Factors associated with institutionalization among the oldest old: Results based on the nationally representative study 'old age in Germany (D80+)'.

OBJECTIVES: To examine the factors associated with institutionalization among individuals aged 80 years and over in Germany (total sample and stratified by sex). METHODS/DESIGN: We used data from the nationally representative 'Old Age in Germany (D80+)' (analytic sample: n = 9572 individuals), including individuals aged 80 years and over in Germany. Institutionalization (private living vs. institutionalization) served as an outcome measure. For the written interview, data collection took place from November 2020 to April 2021. Multiple logistic regressions of the overall sample (also stratified by sex) were applied. RESULTS: In the analytic sample, 10.2% (95% CI: 9.2%-11.3%) of the participants were institutionalized. The odds of being institutionalized were positively associated with being female (OR: 2.02, 95% CI: 1.08 to 3.80), being 90 years and over (compared to 80-84 years, OR: 1.67, 95% CI: 1.17 to 2.40), not being married (e.g., being single compared to being married: OR: 14.06, 95% CI: 6.73 to 29.37), higher education (e.g., high education compared to low education: OR: 1.88, 95% CI: 1.25 to 2.84), more favorable self-rated health (OR: 1.32, 95% CI: 1.07 to 1.62) and greater functional impairment (OR: 15.34, 95% CI: 11.91 to 19.74). Sex-stratified regressions were also conducted, mostly yielding similar results. CONCLUSION: Our study highlighted the role of several sociodemographic factors (particularly marital status, e.g., being single) and functional impairment for the risk of institutionalization among the oldest old in Germany. This study confirms findings in studies in younger samples that functional decline is the main factor associated with institutionalization. As functional decline may be modifiable, efforts to maintain functional abilities may be important. This knowledge is important for relevant groups (such as clinicians and policy-makers) because it may guide early intervention and prevention efforts, can help allocate healthcare resources effectively and shape policies to support independent living. Further insights using longitudinal data is recommended.

Costs of care trajectories of people with dementia compared with matched controls. Longitudinal analysis of linked health and administrative data.

OBJECTIVES: To provide insight into the health and social care costs during the disease trajectory in persons with dementia and the impact of institutionalization and death on healthcare costs compared with matched persons without dementia. METHODS: Electronic health record data from family physicians were linked with national administrative databases to estimate costs of primary care, medication, secondary care, mental care, home care and institutional care for people with dementia and matched persons from the year before the recorded dementia diagnosis until death or a maximum of 4 years after the diagnosis. RESULTS: Total mean health and social care costs among persons with dementia increased substantially during the disease trajectory, mainly due to institutional care costs. For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia, while for those who are admitted to a long-term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. CONCLUSIONS: The steep rise in health and social care costs across the dementia care trajectory is mainly due to increasing costs for institutional care. For those remaining in the community, home care costs and hospital care costs were the main cost drivers. Future research should adopt a societal perspective to investigate the influence of including social costs.

Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria.

Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.

School- and intervention-related factors associated with institutionalization of health promotion interventions in elementary schools. / Facteurs liés aux écoles et facteurs liés aux interventions dans le contexte de l'institutionnalisation des interventions de promotion de la santé dans les écoles primaires.

INTRODUCTION: Long-term availability of health-promoting interventions (HPIs) in school settings can translate into health benefits for children. However, little is known about factors associated with HPI institutionalization in schools. In this study, we identified correlates of the institutionalization of HPIs offered in elementary schools in Quebec, Canada. METHODS: In two-part, structured telephone interviews over three academic years (2016-2019), elementary school principals (or their designees) throughout Quebec identified an index HPI offered at least once in their school during the previous three years, and were asked whether it was institutionalized (i.e. explicitly written in the school's educational project, e.g. in the form of educational objectives and means of achieving them). We examined associations between institutionalization and 10 school-related and 16 HPI-related characteristics in univariable and multivariable logistic regression analyses. RESULTS: School key informants (n = 163) reported on 147 different HPIs that had been available in their schools in the past three years, 56% of which were institutionalized. Three aspects of school culture-parent/community engagement with the school, school/teacher commitment to student health and school physical environment-were positively associated with HPI institutionalization. HPI-related characteristics positively associated with HPI institutionalization included number of competencies addressed by the HPI, number of teaching strategies employed, modifications made to the HPI prior to or during implementation and perceived success of the HPI. Inviting families or community groups to participate in the HPI was inversely associated with institutionalization. CONCLUSION: Better understanding of factors associated with HPI institutionalization may inform the development of school-based HPIs that have the potential for sustainability.

