Les femmes et la politique au Chili : la dynamique et l’impact de l’accession au pouvoir de Michelle Bachelet

Cet article se penche sur la signification de l’élection d’une présidente au Chili dans des conditions politiques atypiques. Dans un contexte où l’élection de Michelle Bachelet, au second tour des présidentielles de 2006, n’émanait ni d’une évolution institutionnelle favorisant une meilleure représentation politique des femmes, ni d’avancées du mouvement féministe au Chili, l’auteure propose d’analyser les éléments qui marquent néanmoins un héritage politique spécifique et sont susceptibles de distinguer et de marquer le passage d’une femme au pouvoir dans la politique chilienne, malgré des conditions institutionnelles défavorables au départ. Seront ainsi analysés les facteurs qui fondent la profonde légitimité de la présidente à gouverner, avec des taux de popularité sans précédents à la fin de son mandat, de même que les orientations politiques particulières qui permettent de distinguer son gouvernement et de parler désormais des « politiques bacheletistes ». Par des avancées en matière d’égalité des conditions des femmes, par l’adoption de politiques pluralistes se revendiquant de l’élargissement des droits universels et d’une position nouvelle en matière de justice, par l’institution de recours judiciaires inédits et par un nouveau style de politique fondé sur la convocation, la première présidente a marqué la politique chilienne d’une option qui lui est propre, tranchant en partie sur la ligne de politiques d’assistance et la démocratie de consensus adoptée par les précédents gouvernements de la Concertation des partis pour la démocratie depuis la fin de la dictature.This article analyses the significance of the election of the first woman to be President of Chile, in atypical political conditions. In a context where the election of Michelle Bachelet was not the outcome of an institutional evolution favorable to a better political representation of women, nor the result of gains made by the Chilean feminist movement, this article proposes to examine some elements that nevertheless show that there is a specific political legacy to Bachelet – as a women – in power, in spite of the unfavorable conditions that prevailed at the start. In order to show this, the article looks at the factors that explain the profound political legitimacy of the President, with unprecedented popularity at the end of her mandate. It also analyzes some specific political orientations that characterize Bachelet’s government and are now considered as “Bacheletistas Politics”. By gains regarding women’s conditions and rights, by pluralistic public policies that rely on the enlargement of universal rights and a new vision of justice, by the institution of new judiciary mechanisms and recourses and by a new political style based on convocation, the first women President has impregnated Chilean politics with a distinctive option that distinguishes it from the type of assistancialist public policies and the consensual democracy led until then by other governments of the Concertación de partidos por la democracia, ever since the end of the dictatorship

Impact of pharmacist-led appointments for hypertension management in a primary care setting: a retrospective analysis

Impact of pharmacist-led appointments for hypertension management in a primary care setting: a retrospective analysis Introduction: High blood pressure is a major risk factor for heart disease and stroke, two of the leading causes of death for Americans.1 Evidence supports the idea that pharmacist-led hypertension management can result in overall blood pressure reduction; however, it remains unclear whether pharmacist-led initiatives can also improve performance metrics.2-5 Research question: Can pharmacist-led appointments for blood pressure management positively impact hypertension metrics? Study design: Retrospective chart review Methods: Primary outcome data was measured via metric inventory, defined as percentage of patients who had reached their blood pressure goal. Two time points were compared at two primary care clinics (1 month before the pharmacist-led HTN appointments were established compared to 4 months after) to determine a potential change in percentage of patients achieving BP goal. Secondary outcome data was obtained via chart review for patients whose hypertension was managed by the pharmacist (n=50) and matched patients managed by their primary care physician (n=50). Results: Overall, the metric for Clinic A decreased from 74.7% to 73.5%, and Clinic B decreased from 72.2% to 65.5%, illustrating less patients had achieved their blood pressure goal. However, a change in the metric definition occurred in the middle of the study period, which may explain the percentage decrease. Examining pharmacist visits, only 38% of patients were at their goal blood pressure initially, but 80% of patients were at their BP goal during their final visit. Pharmacists had an average of 2.2 medication interventions per patient per visit. Conclusions: The overall change in the metric does not suggest pharmacist-led appointments for hypertension management can positively impact the metric; however, changes in the metric definition interfered with proper assessment. Overall, pharmacists were able to optimize medication regimens, and almost half of the patients who were not at goal initially were able to achieve it within 4 months.https://digitalcommons.psjhealth.org/pharmacy_PGY2/1000/thumbnail.jp

