The Collaboration of Private Hospitals with the Public Health Service: The Case of La Rioja, Spain (1986-2019).

In Spain, the public National Health Service provides care to Spaniards and other residents and is tailored for a decentralized state of autonomies. Each Autonomous Community has legislative capacity in its organization and management. We study the case of the collaboration between private hospitals and the public health service in La Rioja, an Autonomous Community of Spain located in the North of the Iberian Peninsula, due to the importance that this relationship has in health systems, in general. We applied the case study method as a methodological tool in a long-term local study. The interpretation was carried out within a national context, which allows us to understand its meaning and the historical keys to hospital development in this region. Primary sources have been reviewed (mainly reports, catalogs, and censuses of hospitals from the Ministry of Health and the Government of La Rioja) and other secondary sources, located in archives, libraries, Institute of Rioja Studies, and Department of Health. The hospital system in La Rioja was characterized by a predominance of public beds compared with private ones, although there has been a growing trend in the number of private beds from 2013 onwards due to the incorporation of health and social care convalescent hospitals (two). La Rioja has been promoting public-private collaboration (seen as a strategic alliance) and focusing on agreements in the socio-health space, particularly using the management service agreement and the concession of work formulas. The development of the public health service in La Rioja, from 1986 to 2019, has been determined by a progressive lower dependence on specialized hospitals from other health services of neighboring Autonomous Communities and by a mixed public-private hospital system.

[The new code of medical ethics (2022) and its general principles]. / El nuevo código de deontología (2022) y sus principios generales.

The article describes and analyses the General Principles of the 2022 Code of Medical Ethics that are included in the articles 4 to 6 of the second chapter. The General Principles make it possible to understand and interpret the set of precepts and recommendations of the code, for which reason the study of this second chapter is of special relevance. In addition, I contextualize General Principles by relating them to other current international ethical-deontological documents. We will also review how they are extended in the broad articles of the new code. We will observe that there is a clear relationship between the General Principles of the new code with respect to previous Spanish Medical Codes, which is logical since they gather permanent values of Medical Ethics. In the General Principles is proposed that each doctor is at the service of the human being and of society and has as primary duties, respect for human life, dignity of each person, as well as the health care of the individual and the society (Article 4.1).

La revisión emocional del encuentro médico-terapéutico en M. Balint, P. Freeling y K. Browne (1957-1967) / The emotional perspective of the encounter between doctor and patient in m. Balint, P. Freeling and K. Browne (1957-1967)

Se analiza la perspectiva emocional de la relación médico-paciente y la confianza propia de esta interrelación, a través de publicaciones y relatos médicos de Michael Balint, Kevin Browne y Paul Freeling, aparecidos en la década de 1960. Balint promovió en la clínica Tavistock (Londres) los llamados ‘Grupos Balint’ en los que participaron Browne y Freeling. Sus publicaciones se enmarcan en la aproximación psicoanalítica y psicosomática, enfoque que actualizó la consideración de la persona como un todo y mostró el significado de las emociones en la enfermedad. Balint, Browne y Freeling destacaron el carácter terapéutico de la relación médico-paciente y subrayaron la subjetividad y la participación tanto del profesional como del paciente, en el encuentro médico-paciente. El movimiento Balint y en ese marco, la obra de Browne y Freeling, se sumó a otras que llevaron a promover la integración de lo psicológico y el entorno social en la definición de la enfermedad y en la práctica de la medicina de ese tiempo. El artículo pone de manifiesto los contrastes entre las propuestas de Michael Balint y las planteadas por la Escuela Psicosomática norteamericana y otros movimientos de origen psicoanalítico, respecto a la psicogenia y a la relación médico-paciente.(AU)

The emotional perspective of the doctor-patient relationship and the trust inherent in this interrelation are analysed through medical narratives published in the 1960s by Michael Balint, Kevin Browne and Paul Freeling. Balint promoted the so-called ‘Balint Groups’ in the Tavistock clinic (London), in which Browne and Freeling participated. Their publications are part of the psychoanalytic and psychosomatic approach, that updated the consideration of the person as a whole and showed the meaning of emotions in illness. Balint, Browne and Freeling highlighted the therapeutic nature of the doctor-patient relationship and underlined the subjectivity and participation of both the professional and the patient in the doctor-patient encounter. The Balint movement and within this framework, the work of Browne and Freeling, joined others that led to promoting the integration of the psychological and the social environment in the definition of the disease and in the practice of medicine at that time. The article also focusses the contrasts between the proposals of Michael Balint and those raised by the American Psychosomatic Society, and other psychoanalytic movements, regarding the doctor-patient relationship.(AU)

