Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

La expresión no verbal y el lenguaje de pacientes con cáncer / Nonverbal Expressions And Language Of Oncological Patients

El cáncer es una enfermedad que demanda un gran número de recursos exigiendo no solo la eficacia sino también la eficiencia de las intervenciones que se realicen durante todo el proceso oncológico. Su diagnóstico puede ser considerado como un evento vital estresante que afectará tanto al individuo, como a su entorno familiar y social. Partiendo de este planteamiento, se deben considerar los aspectos físicos, psicológicos y sociales del fenómeno oncológico y, por consiguiente, un manejo integral y multidisciplinar. El objetivo general de este estudio se basa en observar las expresiones de los pacientes oncológicos con diagnósticos de tumores sólidos metastásicos (estado III – IV), que están en tratamiento con quimioterapia y/o inmunoterapia en la isla de Tenerife, en el Hospital Universitario de Canarias y el Hospital Universitario Nuestra Señora de Candelaria, durante las entrevistas para detectar alteraciones no manifestadas verbalmente. Para ello se ha realizado una investigación cualitativa y fenomenológica, de carácter multicéntrico desde noviembre de 2022 a mayo de 2023. La muestra fue constituida por 362 pacientes con previo consentimiento informado de los sujetos de estudios. Se usó la entrevista semiestructurada procesada mediante análisis de contenido. Se tuvieron en cuenta los criterios de rigor científico y los principios de bioética personalista. Con relación a los resultados, se obtuvieron tres categorías donde se analizó lapercepción de la Calidad de Vida; la satisfacción hacia los profesionales sanitarios y las preocupaciones sobre el pronóstico de la enfermedad. Como conclusión, .... (AU)

Cancer is a disease that demands a large number of resources, demanding not only the effectiveness but also the efficiency of the interventions carried out throughout the oncological process. Its diagnosis can be considered a stressful life event that will affect both the individual and their family and social environment. Starting from this approach, the physical, psychological and social aspects of the oncological phenomenon must be considered and, consequently, a comprehensive and multidisciplinary management. The general objective of this study is based on observing the expressions of oncological patients with diagnoses of metastatic solid tumors (stage III – IV), who are being treated with chemotherapy and/or immunotherapy on the island of Tenerife, at the University Hospital of Canarias and the Nuestra Señora de Candelaria University Hospital, during the interviews to detect alterations not expressed verbally. For this, a qualitative and phenomenological investigation has been carried out, of a multicenter nature from November 2022 to May 2023. The sample was made up of 362 patients with prior informed consent from the study subjects. The semi-structured interview processed through content analysis was used. The criteria of scientific rigor and the principles of personalist bioethics were taken into account. In relation to the results, three categories were obtained where the perception of Quality of Life was analyzed; satisfaction with health professionals and concerns about the prognosis of the disease. In conclusion, the patients who participated in the study perceived the quality of life as a changing state depending on the time of the disease and the treatment, they highlighted the communication skills of the nurses and demanded a multidisciplinary team... (AU)

Effect of Low Versus High-Heeled Footwear on Spinopelvic Alignment at Different Phases of Menstrual Cycle in Young Adult Women: A Biopsychosocial Perspective.

High-heeled shoes adversely affect spinal curvature, increase the risk of low back pain, and disturb the normal gait pattern. The purpose of this study was to examine, from a biopsychosocial point of view, the combined effect of wearing two different heel heights and of hormonal oscillation throughout different phases of the menstrual cycle on spinopelvic alignment. Notably, 70 females with an average age of 20.42 ± 1.51 years participated in this study, wearing each female two different heel heights as follows: low (2.5 cm) and high (7 cm). Spinopelvic alignment was evaluated by rasterstereography formetric 3D analysis during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Statistical analysis showed that there was no significant difference (p > 0.05) on spinopelvic alignment [kyphotic angle (KA), trunk inclination (TI), and pelvic inclination] between wearing low- or high-heeled shoes during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Considering that high-heeled shoes are traditionally associated with femininity, body image, beauty, and charm, this research has important biopsychosocial implications that should be explored in detail in future studies.

