Práticas avaliativas realizadas por psicólogos hospitalares: um estudo descritivo / Evaluative practices performed by health psychologists: a descriptive study / Prácticas evaluativas realizadas por psicólogos clínicos: un estudio descriptivo

As práticas avaliativas estão na gama de possibilidades de atuação do psicólogo no Hospital. Buscou-se investigar o manejo dos processos avaliativos por psicólogos hospitalares inseridos em hospitais não psiquiátricos, quanto aos tipos, origens, características e necessidades solicitadas, identificando a conduta destes frente às demandas. Foi conduzido estudo observacional descritivo, de corte transversal, com levantamento de dados multimétodos por meio de entrevista estruturada com 14 psicólogos hospitalares de Natal/RN. Entre os resultados, observou-se que 87,7% consideram avaliação descritiva como mais frequente, 78,6% percebem que estas acontecem tanto por solicitação da equipe quanto por identificação da necessidade pelo próprio psicólogo e verificou-se um predomínio do uso de técnicas qualitativas como avaliação. Concluiu-se que o ambiente hospitalar oferece desafios para um amplo uso das técnicas existentes que, juntamente com a escassez de material e recursos humanos, tem-se uma conjuntura desfavorável para o uso destas no Hospital. (AU)

Evaluative practices are among the possibilities of a psychologist's work at the Hospital. The aim was to investigate the management of the evaluation processes by hospital psychologists working in non-psychiatric hospitals, regarding the types, characteristics and needs requested, identifying their actions faced with the demands. A cross-sectional, descriptive and observational study was conducted with multi-method data collection through a structured interview with 14 hospital psychologists from Natal/RN. Among the results, 87.7% considered the descriptive evaluation to be the most frequent, 78.6% perceived that these occur due to requests of the team and identification of the need by the psychologists themselves, with a predominance of the use of qualitative techniques in the evaluation. It was concluded that the hospital environment presents challenges for a wide use of the existing techniques, which together with the scarcity of material and human resources present unfavorable conditions for the use of those practices in the Hospital. (AU)

Las prácticas evaluativas se encuentran dentro del abanico de posibilidades de actuación del psicólogo en el ámbito hospitalario. Se buscó investigar la gestión de los procesos de evaluación por psicólogos clínicos insertados en hospitales no psiquiátricos, con respecto a los tipos, orígenes característicos y necesidades solicitadas, identificando la conducta de los psicólogos ante las demandas. Se realizó un estudio observacional descriptivo, de corte transversal, con levantamiento de datos multimétodos a través de una entrevista estructurada con 14 psicólogos clínicos hospitalarios de la ciudad de Natal, Río Grande do Norte. Entre los resultados, se observó que el 87,7% considera la evaluación descriptiva como la más frecuente, el 78,6% afirma que estas ocurren tanto por solicitud del equipo como por el propio psicólogo al identificar la necesidad, verificando un predominio del uso de técnicas cualitativas como evaluación. Se concluyó que el entorno hospitalario presenta desafíos para un amplio uso de las técnicas existentes, que junto con la escasez de recursos materiales y humanos, se da una coyuntura desfavorable para el uso de las mismas en el hospital. (AU)

Preditores de bem-estar psicológico em estudantes do ensino superior / Predictors of psychological well-being in higher education students

The psychological well-being of higher education students is an important positive correlate of personal development and academic success. Enter in a higher education configures a period of multiple transitions that create stress and a demanding adjustment. In Portugal little is known about predictive relationships between biopsychosocial variables and psychological well-being in higher education students. Identifying predictors of psychological well-being is relevant to identify variables with positive influence in the academic context. Objective. To identify predictors of psychological well-being in Higher Education Students. Methodology. Using an exploratory, transversal and correlational study in a non-probabilistic 560-sample Students (446 women; an average of 19.6 years) from the 1st and 2nd year, of the Lisbon District. Participants' informed consent was obtained, and data analysis was quantitative, using descriptive and inferential statistical analysis techniques. An online self-report questionnaire covering variables and measures: demographic and relational; academic; health behaviors; Mental Health Inventory; Satisfaction with Social Support Scale; and Satisfaction with Academic Life Scale were used. Results indicate that the male students, dating, good academic performance, exercise/sport, sleep seven hours, satisfaction with social support and satisfaction with academic life are significant predictors (p< .05) of psychological well-being, the last two with strong preponderance. Conclusions point at the relevance of the predictors of psychological well-being identified, that appear to be robust protective factors for higher education student's mental health. Clinical Relevance: Protective factors should be considered to complement prior information to assist mental health nurses and educators to design specific welfare promotion programs, to increase the potential of mental health and academic success

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Why Digital Tools Have Not Yet Revolutionized Adolescent Health Research and What We Can Do.

