[Therapeutic education and chronic pain : a practical guide]. / Éducation thérapeutique et douleurs chroniques : notions utiles au praticien.

The doctor-patient relationship is changing directions in current medical practice, towards greater involvement of the latter. Pain neuroscience education (PNE) must play an important role in the treatment of chronic pain. Despite the complexity of studies, the effectiveness of PNE is proven, especially when integrated into interdisciplinary programs. It is fundamental that all healthcare professionals use coherent explanations to reassure and actively involve patients in pain. The dissemination of the scientifically validated biopsychosocial model of chronic pain is essential to correct common misunderstandings. Although the implementation of PNE is often carried out in pain or rehabilitation centers, but can also be conducted in medical practices.

La pratique médicale actuelle réoriente la relation médecin-patient vers une plus grande implication de ce dernier. L'éducation thérapeutique du patient (ETP) doit prendre une place importante dans le traitement de la douleur chronique. En dépit de la complexité des études, l'efficacité de l'ETP est prouvée, surtout si elle est intégrée à des programmes thérapeutiques interdisciplinaires. Il est fondamental que tous les professionnels de santé utilisent des explications cohérentes pour rassurer et impliquer activement les patients douloureux. La diffusion du modèle biopsychosocial de la douleur chronique, validé scientifiquement, est essentielle pour corriger les malentendus fréquents. L'ETP est généralement réalisée dans les centres de la douleur ou de réadaptation mais peut également être effectuée au cabinet médical.

Editorial: No short-cuts - translating neurobiological knowledge to clinical practice requires moving away from stand-alone biomarkers to an integrative biopsychosocial approach.

Although decades of research have shown the importance of neurobiological factors in the development of mental health problems in children and adolescents, the translation of this knowledge to use in clinical practice has proven difficult. One of the pitfalls is the false assumption that biological factors are so fundamental that they overrule all other factors and can be used as stand-alone biomarkers or tests for diagnostic purposes and treatment decisions. This assumption is false because all neurodevelopmental disorders result from complex interactions between biology and environment. Therefore, neurobiological assessments should never be used as a shortcut for diagnostic assessments that include the environment, including family, peers, and society at large. Instead, they should be integrated in the diagnostic process. This calls for empirically supported guidance on how to weigh information from neurobiological and psychosocial assessments in the diagnostic and treatment decision process.

The Influence of Social Dynamics on Biological Aging and the Health of Historically Marginalized Populations: A Biopsychosocial Model for Health Disparities.

Historically marginalized populations are susceptible to social isolation resulting from their unique social dynamics; thus, they incur a higher risk of developing chronic diseases across the course of life. Research has suggested that the cumulative effect of aging trajectories per se, across the lifespan, determines later-in-life disease risks. Emerging evidence has shown the biopsychosocial effects of social stress and social support on one's wellbeing in terms of inflammation. Built upon previous multidisciplinary findings, here, we provide an overarching model that explains how the social dynamics of marginalized populations shape their rate of biological aging through the inflammatory process. Under the framework of social stress and social support theories, this model aims to facilitate our understanding of the biopsychosocial impacts of social dynamics on the wellbeing of historically marginalized individuals, with a special emphasis on biological aging. We leverage this model to advance our mechanistic understanding of the health disparity observed in historically marginalized populations and inform future remediation strategies.

A Biopsychosocial Model for Understanding Training Load, Fatigue, and Musculoskeletal Sport Injury in University Athletes: A Scoping Review.

ABSTRACT: McClean, ZJ, Pasanen, K, Lun, V, Charest, J, Herzog, W, Werthner, P, Black, A, Vleuten, RV, Lacoste, E, and Jordan, MJ. A biopsychosocial model for understanding training load, fatigue, and musculoskeletal sport injury in university athletes: A scoping review. J Strength Cond Res 38(6): 1177-1188, 2024-The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport.

Construction of the chronic temporomandibular disorder patients: the association between neural and psychological pathways.

