Factores que Afectan la Percepción de Dolor ¿Cómo Influyen en la Toma de Decisiones Clínicas durante el Proceso de Rehabilitación Kinesiológica? / Factors That Affect Pain Perception: How Do They Influence Clinical Decision Making During the Kinesiological Rehabilitation Process?

Introducción. La percepción del dolor es un fenómeno complejo y subjetivo. Comprender los factores que afectan en la percepción del dolor es crucial en el contexto de la toma de decisiones clínicas durante el proceso de rehabilitación kinesiológica. Objetivo. Exponer los factores que afectan la percepción del dolor, desde la perspectiva del modelo biopsicosocial y discutir sus implicancias para la toma de decisiones clínicas. Métodos. Se describen factores que afectan la percepción de dolor, separados en biológicos como la injuria, sexo, genética y edad, psicológicos como creencias, catastrofismo, kinesiofobia, afectividad negativa, calidad de sueño, atención, afrontamiento y autoeficacia; y socio-culturales como soporte social, rol de género, etnia, aculturación y estatus socioeconómico. Luego se discute cómo estos factores impactan en las decisiones clínicas del profesional kinesiólogo. Finalmente, se entregará un análisis de las barreras y facilitadores descritos por la literatura científica respecto al uso del modelo biopsicosocial.

Background. The perception of pain is a complex and subjective phenomenon. Thus, understanding the factors that influence pain perception is crucial in the context of clinical decision-making during the kinesic rehabilitation process. The objective of this article is to expose the factors that affect the perception of pain, from the perspective of the biopsychosocial model and discuss its implications for clinical decision making during this process. Initially, the biological, psychological and sociocultural factors that affect the perception of pain with the greatest presence in the scientific literature are described. It is discussed how these factors impact the clinical decisions of the kinesiologist professional. Finally, an analysis of the barriers and facilitators described by the scientific literature regarding the use of the biopsychosocial model will be provided.

Centros Especializados em Reabilitação: avaliando os desafios à implementação do modelo biopsicossocial nas práticas assistenciais à pessoa com deficiência / Specialized rehabilitation centers: assessing the challenges in implementing the biopsychosocial model in caring for people with disabilities / Centros Especializados en Rehabilitación: evaluación de los desafíos para la implementación del modelo biosicosocial en las prácticas asistenciales para la persona con discapacidad

Avaliamos, em conjunto com profissionais dos serviços, os desafios à implementação do modelo biopsicossocial nos Centros Especializados em Reabilitação. Por meio da articulação da Avaliação de Quarta Geração e Roda de Conversa (Método Paideia), abordamos os modelos implementados de assistência à pessoa com deficiência, partindo das seguintes questões: trabalhar em reabilitação; prontuário e avaliação; atendimento compartilhado e qualificação da alta. Do conteúdo das rodas emergiram três categorias empíricas: o processo de trabalho em reabilitação; o trabalho em rede; o modelo de cuidado. A identificação de entraves e facilitadores poderá favorecer a plena implementação do modelo biopsicossocial na atenção às pessoas com deficiência, gerando subsídios para o avanço rumo à integralidade do cuidado às pessoas com deficiência representado neste modelo.

We assessed challenges in implementing the biopsychosocial model in specialized rehabilitation centers together with the professionals working in these services. Using fourth generation assessment and conversation circles (the Paideia method), we explored models of care for people with disabilities focusing on the following issues: working in rehabilitation; health records and evaluation; shared appointments; and improving discharge. Three empirical categories emerged from the conversation circles: rehabilitation work processes; the network-based approach; and the care model. The identification of constraints and enabling factors can help promote the effective implementation of the biopsychosocial model, generating important insights to help drive progress towards the delivery of comprehensive care to people with disabilities represented in this model.

Evaluamos en conjunto con profesionales de los servicios, los desafíos para la implementación del modelo biosicosocial en los centros especializados en rehabilitación. Por medio de la articulación de la Evaluación de Cuarta Generación y Rueda de Conversación (Método Paideia), abordamos los modelos implementados de asistencia a la persona con discapacidad, partiendo de las siguientes cuestiones: trabajar en rehabilitación; historial médico y evaluación; atención compartida y calificación del alta. Del contenido de las ruedas surgieron tres categorías empíricas: el proceso de trabajo en rehabilitación; el proceso en red; el modelo de cuidado. La identificación de obstáculos y facilitadores podrá favorecer la plena implementación del modelo biosicosocial en la atención a las personas con discapacidad, generando subsidios para el avance hacia la integralidad del cuidado a las personas con discapacidad representado en este modelo.

