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HEALTH - QUIRAL OPINION

Quiral opinion



It consists of meetings to discuss with experts, representatives of media and institutions of socio world, the annual theme on which research report focuses Quiral.

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Opinión Quiral 40.1: Cáncer de mama y salud reproductiva en la mujer
2019
Breast cancer is the most common tumour in women. As they are getting pregnant later in life there are greater numbers of diagnoses of cancer in women who have never had a child. So how can we reconcile the treatment for cancer with the desire to have children? Recent advances are offering many solutions to this issue. The Opinió Quiral debate on Breast cancer and reproductive health in women took place last 22nd November with the participation of genetics and oncology experts such as Miquel Gil (Head of Medical Oncology support services and Manager of knowledge at the Functional Unit of Oncology Support at the Catalan Institute of Oncology) and Pedro N. Barri (Director of the Department of Obstetrics, Gynaecology and Reproductive Medicine and Women’s Health at Dexeus University Hospital). Miquel Gil focused on the advances that have been made in improving breast cancer survival rates, though in younger women one of the concerns should be to preserve fertility. It is very important for the oncology specialist to ascertain, prior to treatment commencing, whether women younger than forty years old wish to have children, or not, in the future. He also highlighted that becoming pregnant after having cancer does not increase the risk of relapse nor of damage occurring during the formation of the foetus. Pedro N. Barri, specialist in assisted reproduction and women’s health, agreed that the current tendency to have children later in life is related to an increased risk of gynaecological cancer, particularly breast cancer, because the woman does not get the benefit of the protection that comes with pregnancy, birth and breastfeeding. He commented that it is vital to explain to the patient that there are strategies to preserve fertility and improve the chances of having children in the future. Moreover, they have a beneficial effect on the way in which the woman deals with cancer as they reinforce the idea that she will survive the illness. As well as the two medical specialists, journalists in the field of medical communication and professionals in the fields of communication and medicine joined in the debate. It was highlighted that up to fifty percent of oncologists do not inform their younger patients of the possibilities of preserving their fertility, and therefore further research is required involving surveys of patients that are published and national statistics obtained, in addition to training on these issues for professionals in the field. Further issues that were raised were that the evidence suggests that the risk of relapse of cancer is the same in patients who become pregnant after completing the course of treatment as in those who do not have more children, and that undergoing fertility treatment does not increase the risk of gynaecological related tumours. A final recommendation was that the Catalan Health Service should seek to develop a transversal programme, with a network of interconnected specialist centres, with shared information and practice in order to ensure equal access for service users. Descarregar






Opinión Quiral 39.2: Terapia génica
2019
Advances in DNA editing have meant that gene therapy has gone from being merely a possibility to an incipient reality which is beginning to be used in the treatment of certain diseases. However, there is still some debate as to where the limits of its application lie. The idea is to aim for a transparent, safe and prudent application which guarantees the principles of self-determination and beneficiality, or non-disadvantageousness. Taking part in this second Chiral Opinion on gene therapy were experts in genetics such as Dr Eduardo Fidel Tizzano (head of Genetic Medicine at the Vall d’Hebron Instituto de Investigación, VHIR), who explained to attendees how over the last few years gene therapy has moved from the experimental stage to clinical practice. Despite the challenges, he was optimistic about future possibilities arising from these new techniques. Also taking part was Núria Terribas (director of the Fundació Víctor Grífols i Lucas), who emphasised how bioethics is trying to find answers to the questions arising from the application of this new technology. She made special mention of the manipulation of DNA without any therapeutic end and how this is a red line which should not be crossed. Also taking part in the debate were specialist medical journalists and other professionals from the media and medicine. The effectiveness of organisations such as the Comité de Bioética de España and the Comité de Fecundación Asistida was questioned. While applauding the advances made by scientists, the lack of ethical guidelines for research was highlighted. Also explained was a project on neural improvements and how the general public participated in the ethical debate by contributing their criteria, followed by contributions from other doctors attending, who mentioned the possibility of combining gene therapy with stem cell research and immunotherapy in order to push research forward. Apart from the scientific aspect, questions were asked about the possibilities of these therapies reaching the general public, and any savings that could be made by the health system by avoiding lengthy and expensive courses of treatment. Finally, it was pointed out that there is no healthcare specialisation in genetics in Spain, which would train professionals who would act as a filter when communicating to patients the most relevant information when it came to making an informed decision. Descarregar