Chronic temporomandibular disorder (cTMD) as a term based on the diagnostic criteria for temporomandibular disorders (DC/TMD) classification refers, in this paper, to the condition listed that has a non-mechanical association without any obvious organic cause. Specifically, this is the condition that falls under the International Classification of Diseases 11th revision (ICD-11) classification of chronic primary and chronic secondary pains. This implies that there is increased responsiveness of nociceptive neurons in the central nervous system, a phenomenon known as central sensitisation. cTMD patients may have their beginning with genetic susceptibility to pain. Although no single gene is exclusively linked to cTMD, various genes associated with nervous and musculoskeletal systems are believed to play a role. Environmental triggers and epigenetic changes are also thought to contribute to cTMD development. The biopsychosocial model emphasises the need to comprehensively address biological, psychological and social factors in cTMD assessment and management. In this study, we leverage the cyclic causation framework within the biopsychosocial model to illuminate the intricate interplay between biological and psychosocial factors in the context of cTMD. The conceptualisation of cTMD involves the dynamic evolution of genetic predispositions, influenced by life events and other biological susceptibilities. These factors collectively contribute to the emergence of nociplastic changes, ultimately manifesting as the distinctive features observed in individuals afflicted with cTMD.

The relationship between neighborhood social capital and health from a biopsychosocial perspective: A systematic review.

BACKGROUND: The Social Determinants of Health (SDH) influence the health of people throughout their lives, and can be positive, protective or risk factors for the population and, in turn, biological, psychological, or social. The social environment conditions the health status of the neighborhood, population, and social group, which can be a health asset due to its strong psychosocial and socio-cultural influence. Social capital is a community asset of the healthy neighborhood that must be known in order to promote community health. OBJECTIVES: The objective is to determine the relationship between social capital and neighborhood biopsychosocial health. METHODS: A systematic review was conducted based on PRISMA: PubMed, Wos, Scopus, Embase, and Cochrane databases. The search was conducted from January to March 2023. Three authors independently extracted data using a structured form. RESULTS: Out of 527 records, 17 results passed the inclusion and exclusion criteria. The positive and statistically significant relationship between neighborhood social capital (NSC) and the physical and mental health of neighbors is confirmed, that is, the higher the NSC, the more exercise, better oral health in children and physical health in pregnant women, lower tobacco consumption and lower prevalence of human immunodeficiency virus. At the psychological level, greater NSC leads to better mental health, mental well-being, life satisfaction, quality of life, self-perceived health, higher cognitive function, and less depression. CONCLUSIONS: In conclusion, social capital is an important SDH and health asset that influences neighborhood biopsychosocial health and should be known and researched for health promotion in community settings. More evidence is needed to support the results obtained.

Storylines of family medicine II: foundational building blocks-context, community and health.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'II: foundational building blocks-context, community and health', authors address the following themes: 'Context-grounding family medicine in time, place and being', 'Recentring community', 'Community-oriented primary care', 'Embeddedness in practice', 'The meaning of health', 'Disease, illness and sickness-core concepts', 'The biopsychosocial model', 'The biopsychosocial approach' and 'Family medicine as social medicine.' May readers grasp new implications for medical education and practice in these essays.

Chronic pain in pediatric patients: epidemiology, pathophysiology, and mitigation strategies.

PURPOSE OF REVIEW: To provide an updated summary on the epidemiology, pathophysiology, and treatment strategies of chronic pain in pediatric patients and its differences with chronic pain in adults. RECENT FINDINGS: Chronic pain in children is common, can be debilitating and can progress into adulthood, thus it requires an interdisciplinary evaluation and management. Targeting interdisciplinary care, including psychology, physical, and/or occupational therapy, has been shown to improve pain and function. Recent decline in mental health post pandemic has correlated with increase in pediatric chronic pain thus the need to identify patients at risk and offer early interdisciplinary treatment. SUMMARY: Chronic pediatric pain should be addressed under the biopsychosocial model, where the biological, psychological, and social factors are evaluated on how they influence the pain perception, pain experience, functional ability, and treatment focus. Pain education to patients and their families is the crucial initial step towards a functional rehabilitation of pain.

[Transdisciplinary treatment of functional movement disorders: integration instead of dissociation]. / Die transdisziplinäre Behandlung funktioneller Bewegungsstörungen: Integration statt Dissoziation.

