Healthcare encounters and outcomes of Filipino patients with Systemic Lupus Erythematosus managed at a Tertiary COVID-19 Referral Center

Objective@#The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines.@*Methods@#A review of records of all adult patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed.@*Results@#Our population of 403 patients was predominantly young (mean age 34.53 ± 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of which were teleconsultations (81.70%). During an average gap of 53.6 ± 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n=160) was lupus disease flare and the most common cause of death (n=40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died.@*Conclusion@#Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes.

The Boston Group and its proposals for the development of the psychoanalytic psychotherapeutic practice / O grupo de boston e suas propostas para o desenvolvimento da prática psicoterápica

RESUMO: Neste artigo nos dedicamos a retomar criticamente a proposta do Grupo de Boston (que propôs um paradigma unificado para as práticas psicoterápicas), composto por psicanalistas, pediatras, desenvolvimentistas e outros pesquisadores da situação e desenvolvimento da relação mãe-bebê no período perinatal, ressaltando em que sentido suas contribuições - colocando em destaque a necessidade de "algo a mais do que a interpretação", a realidade afetiva do encontro entre o analisa e o paciente, as comunicações verbais e não verbais, os conteúdos explícitos e implícitos nas relações psicoterápicas - podem levar ao desenvolvimento da teoria e da prática psicoterápica, especialmente a psicanalítica.

Abstract: In this article we critically take up the proposal of the Boston Group (which proposed a unified paradigm for psychotherapeutic practices), made up by psychoanalysts, pediatricians, developmentalists, and other researchers related to the situation and development of the mother-baby relationship in the perinatal period. It emphasizes in which sense their contributions - notably the need for "something beyond interpretation", the affective reality of the encounter between analyst and patient, verbal and non-verbal communications, the explicit and implicit contents in psychotherapeutic relationships - may lead to the development of psychotherapeutic theory and practice, especially the psychoanalytic one.

Ideal Pedagógico, Religioso, Social y Ecológico de San Francisco de Asís / Pedagogical, Religious, Social, and Ecological Ideal of St. Francis of Assisi

Resumen En torno al ideal Pedagógico, religioso, social y ecológico de San Francisco de Asís se congregaron, para compenetrarse de él, no solo sus discípulos, sino el mundo de su época hasta nuestros días. Es lo que podría llamarse el triunfo del amor y del ideal. Su propuesta de vida, despertaron no solo la admiración, sino que se constituye en una propuesta para hacer frente a una aguda crisis civilizatoria hoy.

Abstract Around the pedagogical, religious, social, and ecological ideal of St. Francis of Assisi, not only his disciples, but also the world of his time, up to the present day, gathered around him to understand him. It is what could be called the triumph of love and the ideal. His proposal of life, awakened not only admiration, but it also constitutes a proposal to face an acute crisis of civilization today.

Changes in Outpatient Visits to the Family Medicine Centre at a Medium-Sized Urban Hospital during the COVID-19 Pandemic: A Retrospective Cohort Study of the Patient Characteristics and Reason for Encounter / 日本プライマリ・ケア連合学会誌

Introduction: This study assessed the changes in outpatient visits during the COVID-19 pandemic.Methods: Subjects were patients who visited the outpatient clinic of the Family Medicine Centre at Kanai Hospital between April and May in 2019 and 2020. We compared the number of outpatients, their age, and their reasons for encounter (RFEs) classified according to the International Classification of Primary Care, 2nd Edition between 2019 and 2020.Results: A total of 1159 patients in 2019 and 859 patients in 2020 were evaluated. There were 553 male patients in 2019 and 452 in 2020 (P =0.029). The mean age of the patients was 48.4 years in 2019 and 52.4 years in 2020 (P =0.010). The mean number of patients per day was 25.2 in 2019 and 17.9 in 2020 (P < 0.001), with a significant reduction in patients aged 0-4 years in 2020 relative to 2019 (3.64 in 2019 vs.1.02 in 2020; P < 0.001). On evaluation of RFEs classified by organic system, the proportion of respiratory RFEs decreased from 45.3% in 2019 to 31.6% in 2020 (P =0.026), and gastrointestinal RFEs decreased from 17.9% to 5.3% (P =0.003) among children. Among adults, the proportion of respiratory RFEs decreased from 22.6% in 2019 to 15.6% in 2020 (P < 0.001) and skin RFEs decreased from 20.1% in 2019 to 15.3% in 2020 (P =0.011).Conclusion: The number of outpatients decreased during the COVID-19 pandemic. There were differences in the proportion of RFEs between the two periods.