Institutions and institutionalisation: They're part of everyday life.

BACKGROUND: Institutions are established patterns of recurrent social relationships playing a fundamental part in all our lives. The family is the best-known institution, but other 'total' institutions serve as organisations directly affecting the lives of many individuals in the healthcare sector. OBJECTIVE: This paper examines the sociological theory of institutionalisation as applied to individuals admitted to aged-care facilities, where the complete life-rounds of inmates occur within clearly defined limits. The study provides a framework to enable general practitioners, nurses and healthcare professionals to better appreciate the processes involved as individuals adapt to their new environment. DISCUSSION: Sociology provides valuable insights for healthcare providers in understanding how individuals adapt to their loss of independent living and find themselves subjected to intimate regulation in the total institution. The biopsychosocial model of healthcare delivery is better understood when we as health professionals have greater insights to appreciate the competing processes at work.

Open government data use: The Brazilian states and federal district cases.

PURPOSE: This paper presents the results of an online survey and subsequent interviews investigating whether, how, and why public administrations of Brazilian states and the federal district (Federation Units) use open government data. According to the literature reviewed, the questions were categorized into four big groups: benefits, barriers, enablers, and drivers. DESIGN/METHODOLOGY/APPROACH: The Survey method, based on a questionnaire followed by interviews, was used to collect and analyze data from the open data officers of 26 Brazilian Federation Units. FINDINGS: The use of open government data is controversial as responses from the questionnaires and interviews do not match and raise questions about how well-represented each Federation Unit was. Evidence of open government data use was found. Among others, findings showed that political leadership committed to using open data facilitates and motivates public agents to use these data. Additionally, interviews indicated that the lack of human resources with the knowledge, skills, and capabilities to use open data is a relevant barrier to data use. Findings also revealed that open government data mainly support policy and decision-making processes. PRACTICAL IMPLICATIONS: This research contributed to the open data and public administration fields. It portrays diverse realities of open government data use and institutionalization in Brazilian state and district public administrations. In addition, it provides lists of open government data use benefits, barriers, drivers, and enablers from the perspective of these administrations so that they can benchmark against each other and improve their OGD use. ORIGINALITY AND RESEARCH IMPLICATIONS: For academia, this research provides empirical evidence of the factors influencing public administrations' use of open government data at the subnational level in Brazil. Even though Brazil ranks high on OGD global assessments, few studies on its use and reuse in the public sector were identified. This is one of the first academic studies focusing on open government data use in the country. It also contributes by offering to the academic community two instruments, a questionnaire and an interview protocol, which can be applied to other public settings to expand this study's results or open new research paths by applying them to other contexts.

[Manfred Pflanz (1923-1980) - A key Protagonist for the Institutionalization of Social Medicine and Medical Sociology in Germany]. / Manfred Pflanz (1923­1980) ­ zentraler Akteur bei der Institutionalisierung von Sozialmedizin und Medizinsoziologie.

Manfred Pflanz, an internist with his focus on social medicine, medical sociology and epidemiology, (1923-1980) played a key role in the institutional integration of social science expertise into medicine in the Federal Republic of Germany during the 1960s and 70 s. The present study, a biographic sketch of Pflanz, describes his work, his programmatic ideas on social medicine and medical sociology, and his activities as an expert consultant in public health for various political entities. This should enable getting an insight into the origins and ramifications, as well as the contemporary programs and international embeddedness of the overlapping fields of social medicine and medical sociology in Germany.

[Cognitive, Emotional and Dependency Level on Institutionalized Older Adults]. / Estado cognitivo, emocional y nivel de dependencia en personas adultas y mayores institucionalizadas.

INTRODUCTION: It is necessary to analyze the aging process in institutionalized older people. For this purpose, a descriptive and analytical epidemiological study was carried out in nursing homes for older adults before the COVID-19 pandemic. OBJECTIVE: Provide an in-depth insight into cognitive (MEC), emotional (Geriatric Depression Scale), and functional (Barthel Scale) status within the older adult participants. METHOD: A sample of 973 participants analyzed the relationship between cognitive status, vulnerability to depression, and autonomous performance in Daily Day Activities (DDA) to predict the impact of the comorbidity of these variables. Therefore, in addition to the general distribution of the sample in the previously mentioned dimensions, differences were analyzed according to gender, age, educational level, and geographic area. RESULTS: The results confirm the hypothesis that a more impaired cognitive state is associated with higher levels of depression and lower functional capacity. The MEC scores have positive and highly significant correlations with Barthel and Yesavage. The relationship between dementia and autonomy is observed for both sexes, while the relationship between dementia and depression is only observed in women. The educational level influences the MEC scores (the more education, the better performance) and the Barthel scores (the less education, the greater dependency). Statistically significant differences were also found depending on the area of residence location. CONCLUSIONS: The more deteriorated cognitive state will be associated with a higher level of depression and lower functional capacity in daily life activities.