Situação de rua e abordagem social: desafios operacionais ao SUAS / La falta de vivienda y enfoque de atención social: desafíos operativos para el SUAS / Homelessness and social care approach: operational challenges for SUAS

Uma vez revelada a complexidade das experiências biográficas de pessoas em situação de rua, é urgente o aumento do número de estudos que qualifiquem a relação prática entre usuárias/os, políticas públicas e a representação do Estado na execução dos serviços de proteção. Para esta discussão, adicionamos as idiossincrasias sócio-históricas acerca do fenômeno da situação de rua no Brasil e a sua relação com o funcionamento do Sistema Único de Assistência Social (SUAS). No intuito da expansão teórico-prática dessa problemática, este estudo objetivou relatar as experiências de trabalho psicossocial dentro do Estágio Profissional de Psicologia em um serviço de abordagem social no município de Porto Alegre, Brasil. Nossos resultados alocam alguns aspectos estruturais, sócio-históricos e biopolíticos como elementos que interferem na execução ótima dos serviços tipificados pelas políticas públicas, marcando a dissonância entre políticas e suas implementações nos serviços.

Once the complexity of homeless people biographical experiences is unveiled, there is urgency in increasing the number of studies that qualify the practical relationship between users, public policies, and state representation within social protection. To this discussion we add the socio-historical idiosyncrasies about the phenomenon of homelessness in Brazil and their relation with the Brazilian Public Social Care System (SUAS) functioning. In order to theoretical and pragmatically explore this problem, this study aimed at informing about psychosocial work experiences within the scope of professional psychology internship in a social care approach service in Porto Alegre, Brazil. Our results allocate structural, socio-historical, and biopolitical aspects as elements that interfere with the optimal execution of governmental typified interventions, glossing the dissonance between policies and their implementation in public services.

Una vez revelada la complejidad de las experiências biográfico de las personas sin hogar, hay urgencia en aumentar el numero de estudios que califican la relación práctica entre las/os usuarias/os, las políticas públicas y la representación del Estado en la ejecución de servicios de protección. A esta discusión, agregamos las idiosincrasias sociohistóricas sobre el fenómeno de la falta de vivienda en Brasil y el relación con la funcionalidad del Sistema Único de Asistencia Social (SUAS). Para la expansión teórico-práctica de este problema, este estudio tuvo como objetivo informar sobre experiencias de trabajo psicosocial dentro de la pasantía de psicología profesional en un servicio de enfoque de atención social en la ciudad de Porto Alegre, Brasil. Nuestros resultados asignan algunos aspectos estructurales, sociohistóricos y biopoliticos como elementos que interfieren en la ejecución óptima de los servicios tipificados por políticas públicas, marcando la disonancia entre las políticas y sus implementaciones en servicios.

Youth Football Players' Psychological Well-Being: The Key Role of Relationships.

Well-being in youth sport is a growing topic in literature. Practicing sports at a youth level is recognized as an important opportunity for growth and development but also an experience that conversely can prove to be tiring and cause discomfort. Sometimes expectations and pressures make it a risky experience. This is emphasized even more when looking at very popular and spectacular sports, such as football in some European Countries; practicing football often solicits the hope of becoming champions one day and thus being able living thanks to the beloved sport. How do young Italian football practitioners feel? What role do relationships with significant others belonging to the world of sport and extra-sport play on the well-being of young athletes? On which specific aspects of psychological well-being (PWB) are these relationships based? Are there any differences between elite and amateurs levels? These are the questions upon which this paper focuses, considering a sample of young Italian football practitioners. Analysis reveals a strong and positive influence of some dimensions of the relationships with significant others on PWB, specifically team effort, coach closeness, and parental learning climate. Moreover, elite players perceive significantly better relationships than sub-elite and amateurs and have significantly higher levels of PWB. Those results provide a first evidence for the importance of good relationships within and outside sport for an effective development of youth football players since they positively influence players' PWB, which is higher in elite players. It emerges the necessity to further investigate different aspects of PWB and to deepen the knowledge about the meaning of relationship in developmental athletes according to a psychosocial approach.

