Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project.

BACKGROUND: Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation. METHODS/DESIGN: It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals. DISCUSSION: It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources.

Randomised controlled trial of cognitive motivational therapy program for the initialphase of schizophrenia: a 6-month assessment

Background and Objectives: The aim of this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to routine care alone.Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial. Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy(PIPE; n = 21). PIPE comprised individual and family Cognitive-Motivational therapyplus routine care for 12 months. In this paper we present preliminary results at 6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment,and in this manuscript the results at 3 and 6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for variance effects were used for the statistical analysis Results: Significant greater clinical effects were observed in those patients treated inRC+PIPE at three months from baseline assessment and at six months in PANSS scale(Mann-Whitney test; p < 0.000). Other benefits of the program included increase in globalactivity, reduced relapse rates, and reduction of the pharmacological treatment.Conclusions: These findings show the effectiveness of a program of routine care integratedwith cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone for patients who are in the initial phase of schizophrenia (AU)

Comentario: el síndrome de desgaste profesional como problema de salud pública / Comentary: the professional burnout syndrome as a public health problem

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Nivel de ansiedad de jóvenes infractores internados en un centro educativo de régimen cerrado / Level of anxiety in young offenders committed to a closed educational centre

Este estudio analiza el nivel de ansiedad (STAI) de una pobla-ción adolescente infractora (n=57), internada en un centro educativo de régimen cerrado, en relación con sus variables sociodemográficas y con las características de su proceso de internamiento. Los resultados revelan que un 22.8% de los jóvenes presenta altos niveles de ansiedad estado y un 21.1% presenta altos niveles de ansiedad rasgo. Asimismo, la frecuencia de llamadas recibidas (p=.038), de visitas recibidas (p=.019) y la prescripción de psicofármacos (p=.007) se relacionan con el estado de ansiedad, mien-tras que el género (p=.046), el grupo educativo (p=.002) y el tiempo transcurrido desde la fecha de ingreso (p=.013) se asocian con la ansiedad rasgo. Como conclusiones más relevantes cabe señalar que los adolescentes infractores presentan niveles de ansiedad superiores al resto de sus coetáneos y que la ausencia de vínculo con las personas referenciales durante el internamiento aumenta significativamente el nivel de ansiedad estado

This study analyses the level of anxiety (STAI) in a young offender population (n=57), committed to a closed educational centre, in relation to their social and demographical variables, and the characteristics of their internment process. Results reveal that 22.8% of young offenders has high levels of state anxiety, and 21.1% has high levels of trait anxiety. Moreover, the frequency of received calls (p=.038), visits (p=.019), and the prescription of psychopharmacs (p=.007) are related to state anxiety, whereas gender (p=.046), educational group (p=.002), and time since the date of internment (p=.013) associate to trait anxiety. In conclusion, young offenders have higher levels of anxiety than their peers, and the lack of bonds with referential people during internment increases the level of state anxiety significantly

Las intervenciones motivacionales en el tratamiento psicoterapéutico de la fase inicial de la esquizofrenia / Motivational intervention in the initial phase of schizophrenia

Son muchos los estudios que en los últimos quince años han demostrado la efectividad de los programas de intervención precoz en la esquizofrenia y su impacto sobre el pronóstico de la enfermedad. De hecho, la intervención preventiva en la fase prodrómica y posterior al primer episodio se ha convertido en una de las líneas principales de investigación y de aplicación clínica para el abordaje de la esquizofrenia. Durante la fase inicial de la esquizofrenia, quedan paralizadas muchas áreas de actividad y relacionales a las cuales el paciente deberá enfrentarse durante la fase de recuperación. Su grado de motivación en esta fase será de vital importancia para el tratamiento. En el presente trabajo se presenta una revisión y algunas consideraciones a cerca de las intervenciones motivacionales en la esquizofrenia