Outcome measures for adults with Down Syndrome based on the International Classification of Functioning, Disability, and Health Model: A Systematic Review

Introduction: Adults with Down syndrome (DS) have functional disabilities due to the extra presence of chromosome 21. Objective: To identify the functionality and disability assessment instruments used in research involving adults with DS and associate them with the components of the International Classification of Functioning (ICF). Methods: Two independent researchers analyzed articles from PubMed, Lilacs, SciELO, Science Direct, and Cochrane databases, including cross sectional and clinical studies whose results involved functionality and disability for individuals with DS (≥18 years), with no publication date limit for the studies. The methodological quality of the studies was analyzed by the Downs & Black Checklist; descriptive analysis was used for the results. This review was registered in PROSPERO (CRD42021234012). Results: 15 articles were analyzed in which 48 instruments were identified for the assessment of adults with DS (36.42±10.62 years); the quality of the articles was considered "good". Of these 48 instruments, 41 were associated with bodily function, 5 instruments were associated with the activity component, one instrument was associated with social participation and one instrument was associated with the environment. Conclusion: Of the 48 instruments identified to assess adults with DS, most were for the Body Function and Structure component; only the 6MWT and CAMDEX-SD have been validated for this population. LIFE-H and MQE were used to assess Social Participation and the Environment, but they cannot be considered dependable, as they have not been confirmed for individuals with DS.

Beneficial Effects and Potential Mechanisms of Tai Chi on Lower Limb Osteoarthritis: A Biopsychosocial Perspective / 中国结合医学杂志

Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.

Manasika bhavas and roga - A biopsychosocial model

Ayurveda reiterates the relationship between the body and mind in its approach to health as well as illness. Though the vitiated doshas, dhatus and malas remain the physiological basis of illness, the illness itself is a more complex psychosomatic phenomenon. Ayurveda has followed biopsychosomatic approach where more emphasis is given to the aspect of integration body and mind. In somatic diseases the psychological aspect cannot be neglected, similarly in psychological diseases somatic affairs are given due consideration. Social factors also play a major role in the inter relationships, financial support etc. Modern medicine accepted the biopsychosocial approach towards health recently. Manasika bhavas mentioned in Ayurveda such as bhaya, krodha, soka etc., can cause or aggravate several diseases and hence there is a relation between these bhavas and roga. These manasika bhavas act as stressors as it become the cause of several diseases. Body’s response to stress has been widely studied in the branch of Psychoneuroimmunology. Recent research suggests that the mind and body share bidirectional influences, and the science of Psychoneuroimmunology identifies specific mechanisms by which these mind-body changes are mediated. Hence it is important to consider psychological factors along with biological and social factors in all diseases, assess and identify them in a timely manner so as to have effective management.

Looking beyond the obvious: Role of non?invasive electroanalgesia in management of cancer pain

Pain is considered as one of the most debilitating symptoms of cancer and its treatment. Owing to the limited efficacy of traditional pharmacological interventions to address cancer pain in its entirety, an avenue exists for exploration into nonpharmacological therapies. Analgesia using non?invasive electrotherapeutic modalities such as transcutaneous electrical nerve stimulation (TENS) and scrambler therapy emerges as a viable option to address cancer pain. The inability of these modalities to find a place within the recommended clinical guidelines has possibly resulted in the paucity of application of the same within the clinical setup. This perspective article aims at stimulating a discussion surrounding the inclusion of non?invasive neuromodulatory treatment techniques such as TENS and scrambler therapy to combat cancer pain and explore the benefits and pitfalls of using these techniques as an adjunct to the pre?existing treatment strategies. It is envisioned that this opinion piece will open a dialogue about a possible home for non?invasive electroanalgesia within the clinical treatment pathway for cancer pain.

Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators: A randomized, double-blinded, placebo-controlled trial / 中西医结合学报

BACKGROUND@#Beginning with the concepts of stress developed by Selye, an approach to stress and pain management, known as neuro-emotional technique (NET), has been developed. It is a treatment approach based on the principle that the stressor effects of dormant and/or current unresolved issues or trauma are what determine one's bodily responses. These responses are relatively personalized to the conditioned, experiential and emotional reality of the individual.@*OBJECTIVE@#To determine the effect of NET on patients with chronic low back pain (CLBP) over time.@*DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS@#In a randomized, double-blinded, placebo-controlled study conducted in a single clinic, NET or control treatments were given twice weekly for 4 weeks in a population of 112 patients.@*MAIN OUTCOME MEASURES@#Outcome measures, including Oswestry Disability Index, Quadruple Visual Analogue Scale, the psychoneuroimmunology markers of blood serum levels of C-reactive protein, tumour necrosis factor-α, interleukin-1 (IL-1), IL-6, and IL-10, and 10 dimensions of the Short Form Health Survey scale, were assessed at baseline and at 1, 3 and 6 months following the intervention period.@*RESULTS@#Compared to placebo, NET produced clinical and statistical significance (P < 0.001) via declines of virtually all physiological, pain and disability markers, accompanied by gains in quality-of-life indicators at 0 (baseline), 1, 3 and 6 months. Reductions of the percentages of patients whose 5 biomarkers lay outside the normative range were achieved at 1, 3 and 6 months by NET but not control interventions.@*CONCLUSION@#A randomized, controlled trial of CLBP patients indicated that 8 NET interventions, compared to placebo, produced clinically and statistically significant reductions in pain, disability and inflammatory biomarkers, and improvements in quality-of-life measures.@*TRIAL REGISTRATION@#The trial was registered with the Australian and New Zealand Clinical Trials Registry (No. ACTRN12608000002381).

