Jail diversion: the Miami model.

The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP), located in Miami-Dade County, FL, was established in 2000 to divert individuals with serious mental illnesses (SMI; eg, schizophrenia, bipolar disorder, and major depression) or co-occurring SMI and substance use disorders away from the criminal justice system and into comprehensive community-based treatment and support services. The program operates two primary components: prebooking jail diversion consisting of Crisis Intervention Team (CIT) training for law enforcement officers and postbooking jail diversion serving individuals booked into the county jail and awaiting adjudication. In addition, the CMHP offers a variety of overlay services intended to: streamline screening and identification of program participants; develop evidence-based community reentry plans to ensure appropriate linkages to community-based treatment and support services; improve outcomes among individuals with histories of noncompliance with treatment; and expedite access to federal and state entitlement benefits. The CMHP provides an effective, cost-efficient solution to a community problem and works by eliminating gaps in services, and by forging productive and innovative relationships among all stakeholders who have an interest in the welfare and safety of one of our community's most vulnerable populations.

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge.

BACKGROUND: The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. OBJECTIVES: The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. METHOD: Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. RESULTS: The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. CONCLUSION: The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Avaliação da dependência no autocuidado: estudo exploratório do fenómeno em contexto comunitário / Self-care dependency assessment: an exploratory study of the phenomenon in community

The assessment of the dependent person's self-care ability, through measure-ment instruments, and the assessment of the level and kind of dependency, may provide nurses a more assertive method for understand the nature of the problems that affect dependency and for establish an action plan tailored to the development of new practices centered on the dependent person, looking forward to promote autonomy. Within this context, and in order to develop nursing practice in self-care dependency context, this paper serves the goal of the characterization of dependent people in self-care in a community context and the analysis of the different domains of self-care according to sociodemographic and clinical variables. It was used the non-probabilistic sampling method, of the accidental type and for data collection was used the reduced version of the Self-Care Dependency Assessment Form. The results found show that women and the elderly are more dependent, and that the dependence settles mainly gradually. Regarding the level of dependence by self-care domain, the one that registered the highest level of dependence was self-care "taking medication", followed by "dressing and undressing" and self-care "taking a bath". The "global level of dependence" has an average of 2.64 and a standard deviation of 0.83, which reveals high degrees of dependence on self-care. With current demographic changes and consequent health needs and their implications for health policy preparation and planning, the measurement and evaluation of the dependent person and their caregiver is becoming increasingly essential, enabling a holistic and adjusted approach

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The relationship between resilience, emotional distress, and community participation outcomes following traumatic brain injury.

Purpose/Objective: To determine how resilience is associated with social participation outcomes in persons with traumatic brain injury (TBI), in the context of emotional distress, demographics, and injury-related factors.Setting: Individuals with a history of TBI recruited the following stay at three rehabilitation facilities in the USA.Participants: 201 community-dwelling persons with medically documented TBI ranging in severity from mild to severe.Design: Prospective cohort observational study. Data were collected at two time points, approximately 6 months apart.Main Measures: TBI-QOL; PART-OResults: Resilience at baseline was moderately to strongly correlated with baseline psychological distress variables (rs= -.66) and social participation variables (rs =.33 to.57). In regression analyses, resilience was directly associated with social participation outcomes and formed a significant interaction with emotional distress in some models. Resilience failed to show a relationship with social participation at 6-month follow-up, when controlling for baseline social participation.Conclusions: Though related to emotional distress, self-reported resilience makes a unique contribution to predicting outcomes over time following brain injury, and may impact the relationship between stress and negative participation outcomes. As such, it is possible interventions that promote resilience may mitigate distress and promote community integration.

Shifting Academic Health Centers From a Culture of Community Service to Community Engagement and Integration.

There is an increasing need for academic health centers (AHCs) to engage communities across their clinical, research, and educational missions. Although AHCs have a long-standing history of community service, a more comprehensive approach to working with communities is required to respond to shifts toward a population health paradigm, funder requirements for community engagement in research, and demands that medical education focus more on social and environmental determinants of health. Community engagement has been employed at many AHCs, though often in limited ways or relying heavily on students and faculty interested in serving communities. This limited involvement has been due, in part, to lack of infrastructure to support engagement, resource constraints, and the lack of a clear value proposition for long-term investments in community partnerships. However, there are compelling reasons for AHCs to take an enterprise-wide approach to working with communities. An enterprise-wide approach to community engagement will require reconsideration of communities, moving from viewing them as people or groups in need of service to seeing them as assets who can help AHCs better understand and address social determinants of health, enhance students' and trainees' ability to provide care, and increase the relevance and potential impact of research discoveries. To accomplish this, AHCs will need to establish the necessary infrastructure to support long-term community partnerships, adapt policies to support and reward engaged scholarship and teaching, and consider new ways of integrating community members in roles as advisors and collaborators across the AHC.

