Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Abstract Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by themost complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia. (AU)

Impact of personal rehabilitation treatment on life quality and curative effect of schizophrenia patients / 中国基层医药

Objective To explore the impact of the personal rehabilitation treatment on life quality and curative offect of the schizophrenia patients.Methods A total of 84 patients with chronic schizophrenia in Shanxi Rongjun Corelle Hospital from December 2016 January 2018 were randomly divided into intervention group and control group on the basis of random number table,the two groups received psychiatric routine therapy nursing and general entertainment therapy,and the intervention group received 8 weeks of individualized rehabilitation therapy on this basis.The Schizophrenics Quality of Life Scale (SQLS) and Positive and Negative Symptoms Scale (PANSS) were respectively used to evaluate the effect of the two groups before and after intervention.Results After 8 weeks of systematic social skills training,the scores of negative symptoms,general psychopathology and total PANSS score in the intervention group were (14.65 ± 3.68) points,(24.21 ± 3.23) points,(52.83 ± 7.12) points,respectively,which in the control group were (21.82 ± 4.25) points,(28.08 ± 4.56) points,(60.67 ± 9.52) points,respectively,the differences between the two groups were statistically significant(t =5.18,3.35,3.92,all P ＜0.01),while the positive symptom score had no statistically significant difference between the two gorups (P ＞ 0.05).The PANSS scores and total score in the intervention group after intervention had statistically significant differences compared with those before intervention (t =2.17,5.98,3.86,4.13,all P ＜ 0.05).After the intervention training,the psychosocial score,motivation and energy score,symptoms and adverse reactions score,and total score of SQLS in the intervention group were (32.64 ±7.32)points,(39.45 ± 10.87) points,(18.16 ± 10.48) points,(90.34 ± 24.17) points,which in the control group were (35.32 ±10.64) points,(43.82 ± 12.43) points,(21.05 ± 11.52) points,(98.25 ± 32.29) points,respectively,and the differences between the two groups were statistically significant (t =2.46,3.51,3.12,3.96,all P ＜ 0.05).The SQLS scores and total score in the intervention group after intervention had statistically significant differences compared with those before intervention (t =3.94,4.72,3.87,5.01,all P ＜ 0.01).Conclusion The personal rehabilitationtreatment can greatly promote the curative offect of patients with chronic schizophrenia,improve their life qualities.

Impact of personal rehabilitation treatment on life quality and curative effect of schizophrenia patients / 中国基层医药

Objective@#To explore the impact of the personal rehabilitation treatment on life quality and curative offect of the schizophrenia patients.@*Methods@#A total of 84 patients with chronic schizophrenia in Shanxi Rongjun Corelle Hospital from December 2016 January 2018 were randomly divided into intervention group and control group on the basis of random number table, the two groups received psychiatric routine therapy nursing and general entertainment therapy, and the intervention group received 8 weeks of individualized rehabilitation therapy on this basis.The Schizophrenics Quality of Life Scale(SQLS) and Positive and Negative Symptoms Scale(PANSS) were respectively used to evaluate the effect of the two groups before and after intervention.@*Results@#After 8 weeks of systematic social skills training, the scores of negative symptoms, general psychopathology and total PANSS score in the intervention group were (14.65±3.68)points, (24.21±3.23)points, (52.83±7.12)points, respectively, which in the control group were (21.82±4.25)points, (28.08±4.56)points, (60.67±9.52)points, respectively, the differences between the two groups were statistically significant(t=5.18, 3.35, 3.92, all P<0.01), while the positive symptom score had no statistically significant difference between the two gorups (P>0.05). The PANSS scores and total score in the intervention group after intervention had statistically significant differences compared with those before intervention (t=2.17, 5.98, 3.86, 4.13, all P<0.05). After the intervention training, the psychosocial score, motivation and energy score, symptoms and adverse reactions score, and total score of SQLS in the intervention group were (32.64±7.32)points, (39.45±10.87)points, (18.16±10.48)points, (90.34±24.17)points, which in the control group were (35.32±10.64)points, (43.82±12.43)points, (21.05±11.52)points, (98.25±32.29)points, respectively, and the differences between the two groups were statistically significant (t=2.46, 3.51, 3.12, 3.96, all P<0.05). The SQLS scores and total score in the intervention group after intervention had statistically significant differences compared with those before intervention(t=3.94, 4.72, 3.87, 5.01, all P<0.01).@*Conclusion@#The personal rehabilitation treatment can greatly promote the curative offect of patients with chronic schizophrenia, improve their life qualities.

