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La abolición de la política. La tensión entre democracia y la utopía libertaria de R. Nozick
(2025) Schwember, Felipe; Fuentes, Eduardo
La democracia ha sido objeto de numerosas críticas por parte de distintos autores libertarios. En el presente trabajo nos detendremos en la que formula Robert Nozick en Anar-quía, Estado y utopía y que apunta al carácter en último término liberticida de dicha forma de gobierno. Al respecto sostendremos dos cosas: primero, que la plausibilidad de dicha crítica descansa en ciertos supuestos controvertidos acerca de la representación política, supuestos que, sorprendentemente, Nozick comparte con Rousseau; en segundo lugar, que la fuerza de la crítica de Nozick depende que una cierta concepción del pueblo que hace superflua no solo la democracia en general, sino la reflexión acerca de la libertad política en general
Exeundum est e statu naturali: the lex permissiva y el deber de abandonar el estado de naturaleza en la doctrina del derecho de Kant
(2025) Schwember, Felipe
En el presente artículo discuto la interpretación que Christoph Horn hace de la lex permissiva de la Doctrina del derecho de Kant en su libro Nichtideale Normativität. Horn la interpreta como una ley que dispensa del cumplimiento de los principios generales del derecho. Aquí sostendré que esa interpretación es
inaceptable, porque obliga a entender que la propiedad y demás instituciones del derecho privado están fundadas en excepciones a tales principios generales. Sostendré, además, que con el concepto de lex permissiva que adopta Horn no contribuye a explicar el deber de abandonar el estado de naturaleza.
Telepsiquiatría: una herramienta que acerca la salud mental a las personas
(2026) Möller , Matías; Guesalaga, Vicente
La telepsiquiatría se presenta como una estrategia prometedora para mejorar la accesibilidad a la atención de salud mental en los sectores rurales Chile, donde problemas como las barreras geográficas y escasez de especialistas siguen presentes. En esta reflexión se discuten los beneficios y dificultades de este estilo de atención, para que se vean reflejados en una pronta atención. Esperamos que en el futuro se realice una atención dual, a través de la relación que se establezca entre la atención psiquiátrica presencial y la atención en línea, pues ayudará a disminuir las desigualdades en el acceso a la salud mental en nuestro país. Palabras claves: Telemedicina; Telepsiquiatría.
Telepsychiatry is emerging as a promising strategy for improving access to mental health care in rural areas of Chile, where problems such as geographical barriers and a shortage of specialists remain. This article discusses the benefits and challenges of this model of care, with a view to ensuring they are reflected in the provision of timely care. We hope that, in the future, a dual approach to care will be implemented, through the integration of face-to-face psychiatric care and online care, as this will help to reduce inequalities in access to mental health care in our country.
Tasa de egreso hospitalario por síndrome de distrés respiratorio en el recién nacido durante el periodo 2021 a 2024 en chile
(2026) Campos, Catalina; Campos, Ignacia; Hernández, Cristian; Libante, Dayna; Gómez, Alex
Introducción: La patología respiratoria neonatal es una de las causas más importantes de morbimortalidad e ingreso a unidades de cuidados intensivos neonatales a nivel mundial y nacional, afectando principalmente a prematuros.
Objetivo: Determinar la tasa de egreso hospitalario por síndrome de distrés respiratorio en recién nacidos durante el periodo 2021 a 2024 en Chile.
Metodología: Se realizó un estudio observacional, descriptivo, retrospectivo y cuantitativo, utilizando datos estadísticos secundarios del Departamento de Estadística e Información en Salud y del Instituto Nacional de Estadística. Se aplicó análisis de tendencia central mediante software Excel. Al utilizar fuentes públicas anónimas, no se requirió aprobación por comité de ética.
