The position of the Chilean Medical Association with respect to torture as an instrument of political repression.
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The majority of Chilean physicians work as specialists, mainly as internists, surgeons pediatricians or gynaecologists. The number is higher in Santiago than in other parts of the country, with a better supply in the predominantly urban areas of the country. Only a fraction of the Chilean specialists work at the National Health Service. During the 1980 decade a process of specialist certification was initiated as a joint effort of the Universities, the Chilean Medical Association, the scientific societies and the Chilean Academy of Medicine. The residency programs offered by the universities, the high level of specialization, the need for a better knowledge of the specialists needed in the country and the absence of a planning system for the production are discussed.
This review gives information about the origin and development of the Public Health organisms in Chile, particularly the National Health Service, outstanding governmental health institution created in 1952, whose achievements were favored by the coordinated support of the University and the Chilean Medical Association. At the present time, their work is carried on by the National System of Health Services. The National Health systems have contributed to the improvement of population's health conditions, specially of the most vulnerable groups. Among other accomplishments, the life expectancy of the Chilean population has increased from 57 years in 1960 to 1972 years in 1990, and the general and infant mortality rates decreased from 12.6 to 6/1000 and from 120.5 to 16/1000 respectively. In the same period, the system has increased the coverage of its programs, specially those addressed to technical assistance of delivery, responsible parenthood, healthy child control, vaccinations, complementary feeding and sanitary education. The main limitation to the system's actions has been the restricted availability and the unequal distribution of resources assigned to health (about US$ 100 per capita). It is postulated that the implementation of a new Health and Social Welfare System (in study at the present time) should improve the efficiency and solidarity of health care.
Professional colleges lost the ethical control of their members in 1980, when a free market economical model was implemented in Chile. Courts of justice have failed to accomplish this task. To recover such control, the Chilean Medical Association would need to modify its internal organization, separating its functions as a union from those required to control professional ethics. The health reform that is being set forth in the country, proposes a "new instance" for the control of professional ethics, within the Health Services and forming part of the Health Care Authority.
Chile's health system has been evolving rapidly in recent years. Among other things, profit-making enterprises have assumed a growing role, medical care has become increasingly technical, and the importance of less highly trained health workers has grown. Also, the assigned role of the Chilean Medical Association in deciding matters of medical misconduct has diminished, while that of the courts has grown; the nature of the doctor-patient relationship has changed; and clear divergences between medical ethics codes, laws, and prevailing social practices have emerged. Within this context, bioethics has come to be regarded as a necessary element in the teaching and practice of medicine. So while this discipline has not yet become fully institutionalized in Chile, it seems likely to play a growing role in dealing with the aforementioned changes and could make a substantial contribution toward solution of associated problems in the future.
A recent law project pretended to improve the number and distribution of clinical specialists throughout the country. Several Medical Scientific Societies felt that the diagnosis and the treatment proposed for the problem were erroneous. In Chile, there is no such lack of specialists but, unfortunately, they are badly distributed and any solution should include their better geographical distribution. This was the beginning of a common action by 30 Medical Scientific Societies, which realized that they have several problems in common, deciding to create an entity to face them: the Chilean Association of Medical Scientific Societies (ASOCIMED). This association was formed last August. In a few months of work it has studied its bylaws to be submitted for approval to the Member Societies. Also it has started to study, together with the Ministry of Public Health, the needs, number and distribution of specialists in the country and important information should be gathered from this study. ASOCIMED is already representing Medical Scientific Societies in the National Corporation for Medical Certification (CONACEM), together with the National Academy of Medicine is creating a National Award of Medicine and with the Health Insurance Companies is studying a way to face high cost diseases. During its short existence, ASOCIMED has faced a diversity of different issues and it seems reasonable to believe that it will play an important role in Chilean Medicine.
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An analysis of health research in Chile is made, considering factors like exaggerated professional training during undergraduate studies and clinical residencies, and displacement of professionals from academic activities to more remunerative positions. Additionally, the limited role of the Ministry of Health in research promotion, evidenced by the almost absent participation of public hospitals in clinical research is discussed. Research investment, among a 0.6 to 0.8% of the GNP, is far from developed countries and Chile has not defined relevant health problems where a search effort would have an impact in public health. The marked centralism of the country attempts against regional application to financed projects. The following suggestions are made: to increase the financing for investigation, to reassign resources allowing the access of regional institutions, to financing, to discuss in the Chilean Association of Medical Faculties (ASOFAMECH) the creation of an academic degree by means of a thesis during the professional studies and to give facilities to develop research during clinical residencies. Also, the Ministry of Health should be involved, creating a national agenda or research priorities and increasing its association with Universities. Also training programs for professionals with a special interest in investigation should be devised.
