Medwave最新文献

{"title":"Deskilled or upskilled? A personal reckoning with artificial intelligence.","authors":"Vivienne C Bachelet","doi":"10.5867/medwave.2026.08.3259","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.3259","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 9","pages":"e3271"},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary insurance and free-choice modality expenditure in Chile's public insurer Fonasa: Moral hazard or selection bias?","authors":"Matías Goyenechea, Alberto Aylwin","doi":"10.5867/medwave.2026.09.3242","DOIUrl":"https://doi.org/10.5867/medwave.2026.09.3242","url":null,"abstract":"<p><strong>Introduction: </strong>The Isapre system crisis, enrollee migration to the public insurer, and the expansion of complementary insurance have reshaped spending incentives in Fonasa's free-choice modality. Whether the higher spending of insured beneficiaries reflects moral hazard or selection bias is unclear.</p><p><strong>Objectives: </strong>To estimate, from the public payer's perspective, the additional free-choice-modality spending attributable to holding complementary insurance, and to decompose it into selection bias and moral hazard, between 2022 and 2025.</p><p><strong>Methods: </strong>Analytical observational study on individual-level administrative microdata (January 2022 to May 2025). Insurance was identified through its effective use. A counterfactual was built using nearest-neighbour (k = 1, without replacement) on observable covariates, and the classification error was corrected with a non-linear household-size decay model. The outcome was the percentage difference in FAM free-choice-modality spending per beneficiary, in inflation-indexed units.</p><p><strong>Results: </strong>The crude per-capita spending gap was 57.6% higher among the insured; it fell to 44.2% after matching and converged to an average treatment effect on the treated of 30.2% (95% CI: 28.2 to 32.2%) after correcting the classification error, with annual estimates ranging from 28.8% to 31.3%.</p><p><strong>Conclusions: </strong>The higher spending associated with complementary insurance reflects both risk selection and moral hazard; at least 13 percentage points are attributable to differences in the composition of the population purchasing complementary insurance. Complementary insurance is associated with an increase of approximately 30% in spending under the Free Choice Modality, after controlling for observable and classification biases.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 9","pages":"e3242"},"PeriodicalIF":0.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"II International Congress PROSALUD-UCSC \"Health Promotion: Innovation and Sustainability for a Healthy Present and Future\"","authors":"","doi":"10.5867/medwave.2026.S2","DOIUrl":"10.5867/medwave.2026.S2","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 S2","pages":"PROSAL01-PROSAL39"},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring what we cannot interpret: Vitamin D thresholds in the Chilean population.","authors":"Vivienne C Bachelet","doi":"10.5867/medwave.2026.08.3259","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.3259","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 8","pages":"e3259"},"PeriodicalIF":0.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-COVID symptoms prevalence, latent class pattern, and functional impact: A population-based cross-sectional study in two Chilean cities, 2024.","authors":"Paola Rubilar, Mauricio Apablaza, Muriel Ramírez-Santana, Lina J Cortés, Loreto Nuñez-Franz","doi":"10.5867/medwave.2026.08.3234","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.3234","url":null,"abstract":"<p><strong>Introduction: </strong>Post-COVID-19 condition affects approximately 6% of individuals globally. Most evidence is based on hospitalized patients and is from countries with relatively low vaccination coverage. This study estimates the prevalence of symptoms compatible with post-COVID-19 and explores symptom patterns in a population-based sample from Chile, a country with high vaccination coverage. Moreover, it examines their associations with daily activities and demographic, social, and clinical factors.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in May 2024 in two Chilean Cities, involving 654 participants (88.5% response rate) aged ≥ seven years, from randomly selected households. Ten post-COVID-19 symptoms that persisted for ≥ three months were collected. Latent class analysis identified symptom patterns.</p><p><strong>Results: </strong>Among 277 participants with a confirmed COVID-19 diagnosis, 114 reported at least one symptom lasting ≥ 3 months. Population-weighted prevalence of at least one post-COVID-19 symptom was 17.4% in the general population and 40.7% among individuals with prior COVID-19. Among those with post-COVID-19 symptoms, 40.1% reported a reduction in daily activities. Three classes were explored: class 1 (38.4%) characterized by fatigue, ageusia/anosmia, and muscular/joint pain; class 2 (40.7%) with predominant cardiorespiratory symptoms; and class 3 (20.9%) with multisystemic symptoms. Class three was associated with a higher frequency of comorbidities (particularly diabetes), hospitalization, multiple COVID-19 episodes, and Aboriginal affiliation. Classes 2 and 3 were independently associated with younger age and diabetes, class 2 was additionally associated with lower educational attainment and lower BMI, while class 3 was additionally associated with Aboriginal affiliation.</p><p><strong>Conclusions: </strong>This population-based study reveals a substantial burden of at least one post-COVID-19 symptom, with distinct symptom classes highlighting the need for tailored interventions. These findings underscore the importance of targeted public health policies and personalized clinical approaches, particularly for severe symptom classes that impact quality of life and contribute critical data from Latin America to the global understanding of post-COVID-19 condition.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 8","pages":"e3234"},"PeriodicalIF":0.