Factores sociales del estado de salud autorreportado de personas mayores, en Chile / Factors influencing self-reported health in Chilean older people

Background Self-reported health is subjective and depends on external factors such as socioeconomic status, presence of chronic diseases and working status, among others. Aim To determine which factors influence self-reported health among older people in Chile. Material and Methods A secondary analysis of the National Socioeconomic Characterization survey done in 2015. A dichotomous response model was used classifying health status as good or bad. A logit regression model was carried out. Results The model had a good calibration and correctly classified 72 and 68% of men and women, respectively. The main factors that influenced health status self-perception were: not having health problems; having undergone a mental health interview, to receive supplemental nutrition, education, to have a productive work; and to having a social network. Conclusions There are health, cultural, economic and environmental factors that influence self-perceived health status.

Repensar o Édipo, entre o familiar e o estranho / Rethinking Oedipus, between the familiar and the strange

O autor considera necessário repensar o Édipo para incluir em seus modos de resolução não só o familiar, como também o não familiar, o estrangeiro, a alteridade. Acredita que as formas pelas quais seu estudo e sua clínica são encarados atualmente favorecem os mecanismos da exclusão e do desterro, tal como aparece no mito não só do estrangeiro do outro, como também do estrangeiro de si mesmo. Tudo isso se constitui em problemáticas na construção do laço social que considera necessário revisar na sociedade contemporânea. O autor se propõe a revisar as metáforas que parecem guiar as condutas, a ordem da governabilidade, tanto na ordem familiar quanto na social, entre elas a metáfora pastoril, a metáfora têxtil e a metáfora do caminho. Considera que é necessário advertir sobre a presença nos discursos contemporâneos, de acordo com as características performativas da linguagem, de denominações estigmatizantes e culpabilizantes precoces – inclusive antes do nascimento do sujeito, como em Édipo, que requerem práticas de resistência e de cuidado de si para que a psicanálise possa operar na clínica e na sociedade contemporânea alertando para estas denominações e seus efeitos na constituição subjetiva. O estudo de Édipo em Colona significa uma contribuição importante para a consideração das operações de transmissão feitas a partir da experiência, do contato com o real e com o haver podido construir com isso uma versão pessoal...

According to the author, it is necessary to rethink Oedipus in order to include in its resolution ways not only the familiar, but also the non-familiar, the foreign, the alterity. He believes that the forms in which its study and clinic are currently dealt with favor exclusion and banishment mechanisms, as it appears in the myth of the foreigner for the other, but also of the foreigner for him/herself. All this brings about problems in the construction of the social bond that urges to be rethought in current society. The author aims at reviewing the metaphors that seem to guide the behaviors, the order of governance, both in the family and in the social sphere. Among them, there are the pastoral metaphor, the textile metaphor and the path metaphor. He considers that it is of utmost importance to warn about the presence of stigmatizing and early guilt-apportioning designations in contemporary speeches, according to the performing characteristics of language. These designations, which are encountered even before the subject’s birth, as in Oedipus, require practices of resistance and self-care so that psychoanalysis can operate in the clinical practice and within contemporary society, preventing them and their effects on the subject’s constitution. The study of Oedipus at Colonus represents an important contribution to the consideration of the transmission operations made from the experience, from the contact with the real and with the fact of having been able to build with it a personal version...

Repensar el Edipo, entre lo familiar y lo extraño El autor considera necesario repensar el Edipo para incluir en sus modos de resolución no solo lo familiar sino también lo no familiar, lo extranjero, la alteridad. Cree que los modos actuales con que se encara su estudio y su clínica favorecen los mecanismos de la exclusión y de destierro, tal como aparece en el mito no sólo de lo extranjero del otro sino lo extranjero de sí mismo. Todo esto constituye problemáticas en la construcción del lazo social que considera necesario revisar en la sociedad contemporánea. El autor se plantea revisar las metáforas que parecen guiar las conductas, el orden de la gobernabilidad, tanto en el orden familiar como en el social, entre ellas, la metáfora pastoril, la metáfora textil y la metáfora del camino. Considera que se hace necesario advertir la presencia en los discursos contemporáneos, acorde a los caracteres performativos del lenguaje, de denominaciones estigmatizantes y culpabilizantes tempranas – aun antes de nacer el sujeto, como en Edipo, que requieren prácticas de resistencia y de cuidado de si para que el psicoanálisis pueda obrar en la clínica y en la sociedad contemporánea advirtiendo estas nominaciones y sus efectos en la constitución subjetiva. El estudio de Edipo en Colono significa un aporte importante para la consideración de las operaciones de trasmisión hechas a partir de la experiencia, del contacto con lo real y con el haber podido con eso construir una versión personal...