A Personal Growth Experience that Strengthens the Social Fabric in the Intensive Encounter Groups / Experiencia intensiva de grupos de encuentro: un espacio de crecimiento personal que fortalece el tejido social

RESUMEN Este artículo examinó la relevancia de las experiencias intensivas de los grupos de encuentro en la formación académica y personal de los alumnos de la Maestría en Desarrollo Humano del Instituto Tecnológico y de Estudios Superiores de Occidente (Iteso). Se describieron los fundamentos de esta estrategia, la cual tiene como marco teórico la psicología humanista. Se llevó a cabo una investigación con participantes de un grupo de encuentro intensivo dirigido a alumnos y egresados de la Maestría en Desarrollo Humano, a quienes se les solicitó contestar un cuestionario acerca de las vivencias y aprendizajes más importantes. Los hallazgos destacaron que el encuentro promovió el fortalecimiento del tejido social, el desarrollo de actitudes y habilidades para la facilitación, así como experiencias y aprendizajes significativos que abonaron a su crecimiento personal; además, se reconoció la importancia de seguir ofreciendo este tipo de espacios en la Maestría en Desarrollo Humano.

ABSTRACT In this article we intend to show the relevance of Intensive Encounter Groups in the academic and personal formation of students of the Master's in Human Development (MDH) in Guadalajara, Jalisco, Mexico. We describe the bases for this strategy with its theoretical framework in Humanistic Psychology. A small research project was carried out with participants of an intensive encounter group made up of students and graduates of the MDH, through the application, during the event, of a questionnaire about the most important things they have experienced and learnt. The results indicate that the encounter promoted a strengthening of the social fabric, the development of attitudes and skills for facilitation, experiences, and meaningful learning, that contributed to personal development. In addition, the importance of offering this kind of space in the MDH framework was definitely recognized.

Desafios ao encontro: contribuições de Moreno e Freire para a educação de jovens e adultos / Challenges of encounter: Moreno and Freire contributions to the youth and adults education / Desafíos al encuentro: Moreno y Freire contribuciones para la educación de jóvenes y adultos

O fazer docente das professoras e dos professores da Educação de Jovens e Adultos (EJA) apresenta em seu cotidiano múltiplos desafios relacionados a questões socioeconômicas, de saúde pública, de bem-estar, cognitivas e de relacionamento. Carrega, ainda, todo o legado histórico do combate ao analfabetismo, das desigualdades sociais e das fragilidades das políticas públicas educacionais desta modalidade de ensino. Neste cenário desafiador, aproximações teóricas entre Jacob Levy Moreno e Paulo Freire contribuem para uma leitura crítica das situações-limite presentes no dia a dia do trabalho docente. O Sociodrama, como método desta pesquisa, aponta a espontaneidade-criatividade como possibilidade para superação das densas conservas culturais instaladas e da possibilidade do Encontro.

The schooling process of teachers of the Youth and Adult Education shows multiple challenges in its daily life: socioeconomic issues, issues of public health and well-being, cognitive and relationship issues. It also carries all the historical legacy of combating illiteracy, social inequalities, and fragility of the public educational policies of this type of education. In this challenging scenario, theoretical approaches between Jacob Levy Moreno and Paulo Freire contribute to a critical reading of limit situations present in daily teaching. Sociodrama, as a method of this research, points to spontaneity-creativity as a possibility for overcoming the dense cultural conserves installed and the possibility of the Encounter.

El hacer docente de las profesoras y de los profesores de la Educación de Jóvenes y Adultos (EJA) presenta en su día a día múltiples desafíos relacionados a cuestiones socioeconómicas, de salud pública, de bienestar, cognitivas y de relación. Carga, también, todo el legado histórico del combate al analfabetismo, de las desigualdades sociales y de las fragilidades de las políticas públicas educacionales de esta modalidad de enseñanza. En este escenario desafiante, aproximaciones teóricas entre Jacob Levy Moreno y Paulo Freire contribuyen para una lectura crítica de las situaciones-límite presentes en el día a día del trabajo docente. El Sociodrama, como método de esta investigación, apunta a la espontaneidad-creatividad como posibilidad para la superación de las densas conservas culturales instaladas y de la posibilidad del Encuentro.

Investigation of drug use at primary health centres in Nashik, Maharashtra, India

Background: By recognizing the need to promote rational utilization of medicines, the World Health Organization (WHO) in collaboration with the International Network for Rational Use of Drugs (INRUD) developed a set of core indicators. This study aimed to investigate drug use based on it.Methods: The study was performed in Primary Health Centers (PHC) in Nashik District, Maharashtra, India. Prescriptions data for the last one year from PHCs were sampled out retrospectively. Outpatients from PHCs were selected, observed and interviewed for the patient-care indicators, prospectively. Pharmacy personnel was interviewed for the facility-specific indicators. The data were analyzed; results and conclusions were drawn.Results: The average number of drugs per prescription was 3.48 (SD=0.36). The percentages of drugs prescribed by generic name and from Essential Drug List or formulary were 83.98% and 68.97% respectively. The percentages of encounters with antibiotics and injections were 60.33% and 50.83% respectively. The average consultation and dispensing times were 3.89 minutes and 58.28 seconds respectively. 98.19% of the prescribed drugs were actually dispensed. 67.27% of the dispensed drugs were labelled. The percentage of patients’ knowledge of the correct dosage was 87.78%. The percentage availability of the EDL or formulary was 100% and of the key drugs in the stock was 85.71%.Conclusions: The need for improvement in prescribing practices can be encouraged by devising strategies such as training to physicians, rewards systems, etc. There should be plans to increase staff members for a particular working period and to educate patients with healthcare, hygiene, medicines’ compliance and common diseases.

