Training on intellectual disability in health sciences: the European perspective.

BACKGROUND: Intellectual disability (ID) has consequences at all stages of life, requires high service provision and leads to high health and societal costs. However, ID is largely disregarded as a health issue by national and international organisations, as are training in ID and in the health aspects of ID at every level of the education system. SPECIFIC AIM: This paper aims to (1) update the current information about availability of training and education in ID and related health issues in Europe with a particular focus in mental health; and (2) to identify opportunities arising from the initial process of educational harmonization in Europe to include ID contents in health sciences curricula and professional training. METHOD: We carried out a systematic search of scientific databases and websites, as well as policy and research reports from the European Commission, European Council and WHO. Furthermore, we contacted key international organisations related to health education and/or ID in Europe, as well as other regional institutions. RESULTS: ID modules and contents are minimal in the revised health sciences curricula and publications on ID training in Europe are equally scarce. European countries report few undergraduate and graduate training modules in ID, even in key specialties such as paediatrics. Within the health sector, ID programmes focus mainly on psychiatry and psychology. CONCLUSION: The poor availability of ID training in health sciences is a matter of concern. However, the current European policy on training provides an opportunity to promote ID in the curricula of programmes at all levels. This strategy should address all professionals working in ID and it should increase the focus on ID relative to other developmental disorders at all stages of life.

Perspectives: the mental health care gap in intellectual disabilities in Spain: impact analysis and knowledge-to-action plan.

BACKGROUND: Intellectual developmental disorder or Intellectual disability (ID) is a prevalent condition with a high impact along the life-span particularly when associated to other mental disorders (MD). SPECIFIC AIM: To estimate the unmet needs and to design a knowledge to action plan to reduce the care gap in ID-MD in Spain. METHOD: We followed a 5-step `maxi' impact assessment and a mixed qualitative/quantitative design including expert panels, secondary analysis of databases and a prospective survey in the 17 regions in Spain. Schizophrenia was used as comparator due to similar prevalence rates and burden. RESULTS: Persons with ID-MD had ten times less outpatient contacts and hospital admissions than patients with schizophrenia. The outpatient case load was 2.31% in ID and 14.6% in schizophrenia. ID had the lowest hospitalization rate amongst all mental disorders but the highest length of stay. The expert panel estimated that half of persons with ID-MD are not adequately assessed and 95% do not receive the required care in Spain. Basic care needs include 6.5 beds and an ID-MD outpatient service per 1 million population. At least 134 specialized psychiatrists and psychologists and 277 beds are needed to reach the minimum standards in Spain. CONCLUSION: This study quantifies the ID-MD care gap in Spain and the basic specialized services needed. In spite of the societal and health implications of ID-MD the knowledge-to-action plan had a modest impact limited at the regions where ID-MD programmes were already implemented. IMPLICATIONS FOR HEALTH POLICY: Specific priority setting on ID-MH should be incorporated to mental health strategy at the Ministry of Health within a broader health and ID plan. National and regional policies should incorporate an integrative care approach through the life cycle. The development of excellence centers on ID-MD and a national observatory on this topic should be encouraged.

