Quiral opinion

Opinión Quiral no. 43.1: Long Covid-19: a serious health issue
2023
Long Covid-19 has become a serious health issue. It is estimated that one in eight patients who have had Covid still present symptoms after the acute phase of the illness is over. There are a wide range of symptoms and they vary from patient to patient, which presents a challenge for diagnosis and subsequent treatment, and there are many outstanding questions that still need to be resolved. The Opinión Quiral debate Long Covid-19: a serious health issue took place on 22nd March at Fundación Vila Casas, at which the foundation’s president, Antoni Vila Casas, and patron, Montserrat Viladomiu, gave the welcoming address. The speakers were Dr Lourdes Mateu (Head of Long Covid Unit, Hospital Germans Trias i Pujol) and Antoni Calvo (director of Fundació Galatea). Dr Lourdes Mateu emphasized that it was not until October 2021 that the WHO defined what was then termed a post-covid condition, and confirmed that some patients experienced symptoms for a longer period than two months following an acute illness. This condition is observed in 10 to 15% of all infected patients, which can therefore include over sixty million people worldwide. There may be more than 200 symptoms, and these vary according to the physiopathology of each patient. The evolution of the illness is uncertain and only 7% of patients receiving treatment have been cured, while the rest have adapted to their symptoms. She also pointed out that Primary Health Care services should take responsibility for these patients, based on the application of standardized protocols. She highlighted the importance of each patient’s autonomy in keeping a diary of the symptoms and following advice on rehabilitation. Antoni Calvo pointed out that health sector workers have been one of the most affected groups during the pandemic and highlighted the need to understand that the body and mind are not separate. He insisted that long covid patients should be cared for by mental services and networks, but they find it difficult to access such support. He commented that this emphasizes the need to review the health service, and he highlighted the challenge of facing up to these changes in order to respond to the needs of citizens. The emotional impact of the pandemic was devastating for health sector workers and many of them still experience psychological effects, and it is clear that we cannot afford to have ill health professionals in the context of the current needs of the health service. ISSN [Internet]: 2013-4878 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

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