Aportes del psicoanálisis a los estudios de abuso sexual infantil: Análisis del discurso de la madre de una niña abusada sexualmente / Contributions of psychoanalysis to studies of child sexual abuse: Mother's speech analysis about her sexually abused daughter

Se presentan los resultados dela tesis doctoral sobre los deseos y defensas (y sus estados) de la madre de una niña abusada sexualmente, con el objetivo de conocer su estructuración subjetiva en este difícil acontecimiento. Se trata de un estudio de caso en el que se usa como método el Algoritmo David Liberman (ADL), en el análisis del discurso de la madre, seleccionadas tres sesiones y una carta manuscrita. El estudio de deseos y defensas puede contribuir a describir y conocer el posicionamiento subjetivo de una madre frente a la situación abusiva de su hija, y como ésta es vivida por ella AU

The results of the doctoral thesis on the wishes and defenses (and their states) of the mother of a sexually abused girl are presented, with the aim of knowing her subjective structuring in this difficult event. This is a case study in which the David Liberman Algorithm (ADL) is used as a method in the analysis of the mother's speech, three sessions and a handwritten letter selected. The study of desires and defenses can contribute to describing and knowing the subjective position of a mother in the face of her daughter's abusive situation, and how it is experienced by her AU

Feature Deconstruction Strategy Based Identification of Acute Features Associated With Impairment of Activities of Daily Living in Patients With Traumatic Brain Injury / 中山大学学报(医学科学版)

ObjectiveTo identify acute phase features associated with the prognosis of traumatic brain injury （TBI）. MethodsThrough two traditional strategies， correlation analysis and prediction model， and one innovative research strategy based on feature deconstruction， a retrospective analysis was conducted using demographic， acute phase and chronic phase features of 354 TBI patients to identify acute phase features associated with activities of daily living （ADL） in chronic phase of TBI. For feature deconstruction strategy， the LASSO （Least Absolute Shrinkage and Selection Operator） algorithm was used to build a prediction model that could effectively predict ADL based on non-ADL chronic phase features. The model could indicate the key chronic phase dimensions determining the ADL in TBI patients. We then identified demographic and acute phase variables that were significantly associated with these key chronic phase features. ResultsThe feature deconstruction strategy revealed that ADL could be deconstructed into chronic phase dimensions such as weak limbs in TBI population. Importantly， to the best of our knowledge， this strategy revealed for the first time the association of these important acute phase features with specific chronic phase impairment features. For example， TBI patients had a higher risk for chronic phase recent memory impairment if they had a prolonged coma time and low GCS scores at acute phase ［scaled coma time OR95%CI = 94.288 （35.095， 273.231）； scaled GCS OR95%CI = 0.068 （0.030， 0.147）］； the patients had a higher risk for insight impairment and disorientation at chronic phase if they had hydrocephalus at acute phase ［insight impairment OR95%CI = 6.760 （3.653，12.855） ； disorientation OR95%CI = 6.538 （3.530， 12.490）］. All strategies showed that the strongest risk factors for ADL damage in the chronic phase included prolonged coma time and low GCS scores as well as hydrocephalus. ConclusionThis study provides an innovative research strategy to establish the association between acute injury features and chronic recovery features， and to identify demographic and acute phase features associated with the prognosis of TBI.

Emerging role of physiotherapy in management of crush injury over forearm

The objective of the case report is to discuss the case of a patient with crush injury over right forearm. A 37 years old male came with complain of pain, swelling, restricted range over affected side, muscle weakness over right forearm, wrist and hand, reduced grip strength on right hand, and difficulties in ADL扴 over right-handfollowing crush injury over right forearm. Treatment involved physical therapy and Electro modalities for the elimination of pain and returning the patient抯 full range of motion in the wrist and hand. After range of motion was restored, a home exercise program was initiated. The home exercise program included a return to ADLs and occupational related activity and active, resistive, gripping activities of the hand. After 11/2 month follow up, our patient showed dramatic recovery after appropriate Surgical and physiotherapy management. Physiotherapy plays significant role in the elimination of pain, improving range; muscle strength and hand function and also reduces the risk of stiffness, contracture and deformity in crush injuries.