Deficiência: uma heurística para a condição humana / Disability: a heuristic for the human condition / Discapacidad: una heurística para la condición humana

Resumen Estudio de naturaleza teórica donde se evidencia la discapacidad como dispositivo heurístico para indagar la condición humana. La relación entre discapacidad y condición humana ha sido poco explorada. En la primera sección se analiza cómo vulnerabilidad y dependencia pertenecen a la condición humana e inciden en la discapacidad condicionando la pérdida de cualidades. Posteriormente se analiza la modalidad peculiar de posesión de las mismas. En la tercera parte se argumenta cómo a pesar de que con la discapacidad intelectual puede no manifestarse la racionalidad esto no supone una exclusión de la condición personal. Por último, se explica cómo no obstante con la discapacidad se puedan perder cualidades, no es posible perder la corporeidad y la pertenencia a la familia humana. Se empleó el enfoque heurístico con la formulación de preguntas apoyándose en tres casos hipotéticos. La discapacidad es un modo de manifestarse de la condición humana con valor heurístico porque ayuda a examinar aspectos constitutivos de nuestra existencia.

Abstract A theoretical study in which disability is evidenced as a heuristic device to investigate the human condition. The relationship between disability and human condition has been little explored. The first section analyzes how vulnerability and dependence belong to the human condition and affect disability by conditioning the loss of qualities. Subsequently, the peculiar modality of possession of our qualities is analyzed. The third part argues that even though a human being with intellectual disability may not manifest rationality this does not suppose an exclusion of the status of person. Finally, it is explained how, although qualities can be lost with the disability, it is not possible to lose the embodiment and belonging to the human family. The heuristic approach was used with the formulation of questions based on three hypothetical cases. Disability is a manifestation of the human condition. It has heuristic value because it helps to examine constitutive aspects of our existence.

Resumo Estudo teórico em que a deficiência é evidenciada como dispositivo heurístico para sondar a condição humana. A relação entre deficiência e condição humana tem sido pouco explorada. A primeira seção analisa como vulnerabilidade e dependência pertencem à condição humana e afetam a deficiência, condicionando a perda de qualidades. Posteriormente, a ideia de posse de nossas qualidades é analisada. Na terceira parte se argumenta que, embora um ser humano com deficiência intelectual não possa manifestar racionalidade, isso não supõe a exclusão do status pessoal. Por último, se explica como, apesar de ser possível perderem-se qualidades na deficiência, não é possível perder a corporeidade e o pertencimento à família humana. A abordagem heurística foi utilizada com a formulação de questões com base em três casos hipotéticos. A deficiência é uma manifestação da condição humana e tem valor heurístico porque ajuda a examinar aspectos constitutivos de nossa existência.

Biochemical and hematological evaluation in subjects with intellectual disability associated or not to Down syndrome / Avaliação bioquímica e hematológica em indivíduos com deficiência intelectual associada ou não à síndrome de Down

ABSTRACT Down syndrome (DS) is one of the most leading causes of intellectual disability. The aim of this study was to compare biochemical and hematological parameters, triglyceride/high-density lipoprotein cholesterol (HDL-C) and neutrophil/lymphocyte ratios in individuals with intellectual disabilities (ID) associated or not with DS. The main result is the lower HDL-C level in individuals with DS than in the ID group, suggesting a modification in the lipid profile whose origin would lie in genetic alterations. However, further researches are important to analyze if there is any link between trisomy 21 and the reduction of plasma HDL-C levels in individuals with DS.

RESUMO A síndrome de Down (SD) é uma das principais causas de deficiência intelectual. Os objetivos deste estudo foram comparar parâmetros bioquímicos e hematológicos, bem como encontrar a relação triglicerídeo/colesterol da lipoproteína de alta densidade (HDL-C) e a razão neutrófilo/linfócito em indivíduos com deficiência intelectual (DI) associada ou não à SD. O principal resultado foi a diminuição do HDL-C em indivíduos com SD quando comparados àqueles com DI, sugerindo que essa modificação no perfil lipídico pode se relacionar com alterações genéticas. Portanto, pesquisas adicionais são importantes para analisar se existe ligação entre a trissomia 21 e a redução dos níveis de HDL-C em indivíduos com SD.

Lived Experience of Primary Caregivers of People with Mental Disability / 정신간호학회지

PURPOSE: This phenomenological study was done to explore in-depth understanding of the lived experience of primary caregivers of people with mental illness. METHODS: Participants were 7 primary caregivers and data were collected from November 2017 to February 2018. Giorgi's phenomenological method was used in this study. The caregiving experiences were categorized into separate types of situational structures in terms of specific and general descriptions. RESULTS: Six clusters and fourteen sub-clusters were identified. The 6 clusters were found to be ‘Embarrassing encounter with a disease’, ‘Sustained regret and self-defeating’, ‘Family life of constant oppression’, ‘Confinement of a mental illness’, ‘Nagging label of mental illness’, and ‘Recognizing the disease as a fate and taking courage’. CONCLUSION: The study findings emphasize the importance of both local and national support and the provision of information designed for primary caregivers of people with mental disability. Psychiatric nurses should understand and consider the growing number of increasing social prejudices, stigma, and caregiver burden so as to improve interpersonal relationships brought about by mental illness.