Many studies have shown the effectiveness of early intervention programs for schizophrenia and its impact on illness outcome. In fact, the preventive intervention in the prodromical period and after the first episode of psychosis has become the main way for the research and clinical procedures for schizophrenia treatments. During the initial phase of schizophrenia, many activity and relational areas are affected. Patient motivation could be very important to face de treatment during this period. So, the current article presents a literature revision and some considerations about the motivational interventions in the schizophrenia

Las intervenciones motivacionales en el tratamiento psicoterapéutico de la fase inicial de la esquizofrenia / Motivational intervention in the initial phase of schizophrenia

Son muchos los estudios que en los últimos quince años han demostrado la efectividad de los programas de intervención precoz en la esquizofrenia y su impacto sobre el pronóstico de la enfermedad. De hecho, la intervención preventiva en la fase prodrómica y posterior al primer episodio se ha convertido en una de las líneas principales de investigación y de aplicación clínica para el abordaje de la esquizofrenia. Durante la fase inicial de la esquizofrenia, quedan paralizadas muchas áreas de actividad y relacionales a las cuales el paciente deberá enfrentarse durante la fase de recuperación. Su grado de motivación en esta fase será de vital importancia para el tratamiento. En el presente trabajo se presenta una revisión y algunas consideraciones a cerca de las intervenciones motivacionales en la esquizofrenia

Many studies have shown the effectiveness of early intervention programs for schizophrenia and its impact on illness outcome. In fact, the preventive intervention in the prodromical period and after the first episode of psychosis has become the main way for the research and clinical procedures for schizophrenia treatments. During the initial phase of schizophrenia, many activity and relational areas are affected. Patient motivation could be very important to face de treatment during this period. So, the current article presents a literature revision and some considerations about the motivational interventions in the schizophrenia

Valores personales y profesionales en médicos de familia y su relación con el síndrome del burnout / Personal and professional values in primary care physicians and your relation with burnout syndrome

El objetivo de este estudio es analizar si existen diferencias en los valores de los médicos de Atención Primaria con niveles altos o bajos de burnout. La muestra quedó constituida por 61 médicos que habían participado anteriormente en un estudio longitudinal iniciado en 1999. En la primera evaluación participaron 528 médicos de la provincia de Barcelona y en la presente se han evaluado aquellos que obtuvieron las puntuaciones extremas en desgaste profesional. Para la recogida de datos se aplicó un cuestionario de datos sociodemográficos, la versión española del MBI (Maslach Burnout Inventory) y un cuestionario de valores validado con trabajadores del ICS (Institut Català de la Salut). Se observan diferencias significativas entre ambos grupos en los valores de Altruismo (p=0,01), Confidencialidad (p=0,013) y Abnegación (p=0,036). Asimismo se aprecia una correlación directa entre Inmediatez Cansancio Emocional (p<0,05), una relación inversa entre Altruismo Cansancio Emocional (p<0,01) y Altruismo Despersonalización (p<0,05). En suma, todo parece indicar que algunos valores personales y profesionales se asocian a la presencia o ausencia de burnout. Paralelamente, la percepción de conflicto entre los valores personales y los profesionales podría favorecer la presencia de burnout

The aim of the current study was to analyse the differences in values of Primary Care doctors with high or low scores in burnout. 61 Primary Care doctors with extremely scores in burnout who participated in a longitudinal study started in 1999 were chose. In the first assessment were interviewed 528 subjects from Barcelona’s northern countries. There were used a sociodemographic questionnaire data, the Spanish version of the Maslach Burnout Inventory (MBI) and a values questionnaire that was validated in ICS (Institut Català de la Salut) workers sample. Statistically meaningful differences were observed in the following values between groups: Altruism (p=0,01), Confidentiality (p=0,013) y Abnegation (p=0,036). Data shows a direct correlation between Impatience-Emotional Exhaustion (p<0,05), inverse relations between Altruism Emotional Exhaustion (p<0,01) and Altruism Depersonalisation (p<0,05). The study shows some personal and professional values are associated with high or low levels of burnout. In the same way the conflict perception between personal and professional values could be associated with high scores in burnout