Evaluación de discapacidad en los defectos congénitos: una mirada desde la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) / Evaluation of Disability in Birth Defects: A view from the International Classification of Functioning (ICF) / Avaliação de deficiência nos defeitos congênitos: um olhar desde a Classificação Internacional do Funcionamento, a Deficiência e a Saúde, CIF

Introducción: en la actualidad, coexisten dos modelos contrapuestos que han servido como marco para la evaluación y tratamiento de la discapacidad: el modelo rehabilitador y el social. Sin embargo, en 2001, la üms recurre a una tercera vía de interpretación a través de la síntesis de estos dos modelos, que derivan en la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF). Objetivo: evaluar la discapacidad a través de la CIF, en pacientes con defectos congénitos atendidos en un hospital de cuarto nivel de la ciudad de Cali. Materiales y métodos: estudio transversal que incluyó 40 pacientes (niños y adolescentes) con defectos congénitos y sus perfiles de funcionamiento obtenidos a través de la CIF. Resultados: las funciones que con mayor frecuencia se reportaron alteradas en el componente corporal fueron las mentales; las neuromusculoesqueléticas y de movimiento; las del sistema digestivo, metabólico y endocrino, y las sensoriales. En el componente de actividades y participación, las limitaciones se centraron en el aprendizaje básico, movilidad y comunicación. En el componente de factores contextuales, los profesionales de la salud y la tecnología para jugar, fueron los principales facilitadores reportados. Conclusiones: la utilización de herramientas integrales como la CIF para la evaluación, intervención y seguimiento de los pacientes con defectos congénitos, permitirá considerar al fenómeno de la discapacidad como un problema de origen social y, principalmente, como un asunto centrado en la inclusión de las personas en la sociedad

Introduction: The concept of disability has evolved throughout history going through the bases of three models that have served as a framework for the evaluation and treatment of disability: the exclusion model, the rehabilitation model, and the social model; which co-exist in different degrees. Because of this coexistence, in society there are still imaginary ideas and beliefs about disability that focus solely on the traits of people and in what they are unable to do. Objective: To evaluate the degree of disability through the International Classification of Functioning (ICF), in patients with birth defects who attend a high complexity hospital in the city of Cali. Materials and methods: Cross-sectional study that included 40 patients (children and adolescents) with birth defects and their functional profiles obtained from the ICF. Results: The altered functions that are most frequently reported in the corporal component are the mental; the neuromusculoskeletal and movement; the digestive, metabolic and endocrine system, and the sensorial functions. In the activities and participation component constraints were focused on basic learning, mobility and communication. In the contextual factors component, the health professionals and technology for playful activities were the main facilitators reported. Conclusions: the use of integrated tools such as ICF for evaluation, intervention and follow up of patients with birth defects, will allow to consider the phenomenon of disability as a problem of social origin and, mainly, as a matter centered on the inclusion of people in society

Introdução: Na atualidade, coexistem dois modelos contrapostos que têm servido como marco para a avaliação e tratamento da deficiência: o modelo reabilitador e o social. No entanto, em 2001, a OMS recorre uma terceira via de interpretação através da sintetização destes modelos, que derivam na Classificação Internacional do Funcionamento, a Deficiência e a Saúde (CIF). Objetivo: Avaliar a deficiência através da CIF, em pacientes com defeitos congênitos atendidos em um hospital de quarto nível da cidade de Cali. Materiais e métodos: Estudo transversal que incluiu 40 pacientes (crianças e adolescentes) com defeitos congênitos e seus perfis de funcionamento obtidos através da CIF. Resultados: As funções que com maior frequência reportaram-se alteradas no componente corporal foram as mentais; as neuromusculoesqueléticas e de movimento; as do sistema digestivo, metabólico e endócrino, e as sensoriais. No componente de atividades e participação, as limitações centraram-se na aprendizagem básica, mobilidade e comunicação. No componente de fatores contextuais, os profissionais da saúde e a tecnologia para brincar, foram os principais facilitadores reportados. Conclusões: A utilização de ferramentas integrais como a CIF para a avaliação, intervenção e seguimento dos pacientes com defeitos congênitos, permitirá considerar ao fenômeno da deficiência como um problema de origem social e, principalmente, como um assunto centrado na inclusão das pessoas na sociedade

