Análisis dinámico de un equipo interprofesional que implementa un programa de atención psicosocial a víctimas de la guerra / Dynamic analysis of an interprofessional team implementing a psychosocial intervention program for war victims

Resumen Este estudio analiza los cambios estructurales experimentados por un equipo interprofesional que implementa un programa de intervención psicosocial dirigido a víctimas de la guerra en Colombia. Los equipos están compuestos por psicólogos, trabajadores sociales y facilitadores comunitarios que proporcionan atención a nivel individual, familiar y comunitario. Se aplicaron métodos de evaluación estructural para identificar cambios en la cohesión de las redes de reconocimiento entre profesionales, así como la preferencia para colaborar y el intercambio de información enviada y recibida. La recogida de información se produjo en dos series temporales -tiempo 1 (T1) y tiempo 2 (T2)- con un intervalo de tres meses. Se utilizó una estadística aplicada al análisis de datos relacionales para determinar los cambios en las redes en T1 y T2. En el período de referencia se incrementó la densidad en las redes de reconocimiento [. = 1.7105, (IC 95 %: -.0123 - .185), . < .0444] y de preferencia para trabajar [. = 2.0942, (IC 95 %: .005 - .1521), . < .0218]. Las redes de intercambio de información no experimentaron cambios significativos. Las regresiones múltiples a nivel diádico indican que la preferencia para trabajar e intercambiar información en T1, predicen el intercambio de información relativo tanto a peticiones de información recibidas como enviadas en T2. Se discuten los resultados para optimizar la implementación de programas de intervención psicosocial desarrolladas por equipos interprofesionales.

Abstract The study analyzes the structural changes experienced by an interprofessional team implementing a psychosocial intervention program for victims of war in Colombia. The program is called "PAPSIVI" (Programa de Atención Psicosocial y Salud Integral a Víctimas), which has been operating in Colombia since 2013, thanks to Law 1448 of 2011 to improve the quality of life and repair the damage of the victims of the armed conflict in Colombia. It only served people registered in the Single Registry of Victims (RUV), which had 9'165,126 records throughout the country until September 2021. This program follows a comprehensive and restorative approach that defines victims as protagonists of their own process of empowerment and positive change (Laplante and Holguin, 2006; Thompson, 1996). For this purpose, a multilevel intervention is carried out at the individual, family and community levels. The program is implemented by teams of professionals (psychologists, social workers and community facilitators) of varying sizes depending on the number of victims served in the municipalities. Psychologists provide individual psychological care and, to a lesser extent, family therapy is also offered to try to repair psychosocial damage from exposure to situations of violence (Oficina de Promoción Social, 2017). Social workers carry out community interventions to promote the associative fabric and social capital. Community promoters are facilitators and connect professionals with the potential beneficiaries of the intervention. The latter are very important, having themselves the status of victims, which increases the ecological validity of the intervention. Due to the characteristics of the implementation of this initiative, which takes into account the difficulties of the context (with situations of deprivation and vulnerability), as well as the particularities of the participants, it is valid to ask in this research what are the structural changes experienced by the teams of professionals who implement PAPSIVI. For this, structural evaluation methods were applied to identify changes in the cohesion of recognition networks among professionals, the preference to collaborate and the exchange of information sent and received. Data collection took place in two time series (T1 before - T2 after) with an interval of three months. Statistics applied to relational data analysis were used to determine changes in the networks at time T2. In the results it was found that in the baseline period the density in the recognition [t = 1.7105, (95 % CI: -.0123 - .185), p < .0444] and work preference [t = 2.0942, (95 % CI: .005 - .1521), p < .0218] networks increased. Information exchange networks did not experience significant changes. Multiple regressions at the dyadic level indicate that the preference for working and exchanging information at T1 predicts information exchange relative to both information requests received and sent at T2. It is concluded that the results shed light for: (a) optimize the design of psychosocial intervention teams; (b) improve their functioning by introducing horizontal organizational communication tools (among the members of each team), transversal (among the members of the teams implementing the program in different municipalities), and vertical (by promoting communication between professionals and program managers/responsible persons), and (c) achieve that changes in the structure of the teams serve as a diagnostic tool for functional problems of the team associated with the exchange of professional information and the referral of users. Ultimately, better integration of the teams leads to better psychosocial profiles of the users of programs such as PAPSIVI and allows them to better adapt their activities to the needs of the users, which improves the effectiveness of the intervention (Virto, 2021).

Determination of fluorine distribution in shark teeth by laser-induced breakdown spectroscopy.

