Health education can save the environment from medicine residues

Abstract The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.

Medicina anticipatoria vs medicina preventiva. Como crear enfermos buscando la salud. (I) Las Estadísticas / Anticipatory medicine vs preventive medicine. How to create patients looking for health. (I) Statistics

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Psicofármacos na Estratégia Saúde da Família: contribuições da enfermagem para a compreensão do consumo e do processo de medicamentalização da vida / Psychopharmaceuticals in the Family Health Strategy: nursing contributions to understanding consumption and the process of medicationalization of life

O estudo tem como objetivo geral analisar o perfil de utilização de psicofármacos na população assistida pela Estratégia Saúde da Família na área programática 3.3 do município do Rio de Janeiro e, como objetivos específicos, conhecer o contexto socioeconômico dos usuários da área programática 3.3 do município do Rio de Janeiro que fazem uso de psicofármacos, compreender como se dá a assistência prestada pela Estratégia Saúde da Família a essa população, identificar os fatores envolvidos no processo de medicalização da vida, e ressaltar o papel do(a) Enfermeiro(a) junto aos usuários que fazem uso de psicofármacos. Trata-se de uma pesquisa de abordagem quantitativa, de caráter exploratório, realizada nas três unidades da área programática 3.3 do município do Rio de Janeiro, que mais necessitam de reposição de psicofármacos, segundo a coordenação da área programática. A técnica utilizada para o cálculo foi a amostragem estratificada por alocação proporcional, selecionando-se, para a coleta de dados, 13 pacientes na Unidade Básica de Saúde 1, 14 pacientes na Unidade Básica de Saúde 2 e 22 na Unidade Básica de Saúde 3. A coleta de dados foi realizada no período de 22 de maio a 03 de julho de 2020, por meio da aplicação de questionário semi- estruturado. Observou-se maior prevalência do uso de psicofármacos entre mulheres com mais de 60 anos de idade. A maioria dos entrevistados estudaram até o ensino médio e encontravam-se desempregados. Não recebiam nenhum auxílio governamental e contavam com renda inferior a um salário-mínimo. Eram casados e possuíam casa própria, morando acompanhados por uma a duas pessoas. A maioria fazia acompanhamento regular na Estratégia Saúde da Família e considerava não ter acesso a nenhum tipo de lazer. Utilizavam ao menos um psicofármaco diariamente, há mais de 6 anos, para quadros, em sua maioria, de ansiedade e insônia. Grande parte das medicações foi prescrita por especialistas. Os participantes consideraram que o uso desses medicamentos não trazia danos, mas acreditavam que deveriam ser prescritos com mais critérios. Grande parte dos participantes diz nunca ter sido atendido por um enfermeiro. Os participantes não tinham conhecimento suficiente sobre a ação, os riscos e modo de utilização dos psicofármacos prescritos. A maioria deixava o receituário na unidade e depois retornava para buscá-lo renovado, sem passar por atendimento ou avaliação. Sendo assim, entende-se a importância dos psicofármacos no auxílio do sofrimento psíquico, porém o uso racional deve ser refletido pelos usuários, familiares e profissionais de saúde na Estratégia Saúde da Família.

The general objective of the study is to analyse the profile of use of psychiatric drugs in the population assisted by the Family Health Strategy in program area 3.3 in the city of Rio de Janeiro, and, as specific objectives, to know the socioeconomic context of users in program area 3.3 of the city of Rio de Janeiro who use psychotropic drugs, to understand how the assistance provided by the Family Health Strategy is given to this population, to identify the factors involved in the process of the medicalization of life, and to highlight the role of the Nurse in the assistance of users who use psychiatric drugs. This is a research with a quantitative approach, of an exploratory nature, carried out in the three units of the program area 3.3, in the city of Rio de Janeiro, which a greater part need replacement of psychotropic drugs, according to the coordination of the program area. The technique used for the calculation was stratified sampling by proportional allocation, selecting, for data collection, 13 patients at Basic Healthcare Unit 1, 14 patients at Basic Healthcare Unit 2 and 22 at Basic Healthcare Unit 3. Data collection was carried out in the period of May 22 to July 3, 2020, through the application of a semi-structured questionnaire. A higher prevalence of the use of psychiatric drugs was observed among women over 60 years of age. Overall, respondents studied through high school and were unemployed. They did not receive any government aid, and had an income below the minimum wage. They were married and had their own home, living accompanied by one to two people. The greater part regularly followed up at the Family Health Strategy and considered that they did not have access to any type of leisure. They had used at least one psychotropic drug daily, for more than 6 years, mostly for conditions of anxiety and insomnia. Most medications were prescribed by specialists. The participants considered that the use of these drugs does not cause harm, but they believed that they should be prescribed with more criteria. Most participants said that they have never been seen by a nurse. Participants did not have sufficient knowledge about the action, risks and use of the prescribed psychotropic drugs. In general, they left the prescription at the unit and then returned to get it renewed, without undergoing service or evaluation. Thus, while the importance of psychotropic drugs in helping psychological distress is understood, the rational use must be reflected by users, family members and health professionals in the Family Health Strategy.

