Financiamento dos sistemas de saúde na América Latina no capitalismo contemporâneo em crise: uma contribuição a partir do pensamento crítico de Vicente Navarro López / Financing of health systems in Latin America in contemporary capitalism in crisis: a contribution from the critical thinking of Vicente Navarro López

Introdução: No capitalismo contemporâneo em crise, os sistemas de saúde de todo o mundo estão sendo sistematicamente enfraquecidos devido à aplicação de contrarreformas sociais por meio de políticas neoliberais/ultraneoliberais promovidas pelo Estado capitalista. Por um lado, observa-se um permanente subfinanciamento público, e por outro lado, há uma inserção, reprodução e ampliação da lógica de mercado neoliberal no setor saúde. Esse processo tem transformado a saúde em um setor voltado para a acumulação de capital e a busca incessante por sua maior valorização. Objetivo: Analisar a produção cientifica latino-americana sobre o financiamento dos sistemas de saúde na América Latina no capitalismo contemporâneo em crise, com a finalidade de compreender como os autores latino-americanos discutem o financiamento da saúde à luz do pensamento crítico de Navarro, a partir de sua obra "La Medicina bajo el Capitalismo", de 1978. Método: Inicialmente, realizou-se uma revisão da literatura sobre a saúde no capitalismo contemporâneo em crise. Em seguida, realizou-se uma revisão integrativa, a partir da pergunta: Como a literatura cientifica, especialmente latino-americana, vem discutindo o financiamento dos sistemas de saúde na América Latina no capitalismo contemporâneo em crise? A busca bibliográfica foi realizada na Biblioteca Virtual de Saúde, em 3 de fevereiro de 2023, encontrando-se 265 publicações, e incluindo-se, após o processo de seleção, 23 artigos na revisão integrativa. Por fim, realizou-se uma análise comparativa, identificando convergências e divergências entre os resultados da revisão à luz do pensamento crítico de Vicente Navarro López. Resultados: Os artigos incluídos na revisão foram classificados em eixos temáticos: 65,2% discutiram o financiamento e a privatização da saúde e cobertura universal de seguro de saúde; 47,8%, o financiamento em meio a processos de reforma do setor saúde; 43,5%, o subfinanciamento público da saúde; 39,1%, o financiamento em meio a processos de reforma fiscal ou tributária ou busca de novas fontes de financiamento para a saúde; 26,1%, o financiamento em meio a processos de descentralização da saúde; e 17,4%, o financiamento em meio a processos constituintes ou de implementação de novas constituições políticas. Enquanto as convergências e divergências entre os resultados desses artigos e as contribuições do pensamento crítico de Navarro, identificou-se que 39,1% tiveram alguma aproximação ao método de estudo marxista, em oposição ao funcionalismo; 30.4% foram críticos com os supostos da teoria das etapas do desenvolvimento na abordagem da saúde; 47,8% e 21,7% abordaram os determinantes econômicos e políticos do subdesenvolvimento da saúde e do direito à saúde, respectivamente; e 26,1% discutiram a influência das agências internacionais nas decisões de política de saúde. Conclusões: Os pesquisadores latino-americanos no campo do financiamento da saúde enfrentam os desafios de estudá-lo dialeticamente com o cenário econômico, político e social das próprias sociedades capitalistas em que a saúde está inserida, e de incorporar em sua análise a determinação social da saúde no capitalismo contemporâneo em crise. A transição da economia da saúde para a econômica política crítica da saúde exige que esses pesquisadores superem esses desafios para integrar esses elementos em suas futuras investigações no campo do financiamento da saúde.