Overcoming Internalized Stigma in Persons with Psychiatric Disabilities / 정신간호학회지

PURPOSE: This phenomenological study was done to identify comprehensively and in depth the experience of overcoming internalized stigma in persons with psychiatric disabilities. METHODS: Data were collected from December 2015 to June 2016 with 10 persons who had psychiatric disabilities. The participants took part in interviews on their experiences of overcoming stigma. The collected data were analyzed using Colaizzi method. RESULTS: From the raw data obtained from the study participants, 12 themes and 5 theme clusters were identified. The 5 theme clusters were found to be ‘being locked up in one's own stigma’, ‘trying to escape from the self in constraints’, ‘overcoming oneself by oneself’, ‘getting to see the true self’, and ‘living the life desired’. CONCLUSION: Study findings indicate the necessity of developing a mediation program to reduce and overcome the internalized stigma in the persons with psychiatric disabilities. A national and social effort is necessary for persons with psychiatric disabilities to help them overcome the internalized stigma.

Concept Analysis of Motivation for Vocational Rehabilitation in Persons with Mental Disabilities / 정신간호학회지

PURPOSE: This study was conducted to analyze and clarify the concept of 'motivation for vocational rehabilitation in persons with mental disabilities'. METHODS: A hybrid model was used to analyze the concept of motivation for vocational rehabilitation in persons with mental disabilities. The model included a comprehensive literature review and field study. Field study was conducted through in-depth interviews with 5 persons with mental disabilities who had employment experience and participant observation in rehabilitation facilities. RESULTS: The concept of motivation for vocational rehabilitation in persons with mental disabilities was found to be a complex phenomenon having meaning in two dimensions: Goal-oriented and cognitive dimensions. Five attributes and fourteen indicators were defined. Motivation for vocational rehabilitation in these persons was defined as a recognition of the need to get a job, and the willingness and confidence to get and keep a job in order to achieve normal life, happiness, economic stability, and their value. CONCLUSION: The findings from this study will contribute to the development of assessment tools and nursing interventions to reinforce the motivation for vocational rehabilitation in persons with mental disabilities.

Sujeitos deficientes intelectuais: o papel da linguagem na dinâmica familiar / Intellectual disability subjects: the role of language in family dynamics / Sujetos con discapacidad intelectual: el papel del lenguaje en la dinámica familiar

Objetivo: desenvolver a compreensão sobre o papel da linguagem de deficientes intelectuais na dinâmica de suas famílias. Método: trata-se de uma pesquisa qualitativa de caráter retrospectivo observacional em que foram analisados relatos obtidos no contexto do grupo terapêutico fonoaudiológico. Foram realizadas transcrições de gravações, em vídeo, de encontros dos grupos terapêuticos de pais de deficientes intelectuais. Foram selecionados para análise relatos colhidos em três reuniões, nas quais os pais falaram sobre a linguagem de seus filhos. As categorias de análise selecionadas para o presente estudo foram: interesse das mães sobre a linguagem; dificuldade de compreender os filhos; dificuldade de ser compreendida pelos filhos; e, estigmatização. Resultados: verificou-se, por meio da análise dos resultados, que a linguagem é um tema de grande interesse das famílias, inclusive porque as características da linguagem desses sujeitos contribuem fortemente para sua estigmatização. Observou-se, também, que a forma como os pais se posicionam quanto à linguagem de seus filhos relaciona-se ao modo como se estabelecem as relações familiares, com consequências diretas para o desenvolvimento do sujeito deficiente. Conclusões: a troca de experiências entre participantes do grupo favoreceu a (re)significação de seus anseios, e da visão a respeito das potencialidades de seus filhos. Os pais reconheceram o papel essencial da linguagem como função social, bem como sua importância para a compreensão entre pais e filhos. A estigmatização do sujeito com deficiência esteve presente em todas as categorias de análise, o que sugere que as reuniões devam ser constantes, favorecendo as trocas e (re)significações.

Objective: develop the comprehension of the role of language of intellectually disabled subjects in their family dynamics. Methods: this is a qualitative retrospective observational study, where there were analyzed the reports obtained in the context of a speech therapy group. There were carried transcriptions of video recordings of meetings of therapeutic groups for parents of intellectually disabled subjects. There were selected for analysis the accounts collected in three meetings, in which parents talked about their children?s language. The categories of analysis selected for this study were: the interest of mothers on language, the difficulty of understanding the children, the difficulty of being understood by children, and stigmatization. Results: it was found, by analyzing the results, that language is a topic of great interest for families, also because the language characteristics of these subjects strongly contribute to the stigmatization of them. It was also observed that the way parents are positioned in respect to their children language is related to how family relationships are established, with direct consequences for the development of persons with disability. Conclusion: the exchange of experiences among the group participants favored the (re)signification of their wishes, and of the vision of the potential of their children. Parents recognized the essential role of language as a social function, as well as its importance for the understanding between parents and children. The stigmatization of the subject with disability was present in all categories of analysis, suggesting that the meetings should be constant, encouraging exchanges and (re)significations.