Tracking biomedicalization in the media: Public discourses on health and medicine in the UK and Italy, 1984-2017.

This article examines historical trends in the reporting of health, illness and medicine in UK and Italian newspapers from 1984 to 2017. It focuses on the increasing "biomedicalization" of health reporting and the framing of health and medicine as a matter of technoscientific interventions. Methodologically, we relied on two large datasets consisting of all the health- and medicine-related articles published in the online archives of The Guardian (UK) and la Repubblica (Italy). These articles underwent a quantitative analysis, based on topic modelling techniques, to identify and analyse relevant topics in the datasets. Moreover, we developed some synthetic indices to support the analysis of how medical and health news are "biomedicalized" in media coverage. Theoretically, we emphasise that media represent a constitutive environment in shaping biomedicalization processes. Our analyses show that across the period under scrutiny, biomedicalization is a relevant, even if sometimes ambivalent, frame in the media sphere, placing growing centrality on three dimensions: i) health and well-being as a matter of individual commitment to self-monitoring and self-surveillance; ii) biomedicine as a large technoscientific enterprise emerging from the entanglement between research fields and their technological embodiments; iii) the multiverse reforms of welfare systems in facing the trade-off between universal health coverage and the need to render the national healthcare system more sustainable and compatible with non-expansionary monetary policies and austerity approaches in managing state government budgets.

Alcance de la implementación en Cataluña de las estrategias de salud reproductiva (2008-2017) / The extent of the implementation of reproductive health strategies in Catalonia (Spain) (2008-2017)

Objetivo: Analizar la implementación de las estrategias de salud reproductiva en las actividades cotidianas de los servicios y la transformación de las prácticas de profesionales y usuarias. Método: Investigación cartográfica de tipo etnográfico multilocal orientada a captar los procesos de transformación. Técnicas de generación de datos: observación participante y entrevistas situadas. Análisis del discurso del corpus textual a partir de tres líneas de acción promovidas por las estrategias. Resultados: Se observan elementos de transformación en: 1) desmedicalización: aumento de la competencia y autonomía de la matrona, cambios en las episiotomías y facilitación de prácticas de vínculo; 2) calidez en la atención: incorporación de las necesidades y expectativas de la mujer y mejoras en la confortabilidad de los espacios en partos fisiológicos; y 3) participación: acciones que favorecen la toma de decisiones compartida y mayor implicación de la persona acompañante. Conclusiones: La transformación se visibiliza sobre todo en la incorporación de nuevas actitudes, nuevas sensibilidades y nuevas praxis que empiezan alrededor de las viejas estructuras, especialmente en la atención al parto fisiológico. Los espacios más tecnificados han sido menos permeables al cambio. La gestión del riesgo en la toma de decisiones y el abordaje de la diversidad se identifican como campos en los que la transformación es menos evidente

Objective: We analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices. Method: Cartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies. Results: We identified transformations in: 1) demedicalisation: an increase in midwives' know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour. Conclusions: Above all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident

Prevención en la infancia: no toda intervención hoy es más salud para mañana / Prevention in childhood: not all interventions today will mean more health tomorro

