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Intensified human activities are causing ever-growing threats to biodiversity, including humans and ecosystem services. Conversely, evidence showing the multiple benefits and socio-economic values of ecosystem services and goods is increasing substantially. A fundamental societal revolution is urgently needed to preserve the health of populations of living beings, communities and ecosystems. The present article aims to convey that the multidimensional (sanitary, social, economic, political, ecological and ideological) crisis we are facing should force us to build bridges and exchanges between science, the public and politics - an essential prerequisite to implement coherent and sustainable biodiversity, public health and education policies on both local and global scales.
RESUMO
RESUMEN Introducción: el cáncer es la segunda causa de muerte en el mundo; los tumores del sistema digestivo ocupan el segundo lugar y según localización los de páncreas poseen la menor tasa de supervivencia. Objetivo: evaluar la efectividad de la analgesia multidimensional para los pacientes en estadio terminal por cáncer de páncreas. Métodos: se realizó un estudio cuasiexperimental, comparativo, prospectivo y longitudinal en pacientes con dolor por tumor de páncreas en etapa final de su enfermedad, en el Hospital Abel Santamaria Cuadrado desde noviembre 2016 a julio 2019. Se incluyeron todos los pacientes con dolor por tumor de páncreas en estadio terminal, se conformaron tres grupos de acuerdo con el método de analgesia empleado; Grupo I (n=10) analgesia multimodal, Grupo II (n=10) analgesia multidimensional y Grupo III (n=3) esquema de analgesia de la Organización Mundial de la Salud, se evaluó calidad de la analgesia, la necesidad de dosis de rescate y uso de morfina, se compararon los métodos y se determinó la supervivencia. Resultados: la calidad de la analgesia fue mayor en los pacientes del grupo II, en igual grupo no fue necesario el uso de morfina hasta el 7mo mes y en solo dos pacientes, (p=0,00) no hubo diferencias en las tasas de supervivencia. Conclusiones: el enfoque multidimensional de la analgesia, donde se incluya al individuo como ser biopsicosocial y a la familia, logra mayor calidad de la analgesia. El método empleado para el alivio del dolor no influye en la supervivencia.
ABSTRACT Introduction: cancer is the second leading cause of death in the world; the tumors of the digestive system occupy the second place and according to itslocation, those in the pancreas have the lowest survival rate. Objective: to assess the effectiveness of multidimensional analgesia for patients in terminal stage due to pancreatic cancer. Methods: a quasi-experimental, comparative, prospective and longitudinal study was conducted in patients with pain due to pancreatic tumor in terminal stage at Abel Santamaria Cuadrado General Teaching Hospital from November 2016 to July 2019; all patients with pain due topancreatictumor were included. In the terminal stage of pancreatic cancer, three (3) groups were completed according to the analgesia method applied; Group I (n = 10) multimodal analgesia, Group II (n = 10) multidimensional analgesia and Group III (n = 3) following WHO analgesia scheme, analgesia quality, and the need for rescue dose and application of morphine, the methods were compared and survival rate was determined. Results: the quality of analgesia was higher in patients from group II, in the same group the application of morphine was not required until the 7th month and in only two patients (p = 0.00), there were no differences in the rates of survival. Conclusions: the multidimensional approach to analgesia, where the individual is included as a biopsychosocial being and the family achieves greater quality of analgesia, the method applied for pain relief does not influence on survival.
RESUMO
Palliative care and end of life at home remains a challenge for the general practitioner. The success is related to many factors, including the situation of the patient, his social and family environment, the presence of the various health professionals and the physician's engagement. Beyond the medical-technical skills, he plays a central coordinating role in an interdisciplinary team regularly adjusted according to the patient's evolution. The positive emotional impact on bereaved relatives after the end of life at home is often underestimated by the physician.
Des soins palliatifs et une fin de vie à domicile reste un défi pour le médecin traitant. Le succès est lié à de nombreux facteurs, dont la situation du malade, son environnement socio-familial, la présence des divers professionnels de la santé et l'engagement du médecin. Au-delà de ses compétences médico-techniques il a un rôle central de coordination d'une équipe interdisciplinaire régulièrement ajustée en fonction de l'évolution du malade. L'impact émotionnel positif laissé auprès des proches endeuillés après un accompagnement de fin de vie au domicile est souvent sous-estimé par le médecin.