La psicoterapia como una construcción conjunta del sentido de realidad: un acercamiento a los principios constituyentes de una interacción psicoterapéutica / Psychotherapy as a joint construction of the sense of reality: an approach to the constituent principles of a psychotherapeutic interaction

El desarrollo de una intervención psicoterapéutica compromete un encuentro interaccional, caracterizado por la necesaria conjunción de multiversos que convergen en una esfera dialógica, asociada a la resolución de una problemática o consecución de objetivos por parte de la figura consultante. Es en esta interacción dialógica, donde surgen las dudas sobre si la psicoterapia responde a un encuentro de miradas o bien, a una co-construcción de un sentido de realidad entre terapeuta y consultante, miradas que representan un posible descarte o complementariedad en su propia constitución. Una postura sobre la interacción en psicoterapia necesita establecer una posición activa respecto del rol del terapeuta, nutrida de una visión ontológica que repercuta directamente en un trabajo de interacción discursiva. Asimismo, estaría orientada hacia un propósito metódico que configure los quehaceres de los participantes, como elementos en continuo desarrollo, mas no en una respectiva predefinición. El presente artículo tiene como objetivo desarrollar una propuesta de modelo de integración comunicativa, resultando una oportunidad de convergencia en el encuentro de universos desde una dimensión lingüística de interacción en el desarrollo de un proceso psicoterapéutico.

The development of psychotherapeutic intervention engages an interactional encounter, characterized by the necessary conjunction of multiverses that converge in a dialogical sphere associated with the resolution of a problem or achievement of objectives by the consulting figure. It is in this dialogical interaction, where doubts arise as to whether psychotherapy responds to a meeting of views or, to a co-construction that comprises a sense of reality between therapist and consultant, views that represent a possible discard or complementarity in its own nature. An approach to the interaction in psychotherapy raises the need to establish an active position regarding the role of the therapist, nourished by an ontological vision that directly affects the constitution of a work of discursive interaction. In addition, this position should be oriented towards a methodical purpose that configures the tasks of participants, not as a respective predefinition but as elements in continuous development. The present article aims to propose a communicative integration model, resulting in an opportunity for convergence in the meeting of universes from a linguistic dimension of interaction in the development of a psychotherapeutic process

O erro na psicologia analítica: sombra ou luz? / Error in analytical psychology: shadow or light? / ¿El error en la psicología analítica: sombra o luz?

A autora resgata a noção do erro na psicologia analítica, revisitando o trabalho inicial de Jung no teste de associação. Busca compreender o que sustenta o processo analítico, tanto do ponto de vista da psicodinâmica quando dos novos modelos de funcionamento cerebral como propostos pelas neurociências. Discute em que medida a busca do certo, do modelo ideal, pode impedir o desenvolvimento propondo que nosso trabalho enquanto psicoterapeutas seria possibilitar a formação de um campo favorável à (re)construção do movimento intrapsíquico, e não corrigir "erros" introduzindo a importante discriminação entre to cure e to heal.

The author rescues the notion of error in analytical psychology, revisiting Jung's early work on the word association test. She tries to understand what supports the analytical process, both from the point of view of psychodynamics and from the new models of brain functioning as proposed by neurosciences. She discusses, to what extent, the search for the right, the ideal model can inhibit development; proposes that our work as psychotherapists is to enable the formation of a field favorable to the (re) construction of the intrapsychic movement and not to correct "errors" introducing the important discrimination between "to cure" and "to heal".

La autora rescata la noción del error en la psicología analítica, revisitando el trabajo inicial de Jung en la prueba de asociación. Se busca comprender lo que sostiene el proceso analítico, tanto desde el punto de vista de la psicodinámica cuando de los nuevos modelos de funcionamiento cerebral como propuestos por las neurociencias. Analiza, en qué medida, la búsqueda de lo cierto, del modelo ideal puede impedir el desarrollo proponiendo que nuestro trabajo como psicoterapeutas es posibilitar la formación de un campo favorable a la (re) construcción del movimiento intrapsíquico y no corregir errores introduciendo la importante discriminación entre to cure y to heal.

O mito da cadeira vazia / The myth of the empty chair / El mito de la silla vacía

O desenvolvimento pós-moreniano de uma teoria da imaginação e fantasia obriga-nos a revisar o conceito de realidade suplementar, compreendida hoje em sua concepção histórica como um ponto fundamental da teoria do psicodrama, que nos obriga a uma revisão à luz de um conjunto que engloba a filosofia do momento de Moreno, aderida intimamente às suas formulações teóricas e às consequências práticas e técnicas. Sob esse ponto de vista, a técnica da cadeira vazia, tornada mítica, é muito mais que uma técnica, ganhando maior importância quando ultrapassa sua mera definição como objeto intermediário, focada hoje nas raízes de uma realidade suplementar, ou seja, o campo de atuação de nossa criatividade na cena psicodramática e no cotidiano relacional da vida de todos nós.