Quantifying the chemical composition of fast-growing hard tissues in the environment can shed valuable information in terms of understanding ecosystems both prehistoric and current. Changes in chemical composition can be correlated with environmental conditions and can provide information about the organism's life. Sharks can lose 0.1 to 1.1 teeth/day, depending on species, which offers a unique opportunity to record environmental changes over a short duration of time. Shark teeth contain a biomineral phase that is made up of fluorapatite [Ca5(PO4)3F], and the F distribution within the tooth can be correlated to tooth hardness. Typically, this is determined by bulk acid digestion, energy-dispersive X-ray spectroscopy (EDS), or wavelength-dispersive spectroscopy. Here we present laser-induced breakdown spectroscopy (LIBS) as an alternative and faster approach for determining F distribution within shark teeth. Using a two-volume laser ablation chamber (TwoVol3) with innovative embedded collection optics for LIBS, shark teeth were investigated from sand tiger (Carcharias Taurus), tiger (Galeocerdo Cuvier), and hammerhead sharks (Sphyrnidae). Fluorine distribution was mapped using the CaF 603 nm band (CaF, Β 2Σ+ → X 2Σ+) and quantified using apatite reference materials. In addition, F measurements were cross referenced with EDS analyses to validate the findings. Distributions of F (603 nm), Na (589 nm), and H (656 nm) within the tooth correlate well with the expected biomineral composition and expected tooth hardness. This rapid methodology could transform the current means of determining F distribution, particularly when large sample specimens (350 mm2, presented here) and large quantities of specimens are of interest.

[Individual and group factors that impact the exchange of information among intervention programs: a structural view]. / Factores individuales y grupales que inciden en el intercambio de información entre implementadores de programas de intervención: una visión estructural.

The exchange of information between appliers of mental health interventions is essential to guarantee effective program implementation. The study aimed to examine how individual and group factors influence the exchange of information among the implementers of a psychosocial intervention program targeted to victims of the war in Colombia. A cross-sectional exploratory design was developed. Interviews were held with 18 psychologists, 22 social workers, 10 community promoters, and a nurse. The study used the E-i index and the visualization of interclass and intraclass links. There is no homophilic tendency in the exchange of information among the three professional categories. Empowerment predicts the nominations received in the request for information network (ß = 0.296, p < 0.006). To be central in the preference network is the principal predictor of receiving requests for information (ß = 0.562, p < 0.0001). Empowered professionals and those who exchange information on the implementation process are considered key informants that can improve the program's effectiveness.

El intercambio de información entre los aplicadores de intervenciones en salud mental es esencial para garantizar la efectividad de la implementación de programas. El objetivo fue examinar cómo influyen factores individuales y grupales en el intercambio de información entre los implementadores de un programa de intervención psicosocial dirigido a víctimas de la guerra en Colombia. Se desarrolló un diseño exploratorio transversal. Fueron entrevistados 18 psicólogos, 22 trabajadores sociales, 10 promotores comunitarios y una enfermera. Se empleó el índice E-i y la visualización de vínculos interclase e intraclase. No existe tendencia homofílica en el intercambio de información entre las tres categorías profesionales. El empoderamiento predice las nominaciones recibidas en la red de solicitud de información (ß = 0,296, p < 0,006). Ser central en la red de preferencia es el principal predictor de la recepción de peticiones de información (ß = 0,562, p < 0,0001). Los profesionales empoderados y aquellos que intercambian información sobre el proceso de implementación son considerados informantes clave que pueden mejorar la efectividad del programa.

A troca de informações entre os profissionais envolvidos nas intervenções de saúde mental é fundamental para garantir a efetividade da implementação de programas. O objetivo aqui era analisar a maneira como fatores individuais e de grupo influenciam a troca de informações entre os implementadores de um programa de intervenção psicossocial, dirigido a vítimas da guerra na Colômbia. Foi desenvolvido um desenho de estudo exploratório transversal. Foram entrevistados 18 psicólogos, 22 trabalhadores sociais, 10 agentes comunitários e uma enfermeira. Foram utilizados o índice E-i e a visualização de vínculos interclasse e intraclasse. Não existe tendência homofílica na troca de informações entre as três categorias profissionais. O empoderamento prevê as denominações recebidas na rede de solicitação de informação (ß = 0,296, p < 0,006). Ser central na rede de preferência é o principal preditor da recepção de pedidos de informação (ß = 0,562, p < 0,0001). Os profissionais empoderados e aqueles que trocam informações sobre o processo de implementação são considerados informantes chaves que podem melhorar a efetividade do programa.