Effects of Exclusion Items in Outcome Assessment on the KRW Achievement Index in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.

Effects of Exclusion Items in Outcome Assessment on the KRW Achievement Index in Convalescent Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

Objective：To clarify the effect of exclusion items on the KRW achievement index (KRW-AI) in the outcome evaluation of a convalescent rehabilitation ward.Methods：The subjects were 812 inpatients in a convalescent rehabilitation ward. The objective variable was the KRW-AI of 40 or less, and the explanatory variables were the items excluded from the KRW-AI and their combination for a total of eight categories, such as (1) low motor FIM, (2) high motor FIM, (3) low cognitive FIM, (4) elderly, (5) (1)＋(3), (6) (1)＋(4), (7) (3)＋(4), (8) (1)＋(3)＋(4). The adjusted variables were sex, rehabilitation calculation category, and time from onset to admission to the ward. Poisson regression analysis was performed. The Incidence Rate Ratio (IRR) and 95％ confidence interval (CI) were calculated.Results：Five of the eight exclusion categories were significantly associated with low-KRW-AI scores. The highest IRR was 2.29 (95％ CI：1.41-3.69, p＜0.001) for (2).Conclusion：High motor FIM are associated with a higher relative risk of falling below the KRW-AI of 40. Conversely, being older and the presence of cognitive disorder did not interfere with low-KRW-AI scores.

Clinical effect and mechanism of / 中国针灸

OBJECTIVE@#To observe the effect of @*METHODS@#A total of 60 children with intellectual disability were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 2 cases dropped off). In the control group, rehabilitation training and routine acupuncture were adopted, 30 min each time, once a day, 6 times a week for 3 months. On the base of the treatment as the control group, @*RESULTS@#Compared before treatment, the scores of DQ and ADL and the serum levels of DA, NE, 5-HT after treatment were increased (@*CONCLUSION@#On the base of rehabilitation training and routine acupuncture,

The Magnitude of ADL Improvement was Associated with Discharge Home among Older Stroke Patients in a Convalescent (Kaifukuki) Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and ≥ 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.

Trajectory of ADL (Activities of Daily Living) for Six Weeks before Death in Patients with Terminal Cancer

Objective: To examine the trajectory of activities of daily living (ADL) in cancer patients from 6 weeks before death using the Functional Independence Measure (FIM). Method: This study was a retrospective observational study. The participants were cancer patients aged 18 years or older who died and were discharged from the palliative care unit in Tsurumaki-onsen Hospital. Six weeks of FIM data were collected from the patients’ medical records from 6 weeks before death to the time immediately before death (week 0). Results: Fifty-five participants were included in the study. FIM scores declined from 55 points at 6 weeks before death to 25 points immediately before death. Functional independence was higher for cognitive items on the FIM than for motor items, and both cognitive and motor functioning significantly declined just before death. Within the motor subscale, the patients were more independent with regard to eating, grooming, and bladder management compared to other activities until just before death. Within the cognitive subscale, the patients showed greater independence with regard to expression and social interaction. Discussion: A support for ADL needs to be considered to assist out-of bed activities in a safe and comfort manner until two weeks before death. Patients’ activities on the bed can also be continued for independence until just before death.

Z-test: aportes psicoanalíticos para la interpretación cualitativa / Z-test: psychoanalytical contributions for qualitative interpretation

Las contribuciones para la interpretación psicoanalítica cualitativa de el Z-Test (Zulliger) propuesta aquí se basan en la interpretación de símbolos y los deseos predominantes desde la perspectiva de los conceptos argentinos y freudianos de: Liberman, Maldavsky y Sneiderman. El análisis cualitativo de cada símbolo emergente en el Z-Test y la argumentación de las respuestas consisten en un discurso caracterizado por estilos comunicacionales y corrientes psíquicas que dan forma a la personalidad presente en las fases del desarrollo psicosexual: primario y secundario oral, primario y secundario anal, fálico uretral, fálico genital y libido intrasomática. Este trabajo es um rcorte de la tesis doctoral "Um estudo dos símbolos e dos desejos com o Z-Teste e Questionário Desiderativo na avaliação psicológica da personalidade para uso e o porte de armas de fogo, no Brasil" realizada en el Doctorado en Psicología de UCES(AU)

