Implementing the intermed in a post-acute care rehabilitation clinic for traumatic injuries: Obstacles and benefits

In 2003, the INTERMED, an instrument to assess biopsycho- social case complexity and to direct care, was introduced in daily clinical practice in the .Clinique romande de réadaptation suvaCare., a national rehabilitation hospital for traumatic injuries, located in the French speaking part of Switzerland. The introduction of the INTERMED was easy to realize and no major obstacles hampered its systematic implementation. Up to now, about 2,000 patients have been evaluated with the INTERMED and are followed for different outcomes. The INTERMED improved not only patients. assessment by including relevant psychosocial aspects of the clinical situation, it also favoured interdisciplinary communication, enhanced work satisfaction of the nursing staff and allowed early identification and adaptation of treatment for the injured patient showing a high degree of case complexity. Upon follow up, patients with a high degree of case-complexity showed a less favourable outcome, i.e. more health care utilization and lower rates of return to work. In conclusion, the systematic implementation of the INTERMED enabled the reorganization of medical rehabilitation, anchored it in a bio-psycho-social framework, improving interdisciplinary communication and collaboration and ameliorated treatment outcome.

L'Exercici de la docència de la psicologia i el Burnout

En l’actualitat el burnout o síndrome de cremar-se per la feina és considerat un risc emergent als països occidentals essent el col·lectiu docent un dels més afectats. L’espai europeu d’educació superior proposa un nou rol pel professor que haurà de ser compaginat amb la gestió, la recerca i la transferència de coneixement. En la present recerca s’analitza el nivell de burnout en una mostra formada per 42 docents (mitjana d’edat: 37,21 anys; D.T.: 8,98; 70,8% dones) del departament de Psicologia de la Universitat de Girona. El burnout s’ha avaluat amb el Maslach Burnout Inventory (MBI) així com amb un qüestionari d’elaboració pròpia que recull variables sociodemogràfiques, característiques del tipus de treball i de l’ús del temps lliure, el locus de control i el burnout percebut. Els resultats obtinguts indiquen valors mitjans en les puntuacions de les dimensions Cansament Emocional i Despersonalització, i valors elevats en Realització Personal. El 20,5% dels docents es percep cremat per la feina

Dépendances [Addictions]

This year reviews on the addictions emphasizes five aspects, on a bio-psycho-social perspective: (1) The relationship between methadone and cardiotoxicity. (2) The introduction of Eye Movement Desensibilization and Reprocessing (EMDR). (3) The apparition of a possible specific pharmacotherapy for excessive gambling. (4) A better knowledge of the relationship between cannabis and psychoses. (5) Resistance to treatment in the doctor-patient relationship.

Empfehlungen zur Diagnostik und Therapie der behavioralen und psychologischen Symptome der Demenz (BPSD) [Recommendations for diagnosis and therapy of behavioral and psychological symptoms in dementia (BPSD)].

In patients with dementia, Behavioral and Psychological Symptoms of Dementia (BPSD) are frequent findings that accompany deficits caused by cognitive impairment and thus complicate diagnostics, therapy and care. BPSD are a burden both for affected individuals as well as care-givers, and represent a significant challenge for therapy of a patient population with high degree of multi-morbidity. The goal of this therapy-guideline issued by swiss professional associations is to present guidance regarding therapy of BPSD as attendant symptoms in dementia, based on evidence as well as clinical experience. Here it appears to be of particular importance to take into account professional experience, as at this point for most therapeutic options no sufficiently controlled clinical trials are available. A critical discussion of pharmaco-therapeutic intervention is necessary, as this patient-population is particularly vulnerable for medication side-effects. Finally, a particular emphasis is placed on incorporating and systematically reporting psycho-social and nursing options therapeutic intervention.