En este trabajo se investigan los beneficios e inconvenientes de las intervenciones de prevención primaria y promoción de la salud mental infanto-juvenil. Ambas cuestiones son importantes para determinar cuándo y cómo desarrollar estas actividades. Los resultados derivados de una revisión bibliográfica indican que los factores de riesgo tienen que ver con un entorno social problemático o empobrecido y con métodos de crianza inadecuados. De este modo, la parentalidad se erige como uno de los elementos más susceptibles de intervención a través de estrategias preventivas. Sin embargo, no parece que las intervenciones preventivas desde el ámbito clínico sean claramente eficaces. Existe un mayor consenso en que las estrategias útiles son las políticas de promoción de la salud que inciden sobre los entornos sociales problemáticos, modificando prácticas y normas sociales para minimizar la exposición de las familias a acontecimientos estresantes. Posteriormente, hacemos una evaluación de las intervenciones de prevención primaria en los dispositivos de salud mental a la luz de la experiencia clínica. Estas intervenciones, ya sea de acompañamiento psicoterapéutico o de coordinación de intervenciones no clínicas sobre factores de riesgo, no siempre están indicadas y pueden ser potencialmente iatrogénicas por producir estigma, patologización, sobretratamiento y desresponsabilización. Finalmente, proponemos una guía para la toma de decisiones en intervenciones de prevención primaria teniendo en cuenta cinco ejes: la clínica, los factores de riesgo, los recursos del niño y la familia para enfrentar la adversidad, la existencia de demanda de tratamiento y los posibles perjuicios

In this work, we investigate the benefits and problems of primary prevention interventions and mental health promotion in children and adolescents. Both issues are crucial to determine when and how to develop these activities. The results of a bibliographic review on the subject indicate that risk factors are linked to an impoverished, problematic environment and inappropriate nurturing methods. Whereas parenting becomes one of the elements most susceptible to preventive interventions, the latter do not appear to be effective in clinical settings. There is a growing consensus that useful strategies entail health-promoting policies that impact on problematic social environments by modifying social practices and norms to minimize families' exposure to stressful events. Further, we discuss primary prevention interventions in mental health services in the light of clinical experience. These interventions, either psychotherapeutic accompaniment or coordination of non-clinical partners that take part in risk factors control, are not always indicated. They can be potentially iatrogenic because they involve stigma, pathologization, overtreatment and disresponsabilization. Finally, we propose a guide to decision-making in preventive intervention based on five aspects: clinical manifestations, risk factors, children and family resources to deal with adversity, treatment request, and eventual harms

[Undesirable medicalisation: on the nature and background of too much medicine]. / Ongewenste medicalisering.

Over recent years there has been renewed focus on medicalisation. Amongst other things, this is the result of the realisation that expansion of the medical domain can also have undesirable effects. However, the line between justified medical interventions and overdiagnosis is difficult to draw. The first step in regaining control of undesirable medicalisation is to identify and quantify the processes behind it and the situations in clinical practice in which it may occur. In this article we discuss different types of medicalisation and, on the basis of this, we give an indication of the frequency with which medicalisation occurs. Finally, we discuss the mechanisms that facilitate medicalisation.

Social Ecological Examination of Factors That Influence the Treatment of Newborns With Neonatal Abstinence Syndrome.

Health care systems are challenged with issues of overdiagnosis and overtreatment. Neonatal abstinence syndrome (NAS) may be overdiagnosed with standardized assessment protocols and may be overtreated with current NICU-based models of care. Clinical approaches to caring for neonates with NAS and their families have not significantly changed for 40 years, and there is growing interest in revisiting long-standing routine practices. I used Bronfenbrenner's social ecological systems framework to organize an exploration of factors that contribute to overdiagnosis and overtreatment in the care of neonates with NAS.

Women's attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth.

PROBLEM: Rates of medical interventions in childbirth have greatly increased in the Western world. BACKGROUND: Women's attitudes affect their birth choices. AIM: To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. METHODS: This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at <28 weeks gestation when filling in the questionnaire were asked to fill in a second one at ∼34 weeks. Phone follow-up was conducted ∼6 weeks postpartum to assess actual mode of birth. FINDINGS: Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. DISCUSSION: Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. CONCLUSION: Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth.