Objetivo: desarrollar la comprensión sobre el papel del lenguaje de discapacitados intelectuales en la dinámica de sus familias. Método: se trata de investigación cualitativa de caracter retrospectivo observacional en que se analizaron informes obtenidos en el contexto de un grupo terapéutico fonoaudiológico. Se realizaron transcripciones de grabaciones, en videos, de reuniones de grupos terapéuticos para los padres de discapacitados intelectuales. Se seleccionaron para el análisis informes cojidos en tres sesiones, en las que los padres hablaron sobre el lenguaje de sus hijos. Las categorías de análisis seleccionadas para este estudio fueron: interés de las madres sobre lenguaje; dificultad de comprensión de los niños, dificultad de ser entendida por los niños; y estigmatización. Resultados: se encontró, mediante el análisis de los resultados, que el lenguaje es un tema de gran interés de las familias, entre otras razones porque las características del lenguaje de estos sujetos contribuyen fuertemente para su estigmatización. Se observó también que la manera como los padres se posicionan a respeto del lenguaje de sus hijos está relacionado al modo como las relaciones familiares se establecen, con consecuencias directas para el desarrollo de la persona con discapacidad. Conclusión: el intercambio de experiencias entre los participantes de los grupos favoreció la (re)significación de sus deseos, y de la visión a respeto del potencial de sus hijos. Los padres reconocieron el papel esencial del lenguaje como función social, así como su importancia para el entendimiento entre padres e hijos. La estigmatización del sujeto con una discapacidad estuvo presente en todas las categorías de análisis, lo que sugiere que las sesiones deben ser constantes, para favorecer los intercambios y (re)significaciones.

Modeling of Recovery Profiles in Mentally Disabled and Intact Patients after Sevoflurane Anesthesia; A Pharmacodynamic Analysis

PURPOSE: Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. MATERIALS AND METHODS: Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). RESULTS: End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and gamma value were lower in the mentally disabled patients (C50=0.37 vol %, gamma=16.5 in mentally intact patients, C50=0.19 vol %, gamma=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and gamma value to pharmacodynamic model. CONCLUSION: A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients.

Social cognitive performance and different communication settings in groups of children with different disorders / Desempenho sócio-cognitivo e diferentes situações comunicativas em grupos de crianças com diagnósticos distintos

PURPOSE: To investigate the social-cognitive performance of children with diagnostics of autism spectrum disorder (ASD), mental disability (MD) and hearing impairment (HI) in two different communicative situations. METHODS: Participated in this study 30 children ages between 3 and 12 years starting speech language therapy processes, divided in three groups: Group 1 - ten children with diagnoses included in the Autism Spectrum Disorders (ASD); Group 2: ten children diagnosed with mental disabilities (MD) and Group 3: ten children diagnosed with hearing impairment (HI). The subjects were assessed in two different communicative situations (group and individual therapy situation) for 12 months. RESULTS: Data regarding the performance of the three groups in the two situations show that G3 had better absolute performance when compared with other groups, with the variable symbolic play as an important differential criterion for the three groups. CONCLUSION: We conclude that the social-cognitive performance can be used as an auxiliary tool for intervention, helping the identification of variables that could interfere in the communicative performance.

OBJETIVO: Verificar o desempenho sócio-cognitivo de crianças com diagnósticos inseridos nos distúrbios do espectro do autismo (DEA), deficiência mental (DM) e deficiência auditiva (DA) em duas diferentes situações comunicativas. MÉTODOS: Participaram desta pesquisa 30 crianças, entre 3 e 12 anos de idade, em início de atendimento fonoaudiológico, que foram divididas em três grupos: Grupo 1: dez crianças com diagnóstico inserido nos distúrbios do espectro do autismo (DEA); Grupo 2: dez crianças com diagnóstico de deficiência mental (DM); Grupo 3: dez crianças com diagnóstico dentro do grupo de deficiência auditiva (DA). Os sujeitos foram analisados em duas situações comunicativas distintas (situação em grupo e situação individual de terapia), durante 12 meses. RESULTADOS: O grupo composto por crianças e adolescentes com diagnóstico de deficiência auditiva apresentou melhor desempenho absoluto quando comparado com os outros grupos, sendo a variável jogo simbólico um importante critério diferencial nos três grupos. CONCLUSÃO: O desempenho sócio-cognitivo pode ser utilizado como instrumento auxiliar no planejamento terapêutico, facilitando a identificação de variáveis que possam interferir no desempenho comunicativo.