Research of dry eye and type A personality / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the correlation between type A behavior and dry eye.<p>METHODS: Here we used case-control study,100 dry eye patients and 100 healthy persons all completed the questionnaire of type A behavior and unified questionnaire. The results were analyzed by univariate and multivariate conditional logistic regression analysis. <p>RESULTS: There was significant difference on distribution of behavior pattern between dry eye group and normal group(<i>χ</i>2=6.494,<i>P</i>=0.011). After one factor logistic regression analysis, the risk of dry eye for people with type A behavior was higher(<i>OR</i>=2.296, 95%<i>CI</i>:1.202-4.384, <i>P</i>=0.012); that for people using visual display terminal more than 6h was 2.992(95%<i>CI</i>:1.668-5.369, <i>P</i><0.01); that for people staying in air condition room was 2.631(95%<i>CI</i>: 1.472-4.702, <i>P</i>=0.001). After multivariate conditional logistic regression analysis, compared with type B behavior, type A behavior pattern(<i>OR</i>=2.659,95%<i>CI</i>:1.335-5.295,<i>P</i>=0.005), people using visual display terminal more than 6h(<i>OR</i>=2.264, 95%<i>CI</i>: 1.166-4.396, <i>P</i>=0.016), people staying in air condition room(<i>OR</i>=2.053, 95%<i>CI</i>: 1.048～4.020, <i>P</i>=0.036)were more significantly associated with dry eye. <p>CONCLUSION: Type A behavior pattern, using visual display terminal more than 6h and staying in air condition room may be independent risk factors for dry eye.

Multidisciplinariedad en el manejo de enfermedades crónicas / Cross-disciplinarity in the managernent of chronic diseases

La salud del ser humano es un fenómeno complejo, esencialmente multidimensional y de funcionamiento sistémico. Por esa razón, los problemas de salud no pueden ser entendidos aisladamente de la raza, género, problemas sociales, emocionales, asuntos familiares, en definitiva, la historia de vida de las personas y el entorno en el que viven, porque trascienden lo puramente biológico y fisiológico. Las enfermedades crónicas son uno de los principales problemas de salud en el mundo y sus causas se relacionan con el estilo de vida moderno y las creencias occidentales respecto de la vida, el cuerpo y la salud. El objetivo de este trabajo es analizar la necesidad de efectuar la práctica médica y, particularmente el manejo de enfermedades crónicas, a partir de una perspectiva sistémica de la salud. Esto significa apelar a la transversalidad disciplinar, la inclusión e integralidad en el abordaje científico; y comprender que los diversos asuntos del ser humano están interconectados y son interdependientes. Por tanto, su complejidad trasciende la división de su fisiología y la segregación del abordaje médico, y se traduce en una visión holística de la persona y su salud, entendiendo su cuerpo y sus componentes fisiológicos como una parte más de un todo integrado.

The health of the human being is a complex phenomenon, essentially multidimensional and provided with a systemic functioning. Thus, health problems cannot be understood in isolation from the gender, race, social and emotional problems or family issues, in short, separated from each persons history of life and the environment in which they live, beca use they transcend the purely biological and physiological. Chronic diseases are one of the major health problems in the world, and reflect the impact of modern lifestyle and Western beliefs about life, body and health. The aim of this paper is to analyze the need for medical practice, and particularly the management of chronic diseases, from a systemic health perspective. This implies appealing to a cross-disciplinary perspective, inclusion and integrity in the scientific approach as well, and understanding the various issues of human beings, culture and nature are interconnected and interdependent. Therefore its complexity transcends the division of their physiology and segregation of medical approach, but results in a holistic view of the human being and its health, that understand the human being body and its physiological components as a part of an integrated whole.

Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis

Patient self-report questionnaires such as a multidimensional health assessment questionnaire (MDHAQ) have advanced knowledge concerning prognosis, care, course and outcomes of rheumatoid arthritis (RA). The MDHAQ may overcome some limitations of a "biomedical model," the dominant paradigm of contemporary medical services, including limitations of laboratory tests, radiographs, joint counts, and clinical trials, to predict and depict the long-term course and outcomes of RA. A complementary "biopsychosocial model" captures components of a patient medical history on patient questionnaires as quantitative, standard, "scientific" scores for physical function, pain, fatigue, and other problems, rather than as 'subjective" narrative descriptions. A rationale for a biopsychosocial model in RA includes the importance of a patient history in diagnosis and management compared to biomarkers in many chronic diseases such as hypertension and diabetes. Some important observations which support a biopsychosocial model in RA based on patient questionnaires include that MDHAQ physical function scores are far more significant than radiographs or laboratory tests to predict severe RA outcomes such as work disability and premature death; patient self-report measures are more efficient than tender joint counts and laboratory tests to distinguish active from control treatments in RA clinical trials involving biological agents; and MDHAQ scores are more likely than laboratory tests to be abnormal at presentation and to document incomplete responses to methotrexate at initiation of biological agents. Patient questionnaires can save time for doctors and patients, and improve doctor-patient communication. A standardized database of MDHAQ scores consecutive patients over long periods might be considered by all rheumatologists in routine clinical care.

