El abordaje perinatal interdisciplinar desde Atención Primaria de Salud (APS): el desarrollo de una atención bio-psico-social integrada / The interdisciplinary perinatal approach from Primary Health Care (PHC): the development of an integrated bio-psycho-social care

El Equipo de Atención Primaria (EAP) Roquetes-Canteres de Barcelona se plantea, en el marcode investigación impulsada por Bruc Salut (equipo psicoterapéutico), una intervención bio-psico-social integrada. Eneste artículo se describe la investigación desde su inicio y los diferentes programas que se están llevando a cabo desde2014 con un recorrido por todos los programas desarrollados. Se explica detenidamente cómo se han creado, llevadoa cabo, evaluado y su funcionamiento actual, gracias al trabajo coordinado del equipo interdisciplinar para atenderlos aspectos emocionales de la parentalidad, el establecimiento del vínculo y el buen desarrollo del bebé, así como lasensibilización y contención de los profesionales del equipo. Finalmente, se define la figura del profesional sanitariode enlace del EAP, que se ha creado para coordinar y guiar el equipo y fomentar la mirada bio-psico-social entre losprofesionales, vital para evitar una visión fragmentada de las familias.(AU)

The Primary Health Care Team (EAP) Roquetes-Canteres in Barcelona is considering, within theresearch framework promoted by Bruc Salut (a psychotherapeutic team), an integrated bio-psycho-social intervention.This article describes the research since its beginning and the different programmes that are being carried out since2014 with a tour of all the developed programmes. It explains thoroughly how they have been created, carried out,evaluated and their current operation, thanks to the coordinated work of the interdisciplinary team to address theemotional aspects of parenthood, the establishment of the bond and the good development of the baby, as well asthe awareness and self-restraint of the team professionals. Finally, the figure of the EAP liaison health professional isdefined, which has been created to coordinate and guide the team and to promote the bio-psycho-social view amongthe professionals, vital to avoid a fragmented view of the families.(AU)

L’Equip d’Atenció Primària (EAP) Roquetes-Canteres de Barcelona es planteja,en el marc de la investigació impulsada per Bruc Salut (equip psicoterapèutic), una intervenció biopsicosocialintegrada. En aquest article es descriuen la investigació des de l’inici i els diferents programes que s’estan duenta terme des de 2014 amb un recorregut per tots els programes desenvolupats. S’explica detingudament coms’han creat, dut a terme, avaluat i el funcionament actual, gràcies al treball coordinat de l’equip interdisciplinariper atendre els aspectes emocionals de la parentalitat, l’establiment del vincle, el bon desenvolupament del nadói també la sensibilització i contenció dels professionals de l’equip. Finalment, es defineix la figura del professionalsanitari d’enllaç de l’EAP, que s’ha creat per coordinar i guiar l’equip i fomentar la mirada biopsicosocial entreels professionals, vital per evitar una visió fragmentada de les famílies.(AU)

Trastornos de la deglución en niños menores de 3años con condiciones médicas complejas, abordaje interdisciplinario / Interdisciplinary approach in swallowing disorders in children under 3years old with complex medical conditions

Los problemas de alimentación ocurren en el 80% de niños que presentan algún retraso del desarrollo debido a condiciones médicas crónicas, y pueden presentarse en diferentes grados y formas. Los niños con trastornos de la deglución (TD) pueden manifestar síntomas en todo momento de la alimentación. Objetivo: Diagnosticar e intervenir TD y/o trastornos de conducta alimentaria (TCA) en niños con patología médica crónica compleja, derivados a un equipo interdisciplinario, durante el año 2017, en un hospital de alta complejidad. Material y métodos: Estudio analítico, prospectivo y longitudinal con intervención de un equipo interdisciplinario. Se realizó evaluación clínica fonoaudiológica de la deglución, ofreciendo pautas de estimulación y modificación de consistencias. Resultados: Se evaluaron 139 pacientes de entre 2meses y 3años; el 38% eran mujeres, y el 77% con soporte nutricional enteral (SNE). El 73% presentaron TD exclusivamente o asociado a un TCA. El 38% que ingresaron con SNE lograron el destete (sin diferencia significativa entre los que tenían o no TD [p=0,85] y los que tenían o no traqueotomía [p=0,88]), y del grupo que no logró el destete, un 54% aumentaron el aporte por vía oral. Se observó una diferencia estadísticamente significativa en el destete de los pacientes que concurrieron al espacio de la clínica con respecto a los que no (p=0,016) y un mayor tiempo de intervención entre quienes lograron el destete y quienes no: 5,2±3,1 vs 3,45±3,1meses (p=0,0099). El 70% continuqron seguimiento por el fonoaudiólogo. Conclusión: En niños con condiciones médicas complejas es esencial el trabajo interdisciplinario y especializado en esta temática. En los casos de TD, la intervención fonoaudiológica se asume como fundamental para la detección precoz y el correcto abordaje de la disfagia.(AU)