Successful treatment of patients with functional motor disorders is integrative in several ways: the primary treatment goal is the (re)integration of sensorimotor, cognitive and social functioning. The prerequisites for this are an integrated biopsychosocial model of everyone involved as well as close transdisciplinary cooperation. Instead of a simple addition of treatment components, all care providers and patients act in concert.

How Do We Treat Children with Anterior Cutaneous Nerve Entrapment Syndrome and Is the Biopsychosocial Model Also Being Applied? A Scoping Review.

Background: Evidence-based guidelines for managing anterior cutaneous nerve entrapment syndrome (ACNES) in children are absent. The primary aim of this review was to scrutinize the evidence supporting currently used treatment interventions. In accordance with the World Health Organization (WHO) guidelines for managing chronic pain in children, these patients and their families and caregivers should be treated within the context of the biopsychosocial model; pain should not be treated purely as a biomedical problem. Therefore, our second aim was to evaluate whether these interventions are applied within the context of the biopsychosocial model, utilizing an inter- or multidisciplinary approach. Materials and Methods: A scoping review of the literature was conducted to explore treatment strategies for ACNES in children. To ensure a comprehensive overview of published literature on this topic, the search was not restricted based on study type. Two reviewers independently assessed titles and abstracts. After excluding records unrelated to children, full texts were screened for inclusion. Any discrepancies in judgement were resolved through discussion with a third reviewer. Results: Out of 35 relevant titles, 22 were included in this review. Only 4 articles provided information on long-term outcomes. The overall quality of the review was deemed low. The majority of reports did not address treatment or education within the psychological and social domains. A structural qualitative analysis was not feasible due to the substantial heterogeneity of the data. Conclusion: The evidence supporting current treatment strategies in children with ACNES is of low quality. More research is needed to establish an evidence-based treatment algorithm for patients with this challenging pain problem. In line with the WHO recommendation, greater emphasis should be placed on a biopsychosocial approach. The ultimate goal should be the development of a generic treatment algorithm outlining an approach to ACNES applicable to all professionals involved.

The use of a biopsychosocial model in the treatment of patients with chronic.

OBJECTIVE: To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). METHODS: A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. RESULTS: According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. CONCLUSION: BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. PRACTICE IMPLICATION: Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research.

Physical therapist-led interventions based on the biopsychosocial model provide improvement in disability and pain for spinal disorders: A systematic review and meta-analysis.

OBJECTIVE: To summarize the effects of physical therapist-led interventions based on the biopsychosocial (BPS) model in spinal disorders compared to interventions with no BPS model through a systematic review and meta-analysis of randomized-controlled trials. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY: We searched the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27, 2022. METHODOLOGY: Pain intensity and disability were primary outcomes and psychological factors were secondary outcomes in spinal disorders. The included intervention was physical therapist-led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMDs) and 95% confidence intervals (CIs), and the random-effects model was used for the meta-analysis. The subgroup analysis was divided into low back pain group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model. SYNTHESIS: Fifty-seven studies with 5471 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect for the BPS model led by physical therapists in the short, medium, and long terms. The SMDs with 95% CIs were -0.44 (-0.62, -0.27), -0.24 (-0.37, -0.12), and -0.17 (-0.28, -0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium, and long terms. The SMDs with 95% CIs were -0.48 (-0.69, -0.27), -0.44 (-0.64, -0.25), and -0.37 (-0.58, -0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms. CONCLUSION: Physical therapist-led interventions based on the BPS model effectively improve pain intensity and disability in patients with spinal disorders based on low-quality evidence.

Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health.

OBJECTIVE: The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. METHODS: An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. RESULTS: The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. CONCLUSIONS: It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) na graduação em Fonoaudiologia no Brasil / International Classification of Functioning, Disability and Health (ICF) in undergraduate Speech, Language and Hearing Sciences programs in Brazil / Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) en cursos de pregrado en logopedia en Brasil

