Socio-cultural, historical, political and economic dimensions of health and medicine

Health is one of the most important areas of human development and, along with quality of life, occupies a prominent place in the academic world, being studied from various theoretical perspectives and from different scientific disciplines. These studies try to explain, from the micro to the macro, what it means and what elements are involved in the health of individuals in particular and of society in general. However, given the diversity of perspectives, there is no consensus on the definition of health. At the beginning, the study of health focused on biomedical research into disease. This approach has shown its limits in understanding health in its most complete dimension, as defined by the World Health Organization as early as 1946 : “ health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ” ( preamble to the WHO Constitution, 1946 ). This “ positive ” orientation of health is later taken up as a universal human right ( Declaration of Human Rights, art. 25 ), being considered today not only a right, but also a value in itself, an aspiration and a social demand....Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Entender la dimension social de la pandemia es clave para paliar sus consecuencias

Se cumple el primer aniversario del inicio de un confinamiento domiciliario que vaticinaba la gravedad social y económica que suponía afrontar una pandemia en pleno siglo XXI. Hoy, los estudios sobre sus consecuencias sociales se abren paso entre la ingente cantidad de conocimiento biomédico acumulado sobre el coronavirus durante el último año. “Quédate en casa”, rezaba el eslogan institucional que daba cuenta de la obligación decretada por el Gobierno durante el primer estado de alarma. Y en casa nos quedamos. Cada cual en la suya y, por supuesto, cada casa es diferente, como lo es el lugar que ocupa cada uno de nosotros en la estructura social. Las diferencias entre viviendas, entornos y situaciones vitales fueron cobrando más y más peso en la conciencia de los ciudadanos a medida que pasaban los días de encierro

Avoidant coping of the decision-making process on the location of care in old age: A possible conspiracy of silence?

The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence

Social hierarchy of pain and its connection to the memory of previously suffered pain

Lourdes Biedma-Velázquez, María Isabel García-Rodríguez, Rafael Serrano-del-Rosal Institute for Advanced Social Studies, Spanish National Research Council (IESA/CSIC), Córdoba, Spain Background: Pain is a perception conditioned both by the painful experience and by each society’s collective imagination. The general objective of the project which this work forms part of it was to discover what citizens think about different aspects of this complex experience. More precisely, this paper’s objective is to get to know which is the worst pain that can be suffered according to Spaniards and what determines that hierarchy, bearing in mind that this work has chosen a broad definition of pain, including pains of different origins, namely, physical, psychological, and emotional pain. Materials and methods: The data from the CIS 3137 study “Social perceptions of pain” have been used, which is a survey module designed by the Institute of Advanced Social Studies (IESA) of the Spanish National Research Council (CSIC). A hierarchical multiple factor analysis has been performed, using the SPSS statistical analysis software, where the dependent variable is the citizen’s opinion on which is the worst pain that can be suffered, recoded according to the origin of pain (physical, psychological, and emotional pain). Sociodemographic variables and variables linked to the experience of pain have been included as independent variables. Results and conclusion: Although the most frequent pains among Spanish citizens are those of a physical origin, especially those linked to musculoskeletal problems and pains of an orofacial origin, when they are asked about the worst pain a person can suffer, they do not mention this type of pain, but those of an emotional origin. It has also been possible to confirm that the pain that citizens refer to when asked about the worst pain that can be suffered, and, therefore, the hierarchy of pain held by Spanish citizens as a group, is conditioned, although not determined, by the pain that has previously been suffered – by one’s own experience of pain. Keywords: pain, social perception, physical pain, psychological pain, emotional pain, experience of pai

Como evitar que la fatiga pandémica nos haga bajar la guardia

El tercer estado de alarma provocado por el coronavirus ha terminado. La pandemia, todavía no. Las campañas de vacunación avanzan a paso firme y todo indica que se cumplirá el objetivo de inmunizar al 70 % de la población a lo largo de verano. Sin embargo, la incidencia de la covid-19 en muchas Comunidades Autónomas sigue siendo elevadísima y menos del 30 % de los españoles ha recibido al menos su primera dosis. Hay motivos para el optimismo, pero también para la cautela. La fatiga pandémica nos azota y es un factor que puede hacernos tropezar a escasos metros de la línea de meta. Preguntamos a sociólogos, psicólogos y expertos en comunicación cómo evitar este escenario

Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community - the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients' OHIP-14 score and pain duration, pain intensity, and various sociode-mographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p<0.05) was found for gender, age, marital status, chronic pain grade, self-perceived oral health status and pain duration. Conclusions: The analysis of self-perceived oral health status in patients with OP and TMD, as measured by the OHIP-14, showed that oral health is perceived more negatively by women. Moreover, a one-point increase in the Chronic Pain Grade indicator increases the OHIP-14 indicator by 4.6 points, while chronic pain, defined as pain suffered by patients for one year or more, increases the OHIP-14 indicator by 3.2 points. © Medicina Oral S. L