Application of union physio-psycho-social assessment questionnaire in screening anxiety and depression in outpatients from general hospital / 中华行为医学与脑科学杂志

Objective:To explore the application of union physio-psycho-social assessment questionnaire (UPPSAQ-70) in screening anxiety and depression in outpatients from general hospital.Methods:A total of 510 outpatients from Peking Union Medical College Hospital from June 2020 to November 2021 were recruited.They were assessed with UPPSAQ-70, self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The internal consistency of the UPPSAQ-70 was tested by Cronbach′s α coefficient.The convergent validity of the UPPSAQ-70 was evaluated by examining correlations with the SAS and SDS.Clinical diagnosis, being considering as the " gold standard" , was used to test criterion validity.Result:The UPPSAQ-70 showed good item characteristics and reliability (Cronbach α=0.947). The UPPSAQ-70 total score showed significant correlations with SAS( r=0.843, P<0.01) and SDS ( r=0.852, P<0.01). The area under the curve (AUC) of the UPPSAQ-70 was 0.875 ( P<0.01), the cut-off value was 65 points with the sensitivity 83.2% and the specificity 75.5%.The AUC of the SAS and SDS was 0.848 and 0.808 respectively(both P<0.001). For the SAS(standard score of 50 as the cut-off value), the sensitivity was 47.3%, and specificity was 92.5%.For the SDS(standard score of 53 as the cut-off value), the sensitivity was 62.9%, and specificity was 86.8%. Conclusion:UPPSAQ-70 has high sensitivity and is more suitable for screening of anxiety and depression in general hospital outpatients.

What is needed to promote physical activity in a secondary school? a qualitative study / O que é necessário para promover a atividade física em uma escola de ensino médio? um estudo qualitativo / ¿qué se necesita para promover la actividad física en una escuela secundaria? un estudio cualitativo

Interventions are required to modify physical activity behaviours in adolescents, and in this regard, education-based actions seem to be effective. The aim of this study was to explore the beliefs and perceptions of the context stakeholders with respect to adolescents' health behaviours, as well as intervention programmes to gain insight into the setting where the implementation of an intervention is required. Three focus groups were created with twenty-two participants (nine adolescents, four parents, six teachers, and three local politicians). The educational context, in collaboration with the community, was perceived as a setting with high a potential for physical activity promotion. Engagement and coordination of all stakeholders were considered necessary for a tailored intervention, in addition to programme institutionalization to ensure sustainability. Multilevel intervention with a whole-school and community approach is key to increasing physical activity levels among adolescents. (AU)

São necessárias intervenções para modificar os comportamentos de atividade física dos adolescentes e, nesse sentido, as ações baseadas na educação nas escolas parecem ser eficazes. O objetivo deste estudo foi explorar as crenças e percepções das partes interessadas do contexto em relação aos comportamentos de saúde dos adolescentes, bem como aos programas de intervenção para obter uma visão do ambiente em que uma intervenção deseja ser implementada. Foram criados três grupos focais com vinte e dois participantes (nove adolescentes, quatro pais, seis professores e três políticos locais). O contexto educativo, em colaboração com a comunidade, foi percebido como um ambiente com um alto potencial para a promoção da atividade física. O compromisso e a coordenação de todas as partes interessadas foram considerados necessários para uma intervenção personalizada, bem como a institucionalização do programa para garantir a sustentabilidade. A intervenção multinível com uma abordagem de toda a escola e da comunidade é fundamental para aumentar os níveis de atividade física entre os adolescentes. (AU)

Se necesitan intervenciones para modificar los comportamientos de actividad física en adolescentes y, en este sentido, las iniciativas desde la educación parecen ser efectivas. El objetivo de este estudio fue explorar las creencias y percepciones de las partes interesadas del contexto en relación con los comportamientos de salud de los adolescentes y los programas de intervención para conocer mejor el entorno en el que se quiere aplicar una intervención. Se crearon tres grupos focales con veintidós participantes (nueve adolescentes, cuatro padres, seis docentes y tres políticos locales). El contexto educativo, en colaboración con la comunidad, fue percibido como un ambiente con un alto potencial para la promoción de la actividad física. Se consideró necesario el compromiso y la coordinación de todas las partes interesadas para una intervención personalizada, así como la institucionalización del programa para garantizar la sostenibilidad. La intervención multinivel con un enfoque de toda la escuela y la comunidad es clave para aumentar los niveles de actividad física entre los adolescentes. (AU)