Efecto de la crisis económica sobre el consumo de psicofármacos en Asturias / Effect of the economic crisis on consumption of psychotropic drugs in Asturias (Spain)

Objetivo: Evaluar si la crisis económica de 2008ha comportado cambios en la evolución del consumo de ansiolíticos, hipnótico-sedantes y antidepresivos en Asturias. Método: Estudio descriptivo y de utilización de medicamentos durante 2003-2013. Se calcularon las dosis diarias definidas por 1000 habitantes/día (DHD) de ansiolíticos, hipnótico-sedantes y antidepresivos. Se obtuvieron coeficientes de regresión lineal (b) de las DHD de la etapa precrisis (2003-2008) y de la etapa de crisis (2009-2013). Resultados: El consumo de ansiolíticos creció un 40,25%, el de hipnóticos un 88,11% y el de antidepresivos un 80,93%. Para los ansiolíticos: b-(2003-2008)=4,38 DHD/año y b-(2009-2013)=1,08 DHD/año. Para los hipnótico-sedantes: b-(2003-2008)=2,30 DHD/año y b-(2009-2013)=0,40 DHD/año. Para los antidepresivos: b-(2003-2008)=5,79 DHD/año y b-(2009-2013)=2,83 DHD/año. Conclusiones: El incremento del consumo para los tres subgrupos en la época de crisis fue menor que en la época precrisis. No se confirma que la crisis económica haya influido aumentando el consumo de estos medicamentos (AU)

Objective: To assess whether the economic crisis of 2008 has changed the consumption of anxiolytics, hypnotics-sedatives and antidepressants in Asturias (Spain). Method: We conducted a descriptive study of drug use from 2003 -2013. The defined daily doses of 1000 inhabitants per day (DHD) were calculated for anxiolytics, hypnotics-sedatives and antidepressants. Linear regression coefficients (b) of the DHD were obtained for the pre-crisis period (2003-2008) and the crisis period (2009-2013). Results: The consumption of anxiolytics increased by 40.25%, that of hypnotics by 88.11% and that of antidepressants by 80.93%. For anxiolytics: b-(2003-2008)=4.38 DDI/year and b-(2009-2013)=1.08 DDI/year. For hypnotics-sedatives: b-(2003-2008)=2.30 DDI/year and b-(2009-2013)=0.40 DDI/year. For antidepressants: b-(2003-2008)=5.79 DDI/year and b-(2009-2013)=2.83 DDI/year. Conclusions: The rise in consumption of the three subgroups during the crisis period was lower than that of the pre-crisis period. This study does not confirm the influence of the economic crisis on the rise in consumption of these drugs (AU)

La medicalización de la infancia en salud mental: el caso paradigmático de los trastornos de atención / The medicalistation of child hood in mental healthcare: The paradigmatic case of Attention disorders

El presente artículo es una invitación al debate sobre el fenómeno de medicalización en la infancia en salud mental, apelando a una toma de consciencia de los profesionales. Para ello analiza, en clave epistemológica, el ejemplo paradigmático del Trastorno de Déficit de Atención con o sin Hiperactividad (TDA-H). Aborda la construcción social del trastorno y el tratamiento, así como algunas falacias sobre las que se apoya: TDA-H es un déficit neurológico, es diagnosticado por profesionales especializados, los tratamientos son eficaces y se realizan en interés del menor

This article is an invitation to debate about the phenomenon of the medicalisation of children in mental healthcare, appealing for awareness among practitioners. For this purpose, we analyse, from the point of view of epistemology, the paradigmatic case of Attention Deficit Disorder, with or without Hyperactivity (ADD and ADHD). We deal with the social construction of the disorder and its treatment, as well as with some fallacies on which it is based: that AD(H)D is a neurological deficit, that it is diagnosed by specialised professionals, that the treatments are effective and that these treatments are carried out in the interest of the minor

PSICOFÁRMACOS E PSICOTERAPIA COM IDOSOS / PSICOFÁRMACOS E PSICOTERAPIA CON ANCIANOS / PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY WITH ELDERLY PEOPLE