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

LE RÔLE POLITIQUE DE LA MÉMOIRE EN COLOMBIE ET AU CHILI : IMAGINAIRES, MOBILISATIONS, INSTITUTIONS

Le Chili et la Colombie ont vécu des processus de sortie de violence bien différents : au Chili, sortie négociée par les élites d’une dictature marquée par la terreur d’État contre une population revendiquant la démocratie; en Colombie, sortie graduelle d’un conflit armé aux multiples acteurs et paix fragmentée dans l’une des démocraties les plus stables, sur le plan formel, d’Amérique latine. Un trait commun émerge pourtant dans les processus de construction de mémoire de ces deux pays : la présence de mouvements mobilisés autour de la mémoire – notamment des groupes d’étudiants, d’afro-descendants, d’autochtones et de paysans, de femmes, c’est-à-dire que ces mouvements dépassent le cercle des victimes directes. Ces mobilisations « populaires » pour la mémoire semblent se situer ailleurs que sur le plan institutionnel puisque les deux pays présentent des contextes presque opposés, le Chili ayant adopté des politiques renforçant l’amnistie pour les crimes passés et de timides mesures commémoratives 20 ans après la fin de la dictature, tandis que la Colombie, en plein coeur du conflit, a plutôt adopté de nombreuses lois permettant une présence officielle de la mémoire, notamment par la création du Centre national de la mémoire historique. Dans une perspective de politique comparée, ces contextes institutionnels si distincts posent la question des causes communes des fortes mobilisations pour la mémoire issues « d’en bas » : des entretiens de participants des deux pays montrent que ces mouvements portent un rôle politique de la mémoire et un imaginaire de la souffrance partagée face aux violences d’État, situant les violations passées des droits humains dans un continuum avec la violence structurelle et coloniale criminalisant encore les mouvements sociaux en démocratie.Chile and Colombia have undergone very different postconflict processes. Whereas in Chile there was an elite-based negotiated transition from a state terror regime, Colombia presents a gradual exit from an armed conflict involving multiple actors and taking place in one of Latin America’s most stable democracies. A strong common feature nevertheless exists in these two countries: important social movements—notably, student, afro-descendant, Indigenous, and peasant movements—that put forward memory, but which reach beyond the circle of direct victims. These “memory from below” movements in both countries cannot be understood from their institutional contexts, since these are so different: while Chile’s democratic governments strengthened the amnesty law and led only to timid commemorative initiatives twenty years after the end of the dictatorship, Colombia adopted numerous laws that allowed an institutional presence of memory—notably, through the creation of the National Center for Historic Memory—while the armed conflict was still fully fledged. From a comparative politics perspective, these institutional differences lead one to investigate other causes for the presence of “memory from below” movements in both countries: interviews of participants show that these movements stem from a common understanding of the political role of memory, as well as from a common social imaginary of “shared suffering” that seeks to uncover state violence and that understands past human rights violations as being part of a historic continuum of structural and colonial violence aimed at criminalizing and crushing social movements in democracy

La criminalisation de l’action collective dans la crise actuelle des droits humains en Amérique latine

The Latin American human rights crisis is not often analyzed from the perspective of one of its component, namely the presence of the important and phenomenon of the criminalization of collective action and defense of rights, which affect citizens and defenders of rights who become considered as criminals or even as terrorists by a growing number of laws. Among the five Latin American countries where human rights and rights defenders are most affected by criminalization laws are México and Chile. Although, contrary to the case in Mexico, there is no drug traffic and civil violence crisis in Chile, this country nevertheless counts with the most ancient legislation allowing criminalization of collective action. In this sense, a compared analysis of the cases of Chile and Mexico, including their legislation on criminalization allows us to establish that the real presence of drug traffic and civil violence is not necessary for the dynamics of the construction of an internal threat justifying the adoption of laws that enable violations of human rights and rights defenders in Latin America. Therefore, the analysis made in this article strives to shed light on a number of main factors that allow for the justification and legitimization of grave abuses committed by states that have compromised themselves to respect and protect the rights and liberties of their citizens.Dans l’analyse de la crise des droits humains qui sévit dans plusieurs pays d’Amérique latine, un phénomène important passe souvent inaperçu : celui de la montée de la criminalisation de l’action collective et de la défense des droits par l’État qui touche les populations mobilisées pour la défense de leurs droits, populations maintenant considérées comme criminelles ou terroristes en vertu de diverses lois. Parmi les cinq pays d’Amérique latine ciblant le plus les défenseurs des droits par des lois répressives se trouvent le Mexique et le Chili, cas qui sont analysés en perspective comparative dans cet article. Bien que le Chili ne vit pas de crise de sécurité liée au narcotrafic et à la délinquance comme le Mexique, on y retrouve néanmoins la plus ancienne législation permettant la criminalisation de l’action collective. L’analyse comparée des cas chiliens et mexicains, incluant la législation sur la criminalisation, apparaît ainsi utile pour montrer que la présence de réels taux de violence civile n’est pas nécessaire pour que soit enclenchée la dynamique de construction de la menace interne permettant de justifier l’adoption de lois de criminalisation qui facilitent les violations des droits humains en Amérique latine. Ainsi, l’analyse réalisée ici sera centrée sur la mise en lumière de facteurs politiques centraux permettant la justification et la légitimation entourant les abus commis par des États sensés respecter les droits et libertés de leurs populations dans le cadre d’une démocratie centrée sur l’État de droit.En la crisis de Derechos Humanos que padecen muchos países de America Latina, pasa muchas veces desapercibido el fénomeno creciente de la criminalización de la acción colectiva y de la defensa de los derechos de poblaciones consideradas como criminales, o incluso terroristas, por las leyes vigentes. Entre les cinco países de America Latina donde los defensores de derechos se ven más reprimidos por leyes de criminalización se encuentran México y Chile, dos casos que serán analizados en perspectiva comparativa en este artículo. Aunque Chile no se encuentre en una situación de crisis seguritaria ligada a la presencia de narcotráfico y de delincuencia a larga escala cómo es el caso de México, cuenta con la más antigua legislación que incentiva la criminalización de la acción colectiva. Así, el análisis comparativo de los casos mexicanos y chilenos permite demostrar que la presencia real de altos niveles de violencia civil no es necesaria para que exista la dínamica política que permite construir un concepto de amenaza interna necesario para la justificación de una legislación que apoya la criminalización y facilita las violaciones a los defensores de derechos. Así, el análisis realizado en este artículo busca poner en evidencia algunos factores políticos centrales que permiten la justificación y la legitimización de varios abusos cometidos por parte de Estados que se han sin embargo compremetido en respectar y proteger los derechos de sus ciudadanos en el marco de una democracia garantizada por el Estado de derecho.Doran Marie-Christine. La criminalisation de l’action collective dans la crise actuelle des droits humains en Amérique latine. In: Revue Québécoise de droit international, hors-série mars 2015. L’État de droit en Amérique latine et au Canada. pp. 221-246