Psychosocial Influence of Ehlers-Danlos Syndrome in Daily Life of Patients: A Qualitative Study.

(1) Background: Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized connective tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome's influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.

Signs, meanings and practices of people living with human t-cell lymphotropic virus type 1 or tropical spastic myelopathy.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) spreads silently in the world's population and causes several syndromes. Among these, HTLV-1 associated myelopathy, also called tropical spastic paraparesis (HAM/TSP), affects the nervous system. It causes sensorimotor losses, spasticity, muscle weakness, voiding and sexual dysfunction, pain, and balance disorders. There is limited knowledge of the feelings, experiences, and coping mechanisms associated with this neglected disease. The objective of the present qualitative study was to investigate the signs, meanings, and practices of people with HAM/TSP, through narratives obtained from focus groups and individual semi-structured face-to-face interviews. RESULTS: Thirty-eight individuals diagnosed with HAM/TSP participated in the study. The following categories and subcategories emerged from the participants: Signs-physical signs, symptoms, and discovery of the disease; Meanings-reaction to diagnosis and knowledge of disease, fears, and expectations; Practices-daily life, leisure, religious, and treatment activities. CONCLUSIONS: People with HAM/TSP suffer from symptoms that limit their social participation, and they are affected by complex and multidimensional feelings. This awareness can contribute to the implementation of public policies-focused on the real perspective of these patients-that provide more directed, empathic, and harmonious care for these individuals.

Diagnosis and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and Shadows.

Alcohol use disorder is the most common cause of advanced liver disease in the Western world. Diagnosis of alcohol use disorder can be difficult because patients with liver disease tend to deny alcohol intake for the fear of being excluded from treatment and because available biomarkers of alcohol intake have poor specificity in these patients. Alcohol abstinence is the cornerstone of the therapy in these patients. However, pharmacological treatments for alcohol use disorders have not been formally tested in patients with advanced liver disease, except for baclofen. Psychosocial intervention became crucial in these patients considering the limited pharmacological choice. However, psychosocial approach and an appropriate team to manage these patients are not still well defined. In this review, we critically discuss the diagnosis and the management of alcohol use disorder in patients with liver disease.

It is not diabetic foot: it is my foot.

OBJECTIVE: To examine the experiences of patients with diabetic foot ulcers (DFUs). METHOD: This qualitative study, using patient interviews, focused on how inpatients receiving treatment for diabetes experience the disease. Patients were selected using a purposive sampling method. RESULTS: A total of 15 patients participated in the study. Following analysis of patient interviews, four main themes were determined: 'developing diabetic foot', 'living with diabetic foot', 'coping with diabetic foot' and 'expectations'. CONCLUSION: Most of the patients were afraid of losing their feet and had difficulties in coping with the situation. Patients expected health professionals to understand the difficulties they were experiencing. To better understand the needs and experiences of patients, healthcare professionals should work with these patient groups as part of in-service training programmes. Such programmes should also include therapeutic communication techniques and models for professional patient-client communication.

El enfoque sicosocial expresivo de las relaciones interculturales contextualizadas en la enseñanza médica superior cubana / Expressive psychosocial approach to intercultural relationships put in context in Cuban higher medical education

RESUMEN Aunque la educación superior cubana constituye un espacio privilegiado para la atención a la diversidad cultural, se identifica la carencia de una concepción de la interculturalidad desde el sujeto que vive la experiencia y cuya cultura de origen se instaura como dimensión mediatizadora de la relación con respecto a otros; carencia no abordada en profundidad a través del prisma de la sicología social. En este orden se realizó una revisión bibliográfica con el objetivo de profundizar en el enfoque sicosocial expresivo de las relaciones interculturales contextualizadas en la enseñanza médica superior cubana; la misma, contribuyó a la comprensión de la expresión subjetiva conformada alrededor de la realidad objeto de estudio. Los resultados permitieron construir un cuerpo teórico descriptivo-explicativo de las emergencias subjetivas que adquieren su especificidad en las relaciones interculturales desde un compromiso práctico y axiológico. A modo de conclusiones se estableció que en la búsqueda de un campo académico unificado y coherente con la complejidad de la realidad objeto de estudio, la sicología social deviene tributaria de un enfoque centrado en el estudio de las formas de subjetividad social que median en las relaciones interculturales desde el contexto de la enseñanza médica superior cubana.