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Important advances in the accreditation of higher education institutions and programs have occurred in Chile. A definite step forward had been the accreditation of three of the six Medical Schools, considered in the agreement subscribed between the Chilean Medical Faculties Association and the National Committee for Undergraduate Program Accreditation (CNAP). According to this understanding, educational quality was evaluated using international standards and its improvement was encouraged. The accreditation procedure carried out at the University of Chile Medical School is described. Its observation has revealed the difficulties of accreditation procedures and the early benefits obtained after they have been completed. The careful observation of the evaluation procedure will help to improve the used model and to design an effective accreditation instrument that will ultimately improve undergraduate teaching programs.
The role of internists has been extensively debated in the last decades. Chile has a 40 years experience in specialist training, based on USA hospital residency programs. The universities have tuition of programs and financing comes from the Ministry of Health. The Chilean Association of Medical Faculties accredits training centers. The present paper proposes a profile for internists (referred as an adult general physician) in the areas of attitudes and behaviors, knowledge and skills. The features, training areas and educational experiences that the internist should have, based on the described profile are also pointed out. Current training programs should be modified, since they have become the vestibule for super-specialization rather than conducting to the practice of general internal medicine. The internist's amplitude and integration of knowledge, fine clinical skills based on medical interview, physical examination and therapeutic mastery, differentiates him from sub-specialists.
On September 29th, 2000, The Chilean Association of Biomedical Journal Editors was founded, sponsored by the "Comisión Nacional de Investigación Científica y Tecnológica (CONICYT)" (the Governmental Agency promoting and funding scientific research and technological development in Chile) and the "Sociedad Médica de Santiago" (Chilean Society of Internal Medicine). The Association adopted the goals of the World Association of Medical Editors (WAME) and therefore it will foster "cooperation and communication among Editors of Chilean biomedical journals; to improve editorial standards, to promote professionalism in medical editing through education, self-criticism and self-regulation; and to encourage research on the principles and practice of medical editing". Twenty nine journals covering a closely similar number of different biomedical sciences, medical specialties, veterinary, dentistry and nursing, became Founding Members of the Association. A Governing Board was elected: President: Humberto Reyes, M.D. (Editor, Revista Médica de Chile); Vice-President: Mariano del Sol, M.D. (Editor, Revista Chilena de Anatomía); Secretary: Anna María Prat (CONICYT); Councilors: Manuel Krauskopff, Ph.D. (Editor, Biological Research) and Maritza Rahal, M.D. (Editor, Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello). The Association will organize a Symposium on Biomedical Journal Editing and will spread information stimulating Chilean biomedical journals to become indexed in international databases and in SciELO-Chile, the main Chilean scientific website (www.scielo.cl).
BACKGROUND: Treatment compliance among patients with type 1 diabetes mellitus, is low in 50% of diabetic teenagers, becoming a social and medical problem. AIM: To determine psycho-social factors associated to treatment compliance among Chilean diabetic type 1 teenagers. PATIENTS AND METHODS: A non experimental study of 61 diabetic teenagers (age 14.9+/-1.9 years, 37 male). The number of blood glucose determinations, socioeconomic level and practice of sports was measured. Psychological tests were applied to analyze self-efficiency, motivation of achievement, self-esteem and knowledge of the illness and its treatment. As a measure of patient compliance, glycosilated hemoglobin (HB1Ac) was measured. RESULTS: Six patients had a good control of diabetes (HB1Ac <7%), 24 had HB1Ac values between 7 and 8.9, and 31 (51%) had values of 9% or more, considered as a poor diabetes control. The intensified insulin treatment scheme, the knowledge of the illness and its treatment and the sense of self-efficiency, were the factors associated with a better compliance with treatment. Teenagers of higher socio-economical levels had a better compliance with treatment. CONCLUSIONS: Fifty percent of Chilean diabetic teenagers in this sample had a poor control of the disease and the variable knowledge about the disease is the better predictor of patient compliance.