Assuntos
Anormalidades Craniofaciais , Transtornos da Linguagem , Anormalidades Múltiplas , Adenosina Trifosfatases/genética , Pré-Escolar , Anormalidades Craniofaciais/genética , Análise Mutacional de DNA , Éxons/genética , Mutação da Fase de Leitura , Transtornos do Crescimento , Comunicação Interventricular , Humanos , Masculino , Mutação/genéticaRESUMO
BACKGROUND: The prevalence of mental disorders among prisoners has been researched in a few countries worldwide but never previously in Spain. AIM: Our aim was to estimate the lifetime and last month prevalence of mental disorders in a Spanish prison population. METHODS: This is a descriptive, cross-sectional, epidemiological study of 707 male prisoners. Sociodemographic, clinical and offending data were collected by interviewers. Offending data were confirmed using penitentiary records. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Axis I Disorders, and personality disorders were assessed through the Spanish version of the International Personality Disorders Examination. RESULTS: The lifetime prevalence of mental disorder was 84.4%. Substance use disorder (abuse and dependence) was the most frequent disorder (76.2%) followed by anxiety disorder (45.3%), mood disorder (41%) and psychotic disorder (10.7%). The period (last month) prevalence of any mental disorder was 41.2%. Anxiety disorder was the most prevalent (23.3%) followed by substance use disorder (abuse and dependence; 17.5%), mood disorder (14.9%) and psychotic disorder (4.2%). CONCLUSION: Although period prevalence figures, which are those generally provided in research into rates of mental disorder among prisoners, are useful for planning improvements to services within prisons, the fact that almost all of these men had a lifetime prevalence of at least one mental disorder suggests a much wider need for improving services, including community services, for this group.
Assuntos
Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Psicologia Criminal , Estudos Transversais , Humanos , Masculino , Transtornos Mentais/classificação , Pessoa de Meia-Idade , Prevalência , Prisões , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: We aimed to generate expert-based recommendations on the management of breakthrough cancer pain (BTcP) in older patients with cancer. MATERIAL AND METHODS: A two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of statements using a nine-point Likert scale (oneâ¯=â¯totally disagree and nineâ¯=â¯totally agree). Statements were classified as appropriate (median ranged from seven to nine), irrelevant (median ranged from four to six) or inappropriate (median ranged from one to three). Consensus was established when at least two thirds of the panel scored within any of the ranges. RESULTS: A total of 64 specialists from pain units (44.4%), palliative care units (25.4%), medical oncology (19.1%), geriatric medicine (7.9%) and others (3.2%), participated in two consultation rounds. Specialists agreed that effective coordination between the different specialties and levels of care is essential for proper management of BTcP. Most participants (81.3%) supported the assessment of frailty and resolved (96.8%) that frailty status is a better indicator of patient needs than biological age. Participants agreed (75.8%) in the application of the Davies algorithm for diagnosis of BTcP in older patients. A strong consensus was achieved regarding which pharmacological treatment (transmucosal fentanyl) and dosing method (start low and go slow) are the most suitable for the older population. No agreement was reached on how interventionist techniques should be integrated into the therapeutic strategy for BTcP. CONCLUSIONS: The present Delphi has generated a set of recommendations that will help healthcare professionals in the management of BTcP in older patients.
Assuntos
Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Administração através da Mucosa , Idoso , Depressores do Sistema Nervoso Central/efeitos adversos , Indutores das Enzimas do Citocromo P-450/efeitos adversos , Inibidores das Enzimas do Citocromo P-450/efeitos adversos , Tomada de Decisão Compartilhada , Técnica Delphi , Interações Medicamentosas , Fentanila/uso terapêutico , Fragilidade , Avaliação Geriátrica , Geriatria , Humanos , Oncologia , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor , Medição da Dor , Medicina Paliativa , Equipe de Assistência ao Paciente , Guias de Prática Clínica como AssuntoRESUMO
Aunque el término distimia fue acuñado por Kahlbaum, su significado actual se inició en 1980, cuando aparece en el Manual Diagnóstico de la Asociación Americana de PsiquiatrÃa (DSM) designando una depresión crónica de leve intensidad, distinguible de la depresión mayor. Objetivo: En este trabajo se estudian los casos de dos mujeres con este diagnóstico (según CIE-10) y se examinan los "componentes subjetivos" que sustentan los sÃntomas depresivos y que habitualmente no se mencionan en las publicaciones. Material y métodos: Se emplea el "Método de Abordaje de la Subjetividad" (MAS), consistente en realizar entrevistas no-directivas y registrar las expresiones verbales de modo fiel, al tiempo que se prescinde de cualquier alusión a teorÃas, creencias particulares, juicios de valor, etc. Resultados: Se reconoce en estas pacientes una desinserción sentimental respecto al objeto de amor, un convivir desencantado con sus parejas e imposibilidad de separación, al tiempo que aparecen insidiosamente los sÃntomas depresivos. Este fenómeno tiene como base la caÃda del "ideal romántico" al que aspiran, que sostiene sus vidas y que funciona como una "agarradera" o "ancla de personalidad", razones por las que no mejoran su sintomatologÃa. Estas originales apreciaciones cuestionan la noción clásica sobre el duelo. Conclusiones: Para que este tipo de pacientes mejoren sintomáticamente hace falta que hablen y se den cuenta de lo que realmente les está sucediendo. El estudio aquà descrito muestra las coordenadas subjetivas que se requiere conocer para poder conducir una adecuada intervención psicoterapéutica.
