Cuadernos Médico Sociales

Public policies, mental disorders, and patients’ human rights

Alvaro Barrera, Andrew Molodynski — Mon, 30 Dec 2024 00:00:00 +0000

A substantial number of people in Chile, probably millions, live with a diagnosable psychiatric disorder according to WHO criteria. It is a human right that such people have access to treatments that are effective, evidence-based, and provided with respect and compassion, especially given the fact that now the World Bank Chile considers as a high-income country. Those working in psychiatry and mental health, whether clinically or in national or regional government roles, have an ethical duty to advocate for the right to access the required treatments. Neither ideological debates nor therapeutic positions should hinder the exercise of this right by patients and their relatives.

Analysis of the Project on Flat Rate and Elimination of Pre-existing Conditions in ISAPRE

Cesar Oyarzo Mansilla — Mon, 30 Dec 2024 00:00:00 +0000

The project aims to make significant improvements to the Chilean health system. Despite the relevance of the proposed changes, it does not eliminate the segmentation of the insurance system, which complicates its implementation. The law proposes to eliminate pre-existing conditions and risk tables, as well as to establish a Common Health Plan with flat rates, seeking to guarantee equitable and universal access. The project also includes the creation of a mandatory reinsurance system to mitigate the risks of adverse selection. However, this measure appears insufficient to ensure the financial stability of the ISAPRE system. The article highlights the need to establish an inter-ISAPRE compensation fund and measures to regulate mobility between FONASA and ISAPRE. Furthermore, the creation of a Common Plan, along with a reference fee for calculating coverage, presents an opportunity to enhance the model of care and quality of services. However, there is a significant risk if the approach taken is to contain costs by reducing prices.

The public health Budget: analytical framework for the debate on reform approach

Patricio Lagos Araya, Tania Morales Galarce — Mon, 30 Dec 2024 00:00:00 +0000

This article addresses the content of the political debate in the National Congress on the 2025 public sector budget bill, and particularly the one related to the Ministry of Health. For the proposal of an analytical framework that allows for data evidence on the evolution of expenditure and financing of the public health sector using public data sources on budget execution for the period 2014 - 2023 from both DIPRES and Fonasa Open Data. Based on this information, all the graphs and tables are the authors' own. Finally, I conclude with some of the lessons and findings that we do not see when we are present and that arise in the process of discussion and approval of the annual budget.

Retrospective look at the development of the Arterial Hypertension Program. Influence of Psychosocial Factors

Oscar Roman — Mon, 30 Dec 2024 00:00:00 +0000

The clinical picture of primary arterial hypertension (HTN) has been widely studied in the scientific world, achieving consensus about the need to address it in a multidimensional manner. Its usual clinical management encounters various problems that hinder the expected result. There are different types of factors that influence both its evolution and prognosis, such as characteristics of the patient, their family, the community environment, and the comprehensive medical management carried out in the Health Services that care for them. Following such recommendations, at the multiprofessional Arterial Hypertension Center of the San Borja-Arriarán Hospital in Santiago, we have studied the clinical characteristics, risk factors and drug therapies of a series of patients, following their evolution for 30 years, between 1975-2010. Within this analysis we have analyzed some psychosocial factors associated with the comprehensive management of the condition, considering aspects of the individual, their family, community and dependent on the health system, for more than thirty years.

Los Monjes Dominicos, la flora nativa y la llegada de la primavera en Santiago

Maité Rodríguez-Díaz, Mirtha Parada Valderrama — Mon, 30 Dec 2024 00:00:00 +0000

La Orden de los Dominícos, fundada por Santo Domingo de Guzmán en 1215, se dedicó no solo a la evangelización, sino también al estudio científico y humanista. En América Latina, muchos monjes dominícos se interesaron por la flora autóctona y sus propiedades, combinando el saber local indígena con métodos científicos europeos, así como lo hicieron muchos otras ordenenes religiosas, que se destacaron en el rescate de la flora y fauna de los lugares donde se asentaban.