Informe de Rotación Electiva 2019

El presente documento tiene como objetivo hacer una descripción de la experiencia de rotación electiva en el exterior del país. En él se incluye una fundamentación del área de interés, las actividades realizadas durante la rotación, los objetivos propuestos, los aportes brindados a la sede de rotación, se mencionan algunos de los obstáculos y dificultades y se realiza una sistematización de los diversos aprendizajes realizados, principalmente aquellos que abonen al campo de la educación y promoción de la salud. El lugar de rotación elegido fue la organización de Artes Multiculturales para Escuelas y Comunidades (en inglés MASC: Multicultural Arts for Schools and Communities) ubicada en la ciudad de Ottawa, provincia de Ontario, Canadá; ciudad principalmente Angloparlante. El período de rotación comprendió del día 02 de septiembre al 01 de noviembre del 2019, un total de dos meses. (AU)

Efectividad de una estrategia de apoyo individualizado al empleo para personas con trastornos mentales graves / Effectiveness of individual supported employment for people with severe mental disorders

Objetivo: Valorar la efectividad de una estrategia de apoyo individualizado al empleo (IPS) en personas con enfermedad mental grave en la isla de Tenerife (España). Método: Pacientes de los Servicios de Salud Mental Comunitaria con trastornos mentales graves fueron asignados a dos grupos de forma aleatorizada. En uno de ellos se aplicó el método IPS (n=124) y en el grupo control (n=75) se asesoró en la manera habitual de búsqueda de empleo. Los pacientes fueron seguidos una media de 3,4 años y se analizó cuántos trabajaron al menos un día, el tiempo trabajado, los salarios, el número de contratos y el número de admisiones hospitalarias. Se usaron métodos estadísticos no paramétricos en la comparación de resultados (U de Mann-Whitney). Resultados: Los pacientes asignados al grupo IPS trabajaron al menos un día el 99%, frente al 75% del grupo control; trabajaron de media 30,1 semanas/año vs. 7,4; el salario mensual fue de 777,9 euros vs. 599,9 euros; el número de contratos por persona fue de 3,89 vs. 4,85, y los ingresos hospitalarios fueron 0,19 vs. 2,1. Conclusión: La estrategia IPS es efectiva en la integración laboral de personas con enfermedad mental grave, logrando que trabajen más tiempo, tengan mayor salario y menos ingresos hospitalarios, en un contexto social de alto desempleo

Objective: To assess the effectiveness of an individual placement and support (IPS) strategy in people with severe mental disorders in Tenerife Island (Spain). Methods: Patients of Community Mental Health Services with severe mental disorders were randomly assigned to two groups. One of them received IPS (n=124), and the control group (n=75) was advised in the usual job search. Patients were followed up for an average of 3.4 years and an analysis was made of how many patients worked at least one day, working hours, wages, the number of contracts and the number of hospital admissions. Non-parametric methods were used to compare the results (Mann-Whitney U test). Results: The percentage of patients who worked at least one day was 99% in the IPS group compared with 75% in the control group; they worked on average 30.1 weeks per year vs 7.4; the monthly salary was Euros 777.9 vs Euros 599.9; the number of contracts per person was 3.89 vs 4.85, and hospital admissions were 0.19 vs 2.1. Conclusions: The IPS strategy is effective for the labour integration of people with severe mental illness getting them to work longer, have higher wages and fewer hospital admissions

Gobernando la experiencia: salud mental y ciudadanía / Governing experience: mental health and citizenship

En el presente artículo se analiza la salud mental como una tecnología de gobierno que centra su campo de actuación en la experiencia vital de los individuos, a escala mundial y en todas las esferas de la vida. Tomando el concepto de tecnologías del yo de Michel Foucault, se propone pensar un cambio en las formas de producción de sí mismo a raíz de la presencia de la salud mental como organizador vital. A través del análisis de las interacciones en una consulta de un centro de atención primaria de la provincia de Barcelona, se describen tres tecnologías de autogobierno que toman a la experiencia como objeto. Se concluye que dichas tecnologías no están dirigidas a la producción de un sí mismo, sino de un nosotros, que se presenta como modalidad normativa que define la pertenencia política y biológica a un ideal de especie