Introduction: In contemporary capitalism in crisis, health systems around the world are being systematically weakened due to the application of social counter-reforms through neoliberal/ultraneoliberal policies promoted by the capitalist state. On the one hand, there is permanent public underfunding, and on the other hand, there is an insertion, reproduction and expansion of the neoliberal market logic in the health sector. This process has transformed health into a sector focused on the accumulation of capital and the incessant search for its greater appreciation. Objective: To analyze the Latin American scientific production on the financing of health systems in Latin America in contemporary capitalism in crisis, in order to understand how the Latin-American authorsAmericans discuss health financing in light of Navarros critical thinking, from his 1978 work "La Medicina bajo el Capitalismo". Method: Initially, a review of the literature on health in contemporary capitalism in crisis was carried out. Then, an integrative review was carried out, based on the question: How has the scientific literature, especially Latin American, been discussing the financing of health systems in Latin America in contemporary capitalism in crisis? The bibliographic search was performed in the Virtual Health Library, on February 3, 2023, with 265 publications, and including, after the selection process, 23 articles in the integrative review. Finally, a comparative analysis was carried out, identifying convergences and divergences between the results of the review in the light of the critical thinking of Vicente Navarro López. Results: The articles included in the review were classified in thematic bundles: 65.2% discussed the financing and privatization of health and universal health insurance coverage; 47.8%, financing in the midst of health sector reform processes; 43.5%, public health underfunding; 39.1%, financing in the midst of fiscal or tax reform processes or seeking new sources of health funding; 26.1%, financing in the midst of health decentralization processes; and 17.4%, funding in the midst of constituent processes or the implementation of new political constitutions. While the convergences and divergences between the results of these articles and the contributions of Navarros critical thinking, it was identified that 39.1% had some approximation to the Marxist method of study, as opposed to functionalism; 30.4% were critical of the supposed theory of stages of development in the approach to health; 47.8% and 21.7% addressed the economic and political determinants of underdevelopment of health and the right to health, respectively; and1% discussed the influence of international agencies on health policy decisions. Conclusions: Latin American researchers in the field of health financing face the challenges of studying it dialectically with the economic, political and social scenario of capitalist societies themselves in which health is inserted, and to incorporate in its analysis the social determination of health in contemporary capitalism in crisis. The transition from health economics to critical health policy economics requires these researchers to overcome these challenges to integrate these elements into their future research in the field of health finance.

Defunciones por Enfermedad Renal Crónica en Chile según sexo, grupo etario y región entre los años 2021 y 2022 / Deaths from Chronic Kidney Disease in Chile by sex, age group and region between 2021 and 2022

Introducción: La enfermedad renal crónica (ERC) es una afección persistente en la función y estructura renal. La prevalencia de ERC varía mundialmente, siendo más común en personas con diabetes e hipertensión. Además, la tasa de mortalidad por ERC ha disminuido en Chile en los últimos años. Objetivo general: describir las defunciones por ERC en Chile según sexo, grupo etario y región, entre los años 2021 y 2022. Metodología: estudio observacional descriptivo transversal. Se obstuvieron datos sobre ERC según sexo, grupo etario y región desde el Departamento de Estadística e Información en Salud (DEIS). Se utilizó estadística descriptiva y se calculó la tasa de mortalidad. Para el análisis estadístico se utilizó el programa Microsoft Excel. Este estudio no requirió revisión por comité de ética y no existen conflictos de interés. Resultados: Durante 2021-2022 se estudiaron 2478 defunciones por enfermedad renal crónica (ERC). Hubo un aumento del 15.85% en el número total de defunciones. La tasa de mortalidad general fue de 12.54 por cada 100.000 habitantes. Ambos sexos tuvieron tasas de mortalidad similares. El grupo etario de 81-90 años tuvo la mayor cantidad de muertes. La Región Metropolitana registró la mayoría de las defunciones. Discusión: La tasa de mortalidad en Chile es similar a países desarrollados, con tendencia al aumento en ambos sexos. El mayor número de defunciones en mayores de 61 años y la variación de las tasas de mortalidad por región podrían deberse a factores de riesgo cardiovascular. El enfrentamiento de la ERC debe enfocarse en estrategias de prevención y diagnóstico precoz.

Introduction: Chronic Kidney Disease (CKD) is a persistent condition affecting renal function and structure. The prevalence of CKD varies worldwide, with a higher incidence among individuals with diabetes and hypertension. Moreover, the mortality rate due to CKD has decreased in recent years in Chile. General objective: To describe CKD-related deaths in Chile according to sex, age group, and region between 2021 and 2022. Materials and methods: A descriptive cross-sectional observational study was conducted using data obtained from the Department of Health Statistics and Information (DEIS). Descriptive statistics were used and the mortality rate was calculated. Microsoft Excel was used for the statistical analysis. This study did not require ethical committee review, and there are no conflicts of interest. Results: A total of 2478 deaths due to CKD were studied during 2021-2022, with a 15.85% increase in the overall number of deaths. The general mortality rate was 12.54 per 100,000 inhabitants. Both sexes had similar mortality rates, and the 81-90 age group had the highest number of deaths. The Metropolitan Region registered the majority of the deaths. Discussion: The mortality rate in Chile is comparable to developed countries, with an increasing trend in both sexes. The higher number of deaths among individuals over 61 years old and the variation in mortality rates by region may be attributed to cardiovascular risk factors. Addressing CKD requires a focus on prevention and early diagnosis strategies.