Rehabilitación basada en la comunidad frente a la realidad chilena / Community-based rehabilitation facing the Chilean reality

El desarrollo histórico del conocimiento y el acercamiento de la salud a los distintos grupos sociales han promovido el paso desde un enfoque biomédico a uno biopsicosocial. Bajo esta mirada se gestó hace 32 años la Rehabilitación Basada en la Comunidad (RBC) como una estrategia de inclusión y promoción de los derechos de las personas con discapacidad. La implementación de la nueva forma de rehabilitación en Chile ha resultado ser tardía. El escenario actual del país impone múltiples obstáculos para permitir el desarrollo de este modelo. Dadas las características de la sociedad chilena y de sus profesionales, ¿es posible alcanzar las metas y objetivos propuestos para la RBC? En el presente ensayo se describe la realidad chilena y la factibilidad actual de implementar un programa de RBC, siguiendo las guías propuestas por la OMS (2012) y las orientaciones dictadas por el Ministerio de Salud (2010). En éste se logran identificar los principales obstáculos presentes en el país, los que se relacionan con la resistencia social, política y profesional hacia la RBC.

The historical development of knowledge and the health approach to different social groups have promoted the transition from a biomedical approach into a biopsychosocial one. From this perspective, 32 years ago the Community-based Rehabilitation (CBR) was conceived, as a strategy of inclusion and promotion of the rights of the people with disabilities. The implementation of the new way of rehabilitation in Chile has been late. The current stage of the country imposes multiple obstacles to the development of this model. Considering the Chilean society characteristics and it professionals. Is it possible to reach the goals and aims proposed for the CBR? In this essay is described the Chilean reality and the current feasibility of implementing a CBR program, following the guidelines proposed by the WHO (2012) and the orientations dictated by the Health Ministry (2010). In this essay is possible to identify the main obstacles in Chile related to the social, political and professional resistance to the CBR.

Prevalence of poor self-rated health and associated risk factors among older adults in Cali, Colombia / Prevalencia de factores de riesgo de la autopercepción de salud y asociados pobres entre los adultos mayores en Cali, Colombia

Introduction: Self-rated health (SRH) has been considered an important marker of quality of life and an independent predictor of mortality in older adults. Objective: To determine the prevalence of poor SRH and identify risk factors associated with poor SRH among older adults residing in the Commune 18 of the city of Cali, Colombia, in 2009. Methods: A population-based cross-sectional study with a single-stage cluster sampling design. Sample included 314 persons aged 60 and older. The dependent variable, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Independent variables were socio-demographic, biological, mental, functional and geriatric syndromes. Logistic regression was used for multivariate statistical modeling. Results: Overall, 40.1% reported poor SRH (women 42.9%, men 35.0%). Factors independently associated with poor SRH were diabetes mellitus, depression, fear of falling and frailty syndrome (frail and pre-frail vs. non-frail). Widowed men reported poorer health than married men while other marital status (single/separated/divorced) was associated with better self-rated health in women. Conclusion: Potential modifiable factors such as depression and frailty syndrome are important determinants for poor SRH in Colombian older adults.

Introducción: El auto-reporte de salud (SRH) se ha considerado un marcador importante de calidad de vida y un factor predictor independiente de mortalidad en adultos mayores. Objetivo: Determinar la prevalencia de SRH pobre e identificar los factores de riesgo asociados con ARS pobre en adultos mayores que viven en la Comuna 18 de la ciudad de Cali, Colombia, en 2009. Métodos: Un estudio poblacional de corte transversal con un diseño de muestreo por conglomerado monoetápico. La muestra incluyó 314 personas de 60 años o más. La variable dependiente, SRH fue dicotomizada en buena (excelente, muy buena y buena) y pobre (regular o mala). Las variables independientes fueron sociodemográficas, biológicas, mentales, funcionales y síndromes geriátricos. La regresión logística fue usada para modelos estadísticos multivariados. Resultados: En general, 40.1% reportaron SRH pobre (mujeres 42.9%, hombres 35.0%). Los factores asociados independientemente con SRH pobre fueron diabetes mellitus, depresión, temor a caer y síndrome de fragilidad (frágil and pre-frágil vs. no-frágil). Los hombres viudos reportaron más SRH pobre comparados con hombres casados, mientras teniendo otro estado marital (soltero, separado, divorciado) fue asociado con menos SRH pobre en mujeres. Conclusión: Factores potencialmente modificables tales como la depresión y el síndrome de fragilidad son determinantes importantes de una pobre SRH en adultos mayores colombianos.