Children with swallowing disorders (SD) may manifest symptoms at all times during feeding. This clinical entity can present itself in different grades and forms. Objective: To diagnose and intervene in SD and/or eating behavior (EB) in children with complex chronic medical conditions referred to an interdisciplinary team, during 2017, in a high complexity hospital. Material and methods: Analytical, prospective and longitudinal study with the intervention of an interdisciplinary team. Clinical phonoaudiological evaluation of swallowing was performed, offering guidelines for stimulation and consistency modification. Results: 139 patients, between 2 month and 3 years old, 38% women, 77% with enteral nutritional support (ENS) were evaluated, 73% presented SD exclusively or associated with an EB. The 38% who entered with ENS achieved weaning (without significant difference between those who had or not SD, P=.85, and those who had or not tracheotomy, P=.88), and of the group that did not achieve weaning, oral contribution increased in 54% of cases. A statistically significant difference was observed in weaning of patients who attended the interdisciplinary space with respect to those who did not (P=.016) and longer intervention time between those who achieved weaning and those who did not, 5.2±3.1 vs 3.45±3.1 months (P=.0099). And 70% off patients continued follow with the speech therapist. Conclusion: Interdisciplinary and specialized work in this subject is essential in children with complex medical conditions. In cases of SD, speech therapy intervention, it is assumed as essential for early detection and correct approach to dysphagia.

Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19 / Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period

OBJETIVO: Diseñar un protocolo asistencial para reiniciar la actividad quirúrgica programada en un servicio de Urología de un hospital de tercer nivel de la Comunidad de Madrid, de manera segura para nuestros pacientes y profesionales en el contexto de la epidemia por coronavirus SARS-CoV-2. MATERIAL Y MÉTODOS: Constituimos un grupo multidisciplinar que se encargó de analizar las diferentes recomendaciones de la literatura, organizaciones sanitarias nacionales e internacionales y sociedades científicas, así como de su aplicación a nuestro medio. Una vez reiniciada la cirugía programada, se está llevando a cabo un seguimiento de los pacientes intervenidos en cuanto a complicaciones relacionadas con COVID-19. RESULTADOS: Desde el reinicio de la actividad quirúrgica se han programado 19 pacientes, de los cuales 2 han sido suspendidos por presentar COVID-19, diagnosticado uno por PCR positiva para SARS-CoV-2, y otro por alteraciones analíticas y radiológicas compatibles con esta infección. En el seguimiento realizado no se han detectado complicaciones relacionadas con COVID-19, con una mediana de seguimiento de 10 días (4-14 días). CONCLUSIONES: Resultados preliminares indican que el protocolo diseñado para asegurar la correcta aplicación de medidas de prevención de transmisión de la infección por coronavirus está siendo seguro y efectivo

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to covid-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective

Small team-based medical imaging of human cadavers: an innovative tool for interdisciplinary learning inHuman Gross Anatomy andRadiologic Sciences