Borderline Intellectual Functioning: Consensus and good practice guidelines

Introducción: El funcionamiento intelectual límite (FIL) se conceptualiza actualmente como la barrera que separa el funcionamiento intelectual «normal» de la discapacidad intelectual (CI 71-85). A pesar de su magnitud, su prevalencia no puede ser cuantificada y no se ha operativizado su diagnóstico. Objetivos: Elaborar un marco conceptual para el FIL y establecer directrices de consenso que permitan la aplicación de una atención integral centrada en la persona. Metodología: Se utilizó una metodología mixta cualitativa que combinaba un análisis del marco conceptual con el desarrollo de grupos nominales. Se realizó una revisión bibliográfica extensiva en bases de datos de evidencia médica, publicaciones científicas y literatura gris. Se estudió la información encontrada y se redactó un documento de marco conceptual sobre el FIL. Resultados: Las publicaciones centradas en el colectivo de personas con FIL son escasas. El término que mayor número de publicaciones arrojó fue «Borderline Intelligence». Se detectaron una serie de temas sobre los que era necesario alcanzar un consenso y se redactó un documento con las conclusiones del grupo de trabajo. Conclusiones: Es necesario establecer un consenso a nivel internacional sobre el constructo del FIL y sus criterios operativos, y desarrollar instrumentos específicos de detección y diagnóstico. También es necesario elaborar criterios que permitan calcular su incidencia y prevalencia. Saber qué intervenciones son las más adecuadas y cuáles son las necesidades de atención que presenta este colectivo es de vital importancia para implementar un modelo de atención integral centrado en la persona(AU)

Introduction: The Borderline Intellectual Functioning (BIF) is conceptualised as the frontier that delimits ‘‘normal’’ intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. Objectives: To elaborate a conceptual framework and to establish consensus guidelines. Method: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Results: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is ‘‘Borderline Intelligence’’. The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. Conclusions: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual(AU)

Pinel, el Hospital de Zaragoza y la terapia ocupacional / No disponible

No disponible

Borderline intellectual functioning: consensus and good practice guidelines.

INTRODUCTION: The Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits "normal" intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. OBJECTIVES: To elaborate a conceptual framework and to establish consensus guidelines. METHOD: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. RESULTS: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is "Borderline Intelligence". The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. CONCLUSIONS: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual.

La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II / Health among persons with intellectual disability in Spain: the European POMONA-II study

Introducción. Estudios internacionales demuestran que existe un patrón diferenciado de salud y una disparidad en la atención sanitaria entre personas con discapacidad intelectual (DI) y población general. Objetivo. Obtener datos sobre el estado de salud de las personas con DI y compararlos con datos de población general. Pacientes y métodos. Se utilizó el conjunto de indicadores de salud P15 en una muestra de 111 sujetos con DI. Los datos de salud encontrados se compararon según el tipo de residencia de los sujetos y se utilizó la Encuesta Nacional de Salud 2006 para comparar estos datos con los de la población general.Resultados. La muestra con DI presentó 25 veces más casos de epilepsia y el doble de obesidad. Un 20% presentó dolor bucal, y existió una alta presencia de problemas sensoriales, de movilidad y psicosis. Sin embargo, encontramos una baja presencia de patologías como la diabetes, la hipertensión, la osteoartritis y la osteoporosis. También presentaron una menor participación en programas de prevención y promoción de la salud, un mayor número de ingresos hospitalarios y un uso menor de los servicios de urgencia. Conclusiones. El patrón de salud de las personas con DI difiere del de la población general, y éstas realizan un uso distinto de los servicios sanitarios. Es importante el desarrollo de programas de promoción de salud y de formación profesional específicamente diseñados para la atención de personas con DI, así como la implementación de encuestas de salud que incluyan datos sobre esta población (AU)

Introduction. International studies show that both the pattern of health and the healthcare provided for persons with intellectual disability (ID) and the general population are different. Aims. To obtain data about the state of health of persons with ID and to compare them with data about the general population. Patients and methods. The P15 set of health indicators was used in a sample of 111 subjects with ID. The health data that were found were compared according to the subjects’ type of residence and the 2006 National Health Survey was used to compare these data with those for the general population. Results. The sample with ID presented 25 times more cases of epilepsy and twice as many cases of obesity. Twenty per cent presented pain in the mouth and the presence of sensory and mobility problems, as well as psychosis, was high. We also found, however, a low presence of pathologies like diabetes, hypertension, osteoarthritis and osteoporosis. They also displayed a lower rate of participation in prevention and health promotion programmes, a higher number of hospital admissions and a lower usage of emergency services. Conclusions. The pattern of health of persons with ID differs from that of the general population, and they use healthcare services differently. It is important to develop programmes of health promotion and professional training that are specifically designed to attend to the needs of persons with ID. Likewise, it is also necessary to implement health surveys that include data about this population (AU)

[Health among persons with intellectual disability in Spain: the European POMONA-II study]. / La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II.