Irritable Bowel Syndrome and Migraine: Bystanders or Partners?

Irritable bowel syndrome (IBS) and migraine are distinct clinical disorders. Apart from the characteristics of chronic and recurrent pain in nature, these pain-related disorders apparently share many similarities. For example, IBS is female predominant with community prevalence about 5-10%, whereas that of migraine is 1-3% also showing female predominance. They are often associated with many somatic and psychiatric comorbidities in terms of fibromyaglia, chronic fatigue syndrome, interstitial cystitis, insomnia and depression etc., even the IBS subjects may have coexisted migraine with an estimated odds ratio of 2.66. They similarly reduce the quality of life of victims leading to the social, medical and economic burdens. Their pathogeneses have been somewhat addressed in relation to biopsychosocial dysfunction, heredity, genetic polymorphism, central/visceral hypersensitivity, somatic/cutaneous allodynia, neurolimbic pain network, gonadal hormones and abuses etc. Both disorders are diagnosed according to the symptomatically based criteria. Multidisciplinary managements such as receptor target new drugs, melantonin, antispasmodics, and psychological drugs and measures, complementary and alternatives etc. are recommended to treat them although the used agents may not be necessarily the same. Finally, the prognosis of IBS is pretty good, whereas that of migraine is less fair since suicide attempt and stroke are at risk. In conclusion, both distinct chronic pain disorders to share many similarities among various aspects probably suggest that they may locate within the same spectrum of a pain-centered disorder such as central sensitization syndromes. The true pathogenesis to involve these disorders remains to be clarified in the future.

Contribuições da psicologia da saúde para a adesão ao tratamento e qualidade de vida de pessoas que vivemcom HIV/AIDS / Contributions of health psychology to the adherence to treatment and quality of life of people living with Hiv/Aids

O presente artigo tem como objetivo apresentar as contribuições da Psicologia da Saúde, sob a perspectiva do modelo biopsicossocial, para a adesão ao tratamento e qualidade de vida de pessoas que vivem com HIV/Aids em atendimento na saúde pública brasileira. Desta forma, inicia apresentando a área da Psicologia da Saúde e o modelo biopsicossocial e, posteriormente, discute os princípios da saúde pública e as diretrizes para o fortalecimento da adesão ao tratamento preconizadas pelo Programa Nacional de DST/Aids do Ministério da Saúde do Brasil. O presente artigo destaca a importância do modelo biopsicossocial da Psicologia da Saúde e dos princípios da saúde pública para a adesão ao tratamento de pessoas que vivem com HIV/Aids.

This thematic essay has the objective of presenting the contributions of Health Psychology, under the perspective of the biopsychosocial model, to the adherence to treatment and quality of life of people living with HIV/AIDS being treated in Brazilian public health facilities. Thus, it starts presenting the Health Psychology area and the biopsychosocial model and after that, discusses public health principles and policies to treatment adherence strengthening proclaimed by the STD/Aids National Program by Brazilian Ministry of Health. Is important the integration the Health Psychology’s biopsychosocial model and of the principles of public health to the adherence to the treatment of people living with HIV/Aids.

Preditores biopsicossociais de dor, incapacidade e depressão em pacientes brasileiros com dor crônica / Psychosocial predictors of pain, incapacity and depression in Brazilian chronic pain patients

JUSTIFICATIVA E OBJETIVOS: Esta pesquisa foi baseada na perspectiva biopsicossocial de dor crônica, que sugere a existência de interrelação dinâmica entre alterações biológicas, estado psicológico e contexto social, onde cada uma destas dimensões apresenta um papel diferenciado na dor crônica, incapacidade e ajuste emocional. Este estudo examinou a aplicabilidade de preditores de dor, incapacidade e sofrimento propostos pelos modelos biopsicossociais de dor em amostra de pacientes brasileiros com dor crônica. MÉTODO: Estudo de corte transversal realizado com amostra de conveniência de 311 participantes atendidos em diversos centros de dor localizados no Sul e Sudeste do Brasil. As análises estatísticas para examinar as propriedades dos testes e relações entre as variáveis incluíram teste t, Análise de Variância, correlações, regressão hierárquica múltipla e logística. Todas as análises estatísticas foram realizadas com o programa SPSS-14. RESULTADOS: Os fatores orgânicos, sócio-demográficos e cognitivos contribuíram para incapacidade, depressão, intensidade da dor e empregabilidade de forma diferenciada. Nessa amostra, grau de escolaridade, local da dor e autoeficácia contribuíram para incapacidade; pensamentos catastróficos foram o único preditor de depressão; gênero e autoeficácia contribuíram para a intensidade da dor; e idade, grau de escolaridade, incapacidade e autoeficácia foram fatores de risco para desemprego. CONCLUSÃO: As evidências descritas na literatura baseadas na perspectiva biopsicossocial, que enfatizam o papel distinto de fatores biopsicossociais na dor, incapacidade e sofrimento mental foram confirmadas nesse estudo.