O presente artigo se propõe a averiguar a relação entre o uso de psicofármacos e o processo psicoterápico de idosos atendidos em um serviço-escola no Vale do Rio Pardo/RS, durante o período de 1997 a 2011. Trata-se de uma pesquisa documental, baseada em uma abordagem descritiva, desenvolvida a partir da análise de 73 prontuários dos usuários com idade a partir de 60 anos. A pesquisa faz parte de um projeto mais amplo que abrange pesquisas similares em todas as outras faixas etárias (inferiores a 60 anos). Ela mostra que a maior procura pelo tratamento se dá entre as mulheres, e que o principal motivo de procura pelo tratamento está relacionado à tristeza/pessimismo. Revela um número expressivo de medicação psicotrópica entre os idosos pesquisados, inclusive com a utilização de mais de um psicofármaco para uma mesma pessoa, o que reforça os estudos que apontam o aumento da medicação psicofarmacológica na sociedade.(AU)

El presente artículo se propone a averiguar la relación entre el uso de psicofármacos y el proceso psicoterápico de ancianos atendidos en un servicio-escuela en el Valle del Río Pardo/RS, durante el periodo de 1997 a 2011. Se trata de una investigación documental, basada en un abordaje descriptivo, desarrollado a partir del análisis de 73 prontuarios de los usuarios con edad a partir de 60 años. La investigación hace parte de un proyecto más amplio que abarca investigaciones similares en todas las otras fajas etarias (inferiores a 60 años). Ella enseña que la mayor procura por el tratamiento ocurre entre las mujeres, y que el principal motivo de procura por el tratamiento está relacionado a la tristeza/pesimismo. Revela un número expresivo de medicación psicotrópica entre los ancianos pesquisados, incluso con la utilización de más de un psicofármaco para una misma persona, lo que refuerza los estudios que apuntan el aumento de la medicación psicofarmacológica en la sociedad.(AU)

The present article seeks to ascertain the relation between psychopharmacos and psychotherapy processes in elderly people assisted at service-oriented schools, from 1997 to 2011, in Vale do Rio Pardo (RS). It is a documentary research based around the description of 73 dossiers from users aged 60 or above. The survey is part of a broader project which includes similar researches around other age based groups (below 60 years). Research shows that treatments are sought mostly by women and the main reason is related to sadness/pessimism symptoms. In addition to that, it reveals that a great number of psychotropic medications are being used by the interviewed senior citizens, and some of them are taking more than one at a time, a fact which reinforces studies pointing to the ever-increasing use of psychopharmacos in present society. .(AU)

PSICOFÁRMACOS E PSICOTERAPIA COM IDOSOS / PSICOFÁRMACOS E PSICOTERAPIA CON ANCIANOS / PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY WITH ELDERLY PEOPLE

O presente artigo se propõe a averiguar a relação entre o uso de psicofármacos e o processo psicoterápico de idosos atendidos em um serviço-escola no Vale do Rio Pardo/RS, durante o período de 1997 a 2011. Trata-se de uma pesquisa documental, baseada em uma abordagem descritiva, desenvolvida a partir da análise de 73 prontuários dos usuários com idade a partir de 60 anos. A pesquisa faz parte de um projeto mais amplo que abrange pesquisas similares em todas as outras faixas etárias (inferiores a 60 anos). Ela mostra que a maior procura pelo tratamento se dá entre as mulheres, e que o principal motivo de procura pelo tratamento está relacionado à tristeza/pessimismo. Revela um número expressivo de medicação psicotrópica entre os idosos pesquisados, inclusive com a utilização de mais de um psicofármaco para uma mesma pessoa, o que reforça os estudos que apontam o aumento da medicação psicofarmacológica na sociedade...

El presente artículo se propone a averiguar la relación entre el uso de psicofármacos y el proceso psicoterápico de ancianos atendidos en un servicio-escuela en el Valle del Río Pardo/RS, durante el periodo de 1997 a 2011. Se trata de una investigación documental, basada en un abordaje descriptivo, desarrollado a partir del análisis de 73 prontuarios de los usuarios con edad a partir de 60 años. La investigación hace parte de un proyecto más amplio que abarca investigaciones similares en todas las otras fajas etarias (inferiores a 60 años). Ella enseña que la mayor procura por el tratamiento ocurre entre las mujeres, y que el principal motivo de procura por el tratamiento está relacionado a la tristeza/pesimismo. Revela un número expresivo de medicación psicotrópica entre los ancianos pesquisados, incluso con la utilización de más de un psicofármaco para una misma persona, lo que refuerza los estudios que apuntan el aumento de la medicación psicofarmacológica en la sociedad...