Introdução: A formação em saúde, especialmente no Brasil, tem incorporado a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) de modo a desenvolver capacidades para lidar com a vida humana no modelo biopsicossocial. Objetivo: Descrever e analisar a inserção da CIF nos currículos de graduação em Fonoaudiologia no Brasil. Método: Estudo descritivo e transversal, aprovado pelo Comitê de Ética em Pesquisa, conduzido entre novembro de 2021 e julho de 2022. Um questionário, composto por 24 questões, abertas e de múltipla escolha, com aspectos referentes à presença da CIF na matriz curricular, foi disponibilizado via Google Forms. Foram incluídos os cursos de graduação em Fonoaudiologia do Brasil, e excluídos os cursos com educação à distância. Foi realizada análise quantitativa no programa SPSS. Resultados: Dos 78 cursos de Fonoaudiologia contactados, 28,2% responderam ao questionário. Dos respondentes, 50% estavam localizados na região sudeste, e 59,1% vinculados a instituições públicas. Nos cursos participantes, 27,3% incluíram a CIF no projeto pedagógico. Dentre os cursos em que a CIF está presente, 50% se concentram em disciplinas teóricas, 33,3% em disciplinas teóricas e práticas e 16,7% em disciplinas teóricas, práticas e atividades complementares. Conclusão: A CIF está de modo incipiente nos cursos de graduação em Fonoaudiologia brasileiros, predominantemente em componentes curriculares teóricos. Evidencia-se a necessidade de ampliação do debate acerca da formação do fonoaudiólogo no que tange a preceitos que são oportunizados pela CIF, visto que sua inclusão em unidades curriculares, teóricas e práticas, pode favorecer o desenvolvimento de competências, habilidades e atitudes focadas no modelo biopsicossocial. (AU)

Introduction: Health training, especially in Brazil, has incorporated the International Classification of Functioning, Disability and Health (ICF) in order to develop capacities to deal with human life in the biopsychosocial model. Purpose: Describe and analyze the inclusion of the ICF in undergraduate Speech, Language and Hearing Sciences curricula in Brazil. Methods: A descriptive, cross-sectional study, approved by the Research Ethics Committee, conducted between November 2021 and July 2022. A questionnaire comprising 24 open-ended, multiple-choice questions on aspects relating to the presence of the ICF in the curriculum was made available via Google Forms. Brazilian undergraduate courses in Speech, Language and Hearing Sciences were included, and distance learning courses were excluded. Quantitative analysis was carried out using the SPSS program. Results: Of the 78 Speech, Language and Hearing Sciences undergraduate courses contacted, 28.2% answered the questionnaire. Of the respondents, 50% were in the southeast region and 59.1% were linked to public institutions. Of the participating courses, 27.3% included the ICF in their pedagogical project. Among the courses in which the ICF is present, 50% focus on theoretical subjects, 33.3% on theoretical and practical subjects and 16.7% on theoretical, practical, and complementary activities. Conclusion: The ICF is incipient in Brazilian undergraduate courses in Speech, Language and Hearing Sciences, predominantly in theoretical curricular components. There is a need to broaden the debate about the training of speech therapists about the precepts provided by the ICF, since its inclusion in curricular units, both theoretical and practical, can favor the development of competencies, skills and attitudes focused on the biopsychosocial model. (AU)

Introducción: La formación sanitaria, especialmente en Brasil, ha incorporado la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) con el fin de desarrollar capacidades para abordar la vida humana en el modelo biopsicosocial. Objetivo: Describir y analizar la inclusión de la CIF en los planes de estudio de pregrado de logopedia en Brasil. Método: Se trató de un estudio descriptivo, transversal, aprobado por el Comité de Ética de la Investigación y realizado entre noviembre de 2021 y julio de 2022. A través de Google Forms se puso a disposición un cuestionario compuesto por 24 preguntas abiertas de opción múltiple sobre aspectos relacionados con la presencia de la CIF en el plan de estudios. Se incluyeron los cursos de pregrado en Fonoaudiología en Brasil y se excluyeron los cursos a distancia. El análisis cuantitativo se realizó con el programa SPSS. Resultados:De los 78 cursos de logopedia contactados, el 28,2% respondió al cuestionario. De los encuestados, el 50% estaban situados en el sureste y el 59,1% estaban vinculados a instituciones públicas. De los cursos participantes, el 27,3% incluía el ICF en su proyecto pedagógico. Entre los cursos en los que el ICF está presente, el 50% se concentra en asignaturas teóricas, el 33,3% en asignaturas teóricas y prácticas y el 16,7% en asignaturas teóricas, prácticas y actividades complementarias. Conclusión: La CIF es incipiente en los cursos de logopedia de pregrado brasileños, predominantemente en los componentes curriculares teóricos. Es necesario ampliar el debate sobre la formación de logopedas en relación con los preceptos proporcionados por la CIF, ya que su inclusión en unidades curriculares teóricas y prácticas puede favorecer el desarrollo de competencias, habilidades y actitudes centradas en el modelo biopsicosocial. (AU)