BACKGROUND AND OBJECTIVES: This research is based on biopsychosocial chronic pain perspective, which suggests the presence of a dynamic interrelation among biological changes, psychological status and social context, where each dimension has a differentiated role in chronic pain, incapacity and emotional balance. This article has examined the applicability of pain, incapacity and distress predictors, proposed by biopsychosocial pain models, in a sample of Brazilian chronic pain patients. METHOD: This is a transversal study carried out with a convenience sample of 311 participants seen by different pain centers located in the Southern and Southeastern regions of Brazil. Statistical analyses to evaluate tests properties and relationships among variables included t test, Variance Analysis, correlations, multiple and logistic hierarchical regression. All statistical analyses were performed with the SPSS-14 software. RESULTS: Organic, socio-demographic and cognitive factors have contributed to incapacity, depression, pain intensity and employability in a differentiated way. In this sample, education level, pain site and self-efficacy have contributed to incapacity; catastrophic thinking was the sole predictor of depression; gender and self-efficacy have contributed to pain intensity; and age, education level, incapacity and self-efficacy were risk factors for unemployment. CONCLUSION: Evidences described by the literature, based on the biopsychosocial perspective, which emphasizes the different role of biopsychosocial factors on pain, incapacity and mental distress were confirmed by this study.

Anamnesis de la anamnesis / Anamnesis of the anamnesis

El objetivo del trabajo es determinar el modelo médico hegemónico (MMH) o modelo biopsicosocial (MBPS) subyacente en cada capítulo de anamnesis de los libros de Semiología empleados para la enseñanza de grado en la Universidad de Buenos Aires en la Carrera de Medicina desde 1910 a la fecha. Se trata de un trabajo observacional descriptivo longitudinal retrospectivo que implicó la revisión de los capítulos sobre anamnesis donde se tomaron como variables de análisis la extensión absoluta y relativa del capítulo en relación al total de la obra y por otro lado, la indagación sobre aspectos psicosociales y la inclusión de la familia en calidad de recurso de salud de los pacientes. Con esas dos últimas variables se determinó la adherencia a uno u otro modelo. De una totalidad de 8 obras, solo una de ellas (la única cuya primera edición fue en el S. XXI) fue escrita bajo el MBPS, otra obra cuya...

To determine the hegemonic medical model (HMM) or biopsychosocial model (BPSM) underlying in each chapter of Anamnesisof Semiology books used for teaching in undergraduate at the Universityof Buenos Aires from 1910 to date. This is a retrospective, longitudinal observational study that involved the review of the chapters on Anamnesiswhere the variables of analysis taken were the absolute and relative lengthof the chapter in relation to the total work and on the other hand, the inquiry into psychosocial aspects and family inclusion as a health resourcefor patients. With these two last variables adherence to either model was determined. Out of 8 pieces, only one (the only one whose 'rst edition wasin the XXI century) was written under the MBPS, another work whose...

Clasificación internacional del funcionamiento, de la discapacidad y de la salud (CIF) y su aplicación en rehabilitación / International classification of functioning, disability and health (ICF) and its application in rehabilitation

The International Classification of Functioning, Disability and Health (ICF), approved and recommended by the World Health Organization (WHO), established the beginning of a new era for the patient-oriented clinical practice. Conceived as a clinical, research, statics, social policy and educational tool, the ICF's main objective is to unify and standardize the language used to describe health and its related status, improving communication and facilitating data comparison among professionals from different fields, at an international level. Based on the bio-psycho-social model from the WHO, the different components emerge as a base for the classification of 1454 categories, allowing a description of a functionality or disability profile for individuals and populations. To be able to apply the ICF to the field of rehabilitation, it is necessary to make a selection of its category groups or generic core sets. This would allow a description of the appropriate level of functioning for specific health conditions. Under the ICF's model, the multidisciplinary management, based on the rehabilitation cycle (assessment- goal definition- intervention- evaluation), is implemented in a comprehensive manner, facilitating the understanding and description of levels of functionality/disability, throughout the different stages of the patient's rehabilitation process.

