RESUMO
Introducción: en el contexto de un envejecimiento acelerado e inminente, surge la necesidad de implementar cuidados a largo plazo (CLP). Estos son servicios destinados a satisfacer necesidades de personas con afecciones crónicas, que no pueden cuidarse por sí mismas. El objetivo de esta revisión es describir el escenario actual de los CLP para personas mayores en Chile, y revisar políticas públicas relacionadas, utilizando la experiencia de otros países como referencia. Métodos: para describir el escenario actual de los cuidados a largo plazo en Chile, se ingresaron los siguientes términos: "long term care", "elderly" "older adults", "Chile", en tres buscadores (Pubmed, Google Scholar y Web of Science). Luego se realizó una búsqueda sobre políticas públicas de CLP, utilizando los mismos buscadores y los conceptos "long term care", "elderly" y "policies" como palabras clave. La búsqueda incluyó documentos en español e inglés, priorizando aquellos de publicación más reciente y de mayor relevancia para los objetivos de esta revisión. Resultados: en Chile casi un cuarto de la población mayor tiene dependencia. El acceso a los beneficios formales de CLP llega a menos del 4% de la población que podría necesitarlos, y para los restantes, los cuidados provienen principalmente de las familias. Hay múltiples decisiones que tomar a la hora de crear políticas públicas sobre CLP. En cuanto a las maneras de brindar servicios, destaca la provisión de beneficios en especie. Respecto a quiénes considerar beneficiarios, la "universalidad focalizada" es un concepto transversal a muchos países. También destacan los buenos resultados de la implementación de un sistema integrado. Discusión: en Chile debería extenderse un debate sobre los CLP, ya que es un tema que no ha recibido la atención necesaria e influye a una proporción cada vez mayor de la población.
Introduction: In a context of imminent and accelerated ageing the need for long-term care (LTC) arises. These are services designed to satisfy the needs of people with chronic conditions who cannot care for themselves. The objective of this review is to describe the current LTC scenario for older people in Chile and to review related policies, using the experience of other countries as a reference. Methods: To describe the current scenario of long-term care in Chile, the following terms were entered: long term care," elderly," older adults," Chile," in Pubmed, Google Scholar, and Web of Science. Then, CLP public policies were searched, using the same search engines and the concepts "long term care", "elderly", and "policies" as keywords. The search included documents in Spanish and English, priori-tizing those of the most recent publication and greater relevance to the objectives of this review. Results: In Chile, almost a quarter of the elderly population is dependent. Access to formal LTC benefits reaches less than 4% of people that could need them, and for the rest, care comes mainly from families. There are multiple decisions to be made when creating public policies about LTC. Regarding the ways of providing services, the provision of benefits in kind stands out. For those who will be beneficiaries, "targeted universality" is a popular concept across many countries. The good results of the implementation of an integrated system also stand out. Discussions:In Chile, a debate on LTC should take place because it is an issue that has not received the necessary attention and affects an increasing proportion of the population.
RESUMO
Flutamide is a non-steroidal anti-androgenic drug, commonly used in the treatment of advanced prostate cancer, acne and hirsutism. This drug may induce various degrees of liver injury, including acute liver failure (ALF), with further need for liver transplantation. Here, we present a report of 10 consecutive patients seen in a period of 14 years, with acute liver toxicity induced by flutamide (in most cases severe hepatotoxicity): 3 men and 7 women, with a mean age of 75 and 29 years old, respectively. All men received flutamide as treatment of advanced prostate carcinoma and they developed hepatotoxicity without ALF, and three months after withdrawal of the drug, they recovered completely. In contrast, in 7 young female with liver toxicity caused by flutamide as treatment of various hyperandrogenic conditions (acne and hirsutism), ALF was observed in 5 patients, all of them requiring urgent liver transplantation, with excellent outcome and survival in 4 of them. Based on the above, we believe that flutamide treatment should be preferentially avoided in young female patients with benign pathologies, or if it is used, patients should be warned of its potential severe complications. Also, serial liver tests should be closely monitored and, in case of elevations, the drug should be immediately withdrawn.