Endometriose e saúde sexual feminina ­ desafios, tratamento, perfil epidemiológico e impactos biopsicossociais: uma revisão integrativa / Endometriosis and female sexual health ­challenges, treatment, epidemiological profile and biopsychosocial impacts: an integrative review / Endometriosis y salud sexual femenina ­desafíos, tratamiento, perfil epidemiológico e impactos biopsicosociales: una revisión integradora

Introdução:A endometriose consiste em uma patologia ginecológica bastante prevalente emmulheres de múltiplas faixas etárias, consistindo em um desafio constante para a fertilidade, sexualidade e demais aspectos da qualidade de vida.Objetivo:Avaliar o perfil epidemiológico, formas de tratamento e os aspectos biopsicossociais associados à saúde sexual das mulheres com endometriose. Metodologia:Esta é uma revisão integrativa da literatura cujapergunta norteadorafoi "Como a endometriose influencia nos aspectos biopsicossociais inerentes ao comportamento sexual feminino?". Foi aplicada a estratégia de busca "Endometriose AND Dispareunia AND Qualidade de Vida" na Biblioteca Virtual em Saúde (BVS) e sua versão em inglês "EndometriosisAND DyspareuniaAND Quality of Life" na base de dados PubMed, com ofiltro"últimos10anos"aplicadoemambasasplataformas.Critérios de inclusão: estudos que abordassem mulheres cisgênero, em idade fértil,com vida sexual ativa, diagnóstico prévio de endometriose pélvica ou profunda e distúrbios ou queixas sexuais. Critério de exclusão: artigos que contemplassem mulheres em uso de psicofármacos. Resultados:Inicialmente,foram obtidos 227 artigos. Apósanálise primária, 189 estudos foram excluídos, seguindo para a etapa seguinte apenas 38. Destes, somente 15 atenderam aos critérios e foram considerados válidos para compor o presente estudo.No âmbito sexual, a endometriose pode acarretar aredução da frequência das relações, sangramentos durante ou após o coito, desinteresse em preliminares, desconforto em certas posições, términos de relacionamentos, conflitos conjugais, e, sobretudo, dispareunia.Conclusões:Diante dos prejuízos em diversos âmbitos da vida e bem-estar feminino causados pela endometriose, faz-se indispensável maior qualificação dos serviços de saúde para o diagnóstico precoce e intervenções efetivas, bem como apoio, acolhimento e acompanhamento multiprofissional contínuo. Além disso, a adaptação, compreensão e solicitude dos parceiros são fundamentais para que as mulheres sejam capazes de melhor gerenciar tais desafios (AU).

Introduction:Endometriosis is a gynecological pathology that is quite prevalent among women of multiple age groups, representing a constant challenge to fertility, sexuality, and other aspects of quality of life.Objective:To evaluate the epidemiological profile, forms of treatment and biopsychosocial aspects associated with the sexual health of women with endometriosis.Methodology:This is an integrative review of the literature whose guiding question was "How does endometriosis influence the biopsychosocial aspects inherent to female sexual behavior?". The search strategy "Endometriosis AND Dyspareunia AND Quality of Life" was applied in the Biblioteca Virtual em Saúde (BVS) and in the PubMed database, with the "last 10 years" filter applied on both platforms. Inclusion criteria: studies that addressed cisgender women, of childbearing age, with active sexual life, previous diagnosis of pelvic or deep endometriosis and sexual disorders or complaints. Exclusion criteria: articles that included women using psychotropic drugs. Results:Initially, 227 articles were obtained. After primary analysis, 189 studies were excluded, only 38 going on to the next stage. Of these, only 15 met the criteria and were considered valid to be part of the present study. In the sexual sphere, endometriosis can lead to a reduction in the frequency of intercourse, bleeding during or after coitus, lack of interest in foreplay, discomfort in certain positions, relationship endings, marital conflicts, and, above all, dyspareunia.Conclusions:Given the damage to various areas of life and female well-being caused by endometriosis, it is essential to improve the quality of health services for early diagnosis and effective interventions, as well as support, reception, and continuous multidisciplinary monitoring. Furthermore, adaptation, understanding and concern from partners are fundamental for women to be able to better manage such challenges (AU).

