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The purpose of this paper is to delve into the ethical aspects experienced by the healthcare team when they receive the directive to limit therapeutic effort or a do-not-resuscitate order. From an interpretative, qualitative paradigm with a content analysis approach, a process based on three phases was conducted: pre-analysis in which categories were identified, the projection of the analysis, and inductive analysis. During 2023, interviews were conducted in the clinical setting of a high-complexity hospital in Chile with 56 members of the healthcare teams from critical and emergency units, from which four categories emerged: a) the risk of violating patients' rights by using do-not-resuscitate orders and limiting therapeutic effort; b) the gap in the interpretation of the legal framework addressing the care and attention of patients at the end of life or with terminal illnesses by the healthcare team; c) ethical conflicts in end-of-life care; and d) efficient care versus holistic care in patients with terminal illness. There are significant gaps in bioethics training and aspects of a good death in healthcare teams facing the directive to limit therapeutic effort and not resuscitate. It is suggested to train personnel and work on a consensus guide to address the ethical aspects of a good death.

This paper studies a shelter network for Jewish scientists displaced by nazism from the archive of Alexander Lipschütz, a physiologist who lived in Chile since 1926. From the context of the anti-Semitic persecution and the way in which it affected German science and their universities, we have analyzed letters sent to and from Lipschütz between 1935 and 1936, with special attention to people who contacted him to flee Germany and considered Latin America as a possibility to live. We suggest this was a network of personal agencies, charged with subjectivities and intimacy, which had to take into account local anti-Semitism and academic xenophobia.

As a part of the EIS-COVID project on the access and use of information during the COVID-19 pandemic in Chile, the objective of this paper was to ascertain how people's informational environment was constructed during the first stage of the pandemic. It discusses the results of a qualitative study of people belonging to risk groups for COVID-19: people over 18 and under 65 with chronic diseases (hypertension and diabetes) and people 65 and over. Ninety semi-structured interviews were conducted in the Metropolitan and Valparaíso regions between September 2020 and January 2021. The results reveal the problematic nature of the information overload encountered by these groups and the strategies they used to navigate it: a) information avoidance; b) content corroboration and active search for reliable sources; and c) differentiated media use.

Introduction: Autism Spectrum Disorders (ASD) are neurodevelopmental disorders of increasing prevalence. People with ASD have multiple health, education, and community needs, yet there is little information about their situation in Chile., Objective: To learn about the demographic and clinical characteristics, caregiver's first concerns, and age of diagnosis of ASD individuals., Patients and Method: Participants were parents/caregivers of ASD persons, who answered the Caregiver Needs Survey, developed by Autism Speaks specifically for this purpose, and translated into Spanish. The survey is comprised of 4 sections: demographic information, characteristics of the ASD individual, past and present use of Health and Education Services, and parents/caregivers' perceptions of satisfaction, impact, stigma, and quality of life. Data from the first two sections are reported in this paper., Results: The survey was answered by 291 caregivers (86% mothers) of 291 mostly male ASDs (89%), aged between 1-40 years (X: 10.4 SD: 6.1). The average age of parents' first concerns was 29.2m (SD: 23.8) where the main ones were: interaction difficulties (79.4%), unusual response to sensory stimuli (69.8%), behavioral problems (65.3%), unusual gestures/movements (64.3%), and lack of eye contact (63.6%). The ave rage age of diagnosis was 58m (SD: 36.5), with an average delay of diagnosis of 29m. The diagnosis was most frequently made by pediatric neurologists (44.7%), child psychiatrists (19.2%), and pedia tricians (5.5%). The most frequent comorbidities were language impairment, cognitive deficit, and behavioral problems., Conclusions: The late age of diagnosis of ASD and the large gap between the age of first concerns and diagnosis, represent a critical loss of treatment opportunities and jeopardize the chances of a better long-term outcome.