ABSTRACT Even though Cuban higher education is a privileged space for the attention of cultural diversity, the lack of an intercultural conception from the person who lives the experience and whose home culture is established as an interfering dimension in his relationship with others is identified; a problem which is not dealt with in depth through the perspective of social psychology. Therefore, a bibliographic review was made in order to go into depth in the expressive psychosocial approach to intercultural relationships put in context in Cuban higher medical education. It contributed to the understanding of the subjective expression which makes the reality of the object of study. The results allowed to make a descriptive-explanatory theoretical body of the subjective emergencies which become specific in intercultural relationships from a practical and axiological commitment. As a conclusion, it was established the search of an academic field which can be unifying and coherent with the complexity of the reality object of study. Social psychology becomes tributary of an approach that is centered in the study of social subjectivity forms that mediate in intercultural relationships from the context of Cuban higher medical education.

Cáncer de mama: análisis desde perspectivas transdisciplinar, psicosocial y de género en Chile y Cataluña / Breast cancer: analysis from transdisciplinary, psychosocial and gender perspectives in Chile and Catalonia

FUNDAMENTOS: El cáncer de mama es la primera causa de muerte por cáncer en la mujer a nivel mundial. Nuestro objetivo fue comparar las políticas públicas sanitarias de cáncer de mama en Chile y Cataluña, bajo las perspectivas transdisciplinar, psicosocial y de género. MATERIAL Y MÉTODOS: Estudio cualitativo descriptivo que utilizó como método y técnica el análisis comparativo entre políticas públicas sobre cáncer de mama en Chile y Cataluña desde el año 2005 al 2016. RESULTADOS: Ninguna región considera la perspectiva transdisciplinar, y ambos sitios sólo trabajan desde un abordaje multidisciplinar. Por su parte, la perspectiva psicosocial fue descrita como relevante en el ciclo de la enfermedad; no obstante, se reduce a lo disciplinar en ambos contextos. Con respecto a la perspectiva de género, Chile señala su incorporación en las estrategias, pero no es consistente, mientras Cataluña menciona pequeños elementos sin explicitar el enfoque. Entre las categorías emergentes, se incluyen la perspectiva política/ epidemiológica, con ambos espacios prioritizando la elaboración y ejecución de las políticas públicas para la patología, y la perspectiva del empoderamiento de las usuarias, la cual ambas regiones identifican como eje fundamental en la toma de decisiones médicas. CONCLUSIONES: Existe un estado incipiente al abordar las perspectivas analizadas, sin embargo, no condicen con las demandas sociales ni el avance epistemológico sanitario. En lo comparativo, existen mayores similitudes que diferencias, ambos manifiestan una precaria articulación de los planteamientos analizados. Por ahora, es importante comenzar transformando la comprensión sobre el cáncer de mama, tarea pendiente será su materialización en protocolos y guías sanitarias.

BACKGROUND: Breast cancer is the leading cause of cancer death in women worldwide. Our objective was to compare the public health policies of breast cancer in Chile and Catalonia, under transdisciplinary, psychosocial and gender perspectives. MATERIAL AND METHODS: Qualitative descriptive study, which used the method of comparative analysis to compare public policies on breast cancer in Chile and Catalonia between 2005 and 2016. RESULTS: The transdisciplinary perspective was not considered, with both regions only taking a multidisciplinary approach. For its part, the psychosocial perspective was described as relevant in the disease cycle, but in practice both sites showed limited application of this perspective. With respect to the gender perspective, Chile has incorporated it into strategies, though not consistently manner, while Catalonia mentions small elements, without being explicit about the approach. The identified emergent categories include a political/epidemiological perspective, with both locations prioritizing the development and execution of public policies to address the pathology, as well as a perspective of user empowerment, which both Chile and Catalonia identify as a fundamental aspect of medical decision making. CONCLUSIONS: The analyzed perspectives are in early stages of development; however, they are not yet in line with social demands nor current health epistemology. In terms of the comparison, there are greater similarities than differences between the two sites, and both are just starting to articulate the analyzed approaches. For now, it is important that both sites start transforming their understanding of breast cancer, and a pending task will be to materialize that new approach into health protocols and guides.