[On clinical elites and their role in institutionalization of new national clinical disciplines (the second half of XX century)].

The development of national clinical medicine in Russia in XX century is related not only to evolution of scientific schools, but also to such historical phenomenon as clinical elites. In the article definition of therapeutic elites is proposed. The destiny of therapeutic elites and their role in institutionalization of national clinical disciplines is discussed.

Immigration enforcement and the institutionalization of elderly Americans.

This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.

Institutionalization for good governance to reach sustainable health development: a framework analysis.

BACKGROUND: This article explores the concept of institutionalization, which is the process of transforming ideas into programs and automating actions, in the context of health system governance and sustainable development. Institutionalization is a key mechanism for creating accountable and transparent institutions, which are essential for achieving health system resilience and sustainability. This study identifies the components and dimensions of institutionalization in the health system and its relationship with good governance and sustainable health development. MAIN TEXT: We applied a scoping review method in five steps. First, we formulated a question for our research. Then, we concluded a comprehensive literature search in five electronic databases for identifying relevant studies. This review has two phases: identifying the concept of institutional approach and its components in health system, and its relationship with good governance to reach Sustainable Health Development (SHD). The third step was study selection, and the 1st author performed data abstraction. The key issues which are identified in our review, related to the concepts of SDH, its goals, pillars and principles; positive peace; good governance; components of institutional approach components, and their relations. Finally, we summarized and organized our findings in a format of a proposed conceptual framework, to underpin the role of institutionalization in the health system to achieve sustainable development. CONCLUSION: Institutionalization is a key concept for achieving positive peace and good governance, which requires meaningful involvement of leaders, politicians, civil society, and public participation. It also depends on the conditions of justice, human rights, transparency, accountability and rule of law. In the wake of COVID-19, institutionalization is more crucial than ever for advancing sustainable development, especially in the context of low and middle-income countries (LMICs).

Reaching New Heights: A Comprehensive Study of Hand Transplantations in Korea after Institutionalization of Hand Transplantation Law.

PURPOSE: With the revision of the Organ and Transplantation Act in 2018, the hand has become legal as an area of transplantable organs in Korea. In January 2021, the first hand allotransplantation since legalization was successfully performed, and we have performed a total of three successful hand transplantation since then. By comparing and incorporating our experiences, this study aimed to provide a comprehensive reconstructive solution for hand amputation in Korea. MATERIALS AND METHODS: Recipients were selected through a structured preoperative evaluation, and hand transplantations were performed at the distal forearm level. Postoperatively, patients were treated with three-drug immunosuppressive regimen, and functional outcomes were monitored. RESULTS: The hand transplantations were performed without intraoperative complications. All patients had partial skin necrosis and underwent additional surgical procedures in 2 months after transplantation. After additional operations, no further severe complications were observed. Also, patients developed acute rejection within 3 months of surgery, but all resolved within 2 weeks after steroid pulse therapy. Motor and sensory function improved dramatically, and patients were very satisfied with the appearance and function of their transplanted hands. CONCLUSION: Hand transplantation is a viable reconstructive option, and patients have shown positive functional and psychological outcomes. Although this study has limitations, such as the small number of patients and short follow-up period, we should focus on continued recovery of hand function, and be careful not to develop side effects from immunosuppressive drugs. Through the present study, we will continue to strive for a bright future regarding hand transplantation in Korea.

Predicting sojourn times across dementia disease stages, institutionalization, and mortality.

INTRODUCTION: Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild-, moderate-, severe dementia, and institutionalization until death. METHODS: Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento). RESULTS: Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57-6.98) to 10.08 (8.94-12.18) years. DISCUSSION: Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis.

Operationalizing blue carbon principles in France: Methodological developments for Posidonia oceanica seagrass meadows and institutionalization.