The current COVID-19 pandemic has the potential to overwhelm the capacity of hospitals and Intensive Care Units in Chile and Latin America. Thus local authorities have an ethical obligation to be prepared by implementing pertinent measures to prevent a situation of rationing of scarce healthcare resources, and by defining ethically acceptable and socially legitimate criteria for the allocation of these resources. This paper responds to recent ethical guidelines issued by a Chilean academic institution and discusses the main moral principles for the ethical foundations of criteria for rationing during the present crisis. It argues that under exceptional circumstances such as the current pandemic, the traditional patient-centered morality of medicine needs to be balanced with ethical principles formulated from a public health perspective, including the principles of social utility, social justice and equity, among others. The paper concludes with some recommendations regarding how to reach an agreement about rationing criteria and about their implementation in clinical practice.

This short paper focuses on the role of mathematical models to analyze the impact of pandemics on health resources and the different trade-offs that may be included in them. There is a large body of literature suggesting that mathematical modeling may be helpful to estimate how much additional equipment and infrastructure are necessary to mitigate an increase in demand for health services during a large-scale outbreak of an infectious disease. I comment on the crucial role of these models with a special focus on their strengths and limitations.

The Chilean physician Hans Betzhold published the book Eugenesia (Eugenics) in 1939, which was a work that received multiple awards and ran to a second edition in 1942. Both editions and the participation of Betzhold at the Second Peruvian Conference on Eugenics in 1943 attest to the fact that he was an important actor in the field of Chilean eugenics. This paper analyzes his transition from the publication of Eugenesia, in which he proposes a National Eugenics Department combining existing projects and laws to make the eugenic ideal a reality until its intervention, in the year 1943, when his optimism yields to disillusion regarding the task of creating a "Chilean superman."

The aim of this paper was to analyze selected variables that could be involved in vaccination coverage of children in different communal territories of Chile, including the vaccines bacillus Calmette-Guérin (BCG) at birth, pentavalent at 6 months and measles-mumps-rubella (MMR) at 12 months and 6 years, in the period 2008-2011. The methodology includes three phases. The first corresponds to the operationalization of twenty socio-territorial variables that account the general life contexts of the target population. The second phase involves the definition of a scale of values through a panel of experts to weigh the importance of each of the variables. The third phase integrates the information into a spatial decision support system for the identification of territorial patterns, through multi-criteria evaluation and multivariate cluster analysis. The results indicate that it is feasible to group territories into four types. In general terms, it is possible to observe that as the life context improves, higher levels of coverage can be found for each vaccine.

Objective: . This paper aims at assessing the contribution of Chile's Health Care Integrating Councils (CIRA, Spanish acronym) to strengthening governance in health., Materials and Methods: A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA., Results: The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network., Conclusions: In this study, we conclude that there is room for improvements of CIRA's role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

This paper addresses the issue of uncertainty in the measurements used in public health analysis and decision-making. The Shannon-Wiener entropy measure was adapted to express the uncertainty contained in counting causes of death in official vital statistics from Chile. Based on the findings, the authors conclude that metrological requirements in public health are as important as the measurements themselves. The study also considers and argues for the existence of uncertainty associated with the statistics' performative properties, both by the way the data are structured as a sort of syntax of reality and by exclusion of what remains beyond the quantitative modeling used in each case. Following the legacy of pragmatic thinking and using conceptual tools from the sociology of translation, the authors emphasize that by taking uncertainty into account, public health can contribute to a discussion on the relationship between technology, democracy, and formation of a participatory public.

Southern Cone Sub-Regional Project on Cystic Echinococcosis Control and Surveillance: Argentina, Brasil, Chile and Uruguay, is a joint and collaborative tool with the aim of promoting the implementation or the strengthening of programs for disease control. The paper describes the background, the institutional aspects that regulates the structure and functions, as well as the guidelines defined in the technical and operational project. The article emphasize the achievements through Projects of Technical Cooperation among Countries, and the development of integrated and innovative approaches for prevention and control of the disease and training of human resources of the control programs. Some of the challenges are: to achieve the sustainability of the project, implementation of technical groups for analysis and assessment at request of the countries, improvement of the regional information systems, to continue training human resources of the control programs and to expand and strengthen the technical cooperation among countries.