Why Villagers Use Toilets Only During Specific Time and Season? A Mixed-Methods Study in Rural Tamil Nadu

Background: Due to the efforts of sanitation promotion interventions in India, majority of the villagers started using toilets. But there is an inconsistency in toilet usage with regard to time and season. Objectives: The objectives were to determine the time and seasonal variations in toilet usage among vil-lagers who use toilets and to identify the reasons for time and seasonal variations in toilet usage. Methodology: A community-based mixed-methods study was executed in the four field practice villages of UHTC, Villupuram. After IEC clearance, 405 individuals who were using an owned toilet were selected by Simple Random Sampling. Qualitative component (free listing) was used for questionnaire develop-ment and quantitative component (survey + observation) was used for data collection. Results: Majority, 52% villagers used toilets only in the night and 64% villagers used toilets during rainy season. Fear of darkness and snakes, emergency and large family size were the common reasons for night time toilet usage. While, non-availability of open space, illness on exposure to rain and quick filling of toilet pit contributed to toilet usage in the rainy season.Conclusion: The study findings would help in the development of culturally-sensitive and socially-acceptable key messages for future sanitation promotion interventions

Psychosocial Perceptions as Significant Impact Modifiers - A Mixed Method Research Among Hospitalized Covid-19 Patients in A Tertiary Care Hospital in Coimbatore District, Tamil Nadu

Context: Covid 19 pandemic which evolved in successive waves had profound pyschosocial impact on affected in-dividuals. Perceptions had impact on both individual and environmental level with potential behavioural conse-quences. The aim of the research is to study the psychosocial perception and psychological impact of COVID- 19 among hospitalized COVID-19 patients. Methodology: The study was a mixed method research (Quan-Qual sequential design) conducted in the Covid wards of a tertiary care hospital in Coimbatore district. The psychological impact was assessed us-ing the General Health Questionnaire, Perceived Stress Scale. The results of quantitative analyses and qualitative analyses were expressed as proportions and done using thematic analysis using grounded theory respectively. Results: About 55% of the hospitalized Covid-19 patients had psychological impact. On multivariate analysis, the factors which emerged as independent risk factors for presence of psychological morbidi-ties due to COVID were presence of high stress level, sleep disturbances and their perception of COVID as high threat. Conclusions: Focussed Counselling with specific reference to attend to spiritual health component in addition, would go a long way in diminishing immediate and long-term psychological impact due to covid-19 illness.

Influencia de factores psicosociales en el clima y estrés laboral del personal de un hospital ecuatoriano / Influence of psychosocial factors on work climate and stress in Ecuadorian hospital personnel

RESUMEN Introducción: actualmente, el estudio de las relaciones del individuo con las condiciones de su trabajo resulta de gran interés. Objetivo: analizar la influencia de factores psicosociales de riesgo en el clima y estrés laboral de los trabajadores de un hospital básico en la ciudad de Ambato, en Ecuador. Materiales y métodos: estudio no experimental, transversal y prospectivo. A cincuenta trabajadores se le aplicaron tres encuestas: CoPsoq-istas21 (versión 2), cuestionario de clima laboral FOCUS-93 y el cuestionario para la evaluación del estrés (versión 3) de la Pontificia Universidad Javeriana. Se utilizaron la prueba de Chi-cuadrado de Pearson, con un nivel de significancia del 0,05, para descartar la hipótesis nula, y la regresión lineal curvilínea para determinar la influencia de los factores en las dos variables dependientes. Resultados: la estima (100 % de desfavorabilidad), las exigencias psicológicas (94 %) y la doble presencia (90 %) fueron los factores psicosociales peor calificados por los informantes. Solo el 40,5 % de los participantes consideraron su clima laboral como satisfactorio; y se registró en el 80 % de la población la presencia de síntomas fisiológicos y psicoemocionales provocados por el estrés. La inseguridad sobre el futuro y el apoyo social/calidad de liderazgo, fueron las subvariables que mayor número de inferencias estadísticas tuvieron con el estrés y el clima laboral. Conclusiones: los factores de riesgo psicosociales influyeron en la percepción negativa del clima laboral y en el incremento de la sintomatología del estrés.