Building Resilience in Families, Communities, and Organizations: A Training Program in Global Mental Health and Psychosocial Support.

This article describes the Summer Institute in Global Mental Health and Psychosocial Support, a brief immersion training program for mental health, health, and allied professionals who work with populations that have endured severe adversities and trauma, such as domestic and political violence, extreme poverty, armed conflict, epidemics, and natural disasters. The course taught participants to apply collaborative and contextually sensitive approaches to enhance social connectedness and resilience in families, communities, and organizations. This article presents core training principles and vignettes which illustrate how those engaging in such interventions must: (1) work in the context of a strong and supportive organization; (2) appreciate the complexity of the systems with which they are engaging; and (3) be open to the possibilities for healing and transformation. The program utilized a combination of didactic presentations, hands-on interactive exercises, case studies, and experiential approaches to organizational team building and staff stress management.

Efeitos do saber-fazer de psicólogos na Saúde Mental do Piauí / Effects of psychologist´s know-how in mental health in Piauí

Resumo Pretende-se analisar os saberes e práticas de psicólogos que atuam na rede de Saúde Mental, bem como seus efeitos na produção do cuidado e modos de implicação destes profissionais com o processo de Reforma Psiquiátrica em curso no país. Trata-se de um estudo qualitativo, com uso de entrevista semiestruturada (n = 29) e observação dos processos de trabalho e organização dos serviços localizados em Teresina-PI: CAPS, Unidades Básicas de Saúde, serviços ambulatoriais, hospitais psiquiátricos e gerência de Saúde Mental. Os resultados indicam que a formação graduada e pós-graduada aporta poucos conhecimentos teóricos e práticos para os psicólogos atuarem na Saúde Mental. Os norteadores teórico-técnicos e prático-profissionais escolhidos pelos entrevistados indicam um compromisso com o saber-fazer clássico do psicólogo, pouco consoante com a perspectiva da Atenção Psicossocial, e consequentemente, com a sustentação política do processo de Reforma Psiquiátrica e Luta Antimanicomial.(AU)

Abstract The objective is to analyze the knowledge and the practices of psychologists acting in Mental Health, as well as its effects on the care production and in the ways as those professionals are implicated on the Psychiatric Reform process undergoing in the country. It is a qualitative study, using semi-structured interview (n = 29) and observing the work processes and services organization: CAPS, primary health unities and outpatient services, psychiatric hospitals and mental health management. Results indicated that undergraduate and postgraduate formation favored little support for Piauí psychologists to act in Mental Health. The theoretical-technical and practical-professional guiding chosen by the respondents qualify them as well committed professional with the classic know-how of what defines the psychologist nature of work; on the other hand, they place us little consonant with the psychosocial care perspective, consequently, with political sustentation for the process of psychiatric reform underway in the country.(AU)

The decision of out-of-home placement in residential care after parental neglect: Empirically testing a psychosocial model.

Out-of-home placement decisions in residential care are complex, ambiguous and full of uncertainty, especially in cases of parental neglect. Literature on this topic is so far unable to understand and demonstrate the source of errors involved in those decisions and still fails to focus on professional's decision making process. Therefore, this work intends to test a socio-psychological model of decision-making that is a more integrated, dualistic and ecological version of the Theory of Planned Behavior's model. It describes the process through which the decision maker takes into account personal, contextual and social factors of the Decision-Making Ecology in the definition of his/her decision threshold. One hundred and ninety-five professionals from different Children and Youth Protection Units, throughout the Portuguese territory, participated in this online study. After reading a vignette of a (psychological and physical) neglect case toward a one-year-old child, participants were presented with a group of questions that measured worker's assessment of risk, intention, attitude, subjective norm, behavior control and beliefs toward residential care placement decision, as well as worker's behavior experience, emotions and family/child-related-values involved in that decision. A set of structural equation modeling analyses have proven the good fit of the proposed model. The intention to propose a residential care placement decision was determined by cognitive, social, affective, value-laden and experience variables and the perceived risk. Altogether our model explained 61% of professional's decision toward a parental neglect case. The theoretical and practical implications of these results are discussed, namely the importance of raising awareness about the existence of these biased psychosocial determinants.