The contributions for the qualitative psychoanalytic interpretation of the Z-Test (Zulliger) proposed here are based on the interpretation of symbols and the predominant wishes from the perspective of the Argentine and Freudian concepts of: Liberman, Maldavsky and Sneiderman. The qualitative analysis of each emerging symbol in the Z-Test and the argumentation of the answers consist of a discourse characterized by communicational styles and psychic currents that shape the personality present in the phases of psychosexual development: primary and secondary oral, primary and secondary anal, phallic urethral, phallic genital and intrasomatic libido. This work is a part of the doctoral thesis "Um estudo dos símbolos e dos desejos com o Z-Teste e Questionário Desiderativo na avaliação psicológica da personalidade para uso e o porte de armas de fogo, no Brasil" carried out in the Doctorate in Psychology at UCES(AU)

Intergenerational financial transfers and physical health of old people in rural China: evidence from CHARLS data / Transferências financeiras intergeracionais e saúde física de idosos na China rural: evidências de dados CHARLS

ABSTRACT: With the reduction of intergenerational temporal transfers, financial transfers from adult offspring to their elderly parents are prevailing in rural China. Although much has been done, little is known about the association between the expansion of intergenerational transfers and rural old people's physical health in China. The purpose of this paper was to examine the effect of intergenerational financial transfers on the elders' physical health in rural China. Using data collected from China Health and Retirement Longitudinal Study (CHARLS), panel data fixed effect model and threshold model are employed to estimate the impact of intergenerational financial transfers on the old people's physical health in rural areas. Results showed that; although, the intergenerational financial transfers have a positive effect on the old people's physical health, no linear relationship exists between them. Intergenerational financial transfers are clearly less effective for low-income old people's physical health than those of middle-income, while the effect on high-income old people's health is the most insignificant. Studies concerning the effect of intergenerational financial transfers on the elders' health in developing countries remain limited. Findings of this paper provided great insights into how intergenerational transfers, such as intergenerational financial transfers, may affect the well-beings of old residents in rural areas. Additionally, this study can offer inspiration to policy makers regarding what measures they should take to enhance rural old residents' well-beings.

RESUMO: Com a redução de transferências temporais intergeracionais, as transferências financeiras da prole adulta a seus pais idosos estão prevalecendo em China rural. Embora muito tenha sido feito, pouco se sabe sobre a associação entre a expansão das transferências intergeracionais e a saúde física dos idosos rurais na China. O objetivo deste artigo é examinar o efeito das transferências financeiras intergeracionais sobre a saúde física dos anciãos na China rural. Usando dados coletados do estudo longitudinal de saúde e aposentadoria da China (CHARLS), o modelo de efeito fixo de dados do painel e o modelo de limiar são empregados para estimar o impacto das transferências financeiras intergeracionais na saúde física dos idosos em áreas rurais. Os resultados mostram que, embora as transferências financeiras intergeracionais tenham um efeito positivo na saúde física dos idosos, não existe relação linear entre eles. As transferências financeiras intergeracionais são claramente menos eficazes para a saúde física de idosos de baixa renda do que as de renda média, enquanto o efeito sobre a saúde de idosos de alta renda é o mais insignificante. Os estudos sobre o efeito das transferências financeiras intergeracionais sobre a saúde dos anciãos nos países em desenvolvimento permanecem limitados. Os achados deste artigo fornecem grandes insights sobre como as transferências intergeracionais, e as transferências financeiras intergeracionais podem afetar o bem-estar de idosos residentes em áreas rurais. Além disso, este estudo pode oferecer inspiração para os decisores políticos sobre as medidas que devem tomar para melhorar o bem-estar dos residentes rurais.

The Magnitude of ADL Improvement was Associated with Discharge Home among Older Stroke Patients in a Convalescent (Kaifukuki) Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.