The promise of digital tools and devices for spurring new discoveries in adolescence research is enticing. Notably, this special section draws attention to many of the advantages that mobile and wearable devices offer for ambulatory assessment research, which have now been realized. Despite such progress, digital tools have not yet delivered on their predicted revolution of adolescent health research. I offer four reasons for why digital devices have fallen short of this predicted promise. For each barrier, I suggest parallel strategies for ensuring adolescent research benefits from Ambulatory Assessment advances. To avoid being left behind, adolescence scholarship must develop in time with innovations in digital devices and platforms, which are moving forward to support basic science and interventions in mental health.

A Review of Current Ambulatory Assessment Studies in Adolescent Samples and Practical Recommendations.

The use of ambulatory assessment (AA) and related methods (experience sampling, ecological momentary assessment) has greatly increased within the field of adolescent psychology. In this guide, we describe important practices for conducting AA studies in adolescent samples. To better understand how researchers have been implementing AA study designs, we present a review of 23 AA studies that were conducted in adolescent samples from 2017. Results suggest that there is heterogeneity in how AA studies in youth are conducted and reported. Based on these insights, we provide recommendations with regard to participant recruitment, sampling scheme, item selection, power analysis, and software choice. Further, we provide a checklist for reporting on AA studies in adolescent samples that can be used as a guideline for future studies.

The Practicalities and Perils of Ambulatory Assessment's Promise: Introduction to a Special Section.

Ambulatory assessment (AA) offers one of the most exciting approaches for opening the dynamic "black box" of adolescents' daily lives. In this introduction, we spotlight AA's surprisingly restricted market share within adolescent scholarship. We describe thorny challenges these intense methods can pose when conducting adolescent research "in situ" and underscore that capturing quality AA data means placing adolescents' developmental stage at the forefront. The novel research reported in this special section speaks to these challenges and underscores the promise of AA for conducting developmentally salient science. The nine articles included in the section span multiple disciplines (Sociology, Psychology, Public Health) and reflect diverse viewpoints, approaches, and theories. All provide multiple novel best-practice strategies for conducting AA scholarship with adolescents.

Ambulatory Assessment of Adolescent Coping: It's a Complicated Process.

Scholars have long-called for researchers to treat coping as a process that is measured over an arc of time. Ambulatory assessment (AA) offers an appealing tool for capturing the dynamic process of adolescent coping. However, challenges in capturing the coping process are not altogether circumvented with AA designs. We conducted a scoping review of the AA literature on adolescent coping and draw from 60 studies to provide an overview of the field. We provide critiques of different AA approaches and highlight benefits and costs associated with various types of measurement within AA. We also speak to considerations of participant burden and compliance. We conclude with recommendations for developmental scholars seeking to deploy AA to capture this quintessential process among adolescents.

Measuring the Psychobiological Correlates of Daily Experience in Adolescents.

Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well-being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.

Older Adolescents' Understanding of Participant Rights in the BlackBerry Project, a Longitudinal Ambulatory Assessment Study.

For a long-term, longitudinal study that used BlackBerry smartphones for passive ambulatory assessment among older adolescents, this study focused on three areas of ethical concern: (1) adolescents' competence to give assent; (2) understanding of confidentiality, the protection of information, and project goals; and (3) awareness of procedures and benefits, and comfort with the research design. One hundred and seventy-eight participants were 17 and 18 years old (84 girls). Results suggested that participants freely gave consent and understood most, but not all of the informed consent information. Participants reported a high level of satisfaction. Participants showed less understanding of when their confidentiality would be broken and how data would be protected.

Validación de un cuestionario para medir las necesidades psicológicas de los deportistas (CNPD 15) / Validation of a test to evaluate the psychological needs of sportmen and women (PNST 15) / Validação de um questionário para medir as necessidades psicológicas dos esportistas (QNPE 15)

El estudio de las variables psicológicas en el deporte es un punto clave para entender los diferentes comportamientos y resultados en el mundo del deporte, así como para desarrollar diferentes estrategias de intervención psicológica para mejorar el rendimiento. Recoger información de variables psicológicas de una forma sencilla y práctica nos permitirá conocer, en mayor profundidad, el campo de la psicología deportiva. Por ello, el objetivo del presente estudio fue reducir y validar el Cuestionario de Necesidades Psicológicas del Deportista (CNPD) de Dosil (2005) de 30 ítems que se dividen en 4 factores: Concentración, Activación, Confianza y Motivación. Se recogió una muestra de 327 deportistas de 18 deportes diferentes y con edades comprendidas entre los 11 y los 54 años (M = 18.47 ; DT = 7.1). Los resultados de los análisis psicométricos mostraron una buena validez y una alta fiabilidad, obteniendo un instrumento reducido a 15 ítems y 4 factores, adecuado para su aplicación en el ámbito del deporte

The studying of psychological factors is a key element for understanding different behaviours and results in the Sports world, and also for developing different strategies of psychological intervention in order to improve the performance. Collecting data of psychological factors in a simple and practical way will allow us to have a deeper understanding of the Sports Psychology field. Therefore, the goal of this study was to simplify and validate a Cuestionario de Necesidades Psicológicas del Deportistas (CNPD) by Dosil (20015), composed of 30 items, and divided in 4 factors: focus, activation, confidence and motivation. In order to do that, we collected a sample of 327 sportsmen and women of 18 different sports, with ages ranging between 11 and 54 (M = 18.47 ; DT = 7.1). The results of the psychometric analysis showed a good validity and a high reliability, yielding an instrument reduced just to 15 items and 4 factors, which is suitable for the Sports scope

O estudo das variáveis psicológicas no esporte é um ponto chave para perceber os diferentes comportamentos e resultados do mundo do esporte assim como para desenvolver diferentes estratégias de intervenção psicológica e para melhorar o rendimento. Recolher informação de variáveis psicólogas de um jeito simples e prático permitirá conhecer com maior profundidade o ramo da psicologia esportiva. Por isto, o objetivo deste estudo foi reduzir e validar el Cuestionario de Necesidades Psicológicas del Deportista(CNPD) de 30 itens que são divididos em 4 fatores: Foco, ativação, confiança e motivação. Para isso foi realizada uma amostra de 327 esportistas de 18 esportes diferentes e com idades entre 11 e 54 anos(M= 18.47 ; DP= 7.1). Os resultados das análises psicométricas mostraram validez e alta fiabilidades obtendo assim um instrumento reduzido a 15 itens e 4 fatores, adequado ao ramo da Psicologia Esportiva

Picture my well-being: Listening to the voices of students with autism spectrum disorder.

BACKGROUND: Student well-being, though widely researched, continues to be a poorly defined concept. Few student well-being studies focus on students with autism spectrum disorder (ASD), who may have a poorer sense of well-being compared to typically developing students. AIMS: The current study aims to explore the conceptualisation, barriers, and ways to enhance the well-being of students with ASD from their perspectives. METHODS AND PROCEDURES: Photovoice, a participatory research method was used to elicit the views of 16 high school students with ASD to explore the concept of well-being. Data analysis was conducted using a grounded theory approach. OUTCOMES AND RESULTS: Students conceptualised well-being as multidimensional, identified sensory barriers, social barriers, and barriers that were associated with learning, and several external and internal assets that could support their well-being. CONCLUSIONS AND IMPLICATIONS: To promote well-being, barriers should be mitigated, while external and internal assets developed. Researchers should also consider the use of Photovoice to enable students' meaningful participation in research studies.

AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial.

BACKGROUND: A quarter of people with psychotic conditions experience persistent auditory verbal hallucinations, despite treatment. AVATAR therapy (invented by Julian Leff in 2008) is a new approach in which people who hear voices have a dialogue with a digital representation (avatar) of their presumed persecutor, voiced by the therapist so that the avatar responds by becoming less hostile and concedes power over the course of therapy. We aimed to investigate the effect of AVATAR therapy on auditory verbal hallucinations, compared with a supportive counselling control condition. METHODS: We did this single-blind, randomised controlled trial at a single clinical location (South London and Maudsley NHS Trust). Participants were aged 18 to 65 years, had a clinical diagnosis of a schizophrenia spectrum (ICD10 F20-29) or affective disorder (F30-39 with psychotic symptoms), and had enduring auditory verbal hallucinations during the previous 12 months, despite continued treatment. Participants were randomly assigned (1:1) to receive AVATAR therapy or supportive counselling with randomised permuted blocks (block size randomly varying between two and six). Assessments were done at baseline, 12 weeks, and 24 weeks, by research assessors who were masked to therapy allocation. The primary outcome was reduction in auditory verbal hallucinations at 12 weeks, measured by total score on the Psychotic Symptoms Rating Scales Auditory Hallucinations (PSYRATS-AH). Analysis was by intention-to-treat with linear mixed models. The trial was prospectively registered with the ISRCTN registry, number 65314790. FINDINGS: Between Nov 1, 2013, and Jan 28, 2016, 394 people were referred to the study, of whom 369 were assessed for eligibility. Of these people, 150 were eligible and were randomly assigned to receive either AVATAR therapy (n=75) or supportive counselling (n=75). 124 (83%) met the primary outcome. The reduction in PSYRATS-AH total score at 12 weeks was significantly greater for AVATAR therapy than for supportive counselling (mean difference -3·82 [SE 1·47], 95% CI -6·70 to -0·94; p<0·0093). There was no evidence of any adverse events attributable to either therapy. INTERPRETATION: To our knowledge, this is the first powered, randomised controlled trial of AVATAR therapy. This brief, targeted therapy was more effective after 12 weeks of treatment than was supportive counselling in reducing the severity of persistent auditory verbal hallucinations, with a large effect size. Future multi-centre studies are needed to establish the effectiveness of AVATAR therapy and, if proven effective, we think it should become an option in the psychological treatment of auditory verbal hallucinations. FUNDING: Wellcome Trust.

CFS MATLAB toolbox: An experiment builder for continuous flash suppression (CFS) task.

CFS toolbox is an open-source collection of MATLAB functions that utilizes PsychToolbox-3 (PTB-3). It is designed to allow a researcher to create and run continuous flash suppression experiments using a variety of experimental parameters (i.e., stimulus types and locations, noise characteristics, and experiment window settings). In a CFS experiment, one of the eyes at a time is presented with a dynamically changing noise pattern, while the other eye is concurrently presented with a static target stimulus, such as a Gabor patch. Due to the strong interocular suppression created by the dominant noise pattern mask, the target stimulus is rendered invisible for an extended duration. Very little knowledge of MATLAB is required for using the toolbox; experiments are generated by modifying csv files with the required parameters, and result data are output to text files for further analysis. The open-source code is available on the project page under a Creative Commons License ( http://www.mikkonuutinen.arkku.net/CFS_toolbox/ and https://bitbucket.org/mikkonuutinen/cfs_toolbox ).

Uso de las nuevas tecnologías por parte de los psicólogos españoles y sus necesidades / Use of information and communication technologies by Spanish psychologists, and their needs

El objetivo de este trabajo ha sido conocer la situación del uso de las nuevas tecnologías entre los psicólogos de la Comunidad de Madrid (CM) y su actitud ante las mismas. El método para acceder a esta información ha sido construir una encuesta, enviada por e-mail, elaborada a partir de una revisión de la literatura sobre este tema, con poca investigación previa en nuestro entorno pero que ya se ha explorado en otros países. La muestra estaba constituida por la totalidad de los psicólogos inscritos en el COP de Madrid, facilitado por la dirección del mismo, obteniéndose un total de 486 respuestas. Hasta la fecha sólo un 26% utiliza teleterapia. Los principales inconvenientes encontrados son las limitaciones de la comunicación no verbal y la alianza terapéutica, seguidas de la confidencialidad de los datos y los problemas técnicos en el manejo de los mismos

The aim of this paper is to know the real situation in the use of information and communication technologies alongside the attitude of psychologists in Madrid Region. We conducted a quantitative research by means of a questionnaire based on previous literature reviews regarding the same topic in other countries. The sample consisted of all psychologists registered in the Spanish Psychology Association (COP), Madrid branch, with a total 486 responses. Only 26% use teletherapy along with other combined therapy modality involving face to face communication. Drawbacks in the study include primarily limitations of non-verbal communication and the therapeutic alliance, followed by confidentiality of data and technical problems with handling data

The Promise and the Challenge of Technology-Facilitated Methods for Assessing Behavioral and Cognitive Markers of Risk for Suicide among U.S. Army National Guard Personnel.

Suicide was the 10th leading cause of death for Americans in 2015 and rates have been steadily climbing over the last 25 years. Rates are particularly high amongst U.S. military personnel. Suicide prevention efforts in the military are significantly hampered by the lack of: (1) assessment tools for measuring baseline risk and (2) methods to detect periods of particularly heightened risk. Two specific barriers to assessing suicide risk in military personnel that call for innovation are: (1) the geographic dispersion of military personnel from healthcare settings, particularly amongst components like the Reserves; and (2) professional and social disincentives to acknowledging psychological distress. The primary aim of this paper is to describe recent technological developments that could contribute to risk assessment tools that are not subject to the limitations mentioned above. More specifically, Behavioral Signal Processing can be used to assess behaviors during interaction and conversation that likely indicate increased risk for suicide, and computer-administered, cognitive performance tasks can be used to assess activation of the suicidal mode. These novel methods can be used remotely and do not require direct disclosure or endorsement of psychological distress, solving two challenges to suicide risk assessment in military and other sensitive settings. We present an introduction to these technologies, describe how they can specifically be applied to assessing behavioral and cognitive risk for suicide, and close with recommendations for future research.

Revisión del modelo para evaluar la calidad de los tests utilizados en España / Assessing the quality of tests in Spain: revision of the Spanish test review model

Para usar adecuadamente los tests, es necesario que los profesionales cuenten con información rigurosa de su calidad. Es por ello que, desde hace unos años, se viene aplicando el modelo español de evaluación de la calidad de los tests (Prieto y Muñiz, 2000). El objetivo de este trabajo es actualizar y revisar dicho modelo, con el fin de incorporar las recomendaciones hechas en sus aplicaciones, y para incorporar los avances psicométricos y tecnológicos que se han producido durante los últimos años. El modelo original fue revisado en varias fases, y la revisión originalmente propuesta fue revisada por un conjunto de expertos, lo que dio lugar a la versión final que se describe en este trabajo. Se espera que la aplicación del modelo revisado y la publicación de los resultados correspondientes, contribuya a seguir mejorando el uso de los tests y, con ello, la práctica profesional de la Psicología

For professionals to use tests adequately, they must have rigorous information about the quality of the tests. This is why during the last years, the Spanish test review model (Prieto & Muñiz, 2000) has been applied. The goal of this paper is to update and revise this model in order to incorporate the recommendations given after the original model was applied and, to incorporate the latest psychometric and technological innovations. The original model was revised following different steps, and the revised proposal was reviewed by a number of experts. After incorporating their suggestions, we arrived to the final version, which is described in this paper. With the application of the revised model, and the publication of the corresponding results, we expect to continue improving the use of tests, and consequently, the professional practice of Psychology

Cuarta evaluación de tests editados en España: forma y fondo / Fourth review of tests published in Spain: form and content

La evaluación de tests y divulgación de las memorias resultantes se ha implantado en el panorama internacional con el claro objetivo de mejorar el uso de los tests, y con ello la práctica profesional. Se trata de una herramienta que ofrece al usuario de tests una revisión independiente sujeta a procedimientos y criterios definidos. En España se han llevado a cabo cuatro ediciones del proyecto de evaluación liderado por el Consejo General de la Psicología (COP). Básicamente existen dos modelos de evaluación de tests, el modelo Buros y el modelo de la European Federation of Psychologists' Associations (EFPA), utilizado por el COP. Ambos, comparten objetivos y contenido, y excluyendo varias cuestiones de formato y gestión, el fondo en ambos modelos es el mismo. En este trabajo se ofrecen los resultados de la cuarta edición del proyecto de evaluación de tests del COP adecuándolos a las pautas generales que sigue un procedimiento de evaluación de tests, y mostrando los puntos críticos en cada fase del proceso

Assessing the quality of tests and disseminating the test results has been implemented in the international arena with the aim of improving testing and professional practice. Assessing tests provides users with an independent review, which follows clearly defined procedures and criteria. In Spain, the Spanish Association of Psychology (COP) leads the "test evaluation" project, which has recently completed its fourth edition. Basically, there are two primary assessment models; the Buros model and the European Federation of Psychologists’ Associations (EFPA) model, which has been adopted by the COP. The two models share the same objectives and content; excluding the evaluation format and the management system, they are similar in essence. In this paper, we present the results of the fourth edition of the Spanish test evaluation program following the general guidelines for assessing the quality of tests, and we explain the critical points affecting each phase of the process

[Online Counselling: The prospect of a therapeutic connection].

Over the last few years, Internet has become an integral part of daily life. An abundant source of information and a principal gateway of communication between individuals, Internet has been continuously gaining considerable ground as a tool of awareness and intervention in the area of public health. With regard to the field of mental health, Internet exhibits a credible potential in facilitating dialogue not only between experts and their beneficiaries but also between stakeholders. Moreover and with regard to various aspects of public concern, it can serve as a circulation portal of educational material between students and teachers. The advent of remote support services dates back in the decade of 1970-1980. In the present time, they consist of informative guides and self-help groups or online counselling. The latter is defined as the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or e-mail exchange. The benefits of this practice - accessibility, relocation, convenience, anonymity, facilitation of face-to-face psychotherapy and low cost - could make online counseling, in specific cases, the treatment of choice. While the usage of the World Wide Web seems promising for the rectification of mental health disorders, there is some debate among experts regarding the ethical aspect of practicing psychotherapy in an interactive digital environment. Issues such as technical expertise and the tackling of related problems, difficulties in the diagnostic process, interchange of verbal and nonverbal cues, crisis management, safeguarding the therapeutic alliance, protection of personal data, age restriction, keeping boundaries in relation to the setting, the time and the dynamics of the therapeutic relationship and, finally, training and supervisory process of online therapist, are some subjects of disagreement. Relevant research reveals the effectiveness of online counseling in decreasing the magnitude of reported symptoms, with a direct positive impact on the improvement of daily functioning and on future relapses. However, the usefulness of developing a therapeutic relationship through internet connection is being criticized by a group of clinicians, with their main arguments revolving around spatiotemporal issues and the reliability of incoming information. Some other researchers correlate the therapeutic alliance concluded in the context of electronic communication with a positive therapeutic effect. The data on the effectiveness of online practice are not sufficient to draw a definite conclusion. In an era of direct and rapid communication, it is imperative to encourage further research, for the determination of optimal conditions with respect to the practice of internet-delivered psychotherapy and the patients' well being as a result of treatment.

Guía para la aplicación e interpretación del cuestionario de apego CaMir-R / Guide to application and interpretation of the CaMir-R attachment questionnaire / Guia per a L'aplicació I interpretación del qüestionari d'aferrament Ca-Mir-R

El CaMir-R es un instrumento para la evaluación del apego que cuenta con buenas propiedades psicométricas, para su aplicación en el ámbito clínico y de la investigación con adolescentes y adultos. Las dimensiones del CaMir-R pueden utilizarse tanto para describir las representaciones de apego de la persona como para estimar los estilos de apego a partir de dichas dimensiones. En el presente trabajo se realiza una descripción pormenorizada del instrumento y de su aplicación. Además, se explicanlas pautas de interpretación de las dimensiones de apego que evalúa el instrumento, así como el procedimiento para estimar el estilo de apego a partir de las puntuaciones obtenidas en dichas dimensiones (AU)

The CaMir-R presents adequate psychometric properties for assessing attachment in clinical and research context with adolescents and adults. The dimensions of CaMir-R can be used both to describe the attachment representations of the person as well as to identify attachment styles using these dimensions. This work presents a detailed description of the CaMir-R and its application. Furthermore, guidelines for interpreting the dimensions of attachment that the instrument evaluates and the procedure for identifying the attachment style from the scores on these dimensions are explained (AU)

El CaMir-R és un instrument per a l’avaluació de l’aferrament que compta amb bones propietats psicomètriques, per a la seva aplicació en l’àmbit clínic i de la investigació amb adolescents i adults. Les dimensions del CaMir-R poden utilitzar-se tant per descriure les representacions de l’aferrament de la persona com per estimar els estils de l’aferrament a partir d’aquestes dimensions. En el present treball, es realitza una descripció detallada de l’instrument i de la seva aplicació. A més, s’expliquen les pautes d’interpretació de les dimensions de l’aferrament que avalua l’instrument, així com el procediment per estimar l’estil d’aferrament a partir de les puntuacions obtingudes en aquestes dimensions

Attention! A good bedside test for delirium?

BACKGROUND: Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective 'confusion'. METHODS: We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method. RESULTS: 265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity. CONCLUSIONS: Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.

Abuso sexual infantil: desafío multidisciplinar. Un abordaje integral del problema para mejorar su detección y la atención a la víctima / Child sexual abuse, a multidisciplinary challenge: an integral approach to the problem to improve its detection and victim care

El abuso sexual infantil (ASI) es el delito de malos tratos a menores que más sumergida y silenciosamente ocurre ante la sociedad, por lo que en un alto porcentaje queda impune. Las secuelas que origina en la psicología de la víctima son profundas y prolongadas, y a menudo resultan devastadoras para su biografía posterior, hecho que sólo puede ser evitado si el abuso es detectado y se brinda al menor una adecuada rehabilitación psicoemocional. La mejora en su detección y abordaje profesional es una responsabilidad que recae, entre otros servidores públicos, sobre el pediatra. Pero el análisis objetivo de este problema pone de manifiesto que las formas más comunes de presentación clínica del ASI ante el pediatra son las crípticas, sobre todo en forma de trastornos comportamentales o de somatizaciones neuróticas de la víctima, a priori inespecíficas, por efecto del desbordamiento emocional debido al padecimiento silencioso y a la vivencia solitaria de desamparo, en la mayoría de los casos, sin mediar revelación alguna por parte de aquélla ni hallar pruebas físicas en su exploración. Ante este hecho, y partiendo sólo de una mera sospecha o posibilidad intuida, el pediatra se enfrenta a un auténtico desafío en su deber de detección, asistencia, notificación y custodia a la víctima. El presente trabajo tiene por objetivo ayudar al pediatra a orientar correctamente su actuación al afrontar este desafío. Se expone para ello el resultado de un análisis integral del problema, en el que han sido abordados no sólo aspectos de la presentación clínica y la actuación médica a recomendar, sino también de la fenomenología social y familiar del ASI y del devenir judicial y biográfico de los casos, con el fin de orientar mejor la actuación pediátrica. Ésta, que debe tener como objetivo prioritario la protección y rehabilitación emocional del menor, pero intentando minimizar al máximo las posibles repercusiones psicosociales en la víctima y su familia, no halla su única solución en el aumento de formación y concienciación pediátricas, sino que exige la habilitación de recursos especializados y multidisciplinares, ágiles, discretos y capaces de asumir un seguimiento coordinado a largo plazo, lamentablemente aún no disponibles en muchas comunidades de nuestro país. Este tipo de seguimiento multidisciplinar y coordinado, necesario también para otras formas de sospecha de maltrato y patologías de índole psicosocial, es justificación suficiente para reivindicar la creación de Unidades de Pediatría Psicosocial (AU)

Child Sexual Abuse (CSA) is the crime of child abuse that occurs so stealthily and is so submerged in society that it often goes unpunished. The psychological sequels for the victim are both deep and prolonged and can lead to devastating effects on the child's future which can only be prevented if the abuse is detected and appropriate psychoemotional rehabilitation rovided. The improvement of its detection and victim treatment is a professional sponsibility that lies on the pediatrician, along with other public servants. However, an objective analysis of this issue makes it evident that most common forms of clinical presentation of CSA to the paediatrician are cryptic and usually present themselves as behavioral disorders or neurotic somatization of the victim, a priori unspecified, as consequence of the emotional overflow caused by suffering in silence and solitary experience of helplessness, in the majority of cases, without any disclosure on the victim's part or the finding of any physical evidence after our exploration. Given this fact, the pediatrician is faced with the challenging task of detecting, assisting, reporting and taking care of the victim on the basis of mere suspicion or intuition. The present work aims to help the pediatrician to correctly guide their actions to meet this challenge. A comprehensive analysis of the problem is carried out, addressing not only aspects of the clinical and medical action to recommend, but also the social and family phenomenology of CSA and the legal and biographical becoming of cases, in order to target the pediatric performance. This, it must have as a priority the child's emotional protection and rehabilitation, but trying to minimize the maximum the possible sychosocial impact on the victim and his family. To achieve this it's not the only solution in increasing pediatric training and awareness, but requires the empowerment of specialized resources for a multidisciplinary assessment which has to be prompt, discreet and capable of providing long-term follow up, not yet available in many communities in our country. The need for this multidisciplinary and coordinated monitoring, which is also required in other types of abuse and psycho-social pathologies, is reason enough to vindicate the creation of Pediatric Psycho-Social Units (AU)