Conservation of ecosystems is an important tool for climate change mitigation. Seagrasses, mangroves, saltmarshes and other marine ecosystems have particularly high capacities to sequester and store organic carbon (blue carbon), and are being impacted by human activities. Calls have been made to mainstream blue carbon into policies, including carbon markets. Building on the scientific literature and the French voluntary carbon standard, the 'Label Bas-Carbone', we develop the first method for the conservation of Posidonia oceanica seagrasses using carbon finance. This methodology assesses the emission reduction potential of projects that reduce physical impacts from boating and anchoring. We show how this methodology was institutionalized thanks to a tiered approach on key parameters including carbon stocks, degradation rates, and decomposition rates. We discuss future needs regarding (i) how to strengthen the robustness of the method, and (ii) the expansion of the method to restoration of seagrasses and to other blue carbon ecosystems.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

Personal network dynamics across the life course: A relationship-related structural approach.

Building on Georg Simmel's concept of "form", the article presents a relationship related structural concept of social relationships that specifically accounts for opportunities and constraints resulting from the fact that relationships are solidified patterns of interaction that, once established, can develop a power of their own (inertia, momentum) that cannot easily be influenced by the involved actors. In this "relationship-related structural approach", social relationships or "forms" can be understood as specific constellations of "basic structural properties", i.e. specifications of various aspects of quantity, of time, of space, of similarity, and including also a certain degree of freedom to enter or quit a relationship, knowledge about one another, and types and degree of institutionalization. The specification of these structural properties impacts the functional capacity of relationships, as well as the dynamics of both relationships and networks, especially the ways in which relationships are formed, maintained, or lost. Referring to various life course transitions from different phases of the life course, it is demonstrated how this approach helps to better understand the dynamics of social relationships and networks and the impact of life events on personal relationships across the life course. Finally, implications of this novel perspective for life course and network research are discussed.

Diagnosis of behavioral symptoms as a predictor of institutionalization among Medicaid patients with dementia.

OBJECTIVES: Behavioral symptoms are commonly observed in the course of dementia. This study aimed to assess the association of the diagnosis of a cluster of behavioral symptoms (e.g., agitation, aggression, psychotic symptoms, and delirium/wandering) with the likelihood of subsequent institutionalization. METHODS: A retrospective cohort study of adults aged 65 and above diagnosed with dementia identified in the IBM® MarketScan® Multistate Medicaid database between October 01, 2015, and September 30, 2019, was conducted. The index date was defined as the first diagnosis date of dementia. The presence or absence of behavioral symptoms was identified in the 6 months prior to the index date (baseline). Institutionalization was evaluated 12 months (follow-up) post the index date. The association between diagnosed behavioral symptoms during the baseline period and institutionalization in the follow-up period was assessed using a multivariable logistic regression, adjusting for baseline sociodemographic and clinical characteristics. RESULTS: The study cohort included 40,714 patients with dementia. A diagnosis of behavioral symptoms was found among 2,067 (5.1%) patients during the baseline period. An increased likelihood of institutionalization was found during the follow-up among patients with agitation and aggression in baseline (OR = 1.51 (95% CI: 1.18-1.92)) compared to patients without these symptoms at baseline. Patients with psychotic symptoms in baseline had significantly higher odds of getting institutionalized during the follow-up compared to patients without psychotic symptoms in baseline (OR = 1.36 (95% CI: 1.20-1.54)). Similarly, patients with symptoms of delirium and wandering in baseline had a higher likelihood of institutionalization than patients without these symptoms at baseline (OR = 1.61 (95% CI: 1.30-1.99)). CONCLUSION: Several diagnosed behavioral symptoms were associated with a higher risk of institutionalization among older adults with dementia and should be considered when planning treatment strategies for the effective management of the condition.

De normalistas a naturalistas: la especialización de las mujeres en salud pública en Brasil (1920-1960) / From normalists to naturalists: The specialization of women in public health in Brazil (1920-1960)

El artículo tiene como objetivo demostrar como la institucionalización de la especialización en salud pública en Brasil abrió oportunidades para la capacitación y la profesionalización de mujeres a partir de los años 1920. El análisis busca avanzar en la historiografía en lo que toca al desempeño y especialización de las mujeres en el campo de la salud pública en un periodo, hasta entonces, poco estudiado, sobrepasando la Primera República brasileña (1889-1930), hasta 1960. La delimitación del marco temporal se realizó en función de las fuentes, es decir, la documentación de los cursos del Instituto Oswaldo Cruz y los formularios de registro e inscripción de las alumnas, que se encuentran bajo la tutela de la Casa de Oswaldo Cruz, Fundación Oswaldo Cruz.(AU)