The post-Morenian development of a theory of imagination and fantasy requires us to revise the concept of supplementary reality, understood today in its historical conception as a key aspect of the theory of psychodrama, that forces us to review in the light of a set that comprises the Moreno's philosophy of the moment, adhered closely to its theoretical formulations and to the practical and technical consequences. From this point of view, the technique of the empty chair, made mythical, is much more than a technique, gaining more importance when it exceeds its mere definition as an intermediate object, focused today on the roots of a supplementary reality, that is, the field of action of our creativity in the psychodramatic scene and in the relational daily life of all of us.

El desarrollo post moreniano de una teoría de la imaginación y la fantasía nos obliga a revisar el concepto de realidad suplementaria, comprendida hoy en su concepción histórica como un punto central de la teoría del psicodrama, que nos obliga una revisión a la luz de un conjunto que engloba la filosofía del momento de Moreno, adherida íntimamente a sus formulaciones teóricas y a las consecuencias prácticas y técnicas. En este punto de vista, la técnica de la silla vacía, tornada mítica, es mucho más que una técnica, ganando mayor importancia cuando sobrepasa su mera definición como objeto intermedio, enfocada hoy en las raíces de una realidad suplementaria, o sea, el campo de actuación de nuestra creatividad en la escena psicodramática y en el cotidiano relacional de la vida de todos nosotros.

Intervenção psicodramática em ato: ampliando as possibilidades / Psychodramatic act intervention: broadening the possibilities / Intervención psicodramática en acto: ampliando las posibilidades

Considera-se a relevância do ato terapêutico como modalidade de intervenção, dada sua praticidade em oferecer suporte e empoderamento numa única intervenção para várias pessoas. Visa descrever como funciona um ato terapêutico, como ele pode beneficiar segmentos sociais de uma população, promovendo a criatividade-espontaneidade nos grupos, ativando redes sociais e propiciando o encontro. Moreno sempre acreditou no poder criador do homem e na capacidade de mudança de si e do mundo à sua volta. Ele nos deixou o Psicodrama como instrumento de intervenção social e a tarefa de continuar o seu trabalho, promovendo a ampliação da consciência em prol da qualidade de vida e da sustentabilidade, o que calha perfeitamente bem com as demandas da sociedade moderna.

The relevance of therapeutic act is considered an intervention modality, given its practicality in offering support and empowerment in a single intervention for several people. It aims to describe how a therapeutic act works, how it can benefit the social segments of a population, promoting creativity-spontaneity in groups, activating social networks and facilitating the encounter. Moreno has always believed in the creative power of man and in the capacity to change himself and the world around him. He left us the psychodrama as an instrument of social intervention and the task of continuing his work, promoting the expansion of consciousness for the quality of life and sustainability, which fits perfectly with the demands of modern society.

Se considera la relevancia del acto terapéutico como modalidad de intervención, dada su practicidad en ofrecer soporte y empoderamiento en una sola intervención para varias personas. El objetivo es describir cómo funciona un acto terapéutico, cómo ese acto puede beneficiar a segmentos sociales de una población, promoviendo la creatividad-espontaneidaden los grupos, activando redes sociales y propiciando el encuentro. Moreno ha siempre creído en el poder creador del hombre y en la capacidad de cambio de sí y del mundo a su alrededor. Él nos dejó el psicodrama como instrumento de intervención social y la tarea de continuar su trabajo, promoviendo la ampliación de la conciencia en pro de la calidad de vida y de la sostenibilidad, lo que riña perfectamente bien con las demandas de la sociedad moderna.

Ética da alegria e do encontro: elucidações espinosanas e perspectivas psicodramáticas / Ethics of joy and encounter: elucidations of spinoza and psychodramatic perspectives / Ética de la alegría y la reunión: aclaraciones espinosanas y las perspectivas de psicodrama

Este artigo tem como objetivo apresentar aproximações entre os pensamentos de Jacob Levy Moreno e Baruch Spinoza, destacando a concepção de corpo, bem como a ética da alegria e do encontro inerente à filosofia dos dois autores. Portanto, o texto apresenta a convergência de sentidos entre alguns conceitos da Teoria dos Afetos de Spinoza e os do campo teórico do Psicodrama. O artigo também destaca contribuições dos dois pensadores para o campo da Psicologia Social e explicita a colaboração da teoria espinosana para o âmbito da psicoterapia de abordagem psicodramática.

This article aims to present some correspondences between of Jacob Levy Moreno's thoughts and Baruch Spinoza's ones, highlighting the body conception as well as the ethics of joy and the inherent encounter of both authors' philosophy. Therefore, the text presents the convergence of meanings between some concepts of Spinoza's Affect Theory and those of the theoretical field of Psychodrama. The article also focus on some contributions of the two thinkers in relation to the field of Social Psychology and explains the collaboration of Spinoza's theory to the scope of psychotherapy with a psychodramatic approach.