In this article, mental health is analyzed as a governmental technology whose field of action focuses on the life experience of individuals, both worldwide and in all spheres of life. On the basis of Michel Foucault's concept of technologies of the self, it is proposed to think about a change in the forms of production of oneself as a result of the presence of mental health as a vital organizer. Through the analysis of the interactions in a consultation room of a primary care center in the province of Barcelona, three self-governance technologies that take experience as an object are described. It is concluded that these technologies are not aimed at the production of one's self, but at the production of ourselves, which is presented as a normative modality that defines political and biological belonging to an ideal of species

Los cuidados en el marco de una ciudadanía inclusiva / Care as the basis of an inclusive citizenship

La inmadurez biológica del ser humano cuando nace hace que para su supervivencia y desarrollo sea necesario alguien que le cuide y posibilite el paso de cachorro de la especie a sujeto psíquico, es decir, social. Ello se produce en un entramado de vínculos en el seno de una comunidad que ofrece soportes. Las fallas en ese proceso generan diversas experiencias de desvalimiento y predisponen a una fragilidad que emerge cuando fallan los soportes necesarios para hacer frente a las adversidades. Estas situaciones de carencia impactan sobre el sujeto, lo exponen a intensos sufrimientos y al riesgo de apartamiento de su comunidad y del no disfrute de sus derechos de ciudadanía. Sus relatos transmiten la idea de ser sujetos a la intemperie y sus manifestaciones pueden ser descritas como una clínica del desamparo. Cuando ello ocurre, urge la facilitación de experiencias de cuidado que se sustenten en un trato atento y en la recuperación de sus derechos de ciudadanía

The biological immaturity of human beings at birth demands, for their survival and development, that someone takes care of them and makes possible the passage from puppy of the species to psychic subject, i. e., social. This occurs in a network of links within a community that offers support. Failures in this process generate various experiences of helplessness that predispose to a fragility that emerges when the necessary supports to cope with adversity fail. These situations of lack impact on the subject, exposing him to intense suffering and to the risk of being separated from his community and of not enjoying his citizenship rights. Their stories convey the idea of a subject left out in the open and their manifestations can be described as a clinic of helplessness. When this happens, it is urgent to provide experiences of care based on an attentive treatment and on the recovery of their citizenship rights

Multidimensional measure of immigrant integration.

The successful integration of immigrants into a host country's society, economy, and polity has become a major issue for policymakers in recent decades. Scientific progress in the study of immigrant integration has been hampered by the lack of a common measure of integration, which would allow for the accumulation of knowledge through comparison across studies, countries, and time. To address this fundamental problem, we propose the Immigration Policy Lab (IPL) Integration Index as a pragmatic and multidimensional measure of immigrant integration. The measure, both in the 12-item short form (IPL-12) and the 24-item long form (IPL-24), captures six dimensions of integration: psychological, economic, political, social, linguistic, and navigational. The measure can be used across countries, over time, and across different immigrant groups and can be administered through short questionnaires available in different modes. We report on four surveys we conducted to evaluate the empirical performance of our measure. The tests reveal that the measure distinguishes among immigrant groups with different expected levels of integration and also correlates with well-established predictors of integration.

Encajar las piezas del puzle para construir una identidad / Working out the puzzle's pieces in order to build up an identity / Encaixar les peces del puzle per construir una identitat

El hecho migratorio ocasiona una serie de duelos en las familias que, si no pueden ser suficientemente elaborados, producen afectaciones en los diferentes miembros de la unidad familiar, especialmente el desarrollo de los niños y los adolescentes. En este artículo se presenta un caso clínico atendido en un Centro de Salud Mental Infanto-Juvenil (CSMIJ) desde un abordaje terapéutico familiar, en el que, a través de la metáfora de la construcción de un puzle, se lleva a cabo una tarea de reconocimiento y contención de los aspectos dolorosos vividos. El objetivo es facilitar su integración y la constitución de una nueva identidad individual y familiar

Migration phenomenon causes a series of mourning in the families. It affects different members of the family unit, especially the development of children and adolescents. This article talks, from a family therapeutic approach, about a case treated in a Child and Adolescent Mental Health Center (CSMIJ) in which, through the metaphor of the construction of a puzzle, the task of recognition and containment of the painful aspects was carried out. The objective is to facilitate its integration and the constitution of a new individual and family identity

