[Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic.] / La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19.

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. METODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud.

[Machines and artisanal health workers]. / Máquinas y arte-sanos.

This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.

Finger Pricks and Blood Vials: How doctors medicalize 'cultural' solutions to demedicalize the 'broken' hymen in the Netherlands.

This paper provides new perspectives on the scholarship on medicalization and demedicalization, building on an ethnography of hymenoplasty consultations in the Netherlands. By examining how doctors can play an active role in demedicalization, this paper presents novel insights into Dutch physicians' attempt to demedicalize the "broken" hymen. In their consultations, Dutch doctors persuade hymenoplasty patients to abandon the assumed medical definition of the "broken" hymen and offer nonmedical solutions to patients' problems. Drawing from unique ethnographical access from 2012 to 2015 to 70 hymenoplasty consultations in the Netherlands, this paper's original contribution comes from closely examining how demedicalization can be achieved through the process of medicalization. It investigates how Dutch physicians go even further in their efforts to demedicalize by medicalizing "cultural" solutions as an alternative course of action to surgery.