The (commercialised) experience of operating: Embodied preferences, ambiguous variations and explaining widespread patient harm.

This article provides a detailed account of how surgeons perceived and used a device-procedure that caused widespread patient harm: transvaginal mesh for the treatment of pelvic floor disorders in women. Drawing from interviews with 27 surgeons in Canada, the UK, the United States and France and observations of major international medical conferences in North America and Europe between 2015 and 2018, we describe the commercially driven array of operative variations in the use of transvaginal mesh and show that surgeons' understanding of their hands-on, sensory experience with these variations is central to explaining patient harm. Surgeons often developed preferences for how to manage actual and anticipated dangers of transvaginal mesh procedures through embodied operative adjustments, but collectively the meaning of these preferences was fragmented, contested and deferred. We critically reflect on surgeons' understandings of their operative experience, including the view that such experience is not evidence. The harm in this case poses a challenge to some ways of thinking about uncertainty and errors in medical sociology, and calls for attention to a specific feature of surgical work: the extent and persistence of operative practices that elude classification as right or wrong but are still most certainly better and worse.

Safety of high efficacy therapies in older people with Multiple Sclerosis: A real-world evidence study.

INTRODUCTION: the increase of older adults living with Multiple Sclerosis (MS) is associated with higher use of high efficacy therapies (HETs) in a clinical practice. The are no data regarding the safety of HET in this patient group. OBJECTIVE: to analyze the safety of HETs in older people with MS (pwMS) in a real-life cohort. METHODS: retrospective cohort study including pwMS under HETs (cladribine and monoclonal antibodies) treated in two specialized MS centers in Latin America. We compare: pwMS ≥ 50 years old (G1) and < 50 years old (G2). In all pwMS, presence and type of adverse events, and comorbidities were recorded. RESULTS: 882 pwMS were included, 141 (15.9 %) had ≥50 years old, 47 (33.3 %) werunde HETs (G1). The most used DMT in G1 was ocrelizumab (48.9 %), mean time under HETs: 2.06 ± 0.8 years. The most frequent adverse event in G1 was urinary tract infection (UTI) (21.3 %). We did not find significant differences between G1 and G2 in infusion reactions, lymphopenia, neoplasms, respiratory infections, and liver disease. We found differences in the frequency of urinary tract infections (p = 0.004). No cases of VZV reactivation, tuberculosis or progressive multifocal leukoencephalopathy were registered. In a regression model adjusted for MS evolution, time under HET, EDSS, Charlson comorbidity index and phenotype, patients 50 ≥ under HETs did not have a higher incidence of adverse events compared to < 50 (Adjusted OR 0.72; CI95 % 0.143 -3.43, p = 0.67)} CONCLUSION: the short term use of HETs in pwMS older than 50 years old seems to be safe.

From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh.

Beginning in the late 1990s, surgeons around the world widely adopted the transvaginal placement of permanent synthetic mesh for the treatment of several common pelvic floor disorders in women. By 2012 it had become the subject of extensive litigation, including one of the biggest mass-tort cases in U.S. history, with litigants reporting debilitating and unexpected complications. Based on qualitative research that includes interviews with surgeons, observations of medical conferences, and analysis of archival materials, we argue the adoption of transvaginal mesh cannot be fully explained without recognizing the role of mindlines, or collective moral-epistemological ways of knowing and acting responsibly. The adoption of mesh was anchored in a mindline focused on repairing anatomy. The harms that resulted from transvaginal mesh necessitated a shift to a focus on patient experience. We analyze the role of evidence-based medicine (EBM) in the re-organization of these surgeons' mindlines, showing that mindlines are not reducible to evidence as defined by EBM and that evidence thus defined facilitated the adoption of transvaginal mesh.

[The production of the fetus as a "subject of rights": qualitative analysis of medical-Catholic discourses in Chile]. / La producción del feto como "sujeto de derechos": análisis cualitativo de los discursos médico-católicos en Chile.

This article presents the results of a study aimed at identifying and analyzing the discursive construction of the fetus as a subject of rights on the part of medical-religious institutions in the discussion of the decriminalization of abortion due to three causes in Chile during the 2013-2016 period. To this end, a triangulation was carried out based on an analysis of thematic content and an analysis of certain discursive strategies from the critical discourse analysis perspective using a textual corpus composed of 16 documents. Four analytical themes were identified: factual construction, female pastoral power, biopolitical management of the female body, and intervention technologies. It is concluded that the medical-religious discourse uses a series of rhetorical strategies and mobilizes meanings with respect to the fetus based on the hybridization of rhetorical strategies such as resources of factualization, connotation, metaphor and others that validate metaphysical beliefs about the body and the subjectivity of women and allow for an authoritative and irrefutable voice. Thus, the biopolitical management of women's reproductive capacities constitutes a filter that obstructs the possibility of incorporating discussions and ethical positions linked to citizenship and the social contract.