Opinión Quiral 39.1: Diagnóstico genético
2018
The potential of genetic testing is huge and the expectation is that it will change the future of medicine. Foreseeing and preventing illness by identifying genetic and chromosomic alterations could transform the paradigm of health care. Debate exists, however, over its ethical limits. Participating in the first Chiral Opinion to look at genetic testing were experts such as Doctor Anna Veiga (director of the stem cell bank at the Barcelona Centre for Regenerative Medicine at the Duran i Reynals Hospital), who spoke about how genetic testing is used in assisted reproduction. She pointed out that genetic screening is not used for diagnosis but to select donors with a specific genetic makeup which makes them compatible with the receivers in order to prevent illnesses occurring. Also taking part was Doctor Luis Molinuevo (scientific director of the Barcelonaβeta Programme for the Prevention of Alzheimer’s, Fundación Pasqual Maragall Brain Research Centre), who stressed the need for change in the healthcare of the future and greater emphasis on prevention rather than cure. The two speakers were joined in the debate by journalists specialising in medical matters and other professionals from the fields of the media and medicine. It was established that genetic testing provides information about the origins of hereditary illnesses, can detect carriers of mutations and confirm prenatal, neonatal, and preimplantation diagnoses, and even improve responses via pharmacogenetics. It was also mentioned that despite the application of genetic health care being potentially costly and results being long-term, investing in prevention is always more cost-effective than in treatment. The debate concluded with the observation that genetic testing should be made available to the entire population via the public health service in order to reduce the number of children born with genetic problems. Descarregar






Opinión Quiral 38.2: El cambio social y la salud mental
2018
There are many factors which have a bearing on mental health and social change is yet another to take into account. Women entering the workplace, immigrant populaces, and the spread of new communication technologies are only a few of these changes, whose impact is often not taken into account. This edition of Chiral Opinion features contributions from experts on mental health: Doctor Adolf Tobeña (Chair of Medical Psychology and Psychiatry at the Universidad Autónoma de Barcelona), who was critical of the mental health policy and stressed the importance of knowing how to define problems and apply specific measures to them; and Doctor Pilar Solanes (head of the Barcelona City Council Department of Health) who explained why a city should have a mental health policy, a necessary tool for coordinating the actions of all the actors in the sector, and stressed the need to agree on a policy based on the diagnosis of a specific situation and the resources available. She stated that mental health policy “is not an end but a means, with specific measures that help to deal with measurable problems.” During the conference they, and other participants - healthcare professionals, journalists specialising medical matters and social workers, made several contributions which brought to the fore the problems they have encountered and the changes society has undergone over the last few years with an increase in unease in the populace and accompanying mental problems. Emphasis was given to the need to improve living conditions and protect the rights of and approach to people suffering a disability at a specific time of their lives, helping them return to society. Descarregar






Opinión Quiral 38.1: Salud mental como factor de riesgo de otras enfermedades
2017
Mental health is one of the major challenges faced by our health system. Mental illnesses produce changes in conduct of great diversity, which can affect the autonomy of the individual, and should be regarded in the same light as illnesses of an organic nature. However, they require a different approach which is multidisciplinary, transversal and comprehensive. Participating in this edition of Chiral Opinion were two experts in mental health: Dr Lluís San (director of Mental Health at the Parc Sanitari de Sant Joan de Déu in Barcelona), who underlined the need to destigmatize mental health and provide treatment in the same way as that provided to organic disorders, while recognising that there is still a shortage of biological markers for making a diagnosis. And Dr Cristina Molina Parrilla (director of the Directional Plan for Mental Health and Addictions at the Generalitat de Catalunya department of health), who pointed out that according to the WHO “there can be no health without mental health”. She also agreed that mental health treatment should be integrated with that of physical health. The interaction between them and the various participants in the debate, including health professionals and journalists specialising in medical matters, brought to light the need for inclusion of these patients in the workplace as a factor that would help to destigmatize their illness. Great importance was also given to the role of “expert patients” who, due to their visibility, encourage other patients to go to health centres. The development of new care models should be strengthened, support groups should be created with the help of trained expert patients, and in the future it should be possible to move treatment from a hospital environment to the community and family. Descarregar






Opinión Quiral 37.2: Vacunas. Derechos y deberes del ciudadano responsable
2017
Living in society affords citizens certain individual rights, but it also demands of them obligations and duties to be carried out for the common good. We should all benefit from health security and we should all contribute to its maintenance in order to protect both individual and collective health. Recent outbreaks of preventable diseases have sparked debate over the question of whether vaccinations should be obligatory. This latest edition of Chiral Opinion draws on the experience of two experts in vaccination: Dr Joan Guix Oliver (secretary of Catalan Public Health), who emphasised the importance of the impact of vaccines on public health and drew a distinction between vaccines which only affect an individual and those which also affect collective immunity; and Dr Carlos Rodrigo Gonzalo de Liria (head of Paediatrics at Hospital Universitario Vall d’Hebron), who pointed out that vaccination is an essential activity for the health of a population and for the continuing relationship between paediatricians and said population. Their contributions, together with those of other actors present at the debate, medical professionals and journalists specialising in health matters, suggested that doctors ought to know how to explain to the general population that risks associated with a disease are always greater than those associated with inoculation. Mention was also made of citizens’ rights regarding consenting to or refusing vaccination and the duties which, in turn, are entailed concerning solidarity and contributing to the common good. Descarregar




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