The present article seeks to ascertain the relation between psychopharmacos and psychotherapy processes in elderly people assisted at service-oriented schools, from 1997 to 2011, in Vale do Rio Pardo (RS). It is a documentary research based around the description of 73 dossiers from users aged 60 or above. The survey is part of a broader project which includes similar researches around other age based groups (below 60 years). Research shows that treatments are sought mostly by women and the main reason is related to sadness/pessimism symptoms. In addition to that, it reveals that a great number of psychotropic medications are being used by the interviewed senior citizens, and some of them are taking more than one at a time, a fact which reinforces studies pointing to the ever-increasing use of psychopharmacos in present society...

Medicalization, wish-fulfilling medicine, and disease mongering: Toward a brave new world? / Medicalización, medicina del deseo e invención de enfermedades: ¿hacia un mundo feliz?

Western societies are characterized by a growing medicalization of life events, such as pregnancy, aging, or even death. Three concepts -medicalization, wish-fulfilling medicine, and disease mongering- are key in understanding the current practise of Medicine. Quite surprisingly, not a single study has addressed the relationship between all three of these concepts. The term medicalization expanded under the open-ended concept of health developed by the World Health Organization in 1946. One of the consequences of medicalization is the transition from patients to clients. Physicians are under increasing pressure to meet the insatiable demands of their clients. The term wish-fulfilling medicine refers to the increasing tendency of medicine to be used to fulfill personal wishes (i.e. enhanced work performance). The insatiable demand for healthcare is troublesome, particularly in Europe, where the welfare states are more and more under pressure. Finally, the term disease mongering refers to attempts by pharmaceutical companies to artificially enlarge their "markets" by convincing people that they suffer from some sickness and thus need medical treatment. Typical examples of disease mongering are social anxiety disorder, low bone mineral density, and premature ejaculation. Currently, some Public Health Services could be on the brink of collapse as they "navigate" between the scarce resources available and the users’ insatiable health demands. Therefore, it appears necessary to generate clear-cut Public Health Services Port-folios (AU)

Las sociedades occidentales se caracterizan por una creciente medicalización de la vida cotidiana (p. ej., embarazo, envejecimiento y muerte). Tres conceptos-medicalización, medicina del deseo e invención de enfermedades- son fundamentales para entender la práctica actual de la Medicina. Resulta sorprendente que la relación entre los 3 términos apenas haya recibido atención en la comunidad científica. El término medicalización se expandió bajo el paraguas del concepto de salud ilimitado desarrollado por la Organización Mundial de la Salud en 1946. Una de las consecuencias de la medicalización es la transición de pacientes hacia clientes. Los médicos están cada vez bajo una mayor presión por parte de las insaciables demandas de salud de sus clientes. El término medicina del deseo hace referencia precisamente a la tendencia creciente a usar la Medicina para satisfacer los deseos personales (p. ej. aumento del rendimiento laboral). Esta insaciable demanda de salud es problemática, particularmente en Europa, donde los Sistemas de Salud Públicos están bajo una presión creciente. Finalmente, el término «invención de enfermedades» se refiere a los intentos de la industria farmacéutica para aumentar de manera artificial sus «mercados» al convencer a la gente (clientes) que sufren una enfermedad (previamente inexistente), para la cual necesitan un tratamiento. Algunos ejemplos de este último término son la fobia social o la eyaculación precoz. En la actualidad, algunos Servicios Públicos de Salud podrían estar cerca del colapso económico derivado de unos recursos cada vez más escasos y una demanda (deseos) de salud cada vez más insaciable. Por lo tanto, parece necesaria la creación de carteras de salud claramente definidas en aquellos países con Sistemas de Salud Públicos (AU)