Sexualidade e deficiência intelectual: um curso de capacitação para pais / Sexuality and mental retardation: training course for parents

A literatura aponta que a educação sexual de jovens com deficiência intelectual suscita diversas dificuldades entre as famílias, pois muitas não estão preparadas para lidar com essa questão. Diante dessa necessidade, o objetivo deste estudo foi planejar, aplicar e avaliar um programa de intervenção (curso)para nove pais de jovens com deficiência intelectual de uma escola especial de uma cidade do interior de São Paulo. O curso durou dois meses, tendo oito encontros semanais, e teve caráter teórico e prático, com discussões, dinâmicas de grupo, atividades de role-playing, atividades de resolução de problemas e filmes. Por meio de uma avaliação sobre o curso, e também por meio de entrevistas, perceberam-se alguns ganhos advindos do curso, como aprendizado de conteúdos, troca de experiências e ajuda no cotidiano doméstico. Foram notadas também algumas mudanças, como quebra de preconceitos e alteração nas interações pais/filhos, além de revisão de sua postura como educadores sexuais.

Literature points sexual education of mentally disabled youngsters as a source of difficulties for families, once many of them aren’t ready to deal with that matter. Considering that, the goal of this study was to design, apply and assessan intervening program (course) on nine parents of mentally disabled youngsters from a special school at a city in São Paulo state. The course lasted two months, in which time eight weekly meetings, of the oretical and practical character, with discussions, group dynamics, role-playing and problem-solving activities, and films exhibitions, were held. By means of an assessment of the course and the interviews, we could notice some gain resulting from the course, like contents learning, exchange of experiences and help in the domestic routine. We could notice also some shift, such as breaking of prejudices and alterations in the parents-children interactions, as well as a revision of their attitude as sexual educators.

Los derechos civiles de las personas con discapacidad mental en Colombia: una actualización tardía y restringida / Civil rights of persons with mental disabilities in Colombia: a late and restricted update

Introducción: La producción legislativa y la aplicación del derecho son el resultado de la relación de fuerzas y del consenso entre los miembros de la comunidad jurídica, la sociedad civil y los profesionales. El conocimiento de los instrumentos internacionales de promoción de derechos y el ordenamiento jurídico interno en el campo de la salud mental deben permitir a los profesionales y técnicos asumir su papel de veedores para que la brecha entre las declaraciones formales y las prácticas efectivas sea cada vez menor. Su prioridad guarda relación con la creciente carga personal, económica y social; además de la fuerte carga de estigma y discriminación de la que han sido objeto las personas señaladas como enfermas mentales. Objetivo: Analizar los alcances de la Ley 1306 de junio de 2009, específicamente en lo atinente a los derechos civiles de las personas con discapacidad mental, en el marco de las convenciones internacionales suscritas por el país. Resultados: Aunque persisten grandes inconsistencias formales y prácticas para hacer efectivos los derechos de las personas con discapacidad mental, se emprende un camino, aún restringido, en su reconocimiento gradual. Conclusiones: Es urgente la acción y el fortalecimiento de la movilización social, a fin de asumir los desafíos y posibilidades del marco normativo y de lograr instalar la diversidad y pluralidad como condición de una real sociedad democrática...

Introduction: Legislative production and law enforcement are the results of the balance of power and consensus among members of the legal community, civil society, and professionals. The knowledge of international instruments for promoting rights and domestic law in the field of mental health should enable technical professionals to assume their role as providers in order to reduce the gap between formal statements and actual practices. This priority is related to the growing personal, economic and social burden, in addition to the heavy burden of stigmatization and discrimination targeted at persons who have been identified as mentally ill. Objective: To analyze the scope of “Law 1306” of June 2009, specifically as it regards the civil rights of persons with mental disabilities, within the framework of international conventions signed by the country. Results: Although major formal and practical inconsistencies persist in making effective the rights of persons with mental disabilities, there is a beginning —still modest— in their gradual recognition. Conclusions: It is urgent to act and to strengthen social mobilization in order to face the challenges and the possibilities of the normative framework and to achieve the development of diversity and plurality as a condition of a real democratic society...

Attitude of Persons with an Mental Disability to Marriage: Q Methodological Approach / 정신간호학회지

PURPOSE: The purpose of this study was to identify the attitude of persons with an mental disability to marriage. METHODS: The Q-methodology which provides a method of analyzing the individual's subjectivity was used. The 30 participants classified 36 selected Q-statements on a 9 point scale to make a normal distribution. The collected data was analyzed by a PC Quanl Program. RESULTS: Four types of attitude of persons with an mental disability to marriage were identified. Type I: Actively supportive-resistant against social bias, Type II: Passively supportive-reliant on others, Type III: Intensively desiring-less sense of reality, Type IV: Controlling desire-more sense of reality. CONCLUSION: The results of this study suggest a need develop a variety of programs specifically designed for each type of attitude to change attitudes to marriage for persons with an mental disability.