Contribución de las Mutuas de Previsión Social al Sistema Hospitalario español: el caso de La Alianza / Contribution of the Mutual Insurance Societies to the Spanish Hospital System: the case of La Alianza

Las sociedades de ayuda o apoyo mutuos fueron un conjunto variado de insti-tuciones de carácter social, de naturaleza privada y sin ánimo de lucro, que proporcionaron prestaciones socio-asistenciales también en caso de enfermedad, a buena parte de la población, entre la segunda mitad del siglo XIX y primera del XX. En España, fueron escasos los hospitales promovidos por estas instituciones, quizá porque la mayoría no llegaron a tener suficiente número de socios para hacerlo. Los hospitales de este tipo se encontraban, mayoritariamente, en Cataluña, donde las sociedades obreras de ayuda mutua tuvieron un mayor desarrollo. A través del caso paradigmático de los hospitales de La Alianza, el estudio muestra que estos hospitales estuvieron abiertos a diversos tipos de pacientes (privados o derivados por otras instituciones) y tuvieron una dependencia económica múltiple. También se analizan los cam-bios que más influyeron en los hospitales de las mutuas, en la segunda mitad del siglo XX: el proceso de federación de las mutuas de previsión social y el itinerario de concertación pública. Estos hospitales participaron en el desarrollo de nuevas especialidades médico-quirúrgicas hospitalarias. Se advierte que fueron precisamente los hospitales de La Alianza los que llevaron a un mayor desarrollo de esta entidad. (AU)

Assessment of the methodological and ethical quality of clinical trials published in family medicine journals / Valoración de la calidad metodológica y ética de los ensayos clínicos publicados en revistas de medicina de familia (2010-2013)

Objective: To evaluate some methodological and ethical quality variables of clinical trials (CTs) published in 10 family medicine journals. Methods: Quality descriptive study of 10 family medicine journals including CTs in humans published since 2010 to 2013. We obtained 141 CT and 2447 were excluded. Results: CTs parallels controlled in 92.9% (95% confidence interval [95% CI]: 92.0-93.9). Masked randomization in 72.3% (95% CI: 71.7-73.1), decentralized in 51.8% (95% CI: 51.4-52.4) and using as control an active treatment in 82.2% (95% CI: 81.5-83.1). Wrote informed consent in 48.9% (95% CI: 48.5-49.5) and it was not withdrawn in 56.0% of cases (95% CI: 55.5-56.7). Approval by clinical research ethics committee (CREC) in 134, and there was no conflict of interest in 117 CTs. Average κ was 0.96 (95% CI: 0.93-0.99). Conclusions: We observe an increase in some quality variables like masked randomization (19.6%) and approval by CREC (75%) post CONSORT, in CTs published in 10 family medicine journals (2010-2013).

Objetivo: Evaluar algunas variables sobre la calidad metodológica y ética de los ensayos clínicos publicados en 10 revistas de medicina de familia. Métodos: Estudio descriptivo de calidad sobre 10 revistas de medicina de familia incluyendo ensayos clínicos en humanos publicados entre 2010 y 2013. Obtuvimos 141 ensayos clínicos y fueron excluidos 2447. Resultados: Ensayos clínicos controlados paralelos en el 92,9% (intervalo de confianza del 95% [IC 95%]: 92.0-93.9). Aleatorización enmascarada en el 72.3% (IC 95%: 71.7-73.1), descentralizada en el 51.8% (IC 95%: 51.4-52…4) y utilizando como control un tratamiento activo el 82.2% (IC 95%: 81.5-83.1). Consentimiento informado escrito en el 48.9% (IC 95%: 48.5-49.5) y no fue retirado en el 56.0% (IC 95%: 55.5-56.7). En 134 ensayos clínicos se contó con la aprobación por un comité ético de investigación clínica (CEIC), y en 117 no hubo conflicto de intereses. Se obtuvo un κ medio de 0,96 (IC 95%: 0.93-0.99). Conclusiones: Observamos, tras considerar las normas CONSORT, un aumento en algunas variables de calidad, como la aleatorización enmascarada (19.6%) y la aprobación por un CEIC (75%), en los ensayos clínicos publicados en 10 revistas de medicina de familia (2010-2013).