Recommendations for Assessment and Management of Health-Related Quality of Life in Patients with Mucopolysaccharidoses in Latin America

Abstract Mucopolysaccharidoses (MPS) constitute a heterogeneous group of rare genetic disorders caused by enzymatic deficiencies that lead to the accumulation of glycosaminoglycans (GAGs). Clinical observations suggest a health-related impairment in quality of life in patients with MPS. Professionals with extensive experience in the care of patients with inborn errors of metabolism, such as MPS, held a meeting in April 2017 to discuss and propose recommendations for the evaluation and management of quality of life in MPS patients in Latin America. In the light of this scenario, the present work summarizes the content of the discussions and presents the recommendations produced at the meeting. The panel had suggested the use of the following tools for the assessment of health-related quality of life (HRQoL): Children's Health Assessment Questionnaire (CHAQ) for children and patients unable to express their feelings, Health Assessments Questionnaire (HAQ) and EuroQol 5 Domains (EQ-5D) scales for adult patients. Based on the scores verified in these scales, the panel proposes interventions that aim reducing the impairment of the quality of life in patients with MPS disorders.

Predictor of Activities of Daily Living (ADL) Disability in Patients Undergoing Cardiovascular Surgery / 日本心臓血管外科学会雑誌

Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

A Clinical Analysis of patients seen in a Geriatric Mental Health Camp organized in Mumbai

Background: Geriatric mental health is a neglected domain of mental health and many cases remainundetected in the community. Community programs have often helped to detect many cases of the elderlywith psychiatric problems and help them access care. The current paper aims to present an analysis ofpatients seen in a geriatric health camp from a psychiatric perspective.Methods: 103 elderly attended the geriatric camp and were assessed clinically for psychiatric problems. Theywere also administered the Adenbrooke’s Cognitive Examination Revised (ACE-R) Hindi version, Barthel’sIndex for Activities of Daily Living and 3.Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). Theresults were analyzed statistically and presented.Results: The mean age of the subjects in the study was 66.05 ± 7.9 years. 83 subjects (79%) out of the 105were female. The mean BIADL score of the sample was 19.52 ± 1.9 and on the basis of scores on the ACER they were classified as having cognitive impairment (n=67) and not having cognitive impairment (n=27).The cognitively impaired group differed from the non-cognitive impairment on all subscales of the ACE-R.55 (52.4%) reported the presence of elder abuse but had taken no action against it. The BIADL scores showeda significant correlation on all aspects of ACE-R scores.Conclusions: Geriatric health camps can serve as a useful arena for the detection of geriatric mental healthproblems. Further studies in larger populations are needed to corroborate the findings seen in the geriatrichealth camp reported in this study

Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise for periarthritis / 中国针灸

<p><b>OBJECTIVE</b>To compare the effect difference between acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise and acupuncture.</p><p><b>METHODS</b>Sixty patients with periarthritis were randomly divided into an acupuncture group and an acupuncture combined with exercise group (active acupuncture group), 30 cases in each group. Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) was given in both groups. The active shoulder joint during acupuncture was applied in the active acupuncture group. The treatment was given once every two days, 5 times as one course and a total of 2 courses were required. The activity-related pain (VAS score), shoulder joint activity (Melle score), and daily living ability (ADL score) were observed before and after treatment in the two groups.</p><p><b>RESULTS</b>The VAS score, Melle score and ADL score were significantly lower in the two groups after treatment compared with those before treatment (all <0.05); the VAS score, Melle score, and ADL score in the active acupuncture group were lower than those in the acupuncture group (all <0.05).</p><p><b>CONCLUSION</b>The curative effect of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise on periarthritis is superior to that of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) alone.</p>

Clinical Observation of Grain-sized Moxibustion at Back-Shu Points of Zang-organs for Vascular Cognitive Impairment-no Dementia / 上海针灸杂志

