were analyzed.

RESULTS

The target population has an average age of 16 years; Almost 90% of the population is in school; More than 60% have their own home and live with their nuclear family. The reason for admission that demanded more days of hospitalization was Destructive, Impulse Control and Behavior Disorder. The reinternation rate of this study was 31.6%.

CONCLUSION

The intimate relationship of the increasing incidence of mental disorders in the child and adolescent population with the availability of families and society to contain and care for this vulnerable population is more evident.

Errores humanos autorreferenciados por automovilistas de la ciudad de Bahía Blanca, Argentina

Objetivo: Describir los tipos de errores que referencian los conductores de automóviles que circularon en la ciudad de Bahía Blanca durante el período septiembre 2014 y abril de 2015. Método: Estudio descriptivo de corte transversal de tipo cuantitativo. Se definió una muestra por conveniencia y se confeccionó una encuesta en formato digital, de tipo estructurada, dirigida a los automovilistas, teniendo como base el “Driver Behaviour Questionnaire” en la versión traducida al español. Luego fue validada mediante el método Delphi. Se analizó con software estadístico SPSS. Resultados: El 30% al realizar un giro, estuvo a punto de chocar con una bicicleta o moto. Un 36,3% sostuvo que por ir distraído, se dio cuenta tarde de que el vehículo de adelante redujo su velocidad debiendo frenar bruscamente para evitar el choque, el 25,3% se olvida de utilizar el guiñe antes de girar o cambiar de carril. El 80,2% usa siempre el cinturón de seguridad. El 11,4% pasa los semáforos en rojo. Un 43,9% utiliza el celular mientras maneja y el 22,9% de los encuestados reconoce que alguna vez condujo por encima del límite legal de alcohol. El 38% se impacienta y acelera bruscamente a la salida de un semáforo y un 62,7% se impacienta y se adelanta de forma arriesgada a un vehículo lento. Conclusiones: El manejo es una situación compleja que requiere de múltiples habilidades pero fundamentalmente una conciencia de respeto y solidaridad sumado a un enfático control punitorio sobre errores voluntarios graves.