Formación y competencia docente del médico hospitalario / Training and teaching competence of the hospital physician

La enseñanza por competencias se ha impuesto como filosofía hegemónica y como principio organizador en la educación médica. Los estudiantes de medicina, los médicos en formación y los profesionales se enfrentan a una amplia variedad de competencias que han de adquirir y que se han diseñado, sobre todo, por asociaciones educativas o profesionales. El artículo insiste en 3 aspectos de carácter transversal, elegidos por la finalidad a la que están dirigidas las competencias del profesor clínico. El primero es la necesidad de una competencia clínica y científica basada en el estudio. El segundo es la importancia de la ética médica en la formación del profesor y en la del estudiante, para la atención de las cuestiones eticomédicas de la práctica clínica cotidiana. El profesor clínico, a través del ejercicio profesional y humano, ayuda a modelar sus pautas de actuación. Puede ser ejemplo de vida profesional y de categoría humana, en un momento en que la conducta no ética puede ser especialmente nociva. En tercer lugar, parece necesario el conocimiento de la evolución temporal de la medicina, la enfermedad y las prácticas médicas. Es un programa que pretende formar a los futuros médicos en hospitales que sean verdaderos lugares de humanización de la medicina

The acquisition of competences has emerged as a hegemonic philosophy and an organizing principle in Medical Education. Medical students, junior doctors and professionals are currently required to acquire a wide variety of skills. Generally, these health competences are designated by professional or educational medical associations. The article focuses on three aspects selected on the basis of how they fulfill the most important aims, according to clinical teachers. The first is the need for a good clinical and scientific competence based on study. The second is the key role of issues related to medical ethics in everyday clinical work. The clinical professor, through professional practice and human virtues, can shape the patterns and the practice styles of future physicians. Today, behavior can be particularly harmful. Third, knowledge of the evolution of medicine, illness and medical practices is necessary. This program aims to train future doctors in hospitals, which are places of a genuine humanization of medicine

Investigación con pacientes en cuidados paliativos: dilemas éticos y percepción pública sobre su vulnerabilidad. estudio exploratorio / Research with patients in palliative care: ethical dilemmas and public perception of their vulnerability. an exploratory study / Pesquisa com pacientes em cuidados paliativos: dilemas éticos e percepção pública sobre sua vulnerabilidade. estudo exploratório

Resumen Los pacientes con enfermedades oncológicas en cuidados paliativos pertenecen a un grupo caracterizado como altamente vulnerable y su inclusión en estudios clínicos presenta diversos problemas éticos. Estudio de corte transversal, analítico; el 82% de las personas consideró ético realizar investigación con pacientes en cuidados paliativos, con el fin de ayudar a otros en el futuro (40%), con la esperanza de mejorar (32%) o por confianza en su médico-investigador (10%). La amplia aceptación para participar en estos estudios de investigación demostraría que los beneficios potenciales excederían a lo meramente terapéutico; el altruismo, la esperanza de mejorar o la percepción de seguir "luchando" son aspectos que se deben tener en cuenta al momento de evaluar el respeto por la autonomía de las personas involucradas.

Abstract Patients who have an oncological disease and are in palliative care belong to a group that is often characterized as highly vulnerable, and their participation in clinical trials poses a number of ethical problems. This study is cross-sectional and analytic. In all, 82% of those who took part consider it ethical to conduct research with patients in palliative care, either to help other patients in the future (40%), in the hope of gaining some improvement (32%) or due to confidence in the physician-researcher (10%). The wide acceptance to participate in these research studies shows the potential benefits appear to exceed the merely therapeutic ones. Altruism, hoping to improve or the perception of continuing to "fight" the disease are aspects to bear in mind when evaluating respect for the autonomy of the persons involved.

Resumo Os pacientes com doenças oncológicas em cuidados paliativos pertencem a um grupo frequentemente caracterizado como altamente vulnerável e sua inclusão em estudos clínicos apresenta diversos problemas éticos. Estudo de corte transversal, analítico; 82% das pessoas consideraram ético realizar pesquisa com pessoas em cuidados paliativos, com o fim de ajudar outros pacientes no futuro (40%), com a esperança de melhorar (32%) ou por confiança em seu médico-pesquisador (10%). A ampla aceitação para participar nesses estudos de pesquisa demonstraria que os benefícios potenciais excederiam ao meramente terapêutico; o altruísmo, a esperança de melhorar ou a percepção de continuar "lutando" são aspectos que devem ser levados em consideração no momento de avaliar o respeito pela autonomia das pessoas envolvidas.

An Introduction to History of Science and the Emotions.