Se presentan los resultados de una investigación dirigida a identificar y analizar la construcción discursiva del feto como sujeto de derecho por parte de las instituciones médico-religiosas en la discusión sobre la despenalización del aborto en tres causales en Chile, durante el período 2013-2016. Para ello se realizó una triangulación entre un análisis de contenido temático y el análisis de algunas estrategias discursivas propias de la perspectiva del análisis crítico del discurso sobre un corpus textual compuesto por 16 documentos. Se identificaron cuatro ejes de análisis: construcción de hechos, pastoral femenina, gestión biopolítica del cuerpo femenino y tecnologías de intervención. Se concluye que el discurso médico-religioso utiliza una serie de estrategias retóricas y moviliza significados respecto del feto a partir de la hibridación de estrategias retóricas como recursos de factualización, connotación, metáforas y otros que validan creencias metafísicas sobre el cuerpo y la subjetividad de las mujeres y que le permiten hablar con una voz autorizada e irrebatible. Así, la gestión biopolítica de las capacidades reproductivas de las mujeres es una grilla que obtura la posibilidad de incorporar discusiones y posicionamientos éticos vinculados a la ciudadanía y el contrato social.

Narrativas de mujeres sobre la maternidad en un contexto de intervención sociosanitaria en la infancia temprana del Chile actual / Narratives of women about motherhood in a context of socio-health intervention in early childhood in Chile today

Resumen Se presentan los resultados de un estudio dirigido a conocer las narrativas sobre la maternidad y el entramado de sentidos atribuidos a las prestaciones de un sistema estatal de atención en salud infantil, en un grupo de usuarias en la ciudad de Santiago de Chile. Por medio de una estrategia cualitativa-narrativa, se exponen tres narrativas sobre la maternidad en el contexto de intervención: conversión, emprendedora y ambivalente. Se concluye que el dispositivo de atención es un referente central en la experiencia de la maternidad en tanto ofrece significados sobre una maternidad ideal y guiada por expertos. Apreciamos que los objetos para la crianza que el sistema proporciona juegan un rol importante para la construcción de los significados en torno a la propia maternidad y a las prestaciones estatales. La multiplicidad de posicionamientos que estas narrativas ofrecen muestra las formas en que las mujeres se autoproducen como madres, pero además las identificaciones con los discursos del sistema, las resistencias, confrontaciones y cuestionamientos, especialmente en el ámbito de la promoción de la lactancia materna.

Abstract The results of a study aimed at knowing the narratives about motherhood and the network of meanings attributed to the benefits of a state system of child health care, in a group of users in the city of Santiago, Chile, are presented. Through a qualitative-narrative strategy, three narratives about motherhood are presented in the context of intervention: conversion, entrepreneurial and ambivalent. It is concluded that the care device is a central reference in the experience of motherhood as it offers meanings about ideal motherhood and guided by experts. We appreciate that the objects for the upbringing that the system provides, play an important role for the construction of the meanings around the maternity itself and the state benefits. The multiplicity of positions that these narratives offer show the ways in which women self-produce as mothers but also the identifications, resistance, confrontations and questions in key areas for the system itself, such as the promotion of breastfeeding.

Sujetos cerebrales: repertorios interpretativos de los usos de la neurociencia en las políticas públicas de infancia temprana en el Chile actual / Brain Subjects: Interpretative repertoires of the uses neuroscience in early childhood policies in current Chile / Sujeitos cerebrais: repertorios interpretativos dos usos da neurociência nas políticas pública da infância no Chile atual

Resumen: Se presentan algunos resultados de una investigación más amplia, dirigida a conocer los discursos de la infancia y su cuidado de un dispositivo de intervención de la infancia temprana en Chile. Utilizando el recurso del análisis de repertorios interpretativos (Potter y Wetherell, 1987; Wetherell y Potter 1996) se analizó un corpus textual conformado por 12 documentos institucionales. De los múltiples repertorios identificados, aquí presentamos aquellos que nos permitieron captar de forma singular las relaciones entre neurociencias, política pública e infancia: el cerebro como actor social; el riesgo como alteración; y la intervención como optimización. Concluimos, que estos repertorios colaboran a la conformación de representaciones de la infancia altamente biologizadas y fuertemente vinculadas a modelos de capital humano y representaciones tradicionales del género y la maternidad. Si bien los hallazgos de la neurociencia se plantean como promesa para superar la desigualdad social, se trataría más bien de un optimismo cruel (Edwards, Gillies y Horsley, 2015) que ocultaría las profundas desigualdades de género y sociales en nuestro país y el posicionamiento de las madres pobres como responsables de los riesgos, así como del desarrollo cerebral de sus hijos.