Resultado: La mayor tasa de egreso hospitalario se registró en el año 2024 con un valor de 15,41 por cada 1.000 nacidos vivos. El sexo masculino presentó la mayor tasa de egreso hospitalario del periodo con 16,92 por 1.000 nacidos vivos. El mayor promedio de estadía hospitalaria ocurrió en 2022 con 26,13 días. Discusión: El aumento de la tasa de egreso hospitalario se asocia al incremento de la prematurez en Chile. La mayor incidencia en hombres se vincula a factores hormonales que influyen en la producción de surfactante, mientras que la estadía prolongada en 2022 sugiere dificultades logísticas transitorias en el periodo post-pandemia.
Conclusión: La tasa de egreso hospitalario muestra una tendencia al alza vinculada a la prematurez en el país. Esto sugiere la necesidad de actualizar las guías clínicas nacionales y revisar protocolos locales para abordar eficazmente esta prioridad de salud pública.
Introduction: Neonatal respiratory pathology is a leading cause of morbidity, mortality, and admission to neonatal intensive care units both globally and nationally, primarily affecting preterm infants.
Objective: To determine the hospital discharge rate for respiratory distress syndrome in newborns in Chile between 2021 and 2024.
Methodology: An observational, descriptive, retrospective, and quantitative study was conducted using secondary statistical data from the Department of Health Statistics and Information and the National Institute of Statistics. Central tendency analysis was performed using Excel software. Since the study utilized anonymous public data, ethics committee approval was not required.
Result: The highest hospital discharge rate was recorded in 2024, reaching 15,41 per 1.000 live births. Males presented the highest hospital discharge rate during the period (16,92 per 1.000 live births). The longest average length of hospital stay occurred in 2022, with 26,13 days.
Discussion: The increase in hospital discharge rate is associated with the rise in prematurity in Chile. The higher incidence in males is linked to hormonal factors influencing surfactant production, while the prolonged stay in 2022 suggests transient logistical challenges in the post-pandemic period.
Conclusion: The hospital discharge rate shows an upward trend linked to prematurity in the country. This highlights the need to update national clinical
guidelines and review local protocols to effectively address this public health priority.
Policy changes and growth slowdown: assessing Chile’s lost decade
(2025) Emiliano Toni,; Toni, Emiliano; Paniagua, Pablo; Ordenes, Patricio
Latin America has been snared in an economic slowdown since the end of the commodities boom. Within the region, Chile used to stand alone as the poster child of economic growth and political stability from 1990 to 2010. However, a stark contrast is perceived since around 2014, as Chile has also been trapped in a decade of slow economic growth, marking a shift in its economic trend. This paper examines this Chilean slowdown from an empirical perspective and determines how much can be attributed to internal and external causes. Using the Synthetic Control Method (SCM), our empirical analysis suggests that at least two-thirds of Chile’s recent slowdown can be attributed to internal causes (i.e., policy regime change) and only one-third to external ones. Our results are consistent with the literature, confirming that external volatility can explain only a small fraction of poor economic performance, suggesting that internal factors are the primary source. This research sheds light on the effects of policy regime shifts and their economic impact.
Polycentric democracy and dynamic political stability
(2025) Paniagua, Pablo; Pourvand, Kaveh
A perennial question of political thought is how to stabilize a just regime in the face of disagreement. The importance of this question has been heightened with the Weberian state that monopolizes the power of coercion and anchors society under a single governance structure. This political form has given us both liberal democracy and totalitarianism. The stakes could not be higher in ensuring stability without dismantling pluralism. This paper provides a novel solution to the stability problem by focusing on dynamic stability reached through polycentric democracy. Plural and overlapping centers of governance characterize such democracy. This renders a polycentric system more resilient to changing views than a monocentric one and superior on political risk-management grounds by diffusing decision-making risks. A polycentric system also fosters antifragility in society by avoiding seeking a single and fixed point equilibrium, thereby eluding the pitfalls currently afflicting liberal democracy.