The article aims at demonstrating how the institutionalisation of specialisation in public health in Brazil opened up opportunities for the training and professionalisation of women from the 1920s onwards. The analysis seeks to advance the historiography regarding the performance and specialisation of women in the field of public health during a period until then little studied, extending beyond the First Brazilian Republic (1889-1930), until 1960. The delimitation of the time frame was based on the arquives, i.e. the documentation of the courses of the Oswaldo Cruz Institute and the registration and enrolment forms of the students, which are under the care of the House of Oswaldo Cruz, Oswaldo Cruz Foundation.(AU)

Discursos e imágenes sobre la desigualdad. Políticas públicas e institucionalización de la locura en el noroeste argentino (1935-1954) / Discourses and images on inequality. Public policy and institutionalization of madness in the argentinean northwest (1935-1954)

En la presente investigación analizaremos la primera institución psiquiátrica del noroeste argentino, específicamente en la provincia de Tucumán, el Hospital de Alienados (HA), desde el evento que impulsó su creación -la negativa de traslados interprovinciales de pacientes a colonias nacionales en 1935- hasta el retorno a dicha práctica por parte del Estado nacional -en 1954-. Hasta la creación del HA, las posibles respuestas para las personas con problemáticas psiquiátricas eran el traslado a instituciones en otras provincias o el encierro en un asilo de la ciudad y en establecimientos policiales. Ante las graves consecuencias de las últimas alternativas, y la cancelación de los traslados, tuvo que ser el propio Estado provincial el que hiciera frente a la problemática. El HA se constituyó como el primero en Argentina en pertenecer a un Estado provincial y no depender de las arcas nacionales. Este trabajo inaugural en los estudios historiográficos de la región nos permitirá analizar algunos procesos institucionales de las políticas en salud mental a nivel provincial y nacional, las concepciones sobre locura y encierro que se sostenían en aquella época, el flagelo de la pobreza como causa para enloquecer y el efecto de todo lo anterior en la opinión pública.(AU)

In the present investigation we will analyze the first psychiatric institution in northwestern Argentina, specifically in the province of Tucumán, the Hospital de Alienados (HA), from the event that prompted its creation -the refusal of interprovincial transfers of patients to national colonies in 1935- until the return to this practice by the national State -in 1954-Until the creation of the HA, the possible responses for people with psychiatric problems were transfer to institutions in other provinces or confinement in a city asylum and in police establishments. Given the serious consequences of the last alternatives, and the cancellation of the transfers, it had to be the provincial State itself that faced the problem. The HA was established as the first in Argentina to belong to a provincial State and not depend on the national coffers. This inaugural work in the historiographical studies of the region will allow us to analyze some institutional processes of mental health policies at the provincial and national level, the conceptions about madness and confinement that were held at that time, the scourge of poverty as a cause of craziness, and the effect of all of the above on public opinion.(AU)

Castilla del Pino: un faro indispensable para navegantes de lo mental / Castilla del Pino: An Essential Lighthouse for Navigators of the Mental

Castilla del Pino ejerció un indudable liderazgo intelectual sobre varias generacio-nes de españoles en el último tercio del siglo XX, y de forma particular ejerció su función de intelectual aplicado a la práctica clínica de lo mental. Esta tarea constituyó un verdadero ma-gisterio para los profesionales interesados en prácticas clínicas rigurosas, respetuosas con la dignidad y los derechos de los pacientes. En este trabajo se revisan algunas de sus principa-les aportaciones como intelectual a la práctica psiquiátrica y la psicoterapia. Específicamen-te, se abordan sus contribuciones al estudio de la influencia de la ideología en la psicoterapia y la ideología de la locura y su impacto en la práctica psiquiátrica en contexto hospitalario. Sus observaciones y recomendaciones significan una magnífica guía para el ejercicio de la observación rigurosa, la reflexión y el pensamiento crítico frente al dogmatismo. (AU)

Castilla del Pino was an undoubted intellectual leader over several generations of Spaniards in the last third of the 20th century. He specifically played this role as an intellectual in the field of the mental health practice. This task constituted a true teaching for professionals interested in rigorous clinical practices, respectful of the dignity and rights of patients. This paper reviews some of his main contributions as an intellectual to psychiatric practice and psychotherapy. It specifically addresses his contributions to the study of the influence of ideology in psychotherapy, as well as the ideology of madness and its impact on psychiatric practice in a hospital context. His observations and recom-mendations are an excellent guide to the exercise of rigorous observation, reflection and critical thinking facing any dogmatism. (AU)