ABSTRACT Introduction: currently, the study of the relationships between people and their work conditions are of great interest. Objective: to analyze the influence of risk psychosocial factors in the labor climate and stress of the workers of a basic hospital in the city of Ambato, Ecuador. Materials and methods: non-experimental, cross-sectional and prospective study. Three surveys were applied to 50 workers: the CoPsoQ-ista21 (version 2), the FOCUS-93 labor climate questionnaire, and the stress evaluation inventory of the Pontificia Universidad Javeriana (version 3). Pearson's Chi-square test, with a significance level of 0.05, was used to discard the null hypothesis, and curvilinear linear regression was used to determine the influence of the factors on the two dependent variables. Results: esteem (100 % unfavorableness), psychological demands (94 %) and double presence (90 %) were the psychosocial factors the informers rated worst. Only 40.5 % of the participants considered their work climate as satisfactory; and the presence of physiological and psycho-emotional symptoms caused by stress was recorded in 80 % of the population. Conclusions: psychosocial risk factors influenced the negative perception of the labor environment and the increase of stress symptoms.

Research progress on psychotherapy for dental anxiety / 口腔疾病防治

@#Dental anxiety refers to the unique tension, worry and even fear of dental treatment, which may lead to patients refusing to receive treatment and missing the best time for treatment. With the development of bio-psycho-social medical models, psychotherapy has gradually become the optimal treatment for dental anxiety. This article reviewed the etiology, evaluation and psychotherapy of dental anxiety. Research has shown that uncomfortable dental treatment experience is the main cause of dental anxiety, which is commonly assessed using questionnaires in clinical practice. Psychotherapy for dental anxiety is a noninvasive, widely applicable treatment without side effects, mainly including improving the treatment environment and service attitude, behavior therapy, and cognitive therapy, which has been shown to effectively alleviate dental anxiety in patients. However, psychotherapy for dental anxiety is highly demanding for dentists, which hinders its promotion and application. At the same time, the psychotherapeutic mechanism of dental anxiety is not clear and remains to be further elucidated by large-scale and high-quality randomized controlled studies.

Interview and treatment of a case with gender dysphoria / 四川精神卫生

This paper interviewed a case of patient with gender dysphoria via a bio-psycho-social approach. The client， a 21-year-old college student of male sex， had been into female dressing since the age of ten. As an adult， he became increasingly convinced that he should become a woman and began taking hormone therapy in secret and on an irregular basis. He felt himself trapped in a cycle of anxiety and distress， due to the concerns about the side effects of hormone therapy， and the practical problems regarding the impact on his academic and career arrangements， as well as the ways to explain himself to his parents. Through a remote psychiatric consultation， therapists provided targeted interventions based on the bio-psycho-social model.

Interview and treatment of idiopathic hypersomnia comorbidity tics disorder / 四川精神卫生

The purpose of this paper is to present the diagnosis and treatment of idiopathic hypersomnia comorbidity tics disorder. The client is 15 years old， female， a senior student， with frequent blinking and a crooked mouth since childhood， diagnosed with tics disorder. She previously had consistently good academic performance. Since the COVID-19 epidemic in 2020， the client has been sleeping more， averaging 12 hours per day， accompanied by increased daytime sleep with fatigue after waking up， and a significant decline in her studies. She was diagnosed with idiopathic hypersomnia comorbidity persistent （chronic） movement or tic disorder. It was suggested that she adopt a method of comprehensive biopsychosocial intervention. Biotherapy with methylphenidate can improve her arousal， enhance attention and improve drowsiness， meanwhile， changes to tic symptoms must be monitored. Cognitive behavioral therapy was used to help the client correct cognitive biases， reshape cognitive structure， and establish confidence in rehabilitation. Mindfulness therapy was adopted to help the client adjust her emotions. In terms of social resources， the client was encouraged to explore resources actively， seek social support， and build therapeutic alliances. Through coordinating multiple resources， the client reduced symptoms of sleepiness and enhanced her adaptability to continue with her studies.