Desempenho da tarefa transferência lateral, da bateria de teste KTK, em pessoas com deficiência mental / Performance in task lateral transfer, the battery of test KTK, of persons with mental disability

Introdução - Este estudo analisou o desempenho de indivíduos com deficiência mental resultante de avaliações pré e pós-intervenção, em que foi utilizada uma prática sequencial. O instrumento de avaliação utilizado foi a tarefa transferência lateral, que faz parte da bateria de testes KTK4, que avalia a coordenação motora de crianças e adolescentes. Material e Métodos - A amostra foi constituída por nove sujeitos, de ambos os sexos, com idades entre 6 e 11 anos, da APAE de Rolândia/PR. O teste "t" de Student, apontou diferenças estatisticamente significativas, em nível de p<0,05, apresentando os sujeitos, portanto, um bom nível de desempenho. Resultados - Os resultados médios do pré-teste foram de 16,4. No pós-teste desta tarefa, o grupo obteve crescimento, atingindo uma média de 23,2. Conclusões - Estes dados podem indicar um referencial de que um Programa de Educação Física Orientado provocou nos sujeitos do estudo uma melhora ou progresso na coordenação motora, especificamente na transferência lateral, de sujeitos com deficiência mental.

Introduction - This study examined the performance of individuals with mental disability resulting from evaluations pre and post intervention, on that was used sequential practice. Material and Methods - The instrument used was the task lateral transfer, part of the battery of tests KTK4, which evaluates the motor coordination in children and adolescents. The sample consisted of nine subjects of both sexes, aged between 6 and 11 years, of APAE from Rolândia/PR. The test "t" Student, showed statistically significant differences in level of p <0.05, presenting the subjects a good level of performance. Results - The average results of the pre-test were of 16.4. In the post-test of this task, the group achieved growth, reaching an average of 23.2. Conclusions - These data may indicate that the reference to a programme of Oriented Physical Education caused in subjects of the study an improvement or progress in motor coordination, specifically in lateral transfer of subjects with mental disability.

Internação psiquátrica: ouvindo quem passou pela experiência / Psychiatric hospitalization: listening to those who experienced it / Internación psiquiátrica: escuchando a quien vivió la experiencia

Trata-se de um estudo qualitativo de abordagem fenomenológica, com o objetivo de elucidar o fenômeno "estar internado em uma ala de psiquiatria de um hospital geral", com base no relato de quem o vivenciou. Participaram desse estudo oito clientes internados na enfermaria psiquiátrica do Hospital das Clínicas de Marília (HC), por meio de duas entrevistas semiestruturadas, gravadas e transcritas. A primeira entrevista ocorreu nos primeiros cinco dias de internação e a segunda, próxima ao momento da alta hospitalar. A análise das entrevistas se deu mediante a união das falas concordantes em oito unidades temáticas: 1. história da doença; 2. relações familiares; 3. sentimentos envolvidos durante a internação; 4. impressões sobre a ala e o atendimento; 5. influência da religião; 6. medicações; 7. internações antigas em hospitais psiquiátricas; e 8. perspectiva para o futuro. Os resultados mostram que a doença psiquiátrica gera grande sofrimento, que, quando intensificado, torna-se motivo para a internação. As relações familiares patológicas e o uso incorreto das medicações também foram vistos como agravantes desse sofrimento. A religião foi percebida como um fator que exerce grande influência nos pacientes psiquiátricos, tanto de forma prejudicial como fonte de conforto. A internação foi relatada por alguns dos entrevistados como de difícil aceitação a princípio, mas houve reconhecimento dos benefícios no decorrer dela, quando constataram que estavam mais preparados para voltar a conviver em sociedade e vislumbraram suas expectativas para o futuro.

This is a qualitative study with a phenomenological approach that aims to elucidate the phenomenon of "being hospitalized in a psychiatric ward", considering the reports of those who experienced it. Eight patients admitted in a psychiatric ward of the Clinical Hospital of Marilia underwent two semi-structured interviews which were recorded and then transcribed. The first interview was performed within five days of admission and the second one was obtained at the moment of hospital discharge. Patient's reports were analyzed and separated in eight thematic groups: 1) history of the disease; 2) family relationships; 3) feelings during the hospitalization; 4) impressions about the ward and the treatment; 5) influence of religion; 6) medication; 7) previous hospitalization in psychiatric institution, and 8) perspectives for the future. Results show that psychiatric diseases cause great suffering, which may become a reason for hospitalization. Moreover, pathologic family relationships and incorrect use of medications seem to enhance suffering. Religion also seems to have an effect on psychiatric patients, either in a positive or in a negative way. Reports show that patients find it hard to accept hospitalization at first, but they recognize its benefits during the process, when they are able to go back home and relate their perspectives for the future.