Descubriendo el alma de las plantas para la sanación

Mirtha Parada Valderrama — Mon, 30 Dec 2024 00:00:00 +0000

Se relatan los hechos en el seminario de observación goethenistica de plantas, realizado recientemente en Olmué. El relato se centra en contar los fundamentos de la observación y el proceso farmacéutco en que culmina en este seminario en el medio del bosque.

The Nanoemulsions of essential oils: a green alternative for the control of agricultural pests and transmitters of tropical diseases

Ricardo Diego Duarte Galhardo de Albuquerque — Mon, 30 Dec 2024 00:00:00 +0000

Insects, spiders and mollusks are important in the ecosystem, but they also represent risks to health and agriculture. In tropical countries, they transmit serious diseases such as malaria and dengue, as well as causing damage to many economically important crops such as potatoes and tomatoes. In this context, pest control with synthetic pesticides, the most widely used method, causes environmental problems and resistance in pests, so natural alternatives are sought, such as the use of essential oils (EOs), known for their insecticidal properties. Due to their chemical and physicochemical characteristics, these oils have solubility and stability problems in aqueous media, therefore the formulation as a nanoemulsion is a viable alternative for their uses. Nanoemulsions (NEs) are dispersions between immiscible liquids, with nanometric-sized droplets, which improves the stability, penetration and effectiveness of the active compounds. Studies show that NEs from EOs of eucalyptus, basil and other plants are effective against disease-transmitting mosquitoes, such as Aedes aegypti, and agricultural pests. Therefore, NEs from essential oils are presented as an effective and ecological alternative in the control of agricultural and sanitary pests, and their implementation is recommended in agriculture and urban environments.

Ozonated oils in organic farming: use and perspective of ozonated oils in eco-agriculture

Mon, 30 Dec 2024 00:00:00 +0000

The aims of organic farming include obtaining food rich in nutrients and free of chemical agents. To do this, crops are rotated, the use of pesticides and synthetic fertilizers is limited, the use of transgenic organisms is prohibited, and in situ resources such as water and solar energy are used. For pest control, it is preferred to use natural and environmentally friendly agents. Ozonated vegetable oils have become a substrate that eliminates plant diseases caused by fungi, bacteria, and viruses that attack crops around the world, as well as some pests such as mites, beetles, etc.

Revista de Libros y Revistas

Jorge Lastra Torres, Begoña Yarza Sáez, Yuri Carvajal Bañados — Mon, 30 Dec 2024 00:00:00 +0000

The 2025 health budget, a setback for the sector that must be corrected

Ricardo Fábrega — Mon, 30 Dec 2024 00:00:00 +0000

The 2025 health budget in Chile represents a significant regression in both international and national commitments. Key issues include insufficient public spending, decreased fiscal contributions to Fonasa, and limited growth in primary care. Furthermore, the substantial migration of affiliates from Isapre is likely to increase out-of-pocket expenses for citizens. Overall, the general budget falls short of advancing crucial objectives, such as allocating 6% of GDP to public health expenditure and strengthening primary care. These factors are essential for fulfilling the commitment to universal health coverage.

Out-of-Pocket Spending on Medicines in Chile: Policies, Challenges and Reduction Strategies

Alonso Bolbarán Castillo — Mon, 30 Dec 2024 00:00:00 +0000

In Chile, out-of-pocket spending on medications remains one of the main financial burdens for households, especially the most vulnerable. Despite efforts such as promoting generic drugs and centralizing purchases, the high cost of medications continues to significantly impact families. The lack of effective price regulation allows these costs to remain high and out of reach for many, contributing to Chile having one of the highest out-of-pocket spending rates compared to other OECD countries. This situation highlights the urgent need to implement more robust policies to reduce the economic impact of medications, such as price regulation and improved insurance coverage, particularly for essential drugs. Adopting these strategies could alleviate the financial burden on families and improve equitable access to necessary treatments, moving towards a fairer and more accessible healthcare system for all Chileans.