Abstract: Some results of a broader investigation are presented, aimed at knowing the speeches of childhood and their care of an intervention device of early childhood in Chile. Using the resource of interpretive repertoire analysis (Potter and Wetherell, 1987, Wetherell and Potter, 1996), a textual corpus consisting of 12 institutional documents was analyzed. From the multiple repertories identified, we present those that allow us to capture in a singular way the relationships between neurosciences, public policy and childhood: the brain as a social actor; the risk as alteration; and the intervention as optimization. We conclude that these repertoires collaborate in the conformation of representations of childhood that are highly biologized and strongly linked to models of human capital and traditional representations of gender and motherhood. Although the findings of neuroscience are seen as a promise to overcome social inequality, it would be rather a cruel optimism (Edwards et al., 2015) that would hide the deep gender and social inequalities in our country and the positioning of poor mothers as responsible for the risks, as well as the brain development of their children.

Resumo: São apresentados alguns resultados de uma investigação mais ampla, dirigida a conhecer os discursos da infância e seu cuidado de um dispositivo de intervencao da primeira infancia temprana no Chile. Utilizando o análise de recursos de repertórios interpretativos (Potter e Wetherer, 1987) analisou-se se um corpus textual composto de 12 documentos institucionais. Dos vários repertórios identificados, apresentamos aqueles que nos permitem captar de forma singular as relações entre neurociências, políticas públicas e infancia: o cérebro como ator social; o risco como alteração; e a intervenção como otimização. Concluímos que esses repertórios colaboram com as representações da infância altamente biologizadas e fortemente ligadas aos modelos de capital humano e representações tradicionais do gênero e maternidade. Enquanto as descobertas da neurociência surgem como uma promessa para superar a desigualdade social, mais bem tratar-se-ia de um cruel otimismo (Edwards et al., 2015) que ocultaría as profundas desigualdades de gênero e sociais em nosso país, e o posicionamento das mães pobres como responsáveis pelos riscos, bem como o desenvolvimento cerebral de seus filhos.

La producción del feto como "sujeto de derechos": análisis cualitativo de los discursos médico-católicos en Chile / The production of the fetus as a "subject of rights": qualitative analysis of medical-Catholic discourses in Chile

RESUMEN Se presentan los resultados de una investigación dirigida a identificar y analizar la construcción discursiva del feto como sujeto de derecho por parte de las instituciones médico-religiosas en la discusión sobre la despenalización del aborto en tres causales en Chile, durante el período 2013-2016. Para ello se realizó una triangulación entre un análisis de contenido temático y el análisis de algunas estrategias discursivas propias de la perspectiva del análisis crítico del discurso sobre un corpus textual compuesto por 16 documentos. Se identificaron cuatro ejes de análisis: construcción de hechos, pastoral femenina, gestión biopolítica del cuerpo femenino y tecnologías de intervención. Se concluye que el discurso médico-religioso utiliza una serie de estrategias retóricas y moviliza significados respecto del feto a partir de la hibridación de estrategias retóricas como recursos de factualización, connotación, metáforas y otros que validan creencias metafísicas sobre el cuerpo y la subjetividad de las mujeres y que le permiten hablar con una voz autorizada e irrebatible. Así, la gestión biopolítica de las capacidades reproductivas de las mujeres es una grilla que obtura la posibilidad de incorporar discusiones y posicionamientos éticos vinculados a la ciudadanía y el contrato social.

ABSTRACT This article presents the results of a study aimed at identifying and analyzing the discursive construction of the fetus as a subject of rights on the part of medical-religious institutions in the discussion of the decriminalization of abortion due to three causes in Chile during the 2013-2016 period. To this end, a triangulation was carried out based on an analysis of thematic content and an analysis of certain discursive strategies from the critical discourse analysis perspective using a textual corpus composed of 16 documents. Four analytical themes were identified: factual construction, female pastoral power, biopolitical management of the female body, and intervention technologies. It is concluded that the medical-religious discourse uses a series of rhetorical strategies and mobilizes meanings with respect to the fetus based on the hybridization of rhetorical strategies such as resources of factualization, connotation, metaphor and others that validate metaphysical beliefs about the body and the subjectivity of women and allow for an authoritative and irrefutable voice. Thus, the biopolitical management of women's reproductive capacities constitutes a filter that obstructs the possibility of incorporating discussions and ethical positions linked to citizenship and the social contract.