White matter hyperintensities and their impact in brain structure and function in alzheimer's disease and behavioral variant frontotemporal dementia across Latin America and the United States: a cross-sectional study
(2025) Altschuler, Florencia; Canziani, Verónica; Fraile, Matías; Gonzalez, Raul; Hernández, Hernán; Baez, Sandra; Migeot, Joaquín; Fittipaldi, Sol; Maito, Marcelo; Legaz, Agustina; Godoy, Maria; Moguilner, Sebastián; Cruzat, Josephine; Coronel, Carlos; Tagliazucchi, Enzo; Santamaria, Hernando; Reyes, Pablo; Matallana, Diana; Avila, José; Slachevsky Chonchol, Andrea; Behrens, María; Custodio, Nilton; Cardona, Juan; Brusco, Luis; Bruno, Martin; Sosa, Ana; Pina, Stefanie; Takada, Leonel; Franca, Elisa de Paula; Possin, Katherine; De Oliveira, Maira; Hu, Kun; Lawlor, Brian; Yokoyama, Jennifer; Miller, Bruce; Lopera, Francisco; Martin, Adolfo; Medel, Vicente; Ibañez, Agustin; Gonzalez, Cecilia
Background: White matter hyperintensities (WMHs) are a core manifestation of normal and pathological aging and are potentially linked to geographical differences in social and physical exposomes. Previous studies have not examined the impact of WMHs burden on neurodegeneration and cognition in healthy controls (HCs) and patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) across geographic regions. This study addressed this gap by assessing the impact of WMHs burden on participants with and without dementia from Latin America (LA) and the United States (US).
Methods: The study comprised 994 participants, including HCs (n = 402), AD (n = 359), and bvFTD subjects (n = 233) from LA and the US. WMHs and their association with grey matter (GM) atrophy, assessed through GM volume and cortical thickness, were evaluated and compared among groups (HCs, AD, and bvFTD) in LA and the US using a voxel-wise brain imaging approach (p < 0.05 family-wise error-corrected for multiple comparisons, minimum cluster size = 50 voxels). Multiple regressions analysis were employed to examine geographic differences in WMHs burden, WMHs-GM associations, and the effect of WMHs on cognitive performance, as assessed by the Mini-Mental State examination.
Results: In the LA cohort only, higher WMHs load was associated with greater GM atrophy across all groups (HCs, AD, bvFTD), with a specific neurodegenerative pattern involving orbitofrontal, cingulate, and temporal areas. HCs from LA showed a greater WMHs load than their US counterparts, and this effect was dependent on GM atrophy. Finally, WMHs burden negatively impacted cognitive performance in dementia subjects, with a greater effect observed in bvFTD subjects from the US.
Conclusion: WMHs have a more pronounced impact on neurodegeneration across the LA cohort, with a worse impact on HCs, which also show higher WMHs burden than their US counterparts. This could increase the risk of developing dementia. Moreover, WMHs burden differentially impacts cognition, with a greater negative effect observed in bvFTD subjects from the US. These findings highlight geographic variations in WMHs-related conditions, offering valuable insights for tailored future research.
Conceptualising knowledge governance: knowledge regimes and institutions
(2025) Lin, Wanlin; Paniagua, Pablo; Yuan, Minjun
Social scientists are paying attention to the role that knowledge plays in economic phenomena. This focus on knowledge has led to exploring two challenges: first, its governance to reap positive externalities and solve social dilemmas, and second, how we can craft institutions to match the intangible nature of ideas with adequate property rules. This article contributes by elaborating on the different knowledge property regimes and the elements contributing to their classification. This paper first taxonomises knowledge governance regimes based on Ostrom’s work on institutional analysis. Second, it examines why governance structures for managing knowledge production vary across industries, according to (1) the characteristics of knowledge, (2) the attributes of the organisations, and (3) the different rules-in-use to enforce property rights. This is the first study at the intersection of institutional analysis and political economy that highlights the knowledge features, incentive structures, and mechanisms undergirding knowledge governance in different property regimes.