Adherencia terapéutica en oncología. Pacientes oncohematológicos: procesos facilitadores y obstaculizadores / Adherence to treatment in oncology. Oncohematologic patients: facilitating and hindering processes

OBJETIVO: El objetivo de la investigación es conocer la adherencia terapéutica en pacientes oncohematológicos y el modo en que interactúan las diferentes variables entre sí. El centro de la escena está puesto en el punto de vista del paciente acerca de su enfermedad y tratamiento, sus opiniones, percepciones, y evaluaciones, por lo cual el estudio se realiza desde una Perspectiva Psicosocial y con metodología cualitativa. MATERIAL Y MÉTODOS: Se administra una entrevista semiestructurada a 15 pacientes con linfomas, leucemias y mielomas. Las variables estudiadas son: subjetividad / circunstancias personales; equipo de salud / institución; apoyo familiar / social; vulnerabilidad / procesos protectores; y evaluación del paciente, del médico y de la trabajadora social. RESULTADOS: Se observa un alto grado de adherencia; fuerte coincidencia entre la evaluación del paciente, del médico y la trabajadora social; y un enorme potencial de los equipos de salud para mejorar la adherencia terapéutica en los pacientes. DISCUSIÓN: Dada la importante influencia de las instituciones y organización de los servicios de salud, se recomienda: detectar e intervenir en la adherencia terapéutica en la práctica clínica diaria; implementar estrategias de afrontamiento y técnicas de la Psicología Positiva para superar factores obstaculizadores y estimular procesos facilitadores; y promover estudios basados en experiencias locales, institucionales, por patologías, con metodología cuanti-cualitativa, y la transferencia e intercambio de conocimientos.

OBJECTIVE: To analyze aherence to treatment in oncohematologic patients and the way in which the different factors involved interact. Given that the focus is on the patient's view on his/her own opinions, perceptions and evaluations, the study approach is psychosocial and uses a qualitative methodology. MATERIAL AND METHODS: Semi-structured interviews are conducted with 15 patients with lymphoma, leukemia or myeloma. The variables studied are: subjectivity / personal circumstances, health care team / institution, family / social support, vulnerability / protective processes, and evaluation of the patient, the physician and the social worker. RESULTS: it is observed a high level of adherence, strong coincidence among patient's, physician's and social worker's evaluations, and great healthcare teams potential to improve patients' adherence to treatment. DISCUSSION: Given the strong influence of institutions and healthcare services organization, it is recommended: to detect and intervene in therapeutic adherence in everyday clinical practice, to implement coping strategies and Positive Psychology techniques to overcome hindering factors and promote facilitating processes, to promote quantiqualitative studies per pathology based on local institutional experiences, and the transference and interchange of knowledge.

Para uma clínica do uso de álcool e drogas com adolescentes das comunidades do Rio de Janeiro / For clinical use of alcohol and drugs with adolescents from the Rio de Janeiro communities

Analisando circunstâncias e elementos clínicos paradigmáticos, constata-se que as trajetórias de jovens das comunidades populares no que se refere a problemas com a Lei por uso e tráfico de drogas são, na verdade, típicas, isto é: indicam, sob eventos meramente singulares, uma produção intensa e institucionalizada desses jovens enquanto "foras da lei". Omitir esta dimensão do problema pode tornar a pesquisa científica aliada de estruturas que produzem delinquência. No entanto, uma prática derivada da clínica psicanalítica e amparada por uma reflexão sobre a institucionalidade questiona como a relação que esses adolescentes constroem com sua própria palavra nas instâncias de tratamento pode deslocar esses mecanismos institucionais.