Objective To observe the clinical efficacy and action mechanism of grain-sized moxibustion at Back-Shu points of Zang-organs in treating vascular cognitive impairment-no dementia (VCIND) due to marrow insufficiency. Method Ninety-two patients with VCIND due to marrow insufficiency were randomized into a grain-sized moxibustion group, an electroacupuncture group and a Western medication group. Since the grain-sized moxibustion group and electroacupuncture group each had 1 dropout case, there were 90 valid recruited cases, 30 in each group. Xinshu (BL15) and Shenshu (BL23) were selected as the major points, with Middle Line of Vertex (MS5), Middle Line of Forehead (MS1), Lateral Line 1 of Vertex (MS8), Zusanli (ST36), Sanyinjiao (SP6), Xuanzhong (GB39) and Taixi (KI3) as the adjunct points. The grain-sized moxibustion group and electroacupuncture group respectively received grain-sized moxibustion and electroacupuncture at Xinshu and Shenshu, and the adjunct points were treated with ordinary acupuncture. The intervention was given once a day, successive 5 d a week, and 4 weeks as a course of treatment, for 2 courses in total. The Western medication group was prescribed with oral administration of Piracetam tablet, 0.4 g per dose, 3 times a day, for successive 8 weeks. The clinical efficacies, Montreal Cognitive Assessment (MoCA) and Activities of Daily Living (ADL) scores, homocysteine (Hcy) and folic acid contents in serum were compared among the three groups after 8 weeks. Result The total effective rate was 86.7% (26/30) in the grain-sized moxibustion group, superior to 63.3% (19/30) in the electroacupuncture group and 36.7% (11/30) in the Western medication group (P<0.05,P<0.01). The MoCA and ADL scores and serum contents of Hcy and folic acid were significantly improved after the treatment in the three groups (P<0.01), and the grain-sized moxibustion group was significantly better than the electroacupuncture group and Western medication group (P<0.05,P<0.01), and the electroacupuncture group and superior to the Western medication group (P<0.05). Conclusion Grain-sized moxibustion at Back-Shu points of Zang-organs can produce significant efficacy in treating VCIND due to marrow insufficiency, and the effect is possibly realized by declining Hcy and increasing folic acid levels in blood.

Representaciones psicosociales. Un aporte a la teoría y la investigación en psicología social / Psychosocial representations. A contribution to theory and research in social psychology

Según Freud (1895), tanto el pensamiento teórico como el práctico implican un proceso en el que participa: percepción, atención, observación, discernimiento, juicio, representación, asociación y memoria. En este proceso de pensamiento, el otro es representado como semejante pero también como diferente, y satisfactorio o insatisfactorio, según las cualidades que el yo le atribuya, afines a la colaboración o la rivalidad. Sucesivas asociaciones permiten reproducir la representación, a la cual el juicio de realidad se suma para conformar la creencia, que puede ser compartida por miembros de una comunidad. En este artículo describimos los procesos de pensamiento, centrándonos en las investiduras del yo ante la cualidad percibida, discernida y representada en la alteridad, así como en la relación de la representación con el juicio de realidad y la formación de ideales. Para finalizar, proponemos una metodología de análisis que examina las investiduras y los ideales que el estudio del discurso permite inferir acerca de las representaciones que, al compartirse, devienen sociales. (AU)

According to Freud (1895), both theoretical and practical thinking imply a process in which perception, attention, observation, discernment, judgment, representation, association and memory play a part. In this process, the next person (nebenmensch) is represented as similar but also as different, and satisfactory or unsatisfactory, depending on the qualities attributed to him (her) by the ego, promoting collaboration or rivalry. Successive associations allow the reproduction of representations, to which the reality principle is added and thus beliefs, which may be shared by fellow mates, are instituted. In this article, the thinking process is described, with special focus on: a) the ego investitures stemming from qualities perceived, discerned and represented in alterity, and on b) the relation between representations, the reality principle and the internalization of ideals. To conclude, the author proposes a methodology to examine investitures and ideals inferred from discourse, regarding representations, which, when shared become social. (AU)

La intersubjetividad en tratamientos vinculares que manifiestan situaciones de violencia: procesos de pensamiento en una paciente internada y su posición en relación con sus interlocutores / Intersubjectivity in relational treatments manifesting situations of violence: thinking processes in a hospitalized female patient and her position in relation to her interlocutors