Electrospun Polyvinyl Alcohol/Sodium Alginate Nanocomposite Dressings Loaded with ZnO and Bioglass: Characterization, Antibacterial Activity, and Cytocompatibility
(2025) Ortiz, Andrés; Sepúlveda, Francesca; Flores, Siomara; Saavedra, Marcela; Sáez, Suhelen; Jiménez, Thomas; Murgas, Paola; Troncoso, Scarlett; Sanhueza, Camila; Ulloa, María; Porte, Lorena; Ahumada, Manuel; Corrales, Teresa; Palza, Humberto; Zapata, Paula
Chronic wounds pose a great challenge due to their slow healing and susceptibility to infections, hence the need for innovative alternatives to conventional antibiotics, as increasing bacterial resistance limits the efficacy of current treatments. This paper addresses the development of novel electrospun membranes based on polyvinyl alcohol (PVA) and sodium alginate, incorporating therapeutic ZnO and bioglass (54SiO2:40CaO:6P2O5) nanoparticles. While nanocomposites presented smaller fiber diameters than pure polymers, ternary nanocomposites displayed higher values, e.g., in porous areas, values were in the ca. 80-240 nm range and 0.06-0.60 μm2, respectively. The Young's modulus of the PVA/SA membrane, initially 15.9 ± 2.0 MPa, decreased by 65% with 10 wt.% ZnO NPs, whereas 10 wt.% BG NPs increased it by 100%. The membranes demonstrated efficacy against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) isolated from a human wound secretion, as well as two ATCC strains: Staphylococcus aureus and Staphylococcus epidermidis. A cell viability assay conducted with HaCaT cells demonstrated nearly complete survival following 72 h of membrane exposure. Their combined Gram-positive antibacterial activity and cytocompatibility support their potential application as biofunctional dressings for the management of chronic and hospital-acquired topical infections, while also contributing to the global effort to combat antibiotic resistance.
Bespoke science: the use of ad hoc scientific advisory committees in the Covid-19 pandemic
(2025) Koppl, Roger; Pronin, Kira; Cowen, Nick; Podemska-Mikluch, Mart; Paniagua, Pablo
Many governments formed ad hoc scientific advisory committees in the Covid-19 pandemic because they offered the government greater control over policy advice than standing agencies. The difference between ad hoc and standing advisory bodies has been little noted in the literature. High-uncertainty crises demanding expertise and requiring action from the national government increase the value of policy discretion, raising the value of controlling the scientific narrative. An ad hoc body is generally easier to control than a standing body because policymakers have greater liberty to choose its members, specify its mandate, and disband and reconstitute it when needed. Control generally requires either a narrow membership or a narrow mandate. If members cannot be chosen to be reliably aligned with the government or its policy preferences, a narrow mandate will restrain the committee from offering undesired advice or analysis. Our argument builds on the public choice assumption of motivational symmetry: The choices of scientists and politicians are shaped by the same motives and desires that influence individuals in any other sphere of life. Our case studies of Italy, UK, US, Poland, Uganda, and Sweden support our theory.
Ultrasound of the tongue as an uncommon site: a focus on technique and early diagnosis of lingual pathologies
(2025) Campos, Óscar; Aris, Ricardo; Whittle, Carolina; Niedmann, Juan
Tongue ultrasound, although less conventional in radiology, offers high-resolution images without ionizing radiation, allowing for accurate evaluation of superficial lesions. This article aims to increase awareness of its usefulness and promote its adoption in clinical practice. Characteristic findings of a variety of lesions are highlighted through clinical cases evaluated at our institution. This technique emerges as a safe and inexpensive alternative for the diagnosis and monitoring of lingual pathologies, being a promising tool for early detection and effective management of these conditions.
La ecografía de la lengua, aunque menos convencional en radiología, ofrece imágenes de alta resolución sin radiación ionizante, lo que permite una evaluación precisa de lesiones superficiales. Este artículo tiene como objetivo aumentar el conocimiento sobre su utilidad y promover su adopción en la práctica clínica. Se destacan los hallazgos característicos de una variedad de lesiones a través de casos clínicos evaluados en nuestra institución. Esta técnica emerge como una alternativa segura y económica para el diagnóstico y el seguimiento de patologías linguales, siendo una herramienta prometedora para una detección precoz y un manejo efectivo de estas condiciones.