Conditions de travail, chômage et santé : la situation en Suisse à la lumière de l'Enquête suisse sur la santé 2007

"L'emploi et les conditions de travail ont une grande incidence sur l'équité en santé", note l'Organisation mondiale de la santé (OMS) dans un rapport publié en 2008: ils font partie des principaux déterminants sociaux "à l'origine d'une grande part des inégalités en santé observées entre pays et dans les pays". Ce constat se fonde sur un vaste corpus d'enquêtes et de recherches menées à l'échelle internationale, dont le renouveau ces trois dernières décennies a été stimulé par l'explosion du chômage et de la précarisation de l'emploi, ainsi que par l'intensification du travail. Pour la première fois, une vue chiffrée d'ensemble de cette problématique est également disponible pour la Suisse, basée sur les données de la dernière enquête suisse sur la santé, réalisée en 2007 par l'Office fédéral de la statistique (OFS). L'étude dont nous présentons ici les résultats cherche à répondre à trois questions?: 1) Quelles sont les conditions de travail à risque (physique ou psycho-social) les plus fréquentes? Qui y est le plus exposé, en fonction notamment du sexe, de la position sociale ou de la branche d'activité? 2) Quelles associations peut-on mettre en évidence entre ces conditions de travail et l'état de santé? 3) Quels sont les liens entre le fait d'être au chômage ou de craindre pour son emploi et l'état de santé? Les données analysées révèlent un lien significatif entre les conditions de travail à risques, plus fréquentes que souvent admis, et une santé dégradée chez les personnes concernées. L'association est encore plus forte avec le fait d'être au chômage. Ces réalités sont souvent passées sous silence, en Suisse encore plus qu'ailleurs. Cette étude contribue à les rendre visibles et à instruire ainsi le débat nécessaire sur les conditions économiques et sociales de leur changement. Débat dont l'actualité est redoublée par les conséquences dramatiques sur l'emploi et sur les conditions de travail de l'actuelle crise économique internationale. [Ed.]

Pain and beliefs after musuloskeletal trauma: Complex relationships during the first year of rehabilitation

Introduction.- Pain and beliefs have an influence on the patient's course in rehabilitation and their relationships are complex. The aim of this study was to understand the relationships between pain at admission and the evolution of beliefs during rehabilitation as well as the relationships between pain and beliefs one year after rehabilitation.Patients and methods.- Six hundred and thirty-one consecutive patients admitted in rehabilitation after musculoskeletal trauma, were included and assessed at admission, at discharge and one year after discharge. Pain was measured by VAS (Visual Analogical Scale) and beliefs by judgement on Lickert scales. Four kinds of beliefs were evaluated: fear of a severe origin of pain, fear of movement, fear of pain and feeling of distress (loss of control). The association between pain and beliefs was assessed by logistic regressions, adjusted for gender, age, native language, education and bio-psycho-social complexity.Results.- At discharge, 44% of patients felt less distressed by pain, 34% are reinsured with regard to their fear of a severe origin of pain, 38% have less fear of pain and 33% have less fear of movement. The higher the pain at admission, the higher the probability that the distress diminished, this being true up to a threshold (70 mm/100) beyond which there was a plateau. At one year, the higher the pain, the more dysfunctional the fears.Discussion.- The relationships between pain and beliefs are complex and may change all along rehabilitation. During hospitalization, one could hope that the patient would be reinsured and would gain self-control again, if pain does not exceed a certain threshold. After one year, high pain increases the risk of dysfunctional beliefs. For clinical practice, these data suggest to think in terms of the more accessible "entrance door", act against pain and/or against beliefs, adpated to each patient.

Le syndrome métabolique: des spécialistes au médecin de premier recours [Metabolic syndrome: from specialists to the first aid physician]

Numerous algorithms originating from evidence-based medicine already exist; in spite of this, metabolic syndrome management remains problematical and needs to be improved. Specialists, working interactively and referring to clinical scenarios, pooled their specific areas of expertise in a transverse perspective of the metabolic syndrome management by the primary care physician. This concerted multidisciplinary approach has clearly revealed that a bio-psycho-social approach is absolutely essential in the management of this type of patients.

Factors associated with healthcare professionals' intent to stay in hospital: a comparison across five occupational categories.