INTRODUCTION: International studies show that both the pattern of health and the healthcare provided for persons with intellectual disability (ID) and the general population are different. AIMS: To obtain data about the state of health of persons with ID and to compare them with data about the general population. PATIENTS AND METHODS: The P15 set of health indicators was used in a sample of 111 subjects with ID. The health data that were found were compared according to the subjects' type of residence and the 2006 National Health Survey was used to compare these data with those for the general population. RESULTS; The sample with ID presented 25 times more cases of epilepsy and twice as many cases of obesity. Twenty per cent presented pain in the mouth and the presence of sensory and mobility problems, as well as psychosis, was high. We also found, however, a low presence of pathologies like diabetes, hypertension, osteoarthritis and osteoporosis. They also displayed a lower rate of participation in prevention and health promotion programmes, a higher number of hospital admissions and a lower usage of emergency services. CONCLUSIONS: The pattern of health of persons with ID differs from that of the general population, and they use healthcare services differently. It is important to develop programmes of health promotion and professional training that are specifically designed to attend to the needs of persons with ID. Likewise, it is also necessary to implement health surveys that include data about this population.

Psicoanálisis en la institución pública / Psychoanalysis in the public Institution

En este artículo se describen las primeras relaciones entre el psicoanálisis y la institución pública en Europa, América y Cataluña. Se habla de las repercusiones del nuevo Plan Director de Salud Mental y Adicciones aprobado por el gobierno de la Generalitat de Cataluña, que entre otras muchas cosas da carta de naturaleza al reconocimiento de la psicoterapia como una técnica más de tratamiento efectivo en diversas patologías y considera su inclusión en la cartera de servicios de los recursos de salud mental. Se comentan finamente aspectos a salvaguardar para la buena práctica de la psicoterapia en la red pública (AU)

This paper describes the initial relations between psychoanalysis and public institutions in Europe, America, and Catalonia. It deals with the repercusions of the new Director Plan of Mental Health an Addictions, approved by the government of the Generalitat de Catalunya, which amongst other issues recognizes psychotherapy as an effective treatment modality for different disorders and considers its inclusion in the of mental health services to be offered. The author finally reflects on certain aspects relevant to the safeguarding of good psychotherapy practice in the public assistance network (AU)

Modelos de incentivación y carrera profesional / Gratification models and professional career

Se valora la oportunidad de plantearen este momento modelos de incentivación y la carrera profesional como manera de aportar satisfacción y motivación a los profesionales y la repercusión implícita en la mejora de las organizaciones. Se plantean seis elementos complementarios: la carrera profesional, sistemas de retribución variable por cumplimiento de objetivos, incentivos económicos en situaciones especiales, formación continuada, participación en la gestión de las organizaciones y cuidado del profesional. En la carrera profesional se aportan las características de seis modelos diferentes: Servicio Canario de Salud, Institut Cátala de la Salut, Servicio Navarro de Salud, Servicio de Salud de Castilla-La Mancha, la Organización Médica Colegial y la Confederación Estatal de Sindicatos Médicos (AU)

In this paper we have the opportunity to assess gratification models and the professional career in order to contribute in satisfaction and motivation of the professionals and simultaneously affect the improvement of the organizations. It is proposed six complementary elements: the professional career, systems of variable retribution for execution of objectives, economic incentives in special situations, continued training, participation in the administration of the organizations and the professional's care. Regarding the professional career it is taken into account the characteristics of six different models such as: Canary Service of Health, Catalan Institute of Health, Navarrese Service of Health, Castile-La Mancha Service of Health, the Medical College and the State Confederation of Medical Unions (AU)