De la complejidad que evidencia el trabajo con parejas y familias el presente desarrollo focalizará el proceso de pensamiento y la posición de una paciente, Nora, internada en un hospital neuropsiquiátrico (por episodios de violencia y delirio), en relación con sus diferentes interlocutores. Partiremos, para dicho estudio, de la definición freudiana de proceso de pensamiento como un desplazamiento de la energía anímica, pulsional, en el camino hacia la acción, hacia la descarga, que va desde lo inconsciente hacia la manifestación. Asimismo, se observarán las posiciones de la paciente a través del estudio de los vínculos intersubjetivos que establece en las entrevistas vinculares durante el tratamiento de internación en sala. Para ello utilizaremos un método de investigación psicoanalítico, el algoritmo David Liberman (ADL) que explora los deseos, las defensas (y su estado) y la combinatoria intersubjetiva. El instrumento aplicado a la muestra fue la grilla para el estudio de los procesos de pensamiento. (AU)

In the context of the complexity of work with couples and families, the author focuses on the thinking process and position of a female patient, hospitalized in a neuropsychiatric hospital (due to episodes of violence and delusions), in relation to her different interlocutors. The author bases this study on the Freudian definition of thinking process as a flow of psychical, libidinal energy on its path towards action, towards discharge, which evolves from the unconscious to manifestation. The patient's positions are also observed through the study of intersubjective links established in joint interviews during her treatment while hospitalized. For this purpose, the author applies a psychoanalytic method of investigation, the David Liberman algorithm (DLA), which explores wishes, defenses (including their state), and intersubjective combinations. The instrument applied to the sample is the chart for the study of thinking processes. (AU)

Correlation between reliability and validity of Brunel balance assessment with activities of daily living / 重庆医学

Objective To explore the correlation between the reliability and validity of Brunel balance assessment(BBA)with the activities of daily living(ADL).Methods The BBA,ADL and walking ability test were performed on 215 patients conforming to the inclusion standard by two professionals.The Pearson correlation analysis,factor analysis and descriptive statistical analysis were adopted.Results The BBA total score and Cronbach's α coefficient in 3 dimensions was 0.852～0.941(P＜0.01),moreover the relative coefficient of each item with its dimension was higher that that of other dimensions;3 common factors were extracted by the factor analysis,the contribution rate was 83.916％;but BBA had the ceiling effect,the relative coefficient of BBA with ADL and walking ability was 0.284-0.709(P＜0.05).Conclusion BBA has a good reliability and validity and can better reflect the functions of ADL and walk.

Characteristics of cognitive dysfunction in essential tremor patients / 西安交通大学学报(医学版)

Objective To explore the characteristics and influencing factors of cognitive dysfunction in patients with essential tremor (ET).Methods We recruited ET patients diagnosed by the Department of Neurology of the First Affiliated Hospital of Xi`an Jiaotong University and healthy volunteers who matched the ET patients in age, gender and education level for the study.We recorded all the patients` demographic information, tremor degree, and family history based on the family tree.All the participants were tested by MMSE, MoCA, ADL, HAMD and HAMA.Results There were 88 ET patients and 63 normal subjects included in the study.According to MMSE, 31.82％ of the patients had cognitive dysfunctions, with orientation, short-term memory, calculation ability, language skills, retelling, reading comprehension, three-level command and drawing being significantly lower than those of the healthy volunteers (P<0.01);orientation was the most serious damage in cognitive function domain (K=0.624, S=0.726);three-level command was the least serious damage (K=0.274, S=0.319).According to MoCA, 86.36％ of the ET patients had cognitive dysfunction higher than normal people (P<0.05);visual space and execution, clock drawing task, naming, attention, 100-7, language skills, abstract thinking and orientation were significantly lower than normal people (P<0.01);the most serious damage in cognitive function domain was visual space and execution (K=0.651, S=0.786); the least serious damage cognitive function domain was “100-7” (K=0.406, S=0.484). Education level and age affected cognitive dysfunction (P<0.05). ADL scores showed negative correlation with cognitive function (correlation =－0.375 and －0.383, respectively; P<0.001). After the effects of anxiety and depression were excluded, onset age and tremor grading were correlated with cognitive dysfunction (P<0.05). When the above factors were put into binary Logistic regression model, education level was found to be contributed to the model (P<0.05).Conclusion Patients with ET widely suffer from cognitive impairment. Age, education level, daily life disability, age of onset, and tremor degree classification can affect cognitive dysfunction.