This essay introduces our call for an intertwined history-of-emotions/history-of science perspective. We argue that the history of science can greatly extend the history of emotions by proffering science qua science as a new resource for the study of emotions. We present and read science, in its multiple diversities and locations, and in its variegated activities, products, theories, and emotions, as constitutive of the norms, experiences, expressions, and regimes of emotions. Reciprocally, we call for a new reading of science in terms of emotions as an analytical category. Assuming emotions are intelligible and culturally learned, we extend the notion of emotion to include a nonintentional and noncausal "emotional style," which is inscribed into (and can reciprocally be generated by) technologies, disease entities, laboratory models, and scientific texts. Ultimately, we argue that emotional styles interrelate with broader emotional cultures and thus can contribute to and/or challenge grand historical narratives.

The Feeling Body and Its Diseases: How Cancer Went Psychosomatic in Twentieth-Century German.

This essay examines how psychosomatic medicine, as it emerged between 1920 and 1960, introduced new ideas about the emotional body and the emotional self. Focusing on cancer, a shift can be mapped over the course of the twentieth century. While cancer was regarded at the beginning of the century as the organic disease par excellence, traceable to malignant cells and thus not caused or influenced by emotions, in later decades it would come to be thoroughly investigated within the field of psychosomatic medicine. This essay illuminates why and how this shift occurred in Germany and how it was affected by the earlier turn toward a psychosomatic understanding of cancer in the United States.

[Identity and social integration: analysis of sociability in a mutual aid society (1902-1933)]. / Identidad e integración social: análisis de la sociabilidad en una sociedad de socorros mutuos (1902-1933).

This article studies the sociability evidenced in the fiestas and other celebrations held by the Breastfeeding Infant Clinic and periodically organized by La Conciliación Mutual Aid Society between 1902 and 1933 as recreational acts with educational purposes. La Conciliación (1902-1984) was founded in Pamplona as an exclusively male Catholic association (women were admitted from 1936) composed of workers, employers and protector members, with labor, healthcare, and economic objectives under a Mixed Board of Governors with representatives from the three cohorts. The description of the events and the analyses of the emotional practices are based on newspaper reports and the association's archives. The acts organized by the Breastfeeding Infant Clinic served to stimulate positive emotions and maternal feelings of piety and charity and to arouse a sense of social utility in the upper social classes. We acknowledge the regulatory component of the emotions that appeared in the fiesta of La Conciliatión: conferences and social events proposed a social model that reinforced the participation of members and their families in the association's ideological and religious goals. The performative character of emotions was designed to reinforce the identity of the members of La Conciliation and their social integration in the city. This model of sociability strengthened the project of La Conciliation.

Identidad e integración social: análisis de la sociabilidad en una sociedad de socorros mutuos (1902-1933) / Identity and social integration: analysis of sociability in a mutual aid society (1902-1933)

El artículo estudia la sociabilidad en las fiestas y en las celebraciones del Consultorio de Niños de Pecho organizadas periódicamente por la sociedad de socorros mutuos La Conciliación entre 1902 y 1933. Eran actos recreativos que también tenían una finalidad educativa. La Conciliación (1902-1984) fue fundada en Pamplona, con carácter mixto y católico, exclusivamente masculina hasta 1936. Su principal actividad fue la mediación laboral y la asistencia en la enfermedad a los socios obreros y sus familias, a través de un subsidio económico y del servicio médico. A partir de las noticias publicadas en la prensa y de los documentos del archivo de la sociedad de socorros mutuos, se describen los acontecimientos y se analizan las prácticas emocionales de las celebraciones. Los actos del Consultorio de Niños de Pecho suscitaron emociones positivas que estimularon los sentimientos maternales, de piedad y caridad, o de utilidad social de las clases acomodadas. En las fiestas de La Conciliación se reconocen los aspectos emocionales relacionados con la comunicación, la movilización y la regulación: las conferencias y los actos proponían a los socios obreros y a sus familias un modelo social y una concepción ideológica y religiosa. El carácter performativo de las emociones reforzó la identidad de los miembros y su integración social en la ciudad. Se trató de una sociabilidad al servicio del proyecto de La Conciliación (AU)

This article studies the sociability evidenced in the fiestas and other celebrations held by the Breastfeeding Infant Clinic and periodically organized by La Conciliación Mutual Aid Society between 1902 and 1933 as recreational acts with educational purposes. La Conciliación (1902-1984) was founded in Pamplona as an exclusively male Catholic association (women were admitted from 1936) composed of workers, employers and protector members, with labor, healthcare, and economic objectives under a Mixed Board of Governors with representatives from the three cohorts. The description of the events and Contents Dynamis 2015; 35 (2): 263-269 267 the analyses of the emotional practices are based on newspaper reports and the association’s archives. The acts organized by the Breastfeeding Infant Clinic served to stimulate positive emotions and maternal feelings of piety and charity and to arouse a sense of social utility in the upper social classes. We acknowledge the regulatory component of the emotions that appeared in the fiesta of La Conciliation: conferences and social events proposed a social model that reinforced the participation of members and their families in the association’s ideological and religious goals. The performative character of emotions was designed to reinforce the identity of the members of La Conciliation and their social integration in the city. This model of sociability strengthened the project of La Conciliation (AU)

