Development of a Multiplatform Tool for the Prevention of Prevalent Mental Health Pathologies in Adults: Protocol for a Randomized Control Trial.

BACKGROUND: The prevalence of depression and anxiety has increased in recent years, with many individuals having trouble accessing mental health support. Smartphones have become an integral part of modern life, with apps offering new ways to deliver evidence-based self-help strategies to cope with common mental health symptoms. However, most of them do not have empirical evidence of their overall effectiveness or the effectiveness of their components, which could pose a risk for users. OBJECTIVE: The aim of this study is to evaluate the effectiveness of the modules of evaluation, psychoeducation, and emotional regulation strategies in a multiplatform self-help mental health mobile app in the Maule region of Chile. METHODS: A sample of 196 adults will be selected, who will be randomly assigned to different components of the app for a fixed period to assess its ability to reduce symptomatology. RESULTS: The trial is not yet recruiting and is expected to end in October 2024. The first results are expected in April 2024. CONCLUSIONS: This is the first study in Chile to develop and test the effectiveness of a mobile app to manage anxiety and depression symptoms in adults. The intervention proposed is based on evidence suggesting that the internet or remote intervention tools and self-management of prevalent symptomatology could be the future of mental health care systems in the digital era. If the effects of the intervention are positive, wide implementation in Chile and other Spanish-speaking countries could be possible in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52324.

Miocinas: su rol en la obesidad y en las enfermedades cardiometabólicas / Myokines: their role in obesity and cardiometabolic diseases

Resumen Introducción: La obesidad es uno de los principales problemas de salud pública en el mundo. Se considera detonante de múltiples enfermedades cardiometabólicas, como el infarto agudo de miocardio, la hipertensión arterial, la diabetes mellitus tipo 2 y el accidente isquémico cerebral. Es interesante conocer diversos factores fisiopatológicos que no dependen solo de la adiposidad, sino también de la masa muscular. Al entender que el músculo como órgano endocrino corresponde al 40% del peso corporal, las miocinas, como sustancias propias de este órgano liberadas desde la contracción, cobran importancia por su efecto antiinflamatorio y cardioprotector, y suponen un esfuerzo mayor para, a partir de su comprensión, realizar una prescripción adecuada del ejercicio. Objetivo: Estudiar las funciones de las miocinas como sustancias reguladoras de diversos procesos metabólicos, fundamentales en la homeostasis corporal. Método: Se hizo una revisión de tema, resultado de la revisión crítica de la literatura disponible sobre las miocinas, sus funciones y los efectos de la actividad física y el ejercicio en su liberación y acción. Conclusiones: El estudio de las miocinas viene en aumento y cobra relevancia clínica. Los efectos antiinflamatorios y cardioprotectores de las miocinas dependen del tipo de entrenamiento y de las cargas aplicadas al músculo una vez ha sido sometido a diferentes tipos de estímulo (aeróbico/anaeróbico, fuerza). Por tanto, la prescripción correcta del ejercicio es crucial en la modulación de estos mediadores: la optimización de su efecto, el acondicionamiento físico y el mantenimiento del peso adecuado.

Abstract Introduction: Obesity is one of the main public health problems worldwide being considered as a trigger for multiple cardiometabolic diseases such as acute myocardial infarction, high blood pressure, type 2 diabetes mellitus, cerebral ischemic accident among others. For this reason, it is of interest to know the various pathophysiological factors which depend not only on adiposity but also on muscle mass. Taking into account that the muscle as an endocrine organ corresponds to 40 % of the body weight, the importance that myokines charge as substances of this organ with an anti-inflammatory and cardioprotective character and which are released from muscle contraction is an additional study to perform an adequate Prescription of the exercise. Objective: To study the functions of myokines as regulatory substances in various metabolic processes, being essential in body homeostasis. Method: It is presented a topic review article, the result of a critical review of the available literature on myokines, their functions and the effects of physical activity and exercise on their release and action. Conclusions: that the study of myokines is increasing and is becoming more important clinical. The anti-inflammatory and cardioprotective effects of myokines depend on the type of training and loads applied to the muscle once subjected to different types of stimulation (aerobic/anaerobic, strength). Therefore, the proper prescription of exercise becomes crucial in the physical conditioning and in the maintenance of the appropriate weight.

Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world.

Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.

Rehabilitación cardiaca: una transformación acelerada durante la pandemia de COVID-19 / Cardiac rehabilitation: an accelerated transformation during the COVID-19 pandemics

Resumen La rehabilitación cardiaca es un tratamiento valioso para pacientes con enfermedades cardiacas establecidas, y en general para personas con riesgo cardiovascular elevado. La prescripción de la rehabilitación cardiaca debe ser progresiva y con metas individualizadas. Tradicionalmente se inicia en entornos hospitalarios luego de eventos cardiovasculares agudos y se continúa de manera ambulatoria en instituciones de menor complejidad. Se realizó una revisión no sistemática de la literatura sobre la evolución de la rehabilitación cardiaca en el tiempo, su relevancia en el cuidado de los pacientes con enfermedad cardiovascular, las diferentes modalidades en la prestación de este servicio con la tendencia a la rehabilitación cardiaca en casa y la telerrehabilitación, y su transformación acelerada durante la pandemia de COVID-19. Es fundamental garantizar la continuidad en el acceso, así como la suficiente participación de los pacientes en programas remodelados de rehabilitación cardiaca, capaces de transgredir hábitos en la prestación del servicio y de superar las barreras que puede representar la situación actual para la entrega de una atención de alta calidad.

Abstract Cardiac rehabilitation is a valuable treatment for patients with established heart disease, and in general, for people with high cardiovascular risk. The prescription of cardiac rehabilitation must be progressive and with individualized goals. Traditionally, it is performed in hospital settings after an acute cardiovascular event and it's continued as outpatient basis in less complex institutions. A non-systematic review of literature was conducted in terms of the evolution of cardiac rehabilitation over time, it's relevance in cardiovascular disease patient's care, different access modalities, including the evolving tendency towards home based cardiac rehabilitation and tele-rehabilitation, as well as its accelerated transformation during the COVID-19 pandemics. It is essential to guarantee continuity of access as well as sufficient participation of patients in restructured cardiac rehabilitation programs, capable of surpassing service delivery habits and overcoming the barriers that the current situation may represent for the delivery of a high-quality care.

Latent Class Analysis in Depression, Including Clinical and Functional Variables: Evidence of a Complex Depressive Subtype in Primary Care in Chile.

OBJECTIVE: To establish differentiated depressive subtypes using a latent class analysis (LCA), including clinical and functional indicators in a sample of depressed patients consulted in Chilean Primary Health Care. METHODS: A LCA was performed on a sample of 297 depressed patients consulted in Chilean PHC. The Mini International Neuropsychiatric Interview, the Hamilton Depression Rating Scale, the Outcome Questionnaire -social role, and interpersonal subscales were as instruments. A regression analysis of the different subtypes with sociodemographic and adverse life experiences was performed. RESULTS: In a sample characterized by 87.5% of women, two, three, and four latent class models were obtained. The three-class model likely represents the best clinical implications. In this model, the classes were labeled: "complex depression" (CD) (58% of the sample), "recurrent depression" (RD) (34%), and "single depression episode" (SD) (8%). Members of CD showed a higher probability of history of suicide attempts, interpersonal, and social dysfunction. Psychiatric comorbidities differentiated the RD from SD. According to a multinomial regression model, childhood trauma experiences, recent stressful life experiences, and intimate partner violence events were associated with the CD class (p < 0.01). Limitations. The vast majority of participants were females from Chile and the sample studied was not random. So, the results may not necessarily represent outpatient clinics. CONCLUSIONS: This study can provide additional evidence that depression, specifically in female gender, could be better understood as a complex heterogeneous disorder when clinical and functional indicators are studied. Furthermore, adverse life experiences starting in childhood could lead to a differentiated complex depressive subtype.