Interview and treatment of a case with body dysmorphic disorder / 四川精神卫生

This paper reported a case of patient with body dysmorphic disorder in order to improve the clinical interview skills， diagnosis and treatment of clinicians in psychiatric department. The client was a 17-year-old unmarried male， came for psychological consultation because he was not satisfied with his appearance and had low self-esteem. After the changing of learning environment， the client showed excessive attention to his appearance along with low mood. The client was diagnosed with body dysmorphic disorder， and a biological-psychosocial comprehensive intervention was recommended. Sertraline combined with quetiapine was given as biotherapy to improve his mood and cognition. The psychotherapy included mindfulness-based stress reduction and cognitive behavioral therapy. These therapies helped the client learn to relax and correct cognitive biases. In terms of social resources， family members were encouraged to pay more attention to the client’s advantages， and schoolwork management on campus was strengthen. These methods promoted the development of client’s self-confidence.

Predictores de sintomatología postraumática aguda y crecimiento post-estrés tras un accidente laboral reciente / Predictors of Acute Posttraumatic Symptoms and Post- Stress Growth After a Recent Work Accident

Resumen El propósito de este estudio fue evaluar un modelo predictivo de sintomatología postraumática aguda (SPT) y de crecimiento post-estrés (CPE) en trabajadores que sufrieron un accidente laboral reciente. Se encuestaron 246 trabajadores (23.2% mujeres) entre los 18 y los 73 años. Se encontró que los principales predictores de la SPT son: severidad subjetiva del evento, afrontamiento religioso negativo, reinterpretación positiva y rumiación de tipos intrusiva, negativa y deliberada. A su vez, los principales predictores de CPE fueron: rumiación deliberada y afrontamiento religioso positivo. Se realizó un análisis de sendero para evaluar un modelo en el cual la rumiación intrusiva y la deliberada cumplen una función mediadora, obteniendo adecuados índices de ajuste. Se plantea la necesidad de contar con un método de evaluación temprana de las respuestas psicológicas tras un accidente.

Abstract The aim of this study is to evaluate a predictive model of acute posttraumatic symptomatology (PTS) and post-stress growth (PSG) in workers who suffered a recent work accident. To this end, 246 workers (23.2% women) were surveyed, aged between 18 and 73 years. The main predictors of PTS were subjective severity of event, negative religious coping, positive reinterpretation, and intrusive, brooding and deliberate rumination. At the same time, the main predictors of PSG were deliberate rumination and positive religious coping. A path analysis was performed to evaluate a model in which intrusive and deliberate rumination fulfill a mediating function, obtaining adequate goodness-of-fix indices. The need to have a method of early evaluation of psychological responses after an accident is proposed.

Introduction of a Social Determinants of Health Education Program into Clinical Clerkship at the University of Tsukuba / 医学教育

The University of Tsukuba School of Medicine introduced an education program on the social determinants of health (SDH). It consists of lectures during the 3rd year and a 4-week family practice and community medicine clerkship between 5th and 6th years. In the clinical clerkship, students receive lectures on the first day, are instructed to consider the SDH in a patient they met during the course, give group presentations and hand in written reports on the last day. Most students were able to analyze patients beyond the biomedical model, but only a few students were able to consider the social background and timeline of each patient. Our future challenge is to enhance students' understanding of SDH through educational programs for faculty members.