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Factors associated with maternal mortality in Ica, Peru: A matched case-control study.","authors":"Editors Medwave","doi":"10.5867/medwave.2026.08.8709","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.8709","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 8","pages":"e8709"},"PeriodicalIF":0.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The FINDRISC Questionnaire and Its Diagnostic Accuracy in the Totonac Indigenous Population.","authors":"Stéfany Sunción Roque","doi":"10.5867/medwave.2026.08.3260","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.3260","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 8","pages":"e3260"},"PeriodicalIF":0.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of clean intermittent catheterization on quality of life and resource utilization in patients with spinal cord injury and urological complications: A narrative review.","authors":"Rony Lenz-Alcayaga, Sebastián Lenz-Ortiz","doi":"10.5867/medwave.2026.08.3240","DOIUrl":"https://doi.org/10.5867/medwave.2026.08.3240","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize the international evidence on the impact of clean intermittent catheterization on quality of life and resource utilization in patients with spinal cord injury and urological complications, to support a review of policies that shift the financial burden of catheterization to families in Chile.</p><p><strong>Methods: </strong>A narrative review based on the MEDLINE/PubMed database and gray literature published between 2014 and 2025, in Spanish and English. The research question was structured using the population, concept, and context framework. Two search algorithms were applied, combining MeSH terms, free-text keywords, and Boolean operators. Screening was conducted in three successive stages (title, abstract, and full text), with a second reviewer resolving any uncertainties by consensus.</p><p><strong>Results: </strong>After screening 880 references, 65 studies met the inclusion criteria. Findings were organized into five dimensions: patient quality of life, caregiver quality of life, urinary tract infections, resource use, and emerging care models. Based on this evidence, an archetype of the chronic catheter user was developed: a man aged between 25 and 45 with a traumatic spinal cord injury, who uses a wheelchair in more than 67% of cases, spends more than 53 minutes a day on catheterization, has a prevalence of urinary tract infection exceeding 50% (two-thirds of which are antimicrobial resistant), and reports a 36% dissatisfaction with his urinary quality of life. Furthermore, he reuses catheters primarily for economic reasons; 90% of patients who used reusable catheters preferred switching to single-use catheters, and 84% reported greater satisfaction. Multiple cost-effectiveness analyses show that hydrophilic single-use catheters are cost-effective or dominant strategies in high-income settings. Caregivers -mostly mothers or partners- report insufficient training, social restriction, and work-related difficulties that the healthcare system fails to address.</p><p><strong>Conclusions: </strong>Access to appropriate catheterization supplies, combined with structured patient and caregiver education and continuity of care, improves quality of life, reduces urinary complications, and is cost-effective. Chile's current policy of shifting the financial burden of catheterization to families is inconsistent with the available international evidence.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 8","pages":"e3240"},"PeriodicalIF":0.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gap in child and adolescent psychiatrists in Chile's public health network: estimate of service supply and requirements for 2025.","authors":"María José Calletti Godoy, Cristian Rebolledo Díaz","doi":"10.5867/medwave.2026.07.3223","DOIUrl":"https://doi.org/10.5867/medwave.2026.07.3223","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 7","pages":"e3223"},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of genomic bioinformatic tools in clinical psychiatry and counseling.","authors":"Angela Muñoz, Trinidad Kahler, M Leonor Bustamante, Camila Vargas, Fernanda Vargas, Marcelo Arancibia","doi":"10.5867/medwave.2026.07.3225","DOIUrl":"10.5867/medwave.2026.07.3225","url":null,"abstract":"<p><p>Genomic medicine has introduced transformative tools for psychiatric practice, facilitating the diagnosis of complex cases through the identification of genetic variants. The gene encodes a key component of the histone methyltransferase complex. Mutations in this gene have been linked to neurodevelopmental disorders and schizophrenia, particularly in cases with early onset and cognitive impairment. The aim of this article is to describe the application of genomic tools and international criteria for interpreting genetic pathogenicity in psychiatric clinical practice, using as a model. Based on an illustrative clinical case of a 13-year-old patient with psychotic symptoms, we conducted a comparative analysis of two single-nucleotide variants in (c.2209C>A and c.2209C>T). Genomic databases (Ensembl, ClinVar, gnomAD) and prediction tools (PolyPhen-2, MutationTaster, Align-GVGD) were used, following the American College of Medical Genetics and Genomics guidelines. The c.2209C>T (nonsense) variant was classified as pathogenic due to its truncating effect and prior reports. In contrast, the c.2209C>A (missense) variant, initially of uncertain significance, was reclassified as likely benign after a familial segregation study showed the variant was inherited from an unaffected parent. The integration of genomic tools allows for a precise approach to neuropsychiatric phenotypes. However, bioinformatic analysis must be complemented by clinical correlation and cosegregation studies. Finally, genetic counseling is emphasized as an essential process to integrate technical findings with the psychological and educational needs of the patient and their family.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 7","pages":"e3225"},"PeriodicalIF":0.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}