Screening for consequences of trauma - an update on the global collaboration on traumatic stress.

This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.

Valor pronóstico de biomarcadores cardíacos en la enfermedad por COVID-19 / value of cardiac biomarkers in COVID-19 disease

Resumen Introducción: En la enfermedad por COVID-19 se ha establecido que los pacientes con enfermedad cardiometabólica de base tienen mayor riesgo de presentar desenlaces adversos. Esto ha incrementado el interés en estudiar variables cardiovasculares relevantes, para plantear su correlación con los desenlaces clínicos en esta población. Objetivo: Describir el valor pronóstico de los biomarcadores cardíacos en la enfermedad por COVID-19. Métodos: Revisión no sistemática de la literatura en bases de datos como PubMed, Google Scholar, Clinical Key, SciELO, entre otras, utilizando palabras clave, términos planos y términos MeSh. Resultados: Se eligieron 22 bibliografías, entre ellas artículos de revisión de tema, revisiones sistemáticas, metaanálisis, estudios observacionales y artículos originales publicados hasta la fecha (mayo 13 de 2020), que en su mayoría describen la alteración de biomarcadores cardiacos y su relación con la evolución clínica de los pacientes con COVID-19. Discusión: Se encontró que la troponina y el péptido natriurético se comportan como factores de riesgo independientes para compromiso clínico severo, requerimiento de soporte ventilatorio o hemodinámico, estancia en la UCI, y aumento de la mortalidad. Conclusiones: Es razonable plantear el uso de estos biomarcadores en la estratificación del riesgo en pacientes con COVID-19 y enfermedad cardiovascular establecida.

Abstract Introduction: It has been established that patients with an underlying cardiometabolic disease and COVID-19 infections, have a higher risk of an adverse outcome. This has led to an increase in the interest of studying relevant cardiovascular variables, in order to establish their association with clinical outcomes in this population. Objective: To describe the prognostic value of cardiac biomarkers in disease caused by COVID-19. Methods: A non-systematic review of the literature was carried out in data bases that included PubMed, Google Scholar, Clinical Key, SciELO, using the key words, plain terms, and MeSH terms. Results: A total of 22 articles were chosen. They consisted of review articles on the subject, systematic reviews, meta-analyses, observational studies, and original articles published up until 13 May 2020. The majority of them described the changes in cardiac biomarkers and their relationship with the clinical outcome of patients COVID-19. Discussion: It was found that Troponin and Natriuretic Peptide behaved as independent risk factors for severe clinical compromise, requiring ventilatory or haemodynamic support, admission to ICU, and an increase in mortality. Conclusions: It is reasonable to recommend the use of these biomarkers in the risk stratification in patients with COVID-19 and an established cardiovascular disease.

Mielitis isquémica como presentación de aorta shaggy en paciente con síndrome aórtico agudo concomitante / Ischaemic myelitis as a presentation of a shaggy aorta in a patient with concomitant acute aortic syndrome

Resumen La aorta shaggy se define como una degeneración ateromatosa agresiva y extensa de la aorta, cuya friabilidad predispone a ulceración y complicaciones embólicas, cursa con alto riesgo de embolia sistémica y no se conocen prevalencia ni incidencia en poblaciones de riesgo. La mayoría de casos publicados hacen referencia a complicaciones en procedimientos quirúrgicos. En la literatura no se hallaron reportes que asocien ateroembolia aórtica con obstrucción de la arteria de Adamkiewicz, cuyo diagnóstico no siempre es posible visualizando su oclusión por angiotomografía o por angiorresonancia, pues el defecto puede ser evanescente o puede existir compromiso distal con obstrucción microvascular, difícilmente aparente con arteriografía selectiva. Se presenta un caso de mielopatía isquémica embólica asociada a aorta shaggy con probable oclusión de la arteria de Adamkiewicz como responsable del deterioro neurológico agudo de la paciente, confirmado por resonancia magnética nuclear. Para caracterizar mejor esta enfermedad y para tener las estrategias diagnósticas y terapéuticas apropiadas en su abordaje oportuno, consideramos importante el reporte de casos similares aumentando así su sospecha diagnóstica.

