¿De qué está hecha la objeción? Relatos de objetores de conciencia a servicios de aborto legal en Argentina, Uruguay y Colombia / Do que é feita a objeção? Narrativas de objetores de consciência em serviços de aborto legal na Argentina, Uruguai e Colômbia / What is objection made of? Accounts of conscientious objectors to legal abortion services in Argentina, Uruguay and Colombia

Resumen Este artículo examina el fenómeno de la objeción de conciencia (OC) a los servicios de aborto legal en Argentina, Uruguay y Colombia. Basado en relatos obtenidos a través de entrevistas, el análisis toma distancia de aquellos enfocados en diferenciar entre OC y barreras al servicio, o en identificar si las razones de objeción son verdaderas o válidas. Partiendo del hecho de que en muy pocos casos las/los objetoras/es están al tanto de las definiciones legales de la OC, se busca entender los significados que las/los entrevistadas/os le atribuyeron, y desde los cuales organizan su práctica médica, y justifican su negación a prestar servicios de aborto. En los tres países las/los entrevistadas/os se oponían principalmente a que fueran las mujeres quienes tomaran la decisión de qué embarazos interrumpir, y cómo y cuándo hacerlo. Los discursos contingentes a través de los cuales las/os médicas/os construyen las racionalidades de su OC están hechos, sobre todo, de un incuestionado apego al control de los cuerpos con capacidad de gestar; y de entendidos médico-sociales de las mujeres como inexorablemente madres, máquinas de reproducción o soportes vitales de fetos.

Resumo Este artigo examina o fenômeno da objeção de consciência (OC) nos serviços de aborto legal na Argentina, Uruguai e Colômbia. Com base nas narrativas obtidas por meio de entrevistas, a análise se distancia daquelas focadas na diferenciação entre OC e barreiras ao serviço, ou na interrogação sobre a verdade ou validade das razões para a objeção. Partindo do fato de que, em poucos casos, os objetores conhecem as definições legais da OC, procura-se compreender os significados que as/os entrevistadas/os lhe atribuíram e a partir dos quais organizam a sua prática médica e justificam a sua recusa em prestar serviços de aborto. Em todos os três países, os/as entrevistados/as se opuseram principalmente a que as mulheres decidissem por si mesmas quais gravidezes interromper, como e quando o fazem. Os discursos contingentes através dos quais os/as médicos/as constroem as racionalidades da sua OC são feitos, sobretudo, através de um apego inquestionável ao controle dos corpos capazes de gestação; e de compreensões médico-sociais das mulheres como inexoravelmente mães, máquinas de reprodução ou suportes vitais dos fetos.

Abstract This article examines conscientious objection (CO) to legal abortion services in Argentina, Uruguay and Colombia. Based on interviews, the analysis offers an alternative from studies focusing on differentiating between CO and access barriers, or in identifying if the reasons for the objections are true or valid. Considering the fact that it is only in very few cases that the objectors knew the legal definition of CO, the article seeks to understand the meanings that the interviewees attribute to their objection, how they organize their medical practices and how they justify their denial to provide abortion services. In all three countries, the interviewees' main opposition was to women themselves making the decision to interrupt a pregnancy, and how and when to do it. The contingent and variable discourses through which the doctors construct the logic of their CO are made of an unquestioning attachment to controlling gestating bodies; and a default socio-medical understanding of women as mothers, reproductive machines or as fetal life support systems.

Subtipos neurocognitivos de esquizofrenia / Neurocognitive Subtypes of Schizophrenia

Objetivo. Identificar empíricamente subtipos neurocognitivos de esquizofrenia y establecer la asociación de estos con características clínicas. Métodos. Se aplicaron pruebas de atención sostenida, función ejecutiva, reconocimiento facial de emociones, memoria verbal y de trabajo a 253 sujetos con esquizofrenia. A partir de los resultados de estas pruebas se identificaron los subtipos mediante análisis de clases latentes. Posteriormente, se evaluó la asociación de cada subtipo con características clínicas. Resultados. Se identificaron cuatro subtipos: 1) déficit cognitivo global, 2) déficit de memoria y función ejecutiva, 3) déficit de memoria y reconocimiento de emociones y 4) sin déficit cognitivo. Al comparar con el subtipo sin déficit cognitivo, se observó que tanto el de déficit de memoria y función ejecutiva como el de déficit cognitivo global tenían mayor frecuencia individuos de sexo masculino, desempleados, con deterioro grave y adherentes al tratamiento. Sin embargo, en el subtipo con déficit cognitivo global la diferencia fue más alta y presentaron una frecuencia más baja de antecedentes de episodios depresivos (OR 0,39; IC95%: 0,16 a 0,97). El subtipo de déficit de memoria y reconocimiento emocional tenía más sujetos con deterioro grave (OR 5,52; IC95%: 1,89 a 16,14) y desempleo (OR 2,43; IC95%: 1,06 a 5,55), pero menos con antecedentes de episodios depresivos (OR 0,21; IC95%: 0,07 a 0,66). Conclusión. Los resultados muestran cuatro subtipos neurocognitivos de esquizofrenia con un posible espectro de severidad, asociándose en un extremo con mayor disfunción, y en el otro con mayor psicopatología afectiva y menor adherencia al tratamiento