OBJECTIVE: To identify factors associated with intent to stay in hospital among five different categories of healthcare professionals using an adapted version of the conceptual model of intent to stay (CMIS). DESIGN: A cross-sectional survey targeting Lausanne University Hospital employees performed in the fall of 2011. Multigroup structural equation modeling was used to test the adapted CMIS model among professional groups. Measures Satisfaction, self-fulfillment, workload, working conditions, burnout, overall job satisfaction, institutional identification and intent to stay. PARTICIPANTS: Surveys of 3364 respondents: 494 physicians, 1228 nurses, 509 laboratory technicians, 935 administrative staff and 198 psycho-social workers. RESULTS: For all professional categories, self-fulfillment increased intent to stay (all β > 0.14, P < 0.05). Burnout decreased intent to stay by weakening job satisfaction (β < -0.23 and β > 0.22, P < 0.05). Some factors were associated with specific professional categories: workload was associated with nurses' intent to stay (β = -0.15), and physicians' institutional identification mitigated the effect of burnout on intent to stay (β = -0.15 and β = 0.19). CONCLUSION: Respondents' intent to stay in a position depended both on global and profession-specific factors. The identification of these factors may help in mapping interventions and retention plans at both a hospital level and professional groups' level.

Crises non épileptiques psychogènes: le défi des troubles fonctionnels en neurologie

Psychogenic non epileptic seizures (PNES) look like epilepsy, but are not accompanied by the electrophysiological alterations found in epilepsy. The diagnosis requires a complex process at the interface between neurology and psychiatry. Diagnostic restitution to the patient and treatment of the condition should be a collaboration between neurologist and psychiatrist including as much as possible a general practitioner. Vulnerability and triggering psycho-social factors, as well as frequent psychiatric co morbidity implicate that psychiatric-psychological care is needed in a majority of situations, however this cannot be done without a strong "somatic back-up" with rapid access to somatic facility for advice and care when needed. The neurological presentation of the disease, with psychiatric causes underlying the condition, bear the risk for the patient that neither neurological nor psychiatric care is offered. Current knowledge about the condition is still scarce, but the field is progressively enriched by studies with stronger methodologies. Recent neuroimaging studies open fascinating avenues on our understanding of the interplay between emotional regulation, representation of the self, and dissociative symptoms. These new avenues help our understanding of these disorders which challenge classical frontiers between neurology and psychiatry. In this paper we try to formulate a framework for the care of patient with dissociative disorders including NEPS.

Propuesta de programa de prevención de trastornos de la conducta alimentaria y la obesidad dirigido a profesores de educación física de secundaria

En la actual concepción bio-psico-social, los Trastornos del Comportamiento Alimentario (TCA) y la obesidad están plurideterminados por factores biológicos, psicológicos y socioculturales que actúan como elementos perpetuantes en el tiempo. Se pueden modificar actitudes contraproducentes con un programa de prevención multidisciplinar y disminuir de modo significativo la población con riesgo de obesidad y de padecer un TCA. Para ello, es necesario desarrollar dichos programas de prevención, previos a la atención primaria, y la estrategia para lograrlo es la intervención ante factores de riesgo, integrada en un conjunto de actividades de educación para la salud más global. Esta propuesta educativa pretende brindar a los profesores de Educación Física una revisión bibliográfica sobre la dimensión que desde la cultura occidental se tiene de los Trastornos del Comportamiento Alimentario (TCA) y la obesidad, al tiempo que promueve la reflexión sobre las posibilidades de intervención que ofrece la Educación Física desde el ámbito educativo en cuanto a la prevención de la obesidad, de los TCA, y de las conductas de riesgo. La presente propuesta de proyecto de prevención quiere destacar la función que cumplen docentes, tutores y tutoras, como acompañantes de los estudiantes, su posición privilegiada para conocerlos de cerca y estar así atentos a sus vivencias y la posibilidad de identificar oportunamente conductas no saludables en estudiantes que necesiten ciertas pautas para mejorar su estilo de vida, modificar sus habitos, o ser derivados para una atención especializada. Por ese motivo, en esta propuesta educativa se invita a los docentes y tutores a revisar sus convicciones personales y cuestionar la manera de pensar sobre la belleza física y el cuidado corporal. Esta reflexión junto a las pautas metodológicas permitirá abordar el tema de los TCA y la obesidad con tacto, respeto y la atención necesaria frente a los sentimientos de los y las estudiantes que se encuentran en un periodo de cambios importantes y con interrogantes en torno a su identidad e imagen corporal