Abstract A shaggy aorta is defined as an aggressive and extensive atheromatous degeneration of the aorta. Its friability predisposes to ulceration and embolic complications. It carries a high risk of systemic embolisms, and its prevalence and incidence in risk populations is unknown. The majority of published cases mention complications in surgical procedures. No reports have been found in the literature that associate aortic atheroembolism with obstruction of the artery of Adamkiewicz. Its diagnosis is not always possible by visualising its occlusion by computed tomography angiography or by magnetic resonance angiography, since the defects may be evanescent, or there may be a distal compromise with a microvascular obstruction, hardly apparent with selected angiography. A case is presented of embolic ischaemic myelitis associated with a shaggy aorta, with probable occlusion of the artery of Adamkiewicz being responsible form the acute neurological deterioration of the patient, confirmed by a nuclear magnetic resonance scan. In order to better describe the features of this disease and to have the appropriate diagnostic and therapeutic strategies for its timely approach, it is considered important to report all similar cases, thus increasing its diagnostic suspicion.

Trombosis venosa subclavia asociada a electrodo de marcapasos y síndrome de la plaqueta pegajosa / Subclavian venous thrombosis associated with pacemaker electrode and sticky platelet syndrome

Resumen El síndrome de la plaqueta pegajosa en un trastorno cualitativo plaquetario en el que bajas concentraciones de epinefrina y adenosina difosfato producen hiperagregabilidad plaquetaria considerable. Se ha especulado mucho sobre la etiología de este trastorno sin que sean claros sus mecanismos fisiopatológicos. Desde el punto de vista clínico, se asocia a trombosis arteriales y venosas recurrentes en pacientes jóvenes, pérdidas gestacionales, otras complicaciones obstétricas y cefalea recurrente.En la literatura se ha descrito su presentación familiar, lo que hace sospechar su comportamiento hereditario autosómico dominante; también se ha reportado un fenotipo adquirido de la enfermedad en algunas poblaciones especiales como pacientes con enfermedad renal crónica en terapia de reemplazo renal o posterior al trasplante renal y en pacientes con cuadros inflamatorios o inmunosupresión. Se expone el caso de una paciente con antecedente de cefalea de difícil manejo, síndrome hipertensivo asociado al embarazo y mortinato, con síndrome del nodo enfermo y disautonomía manejadas con implantación de marcapasos definitivo bicameral con sensor CLS, que desarrolló trombosis de la vena subclavia, asociada al electrodo de marcapasos, recurrente a pesar de anticoagulación con warfarina y rivaroxabán e incluso a pesar de antiagregación con ácido acetilsalicílico, con posterior diagnóstico de síndrome de la plaqueta pegajosa.

Abstract Sticky platelet syndrome is a qualitative platelet disorder in which low concentrations of adrenaline and adenosine diphosphate produce considerable platelet hyperaggregability. There has been much speculation on the origin of this disorder as its pathophysiological mechanisms of action are not yet clear. From a clinical point of view, it is associated with recurrent arterial and venous thrombosis in young patients, miscarriages, other obstetric complications and recurrent headaches.Its familial presentation has been described in the literature, suspecting that it is of a dominant autosomal hereditary nature. An acquired phenotype of the disease has also been reported in some particular patients, such as patients with chronic kidney disease on renal replacement therapy or after a kidney transplant, as well as in patients with inflammatory processes or immunosuppression. The case is presented of a patient with a history of difficult to manage headaches, a hypertensive syndrome associated with the pregnancy, and a foetal death. She also had sick sinus node syndrome and dysautonomia managed with a definitive dual-chamber pacemaker with a CLS sensor. There was then a thrombosis in the subclavian vein associated with the pacemaker electrode, being recurrent despite anticoagulation with warfarin and rivaroxaban, and even despite anti-aggregation treatment with acetyl salicylic acid. She was subsequently diagnosed with sticky platelet syndrome.