Factores de riesgo del cáncer de mama en un consultorio médico / Risk factors for breast cancer in a family doctor's office

Introducción: La incidencia de enfermedades oncológicas se ha incrementado considerablemente en todo el mundo y el cáncer de mama no es la excepción. El cáncer de mama constituye el tumor más frecuente en la mujer y cada año mueren alrededor de 373 000 mujeres por dicho cáncer. Objetivo: Identificar los factores de riesgo de cáncer de mama. Métodos: Se realizó un estudio observacional descriptivo, de corte transversal en mujeres de 15 años o más del consultorio 5 del Policlínico Aleida Fernández Chardiet en el año 2016. El universo estuvo constituido por 131 mujeres. Se utilizaron distribuciones de frecuencias y cálculos porcentuales. Resultados: El 35,88 por ciento de las mujeres presenta edad mayor o igual a 60 años. El 68,3 por ciento de las féminas había presentado la menopausia entre los 45 y 55 años de edad, el 54,5 por ciento de las nulíparas presentaron edad igual o mayor a 60 años, el 33,9 por ciento dio de lactar por menos de 4 meses. Conclusiones: La mayoría de las féminas del estudio presentaron edad mayor o igual a 60 años. Las mujeres que en mayor ocasión no habían tenido hijos presentaron edad igual o mayor a 60 años. La mayoría de las mujeres no ofrecieron lactancia materna o lo hicieron por menos de 4 meses. Se pudo observar una asociación estadísticamente significativa entre la edad y el tiempo de lactancia materna(AU)

Introduction: The incidence of oncological diseases has increased considerably worldwide and breast cancer is not the exception. Breast cancer is the most frequent tumor in women and every year die about 373,000 women from cancer. Objective: To identify the risk factors of breast cancer. Methods: A descriptive, cross-sectional, observational study was carried out with women of 15 years of age or older from the family doctor's office 5 of Aleida Fernández Chardiet Outpatient Polyclinic in 2016. The study population consisted of 131 women. We used frequency distributions and percentage calculations. Results: 35.88 percent of the women are 60 years of age or older. 68.3% of women had menopause between 45 and 55 years of age, 54.5 percent of nulliparous women were 60 years of age or older, 33.9 percent gave breastfeeding for less than 4 months. Conclusions: The majority of the women in the study were at age 60 years or older. The women who had not had mostly more children were 60 years of age or older. Most of the women did not offer breastfeeding or did so for less than 4 months. We observed a statistically significant association between age and time of breastfeeding(AU)

Evaluación clínica y radiológica de la prótesis de núcleo discal Nubac: informe preliminar / Clinical and radiological follow-up of Nubac disc prosthesis: preliminary report

BACKGROUND: Lumbar arthroplasty is an alternative to fusion for the treatment of degenerative disc disease. Replacement of the nucleus pulposus preserves the biomechanical properties in the annulus and plates, conserving lumbar motion. Our objective was to evaluate the feasibility and clinical and radiological findings at 3 months follow-up with the Nubac device. METHODS: Ten patients from the National Institute for Rehabilitation (INR, Mexico City) with degenerative disc disease were selected to participate in the study. They underwent discectomy with Nubac device with a follow-up period of 3 months. Evolution was evaluated with the VAS and Oswestry scales. RESULTS: Five men and five women were included in the study (average age 41.6 years). Surgical approach was anterolateral (4 patients), posterior (3 patients) and anterior (3 patients), VAS improved from 8.1 to 2.5 (p <0.05) and Oswestry Disability Index (ODI) improved from 58.2% to 24.2% (p <0.05). Disc height before surgery was 9.4 mm, and 3 months postoperatively was 12.5 mm with no complications, migration, or subsidence. CONCLUSIONS: Nubac prosthesis improved lumbar discogenic pain in a short time when evaluated using ODI and VAS scales. Disc height improved after a 3-month follow-up, but lumbar motion did not improve. No complications have been reported; however, a minimum follow-up of 4 years is needed to make a definite conclusion.

Saturnismo: intoxicación por plomo / Saturnism: intoxication by plumb

El saturnismo es definido como la intoxicación aguda ó crónica por plomo o alguna de sus sales. Los autores hacen una amplia revisión sobre las características del plomo y sus componentes, su amplio uso en la industria y en infinidad de productos de uso en la vida diaria. Describen también su metabolismo y las alteraciones tóxicas que produce a nivel hematopeyético, sistema nervioso central, riñon y fibra muscular. Se revisa la clínica de esta entidad, en sus formas tanto crónica como aguda, y los métodos auxiliares de diagnóstico. Adicionalmente se revisan las bases del tratamiento actual y se, señalan pautas para la prevención de esta entidad en relación a trabajadores de plantas industriales, donde la incidencia es mayor.