The purpose of this study was to develop an interdisciplinary activity that merged the disciplines of human gross anatomy and radiology early in the educational process of doctors and radiographers allowing students to use human cadavers to learn anatomy and medical imaging (technique and in-terpretation) through small-group problem-solving sessions. Over 10 years, 734 student doctors and radiographers were divided into small groups and assigned cadavers. Images of cadavers included x-rays, CT and MRI regional and full-body series. Students problem-solved radiographic parameters and interpreted images. Student radiographers completed a semester project labeling anatomical structures in a CT or MRI series. Student doctors used images during dissection and presented radiographic series to demonstrate understanding of anatomy, radiology and skilled use of image analysis software. Participants completed a 100-question LIKERT Scale survey. Data were ana-lyzed based on overall group, cadaver experience, and radiography experience. Students produced high-quality images for use in the laboratory andclassroom, and 95% agreed that this activity helped them to learn anatomy and radiography. Students agreed that x-rays, CT and MRI scans were 92.0%, 91.1% and 90.1% beneficial, respectively, in learning anatomy and radiology, and 90% of participants documented that this program had a positive impact in knowledge and competency development for his or her chosen career. Both radiography and medical students reported that working on interprofessional teams enhanced their knowledge of anatomy and radiology and under-scored the importance of partnerships in healthcare. This program serves as a novel model for interdisciplinary team-based-learning of human anatomy and radiology

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Education in public health, epidemiology and biostatistics in Spain from a global and comparative perspective / La educación en salud pública, epidemiología y bioestadística en España desde de una perspectiva global y comparativa

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Cambio de paradigma / Paradigm shift

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Psiconeuroinmunología: hacia la transdisciplinariedad en la salud / Psychoneuroimmunology: Towards transdisciplinary health care

El propósito de este estudio fue analizar los biomarcadores conductuales dentro de las ciencias de la salud. Se han revisado aportaciones clásicas y recientes de la Psiconeuroinmunología que ilustran la importancia de los factores psicosociales que modulan determinadas funciones y sistemas biológicos ofreciendo una perspectiva epigenética sobre la salud y la enfermedad. Los resultados obtenidos confirman la modulación de los sistemas inmunitario e inflamatorio por factores psicosociales y proponen vías sumativas de intervención a problemas de salud con alta tasa de prevalencia y mortalidad. Se discuten los resultados de investigaciones revisadas al ofrecer pistas importantes para legisladores, profesionales y estudiantes de ciencias de la salud. Además, se reflexiona sobre los retos y oportunidades para investigadores y docentes del área sanitaria interesados en la etiopatogenia del binomio mente-cuerpo y se abren nuevas perspectivas futuras de trabajo

The purpose of this study was to analyse behavioural biomarkers within the health sciences. Recent and classic contributions of Psychoneuroimmunology have been reviewed, illustrating the importance of psychosocial factors that modulate certain functions and biological systems offering an epigenetic perspective on health and disease. The obtained results confirm the modulation of the immune and inflammatory systems by psychosocial factors, proposing summative ways of intervention to health problems with high prevalence and mortality rate. The results of the reviewed research are discussed, offering important clues to legislators, professionals and students of health sciences. It also reflects on the challenges and opportunities for researchers and teachers in the health area interested in the aetiopathogenesis of the mind-body binomial, and the opening of new future perspectives of work

La enfermería, una ciencia interdisciplinaria / Nursing, an interdisciplinary science

El presente ensayo describe la complejidada en enfermería, desarrollando los aspectos teóricos y prácticos que permiten definirla como interdisciplina. La enfermería se autoconceptualiza como la ciencia universal del cuidado de la salud humana. Si bien el arte del cuidar es uno de los más antiguos, en su calidad de profesión y de ciencia es joven y moderna, pues se inició en el siglo xix. Es ciencia porque su teoría se sustenta en patrones observados de la realidad, que han dado lugar a la formulación de razonamientos, hipótesis, principios y leyes organizados por medio de un método científico. En el curso del siglo xx surge la utilización de la noción de complejidad, acuñada por Edgar Morin en su pensamiento complejo, cuando se refiere a la capacidad de interconectar distintas dimensiones de lo real, promoviendo un enfoque interdisciplinario, transdisciplinario y holístico para una mejor comprensión de la realidad. ¿Es posible comprobar esta complejidad, esta singularidad interdisciplinaria en enfermería? ¿Cuáles son los signos de dicha complejidad? A través de la revisión de la literatura disciplinaria y de conceptos del pensamiento complejo elaborado por Edgar Morin, pretendo dar una respuesta innovadora a estas dos preguntas (AU)