Reflections on community tensions towards the primary health care model in the district of Buin

Cristóbal Escobar Romero — Mon, 30 Dec 2024 00:00:00 +0000

This article explains the different tensions towards the Integral Health Model arising from the community diagnoses carried out in the different Primary Health Care health centers in the district of Buin. The information was collected through focus groups with leaders, social leaders linked to the nine health centers of the district, based on the interpretative and critical analysis of the results revealed in the diagnostic instances, it was concluded that the main challenge of the Primary Health Care model in Buin is to broaden the current epistemological framework and orient it towards other approaches that help to better understand the community development and relevance of the diverse territories of the district, challenging the current model, forcing it to broaden its horizons of understanding, and therefore, to reformulate the current limits of what to do in local health policy and planning.

ÍNDICE ANUAL, VOLUMEN 64, AÑO 2024

Cuadernos Médico Sociales — Mon, 30 Dec 2024 00:00:00 +0000

Exitosa presentación del tercer número del año de nuestra revista en el Instituto de Salud Pública

Cuadernos Médico Sociales — Mon, 30 Dec 2024 00:00:00 +0000

Tercer número de Cuadernos Médico Sociales se presenta en Colmed Regional de Valparaíso

Cuadernos Médico Sociales — Mon, 30 Dec 2024 00:00:00 +0000

Cuadernos Médico Sociales presente en el lanzamiento de los libros “Miradas críticas de la gestión en salud en Chile” y “Ecólogo de delantal blanco”

Cuadernos Médico Sociales — Mon, 30 Dec 2024 00:00:00 +0000

Editorial: ¿Cómo recuperamos la capacidad de reforma?

Jorge Lastra Torres — Mon, 30 Dec 2024 00:00:00 +0000

Invitation to build a common diagnosis of the current condition of Chile

Yuri Carvajal Bañados — Mon, 30 Dec 2024 00:00:00 +0000

This article invites colleagues and health professionals to build a vision of the environmental condition of Chile. Considers that this is the first order of national issues and that a biological and health perspective must be highlighted. It proposes a thematic order and suggests some topics to develop.

Overview of Bioethics in Chile

Álvaro Hevia Castillo — Mon, 30 Dec 2024 00:00:00 +0000

From the latest events, which have awakened the public bioethical discussion in our country, we ask ourselves where is bioethics in Chile and what are the main forces that face each other in the power dispute. The result is a kind of general overview of national bioethics.

Objeción de conciencia en medicina

Miguel Kottow — Mon, 30 Dec 2024 00:00:00 +0000

La objeción de conciencia es un derecho derivado del derecho a libertad de pensamiento, expresión y religión, invocada para lograr la eximición al servicio militar y la eventual obligación de portar armas. La eximición es solicitada individual y formalmente, por conductos reglamentados de diversos modos. En recientes años, la objeción de conciencia en medicina es gatillada ante derechos de intervención especialmente en los extremos de la vida, derechos que se ejerce en condiciones y bajo reglamentaciones dictaminadas por ley.

El objetor individual ha de formalizar su solicitud de eximición y, de ser aprobada, ejercerla de modo que no perjudique o dañe a la persona solicitante, para lo cual debe referirla sin dilación aa una instancia no objetante. En situaciones de suma urgencia o dificultad de derivación conciencia de objetar deberá ponderarse con la conciencia profesional del médico, para llegar a una decisión en que prime el mandato de primum non nocere.

La objeción institucional ha de tener la cautela de contar con programas preestablecidos de referencia oportuna y eficiente que garanticen que la derivación de el/la solicitante no sufra desmedro alguno.

Las leyes sobre aborto en probable revisión, de eutanasia en discusión parlamentaria, deben establecer rigurosamente tanto las condiciones de solicitud de intervención, como la formalización de la objeción de conciencia, para evitar perjuicios y desmedros a pacientes y médicos.