Higiene puertas adentro: la incorporación del baño en el hogar chileno a través de la Publicidad (1850-1950)
(2025) Dussaillant Christie, Jacqueline
En el marco de la historia cultural y del consumo, este artículo estudia la incorporación del cuarto de baño en la vivienda en Chile, principalmente de Santiago y Valparaíso, en el contexto del cambio de paradigma de salubridad desde la teoría miasmática a la bacteriológica. La oferta en el mercado de diferentes artefactos y objetos orientados a la práctica sistemática del aseo personal en la intimidad de este espacio doméstico, fue parte esencial de la modificación de los hábitos higiénicos de la población. A partir del supuesto de que los avisos publicitarios constituyen difusores culturales que revelan algunos aspectos del mercado, por medio de la revisión de la publicidad en la prensa chilena entre 1850 y 1950 se propone estudiar qué productos orientados a la higiene se ofrecían a través de la prensa y bajo qué discursos. Se postula que el discurso publicitario contribuyó a la difusión de los nuevos conocimientos bacteriológicos entre sus lectores.
¿Un libertarianismo medioambientalista? Propiedad, utopía y política medioambiental en las teorías libertarias
(2025) Schwember, Felipe; Loewe, Daniel
Este artículo examina los modos en que el iusnaturalismo libertario ha afrontado los desafíos medioambientales que suscita la adquisición de la propiedad. Se persiguen tres propósitos: primero, discutir algunos de los supuestos libertarios acerca de la naturaleza y la tecnología; segundo, explorar el potencial
medioambientalista de la estipulación de Locke/Nozick; tercero, indicar algunas de las dificultades a que conduce dicha estipulación cuando se la aplica a la resolución de problemas medioambientales. Sostengo que la estipulación conduce a dos resultados, según como se la interprete. El primero ofrece la posibilidad de desarrollar efectivamente un libertarianismo medioambiental robusto, pero solo al precio de imponer severas restricciones a las adquisiciones; el segundo evita tales restricciones, al precio de renunciar a una política medioambiental significativa. Concluyo con algunas reflexiones acerca de la relación entre teoría de la propiedad y medioambientalismo.
Driving research on successful aging and neuroprotection in Latin America: Insights from the inaugural symposium on brain resilience and healthy longevity
(2025) Quiroz, Yakeel; Aguillón, David; Arboleda, Joseph; Bocanegra, Yamile; Cardona, Gloria; Corrada, Maria; Diez, Ibai; Garcia, Elkin; Kosik, Kenneth; Martinez, Lusiana; Pineda, David; Posada, Rafael; Roman, Norbel; Sepulveda, Diego; Slachevsky Chonchol, Andrea; Soto, Marcio; Tabilo, Evelyn; Vasquez, Daniel; Villegas, Andrés
Introduction: Global life expectancy has steadily increased in recent decades, resulting in a significant rise in the number of individuals aged 80 years and older. This trend is also evident in Latin America, where life expectancy is improving, though at varying rates across countries and regions.
Methods: Partnering with the Neurosciences Group of Antioquia (GNA), we launched a Colombian study on resilience in families with autosomal dominant Alzheimer's disease and the oldest-old population. Over the past 2 years, the project has expanded to include participants from Peru, Chile, and Costa Rica.
Results: This research led to the first symposium on Brain Resilience and Healthy Longevity, held in Medellín, Colombia, in August 2024.
Discussion: The article summarizes key discussions from the symposium, highlighting the most promising opportunities for brain resilience and prevention research in the region and offering recommendations for future research to promote healthy aging and dementia-free communities.
Highlights: Uncovering the genetic and physiological drivers of cognitive resilience, neurodegeneration resistance, and healthy longevity is essential for maintaining brain function as we age. "Superagers" and cognitively resilient individuals from Latin American families with Alzheimer's disease offer valuable insights into brain protection mechanisms. Studying the interplay of socio-environmental and genetic factors in the oldest-old is key to understanding healthy longevity and improving dementia prevention. The inaugural Brain Resilience and Healthy Longevity Symposium highlights the need for global collaboration to uncover factors that drive cognitive resilience and healthy aging in Latin America, advancing dementia prevention.
Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies
(2025) Haghayegh, Shahab; Hermida, Ramon; Smolensky, Michael; Jimenez, Mili; Duran, Claudia; Slachevsky Chonchol, Andrea; Behrens, Maria Isabel; Aguillon, David; Santamaria, Hernando; García, Adolfo; Matallana, Diana; Ibáñez, Agustín; Hu, Kun
Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer's disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia.
AO Spine Clinical Practice Recommendations: Reducing the Surgical Footprint of Surgery for Spinal Metastases
(2026) Silva, Alvaro; Chen, Hanbo; Disch, Alexander; Kam, Jeremy; O'Toole, John; Dea, Nicolas; Gasbarrini, Alessandro; Laufer, Ilya; Netzer, Cordula; Reynolds, Jeremy; D Rhines, Laurence; Sahgal, Arjun; Verlaan, Jorrit-Jan; Fisher, Charles; Barzilai, Ori
Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established. Given the significant morbidity associated with spine surgery in this frail population, efforts are ongoing to decrease the surgical footprint. The objective of this study is to provide the readers with a concise curation of the latest spine literature on reducing the surgical footprint for spine metastases and clinical recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsThe latest spine literature in the topic of reducing the surgical footprint for spine metastases was reviewed and clinical recommendations were formulated. The recommendations are dichotomously graded into strong and conditional based on the integration of scientific methodology and content expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high impact studies were selected for review. The findings suggest that surgery plays a key role in improving patients' quality of life, but incidence of adverse events remains high and hence methods to decrease surgical morbidity are necessary. The integration of radiation into the treatment algorithm allows for less extensive surgical procedures and SBRT should be strongly considered after surgery for spine metastases in appropriate patient populations. Implementation of enhanced recovery after surgery (ERAS) protocols reduce perioperative morbidity for both open and minimally invasive surgeries and should be considered on an institutional level. Utilization of minimally invasive surgical stabilization should be considered as it results in fewer post operative complications, lower infection rates, less blood loss during surgery, and a shorter hospital stay compared to open stabilization of unstable pathology thoracolumbar fractures.ConclusionsThe role and benefits of surgery for metastatic spine disease are well established, yet surgery carries significant risk for adverse events which may negatively affect overall cancer care. Methods for reducing the surgical footprint include incorporation of stereotactic radiation allowing less extensive surgery, implementation of ERAS protocols and utilization of minimally invasive surgical strategies.
Conditiones non sunt multiplicanda sine necessitate: el problema de la equivalencia de las estipulaciones de Locke y Nozick
(2025) Schwember, Felipe; Fuentes, Eduardo
Aunque se inspira en Locke para formular su propia teoría de la propiedad, Nozick exige una y no tres condiciones (o estipulaciones) para la validez de las adquisiciones originarias. Esta diferencia invita a preguntarse si acaso la interpretación de Nozick de las estipulaciones de Locke es correcta o si, en cambio, el filósofo inglés no habrá multiplicado innecesariamente las estipulaciones. El presente trabajo examina ese problema por medio de la aplicación de las respectivas estipulaciones a diferentes situaciones hipotéticas. Sostendremos que la estipulación de Nozick es casi tan eficaz como las tres estipulaciones de Locke para preservar los derechos u oportunidades de terceros. No obstante, sostendremos también que la estipulación de Nozick es incapaz de hacer frente a ciertas dificultades que plantea la explotación de recursos naturales, dificultades que, sin embargo, sí pueden enfrentarse por medio de la estipulación de Locke de no desperdicio.
Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians
(2025) Villalón López, Francisco; Mundt, Adrian P.; Hirmas, Alejandro; Rivera, Rita M.; Guiloff, Rodrigo
Background During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies.