This essay describes nursing as a complex science. It discusses the theoretical and practical aspects that convey its interdisciplinary nature. Nursing auto-conceptualises itself as the universal science of human healthcare. While the art of caring is ancient, nursing is a young and modern science and profession, which only began in the xix Century. Nursing is a science: its theory is based on patterns observed, resulting in the development of reasoning, hypotheses, principles and laws organized according to the scientific method. During the course of the xx Century, the term complexity was coined by Edgar Morin in Complex Thinking for a Complex World. The term referred to the capacity of interconnecting reality’s different dimensions, promoting a holistic and interdisciplinary approach for a better comprehension of the latter. Our questions are: is it possible to prove complexity, understood as an interdisciplinary particularity in nursing? And if yes, which are the signs of such complexity? Through a review of the discipline’s literature and concepts attached to Morin’s complex thought, we intend to offer an innovative answer to our inquiries. Is it possible to confirm this complexity, this multidisciplinary singularity in nursing? What are the signs of such complexity? Through the review of the disciplinary literature, we intend to give an innovative answer to these two questions (AU)

Student perception of interprofessional education application at the Health Sciences University of Sumatera Utara

Objective: Interprofessional education (IPE) includes collaborative interprofessional learning activities involving students and lecturers from the health sciences faculties at the University of Sumatera Utara. This descriptive study aimed to explore the students' perceptions of the application of the IPE program. Method: Descriptive study was conducted and one hundred sixty students were selected from four faculties including the faculties of medicine, nursing, pharmacy, and public health. Results: The results of the study showed that 68% of the participants stated that they had heard IPE information, whereas 97% reported that they had never joined in IPE activities. In the health sciences faculties, 57% of nursing students had heard IPE information, but more than 90% of the participants from the other faculties had never heard the IPE information. Also, based on aspects of their participation, all of the students reported that they had never joined in the IPE activities. Conclusions: according the results, the implementation of IPE can be realized in the integration of learning methods, such as lectures, practicum, clinical skills, and tutorials. It can be a university policy so that the implementation of IPE with specific learning methods can take place to improve the competence of collaboration students

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El estrés oxidativo, un núcleo conceptual interdisciplinario en la docencia médica superior básica en Cuba / No disponible

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Metodologia da problematização: possibilidade para a aprendizagem significativa e interdisciplinar na educação médica / Problematization methodology: possibility for meaningful learning and interdisciplinary in medical education

Na escola médica vem ganhando cada vez mais destaque o discurso sobre a necessidade e importância de que a organização curricular e o conteúdo programático assumam uma proposta interdisciplinar, desvinculando-se da organização curricular fechada, estanque, biologicista, com pouca, ou nenhuma, relação entre as diferentes áreas do conhecimento e ausente de uma visão unificada do corpo humano. Assim, partindo-se do pressuposto de que, em qualquer segmento da escolaridade, o conhecimento é uma construção realizada pelo sujeito cognoscente, e que essa construção depende de estratégias de ensino que tornem os conteúdos significativos aos alunos, neste trabalho são feitas algumas reflexões sobre o papel e o valor da metodologia da problematização como dinâmica possibilitadora de um ensino significativo e interdisciplinar (AU)

In medical school is gaining more prominence the speech on the need and importance of the curriculum as well as its organization take an interdisciplinary approach, decoupling closed curricular organization, tighten, biologicist with little, or no relationship among the different areas of knowledge and absent in unified vision of the human body. Thus, starting from the assumption that, in any segment of education, knowledge is a building held by the knowing subject, and that its development depends on teaching strategies that make them meaningful content to students, this work presents some reflections on the role and the value of questioning the methodology as a dynamic enabler of a significant and interdisciplinary teaching (AU)

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De la confusión a la identidad adolescente. Tratamiento interdisciplinar en un hospital de día / Adolescence: from confusion to identity shaping. Inter-disciplinary treatment in a day hospital