Factores individuales y grupales que inciden en el intercambio de información entre implementadores de programas de intervención: una visión estructural / Individual and group factors that impact the exchange of information among intervention programs: a structural view / Fatores individuais e de grupo que incidem na troca de informações entre implementadores de programas de intervenção: uma visão estrutural

Resumen: El intercambio de información entre los aplicadores de intervenciones en salud mental es esencial para garantizar la efectividad de la implementación de programas. El objetivo fue examinar cómo influyen factores individuales y grupales en el intercambio de información entre los implementadores de un programa de intervención psicosocial dirigido a víctimas de la guerra en Colombia. Se desarrolló un diseño exploratorio transversal. Fueron entrevistados 18 psicólogos, 22 trabajadores sociales, 10 promotores comunitarios y una enfermera. Se empleó el índice E-i y la visualización de vínculos interclase e intraclase. No existe tendencia homofílica en el intercambio de información entre las tres categorías profesionales. El empoderamiento predice las nominaciones recibidas en la red de solicitud de información (β = 0,296, p < 0,006). Ser central en la red de preferencia es el principal predictor de la recepción de peticiones de información (β = 0,562, p < 0,0001). Los profesionales empoderados y aquellos que intercambian información sobre el proceso de implementación son considerados informantes clave que pueden mejorar la efectividad del programa.

Abstract: The exchange of information between appliers of mental health interventions is essential to guarantee effective program implementation. The study aimed to examine how individual and group factors influence the exchange of information among the implementers of a psychosocial intervention program targeted to victims of the war in Colombia. A cross-sectional exploratory design was developed. Interviews were held with 18 psychologists, 22 social workers, 10 community promoters, and a nurse. The study used the E-i index and the visualization of interclass and intraclass links. There is no homophilic tendency in the exchange of information among the three professional categories. Empowerment predicts the nominations received in the request for information network (β = 0.296, p < 0.006). To be central in the preference network is the principal predictor of receiving requests for information (β = 0.562, p < 0.0001). Empowered professionals and those who exchange information on the implementation process are considered key informants that can improve the program's effectiveness.

Resumo: A troca de informações entre os profissionais envolvidos nas intervenções de saúde mental é fundamental para garantir a efetividade da implementação de programas. O objetivo aqui era analisar a maneira como fatores individuais e de grupo influenciam a troca de informações entre os implementadores de um programa de intervenção psicossocial, dirigido a vítimas da guerra na Colômbia. Foi desenvolvido um desenho de estudo exploratório transversal. Foram entrevistados 18 psicólogos, 22 trabalhadores sociais, 10 agentes comunitários e uma enfermeira. Foram utilizados o índice E-i e a visualização de vínculos interclasse e intraclasse. Não existe tendência homofílica na troca de informações entre as três categorias profissionais. O empoderamento prevê as denominações recebidas na rede de solicitação de informação (β = 0,296, p < 0,006). Ser central na rede de preferência é o principal preditor da recepção de pedidos de informação (β = 0,562, p < 0,0001). Os profissionais empoderados e aqueles que trocam informações sobre o processo de implementação são considerados informantes chaves que podem melhorar a efetividade do programa.

Examining the effect of the individual characteristics of implementers and the interaction of multiple relationships on the structure of psychosocial intervention teams.

BACKGROUND: Teams' structure may undergo modifications due to the individual attributes of actors and collective-level variables. This research aims to understand the effect of extensive experience working in the program and the simultaneous interaction among different relationships in the network structure of a team of implementers. The Psychosocial Care Program for Victims of Conflict is implemented by psychologists, social workers, and community advocates. METHODS: A cross-sectional study was carried out. Multivariate analysis, quadratic assignment procedures, and graphic visualization are used to (a) determine how seniority affects the professionals' level of centrality in the program and (b) clarify how the interaction among professionals favors new relationships. RESULTS: Longer-lasting professionals in the program report stronger network bonding, predisposition to work, and information exchange. The nonparametric permutation test indicates an intense association between the information requests submitted and received and between the predisposition to work network and the network of received information requests. The results are discussed to optimize the teams implementing the intervention programs. CONCLUSIONS: Network analysis is a powerfull tool to evaluate program implementation processes. Analyzing the interactions among multiples relationships that emerge between members of multidisciplinary teams allows knowing how certain relationships (e.g., information exchange) triggering other kind of relationships (e.g., users referral). The implementers who have been collaborating in the program for a long time are key informants who can facilitate the process of adaptation of newly incorporated professionals.

Sense of community, psychological empowerment, and relational structure at the individual and organizational levels: Evidence from a multicase study.