La Clasificación Internacional del Funcionamiento, de la discapacidad y de la salud aprobada y recomendada por la OMS, establece el comienzo de una nueva era en la práctica clínica orientada al paciente. Concebida para ser aplicada como herramienta clínica, de investigación, estadística, política social y educacional. Su principal objetivo es unificar y estandarizar el lenguaje para la descripción de la salud y sus estados relacionado, mejorando la comunicación y facilitando la comparación de datos entre profesionales de los distintos campos a nivel internacional. La CIF se basa en el modelo biopsicosocial de la OMS, del cual surgen sus componentes sobre los que se estructura la clasificación que consta de 1454 categorías, permitiendo describir ampliamente el perfil de funcionamiento o discapacidad de las personas o poblaciones. Para su aplicación en rehabilitación es necesario el empleo de selección de agrupaciones de categorías CIF, Core Sets genéricos, que permiten describir el perfil de funcionamiento apropiado a condiciones de salud específicas; bajo el modelo CIF, el manejo multidisciplinario, basado en el ciclo de rehabilitación (valoración-definición de metas-intervención-evaluación) es llevado a la practica de una manera comprensible, facilitando el entendimiento y la descripción del funcionamiento/discapacidad a lo largo de las distintas etapas del proceso de rehabilitación de los pacientes.

Healthcare for the poor and dispossessed from Alma-Ata to the millennium development goals / Atención a la salud para los pobres y desposeídos: de Alma-Ata a las metas de desarrollo del milenio

Healthcare models which recognize the equity principle have had to confront the challenge of providing healthcare for the poor and dispossessed. Healthcare premised on "human rights" strives to remove/reduce barriers to access by a complete waiver of all fees in the public sector or various other subsidies to make healthcare more affordable. Social welfare programmes are held hostage to the vagaries of the economy and resource scarcity. The Alma-Ata's primary healthcare is inherently a health development strategy which embraces a wholistic approach to health and wellness. This strategy, by refocussing on the Millennium Development Goals, can therefore accommodate the innovations required to overcome the challenges posed by technological, financial, cultural and geographical factors to provide a better quality of life for all, but moreso for the poor and dispossessed.

Los modelos de atención a la salud que reconocen el principio de la equidad han tenido que hacer frente al reto de brindar atención a la salud de los pobres y los desposeídos. La atención a la salud estipulada en los "derechos humanos" lucha por eliminar o reducir las barreras de acceso, a través de la completa exoneración de todos los pagos en el sector público y varios otros subsidios encaminados a poner los servicios de salud al alcance de todos. Los programas de bienestar social son rehenes de los caprichos de la economía y la escasez de recursos. La atención primaria a la salud en conformidad con Alma-Ata es en esencia una estrategia de desarrollo que se adhiere a un enfoque holístico de la salud y el bienestar. Esta estrategia, que reenfoca el Objectivos Desarrollo del Milenio, puede por tanto dar espacio a las innovaciones requeridas para superar los desafíos que los factores tecnológicos, financieros, culturales y geográficos presentan a la posibilidad de ofrecer una mejor calidad de vida a todos, pero sobre todo a los pobres y los desposeídos.

Eficacia de un programa para la promoción del bienestar a partir de las dimensiones del esquema de si mismo en un grupo de adultos mayores de la ciudad de Bucaramanga / Effectiveness of a program for the promotion of the welfare in the dimensions of the scheme of their selves into a group of elder adults in the city of Bucaramanga

El presente estudio tuvo como objetivo evaluar la eficacia de una intervención para la promoción del bienestar en sus dimensiones de percepción de eficacia, valía personal, concepto sobre si mismo e imagen corporal en un grupo de adultos mayores de la ciudad de Bucaramanga. Participaron 188 adultos entre 50 y 95 años de edad, de géneros masculino y femenino, estrato socioeconómico de 0 a 4 y de diferente estado civil con limitaciones psicosociales en cada una de las dimensiones de bienestar mencionadas. El programa se evaluó siguiendo un diseño pre experimental de un solo grupo con medidas pre y post a través de la prueba t de Student con p<0.05 y mediante cuestionarios construidos para el estudio. Los datos procesados en el paquete estadístico spss versión 12.0, muestran la eficacia de la intervención con valores t student para Auto concepto de (t=-11,46), para auto eficacia (t=-7,5), para autoestima (t=-9,95) y para auto imagen (t=-11,97) con diferencias significativas en cada caso. Se concluye la efectividad del programa para promover actitudes de auto confianza, aceptación personal y física y sentimiento de control en los adultos mayores.

This survey had as objective to assess the results of a program towards to welfare in the dimensions of: Own's efficacy perception, self esteem, self-concept, self image into a 50 to 95 aged elder people in the city of Bucaramanga (Colombia). Participants were 188, they belong both genders, economical status from 0 to 4 and several civil status and with lackness in all the four welfare dimensions assessed by the intervention which followed a pre-experimental design with an only one group with measure before and after the program. Results were processed by spss program 12.0 version, showing the usefulness of the program getting changes to self-concept with t student values like (t=-11,46), to self-efficacy like (t=-7,5), to self-confidence like (t=-9,95) and to self-image like (t=-11,97).It is concluded that program was helpful to promote welfare attitudes and behaviors in the participants.