Psychometric Evaluation of the Union Physio-Psycho-Social Assessment Questionnaire / 中国医学科学院学报

Objective To validate the Union Physio-Psycho-Social Assessment Questionnaire(UPPSAQ-70)and test its validity and reliability.Methods From April,2013 to July,2018,patients were asked to finish the computer evaluation of UPPSAQ-70 and Symptom Checklist 90(SCL-90)in Peking Union Medical College Hospital(PUMCH).Confirmatory factor analysis(CFA)was conducted on the SPSS 17.0,and the number of fixed factors was 8 factors and 3 factors.Amos 23.0 was used to verify the original 8-factor model,8-factor revision model,3-factor model,3-factor revision model,and single-factor model.Each factor of SCL-90 was used as the calibration standard to calculate the correlation coefficient between factors.The retest reliability was tested by the outpatients in PUMCH in July,2018.Results Exploratory factor analysis indicated that the 8-factor revised model included:depression,anxiety and fatigue,sleep,physical discomfort,sexual function,happiness and satisfaction,hypochondria,and social anxiety.The 3 factors revised model included that:psychological,physiological and social dimension.Confirmatory factor analysis indicated that the 8-factor modified model was superior to the 3-factor model and the single-factor model: =10 410.4,=1862,RMSEA=0.07,CFI=0.753,and NFI=0.715.With SCL-90 as the standard criteria,except the low correlation coefficient between emotional scale and depression(=0.600)and anxiety(=0.520),the correlation coefficients of other symptoms were below 0.5.The chronbach's between each factor and total score of UPPSAQ-70 was between 0.823 and 0.904,and the Chronbach's coefficient of the whole scale was between 0.954 and 0.956 after each item was deleted.The retest reliability of the scale of 32 participants Chronbach's was 0.847.Each item of the scale measured between one week was significantly correlated(<0.05). Conclusion UPPSAQ-70 is a good scale for evaluating overall health status and is especially feasible in general hospitals.

Analysis of the suicidal behavior and psychosocial factors among HIV positive patients in Guangzhou / 中华疾病控制杂志

Objective To investigate the status of suicidal behaviors and suicidal ideation among HIV positive patients in Guangzhou, and to explore its relevant psycho-social factors. Methods We conducted a cross-sectional survey of HIV positive adult patients in six districts of Guangzhou to collect social-demographic characteristics, HIV infection time, suicidal ideation, suicidal behaviors and psycho-social factors. Use suicidal ideation and suicidal behaviors as the dependent variables to conduct the univariate analysis and multivariate Logistic regression analysis. Results Of the 464 subjects,5.2% and 17.4% of them had suicidal behaviors and suicidal ideation. Analysis showed that the infection route, depression, anxiety, social discrimination, self-discrimination were correlated with the suicidal behaviors(all P<0.05), while age, health status, spouse infection, depression, anxiety and social support, social discrimination, self-discrimination were correlated with the suicidal ideation(all P<0.05). Multivariate Logistic regression model showed that depression and self-discrimination were associated with suicidal behaviors(all P<0.05),depression and social discrimination were associated with suicidal ideation (all P<0.05). Conclusions HIV-positive adult patients in Guangzhou have a high incidence of suicidal ideation and behaviors. Psychological counseling, risk assessment and timely treatment related to depression, social discrimination self-discrimination and early antiviral treatment should be targeted in HIV-positive adult patients.

La evaluación psicosocial de un donante vivo de riñón / Psycho-Social Evaluation of a Living Kidney Donor