El fet migratori ocasiona una série de dols en les famílies que, si no poden ser suficientment elaborats, produeixen afectacions en els diferents membres de la unitat familiar I comprometen especialment el desenvolupament dels nens I adolescents. En aquest article, es presenta un cas clínic atés en un centre de salut mental infantil I juvenil (CSMIJ) des d'un abordatge terapéutic familiar en el qual, mitjançant la metáfora de la construcció d'un puzle, es porta a terme una tasca de reconeixement I contenció dels aspectes dolorosos viscuts. L'objectiu és facilitar la seva integració I la constitució d'una nova identitat individual I familiar

The community role of schools in Jicamarca and Villa El Salvador (Peru): crosscutting behavior settings in personal networks / El rol comunitario de las escuelas en Jicamarca y Villa El Salvador (Perú): sección transversal de configuraciones de comportamiento en las redes personales

The personal networks of 138 parents of children participating in a child labor prevention initiative in three schools in Lima (Peru) are analyzed. First, relevant behavior settings in two informal population settlements in the periphery of the big city were detected. Second, the distribution of personal relationships in that small set of community contexts served to describe the everyday interaction in the neighborhood. Each interviewee provided information on the 45 persons with whom he/she interacts regularly, indicating in each case the context where that relationship preferably takes place. They also reported on the involvement of families in school and citizen participation initiatives in their community. The clustered graphs technique showed that the school is the second most relevant space for the development of interpersonal relationships in the neighborhood. Relationships among different family households were the most powerful predictor of community integration in the neighborhood of residence. The highest rates of child labor coincide with the most recently created community environments, with more fragmented personal networks, and with a less structured community as a whole. School is a community hub that facilitates interaction between the families of the neighborhood and connect to value resources outside of their usual place of residence

Se analizan las redes personales de 138 padres de niños que participaron en una iniciativa de prevención del trabajo infantil en tres escuelas de Lima (Perú). En primer lugar, se detectaron configuraciones de comportamientos relevantes en dos asentamientos informales de población en la periferia de la gran ciudad. En segundo lugar, la distribución de las relaciones personales en ese pequeño conjunto de contextos comunitarios sirvió para describir la interacción cotidiana en el vecindario. Cada entrevistador facilitó información sobre las 45 personas con las que interaccionaba habitualmente, indicando en cada caso el contexto en el que tenía lugar preferentemente dicha interacción. También informaron sobre la implicación de las familias en la escuela y de las iniciativas de participación ciudadana en su comunidad. La técnica de gráficos agrupados muestra que la escuela es el segundo espacio más importante en el desarrollo de relaciones interpersonales en el vecindario. Las relaciones entre diferentes familias vecinas constituían el mejor predictor de la integración comunitaria en el vecindario de residencia. Los mayores índices de trabajo infantil coinciden con los entornos comunitarios más recientemente creados y con una comunidad menos estructurada en conjunto. La escuela constituye un núcleo que facilita la interacción entre familias en el vecindario y conecta con los recursos de valores fuera de su lugar habitual de residencia

Mantenimiento de los resultados de integracion laboral tras el alta en centro de rehabilitacion laboral (comunidad de Madrid) / No disponible

A lo largo de los años, la integración laboral de las personas con trastorno mental grave está cobrando más importancia y ya se considera un objetivo fundamental de su proceso rehabilitador. Los centros de rehabilitación laboral (CRL) de la Comunidad de Madrid combinan diferentes estrategias (entrenamiento prelaboral, empleo con apoyo, etc) para favorecer la inserción laboral de sus usuarios. Objetivo: describir el estado de los ex usuarios del CRL tras su salida del dispositivo e identificar las posibles variables relacionadas con la obtención de empleo. Método: estudio ex post facto retrospectivo con grupo cuasi-control. Muestra formada por 70 ex usuarios de los CRL de Retiro y de Vallecas. Se comparó el grupo de sujetos que tuvieron actividad laboral tras la salida del recurso (N=24) con los sujetos que no tuvieron ningún empleo (N=46). Los datos del estudio se recogieron mediante un cuestionario ad hoc. Conclusiones: Es necesario obtener evidencias sobre la efectividad de los programas de rehabilitación laboral a largo plazo y su capacidad de generalización en el tiempo. Así como conocer los factores que mejoran la efectividad del proceso rehabilitador. Sería conveniente continuar desarrollando estudios que ayuden a conocer mejor estos elementos