El Congreso médico-regional de Navarra (1886): un ejemplo de la transmisión del conocimiento científico / The 'Regional-Medical Congress of Navarre' (1886): an exercise in sharing scientific knowledge

La última ola epidémica del cólera en Navarra (1884-1885) es la menos estudiada porque apenas afectó a Pamplona, el núcleo urbano más importante de la región, pero creó una situación crítica en otras áreas como la Ribera. Fundamento. El ‘Congreso médico-regional de Navarra’ celebrado en Tafalla (Navarra), en 1886, se convocó para estudiar la epidemia de cólera de 1885 en la región. El interés de esta reunión científica estriba en la actitud de los médicos ante el desarrollo de la microbiología y la higiene pública. En un momento en que Robert Koch aisla el Bacillus vírgula, en 1883, y tiene lugar la polémica desarrollada por la difusión de la vacuna de Jaime Ferrán y Clúa, en 1885. Material y métodos. A través de las actas y de las memorias presentadas al Congreso analizamos la influencia de autores e instituciones internacionales en los profesionales navarros. Conclusiones. La reunión científico médica de Tafalla fue una iniciativa singular para Navarra. En ella se observa la transferencia de ideas de los congresos internacionales sobre la epidemia colérica. Esta influencia fue mediada por personalidades como Nicasio Landa y A. Espina y Capo. Hemos observado diferencias en las concepciones de los médicos, en el momento en el que no existía una teoría etiopatogénica única. La metodología seguida por los médicos ejemplifica el análisis y las medidas higiénico sanitarias propuestas para combatir el cólera (AU)

This paper discusses the last wave of cholera in Navarre (1884-85). This epidemic has been the least studied because it barely affected Pamplona, the largest urban area in the province. But the situation was critical in other zones close to the River Ebro (the Ribera area). Background. In 1886, the ‘Regional-Medical Congress of Navarre’, held in Tafalla (Navarre), studied the latest cholera epidemic in the region. An analysis of this scientific meeting is of interest because of the data it offers on the physicians’ reactions to the development of microbiology and public hygiene, shortly after Robert Kochhad isolated the comma-shaped cholera bacillus in 1883 (‘Bacillus virgula’), and the controversy over the distribution of the vaccine by Jaime Ferrán y Clúa, in 1885. Material and methods: Analysis of the conference reports presented at the ‘Regional-Medical Congress’. Conclusions: This scientific medical gathering ‘in Tafalla was innovative for Navarre. The transfer of ideas from international conferences on the cholera epidemic can be seen. The development of the Conference was influenced by medical celebrities like Nicasio Landa and Antonio Espina y Capo. We can also observe differences in the physicians’ ideas. At the time there was no paradigm onmicrobiology in the world of science. The questionnaires produced by the Navarrese physicians for the study of the epidemic are a good example of the procedure for analysing a public health problem and of the measures proposed in a situation of cholera epidemic (AU)

[The medical and pharmaceutical profession and the mutual care system in the writings of Jaime Vera (1859-1918)]. / Profesión y asistencia médico-farmacéutica en los escritos de Jaime Vera (1859-1918).

This article presents the perspectives of the physician and politician Jaime Vera y López (1859-1918), co-founder of the Spanish Socialist Workers' Party, on the medical profession, medical practice, and healthcare systems. It compares the Report (Informe) that he presented to the Comisión de Reformas Sociales (1884) with his later writings published in the socialist press ("Farmacia y cooperación obrera,, 1914 and "La locura en los niños. Camino del remedio", 1916). We observe the discrepancies between the political-programme documents and the articles centring on professional questions and highlight how his theoretical focus is modified when applied to matters of medical practice.

Las consultas médicas en la España del siglo XVIII: razones de su existencia

Estudiamos cómo justifican los médicos españoles del siglo XVIII las consultas o juntas de facultativos, así como los casos en los que se recomendaba este procedimiento. En un segundo momento analizamos los requisitos del consultor y su responsabilidad profesional, y los aspectos económicos. Concluimos con una revisión de los perjuicios y críticas que ocasionaba la realización de las consultas (AU)