resumen La decisión de convertirse en donante vivo de riñón suele ser conflictiva. Generalmente se cree que el candidato conoce sus motivos, que es consciente de ellos, que ha pensado largamente su decisión y hasta ha consultado sobre ella. Sorprende corroborar que -en muchos casos- solo tiene una conciencia vaga, más bien oscura, de sus razones y de la validez de ellas. Otras veces ha tomado una decisión impulsiva, guiado por sus afectos, y se ha confiado a su suerte y/o a su fe. Y, otras más, viene indeciso, presionado por diversas circunstancias. La evaluación de salud mental debe ayudarle a poner sus motivos en claro, es decir, a hacerlos conscientes, a verbalizarlos. Debe permitirle analizarlos y afirmarse en su decisión o arrepentirse de ella. Es decir, debe ser una experiencia positiva, que enriquezca la decisión, la madure o la descarte. Y debe dejar al candidato la sensación interior de haber recibido ayuda para tomar la mejor decisión posible en su caso. La evaluación psicosocial debería ser la primera de varias valoraciones a las que debe someterse un candidato, porque una decisión bien tomada es requisito para realizar un proceso adecuado. El autor revisa las condiciones en que debe desarrollarse la entrevista, los requisitos que debe cumplir la decisión y las técnicas apropiadas para obtener la información indispensable.

abstract The decision to become a living kidney donor is full of conflicts. It is generally believed that the candidates are aware of their reasons, that they have thought long about it, and have even asked questions about it. Thus it is surprising that, in many cases, they are only vaguely aware of their reasons and their validity. Sometimes, it is an impulsive decision guided by their emotions and entrusted to their luck or faith. Sometimes, they are undecided and put under pressure due to various circumstances. The mental health assessment should help to clarify their reasons, and to put them into words. It should be a positive experience, enriching their decision. It should give the candidate the inner feeling of having received help for taking the best decision. The psychosocial evaluation should be the first of multiple assessment ratings that the living kidney donor must face. A well-taken decision is a requirement to start the process properly. The author reviews the conditions in which that interview should be developed, the requirements to be met by the decision, and the proper techniques to obtain accurate information.

Proceso de trabajo y salud docente. Un abordaje socio-antropológico de las relaciones entre los riesgos organizacionales y psicosociales del trabajo en contextos de pobreza urbana de Rosario (Argentina) / Work process and teacher's health. A socio-anthropological approach to the relationship between the organizational and psychosocial workplace risk factors in the context of urban poverty in Rosario (Argentina)

El presente escrito aborda las relaciones entre el proceso de trabajo y los procesos de salud-enfermedad de docentes de Nivel Medio de la ciudad de Rosario (Argentina), en el contexto de las reformas educativas de la denominada posconvertibilidad. El objetivo específico de este artículo es analizar los riesgos organizacionales y psicosociales presentes en una escuela secundaria ubicada en un contexto barrial de creciente fragmentación, diferenciación socioeconómica y pobreza. El estudio se realiza a partir de un enfoque propio de la Antropología del Trabajo y retoma asimismo los aportes de la Medicina Social. En este sentido, entendemos los procesos productivos a partir de su condición sociohistórica y a los procesos de salud-enfermedad a estos asociados como expresión del conflicto entre capital y trabajo (Grimberg, 1991). Se privilegió el desarrollo del denominado enfoque etnográfico, el cual implicó optar por estrategias intensivas de construcción de la información, tales como la observación participante y las entrevistas semiestructuradas. A partir de un referente empírico acotado se identificaron riesgos psicosociales vinculados con la condición social de los alumnos y sus familias, los cuales forman parte de la dinámica escolar en el contexto específico. Asimismo, se profundizó la identificación y análisis de los riesgos organizacionales vinculados a las formas de contratación; tiempo de trabajo, salario y exigencias de capacitación. El enfoque propuesto que vincula analíticamente los riesgos psicosociales y organizacionales es plausible de ser retomado para abordar la relación trabajo-salud de docentes en otros contextos escolares similares(AU)

In this article, we analyze the relationships between the work process, psychosocial risk factors and the health-disease processes of secondary level school teachers in Rosario (Argentina), in the context of the so-called "postconvertibility educational reforms". The main objective was to analyze organizational and psychosocial risk factors, based on a case study of a school located in an urban area affected by increasing fragmentation, socioeconomic differentiation and poverty. We used an approach based on the anthropology of work, with some contributions from the field of social medicine. In this sense, we understand productive processes as based on their socio-historical condition, and the associated health-disease processes as the expression of the conflict between capital and work. We prioritized the implementation of the ethnographic approach, which led us to select intensive strategies to construct the information, such as participant observation and semi-structured surveys. Based on a limited empirical reference, we were able to identify psychological risks attached to the students and the social conditions of their family. These risks reflect the different dimensions of school dynamics within this general context. Moreover, we went further by identifying and analyzing the organizational risks connected to hiring, working time, wages and training demands. We consider that this approach, which connects psychological and the organizational risk factors, has been scarcely researched in studies in this area. Thus, it is plausible that it can be used to further investigate relationships between work and health among teachers in similar school contexts(AU)