Objective To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment.
Design A cross-sectional online survey conducted from November 2020 to December 2020.
Participants Physicians registered with the Medical College of Chile.
Setting Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare.
Primary outcomes Burnout was assessed using the Maslach Burnout Inventory for Human Services.
Secondary outcomes Self-reported medical errors, medical leave and turnover.
Independent variables Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied.
Results Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p<0.01), turnover (ß=0.012, p<0.05) and perceived medical errors (ß=0.009, p<0.001). In contrast, burnout was inversely correlated with age (ß=−0.125, p<0.001), agreeableness as a personality trait (ß=−0.107, p<0.001), psychological well-being (ß=−0.248, p<0.001) and the mindfulness factor awareness (ß=−0.145, p<0.001). In the work environment, time pressure (ß=0.167, p<0.001) was positively associated with burnout among others.
Conclusion Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.
The challenges of establishing centers for the surgical management of epilepsy in low- and middle-income countries
(2025) Vidaurre, Jorge; Pérez, Juan; Campos, Manuel; Weisleder, Pedro
Epilepsy affects over 50 million individuals globally, with more than 80 % residing in resource-limited countries. While the majority of patients achieve seizure control with antiseizure medications, approximately one-third are diagnosed with drug-resistant epilepsy (DRE). For these individuals, epilepsy surgery represents a potentially effective therapeutic option. Expert consensus from the Surgical Therapies Commission of the International League Against Epilepsy (ILAE) recommends prompt referral for surgical evaluation upon diagnosis of DRE. Nevertheless, despite substantial supporting evidence, such referrals are frequently delayed-particularly in low- and middle-income countries (LMICs). This article examines the barriers to timely surgical evaluation and explores strategies to facilitate the development of epilepsy surgery programs in resource-constrained settings.
Quality management in imaging services
(2025) Ubeda, Carlos; Soffia, Pablo; Inzulza, Alonso; Khoury, Helen; Khoury, Viviane; Wunderlen, Kevin; Donoso, Sigrid; Pérez, María; Franco, María
In an imaging procedure with ionizing radiation, different elements are involved, and each possible failure in one of them can be associated with a detriment to its quality. The loss of quality has ethical and economic implications, which is why it must be managed intentionally. Therefore, it is recommended to establish a quality management system (QMS), which represents a standard framework for the administration that ensures correct execution and the desired results through compliance with a series of requirements on the different aspects or components of the service. To guarantee the success of a QMS, actions based on quality assurance (QA) and quality control (QC) must be established. When reviewing the Chilean regulations that regulate the use of ionizing radiation in medicine, we found that there is a deficiency in the concepts and applications in the requirements that refer to QMS, QA and QC. The purpose of this narrative review is to present an updated revision for health administrators and professionals on the rationale and purpose of a QMS, and QA and QC as its essential components, in imaging services.
En un procedimiento imagenológico con radiaciones ionizantes intervienen diferentes elementos, y a cada posible fallo en alguno de ellos cabe asociar un detrimento en la calidad del mismo. La pérdida de calidad tiene implicancias éticas y económicas, razón por la cual esta debe ser gestionada con intencionalidad. Así, se recomienda establecer un sistema de gestión de la calidad (SGC), que representa un marco estándar para la administración que asegura la correcta ejecución y los resultados deseados mediante el cumplimiento de una serie de requisitos sobre los diferentes aspectos o componentes de la atención. Para garantizar el éxito de un SGC se deben establecer acciones sustentadas en la garantía de calidad (GC) y el control de calidad (CC). Al revisar la normativa chilena que regula el uso de las radiaciones ionizantes en medicina, constatamos que existe un vacío de conceptos y aplicaciones en los requerimientos que hacen referencia a SGC, GC y CC. La presente revisión narrativa tiene como propósito presentar una revisión actualizada para administradores y profesionales de la salud sobre la justificación y el propósito de un SGC, y de la GC y el CC como sus componentes esenciales, en los servicios de imagenología.