Quiral opinion

Opinión Quiral núm. 42.2: La sexta ola: desde la epidemiología y desde las UCI
2022
Some of the variants of SARS-CoV-2 – resulting from the mutation processes typical of a virus that has spread around the globe over a period of two years – have presented real challenges in managing the pandemic. The most recent example, the Omicron variant, caused a sixth wave with an unprecedented number of cases of Covid-19. The Quiral Opinion debate The sixth wave: from epidemiology and from the ICUs took place on 23rd March at Fundació Vila Casas, with the president, Antoni Vila Casas, and patron, Miquel Vilardell, welcoming the participants. The expert speakers from the field were Dr Magda Campins, Head of the Preventive Medicine and Epidemiology Service and member of the Epidemiology and Public Health Research Group at Vall d’Hebron Research Institute (VHIR), and Dr Pere Domingo, Coordinator of Covid Hospitalization at the Hospital de la Santa Creu i Sant Pau in Barcelona. Dr Magda Campins explained that the sixth wave has had the highest number of cases, but not the highest rates of hospitalization nor mortality, and she highlighted the characteristics of the Omicron variant: higher rates of transmission and evasion of natural and vaccine related immunity as compared to previous variants, as well as a reduction in the effectiveness of antivirals, without an increase in the severity of the infection. She also outlined the most likely future scenario in which the illness will be light for most people, but with a strong impact on people who are vulnerable or unvaccinated. She pointed out the need to improve supervision systems, vaccination with booster doses and reinforce communication on the importance of wearing masks to protect the vulnerable population. Dr Pere Domingo spoke about the great milestone that has been reached with the development of the vaccines and that there are currently up to three antiviral drugs and monoclonal antibody treatments available for the most vulnerable patients. He finished by remarking on two important challenges: immunosuppressed patients and the child population, both with low immunity, as a breeding ground for new variants and strains that arise from animal reservoirs of the virus. Finally, they stressed the need to reinforce supervision systems, integrate information systems, promote vaccination, evaluate the need for a fourth dose against new variants and continue research into treatments. Descarregar

Opinión Quiral núm. 42.1: 600 días de pandemia
2021
The Covid-19 pandemic has had serious consequences for public health, it has highlighted the lack of professionals and resources in the health service and had a major economic and social impact. But it has also served to show that investing in research can reap great rewards. After more than 600 days of the pandemic, we take stock of everything that has happened and reflect on possible future scenarios. The Opinión Quiral debate on Communication and Perception of Covid-19 took place on 24th November at Fundació Vila Casas, with an introduction by the president, Antoni Vila Casas, and a welcoming speech by the trustee, Miquel Vilardell. The event heard from experts in the field: Carmen Cabezas (Secretary of Public Health, in the Generalitat de Catalunya) and Antoni Trilla (Head of the Preventive and Epidemiological Medicine Service at the Hospital Clínic in Barcelona). Carmen Cabezas pointed out that we should use the word syndemic to refer to what is happening, since the situation affects people unequally according to their socio-economic level and the social and health factors affecting their lives. Antoni Trilla highlighted the importance of vaccination and other prevention measures to try and reduce the risk of contagion (masks, ventilation and distance) and to avoid the return to harsh restrictions. In addition to both speakers, the debate included contributions from journalists specializing in medical communication, as well as other professionals from the field of medicine and the media. Descarregar

Opinión Quiral 41.1: El sueño saludable, un nuevo agente de salud
2021
The scientific knowledge available today on "why we sleep" and "what happens if our sleep is not of good quality" is of vital importance. Until only a few decades ago it was not even suspected that human life expectancy was linked to our sleep patterns over the years, nor that cancer, metabolic and neurodegenerative diseases may be closely related to how we sleep. We know the importance of sleeping well in order to maintain a good frame of mind and quality of life. Moreover, science recognises sleep as a primary determinant of health. However, only one third of the population believes they sleep well and do not suffer from tiredness during the day. Descarregar

Opinión Quiral 40.2: Mujeres y salud: diferencias y desigualdades
2020
Women's life expectancy is greater than men's, but their health is worse, and they suffer more in the later years of their lives. Family and occupational roles play an important part in health, producing chronic disorders that continue throughout a lifetime. In addition, biological differences (genetic and physiological factors) between women and men also result in differences in the diseases they may contract, the severity of the diseases and their responses to them. Being a woman: a determinant of social inequalities in health? Cardiovascular disease in women: what we know and what remains to be done. Descarregar

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