Costos reales de tratamientos intensivos por paciente y día cama / Real daily costs of patients admitted to public intensive care units

Background: Patient care costs in intensive care units are high and should be considered in medical decision making. Aim: To calculate the real disease related costs for patients admitted to intensive care units of public hospitals. Material and Methods: Using an activity associated costs analysis, the expenses of 716 patients with a mean age of 56 years, mean APACHE score of20 (56% males), admitted to intensive care units of two regional public hospitals, were calculated. Patients were classified according to their underlying disease. Results: The costs per day of hospital stay, in Chilean pesos, were $ 426,265for sepsis, $ 423,300for cardiovascular diseases, $ 418,329 for kidney diseases, $ 404,873 for trauma, $ 398,913 for respiratory diseases, $ 379,455for digestive diseases and $ 371,801 for neurologic disease. Human resources and medications determined up to 85 and 12% of costs, respectively. Patients with sepsis and trauma use 32 and 19% of intensive care unit resources, respectively. Twenty seven percent of resources are invested in patients that eventually died. Conclusions: A real cost benefit analysis should be performed to optimize resource allocation in intensive care units.

Limitación del esfuerzo terapéutico / Limitation of the therapeutic effort

El progreso de la Medicina Intensiva conlleva la necesidad de incluir dentro de sus acciones la Limitación de Terapias para aquellos pacientes que, luego de un análisis objetivo y prudente, se consideran no tendrán beneficio con medidas que pretendan revertir el proceso mórbido en curso. Es necesario que los miembros del equipo de salud involucrado en los cuidados del paciente mantengan entre ellos un dialogo que permita concordar posiciones, y una comunicación coherente y oportuna con el paciente o sus representantes. Se trata de considerar que es parte del compromiso ético con nuestros pacientes, con la práctica de la medicina y con la sociedad, el reconocer adecuadamente cuales son los límites de nuestro accionar. En este proceso debemos evitar la obstinación en terapias, valorar en su plenitud la autonomía de nuestros pacientes, así como respetar las consideraciones legales del ejercicio de la medicina.

The advancement of Intensive Medicine entails the need to include within its practices the Limitation of Therapies for those patients who-after an objective and careful analysis-it is estimated will not be benefited with measures aimed at reverting the ongoing morbid process. It is essential for health care team members involved in patient care not only to maintain a permanent dialogue among them, so as to be in agreement about points of view and positions, but also a coherent and timely communication with the patient or his proxies. We have considered that an adequate recognition of the limits of our deed is a fundamental part of the ethical commitment to our patients, to the practice of medicine, and to society. In this process we must avoid therapeutic obstination, show a real valuation of patient's autonomy while respecting legal issues concerning the practice of medicine.

Muerte encefálica: una perspectiva desde la unidad de pacientes críticos / Brian death: a critical care units perspective

Sobre ®muerte encefálica¼ existe una amplia variedad de discursos, transformándose en un ®problema¼ social y sanitario producto de la irrupción de los Cuidados Intensivos, pues los criterios tradicionalmente utilizados para la definición de muerte ya no cubren todas las condiciones que enfrentan los clínicos. El objetivo de este trabajo es analizar el concepto de muerte encefálica, mirado desde el interior de la Unidad de Pacientes Críticos, una perspectiva que no está representada en la literatura nacional. Se revisa el criterio neurológico de muerte que surge para dar respuesta a los vacíos que se generaron de las insuficiencias del criterio cardiopulmonar una vez masificada la práctica de la Medicina Intensiva. La muerte producida en tales unidades no será un hecho natural espontáneo, sino un evento intervenido. La reanimación cardiopulmonar y la sustitución de funciones abren un nuevo contexto que impulsa a la sociedad a considerar la práctica clínica como una instancia de encuentro con la ética, y por tanto un fuerte catalizador de la bioética. El criterio neurológico de muerte, llamado habitualmente ®muerte encefálica¼, ha significado un cambio de paradigma en la práctica de la medicina, y el escenario de ello ha sido la Unidad de Cuidados Intensivos. Tanto el equipo de salud como la sociedad, nos vemos enfrentados a situaciones de complejidad no vistas antes, que exigen a cada uno de los actores voluntad de entendimiento, diálogo permanente y prudencia en las decisiones.