Over the years, the labor integration of people with severe mental disorder is becoming more important and is already considered a fundamental objective of their rehabilitation process. The centers of labor rehabilitation (CRL) of the Community of Madrid combine different strategies (pre-employment training, employment with support, etc.) to promote the employment of its users. Objective: to describe the status of former CRL users after their exit from the device and identify the possible variables related to obtaining employment. Method: retrospective ex post facto study with quasi-control group. Sample formed by 70 former users of the CRLs of Retiro and Vallecas. We compared the group of subjects who had work activity after leaving the resource (N = 24) with the subjects who had no employment (N = 46). The study data were collected through an ad hoc questionnaire. Conclusions: It is necessary to obtain evidence on the effectiveness of long-term labor rehabilitation programs and their generalization capacity over time. As well as knowing the factors that improve the effectiveness of the rehabilitation process. It would be convenient to continue developing studies that help to better understand these elements

La adherencia predice la remisión sintomática y psicosocial en esquizofrenia: estudio naturalístico de la integración de los pacientes en la comunidad / Adherence predicts symptomatic and psychosocial remission in schizophrenia: naturalistic study of patient integration in the community

Introducción. El funcionamiento psicosocial en pacientes con esquizofrenia que son atendidos en la práctica diaria es un aspecto que no está suficientemente estudiado. El objetivo de este estudio fue evaluar la relación entre la remisión sintomática y psicosocial y la adherencia al tratamiento en esquizofrenia. Métodos. Este estudio transversal, no intervencionista y multicéntrico evaluó la remisión sintomática y psicosocial y la integración comunitaria de 1.787 pacientes ambulatorios con esquizofrenia atendidos en servicios de salud mental españoles. La adherencia a la medicación antipsicótica en el año anterior se dividió en las categorías ≥ 80% y < 80%. Resultados. La remisión sintomática se alcanzó en el 28,5% de los pacientes, y la remisión psicosocial en el 26,2%. En total, el 60,5% de los pacientes se clasificaron dentro de la categoría de pacientes con adherencia al tratamiento antipsicótico y el 41% dentro de la de pacientes con adherencia al tratamiento no farmacológico. Durante la visita de estudio, se cambió el tratamiento al 28,4% de los pacientes, en el 31,1% debido a la baja adherencia (8,8% de la población total). Los pacientes con adherencia al tratamiento presentaron mayores porcentajes de remisión sintomática y psicosocial que aquellos sin adherencia (30,5 frente al 25,4%, p<0,05; y 32 frente al 17%, p<0,001, respectivamente). Solo el 3,5% de los pacientes presentaron un nivel adecuado de integración comunitaria, que también fue más alta entre los pacientes adherentes (73,0 frente al 60,1%, p<0,05). Conclusiones. La adherencia al tratamiento antipsicótico se asoció con la remisión sintomática y psicosocial, así como con la integración comunitaria (AU)

Introduction. Psychosocial functioning in patients with schizophrenia attended in daily practice is an understudied aspect. The aim of this study was to assess the relationship between symptomatic and psychosocial remission and adherence to treatment in schizophrenia. Methods. This cross-sectional, non-interventional, and multicenter study assessed symptomatic and psychosocial remission and community integration of 1,787 outpatients with schizophrenia attended in Spanish mental health services. Adherence to antipsychotic medication in the previous year was categorized as ≥ 80% vs. < 80%. Results. Symptomatic remission was achieved in 28.5% of patients, and psychosocial remission in 26.1%. A total of 60.5% of patients were classified as adherent to antipsychotic treatment and 41% as adherent to non-pharmacological treatment. During the index visit, treatment was changed in 28.4% of patients, in 31.1% of them because of low adherence (8.8% of the total population). Adherent patients showed higher percentages of symptomatic and psychosocial remission than non-adherent patients (30.5 vs. 25.4%, P<.05; and 32 vs. 17%, P<.001, respectively). Only 3.5% of the patients showed an adequate level of community integration, which was also higher among adherent patients (73.0 vs. 60.1%, P<.05). Conclusions. Adherence to antipsychotic medication was associated with symptomatic and psychosocial remission as well as with community integration (AU)

La integración de la información de salud del paciente / Integration of health information patient