Este trabajo tiene como objetivo presentar similitudes entre los pensamientos de Jacob Levy Moreno y Baruch Spinoza, destacando el diseño del cuerpo, así como la ética de la alegría y la reunión inherente de la filosofía de los dos autores. Por lo tanto, el texto presenta la convergencia de los significados entre algunos conceptos de la Teoría de los Afectos de Spinoza y el campo teórico del Psicodrama. El artículo también destaca las contribuciones de los dos pensadores para el campo de la Psicología Social y la colaboración explícita de la teoría de Spinoza en el ámbito de enfoque psicodrama a la psicoterapia.

Health Problems in a Rural Island of Okinawa: Changes Over 25 Years / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>Currently, there are no studies on changes in health problems due to population aging in Japan. This study was conducted to estimate the changes by comparing the present health problems using the International Classification of Primary care second edition (ICPC-2) with a previous study.</p><p><b>Methods: </b>We conducted a retrospective open cohort study on a rural island in Okinawa. We classified health problems of all patients using ICPC-2, and compared the data with a previous study using the International Classification of Health problems in Primary care-2 defined (ICHPPC-2 defined) from 1990.</p><p><b>Result: </b>The total number of visits to the clinic was 4660 per year (age 0-14 years, n=828; age 15-64, n=2146; age 65 or older, n=1688). In 2015, the frequency of musculoskeletal, skin and general, and unspecified problems was higher. The number of health problems contained within the top 50% of all health problems, which is an indicator of the comprehensiveness of practice, was higher in the previous study.</p><p><b>Conclusion: </b>The present study suggested that orthopedic and dermatological disorders increased, and greater comprehensiveness of practice is needed.</p>

O vínculo entre profissional de saúde e pessoas com transtornos alimentares / The bond between health professionals and people with eating disorders / La relación entre profesionales de la salud y personas con trastornos de la alimentación

Este artigo tem como objetivo contribuir para a compreensão do vínculo interpessoal entre profissionais de saúde e pessoas portadoras de transtornos alimentares, por meio do relato de um estudo de caso com uma participante de sete entrevistas em grupo focal, conduzidas segundo o método psicodramático, com temas escolhidos entre aqueles da escala SATIS-BR. Os resultados permitiram afirmar que a participante demonstrou inegável desenvolvimento de sua espontaneidade, expresso na conscientização das representações inadequadas que a bloqueavam em papéis cristalizados e vínculos enrijecidos com os profissionais, ilustrativos da conserva cultural em que se encontrava aprisionada.

The paper aims to contribute to the understanding of the interpersonal relationship between professionals and people with eating disorders, through the report of a case study with a participant of seven focus group interviews, conducted according to the methods of psychodrama, based on themes chosen from the SATIS-BR scale. From the results it was possible to state that the participant demonstrated undeniable development in spontaneity expressed in her awareness of the inadequate representations that were blocking her in crystallized roles and tense links with professionals, which illustrates the cultural conserve in which she was held captive.

Este artículo tiene por objetivo contribuir a la comprensión de la relación interpersonal entre los profesionales de la salud y las personas con trastornos de la alimentación, a través del informe de un estudio de caso con una participante de siete entrevistas en grupo focal, realizado según el método de psicodrama, con temas elegidos de la escala SATIS-BR. Los resultados confirmaron que la participante ha presentado el desarrollo evidente de su espontaneidad, expresado en la concienciación de las representaciones inadecuadas que la bloqueaban en papéles cristalizados y vínculos rígidos con los profesionales, ilustrativos de la conserva cultural en la cual se encontraba encarcelada.

Academic administrative staff feel difficulty when dealing with health-care professional students / 医学教育

<p>　This study examined the cases of the difficult encounters with problematic students that academic administrative staffs in the health professions education institutons faces. 185 cases were obtained from the 143 administrative staffs who participated in the training program for academic administrative staffs training from 2013 to 2015. Although there are 136 cases (73.5%) related to the problem students, some cases existed which problems were from the system or faculty members. In order to dealing with difficult encounters appropriately in the health care professional training institutions, the cooperation between teachers and academic administrative staffs is indispensable.</p>

Reasons for Encounter and Health Problems Using ICPC-2 in a Rural Area with Limited Access to Advanced Care : A Retrospective Open Cohort Study / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : This study was conducted to estimate actual reasons for encounters and health problems, which is difficult to assess in a free-access system, in an area with limited access to advanced care by using the International Classification of Primary care second edition (ICPC-2).<br><b>Methods</b> : We conducted a retrospective open cohort study on an isolated island in Okinawa Prefecture, Japan. We encoded reasons for encounter (RFE) and health problems of all patients using ICPC-2.<br><b>Results</b> : The total number of visits to the clinic was 5682 a year (age 0-14 years, n=862 ; age 15-64 years, n=2205 ; age 65 or older, n=2615). The top 3 RFE classified by organic systems were R (respiratory), S (skin) and L (musculoskeletal). Dementia (ICPC-2 code : P-70) was eighth in the rank of chronic health problem among elderly people. Visits due to health maintenance/prevention (ICPC-2 code : A-98) was third in the rank of new health problem among children.<br><b>Conclusion</b> : In the present study, rankings of major RFE and health problems are similar to those in previous studies. Among elderly people, however, the rank order of dementia among chronic health problems was higher than that in previous studies. In addition, among children, the rank order of health maintenance/prevention among new health problems was higher than that in previous studies.