Introducción:La endometriosis esuna patología ginecológica bastante prevalente en mujeres de múltiples grupos etarios, que supone un reto constante para la fertilidad, la sexualidad y otros aspectos de la calidad de vida.Objetivo:Evaluar elperfil epidemiológico, las formas de tratamiento y los aspectos biopsicosociales asociados a la salud sexual de las mujeres con endometriosis.Metodología:Se trata de una revisión integradora cuya pregunta orientadora fue "¿Cómo influye la endometriosis en los aspectos biopsicosociales inherentes a la conducta sexual femenina?".Se aplicó la estrategia de búsqueda "Endometriosis AND Dispareunia AND Calidad de Vida" en la Biblioteca Virtual en Salud (BVS) y su versión en inglés en PubMed, con el filtro "últimos 10 años" enambas plataformas. Criterios de inclusión: estudios dirigidos a mujeres cisgénero en edad fértil, con vida sexual activa, diagnóstico previo de endometriosis pélvica o profunda, y trastornos o quejas sexuales. Criteriode exclusión: artículos que incluían mujeres usuarias de psicofármacos.Resultados:Inicialmente se obtuvieron 227 artículos. Después del análisis primario, se excluyeron 189 estudios y solo 38 pasaran a la siguiente etapa. De estos, solo 15 cumplieron con los criterios y seconsideraron válidos para el presente estudio. En el ámbito sexual, la endometriosis puede provocar reducción de la frecuencia de relaciones sexuales, sangrado durante o después de las relaciones sexuales, falta de interés por los juegos previos, molestias en determinadas posiciones, rupturas, conflictos matrimoniales y, sobre todo, dispareunia.Conclusiones:Ante los daños causados por la endometriosis en diversos ámbitos de la vida y el bienestar de las mujeres, es indispensable mejorar la calidad de losservicios de salud para el diagnóstico precoz y las intervenciones efectivas, así como apoyo, acogida y seguimiento multidisciplinar continuo. Además, la adaptación, comprensión y solicitud de las parejas son fundamentales para que las mujeres puedan gestionar mejor estos desafíos (AU).

Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo.

BACKGROUND: Biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation. METHODS: This cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories. RESULTS: Initially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. CONCLUSIONS: The results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.

[Psychiatric Applications of "Avatar-based Communication": Considerations from the Biopsychosocial Model Perspective].

In this paper, we consider the application of "avatar-based communication" to psychiatric care from the perspective of the biopsychosocial model. There are various possible medical applications of avatar-based communication. It has the potential to provide online convenience and liberate humans from the constraints of reality, enable cognitive interventions through body augmentation technology, and even influence biological factors.

Complex Posttraumatic Stress Disorder and a Biopsychosocial Model of Borderline Personality Disorder.

ABSTRACT: This review offers a critique of recent attempts to reconceptualize some cases of borderline personality disorder (BPD) within the newer diagnosis of complex posttraumatic stress disorder (CPTSD). The CPTSD construct focuses on the role of childhood trauma in shaping relational problems in adulthood, difficulties that have been previously seen as features of a personality disorder. The CPTSD model fails to consider the role of heritable personality traits, as well as a broader range of psychosocial risk factors. This review proposes that a biopsychosocial model of BPD is more comprehensive, taking into account a wider range of risk factors, while viewing BPD as rooted in gene-environment interactions. In this model, heritable traits are amplified by an adverse psychosocial environment. One can acknowledge the role of trauma as a risk factor without assuming that it fully accounts for the development of personality pathology.