Endocarditis por Escherichia coli de válvula nativa asociada a dispositivos cardíacos implantables / Endocarditis due to Escherichia coli of a native valve associated with implantable cardiac devices

Resumen La endocarditis bacteriana es una enfermedad con alta morbimortalidad, causada principalmente por cocos gram positivos, menos frecuentemente por organismos del grupo HACEK e inusualmente por otras enterobacterias. La Escherichia coli es la principal causa de bacteriemia nosocomial, pero en la literatura existen reportes de no más de 50 casos de endocarditis por este microorganismo. El tracto genitourinario es la fuente usual del compromiso infeccioso favorecido por factores de riesgo como diabetes mellitus, cardiopatía estructural, antecedente de malignidad, uso de drogas intravenosas, material protésico y edad avanzada. La E. coli en válvulas nativas presenta tropismo por válvulas del lado izquierdo. Así mismo, se han descrito presentaciones inusuales en relación con material protésico y organismos resistentes, aunque es mucho más frecuente encontrar cepas silvestres. La endocarditis por E. coli se asocia fuertemente con complicaciones locales y necesidad de manejo quirúrgico. La filogenética de las cepas de E. coli aisladas en infecciones endocárdicas y los factores de virulencia que le permiten adherirse a este tejido en presencia o no de material protésico, han sido bastante discutidas. Se expone un caso de endocarditis asociada a electrodo de marcapasos por E. coli y posteriormente se hace una revisión de la literatura disponible sobre esta enfermedad.

Abstract Bacterial endocarditis is a disease with high morbidity and mortality, and is mainly caused by gram positive cocci, less frequently due to organisms of the HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella), and unusually by other bacteria. Escherichia coli is the principal cause of nosocomial bacteraemia, but there are no more than 50 cases reported in the literature of due to this microorganism. The genitourinary tract is the usual sources of infectious compromises favoured by risk factors such as, diabetes mellitus, structural heart disease, history of malignancy, use of intravenous drugs, prosthetic material, and advanced age. E. coli in native valves have tropism for valves of the left side. Furthermore, unusual presentations have been described as regards prosthetic material and resistant organism, although it is much more common to find wild strains. Endocarditis due to E. coli is strongly associated with local complications, and a need for surgical management. The phylogenetics of the E. coli isolated in endocardial infections, and the virulence factors that enable it to adhere to this tissue whether in the presence or not of prosthetic material, has been widely discussed. A case is presented of endocarditis associated with a pacemaker electrode due to E. coli, followed by a review of the available literature on this disease.

Propuesta de mejora para la prescripción del tratamiento empírico en la infección de piel y partes blandas / Empirical treatment prescribing improvement proposal in skin and soft tissue infection

No disponible

Childhood trauma and psychiatric comorbidities in patients with depressive disorder in primary care in Chile.