Objectives: Although the term dysthymia was coined by Kahlbaum, its current clinical meaning originated in the 1980s, when it appears in the American Psychiatric Association Diagnostic and Statistical Manual (DSM) designating a chronic mild depression distinguishable from Major Depression Disorder. In this article, the cases of two female patients with this disorder (according to the CIE-10) are presented and the "subjective components" that sustain the depressive symptoms, not usually mentioned in the publications, are examined. Material and methods: The Approach to Subjectivity Method (MAS) was used; it consists of non-directive interviews writing down the patientâs exact verbal expressions, and avoiding any allusion to theories, particular beliefs, values, judgments, etc. Results: We concluded that these two women have a sentimental distancing from their love object, even though they are unable to separate from or leave him while depressive symptoms appear in an insidious way. This drives them to fall off the romantic ideal they were looking for as a guide for their lives and an anchor of their personality, and it can also explain why their symptoms do not improve. This point of view questions to some extent the classic notions about "mourning". Conclusions: To improve symptomatically, the dysthymic patients need to talk about and realize what is really happening to them. What is found here shows the subjective coordinates that are necessary in order to conduct an adequate psychotherapeutic intervention.
RESUMO
En el presente trabajo estudiamos la dismenorrea primaria, un cuadro bastante aparatoso para el que se han venido postulado numerosas hipótesis, predominando las de índole biológica. No obstante, una serie de autores se han referido a la intervención de factores psicológicos en el cuadro. El objetivo que nos mueve consiste en descubrir cuáles son los componentes subjetivos que favorecen la aparición y/o mantenimiento del dolor en estas mujeres, más allá de las directrices biológicas. Para lograrlo tomamos un grupo de jóvenes (entre 17 y 25 años) que, aunque consultaron por otros problemas, el dolor menstrual era un síntoma importante, y a las que se trató mediante psicoterapia. Las entrevistas realizadas con ellas, aparte de ayudarlas a mejorar, nos permitieron obtener un material verbal que era expresivo del síntoma. Este proceder nos permitió desentrañar los diferentes aspectos subjetivos propios de la alteración, entre ellos destacan: la escasa tolerancia al dolor, la respuesta emocional exagerada y, sobre todo, el rechazo referido a la maduración como mujer y a los desempeños propios de ésta. Estos últimos factores se sostienen en significados personales erróneos y sustentados en los mensajes recibidos por la paciente y aceptados como propios.
In this paper we study primary dysmenorrhea, a rather cumbersome disorder for which numerous hypotheses have been postulated, predominantly of biological nature. However, a number of authors have referred to the intervention of psychological factors in these clinical symptoms. The goal that moves us is to find out which subjective components favor the appearance and maintenance of pain in these women, beyond the biological guidelines. To achieve this we take a group of young women (between 17 and 25 years old). Although they consulted for other problems, the menstrual pain was an important symptom, and they were treated with psychotherapy. The interviews realized with them, apart from helping them to get better, allowed us to obtain a verbal material that was expressive of the symptom. This procedure allowed us to unravel the different subjective aspects own of the alteration. Among them are stand out: the low tolerance to pain, the overreacted emotional answer and, above all, the rejection of the development as woman and the assumption of her corresponding role. The last factors mentioned are sustained by those erroneous personal meanings in the patient that were accepted as own.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Dismenorreia/psicologia , Medição da Dor , Entrevistas como Assunto , Emoções , Menstruação/psicologiaRESUMO
Advances in treatment of breast cancer have not avoided using mastectomy in all cases, and when this happens, we are dealing with a woman who is suffering from psychological problems. In order to study this issue we have carried out a research with the collaboration of The Andalusian Association of Women with Mastectomies (AMAMA) in Seville, which provided us with a sample of 46 mastectomized women. The objective of this study is to analyze in depth the psychological reaction of women to mastectomy through its different stages from diagnosis to surgical treatment. We chose a cualitative method so as to explore the subjective components of psicologycal respons. As a result, we found in studied women: (a) The "fracture" of the "corporal imaginary" related to the disappearance of a valuable organ, linked to the feeling of loss of personal attractiveness, low self-esteem and avoidance of social relationships. (b) The problem with "femininity" has been linked to the issue of "desirability", something innate in the "feminine position". (c) Many of them keep in mind the idea of mutilation, as a "hole" which is impossible to integrate. (d) Finally, we demonstrate how certain features of personality made them especially vulnerable to the explained phenomena.
RESUMO
The aims of this study were to test the face, content, and construct validities of a virtual-reality haptic arthroscopy simulator and to validate four assessment hypothesis. The participants in our study were 94 arthroscopists attending an international conference on arthroscopy. The interviewed surgeons had been performing arthroscopies for a mean of 8.71 years (σ = 6.94 years). We explained the operation, functionality, instructions for use, and the exercises provided by the simulator. They performed a trial exercise and then an exercise in which performance was recorded. After having using it, the arthroscopists answered a questionnaire. The simulator was classified as one of the best training methods (over phantoms), and obtained a mark of 7.10 out of 10 as an evaluation tool. The simulator was considered more useful for inexperienced surgeons than for surgeons with experience (mean difference 1.88 out of 10, P value < 0.001). The participants valued the simulator at 8.24 as a tool for learning skills, its fidelity at 7.41, the quality of the platform at 7.54, and the content of the exercises at 7.09. It obtained a global score of 7.82. Of the subjects, 30.8% said they would practise with the simulator more than 6 h per week. Of the surgeons, 89.4% affirmed that they would recommend the simulator to their colleagues. The data gathered support the first three hypotheses, as well as face and content validities. Results show statistically significant differences between experts and novices, thus supporting the construct validity, but studies with a larger sample must be carried out to verify this. We propose concrete solutions and an equation to calculate economy of movement. Analogously, we analyze competence measurements and propose an equation to provide a single measurement that contains them all and that, according to the surgeons' criteria, is as reliable as the judgment of experts observing the performance of an apprentice.