Teràpia aquàtica en pacients afectats d' AVC

La teràpia aquàtica o hidroteràpia és una de les tècniques de fisioteràpia poc valorades pels beneficis que aporten. En aquest estudi analitzem com aquest tractament en el medi aquàtic pot beneficiar als pacients afectats de un accident vascular cerebral (AVC). Els participants d’aquest estudi son pacients els quals han patit un AVC en els últims dos anys. Aquest estudi serà dut a terme ha l’Hospital Sant Joan de Déu de Palma de Mallorca. La investigació consisteix en una combinació entre el mètode qualitatiu i el mètode quantitatiu, cada mètode aporta diferents visions de l’estudi amb la finalitat d’obtenir resultats més complets, arribant als objectius marcats. Per una banda, l’aspecte bio-psico-social serà avaluat utilitzant el mètode qualitatiu, realitzant entrevistes semi-estructures abans i després del tractament amb la finalitat d’obtenir la sensació que percep el pacient en cada moment. Per l’altre banda, l’espasticitat la valorarem mitjançant l’escala de Ashworth amb el mètode quantitatiu abans i després del tractament. Tenint en compte que poden sorgir varis limitacions com el temps de durada de l’estudi, la planificació o limitacions entre els participants, és un estudi interessant per valorar els canvis en la qualitat de vida d’aquestes persones.

Cambios en los cuidadores informales en cuanto a estilos de vida, relaciones y alteraciones de salud mental

Changes in the informal caregiver life styles, relations and alterations of mental health. Justification.The increase of the population aged 65 years and older in developed countries is generating a proportional increasing of the dependency caused by chronic pathologies. The care of these persons is being carried out by relatives, informal carers, leading to some alterations in diverse areas, among them mental alterations, as a consequence of taking care. Objectives. To develop a profile of the informal carers and to correlate the caregiver burden with the carers disorders. To detect risk factors to allow carrying out premature nursing interventions to diminish the disorders in the informal carers. Design. An observational and cross-sectional study is made in primary care health services area of the city of Girona. Methodology. Random sample of carer of dependent people at their home , assigned to the program of domiciliary attention (ATDOM) of the educational basic areas of health (ABS). A sample size of 269 persons, with a level of precision of 9% was needed. Questionnaire ICUB 97, the test of Barthel, the Philadelphia Geriatric Center scale, and a questionnaire are used as instruments that includes demographic and social variables, and mental and physical carers disorders.Results. A total of 80 participants were interviewed. The most common problems as consequence of taking care were the backache, to feel more tired, to feel impotent and to have less free time. Correlation between the level of dependence of the patient with the number of problems perceived by the caretaker does not exist. Since they are informal carers they eat frequently outside the habitual schedule, took place an increase or loss of weight, experienced more disorders in sexual life and an increasing lack of interest in surroundings. A 33% of the informal carers are being treated for problems related to the mental health.Conclusion. The fact of being informal carer carries important consequences in their health, the lifestyles and the social relations. These can be attenuated if the nursing interventions are able to consider to the well-taken care of subject, and its surroundings in an holistic way. The professionals of infirmary of mental health must contribute to their knowledge and abilities contributing to make an assessment, a diagnosis and an intervention paying special attention to psycho-social aspects mentioned

Cambios en los cuidadores informales en cuanto a estilos de vida, relaciones y alteraciones de salud mental