Childhood trauma is associated with different psychiatric disorders during adulthood. These disorders are often presented in comorbidity with depression. OBJECTIVE: To establish the relationship between psychiatric comorbidities and childhood traumatic events in patients with depression in Chile. METHODS: Three hundred and ninety-four patients with major depression were assessed using the MINI International Neuropsychiatric Interview and a screening for childhood trauma. RESULTS: Social anxiety disorder was associated with having witnessed domestic violence during childhood (OR = 2.2, CI 1.2 - 3.8), childhood physical abuse (OR = 2.7, CI 1.6 - 4.4), physical injury associated with physical abuse (OR = 2.3, CI 1.3 - 4.7) and sexual abuse by a non-relative (OR = 2.7, CI 1.3 - 4.2). Posttraumatic stress disorder was associated with physical injury associated with physical abuse (OR = 1.9, CI 1.1 - 3.6), sexual abuse by a relative (OR = 3.2, IC 1.8 - 5.9) and sexual abuse by a non-relative (OR = 2.2, CI 1.2 - 4.1). Antisocial personality disorder was associated with traumatic separation from a caregiver (OR = 3.2, CI 1.2 - 8.5), alcohol abuse by a family member (OR = 3.1, CI 1.1 - 8.1), physical abuse (OR = 2.8, CI 1.1 - 6.9) and sexual abuse by a non-relative (OR = 4.8, CI 1.2 - 11.5). Panic disorder was associated with sexual abuse by a relative (OR = 1.9, CI 1.1 - 3.1). Generalized anxiety disorder was associated with sexual abuse by a non-relative (OR = 1.9, CI 1.1- 3.3). CONCLUSIONS: Further clinical recognition is required in patients seeking help for depression in primary care. This recognition must take into account the patient's current psychiatric comorbidities and adverse childhood experiences.

[The place of the individual in the field of health: lessons from qualitative investigation]. / El lugar del sujeto en el campo de la salud: enseñanzas de la investigación cualitativa.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

Depression and psychological trauma: an overview integrating current research and specific evidence of studies in the treatment of depression in public mental health services in chile.

In the last two decades, different research has demonstrated the high prevalence of childhood trauma, including sexual abuse, among depressive women. These findings are associated with a complex, severe, and chronic psychopathology. This can be explained considering the neurobiological changes secondary to early trauma that can provoke a neuroendocrine failure to compensate in response to challenge. It suggests the existence of a distinguishable clinical-neurobiological subtype of depression as a function of childhood trauma that requires specific treatments. Among women with depression and early trauma receiving treatment in a public mental health service in Chile, it was demonstrated that a brief outpatient intervention (that screened for and focused on childhood trauma and helped patients to understand current psychosocial difficulties as a repetition of past trauma) was effective in reducing psychiatric symptoms and improving interpersonal relationships. However, in this population, this intervention did not prevent posttraumatic stress disorder secondary to the extreme earthquake that occurred in February 2010. Therefore in adults with depression and early trauma, it is necessary to evaluate prolonged multimodal treatments that integrate pharmacotherapy, social support, and interpersonal psychotherapies with trauma focused interventions (specific interventions for specific traumas).

El lugar del sujeto en el campo de la salud: enseñanzas de la investigación cualitativa / The place of the individual in the field of health: lessons from qualitative investigation

En este artículo se cuestiona la exclusión de la subjetividad derivada de los ideales de objetividad y neutralidad del paradigma científico moderno. Se exponen algunas de sus consecuencias en lo que atañe a la construcción de la salud y el cuidado de la enfermedad. Se discuten cinco nudos problemáticos en los que la investigación cualitativa tiene valiosos aportes qué ofrecer para la recuperación del lugar del sujeto: la salud y la enfermedad como experiencias subjetivamente percibidas y significadas; la brecha que separa a la visión de los expertos y de quienes no lo son; los desencuentros entre los profesionales de la salud y la población, tanto en el frente curativo como en el preventivo; el silenciamiento de la voz del enfermo sobre su vivencia de la enfermedad; y la esterilización de la creatividad subjetiva en la construcción de rutas más diversas para el cuidado de la salud. Se postula que, con todos los retos implicados, ciertas corrientes de la investigación cualitativa cuyos fundamentos se ubican en el polo más avanzado de la reflexión epistemológica, ética e incluso estética de nuestros días, pueden ayudar a abrir nuevas rutas hacia alternativas más ricas e imaginativas para el cuidado de la salud y la atención de la enfermedad en las sociedades latinoamericanas.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

[Sampling in qualitative research: basic principles and some controversies]. / El muestreo en investigación cualitativa: principios básicos y algunas controversias.

This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.