For a clinic of drug and alcohol abuse with adolescents from popular communities in Rio de Janeiro. Parting from clinical circumstances and paradigmatic elements, the paper argues that many of the trajectories of youngsters from popular communities facing problems with the law regarding the use and trafficking of drugs are, indeed, typical. They indicate, under mere singular events, an important and institutionalized production of these young people as outlaws. Overlooking this dimension of the problem may compromise scientific research with structures that produce delinquency. Whereas a practice oriented towards psychoanalytic clinic, informed by some reflection on the institutional framework, questions how the relation these adolescents develop, to their own word, in treatment, can change these institutional mechanisms.

Para uma clínica do uso de álcool e drogas com adolescentes das comunidades do Rio de Janeiro

Analisando circunstâncias e elementos clínicos paradigmáticos, constata-se que as trajetórias de jovens das comunidades populares no que se refere a problemas com a Lei por uso e tráfico de drogas são, na verdade, típicas, isto é: indicam, sob eventos meramente singulares, uma produção intensa e institucionalizada desses jovens enquanto "foras da lei". Omitir esta dimensão do problema pode tornar a pesquisa científica aliada de estruturas que produzem delinquência. No entanto, uma prática derivada da clínica psicanalítica e amparada por uma reflexão sobre a institucionalidade questiona como a relação que esses adolescentes constroem com sua própria palavra nas instâncias de tratamento pode deslocar esses mecanismos institucionais(AU)

For a clinic of drug and alcohol abuse with adolescents from popular communities in Rio de Janeiro. Parting from clinical circumstances and paradigmatic elements, the paper argues that many of the trajectories of youngsters from popular communities facing problems with the law regarding the use and trafficking of drugs are, indeed, typical. They indicate, under mere singular events, an important and institutionalized production of these young people as outlaws. Overlooking this dimension of the problem may compromise scientific research with structures that produce delinquency. Whereas a practice oriented towards psychoanalytic clinic, informed by some reflection on the institutional framework, questions how the relation these adolescents develop, to their own word, in treatment, can change these institutional mechanisms(AU)

Effectiveness of psychoeducation for depression: a systematic review.

OBJECTIVE: Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature. METHOD: Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including 'psychoeducation', 'psychoeducational intervention' and 'depression', with no restriction regarding publishing dates. RESULTS: Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patients with depression: 10 papers evaluated in-person psychoeducation approaches and three papers evaluated long-distance approaches. In addition to these 13 papers, one evaluated psychoeducational interventions for patients' families and patients' responses and another evaluated psychoeducational interventions for patients' families and families' responses. Findings suggest that increased knowledge about depression and its treatment is associated with better prognosis in depression, as well as with the reduction of the psychosocial burden for the family. CONCLUSIONS: Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy. However, there are only a few studies regarding its effectiveness on adult patients with major depressive disorder. Although the publications in this area are still very limited, the articles selected in this review suggest that psychoeducation is effective in improving the clinical course, treatment adherence, and psychosocial functioning of depressive patients.

Horizontalidad, expresión y saberes compartidos enfoque psicosocial en procesos de acompañamiento a víctimas de violencia política en Colombia / Horizontality, expression, and shared knowledge: an approach on psychosocial processes of accompaniment to victims of political violence in Colombia

El siguiente artículo plantea una discusión profunda sobre los procesos de intervención psicosocial con víctimas de violencia política, a la luz de sus relatos de vida en un contexto de investigación sobre el papel de la memoria en la reconstrucción del tejido social. La categoría de lo psicosocial surgió como emergente de estos relatos de vida y grupos de discusión y posibilitó una mirada crítica a procesos de intervención que se realizan en Colombia, desde la voz y el testimonio de los y las participantes. Finalmente, recoge desde esta misma voz, la de la gente, propuestas y formas de acción que impliquen una revisión a los modelos individualistas, patologizantes, verticales, tecnócratas y burocráticos de la acción, para proponer acciones integrales y sistémicas de recuperación de la dignidad y transformación subjetiva desde la participación, diálogo de saberes, expresión lúdica y performativa, relaciones horizontales, apoyo mutuo y construcción de ciudadanía y subjetividad de derechos.

