A ética médica em discussão: análise dos principais temas de ética médica na prática clínica em revistas nacionais de medicina e bioética 1998-2013

The aim of this investigation is to identify the main topics of the discussion about medical ethics in clinical practice in Chile. 143 articles in Chilean medical and bioethics journals were identified. They were put under a systematic study using comparison, codification and text analysis techniques of the Grounded Theory approach. 30 subjects were identified in the discussion, where the treatment of the ethics from a “professional deontology” predominates. Emergent speeches of an ethics that appeals to goods and values superiors to the professional duties in the search of the good of the patient can be found. The transformation of the context in which the clinical practice takes place is the background of the discussion.El objetivo de esta investigación es identificar los principales temas de la discusión sobre de ética médica en la práctica clínica en Chile que se suscitan en las revistas de Medicina y Bioética chilenas. Se identificaron 143 artículos que fueron sometidos a un análisis sistemático utilizando técnicas de comparación, codificación y análisis de textos propios del enfoque de la Teoría Fundamentada. Se distinguieron 30 temas en la discusión, en la que predomina el tratamiento de la ética desde la “deontología profesional”. También se observan discursos emergentes de una ética que apela a bienes y valores superiores a los deberes profesionales en la búsqueda del bien del paciente, en el marco de un proceso de transformación del contexto en que se ejerce la práctica clínica.O objetivo desta pesquisa é identificar os principais tópicos da discussão sobre ética médica na prática clínica no Chile, presentes nas revistas nacionais de medicina e bioética. Identificaram-se 143 artigos que foram submetidos a uma análise sistemática, utilizando-se técnicas de comparação, codificação e análise de textos próprios da abordagem da Teoria Fundamentada. Identificaram-se 30 temas na discussão, nos quais predominam o tratamento da ética a partir da “deontologia profissional”. Também se observam discursos emergentes de uma ética que apela aos bens e valores superiores aos deveres profissionais na busca pelo bem do paciente, no âmbito de um processo de transformação do contexto em que é exercida a prática clínica

Centros infantiles en Bolivia : atención, infraestructura y calidad de servicios de desarrollo infantil

En una serie de trabajos publicados en 2008 en la revista científica The Lancet, se señala que los daños provocados por la desnutrición en los primeros años de vida no solamente llevan a rezagos permanentes, sino que además pueden afectar a las generaciones futuras. Los primeros 1000 días de vida (desde el embarazo hasta aproximadamente los 2 años de edad) de niños y niñas constituyen una ventana única de intervención en desarrollo infantil temprano para la estimulación y para orientar a padres en prácticas de paternidad. Como respuesta a los retos persistentes de la situación del desarrollo físico, cognitivo y socioemocional de la niñez en Bolivia, el gobierno está implementando el Programa de Desarrollo Infantil Temprano “Crecer Bien para Vivir Bien”. La información presentada en esta nota técnica analiza los datos de línea de base de la evaluación de impacto para el componente de fortalecimiento de centros infantiles del programa. El estudio representa un primer esfuerzo de levantar datos estandarizados sobre la calidad de centros infantiles en Bolivia, en particular en los departamentos de Chuquisaca y Potosí

El proceso de transición de servicios pediátricos a adultos: visión de adolescentes hospitalizados portadores de enfermedades crónicas

ResumenIntroducciónLas enfermedades crónicas durante la adolescencia son un gran desafío para el paciente, su familia y los proveedores de salud. La transición desde los servicios de salud pediátricos a adultos involucra el proceso de traspaso programado y planificado, de adolescentes portadores de enfermedades crónicas, para mantener una buena calidad de vida y desarrollo biopsicosocial. No existe, actualmente, un modelo único de transición. El objetivo del estudio es comprender el proceso de transición desde la perspectiva de adolescentes hospitalizados, para colaborar al diseño de un modelo acorde a las necesidades estudiadas.Pacientes y métodoIncluye entrevistas semiestructuradas a 13 adolescentes portadores de enfermedades crónicas, hospitalizados en 2 centros asistenciales de Santiago de Chile, en un estudio analítico-relacional, sostenido por una metodología de carácter cualitativo.ResultadosEn el análisis destacan 5 temas principales: experiencia de la vivencia de la enfermedad, importancia de la relación médico-paciente, concepto de autonomía limitado a lo farmacológico, ausencia de un proceso de transición propiamente dicho y la identificación de barreras y necesidades para una transición adecuada.ConclusionesEste estudio es pionero en Chile en explorar el fenómeno de la transición en adolescentes con enfermedades crónicas. Enfatiza la necesidad de reforzar el concepto de autocuidado y autonomía desde etapas tempranas del cuidado y la importancia de la planificación temprana de un proceso de transición saludable, de acuerdo a las necesidades detectadas por los propios adolescentes.AbstractIntroductionChronic illnesses during adolescence are a big challenge for the patient, his or her family, and health care providers. The transition from paediatric health services to adult health services involves a programmed and planned transfer process of adolescent sufferers of chronic illnesses, in order to maintain a high quality of life and bio-psycho-social development. There is currently no transition model. The objective of the study is to understand the transition process from the perspective of hospitalised adolescents to collaborate towards the design of a model that meets the needs studied.Patients and methodSemi-structured interviews with 13 adolescent sufferers of chronic illnesses, hospitalised in two healthcare centres in Santiago, Chile, in one analytical-relational study, supported by qualitative methodology.ResultsIn the analysis, 5 major themes stand out: experience of living with the illness, the importance of the doctor-patient relationship, the concept of limited autonomy to the pharmacology, the absence of the transition process as such, and the identification of barriers and needs for an adequate transition.ConclusionsThis study is new in Chile in that it explores the phenomenom of the transition of adolescents with chronic illnesses. It emphasises the need to reinforce the concept of self-care and autonomy from early stages of care, and the importance of early planning of a healthy transition process, in accordance to the detected needs of the adolescents themselves

El impacto de la pandemia de COVID-19 en la salud mental de los trabajadores de la salud en Chile: datos iniciales de The Health Care Workers Study

Background: Healthcare workers’ mental health was affected by SARS-CoV-2 pandemic. Aim: To evaluate healthcare workers’ mental health and its associated factors during the pandemic in Chile. Material and Methods: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. Results: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. Conclusions: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it

[Impact of COVID-19 pandemic on the mental health of healthcare workers].

BACKGROUND: Healthcare workers' mental health was affected by SARS-CoV-2 pandemic. AIM: To evaluate healthcare workers' mental health and its associated factors during the pandemic in Chile. MATERIAL AND METHODS: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. RESULTS: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. CONCLUSIONS: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it

Reflexiones en torno a las emociones en la toma de decisiones éticas en medicina.

We review general decision making theories and in bioethics, identifying those normative and descriptive theories. I argue about the need to develop models, based in empiric research and in anthropologica arguments, in which emotions are considered along with cognition. These models will help to understand better moral action.El objetivo de este trabajo es revisar las teorías de toma de decisiones en general y en bioética, identificando teorías normativas y descriptivas. Se argumenta sobre la necesidad de desarrollar modelos basados en el conocimiento empírico disponible y en presupuestos antropológicos claros, en el que las emociones son consideradas como un aspecto inseparable de la cognición (racionalidad). Estos modelos permitirán comprender mejor la acción moral de la persona humana