Este trabajo se propone, por un lado, describir de forma detallada un caso clínico y, por el otro, realizar una reflexión teórica sobre el mismo. Apoyado en los aspectos específicos del proceso del tratamiento, desde el ingreso hasta el alta, los autores interrelacionan y amplifican los elementos del abordaje interdisciplinar que se lleva a cabo en el dispositivo asistencial, con el fin de matizarlo y enriquecerlo, sobre todo a partir del discurso y las aportaciones psicoanalíticas (AU)

The current article provides an in depth description of a clinical case followed by a theoretical reflection. Supported by specific aspects of the whole treatment process from admission to discharge, authors interrelate, enrich, and nuance individual elements of an interdisciplinary therapeutic approach. The aim is to provide an enriched understanding of the interdisciplinary approach in a health care system while underscoring the value of psychoanalytic contributions (AU)

Medicina y artes: un curso interdisciplinario usando el aprendizaje basado en problemas en el Grado de Medicina / Medicine and arts: an interdisciplinary course using problem-based learning in the medical programme

Introducción. Este artículo describe una optativa interdisciplinaria, 'Disease and Medicine in the Plastic Arts', ofrecida por la Facultad de Medicina de la Universitat de Girona, incluyendo los resultados y reflexiones sobre esta experiencia. Materiales y métodos. A través de la observación y descripción de tres cuadros de arte, los estudiantes trabajaron sobre tres diferentes temas médicos. La estrategia de aprendizaje utilizada fue el aprendizaje basado en problemas (ABP). Además, se incluyeron un seminario impartido por una historiadora de arte y dos ejercicios escritos sobre fotografías. Resultados. Veintidós estudiantes se matricularon en la optativa, divididos en dos grupos. El examen de ABP y los ejercicios escritos que realizaron mostraron su progreso. Conclusiones. Los comentarios de los estudiantes en las encuestas son positivos, aunque el número de encuestas completadas no es alto, lo que constituye una tarea a mejorar en el futuro. Treinta y seis estudiantes han elegido esta optativa como su preferencia para el próximo curso (2012-2013), lo cual es indicativo del éxito de esta iniciativa y del progresivo interés de los estudiantes sobre la integración de la medicina y las humanidades

Introduction. This article describes an interdisciplinary elective, 'Disease and Medicine in the Plastic Arts', offered by the Medical School at the University of Girona, including the results and reflections of this experience. Materials and methods. Through the observation and description of three paintings, the students worked on three different medical issues. The learning strategy was problem-based learning (PBL). Furthermore, there was a seminar given by an art historian and two write-ups on photographs. Results. Twenty-two students registered for the elective, from which two groups were formed. The PBL exam and write-ups showed progress of the students. Conclusions. The comments of the students in the survey are positive, although the number of students that has responded is not very high, which is a task for improvement in the future. Thirty-six students have chosen this elective as their preference for the following academic year (2012-2013), which shows the success of this initiative and the rising interest of the students in the integration of medicine and humanities

El estatuto epistemológico de la bioética / The epistemological stature of the bioethics

El artículo expone el debate teórico acerca de la configuración epistemológica de la Bioética. Se realiza un análisis descriptivo y crítico de las principales aportaciones. Muestra como la Bioética siempre ha tenido dificultades para ser definida, los límites y las características internas de lo definido han sufrido importantes modificaciones en su corta historia. Otro problema presente, no menos sustancial, se debe a los distintos modos de entenderla y por tanto a que no exista un concepto unívoco de Bioética. Por último, se apuntan tres rasgos esenciales que sustentan su base conceptual, y que a nuestro entender, están todavía por resolver (AU)

The article exposes the theoretical debate brings over of the configuration epistemological of the Bioethics. There is realized a descriptive and critical analysis of the principal contributions. Sample like the Bioethics always has had difficulties to be defined; the limits and the internal characteristics of the definite thing have suffered important modifications in his short history. Another present, not less substantial problem, it owes to the different manners of understanding it and therefore to that there does not exist Bioethical univocal concept. Finally, there sign three essential features that sustain his conceptual base, and that to ours to deal, are still for resolving (AU)

Formación médica continuada en úlceras vasculares / Continuing medical education in vascular ulcers

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Entrenamiento de equipos interdisciplinares en urgencias obstétricas mediante simulación clínica / Training of interdisciplinary teams in obstetric emergencies through clinical simulation