Princípios fundadores e atualidade de uma prática psicoterapêutica de orientação fenômeno-estrutural / Founding principles and actuality of a psychotherapeutic practice phenomenon-structural guided / Principes fondateurs et actualité d'une pratique psychothérapeutique á orientation phénoméno-structurale

A preocupação curativa não se situa no centro nem da reflexão nem do comportamento fenômeno-estrutural. Seria dizer que essa prática permaneceria indiferente, totalmente insensível e hermética à angústia do outro até ficar surda a seu sofrimento, expresso ou não, e à sua aspiração legítima, explícita ou implícita, de melhoria de sua condição? Quem poderia querer tal desdém, ainda mais emanante de uma corrente de pensamento e de ação que valoriza por outro lado uma solidariedade inter-humana e reivindica à vontade laços com raízes e intenções humanistas? É por que sua função é mais larga, mais ambiciosa por certos lados, mas também mais humilde e mais realista, visto sob outro ângulo, que essa aproximação pode permitir-se o que poderia parecer a um olhar desprevenido, seja como uma pretensão extensiva seja como uma surpreendente falta de ambição. As páginas abertamente dedicadas no início dos anos 1950 à questão psicoterapêutica pelo promotor desse método, Eugène Minkowski, apesar de raras e limitadas na sua obra, comportam eixos de orientação de um rigoroso e surpreendente frescor visionário, mesmo transpostos à nossa situação contemporânea onde sua pertinência se faz ainda mais sentir. Na sequência, colocando não o cuidado, mas sim, o encontro como princípio de base do estabelecimento do contato com o paciente, em plena consciência da atitude inicial que ele supõe e requer na duração assim como na natureza do recolhimento dos dados clínicos que provirá, mostraremos como fontes de análise podem emergir para desembocar, a cada polo da relação, sobre perspectivas de evolução da pessoa para contribuir a um encaminhamento significante do olhar sobre o outro e sobre si mesmo particularmente propício à uma evolução sentida e compartilhada em conjunto.

Neither does the curative concern stand at the core of reflection nor in the method of the phenomeno-structural approach. Should it mean that this practice could remain indifferent, insensitive and totally hermetic to one's distress to the point of staying deaf to its suffering, expressed or not, and its legitimate aspiration, formulated or implied, to improve one's condition? Who could pretend to such a disdain, especially originating from a school of thought and action empowering inter-human solidarity and furthermore claiming roots and attachments to humanistic intentions? It is specifically because of its broader project, more ambitious in many ways but also on the other hand more humble and realistic, that this approach can afford what would appear to an outsider as excessive arrogance or on the contrary, as a stunning lack of ambition. At the beginning of the 1950's, pages explicitly devoted to the psychotherapeutic question by the proponent of this method, Eugène Minkowski, although rare and limited in his work, contain nevertheless guidelines of a rigorous and surprising visionary freshness, even transposed today in a contemporary world, where their relevance are especially required. In his wake, by putting the encounter as the basic principle to establish the contact with a patient instead of his cure, in full awareness of the initial attitude supposed and required over time, as well as the nature of the collection of its clinical data, we will demonstrate how sources of analysis can emerge, leading at each point of the relationship, to perspectives of an individual transformation, contributing to a significant progress in regarding others and oneself as particularly suitable when this experience and evolution is shared.

La préoccupation curative ne se situe au coeur ni de la réflexion ni de la démarche phénoméno-structurale. Est-ce à dire que cette pratique resterait indifférente, totalement insensible et hermétique à la détresse d'autrui jusqu'à rester sourde à sa souffrance, exprimée ou pas, et à son aspiration légitime, explicite ou implicite, d'amélioration de sa condition? Qui pourrait prétendre à un tel dédain, d'autant plus émanant d'un courant de pensée et d'action qui valorise par ailleurs une solidarité interhumaine et se revendique volontiers d'attaches avec des racines et intentions humanistes? C'est parce que son entreprise est plus large, plus ambitieuse par certains côtés mais aussi plus humble et plus réaliste, vu sous un autre angle, que cette approche peut se permettre ce qui pourrait apparaître, à un regard extérieur mal averti, soit comme une prétention extensive soit comme un sidérant manque d'ambition. Les pages consacrées ouvertement au début des années 1950 à la question psychothérapeutique par le promoteur de cette méthode, Eugène Minkowski, pour rares et limitées qu'elles soient dans son oeuvre, n'en comportent pas moins des axes d'orientation d'une rigoureuse et étonnante fraicheur visionnaire, même transposés à notre situation contemporaine où leur pertinence se fait encore plus pressément ressentir. Dans son sillage, en posant non pas le soin mais la rencontre comme principe de base de l'établissement du contact avec le patient, en pleine conscience de l'attitude initiale qu'elle suppose et requiert dans la durée ainsi que de la nature du recueil des données cliniques qui en découlera, nous montrerons comment des sources d'analyse peuvent émerger qui s'avèrent déboucher, à chaque pôle de la relation, sur des perspectives d'évolution de la personne, pour contribuer à un cheminement signifiant du regard sur autrui et soi-même particulièrement propice à une évolution éprouvée et partagée ensemble.

Encontro analítico: a ênfase no mundo interno / The analytical encounter: the emphasis on the internal world / El encuentro analítico: énfasis en el mundo interno

O autor aborda o encontro analítico, com ênfase no mundo interno de cada um dos componentes da dupla e em sua interação. Após vinheta clínica apresentada como estímulo e um recorte de compreensão teórica, examina o que ocorre com o paciente, que procura análise, e com o analista, em seu trabalho clínico. Privilegia o conceito de transferência primária para situar questões do mundo interno do paciente, e focaliza a personalidade do analista trabalhando em duplo nível, desdobrando a questão da contratransferência no uso de capacidades adquiridas na formação e no aspecto emocional presente. O preparo do analista é descrito em termos de vocação, anos de formação e vicissitudes do analista formado. A seguir, apresenta questões do vínculo analítico e da interação da dupla, focalizando a intersubjetividade e os vínculos em geral. Aborda outros níveis de ocorrências presentes no encontro analítico, como o não verbal, as atuações e enactments e, de maneira mais abrangente, a existência de outra cena que subjaz ao encontro...

This paper shows the author's approach to the analytical encounter, with an emphasis on the internal world of each one of the two participants, and on their interactions. After a clinical vignette that was brought as a stimulation and an excerpt of theoretical understanding, the author examines what happens with the patient, who seeks an analysis, and with the analyst, in his clinical practice. The author gives priority to the concept of primary transference in order to place subjects relating to the patient's internal world. He also focuses on the analyst's personality, working on two levels: unfolding the countertranference issue in the use of the skills that he acquired during psychoanalytic training, and in the existing emotional aspect. The professional preparation of the analyst is described in terms of vocation, years of training, and all ups and downs after his final graduation. Then the author brings up some issues related to the analytic bond and the two-person interaction, focusing on intersubjectivity and general bounds. He writes about other levels of events in the analytical encounter, such as nonverbal behavior, performings and enactments, and the existence of other scene - a scene that underlies the encounter - in a more comprehensive way...

El autor propone estudiar el encuentro analítico con énfasis en el mundo interno de cada uno de los componentes de la dupla y su interacción. Presenta una viñeta clínica como estímulo y una propuesta de comprensión teórica, para examinar lo que ocurre con el paciente cuando busca un análisis y con el analista en su trabajo clínico. Elige el concepto de transferencia primaria para situar cuestiones del mundo interno del paciente y focaliza la personalidad del analista trabajando en doble nivel, al examinar la cuestión de la contratransferencia tanto en el uso de las capacidades del analista, adquiridas en su formación, cuanto en los aspectos emocionales presentes. La preparación del analista es descripta en términos de vocación, años de formación y vicisitudes del analista ya formado. Luego, el autor, presenta cuestiones sobre el vínculo analítico y sobre la interacción de la dupla, focalizando en la intersubjetividad y los vínculos en general. Finalmente, aborda otros niveles presentes en el encuentro analítico, como el no verbal, las actuaciones y enactments; así como de forma más amplia, la existencia de otra escena que subyace al encuentro...

Afetividade e seus sentidos no trabalho do agente comunitário de saúde / Affectivity and its meanings in the community health agent's work

ResumoO agente comunitário de saúde (ACS), em seu papel híbrido de profissional de saúde e morador de sua comunidade, experimenta diferentes afetos e potências. Tornam-se mais diluídas as fronteiras de convivência dos vizinhos com o profissional, e este se torna alvo de diferentes expectativas, ao mesmo tempo em que pode ajudá-los com seu trabalho. O ACS, então, pode se sentir tão potente quanto sobrecarregado, e é através desses afetos que busca compreender suas vivências. O trabalho tem como objetivo refletir sobre o papel da afetividade e sentidos sujetivos a ela atribuídos pelo ACS em seu cotidiano. Estudo de caráter qualitativo, segundo o referencial da Epistemologia Qualitativa de González-Rey. Resultados apontam a afetividade como caminho para a construção de vínculos potencializadores dos envolvidos. Nos encontros entre ACS, munícipes e equipe de trabalho, congregam-se bons afetos que viabilizam relações potentes. Nestas, o serviço de saúde se aproxima dos sujeitos que dele necessitam, e estes, por sua vez, tornam-se partícipes do processo de cuidado. A amizade que se forma nessa relação e entre os próprios trabalhadores fortalece sua liberdade, motivada pelo interesse legítimo entre os sujeitos que moram e trabalham próximos um do outro.

