Ghost of Medical Gaslighting

Medical gaslighting is when the actual symptoms of patients are dismissed or downplayed by medical professionals. It occurs frequently among patients suffering from chronic illnesses for which medical science gives no authoritative diagnostic protocol or effective treatment and those from populations underrepresented in clinical trials such as the female gender, specific races and ethnicity, third gender and patients with disability. Gaps in scientific knowledge and missing empathy have been cited as possible reasons. Respecting patient symptoms, accepting epistemic humility and investing in research may be possible solutions for this disharmony.

Impact of COVID-19 pandemic on non-communicable chronic lifestyle diseases in population of India: A systematic review

Background: Diabetes, chronic respiratory diseases, heart diseases, and cancers are diseases of public health importance in India. People with pre-existing non communicable diseases (NCDs) are vulnerable to COVID and associated complications. Risk factors for NCDs were found to have increased due to pandemic. Aims and Objectives: The aim of the study was to study the impact of the COVID 19 on chronic NCDs and life style diseases. Materials and Methods: Articles from India published between March 2019 and May 2022 were searched from database such as PubMed, Scopus, Google scholar using MeSH and keywords such as “COVID 19” OR “Coronavirus” OR “SARS-2 CoVirus” AND Lifestyle diseases,” “COVID-19” OR “Coronavirus” OR “SARS-2 CoVirus” AND “Diabetes” OR “HYPERTENSION.” Summary of 18 articles was presented after inclusion and exclusion criterion and removing of duplicates. Results: Risk of COVID 19 in people with pre-existing non-communicable diseases is high, prognosis is poor, and complications are higher. COVID 19 and lockdown measures resulted in restrictions of movements, dietary and sleep pattern changes, psycho social impacts, non-availability or difficulty in procuring medicines, accessibility to health-care facilities, burden on health-care facilities, difficulties in (using or lack of awareness) about tele-consultations facilities, and thus burden of NCDs is expected to rise in future. Conclusions: COVID 19 pandemic had direct and indirect impact on screening, diagnosis and management of patients with NCDs. Burden of NCDs may rise thereby putting extra burden on health-care facilities which warrants preparedness.

Clasificación de pacientes especiales según sus requerimientos en la atención estomatológica / Classification of specials patients according their dentist attention requirements

Introducción: El paciente de riesgo quirúrgico es aquel susceptible a un posible daño que amenaza al individuo que será sometido a una intervención quirúrgica. Este tipo de paciente es llamado"paciente especial", o que presenta deficiencias y existen además otros conceptos donde pudiera estar implícito. Este paciente no es claramente identificado y esto hace más complicado unificar criterios que permitan llevar a cabo un el tratamiento estomatológico sin causar daños colaterales. Objetivo: Elaborar una clasificación de pacientes especiales según sus requerimientos en la atención estomatológica. Métodos: Investigación cualitativa. Se realizó revisión bibliográfica y se tomaron en consideración investigaciones previas de la autora principal para la confección de la propuesta de clasificación. Para evaluar la misma se utilizó el método Delphi, lo cual permitió llegar a opiniones de consenso de los expertos, quienes valoraron la propuesta como: inadecuada, poco adecuada, adecuada, bastante adecuada y muy adecuada. Resultados: Se expone la clasificación de pacientes especiales según requerimientos durante la atención estomatológica. Incluyó a cinco grupos. El grupo I, nombrado de riesgo quirúrgico, se subdividió en cinco subgrupos. Los expertos consideraron la clasificación propuesta como Bastante Adecuada(2) y Muy Adecuada (12). Conclusiones: La clasificación propuesta facilita al estomatólogo una atención diferenciada al paciente especial, donde se hace adecuaciones en el paciente de riesgo quirúrgico teniendo en cuenta las características más importantes de las enfermedades de base. La clasificación propuesta fue catalogada como aceptada(AU)

Introduction: Numerous definitions exist where the patient of surgical risk can be incorporate keeping in mind her definition that is possible damage that she threatens the individual that will be subjected to a surgical intervention, such as patient special, with deficiencies among other but it has not been find a classification of patient of risk surgery. It cannot allow indentify those and it is difficult the dentist treatment without systemic complication. Objective: To elaborate a classification proposal of specials patients according dentist attention requirements. Methods: it was qualitative research. It was carried out exhaustive bibliographical revision and it took in consideration previous investigations carried out by the main author, with this consideration the classification proposal was made. To evaluate the proposal it used the method Delphi, which allowed arriving to opinions of the experts' consent. It took into consideration different variables: Inadequate, Not Appropriate, Appropriate, Quite Appropriate and Very Appropriate. Results: The classification is exposed of patient special according dentist attention requirements, it included to five groups and the group I was subdivided, called surgical risk, in five subgroups. 100 percent experts considered the classification like Quite Appropriate and Very Appropriate 2 in the first categories and 12 in the second one. Conclusions: The proposed classification facilitates to the dentist an attention to the differentiated special patient with emphasis in surgical risk patients keeping in mind the most important characteristics in the base illnesses. The proposed classification was classified as having accepted(AU)

El proceso de atención al Adulto Mayor en Cienfuegos: ¿salud o bienestar? / The process of care to the elderly in Cienfuegos: Health or well-being?