Prevalence of Burnout Syndrome in staff of juvenile facilities: Differences according to their socio-labour context / Prevalência da síndrome de Burnout em pessoal de centros de menores: diferenças segundo seu contexto socioprofissional / Prevalência del síndrome de Burnout en personal de centros de menores: diferencias según su contexto sociolaboral

Abstract This study is aimed at determining the prevalence of burnout and its three components (emotional exhaustion, depersonalisation and lack of self-fulfilment) in the staff of juvenile facilities in Spain, and to analyze the predictive capacity of various epidemiological and occupational factors regarding the likelihood of suffering the aforementioned syndrome. For this end, a quantitative cross-sectional research was carried out with a sample of 160 professionals by means of an ad hoc questionnaire and the Maslach Burnout Inventory. The burnout results in juvenile facilities show an average impact of emotional exhaustion (40%) and self-fulfilment (41.2%) and a low depersonalisation (55.6%). Likewise, it is confirmed that the location and the age of the centre are significant sources of variation in emotional exhaustion, as well as gender is in depersonalisation, and profession in self-fulfilment. In conclusion, the greatest predisposition to suffer Burnout occurs in unmarried women aged between 34 and 43, with little work experience, permanent contract and working as social educators or social workers in alternate shifts (morning or afternoon) in urban centres.

Resumo O objetivo deste estudo foi determinar a prevalência da síndrome de burnout e de seus três componentes (esgotamento emocional, despersonalização e falta de realização pessoal) no pessoal de alguns centros de menores na Espanha e analisar a capacidade preditiva de diversos fatores epidemiológicos e profissionais sobre a probabilidade de padecer dessa síndrome. Para isso, realizou-se uma pesquisa quantitativa de corte transversal numa amostra de 160 profissionais mediante a aplicação de um questionário elaborado ad hoc e do Maslach Burnout Inventory. Os resultados obtidos mostram uma incidência média em esgotamento emocional (40%) e realização pessoal (41,2%), e uma baixa despersonalização (55,6%) no burnout de profissionais de centros de menores. Além disso, confirma-se que a localização do centro e a antiguidade são fontes significativas de variação no esgotamento emocional, bem como o sexo na despersonalização, e a profissão na realização pessoal. Em conclusão, a maior pré-disposição a sofrer burnout é produzida em mulheres solteiras, com idade entre 34 e 43 anos, com pouca experiência profissional, contrato fixo e que trabalham como educadoras ou trabalhadoras sociais em períodos alternados (manhã ou tarde) dos centros localizados em centros urbanos.

Resumen El objetivo del estudio fue determinar la prevalencia del síndrome de burnout y de sus tres componentes (agotamiento emocional, despersonalización y falta de realización personal) en el personal de algunos centros de menores en España y analizar la capacidad predictiva de diversos factores epidemiológicos y laborales sobre la probabilidad de padecer dicho síndrome. Para ello, se llevó a cabo una investigación cuantitativa de corte transversal en una muestra de 160 profesionales mediante la aplicación de un cuestionario elaborado ad hoc y el Maslach Burnout Inventory. Los resultados obtenidos muestran una incidencia media en agotamiento emocional (40 %) y realización personal (41.2 %), y una baja despersonalización (55.6 %) en el burnout de profesionales de centros de menores. Asimismo, se confirma que la ubicación del centro y la antigüedad son fuentes significativas de variación en el agotamiento emocional, así como el sexo en la despersonalización, y la profesión en la realización personal. En conclusión, la mayor predisposición a sufrir burnout se produce en mujeres solteras y con edades entre los 34 y 43 años, con poca experiencia laboral, contrato fijo, y que trabajan como educadoras o trabajadoras sociales en turnos alternos (mañana o tarde) de los centros ubicados en cascos urbanos.