Objective. To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. Methods. Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. Results. We identified four neurocognitive subtypes: 1) 'Global cognitive deficit', 2) 'Memory and executive function deficit', 3) 'Memory and facial emotion recognition deficit,' and 4) 'Without cognitive deficit.' In comparison with the subtype 'without cognitive deficit,' we found that the 'memory and executive function deficit subtype' and the 'global cognitive deficit subtype' had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the 'global cognitive deficit subtype' the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The 'memory and facial recognition deficit subtype' had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). Conclusion. Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction

Neurocognitive subtypes of schizophrenia.

OBJECTIVE: To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. METHODS: Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. RESULTS: We identified four neurocognitive subtypes: 1) “Global cognitive deficit”, 2) “Memory and executive function deficit”, 3) “Memory and facial emotion recognition deficit,” and 4) “Without cognitive deficit.” In comparison with the subtype “without cognitive deficit,” we found that the “memory and executive function deficit subtype” and the “global cognitive deficit subtype” had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the “global cognitive deficit subtype” the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The “memory and facial recognition deficit subtype” had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). CONCLUSION: Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction.

Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms.

OBJECTIVE: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. METHODS: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for "negative symptoms" and "disorganization" was performed afterwards. RESULTS: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. CONCLUSION: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia.

Memoria de trabajo verbal en individuos con esquizofrenia y sus familiares de primer grado: Relación con los sintomas negativos y desorganizados / Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms

Objetivo: Determinar si hay diferencias en la memoria de trabajo verbal entre sujetos con esquizofrenia, familiares de primer grado y controles, y evaluar la influencia que pueden tener en estas diferencias los síntomas del trastorno, como un paso para establecer si esta función cognitiva es un endofenotipo. Métodos: A 197 sujetos con esquizofrenia, 197 familiares de primer grado y 200 controles comunitarios, se les hizo evaluación psiquiátrica y se les aplicó la prueba sucesión de letras y números (SLN). Se comparó el desempeño de los tres grupos ajustando por edad, sexo y escolaridad, y luego se ajustó también por síntomas negativos y desorganizados. Resultados: Los sujetos con esquizofrenia mostraron un menor desempeño en la SLN con respecto a sus familiares de primer grado no-afectados y los controles, con tamaños de efecto de 0,75 y 1,18 respectivamente. Hubo una diferencia pequeña pero significativa entre familiares y controles (tamaño de efecto =0,38). Estas diferencias siguieron siendo significativas después de ajustar por síntomas negativos y desorganizados, pero los tamaños de efecto disminuyeron a: 0,26 para familiares vs sujetos con esquizofrenia, 0,56para controles vs sujetos con esquizofrenia y 0,33 para familiares vs controles. Entre los sujetos con esquizofrenia, el desempeño en la SLN no se asoció significativamente con duración del trastorno, edad de inicio, uso de antipsicóticos, ni historia de episodios depresivos o trastornos por uso de sustancias. Conclusión: Los resultados sugieren que la memoria de trabajo verbal puede ser considerada un endofenotipo de la esquizofrenia (AU)

Objective: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. Methods: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for “negative symptoms” and “disorganization” was performed afterwards. Results: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. Conclusion: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia (AU)

An integrated malaria control program with community participation on th Pacific Coast of Colombia

Se presentan los resultados de un programa de Control Integrado de Malaria con participación comunitaria en 23 comunidades de la parte norte de la Costa Pacífica de Colombia, en 21 de las cuales la atención médica es prestada únicamente por una auxiliar de enfermería. Participaron 11.468 habitantes bajo la coordinación de la Corporación para Investigaciones Biológicas (CIB), del Centro Internacional de Educación y Desarrollo Humano (CINDE) y del Instituto Colombiano de Medicina Tropical (ICMT). Se emplearon 3 estrategias: educación, diagnóstico oportuno y tratamiento adecuado y control de vectores. Los resultados fueron muy satisfactorios. La incidencia disminuyó en un 45,36 por cento. No hubo muertes por malaria, (antes del programa se presentaban de 5 a 8 casos por año). No hubo un solo caso de malaria cerebral en los 8 años del programa; con anterioridad al programa, se presentaban 90 a 110 casos al año. La duración de los episodios de malaria disminuyó de 7,52 días a 3,7 días por episodio. El beneficio económico para la comunidad superó al costo total de la inversión en el programa.