[Experience of a research Ethics Committee and the challenges of the new Chilean legislation on research in human beings]. / Experiencia del Comité de Ética de Investigación en Seres Humanos de la Facultad de Medicina de la Universidad de Chile y los desafíos que impone la nueva legislación chilena en la investigación médica.

The welfare of research participants must be guaranteed by international ethical standards. This article communicates the procedures of the Research Ethics Committee of the School of Medicine, University of Chile (CEISH). The new Chilean legislation on research in human beings is also discussed. Law 20.120: "On scientific research in human beings, its genome and forbidding human cloning" establishes the ethical principles that must be accomplished in every research involving human beings. Article 28 of the Law 20.584 "Regulation of the rights and duties of health care users", forbids the participation of handicapped people who cannot express their will in scientific research. Article 13 states that people not related directly with patient care cannot have access to his clinical records (with the exception of people with notarial authorization by the patient). CEISH proposes that, in case of people with intellectual deficiency, the decision to approve a scientific research should be analyzed on an individual basis. If the person is capable of expressing his or her will or has stated his or her consent beforehand, the research can be authorized. If the person cannot express his or her will, the scientific research cannot take place. In prospective studies, a consent from the patient and an authorization of the health authority should be required to access clinical records. In retrospective studies, consent should be obtained from the patient when personal information is going to be used. If the information is nameless, the consent can be disregarded.

[Characteristics of employment and wellbeing among physicians working in Santiago, Chile]. / Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana.

BACKGROUND: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. AIM: To describe the characteristics of employment in a representative sample of Chilean physicians. MATERIAL AND METHODS: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. RESULTS: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. CONCLUSIONS: The number of jobs is inversely related to the general wellbeing of physicians.

[A survey about physicians’ professional satisfaction]. / Percepción de cambios en la práctica médica y estrategias de afrontamiento.

BACKGROUND: A change in the social structure of medicine and its impact on clients has occurred in the last decades. AIM: To perform a survey about subjective wellbeing among physicians. MATERIAL AND METHODS: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70% males), working in Metropolitan Santiago. RESULTS: Physicians perceive changes in all the examined professional domains and approximately 50% of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. CONCLUSIONS: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.

[Generation and validation of a scale to measure physicians' wellbeing]. / Validación de una escala para medir el bienestar subjetivo de los médicos (BISUMED).

BACKGROUND: the recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. AIM: to study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. MATERIAL AND METHODS: a scale, consisting of 54 items grouped in nine dimensions to measure physicians’ subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). RESULTS: the internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. CONCLUSIONS: these results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.

Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana / Characteristics of employment and wellbeing among physicians working in Santiago, Chile

Background: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. Aim: To describe the characteristics of employment in a representative sample of Chilean physicians. Material and Methods: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. Results: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. Conclusions: The number of jobs is inversely related to the general wellbeing of physicians.

Appreciation of art in a workers' hospital in Chile.

To assess the impact of selected murals in the Workers' Hospital in Santiago on different groups of clients, a quantitative and qualitative approach, including a semantic differential scale, was applied. The sample was composed of 120 subjects-40 patients, 40 visitors and 40 hospital staff. Appreciation of the paintings (45-87%) and assessment of the benefit of each painting (56-84%) varied widely. Differences in perceptions according to age, gender and educational level were not significant. Over two-thirds of the sample had a positive appreciation of the murals and considered them beneficial. Differences in perception relate to personal characteristics of the subjects and are also associated with certain characteristics of the murals, such as location, or the structure and style of the work. This study, the first of its kind in Chile, provides grounds for the development of an art-for-health policy in the future, showing that most people are willing to participate by giving their opinions and assessments.

Percepción de cambios en la práctica médica y estrategias de afrontamiento / A survey about physicians’ professional satisfaction

Background: A change in the social structure of medicine and its impact on clients has occurred in the last decades. Aim: To perform a survey about subjective wellbeing among physicians. Material and Methods: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70 percent males), working in Metropolitan Santiago. Results: Physicians perceive changes in all the examined professional domains and approximately 50 percent of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. Conclusions: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians.

Validación de una escala para medir el bienestar subjetivo de los médicos (BISUMED) / Generation and validation of a scale to measure physicians' wellbeing

Background: The recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. Aim: To study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. Material and Methods: A scale, consisting of 54 items grouped in nine dimensions to measure physicians’ subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). Results: The internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. Conclusions: These results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.

[The change in medical practice. Psycho-social challenges for the profession]. / El cambio de la práctica médica. Desafíos psicosociales para la profesión.

This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physiciansfrom the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes.

[Why should we research in bioethics?]. / Por qué investigar en bioética?

This article reviews the conceptual evolution of bioethics, conditioned by cultural changes. The discipline could be strengthened with new analytical methodologies and with an empirical approach. The dangers of a purely descriptive bioethics, solely linked to practical experience are also discussed. This may cause the loss of the regulatory frame, that allows bioethics to enrich medical practice from a humane and moral viewpoint. Therefore, there is a need to find the balance between the theoretical analysis and an empirical approach, to face the growing complexity of contemporary ethical problems.

Países en desarrollo: trabajo integrado de cientistas sociales y profesionales / Developing countries: social scientist and health personal comprehesive work

Revisa algunas de las modalidades de trabajo colaborativo entre cientistas sociales y profesionales de la salud en los países en desarrollo, ilustrándolas con ejemplos de la realidad chilena. El propósito no ha sido una revisión exhaustiva del tema sino más bien comentar algunos de los problemas principales, con el fin de motivar el intercambio y la discusión al respecto, a partir de diferentes experiencias y realidades nacionales. El abordaje de los problemas de salud del presente y del futuro cercano requerirían de una nueva manera de organizar el trabajo integrado entre cientistas sociales y profesionales de salud