The aim of this study was to determine the associations among psychological sense of community (PSoC), psychological empowerment (PE), and relational structure with indicators of centrality and cohesion in egocentric and sociocentric networks when analyzed at different levels. A multicase analysis was used (four developed in Colombia and one in Spain) in which 458 people participated in five studies conducted in organizational and community contexts of vulnerable urban and rural areas. The results suggest that PSoC and PE are intertwined processes whose association is accentuated in organizational contexts. However, the relationships between relational context and PSoC and PE vary notably depending on (a) the type of relationship evaluated, (b) the focus of the study (individual/egocentric vs. group/sociocentric) and the type of indicator used to assess the relational context (centrality vs. structural cohesion). Findings are discussed to understand the role that social bonds play in the development of PSoC and in the ability of subjects to empower themselves in different contexts.

Volcanic glass properties from 1459 C.E. volcanic event in South Pole ice core dismiss Kuwae caldera as a potential source.

A large volcanic sulfate increase observed in ice core records around 1450 C.E. has been attributed in previous studies to a volcanic eruption from the submarine Kuwae caldera in Vanuatu. Both EPMA-WDS (electron microprobe analysis using a wavelength dispersive spectrometer) and SEM-EDS (scanning electron microscopy analysis using an energy dispersive spectrometer) analyses of five microscopic volcanic ash (cryptotephra) particles extracted from the ice interval associated with a rise in sulfate ca. 1458 C.E. in the South Pole ice core (SPICEcore) indicate that the tephra deposits are chemically distinct from those erupted from the Kuwae caldera. Recognizing that the sulfate peak is not associated with the Kuwae volcano, and likely not a large stratospheric tropical eruption, requires revision of the stratospheric sulfate injection mass that is used for parameterization of paleoclimate models. Future work is needed to confirm that a volcanic eruption from Mt. Reclus is one of the possible sources of the 1458 C.E. sulfate anomaly in Antarctic ice cores.

Underlying Dimensions of Social Cohesion in a Rural Community Affected by Wartime Violence in Colombia.

War deteriorates the quality of life of the population and profoundly alters social dynamics. We discuss a rural community in northern Colombia whose population was the victim of a massacre and examine the main components that model social cohesion: (a) positive attitudes towards the community, (b) prosocial behaviours and (c) interpersonal relationships. This investigation is a cross-sectional empirical study that includes an analysis of social support networks. The research involved 106 residents, (81.1%, women), with an average age of 42.5 years (standard deviation (SD) = 16.4), who have lived in the community an average 28.8 years (SD = 18.75). Cluster analysis shows that there are two types of personal networks based on homophily and the duration of the ego-alter relationship. The networks that provide the most types of social support shows a moderate level of homophily according to the type of relationship and place of origin and in which the duration of the ego-alter relationship is shorter, compared to networks characterized by high homophily and in which the duration of the ego-alter relationship is longer (χ² = 5.609, p < 0.018). Homophily based on place of residence actively affects the sense of community and social cohesion. Moreover, the sense of community is the variable that most affects social cohesion (ß = 0.650; p < 0.001) and is, in turn, determined by prosocial behaviour (ß = 0.267; p < 0.006). However, prosocial behaviours do not significantly affect interpersonal relationships or community cohesion. The results are discussed to promote social development strategies aimed at building individual, organizational and community capacity to foster psychosocial well-being in post-war contexts.

Acercamiento multifactorial a la fisiopatología de la obesidad. Modelo de abordaje COD2 / A multi-factor approach to the physiopathology of obesity: COD2 model

La obesidad en este momento representa una de las peores amenazas del sector salud. El acelerado aumento de la prevalencia y mortalidad a causa de enfermedades cardiovasculares establece un precedente histórico como problema de salud pública mundial. La elevada incidencia de obesidad y enfermedades crónicas ha llevado a múltiples áreas de la salud a entender y buscar un detonante claro que explique esta patología. Existen numerosas causas que explican su comportamiento agresivo, progresivo y crónico. Sin embargo, ninguna de ellas satisface como el solo factor desencadenante que ofrezca un tratamiento único que genere una reducción de su rápida expansión. En este artículo se buscan explicar las principales causas relacionadas con esta entidad así como los mecanismos que lo demuestran, para lograr entender el abordaje adecuado de los pacientes que acuden buscando el manejo de la obesidad (modelo COD2).

Obesity is currently considered as one of the major life-threatening conditions affecting the healthcare system. The accelerated increase in prevalence and mortality due to cardiovascular diseases establishes an historical precedent as a global public health issue. The increased incidence of obesity and chronic diseases, has led multiple health researchers to try to identify a clear triggering factor contributing to obesity. There are numerous causes which explain its aggressive, progressive and chronic behavior. However, they do not satisfactorily elucidate a unique triggering factor which would determine a unique treatment to help decelerate its rapid expansion. This article seeks to explain the major causal factors and mechanisms leading to obesity, in order to find the most appropriate approach for obese patients seeking treatment options (COD2 model).