RESUMEN Este artículo surge de la necesidad de facilitarles a los profesionales de la Cultura Física de un programa con los elementos necesarios para la atención de los adultos mayores. El objetivo de la investigación es proponer un Programa de Ejercicios Físicos para el tratamiento de la hipertensión arterial en el Adulto Mayor. Esta situación hace necesario el desarrollo de la atención integral de los ancianos que se realiza esencialmente a través de los Círculos de Abuelos constituidos a lo largo de todo el país, atendidos por profesionales del Ministerio de Salud Pública y el Instituto de Cultura Física, Deportes y Recreación.

ABSTRACT This article arises of the necessity of facilitating to the professionals of the Physical Culture of a program with the necessary elements for the attention of the biggest adults. The objective of the investigation is to propose a Program of Physical Exercises for the treatment of the arterial hypertension in the biggest Adult. This situation makes necessary the development of the integral attention of the old men that is carried out essentially through the Circles of Grandparents constituted along the whole country, assisted by professionals of the Ministry of Public Health and the Institute of Physical Culture, Sports and Recreation.

Calidad de vida relacionada con la salud: exclusión de la subjetividad / Health-related quality of life: Exclusion of subjectivity

Resumo La Calidad de Vida es un concepto utilizado cada vez con más frecuencia para evaluar la afectación de las enfermedades crónicas y la efectividad de los tratamientos médicos. Su abordaje en el campo de la salud suele realizarse a través de cuestionarios autodiligenciados, dada la alta instrumentalización actual del ejercicio clínico. Esos instrumentos tienen utilidad para los profesionales de la salud, al permitirles analizar el efecto de sus intervenciones. Igualmente, son relevantes para la salud pública, en tanto informan acerca de las condiciones de quienes presentan enfermedades cuya prevalencia va en aumento. Sin embargo, en este artículo se plantea que el abordaje de la calidad de vida es limitado cuando se realiza con instrumentos estructurados. En particular se reflexiona acerca de cómo estos excluyen la subjetividad, pese a que son autodiligenciados por los pacientes. También se analizan las limitaciones concernientes a la cuantificación y a la transversalidad que se presenta al evaluar la calidad de vida con estas escalas. Como alternativa para superar estas falencias, se propone el abordaje narrativo, el cual permite dar cuenta de los cambios que se experimentan en la subjetividad con el transcurrir de la enfermedad.

Abstract Quality of life is a concept increasingly being used to assess the impact of chronic illnesses and the effectiveness of medical treatment options. The approach in the field of health is usually conducted using self-administered surveys, given the current high cost of instrumentalization of clinical practice. These instruments are useful for health professionals enabling them to analyze the effect of their interventions. Likewise, they are also relevant to public health, as they report on conditions of those with illnesses whose prevalence is increasing. Nevertheless, in this article, it is proposed that the quality of life approach is limited when it is carried out with structured instruments. It particularly reflects on how these instruments lack subjectivity, despite the fact that they are self-administered by patients. The limitations relating to quantification and transversality that arise when evaluating quality of life with these parameters are also analyzed. As an alternative to overcome these shortcomings, the narrative approach is proposed, as it makes it possible to report on changes experienced in subjectivity with the ongoing progress of the illness.

Transición de adolescentes portadores de enfermedades crónicas desde servicios pediátricos a servicios de adultos: Recomendaciones de la Rama de Adolescencia de la Sociedad Chilena de Pediatría / Transition from pediatric to adult health care services for adolescents with chronic diseases. Recommendations from the Adolescent Branch from Sociedad Chilena de Pediatría

La Rama de Adolescencia de la Sociedad Chilena de Pediatría apoya la implementación de programas planificados de transición de servicios pediátricos a adultos para adolescentes portadores de enfermedades crónicas, con objeto de asegurar la continuidad de una atención de salud de alta calidad acorde a las necesidades de desarrollo de esta etapa. Se plantean recomendaciones de atención que se enmarcan en el Proyecto FONIS y VRI PUC realizado por la División de Pediatría de la Pontificia Universidad Católica de Chile: "El proceso de transición de servicios pediátricos a adultos: visión de adolescentes portadores de enfermedades crónicas, sus cuidadores y los profesionales de salud", cuyo objetivo es describir la experiencia, barreras, puntos críticos y facilitadores percibidos por adolescentes portadores de enfermedades crónicas, cuidadores y profesionales de salud, en el proceso de transición. Los puntos críticos detectados en este estudio fueron: resistencia a la transferencia a servicios de adultos, tanto de adolescentes y cuidadores, como del equipo pediátrico; existencia de fuerte vínculo entre profesional, adolescente portador de enfermedad crónica y cuidador; dificultad en el desarrollo de la autonomía del adolescente portador de enfermedad crónica; invisibilidad de la adolescencia propiamente tal en el proceso de atención de la enfermedad crónica; y dificultad en la coordinación entre el equipo pediátrico y adulto durante la transferencia. Acorde a estas necesidades, barreras y puntos críticos y en base a experiencias internacionales publicadas, se plantean recomendaciones para la implementación de procesos graduales y planificados de transición, con énfasis en el diseño e implementación de políticas de transición, constitución de equipos multidisciplinarios y la planificación de la transición. Se discuten aspectos relativos a la coordinación de equipos, momento de transferencia, autocuidado y autonomía, registros para transferencias, participación de familias y adolescentes, necesidad de apoyo emocional, aspectos éticos involucrados, importancia de la confidencialidad, necesidad de adecuación de los servicios hospitalarios y de capacitación profesional, y la necesidad de evaluación y mayor investigación en el tema.