Objective: To explore the Chilean health system financing based on the most recent available data., Material and Methods: Using the WHO World Health Report 2000 framework, this paper analyzes the Chilean health system financing, with special emphasis on insurance schemes., Results: The analysis shows that a great proportion of people is covered by the existing health insurance schemes (about 88%). However, there is a tendency towards segmentation of the population in terms of risk and income.Additionally, efforts have been made, especially by FONASA (National Health Fund), to perform a strategic purchasing of healthcare., Conclusions: There still is a need for improving the Chilean health system financing in terms of pooling and strategic purchasing.

This paper examines the main changes in the Chilean health system from the 1920s to the present, identifying contradictions, limits, and successes in terms of policy outcomes. Taking equity as the central theme, the analysis focuses on decisions made from the mid-1920s until 1973 in moving toward socialized medicine, with the sudden interruption of this process by the military coup in 1973. The author then discusses the set of regressive measures taken by authoritarian neoliberalism, with the help of Pinochet, to insert health into the market economy. Finally, the article analyzes efforts made by democratic administrations since 1990 to redress the legacy of socioeconomic inequalities, focusing on the commitment to rebuild the health care system with a new basis in equity, solidarity, and people's participation.

The combination of inspiration, science, and politics is a cornerstone precept for the common good of humanity, towards the fulfillment of social objectives. Based on this precept, this paper reviews core experiences of the Chilean Health Sector. Health sector key events taking place during the first half of the 20th century were the creation of the National Health Service and the development of mother and child healthcare policies. After the earthquake of 1939, the future President of Chile, Doctor Salvador Allende, set up the Special Sanitation Council, to balance policies. Also, he launched the Social Security reform process, which endured financing restrictions and the animosity of physicians opposing the socialization of medical care. In 1951 the reform was approved, to extend coverage to blue collar workers and their families; separate health provision from healthcare security; emphasize preventive pediatric care in mother's health, and reproductive health. The basic tenets of healthcare reform were the right to health, solidarity, and equity, as the pillars of policy-making and healthcare programming. The question of whether the evolution of social security in Chile has been consistent with the original healthcare reform tenets is raised by the author.

This paper, using the nutrient density concept and the development of Food-Based Dietary Guidelines (FBDG), explores the nutritional adequacy of food patterns based on the main staples around the world--maize, wheat, rice and potato. The nutritional adequacy of the vitamins A, C, folates and the minerals iron, zinc and calcium in diets composed by these staples is analyzed. Projected diets modified by the addition of foods high in vitamins and minerals, based on food table composition information, are analyzed for changes in nutritional adequacy, in order to cover the nutritional requirements of all family members. This theoretical exercise shows that diets diversified by the addition of relatively small quantities (27-70 g) of foods like fruits, vegetables, legumes and meat improve substantially the nutritional adequacy of the vitamins A, C, folates, iron and zinc. In the case of calcium, the addition of a dairy source becomes essential. From the practical point of view, the implementation of the food based approach requires a national effort in order to support the production of nutrient rich foods and to promote consciousness of nutrient bioavailability, so that people may obtain all nutrient potential from foods. Simultaneously, the need of fortification programs at the national level is recognized. This is the case for critical nutrients, where requirements might be above the potential in available foods. A similar situation occurs in the case of vulnerable groups like pregnant women and infants, who need supplementation to ensure nutritional adequacy of their diets. In conclusion, the use of FBDG is a good alternative for improving the nutritional adequacy of diets based predominantly on staple foods. However, food fortification and supplementation programs directed to vulnerable groups are necessary and complementary practices to the FBDG implementation.

This paper analyzes the importance of food consumption surveillance; as food consumption is determined by multiple factors, the difficulties involved in this process are established. Some direct methods used for food consumption assessment and other indirect methods that can be used to infer it, are analyzed and discussed in terms of their advantages and disadvantages. Other methods based on the follow up of food basket cost and purchasing capacity of poor population wages in terms of some selected food commodities, are proposed. The importance of food consumption surveillance as an instrument for decision making is pointed out.