Se trata de un estudio cualitativo de enfoque fenomenológico con el objetivo de elucidar el fenómeno de "estar internado en una ala de psiquiatría de un hospital general", a partir del relato de quien lo vivió. Participaron ocho clientes internados en la enfermería psiquiátrica del Hospital de las Clínicas de Marília (HC), a través de dos entrevistas semiestructuradas, grabadas y transcritas. La primera entrevista ocurrió en los primeros cinco días de internación y, la otra, cerca del alta hospitalaria. El análisis de las entrevistas se realizó vinculando las respectivas charlas en ocho unidades temáticas: 1) historia de la enfermedad; 2) relaciones familiares; 3) sentimientos durante la internación; 4) impresiones sobre el ala y la atención; 5) influencia de la religión; 6) medicación; 7) internaciones antiguas en hospitales psiquiátricos; y 8) perspectivas para el futuro. Los resultados muestran que la enfermedad psiquiátrica genera mucho sufrimiento y que, cuando se intensifica, se torna motivo para la internación. La relaciones familiares patológicas y el uso incorrecto de los medicamentos agravan el sufrimiento. La religión fue percibida como un factor que ejerce mucha influencia en los pacientes psiquiátricos, ya sea de forma perjudicial o como fuente de confort. La internación fue relatada como de difícil aceptación al principio; sin embargo, más tarde se reconocieron sus beneficios cuando algunos de los entrevistados afirmaron estar más preparados para volver a convivir en sociedad y pudieron relatar sus expectativas para el futuro.

Calidad de vida relacionada con la salud en personas con discapacidad intelectual en España / Health-related quality of life among people with intellectual disabilities in Spain

Objetivo. Establecer la calidad de vida relacionada con la salud (CVRS) percibida por las personas con discapacidad intelectual en la provincia de Salamanca, España. Métodos. Estudio descriptivo transversal de base poblacional. Se aplicó el cuestionario desalud SF-36, adaptado y validado para la población española, a 265 personas con discapacidad intelectual de la provincia de Salamanca, España. Se realizaron entrevistas personales a losparticipantes en presencia de sus padres, tutores o familiares cercanos. Se exploraron ocho dimensiones de la calidad de vida: salud general, función física, rol físico, rol emocional, funciónsocial, dolor corporal, vitalidad y salud mental a partir de variables sociodemográficas y de estilo de vida, utilización de servicios de salud, necesidades de apoyo, y estado de salud y CVRS. Resultados. De las 265 personas estudiadas, 69,8% eran hombres y 30,2% eran mujeres (edad media: 35 años; mínima: 16; máxima: 72). Las puntuaciones máximas obtenidas correspondieron a las dimensiones rol físico y función física (por encima de 85 puntos) y las mínimas, a salud general y vitalidad (por debajo de 70 puntos). No se observaron diferencias significativasentre los hombres y las mujeres en ninguna de las ocho dimensiones. Las variables independientes edad, ingresos familiares, nivel educacional y necesidad de apoyo presentaronla mayor cantidad de asociaciones independientes con las dimensiones salud general, función física y función social. De los participantes, 41,5% manifestó que su salud percibida era buena. Conclusiones. Los participantes en este estudio percibieron su CVRS como buena, especialmente en las dimensiones rol físico y función física. Se deben diseñar estudios para evaluarla CVRS en personas con diferentes grados de discapacidad intelectual para contribuir a elaborar intervenciones y programas sanitarios y sociales específicos para esta población...

Objective. To measure health-related quality-of-life (HRQL) among people with intellectual disabilities in the province of Salamanca, Spain. Methods. A population-based, cross-sectional descriptive study. The SF-36 HealthSurvey, adapted and validated for the Spanish population, was selected and administered to 265 people with intellectual disabilities in the province of Salamanca, Spain. Personal interviews were also conducted with the participants in the presence of theirparents, tutors, or close family. Eight quality-of-life scales were explored: general health, physical functioning, role–physical, bodily pain, role–emotional, social functioning, vitality, and mental health, based on questions on sociodemographic and lifestyle variables, health services utilization, support needs, and health status andHRQL. Results. Of the 265 people studied, 69.8% were men and 30.2% were women (median age: 35 years; minimum: 16; maximum: 72). The highest number of points pertainedto role–physical and physical functioning (more than 85 points), and the lowest,to general health and vitality (less than 70 points). No significant differences were found between men and women for any of the eight components. The independent variables, age, family income, level of education, and support needs showed the greatest number of independent associations with the general health, physical functioning,and social functioning components. Of the participants, 41.5% indicated thatthey felt their health was good. Conclusions. The study participants perceived their HRQL to be good, especially on the role–physical and physical functioning scales. Additional studies should be designed to evaluate HRQL in people with different degrees of intellectual disability to further contribute to intervention efforts and health and social programs designedspecifically for this population group and to evaluate the interventions and program already underway.