Las tecnologías de la información y la comunicación (TIC) están implementadas en los sistemas de salud. Sin embargo, la actual situación socioeconómica plantea algunos interrogantes respecto a cómo evolucionará el sistema de salud en un contexto de uso generalizado de las TIC, pero con dificultades de sostenibilidad. Además de la sostenibilidad y la consolidación, ahora el reto planteado es la integración de la información y en qué ámbito asistencial y qué profesionales de la salud deberán liderar este paso adelante en la atención de salud de las personas de la comunidad. Todo ello supone un importante cambio de mentalidad para los usuarios de los sistemas de salud, y la necesidad de integrar todos los cuidados de salud, trabajando de manera más transversal, con el objetivo de dar continuidad asistencial y propiciando más calidad en la atención de salud del ciudadano (AU)

Information and communications technology (ICT) is implemented in health systems. However, the current economic situation raises questions regarding how the health system will evolve in a context of widespread use of ICT, but with sustainability problems. Beside sustainability and consolidation, now a days, the challenge is the integration of information and in which care level and who among health professionals should lead this step forward in health care. All this represents a major change of mindset for users of health systems, and the need to integrate all health care, working more transversely, with the aim of achieve more health care continuity and provide better quality in health care of citizen (AU)

Impacto del daño cerebral adquirido en la integración comunitaria: reinserción laboral, discapacidad y dependencia dos años después de la lesión / Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury

Objetivos. Analizar el impacto del daño cerebral adquirido en la integración comunitaria (trayectoria laboral, discapacidad y dependencia) en una muestra de sujetos con daño cerebral adquirido de etiología vascular, traumática y tumoral, durante un período de dos años tras la lesión original, y examinar qué variables sociodemográficas, datos clínicos premórbidos y relacionados con la lesión predicen la integración en la comunidad. Pacientes y métodos. Muestra de 106 sujetos adultos con daño cerebral adquirido, atendidos en el Área de Neuropsicología y Neuropsiquiatría del Complejo Hospitalario de Navarra, con déficit de memoria como secuela principal. Las diferencias entre grupos se analizan con los tests t de Student, chi al cuadrado y U de Mann-Whitney. Resultados. De los participantes que antes de la lesión se encontraban activos laboralmente, el 19% y 29% recuperaron su estatus previo al año y a los dos años, respectivamente; a un 45% de la muestra total se le reconoció la discapacidad, y a un 17%, la dependencia. No se halló relación entre las variables sociodemográficas y clínicas y los parámetros funcionales contemplados. Conclusiones. La lesión cerebral adquirida impacta con intensidad en la trayectoria vital de los afectados, aunque no se han estudiado antes en España sus consecuencias en el ajuste sociolaboral en los dos años siguientes al daño a través de parámetros funcionales valorados con instrumentos oficiales estatales en una muestra de etiología vascular, traumática y tumoral (AU)

Aims. To analyze the impact of acquired brain injury towards the community integration (professional career, disability, and dependence) in a sample of people affected by vascular, traumatic and tumor etiology acquired brain damage, over a two year time period after the original injury, and also to examine what sociodemographic variables, premorbid and injury related clinical data can predict the level of the person’s integration into the community. Patients and methods. 106 adults sample suffering from acquired brain injury who were attended by the Neuropsychology and Neuropsychiatry Department at Hospital of Navarra (Spain) affected by memory deficit as their main sequel. Differences among groups have been analyzed by using t by Student, chi squared and U by Mann-Whitney tests. Results. 19% and 29% of the participants who were actively working before the injury got back their previous status within one and two years time respectively. 45% of the total sample were recognized disabled and 17% dependant. No relationship between sociodemographic and clinical variables and functional parameters observed were found. Conclusions. Acquired brain damage presents a high intensity impact on affected person’s life trajectory. Nevertheless, in Spain, its consequences at sociolaboral adjustment over the the two years following the damage through functional parameters analyzed with official governmental means over a vascular, traumatic and tumor etiology sample had never been studied before (AU)

Evaluación de la calidad de la información disponible en Internet sobre odontología y síndrome de Down / Evaluation of the quality of the information available on the Internet regarding dentistry and Down syndrome

No disponible

[Work in psychiatry: a political question]. / Du travail en psychiatrie : une question politique.

In the experience of Saint Alban, therapeutic work is a major focus of institutional psychotherapy. What is the place today of work in the therapeutic projects led by caregivers? The principle of reality concerning our society clashes with the importance which the caregiving team attaches to work as a principle of reintegration. New opportunities for sociability and integration must be designed and bridges must be co-constructed by nurses and patients towards associations and activities in the community.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning.

OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions.