Relaciones afectivas y calidad de vida en el ámbito de las enfermedades raras: una revisión sistemática / Affective Relationships and Quality of Life in Rare Diseases: A Systematic Review

La calidad de vida en pacientes y cuidadores no puede ser concebida sin incluir a las necesidades sociales. El objetivo de esta investigación es realizar una revisión sistemática que muestre evidencias empíricas de cómo influyen las relaciones afectivas en la calidad de vida de pacientes con enfermedades raras y sus cuidadores. Se realizó una búsqueda en las bases de datos Web of Science, Scopus y PsycInfo. Se encontraron 4923 artículos que tras el proceso de cribado quedaron reducidos a 12 estudios. Se hallaron efectos de las relaciones afectivas tanto el núcleo familiar como en sus componentes de forma independiente (padres, hermanos y pacientes). Se evidencia que tanto el ámbito familiar como extrafamiliar son esenciales para abordar una mejora de la calidad de vida. Se recomienda en futuras investigaciones el estudio de las interacciones entre las relaciones establecidas para poder ofrecer una mejor intervención . (AU)

Quality of life in patients and caregivers cannot be conceived without including social needs. The aim of this research is to conduct a systematic review showing empirical evidence of how affective relationships influence the quality of life of patients with rare diseases and their caregivers. A search was conducted in the Web of Science, Scopus and PsycInfo databases. A total of 4923 articles were found, which after the screening process were reduced to 12 studies. The effects of affective relationships were found both in the family nucleus and in its components independently (parents, siblings and patients). It is evident that both the family and the extra-familial environment are essential to improve quality of life. It is recommended that future research should study the interactions between the established relationships to offer a better intervention. (AU)

Relaciones afectivas y calidad de vida en el ámbito de las enfermedades raras: una revisión sistemática / Affective Relationships and Quality of Life in Rare Diseases: A Systematic Review

La calidad de vida en pacientes y cuidadores no puede ser concebida sin incluir a las necesidades sociales. El objetivo de esta investigación es realizar una revisión sistemática que muestre evidencias empíricas de cómo influyen las relaciones afectivas en la calidad de vida de pacientes con enfermedades raras y sus cuidadores. Se realizó una búsqueda en las bases de datos Web of Science, Scopus y PsycInfo. Se encontraron 4923 artículos que tras el proceso de cribado quedaron reducidos a 12 estudios. Se hallaron efectos de las relaciones afectivas tanto el núcleo familiar como en sus componentes de forma independiente (padres, hermanos y pacientes). Se evidencia que tanto el ámbito familiar como extrafamiliar son esenciales para abordar una mejora de la calidad de vida. Se recomienda en futuras investigaciones el estudio de las interacciones entre las relaciones establecidas para poder ofrecer una mejor intervención . (AU)

Quality of life in patients and caregivers cannot be conceived without including social needs. The aim of this research is to conduct a systematic review showing empirical evidence of how affective relationships influence the quality of life of patients with rare diseases and their caregivers. A search was conducted in the Web of Science, Scopus and PsycInfo databases. A total of 4923 articles were found, which after the screening process were reduced to 12 studies. The effects of affective relationships were found both in the family nucleus and in its components independently (parents, siblings and patients). It is evident that both the family and the extra-familial environment are essential to improve quality of life. It is recommended that future research should study the interactions between the established relationships to offer a better intervention. (AU)

Interparental Relationship Quality During Pregnancy: Implications for Early Parent-Infant Bonding and Infant Socioemotional Development.

Research demonstrates the central role of mother-child relationships in child socioemotional development; however, families are complex systems and the unique roles of multiple family subsystems in early infant development have received less attention. In the present study, we investigated the role of multiple family relationships (interparental, mother-infant, father-infant), during pregnancy and the first month after childbirth, in infant socioemotional functioning at 6 months. We administered semi-structured interviews during pregnancy to assess multiple qualities of the interparental relationship. At 1 month postpartum, parents completed reports about their feelings and attitudes toward their infant to assess impaired bonding. At 6 months, parents provided reports of child socioemotional functioning. Both mother-infant and father-infant impaired bonding were uniquely associated with infant socioemotional impairment, controlling for prenatal interparental relationship quality. Additionally, multiple dimensions of the interparental relationship (i.e., poor-quality conflict management, inadequate support for fathers, and low levels of respect toward mothers) were associated with infant socioemotional impairment controlling for parent-infant bonding. Results also demonstrated an indirect pathway, such that poor sexual quality during pregnancy was associated with fathers (but not mothers) reporting more impaired bonding with their infants, which was linked to greater infant socioemotional impairment. Results highlight the importance of understanding the broad family environment, prior to and immediately following the birth of the child, to identify at-risk children at the earliest possible stages of intervention.

Las investigaciones demuestran el papel fundamental que desempeñan las relaciones entre madre e hijo en el desarrollo socioemocional del niño; sin embargo, las familias son sistemas complejos, y los papeles únicos que desempeñan los múltiples subsistemas familiares en el desarrollo temprano del bebé han recibido menos atención. En el presente estudio, investigamos el papel que desempeñan varias relaciones familiares (interparentales, mamá-bebé, papá-bebé) durante el embarazo y el primer mes después del parto en el funcionamiento socioemocional a los 6 meses. Administramos entrevistas semiestructuradas durante el embarazo para evaluar varias cualidades de la relación interparental. Un mes después del parto, los padres realizaron informes acerca de sus sentimientos y actitudes hacia su bebé para evaluar deficiencias en el vínculo. A los 6 meses, los padres proporcionaron informes del funcionamiento socioemocional del niño. Los vínculos deficientes tanto entre la madre y el bebé como entre el padre y el bebé estuvieron asociados exclusivamente con una deficiencia socioemocional del bebé, teniendo en cuenta la calidad de la relación interparental prenatal. Además, varias dimensiones de la relación interparental (p. ej.: la mala calidad de la gestión de conflictos, el apoyo inadecuado para los papás y los niveles bajos de respeto hacia las mamás) estuvieron asociadas con una deficiencia socioemocional del bebé teniendo en cuenta el vínculo entre los padres y los bebés. Los resultados también demostraron una vía indirecta, por ejemplo, que la mala calidad de vida sexual durante el embarazo estuvo asociada con el informe de los padres (pero no de las madres) de un vínculo más deficiente con sus bebés, el cual estuvo ligado a una mayor deficiencia socioemocional del bebé. Los resultados destacan la importancia de comprender el entorno familiar amplio antes e inmediatamente después del nacimiento del niño a fin de identificar niños en riesgo lo antes posible en las etapas de la intervención.

La experiencia de divorcio y la terapia familiar: miradas diversas / The experience of divorce and family therapy: diverse views

El proceso de divorcio es un acontecimiento que involucra a todo el sistema familiar, llegando a experimentar distintas emociones, sentimientos y sucesos que se presentan antes, durante y después del mismo. Así las cosas, se espera, mediante la investigación, identificar las diferentes miradas del sistema familiar y cómo el profesional que se encuentra en el espacio terapéutico atraviesa al proceso de divorcio. Para ello, se implementó un enfoque cualitativo y un método hermenéutico, que permitirán profundizar de forma detallada los hechos y entender las distintas realidades. Finalmente, se logró mostrar cómo se concibe el proceso de divorcio desde la terapia familiar y la vivencia de sus actores; además de generar conocimientos que aporten a la formación profesional y que puedan beneficiar a otras familias.

The divorce process is an occurrence that involves the entire family system, getting to experience different emotions, feelings and issues that occur before, during and after it. In this context and through research, there is the intention to identify the different views of the family system and how the professional in the therapeutic space experiences the divorce process. In order to achieve the set purposes, a qualitative approach and a hermeneutical method were implemented, which will allow to deepen the issues in detail and understand the different realities. Finally, it was possible to evidence how the divorce process is conceived within family therapy and the experience of its actors; besides generating knowledge that contribute to vocational training and that can be of benefit to other families.

La familia, la comunicación humana y el enfoque sistémico en su relación con la esquizofrenia / Family, human communication and systemic approach in their relation with schizophrenia

Para el análisis teórico y práctico de la familia es necesario conocer su funcionamiento, el concepto de sistema y sus diferentes teorías, la comunicación como elemento primordial en todo grupo social y las particularidades del doble vínculo en aquellas con un miembro esquizofrénico, ya que generalmente muestran problemas en la comunicación, no solo desde el comportamiento del enfermo, sino también desde los demás familiares. En ese sentido se efectuó una revisión bibliográfica relacionada con el tema que permite la selección del enfoque sistémico para la aplicación en la práctica diaria(AU)

For the theoretical and practical analysis of the family it is necessary to know its way of functioning, the system concept and its different theories, communication as main element in all social group and the particularities of double binding in those with a schizophrenic member, since generally they show problems in communication, not only from the sick person's behavior, but also from the other family members behavior. In that sense, a literature review related to the topic was carried out which allows the selection of the systemic approach for the implementation in the daily practice(AU)

La familia, la comunicación humana y el enfoque sistémico en su relación con la esquizofrenia / Family, human communication and systemic approach in their relation with schizophrenia

Para el análisis teórico y práctico de la familia es necesario conocer su funcionamiento, el concepto de sistema y sus diferentes teorías, la comunicación como elemento primordial en todo grupo social y las particularidades del doble vínculo en aquellas con un miembro esquizofrénico, ya que generalmente muestran problemas en la comunicación, no solo desde el comportamiento del enfermo, sino también desde los demás familiares. En ese sentido se efectuó una revisión bibliográfica relacionada con el tema que permite la selección del enfoque sistémico para la aplicación en la práctica diaria.

For the theoretical and practical analysis of the family it is necessary to know its way of functioning, the system concept and its different theories, communication as main element in all social group and the particularities of double binding in those with a schizophrenic member, since generally they show problems in communication, not only from the sick person's behavior, but also from the other family members behavior. In that sense, a literature review related to the topic was carried out which allows the selection of the systemic approach for the implementation in the daily practice.

Transitando entre o íntimo e o social na contramão da cisnormatividade: a experiência de ressignificação de crenças em direção ao acolhimento das identidades trans pelo sistema familiar / Transiting between individual and social events while moving against cisnormativity: the family process of meaning-making towards transgender identities acceptance

Trata-se de uma pesquisa qualitativa orientada pelo Interacionismo Simbólico enquanto referencial teórico e pela Teoria Fundamentada nos Dados como abordagem metodológica, com o objetivo de compreender o processo de transição de gênero no contexto da família. Utilizou-se a técnica snow ball sampling para o recrutamento de pessoas trans e familiares, agregando um total de 20 participantes. Os dados foram obtidos por meio de entrevistas individuais em profundidade e submetidos à análise comparativa, o que possibilitou identificar significados e estratégias que compõem a experiência da família que vivencia o processo de transição de gênero. Esta experiência é composta por seis subprocessos: deparando-se com a transexualidade; vivendo um paradoxo presença/ausência; buscando um sentido para a transição de gênero; vivendo os efeitos do preconceito; desenvolvendo estratégias protetivas e redesenhando relacionamentos. A articulação destes subprocessos permitiu identificar a categoria central Transitando entre o íntimo e o social na contramão da cisnormatividade, a partir da qual é proposto um modelo teórico representativo do processo de transição de gênero no contexto da família. O modelo indica um processo de interação dinâmica e não linear entre elementos intrapessoais, interpessoais e relacionais ao longo do tempo, em um contexto de estresse familiar. A adaptabilidade e a comunicação são fatores determinantes para a reconstrução de significados e crenças, o que facilita a elaboração de perdas vivenciadas ao longo do processo e promove a movimentação familiar em direção ao acolhimento da pessoa trans. Os resultados trazem avanços para o campo da saúde ao destacar a transição de gênero enquanto processo sistêmico, possibilitando que o profissional reconheça nuances socioculturais que exercem influência nas vivências trans e, consequentemente, na saúde destas pessoas e seus familiares. Conhecer os aspectos familiares da transexualidade permite integrar, estrategicamente, a qualidade interacional deste grupo social ao espectro dos cuidados de saúde integral, reconhecendo o caráter protetivo do acolhimento familiar para a saúde da pessoa trans, com destaque para a potência de atitudes maternas como agentes multiplicadoras de transformação social. Os dados revelam ainda a relevância das intervenções realizadas por psicólogos, médicos e enfermeiros, ao executar estratégias de comunicação responsável, educativa e não violenta, para os desfechos do processo de ressignificação de crenças cisnormativas, que são limitantes à compreensão e ao acolhimento familiar. Conclui-se que o profissional de saúde diante da transexualidade deve reconstruir as bases que orientam suas intervenções para além das concepções cisnormativas e alargar o reconhecimento de fatores socioculturais como geradores de sofrimento na experiência da transexualidade vivenciada pelo sistema familiar

This is a qualitative research oriented by Symbolic Interactionism as a theoretical framework and by the Theory Grounded as a methodological approach, aiming to understand the process of gender transition in the context of the family. The snowball sampling technique was used for the recruitment of trans and family persons, gathering a total of 20 participants. Data collection was obtained through in-depth individual interviews and submitted to constant comparison analysis, which made it possible to identify the meaning-making strategies family members develop while experiencing a loved ones gender transition. This experience is composed of six subprocesses: encountering transsexuality; living a presence/absence paradox; seeking meaning for the gender transition; living the effects of prejudice; developing protective strategies and redesigning relationships. The articulation of these subprocesses allowed to identify the ceore category "Transiting between individual and social events while moving against cisnormativity. A theoretical model, representative of the process of gender transition in the context of the family is proposed. The model indicates a dynamic and non-linear process of interaction between intrapersonal, interpersonal and relational domains over time, in a context of family stress. Adaptability and communication were identified as determining factors for the reconstruction of meanings and belief systems, which facilitates the elaboration of ambiguous losses experienced throughout the process and promotes the family attunement towards the acceptance of the trans person. The results bring advances for the health care field by highlighting the gender transition as a systemic process, thus, enabling health care professionals to recognize sociocultural factors that impact the health and well-being of trans persons and their families. Knowing the family experiences regarding gender transition allows professionals to strategically integrate the interactional aspects of family relations to the spectrum of health care promotion by recognizing the protective character of family acceptance for the transgender person health. Findings also reveal the relevance of interventions performed by psychologists, physicians and nurses, when implementing strategies of responsible, educational and non-violent communication, for the outcomes of the process of resignification of cisnormative beliefs. In conclusion, health care professionals caring for transgender care must reconstruct the bases that guide interventions, extending their understanding to cisnormatives and socialcultural factors as main elements originating possible experiences of ambiguous loss in gender transitioning

Transitando entre o íntimo e o social na contramão da cisnormatividade: a experiência de ressignificação de crenças em direção ao acolhimento das identidades trans pelo sistema familiar / Transiting between individual and social events while moving against cisnormativity: the family process of meaning-making towards transgender identities acceptance

Trata-se de uma pesquisa qualitativa orientada pelo Interacionismo Simbólico enquanto referencial teórico e pela Teoria Fundamentada nos Dados como abordagem metodológica, com o objetivo de compreender o processo de transição de gênero no contexto da família. Utilizou-se a técnica snow ball sampling para o recrutamento de pessoas trans e familiares, agregando um total de 20 participantes. Os dados foram obtidos por meio de entrevistas individuais em profundidade e submetidos à análise comparativa, o que possibilitou identificar significados e estratégias que compõem a experiência da família que vivencia o processo de transição de gênero. Esta experiência é composta por seis subprocessos: deparando-se com a transexualidade; vivendo um paradoxo presença/ausência; buscando um sentido para a transição de gênero; vivendo os efeitos do preconceito; desenvolvendo estratégias protetivas e redesenhando relacionamentos. A articulação destes subprocessos permitiu identificar a categoria central Transitando entre o íntimo e o social na contramão da cisnormatividade, a partir da qual é proposto um modelo teórico representativo do processo de transição de gênero no contexto da família. O modelo indica um processo de interação dinâmica e não linear entre elementos intrapessoais, interpessoais e relacionais ao longo do tempo, em um contexto de estresse familiar. A adaptabilidade e a comunicação são fatores determinantes para a reconstrução de significados e crenças, o que facilita a elaboração de perdas vivenciadas ao longo do processo e promove a movimentação familiar em direção ao acolhimento da pessoa trans. Os resultados trazem avanços para o campo da saúde ao destacar a transição de gênero enquanto processo sistêmico, possibilitando que o profissional reconheça nuances socioculturais que exercem influência nas vivências trans e, consequentemente, na saúde destas pessoas e seus familiares. Conhecer os aspectos familiares da transexualidade permite integrar, estrategicamente, a qualidade interacional deste grupo social ao espectro dos cuidados de saúde integral, reconhecendo o caráter protetivo do acolhimento familiar para a saúde da pessoa trans, com destaque para a potência de atitudes maternas como agentes multiplicadoras de transformação social. Os dados revelam ainda a relevância das intervenções realizadas por psicólogos, médicos e enfermeiros, ao executar estratégias de comunicação responsável, educativa e não violenta, para os desfechos do processo de ressignificação de crenças cisnormativas, que são limitantes à compreensão e ao acolhimento familiar. Conclui-se que o profissional de saúde diante da transexualidade deve reconstruir as bases que orientam suas intervenções para além das concepções cisnormativas e alargar o reconhecimento de fatores socioculturais como geradores de sofrimento na experiência da transexualidade vivenciada pelo sistema familiar.

This is a qualitative research oriented by Symbolic Interactionism as a theoretical framework and by the Theory Grounded as a methodological approach, aiming to understand the process of gender transition in the context of the family. The snowball sampling technique was used for the recruitment of trans and family persons, gathering a total of 20 participants. Data collection was obtained through in-depth individual interviews and submitted to constant comparison analysis, which made it possible to identify the meaning-making strategies family members develop while experiencing a loved ones gender transition. This experience is composed of six subprocesses: encountering transsexuality; living a presence/absence paradox; seeking meaning for the gender transition; living the effects of prejudice; developing protective strategies and redesigning relationships. The articulation of these subprocesses allowed to identify the ceore category "Transiting between individual and social events while moving against cisnormativity. A theoretical model, representative of the process of gender transition in the context of the family is proposed. The model indicates a dynamic and non-linear process of interaction between intrapersonal, interpersonal and relational domains over time, in a context of family stress. Adaptability and communication were identified as determining factors for the reconstruction of meanings and belief systems, which facilitates the elaboration of ambiguous losses experienced throughout the process and promotes the family attunement towards the acceptance of the trans person. The results bring advances for the health care field by highlighting the gender transition as a systemic process, thus, enabling health care professionals to recognize sociocultural factors that impact the health and well-being of trans persons and their families. Knowing the family experiences regarding gender transition allows professionals to strategically integrate the interactional aspects of family relations to the spectrum of health care promotion by recognizing the protective character of family acceptance for the transgender person health. Findings also reveal the relevance of interventions performed by psychologists, physicians and nurses, when implementing strategies of responsible, educational and non-violent communication, for the outcomes of the process of resignification of cisnormative beliefs. In conclusion, health care professionals caring for transgender care must reconstruct the bases that guide interventions, extending their understanding to cisnormatives and socialcultural factors as main elements originating possible experiences of ambiguous loss in gender transitioning.

Vivências dos Familiares da Pessoa com Demência: Papel do Enfermeiro de Família / Experiences of Relatives of the Person with Dementia: Role of the Family Nurse

Na família a saúde de um elemento pode afetar todo o sistema, contudo também a funcionalidade e organização da família podem determinar a saúde e bem-estar de cada um dos seus elementos. A alteração do equilíbrio familiar através de uma doença crónica, como a Demência, exige mudanças na estrutura do sistema familiar, nas suas rotinas e nas funções desempenhadas por cada um dos seus elementos. Numa situação de crise, como no caso de doença de um dos seus elementos, a família, surge como um fator fundamental na proteção e cuidado da pessoa portadora, valorizando o acompanhamento e o trabalho em parceria com o enfermeiro de família, de forma a promover a adaptação do sistema familiar e prevenir complicações e/ou outras crises. Este estudo foi realizado no sentido de compreender o fenómeno da vivência familiar da Demência, através da perceção e do sentido que este assume para os elementos familiares que estão mais próximos do doente e que acompanham este processo. Para atingir os seus objetivos foi desenhado como uma reflexão fenomenológica, de natureza qualitativa e os participantes foram selecionados segundo os seguintes critérios: pertencer a um sistema familiar portador de uma pessoa com o diagnóstico de Demência e residirem na área de abrangência da Unidade Local de Saúde. O número de participantes foi determinado por saturação de dados. Os resultados demonstram a existência de respostas familiares específicas em cada uma das fases da evolução da doença em que a família se encontra, tendo sido identificados aspetos que influenciaram a sua capacidade de adaptação à doença e à sua evolução. Por outro lado, foram reconhecidas repercussões na estrutura, papéis, comunicação e rotinas do sistema familiar, consequentes da introdução da Demência no dia-a-dia destas famílias. Assim, conclui-se que a Demência afeta a realidade do sistema familiar na sua estrutura, funcionalidade e dinâmica e que a introdução de um elemento chave, que tenha conhecimentos ao nível da doença, bem como do próprio sistema familiar, constitui uma mais valia aquando de momentos de crise e dúvida ao longo da evolução da doença.

In the family context, the health of one element can affect the hole system, as well as, it's organization and functionality can determine the health and quality of life of each element of the family system. Disturbance in the family's balance, through the diagnose of a chronic illness, like Dementia, demands changes in the family system's structure, routines and in its behaviour. Therefore, in a crisis situation, as in the sickness of one of its elements, family is a key factor for the protection and care of the patient yet needing the assistance and partnership of a family nurse to promote a healthy system and to prevent any complications or new crises on the way. This study was made in the sense of understanding the family's experiences of Dementia, as a phenomenon, comprehending the perspective and meaning of the illness to the individuals that are closer to the patient, in this period of their lives. To achieve the goals, we used a phenomenological reflection, qualitative in its nature, and the participants where select following two criteria: being part of the patient's family and live in the geographic area of assistance of a local health unit. The number of participants was determined by saturation of data. The results showed the existence of specific responses from the family in each one of the states of the disease and were identified some factors that determined the adaptability of the family system. On the other hand, it was possible to recognize some consequences of Dementia in the structure, relationships, function, communication and routines of the family. Therefore, the conclusions were that the reality and balance of the family system is disrupted by the Dementia in many ways, from its structure to his function, making evidence the need and the importance to these families of the existence of a key element, that has specialized knowledge about the disease, and that knows the family enough, so he can help them when they need or when they feel challenged by the disease.

Prospective Pilot Study of the Mastering Each New Direction Psychosocial Family Systems Program for Pediatric Chronic Illness.

Psychosocial interventions for pediatric chronic illness (CI) have been shown to support health management. Interventions that include a family systems approach offer potentially stronger and more sustainable improvements. This study explores the biopsychosocial benefits of a novel family systems psychosocial intervention (MEND: Mastering Each New Direction). Forty-five families participated in a 21-session intensive outpatient family systems-based program for pediatric CI. Within this single arm design, families were measured on five domains of Health-Related Quality of Life (HRQL) self-report measures; Stress, Cognitive Functioning, Mental Health, Child HRQL, Family Functioning. Both survey and biological measures (stress: catecholamine) were used in the study. Results from multivariate general linear models showed positive pre-, post-, and 3-month posteffects in all five domains. The program effects ranged from small to moderate (η2  = .07-.64). The largest program effects were seen in the domains of cognitive functioning (η2  = .64) and stress (η2  = .27). Also, between disease groups, differences are noted and future implications for research and clinical practice are discussed. Conclusions suggest that the MEND program may be useful in helping families manage pediatric chronic illnesses. Study results also add to the growing body of literature suggesting that psychosocial interventions for pediatric chronic illness benefit from a family systems level of intervention.

Attachment and Family Processes in Children's Psychological Adjustment in Middle Childhood.

This study examined the links between parent-child attachment, whole family interaction patterns, and child emotional adjustment and adaptability in a sample of 86 community families with children between the ages of 8 and 11 years. Family interactions were observed and coded with the System for Coding Interactions and Family Functioning (SCIFF; Lindahl, 2001). Both parents and each target child completed the appropriate form of the Behavior Assessment System for Children-2nd Edition (BASC-2; Reynolds & Kamphaus, 2004). Target children also completed the Children's Coping Strategies Questionnaire (CCSQ; Yunger, Corby, & Perry, 2005). Hierarchical multiple regressions indicated that Secure mother-child attachment was a robust predictor of children's emotional symptoms, but father-child attachment strategies were not significant independent predictors. Positive Affect in family interactions significantly increased the amount of variance accounted for in children's emotional symptoms. In addition, Family Cohesion and Positive Affect moderated the relationship between father-child attachment and children's emotional symptoms. When data from all BASC-2 informants (mother, father, child) were considered simultaneously and multidimensional constructs were modeled, mother-child security directly predicted children's adjustment and adaptive skills, but the influence of father-child security was fully mediated through positive family functioning. Results of the current study support the utility of considering dyadic attachment and family interaction patterns conjointly when conceptualizing and fostering positive emotional and behavioral outcomes in children.

[Family-centered care: A model for approaching dementia care in the community]. / Atención centrada en la familia: un modelo para abordar los cuidados de la demencia en la comunidad.

Along with ageing population, there has been an increase in the prevalence and incidence of chronic and debilitating conditions, such as dementia which, in turn, has increased the demands for long term care in the community. This is challenging current health care systems that wish to provide an appropriate response whilst intensify its efforts to contain costs. This paper, through a critical reflection, argues for an integrative, positive, and systemic care approach, focused not only on the person with dementia but also on the entire family unit. For this purpose, it approaches the impact that dementia has for the family, and therefore for Primary Health Care professional. In addition care strategies aimed at strengthening the whole family system are suggested.

Pensamiento sistémico y psicología: un cambio de paradigma para la comprensión de realidades complejas / Systemic thinking and psychology: a paradigm shift for the understanding of complex realities

El creciente interés por el modelo de pensamiento sistémico en la última década y de las ciencias de la complejidad o paradigma de la complejidad, cuyo exponente más reconocido en la actualidad es Edgar Morín, tiene un desarrollo histórico de más de 40 años, que se viene nutriendo de varias corrientes del pensamiento filosófico y científico. En este ejercicio de escritura revisaremos la necesidad que emerge en la época actual de revolucionar el pensar científico y para ello se retomarán los aportes de Thomas Kuhn, defensor del desarrollo y cambio de la ciencia, a la luz de la evolución y del análisis epistemológico de los constructos científicos. Se parte de reconocer dicho cambio como necesario y como producto de un desarrollo histórico, que atraviesa las formas de conocer y producir conocimientos de los seres humanos. De igual manera se hace una breve descripción de los aportes de algunos teóricos en la consolidación del marco epistemológico de las ciencias de la complejidad como marco referencial del pensamiento sistémico y de ellos se rescatan los aportes de la Teoría General de Sistemas y la Cibernética de Segundo orden, evidenciando que en la actualidad a las diversas disciplinas de las ciencias sociales y humanas, se les exige el estudio y la comprensión de una importante cantidad de variables de mayores niveles de complejidad, que reclaman a la academia, a los teóricos y profesionales, ampliar sus marcos de comprensión epistemológica hacia metateorías que faciliten la multireferencialidad. Este ejercicio de escritura se configura, entonces, como una invitación para los profesionales de la psicología, a leer y comprender el momento histórico del cual somos participes como grupo disciplinar.

The growing interest in the systemic thinking model in the last decade and the complexity sciences or paradigm of complexity, whose most recognized exponent is Edgar Morín, has a historical development of more than 40 years, which is coming nourishing various currents of philosophical and scientific thought. In this writing exercise we will review the need that emerges in the current era to revolutionize scientific thinking and for this we will return to the contributions of Thomas Kuhn, defender of the development and change of science, in the light of evolution and the epistemological analysis of the scientific constructs. It starts from recognizing this change as necessary and as a product of a historical development, which goes through the ways of knowing and producing knowledge of human beings. Likewise, a brief description of the contributions of some theorists in the consolidation of the epistemological framework of the complexity sciences is made as a referential frame of systemic thinking and from them the contributions of the General Theory of Systems and the Second Cybernetics are rescued. order, evidencing that currently the various disciplines of the social and human sciences are required to study and understand a large number of variables of higher levels of complexity, which demand the academy, the theorists and professionals, expand their frameworks of epistemological understanding towards metateorías that facilitate multireferenciality. This writing exercise is configured, then, as an invitation for professionals in psychology, to read and understand the historical moment of which we are participants as a disciplinary group.

Sobre regimes demográficos restritos: comportamento reprodutivo e cultura familiar entre os ucranianos no meio rural paranaense (1895-1980) / Sobre regímenes demográficos restringidos: comportamiento reproductivo y cultura familiar entre los ucranianos en el medio rural paranaense (1895-1980) / On restricted demographic regimes: reproductive behavior and ukrainian family culture in rural areas of the Brazilian state of Paraná (1895-1980)

O estudo acompanha a dinâmica familiar de imigrantes originários da área da atual Ucrânia, chegados ao Brasil em 1895 e estabelecidos em área rural do Paraná, na colônia Antonio Olyntho. Dada a alta fecundidade legítima do grupo, nas coortes estabelecidas para o estudo (1895-1949/1950-1980), procurou-se compreender as razões da manutenção de uma descendência final alta ao longo de todo o período analisado (entre 8 e 9 filhos, na primeira coorte, e entre 7 e 8, na segunda) e o que isso implicou em termos de organização social, familiar e doméstica. Disso restou considerar que o comportamento reprodutivo é fruto de um complexo sistema de representações, no qual interagem modos de conceber as relações de gênero e as intergeracionais, bem como o papel do casamento e da constituição domiciliar. Se assim for, as práticas concernentes à fecundidade correspondem, sobremaneira, ao exercício social de uma determinada visão de mundo. Em especial nos grupos que vivem em certo isolamento social, as chances de reproduzir modelos ancestrais de reposição geracional são favorecidas. Entre os imigrantes estudados, quase um século no Brasil foi insuficiente para mudar o sistema familiar que veio em sua bagagem: aqui continuaram a produzir prole extensa, mesmo que para isso tenham ativado uma continuada migração dos filhos excedentes.

This study focuses on the family dynamics of immigrants from the present country of the Ukraine. the ancestors of these families came to Brazil in 1895 and settled in a rural area of the State of Paraná known as Colônia Antonio Olynto. Due to the group's high legitimate fertility rate in the cohorts established for the study (1895-1949/1950-1980), the research focused on understanding the maintenance of this high rate during the period analyzed (between 8 and 9 children in the first group and 7 and 8 in the second) and the consequences in terms of family, home and social organization. In other words, the analysis questions the reasons why this group tried to perpetuate a reproductive system that historically corresponded to the realities of a quite different social space, when, in their adopted country the gross fertility rate was quickly reduced, particularly in the period that corresponded to the second group of the study. the only conclusion possible would seem to be that reproductive behavior is the result of a complex system of representation interfacing the different ways of conceiving gender-based and inter-generational relations. Also important are the role of marriage and the establishment of a home. If this is so, fertility behavior overwhelmingly corresponds to the social exercise of a specific perception of the world, especially in groups that live in social isolation, where the opportunity to reproduce ancestral models of generational replacement is favored. Among the immigrants studied, almost a century in Brazil was not enough to change the system that the families brought with them from the Ukraine. In Brazil they repeated behavior of having large numbers of offspring, even at the cost of the inevitable migration of many of their children in adulthood.

El estudio hace un seguimiento de la dinámica familiar de inmigrantes originarios del área de la actual Ucrania, llegados a Brasil en 1895 y establecidos en el área rural de Paraná, en la colonia Antonio Olyntho. Dada la alta fecundidad legítima del grupo, en las cohortes establecidas para el estudio (1895-1949/1950-1980), se procuró comprender las razones del mantenimiento de una descendencia final alta a lo largo de todo el período analizado (entre 8 y 9 hijos, en la primera cohorte, y entre 7 y 8 en la segunda) y lo que eso implicó en términos de organización social, familiar y doméstica. De esto restó considerar que el comportamiento reproductivo es fruto de un complejo sistema de representaciones, en el cual interactúan modos de concebir las relaciones de género y las inter-generacionales, así como el papel del casamiento y de la constitución familiar. Si así fuera, las prácticas concernientes a la fecundidad corresponden, sobremanera, al ejercicio social de una determinada visión del mundo. En especial en los grupos que viven en cierto aislamiento social, las posibilidades de reproducir modelos ancestrales de reposición generacional son favorecidas. Entre los inmigrantes estudiados, casi un siglo en Brasil fue insuficiente para cambiar el sistema familiar que vino en su bagaje: aquí continuaron reproduciendo una prole extensa, aunque por eso hubieran activado una continuada migración de los hijos excedentes.

O conceito de coparentalidade e suas implicações para a pesquisa e para a clínica: implication for research and clinical practice / The concept of co-parenting

Este estudo tem por objetivo revisar o conceito de coparentalidade e suas implicações para a pesquisa e para a clínica. Para isso, examinou-se a origem e a evolução do conceito e sua relevância para o contexto atual. O uso deste conceito nas pesquisas tem sido ampliado, passando de uma ênfase nas díades mãe-criança para uma concepção que envolve a tríade mãe-pai-criança. Esta evolução no conceito de coparentalidade tem implicações para a clínica, tanto com famílias de pais casados como divorciados. Verificou-se também uma carência de instrumentos nessa área, cuja elaboração merece ser enfocada em futuros estudos.(AU)

The aim of this study was to review the concept of co-parenting and its implication for research and clinical practice. For this purpose, the historical origin of this concept and its relevance for the current context are examined to allow an evolution of the concept. The results show a trend that move away from the mother-child dyadic concept towards a concept involving the mother-father-child triad. These studies have implications for clinical practice because they offer new possibilities of working with co-parenting (both married or divorced parents), as a focus. A lack of instruments in this area was noted; an issue that should be highlighted in future studies.(AU)