The Effects of Psychosocial Rehabilitation Programs on the Levels of Self-Efficacy for Mentally Disabled Persons

PURPOSE: This study investigated the effects of psychosocial rehabilitation programs provided by a psychosocial rehabilitation center on the levels of self-efficacy for mentally disabled persons. We followed the study subjects for 2 yr in order to examine whether the psychosocial rehabilitation programs had a positive impact on their levels of self-efficacy. METHODS: There were 18 subjects in the experimental group and they received all the psychosocial rehabilitation services available at the psychosocial rehabilitation center for 2 yr. In the comparison group, there were 17 participants who voluntarily refused to participate in the psychosocial rehabilitation programs. RESULTS: The results indicated that the psychosocial rehabilitation programs were effective in increasing the levels of the self-efficacy total score and specific self-efficacy score. CONCLUSION: The overall study results indicated that psychosocial rehabilitation programs provided by a psychosocial rehabilitation center had a positive impact on increasing the levels of self-efficacy for mentally disabled persons.

A organização de rede social: as associações de familiares dos serviços de saúde mental / The organization of social networks - family associations and mental health services / La organización de red social - las asociaciones de familiares de servicios de salud mental

Este estudo tem como objetivo compreender, na visão de familiares, o papel das associações de usuários e familiares dos serviços de saúde mental perante as propostas preconizadas pela Reforma Psiquiátrica. Os cenários utilizados foram a Associação Franco Basaglia (SP) e a Associação de Amigos, Familiares e Doentes Mentais do Brasil (RJ). A coleta de dados constou de consulta aos documentos relativos à criação e à organização das duas associações e realização de entrevistas semi-estruturadas. Foram feitas dez entrevistas com familiares que ocupam cargos de direção nas Associações. A investigação revelou que as associações representam uma rede de apoio e solidariedade para os familiares. Elas se tornam, também, locais de reivindicações e de luta dos familiares em face das políticas públicas para a área da saúde mental. Essa posição é compartilhada pelos familiares tanto da AFB como da AFDM, que percebem essas entidades como instâncias de proteção aos direitos dos familiares e dos usuários na assistência em saúde mental.

Este estudo tem como objetivo compreender, na visão de familiares, o papel das associações de usuários e familiares dos serviços de saúde mental perante as propostas preconizadas pela Reforma Psiquiátrica. Os cenários utilizados foram a Associação Franco Basaglia (SP) e a Associação de Amigos, Familiares e Doentes Mentais do Brasil (RJ). A coleta de dados constou de consulta aos documentos relativos à criação e à organização das duas associações e realização de entrevistas semi-estruturadas. Foram feitas dez entrevistas com familiares que ocupam cargos de direção nas Associações. A investigação revelou que as associações representam uma rede de apoio e solidariedade para os familiares. Elas se tornam, também, locais de reivindicações e de luta dos familiares em face das políticas públicas para a área da saúde mental. Essa posição é compartilhada pelos familiares tanto da AFB como da AFDM, que percebem essas entidades como instâncias de proteção aos direitos dos familiares e dos usuários na assistência em saúde mental.

El objeto del presente estudio es comprender, desde el punto de vista de los familiares, el rol de las asociaciones de usuarios y familiares de los servicios de salud mental frente a las propuestas de la Reforma Psiquiátrica. Los escenarios utilizados fueron la Asociación Franco Basaglia (SP) y la Asociación de Amigos, Familiares y Enfermos Mentales de Brasil (RJ). La colecta de datos constó de consulta de documentos relativos a la creación y organización de las dos asociaciones y entrevistas semiestructuradas. Se realizaron diez entrevistas a familiares que ocupan cargos de dirección en las asociaciones. La investigación reveló que, para los familiares, las asociaciones representan una red de apoyo y solidaridad y que también se transforman en lugares donde pueden reivindicar su lucha ante las políticas públicas para el área de salud mental. Tanto los familiares de la AFDN como los de la AFB comparten la misma postura: ven las entidades como instancias de protección de los derechos de familiares y usuarios en la asistencia a la salud mental.

Ejercicio de la autonomía en discapacitados mentales

El ejercicio de la autonomía adquiere características peculiares en individuos con alguna discapacidad mental y se halla en dependencia del grado o severidad de su afección. Se abordan diferentes criterios al respecto con el objetivo de promover el debate sobre el tema.

The exercise of autonomy adquires particular characteristics in those individuals with some mental discapacity and it depends on the level or severity of such affection. A number of criteria in this regard are addressed in this paper so as to promote discussions on this issue.