AbstractThe community health worker (CHW), in his hybrid role as healthcare worker and residing member of his community, experiences different affects and potencies. His frontiers with neighbors become blurred and several expectations are placed on him, at the same time that he can help them with his work. This work aims to reflect upon the role of affectivity and subjective meanings attributed to it by the CHW in his daily work. Qualitative study, based on González-Rey's Qualitative Epistemology. Results point to affectivity as a way towards the building of bonds which increase the potency of those involved. During the CHW's encounters with patients and co-workers, good affections congregate, making potent relationships possible. In these, the healthcare service gets closer to the people who need it and they, in turn, become participants in the process of care. The friendship crafted in this relationship and also among the workers themselves strengthens their freedom, moved by legitimate interest between people who live and work close to each other.

Um olhar psicanalítico em uma enfermaria de alto risco obstétrico / A psychoanalytical look at a high-risk obstetrical infirmary

Este artigo versa sobre a vivência de inserção da autora, como psicanalista, em uma equipe multidisciplinar de alto risco obstétrico, em um hospital geral do Sistema Único de Saúde de Porto Alegre, referência no sul do país. Discorre sobre a construção de um setting apropriado a esta tarefa. Do mesmo modo que o feto é percebido, pela mãe, no início da gravidez, como um estrangeiro, a autora vivencia seu ingresso na equipe como um corpo estranho. Enquanto a autora se disponibiliza internamente para receber e conter as intensas angústias que rondam a equipe, que trabalha sempre pressionada pelo risco iminente de perder a mãe e ou o feto, vai tecendo histórias que revelam, na ausência de palavras, o que só pode ser expresso pelo corpo através de sinais e sintomas. Conclui com o relato de um encontro terapêutico com uma grávida na 30ª semana de gestação, com crescimento intrauterino restrito (CIUR), sem uma causa detectada, pelos exames realizados, de origem materna ou fetal. Em sua forma de abordagem do caso, expõe de que modo foi se constituindo como uma psicanalista em uma unidade de alto risco, a partir de sua formação psicanalítica, dos instrumentos que desenvolve, a partir da observação da relação mãe-bebê (ORMB) pelo método preconizado por Esther Bick, que lhe dão acesso a todo o universo primitivo, aliada a um amplo diálogo e estudo adquiridos por meio de conhecimentos advindos de áreas afins.

This paper presents the author’s insertion experience as a psychoanalyst in a multidisciplinary team of a high-risk obstetrics, in a National Health System General Hospital of Porto Alegre, a reference in the south of the country. It comments the construction of an appropriate setting for this task. The same way that in early pregnancy the mother perceives the fetus as a foreigner, the author experienced her own entrance in the team as a foreign body. While the author was offering herself internally to receive and hold the intense anxiety felt by the staff – that always work with an imminent risk of losing the mother or the fetus – she was weaving stories that, in the absence of words, reveal what the body can only express through signs and symptoms. The paper ends presenting a report of a therapeutic encounter with a 30-week pregnant woman, a pregnancy with IUGR (intrauterine growth restriction), maternal or fetal origin, issues not detected. In her approach of the case, the author exposes how she became feeling a psychoanalyst in a high-risk unit: throughout the use of instruments learned in her psychoanalytical formation, such as the Esther Bick’s method of observation of mother and baby relationship, which allows an approach to the primitive universe, and, also, throughout the dialogue with related fields knowledge.

Este documento analiza la experiencia de inserción de la autora, como psicoanalista, en un equipo multidisciplinario de Alto Riesgo Obstétrico en el Sistema Único de Salud del Hospital General de Porto Alegre, referencia en el sur del país. Discute la construcción de un entorno adecuado para esta tarea. Del mismo modo que el feto es percibido por la madre al comienzo del embarazo como un extranjero, la autora experimentó su entrada en el equipo como un cuerpo extraño. Mientras la autora se prepara internamente para recibir y contener la intensa ansiedad que vivencia el equipo, que siempre trabaja con el riesgo inminente de perder la madre o el feto, fue viviendo historias que revelan la ausencia de palabras que sólo podían expresarse en el cuerpo a través de señales y síntomas. Concluye con un relato de un encuentro terapéutico con una mujer embarazada a las 30 semanas de gestación con RCIU (restricción del crecimiento intrauterino) y sin un problema, detectado por los exámenes, de origen materno o fetal. En su enfoque, el caso expone como se formó una psicoanalista en una unidad de alto riesgo desde su formación psicoanalítica, los instrumentos desarrollados a partir de ORMB, método defendido por Esther Bick, que le da acceso en todo el universo temprano, combinado con un amplio diálogo y estudio adquirido a través de los conocimientos derivados de las áreas relacionadas.