Atendimento psicossocial a crianças e adolescentes em situação de violência: o psicólogo e a rede de atenção / Psychosocial care for children and adolescents in situation of violence: the psychologist and the attention network / Atención psicosocial para niños y adolescentes en situación de violencia: el psicólogo y la red de atención

Este estudo de caso discute o atendimento psicossocial oferecido a crianças e adolescentes em situação de violência, em um centro de extensão universitário voltado a essa clientela, no município de Goiânia (GO). Tratou-se de uma família que enfrentava situação de vulnerabilidade social e de violência física, encaminhada para instituição especializada no atendimento a situações de violação de direitos. Além do atendimento psicológico, foram necessárias ações para garantir os direitos desses sujeitos, o que exigiu da psicóloga um posicionamento estratégico para dialogar com outros profissionais e instituições. Entre os impasses para a eficácia dessas ações, destacaram-se a escassa e demorada articulação entre os profissionais da rede e a falta de capacitação no sentido de superar formas tradicionais de atendimento, correndo-se o risco de perpetuar práticas retrógradas e estigmatizantes em detrimento da doutrina da proteção integral.

This case study discusses the psychosocial care offered to children and adolescents in a situation of violence, in a university extension center addressed to this clientele, in the city of Goiânia (GO). It was a family that faced a situation of social vulnerability and physical violence, referred to an institution specialized in dealing with situations of violation of rights. In addition to psychological care, actions were required to guarantee the rights of these subjects, which required the Psychologist a strategic position to dialogue with other professionals and institutions. Among the impasses for the effectiveness of these actions were the scarce and time-consuming articulation between the network professionals and the lack of training in order to overcome traditional forms of care, running the risk of perpetuating retrograde and stigmatizing practices to the detriment of the doctrine of integral protection.

Este estudio de caso discute la atención psicosocial que se ofreció a niños y adolescentes en situación de violencia, en un centro de extensión universitario dirigido a esta clientela, en la ciudad de Goiânia (GO). Fue una familia que se enfrentó a una situación de vulnerabilidad social y violencia física, referida a una institución especializada en atender situaciones de violación de derechos. Además de la atención psicológica, se requerían acciones para garantizar los derechos de estos sujetos, lo que exigía de la psicóloga una posición estratégica para dialogar con otros profesionales e instituciones. Entre los impases para la efectividad de estas acciones estaban la escasa y demorada articulación entre los profesionales de la red y la falta de formación para superar las formas tradicionales de atención, corriendo el riesgo de perpetuar las prácticas retrógradas y estigmatizadoras en detrimento de la doctrina de protección integral.

Masquerade of Falls and Depression, and Transitions of Care

Falls in an elderly require a comprehensive bio-psycho-social approach to evaluate for the root causes. These may be multi-factorial, and we need to deal with most of them, if not all, in order to effectively reduce the risk for falls. Frailty is a marker of poor functional outcomes. Sarcopenia is a major modifiable risk factor for frailty. There are various community programmes providing a comprehensive range of services to keep the elderly physically, mentally, and socially active. Communication with primary care physicians is important to ensure smooth transition back into the community, optimal management of chronic diseases and minimal re-admission.

Medical Integration from the Perspective of Humanistic Medicine:The Inevitability and the Leading Role of Holistic Integrated Medicine / 中国医学伦理学

Humanistic medicine is the contemporary essential characteristics of medicine,which is different from the ancient and modern medicine.The basic modality of humanistic medicine is integration,and the implementation of bio-psycho-social medical model is the basic content of humanistic medicine integration.Holistic integrated medicine is a clear understanding of the comprehensive modality of humanistic medicine,and leads and promotes the integration of humanistic medicine.The continuous improvement of the theoretical framework of holistic integrated medicine and its implementation in practice will promote the development of health care.