Objetivo. Describir el programa de entrenamiento de equipos sanitarios en urgencias obstétricas graves mediante simulación clínica con un abordaje interdisciplinar, desarrollado en el Hospital virtual Valdecilla. Material y métodos. El programa fue dirigido a los profesionales implicados en la atención de la urgencia obstétrica (obstetras y ginecólogos, anestesiólogos, intensivistas y matronas). Se constituyó un equipo de trabajo para definir los objetivos, diseñar los escenarios y coordinar la realización de cada curso. Se dispuso dos salas de simulación con simuladores de pacientes, salas de control y sistemas de grabación audiovisual, un aula de análisis, un aula polivalente, y diverso material médico-quirúrgico. Para analizar los resultados de la actividad los participantes completaron una encuesta de evaluación. Resultados. Un total de 30 miembros de los equipos clínicos realizaron el entrenamiento en las entidades clínicas más frecuentemente implicadas en los casos de mortalidad materna (hemorragia postparto, embolismo de líquido amniótico y eclampsia), seleccionadas de los resultados de una encuesta de muerte materna enviada por correo a 69 hospitales españoles. Cada curso consistió en 3 casos clínicos realizados en quirófano, sala de puerperio y paritorio, seguidos de una sesión de análisis de la experiencia vivida. Los resultados valoraron como muy útil la experiencia vivida, destacaron la oportunidad que la simulación clínica brinda para practicar sin riesgo y entrenar el trabajo en equipo, y recomendarían su realización a otros compañeros. Conclusiones. El entrenamiento de profesionales sanitarios en urgencias obstétricas mediante simulación clínica con un abordaje interdisciplinar permite una práctica segura y efectiva de los algoritmos de diagnóstico y tratamiento, y de las habilidades de comunicación y trabajo en equipo, antes de enfrentarse a estas situaciones en la práctica diaria (AU)

Objectives. To describe the healthcare team training in obstetric emergencies using clinical simulation with an interdisciplinary approach, developed at the Hospital virtual Valdecilla. Material and methods. The program was aimed at health professionals involved in emergency obstetric care (obstetricians and gynecologists, anesthesiologists, intensivists and midwives). A working team was established to define the objectives, design the scenarios, and coordinate the completion of each course. Two simulation rooms were available with patient simulators, control rooms and audiovisual recording systems, an analysis room, a multipurpose classroom, and diverse medical and surgical equipment. To analyze the results of the program, the participants completed an evaluation survey. Results. A total of 30 members of clinical teams underwent training in the clinical entities most frequently involved in cases of maternal mortality (postpartum hemorrhage, amniotic fluid embolism and eclampsia), selected from the results of a survey of maternal death mailed to 69 Spanish hospitals. Each course consisted of three clinical cases performed in the operating room, postpartum and birthing room, followed by a debriefing session. Participants rated the courses as highly useful, highlighted the opportunity provided by clinical simulation to practice without risk and to train teamwork skills, and would recommend their peers to undergo the same training. Conclusions. Training of healthcare teams in obstetric emergencies using simulation with an interdisciplinary approach provides safe and effective practice of diagnostic and treatment algorithms, as well as of communication and teamwork skills, before these situations are met in daily practice (AU)

Supportive care for patients with early breast cancer

Breast cancer treatment currently requires the joint efforts of a multidisciplinary team to effectively combine chemotherapy, hormone therapy, biological agents, surgery and radiation therapy when needed. To develop such a treatment plan, it is important to know the benefits as well as the potential toxic effects of each therapy. Thus, many patients with early breast cancer complain of collateral adverse events such as fatigue, nausea, vomiting, loss of libido, hot flashes, night sweats or neuropathy due to the complex therapies they are receiving. To date, the treatment of such symptoms is an important issue that greatly affects the quality of life of these patients. In this review, we report the content of a multi-expert meeting where the incidence of and medical approach to some of the most common adverse events encountered during the treatment of patients with early breast cancer were analysed (AU)

Tratamiento grupal / No disponible

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Fragilidad: un concepto atractivo con necesidad de desarrollo / No disponible

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