the following article presents a deep discussion about the processes of psychosocial intervention with victims of political violence, in the light of their life stories in a context of research on the role of memory in the reconstruction of the social fabric. The category of the psychosocial emerged as a result of these life stories and discussion groups and allowed a critical look at the intervention processes that take place in Colombia, from the voice and the testimony of the participants. Finally, it also collects proposals from this same voice, that of the people, and forms of action involving a revision to the individualistic, pathological, vertical, technocratic, and bureaucratic models of the action, to propose comprehensive and systemic actions for the recovery of dignity and the subjective transformation from participation, dialogue of knowledge, playful and performative expression, and horizontal relationships, mutual support and construction of citizenship and subjectivity of rights.

A atuação do enfermeiro nos centros de atenção psicossocial a luz do modo psicossocial / The performance of the nurse in the psychosocial care centers under a psychosocial approach / El funcionamiento de la enfermera en los centros de la atencion psicosocial a la luz de la manera psicosocial

Neste estudo qualitativo do tipo descritivo e analítico, trata-se da atuação do enfermeiro em um dia típico de trabalho nos Centros de Atenção Psicossocial (CAPSs) e sua relação com o modo psicossocial. O instrumento de pesquisa utilizado foia entrevista estruturada, realizada com 15 enfermeiros dos CAPSs I, II e CAPS AD, pertencentes à área de abrangência da Terceira Coordenadoria Regional de Saúde do Rio Grande do Sul (3ª CRS/RS). Os dados obtidos referem-se às atividades realizadas e às ações desenvolvidas pelo enfermeiro no cotidiano do CAPS, as quais foram analisadas tendo como referência o modo psicossocial no contexto da reforma psiquiátrica. As atividades foram divididas em dois tópicos: Meios de trabalho do enfermeiro ressignificados no modo psicossocial – no qual foram incluídas as atividades de administração e supervisão da medicação, cuidado com a higiene pessoal, atividades burocráticas (laudos, receitas, atestados), treinamento do pessoal da enfermagem, observação dos usuários não inseridos em atividades; e Meios de trabalho do enfermeiro construídos no modo psicossocial – que compreende as atividades de acolhimento, atenção individualizada, oficinas terapêuticas, grupos terapêuticos, assembleias, reunião de equipe, reuniões de coordenadores dos Serviços de Saúde Mental, visitas domiciliares, acompanhamento em consultas e participação em atividade de lazer/socialização (festas, passeios e jogos).

This descriptive and analytical qualitative study examines the nurses’ performance in a typical work day in the Psychosocial Care Centers (in Portuguese CAPS) and its relationship with the psychosocial model. The research instrument used was structured interviews conducted on 15 nurses working on the area covered by the Third Regional Health Care Department of the state of Rio Grande do Sul (3ª CRS/RS). The data collected refer to activities conducted by the Centre nurse in a psychiatric reform context and analyzed through a psychosocial method. The activities were divided into two themes...

Estudio analítico descriptivo que busca analizar el desempeño de enfermeros en un típico día laboral en los Centros de Atención Psicosocial (CAPS) y su relación con el modelo psicosocial. El instrumento de investigación fue la entrevistae structurada a quince enfermeros de los CAPS I, II y CAPS AD del área de alcance de la Tercera Coordinación Regional de Salud del Estado de Rio Grande do Sul (3ª CRS/RS). Los datos recogidos se refieren a las actividades realizadas y a las acciones de los enfermeros en el cotidiano de los CAPS. Estos datos se analizaron según el modo psicosocial dentro del contexto de la reforma psiquiátrica. Las actividades incluyen dos temas: Medios de trabajo del enfermero resignificados a partir del enfoque psicosocial, (tareas administrativas y control de la medicación, atención a la higiene personal, tareasburocráticas -laudos, prescripciones médicas, certificados - capacitación del personal de enfermería, observación delos usuarios no insertados en actividades...