Changes in the informal caregiver life styles, relations and alterations of mental health. Justification.The increase of the population aged 65 years and older in developed countries is generating a proportional increasing of the dependency caused by chronic pathologies. The care of these persons is being carried out by relatives, informal carers, leading to some alterations in diverse areas, among them mental alterations, as a consequence of taking care. Objectives. To develop a profile of the informal carers and to correlate the caregiver burden with the carers disorders. To detect risk factors to allow carrying out premature nursing interventions to diminish the disorders in the informal carers. Design. An observational and cross-sectional study is made in primary care health services area of the city of Girona. Methodology. Random sample of carer of dependent people at their home , assigned to the program of domiciliary attention (ATDOM) of the educational basic areas of health (ABS). A sample size of 269 persons, with a level of precision of 9% was needed. Questionnaire ICUB 97, the test of Barthel, the Philadelphia Geriatric Center scale, and a questionnaire are used as instruments that includes demographic and social variables, and mental and physical carers disorders.Results. A total of 80 participants were interviewed. The most common problems as consequence of taking care were the backache, to feel more tired, to feel impotent and to have less free time. Correlation between the level of dependence of the patient with the number of problems perceived by the caretaker does not exist. Since they are informal carers they eat frequently outside the habitual schedule, took place an increase or loss of weight, experienced more disorders in sexual life and an increasing lack of interest in surroundings. A 33% of the informal carers are being treated for problems related to the mental health.Conclusion. The fact of being informal carer carries important consequences in their health, the lifestyles and the social relations. These can be attenuated if the nursing interventions are able to consider to the well-taken care of subject, and its surroundings in an holistic way. The professionals of infirmary of mental health must contribute to their knowledge and abilities contributing to make an assessment, a diagnosis and an intervention paying special attention to psycho-social aspects mentioned

Soins aux mineurs non accompagnés (MNA): l'expérience lausannoise [Caring for unaccompanied minors: an experience from Lausanne].

La prise en charge médicale du mineur non accompagné est complexe et nécessite la mise en place d'un réseau biopsychosocial. A Lausanne, l'Unité multidisciplinaire de santé des adolescents (UMSA) joue un rôle préventif et curatif pour cette population extrêmement vulnérable. Une prise en charge psychologique rapide est souvent nécessaire en raison des événements de vie dramatiques auxquels la plupart de ces adolescents ont été confrontés. L'absence de projet d'avenir pour la majorité de ces adolescents reste une entrave majeure à leur développement et à leur santé mentale et physique. Medical treatment of an unaccompanied minor is made more complicated firstly by its connections with the politics of immigration and secondly by the difficulty in gaining recognition of the priority of the minor's interests. Enabling healthcare teams to travel and meet these particularly vulnerable youths makes medical care more accessible to them and facilitates an optimal bio-psycho-social treatment. For most of these adolescents it is their lack of plans for the future which remains the major obstacle to their development and mental and physical health.

Farmer-Managed Natural Regeneration Enhances Rural Livelihoods in Dryland West Africa

Declining agricultural productivity, land clearance and climate change are compounding the vulnerability of already marginal rural populations in West Africa. 'Farmer-Managed Natural Regeneration' (FMNR) is an approach to arable land restoration and reforestation that seeks to reconcile sustained food production, conservation of soils and protection of biodiversity. It involves selecting and protecting the most vigorous stems regrowing from live stumps of felled trees, pruning off all other stems, and pollarding the chosen stems to grow into straight trunks. Despite widespread enthusiasm and application of FMNR by environmental management and development projects, to date, no research has provided a measure of the aggregate livelihood impact of community adoption of FMNR. This paper places FMNR in the context of other agroforestry initiatives, then seeks to quantify the value of livelihood outcomes of FMNR. We review published and unpublished evidence about the impacts of FMNR, and present a new case study that addresses gaps in the evidence base. The case study focuses on a FMNR project in the district of Talensi in the semi-arid Upper East Region in Ghana. The case study employs a Social Return on Investment (SROI) analysis, which identifies proxy financial values for non-economic as well as economic benefits. The results demonstrate income and agricultural benefits, but also show that asset creation, increased consumption of wild resources, health improvements and psycho-social benefits created more value in FMNR-adopting households during the period of the study than increases in income and agricultural yields.