The Adolescent Branch from Sociedad Chilena de Pediatría supports the implementation of planned programs for transition from child to adult health centers, oriented to adolescents with chronic diseases, in order to ensure an appropriate follow-up and a high-quality health care. Recommendations for care are set out in the FONIS and VRI PUC project carried out by the Division of Pediatrics of the Universidad Católica de Chile: "Transition process from pediatric to adult services: perspectives of adolescents with chronic diseases, caregivers and health professionals", whose goal was to describe the experience, barriers, critical points, and facilitators in the transition process. Critical points detected in this study were: existence of a strong bond between adolescents, caregivers and the pediatric team, resistance to transition, difficulty developing autonomy and self-management among adolescents; invisibility of the process of adolescence; and lack of communication between pediatric and adult team during the transfer. According to these needs, barriers and critical points, and based on published international experiences, recommendations are made for implementation of gradual and planned transition processes, with emphasis on the design and implementation of transition policies, establishment of multidisciplinary teams and transition planning. We discuss aspects related to coordination of teams, transfer timing, self-care and autonomy, transition records, adolescent and family participation, need for emotional support, ethical aspects involved, importance of confidentiality, need for professional training, and the need for evaluation and further research on the subject.

El proceso de transición de servicios pediátricos a adultos: visión de adolescentes hospitalizados portadores de enfermedades crónicas / The transition process from paediatric to adult services: a perspective from hospitalised adolescent sufferers of chronic diseases

INTRODUCCIÓN Las 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 MÉTODO Incluye 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. RESULTADOS En 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. CONCLUSIONES Este 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.

INTRODUCTION Chronic 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 METHOD Semi-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. RESULTS In 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. CONCLUSIONS This 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.

Deconstructing Medicine: The Alternative Cellular Energy Pathway.

The pharmaceutical model for treating chronic illnesses has largely dominated the practice of medicine since the Flexner report of 1910. It essentially entails biochemical based endeavors to correct detectable or discerned metabolic imbalances in diseased cells. These manipulations almost invariably alter the metabolism of normal cells leading to predictable adverse side effects. Enhancing cellular energy can potentially help overcome cellular impairments in diseased cells without necessarily affecting normal cells. The identification of the alternative cellular energy (ACE) pathway, expressed as a dynamic (kinetic) quality of biological fluids, is providing a useful new paradigm for universally applicable therapeutic endeavors. This article reviews the current understanding of the fluid activation process. It appears to be mediated by a repulsive environmental force termed KELEA (kinetic energy limiting electrostatic attraction), which reduces the strength of intermolecular hydrogen bonding. Various means of imparting KELEA to drinking water are discussed. The article is intended to encourage widespread clinical evaluation of KELEA activated “ACE Water” as a waterceuticalÔ in the prevention and therapy of many clinical illnesses.

Morbidity profile of adolescents reported to an urban health center in Kancheepuram district of Tamil Nadu, India.

Background: Adolescents are the group of children transforming to adults (aged 10 to 19 years). There are more than 1.2 billion adolescents worldwide and about 243 million live in India i.e. about 20% of Indian population. They are apparently healthy people but they do also have health related issues. Objective of this study was to determine the morbidity pattern prevalent among adolescents who attended an urban health training centre in Kancheepuram district. Methods: A cross sectional study was carried among 918 adolescents aged between 10 to 19 years, who visited the urban health training centre during the study period using convenient sampling technique. Data collection was done by using a structured questionnaire which consisted of questions related to their demographic characteristics and the reason for coming to the centre seeking medical help. Data analysis was done using SPSS version 16 and the results expressed in percentages. Results: Among the study population of 918, 57% were males and 43% were females. About 81.8% were studying while 17.7% were working. About 78.2% adolescents (84.3% of males and 70.1% females), were suffering from acute conditions while 21.8% (15.7 % males and 29.9% females) were suffering from chronic conditions. Among the acute conditions, upper respiratory tract infection constituted 22.5% of complaints followed by musculo-skeletal, gastrointestinal and ENT problems. The most common chronic condition reported was anemia (6.2%) which was followed by acne on their face and minor psychiatric illnesses like anxiety and depression. Conclusions: Improvement in the quality of diagnosis and treatment for both acute and chronic illnesses among adolescents are required to be implemented at all levels.