De madres y expertos: la psicología de posguerra y el disciplinamiento de los cuidados maternos / Of mothers and experts: the psichology of pos war period and the disciplining of maternal care

El artículo reflexiona acerca de la construcción discursiva de los cuidados maternos en la psicología. Se discute la emergencia de estos saberes y su relación con las transformaciones políticas y económicas ocurridas durante el periodo de posguerra y el inicio de la guerra fría. La hipótesis general que guía la reflexión desde una perspectiva foucaultina, señala que los cuidados son prácticas individuales y espontáneas de las madres, más que efectos de relaciones de poder/saber históricamente situadas , siendo tales cuidados una práctica social través de la cual, la Psicología se erigió como ciencia y dispositivo de la normalidad y la subjetividad.

The article reflects on the discursive construction of maternal care in Psychology: We discuss the emergence of this knowledge and its connections to the political and economic transformations occurred during the postwar period and the beginning of the Cold War. From a Foucauldian perspective, the general hypothesis guiding this reflection states that motherly care practices, rather than having an individual and spontaneous character, represent a product of power relationships and knowledge relationships both historically situated and a social practice trough which, Psychology emerged as science and device of normality and subjectivity.

Perfil psicosocial de la población usuaria del Programa de Atención y Prevención de Violencia Intrafamiliar durante el Año 2006 en Lo Espejo, Región Metropolitana de Santiago, Chile / Psychosocial profile of Family Violence Attention and Prevention Program users during year 2006 in Lo Espejo, Region Metropolitana de Santiago, Chile

Se presentan los resultados de un estudio descriptivo cuyo objetivo fue el levantamiento de un perfil psicosocial y problemáticas asociadas de las usuarias atendidas por el programa municipal de Atención y Prevención de la Violencia Intrafamiliar (VIF) de la comuna de Lo Espejo, durante el año 2006. Como resultado se destaca que la mayoría de las personas que viven VIF y acceden al programa, corresponden a mujeres victimas de violencia física (que en un porcentaje importante se acompaña de uso de armas), jóvenes, dueñas de casa cuyo nivel de escolaridad no alcanza primer ciclo de la enseñanza media. Se concluye que el deterioro e impacto que genera la VIF en la salud mental así como en la calidad de vida de la población requiere de una intervención específica multidimensional e interdisciplinaria y que sea capaz de superar las fronteras entre intervención social e intervención clínica.

Experiencia en atención de salud integral y prevención en salud mental pediátrica: aplicación del modelo de atención de salud amigable / Integrated health care and prevention in pediatric mental health experience: application of friendly health care attention model

El siguiente artículo presenta la experiencia del Hospital Dr. Luis Calvo Mackenna en la implementación del “Modelo de Atención de Salud Amigable para Niños”. Esta nueva forma de atención propone que se debe satisfacer las necesidades individuales tanto del niño como de su familia, procurando reducir el miedo, la ansiedad y el sufrimiento que se produce debido a la atención de salud recibida. Para ello se realizó un estudio diagnóstico de tres de doce estándares de atención basados en los derechos del niño, a través de una metodología de evaluación y mejoramiento continuo, que permite monitorear sistemáticamente los avances de la instalación de prácticas amigables. Esta experiencia piloto se está desarrollando con el esfuerzo colectivo de un equipo de trabajadores sociales y psicólogos, cuyo desafío es promover la humanización de la atención de salud, objetivo considerado estratégico por nuestra organización.

The following article presents the experience of Dr. Luis Calvo Mackenna Hospital in the implementation of the "Child Friendly Healthcare Initiative Model". The model developed by Child Advocacy International (CAI), in collaboration with UNICEF, WHO, and the Royal Colleges of Pediatrics and Nursing of the United Kingdom, proposes that the pediatric health care must satisfy the individual needs of the child and his/her family assuming the responsibility of reducing the fear, the anxiety and the unnecessary suffering that takes place during and due to the health care. It proposes 12 standards based on the rights of the child and a methodology of evaluation and constant improvement, allowing a systematic progress monitoring of the installation of friendly practices. This pilot experience is developed with the collective effort of a team of social workers and psychologist of the hospital, which challenge is to promote the humanization of the Health Care.